Legal aspects of medical clearance for sports: a review

Medical clearance for sports serves not only as a measure to protect the athlete’s health and life, but also as a legal act that requires compliance with a range of legislative and advisory documents. Lack of awareness of these regulations can lead to adverse consequences for the athlete, coach, sports team, and physician.

A search and analysis of current (as of August 2025) regulatory and legal documents concerning medical clearance for sports at various stages of athletic training, as well as for national team athletes of the Russian Federation, were conducted.

Sources were identified using the legal reference service with expert support Kontur.Normativ, the Russian scientific electronic library eLIBRARY.RU, and the biomedical research database PubMed. Additionally, the results of an anonymous online survey of 205 sports medicine physicians—subscribers of the Telegram channel Medical Office of the Sports Physician—were analyzed.

The review addresses the following issues: which institutions and specialists are authorized to issue medical clearance for different sports and stages of athletic training; the scope of examination required for clearance; and the established forms of medical authorization for training and competition. The article also discusses the issue of improper medical clearance, including cases involving specialized physicians, which, according to the online survey of 205 sports medicine doctors, significantly complicates the work of sports physicians.

It was found that in Russia, medical clearance for training and competition falls under interdepartmental regulation and is governed by federal laws; presidential decrees and directives; orders of the Ministry of Health of the Russian Federation, the Federal Medical-Biological Agency, the Ministry of Labor and Social Protection of the Russian Federation; the Labor Code of the Russian Federation; as well as 20 advisory documents.