Role of the coach

I coach them, I treat them, I listen to them’: the multifaceted role of the coach – a qualitative study on stakeholders’ perspectives on injury prevention and management in Senegal (Africa)

Key words: Qualitative Research; Sporting injuries; Sports medicine; Prevention; Africa

Why is this study important?

This study addresses a critical gap in sports medicine: the difference between what is recommended in the literature and what actually happens in the field, particularly in low-resource settings (1). Most injury prevention and management strategies have been developed and validated in high-income countries, where structured medical support, access to rehabilitation and multidisciplinary teams are widely available.

However, these conditions are not universal. In many contexts, including parts of Africa, athletes and practitioners operate within very different realities. Understanding these realities is essential if we want prevention strategies to be effective and not just theoretically sound.

By focusing on Senegal, this study also gains particular relevance in light of the upcoming 2026 Youth Olympic Games. It provides timely insights into the current state of athlete care and highlights opportunities for meaningful, context-specific improvements. 

How did the study go about this?

The study used a qualitative design to explore real-world experiences. Sixteen stakeholders involved in elite sport in Senegal (including athletes, coaches and health professionals) took part in in-depth, semi-structured interviews.

This approach allowed participants to describe their daily practice, challenges and perceptions in their own words, rather than being constrained by predefined questionnaires. The interviews were then analysed using a grounded theory method, which involves systematically identifying patterns, (sub)categories and relationships within the data.

The aim was not to quantify behaviours, but to build a conceptual understanding of how injury prevention and management are organised and experienced in this specific context. 

What did the study find?

The findings reveal a system that relies heavily on individual initiative rather than structured organisation. Injury prevention is often informal, based on personal experience rather than standardised programmes, and tends to be implemented inconsistently. In many cases, prevention becomes a priority only after an injury has occurred, reflecting a predominantly reactive approach.

Injury management is similarly affected by contextual constraints. Limited financial resources, restricted access to healthcare and fragmented systems make it difficult to ensure appropriate diagnosis, treatment and follow-up. As a result, athletes often return to sport prematurely, sometimes without clear clinical criteria, increasing the risk of recurrence or long-term consequences. ACL injuries are often considered as a career-ending event. 

One of the most striking findings is the central role of the coach. In the absence of structured medical support, coaches frequently take on responsibilities that go far beyond their traditional role. They provide first aid, make return-to-play decisions, support athletes emotionally and sometimes even assist with social or financial issues. This highlights both their importance within the system and the lack of formal support structures.

The study also underscores the influence of cultural and social factors. Pain is often normalised, and continuing to play despite injury can be seen as a sign of strength. Traditional medicine remains widely used, mainly due to accessibility and cost, and sometimes coexists with or replaces conventional care. Mental health is rarely addressed, with stigma limiting open discussion and access to support. In addition, gender-related barriers continue to restrict participation and access to care for women athletes.

Despite these challenges, the study also highlights a strong motivation among stakeholders to improve practices, particularly if solutions are adapted to their context.

What are the key take-home points?

This study reminds us that effective injury prevention cannot rely on evidence alone. It must fit the context in which it is applied. Strategies developed in well-resourced environments may lose their impact if they are not adapted to local realities, including financial constraints, access to care and cultural beliefs.

One of the most important messages is the central role of the coach. In this context, the coach is not just responsible for performance but often becomes the main point of contact for injury prevention, management and even psychosocial support. This highlights a clear opportunity: supporting and educating coaches may be one of the most efficient ways to improve athlete health in similar settings.

Another important message is that cultural factors cannot be ignored. Beliefs around pain, the use of traditional medicine, and the stigma surrounding mental health all influence how athletes report symptoms, seek care and adhere to recommendations. Any intervention that does not take these dimensions into account is unlikely to be effective.

Finally, the findings highlight that improving athlete health in these settings requires a broader perspective. It is not only about medical knowledge, but also about education, organisation and long-term system development. Events such as the Youth Olympic Games represent a unique opportunity to drive change, but only if they are followed by sustainable actions and locally adapted strategies.

Blog authors: Camille Tooth

References:

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