Science and Medicine in Football

ISSN: 2473-3938 (Print) 2473-4446 (Online) Journal homepage: http://www.tandfonline.com/loi/rsmf20

A new model for injury prevention in team sports:

the Team-sport Injury Prevention (TIP) cycle

James O’Brien, Caroline F. Finch, Ricard Pruna & Alan McCall

To cite this article: James O’Brien, Caroline F. Finch, Ricard Pruna & Alan McCall (2018): A new
model for injury prevention in team sports: the Team-sport Injury Prevention (TIP) cycle, Science
and Medicine in Football, DOI: 10.1080/24733938.2018.1512752

To link to this article: https://doi.org/10.1080/24733938.2018.1512752

Published online: 12 Sep 2018.

Submit your article to this journal

View Crossmark data

Full Terms & Conditions of access and use can be found at

http://www.tandfonline.com/action/journalInformation?journalCode=rsmf20
SCIENCE AND MEDICINE IN FOOTBALL
https://doi.org/10.1080/24733938.2018.1512752

A new model for injury prevention in team sports: the Team-sport Injury Prevention
(TIP) cycle
James O’Briena,b, Caroline F. Finch c
, Ricard Prunad and Alan McCalle,f
a
Research & Development Department, FC Red Bull Salzburg, Salzburg, Austria; bSchool of Health and Life Sciences, Federation University Australia,
Ballarat, Australia; cSchool of Medical and Health Sciences, Edith Cowan University, Perth, Australia; dMedical Department, FC Barcelona,Ciutat
Esportiva Joan Gamper, Barcelona, Spain; eSport, Exercise and Health Sciences, School of Applied Sciences, Edinburgh Napier University,
Edinburgh, UK; fResearch & Development Department, Arsenal Football Club, London, UK

ABSTRACT ARTICLE HISTORY

Recently, there has been growing interest in injury prevention for football and other team sports, including Accepted 12 August 2018
the development of models and frameworks to guide injury prevention efforts. However, many existing
KEYWORDS
models are geared towards the conduct of injury prevention research and do not reflect the everyday injury Injury prevention; model;
prevention approach of sports medicine and sports science practitioners working in professional teams. framework; football;
Here, we present a new model, the Team-sport Injury Prevention (TIP) cycle, specifically aimed at the sports team sport
team medicine/science practitioner. It involves a simple continual cycle with three key phases: (Re) evaluate,
Identify and Intervene. These phases incorporate key aspects of previous models, along with important
implementation aspects. By progressing through the model’s three phases, team medicine/science practi-
tioners can develop a context-specific and dynamic injury prevention strategy.

Introduction 2007; Fuller and Dvorak 2012), reductionist (Bittencourt et al.

2016) or generic approaches (Roe et al. 2017); a lack of opera-
Injuries are common in football and their negative impacts on
tional steps (Padua et al. 2014; Roe et al. 2017); and the failure to
both the health of players (Kuijt et al. 2012; Lohkamp et al. 2017)
incorporate player workloads (Windt and Gabbett 2017).
and the performance of their teams (Hägglund et al. 2013; Windt
The applicability and relevance of each model is context-
et al. 2017) are well documented. Recently, there has been
dependent, with the majority being geared towards the conduct
growing interest in injury prevention for football and other
of injury prevention research, (van Mechelen et al. 1992; Finch
team sports, including the development of models and frame-
2006) and developing etiological theory (Meeuwisse et al. 2007;
works to guide injury prevention efforts (van Mechelen et al.
Bittencourt et al. 2016). However, practitioners working at the
1992; Finch 2006) and improve understanding of injury aetiol-
injury prevention “coalface” will be better served by a model
ogy (Meeuwisse 1994; Meeuwisse et al. 2007; Windt and
more reflective of risk management approaches (Fuller 2004;
Gabbett 2017). The most widely cited injury prevention model
Donaldson et al. 2013). Such a model should be simple, directly
is called the “sequence of prevention” (van Mechelen et al.
applicable to the team’s specific context and also acknowledge
1992). This model builds on previous public health approaches
real-world implementation challenges (O’Brien and Finch 2014).
(World Health Organization 2018) and consists of four key steps:
Furthermore, the model should reflect the cyclical nature of real-
world injury prevention, requiring ongoing evaluation and adap-
(1) Establishing the extent of the injury problem
tation of preventive strategies, as opposed to a simple linear
(2) Identifying the key risk factors and mechanisms of
step-by-step process.
injury
In the process of developing the 2018 FC Barcelona Muscle
(3) Introducing preventive strategies to mitigate the risk of
Injury Guide, (to which this article is linked) it became apparent
injury
that no existing model adequately reflected the everyday injury
(4) Evaluating the effectiveness of preventive strategies by
prevention approach of sports medicine and sports science
repeating Step 1
staff working in professional football teams. To remedy this,
we developed a new model, the Team-sport Injury Prevention
Finch (Finch 2006) introduced an extension of the van
(TIP) cycle, specifically aimed at the sports team medicine/
Mechelen model called the Translating Research into Injury
science practitioner. It involves a simple continual cycle with
Prevention Practice (TRIPP) framework, which emphasises the
three key phases (Figure 1):
key role of implementation aspects in achieving real-world injury
prevention success. Subsequent discussion in the literature has
(1) (Re) evaluate
aimed to address potential limitations of injury prevention mod-
(2) Identify
els. These limitations include the use of linear (Meeuwisse et al.
(3) Intervene

CONTACT James O’Brien drjamesob@outlook.com

© 2018 Informa UK Limited, trading as Taylor & Francis Group
2 J. O’BRIEN ET AL.
Figure 1. The Team-sport Injury Prevention (TIP) cycle.
These phases incorporate key aspects of previous models, (van
Mechelen et al. 1992; Finch 2006) along with important imple-
mentation aspects and is consistent with the risk management
approach described by Fuller et al. (Fuller 2004; Fuller and
Dvorak 2012).
Phase 1: evaluation
This phase involves evaluating the current “state-of-play” in
the team. Addressing the question “What is the current
injury situation?” involves evaluating the type, incidence
and severity/burden of injuries in the team. The second
question “What is the injury prevention situation?” involves
analysing which injury prevention strategies are currently
being used (or not used) and the reasons why. For example,
is the team implementing the evidence-based Nordic
Hamstring (Petersen et al. 2011) and Copenhagen
Adduction (Harøy et al. 2018) exercises, what is the team’s
current strategy for managing high-speed running load?
What recovery strategies are in place following match-play?
Is squad rotation being used? Which other preventive stra-
tegies are currently in place and with what rationale? A
detailed understanding of all team members’ perceptions
towards injury risk and injury prevention is important to
inform subsequent phases in the cycle.
In addition to establishing what is being done, it is essential
to determine precisely how these strategies are being carried
out. For example, in the case of exercises, key considerations
are the number and frequency of sessions, the exercise dose
within these sessions (e.g., sets, repetitions, intensity) and also
the quality of exercise execution.
In practice, teams might carry out the evaluation phase by
asking different staff departments to summarise relevant data
(e.g., injury statistics from the medical team and workload data
from the sports science team) and present this information to
other staff members in a group discussion meeting.
Perceptions regarding the injury prevention situation could
be obtained from players, coaches and other staff members
using a simple online survey, followed by a meeting to discuss
the findings.
As a real-world example, when the staff members of a
professional football team evaluated data from the recently
completed season, they noticed a rise in time-loss groin inju-
ries compared to previous seasons. Regarding the injury pre-
vention situation, team staff members noted a lack of injury
prevention strategies specifically targeting groin injuries, com-
pared to several strategies targeting other injuries (e.g., ham-
string and knee injuries).
Phase 2: identification
The next phase in the cycle involves exploring the risk factors
and mechanisms underpinning the injuries identified during
the evaluation (Phase 1). This process will be primarily driven
by the team’s internal data (e.g., injury, tracking and screening
data), along with consideration of established risk factors and
mechanisms from the published literature. It is important to
appreciate the multi-factorial nature of injury epidemiology,
(Bittencourt et al. 2016; Windt and Gabbett 2017) assess injury
risk at an individual player level (Roe et al. 2017) and consider
the degree to which identified risk factors can be modified.
This phase also involves identifying barriers and facilitators
to implementing injury prevention strategies, which will

strongly impact on the ultimate success of a preventive strat-
egy. These factors will be specific to each team’s unique
situation, but recent research has highlighted a number of
potential barriers/facilitators to implementing injury preven-
tion exercise programmes (McCall et al. 2015; O’Brien et al.
2017). These relate either to the content and nature of the
prevention programme itself, or to how it is delivered and
supported by players, coaches and team staff members and
club administrators. Although medical/sports science staff are
often considered responsible for the team’s injury situation,
the support of decision makers (e.g., coaches and club admin-
istrators) and the head coach’s leadership style are also crucial
(Ekstrand 2013; Finch and Donaldson 2010; Ekstrand et al.
2017). In large, multi-disciplinary sports medicine/science
teams there is potential for conflicting views about what
needs to be done and what needs to be prioritised (Gabbett
and Whiteley 2017; Sporer and Windt 2017), which can jeo-
pardise the success of injury prevention efforts. Identifying
these staff-related factors will inform the subsequent interven-
tion phase.
To operationalise the identification phase, discussion
groups can be formed (e.g., with the team doctor, phy-
siotherapist and sport scientist) to analyse individual player
profiles, along with the nature and mechanism of the team’s
past injuries. Implementation barriers and facilitators can be
identified by surveying key players and staff members (e.g., a
short online survey) and analysing past experiences with injury
prevention strategies in group discussions.
Continuing with the previous real-world example, input
from the players/staff of a professional football team identified
three factors potentially associated with the increase in groin
injuries: first, the injuries primarily affected younger players
promoted from the reserve team to the first team; second,
there were differences in the football and strength training
philosophies between first and reserve teams, potentially mak-
ing it difficult for promoted players to adjust; finally, the
majority of affected players had a history of previous groin
injury. In terms of implementation barriers, both a perceived
lack of time for additional injury prevention strategies and lack
of acceptance from football coaches for any changes to the
training philosophy were apparent.
Phase 3: intervention
The next phase involves planning both the content (what to
do) and delivery (how to do it) of injury prevention strategies.
This process will be influenced by the team’s current situation,
the identified injury risk factors and implementation barriers/
facilitators, published injury prevention research and the team
staff members’ previous experiences from working in the field.
Teams will need to employ multiple preventive strategies (e.g.,
load management, recovery strategies and specific exercise-
based interventions), reflecting the multi-factorial epidemiol-
ogy of injuries in football.
Implementation research highlights the importance of
securing administrative support for preventive strategies
(Padua et al. 2014) and engaging all key partners in the
design process (Donaldson et al. 2017). In the professional
football setting, this means involving club officials (who
SCIENCE AND MEDICINE IN FOOTBALL 3
decide on club policy), coaches and team staff members
(who deliver injury prevention) and key players (the targeted
health beneficiaries) from the onset. Through involvement of
all key partners in the design phase, tailored strategies can
be developed which have adequate support and account for
barriers/facilitators in the team’s specific context from the
onset. In practice, teams will need to organise a series of
meetings dedicated to planning and designing injury pre-
vention interventions, perhaps led by a moderator.
Following initial discussions with broad participation from
club administrators and team staff, a smaller discussion
group can further develop specific aspects of the injury
prevention strategies.
Continuing further with the previous example, the professional
football team refined its injury prevention strategy for the upcom-
ing season, on the back of several meetings involving administra-
tors, coaches, team staff and players. Differences in the football
training philosophy (first/reserve team) could not be resolved, but
the sport science staff agreed to align certain aspects of their
strength training and warm-up programmes more closely.
Furthermore, modified Copenhagen Adduction Exercises (Harøy
et al. 2018) were added to the individual training programmes of
those reserve team players judged to be at high risk (i.e., groin
injury history and/or likely to be promoted to the first team). Due to
the previously identified lack of time for additional injury preven-
tion strategies, these exercises were not added to the team-based
training programmes for the time being.
Ongoing re-evaluation and modification
Injury prevention in the real-world context of professional
team sport needs to be a dynamic, cyclical process. Having
introduced or modified a preventive measure, ongoing eva-
luation is required. In the re-evaluation phase, successful
implementation can be judged against metrics such as
injury and physical performance data, team members’ per-
ceptions and the degree of fidelity to the injury prevention
strategy (e.g., the number and quality of completed injury
prevention exercise sessions). With continual progression
through the model’s three phases, the team’s injury preven-
tion strategy can dynamically evolve, responding to various
changes in the team’s environment (e.g., new players, new
staff members and varying game schedules). While evalua-
tion of certain metrics will occur on a daily basis in profes-
sional teams (e.g., wellness scores, workload data), it is
recommended that teams also undertake broader data
reporting and conduct more formal injury prevention eva-
luation, involving all key individuals, two or three times per
season.
Disclosure statement
No potential conflict of interest was reported by the authors. This article is
connected to the 2018 FC Barcelona Muscle Injury Guide, which is offi-
cially supported by the Science and Medicine in Football Journal. Any
paper submitted to Science and Medicine in Football Journal that is
connected to the 2018 FC Barcelona Muscle Injury Guide is subject to
the normal external peer review process.
4 J. O’BRIEN ET AL.
ORCID
Caroline F. Finch http://orcid.org/0000-0003-1711-1930
References
Bittencourt NF, Meeuwisse WH, Mendonca LD, Nettel-Aguirre A, Ocarino
JM, Fonseca ST. 2016. Complex systems approach for sports injuries:
moving from risk factor identification to injury pattern recognition-
narrative review and new concept. Br J Sports Med. 50:1309–1314.
Donaldson A, Borys D, Finch CF. 2013. Understanding safety management
system applicability in community sport. Saf Sci. 60(Supplement C):95–104.
Donaldson A, Lloyd DG, Gabbe BJ, Cook J, Finch CF. 2017. We have the
programme, what next? Planning the implementation of an injury
prevention programme. Inj Prev. 23:273–280.
Ekstrand J. 2013. Keeping your top players on the pitch: the key to football
medicine at a professional level. Br J Sports Med. 47(12):723–724.
Ekstrand J, Lundqvist D, Lagerbäck L, Vouillamoz M, Papadimitiou N,
Karlsson J. 2017. Is there a correlation between coaches’ leadership
styles and injuries in elite football teams? A study of 36 elite teams in
17 countries. Br J Sports Med. 52:527-531.
Finch C. 2006. A new framework for research leading to sports injury
prevention. J Sci Med Sport. 9(1–2):3–9.
Finch CF, Donaldson A. 2010. A sports setting matrix for understanding
the implementation context for community sport. Br J Sports Med. 44
(13):973–978.
Fuller DS. 2004. The application of risk management in sport. Sports Med.
34(6):349–356.
Fuller JA, Dvorak J. 2012. Risk management: FIFA’s approach for protecting
the health of football players. Br J Sports Med. 46(1):11–17.
Gabbett TJ, Whiteley R. 2017. Two training-load paradoxes: can we work
harder and smarter, can physical preparation and medical be team-
mates? Int J Sports Physiol Perform. 12(Suppl 2):S250–S254.
Hägglund M, Waldén M, Magnusson H, Kristenson K, Bengtsson H,
Ekstrand J. 2013. Injuries affect team performance negatively in profes-
sional football: an 11-year follow-up of the UEFA champions league
injury study. Br J Sports Med. 47(12):738–742.
Harøy J, Clarsen B, Wiger EG, Øyen MG, Serner A, Thorborg K, Hölmich P,
Andersen TE, Bahr R. 2018. The adductor strengthening programme
prevents groin problems among male football players: a cluster-rando-
mised controlled trial. Br J Sports Med. Published Online First Jun 10.
doi: 10.1136/bjsports-2017-098937.
Kuijt MT, Inklaar H, Gouttebarge V, Frings-Dresen MH. 2012. Knee and
ankle osteoarthritis in former elite soccer players: a systematic review of
the recent literature. J Sci Med Sport. 15(6):480–487.
Lohkamp M, Kromer TO, Schmitt H. 2017. Osteoarthritis and joint replace-
ments of the lower limb and spine in ex-professional soccer players: a
systematic review. Scand J Med Sci Sports. 27(10):1038–1049.
McCall A, Davison M, Andersen TE, Beasley I, Bizzini M, Dupont G, Duffield
R, Carling C, Dvorak J. 2015. Injury prevention strategies at the FIFA
2014 World Cup: perceptions and practices of the physicians from the
32 participating national teams. Br J Sports Med. 49(9):603–608.
Meeuwisse THH, Hagel HB, Emery HC. 2007. A dynamic model of etiology
in sport injury: the recursive nature of risk and causation. Clin J Sport
Med. 17(3):215–219.
Meeuwisse WH. 1994. Assessing causation in sport injury: a multifactorial
model. Clin J Sport Med. 4(3):166–170.
O’Brien J, Finch CF. 2014. The implementation of musculoskeletal injury-
prevention exercise programmes in team ball sports: a systematic
review employing the RE-AIM framework. Sports Med. 44(9):1305–1318.
O’Brien J, Young W, Finch CF. 2017. The delivery of injury prevention
exercise programmes in professional youth soccer: comparison to the
FIFA 11+. J Sci Med Sport. 20:26–31.
Padua DA, Frank B, Donaldson A, de la Motte S, Cameron KL, Beutler AI,
DiStefano LJ, Marshall SW. 2014. Seven steps for developing and
implementing a preventive training program: lessons learned from
JUMP-ACL and beyond. Clin Sports Med. 33(4):615–632.
Petersen J, Thorborg K, Nielsen MB, Budtz-Jorgensen E, Holmich P. 2011.
Preventive effect of eccentric training on acute hamstring injuries in
men’s soccer: a cluster-randomized controlled trial. Am J Sports Med.
39(11):2296–2303.
Roe M, Malone S, Blake C, Collins K, Gissane C, Buttner F, Murphy JC,
Delahunt E. 2017. A six stage operational framework for individualising
injury risk management in sport. Inj Epidemiol. 4(1):26.
Sporer BC, Windt J. 2017. Integrated performance support: facilitating
effective and collaborative performance teams. Br J Sports Med.
Published Online First Aug 21. doi: 10.1136/bjsports-2017-097646.
van Mechelen W, Hlobil H, Kemper HC. 1992. Incidence, severity, aetiology
and prevention of sports injuries. A review of concepts. Sports Med. 14
(2):82–99.
Windt J, Ekstrand J, Khan KM, McCall A, Zumbo BD. 2017. Does player
unavailability affect football teams’ match physical outputs? A two-
season study of the UEFA champions league. J Sci Med Sport.
Published Online First Aug 24. doi: 10.1016/j.jsams.2017.08.007.
Windt J, Gabbett TJ. 2017. How do training and competition workloads
relate to injury? The workload-injury aetiology model. Br J Sports Med.
51(5):428–435.
World Health Organization. 2018. Public health approach. [accessed 2018
Mar 23]. http://www.who.int/violenceprevention/approach/public_
health/en/.