The coaches expected that health professionals, especially physiotherapists and chiropractors should contact them to provide information and instruction on how to proceed with the injured child or adolescent. Although the coaches often sought information themselves via the child’s parents, they did not feel they had the time for it. Often, the coaches were present in their free time in the evenings and weekends when nursing staff were not on duty. At the same time, they showed understanding that no physiotherapists were able to contact them. The coaches thought that it was absolutely impossible to get in touch with the doctors, who never contacted the coaches themselves. As one coach puts it:

Coaches conveyed the importance of children and adolescents feeling welcome even if they are hurt, and they felt that the child should have the coach’s full understanding of how he or she felt due to the injuries. Coaches felt that some children were more difficult to talk to than others and thought that maybe they were looking for more support from their teammates. However, this was not always the case; sometimes they chose to withdraw and maybe stop playing the sport. The coaches did not know if someone had the responsibility, but just thought that someone else will take responsibility. Brewer et al. (1995) describe in their study that acutely injured children who lack self-confidence and control of their rehabilitation are more sensitive to emotional distress because of injury, which again emphasises that young athletes are in greater need of social support than adults in connection with a sports injury. Coaches felt that children could easily get performance anxiety and try to do more than they really were ripe for, like in Taylor and Taylor’s results (1997). The coaches in this study believed that parents had important role to support their children, which was not always the case. According to them, parents often lacked knowledge about how their child was actually doing. Previous studies have also demonstrated that athletes often stop participating in their sports because of high expectations from coaches and parents, which can be one of the causes of “burnout” - a multidimensional syndrome (Creswell and Eklund, 2006; Gould, 1996; Gould et al., 1996; Gustafsson et al., 2008). In a group of Swedish young sportsmen, estimated 1%–2% stopped participating in sports because of “burnout” (Gustafsson et al., 2007), and the figure is expected to rise with increased training and more competitions at younger ages (Gould and Dieffenbach, 2002). Some of the coaches suggested that it might be beneficial to have some kind of mentor of the same age as the child. This would allow the child to talk with and vent his or her feelings with someone who had previously been through basically the same injury. Further, it may be comforting for the child to talk to someone completely outside. This is also something that Podlog and Dionigi (2010) addressed in their study when referring to ”role models.”

End of career represents a unique type of transition in life that all athletes go through (Wylleman et al., 2004). Transitions can be divided into normal and abnormal (Schlossberg, 1984). Normal transitions occur when the athlete decides to leave the sport and abnormal and unexpected transitions occur, for example, when the athlete suffers a sports injury (Blinde and Greendorfer, 1985). Many researchers have acknowledged that athletes who end a sports career can experience a range of emotions such as sadness, loss of identity, loneliness, anxiety and fear, loss of self-esteem, depression, alcohol abuse and even suicide (Alfermann et al., 2004; Lally, 2007; Pearson and Petitpas, 1990). According to Stoltenburg et al. (2011), the reactions when the athlete ends with a sport are stronger if one has a strong sporting character because the sport is very important for the person as an athlete. Most athletes do not develop a life after the sport. With the knowledge that children’s reactions to injury is greater than in adults (Brewer et al., 1995), it is very important to catch children when they stop their sport for whatever reason and thus hopefully prevent children from feeling bad and help them to understand that they have some kind of affiliation, even without their sport.

There are different views among the coaches in this study as to how best to get the children back into the sport. All the coaches, however, agreed that something should be done to facilitate children’s return to the sport. The coaches in team sports felt that it seemed to be harder for girls to return to the sport than boys. They felt that girls could be unfair to each other and not as supportive as the boys usually are. This feeling that girls could be unfair to each other compared to boys is not something that was noted by coaches of artistic gymnastics, having had experience training both girls and boys, but they agreed that girls found it harder to return to sport compared to boys.

All those interviewed described the feeling that children who suffered a sports injury were undergoing major trauma. They saw that children’s emotional reactions were very strong, and the younger they were the greater reactions. This is in line with previous studies (Brewer et al., 1995; Nordahl et al., 2014). They all also agreed that family and friends were most important during the injury period, while parents described that it was not until afterwards that they realised how the injury had actually affected their children. The coaches agreed that it was entirely dependent on them as to whether the children retained their interest in the sport over the injury period or not, but, of course, it was also about the support they received from home and their inner desire. This finding is in line with that from earlier study by Podlog and Dionigi (2010) in which they described that athletes have to overcome psychological barriers that arise due to lost confidence, fear of reinjury, feeling of isolation from the team and time pressure to return to the sport. Coaches felt that they could help children better if they had previous experience of working with injured children and adolescents. Due to the fact that educational level was quite low regarding psychological aspects, coaches in this study believed that having experience was very important.

Parents conveyed a resignation to medical care. They described that some doctors found it difficult to understand importance of rapid response, in the case of sports injuries in children and adolescents. Parents felt that ending up with a doctor with great interest and knowledge in sports injuries was crucial for their children to get the right care. Some of the parents were very satisfied with the communication in healthcare, while others thought it was very bad. Some had, for example, received responses from physiotherapists indicating that they did not have time to contact the parents. Some also described that their child had a much more difficult time when returning to the sport than during rehabilitation. The parents felt that children themselves had difficulty talking about their feelings, especially boys, whereas girls often found security in confiding in their friends.

Parents in the study completely agreed that they were the legal guardians who had the ultimate responsibility for their children. Since parents felt that communication was a big problem, some of them suggested that some form of written rehabilitation plan could facilitate this communication that was lacking. They felt that a document issued by the attending healthcare professional for the child, clearly stating the objectives to be achieved, as required by the child, coach, parent, and physiotherapist as well as a timetable would be beneficial. They thought that it was also more practical for a child to look at a piece of paper and follow a plan and that it would increase security knowing that everyone involved had the same information and goals to work towards. Most parents agreed that the support that their children should receive in connection with primarily return to the sport could be conducted in a different manner than the current, but they also agreed that it was related to the specific coach the child had as well as his or her involvement.

Parents felt insufficient and had difficulties to respond to their children when they were injured and thus could not find an outlet for their energy through their sports participation, which they were accustomed to. Most did not believe that the coaches would contact their children and wondered what would happen and how they would feel, since this made children lose their identity as athletes. The family’s support is very important for the injured young athletes. Parents described that the children seemed to experience emptiness, became irritable and found it harder to concentrate, which hampered their school work.

What has emerged in this study, which was not addressed in previous studies, is the parents’ experiences when their children suffer a sports injury. The parents felt that it was difficult to see their children being injured, hard to fight their way through the medical care, and some did not believe that their children got the right response from the sports when they returned to their sport after the injury.

Physiotherapists considered that it was the coaches’ responsibility to contact them to get the information about the injured child, which was rarely done even if they left contact information with children and parents. This applies both for rehabilitation and above all in connection with return to sport. Several of the physiotherapists stated they never talked to any coach. Those who had contact with coaches felt that collaboration worked only if there was already an established contact and that one had to maintain contacts for a long time to gain the confidence of the coaches. They disclosed that there were communication problems with doctors as well as problems getting help with rapid diagnostics.

It was much easier for those clubs that had a physiotherapist associated with it, who participated in the training. It emerged during the interviews that they wished to have a part-time employed physiotherapist to sit down and talk to the coach and discuss the exercises. As a result, the coaches felt calmer and safer, which also rubs off on the children. This was also described by Podlog and Dionigi (2010), where the coaches emphasised the importance of direct communication with those treating the athlete to succeed in his or her return to the sport as soon as possible.

Physiotherapists serve a useful purpose regarding the children’s identity as athletes. They felt that the children seemed to find a new identity during their rehabilitation. The children got to meet others in the same situation as them, and they felt they experienced a bond with the physiotherapist, who was viewed as their new coach and someone they could turn to in order to discuss their situation. They also noticed that as children got older, they began to think more about the risks and consequences of returning to the sport, and questioned if it was really worth it. They thought that they sometimes could see that other interests had greater importance for the injured child than return to the sport, and some of them also experienced their injury as liberation from the sport. They wanted deeper knowledge of cognitive behavioural therapy to be able to respond to children’s needs in the best way.

Physiotherapists in the study were fully aware that they had medical responsibility for rehabilitation, but they also believed, like parents, that it was the parents who had overall responsibility regarding what is best for the child. They believed that the children who were most successful in rehabilitation were the ones who got the best support from home, had great confidence and trust in themselves and believed in his or her own body, which Nordahl et al. (2014) described in their study. Responding physiotherapists also described that they noticed that those children whose parents pushed too much and did not let the rehabilitation take its time were less successful in returning to the sport. Physiotherapists also had a feeling that adolescents in their late teens had more difficulty to return to the sport after an injury, but they noticed no gender differences, unlike the coaches.