Introduction
The International Federation of Sport Physical Therapy (IFSPT) clinical seminar at the World Physiotherapy Congress 2025 (Tokyo) emphasized the role of sustainable health and physical activity in preventing sports injuries. It highlighted the need for sports physiotherapists to identify and address risk factors, design individualized prevention programs, and apply advanced expertise when working with athletes. Sustainable rehabilitation was presented as a form of secondary prevention delivering high-quality, immediate care without compromising future health capacity. The seminar advocated for prompt diagnosis and physiotherapy intervention to optimize recovery and reduce re-injury rates particularly in common acute soft-tissue injuries (e.g., lateral ankle sprain, hamstring strain). It also underscored the importance of educating athletes on movement control, movement quality, and health literacy to promote long-term sustainable human movement. Integrating biological, psychological, and social factors was recommended to optimize health management. Ultimately, the seminar aimed to challenge the existing literature and introduce innovative concepts for sustainable preventive measures and rehabilitation strategies to enhance athletes’ health and performance. One clear message emerged: building a sustainable sporting career begins long before injuries occur. Prevention is essential - it forms the foundation for an athlete’s long-term health, and can be categorized as primary, secondary, or tertiary.
Primary Prevention of Injuries in Youth Sports
Primary prevention of injuries among adolescents in sport focuses on encouraging regular physical activity and promoting proper training techniques.The World Health Organization recommends at least 60 minutes of moderate-to-vigorous activity daily for adolescents; however, 80% fail to meet this standard, increasing sedentary behavior and injury risk.
A major challenge in youth sport is preventing dropout due to injuries, particularly those affecting the lower limbs. Multimodal prevention programs, such as individualized training plans, appropriate load management strategies, and long-term goal setting, have been shown to reduce injury risk.1 However, implementing and maintaining these programs over the long term remains difficult.
Evidence indicates that early sport specialization is not necessary for elite success and may increase the risk of overuse injuries and burnout. In contrast, early diversification and multisport participation promote healthy development and lower injury rates without hindering long-term athletic achievement.2
Despite numerous intervention studies, a notable gap remains between research and practical implementation, particularly regarding program adoption and sustainability. Future efforts in primary prevention should address not only the effectiveness of injury prevention strategies but also their realistic integration into youth sports systems.3 Enhanced collaboration between coaches, parents, and governing bodies is crucial for maintaining healthy participation and minimizing both acute and overuse injuries in young athletes. When a young athlete’s health is protected, the future of sport itself is protected. However, it must be noted that even with the most robust foundations and preparation, no prevention program can completely eliminate risk. When injury occurs, secondary prevention transforms a setback into an opportunity for a safe and sustainable return to performance.
Secondary Prevention and Rehabilitation for the Sustainable Careers of Athletes
Within the safe life cycle of an athlete, preventive healthcare interventions are paramount. Unlike primary prevention, which focuses on avoiding the initial occurrence of injury, secondary prevention is essential for managing athletes who have sustained an injury, are at risk of reinjury, or chronic dysfunction. In sports physiotherapy, secondary prevention seeks to direct and guide the healing process of the injured tissue, restore function, facilitate a safe return to sport with minimal reinjury risk, and maintain career longevity.4,5
Effective secondary prevention requires comprehensive, interdisciplinary, biopsychosocial teamwork to understand the multifactorial nature of reinjury risk, implement sustainable rehabilitation with appropriate and graded functional training, and prepare the athlete in terms of psychological readiness.6 Identifying the root cause of injury/re-injury which involves biomechanical, physiological, or contextual factors is essential.7 Abnormal mechanics, training/competition overload, suboptimal movement strategies, and neuromuscular deficits should be thoroughly assessed.8,9 This enables clinicians to implement targeted strategies for load management and dosage arrangements to ensure training volumes/intensities for tissue adaptation, improve neuromuscular control for joint stability and movement efficiency, and address the entire kinetic chain for overall enhancement sensorimotor control, movement efficiency, and load tolerance.1
Secondary prevention is most effective when integrated into progressive rehabilitation phases (acute, subacute, remodeling, return-to-sport, maintenance and performance optimization) within an athlete-centered, reactive model. Across these phases, clinicians should emphasize integrated neuromuscular control, cognitive training and neuroplasticity, continuous monitoring, education and athlete engagement, reinforcement of psychological readiness, and consistent communication between athletes, the medical team, and coaching staff .5,10
Every injury is an opportunity — not only to heal, but to build resilience for the years ahead. Once recovery is achieved, the journey does not end. Successful rehabilitation marks the beginning of a long-term commitment. Tertiary prevention focuses on extending careers while safeguarding long-term health through rigorous interdisciplinary follow-up.
Interdisciplinary approach in tertiary prevention
Tertiary prevention in sports focuses on restoring function and preventing long-term sequelae following injury, with physiotherapy playing a pivotal role in this phase.5 Sustainability in tertiary prevention requires an approach that not only addresses immediate injury recovery but also supports the athlete’s long-term health, career longevity, and ability to return to sport with minimized reinjury risk. Implementing sustainable tertiary prevention means embedding evidence-based rehabilitation and ongoing workload management strategies into daily practice, which is particularly challenging given the dynamic and complex environments of different sports.11
An interdisciplinary approach is essential, fostering collaboration between physiotherapists, physicians, psychologists, coaches, and nutritionists.12 Unlike multidisciplinary models where professionals work in parallel but with limited interaction an interdisciplinary team integrates perspectives, constructing context-sensitive, individualized care pathways that adapt to each sport’s unique demands.12 This approach proves especially valuable in sports with distinctive risks (e.g., throwing sports vs. contact sports), where rehabilitation goals and methods must be sport-specific, flexible, and adaptable to changes in the athletes’ condition.5
Tertiary prevention prioritizes athlete education to manage persistent conditions and long-term load. Core components include education on training-load management (understanding and planning volume, intensity, and recovery), symptom-response monitoring (early warning signs and graded activity modification), and pre-agreed flare-up plans. Integrating behavior-change strategies (motivational interviewing, habit formation) enhance adherence to maintenance programs (strength, neuromuscular control, conditioning).13 Delivered iteratively and task-specifically, this education builds self-efficacy, supports career longevity, and mitigates re-injury risk.
Translating Prevention Evidence into Practice
Significant challenges remain in translating research to clinical practice in the context of prevention, such as poor adherence to rehabilitation protocols, variability in stakeholder engagement, and the complexity of injury mechanisms.5,11 Additionally, gaps in the literature include inconsistent prevention definitions, a lack of robust evidence for many interventions in elite populations, and limited research on sustainable, context-driven implementation strategies.5 Closing these gaps requires integrating ongoing feedback, fostering organizational support, and continuously adapting best practices to real-world settings – efforts in which physiotherapy, at the core of the interdisciplinary team, is indispensable.11
Sustainable performance begins with sustainable health — and it starts with us. From the first steps in development of a young athlete to the final season of a veteran, sustainable prevention is a continuum and a shared responsibility across the entire sports community.
Conclusion
Maintaining athlete health demands a life course approach that integrates primary, secondary, and tertiary prevention. In youth sports, the primary prevention strategy focuses on diverse participation, tailored load management, and goal setting to reduce both acute and overuse injuries. Secondary prevention builds on prompt diagnosis, targeted rehabilitation, and psychological readiness to guide a safe return to sports. Tertiary prevention includes evidence-based protocols, workload monitoring, and inter-disciplinary collaboration to promote career longevity. Sustainable practice requires seamless cooperation among physiotherapists, coaches, trainers, physicians, psychologists, and nutritionists, supported by continuous monitoring and athlete education. Future priorities should include relevant interventions and research collaborations to implement sustainable health models in sports. Sustainable performance is founded on sustainable health, and sports physical therapists are the cornerstone.
Conflicts of interest
The authors report no conflicts of interest.