Consent for a procedure is a conversation that leads to a decision, not a signature collected at the end of one, and for injections in sport and exercise medicine (SEM) it is where clinical judgement, professional standards and the pressures of competitive sport meet most directly. The legal and professional standard in the UK is patient-centred: the clinician must take reasonable care to ensure the patient is aware of any material risks in a proposed treatment and of any reasonable alternatives, judged by what would matter to this particular patient rather than by what clinicians conventionally disclose. The general principles of valid consent and capacity are covered in the related foundations material; this page focuses on what that means in practice when you are about to inject someone, including the specific pressures that arise when the patient is an athlete under selection pressure.
What must be discussed before a procedure?
The content of a procedural consent conversation follows a predictable shape. It starts with the working diagnosis and why an injection is being proposed now, since a patient cannot weigh a treatment without understanding the problem it addresses. It then covers what the procedure actually involves, in plain terms: where the needle goes, roughly how long it takes, whether imaging will be used, and what it will feel like. The expected benefit is stated honestly, including its likely size and duration, and for most injections this means being explicit that relief may be partial and may be temporary, and that the injection is intended to support rehabilitation rather than replace it. The material risks come next, and the reasonable alternatives are set out, which always includes continued conservative management and the option of doing nothing. Finally the patient is told what happens afterwards, including aftercare and the safety-net advice that would prompt them to seek urgent review. Three further items are easily missed and may be material: any uncertainty in the diagnosis or in the expected treatment effect, any direct cost to the patient, and any relevant clinician or organisational conflict of interest.
The conversation covers the diagnosis, what the procedure involves, expected benefit including that it may be short-lived, material risks, reasonable alternatives including doing nothing, and aftercare. Materiality depends on what matters to this particular patient.
What counts as a material risk is the part most often got wrong. It is not a fixed list attached to the procedure; it is judged both by what a reasonable person in the patient's position would consider significant and by what this particular patient would consider significant, which means the clinician has to find out what matters to them. A small risk of skin depigmentation may be immaterial to one patient and important to another; a short-lived post-injection flare may be trivial in most contexts but decisive for someone with a competition in four days. This is why the professional standards frame decision making as a meaningful dialogue in which the clinician shares relevant information about benefits, harms and reasonable alternatives, including the option of taking no action, and helps the patient reach a decision that is right for them. Information should not be withheld simply because the clinician fears it might deter the patient from a recommended treatment. The exception, where the disclosure itself would cause the patient serious harm, is very exceptional; it does not cover causing distress or the likelihood that the patient will refuse, and using it should prompt senior, defence body or legal advice, with the reasoning recorded. A patient may also decline to hear detailed information, which should be respected and recorded, although they usually still need basic information about the options, the purpose of the procedure, how invasive it is, the discomfort involved and the risk of serious harm.
What is different about consent in athletes?
Voluntariness is the element most likely to be compromised in sport. Valid consent must be given freely, and an athlete deciding whether to have an injection may be under pressure from a coach, a contract, selection for a fixture, or their own fear of losing a place, none of which is created by the clinician but all of which can distort a decision. The professional response is to notice it and to manage it: see the athlete alone for the decision-making conversation where possible, ask directly whether they feel under pressure, be clear that the decision is theirs, that you will not characterise declining treatment as non-compliance, and that information will be shared only within the confidentiality boundaries the athlete has agreed or on another lawful basis, and separate the clinical recommendation from the team's interests. It is worth being explicit with the athlete that your duty is to them as your patient, which is the professional position even when the club or governing body is paying for the service. Where a coach or manager asks about the athlete's care, the answer is governed by confidentiality and by whatever the athlete has consented to being shared, and that consent should be explicit rather than assumed from the fact that everyone works together.
Coach, contract, calendar and selection pressures can distort an athlete's decision, so the conversation is protected by seeing them alone, asking directly and making clear the decision is theirs. Anti-doping status and return-to-play effects are material information.
Several other athlete-specific issues belong in the conversation. Anti-doping status is material information for a competing athlete: if the proposed injection is a glucocorticoid, the athlete needs to know that injectable glucocorticoids are prohibited in-competition, what the washout implications are for their fixture list, and what documentation or exemption is required, since a decision made without that information is not informed. The effect of the treatment on return to play, including any period of relative rest, is similarly material. Where a treatment is not standard care, such as an orthobiologic, the fact that it is unproven and privately funded must be stated plainly, and the commercial dimension acknowledged rather than glossed over. Consent must also be revisited rather than treated as permanent: a decision made at the start of a season does not authorise a repeat injection months later, and consent can be withdrawn at any point, including during the procedure. Finally, the record matters. Documenting the options discussed, the material risks explained, the patient's questions, the decision and any written information given is both good practice and the main contemporaneous evidence of what was discussed.
Exam Tips
•The standard is patient-centred: take reasonable care to ensure the patient is aware of material risks and of reasonable alternatives, including the option of taking no action; withholding information because disclosure would cause serious harm is very exceptional and does not cover distress or likely refusal.
•Materiality is judged by what a reasonable person in the patient's position and what this particular patient would consider significant, so find out what matters to them rather than reciting a fixed list.
•Cover the diagnosis, what the procedure involves, expected benefit including that it may be partial and short-lived, material risks, alternatives and aftercare with safety-net advice, plus any diagnostic uncertainty, direct cost to the patient and relevant conflicts of interest.
•Voluntariness is the element most at risk in sport; manage coach, contract and selection pressure by seeing the athlete alone, asking directly, making clear the decision is theirs, and sharing information only within agreed confidentiality boundaries.
•Anti-doping implications and the effect on return to play are material information for a competing athlete, and an unproven or privately funded treatment must be described as such.
•Consent is a process that can be withdrawn at any time and must be revisited for repeat procedures; document the options, risks, questions, decision and any written information provided.