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7 Lessons

The last official FIFA survey (“Big Count 2006”) revealed that there were approximately 900,000 registered referees and assistant referees worldwide – across all levels of football. Of these, about 90% are male and 10% female. There are currently also around 3,400 registered international referees wearing FIFA badges.

This section will provide an overview of the relevant physiological and medical aspects relating to match officials. Clinicians working in football need to understand the specific match demands, the fitness requirements, the injury profile, and other related issues of these athletes.

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Learning outcomes

By the end of this module you should:

  • Understand the physical demands associated with being a match official in football
  • Have an awareness of the nutritional needs of match officials
  • Understand the injury mechanisms and characteristics typically seen among match officials
  • Be able to perform a pre-competition medical assessment for match officials
  • Have an understanding of the FIFA 11+ for Referees


  • Read pages 118-122 of the F-MARC Football Medicine Manual and other required reading
  • Review the suggested reading
  • View or listen to relevant multimedia content
  • Complete the course quiz


  1. Keller DI, Bizzini M, Feddermann N, Junge A, Dvorak J. FIFA Women’s World Cup 2011: pre-competition medical assessment of female referees and assistant referees. Br J Sports Med. 2013;47(3):179-181.
  2. Bizzini M, Schmied C, Junge A, Dvorak J. Pre-competition medical assessment of referees and assistant referees selected for the 2010 FIFA World Cup. Br J Sports Med. 2012;46(5):374-376.
  3. Bizzini M, Junge A, Bahr R, Helsen W, Dvorak J. Injuries and musculoskeletal complaints in referees and assistant referees selected for the 2006 FIFA World Cup: retrospective and prospective survey. Br J Sports Med. 2009;43(7):490-497.
  4. Bizzini M, Junge A, Bahr R, Dvorak J. Female soccer referees selected for the FIFA Women’s World Cup 2007: survey of injuries and musculoskeletal problems. Br J Sports Med. 2009;43(12):936-942.
  5. Bizzini M, Junge A, Bahr R, Dvorak J. Injuries and musculoskeletal complaints in referees – a complete survey in the top divisions of the Swiss football league. Clin J Sport Med. 2009;19(2):95-100.
  6. Bizzini M, Junge A, Bahr R, Dvorak J. Injuries of football referees: a representative survey of Swiss referees officiating at all levels of play. Scand J Med Sci Sports. 2011;21(1):42-47.
  7. Bizzini M, Dvorak J. FIFA 11+: an effective programme to prevent football injuries in various player groups worldwide – a narrative review. Br J Sports Med. 2015;49(9):577-579.