“We do not rise to the level of our goals. We fall to the level of our systems”.
James Clear
Introduction
The welfare of athletes should be an unwavering priority for sporting bodies and organisations. Long-term athlete welfare encompasses the comprehensive care and support provided to athletes to ensure their physical, mental, and emotional well-being. It emphasises the need for a holistic approach that goes beyond physical health, recognising the interconnected nature of athletes' overall welfare. Such an emphasis is not just ethically imperative; it is essential for athletes' sustained success and growth in their careers and ultimately serves the self-interest of sports organisations. This article delves into the importance of protecting long-term athlete welfare, with a specific focus on the responsibilities of sporting bodies and organisations. Real-life case studies draw attention to the challenges faced by athletes, driving home the urgency of proactive measures. In the context of growing public awareness arising from the 2023 FIFA Women’s World Cup, the discourse highlights the significance of strategies such as injury prevention, mental health support, and career transition facilitation.
The Ethical Case - Duty of Care
The ethical case for prioritising long-term athlete welfare is exemplified by the Duty of Care in Sport review, carried out in 2017, led by Baroness Tanni Grey-Thompson DBE, DL. While progress has been made, implementation remains incomplete. The article underlines the necessity of addressing the long-term consequences of athlete health, such as concussion risks. Additionally, the article explores the pressing need for gender-specific approaches, exemplified by the Female Athlete Triad and Relative Energy Deficiency in Sport (RED-s).
Sporting bodies have an inherent duty of care towards athletes. Recent UK statistics reveal that athlete welfare concerns, including physical injuries, mental health issues, and abuse, have gained significant attention. According to a study conducted by the University of Portsmouth in 2016, over 70% of surveyed elite athletes reported experiencing mental health issues, emphasising the urgent need for robust support systems. In 2019, the International Olympic Committee (IOC) released a consensus statement on mental health in elite athletes, identifying 11 mental health disorders that can be experienced by athletes, including sleep disorders, depression, anxiety, eating disorders, gambling addiction, and sports-related concussions. Furthermore, the IOC has recently developed a new Mental Health Action Plan, recognising the role of mental health in the overall well-being of athletes and the promotion of psychologically safe environments. The new plan aims to prioritise mental well-
being and will guide the IOC's efforts across its various spheres of responsibility and roles.
In 2017, Baroness Tanni Grey-Thompson DBE, DL was invited by the UK government’s Department for Digital, Culture, Media and Sport (DCMS) to lead an independent report on the Duty of Care in Sport following several high-profile cases of abuse in sport. The report defined 'Duty of Care' broadly, covering everything from personal safety and injury to mental health issues and support given to people at the elite level. It highlighted the need for transparency, accountability, and robust systems to protect participants from abuse in sport. The review established a Framework outlining seven crucial elements that constitute the Duty of Care in Sport, including Safeguarding, Equality, Diversity and Inclusion, Safety, Injury, and Medical, Transition, Mental Health, Representation of the Participant's Voice, and Education.
While several organisations welcomed the recommendations, they have not yet been fully implemented. It is crucial to address the long-term health consequences faced by athletes, such as the risks associated with concussions. Athletes in high-impact sports, such as rugby and ice-sliding sports, can risk life-altering injuries, and there have been instances where governing bodies have faced potential negligence action for breaching their duty of care. Protecting athletes' long-term health should extend beyond their time on a team or performance programme.
Interviewed for this article, Team GB 7s Olympic rugby player Emma Uren was notably positive about the Rugby Football Union (RFU) for continuously upholding their duty of care, noting their due diligence in prioritising the long-term health of their athletes. The RFU had helped players manage injuries through individualised rehabilitation and return-to-play protocols and provided access to ongoing mental health and advocacy support for athletes through their partnership with the Rugby Players Association. However, Uren admitted that “passion is limited by funding”, noting that, while the duty of care is upheld, a lack of funding and contact time with her support network limits the engagement she has with the wider team which can lead to misunderstandings in relation to injury management. In the realm of athlete welfare, effective transition planning, planning, and support are crucial for easing the mental health burden during the transition out of professional or semi-professional sports. Take Tommy Hart, a semi-professional rugby player who had to retire on the advice of team managers after he suffered 45 concussions over 11 years. Rugby was not just a sport for Tommy; it was an integral part of his identity, making the idea of retiring emotionally challenging. Without proper career transition, planning, and support, athletes like Tommy struggle to find a new direction and face a loss of identity after retiring from their sports careers, which may prolong their time in sport. Sporting bodies and organisations have a crucial role in facilitating a smoother transition. They can implement comprehensive career development programmes that include educational opportunities, vocational training, and networking events, connecting athletes with professionals from various industries.
Prioritising Women in Sport
In addition to the duty of care towards athletes generally, there is a specific need for sports organisations to address the welfare needs of women in sport. With sport typically understood as being designed by men for men, there has been a general expectation that
women simply fit into this mould, often stemming from the oversimplified notion that women are just ‘small men’. However, much discussion around athlete welfare has shed light on the gender specific needs within sport. In particular, how Relative Energy Deficiency in Sport (RED-s), formerly known as the Female Athlete Triad, is widely recognised and understood in the sporting world. However, there are few examples of sports implementing safeguards to prevent this disorder. One such sufferer was Bobby Clay, a young female middle-distance Olympic hopeful, who suffered a career-ending injury due to developing osteoporosis at 18. This condition was the result of years of undereating and overtraining, causing her bones to become weak.
To prevent the increased risk of injury to women in sport, there is a need for gendered training programmes, greater coaching education on the impacts of the menstrual cycle, and more medical sport research on optimising the field of play in women's sports. Recent studies have found that women are up to six times more likely to suffer non-contact anterior cruciate ligament injuries of the knee than men in certain sports including basketball, football, rugby, wrestling and jiujitsu. Injury prevention programmes that address key risk factors mostly found in women's sports can proactively reduce the risk of such injuries.
Sports organisations should make greater commitments to protecting the long-term welfare of female athletes. Companies such as The Well HQ are leading the way by advocating for greater research into women's sports and providing courses and qualifications for coaches, teachers, trainers, and active women on best practises throughout women's life stages. The Open University, in partnership with Well HQ, has also developed a free course on "Supporting female performance in sport and fitness" to promote tailored approaches in women's sport, from coaching to appropriate performance wear. By utilising educational resources like these, sporting bodies can enable female athletes to perform at their best and enjoy longer, healthier careers.
Physical Health and Injury Prevention
Injury prevention programmes have been proven effective in reducing the prevalence of injuries in athletes, particularly amongst female athletes. Studies have shown that implementing neuromuscular training and proper warm-up routines significantly decrease the incidence of injuries.(1) Additionally, rehabilitation programmes that follow an athlete-centred model, focusing on individualised treatment plans, multidisciplinary care, and a gradual return to play have been found to improve athletes' recovery and reduce the risk of re-injury.(2) In recent times, the focus on concussions in sports has garnered significant attention due to the substantial risk they pose to athletes and the very future of several sports. While sport’s governing bodies have established clear concussion protocols, the long-term consequences of these head injuries have only recently started to be extensively documented. Many former high-profile athletes now suffer from life-altering conditions caused by repeated and direct trauma to the head.
In April 2023, the UK Government took a crucial step forward by publishing stringent guidelines for concussion management in grassroots sports. This initiative was a collaborative effort led by the Sport and Recreation Alliance, Professor James Calder, chair of the expert drafting group, and Laurence Geller, the Government's Adviser on Concussion in Sport. It built upon the pioneering work conducted in Scotland, where comprehensive guidelines covering all sport types and levels were introduced, making Scotland the first nation in the world to implement such guidelines. Stricter concussion protocols and better equipment standards have successfully reduced the incidence and severity of head injuries in various sports, but there remains a significant amount of work to do. During an interview with I Trust Sport, recently retired semi-professional rugby player Amy Humphries discussed the lasting impact her early, untreated concussions have had, resulting in an abrupt end to her rugby career at the age of 26. A lack of formal education on concussions and consistency of return to play protocols across clubs contributed to her being diagnosed with a several long-term health issues as a direct result of playing rugby. Athletes such as Amy welcome the new concussion guidelines in the hope that they mobilise the rugby community to put better safeguards in place.
The 2023 FIFA Women's World Cup has reignited conversations beyond victories and goals, it has shed light on the pressing issue of knee related injuries, particularly anterior cruciate ligament (ACL) injuries, particularly in women’s sport. A recent award winning study conducted by sports scientists in the UK and Canada has underscored the stark reality – women are up to five times more likely to suffer ACL injuries compared to their male counterparts. With factors ranging from generalised laxity of ligaments and dominance of the quadricep muscle in knee stabilisation to anatomical differences, as well as the gendered environmental disparities in sport, the urgency to address these challenges has become paramount.
From the past to the present, researchers and institutions have risen to the occasion. While the previously mentioned “Supporting female performance in sport and fitness” course offered by the Open University in collaboration with The Well HQ covers female ACL injury prevention, The UK Sports Institute (formally known as the English Institute of Sport) also launched a campaign in 2019 called SmartHer that not only encourages research into female-specific health, promoting open dialogue between coaches and athletes. This dialogue extends to crucial considerations such as the menstrual cycle and appropriate sports bra support. More recently, the UK Sports Institute has partnered with Manchester University with a focus on how to apply the research being undertaken on the impacts of the menstrual cycle and hormonal contraception on performance, to best impact athletes and coaches.
Physiotherapy interventions have also emerged as a critical tool in reducing ACL injury risks. Strength training programmes, meticulously designed to enhance the strength and endurance of hip and knee muscles, have become integral to athlete development. Addressing landing mechanics, speed, and agility, these programmes strive to equip female athletes with the resilience needed to thrive on the field. All factors that are already deeply engrained into male sport.
The Role of Research and Technology
Amid the current discourse centred around athlete welfare, significant research is underway to enhance injury prevention and management. The incorporation of technology will empower sports organisations to revolutionise their approaches, leveraging real-time data and advanced analytics to fine-tune injury prevention strategies, optimise training regimens, and swiftly respond to potential risks. This fusion of technology and proactive measures not only enhances the overall safety of athletes but also drives a paradigm shift towards a culture of well-being within the sports community.
In the context of increasing concerns over head traumas and concussion in rugby, innovative mouthguard technology has emerged as a valuable new tool. Both rugby league and union have been taking proactive measures to protect their players and preserve the future of the codes. The development of mouthguards equipped with tiny sensors has provided new insights. Companies such as Sports and Wellbeing Analytics have introduced their Protecht mouthguards, which have already been utilised by professional teams including Salford, St Helens, Harlequins, and Gloucester. These innovative mouthguards can measure the impact of collisions in real time, allowing medical staff to monitor players' head movement and assess potential risks. By providing crucial data and facilitating immediate intervention, these mouthguards play a vital role in monitoring player well-being on the field.
Furthermore, complementing the advancements in mouthguard technology, the implementation of the Sportsmart app from Podium Analytics is having a significant impact on athlete welfare and concussion management in grassroots sports. The app fosters collaboration among athletes, coaches, and medical professionals, supporting athletes' well-being. With its proactive approach, the Sportsmart app enables timely diagnosis, treatment, and recovery of concussions, hopefully reducing the likelihood of long-term health complications. By centralising data, the app can inform evidence-based injury prevention measures.
The trend of integrating technology to enhance athlete well-being is also progressing towards addressing certain disparities in women's sports. With much attention on the topic, adidas has ventured into the realm of sport bra engineering, prioritising individual shapes and the unique physical demands of the sport. Through a partnership with the Research Group in Breast Health, led by Professor Joanna Wakefield-Scurr, players have gained access to sport bra solutions that blend optimal support and fit. In a recent interview Professor Wakefield-Scurr had this to say: "Girls and women are now understanding that wearing the right sports bra can reduce damage and improve discomfort, and as a result impact their overall performance."
The 2023 FIFA World Cup has provided a glimpse a promising future for female athletes, extending beyond on-field achievements. A pioneering study has highlighted the disparities in football boots designed predominantly for male players, emphasising the need for tailored solutions for women. This revelation, marked by research led by Dr. Katrine Okholm Kryger, is poised to spark a transformation in the world of women's football footwear.
Acknowledging that female feet, and general anatomy, differ significantly from their male counterparts; the study has opened doors to new boot designs that align with the anatomical nuances of the female foot. The pursuit of comfort, safety, and injury prevention remains at the forefront of this movement, driven by a shared commitment to empower female footballers.
As the Women's World Cup has shone a spotlight on the extraordinary talents of female athletes, it also stands as a testament to the collective efforts aimed at safeguarding their physical well-being. The journey toward comprehensive support and innovative solutions is an ongoing one, fuelled by a vision of a future where female athletes can thrive, inspire, and elevate the world of sports to new heights. Embracing technology and prioritising athlete welfare, allows sporting organisations to not only enhance their reputation but also attract talented athletes, showcasing their willingness to be innovative in protecting their health. Through the implementation of such technological solutions, sports bodies create safer environments and actively safeguard the health and performance of athletes at all levels.
Self-Interest and Long-Term Benefits
Recognising the importance of athlete welfare extends beyond ethical considerations—it also aligns with self-interest and the overall sustainability of sporting organisations. When sporting bodies prioritise the well-being of athletes, they not only fulfil their moral obligations but also attract and retain talented individuals. In the UK, many NGBs receive public funding through the National Lottery. Prioritising long-term athlete welfare and duty of care in these organisations brings several significant benefits.
Firstly, public perception and reputation play a vital role in the sustainability of NGBs. They rely on public support and funding to sustain their operations. When NGBs prioritise athlete welfare and demonstrate a commitment to the well-being of athletes, it enhances their public perception and reputation. In the gradual shift away from a ‘win at all costs’ mentality, there is a growing expectation from the public that NGBs will act responsibly and protect the welfare of athletes who represent the country.
By prioritising long-term athlete welfare, NGBs increase the chances of a “virtuous cycle”, where a safe and supportive environment for athletes resonates with the public and stakeholders, leading to increased trust, support, participation, and investment.
Furthermore, the role of parents in the decision-making process cannot be overlooked. Negative publicity surrounding athlete injuries can deter parents from enrolling their children in certain sports, fearing potential harm. By establishing robust injury prevention programmes and emphasising athlete welfare, organisations can alleviate parental concerns and promote participation. Parents are more likely to trust and support sports organisations that prioritise their child's safety and well-being.
It is worth noting that sponsors and fans exert a significant influence on the sports environment. As ethical practises and social responsibility gain prominence, sponsors and fans expect sporting organisations to exhibit a sincere dedication to athlete welfare. By giving priority to the long-term health and safety of athletes, organisations not only improve their standing but also foster greater fan involvement and backing. Furthermore, such organisations may find themselves better positioned for long-term financial viability, as sponsors and fans are more inclined to associate themselves with entities that uphold ethical responsibility.
Conclusion
In the dynamic and ever-evolving world of sports, the call for prioritizing long-term athlete welfare has grown stronger than ever before. As the saying goes, "We do not rise to the level of our goals. We fall to the level of our systems." This sentiment underlines the profound importance of creating comprehensive systems that safeguard the physical, mental, and emotional well-being of athletes.
This article has delved into the multifaceted nature of athlete welfare, highlighting not only the ethical imperative but also the self-interest and organisational sustainability that come with it.
The journey towards championing athlete welfare is fuelled by a combination of ethical duty and strategic foresight. Sporting bodies must recognise that athlete welfare is not an afterthought but a core principle that shapes their identity, credibility, and impact. The Duty of Care in Sport review and subsequent initiatives exemplify the commitment of various organizations to address athlete well-being comprehensively. However, there is still work to be done, especially in areas including concussion management and gender-specific approaches.
Technology and research have emerged as powerful allies in this endeavour. From innovative mouthguard technology that monitors head traumas to apps fostering collaboration among athletes, coaches, and medical professionals, technological advancements are redefining athlete care. In particular, the pursuit of tailored solutions for female athletes, such as sports bras and footwear, underscores the commitment to addressing the unique needs of women in sports.
The stakes are high, and the implications far-reaching. Beyond the moral obligation to athletes, prioritising welfare is a strategic choice that influences public perception, sponsor support, and financial viability. The interplay between athlete welfare and organisational success creates a symbiotic relationship where one's prosperity feeds into the other's growth.
As the sporting world continues to evolve, embracing a culture of comprehensive athlete welfare stands as a defining characteristic of forward-thinking organisations. By nurturing the well-being of athletes, sporting bodies not only safeguard their futures but also pave the way for a more inclusive, safe, and thriving sports landscape. The journey is ongoing, but the collective commitment to athlete welfare is reshaping the world of sport for the better
