Football - The people’s game
Written by Pieter d’Hooghe, Qatar
Category: Sport and Society

Volume 2 | Targeted Topic - Sports Medicine in Football | 2013
Volume 2 - Targeted Topic - Sports Medicine in Football


– Written by Pieter d’Hooghe, Qatar



There are reports of football being played through the streets of English villages in the Middle Ages, using an animal bladder as a ball. At that time, games were described as nothing less than organised riots, and were more often noted for the royal decrees banning the games than in the games themselves!


The first official international football game in history was between England and Scotland in 18721. The game was played on a cricket pitch in Scotland. Both teams presented a mostly attacking squad so it is therefore not surprising to learn that the final score was 0-0.


From the outset, football was a game played with 11 vs 11 players. This is because football was essentially played between the dormitories of English colleges. Every dormitory had 10 beds and the dormitory surveyor, ‘the guardian’, who was the keeper. However, there was no referee to begin with. If there was doubt during a game, both team captains decided, as real ‘gentlemen’, whether the ball had crossed the line or not. This was the predecessor to modern goal-line technology.


It was not long before a referee entered the football pitch – it was said at that time that rugby was a sport for hooligans, played by gentlemen, while football was considered a sport for gentlemen, but played by hooligans. There quickly arose the need for a neutral figure, who sat at a desk on the centre pitch sideline. In case of dispute, the captains ‘referred’ to this man, and that is how the referee was established.


If the person who invented this simple game returned today, he would see an impressive evolution that football has gone through. This evolution has gone through four various phases:

  1. Industrial phase: English industrial companies used football as a leisure activity for their staff between working sessions. For example, Arsenal Football Club was formed by munitions factory workers during World War I and is a product of this period2.
  2. Religious phase: Many sports clubs throughout the whole of Europe linked religion and education in their formation. For example, Liverpool Football Club was founded as a reaction against the Protestant Everton Football Club3. Similarly, same-city rivals Glasgow Rangers and Celtic Football Club were not just sporting rivals but religious as well (Protestant and Catholic, respectively)4.
  3. Nationalistic phase: Football teams became the reflection of a whole nation. The Germans were known for their discipline and the Brazilians for their Samba-like technical skills.
  4. Identification phase: Today, team supporters identify with the team in victory. When asked about the team’s results, a supporter will say, “We won”. Interestingly, when the team is defeated, it is common for a supporter to lament, “They lost”.


Today football is a family with 209 parents as the national associations worldwide. The active children of these parents are some 300 million young football players affiliated with professional and amateur clubs in their respective countries. There are also eight confederations which operate on each continent.



Although the game of football has existed since the first half of the 19th century and originated in England, FIFA was founded in 1904, in Paris. The founding fathers of FIFA were the Netherlands, Denmark, France, Switzerland, Sweden, Portugal and Belgium, while Real Madrid represented the Spanish contingent.


The founders had 4 main objectives:

  • To protect and develop the game.
  • To promote football globally.
  • To look after the laws of the game.
  • To organise its own international competitions.


It is interesting to note that today, over 100 years later, these main objectives remain largely the same, although the game itself has had a remarkable evolution. Led by FIFA today, sporting, social, economic and medical activities are the four most important pillars around the development of the football game.



The World Cup

No other sport event enthrals the public around the world as much as the Men’s Senior FIFA World Cup. Since the inaugural World Cup in Uruguay in 1930, football’s flagship competition has steadily grown in popularity and prestige.


The original idea of bringing together the elite national teams to compete in a world championship was the brainchild of several enlightened French football officials. Inspired by Mr Jules Rimet, the enterprising FIFA President at that time, they drew up a plan to stage a world championship in the early part of the last century. The tournament was held on three occasions before World War II and then brought to an abrupt halt that was to last for 12 years. The competition was revived in Brazil in 1950 and in no time the World Cup acquired the status of the biggest single-sporting event in the world.


New ground

In 2002, when the FIFA World Cup was staged in Korea and Japan, the long tradition (established in 1958) of alternating between the continents of Europe and the Americas was broken. In 2010 the World Cup once again broke new ground when South Africa became the first African country to host the competition. And in 2022, the World Cup will be held in the Middle East for the very first time, in Qatar.



The popularity of the World Cup was demonstrated at the 2006 tournament in Germany, which was one of the most watched events in television history. Hundreds of millions of people watched the action in Germany in their homes. The Italy vs France final alone attracted 715 million television viewers. Almost 3.5 million fans flocked to the German stadiums to watch the 64 matches of the tournament, while another 18 million converged on the public-viewing Fan Fest area at the Brandenburg Gate. Italy were ultimately crowned champions for the fourth time following previous triumphs in 1934, 1938 and 1982, a record only surpassed by five-time world champions Brazil. Only 7 teams (Argentina, England, France, Germany, Uruguay, Brazil, Italy) have managed to triumph in the 18 World Cup competitions held since 1930.


Other competitions

The World Cup is arguably one of the most important organised sports events in the world but what is not always known is that FIFA actually organises 13 World Cup competitions for all kinds of football (female, beach football, indoor football), both genders and different age categories (adult, Olympic, under 20s, under 17s). The preparation and guidance of all these World Cup competitions consists of much more than the football games themselves.


Women’s football

Of course, it is not just men who play football. According to a recent survey, some 29 million girls and women play football in 180 countries5. Much work is done to support the development and promotion of women’s football through dedicated information and awareness campaigns. By systematically stimulating interest in the game, football not only raises the women’s competition to a higher level, it also increases the standing of women in society and helps them to overcome social and cultural obstacles.


Football at the Olympics

Football has also played an important role in the history of modern Olympic Games. Football was first introduced as an exhibition sport at the 1900 and 1904 Games. Four years later it went on to become the first team sport included in the Olympic schedule. One hundred years later, football continues to be one of the major attractions of the Games, as witnessed at the 2008 Olympics in Beijing when attendance figures reached a new record of 1.9 million cumulative spectators after the semi-final stage6.



FIFA’s football mission contains three important parts:

  • Develop the game.
  • Touch the world.
  • Build a better future.


Developing the game

This concerns infrastructure and financial assistance, as well as education:

The Goal Programme collaborates around 600 projects worldwide, supporting the construction of technical centres, headquarters and football turf pitches.

Course programmes for the youth, futsal, refereeing, women’s football, sports medicine and administration are run all over the world.

Specific Development Interests are run in the host nation of every World Cup (in 2010 it was run over the entire African Continent).

After the tragic tsunamis in Asia, FIFA donated millions of dollars to the reconstruction of local sports infrastructure in affected countries including India, Indonesia and Japan.


Touching the world

This is achieved through the organisation of the different events, spearheaded by the Men’s Senior FIFA World Cup. These competitions impact on different areas including stadia, media, marketing, television and medicine.


Building a better future

The ‘Football for Hope’ projects support programmes that use football as a tool to tackle social issues in communities. As a social legacy of the South African World Cup in 2010, twenty ‘Football for Hope’ centres were built, focusing on education and public health in Africa. This movement now has over 100 programmes running in 50 countries. In each centre there is a football pitch, a classroom and medical infrastructure. Other campaigns on anti-discrimination, fair-play, anti-racism and anti-match fixing/betting are also practical examples of the target areas that can be improved through football and its community.



Football has become a stable economic pillar in modern society and has created many jobs both on and off the pitch - in areas as diverse as catering, retail and construction. FIFA’s highest revenue maker is by far through the Men’s Senior FIFA World Cup, held quadrennially. Ticket sales, television rights and advertising contracts are the major part of this revenue. However, the expenses for administrative staff, national associations, doping controls, various commissions, worldwide courses and other activities are huge, and the financial success of every World Cup is an absolute necessity in order for FIFA to continue its different strategies, activities and support.


FIFA in numbers

Since 1999, USD 800 million has been allocated to the National Football Associations for their respective team’s development and support.


Since 1999, USD 262 million has been invested in 522 Goal Programme projects for 193 football associations.


In 2010, 490 instructional courses were supported with an investment of over USD 6 million towards youth, female football, sports medicine and refereeing.


Each national association receives USD 250,000 per year, while every confederation is granted USD 2.5 million yearly.


In 2010, USD 253 million was invested in Africa through specific projects and programmes to guarantee the legacy of hosting the first World Cup in the African continent.


FIFA’s revenue between 2007 and 2010 was USD 4,189 million.


FIFA’s expenses between 2007 and 2010 were USD 3,558 million.



Football has helped in the evolution of medicine itself. In sports medicine, for example, the focus is not only on the athlete’s health, but also on his/her physical condition. Aerobic/anaerobic training methods, cardio-guided endurance testing, mental coaching, altitude training, diet and food supplements have all found their way into the daily routine of a professional football player. More and more team doctors are becoming co-ordinator of the medical sub-disciplines related to players’ issues, instead of the responsible general ‘all-knowing’ practitioner.



The question around doping in football, and specifically why there are so few positive doping cases, is often raised. There is less than 0.4% positive tests measured worldwide7, which is low compared to other sports. Interestingly, these positive findings mainly involve social drugs like marijuana and cocaine which are commonly used by amateur level players. The reasons for this might be that preventative campaigns during youth tournaments are working and also that the chance of getting ‘caught’ is certainly very high – since 35,000 worldwide controls are performed yearly. Another reason might be that in football, physical conditioning is very important, but so too are the technical and tactical elements which cannot necessarily be enhanced by doping. Also, the team nature of football creates an element of social responsibility since players do not want to let their teammates down. However, doping remains a focus as it is against the integrity of competition - where the essence is talent, motivation and team-spirit.



The face of FIFA’s medical activities is F-MARC (the FIFA Medical and Research Centre). During every FIFA World Cup, F-MARC collaborates with the local Medical Commission to concentrate on:

  • The qualified teams and their staff.
  • The FIFA family.
  • The representatives of the media.
  • The fans.
  • The epidemiology of injuries during the tournament.
  • The in-and-out-of-competition doping controls.


Specific fields of interest are problems related to youth football, female football and referee injuries (e.g. Achilles tendinopathy is quite common in those who often run backwards).


Data on the evolution of traumatology, orthopaedics, physiology, cardiology, neurology, pharmacology, psychology, hydration, diet and hygiene are analysed, in order to gather state of the art information and derive global guidelines considering health of players as its most important concern. Other factors that are followed closely are the effect of altitude, jetlag and football in extreme conditions (e.g. heat) on players. Because of the worldwide globalisation of football, these issues are more relevant today than ever before.


Through these activities, football is being promoted as a service to human society to obtain better health, reduce risk factors for chronic disease and as a preventative measure towards public health.



Never! A match, a league championship or a season might be over at the sound of the final whistle, but the next kick-off is always just around the corner, signalling new excitement for the next game. Against this background of constant renewal, the essence of football remains unchanged. Through unpredictable results, the elation of victory and the anguish of defeat, football will never cease to be a moving experience.


Pieter d’Hooghe M.D.

Orthopaedic Surgeon

Aspetar - Orthopaedic and Sports Medicine Hospital

Doha, Qatar





  1. British Broadcasting Corporation. A Sporting Nation. From Accessed January 2013.
  2. ‘Royal Arsenal’ formed in Woolich. From Accessed January 2013.
  3. Liverpool F. C. Liverpool Club is Formed. From Accessed January 2013.
  4. Wilson R. Inside the Divide: One City, Two Teams ... The Old Firm. Canongate Books Ltd, Edinburgh 2012.
  5. FIFA. The Women’s Game. From January 2013.
  6. PaddockTalk. Olympic Football Attendance Figures Reach New All-Time Record Total. From Accessed January 2013.
  7. FIFA. Fight against Doping and Football. From Accessed January 2013.


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Volume 2 | Targeted Topic - Sports Medicine in Football | 2013
Volume 2 - Targeted Topic - Sports Medicine in Football

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