An athlete experience

‘Reflecting on my time as an Olympic athlete, having the honour of representing my country on the international stage for over 7 years, it is unfortunate that my story is not different than many others.’

These sentiments shared by a former Olympian resonate with too many athletes involved in elite sport. Regardless of the sport (summer, winter, team, individual, elite and youth) or location, the experiences of many athletes have common threads of accomplishments through pain, suffering and what we now understand to be interpersonal violence (IV). Most of the time, it starts with a dream—the Olympic Games, Paralympic Games, Continental Games, National or World Championships. Then comes the physical and mental conditioning to reach peak performance that occurs from a young age. Many athletes are taught it is essential to do whatever it takes to be the best, to obey your coach (because they are the experts), to push through pain, and most importantly, that ‘winning is everything’.

What follows is a culture of tolerance for many unacceptable behaviours that are normalised. Being yelled at, told you are worthless and publicly embarrassed (ie, psychological violence); having injuries and illnesses ignored (ie, neglect) because ‘pain is for the weak’; having water bottles thrown at you (ie, physical violence) to ‘motivate’ you to work harder; and receiving sexualised comments about the body, intrusive glances from coaches and peers and shattered sexual boundaries which are crossed (ie, sexual violence) while the guilt, shame, and fear of repercussions keep athletes silent. Despite these negative experiences, athletes still find a way to persist in sport. Leaving sport is considered quitting and a perceived personal failure. Quitting also can validate beliefs that ‘you weren’t tough enough’ and ‘you couldn’t handle the pressure.’

While experiences of IV are sadly common among athletes, there is hope. Progress has been made in addressing this issue. Not only do we have previous ethical issues within sport to learn from (eg, the use of prohibited substances), but there has also been a significant rise in research and practical action addressing IV in sport. As we advance the safeguarding of athletes in sport, the athlete should remain a critical actor. We need to be working with athletes, not just for athletes. In all aspects of safeguarding in sport, we must engage with athletes who have experienced IV in sport and learn best practices from athletes who have had a positive sporting experience. In doing so, sport will become a safer space for all people in the sport environment.

However, one thing is clear: this athlete experience must not be repeated. We must be impatient for change. This themed edition helps to address some of the evidence and implementation gaps to improve safeguarding from IV in sport.

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Where is the field of science in athlete safeguarding?

This edition of the British Journal of Sports Medicine focuses on key aspects of an athlete’s journey. The behaviours identified in the athlete story are unacceptable in sport and collectively, all involved in sport, including sports organisations, healthcare providers, other members of the athlete entourage, media and sponsors, have an important role to play in changing the culture to ensure a safe sport environment. As indicated, progress has been made in athlete safeguarding science. Notably, this edition features the International Olympic Committee consensus statement on IV and safeguarding in sport which summarises scientific advances as well as proposes recommendations for implementing change within the sport ecosystem to address the toxic culture described above (see page 1322) .

A second paper in this edition is an empirical cohort study which captures the experiences and impacts of IV on the physical and mental health of elite athletes at various World Championships. It highlights the important association between IV and athlete well-being and through the novel associations between IV and physical health, serves to expand the focus of sports medicine practitioners to include IV in injury and illness prevention (see page 1360) .

A study in this edition employing a mixed methods approach, assesses the status of sexual violence screening of collegiate athletes in the United States. identifying that less than a quarter of the cohort were asked about a history of sexual violence. The qualitative component of this study identifies themed approaches to improve disclosures of sexual violence (see page 1369) .

Solutions to address athlete hope for safe sport

Athlete stories of IV underscore the need for change. Athletes with lived experience of IV are silenced by internal factors of fear and guilt as well as by external factors within the sports environment such as acceptance and perpetuation of sport cultural norms, such as power imbalances and ‘win at all costs’ values.1 An important action to change this narrative is to ensure that members of the athlete health and performance team are equipped with the clinical skills to identify and appropriately respond to IV in sport. A study of sports medicine physicians illuminates gaps in clinician attitudes and self-efficacy regarding IV detection and reporting, identifies barriers to physician reporting of IV, as well as the assessment of clinical competence in supporting affected athletes, and the desire for further education (see page 1353) . An essential clinical skill in caring for athletes who are silenced by IV is the adoption of trauma-informed and violence-informed care (TVIC) competence to facilitate recognition of IV and to prevent retraumatisation. An editorial by Sheppard-Perkins et al introduces a model to support the adoption of TVIC principles (see page 1311) .

The responsibility to change the narrative on IV does not lie solely with sports medicine physicians. International sports organisations play an important role in implementing safeguarding policies and procedures as well as prevention strategies. Importantly, they also can require their national federations and member clubs to align safeguarding activities at all levels of sport. An editorial on the status of safeguarding activities of the Olympic International Sport Federations provides a baseline measurement and introduces a framework to evaluate progress over time (see page 1319) . Sport organisations also need to be cognisant of and take measures to address a current ‘blind spot’ of IV in sport: cyber abuse. An editorial by Kavanagh and Mountjoy identifies various types of cyber abuse, the potential impacts and strategies to mitigate this risk (see page 1313) .

Importantly, we cannot reframe the athlete story of IV without high-quality scientific knowledge. While advances have been made in understanding the prevalence and impacts of athlete experiences of IV, this research field is relatively new. This themed edition includes two pivotal papers to improve the quality of IV research: (1) ‘what’ topics researchers should prioritise and (2) ‘how’ to conduct IV studies. A Delphi study by Parent et al identifies research priorities in the field to focus research activity to address important gaps in our knowledge (see page 1313) . In an editorial, Vertommen et al propose recommendations for conducting high-quality research on IV in sport while adhering to TVIC principles (see page 1315) .