Performance vs. care: how coaches’ discourse shapes health-related decision making in German elite handball

This study explores the broader discourses coaches in German elite handball mobilise when constructing meanings around athlete pain and injury and how these discursive practices shape health-related decision making. Semi-structured interviews were conducted with ten handball coaches and analysed using a discourse-oriented thematic approach. The analysis revealed two central discursive effects. First, coaches normalised pain by drawing on minimisation, toughness, and performance discourses. Through discursive practices such as downplaying of discomfort, using metaphors, and blurring the boundaries between discomfort and harm, coaches framed continued participation despite pain as expected and legitimate, thereby incentivising risk-taking behaviours such as playing hurt. Second, coaches retained decision-making authority while delegating responsibility by invoking professional responsibility discourse. Through positioning practices, coaches delineated their own expertise in performance and selection from the professional expertise of medical staff and the supposed bodily autonomy of athletes. This produces an illusion of cooperative decision-making in which athletes internalise responsibility while lacking control and medical expertise remains advisory rather than authoritative. Coaches’ discursive practices therefore functioned to prioritise performance over care and undermined athlete safeguarding in health-related decisions. These findings contribute to the sociological understanding of how authority and responsibility are distributed through discourse in elite sport and highlight the need for institutional interventions, including clearer role definitions and standardised return-to-sport protocols.