Introduction
Studying at high school (ie, secondary education) represents a period when youth (adolescent) athletes are at a ‘development athletic level’ in most sports.1 This also represents a period in life when youth athletes are still under the responsibility and care of their parents/carers but when they also begin to make their own decisions about life and participation in sports.2–4 The opportunity to be a student at a sports high school (or sports academy) can facilitate the path towards a future career as an elite athlete.1 5 The overall aim of the sports high schools is to allow the students to have a ‘dual career’ by allowing them to combine secondary education and elite sports practice (eg, providing access to training facilities and time to practise their sport during typical school hours). Studying at this type of high school also means, in most cases, that youth athletes move away from home to a new environment. In Sweden, sport high schools are aimed at students aged between 16 and 19 who want to combine their secondary education with an elite sports education. These high schools—48 in total (representing 28 sports)—recruit nationally. That is, students from all over the country can apply. The education has a clear focus on elite sports. The Swedish school board approves the schools and is governed by the Swedish National Sports Confederation (https://www.rf.se). The affiliated national sports federation is the governing body for schools with a specific specialism.
Research from several countries has shown that sports-oriented school environments are not all positive and can contribute to unwanted consequences, such as health problems (ie, injury and illness) and burn-out.6–9 For example, the burden of injuries in such school settings has been reported to be high; 4 out of 10 athletes are injured during training periods, and close to 8 out of 10 athletes sustain a new injury during a calendar year.6 8 In addition, it has been shown that an athlete who begins a season with an injury is more than twice as likely, compared with non-injured athletes, to sustain additional injuries during the season, which will greatly affect the athlete’s ability to participate.8
Research in Swedish Athletics (SA) and at Swedish Sports High Schools, with an athletics (track and field) specialism (SSHS-A), has presented evidence that 16-year-old athletics athletes have almost the same prevalence and incidence of injury as older adult elite athletes over a full athletics season and that most injuries are related to overuse.6 10 Although these observations have been well documented, the literature is sparse on the underlying causes of the high injury rates in these sports-orientated school environments. This could be because most research has adopted prospective and longitudinal designs, almost exclusively focused on quantitative outcomes. Although useful, this approach will not provide a full and in-depth understanding of the context of existing problems.11 Also, research with youth athletes that has used mixed methods or qualitative approaches has shown that complex causal relationships (eg, between sleep and training volume) may exist.12
As the governing body, SA is ultimately responsible for how the activities are conducted at the SSHS-A. To develop tailored interventions addressing ill health in these settings, SA needs to gain a deeper overall understanding of the reported problems from the stakeholders’ perspective of the reported problems.13 The need to supplement quantitative study designs with qualitative approaches has been emphasised.14 Moreover, this research project is also supported by previous research which emphasises the importance of involving end users (ie, youth athletes) early in the development and implementation of health programmes (eg, introducing measures to reduce injury risk) and that these programmes are contextualised to the specific age and social environment of the athletes.15 16 Because musculoskeletal injuries have previously been identified as a significant problem in this group of athletes,6 the initial objective of this study was to examine the knowledge and understanding of musculoskeletal injuries and their occurrence among students at SSHS-A. A second objective was to understand athletes’ needs in managing health problems in this setting.