Understanding the Medical Process Behind Football Transfers
A recent deal aimed at moving Atalanta and Brazil midfielder Ederson to Manchester United during the 2026 summer transfer window fell through due to the results of his medical exam. The medical process is crucial in evaluating a player’s fitness and health, although clubs are not legally required to conduct one prior to a signing.
During a medical, which can last up to six hours, doctors assess several health aspects, including:
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Physical Tests: Players undergo general health evaluations that include measurements of height, weight, blood pressure, and heart rate. Muscles, joints, and bones are thoroughly examined.
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Cardiovascular Health Tests: More complex assessments such as electrocardiograms (ECGs), echocardiograms, and stress tests help evaluate heart health.
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Blood Tests and Urinalysis: Doctors perform blood tests to obtain a complete blood count, check liver function, and administer urine and drug tests.
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Full Physical Examination: This involves testing motion, strength, and posture through full-body MRI scans, X-rays, and ultrasounds.
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Neurological Assessments: These tests examine psychology, balance, coordination, and concussion history.
The results of these evaluations are then sent to the managerial team of the purchasing club, enabling their medical staff to analyze the findings.
Concerning the outcome of the medical exam, it is important to note that a player does not officially “pass” or “fail” their medical. Instead, the decision rests with the buying club on whether to accept the risks associated with any identified issues. Dr. Charlotte Cowie, former head of medical departments at Tottenham and Fulham, emphasized that one club’s concerns might not be relevant to another’s strategic plans.
In the past, medical evaluations have impacted transfer deals significantly. For example, Ruud van Nistelrooy’s transfer to Manchester United was delayed due to findings in his medical exam. Similarly, issues identified in George Boyd’s eye test in 2013 halted his move to Nottingham Forest. Recent cases include Kurt Zouma’s failed move to Shabab Al-Ahli in 2024 and Jean-Philippe Mateta’s deal with AC Milan being called off in January 2026 due to complications found during medical checks.
As the transfer window opens, medical teams at various clubs are prepared to accommodate the surge in medical requests. The Manchester Institute of Health and Performance (MIHP) operates with flexibility and availability to meet club demands, ensuring that high clinical standards are consistently maintained. Sarah McDermott, MIHP’s clinical lead, highlighted that players are evaluated with the same care, regardless of their attitudes during the medical process.
Decisions made in the transfer window often carry immense consequences for clubs, making the medical exam a pivotal step in the acquisition of new talent.
The deal has been agreed, personal terms sorted, now it is time for a footballer to complete their medical – but what does it entail?
A medical is used to assess the overall health and fitness of a potential signing, as well as identifying any underlying medical issues they may have.
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There is no legal requirement for players to have a medical before a transfer, but they do help a club to decide whether to complete a signing.
Atalanta and Brazil midfielder Ederson was set to move to Manchester United in the 2026 summer transfer window, but this deal fell through because of the outcome of his medical.
What do the doctors look for?
A medical test can take as long as six hours, and includes:
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Cardiovascular health tests
Physical tests look at the general health of a player, including measuring their height, weight, blood pressure and heart rate. Doctors also assess their muscles, joints and bones.
The cardiovascular health tests are a little more complex and assess the heart health of a player through doing electrocardiograms (ECGs), echocardiograms and stress tests.
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Doctors will give players blood tests in order to get a complete blood count. They also assess liver function and will request urine tests and drugs tests too.
Footballers also have a full physical examination – testing their motion, strength, movement and posture. This can be done through a full-body MRI exam, X-rays and also ultrasounds.
Neurological tests look at psychology, balance, coordination and also complete concussion assessments.
The results are then sent to the managerial team of the buying club, where their doctors and medical staff can analyse the information.
Can a football player fail a medical?
A player does not actually ‘pass’ or ‘fail’ a medical exam, they just complete one before joining a new club.
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It is then up to the buying club to decide whether signing the player in question is worth any risk should there be any abnormalities found in the results.
Think of it a bit like buying a house. Buyers will get a survey done, and weigh up whether they will complete the purchase depending on the findings.
Like a house survey, if a manager or team is determined to sign a player, they can do so despite any issues in the medical test.
Dr Charlotte Cowie, who was previously in charge of the medical departments at Tottenham and Fulham, told BBC News medical teams never really “pass” or “fail” a player.
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”One man’s fail is another man’s pass,” said Dr Cowie. “It really depends on where the player is injury-wise, what the manager and the club want from that player and what it’s going to cost. It’s a risk-benefit analysis.”
There have been occasions when the results have come back with issues, preventing a move.
Ruud van Nistelrooy was set to join Manchester United in 2000 but his move was delayed after his medical. The Dutchman ruptured his anterior cruciate ligament within a week of the deal being delayed.
Then Peterborough United forward George Boyd’s move to Nottingham Forest fell through in 2013 after an eye test came back “inconclusive”. Despite the finding, Boyd continued to play elsewhere.
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In 2024, Kurt Zouma’s proposed move to United Arab Emirates side Shabab Al-Ahli collapsed after the West Ham defender’s medical with the club.
In January 2026, AC Milan’s deadline day move for Crystal Palace striker Jean-Philippe Mateta was called off following issues identified during his medical.
Are doctors on hold during the transfer window?
Medical staff at facilities used by football clubs will have plans in place during the transfer window to ensure needs are met.
The Manchester Institute of Health and Performance (MIHP) says its staff are “reactive” during the transfer window.
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MIHP also said it undersood the need to be fully flexible and offer round-the-clock availability for clubs to book medicals with their team.
“We have to be as responsive as possible during the transfer window to medical requests from clubs – this includes working after hours and weekends,” MIHP clinical lead Sarah McDermott told BBC Sport.
McDermott added that during the busy transfer period “high clinical standards never change” and every player receives the “same attentive care and a comprehensive evaluation”.
Francesca Bagshaw, who is part of the performance team at MIHP, said every department “works seamlessly to deliver fast, high‑quality service under tight timelines”.
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Turnaround for results depends on the complexity of tests and urgency on the day, but MIHP sends clubs a verbal report on the same day, and blood results within four hours.
“All players are different and approach medicals with a range of attitudes, some are relaxed and some are more apprehensive,” said McDermott.
Thanks to Thomas in Penrith for the question.
This article is the latest from BBC Sport’s Ask Me Anything team.
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