Objectives Long-term, nationwide data on injuries and illnesses in professional football, particularly in women, remain limited. This study aimed to describe injury and illness epidemiology in German professional male and female football using prospective registry data, with a focus on incidence, distribution, and return-to-play times and on sex-specific differences.

Methods Two prospective registries were introduced in the first and second divisions of German professional football (men: 2022/2023, women: 2023/2024). Team medical staff reported all time-loss injuries and illnesses using a standardised, pseudonymised protocol on an online platform. Data included diagnosis, injury mechanism and return-to-play data. Injury and illness match incidence was calculated per 1000 hours of match exposure.

Results A total of 1514 players (963 men, 551 women) from 54 teams participated. During the first season, 1185 time-loss events were recorded (men: 503 injuries, 176 illnesses; women: 362 injuries, 144 illnesses). In men, the most affected areas were the thigh, ankle and knee, whereas in women, injuries predominantly affected the knee, followed by the ankle and thigh. Ankle sprains were the most frequent injury type in both sexes. ACL ruptures were associated with the longest return-to-play times, particularly in female players. Illnesses caused 3188 absence days in total, mainly due to respiratory infections.

Conclusion The registries reveal clear sex-specific differences in injury distribution and time-loss in German professional football and demonstrate a substantial burden of illness-related absence. These nationwide data provide a foundation for longitudinal monitoring and future research on sex-specific prevention and return-to-play strategies.