How injury prevention programs are being structured and implemented worldwide: an international survey of sports physical therapists

Key points

1. 01Athlete injury history (68.84%) and most common injuries in the sport (67.87%) were the top factors used to customize prevention programs
2. 02Warm-up and individually PT-guided exercise-therapy were each selected by 70.04% as preferred prevention methods
3. 03Lack of time in athletes' weekly training schedule was the main barrier to implementation, reported by 66.66% of respondents
4. 04Most sports PTs (76.33%) collaborated with other professionals such as a second PT, strength and conditioning coach, or head coach
5. 05Sports PTs working with female teams perceived their programs as significantly less effective than those working with male teams (p=0.01)

How it was conducted

Design

Cross-sectional international survey (STROBE-reported)

Setting

Online survey distributed via LimeSurvey through the International Federation of Sports Physical Therapy (IFSPT)

Participants

Sports physical therapists working with athletes, recruited internationally through IFSPT member organizations

Primary outcome

Injury prevention program (IPP) structure and implementation practices, barriers, and perceived effectiveness

Analysis

Descriptive statistics; independent Student-t and Pearson chi-square tests comparing responses by PT age, gender, experience, and athlete team gender

What they found

• 76.08% of respondents regularly consulted scientific literature to implement preventive strategies
• 50.25% consulted literature monthly; 26.35% weekly; 14.92% once a year; 23.91% did not consult scientific evidence at all
• Athlete injury history was used by 68.84% to customize IPPs; most common sport injuries by 67.87%; preseason screening results by 74.01%
• 49.71% performed fully individualized prevention per athlete; 20.58% divided athletes into groups by risk profile; 30.02% provided a generic IPP or mixed approach
• 28.26% organized IPP as an exclusive part of the training session by the sports PT; 28.98% as part of warm-up organized by the strength and conditioning coach
• More than half of sports PTs (respondents; exact n not fully legible) experienced difficulties implementing the preventive program in weekly training
• Lack of time in athlete's routine was the top barrier (66.66%); lack of athlete support (42.13%); lack of head coach support (38.88%); lack of infrastructure (37.50%)
• 89.85% regularly analysed the perceived effect of their IPP; 4.15% did not verify effect
• 72.84% assessed effect by comparing number of injuries between seasons; 49.46% used time-loss comparison
• 71.25% considered their IPP effective; 14.25% did not; 14.49% had no opinion
• Perceived IPP success mean score 6.75 (SD 1.66) on a 1-10 scale; scores differed significantly between PTs working with female vs male teams (p=0.01): female-team PTs mean 5.89 (SD 1.73) vs male-team PTs 6.76 (SD 1.65)
• Significant differences in implementation strategies by PT gender (p=0.02) and years of experience (p=0.02)

Limitations

• Results are susceptible to reporting bias, as respondents answered based on personal beliefs, perceptions, and experiences rather than objective data
• Sample size may be limited for an international survey spanning multiple countries, restricting generalizability
• The survey did not capture whether PTs systematically applied load control, recovery, and sleep elements in practice, only their perceived importance
• This is part 2 of a 2-part publication; participant demographics are reported in the companion paper, making standalone interpretation harder

Why it matters

For patients

Athletes benefit most when their sports PT uses a personalized approach based on prior injury history and structured preseason screening, but time constraints in training schedules often prevent full program delivery.

For clinicians

Sports physical therapists can benchmark their IPP structure against international peers and recognize that collaboration with coaches and other professionals, as well as addressing schedule barriers, are key to effective implementation.

For readers

This is the first international survey mapping how sports PTs organize injury prevention, providing a foundation for standardizing evidence-based practices worldwide.