Abstract
Elite athletes face extreme challenges to perform at peak levels. Acute and chronic musculoskeletal injuries are an occupational hazard while pressures to return to play post-injury are commonplace. Therapeutic options available to elite athletes range from novel 'cutting edge' biomedical therapies, established biomedical and surgical techniques, and physiotherapy, to a variety of non-orthodox therapies. Little is known about how different treatment options are selected, evaluated, nor how their uses are negotiated in practice. We draw on data from interviews with 27 leading sports medicine physicians working in professional football and cycling in the UK, collected 2014-16. Using idea of the 'therapeutic landscape' as a conceptual frame, we discuss how non-orthodox tools, technologies and/or techniques enter the therapeutic landscape of elite sports medicine, and how the boundaries between orthodox and non-orthodox therapy are conceptualised and navigated by sports medicine practitioners. The data provide a detailed and nuanced examination of heterogenous therapeutic decision -making, reasoning and practice. Our data show that although the biomedical paradigm remains dominant, a wide range of non-orthodox therapies are frequently used, or authorised for use, by sports medicine practitioners, and this is achieved in complex and contested ways. Moreover, we situate debates around nonorthodox medicine practices in elite sports in ways that critically inform current theories on Complementary and Alternative Medicine (CAM)/biomedicine. We argue that existing theoretical concepts of medical pluralism, integration, diversity and hybridisation, which are used to explain CAMs through their relationships with biomedicine, do not adequately account for the multiplicity, complexity and contestation that characterise contemporary forms of CAM use in elite sport.
Highlights
The use of non-orthodox therapies by athletes is prevalent across the globe (Carter, 2010; Pike, 2005; Theberge, 2008; Bundon and Hurd Clarke, 2014; Yang et al, 2016)
We argue that existing theoretical concepts of medical pluralism, integration, diversity and hybridisation, which are used to explain Complementary and Alternative Medicine (CAM) through their relationships with biomedicine, do not adequately account for the multiplicity, complexity and contestation that characterise contemporary forms of CAM use in elite sport
We propose that the concept of ‘therapeutic landscape’ broader and more loosely defined than the foregoing concepts, is better placed to account for contemporary forms of CAM use and the porous boundaries we observe between different therapeutic approaches, tools, technologies and techniques in clinical practice
Summary
The use of non-orthodox therapies by athletes is prevalent across the globe (Carter, 2010; Pike, 2005; Theberge, 2008; Bundon and Hurd Clarke, 2014; Yang et al, 2016). Previous studies focusing on athletes indicate that non-orthodox therapies are used for a variety of interconnected reasons such as recovery from prolonged periods of injury or illness, and/or dissatisfaction with the perceived inadequacy of orthodox biomedical care, and/or pressure to accelerate return to Social Science & Medicine 251 (2020) 112905 play, and to enhance performance (Faulkner et al, 2017; Kimmerle et al, 2012; Pike, 2005; Theberge, 2008). Obscure are the rationales for different treatment options: how they are selected, evaluated, negotiated and combined into therapeutic regimens within the landscape of elite sports medicine, where a plurality of therapeutic options exists
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