Healthy Athletes win Medals ~ Evert Verhagen

The recent quarter final between Barcelona and Paris St Germain (PSG) was a striking example of a sports medicine goal that is generally under-recognized. Let me first explain what happened in the quarter final. In the away match Messi (Barca’s star player) injured his hamstring. Although the injury seemed minimal, he could not start in the return match. Against all odds, PSG had the upper hand. Only until Messi finally entered the arena in the second half did Barca’s engine start again and they managed to pull through.

While watching this unfold, I recalled a tweet I send out a couple of weeks ago: “It is time athletes and coaches understood that inj prev is the next step in performance enhancement. No injury = better perf”. This tweet seems to have caused some stir within my social network and beyond. The point I was making is that sports medicine is an under-developed, under-recognized, and under-reported topic in relation to performance enhancement.

Photo by Jan SOLO. Used with permission. All rights reserved. Source: flickr

Photo by Jan SOLO. Used with permission. All rights reserved. Source: flickr

When it concerns performance enhancement a lot of funds and effort are being put into –amongst others– the development of new training methods, training materials, and equipment -all with the aim to make our athletes stronger, faster, better. Over the past decades, the budget of such developments has grown exponentially. The overall idea is that one can buy Olympic gold medals by investing in performance enhancement.

What is generally neglected is that in order for athletes to (fully) benefit from newly developed and improved training methods they have to remain in full health and uninjured. As such I would argue that the next step to have an edge on your competitors is to keep your athletes healthy … healthy athletes win medals.

Recent developments in the registration of overuse injuries have shown that they are a serious problem in sports [1,2]. A plethora of athletes suffer from overuse injuries, hampering their performance levels throughout training and competition. Added to this high prevalence, we shockingly found in one of our previous studies (a qualitative report on overuse injuries) that coaches and players have a shifted view of what causes them [3].

We, sports medicine professionals, would say that an overuse injury is caused by a loading too high for the system; while players and coaches state that overuse injuries are the result of a system being too weak for the load, ie, their body is not strong enough to deal with the load. A subtle yet important difference. With this view they take two steps forward in performance and one step back due to injury.

It may be wiser to take one step back in training load to take three forward.  What is happening here is a system error. There is simply too much emphasis on performance enhancement based upon the Australian Institute of Sports model that injury prevention as a performance enhancing tool is neglected.

A few research groups have dedicated projects on exactly this issue. The Oslo Sports Trauma Research Center being the most prominent of these. Aspetar is up and coming in this field as well, albeit most of the researchers there come from groups that already act on this topic. Yet, there remains a lot of ground to cover. Not only research-wise but also in terms of educating athletes, coaches, and policy makers. A task we sports medicine professionals should heartily pick up!

Evert Verhagen is a human movement scientist, epidemiologist, and  Associate Professor at the Department of Public and Occupational Health of the VU University Medical Center and the EMGO+ Institute in Amsterdam. His research focuses on the prevention of sports and physcial activity related injuries, including cost-effectiveness and implementation issues. He chairs the Dutch Research Council Sport, Physical Activity & Health (LOSO), which has the mission to stimulate high quality scientific research on sport, physical activity & health with the accent on prevention, medical care and performance.


  1. Clarsen B, Myklebust G, Bahr R. Development and validation of a new method for the registration of overuse injuries in sports injury epidemiology. Br J Sports Med. 2012 Oct 4.
  2. The Oslo Sports Trauma Research Center questionnaire on health problems: a new approach to prospective monitoring of illness and injury in elite athletes. 2013 Feb 21.
  3. Wilgen PV, Verhagen E. A qualitative study on overuse injuries: The beliefs of athletes and coaches. J Sci Med Sport. 2011 Dec 19.

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