Introduction: Upper limb injuries impact training availability and are putatively considered related to upper limb training loads in elite women`s water polo athletes. Little is known about the experiences of coaches, athletes and support staff in managing upper limb injuries and monitoring training load. We sought stakeholders` experiences with managing upper limb injuries and monitoring training loads - with a view to understanding any perceived barriers or enablers. Methods: Inductive qualitative design. We purposefully recruited and interviewed nationally categorised athletes who had experienced upper limb injuries, as well as coaches and support staff who had managed athletes with upper limb injuries (n=20). MHK and NC interviewed participants face-to-face or online. Interviews were audio-recorded, de-identified, transcribed verbatim and cleaned to ensure accuracy, before being thematically analysed. Results: Analysis identified five interrelated themes: 1) Current upper limb injuries management is adequate - but `adequate` is not enough: Athletes, coaches and support staff highlighted several opportunities for improvement, such as upper limb injury prevention and use of guidelines; 2) Current training load monitoring creates uncertainty and lack of consistency: Participants highlighted both reliance on internal training load monitoring and lack of external load monitoring as problematic - believing they hindered performance and upper limb injury management; 3) Optimal training load monitoring requires technology, communication and collaboration between stakeholders: by using precise external load monitoring; 4) Athlete-centred philosophy matters: individually tailored assessments, exercises and rehabilitation programmes were considered essential to athlete's inclusion in managing their upper limb injuries and monitoring their training loads; 5) There is more to upper limb injuries than load monitoring and pain: Both experiencing upper limb injuries and managing athletes with upper limb injuries went beyond dealing with physical aspects and involved navigating emotions, such as feeling inadequate and frustrated. Discussion: Athletes, coaches and support staff provided their views on opportunities for improvement of managing upper limb injury and monitoring training load - by using technology, external training load monitoring tools and athlete centred approaches. They highlighted these could enhance injury prevention, communication and collaboration between water polo stakeholders, and potentially improve current upper limb injury management and training load monitoring.
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