A system that rewards sacrifice over health: why injured athletes keep competing.
Every major sporting event produces a variation of the same story: an athlete competing through visible pain or injury on the world stage. Public commentary is often split into two camps: one praising the athlete’s “bravery” and hailing them a national hero, while the other condemns them as “irresponsible” and a poor role model for aspiring young athletes.
Both, we would argue, fail to get to the crux of the issue. While people rush to attack individual athletes, few question the system that makes the decision to compete for these athletes feel like the only viable ‘choice’.
To grasp the decision to compete through what can be career-ending or even life-changing injury, we must understand the context in which elite athletes are making decisions. Athletes are shaped by their environments in which risk taking is normalised, praised even, especially in extreme sports, and winning medals is rated higher than long-term health.
We won’t pretend to write this from a moral high-ground. As athletes ourselves, with more injuries between us than we can count, we understand the internal and external pressures to compete, even when injured. We know we would have refused to step away from an Olympic start line due to injury, and we have both stood on start lines when we shouldn’t have. We would have made the same choice to compete as all the athletes in the headlines, not because it was safe, but because we too were raised in a system where medals were valued more highly than long-term physical health.
Who really holds responsibility?
If we shouldn’t be looking to the athlete to ascertain where responsibility lies, where should we look?
The welfare of every athlete is a shared responsibility. Athletes at the elite level will likely have personal coaching and medical staff, as well as support staff from their National Governing Body, or national team. This team will often have a say on training and competition schedules, injury decision-making, and have influence over funding and team selections. All have a duty of care to the athlete. This means that those in positions of influence have an ethical, and sometimes legal, responsibility to protect the athlete’s safety, wellbeing, and long-term health.
When an athlete competes injured, rather than questioning the individual’s decision or placing blame, from a safe sport perspective we would ask the following questions:
Guidance and information:
What medical guidance did the athlete receive?
Were risks transparently communicated?
Pressure and incentives:
Was explicit or implicit pressure applied?
Were medals, selection or performance metrics discussed?
Permission not to compete
Did anyone, at any point, tell the athlete it was okay not to compete?
Even though we would look for a decision making framework that asks these types of questions, if all of the above formed part of a decision making process, and an athlete was cleared to compete, it does not mean risk was absent, only that the level of risk has been deemed acceptable.
Despite similar stories of athletes competing through injury hitting the headlines, there are examples of support teams shaping decisions toward safety when athlete wellbeing is treated as non-negotiable. Although not in relation to a physical injury, Simone Biles has praised the full support of her coaching and medical team during her decision to pull out of competition at the Tokyo Olympics due to concerns for her safety and wellbeing. It is reported that the support team took a daily assessment approach with Biles to monitor wellbeing and make decisions on whether to compete. This shows that even at the highest level of sport, with global attention and medals at stake, support teams can still make decisions with the athlete that prioritise the person beyond the athlete.
While collaborative decision making is ideal, athletes can often choose to compete despite medical advice. This is where duty of care can become complicated, and a tension between athlete agency and professional responsibility appears.
In some circumstances, coaches, medical staff and federations must have a responsibility to intervene when risk becomes too high, even when that means removing an athlete from competition.
Some sports already override athlete choice when risk becomes unacceptable. For example, Rugby Union has strict protocols for concussion, where any athlete who shows symptoms of concussion before, during or after a match, must be immediately removed from play, undertake an assessment and follow a return to play programme However, this is not a consistent practice across all sports or for different types of physical risk.
All of these questions and frameworks may appear overly paternalistic, especially when adult athletes are concerned. We’d be the first people to talk about athlete agency and autonomy, but on occasion, that must be trumped by safeguarding the athlete.
Too often, the decision to compete is framed as the athlete’s alone, but in reality it is shaped by support teams, selection systems and sporting culture. They don’t happen in isolation but within a culture that rewards sacrifice.
A culture that rewards sacrifice
Sacrifice is baked into sport’s win-at-all-costs culture that rewards athletes who push through pain. Competing while injured is not an exception but rather is normalised across sport, and we see it at every level. Marathoners running on stress fractures, footballers playing through torn ligaments, and Olympic athletes standing on the startline despite serious injury. Every time the media rewards the ‘choice’ to compete with a hero narrative, reinforcing the idea that sacrifice is admirable.
These repeated patterns indicate we are talking about systems that shape behaviours at every level and every role in sport, not just a few outliers or rogue support teams.
The pressure to compete comes from multiple sources. Medals drive funding at both the personal, national and commercial level, creating conflicts of interest with duty of care. National expectations place additional weight on athletes carrying their country’s hopes. Injury is often treated as a badge of honour, reinforcing that suffering equals courage. Finally, athletes’ identities and public images are tightly linked to performance, creating an internal pressure to compete even when it feels unsafe.
As an athlete undertaking that cost-risk analysis, the only rational decision is to compete, when funding, selection, and identity depend on performance.
Coaches, medical and support staff are not immune to this culture either. They too are responding to and existing in an unhealthy system, and more often than not, are ex-athletes who competed under these same circumstances. They are also judged on performance outcomes, and are incentivised to get athletes competing, further perpetuating the problem.
Creating a safer sporting culture
To get to the root of the problem, we have to flip the message. That shift must begin early in an athlete’s development.
Sport doesn’t need to lose its competitive edge to become safer, but we do need to reconsider how we define success, what behaviours we reward, and how we define courage.
What if all sporting environments made participation, enjoyment, wellbeing and long-term development the default? What if injury was not treated as an inevitable part of sport, nor worn as a badge of honour, but instead recognised as something athletes should be protected from wherever possible, and supported through when it does occur?
A crucial part of this cultural shift will be teaching young people what it means to make sacrifices versus suffer for your sport. Sport can teach important life skills of commitment, self-belief and resilience, but framed wrongly, can result in behaviours that risk long-term health.
This also means encouraging athletes to develop identities, and similar life skills, that extend beyond sport. When an athlete’s performance in sport becomes their measure of self-worth, the perceived cost of stepping away from competition becomes too high. An athlete who also likes to sing, or paint, enjoys volunteering, or has a passion for science in addition to their sporting endeavours, has a wider, more diverse community around them and understands their place in the world away from sport, which reduces the pressure to compete at any cost.
Cultural change on this scale will require courage from people in leadership positions to move away from a business-as-usual, performance-based sport system. For too long, we have praised a sporting system that rewards sacrifice over safety and prioritises winning over wellbeing, but in reality, we know success comes despite the system not because of it. Nothing short of a system overhaul, where individual wellbeing guides investment, decision-making, and definitions of success, will meaningfully shift this culture.
Conclusion:
A safer sporting culture will not emerge from asking athletes to make better choices in isolation. It will come from building environments around athletes where the safest decision is the supported and respected one. Environments where athletes don’t fear contracts being cut, reputations tarnished, or media scrutiny for simply making the right decision for their body.
We have to build a sports ecosystem where athletes do not have to choose between their health and their careers. Only then can the ‘choice’ to compete truly be considered a choice.