Table 6

Themes, subcodes and exemplary quotes on ongoing evolution in sports culture on sports injury prevention

Main theme	Subcode	Exemplary quote
Changes in sports culture	More resources	Manager 03: “Yes, because now they have a medical staff and before that didn’t exist, and it is all, now 2 years ago that they really do prevention on the injuries.” Coach 02: “Now all these facilities are definitely a lot better than it was 30–40 years ago, and that is why also there we have just because of that already less injuries now than early on.” Strength and conditioning coach: “I think that now the federation is trying to change and to implicate, improve.(…)I think it is better now. It is better than when I started with the federation. They understand the importance of physical work and the prevention.”
	Adding professionalism	Athlete 05: “I think how the sport is now; it is becoming more and more professional. It also means that we have to take much more care about ourselves.” Athlete 07: “But for sure the last few years, the professionalism in the national team really grew up. So, I think you have a lot more people that will help you, and you can always ask them to help you.” Coach 02: “So, that is why I think that at the moment, the people, riders, trainers, (and staff) concentrate more on training with less risk of injuries than it was many years ago.”
	More people around the athlete	Physical therapist 01: “I was myself a judoka, but when I was young, there was no physio. When you were injured, you didn’t say it(…). But now it is more, it is good, it is better. So, there is a change. There are more people around the athlete.” Manager 02: “The evolution in professionalism is really when you compare it to 20 years ago it was a hobby and even if it was top sport at that moment, if you compare it then to now, the crew that these guys have around them, the people taking care of, it is terrible. You know, it is like maybe almost a rock star.” Athlete 07: “I think our better results helped to have more money, and now we have more people that are helping us 5 years ago(…)there was no money to do this, we had only one physio, and I don’t even know if we had a physical coach.”
	Age, generational changes and passing of time	Medical doctor: “Now I think the culture is evolving, especially for the last 10–15 years. I think that the IOC gives this prevention to take care of the athletes, (which) is very important for them.” Coach 02: “I think that the sport always develops because when I early on was talking about my own sports career, the sport 40 or 30 years ago, I still was competing 20 years ago, was different than it is now.” Athlete 08: “In that way, I think there is getting a more tendency that people get aware of it, you know. Let’s say 5 years ago, I wouldn’t say any, and now people who are doing the top sport are aware that it is necessary to have somebody to help you with injury prevention(…)I think it is, but still on a very low level.”
Education on injury prevention	Educate and raise awareness on young athletes	Athlete 01: “I wish I knew a lot more than I know now when I was younger because I did have a lot of really serious injuries that I believe(…)they could have been prevented if I was, from a younger age, monitored right because I didn’t know.” Athlete 05: “But now it is to try to teach, to make the riders know that it is very important to work on it before you have pain.(…)Like me, I am doing now quite a bit because I feel like I have to.” Manager 01: “You cannot reach that level of performing in your sport if during your younger years you were not educated in the right way surrounding injury prevention in the whole scale.”
Challenges on injury prevention	Lack of awareness and engagement	Manager 01: “That is something in my opinion that still has to evolve in the heads of everybody involved. That part is just a crucial part of it that it is better to spend some of your practice time on those kinds of things to get a better result which takes a little more time. That is true. It is an investment, return on investment, but if you don’t do it, that’s a little bit a problem.” Athlete 07: “Now it’s ok, but in the beginning, I felt a little bit lost, and I went asking everywhere, and you don’t really know what it’s best. So, it’s a process of searching.”
	Lack of interest	Medical doctor: “Because in some sports they don’t care about prevention and they don’t want it, even in the international federation.” Athlete 06: “Because I don’t have like, really, problems. You know, I feel good, so I go, and I am ready. Like, I don’t have pain, I feel nothing, so I just can go. When my hamstring is sore or something, then I will stretch for sure a little bit before practice.”
Aspects to improve	Improving facilities and organisation	Manager 01: “We work with kids from the age of 12(…)in the schools we have full-time coaches, physical coaches, physios and everything. So, we start educating them very intensely on all these things.” Manager 02: “We also get a lot of help from the Olympic Committee. We get special days where we can go as a federation, and then they are going to give us tools to do injury prevention, to have a good warming up, what to do if you have an injury, so we get a lot of help from these structures.” Athlete 03: “When I was in the US, I just went to training, but before starting, I was in the room to chill with my teammates, and we stretched, we were with the physio, and I had a massage or stretching. It is that I don’t have here (Belgium) and also after the training, for example in Belgium I can’t really take an ice bath or go to the physio.”
	Convince and educate all stakeholders	Medical doctor: “For the athlete, we have to discuss with them to explain what the goals are, the aim of this evaluation. We have to convince them that it is better to avoid injuries, to avoid loss of time for competition preparation or training and also I discuss that with them, but it is not always easy for them to understand.” Strength and conditioning coach: “So, it is education. It is after some injury that they understand that it is important.(…)If I see them after injury or after some pain problem and I work with them on this part, and they feel that it is better after their mind changes(…)they can work alone on this because they don’t want to have some problem after. So, I think it is like that they understand it.” Athlete 01: “But for me, I really need to be explained why it is important and why we are doing something.”
Context of Belgium	Recent accomplishments as a turning point	Athlete 07: “I think our better results helped to have more money, and now we have more people that are helping us. I think 5 years ago we were not on the European Championships (of Basketball), and there was no money to do this.” Coach 01: “5 years ago, nobody cared for the Belgian Cats (Women Basketball National team). We didn’t know that we had a team.(…)Now when you speak about the Cats, everybody knows the Cats because we were at the World Championship, we are the first basketball team that goes to the Olympics, we are on tv. So, it is great.” Coach 02: “When I took over the Belgium Equestrian team, it was in the second division.(…)so, the first aim was to get up from second division to first division. We did in the first year(…), and then in the second year, we jumped all the first division nation cups and big shows. We won the Nations Cup final, and last year, we became European champions.”