RESEARCH REVIEW

Communication quality between the medical team and the head coach/manager is associated with injury burden and player availability in elite football clubs

Original article by Jan Ekstrand et al.

Background

For years, elite football has seen injury rates and player availability plateau despite our best efforts in load management, recovery protocols, and sophisticated data monitoring. This begs the question: if our training methods and equipment are state-of-the-art, what else could be holding us back? An article from the UEFA Elite Club Injury Study highlighted one often-overlooked factor: internal communication. From the way coaches speak with their medical teams to how performance coaches relay critical data, the nuances of our everyday interactions may be as impactful as any recovery strategy or ‘preventative exercise’.

What the authors did

In a unique study, the researchers examined 36 elite football clubs across 17 European countries over a four-year period. The objective was to:

Collect data where medical staff rated the quality of internal communication on a scale of 1-5 to assess relationships from within medical teams to interactions with head coaches, fitness coaches and even high-up leadership

Alongside this data, the researcher tracked injury burden (days lost per 1,000 exposure hours), the incidence of severe injuries (those sidelining players for over 28 days), training attendance, and match availability.

They then analysed this data by categorising teams into low, moderate, and high communication groups. The researchers could pinpoint exactly how differences in communication quality aligned with on-field performance and injury outcomes.

Key Findings

Communication counts

Teams with high overall communication scores experienced a statistically significant lower injury burden and fewer severe injuries, alongside higher training attendance and match availability. “The highest overall quality of communication (5 out of 5) was correlated to a low injury burden (rs=–.31, p=0.007); a low incidence of severe injuries (rs=.–32, p=0.005); a high training attendance (rs=0.31, p=0.006) and high match availability (rs=0.27, p=0.048).”

The Vital Connection Between Head Coach and Medical Team

This relationship proved to be critical. Teams scoring low in communication between their head coach/manager and medical team had a 50% higher injury burden and 6–7% lower player availability compared to teams with moderate or high communication quality.

Additional Key Relationships

Even slight drops in communication quality between the Medical Team & Fitness Coaches were associated with a 4–5% decrease in training attendance.

Interestingly, communication with the CEO/Board did not significantly correlate with injury or availability metrics, highlighting that the real magic happens on the frontline, where coaching and medical teams intersect.

Limitations

While the findings are compelling, a few caveats are worth noting:

• Subjectivity: Communication quality was self-reported by medical staff. Their perceptions, influenced by seasonal highs and lows, could skew the data. They did not test the reliability of the data.

• Static Snapshot: The evaluations were done once per season, offering a single snapshot of a process that is undoubtedly dynamic and ever-changing. It’s possible that their reflections represent an isolated and somewhat short-term recollection of the communication across the whole year.

• Scope of Study: The focus was solely on elite men’s football. While the insights are profound, we should be cautious when generalising these results to other sports or levels.

• Cause ≠ Effect: While a strong link exists between communication quality and injury rates, we can’t say poor communication causes more injuries. It’s possible that high injury rates or situations where medical feedback is overlooked contribute to perceptions of poor communication.

Coach's Takeaway

As I discussed in my last article, “The Most Important "C" in Strength and Conditioning Coaching”, we sometimes get so caught up in the latest gadgets, load protocols, and biomechanical analysis that we forget the real simple secret sauce: great communication. I am as guilty as any; I’ve spent countless nights buried in injury prevention studies and obsessing over the perfect loading strategy. All in an effort to feel like I’ve got the answer to every conceivable problem. Sometimes, at the expense of just sitting down and talking to the staff and players about what’s going on.

The evidence is compelling. Teams with high-quality internal communication that is characterised by transparent, regular, and clear dialogue between head coaches, medical staff, and fitness coaches, consistently show a reduction in injury burden. In fact, data reveal that clubs with superior communication recorded an injury burden as low as 105.0 days per 1,000 hours of exposure, compared to 183.6 days for teams with poor communication—a nearly 50% improvement. Training attendance and match availability also improved by 6–7%, translating directly into more playing time and on-field continuity. We cannot forget that nothing prepares players for the game like playing the game.

For us on the field, these aren’t just numbers; they represent tangible improvements in athlete well-being and performance. When the coaching team and support staff are constantly aligned, athletes receive consistent messages regarding recovery, training load adjustments, and performance expectations. This unified approach not only minimises injury risks but also builds trust within the team, ensuring that players feel supported both physically and mentally.

To truly harness these benefits, consider these strategies:

Establish Structured Communication Protocols:

Regular, scheduled meetings, whether daily check-ins or weekly huddles, between key stakeholders, can ensure everyone is aligned. Using digital tools for real-time updates can further enhance this process, even if it is as simple as a shared Google sheet and a WhatsApp group.

Embrace Two-Way Dialogue: 

Decisions shouldn't solely come from the top. It's essential to seek input from players and frontline staff, allowing for quick adjustments. This approach is vital for spotting early signs of overtraining or developing injuries. One transformative shift in my approach was building a genuine, open rapport with my head coach. Now, we can comfortably toss around ideas like, “I think the squad might have overdone it in practice today,” or “Maybe we should try X instead of Y,” without fear of stepping on each other’s toes.

Foster a Culture of Transparency

When every member of the support staff operates from the same playbook, it creates an undeniable sense of confidence across the team. That “culture”, which is often thrown about in post-game interviews as the magic ingredient behind success, is genuinely more than just a buzzword; it’s the embodiment of a shared commitment to open, honest communication in line with a common goal. When athletes know that their coaches, medical staff, and trainers are all aligned and transparent, they feel safe to report even the smallest twinge of pain before it snowballs into something more serious. Consider the findings from Whalan et al. (2019): athletes who experienced minor to moderate non–time-loss complaints were 3.6 to 6.9 times more likely to suffer a time-loss injury later on. These data highlight how vital those early conversations are in keeping players healthy and performing at their best.

Final Thoughts

At its core, effective internal communication isn’t just another “nice-to-have” skill—it’s the secret ingredient that makes a team tick. When we fine-tune how we exchange ideas and act on them, we create an environment where injury prevention isn’t an afterthought but part of the everyday routine. Investing in strong communication might be the simplest, most cost-effective way to take a team from good to great. And while “talk is cheap” usually carries a different meaning, the reality is even the most underfunded team can afford a conversation over a coffee, a WhatsApp group and a shared Google Sheet.

Thanks for reading!

~ Murray

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