ANALYSIS | The dangers of elite athletes pushing themselves to the limit, and beyond

Andrea Fuentes recounts the rescue of Anita Álvarez 1:07

(CNN) --

The images are dramatic and shocking, and that's why they've been seen around the world.

Anita Álvarez lies unconscious at the bottom of the pool after finishing her routine at the FINA World Aquatics Championships.

Her knees touch the tiles, her arms are limp, her eyes are closed.

Later, we found out that she was not breathing.

What if her coach, Andrea Fuentes, hadn't noticed that the swimmer's feet looked paler than normal, putting her on high alert, and what if she hadn't reacted like lightning jumping to save his athlete when he saw that the American was sinking instead of rising to breathe?

• Andrea Fuentes recounts the rescue of Anita Álvarez: I didn't ask myself if I had to go or not, I wasn't going to wait"

In the end, as Fuentes has told numerous journalists after Wednesday's incredible rescue, it all worked out.

But the extraordinary images captured by photographer Oli Scarff highlight how achieving extraordinary things can often come at a cost.

Perhaps for those who never watch synchronized swimming, or only watch it every four years at the Olympics, the most surprising thing of all is to hear those involved in this sport talk about how what happened to Álvarez in Budapest is a risk that comes with sport.

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Álvarez (left) was rescued by her coach, Andrea Fuentes, a four-time Olympic medalist in synchronized swimming.

In fact, that was the second time Fuentes had rescued Alvarez.

Last year, he jumped into the pool during an Olympic qualifying event to get the 25-year-old to safety.

Sources told CNN this week that swimmers often hold their breath for long periods to improve their lung capacity, but said such practices were never against medical advice.

Former Spanish artistic swimmer Gemma Mengual, a three-time Olympian, described feeling a tingling sensation in her face, nearly passing out in the pool, and abandoning a routine for fear of what might happen.

"It's a very demanding sport. You were always going to the limit. I was always scared when I competed," she told Atresmedia in Spain.

And that, in essence, is what elite sport is all about.

It's about pushing yourself to the limit, physically and mentally;

in training, in competition, day after day, year after year, because that is where the bar has been set, in all sports.

"There are small prices that it is okay to pay"

Synchronized swimmers can look serene, ballet-dancing in the water.

They are prepared, they smile, they charm the crowds.

Heck, there's even music, makeup, and sequins.

It all seems simple, but that's because those who stand out always make it seem that way.

It does not mean that there is no pain before, during or after.

Look below the surface and there are dangers.

Getting punched or kicked is commonplace for artistic swimmers performing in unison a few feet away, often for up to four minutes.

Lying on your stomach and holding your breath for long periods can also cause dizziness and blurred vision.

Concussion is even a problem, as reported by the New York Times, in what is essentially a contact sport.

"I've been an athlete my whole life, for 20 years in the pool...sometimes, there are small prices that it's okay to pay," Fuentes told CNN.

"And in all sports, if you meet a high-performing athlete, that's part of the beauty: push your limits and grow from it."

Members of the United States team react when Anita Alvarez is treated by medical personnel.

In sport there is no greatness without sacrifice.

There is no way to be very, very good without sacrifice.

Elite athletes are the best in their sport, and while they may not all be the best of all time, they are still the best in the world at what they do, and to be that good you have to possess certain characteristics.

Talent, yes, determination, without a doubt, but also the ability to push yourself, to live life to the extreme, and that's hard.

Parties are missed, nights out are declined, family holidays are ruined, all for what British Cycling during its heyday of the last decade would describe as "marginal gains".

They are small improvements, refining everything by 1%, to significantly increase your overall performance;

Because when the difference between success and failure is a fraction of a second or an inch, every little thing matters.

For British Cycling, that meant hiring a surgeon to teach each cyclist the best way to wash their hands to reduce the chances of catching a cold, and choosing the best type of pillow and mattress so each cyclist could get the best sleep possible.

When constantly doing that little bit more is your life, then pushing yourself to such an extreme, or more relevant, without knowing where the limit really is, during the competition so that your well-being, or even your life, is put in danger, perhaps becomes more understandable for the disciplined athlete.

In a 2012 column in England's The Guardian, triathlete Lesley Paterson wrote: "All the best athletes are a little crazy, a little obsessive, very selfish and certainly not the norm."

Anita Alvarez competes before collapsing during the synchronized swimming solo free final at the FINA World Championships.

Perhaps that is why athletes need to be protected, cared for by those who realize that winning should not come at any cost.

But how much is too much?

In his statement posted on Instagram, Fuentes says artistic swimming is no different from other high-endurance sports.

"We've all seen footage where some athletes don't make it to the finish line and others help them get there," he said.

And we have.

Who could forget seeing the footage of British triathlete Alistair Brownlee stopping to help his brother in distress and almost picking him up before launching him over the finish line?

At the Gold Coast Commonwealth Games, Scotland's Callum Hawkins missed out on men's marathon gold after collapsing and hitting his head against a roadside barrier two kilometers from the finish in scorching east coast heat .

There is also, of course, the story of the now mythologized Greek runner Pheidippides, the inspiration for the modern marathon.

Did he announce Greece's victory over the Persians and fatally collapse after running from Marathon to Athens?

Depends on who you ask.

Thousands of years ago the sport came with risk, and it still does.

In 2008, 11 climbers died in the quest to reach the top of K2, the world's second-highest mountain, when an ice avalanche toppled a fixed rope used by the climbers.

The witness who captured the live rescue of Anita Alvarez 1:29

However, elite athletes tend to differentiate between risk and consequence.

For Alex Honnold, widely regarded as the greatest climber of all time, the risk of scaling dizzying rock without a rope is low, the consequence - which could be death, of course - high.

In 2017, the American became the first person to climb the 975-meter El Capitan monolith without ropes, a skill known as "free soloing."

Attempting the feat was him, he told CNN a few years ago, "business as usual" and it was based on decades of practice.

And it's that practice, the thousands of hours spent perfecting a craft, that the average person doesn't see.

The end product is often a flawless performance, enhancing the athlete's otherworldly status, which is why a dramatic fall or rescue becomes front-page news around the world.

What happened in Budapest this week was a reminder that elite athletes, while far from average, are also human.