The goal of public health is to ensure the prevention and management of adverse outcomes in the population. Those of us involved with athletic training and sports medicine research and practice constantly aim to establish a culture that advocates for appropriate onsite medical coverage and injury prevention, detection, and management. However, these cultural norms we aim to create must transcend the sports settings in which we work and become enmeshed in other settings that emphasize physical activity; injury prevention is not exclusive to the sports setting. As noted by the American College of Sports and Medicine's “Athletes and the Arts” initiative,1 performing artists are athletes, as they too play through pain, practice or perform almost every day, compete in challenging environments, and face the real risks of career-threatening injury. Previous research in the Journal of Athletic Training has examined such performers,2 and the National Athletic Trainers' Association3 notes that the performing arts is an emerging setting in which athletic trainers provide care.
One large-scale setting that combines performance, competition, and perseverance is the Eurovision Song Contest (ESC).4 Each year, the European Broadcasting Union (EBU) oversees a television program that features national broadcasters from numerous countries who each present a 3-minute original song performed live by a selected artist, group, or band. Through each country's team of national jurors and televoting, a winning song is selected, and the winner's national broadcaster hosts the following year's show. Viewership reaches nearly 200 million annually. A total of 43 countries participated in ESC 2018, and Rádio e Televisão de Portugal was the host in Lisbon. Aside from my work as a sports injury epidemiologist, I have also served as an accredited press member, reviewing rehearsals and interacting with the artists and their delegations.
Although I did not attend this year's show, I continued my work as a journalist from the United States, communicating with the onsite team. On the first day of rehearsals, the Czech Republic representative, Mikolas Josef—one of the precontest favorites to win5—attempted a flip as part of his performance and landed in an awkward manner.6 According to my colleagues at the press center, the awkward landing was noticeable. Although Josef was able to finish the rehearsal, his pain was evident; at one point, he stopped rehearsals to ask the stage director to be certain the onstage props were secure to prevent any injuries to him or his backup dancers.7
After the rehearsals, Josef was taken to a local hospital as a precautionary measure. Czech Republic media soon reported he had sustained a cervical spine injury.8 However, at a press conference, the head of the Czech Republic delegation told the press and fans that Josef had sustained a back injury but to rest assured that the injury was not serious,9 yet hours later, Josef posted on Instagram that his condition had worsened and he could not walk.10 Still, he insisted, “I will perform no matter what.” In communications with his fans over the next few days, Josef stated his condition was improving, he had agreed to take painkillers, and he would rehearse and perform as planned, modifying his choreography as needed.11 Unfortunately, various factions of Eurovision fans accused the Czech Republic delegation of conspiring in 2 ways: first, by downplaying the severity of the injury, and second, by faking the injury to garner a sympathy vote and obtain a better result. In the end, Josef performed in the first semifinal without the front flip and successfully qualified for the Grand Final, which took place 4 days later. Josef repeated his performance, adding the front flip, and finished sixth, the highest placement ever for the Czech Republic.
Although it may seem at first glance that the cultures of sports and Eurovision are disparate, many parallels exist. As in the Olympics, fans of Eurovision recognize their respective country's act and song as representative of their own national identity.12 Similar sentiments can be found in the United States and globally in sports13–15 ; being a fan of a sports team can represent your love for your alma mater, city, or country. However, in this case study of Mikolas Josef at ESC 2018, the parallels between sports and Eurovision extend to how we perceive injury. A favorite participant is injured, causing fans to worry about how this will affect his and his country's results. Other fans angrily respond that he is seeking an unfair advantage. In contrast, the national organizing committee (ie, the delegation) is also accused of downplaying the severity of the injury, perhaps to provide Josef with the privacy to recover without undue external pressure that could exacerbate his internal pressure to perform. This feels all too familiar; we could easily change aspects of this Eurovision-based case study to fit within a sports injury-based narrative: a star player sustains an injury right before a championship game and faces pressures to play through the injury and pain.
Eurovision and the EBU have encountered minor injuries in the past,16 but this was likely the first time a more potentially severe injury occurred. Although the final outcome (as we currently know) was positive for all involved, it is important to digest and synthesize what happened, what went well, and what could have been improved. As those involved in the prevention, care, and management of athletic injuries, we must do the same. For myself, as both a sports injury epidemiologist and a Eurovision aficionado, I clearly see how this Eurovision case study relates to the work that athletic training and sports medicine researchers and practitioners perform in any setting where individuals engage in physical activity.
All settings that incorporate physical activity, including sports settings and the performing arts sector, need to ensure “buy-in” from all stakeholders to promote a culture of safety and injury prevention and management. This need for stakeholder buy-in can be best applied to the tenets of the socioecological framework when considering strategies to increase the adoption of best practices and implementation of measures to protect the health and safety of individuals.17 As applied to this Eurovision-based case study, the socioecological framework organizes influential factors into 5 categories: (1) individual (the performer, Mikolas Josef); (2) interpersonal (eg, the communication Josef had with fans via social media as well as their reactions and interactions); (3) organizational (the response of the Czech Republic delegation); (4) environmental (norms related to how an injured performer should proceed despite injury); and (5) policy (how the EBU that oversees Eurovision ensures the safety of participants). Although the socioecological framework is not often used in athletic training and sports medicine—and even less often in the performing arts—it is integral to considering how to create effective injury-prevention and -management interventions that address multiple levels of influence. Authors18 publishing in the Journal of Athletic Training have begun to engage athletic training and sports medicine researchers and practitioners in discussion regarding this topic. I hope to see this dialogue continue, while expanding on the prominent topics found within this case study, including the role of social media and the control of sensitive medical information.
Although onsite medical care was available at ESC 2018, other aspects of injury prevention and management might have been improved. Could more have been done by the contest organizers to ensure the safety of the performers? Could the Czech Republic delegation have been more transparent about Josef's health status rather than relying on the performer himself to post updates via social media? Could more have been done to control sensitive medical information, particularly as social media becomes a frequent and normalized means of communication? Could some fans actually stop thinking about the fact that this was a contest and instead focus on wishing Josef a safe recovery? And could he have put too much pressure on himself to perform too soon, despite the rest and recovery he had pursued? Similarly, stakeholders in any organized setting involving physical activity should thoughtfully consider related questions regarding safety.
I do not wish to single out any individual or organization. As in the sports setting, we all have a shared responsibility to ensure the health, safety, and wellbeing of our participants, be they high school student-athletes or performers on the world's biggest stage. These lessons from ESC 2018 likely also apply to sports settings, just as much of what we know about injury prevention and management in sports settings can apply to emerging areas such as the performing arts. All stakeholders play important roles in injury prevention and management. Public health frameworks such as the socioecological model may help athletic training and sports medicine researchers and practitioners ensure that every setting builds the buy-in necessary to protect the health and safety of the athletes we serve.
Thank you to Johna K. Register-Mihalik, PhD, ATC, and Connor Terry for their review of this commentary. I write for ESC United, but this commentary is my opinion and does not represent the views of the other editors of ESC United or ESC United as a whole.