While some studies focus on the relationship between injury risk and individual factors such as personality traits and BMI, other studies assess injury risk in elite sport from a general health and safety perspective. For example, of the studies reviewed, many focus on elite athletes’ injury-related knowledge or certain types of injury prevention techniques, such as ankle sprain prevention and knee injury prevention. To date, researchers have studied sporting injury from different perspectives. If injury awareness were given a similar weighting in elite sport as in any other highly physical occupation, the potential benefits to elite athletes and their long-term health and wellbeing could be highly significant. The incorporation in elite sport of OSH practices to reduce risky behaviours could minimise the health impacts of inevitable sporting injuries in the long-term. OSH management practices have been embedded into organisational management in international and national health and safety legislation but not completely adopted in elite sport organisations. One potential reason for this is that non-sporting workplaces have adopted OSH management practices to reduce the risk to as low as reasonably practicable (ALARP). According to statistics reported in the UK, the overall injury risk in professional soccer is 1000 times higher compared to other high-risk occupations such as construction and mining. Sporting injuries limit an athlete’s preparation and subsequent performances, which can have both short-term and long-term health impacts. The pressure of sports competitiveness inspires elite athletes to “win at all costs” and may lead them to neglect injuries and continue playing with pain, resulting in a higher occupational risk acceptance. In an article about concussion in professional rugby union, ex-Scotland representative player Rory Lamont comments that “a flagrant disregard for your own welfare almost seems a prerequisite for achieving success at the highest level”. Based on the papers reviewed, the study population was categorised as elite, professional, high-performance amateur and student-athletes. Further research is required to develop a quantitative measurement instrument to evaluate occupational health awareness in the sport context. This review contributes to a better understanding of how to build a positive safety culture, one that could reduce elite athletes’ injury rate and improve their long-term wellbeing. The factors impeding athletes’ injury awareness from achieving occupational health standards are discussed from three safety management perspectives: organisational, societal and individual. All the 39 studies identified met the moderate methodological quality criteria according to the Mixed Methods Appraisal Tool (MMAT). This review identifies that most elite athletes are not aware that sporting injuries are occupational injuries requiring behaviours determined by OSH rules. If injury awareness were given a similar weighting in elite sports as in any other highly physical occupation, the potential benefits to elite athletes and their long-term health could be highly significant. The objective of this narrative review is to (1) summarise elite athletes’ attitudes towards important occupational safety and health (OSH) practices, including injury reporting, medicine usage and personal protective equipment (PPE) usage, and (2) explore factors that may influence elite athletes’ injury awareness. To date, many studies have focused on elite athletes’ specific injury prevention techniques. Professional athletes often expose themselves to risky behaviours, resulting in a higher acceptance level of occupational risk compared to other occupations. Professional athletes involved in high-performance sport are at a high injury risk, which may lead to long-term health consequences.
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