Risk management: FIFA's approach for protecting the health of football players

Abstract

Sport and exercise have long-term health benefits, but there is also a risk that participants will sustain injuries and/or ill health from these activities. For this reason, international sports governing bodies have a responsibility to identify the risks that exist within their sport and to provide guidance to participants and other stakeholders on how these risks can be controlled within acceptable levels.
To demonstrate how Fédération Internationale de Football Association (FIFA), as football's governing body, uses a risk management framework to identify, quantify, mitigate and communicate the risks of injury and ill health in football for men, women and children in all environments.
All the research papers published by FIFA's Medical Assessment and Research Centre (F-MARC) during the period 1994 to 2011 were reviewed and categorised according to an established sport-related risk management framework.
F-MARC investigated and mitigated 17 areas of risk to footballers' health in a coherent and consistent approach through the process of risk management.

Full text

Original article
Br J Sports Med 2012;46:11–17. doi:10.1136/bjspor ts-2011-090634 11
FIFA Medical Assessment
and Research Centre, Zurich,
Switzerland
Correspondence to
Colin Fuller, FIFA Medical
Assessment and Research
Centre, FIFA-Strasse 20,
PO Box 8044 Zurich,
Switzerland;
colin.fuller@f-marc.com
Received 29 September 2011
Accepted 30 October 2011
Published Online First
5 December 2011
Risk management: FIFA’s approach for protecting
the health of football players
Colin W Fuller, Astrid Junge, Jiri Dvorak
ABSTRACT
Background Sport and exercise have long-term health
benefi ts, but there is also a risk that participants will
sustain injuries and/or ill health from these activities. For
this reason, international sports governing bodies have a
responsibility to identify the risks that exist within their
sport and to provide guidance to participants and other
stakeholders on how these risks can be controlled within
acceptable levels.
Purpose To demonstrate how Fédération Internationale
de Football Association (FIFA), as football’s governing
body, uses a risk management framework to identify,
quantify, mitigate and communicate the risks of injury
and ill health in football for men, women and children in
all environments.
Method All the research papers published by FIFA’s
Medical Assessment and Research Centre (F-MARC)
during the period 1994 to 2011 were reviewed and
categorised according to an established sport-related
risk management framework.
Conclusions F-MARC investigated and mitigated
17 areas of risk to footballers’ health in a coherent
and consistent approach through the process of risk
management.
INTRODUCTION
Corporate governance became an important
business issue in the early 1980s; initially, atten-
tion focused on protecting company interests,
but then moved to shareholders’ fi nancial inter-
ests.1 In the 1990s, a number of committees
reviewed and reported on various aspects of cor-
porate governance:2–4 the Report of the Hampel
Committee2 stated ‘The board should maintain
a sound system of internal control to safeguard
shareholders’ investment and company’s assets.
This covers fi nancial controls and operational and
compliance controls, as well as risk management,
since there are potential threats to sharehold-
ers’ investments in each of these areas’(p21). The
Report of the Turnbull Committee,4 which pro-
vided guidance on how to implement an ‘internal
control’ system to meet the requirements of cor-
porate governance, stated: ‘the guidance is based
on the adoption by a company’s board of a risk-
based approach to establishing a sound system of
internal control and reviewing its effectiveness’
(p4) and, in particular, ‘the purpose of internal
control is to help manage and control risk appro-
priately rather than to eliminate it’(p5).
Generally, sport and exercise are considered to
have long-term health benefi ts for participants;
however, all physical activity carries risks that
participants will sustain an injury or ill-health
and these must be balanced against the benefi ts.5 6
Each sport has a different level of risk associated
with it, which is related to the underlying char-
acteristics of the sport, the laws or the rules that
govern how the sport is played and, in the case of
team sports, the respect par ticipants have for their
fellow participants. As for the boards of direc-
tors in any business, international sports govern-
ing bodies have a responsibility to demonstrate
that corporate governance principles have been
implemented within their operations, includ-
ing the identifi cation and characterisation of the
risks that exist within their sport, and to provide
guidance to participants and other stakeholders
on how the risks can be controlled within accept-
able levels. Individuals can then make informed
choices about which sports align with their own
risk-taking behaviour.6
Football is the most popular team sport world-
wide for men, women and children;7 there-
fore, it is particularly important that the risks
associated with this sport are managed effec-
tively. Fédération Internationale de Football
Association ( FIFA), as the international govern-
ing body, recognised this responsibility and cre-
ated FIFA’s Medical Assessment and Research
Centre (F-MARC) in 1994 specifi cally to investi-
gate risks to players’ health that were associated
with football. The process of risk management
provides a comprehensive framework within
which to study the risks of injury and ill health
because it includes issues related to risk identifi -
cation, estimation, perception, evaluation, miti-
gation and communication.8 The objective of this
paper is to summarise how the risk management
approach has been used by F-M ARC to provide a
coherent and transparent approach for protecting
the health of players with the aim of encouraging
other sports governing bodies to adopt a similar
approach.
The risk management framework
Risk management provides a formal framework
within which organisations can identify, classif y
and investigate risks using a logical and trans-
parent protocol. It is essential to appreciate that
the objective of the risk management process is
not to reduce risks to zero, but to control them
within acceptable levels and then to ensure that
stakeholders are made aware of the residual
risks. The framework adopted by F-MARC has
been described previously8 9 and those publica-
tions should be referred to for a detailed discus-
sion of the individual elements of the framework.
However, for the benefi t of the discussion in this
paper, a version of the framework (fi gure 1) and
the core defi nitions are presented here. Risk is a
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12
combined measure of the probability of occurrence and the
consequences of an adverse event; a risk factor is a condition
or a situation that predisposes an individual, organisation or
society to an adverse event; risk estimation is a quantitative
or a qualitative measurement of the risk associated with speci-
fi ed risk factors; risk evaluat ion is t he comparison of measured
or perceived risks against an organisational, national and/or
international standard of an acceptable level of risk; risk miti-
gation is the introduction of measures to reduce the level of
individual, organisational or societal risk arising from speci-
fi ed risk factors. The central part of the management frame-
work is the identifi cation of intrinsic and extrinsic risk factors
affecting participants followed by the estimation and evalua-
tion of the level of risk associated with these factors in a pro-
cess collectively known as ‘risk assessment’. If the level of risk
associated with any of the individual risk factors is considered
to be too high, then potential mitigation strategies should be
considered, including the potential for reducing either the inci-
dence and/or the nature and severity of injuries and ill health.
Epidemiological studies using appropriate cohort populations
or randomised control trials are employed to provide an evi-
dence base for estimating the levels of risk before and after the
introduction of risk mitigation initiatives. Finally, the residual
levels of the risk associated with individual risk factors should
be communicated to stakeholders in an appropriate and acces-
sible format to encourage informed critical discussions about
the risks of injury and ill health at all levels of play and in all
settings.
There is a recognised process within FIFA for managing
potential injury and health risks in football: issues can be
raised by a variety of stakeholders, including players, match
offi cials, FIFA Committees, FIFA confederations and mem-
ber associations, external bodies and from within F-M ARC.
Potential risks are evaluated by F-MARC using the existing
published information; a decision is then made as to whether
more detailed evaluations of the scientifi c literature or novel
research studies are required. The outcomes and recommen-
dations from these deliberations and research studies are for-
mally presented by F-M ARC to FIFA’s Medical Committee
for onward commun ication to FIFA’s Executive Com mittee,
which may then make decisions on regulations or make rep-
resentations for law changes to the International Football
Association Board.10 The results and conclusions from every
research study are submitted for publication in international,
peer-reviewed scientifi c journals with no input or infl uence
from any other part of the FIFA organisation. Based on the
results obtained from literature reviews and research studies,
F-MARC proposes and evaluates risk mitigation strategies; if
successful, these proposals are then translated into guidance
documents for stakeholders.
The following discussion presents a number of F-MARC
research studies in order to illustrate how the risk manage-
ment process brings a wide range of issues together within
a single unifi ed management framework and to demonstrate
how FIFA communicates t he results obtained in the studies to
the scientifi c community and to the wider football family.
DISCUSSION
The discussion presented relates to the risks of injury and ill
health to football players – professional and amateur; F-MARC
also investigates risk factors for match offi cials but these are
not included in this review.
Figure 1 Injury risk management model (adapted from Fuller).8
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Br J Sports Med 2012;46:11–17. doi:10.1136/bjspor ts-2011-090634 13
Table 1 Risk assessments: evaluations undertaken by FIFA’s Medical Assessment and Research Centre
Risk factor Literature review (L)/research (R) study Outcome Action required
Intrinsic factor s
Part icipant rela ted
Age Comparison of the inci dence of injur y for mal e amate ur
player s as a function o f age (R)23
Incide nce of injury increases wit h age and is highes t
among senior pl ayers
Develop techn iques to deter mine the age
of young player s and monitor the age
of players competing in age- rest ricted
competitions
Assess whet her over-age pla yers take par t in age-
rest ricted compe titions (R)24
Some evidence of overa ge players tak ing part in age -
restricted competitions
Drugs /medication Excretion of nandrolone me tabolites by a mateur and
profe ssional playe rs following e xercis e (R)25
Variations in postac tivity urine leve ls of some stero ids
in non- drug-tak ing players occur across ethnic groups;
resul ts indicate t hat individual ster oid pro fi ling should be
consid ered. H igh usage of NSA IDs by players
Insti gate dr ug-testin g proce dures in football
to support WADA. Info rmation to team
physic ians on the side ef fects of NSAIDs
Steroid profi les in e lite fo otballers (R)26
Evalu ate the use of med ication during compe tition
(R)27
Gender Comparison of incidence and severity of inj ury fo r
inter national male and fem ale players (R)28
Incide nce of injury is higher a mong male players
than am ong female players but female player s are
signi fi can tly more likel y to sust ain ACL injuries than men
Develop a preve ntion p rogramme to reduce
the incidence o f ACL inju ries am ong fem ale
players
Comparison of incidence and severity of inj ury fo r
amate ur male and female playe rs (R)29
Medical history Risk fac tor analysis (R)30 Previous injury most importa nt risk f actor for inju ry.
Players frequent ly ret urned to play while sti ll feel ing
the effects of an injury. Players may have undiagnosed
cardi ovascu lar pro blems w hen playing hig h-le vel foo tball
Review t he best practice procedur es and
develop protocols to e valua te player’s
medical condi tion prior to FI FA tournaments
Precompetition musculoskeletal evaluation (R)31
Precompetition cardiovascular assessment (R)32
Psycho-soc ial Impac t of player behav iour on fair pla y (R)33 A wide r ange of psycho social facto rs impa cted on
player s attitudes towards fair play
Review FIFA poli cy towards all aspect s of
‘fair play ’
Impac t of psycholog ical charact eristics on f air play (R)34
Standard of play Comparison of the inci dence of injur y at internat ional
men’s tou rname nts (R)28
For men, the incidence of injur y at World C ups
lower than the incidences of injury at <17 and <20
tourn aments; for women, no clear tr ends
Develop an injury pre vention programme f or
player s of all skill le vels.
Comparison of the inci dence of injur y at internat ional
women’s tournaments (R)28
Tackling Comparison of risks as sociated with making dif ferent
type s of tackle by ma le playe rs (R)35
Video a nalys is of tac kles sh owed th at players mak ing
a tackle were more likely to be inj ured when tackles
involved a clas h of heads or were t wo-footed
Review t he laws of the game
Comparison of risks as sociated with making dif ferent
type s of tackle by fe male players (R) 36
Ext rinsic facto rs
Facility-related
Playing sur face Co mpari son of th e incide nce of injury among non -
profe ssional playe rs on ar tifi cial tu rf and g rass playing
surfaces (R)29
There were no signifi cant d ifferences in the overall
incide nce of injury for male an d femal e footb aller s
playing on artifi cial tur f compared with nat ural grass
Maint ain quality criter ia for FIFA-ap proved
arti fi cial turf pitches
Comparison of the inci dence of injur y among
profe ssional playe rs on ar tifi cial tu rf and g rass playing
surfaces (R)37
Stadi um design Asses s the env irons o f the playing ar ea that m ay
impac t on a playe r’s saf ety (R) 38
Hazardous si tuations and object s were found in the
envir ons of th e playing area
Produce stadium des ign guid elines
Equipment-related
Headgear/footballs Biomechanical analysis of protection offered by
headgear (R)39
No evidence found tha t commerciall y available he adgear
provided a sign ifi cant level of head protection to player s
Some evidence that re ducing b all siz e and ball press ure
could r educe impact forces during heading
Review technical specifi c ations for wat er
uptake of balls
Biomechanic al anal ysis of football properties (R)40
Environment-related
Alti tude Eff ect of al titude on football p erfo rmance (L)41 Pl ayers f rom low altit ude must accli matis e for 1–2
weeks before c ompet ing at high alti tude to a void
adver se effect s on per formance
Develop a statement on playing foot ball at
altitude
Preparati ons for playing f ootball at altitud e (L)42
Being t ackle d Comparison of risks as sociated with dif ferent typ es of
tackle on male p layer s (R)35
Video a nalys is of tac kles sh owed th at players being
tackled were more likely to be injured w hen the tackles
involved a clas h of heads or were t wo-footed
Review t he laws of the game and the
punish ments given against p layer s causing
severe injuries
Comparison of risks as sociated with dif ferent typ es of
tackle on female players (R)36
Playing position Impac t of play ing posi tion on the incidence of injur y
among male play ers (R)35
No signi fi cant dif ference fou nd in the inciden ce of injury
as a func tion of playin g posit ion for men but forwar ds
and def ender s showed higher incidences of injury among
female players
None required
Impac t of play ing position on t he incidence of i njury
among female players (R)43
Ramada n Impac t of Ramadan on phy sical and football
performance (R)44
Changes in slee p and nutriti on pat terns d uring Ramadan
had no signifi cant effec ts on physical p erformance
Provide advice on nut rition; rec ommendation
that pl ayers ensure adequate sleep and
nutr ition during Ra madan
Infl uence o f Ramada n on physiological par amete rs (R)45
Refer eeing Assess refe rees’ d ecision-making in player injury
situations (R)46
Current laws were adequate to protect players fr om
injur y but in matches referees were under pressure to
make diffi c ult decisions in high pre ssure situations and
match r efer ees of ten failed to pu nish pla yers in i nciden ts
leading to injury
Review referees training programmes
Stage i n match Eff ect of stage in match on the incidence of injury in
men’s foo tball (R)47
For men, there were signifi cantly more inj uries in the
second half of m atche s than in t he fi rst half b ut for
women there were no dif ferences. Effects in t he men’s
game may be cause d by fatigue
Develop an injury pre vention programme f or
player s of all skill le vels
Eff ect of stage in match on the incidence of injury in
women’s footba ll (R)36
Tempera ture Playing football in hot environ ments (L)48 High temperatures, especially when accompanied by
high humidity, have an adverse effec t on per formance
Develop a statement on playing football
in hot conditions
Effect of he at on the physical activity o f
footballers (R)49
ACL, an terior cruciate lig ament; FIFA, Fédér ation I nternationale de Fo otball Association; NSAIDs, non-steroidal anti -infl amma tor y drugs; WADA, Wor ld Anti-doping Agency.
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Risk assessment
Van Mechelen et al discussed the management of sports injuries
in terms of internal (intrinsic) and external (extrinsic) risk fac-
tors and presented a research model for addressing this issue,11
while Meeuwisse et al discussed the causative role of intrinsic
and extrinsic risk factors in sports injuries and summarised this
in an injury causation model.12 The initial focus for any sport-
related risk management system refl ects these models through
the identifi cat ion of the int rinsic a nd extr insic r isk factors c losely
followed by an estimation and evaluation of the level of risks
in the combined process referred to as risk assessment. If the
results of these risk assessments are to be universally accepted
in a worldwide sport such as football, it is essential that the risk
estimations be based on robust and consistent defi nitions and
procedures. To ensure unequivocal acceptance of its research
results, F-M ARC initiated an international consensus meeting
to produce an agreement on the procedural criteria that should
be used for epidemiological studies in football: the agreement
addressed the defi nitions of injur y, severity and exposure, clas-
sifi cation categories for the location and type of injury and
reporting parameters. The conclusions and recommendations
from this consensus meeting, which were published simulta-
neously in three international sports medicine journals,13 have
become the benchmark for epidemiological studies in football
and have also provided the basis for the development of similar
consensus agreements in other sports.14–16
The overall strategy adopted by F-MA RC has been to moni-
tor all FIFA tournaments since 1998 in order to provide base-
line data on the level of risk and to identif y the step changes
and trends in the incidence, nature and causes of injuries. This
ongoing sur veillance programme is supplemented with the
studies of specifi c risk factors, which can be subcategorised
conveniently into intrinsic (participant-related) and extrin-
sic (facility-, equipment- and environment-related) factors.
Studies of risk factors undertaken by F-MARC during the
period 1994 –2010 together with the key outcomes and the rec-
ommended actions are summarised in table 1; of these stud-
ies, 15 addressed intrinsic risk factors and 18 extrinsic factors
(facilities: 3; equipment: 2; environment: 13).
Risk mitigation
Although investigating and evaluating risk factors in football
is i mpor tant, an essenti al aspect of the r isk management pro -
cess is translating the results and recommendations from risk
assessments into effective risk mitigation proposals. There
are two general ways in which the risk of injury/ill health
from a particular risk factor can be mitigated:5 either through
risk acceptance (eg, insurance, self/organisational accep-
tance) or through risk reduction (eg, control, elimination).
Risk control can be achieved through reductions in the inci-
dence with which adverse events occur (preventive interven-
tions) or through reductions in the severity of the outcomes
Table 2 Risk mitigation: strategies developed by FIFA
Risk factor Prevention (P) and therapeutic (T ) risk mitigation action
Intrinsic factors
Participant-related
Age determination Developed MRI examination technique for assessing the age of players taking part in FIFA U-17 tournaments (P)50
Drugs /medication Prepared a guidance documen t on doping in football (P)51
Defi ned drug -testing procedur es and publication of doping results in football (P)52
Established a network of F-MARC Doping Control Offi cers and doping control wor kshops for physicians (P)52
Concussion Prepared consensus statements on diagnosis, treatment and r etur n-to -play criteria for concussion in sport (T)53–55
Functional rehabilitation Proposed technique for quan tifying functional rehabilit ation f rom injury (T)56
Gender Prepared a guidance documen t on heal th and fi tness for female players (P)57
Medical history Developed and implemented a precompe tition medical assessment protocol for pr ofessional players (P)58
Reviewed the best practice procedures for the managemen t of on-fi eld sudden cardiac ar rest (T)59
Physical condition Develope d, implemented and evaluate d an injur y prevention educational programme for youth players (P)60
Developed, implemented and evalua ted the ‘11+’ injury prevention progr amme for player s (P)61
Developed, implemented and evalua ted an ACL injury prevention programme for female players (P)62
Psycho-social Continued promotion of the FIFA ‘ fair play’ campaign to encourage all aspects of fair play and respect for ot hers (P)63
Tackling Recommended to IFAB that tackling from behind should be a red card off ence in 1998 (P)
Recommended to IFAB that the use of the elbow to the he ad when tackling should be a red card of fence in 2006 (P)
Ext rinsic factors
Facility-related
Medical facilities Established FIFA Medical Cen tres of Excellence to provide expert medical support for players in 2005 (T)
Playing surface Developed the ‘FIFA Quali ty Concept for Football Turf ’ to ensure that the risk of injur y on artifi cial tur f pitches is no gr eater than on na tural grass
surfaces (P)64
Stadium design Developed design criteria for football stadiums that took into account player saf ety (P)65
Specifi ed saf e design of goalposts in the Laws of the Game (P)66
Equipment-related
Footballs Developed the ‘ FIFA International Matchb all Standard’ to ensure tha t footballs reach and maintain standards for parameter s such as weight ,
water absorption and pressure (P)67
Environment-related
Altitude Prepared a conse nsus st atement on playing football at altitude (P)68
Being tackled Recommended to IFAB that tackling from behind should be a red card of fence in 1998 (P)
Recommended to IFAB that the use of the elbow to the he ad when tackling should be a red card of fence in 2006 (P)
Ramadan/nu trition Prepared a guidance documen t on nutrition for footballers (P)69
Tempe ra tu re Prepared a position statement on playing football in hot environments (P)70
ACL, an terior cruciate ligament; FIFA, Fédération Internationale de Football Association; F- MARC, FIFA’s Medical Assessment and Research Centre; I FAB International
Football Association Boar d.
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from the adverse events (therapeutic interventions). In terms
of preventive interventions, reductions in incidence can be
achieved through measures directed at physical (eg, equip-
ment), management (eg, laws of the game) or human (eg,
player behaviour) aspects of the game. In terms of therapeutic
in ter vent ions, reduct ions in sever ity can be achieved t hroug h
improvements in injury/ill-health treatment (eg, provision of
specialist medical expertise and facilities) or rehabilitation
(eg, improvements in functional recovery procedures). These
approaches can be summarised within the two-dimensional
Haddon matrix of injury prevention; dimension 1: time of
risk – pre-event, event, postevent; dimension 2: control strat-
egy – physical, management, human.9 Al l these combinations
have been used by FIFA and proposals for these initiatives
have taken a variety of formats, including technical specifi ca-
tions, such as those for artifi cial turf, footballs and stadiums;
implementation protocols, such as the 11+ injury prevention
programme and doping control procedures; consensus state-
ments, such as those for concussion, altitude and heat; and
general guidance documents, such as those for nutrition-
and gender-related issues (table 2). F-MARC’s philosophy is
to ensure that all recommendations for risk mitigation are
evidence based and in this respect strategies proposed are
always underpinned by the peer-reviewed research results or
the best practice procedures that have been identifi ed from
literature reviews.
Risk communication
Risk communication is perhaps the most important element
of the risk management process because without an effective
communication strategy, risk mitigation strategies will not
be accessible to stakeholders. To provide an effective com-
munication strategy, it is important to present information
in a number of appropriate formats: this presents a challenge
because potential stakeholders include, for example, research-
ers, physicians, physiotherapists, sports scientists, players,
coaches, parents, referees, member associations, teachers
and administrators. To reach such a diverse range of people,
F-MARC employs an equally diverse range of communica-
tion formats, such as peer-reviewed research papers, journal
supplements, lectures, FIFA medical conferences, training
courses, centres of excellence, books, videos, laymen publica-
tions and web pages. Because of the large number of F-MARC
communication activities, it is not possible to reference each
individual item in this document; however, the information
contained within table 3 and many other examples can be
accessed through F-MA RC’s Medical Network website,17
which is freely available.
CONCLUSIONS
Although the risks of injury and ill health are generally higher
in contact sports than in non-contact sports, many athletes
c ho os e t o t a ke pa r t i n c o nt ac t r at h er th a n i n n on -c on t ac t s po r ts .
The risks in contact sports could be reduced signifi cantly sim-
ply by making major changes to the laws of the sport; this,
however, would undoubtedly change the fundamental nature
of the sport and that would make the sport unacceptable to
many of the athletes taking part. These athletes would almost
certain ly leave the sport and seek out other sports that more
closely match their needs and aspirations. Each of the interna-
tional sports governing bodies therefore has a responsibilit y
to eliminate, wherever possible, unacceptable risks of serious
injur y and even death and to reduce the level of other risks
so far as is reasonably practicable, while not fundamentally
changing the nature of their sport. F-MARC has followed this
philosophy within football since 1994 using the risk manage-
ment approach and the examples of risk assessment, risk miti-
gation and risk communication presented here demonstrate
how this process can be implemented effectively; for example,
the implementation of an injury prevention programme in
football reduced the incidence of injury and reduced national
healthcare costs.18 By adopting this approach, F-MARC work-
ing alone, in conjunction with other researchers or with other
governing bodies, has been at the forefront of many sports
medicine initiatives over the past 17 years. Of particular note
are activities associated with injury epidemiology, injury pre-
vention, precompetition medical assessment, sudden cardiac
death, playing at altitude and in heat, management of con-
cussion, artifi cial turf surfaces, drug testing and age deter-
mination. In addition, F-MA RC has developed new ways in
which governing bodies communicate risks and risk mitiga-
tion information to stakeholders, including the use of journal
supplements, guidance documents, videos and dedicated web
pages. Finally, new initiatives aimed at providing better medi-
cal ser vices within football have been established in the form
of FIFA Medical Centres of Excellence and the freely available
web-based FIFA medical network for sports physicians and
physiotherapists.
Other bodies around the world also actively promote the
use of risk management in sport. In the UK, UK Sport19 pub-
lished a guidance document for managing the risks associ-
ated with sports events; in Ireland, the International Rugby
Board20 reviewed the risks of catastrophic injur y in the sport
and subsequently established a worldwide injur y surveil-
lance study to collect more detailed information about the
risks; Standards Australia published guidelines for risk man-
agement in sport and recreation;21 and in Canada, the 2010
Table 3 Risk communication: strategies developed by F-MARC
Communication format Information provided10
Confe rence s FIFA International Football Medicine Conferences (4) in 2001 (Los Angeles); 2006 (Dusseldorf); 2009 (Zurich); 2010 (Sun City)
Journal supplements F-MARC-sponsored Journal Suppleme nts (11) containing 136 peer-r eviewed rese arch pa pers
Laymen publications Laymen publications (4) about n utri tion, doping, female players and F-M ARC research projects
Manuals F-MA RC Manuals (3) covering Foo tball M edicine,71 Emergency Medicine72 and F-MARC Resear ch73 (also available in CD format and
on FIFA web pages)
Medical Centres of E xcellence Medical Centr es of Excellence (24) based in 17 countries situated on six con tinen ts
Peer-reviewed research publications Peer-reviewed research papers (79), excluding papers published in F-MARC journal supplements
Posters 11+ injur y prevention programme
Training course s FIFA Futuro III medical education training courses for sports physicians and physiotherapists presented on six continents
Videos F-MA RC 11+ injury prevention progr amme; am bassador players promoting ‘11 for Health’ programme
Websites Medical Education and playe rs’ health on FIFA websites and extranet
CD, compact disc; FIFA, Fédération Internationale de Football Association; F- MARC, FIFA’s Medica l Assessment and Research Centre.
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Original article
Br J Sports Med 2012;46:11–17. doi:10.1136/bjspor ts-2011-090634
16
Legacies Now organisation produced a risk management guide
for community sports organisations.22 It is hoped that further
sports bodies will recogn ise the importance of understanding
and managing risks to athletes and adopt similar proactive risk
management approaches.
Contributors CF: developed the risk management framework; contributed to the
structure of this paper; prepared the fi rst draft; edited and approved the fi nal text.
AJ: contributed to the structure of this paper; reviewed the fi rst draft; edited and
approved the fi nal text. JD: contributed to the structure of this paper; reviewed the
fi rst draft; edited and approved the fi nal text.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.
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