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The role of medicine and the team doctor in football has become crucial in the modern-day game – with UEFA making its own vital contribution to the area of football medicine, injuries and sports science.

All UEFA's medical projects are managed by UEFA's medical unit under the direction of the medical committee, which is made up of 13 elite football doctors from around Europe, most of whom are either current or previous national team doctors with specialisms in orthopedics, cardiology and sports medicine.

Medical screening
UEFA medical regulations specify a detailed medical screening process which players undertake prior to their participation in UEFA football competition.

Anti-doping
UEFA's anti-doping programme involves urine and blood testing in and out of competition, with regular unannounced doping controls conducted for the full duration of the competition. Tests include screening for substances such as EPO and human growth hormone. All samples are collected by medical doctors appointed by UEFA and are analysed at WADA-accredited laboratories.

Medical symposium
UEFA medical symposiums bring together experts from clubs, associations and the wider football family to review and discuss key medical issues in football such as prevention of injuries, sports medicine, women's and youth football, and current and future developments in football medicine. The latest UEFA Medical Symposium took place in February 2014.

Injury study

Injuries are common in football, and FIFA, UEFA and national football organisations are all concerned about the safety of players. In 2001, UEFA initiated a research programme with the aim of increasing the safety of players in its competitions and contributing to the wider understanding of injury in sport. This project, the UEFA Elite Club Injury Study, has now been conducted with elite clubs in the UEFA Champions League and beyond for over a decade with results regularly published in scientific journals such as the British Journal of Sports Medicine.

The aims of the Elite Club Injury Study are as follows:

• To evaluate the injury risk and circumstances of injury, considering exposure during training sessions and matches

• To analyse injury patterns and injury severity

• To compare injury risk and injury patterns with previous years of the study

• To contribute to the existing UEFA injury study database, and to monitor trends in injury risk and injury pattern over time

One of the initial goals of the research programme was to monitor the increasing load on professional football players and to evaluate the correlation between this increasing load and injuries. In other words, to study the possible effects of 'over-playing'. This aim has remained, however the study has since covered a wide range of research topics such as the effects of playing on artificial turf v grass, the occasions during a 90-minute match when certain injuries are more likely to occur, and whether injury risks for players are higher at certain points of the season.

At the start of the 2014/15 season, 36 clubs were participating in the study and all but four of the teams who have reached the semi-finals of the UEFA Champions League since season 2001/02 have been submitting data to the study, making it a true elite sport scientific study.

Data collection
Data collection is performed using standardised forms with all participating clubs required to submit training and match injury data every three days to the Sweden-based Football Research Group, headed by renowned injury expert and vice-chairman of the UEFA medical committee Professor Jan Ekstrand.

Injury is defined as any physical damage that occurs during football activities (scheduled matches or training sessions) which results in the player being unable to participate fully in future training sessions or matches.

All participating clubs receive a mid-season and end-of-season report showing injury trends during the season and compared to previous seasons, and also showing their injury records in comparison to other teams in the study (listed anonymously). This allows clubs to review their own performance and to make adjustments where required. Also useful in this area is a 'pursuit of excellence' summary sent to all clubs where tips and techniques are shared to try and further overall knowledge within the game.

Football doctor education programme

The UEFA Football Doctor Education Programme (FDEP) is a three-part programme teaching doctors from all 54 of UEFA's member associations the key skills of the modern football doctor. The programme adopts a blended learning approach, marrying face-to-face workshops where doctors learn and practise techniques with an online e-learning support platform containing instructional videos, tests of participants' knowledge and process guidelines for doctors to refer to at any time. An online forum is also in operation, allowing course participants to discuss and resolve key issues between themselves outside of the workshops.

The first of the three course workshops was held in Vienna in February 2012, covering the roles and responsibilities of the football doctor and emergency treatment of players. The second, covering the diagnosis and treatment of injuries, was held in Amsterdam in September 2013 and the third, on the topic of 'protecting the player', was held in Budapest in April 2015. All workshops are run by recognised international experts in the relevant fields, and members of the UEFA Medical Committee, many of whom have years of working as team doctors for their senior national teams.

One key aspect of the workshops is that participants are required to undergo a rigorous testing process at the end of each one to evaluate the skills and knowledge obtained. This evaluation is essential because as well as learning key skills, one of the unique aspects of the FDEP is that all participants are taught how to 'cascade' their own version of the course for doctors in their own country. It ensures that only those participants who demonstrate competence in the topic area are authorised to pass those skills and knowledge on to their peers at a cascaded workshop.

In order to maintain UEFA's high standards, all cascaded courses must follow the course manual and course structure used for UEFA's own workshop. UEFA offers both translation support for course materials and logistical support for practical sessions, with national associations able to borrow the medical kit required for the course from UEFA free of charge. Doctors are also allowed access to the FDEP's e-learning platform to further supplement their skills.

As regards the educational aspects of the cascaded courses, strict requirements are set by UEFA to ensure that all tutors have the medical specialisms required in order to teach other doctors. This is necessary in order for a cascaded course to be recognised by UEFA. Finally, in many cases cascaded courses are attended by doctors from the UEFA Medical Committee, who oversee the successful delivery of the course and ensure that it meets UEFA's high standards and preserves the integrity of the FDEP.

As a result of the cascading process, UEFA has now begun to create a network of skilled medical tutors disseminating the skills learned on the course across Europe's wider football community. This, combined with UEFA's Minimum Medical Requirements (MMRs), which require clubs and associations to provide emergency medical equipment and services at all UEFA matches, means that considerable steps have been taken to improve the medical support available to players.

Thus, as the cascading aspect of the FDEP develops in tandem with the MMR in future, UEFA's matches and competitions will be supported not only by a set of guaranteed medical services and standards, but also by increasing numbers of doctors trained to apply techniques and use equipment that could make the difference between a life being lost and a life being saved.

Research

The UEFA Research Grant Programme is designed to establish a series of awards of up to €20,000 to support the valuable work of doctoral and post-doctoral researchers studying European football. By shedding new light on football and the myriad ways in which it interrelates with society as a whole, quality research can help the members of the European football family fulfil their mission and reach more informed decisions.

Medical sciences awarded (2014/15):

• Risks versus benefits: should youth football players be encouraged to take creatine? (by Pascale Kippelen, Brunel University (UK))

• Player load monitoring: Protecting the elite player from overload using miniature high frequency triaxial accelerometers (by Mark Robinson, Liverpool John Moores University (UK))

Medical sciences awarded (2013/14):

• The effects of mental fatigue on repeated sprint ability and cognitive performance in football players (by Samuele Marcora, University of Kent (UK))

• Football as a novel therapeutic approach to pediatric obesity. A randomized controlled trial and its effects on fitness, body composition, cardiometabolic and oxiadive markers (by André Seabra, University of Porto (Portugal))

Medical sciences awarded (2012/13):

• The validation and application of an integrated metabolic cost paradigm using high frequency GPS technology in soccer to assess match play training load (by Doran Dominic, Liverpool John Moores University (UK))

• Influence on injurability and injury recovery time of single nucleotide polymorphisms (SNPs) in genes involved connective tissue repair (by Ricard Pruna, University of Barcelona (Spain))

Medical sciences awarded (2011/12):

• Effect of extreme environmental conditions on decision-making ability of active referees and additional assistant referees (by John Brewer, University of Bedfordshire (UK))

• Protect her knees: Exploring the role of football-specific fatigue on dynamic knee stability in female youth football players (by Mark De Ste Croix, University of Gloucestershire (UK))

Medical requirements

In its continuous attempts to protect the health of everyone involved in UEFA matches, the UEFA Medical Committee defined minimum medical requirements (MMR) for players, team officials, referee teams and match officers at matches and tournaments which entered into force at the start of the 2012/13 season. These requirements are contained in the UEFA Medical Regulations and are designed to provide a minimum standard of equipment and medical services to deal with accidents at matches which might threaten lives or cause permanent injury.

The host club or national association is required to provide a minimum level of medical service in four key areas:

• Pitchside medical equipment (e.g. defibrillator, spinal board, resuscitation equipment)

• Ambulance (which must be an Advanced Life Support Ambulance)

• Medical staff (including a dedicated pitchside doctor and stretcher team)

• Emergency medical room equipment (equipped with emergency drugs and medical materials)

Furthermore, the host must submit its stadium medical plan to the visiting team(s) in advance of the match or tournament stating such points as emergency evacuation routes, the contact details of the host team medical officials and the contact details of local hospitals.

The MMR requirements are designed to ensure a standardised minimum service across UEFA competitions and to ensure that travelling teams and their medical staff can be sure that a certain standard will be provided regardless of the country in which the matches are played. Medical equipment is inspected by the UEFA match delegate on the day before matchday during the official Matchday-1 training session (where applicable to the competition) and again on matchday. Clubs and associations who fail to meet MMR requirements are referred to the UEFA Control and Disciplinary Body for non-compliances.

The MMR are reviewed by the UEFA Medical Committee each year to ensure that the medical needs of players and officials can be met with the least possible burden on clubs and associations in providing equipment and services. Flexibility is also built into requirements where possible to allow for local variations, such as the different brands of emergency drugs that may exist in different countries.

In addition to the MMR, UEFA also requires the hosts of its final tournaments to provide a full tournament medical service which includes the production of a comprehensive medical services concept containing additional information on hospitals, imaging facilities and dental services, procedures for obtaining prescriptions and immunization requirements for the host country.

UEFA publishes guides to the provision of MMR in seven languages, all of which are available to download from UEFA.org.

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