'Considering the reality, I am very lucky': how professional players and staff perceive injury

Key points

1. 01Professional teams use multidisciplinary staff, load monitoring, and individualised approaches that players and staff regard as effective
2. 02Amateur and semiprofessional players face higher injury risk due to limited healthcare access, poor recovery conditions, and absence of structured prevention strategies
3. 03The transition to professional football brought dramatic improvements in recovery, nutrition, staffing, and training conditions for most players
4. 04Injury was viewed as multifactorial, with training load, previous injuries, menstrual cycle, mental health, and pitch quality all cited as contributors
5. 05Participants called for education and structured injury prevention to be embedded from youth and lower-division levels, not just at the elite tier

How it was conducted

Design

Exploratory qualitative study using semistructured interviews, grounded theory principles, and constant comparison analysis

Participants

18 participants: 5 players, 2 physiotherapists, 3 team doctors, 2 head coaches, 3 strength and conditioning coaches, 2 managers, 1 head of performance

Teams

3 top-tier clubs from 2 countries (Portugal and England), representing UEFA tier 1 and tier 2

Data collection

Online semistructured interviews conducted March to December 2020, average duration 34 minutes (range 23 to 49 minutes)

Analysis

Verbatim transcription, open coding by two coders, constant comparison, MAXQDA software; saturation reached after 18 interviews

What they found

• 18 participants were interviewed across 3 clubs; saturation was reached after 16 interviews with 2 confirmatory interviews adding no new themes
• Average interview duration was 34 minutes (range 23 to 49 minutes)
• Four main concepts emerged: identifying and reporting injury; the past (bumpy road to professionalism); the present (top level, top care); and the future (we are not there yet)
• No major differences were found between the perspectives of players and staff
• Players described moving from training 2 nights per week while working 3 other jobs to full-time professional conditions as a 'drastic change'
• All players acknowledged personal responsibility for injury prevention and ownership of prevention strategies at the professional level

Limitations

• Only 3 clubs from 2 countries were included, limiting transferability to other leagues, cultures, and levels of women's football
• The sample is from a very exclusive group of elite professionals and does not reflect realities at lower or youth levels
• Researcher involvement in women's football and injury prevention may have influenced analysis, despite steps taken to improve confirmability
• Players' beliefs about the menstrual cycle increasing injury risk were reported but current evidence does not support general guidance on modulating exercise across the cycle

Why it matters

For patients

Female football players at non-professional levels can expect fewer injury prevention resources and support structures, which may increase injury risk during the critical pathway to professional sport.

For clinicians

Clinicians working in women's football should advocate for structured prevention programmes and multidisciplinary staffing at youth and semiprofessional levels, not only at the elite tier.

For readers

This study highlights that injury prevention quality in women's football is strongly tied to professional status and funding, and that systemic investment at lower levels is needed to protect players throughout their careers.