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Footballers at training kicking ball to trainer

Nick Worth – The Medico-Legal Field in Elite Football/ Sports – Injury Rehab Network

The April Injury Rehab Network event with BASRaT featured a presentation from Nick Worth, Physiotherapist. The online event took place on the evening of Wednesday 9th April with 120 sports rehabilitation practitioners in attendance.

Nick discussed the medico-legal field in elite football/ sports. The recording is available to watch here.

Profile picture of Nick Worth Nick Worth – Physiotherapist

Nick has worked in professional football for over 23 years and is a highly experienced physiotherapist, spending most of his career with Premier League teams. He was the England Under-21 Team Physiotherapist from 2000 to 2003.

In the medico-legal field, he has acted as an expert witness in several high-profile cases involving Premier League players and staff. Some of these cases have since influenced how health professionals manage elite-level athletes. His experience at the highest level of professional sport—both domestically and internationally—has informed a realistic, professional, and measured approach to medico-legal work.

He also advises The Players Trust on sports medicine and performance matters. The group supports the safeguarding and wellbeing of youth footballers, helping them navigate financial, performance, injury-related, and educational pressures that could affect their careers.

A key member of the medical team that helped Al Jazira (Abu Dhabi) secure their first league and cup double in 2011, his professional background also includes roles at Bolton Wanderers, West Bromwich Albion, Manchester City Academy, Wigan Athletic, Fulham, Burnley, Sheffield Wednesday, and the Thailand National Team.

He is an experienced lecturer and Module Lead on the MSc programme at Salford University. As a Fellow of the Society of Orthopaedic Medicine, he teaches physiotherapists and GPs in manual therapy, manipulations, and injections. He also lectures internationally on sports injuries and the assessment, diagnosis, and treatment of musculoskeletal conditions.

The Medico-Legal Field in Elite Football/ Sports

Footballers at training kicking ball to trainer

The Medico-Legal Maze

The presentation began with an overview of the complex medico-legal landscape in elite sport. Myths, half-truths, and misunderstandings were addressed, along with the need for practitioners to understand the process and implement steps to mitigate risk within the realities of professional sport.

Reducing Litigation

Drawing on experiences as a physiotherapy expert witness, recurring themes in expert reports were highlighted. It was suggested that improved practice can not only reduce litigation and costs but also lead to better rehabilitation outcomes.

Fear

Several fear factors within elite sport that can lead to poor practice were discussed. These include pressure to achieve results, the impact of fame and sponsorship, concerns over income, family responsibilities, fan expectations, and the need to secure or retain a place in the team. Practitioners may also fear making mistakes, lacking knowledge, or losing their jobs.

The Medico-Legal Process

The typical sequence of events in elite football cases was outlined. A player may approach a solicitor, prompting the creation of an expert witness report that includes a statement from the athlete, medical records, and defence documentation. Competence is assessed using the Bolam standard, and joint expert witness reports may follow. Cases are often settled out of court, though attendance may occasionally be required.

Case Example – Concussion Injury

A case involving a concussion was presented: a player sustained a head injury, and only a partial SCAT assessment was completed. The medical notes were inadequate, and the player may not have been fully honest. The GRTP protocol was initiated, but the player’s condition worsened, and they reported symptoms to the S&C staff. Under pressure to play and with contract discussions ongoing, the player suffered two more concussive incidents before ultimately retiring. The litigation risks arising from such a case were considered.

Actions to Take

Emphasis was placed on the importance of honesty and clear communication. Medical decisions rely on accurate information, and it’s essential to understand the athlete’s perspective. A supportive and inclusive approach within the medical team was encouraged.

Therapist talking to athlete

Note Writing Tips

Good clinical note writing was strongly recommended. Common challenges include time pressures, lack of interest, and fear of getting it wrong. It was stressed that what is unwritten can be just as important as what is recorded, and subjective notes carry as much weight as objective ones. Notes offer a record of clinical reasoning and should include any dialogue or disagreement with players. Maintaining proper records is considered a professional standard.

The Team Behind the Team

The structure of elite sports teams was discussed, with a focus on ensuring junior staff are well supported and aware of their responsibilities. Collaboration between the S&C and medical departments is key, especially regarding significant issues. Accountability may vary, with some teams placing responsibility on the coach, while others assign it to a technical director or CEO.

Scope of Practice

It was emphasised that practitioners should remain within their professional boundaries, as roles in elite sport can become blurred. Requests to act outside of one’s expertise can increase stress and tension. There may also be pressure from contractual obligations or ambition to progress professionally. Understanding the legal framework is essential.

Player Responsibility

Issues were raised about how players’ accounts may change over time due to emotional memory. Practitioners were advised to maintain detailed, factual notes. Open communication between the player, family, agents, and the medical team is important.

When Things Don’t Go to Plan

When outcomes are not as expected, practitioners should fall back on evidence-based medicine, adapt their approach, and focus on the individual athlete in front of them. Collaboration remains key in achieving the best results.

Open Dialogue

In high-pressure environments, open dialogue becomes especially important. Player wellbeing must remain the priority, and practitioners should provide a safe, non-judgemental space. Even in disagreement, understanding the pressures involved and applying emotional intelligence are essential.

Doing the Right Thing

Traits of good practitioners were outlined, including honesty, courage, integrity, resilience, empathy, and teamwork.

Final Summary Points:

  1. Things don’t always go to plan
  2. Become comfortable with having uncomfortable conversations
  3. Always maintain lines of communication

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Q&A

Nick kindly answered questions put forward by practitioners who attended the session. Please see the presentation recording for Nick’s insights.

Presentation Recording

The recording of Nick’s presentation is available to watch here.

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