Supporting athletes in high performance environments

Athletes competing in high-performance environments often present to general practice with concerns that extend beyond musculoskeletal injuries or acute illness. While physical training is a core component of athletic success, peak performance and long-term wellbeing depend on a broader support system that includes mental health care, social support, and appropriate clinical oversight.

Primary care GPs play a central role in identifying early signs of physical overload, psychological distress, and burnout. Without timely and coordinated support, the cumulative pressures of elite sport can contribute to anxiety, depression, injury recurrence, and reduced performance.

Understanding the demands on high-performance athletes

Athletes operating at elite or sub-elite levels face unique stressors, including high training loads, frequent competition, public scrutiny, and ongoing pressure to perform. These demands can significantly increase the risk of both physical and mental health concerns.

Transitions into high-performance sport (particularly for adolescents and young adults) are a recognised period of vulnerability. Athletes may present to general practice during this phase with non-specific symptoms such as fatigue, sleep disturbance, recurrent injury, mood changes, or reduced motivation.

Physical stressors

Increased training intensity, altered nutrition requirements, travel demands, and disrupted sleep patterns can place significant strain on the body. Over time, these stressors may contribute to overtraining, immune suppression, and injury, often presenting subtly in primary care settings.

Psychological pressures

Psychological stressors may include performance anxiety, fear of deselection, identity issues, and difficulties balancing sport with education, work, or family life. Strong relationships with coaches and support staff can be protective, but many athletes rely on their GP as a trusted, confidential point of care.

Holistic support in general practice

Supporting high-performance athletes requires a holistic, biopsychosocial approach. For GPs, this involves considering physical symptoms in the context of training load, recovery, mental health, and social environment.

Effective care may include:

• Monitoring training and recovery balance
• Screening for mental health concerns
• Supporting autonomy and shared decision-making
• Coordinating care with allied health and sports medicine teams

Optimising physical performance and recovery

From a primary care perspective, optimising performance involves recognising early signs of overload and inadequate recovery. Structured training programs are typically managed by coaches and sports scientists, but GPs can play an important role in identifying red flags such as persistent fatigue, recurrent infections, or unexplained pain.

Sleep optimisation, nutrition, physiotherapy, and adequate rest are essential components of recovery. Addressing these factors can reduce injury risk, support mental health, and prevent burnout.

Supporting mental health and psychological resilience

Mental health presentations are common among high-performance athletes, yet stigma may delay help-seeking. GPs are often the first clinicians athletes feel comfortable approaching.

Assessment and management may include:

• Screening for anxiety, depression, and disordered eating
• Supporting athletes during injury, performance slumps, or career transitions
• Referral to sports psychologists or mental health professionals where appropriate

Creating a safe, non-judgemental space for discussion is critical, particularly when athletes are reluctant to disclose concerns within their sporting organisation.

Nutrition and supplement use

Athletes frequently seek advice on nutrition and supplementation. GPs should be alert to inadequate energy intake, relative energy deficiency in sport (RED-S), and unsafe or unnecessary supplement use.

Referral to an accredited sports dietitian is recommended for individualised nutrition planning, particularly where injury, fatigue, or menstrual disturbance is present.

Injury prevention and management

While injury prevention programs are often led by coaches and physiotherapists, GPs play an important role in early assessment, imaging decisions, and coordination of care.

Timely management of injuries (including appropriate rest, rehabilitation, and return-to-play guidance) reduces the risk of chronic issues and supports both physical and psychological recovery.

Working within a multidisciplinary team

Coaches and technical staff

Clear communication between GPs and coaching staff (with athlete consent) supports safe training decisions and realistic expectations during injury or illness.

Sports scientists and medical professionals

Collaboration with sports physicians, physiotherapists, and sports scientists allows for integrated care that balances performance goals with long-term health.

Psychologists and mental performance consultants

Mental health professionals play a key role in supporting coping strategies, stress management, and emotional regulation. GPs are often central in facilitating timely referral and follow-up.

Creating sustainable high-performance pathways

Sustainable athletic development prioritises long-term health over short-term performance gains. GPs can advocate for ethical practice, appropriate workload management, and mental health support, particularly for younger athletes.

By recognising the broader determinants of health in high-performance sport, primary care clinicians can help athletes maintain both performance and wellbeing across their careers.

Primary care GPs are uniquely positioned to support athletes in high-performance environments through early identification of risk, holistic assessment, and coordinated care. By integrating physical health, mental wellbeing, nutrition, and injury management within a multidisciplinary framework, GPs can play a vital role in promoting sustainable performance and long-term athlete health.

- Dr Humda, Physiotherapist

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References

https://pubmed.ncbi.nlm.nih.gov/40134904/
https://onlinelibrary.wiley.com/doi/abs/10.1111/jsr.70063
https://pmc.ncbi.nlm.nih.gov/articles/PMC11747821/
https://pmc.ncbi.nlm.nih.gov/articles/PMC12170128/
https://pmc.ncbi.nlm.nih.gov/articles/PMC11937034/