Discussion
Our study explored the perceptions of critical technical and medical staff members of injuries and their prevention in Qatari professional football. The perceptions of HCs, FCs, TDs (team doctors) and PHs (physiotherapists) were investigated, providing insights into injury prevention and its implementation in Qatar’s specific context of professional football. All respondents described injury prevention as necessary. The main themes demonstrate that injury prevention depends on the teamwork of multiple stakeholders and that it is influenced by a context that stretches from culture to environment.
Taking context into account
Our results align with Bolling et al,15 we found that context matters in how injury prevention is perceived and carried out. The Qatari context (environment, culture) has an influence on injury prevention and also on how team communication is structured. In the case of this study and supported by Verhagen et al19’, the behaviour and lifestyle of individual players are believed to play an essential role in preventing injuries. Indeed, lifestyle habits have been proven to be a risk factor for injuries.20 21 Studies found that well-regulated lifestyle habits like a consistent sleep pattern and high sleep quality result in better performance and fewer injuries in professional football players.22 In this context, Khalladi et al23 showed that 68,5% of a sample of players from the Qatari league had poor sleep quality. This is in line with what the respondents of our study mentioned: many players report poor sleeping patterns. Therefore, understanding the life behaviour of each player is important to address all related injury risk factors. Recently, Tabben et al24 have shown24 that karate athletes, educated on injury prevention and supported by FCs, are more likely to practice injury prevention. The strategy of player education can also be applied in the Qatari football context to improve injury prevention, mentioning the importance of considering lifestyle habits when implementing injury prevention strategies for all staff.
The management’s pressure on the HCs was described as higher in Qatar than in other countries, based on personal HCs’ experience reports. This is illustrated by the constant turnover of coaching staff in the teams. This factor, which does not favour long-term strategies, has been mentioned as potentially leading to more injury-related risk-taking decisions from the HC. This point probably explains HC behaviour regarding training time management—‘Performance comes first’—despite the literature showing that a player’s performance is strongly linked to a player’s health.25 This discrepancy could be tackled by working on the communication between team management and HCs, having a longer-term HC strategy applied in clubs, or suggesting performance directors who can ensure this happens.
Communication and teamwork
The respondents in our study agreed that good communication (among staff and between staff and players) is essential for injury prevention, supporting the existing literature showing that football teams with poor communication suffer more injuries.26 While diverse ideas and experiences can be a significant asset if harnessed well through good communication, shared responsibility and decision-making, the existing diversity can also lead to misunderstandings, which should be considered to avoid miscommunication. For instance, this study showed that the FC plays an essential role in communication and is usually the communication channel between the medical staff and the HC. The medical staff sometimes did not perceive this well, preferring direct contact with the HC. In most cases, this FC communication channel is a consequence of him being usually hired by the HC himself and, most of the time, working with him for a long time. Bizzini et al27 considered communication with the HC in their works. They concluded that information, education and speaking a common language (line of thinking) are essential to prevent professional football injuries. Based on our findings, medical staff would need to take the first step in building a good relationship and communication with the FC in order to get them aligned with their injury prevention strategies. Especially that in the Qatari context, where it is more probable to change the technical team than the medical team.
Communication between the staff and the players is also important. Education and experience can also play a role in this form of communication. In this context, ‘trust’ has also been essential for optimal communication. Thus, coaching and medical staff members should carefully consider that trust between a player and a staff member can help the player comply with prevention exercises or even impact the player’s lifestyle habits. Staff turnover could also negatively impact communication and the trustworthy relations between players and staff.
Our study confirms previous studies that injury prevention is seen as teamwork.28 29 All staff members and, importantly, the players are deemed responsible for the success of the injury prevention implementation process. Every staff member has their task and responsibility for this. A respondent mentioned that if one job is not carried out properly, the circle is not round anymore and injury prevention is not as effective as it should be. So, injury prevention is teamwork, and everyone is involved but with different and complementary tasks. However, the main goal of the technical staff is to win games. At the same time, the medical staff might be focused on the recovery and health of the players.30 Therefore, shared decision making must be considered to keep the sensitive balance of both team performance and player health.30
Methodological considerations
To ensure the quality of our study, several methodological strategies were used.31 32 The study included the multiple perspectives of key staff members with critical roles. However, future studies should also consider interviewing players, as they also have an essential role in injury prevention.
To improve confirmability, there were multiple independent coders for the first interviews. Also, the data analysis was not carried out by the researcher in charge of the data collection, ensuring a neutral view of the data. During the data analysis, constant reflectivity occurred through regular meetings between the coders and the researcher responsible for the data collection.
The study looks at a specific context, namely professional football in Qatar. Competition, player lifestyle, culture and the environment differ between countries and leagues. Consequently, transferring our findings into other sports or other regional contexts should be done with utmost diligence.