Can better communication between medical staff and the coach reduce injuries? Let’s explore the options.

Avoiding injuries ensures high player availability and allows coaches to have the best squad possible available for training and to select their best squad for matches. In the UEFA Champions League (UCL), the unavailability of players to compete in matches due to injury averages 14% but varies between 5% and 20%. Lower injury rates have been linked with team success in national and international matches according to research.

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Top players are expensive to sign (transfer fees) and they have large salaries. It has been estimated that an injured player in the starting 11 of a UCL team will cost the club around €500 000 to €600 000 a month or around between €17 000 and €20 000 a day.

Doctors responsible for clubs that participated in the UEFA Elite Club Injury Study suggest that the most important risk facts that can cause an injury are as follows:

  • Training and competition load which players are subject to
  • The player’s well-being
  • The quality of internal communication within teams
  • The coach management style.

Communication is key

Recent research has demonstrated the importance of internal communication within elite football teams and how it relates to injuries and the availability of players to train and compete.  A member of the medical staff of each club answered a questionnaire to describe their assessment in regard to the quality of the internal communication within their club. The quality of the communication was rated on a Likert scale of 5 points from “poor” (rating = 1) to “very, very good” (rating = 5). The quality of the communication evaluated the internal relationships between the medical staff (doctors and physical therapists), their relationship with the coach and the strength and conditioning coaches, and their communication with the sport’s director and the management board. The outcomes are very interesting. In general, a good internal communication within clubs (rating = 5) was correlated to a smaller number of injuries (rs = 0.31, p = 0.007); a low incidence of serious injuries (rs = 0.32, p = 0.005), and a greater availability of players to exercise (rs=0.31, p=0.006) and play matches (rs=0.27 p=0.048). The best communication was produced within the medical staff (between doctors and physical therapists) rating 4.5 (range of 2 to 5). Communication between other members of the team varied between 3.4 and 3.9 (range of 1 to 5 for everybody).Communication between the main coach and the medical staff was the one with the greatest influence in the injury and availability of footballers to exercise and compete-rate. Teams with a low-quality internal communication (rating 1-2), obtained a 5%-8% less of training attendance (76% vs 83%, p=0.001) and less availability of players to play matches (82% vs 88%, p=0.004) compared to teams with medium or high-quality internal communications (rating 3-5).

Effective coach leadership requires frequent communication with individuals who perform different functions and roles on the team. Leadership styles that promote high-quality communication were suggested to enhance team cohesion and wellness . Highly cohesive teams worked together more efficiently, and consequently, performed better than less cohesive teams. In contrast, leadership that does not promote high-quality communication might risk insufficient collaboration within the team, poor decision-making and high stress, which in the long run might cause injuries. This scenario was supported by a recent study on female football players that perceived their coach as a source of stress due to poor communication; with that team exhibiting a high risk of developing overuse injuries.

Take home message

Having in mind these results, it is necessary to pay a lot of attention to create a good team task force. It is also important to create a good working environment  respecting the opinions of others. Coaches should ask and show interest in the job done by other members of the technical and medical staff. It is crucial for teams to work internal communication protocols (channels, meeting schedules, reports to present, etc.) in order to encourage positive interactions between all squad members.


Georgios Kakavas PT OMT ATC MSc.PhDc.


  1. Ekstrand J, Waldén M, Hägglund M. Hamstring injuries have increased by 4% annually in men’s professional football since 2001: a 13-year longitudinal analysis of the UEFA Elite Club injury study. Br J Sports Med 2016; 50:731–7.
  2. Ekstrand J. Preventing injuries in professional football: thinking bigger and working together. Br J Sports Med 2016; 50:709-10
  3. EkstrandJ, LundqvistD, Davison M, et al. Communication quality between the medical team and the head coach/manager is associated with injury burden and player availability in elite football clubs Br J Sports Med 2019; 53: 304-308.

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