29 November 2011 - The medical directors of the currently accredited 22 FIFA Medical Centres of Excellence from all five continents gathered together at Aspetar on 27 November. The centre in Doha, under the leadership of Dr Mohammed G. A. Al Madheed, had invited their colleagues to discuss their future collaboration in joint projects in football medicine research, and also the implementation of prevention programmes and education. Since the inauguration of the first centre in 2005 in Zurich, a structured process has been implemented where interested institutions have to submit an extensive documentation supporting their application, which then undergoes evaluation by an expert group prior to the final decision of the FIFA Medical Committee. Centres are also required to demonstrate their collaboration with the respective national football association in their country. The focus of the FIFA Medical Committee has always been on protecting the health of players and contributing to the development of the game of football, stressed Chairman of the FIFA Medical Committee and FIFA Executive Committee member Dr Michel D’Hooghe in his welcoming address. This would be the primary criteria for any study and project conducted with the support of FIFA. It was in this spirit that the FIFA Medical Assessment and Research Centre F-MARC had been founded in 1994, with the major aim of creating the scientific base for the prevention of injuries in football players. Prof. Jiri Dvorak, Chairman of F-MARC and FIFA Chief Medical Officer, described how the implementation of FIFA’s programme, '11+ - a complete warm-up to prevent injuries', started on a broad scale this year in several countries including the home countries of both the men’s and women’s current world champions Spain and Japan. The support and introduction of this programme represents an important task for the FIFA Medical Centres of Excellence in their countries, as do the pre-competition medical assessment and age determination by MRI, both also developed by F-MARC, and providing second opinions in injury assessment of players. While all the above falls under the headline of protecting players’ health, FIFA went a step further and developed a programme to improve public health by teaching children how to protect themselves from disease in a football setting. FIFA’s “11 for Health” has been started in Africa prior to the 2010 FIFA World Cup™ and runs now successfully in several countries. Currently, the expansion to South America and Oceania is on the way. Accredited centres may also play a role in the implementation of this programme, together with football associations and governmental bodies. Ten centres presented their proposals for multicentre studies requiring the collaboration of the network. Their main themes followed the outline given by FIFA: With regard to injuries, stress was on the hip and knee as the two most often injured joints after the ankle. Next to the very common problem of hip and groin pain, particularly cartilage injuries of the knee with their considerable potential for long-term complications were discussed intensely. The lower back was proposed as another important area for closer investigation as it is an often neglected body region in football players. The heart presented a further focus of discussion. Sudden cardiac arrest on the pitch as it occurs time and again in football is a traumatising experience for players, team physicians, spectators and in fact the whole football family. FIFA had already done some preventive work and included a comprehensive cardiac assessment in their pre-competition medical assessment. However, not all factors causing sudden death in a young and apparently healthy player can be identified by the examination and do therefore require further investigation to improve risk management. Prior to a decision on the best way forward, proposals will be further developed and re-evaluated with compliance with the FIFA strategy focussing on prevention being paramount. The meeting was closed by an impressive overview on the extensive research programme of the host Aspetar covering major aspects of football medicine. Aspetar became a FIFA Medical Centre of Excellence in 2009 and contributed on several occasions to the advancement of football medicine not only through publications but also by organising symposia and meetings on topics such as Ramadan and football, playing in the heat and new techniques in the treatment of musculoskeletal injuries.