Injury Prevention in Youth Sport – Understanding the Coaches’ Perspective

Many thanks to Dr. Johna Register-Mihalik for providing this week’s EXSS Impact post, which highlights the importance of understanding the coaches’ perspective towards effective injury prevention in youth sport.  This work was completed as part of a Junior Faculty Development Award that Johna received to support this work. 

Currently, there are over 40 million youth ages 5-18 who participate in organized sport.1 Sports are one of the primary ways that children and adolescents engage in physical activity. However, with sports also come the risk of injury, which can lead to acute and long-term issues, as well as potential decreases in physical activity due to restraints from the injury or fear of re-injury2-4 Recent focus on safety and prevention of injuries, specifically traumatic brain injury (TBI), has shifted to implicating the “culture of sport” as one of the primary contributors to injuries and patterns that may reduce safety in youth sport. However, little data exists to provide the perceptions and norms that contribute to this culture. Coaches are often the main focus of this discussion due to their unique and influential relationship with young athletes. Coaches are also often the leaders in creating the culture of a team and the environment of play.5-7 Despite preliminary work inclusive of coaches’ knowledge about concussion, no studies have examined coaches’ perceptions of sport culture and its relationship to safety and injury in sport. Broadly, this study serves as the initial framework in understanding perceptions of sport culture and its influence on injury prevention and safety.

youth soccer headWhy did you do this study?

In 2013, the Institute of Medicine (IOM) released a report specific to TBI/concussion among youth that contained six goals for future research and development. One of these goals states that cultural and behavioral change is needed.8 However, few to no studies have sought to study the culture and what it means to the people whose culture we are attempting to change. Increasing safety and improving injury prevention efforts at the youth level are essential in order to decrease the impact of injury on children’s overall health and to encourage physical activity throughout their life. Although there are many injury prevention and educational programs available, very few were developed with coach involvement and input, leading to a lack of implementation and effectiveness.9 We have selected coaches as for our first set of focus groups, as coaches have significant power over their players at the youth level. Their actions and attitudes towards health and safety influence the way children respond to injury and injury prevention.7,10 In order to develop effective interventions, a thorough understanding of coach perceptions, attitudes and beliefs are needed. No studies have used in-depth qualitative methods, inclusive of youth sport coaches to understand culture and injury at the youth level, specifically TBI. This work brings together expertise in public health, social science and sports medicine to serve as the framework for a larger more comprehensive examination of these concepts, followed by in-depth interviews and surveys aimed at understanding the norms concerning safety and injury in sport. The primary purpose of this work was to: develop an understanding of attitudes, perceptions and norms around sport culture and injury among youth sport coaches using a mixed methods approach (survey and focus groups)

coachWhat did you do and what did you find in this study?

We conducted five in-depth focus groups with thirty youth sport coaches (n=30) around their perceptions of the culture of sport and the ties into injury prevention and safety in sport. Coaches also completed a short survey around these concepts. We are currently analyzing the data, however after preliminary analysis, we observed that coaches strongly felt that development of character and skill as well as persistence were key positive aspects of the culture of sport. The coaches also felt there were team and league based factors that made it difficult to implement safety measures such as lack of support, lack or education and lack of time. Many also felt it was their job as coaches to aid in preventing injuries and improving safety in their sport. Although we are continuing to analyze these data, we have begun to discuss the broad implications of our findings. Many of the key, positive cultural aspects of spot are also potentially background concepts that may then drive negative behaviors (non disclosure of injury, playing no matter the costs, etc).

girl-soccer-player-ankle-injury_tjzneiHow do these findings impact the public?

Our preliminary findings support the notion that youth sport coaches should be involved in the promotion of the positive aspects of sport and in promotion of safety in their sport. Barriers such as league support and time to devote to safety measures should be considered when addressing injury prevention in youth sport communities. We will continue to analyze this data and believe it can inform development of injury prevention and safety initiatives in community-based youth sport.


  1. National Council of Youth Sports. Report on trends and participation in organized youth sports. Stuart, FL, 2008.
  2. Iverson GL, Gaetz M, Lovell MR, Collins MW. Cumulative effects of concussion in amateur athletes. Brain Inj. May 2004;18(5):433-443.
  3. Moser RS, Schatz P, Jordan BD. Prolonged effects of concussion in high school athletes. Neurosurgery. Aug 2005;57(2):300-306; discussion 300-306.
  4. Roelofs J, Sluiter JK, Frings-Dresen MH, et al. Fear of movement and (re)injury in chronic musculoskeletal pain: Evidence for an invariant two-factor model of the Tampa Scale for Kinesiophobia across pain diagnoses and Dutch, Swedish, and Canadian samples. Pain. Sep 2007;131(1-2):181-190.
  5. Shields DL, LaVoi NM, Bredemeier BL, Power FC. Predictors of poor sportspersonship in youth sports: personal attitudes and social influences. J Sport & Exerc Psych. Dec 2007;29(6):747-762.
  6. Jowett S. What makes coaches tick? The impact of coaches’ intrinsic and extrinsic motives on their own satisfaction and that of their athletes. Scand J Med Sci Sports. Jan 14 2008.
  7. Ommundsen Y, Roberts GC, Lemyre PN, Miller BW. Parental and coach support or pressure on psychosocial outcomes of pediatric athletes in soccer. Clin J Sport Med. Nov 2006;16(6):522-526.
  8. Medicine. Io. Sports-related concussions in youth improving the science, changing the culture. Institute of Medicine;2013.
  9. Sarmiento K, Mitchko J, Klein C, Wong S. Evaluation of the Centers for Disease Control and Prevention’s concussion initiative for high school coaches: “Heads up: concussion in high school sports”. J Sch Health. Mar 2010;80(3):112-118.
  10. Malinauskas R. College athletes’ perceptions of social support provided by their coach before injury and after it. J Sports Med Phys Fitness. Mar 2008;48(1):107-112.
  11. Strauss A. Basics of qulitative research: Grounded theory procedures and techniques. Thousand Oaks, CA: Sage Publications, Inc.; 1990.