The organisation of medical and performance departments in European elite football teams

Elite football clubs rely heavily on medical and performance units to optimise players’ health care and performance. Despite their growing importance, little is known about how these departments are structured and managed. This study investigates the organisational structure and operational processes within medical and performance departments in elite European football clubs. An online survey was distributed to 193 professional football clubs in 29 European countries, with 66 complete responses (34% response rate). Descriptive quantitative analyses and descriptive analyses of open-ended items explored leadership models, communication, data management, and return-to-play (RTP) procedures. Organisational structures varied, with flat (30%), functional (21%), and matrix (23%) models most common. Regional differences in leadership configurations were observed, though not statistically significant between European regions. Most departments reported to a Sports Director (42%) and operated with established communication pathways, with 89% agreeing that information was effectively transferred. Data were primarily stored centrally within the medical department or the club. Return-to-play practices almost exclusively followed a phased model, with physiotherapists central across all stages. Team doctors were heavily involved in early stages but less so during return to performance, where sport scientists and rehab coaches became more prominent reflecting current multidisciplinary RTP frameworks. High levels of external engagement (91%) and research involvement (62%) highlight a growing emphasis on evidence-based practice. These findings describe substantial structural heterogeneity and increasing professionalisation of medical and performance departments in European elite football. Regional variability and differences in leadership, data management, and decision-making processes warrant further investigation rather than direct comparison.