The use of local anaesthetic painkilling injections in professional football can counter the performance-reducing impact of injury and lower the rate of players missing matches through injury. In the majority of cases, these injections are probably safe, although scientific evidence in this area is scant, particularly regarding long-term follow-up. The known long-term injury sequelae of professional football, such as increased rates of osteoarthritis of the knee (in particular), hip, ankle and lumbar spine, do not generally relate to the injuries for which local anaesthetic is commonly used. The most commonly injected injuries (acromioclavicular joint sprains, finger and rib injuries and iliac crest haematomas) are probably the safest to inject. There are risks of worsening injuries and known specific complications when local anaesthetic is used, and players requesting injections should be made aware of these. Local anaesthetic injections as painkillers should only be used when both the doctor and player consider that the benefits clearly outweigh the anticipated possible risks. Intra-articular injections to the knee, ankle, wrist, joints of the foot, and to the pubic symphysis and major tendons of the lower limb are best avoided in most circumstances. To enable the benefit and risk profile of local anaesthetic injections to be better understood, it is recommended that professional football competitions make local anaesthetics legal only with compulsory notification.