Pushing an athlete: how much is too much?

Slogans such as "Go hard or go home," "No pain, no gain," and "Go for the burn" typify the 110%-effort orientation many coaches promote. By rewarding such effort without also emphasizing the need to recognize and accept injuries, coaches encourage their athletes to play hurt or take undue risks (Rotella & Heyman, 1986). A college football player, for instance, may be repeatedly rewarded for sacrificing his body on special teams. He becomes ever more daring, running down to cover kickoffs, until one day he throws his body into another player and sustains a serious injury.

This is not to say that athletes should not play assertively and hit hard in football, wrestling, and rugby. But giving 110% should not be emphasized so much that athletes take undue risks - such as spearing or tackling with the head down in football - and increase their chances of severe injuries.

The act-tough orientation is not limited to contact sports. Many athletes and exercisers are socialized into believing that they must train through pain and that "more is always better." They consequently overstrain and are stricken with tennis elbow, shin splints, swimmer's shoulder, or other injuries. Some sports medicine professionals believe that these types of overuse injuries are on the rise, especially in young athletes (DiFiori, 2002; Hutchinson & Ireland, 2003). Hard physical training does involve discomfort, but athletes and exercisers must be taught to distinguish the normal discomfort that accompanies overloading and increased training volumes from the pain that accompanies the onset of injuries.

Some people learn to feel worthless if they are hurt, an attitude that develops in several ways. Coaches may convey, consciously or otherwise, that winning is more important than the athlete's well-being. When a player is hurt, that player no longer contributes toward winning. Thus, the coach has no use for the player - and the player quickly picks up on this. Athletes want to feel worthy (like winners), so they play while hurt and sustain even worse injuries. A less direct way of conveying this attitude that injury means worthlessness is to say the "correct" thing (e.g., "Tell me when you're hurting! Your health is more important than winning") but then act very differently when a player is hurt. The player is ignored, which tells him that to be hurt is to be less worthy. Athletes quickly adopt the attitude that they should play even when they are hurt. The "Injury Pain and Training Discomfort" case study shows how athletes should be encouraged to train hard without risking injury.

Over the past 20 years, a growing body of sociological research has contributed to a greater understanding of the sport norms, values, and environments that are linked to the occurrence of injury (see Heil & Podlog, 2012, for a review). Much of this research examines the personal experiences of injured athletes, the ways in which athletes internalize "macho" and gendered beliefs about playing with pain and injury, and the normalization of pain and injury. From a sociological perspective, injury risk increases the more a culture narrowly defines success according to win - loss records, values external forms of success (e.g., scholarships, prize money) over intrinsic achievement, and promotes an unquestioning adoption of or overconformity to the norms of a sport ethic that cultivates a culture of risk.

The statement "Winners never quit and quitters never win" seems accurate at first glance, but the message is really that athletes should play through pain and injury because winning is more importantthan losing. Athletes who do play with injury and pain are valued more by coaches and teammates, which increases the pressure to play when hurt, even when it may risk the athlete's career. Long-term health is often jeopardized by the short-term goal of winning. Many athletes who play with injury and pain years later walk with crutches, take an hour to get out of bed, or suffer from brain injury (usually caused by multiple concussions). Deciding whether an athlete should play or sit out is not easy. However, the long-term health and well-being of athletes must be paramount for the coaches, athletic trainers, and medical personnel making these types of decisions.

This sport ethic is especially evident in football, where bravado and machismo lead to a denial of pain and injury (Gregory, 2010). The negative effects of this culture are seen in the recent highlighting of concussions, which revealed that many football players suffered multiple concussions during their careers but still went back in and continued playing. Some of these players exhibited disturbing psychological reactions (e.g., suicide, cognitive deficits, severe depression, cumulative deterioration of brain functioning) after retiring from football. Mounting evidence is starting to indicate that concussions caused these psychological issues after retirement. As a result, new procedures of monitoring concussions much more closely and taking precautions with players who have more than one concussion are being put in place.