Objectives This study explores how medical staff in German elite handball interpret their roles in managing athlete health and how they navigate role-related challenges within the performance-driven context of elite sport. Design Qualitative study using a constructivist framework, positing that reality is constructed through active engagement with and interpretation of experiences. Methods Twenty semi-structured interviews were conducted with doctors and physiotherapists (n=10 each) working in Germany's elite handball system, including the national team and Bundesliga clubs. A reflexive thematic analysis of the data was conducted, focusing on patterns of meaning to gain a nuanced understanding of the complex role interpretations of medical staff. Results We generated five roles for medical staff in elite handball: (1) Decide, (2) Coordinate, (3) Educate, (4) Enable, and (5) Protect. These roles illustrate the interdependence between the visible, compensated work and invisible, often unrecognized work that medical staff perform. Within each role we uncovered tensions between athlete care and performance imperatives. Ethical dilemmas arose in relation to analgesic use and return to sport. Participants described role ambiguity due to unclear boundaries and expectations. Conclusions Doctors and physiotherapists in elite handball navigate complex and ethically charged roles. Their unseen labor and boundary work are central to athlete health management but remain under-supported in current sport systems. Recommendations include interdisciplinary communication training, clearer ethical codes, and employing independent medical staffing. Future research should examine cooperative decision-making from multiple perspectives and over time.
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