Injuries, risk factors, consequences and injury perceptions in adolescent elite athletes

Abstract: Background: Injury and health data are not fully explored in adolescent elite athletes, yet essential for understanding injury risk, consequences of injuries and developing injury preventive programs. Aims: To explore injury patterns, training and health variables, such as nutritional behaviour, self-esteem, self-perceived stress, sleeping habits, as well as identify risk factors for sustaining a sport injury among adolescent elite athletes. Further, to explore consequences of sport injuries and athletes’ perceptions and experience of being injured. Methods: A valid and reliable questionnaire about training exposure, injury and illness was repeatedly e-mailed over one or two years to 680 adolescent elite athletes from 16 different sports at 24 National Sports High Schools. At the start of each term, athletes were sent a background questionnaire about competence-based self-esteem, nutrition, self-perceived stress and sleep. Twenty athletes from the same cohort were interviewed in focus group discussion format about their injury experience and perceptions. Results: The average injury prevalence and substantial injury prevalence were in year one 31% and 15% and in year two 39% and 18%, respectively. During year two, 30% of the athletes were injured more than half of all reporting times and 10% reported substantial injury more than half of all reporting times. The recommended intake of fruits, vegetables, and fish was not met for 20%, 39%, and 43% of the adolescent elite athletes, respectively. The recommended amount of sleep during weekdays was not obtained by 19%. Increasing the training load, training intensity, and at the same time decreasing the sleep volume resulted in a higher risk for injury compared to no change in these variables. An athlete having the previously mentioned risk factors, with an average competence-based self-esteem score, had more than a threefold increased risk for injury, compared to an athlete with a low perceived competence-based self-esteem and no change in sleep or training volume. The adolescent elite athletes who were interviewed experienced a loss of identity and described a sense of feeling lonely and excluded from regular sports involvements while dealing with the injury. Discrepancies in rehabilitation expectations between athletes and practitioners were expressed, where some athletes described that their rehabilitation was not adjusted to their needs and requested to receive an injury diagnosis in an early stage following injury. Conclusion: A considerable number of adolescent elite athletes are injured regularly, resulting in serious consequences on sports participation and performance. Sports involvement seems to constitute an important social component for an adolescent elite athlete, and being injured may lead to a loss of identity and experience of loneliness, self-blame or self-criticism. Medical teams, accessible to all athletes at each National Sports High School, are warranted to reduce the unhealthy behaviour, injury risk and help athletes return to sports safely following injury. These medical teams should be aware of the multiple consequences of injury in adolescent elite athletes.