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Competing loyalties in sports medicine: Threats to medical professionalism in elite, commercial sport



This paper explores the ways in which the environment of elite-level and, in particular, commercial sport produces expectations and pressures on sports doctors that may compromise their professional standards. Specifically, this paper addresses the pressures and demands that emerge from varying groups and individuals with whom doctors have relationships within the world of elite sport including: the athlete, coach, management, media (including broadcasters) and sponsors. Using grounded theory and drawing upon qualitative data collected from semi-structured interviews with 16 sports doctors the study explores the ethical concerns of medical practitioners working with elite athletes and teams in New Zealand. Key emerging themes include: the complex environment within which sports doctors work, including the limited control over their work environment, the pressures arising from the commercial interests of sport, the issue of competing obligations, and emerging threats to medical professionalism.
Sociology of Sport
International Review for the
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DOI: 10.1177/1012690211435031
July 2012
2013 48: 238 originally published online 13International Review for the Sociology of Sport
Lynley Anderson and Steve Jackson
in elite, commercial sport
Competing loyalties in sports medicine: Threats to medical professionalism
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Sociology of Sport
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DOI: 10.1177/1012690211435031
Competing loyalties in sports
medicine: Threats to medical
professionalism in elite,
commercial sport
Lynley Anderson
University of Otago, New Zealand
Steve Jackson
University of Otago, New Zealand
This paper explores the ways in which the environment of elite-level and, in particular,
commercial sport produces expectations and pressures on sports doctors that may compromise
their professional standards. Specifically, this paper addresses the pressures and demands that
emerge from varying groups and individuals with whom doctors have relationships within the
world of elite sport including: the athlete, coach, management, media (including broadcasters)
and sponsors. Using grounded theory and drawing upon qualitative data collected from semi-
structured interviews with 16 sports doctors the study explores the ethical concerns of medical
practitioners working with elite athletes and teams in New Zealand. Key emerging themes include:
the complex environment within which sports doctors work, including the limited control over
their work environment, the pressures arising from the commercial interests of sport, the issue
of competing obligations, and emerging threats to medical professionalism.
elite sport, ethics, New Zealand, sports medicine
In 2009 UK sports doctor Wendy Chapman was suspended by the British General
Medical Council for deliberately cutting the inside of the mouth of Harlequins’ rugby
player Tom Williams. Newspaper reports suggested the player asked the doctor to make
Corresponding author:
Lynley Anderson, Bioethics Centre, Division of Health Sciences, University of Otago, PO Box 913, Dunedin,
New Zealand.
435031IRS48210.1177/1012690211435031Anderson and JacksonInternational Review for the Sociology of Sport
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Anderson and Jackson 239
the cut in order to fake an injury by using a blood capsule so that a specialist kicker could
replace him and win the match (Rees, 2009).The blood capsule was allegedly given to
him by team physiotherapist Stephen Brennan (he was subsequently struck off the physi-
otherapy register by the Health Professions Council; this was overturned on appeal to the
High Court in 2011). Although it could be argued that the injury was minor, with no
likely long-term effects, outsiders might wonder how members of two respected health
professional groups could support such blatant cheating. While not excusing the actions
of the doctor and physiotherapist, we can better understand their actions by considering
the contemporary cultural and economic context of elite and professional sport and the
threat this might pose to medical professionalism.
Consider, for example, the fact that the highly synergistic relationships between sport-
ing bodies, global media networks and corporate sponsors have had a dramatic impact on
the structure, organisation, production and consumption of sport (Andrews, 2004, 2006;
Burstyn, 1999; Giulianotti and Robertson, 2007; Harvey et al., 2001; Horne, 2006;
Maguire, 1993, 1999; Rowe, 1999; Rowe and Gilmour, 2009; Scherer and Jackson,
2010; Shogan, 1999; Wenner, 1989). However, these complex configurations also influ-
ence a range of other institutional and interpersonal relationships associated with sport.
For example, the power of global sport cartels increasingly shapes who is empowered to
report the news and business of the industry and more significantly how this information
is presented to its audience. Likewise, major sports seek to control, and in their view
arguably need to control, as many aspects of the business as possible including person-
nel, both athletes and all other labour – coaches, managers, public relations and support
personnel. One of the increasingly important, yet least understood relationships is that
between the team owners, administrators, athletes and a diverse range of medical support
personnel, and the ways in which these relationships impact on the provision of health
Elite, professional sport is highly contested and occurs within a complex sociocultural
context where sponsors, owners, management, coaches, and others have an interest in the
pursuit of excellence and the success of athletes and teams. These interests have
the potential to generate pressures that can negatively impact on the health of athletes,
the ability of sports doctors to provide quality medical care, and to practise ethically. As
Safai (2005: 109) has argued: ‘it is necessary to ask some hard questions about the ideol-
ogy of excellence in relation to the health and healthcare of athletes, particularly with
regard to the elite sport system’s greater focus on performance than health’. Arguably,
one particular issue that needs to be addressed is the nature of contemporary sport culture
into which medicine is embedded and, in turn, the emerging source and degree of pres-
sure on sports doctors. As one sports physician states, ‘Our professional commitment to
sport cannot exist in isolation of any analysis of the environments in which it is deliv-
ered’ (Pipe, 1993: 899).
This paper explores the context of elite, professional sport and the concomitant
demands, pressures and expectations it places on the sports doctor using an interactionist
approach to analyse data from sports medical practitioners. The study draws on data
from a previous larger qualitative research project that looked at the ethical concerns of
sports medical clinicians working with elite athletes and teams in New Zealand
(Anderson, 2005, 2007, 2008, 2009). Specifically this paper addresses the pressures and
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240 International Review for the Sociology of Sport 48(2)
demands that emerge from varying sites and relationships including from the coach and
management, the athlete, sponsors and the media and broadcasters. Hence, while the data
emerging from this study are drawn from participants’ views of micro-level relationships
with other key personnel within sport organisations, these relationships are in effect
structured and influenced by wider macro factors.
The New Zealand context
This study focuses on New Zealand, in part because it serves as a unique site for the
analysis of medicine in sport for at least three key reasons. First, we note New Zealand’s
largely self-perpetuated reputation as ‘the great little sporting nation’ (Jackson, 2004)
and the historical conditions that facilitated the strong links made between sport and
national identity. The sport of rugby, in particular, has played a key role in the develop-
ment of New Zealand national identity (King, 2003). Historically, the national rugby
team, the All Blacks, came ‘to be accepted… as the purest manifestation of what a New
Zealander was’ (Phillips, 1987: 109). Today New Zealanders retain a strong sense of self
from sporting success. Sport New Zealand (SportNZ) state that, ‘Sport is integral to New
Zealand’s culture and way of life. It helps define who we are as a nation and how we are
viewed by the rest of the world’ (SportNZ, 2012).
This offers some insight into the cultural importance of sport in New Zealand. Second,
New Zealand is a unique site of analysis given that it has had a structure of specialist
vocationally trained sports medicine physicians for more than 10 years. This sets New
Zealand apart from most other nations who are still attempting to establish or have only
recently established a similar structure. That sports medicine is a recognised speciality
indicates that the practice is structurally robust. Finally, New Zealand is somewhat
unique, at least with respect to Western societies, in light of its small population (four
million) and correspondingly its small community of sport doctors (approximately 26).
This situation may contribute to higher levels of social interaction, shared values and, of
particular importance to this study, the need for great care in protecting participants’
The health care system in New Zealand has a similar structure to that found in the UK,
(Australia, Canada, Scandinavia, and other social welfare states) with the bulk of health
care provided by the state. One major difference in the New Zealand health care scene is
a no-fault compensation system run by the Accident Compensation Corporation (ACC).
This system provides public funding for all injury resulting from accident, and also
removes the right for accident victims to pursue a legal remedy. For example, if an athlete
suffered a spinal injury from a tackle in rugby, then future health care and loss of earnings
(to some degree) would be covered by ACC. If that same person suffered the same injury
while driving to the match, this too would be covered regardless of fault. ACC is funded
primarily ‘from levies on people’s earnings, businesses’ payrolls, the cost of petrol and
vehicle licensing fees as well as Government funding’ (ACC, 2010).
Before proceeding, we wish to distinguish between a sports doctor and sports physi-
cian. A sports doctor is a registered physician, most likely a general practitioner, who has
an interest in and role in sport. Sports physicians are also registered medical practitioners
but they have completed a four-year fellowship in sport and exercise medicine, and
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Anderson and Jackson 241
become Fellows of the Australasian College of Sports Physicians. Sports Physicians are
therefore specialists who practise largely on a referral only basis. In New Zealand sports
doctors and physicians are both funded via ACC claims and private fees.
Sociological understanding of medicine in sport
The sociological analysis of the work of medical clinicians in sport is receiving increas-
ing scholarly attention (Berryman and Park, 1992; McEwan and Taylor, 2010; Malcolm,
2006, 2009; Safai, 2004, 2005, 2007; Theberge, 2008, 2009; Waddington, 1996). In par-
ticular, scholars within the broad realm of sport studies have focused on the experiences
of athletes in dealing with pain and injury (Coakley, 1998; Howe, 2001, 2004; Maguire,
1999; Nixon, 1993; Young, 1993; Young et al., 1994). However, few authors have
explored the work of sports medicine and the experience of sports doctors. Scholars writ-
ing about athletes’ experiences have identified a ‘culture of risk’ which is accepted and
normalised as part of both the sport ethic and sport environment (Coakley, 1998; Maguire,
1999; Nixon, 1993; Safai, 2003; Young, 1993; Young et al., 1994; Young and White,
1995). Safai (2003) suggests that the sports ethic is reinforced and perpetuated by a net-
work of coaches, managers, and sports medicine personnel, which Nixon refers to as
‘sportsnets’. Sports doctors are included as part of the ‘sportsnets’ as they too are thought
to be complicit in the role of negotiating the acceptance of risk (Safai, 2003: 130).1
Of those authors writing on sports medicine, Malcolm (2006) has explored the power
held by sports doctors. He suggests that while medical authority exists in other areas of
medicine, sports doctors (at least those involved in rugby at the club level in the UK)
have a ‘relative lack of influence and low status’ (Malcolm, 2006: 391). Malcolm sug-
gests that this low status can, in part, be attributed to the professional structure of medi-
cine in sport, the nature of the workplace and the relationships with other health
professionals within sport. Malcolm utilises the work of Freidson (1970) and others to
examine the power structure at play for doctors involved in sports medicine. Most
recently McEwan and Taylor (2010) have explored the ongoing workplace negotiations
and positioning of sports health professionals using a Bourdieusian analysis.
Waddington (1996) and Hoberman (2001) have also explored the relationship between
sport and medicine. According to Waddington the relationship between medicine and
sport arose from two particular social influences. The first involved an expansion of the
scope of medicine beyond the traditional sphere of illness to areas of life not traditionally
reliant on medical care, including athletic performance. The other significant change
occurred within sport. Sport became increasingly competitive after the Second World
War when the political aims of nation states came to be realised through sport. As a
comparisons of the number of Olympic medals won… took on a new significance, for the
winning of medals came to be seen as a symbol not only of national pride but also of the
superiority of one political system over another. As many governments came to see international
sporting success as an important propaganda weapon in the East-West struggle, so those athletes
who emerged as winners came increasingly to be treated as national heroes with rewards –
sometimes provided by national governments to match. (Waddington, 1996: 6)
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The other force that has impacted upon sport has been the commercialisation and
commodification of sport. Media interest, broadcasting deals and corporate sponsorship
have raised the funding levels of sport exponentially. The increase in competitiveness
and commercialisation marked by the rising importance of winning has subsequently
turned athletes and sports organisations towards sports science and almost by default to
sports medicine to seek ways of optimising performance. Both Hoberman and Waddington
discuss a shift over time from sport being a rich vein for research into human physiology
for medicine and medical science, to a post-Second World War era where the desire for
athletic and sporting success has slowly become an increasingly higher priority within
sports medicine. This fundamental shift is problematic, not only professionally but ethi-
cally as well. As demands for success grow, so too does the pressure intensify on the
sports doctor to deviate from accepted medical practice and ethical values. Next, we
discuss the culture and values of professional medicine and their relationship to contem-
porary sport.
Medicine and the place of medicine in sport
Medicine has long-established values and professional codes that confer an obligation on
doctors to behave in certain ways; instilling a commitment to promote the health and
welfare of an individual patient and a prohibition against causing harm. On the other
hand many would argue that the central concerns of contemporary sport, especially at the
elite level, are strongly associated with commercial aims and the desire to win. It is not
surprising therefore that sports doctors will at times experience some ethical disquiet
about the practice of medicine within such an environment. Ultimately, the sports doctor
is located at the interface between two powerful groups in society, each with very differ-
ent aims and ends. As the title of this paper suggests, this often leads to competing
Ultimately, understanding the place of medicine in sport requires consideration of the
value of the role of medicine to sport. Medicine can offer sport assistance in two ways:
first, the skills and knowledge of medicine can facilitate care and provide access to sec-
ondary and tertiary medical services; second, the social power and authority medicine
brings to the field (Brody, 1993).
The degree of authority medicine brings can be utilised in many ways including vali-
dation of sporting practices that threaten the health of the athlete (e.g. doctors pushing
athletes to their physiological limits and beyond), or sporting bodies accepting sponsor-
ship from companies promoting unproven health products (expecting medical personnel
endorsement). Medical services can therefore be understood as a valuable commodity
making them an important component in the business of sport. Hence, the knowledge
and skills of sports doctors can add value to the sporting product.
Consequently, within the context of a commercial sport system the medical profes-
sional could face undue pressure (Hafferty, 2006). Historically, professionalism in medi-
cine rests upon the pillars of humanism, altruism, accountability and excellence (Stern,
2006). Arguably all of these are implicit or explicit tenets of sport and are perhaps most
clearly articulated within the espoused values of the Olympics. For example, humanism
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contains ideas such as integrity, honour, compassion and empathy. Altruism has at its
heart the idea of placing the interests of the patient ahead of that of the physician.
Accountability is a broad concept and includes participating in assessment of compe-
tence, ‘adhering to medicine’s time-honoured precepts’, and being open and honest
about conflicts of interest. Finally, excellence involves maintaining competence in clini-
cal knowledge, ethical values, the law, and communication skills (see Stern, 2006). In
much the same way, Olympic values and professional medical values are aspirational
statements that members of the respective communities are expected to uphold. Because
these values are generally aspirational, they may be more difficult to uphold in the face
of the commercial interests in sport, or they may be neglected in such an environment. At
this point we briefly refer to the objectives and values of elite commercial sport and their
implications for sports medicine.
Commercial interests in sport
The methods by which large corporations influence and control the organisation and
practice of sport is evident in the ways in which sports are marketed, promoted, spon-
sored, televised and reported (Andrews, 2006; Coakley, 1998; Jackson et al., 2005; Real,
1998; Rowe, 1999; Slack, 2004).
The sports that are most likely to attract sponsors and media interest are those that
appeal to a market of spectators with current or future disposable income – that is, males
in the 18–34 year-old age group, a group ‘prized by corporate advertisers’ (Andrews,
2004: 8). This makes top-level sport a unique and potent form of culture because it is
both a commodity in and of itself, and a powerful medium through which to market other
commodities. Not surprisingly, those who pay enormous fees for broadcasting rights to
major sporting events seek to exert as much control as possible in order to ensure the
production of entertainment spectacles attractive to audiences. In turn, the emerging
commercial pressures trickle down to various organisations and their personnel to
This raises an important question central to this study, namely, how are the commer-
cial interests in sport manifest with regards to the provision of contemporary sports med-
icine? The financial interest of sport organisations in the success of a professional team
is obvious: winning teams attract fans, television contracts and sponsorship. As the effec-
tive labour force for sport organisations, athletes are central to success and this highlights
the important role of the sports doctor (and other medical team members) in maintaining
athletes to a match-fit level. It is exactly these expectations that can impose a great deal
of pressure on the sports doctor trying to negotiate and balance the often conflicting aims
of maximising performance and profit on the one hand and duty of care on the other.
Success is also important to coaches and management with respect to their own career
and financial future. Given the rapid turnover of coaching staff and management it is
clear that they are under enormous pressure to produce winning teams (Waddington and
Roderick, 2002: 122). It is that pressure within the culture of elite sport that creates the
potential for excessive demands to be made of both athletes and sports doctors. One of
the most common ways this is manifest is when a player is pressured to return to the field
before they are medically ready (Macauley, 1997; Polsky, 1998; Roderick et al., 2000).
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Coaches have been known to create conditions that make playing with an injury the norm
in some teams through a range of techniques including bullying, ridicule and isolation
from other team members (Roderick et al., 2000). One retired athlete describes his
coach’s attitude to playing hard and with injury: ‘In my day if you weren’t bleeding by
halftime the coach would say, “What’s wrong with you? You’re a poof”’(Reid, 2005).
One consequence of the stress on coaches and sport managers is the subsequent pres-
sure they put on doctors to maintain players at peak fitness (Apple, 2002; Orchard et al.,
1995). At times, such demands may influence the doctor to breach his or her professional
standards. According to Macauley (1997: 1), ‘In this highly competitive sporting market
doctors may find their professional independence threatened by pressures to treat, reha-
bilitate, inject, or operate in a manner that they find unacceptable’. While it might be easy
to assume that the doctor should put the care of the athlete first, refusing to comply with
the demands of management may impact negatively on the doctor’s re-employment.
Furthermore, athletes attempting to be the best in their sport will often be willing to
take on severe training regimes and diets and will almost certainly be willing to take on
risks of harm (Magdalinski, 2009). At times, athletes may request the assistance of the
doctor in facilitating risk-taking such as returning to the game early or may request
access to banned performance-enhancing drugs.2 Thus, while we might expect that the
source of the greatest pressure is from management, pressure also comes from the ath-
letes themselves who are subject to the forces extant in professional and commercial
sport (Opie, 1991: 512; Polsky, 1998). As one New Zealand sports doctor notes:
Huge amounts of natural talent, training and single-minded determination have brought [an
athlete] close to the top of his sport. Athletic prowess has also elevated him to the bottom of the
commercial food chain. If you don’t recognise this, you don’t recognise a truism of professional
sport. Vested interests permeate and manipulate to maximise financial reward. The promise of
receiving some share of this is intoxicating and can distort risk perception. If that sounds harsh,
then you are getting the picture. (Dreyer, 2004: 34)
Athletes face a range of occupational pressures, the most significant being the tenuous
nature of their position in the team, their status, income and future. An athlete’s fear of
losing a position in the team is heightened by the fact that there is always someone else
waiting to show the selectors that they are better or that they are willing to sacrifice their
bodies unconditionally by playing injured. Stated plainly by Orchard (2001):
The bottom line is that if a player stays on the field enough, his contract as a professional
footballer is extended. If he spends too much time on the injury list – for example, with his wrist
in plaster recovering from a wrist reconstruction – then he gets cut by the team and loses his
contract. (Orchard, 2001: 212)
The utilisation of sports doctors and other health professional personnel is an obvious
route to recovery and return to the field of play. However, at times athletes can put pres-
sure on sports doctors to return to the field before they are medically ready (Brukner and
Khan, 2001; Fullagar, 1996; Polsky, 1998). Indeed, at times, the athlete-as-patient, sup-
ported by the organisation, may demand intervention that the doctor believes is in con-
flict with professional standards or ethics. As a contracted employee, doctors will be
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Anderson and Jackson 245
aware of their responsibility to the organisation, and in the harsh business world of top
sport, contracts may be short and depend on performance and compliance with company
policy (Macauley, 1997).
The ethical issues facing sports doctors were examined using semi-structured interviews
with 16 sports doctors (n = 12 male, 4 female) working with elite athletes and teams in
New Zealand. To be eligible for inclusion as a research participant, sports doctors had to
be working with athletes or teams who represented New Zealand, or were professional
athletes. These two groups (NZ representatives and professional athletes) are not coex-
tensive, though there may be some overlap. Many athletes who represent New Zealand
are not professional (that is, they do not get paid), while some professional athletes may
never achieve a place in the national side – for example, Rugby Union players in the
SANZAR (the South African, New Zealand and Australian rugby triumvirate) Super 15
Following approval from the relevant Human Ethics Committee, recruitment of
participants was undertaken by a ‘snowball’ technique (Patton, 1990). Each inter-
view lasted approximately one hour. The interviews were transcribed and returned to
the participant for checking. This stage allowed participants an opportunity to delete,
add or correct material. Nearly all doctors took up the opportunity. The sensitive
nature of some of this data required serious attention to the confidentiality of partici-
pants, not only to protect the doctors but also their high-profile patient group. Given
the interest of the media in the activities of elite sportspeople, every effort was taken
to ensure that the data were anonymised. Although each of the participants worked
with elite or professional athletes or teams in New Zealand, half the participants
worked predominantly with amateur athletes, while three worked mostly with pro-
fessional athletes.3
Overall, the participants in the study represent a group of highly experienced senior
clinicians working at the very pinnacle of sport in New Zealand. They also spend a great
deal of their week on sports medicine with nine of them spending their whole week
working as a sports doctor. The remaining seven combined sports medicine with other
specialised forms of medical practice. The number of years each of the participants had
worked as a sports doctor ranged from 6–26 years, with the average being 11.6 years.
The participants had high qualifications, 12 held a postgraduate diploma in sports medi-
cine or musculoskeletal medicine, while seven were Fellows of the Australasian College
of Sports Physicians.4 There were five other qualifications held by the group of partici-
pants related to the sports medicine role, including either undergraduate degrees or diplo-
mas, or Masters degrees.
Grounded theory was utilised for the initial data analysis of the broader project of
sports medicine, given that it uses an inductive form of analysis, where the theory
emerges from the data rather than starting with an existing theory and requiring the data
to fit the theory. (Glaser, 1967). However, while grounded theory was ideal for the
broader project, an interactionist approach is used for analysis of the data for this paper.
Specifically, following Malcolm (2006), we draw upon the work of Eliot Freidson, a
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246 International Review for the Sociology of Sport 48(2)
sociologist from the interactionist school, who studied professions and in particular the
medical profession.
Freidson suggests that professional behaviour has more to do with the situation peo-
ple find themselves in rather than their training. He states:
a significant amount of behaviour is situational in character – that people are constantly
responding to the organized pressures of the situations they are in at any particular time, that
what they are is not completely but more their present than their past, and that what they do is
more an outcome of the pressures of the situation they are in than of what they have earlier
internalized. (Freidson, 1970: 90)
This does not mean that Freidson rejects the important influence of education on pro-
fessionalism and professional behaviours or the personal attributes of an individual pro-
fessional, but he considers that the work situation is the dominant variable in accounting
for variations in professional behaviour. (Freidson, 1970: 87–88)
Freidson identifies two extreme forms of practice governance. At one extreme,
physicians are subject to a colleague-dependent practice, that serves the needs of other
physicians, and at the other extreme, the physician is subject to lay control. At this extreme
the physician ‘is chosen on the basis of lay conceptions of what is needed, not by profes-
sional criteria… And to be chosen again and survive, he must be prepared to provide
services that honour the client’s prejudices’ (p. 107). Freidson suggests that professional
standards are higher in colleague-dependent practice and lower in situations where a phy-
sician meets lay demands (p. 107). Malcolm’s study ‘did not find much evidence to con-
firm’ (2006: 386) this claim and this has also been the case in our research.
Results and discussion
The results and discussion section is a collation of the views and voices of the sports
doctors that describe the pressures associated with elite sport that often give rise to com-
peting professional obligations. These pressures are categorised with respect to the fol-
lowing groups: coach and management, athletes, sponsors, media and broadcasting
structures. The key themes addressed focus on the complex environment within which
sports doctors work including the lack of control over their work environment, the com-
peting obligations they face, the pressures that arise from the commercial interests
involved in sport, and the threats to medical professionalism.
The results of this study confirm that sports medical practitioners work under a great
deal of pressure stemming from the commercial interests of others to generate profile and
income. The risk is that these kinds of pressures may distort the focus of sports doctors
such that they identify less with the health needs of the athlete and get pulled towards the
aims of others involved in the sporting network.
Coach and management
As identified by Waddington and Roderick, coaches are under pressure to field a winning
team. The desire of the coach to succeed can be a source of pressure on a doctor to get an
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Anderson and Jackson 247
injured athlete back into action before medical clearance (Macauley, 1997; Polsky, 1998;
Roderick et al., 2000). This was reiterated in our research and was identified as a source
of pressure by sports clinicians:
Yes, the [coach] often wants them [athletes] back on as soon as possible, of course. Especially
if they’re one of the good players in the team, vital to the team. So yes, there’s a lot of pressure
to rehabilitate players and get them back out there, from the players themselves, and from the
coach’s point of view.
The pressure a coach can apply to the athlete to play with an injury can be immense,
especially when there is a ‘no play – no pay’ payment structure as one participant
The difficulty comes when the coach says I want this player to play, and goes to the player
himself and says you’ve got to play, if you don’t play you’re not going to be played again, and
there’s a bonus system where if you’re not playing you’re not getting paid sort of thing.
Another participant describes the way in which some coaches can limit the ability of
the sports doctor to look out for the medical interests of the athlete.
Even me [as the sports doctor] trying to remove someone [an athlete] from the field of play
and they [the coach] have not wanted that player removed… and I… say, ‘look [this athlete]
is struggling, he feels unable to go on, he’s got this injury I think we have got to get him off’
and I was told in no uncertain terms, that he is a wimp and he has to stay on and die for the
The motive for coaches may not solely be for team success but for the coach’s own
interests as well (Waddington and Roderick, 2002: 122). A team that is doing well reflects
well on the coach, and may contribute to reappointment, a positive salary review, or help
when applying for other jobs. So coaches have a personal financial interest in the wellbe-
ing of athletes.
I think that straight away you have got people that have got a financial interest, in their wellbeing
clearly, and in terms of coaches, they have not just got a financial interest they have a career
interest, if this player performs well it enhances not only the player’s career, but the coach’s
career, and that’s clearly been an issue with me.
When asked whether not complying with coach demands could impact on their re-
employment, one participant captured the mood of many of the others, stating:
Ah, yes, that did initially bother me when I was still quite wet behind the ears. To be honest with
you it did concern me a little bit, but now I realise that there are a lot of teams… management
styles change and coaches change and I think that if you didn’t compromise, people will
eventually see the good in it. And to be honest with you, I think there are many teams. If you
don’t get a job here, you can get a job somewhere else. For me it’s an issue of enjoying the job
rather than feeling guilty and trying to work around issues like that.
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248 International Review for the Sociology of Sport 48(2)
In combination these comments highlight the powerful links between the commercial
aspects of sport and how they shape management and coach attitudes and behaviours
towards their athletes. The stresses on coaches and others for sporting success will trans-
late into stress on the sports doctor, at times encouraging them to act in a manner outside
of accepted professional standards. In some respects these views highlight another
dimension of competing loyalties: management and coaches may find themselves torn
between proving their own value in a highly competitive sport-business environment,
ensuring the viability of their franchise and their desire to protect the welfare of players
– this is something worthy of further investigation. It is also worth noting the role of
masculinity within this culture; most elite professional coaches are male and their own
experiences and training in sport is likely to influence how they view sporting bodies,
injuries and the culture of risk (Burstyn, 1999; Young, 1993, 2004).
Athlete funding
Intense commercial interest in sport has a relatively short history in New Zealand com-
pared to some other countries. For example, rugby has only been professional since 1995
(Jackson et al., 2001). Many sports continue to struggle with low levels of funding, while
others are particularly well funded. This resonates with comments by sports doctors (and
others) in the literature (Brukner and Khan, 2001; Dreyer, 2004; Macauley, 1997; Opie,
1991; Orchard, 2001; Polsky, 1998) who are aware that athletes can put direct pressure
on sports doctors to return to sport before they are medically ready in order to retain
The influence of sponsors
Attracting sponsors is one way of improving the funding of individual athletes and teams.
At first glance, the sponsorship of sport could be considered to be a reciprocal arrangement
between a sports body or individual athlete and a company, with both benefiting from their
joint participation. However, Slack and Amis (2004) are quick to point out that while this
is indeed true, such a simplistic understanding of the relationship between the two parties
fails to appreciate the true nature of sponsorship relationships. In the vast majority of cases
the relationship between the sponsor and the athlete is unequal. The athlete may be expected
to play more frequently, and if they fail to play, then spectators will be less likely to watch
– a key concern of sponsors. One doctor spoke about how aware they were of the need for
a sponsored athlete to be both selected (putting pressure on coaches) and to be seen despite
potential injury (putting pressure on the athlete, coach and sports doctor).
Doctor: …they have to use players that are more marketable and so there’s
pressure on to have those players out there for the public to see. So, yes.
Interviewer: Right. And the coaches acknowledge that?
Doctor: Oh, yes, marketing’s a huge part of the game now.
Interviewer: Right, so [a player] and [the player-sponsored product]?
Doctor: Yes, so she needs to be on court. Yeah, so it does come into it.
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Anderson and Jackson 249
Interviewer: And that would influence you as well?
Doctor: Well, it makes you very aware that you’ve got to get them up and going
and back out there – yeah, so it’s marketable. And for them, it’s often
their income – it will be in the future, as things get more professional.
Ultimately sponsors are paying for visibility and brand awareness, whether through
corporate signage at the stadium, logos on uniforms or via celebrity athletes. This has two
key implications: (1) the sponsor’s name will be seen on the team members’ uniforms, in
effect making the athletes walking billboards; and (2) it is assumed that the athletes will
be using their products, thus providing both brand exposure and a form of endorsement.
Twelve of the 16 participants raised the issue of sponsorship by footwear companies
as causing problems for the athlete and sports doctor. The problem arises when sponsor-
ship involves the whole team, and all players must wear a particular brand of sport shoe
even though the product may not suit an individual’s feet.
Some companies will go to great lengths to try and find suitable footwear. But where
this can’t be done, sports doctors may be involved in altering a rival manufacturer’s
product to look like the sponsor’s product. This involves removing the logo from the new
footwear and painting on the sponsor’s logo. One doctor describes the surveillance the
sponsor does to check athletes are wearing the right product.
Doctor: We try and actually blacken the boots out completely. But we get
told off for that.
Interviewer: Who from, the sponsor?
Doctor: The sponsor. Yeah, they pay people to watch the games to check
people are wearing the right stuff.
Interviewer: I didn’t realise that.
Doctor: Yeah, there’s big money. There’s millions of dollars involved, so
they do – yeah, we get phone calls after the game, so-and-so wasn’t
wearing the right boots – [we] get in trouble. So we’re monitored.
In these instances sports doctors are using subversive actions in order to look out for the
interests of their patients. Other subversive activities reported by participants included empty-
ing the sponsor’s drink product from the sponsor’s bottle and replacing it with another prod-
uct. Here, the sports doctor is under pressure from various sources, including players who do
not have a legitimate medical reason for not using a sponsor’s product; as such the doctor is
actually involved in a commercial negotiation rather than medical treatment. The influence of
sponsors points to another element of a form of surveillance over the image and practices of
athletes and teams and those charged with supporting them. The above examples demonstrate
the far-reaching effects of commercial interests and the ethical dilemmas these can pose.
Media and broadcasting concerns
While the relationship between sport and the media has been well explored (Andrews,
2006; Real, 1998; Rowe, 1999; Slack, 2004; Wenner, 1989), the relationship between the
media and sports doctors has not received the same attention. Elite sportspeople have
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250 International Review for the Sociology of Sport 48(2)
become celebrities in New Zealand, and public interest runs high. When a particular
athlete is injured or becomes ill, one of the main sources for information is the sports
doctor, either directly or indirectly through the manager or appointed team media liaison
officer. Some doctors indicated that ‘you get pestered by the media the whole time’. This
scrutiny and close and regular contact with the media sets doctors apart from their peers
in other medical settings.
Dealing with the media is easier for some sports doctors than others and doctors use
different approaches. Some simply repeat facts that the journalist already knows, others
say very little. As one doctor put it, ‘we give them enough to keep them happy’. Two
sports doctors identified that reporters were known to make up stories about player inju-
ries and one reporter told a physician, ‘if you don’t tell me, I’ll make it up’.
However, the relationship between the media and the team is more than just the provi-
sion of information about the players; the media create the interest in the team, which in
turn enhances the value for sponsors. Confirming this, one doctor stated that, ‘informa-
tion has to be released to the media because the media are what create our sponsorship
arrangements which is eventually what pays our wages’. However, the right of players to
confidentiality of personal health information is potentially compromised by the need to
generate a high profile to attract the sponsors.
Talking to the media raises concern regarding an athlete’s confidentiality as illustrated
by the following remark:
in the last six years national and international competitions have really become a professional
entertainment business, and a lot of media representatives feel they’ve got a right to the
information about players, and there’s a lot of pressure on us to release information quickly
about injuries
In sum, the media are another source of pressure on the sports doctor and maintaining
athlete confidentiality is of concern.
In attempting to attract viewers and media interest, competitions have been created
which are designed to push athletes to the edge and sometimes beyond their physical and
psychological limits. Doctors may find their involvement with such endurance races dif-
ficult, especially when the boundaries of good health are breached. One doctor describes
their experience after a large number of competitors became unwell at a particular endur-
ance event.
… when I was [working for an endurance race]… one athlete in five… who started that race
finished up sick in the medical tent at the end of the day. So these are healthy, superbly healthy,
superbly fit human beings, many of them young, and the race… caused one in five of them to
end up needing to see a doctor, caused 16 of them to have to go to hospital, caused two of them
to have to go to intensive care, and one to be unconscious for four days in hospital. So this was
the race that did this, and the nature of the race and what they did during the race. So that
bothered me enormously, hugely at the time – not my involvement in it – but here was this
event that was way beyond the realms of good health.
Some might consider the statement ‘way beyond the realms of good health’ naïve
from what appears to be a highly qualified person. After all, it is well known that an elite
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Anderson and Jackson 251
and commercial sport breaches the boundaries of good health (Nixon, 1993; Roderick et
al., 2000; Safai, 2003; Young, 1993). Despite their qualifications and experience (or
perhaps because of their previous experiences in non-sport areas) maybe some sports
doctors find the juxtaposition of practising medicine in an environment of elite sport
philosophically troubling.
Commercial motivations central to elite televised sport also have the potential to limit
the ability of sports doctors to care for injured athletes. For example, television broad-
casting contracts that schedule televised games back-to-back will restrict the time avail-
able for doctors to assess and treat injured athletes.
… at Super Twelve5 games you don’t get an injury break. In NPC6 rugby you can take a player
off for ten minutes and assess them. In Super Twelve you don’t have that; you’ve got to make
a call there and then whether the player stays on or comes off. And once they’re off they can’t
come back on. Although, you can bring them off for a blood injury… so if you can find a little
bit of blood and get the referee to agree that they can come off, it gives you a chance to assess
whatever else. And probably the commonest thing that you really want a minute or two for is
where they’ve had a knock to the head. You want a couple of minutes to see that that’s going to
clear, and they’ve not got visual disturbances and they’re not completely fluent in their
processing… whether they really need to be off… and so you do sometimes keep a player on,
and you’re really watching them closely for a few minutes until you’re sure that they are fine.
Or until you realise that they’re really not fine.
By restricting time to assess the injury on field, the length of the game is not disrupted
and match completion time is more predictable. But this can threaten the ability of sports
doctors to provide quality care. One doctor gave an example of a game scheduled for the
hottest part of the day in Brisbane thought to be related to maximising television ratings.
These are also examples of the limited control sports doctors have over their workplace
Recent literature on medical professionalism lists commercialism as one of the major
threats to professional ethics (Stern, 2006; Van Mook et al., 2008) Human nature, self-
interest, pressure from peers and commercialism are well recognised challenges to pro-
fessionalism (Van Mook et al., 2008). Discussion about commercialism is often limited
to the examples of managed care and corporate medicine; however we posit that the
commercial elite sport environment within which a sports doctor works is immersed is
equally problematic for maintaining professionalism. Given Freidson’s theory that the
behaviour of professionals (and in this case, doctors) is more a product of their present
working environment than what they have learned in the past, the findings above are
However, commercial pressures are not the only factor that contribute to threats
to medical professionalism. The complexity of the commercial world of elite sport,
including the inherent web of interconnected relationships, also contributes.
Firstly, the employment structure of the sports doctor often aligns him/her more
strongly to team management and may place expectations via the employment
contract that encourage deviation from traditional obligations, creating a conflict
of obligations for a sports doctor. The central issue is the divided loyalties of the
clinician. Each clinician who has a contract with an employer has an obligation to
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252 International Review for the Sociology of Sport 48(2)
that employer, and to the patient. As this study has demonstrated, these obligations
can conflict.
Secondly, sports doctors have limited control over the manner of their work. An
example of this is the sports doctor who describes limited time for injury assessment
because of the television broadcast schedule. Clearly, athlete welfare is secondary to
other aims. Such examples indicate that sports doctors have limited control over their
workplace. Instead the workplace structure is often dictated by others.
Thirdly, sports doctors are isolated both clinically and professionally. They often
work alone or are part of a small medical team, so they may not have the professional
support immediately at hand when faced with an ethically difficult situation.
The results of this New Zealand study are, to some extent, in line with the findings of
Malcolm’s (2006) research with rugby club doctors in the UK. Malcolm (2006: 391)
attributes the lack of power and influence that sports doctors have to a number of impor-
tant factors including the workplace setting, the relationships that sports doctors have
with others and the structure of the profession of sports medicine. While there is a sense
of lack of power in this research that resonates with Malcolm’s findings, these clinicians
can exercise power through subversive acts such as changing products to look like that
of the sponsor, or through using the media for the benefit of the team and the sports
The relationships with others have been one of the key themes in this paper; it is those
relationships that can put pressure on the sports doctor that may encourage the doctor to
act differently than they perhaps would in other settings. This is in line with Freidson’s
theory that the working environment plays a large part in determining the behaviour of
professionals. In this case sports doctors are enmeshed in an environment that creates a
strong pull to the needs and demands of a highly commercial environment. Traditional
obligations learned in medical training and clinical practice may become secondary to
the everyday employment environment of sport at this level, hence creating divided loy-
alties whereby what sports doctors were being asked to do and what they considered to
be good clinical practice are two different things.7
Sports doctors are alert to many of the pressures that exist in sport that have the poten-
tial to distract their focus from patient interests or distort their professional values.
There are clearly threats to professionalism through the commercial nature of high-
profile sport and through the pressures to be successful, and this may be compounded by
the employment context.
Moves to strengthen medicine’s role in sport have commenced in New Zealand.
Specialist status has been achieved in the field of sport and exercise medicine, and the
number of sports physicians is now growing. This new role could potentially move sports
medicine along the continuum away from lay control and, because physicians rely on
referrals from other health professionals, towards colleague control. However, it is hard
to imagine that this group will overcome many of the pressures extant in a commercial
elite environment. New codes of ethics are also being written directly addressing many
of the concerns raised by the employment structure and clarifying expectations
(Anderson, 2009). These new codes have been written in such a way as to provide a
shield to sports doctors who are asked to act outside professional expectations.
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Anderson and Jackson 253
Understanding the place of medicine in sport requires consideration of the value of the
role of medicine to sport. As stated earlier, medicine can offer sport assistance in two
ways: first, the skills and knowledge of medicine are used to facilitate care and access to
secondary and tertiary medical services only they can provide; second, the social power
and authority medicine holds. Medical authority can bring a sense of social acceptance
and validation to a range of sporting practices that can threaten the health of the athlete.
Medical services can therefore be understood as a valuable commodity to sport. The
medicalisation of sport whereby high-performance athletes who want to achieve the ulti-
mate performance are viewed as those requiring medical attention is an important claim
and one that has been challenged by a number of scholars (Hoberman, 2001; Maguire,
1991, 2004; Shogan, 1999; Walsh and Giulianotti, 2007). However, we must also
acknowledge that the practice of medicine in sport is open to abuse from the very envi-
ronment of high-performance sport. Sports doctors who are part of the machinery of
sport will have a number of competing obligations and threats to their professionalism.
Further research is required in order to better understand those interests and influences
that encourage a doctor to abandon their traditional obligations to the patient and to their
own professionalism. This is important, not just because we might consider that medi-
cine is a valuable social good, but ultimately for the wellbeing of athletes.
This research received no specific grant from any funding agency in the public, commercial, or
not-for-profit sectors.
1. For a full discussion on ‘sportsnets’ see Walk (1997), Nixon (1993), and Safai’s (2003) evalu-
ation of the concept within the Canadian university setting.
2. While sports doctors and physicians in this study had received requests for performance-
enhancing drugs, this is not the focus of this paper and will be the subject of future research.
3. Although few professional sports in New Zealand (with the exception of rugby, rugby league,
and a few isolated teams and individuals) provide a full-time employment income, there are
a large number of elite amateur or semi-professional sportspersons. Many of these individu-
als are immersed within a highly structured, high-performance environment often based on
a professional, corporate model. Thus, while this paper may tend to refer to commercialised
sport, our main concern is the impact of the culture of contemporary elite sport working with
both professional and amateur sports.
4. Sports medicine became a recognised specialty in New Zealand in 2000 with vocational reg-
istration awarded by the New Zealand Medical Council There are currently 20 vocationally
registered Fellows of the Australasian College in New Zealand, working solely as specialists
in the area of sport and exercise medicine. To maintain certification sports physicians must
meet certain yearly expectations for continuing medical education, teaching and research and
quality assurance activities.
5. The Super Twelve tournament is a rugby tournament played between the top regional teams
from South Africa, Australia and New Zealand. This tournament became the Super 15 begin-
ning in 2011.
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254 International Review for the Sociology of Sport 48(2)
6. The NPC tournament is a rugby tournament within New Zealand based on regions. NPC
stands for National Provincial Championship.
7. Murray (1986: 831) describes divided loyalties as occurring ‘when conflicting moral claims
are made that cannot be honoured simultaneously’.
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... Embedded in elite sports is a normalised 'culture of risk' (Bette, 2004) in which competing hurt, the expectation of always striving for success and accepting health risks are internalised by athletes, coaches and sports medicine specialists (Anderson and Jackson, 2013;Roderick, 2006;Roderick et al., 2000). Sporting careers are often short-lived, insecure and uncertain (Roderick, 2006) with a significantly higher risk of injury and dependence on the body's functionality compared with most other occupations (Bette, 2004). ...
... Coaches and medical staff play a pivotal role in decisions whether to compete while injured (Mayer and Thiel, 2018). Medical personnel are faced with dual roles and pressures and must negotiate between restoring athletes' health while simultaneously assisting in enhancing performance levels (Anderson and Jackson, 2013;Safai, 2003). This is an interaction that occasionally relates medical advice to lack of care for the injured athlete's health (Waddington and Roderick, 2002), breaches in athlete-patient confidentiality (Malcolm and Scott, 2014) and often results in a too early return to sport and in the use of analgesics to be able to do so (Waddington and Roderick, 2002). ...
... Different actors potentially play a role with regard to sport-related drug use (Overbye, 2018). The ways sports medicine clinicians interact are critical (Andersen and Jackson, 2013;Safai, 2003). The results show that athletes often had several sources of guidance on the use of analgesics and that the roles of doctors, coaches/managers or physiotherapists varied between sports ( Figure 5; Table 2: qoute#1, #16, #17, Section: 'Sport-related use of analgesics, guidance and self-administration'). ...
Pain and injuries are inevitable occupational hazards and health risks in athletes’ working lives. The sport-related use of analgesics with and without injury is widespread. Taking analgesics to compete while injured is conceptualised as a sickness presenteeism problem. This study examines the complexity of the sport-related use of analgesics in elite sport. A mixed-method design was adopted consisting of a survey ( n=775) and interviews ( n=21) with elite athletes. Many athletes reported a sport-related use of analgesics. Analgesics had commonly been used to enable an injured athlete to: compete in an important match; train during an important period; qualify for an important match/final; and keep one’s position on the team or have one’s contract prolonged. In particular, team-sport athletes had experience of such use. Apart from the therapeutic use of analgesics, they were sometimes integrated into different routines: for example, enhancing performance, avoid lowering performance, aiding recovery, training/competing injured and prophylactic use. Simultaneously, many had refrained from using or sought to minimise their sport-related use of analgesics; reasons were related to: trust in/feeling the body, side-effects, knowledge and social norms. Social norms and interaction with support personnel played a key role. Physiotherapists and doctors often advised athletes on analgesics, but self-administered use was widespread. How risk cultures manifested themselves varied greatly between sports, and gender differences were scarce. Although ‘absenteeism’ is also present, a majority of athletes would be willing to ‘walk the line’, using analgesics to compete when injuries may threaten their career or sporting success.
... Thus, wanted to ensure complete recovery that may allow him return to participation fully fit. Anderson and Jackson reported that most players for fear of losing their positions on the team prefer to play even while injured [15] . The low level of involvement of Physiotherapists in many sports teams in Ghana could also be a contributory factor. ...
... With regards to return to participation of an injured player, more than half of the participants of the study were of the opinion that the Physiotherapist and doctor had a say while a minority of the participants averred that the coach had a say in the return of an injured player. This is not proper since it does not serve the player's interest however it happens because Anderson and Jackson, [15] reported that members of the sports medicine team may sometimes have to breach professional standards due to pressures from coaches to return injured players to play earlier than is advisable. An insignificant number of participants were of the view that the team owner or financiers should have a say on the return to participation of an injured player. ...
... An insignificant number of participants were of the view that the team owner or financiers should have a say on the return to participation of an injured player. This may result in pressures from the team owner or financier as corroborated by Anderson and Jackson to field the full measure of players including injured players at all times [15]. ...
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Background: Physiotherapy plays an important role in the prevention and management of sports injuries to enable athletes return to play when fully fit. In Ghana first aid personnel and team masseurs generally manage sports injuries. Inadequate knowledge on the role of Physiotherapy may be the reason for not seeking Physiotherapy services. We objectively set out to determine the knowledge and perception about the role of Physiotherapy in managing sports injuries among hockey players and technical staff. Methods: This cross-sectional study involved 65 members of 15 hockey teams in Accra. Participants included female and male hockey players between the ages of 15 and 50, coaches and team managers. They were made to complete a self-administered questionnaire. Data obtained was analyzed using SPSS, version 23. Spearman correlation was used to determine the association between variables at a significant level of 5%. Results: Fifty hockey players and 15 technical staff took part in the study. Majority (94%) and (91%) of participants identified ice and exercises as modalities used by Physiotherapists. About 66.2% of hockey players had high knowledge and perception (p=0.032) about the role of Physiotherapy and reported that 18% of their injuries were treated by a Physiotherapist while majority (89%) were of the view that a Physiotherapist is a competent professional. Sixty-six percent participants perceived that Physiotherapists were involved in research, however, there was no significant association between, knowledge, perception and years of experience of hockey players (p=0.945) and technical staff (p=0.201). Conclusion: Majority of participants had good knowledge and perception on the role of Physiotherapy in training common hockey injuries, although very few of their injuries were managed by Physiotherapists. There is a need to educate players and technical staff on the role of Physiotherapy in the prevention and management of sports injuries, which may encourage players to seek early treatment for injuries rehabilitation.
... Third, multiple studies have shown that coaches' insufficient health and safety support could jeopardise athletes' careers (e.g. Anderson and Jackson 2013;Barker-Ruchti et al. 2019;David and Robinson 2007;Dohlsten, Barker-Ruchti, and Lindgren 2021). Authoritative coaching styles and hierarchical relationships legitimise risky environments that require athletes to withstand injuries and return prematurely from rehabilitation (Cavallerio, Wadey, and Wagstaff 2016;Jenny et al. 2020;Roderick, Waddington, and Parker 2000); in such cases, players may feel like 'a dispensable tool' for victory rather than a person (David and Robinson 2007, 135). ...
... As prescribing rest and treatment that prevent athletes from continuous sporting engagements is the most prevalent clinical option for sports-related illness, medical professionals often encounter relational difficulties and a lack of power in the sportsnet (Al Hashmi and Matthews 2021; Anderson and Jackson 2013;Malcolm 2006). For instance, our participants frequently partook in medical-practice shopping (Pike 2005) to find treatments that fit their sporting goals and ignored medical advice that did not align with their preference by admitting their injuries only in extreme conditions, such as 'ligament rupture' (Athlete 2; Coaches 2 and 3), 'fracture' (Athlete 3), 'inability to move' (Athlete 1), and 'eyesight loss' (Athlete 5). ...
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As the phenomenon of playing hurt persists in sports, extant literature has explored the risk, pain, and injury custom (RPIC) from diverse angles. However, academic endeavours revealing the agency–structure continuum between individual agents’ willingness to play hurt and the capital structure related to the RPIC remain limited. This study aims to investigate professional athletes’ health-compromising practice and its underlying mechanism through capital games. Drawing on Bourdieu’s theory of practice, we examined two research questions: (a) how does individual athletes’ desire for capital justify playing hurt? and (b) how are their capital games connected to the RPIC? Empirical data were collected through semi-structured and photo-elicitation interviews with eight athletes and six coaches (ex-athletes) from three combat sports. The data were interpreted using reflexive thematic analysis. The findings were categorised into two narratives: (a) rationalisation of playing hurt and (b) reproduction of the RPIC. First, our participants continued playing hurt, expecting certain rewards (cultural, social, economic, and performance capital); this profit-seeking aspiration rationalised self-destructive action as an investment to garner social energy in the field. Second, the more athletes immersed themselves in capital games using health as a token, the more prominent the habitus of playing hurt became in the field. This RPIC reproduction mechanism drove former/present athletes’ choices to converge into an identical career trajectory, uni-taste, and limited subversion strategy, trapping them in a cycle where the victim becomes another perpetrator of playing hurt. These results are expected to provide sport institutions with insights into building safer sporting environments.
... Professional rugby union is a results-based industry and coaches are the subject of considerable scrutiny from industry stakeholders such as club directors, media and fans concerning team selection, style of play and because a manager's tenure is highly dependent on team performance and success they can often pressurize 'key players' to play while injured. Moreover, pressure from coaches regarding injury disclosure is widespread in sports [18] and sometimes when making team selection decisions coaches put medical staff under pressure to get an injured (key) player back to play before medical clearance [19]. ...
... (Coach6) Sometimes, coaches put medical staff under pressure regarding post-injury RTP [16]. The desire of the coach to succeed can be a source of pressure for a doctor to get an injured player back to play before medical clearance [19]. Interestingly, this phenomenon was revealed by Coach6 as a common behaviour, which should have been reported by medical staff as an unethical behaviour. ...
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The intense, physical contact nature of rugby union often encourages the normalization of risk-taking behaviour resulting in a relatively high acceptance of risk. This study aims to explore safety culture in rugby union from an OSH perspective, with the purpose of assisting coaches and management in their decision-making processes to improve players’ health, welfare, and long-term well-being. In terms of data collection, this study involved semi-structured interviews with senior support staff (n = 15) in elite rugby union. Interview transcripts underwent inductive analysis prior to an abductive analysis that was guided by an established occupational-safety-and-health (OSH) framework. Rugby union players’ safety can be considered from two dimensions: management’s commitment to safety (i.e., safety prioritization, safety empowerment, and safety justice), players’ involvement in safety (i.e., safety prioritization, and trust in other players’ safety competence, and players’ safety concern for the opposition players). Within the themes identified, players’ attitude towards their opponents’ safety which has been rarely considered as a factor for injury prevention is also discussed in this study. If sport support staff (i.e., managers/coaches/medical) can become more involved in players’ performance-orientated training using OSH management processes to aid in their decision-making, their exists the capacity to benefit players’ safe return to play after injury rehabilitation. Meanwhile, directing the development of appropriate behavioural educational interventions to raise safety-awareness amongst players can improve their long-term health and well-being and provide them with the necessary safety and health information to support their own decision-making processes. As a multidisciplinary design, this study contributes new multidisciplinary insights that have the potential to advance managerial practices utilizing an OSH perspective, including decision-making supporting risk alleviation for safety and long-term health and wellbeing initiatives in competitive team sports.
... It is also likely that these institutions provide increased access to scholarly activity and have more research staff. This is supported by a study that included all faculty at United States adult reconstruction fellowship programs that indicated that most of the literature in adult reconstruction is generated from a small subset of academic institutions [23]. Thus, orthopaedic surgeons in-training interested in pursuing academic leadership positions may be more incentivized to select programs that promote orthopaedic surgery research. ...
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Background: Fellowship directors (FDs) in sports medicine influence the future of trainees in the field of orthopaedics. Understanding the characteristics these leaders share must be brought into focus. For all current sports medicine FDs, our group analyzed their demographic background, institutional training, and academic experience. Aim: To serve as a framework for those aspiring to achieve this position in orthopaedics and also identify opportunities to improve the position. Methods: Fellowship programs were identified using both the American Orthopaedic Society for Sports Medicine and the Arthroscopy Association of North America Sports Medicine Fellowship Directories. The demographic and educational background data for each FD was gathered via author review of current curriculum vitae (CVs). Any information that was unavailable on CV review was gathered from institutional biographies, Scopus Web of Science, and emailed questionnaires. To ensure the collection of as many data points as possible, fellowship program coordinators, orthopaedic department offices and FDs were directly contacted via phone if there was no response via email. Demographic information of interest included: Age, gender, ethnicity, residency/fellowship training, residency/fellowship graduation year, year hired by current institution, time since training completion until FD appointment, length in FD role, status as a team physician and H-index. Results: Information was gathered for 82 FDs. Of these, 97.5% (n = 80) of the leadership were male; 84.15% (n = 69) were Caucasian, 7.32% (n = 6) were Asian-American, 2.44% (n = 2) were Hispanic and 2.44% (n = 2) were African American, and 3.66% (n = 3) were of another race or ethnicity. The mean age of current FDs was 56 years old (± 9.00 years), and the mean Scopus H-index was 23.49 (± 16.57). The mean calendar years for completion of residency and fellowship training were 1996 (± 15 years) and 1997 (± 9.51 years), respectively. The time since fellowship training completion until FD appointment was 9.77 years. 17.07% (n = 14) of FDs currently work at the same institution where they completed residency training; 21.95% (n = 18) of FDs work at the same institution where they completed fellowship training; and 6.10% (n = 5) work at the same institution where they completed both residency and fellowship training. Additionally, 69.5% (n = 57) are also team physicians at the professional and/or collegiate level. Of those that were found to currently serve as team physicians, 56.14% (n = 32) of them worked with professional sports teams, 29.82% (n = 17) with collegiate sports teams, and 14.04% (n = 8) with both professional and collegiate sports teams. Seven residency programs produced the greatest number of future FDs, included programs produced at least three future FDs. Seven fellowship programs produced the greatest number of future FDs, included programs produced at least four future FDs. Eight FDs (9.75%) completed two fellowships and three FDs (3.66%) finished three fellowships. Three FDs (3.66%) did not graduate from any fellowship training program. The Scopus H-indices for FDs are displayed as ranges that include 1 to 15 (31.71%, n = 26), 15 to 30 (34.15%, n = 28), 30 to 45 (20.73%, n = 17), 45 to 60 (6.10%, n = 5) and 60 to 80 (3.66%, n = 3). Specifically, the most impactful FD in research currently has a Scopus H-index value of 79. By comparison, the tenth most impactful FD in research had a Scopus H-index value of 43 (accessed December 1, 2019). Conclusion: This study provides an overview of current sports medicine FDs within the United States and functions as a guide to direct initiatives to achieve diversity equality.
... If pressure is applied to prevent or influence player removal decisions it could go against the professional responsibility that medical staff have for player welfare (Anderson and Gerrard 2005). In an un-supportive environment, medical staff could find their professionalism being tested against obligations they felt towards employers who are concerned about success of the team, or players who will disregard their own wellbeing to continue to play (Polsky 1998;Anderson and Jackson 2013). Clinical staff found to have failed to deliver a standard of reasonably expected care could find themselves open to negligence associated medicolegal risk (Turner et al. 2020). ...
Objectives: Explore sport-related concussion (SRC) awareness, behaviours and attitudes of medical team staff working in elite football in the United Kingdom. Including usage and awareness of the FA guidelines, concussion education rates of players and coaching staff, and collection of baseline concussion assessments. Additionally, pitch-side confidence in SRC recognition, associated perceived influence of players, coaching staff, referees and other officials on decisions, and attitude towards a “concussion” substitute were explored. Methods: Cross-sectional questionnaire study distributed online by organisations including or representing medical staff working in elite football in the United Kingdom. Results: 120 responses were gathered. High awareness rates of the FA guidelines were found (97%) with variable rates of player and coaching staff concussion education. Baseline concussion assessments were collected by 78%. Of those, 99% collected SCAT5 with low rates of other neuro-psychometric testing (17%). Confidence of pitch-side SRC recognition was high (93% feeling very confident or confident). A small number of respondents thought players never under-reported symptoms to avoid removal (6.6% selecting it rarely or never occurred). There is a perception of coaching staff trying to influence removal decisions with 40% often or sometimes feeling influence. Introduction of a “concussion” substitute was seen as strongly positive for player welfare (85% strongly agreeing or agreeing). Conclusions: High awareness rates of the FA concussion guidelines are not consistent with adherence to recommendations around baseline concussion assessment and concussion education. Confidence in SRC recognition was high but removal decisions could be subject to attempted influence by players and coaching staff.
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Background: Soccer is one of the fastest growing sports in South Africa and the number of physiotherapists working with soccer teams has increased significantly. Despite increased appointments, very little is known regarding the demographic, education and work profiles of these physiotherapists. Objective: To determine the profiles of physiotherapists working with soccer teams in South Africa. Methods: A descriptive, cross-sectional study was used to collect data from physiotherapists employed with soccer teams. Physiotherapists who were employed on a part-time basis and not registered with the Health Professions Council of South Africa and who did not give consent were excluded. A total of 38 physiotherapists working with soccer teams participated in our study. A questionnaire was circulated, and participants were given 4 months to complete and submit it. Results: Results showed that participants had a mean age of 31.35 years and were employed for a mean time of 3.41 years. Most participants were African (89.48%) and worked with amateur soccer teams (52.63%). The education results indicated that 66.67% of participants held bachelor’s degrees. Postgraduate- and undergraduate education were used most frequently by participants to guide clinical decision-making. Job satisfaction was satisfactory, but they were not satisfied with their salaries. Conclusion: Our study is the first to investigate the profiles of physiotherapists working with soccer teams in South Africa. Demographic, education and work profiles for physiotherapists working with soccer teams were compiled, and the lack of information regarding the profiles of these physiotherapists was identified. Clinical implications: Extensive future research is needed to inform and train physiotherapists regarding the management of soccer teams. Keywords: physiotherapy; profile; soccer; football; teams; education; South Africa.
Study design and setting Returning rugby players to the sport following musculoskeletal injuries is a multi-factorial and challenging process. A cross-sectional observational study was conducted among health and sport practitioners involved with injured rugby players in South Africa. Objectives and outcome measures The views, current practices and barriers encountered by health and sport practitioners during return to rugby were investigated using a self-developed online survey. Results 64 practitioners participated in the survey including physiotherapists, orthopaedic surgeons, biokineticists and sports physicians. Return to sport (RTS) protocols were considered important, however, participants also indicated that they were slightly more likely to use anecdotal protocols compared to published protocols. Time frames, stages of healing, pain and subjective ratings along with functional outcome measures (such as range of motion, muscle function and proprioception) and sport-specific skills were rated as important and commonly utilised in different RTS phases (i.e., return to non-contact, return to contact and return to matches). The most commonly perceived barriers encountered were related to lack of access and time-constraints. Conclusion Return to rugby guidelines with consideration of a broad range of criteria and common barriers encountered should be developed to facilitate safe, practical and time-efficient return to rugby following musculoskeletal injuries.
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Este artículo pretende determinar las condiciones bajo las que los periodistas deben tratar los asuntos médicos de los deportistas profesionales. Para ello se recurre a una metodología cualitativa, empezando con una búsqueda de los documentos normativos y jurisprudenciales que afectan al tema. Sobre ellos se aplica un análisis de contenido temático para extraer las referencias al derecho a la privacidad de los datos médicos y al derecho a la información deportiva. Los resultados permiten identificar los criterios a sopesar en caso de conflicto entre derechos y resaltan la conveniencia de promover una política de divulgación de la información.
‘My consumers are they not my producers?’ James Joyce, Finnegans Wake James Joyce's writing is famously, notoriously difficult, especially his two epic works, Ulysses, sometimes described as the book everyone claims to have read but no one actually has, and Finnegans Wake, whose difficulties have led to innumerable reading groups formed for the sometimes lifelong task of reading and puzzling over the book, a page or two at a time. A famous photograph of Marilyn Monroe exhibits the paradox of Joyce's fame as a writer, coupled with the complexities of his writing: Monroe, wearing a swimsuit, sits in a park absorbed in Ulysses. The contradictory conjunction of movie star with great book in the picture is worth, as they say, at least a thousand words - how could the icon of mass celebrity culture, and a supposed 'dumb blonde' to boot, undertake the reading of the twentieth century's supreme work of high literature? It turns out that Marilyn Monroe did succeed in reading at least parts of the book, and the fact that she wanted to make the effort says as much for the celebrity of Joyce and his novel as it does for the intellectual aspirations of the star. In fact, the paradox of the photograph lies not its seeming encounter between opposite poles of modern culture, but in its proof that James Joyce's rarefied literary works are also themselves artifacts of mass culture. Any reader or student approaching them for the first time has Marilyn Monroe as an inspiration, and as quirky evidence that Joyce's writing, like Joyce the author, is as much a part of mass culture or consumer culture as we all are. © Cambridge University Press, 1990, 2004 and Cambridge University Press, 2006.
Recent work has suggested that masculinist sport subcultures (e.g., Young & White, 1995) and "conspiratorial" sports organizations (Nixon, 1992a) foster the acceptance of pain and injury by athletes. Using semistructured interviews, this study examined the experiences and beliefs of 22 student athletic trainers at a large university. The study found that student athletic trainers had conflicting alliances to student athletes and to staff trainers, held competing beliefs about athlete pain and injury, and struggled with athletes who did not properly use health care services and advice. It is recommended that future studies focus upon processes of negotiation and conflict, that more attention be directed to medical treatment of injured women athletes, and that recommendations to change medical services for athletes await further research.
This paper maps the current ownership patterns of North American major professional sports franchises in order to assess the extent to which they are interconnected with media/entertainment conglomerates. First, the 120 franchises are classified according to owner's industrial sector. Second, five models of linkages between franchises and media/entertainment corporations are followed by case studies representative of each. The paper concludes that indeed emperical evidence supports the alleged increasing control of North American pro sport franchises by large media/entertainment conglomerates. However, the paper also demonstrates that the phenomenon involves much more diversity than the major conglomerates commonly identified in the current literature. Finnally, the paper discusses the impacts of this trend on sport, as well as on fans.
This paper considers the nature and implications of cultural messages about risk, pain, injury, and comebacks in sport that are mediated by a popular American sports magazine. The analysis is based on evidence from a content analysis of Sports Illustrated articles, the results of which suggest that athletes are exposed to a set of mediated beliefs about structural constraints, structural inducements, general cultural values, and processes of institutional rationalization and athletic socialization that collectively convey the message that they ought to accept the risks, pain, and injuries of sport.