#WeRideTogether works to promote awareness regarding all types of abuse. It’s important to discuss potentially under-explored forms of abuse, as signs of abuse may not always be outwardly evident. One often overlooked form of physical abuse and neglect is sports injury and overtraining.
Sports-related injury is unfortunately all too common amongst athletes of all levels. Injury can occur in a variety of different ways and can devastate athletes with both short- and long-term physical and mental health effects.
In abusive sporting environments, injury can result from training athletes beyond their capacity, forcing athletes to compete or train while injured, or intentionally causing injury through physical punishment. This practice is abusive and neglectful, reflecting a lack of education on best practices and a lack of care for athletes.
Athletes, coaches, and parents can help prevent these harmful practices by recognizing pain signals and speaking up when uncomfortable. If an injury occurs, it’s important that the athlete stays socially involved with their athletic community and prioritizes rest. Coaches and sporting organizations have a responsibility to stay consistent and educated on athlete injury prevention and protocol. Fundamentally, it’s critical that adults prioritize the long-term career of youth athletes instead of short-term achievements to end the perceived need to force athletes to “push through pain.”
General Statistics
In the U.S., more than 3.5 million children (ages 5 to 14) of the 30 million involved in organized sports suffer sports-related injuries a year 1. 34-65% of adolescent athletes (ages 14-21) suffer a sport-related injury 2.
Sports-related injury refers to injuries occurring during sports or exercise by active individuals 3. Sports injuries are typically either acute – for example, dislocating a joint – or chronic – for example, shin splints that gradually develop over time. Accidents can happen, and experiencing pain during or after exercise isn’t necessarily indicative of an injury. However, injury in sports is a frequent occurrence – in fact, a significant source of injury suffered during childhood is sports-related. Almost ⅓ of childhood injuries are sports-related injuries 1.
The majority of injuries for both children and adolescents are from contact sports, primarily football – out of the 775,000 emergency department visits for sports-related injury among children aged 5 to 14 per year, 215,000 of these children are treated for football-related injuries 1. The majority of traumatic brain injuries among children – which often have devastating consequences – are from sports 1. Basketball has one of the highest injury rates due to a combination of fast, repetitive movement and bodily collisions on the court 1. Baseball has the highest rate of death due to sport-related injuries per year among children 5-14 1. While the reasoning for this is unclear, likely causes include ball hits to the head and commotio cordis, a sudden death incurred by a ball hit to the chest. In aesthetic sports, like figure skating, dance, and artistic swimming, girls are more likely to be injured than boys and most commonly suffer ligament and muscle strains and fractures 4. 72% of pre-professional dancers and 64.4% of gymnasts experience overuse injury while involved in the sport 5.
Risk Factors
Risk factors for injury in sports vary. In team contact sports, certain positions may place athletes at a higher risk of injury – for example, 57% of players who sustain injury in football were playing offensive positions 6. In soccer, goalies are more likely to sustain injury. Early sport specialization, which is common practice in aesthetic sport to get a “head start” on learning sport-specific technique, places athletes at a higher risk of injury because young, developing bodies are often not prepared for the intense strain of flexibility training and muscle development. This is similarly reflected with body weight – both obesity and low body weight are considered risk factors for injury due to the strain it places on the body.
The environment also plays a role in determining the risk of injury in sport. Cold injuries – namely hypothermia and frostbite – occur often in winter sports or sports where seasons extend into colder conditions, like football. Similarly, heat exhaustion and heat stroke are seen frequently in summer sport athletes. Open water events, common in multisport events (like triathlons) and in extreme sports (for example, diving), pose additional risks due to elements like water temperature and inclement weather conditions. In triathlon, the majority of deaths occur during the swim portion. Inclement weather events are a source of injury risk in multiple outdoor sports, including rowing, baseball, and auto racing. In equestrian sports, an additional factor to consider is the animal component – most injuries occur due to falling off of the horse.
The Impacts of Injury
Injury ranks among the top concerns for youth athletes, coaches, and parents.
Injuries often impact an athlete’s experience inside and outside of sport and can cause great physical and emotional distress. Many of the most detrimental injuries are characterized by both long- and short-term impacts – for example, concussions cause vision problems, headaches, and vomiting but can also lead to post-concussion syndrome, where negative symptoms can last for months and even years.
Not only are athletes having to contend with the pain experienced in the moment, but also the grueling rehabilitation process that often places a significant time and monetary burden on an athlete and their support system. Athletes also have to cope with the pain caused by the loss of their sport. Especially as athletes climb the upper echelons of their sports, any amount of time off can isolate an athlete from their friends and teammates and can jeopardize their position on their team, ability to compete, and performance trajectory.
Injury often contributes to long-term mental health issues. Many athletes report symptoms reminiscent of post-traumatic stress disorder after experiencing injury. Other common post-injury mental health symptoms include depressed mood, diminished self-identity, and burnout. Athletes often turn to maladaptive coping mechanisms, such as disordered eating and substance use. Disordered eating is especially common, as time off from extensive exercise may lead to athletes gaining weight in the recovery phase or experiencing changes in body composition (such as muscle atrophy). Additionally, disordered eating patterns are often connected to a perceived loss of control over other aspects of life. An injury sidelining an athlete evokes similar emotions - uncertainty on recovery, accompanied by feeling changes in body composition, may result in disordered eating as a maladaptive coping mechanism that creates a false sense of control during a tumultuous time.
While injury is physically and emotionally distressing to an athlete, many actions can be taken to mitigate the negative effects. Social support, or the existence of a network that provides emotional and physical support to an individual during a time of need, is often cited as one of the most critical elements to a successful recovery and reduces the isolation and depression experienced. Coordinated and openly communicated care among athletic staff and medical staff is also important in ensuring that an athlete can return to a sport safely. Ultimately, prioritizing the athlete during a markedly vulnerable time in their career is most important in promoting the best outcomes.
Injury is evidently a serious and major concern among athletes on all levels. But what happens when injury is intentionally caused or worsened by the adults in a sporting environment?
Current events chronicle a myriad of injuries either caused by or worsened by coaching.
Sometimes, we see injuries sustained by workouts that exceed an athlete's skill level. Nine male lacrosse players at Tufts University in Medford, MA were hospitalized for rhabdomyolysis after undergoing a workout administered by a Navy SEAL graduate and Tufts alumnus 7. Rhabdomyolysis is a painful and life-threatening condition that occurs when muscles break down due to overuse, overheating, and dehydration 8. The muscle degradation causes damage to the kidneys and can lead to kidney damage if untreated. Elite athletes – and especially male athletes – are considered an at-risk population for rhabdo that may experience more severe symptoms due to their higher amount of muscle mass.
Three of the last Olympic and world champion women’s figure skaters – Yulia Lipnitskaya, Evgenia Medvedeva, and Alina Zagitova – have all suffered career-ending physical and mental injuries due to poor technique training for complex figure skating moves. All of them trained under the same coach – Eteri Tutberidze 9, arguably the most dominant coach in women’s figure skating – who encourages restrictive eating and pre-rotation (a harmful technique, in which the back supports initial jump rotations as opposed to the legs) to land quad jumps.
In other cases, we see coaches forcing athletes to practice while injured. The former head coach of the USA Artistic Swimming team 10, Hiea-Yoon Kang, was suspended by SafeSport in May 2024 for both injuring athletes through overly strenuous workouts – including dislocating a swimmer’s toe during a workout – and for forcing athletes to practice while injured.
The San Francisco Ballet (SFB) is currently the subject of two lawsuits alleging medical negligence by SFB artistic staff and their volunteer doctor 11. The dancers allege that they were encouraged to perform despite injury and pain – and provided painkillers and cortisone injections, as opposed to diagnosing the injury and allowing time off – that eventually resulted in a permanent, career-ending injury.
Gymnastics has also seen its fair share of lawsuits and controversies regarding this practice – six-time U.S. national team member Riley McCusker sued her former coaches, Maggie Haney and Victoria Levine, for forcing her to practice and compete on multiple fractured bones and muscular injuries (among other harmful practices) that led to long-term worsening injury and eventually induced exercise-induced rhabdo 12.
Simone Biles, the most decorated gymnast of all time, faced massive backlash after backing out of the Tokyo 2020 Olympics due to a case of “twisties” or a lack of air awareness while flipping 13. Much of this backlash consisted of comparison to Kerri Strug, a gymnast who competed at the 1996 Olympics with a severely injured ankle 14, 15.
Physical “punishments” for perceived bad behavior are also an unfortunately common practice – at Evans Middle School in Lubbock, TX, thirteen cheerleaders suffered first- and second-degree burns on their hands after being forced to do bear crawls and crab walks on 125-degree outdoor track 16. This was a “punishment” administered by a school coach, who threatened the students’ future in competitive cheer if they didn’t comply.
Former baseball coach Nicolas Morton is facing twenty counts of sexual abuse and sexual conduct against a child after multiple underage players he coached alleged that he forced them to complete overly intense training as a form of physical punishment unless they complied with his sexually abusive demands 17.
Adriana Grucia was an eleven-year-old Romanian gymnast who was beaten to death by her coach as “punishment” for making mistakes during practice 18. During the proceedings, the coach cited Romanian and U.S. national women’s gymnastics team coaches and coordinators Bela and Marta Karolyi as where he learned this tactic 19. While both Karolyis have vehemently denied any accusations of abuse occurring in Romania or the U.S., Nadia Comaneci 20 and Dominique Moceanu 21 both have accused the Karolyis of using physical abuse as “punishment”.
No matter what context in which this occurs, the practice of forcing athletes to train while injured or to the point of injury is abusive. The level of physical distress it places athletes under and the great risk for potential harm classifies it as a form of physical abuse. This behavior places athletes at risk of creating new injuries or worsening existing injuries. It also contributes to long-term health effects caused by physical health conditions related to overexertion. Exercise-induced rhabdo is painful and can lead to kidney failure if untreated. Another health concern, relative energy deficiency in sport (RED-S), is caused by underfueling and overexertion and can seriously impair an athlete’s cardiovascular, skeletal, reproductive, and immune systems 22. Overtraining syndrome (OTS), caused by excessive exercise without enough rest, is another health issue plaguing athletes that results in long-term disturbances to mood and hormonal systems 23.
The physically abusive effects of this practice are staggering, but the connection to other types of abuse is equally as horrific. Athletes with disabilities and long-term physical health conditions are at an increased risk of sexual abuse 24. The emotional and physical distress caused by injury and forcibly training through it may make an athlete more vulnerable to grooming, as perpetrators of sexual abuse often seek out children who are more emotionally vulnerable and isolated 25.
Weaponizing training and injury in this manner is also a reflection of neglect and malpractice on the part of the athletic staff. Refusing to provide adequate medical care in response to an athlete expressing pain or injury and outright dismissing an athlete’s health concerns are forms of physical and emotional neglect. It’s also negligent to have athletes train in ways that are beyond their capacity or are intentionally harmful. Even if ignorance is a factor and training beyond capacity or while injured is done unintentionally, it still constitutes abuse and contributes to the needless suffering of athletes. There are a myriad of resources online – both general and sport-specific – that cover developmentally appropriate athlete training, and there is an obligation on behalf of adults involved in coaching children to stay informed on best practices to promote long-term athletic success.
But why does this happen?
This practice reflects a broader issue within sport – prioritizing athletic and financial success over an athlete’s well-being. Coaches, whose jobs rely on an athlete’s success, may pressure an athlete to “push through” an injury to achieve success. Riley McCusker cited former coach Haney as pressuring her to compete through multiple national and international events, even as Riley expressed immense pain and discomfort 12.
This may be exacerbated by valorization or equating a coach’s success with moral upstanding. This creates a power imbalance that coaches can take advantage of, allowing them to go completely unquestioned in the sporting environment – remember, a healthy coach-athlete relationship should be based on care and support, not power and control. This level of loyalty culture is often linked to authoritarian leadership styles – where physical punishment is common, like in the case of Evans Middle School – and an increased risk of abuse of all forms.
Competing while injured or training to the point of injury may not be directly encouraged by coaches but instead may be an active choice of the athlete. Many athletes report feeling pressure to not let their team down, fear losing competitive time (especially when scholarships are involved), and often fear losing their sport entirely. Therefore, athletes may continue to push past the point of pain and injury in order to keep their spot and stay within good graces.
This is especially compounded with minor athletes. The prefrontal cortex (PFC), or the part of the brain that controls decision-making and long-term planning, does not fully develop until the age of 25 26. Because of this, children and adolescents often are not making decisions that consider long-term consequences. Education is one of the biggest protective factors against abuse, and lacking education on abuse is considered a risk factor for abuse. Athletes – especially minors – require education on what constitutes abuse, when to say no, and the potential consequences of training in unsustainable ways.
Many sporting environments (particularly ones where emotional and physical abuse are common) develop an “ethical code” for athletes to follow, which typically consists of pushing through pain and past one’s limits to achieve success 27, 28.
Certain practices ingrain themselves within a sport and often go unquestioned over time. When looking at the lawsuits against SFB, the current artistic director Tamara Rojo famously performed on a bunion the size of a tennis ball (among other injuries) 29, cementing the idea of dancing while in extreme pain and injury as laudable and something that should be repeated by all dancers. In sports where certain injuries are common – basketball’s “jumper knee,” “dancer’s hip,” and concussions in football – these injuries often get written off as just “part of the sport.”
Additional pressure is created when considering the idea of being “replaceable.” Many athletes are often told – both implicitly and explicitly – that they could easily be replaced by another athlete, so an injury creates fear within the athlete that they will be disposed of during their recovery time. To combat this, injury gets hidden, and athletes may comply with physically abusive demands to “prove themselves” as indispensable.
This is reinforced by what society perceives an athlete to be – like Kerri Strug, someone who pushed through a severe injury to help her team on the world stage. “No pain, no gain” is considered a standard part of the sports lexicon and contributes to this pressure to compete while injured or train to the point of injury on all levels of sport. Many athletes may not even perceive the practice as wrong or unhealthy – and may encourage other athletes to do the same – simply because it is so ingrained in the sport zeitgeist.
Reporting Abuse
If you see, suspect, or hear of abuse in sport, it is imperative to follow reporting guidelines and procedures specific to your sporting organization. If your sport falls under the jurisdiction of the U.S. Center for SafeSport, their reporting process is available online and includes necessary information to include in a report. Many sports do not fall under SafeSport jurisdiction – if you belong to one of these sports, reporting to a sport-specific governing body or to law enforcement are available options. In collegiate athletics, your campus’s Title IX office is an excellent resource for reporting incidents of abuse. If any confusion or concern regarding the reporting process arises, contacting the Courage First Athlete Helpline is a great step.
Physical abuse in this way is a reportable offense, and multiple coaches have faced consequences for inflicting this abuse on athletes. Maggie Haney was initially suspended by the U.S. Center for SafeSport for eight years from coaching but appealed her case and reduced her sentence to five years. Hiae Yoon-Kang remains suspended from coaching artistic swimming. The coach from Evans Middle School in Lubbock, TX, was fired after news organizations reported on the abuse that occurred. Nicolas Morton will likely face a substantial prison sentence as a result of the abuse he inflicted on his players.
Tools are available to help athletes and others involved in sports be safe and active bystanders. It takes all of us to change the culture in sports to promote healthy and sustainable athletics, and educating ourselves on what to do if we witness abuse is critical to making that change.
Ways to Make Change
What can athletes and parents do to combat this in their sporting environments? Athletes should be encouraged to do gut checks – does this feel right? Am I being forced into doing something I am incapable of or unwilling to do? Athletes should also be encouraged to recognize pain signals – when something is uncomfortable in a manageable way versus when something is outright painful. Other body signals – such as swelling of a painful area or a worsened range of motion – should be actively monitored.
As an athlete, you have the right to say no to doing something you’re physically uncomfortable with or in pain while doing. The adults in a minor athlete’s life should encourage athletes to stand up for themselves and vocalize distress. When an athlete is injured, including them in social activities – especially within their athletic community – is considered critical to a successful rehabilitation process. Remember that time off from an intensive sport schedule is not a bad thing, and instead allows for an athlete to come back stronger.
On a broader scale, there are a myriad of ways that adults in a sporting environment can end this harmful practice.
Athletic staff can stay educated on best practices and encourage developmentally appropriate training. We have more research and information readily available and easily accessible than at any other point in human history. Because of this, we also have the greatest ability to appropriately train and care for athletes. Staying educated is critical to reducing abuse in sport and protecting athletes in the long-term. Taking this information and utilizing it in the sporting context allows us to do better and promote best outcomes for future generations of athletes, as opposed to repeating the same outdated and abusive practices that cause devastating short- and long-term consequences for athletes. Many NGBs offer resources on how to help athletes achieve success while still prioritizing athlete’s long-term health and well-being – for example, British Gymnastics provides flexibility training best practices on their websites for coaches and athletes alike to access 30.
When injury does occur, coordinated care between athletic staff, medical practitioners, and athletes is considered key to a successful rehabilitation process. Incorporating rest and time off into an athlete’s sport schedule can reduce the likelihood of injury at practice or in competition and can allow athletes time to recuperate. Taking a holistic approach to sport – where athlete welfare is prioritized as opposed to their short-term achievements – reduces the need to “push through pain” and instead focuses on extended and healthy careers.
If you or someone you know is currently experiencing abuse, please visit our crisis resources page for additional support.
For more information about the types of abuse that exist, check out our Types of Abuse in Sports blog post.
Annelise Ware, MHS
Dancer
