The use of sand as an alternative surface for training, injury prevention and rehabilitation in English professional football and barriers to implementation: a cross-sectional survey of medical staff.

Only 18 (31%) of the clubs surveyed used sand-based interventions across the last 3 seasons. Respondents felt sand-based interventions would be effective at improving physiological gains (median 4, interquartile range [IQR] 4-5) and as part of injury prevention and rehabilitation strategies (4, IQR 3-4) but were indifferent in relation to its potential to improve sporting performance (3, IQR 3-4). Barriers to implementation of sand-based interventions within wider football were a lack of facilities, lack of awareness of its potential benefits, lack of high-quality evidence and the surface not being specific to the sport. Medical staff also did not perceive that coaches' positively viewed sand interventions as a training or injury management strategy.