Elite-level Sports Research Articles

Finding a way in and making it stick: an exploration of chiropractor experiences working in team-oriented elite sport practice settings

Interprofessional healthcare teams have become the benchmark for optimising athlete health and performance in high-stakes sports. Despite a history of utility as provider partners, chiropractors are currently a relatively underutilised...

Centralizing an ecological sport psychology through science-practice dialectics

There has been considerable discussion for more than 50 years of how scientists and practitioners in elite level sport can work collaboratively to ensure that evidence-based practice augments the sport performance and human development of elite amateur and professional athletes. The bridging of these two, often disparate competencies, science and practice, though considered at the conceptual level, continues to be scarcely evidenced within the international sport science community. Much of the research that frames the experiences of elite athletes and their consequent needs, is heavily influenced by scientists, often without direct reciprocity to bridge science, theory, and applied context. The knowledge influencing these interventions has derived from qualitative methods, such as semi-structured interviews, surveys, and focus groups, as well as a breadth of psychometric assessments. Though these approaches to gathering robust data are a necessary part of inquiry, they often produce decontextualized data collection strategies and results, which can lead to generalized, ineffective practices in sport performance environments. Within this submission, the first author cooperated with an international team of scientist-practitioners who are well versed in elite sport to delineate ecologically sound science-practice reciprocity. The authors consider the strengths and weaknesses of conventional qualitative research strategies in terms of their utility and the parlance of evidence into intervention and world-class performance. Two emerging, context driven approaches to inquiry are proposed; arts-based methods and an idiosyncratic approach to ethnography to encourage the reader toward an expanded selection of inquiry approaches from which better understanding and intervention can be generated. This contribution conclude with summary points to open further possibilities for innovative science to practice approaches.

Body Mass Index Trends for the Top Five Finishers in Men's Grand Tour and Monument Cycling Events from 1994-2023: Implications for Athletes and Sporting Stakeholders.

Weight-related issues can be prevalent in elite-level sports, especially in men's road cycling, where riders may exhibit harmful behaviours, with potentially adverse outcomes for mental and physical health. This study investigated Body Mass Index (BMI) values amongst the top five finishers in the three Grand Tours and the five Monuments races between 1994 and 2023 to assess longitudinal patterns. Publicly available height and weight figures were sourced from ProCyclingStats and BMI scores were calculated for n = 154 and n = 255 individual athletes for the Grand Tours and Monuments, respectively. Two analyses were conducted with correlations and ANOVAs: the first included the BMIs of all top-five finishes and the second focussed on the BMIs of new top-five entrants. The results from both analyses revealed consistent mean BMI decreases over the years and larger effect sizes were apparent in the Grand Tours compared to the Monuments. Although lower BMIs are associated with certain performance advantages, these declining trajectories suggest a need for enhanced awareness in the cycling community and possible regulatory measures and educational programmes to promote the sustainable wellbeing of riders. This may be particularly pertinent given the wider evidence of unhealthy weight-related attitudes and behaviours throughout the sport.

Pregnancy, Parenthood, and Elite Athletics: “There’s a Lot of Work Still Yet To Be Done”

Several female athletes have recently challenged the long-standing assumption that pregnancy/parenthood (particularly motherhood) and participation in elite-level sport are mutually exclusive. These women’s actions have elicited change across the elite athletics industry and have sparked a need for further research to understand how elite athlete-parents perceive these shifts. We used feminist poststructuralist theory, feminist participatory action research, and semistructured interviews to explore the perspectives of 21 pregnant and parenting elite/international and world-class athletes (11 women and 10 men) on the developing degree of acceptance of parenthood in elite athletics. Through feminist poststructuralist discourse analysis, we identified that, despite considerable recent advancements, there is still a need for continued change in the degree to which pregnant/parenting elite athletes are accepted and supported within elite athletics.

Regenerative Anterior Cruciate Ligament Healing in Youth and Adolescent Athletes: The Emerging Age of Recovery Science.

Anterior cruciate ligament (ACL) injuries mainly arise from non-contact mechanisms during sport performance, with most injuries occurring among youth or adolescent-age athletes, particularly females. The growing popularity of elite-level sport training has increased the total volume, intensity and frequency of exercise and competition loading to levels that may exceed natural healing capacity. Growing evidence suggests that the prevailing mechanism that leads to non-contact ACL injury from sudden mechanical fatigue failure may be accumulated microtrauma. Given the consequences of primary ACL injury on the future health and quality of life of youth and adolescent athletes, the objective of this review is to identify key "recovery science" factors that can help prevent these injuries. Recovery science is any aspect of sports training (type, volume, intensity, frequency), nutrition, and sleep/rest or other therapeutic modalities that may prevent the accumulated microtrauma that precedes non-contact ACL injury from sudden mechanical fatigue failure. This review discusses ACL injury epidemiology, current surgical efficacy, the native ACL vascular network, regional ACL histological complexities such as the entheses and crimp patterns, extracellular matrix remodeling, the concept of causal histogenesis, exercise dosage and ligament metabolism, central nervous system reorganization post-ACL rupture, homeostasis regulation, nutrition, sleep and the autonomic nervous system. Based on this information, now may be a good time to re-think primary ACL injury prevention strategies with greater use of modified sport training, improved active recovery that includes well-planned nutrition, and healthy sleep patterns. The scientific rationale behind the efficacy of regenerative orthobiologics and concomitant therapies for primary ACL injury prevention in youth and adolescent athletes are also discussed.

The Relationship Between Musculoskeletal Disorders, Anxiety and Body Awareness in Elite Athletes

Objective: The aim of this study was to determine the most common musculoskeletal disorders in athletes and to investigate the relationship between musculoskeletal complaints and sport-related anxiety and body awareness. Methods: This study, which was designed using the relational screening method as a quantitative research, was conducted using the online survey method (via Google Forms). The study included 80 athletes aged 18-35 years, who were actively involved in elite level sport. The Nordic Musculoskeletal Questionnaire was used to assess musculoskeletal disorders, the Sports Anxiety Scale-2 (SAS-2) to assess anxiety, and the Body Awareness Questionnaire (BAQ) to assess body awareness. Results: There was a significant difference in somatic anxiety levels between the athletes who experienced musculoskeletal pain and those who did not (p<0.05). The somatic anxiety levels of athletes with musculoskeletal disorders were found to be higher than those without musculoskeletal disorders. A weak correlation at a high level of significance was found between athletes' somatic anxiety levels and the number of areas of complaint reported in the last 12 months and athletes' somatic anxiety levels (p<0.01). With the body awareness status of the athletes; while a positive significant weak level relationship was found with somatic anxiety level (p<0.05), a negative negative relationship was found with concentration disorganisation at a high level of significance ( p<0.05). Conclusion: It was observed that athletes with musculoskeletal disorders had higher levels of somatic anxiety and that the number of regions in which the athlete experienced complaints was related to the level of somatic anxiety; there was no relationship between body awareness levels and musculoskeletal complaints. A multidisciplinary study with a psychological perspective is important for the clinical care and support of elite athletes in different sports.

A Matter of Distinction? A Case Study Examining the Development of a Sporting Habitus Amongst Male Sixth-Form Pupils in a Private School in the United Kingdom

This research project explores how upper-middle-class private school pupils are socialised into and through sports. Particularly around major sporting events such as the Olympics, there has often been commentary in the mass media regarding the extent to which former private school pupils tend to be overrepresented in Team GB within many elite-level sports. However, a need remains to research the experiences and underpinning processes that contribute to the sporting participation patterns of private school students. Semi-structured interviews were conducted to explore private school pupils’ lived experiences and better understand how they are socialised into and through sports. Primary socialisation within the family and secondary socialisation within primary school, private school, and other external agents such as sports clubs were discussed. The research findings show that an individual’s sporting habitus is not static but changes and develops throughout their lifetime depending upon the ‘fields’ they are exposed to. Pierre Bourdieu’s (1984) theoretical ideas relating to [(Habitus) (Capital)] + Field = Practice proved helpful in enabling the research to conceptualise and interpret how parental and family upbringing shaped this relationship and, therefore, provides the theoretical lens used to analyse this phenomenon. Participants demonstrated a robust sporting habitus, regularly engaging in sports and physical activity inside and outside school. The social class background of an individual affects the volumes of economic, social, cultural and physical capital they possess. Members of the upper-middle classes, therefore, seek to invest in developing different forms of capital for their children linked to the sporting ‘tastes’ and ‘distinctions’ of their class (Bourdieu, 1984).

Fatherhood and Elite Athletics: Sacrifice, Selfishness, and Gaining "Dad Strength".

This study contributes to a growing body of scholarly discussions around the many aspects and challenges of combining parenthood with elite-level sport, with a particular focus on the experiences of male elite athletes who are fathers. We used a caring masculinities theoretical framework, community-based participatory research, and semi-structured interviews to explore the experiences of 10 elite/international and world-class athletes (n = 9 fathers, n = 1 expectant father). Through reflexive thematic analysis, we identified three main themes: fatherhood can (1) improve and (2) impede elite athlete-fathers' athletic performance; and (3) athlete-fathers experience a trade-off between athletic performance and fatherhood responsibilities. Our findings underscore the ways in which male athletes' experiences with parenthood reflect the new era of involved fatherhood and are analogous to some of the identity tensions that have been reported with regard to the experiences of elite female athletes who are pregnant and/or mothers. Recognizing the impact of children on male athletes' athletic careers and the parallels between fatherhood, motherhood, and elite sport may lead to better support for athlete-fathers while also contributing to diminishing the expectation that women are primary caregivers to children.

Long-term cardiac follow-up of athletes infected with SARS-CoV-2 after resumption of elite-level sports

ObjectiveLongitudinal consequences and potential interactions of COVID-19 and elite-level sports and exercise are unclear. Therefore, we determined the long-term detrimental cardiac effects of the interaction between SARS-CoV-2 infection and the...

Anabolic-androgenic steroids: Considerations for forensic psychiatry, sports psychiatry, and the law

Anabolic-androgenic steroids: Considerations for forensic psychiatry, sports psychiatry, and the law

We're not Superhuman, We're Human: A Qualitative Description of Elite Athletes' Experiences of Return to Sport After Childbirth.

BackgroundA growing number of athletes return to elite sport following childbirth. Yet, they face significant barriers to do so safely and successfully. The experiences of elite athletes returning to sport following delivery are necessary to support evidence-informed policy.ObjectiveThe purpose of this qualitative description was to describe the experiences of elite athletes as they returned to sport following childbirth, and to identify actionable steps for research, policy and culture-change to support elite athlete mothers.MethodsEighteen elite athletes, primarily from North America, who had returned to sport following childbirth in the last 5 years were interviewed. Data were generated via one-on-one semi-structured interviews that were audio-recorded, transcribed verbatim, and analyzed through a process of content analysis.ResultsThe findings of this study are represented by one overarching theme: Need for More Time, and five main themes: (a) Training “New Bodies” Postpartum, (b) Injuries and Safe Return to Sport, (c) Breastfeeding While Training, (d) Critical Supports for Return to Sport, (e) Navigating Motherhood and Sport. The athletes identified the urgent need to develop best-practice policies and funding to support return to sport, as well as develop evidence-based return-to-sport protocols to support a safe and injury-free return.ConclusionAthletes shared detailed stories highlighting the challenges, barriers and successes elite athletes experience returning to elite-level sport following childbirth. Participants provided clear recommendations for policy and research to better support the next generation of elite athlete mothers.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40279-022-01730-y.

Parents’ experiences of family food routines in adolescent elite-level swimming

ObjectiveParents have an important role in their child’s food routines and eating behaviour and face additional demands when that child is an athlete. Yet little is known about how parents manage providing food for their athletic child, in addition to the wider family, within the context of elite-level youth sport. MethodsSemi-structured interviews were conducted with sixteen parents (mothers = 11; fathers = 5) of elite level adolescent swimmers (i.e., competing at UK national level or above; child mean age = 15.4 years) to explore their experiences of family food routines and eating behaviour. Reflexive Thematic Analysis was used to analyse the data. ResultsParents outlined the importance of ‘optimal’ fuelling for their athletic child. Parents had an active role in their child’s eating behaviour and shaping their food choices but expressed uncertainty regarding the volume of food their child should consume and concerns regarding their child’s future relationship with food. Meticulous organisational and logistical strategies were employed to meet the extensive food requirements of their adolescent elite swimmer in the face of intensive training schedules. Such schedules also impacted food routines for the wider family (i.e., fewer family mealtimes), and on the quality of parents’ own diets. ConclusionThe findings highlight that clearer guidance is needed for parents of elite adolescent swimmers in relation to quantities of food intake and how to support a positive future relationship with food (specifically during any periods of transition in their training or out of the sport). The findings also identify a novel organisational stressor for parents in elite youth sport, in managing and prioritising their own diet. Further research is needed to explore the extent to which parental diet may be impacted by supporting an adolescent athlete.

Comparison of Postural Stability and Regulation among Male Athletes from Different Sports

The purpose of this study was to assess the postural control of 50 male athletes (age: 24.9 ± 4.55 years) who participate in different elite-level competitive sports. Athletes from two team sports from the third German league (ice hockey: n = 16; soccer: n = 23), and one individual sports (diving: n = 11) were included. These athletes were investigated using posturography under different conditions (e.g., stable surface, unstable surface; eyes open, eyes closed) to determine postural stability and regulation. Most of the performance maxima were found among the divers (6), followed by ice hockey (5) and soccer (4). The biggest effect of sport was found in the stability indicator, where the subject was standing on a stable surface and their eyes were closed (NC; p = 0.001, ηp2 = 0.273). This significance was observed between the soccer (17.3 ± 5.66) and diving (24.9 ± 6.98) subjects. The stability indicator had the largest significant effect (50%, 2/4). These results provide coaches and athletes insight into the postural stability and regulation of male athletes in sports with different demands on postural control. Especially for soccer players, it may be beneficial to address muscular imbalances to reduce the risk of lower extremity injuries.

Impaired one-legged landing balance in young female athletes with previous ankle sprain: a cross-sectional study.

Ankle sprain is the most common type of sports injury, especially in team sports. Standing and dynamic landing balance, as an indicator of ankle instability, were investigated using varying experimental approaches. In the present cross-sectional study, 81 adolescent female elite handball and football players were divided into two groups based on previous ankle sprain injury (PI) or not (C). At time of test, all players were fully returned to elite-level sport. Subjects were tested during a one-legged landing (OLL) and in a one-legged static standing balance test (OLBT). In the OLL CoP trajectory displacement was calculated in 200 ms time epochs for evaluation of the initial stages of dynamic landing balance. OLBT was evaluated by calculating total displacement of the CoP trajectory. CoP displacement was greater in PI than C during the first 200 milliseconds epoch after landing (P=0.001, 252 mm [44], vs. 223 mm [28]), respectively) and in the subsequent 200 ms epoch (P=0.021, 72 mm [20], vs. 61 mm [16], respectively). No significant differences between PI and C were observed in time epochs from 400 to 1000 milliseconds or in OLBT. Adolescent elite athletes with a history of previous ankle sprain demonstrate impaired OLL balance in the first 400 milliseconds following jump landing compared to non-injured controls. Consequently, although athletes with previous ankle sprain may return to sport, dynamic postural control may not be fully restored. Future prospective studies are needed to decide, if the OLL test could be considered a relevant criterion tool for safe return-to-sport.

Pregnancy and motherhood in elite sport: The longitudinal experiences of two elite athletes

Since the end of the 20th century, the elite athlete mother has been a growing social phenomenon, with increasing numbers of female athletes returning to elite level sport postpartum. Allyson Felix and Serena Williams are two recent elite athletes who successfully transitioned into their new identity of elite athlete mother. However, there is no guarantee that all transitional journeys will be as successful. The purpose of the present study was to enhance current knowledge of the experiences during pregnancy and motherhood in elite sport by exploring how becoming a mother impacted on the perceived personal and physical identity of elite athletes. Two elite athletes who had recently given birth to their first child were interviewed at two-months, six-months, and 15–16 months post-birth. Interviews were analyzed using a reflexive thematic analysis to explore how identity may have changed over the initial 15–16 months of motherhood. Three themes were developed, comprising: athlete identity; mother identity; and athlete mother identity. The sub-themes of identity, physical identity, shifting of goals, juggling athlete and mother identity, dual identity, priorities, and lifestyle were generated and demonstrated both similarities and nuances in the experiences of the two athletes. This study is the first to provide longitudinal insights into the experiences of both para and non-para elite athlete mothers during the initial stages of motherhood. Findings highlight the individual nature of such an experience and illuminate some of the negotiations of the personal, athlete, and mother identity that an athlete mother may experience.

Three-Dimensional Morphometric Characterization of Femoral Cam Lesions: Quantifying the Radial and Lateral Extents

To quantify the radial and lateral extents of femoral cam lesions in FAI patients relative to the alpha angle and correlate with clinical data. Retrospective study of 81 hips with femoral cam morphology that underwent arthroscopic surgery between 2017 and 2019. At each hour over the clockface, the alpha angle (α) (abnormal defined as > 55°), radial extent, and lateral extent of cam lesions were measured on CT. These measurements were correlated with clinical and arthroscopic data. Statistics included independent samples t-test and chi-squared test with Bonferroni correction and multivariate logistic regression. Larger α at 12:00-4:00 in males vs females (56.6-63.4° vs 44.3-58.5°, P < 0.001) and at 2:00-4:00 with elite sports participation vs without (56.7-70.9° vs 49.6-61.1°, P ≤ 0.004). Independent risk factors for radial extent beyond 12:00-3:00 were: male sex (OR 4.82, 95% CI [1.46, 15.85], P=0.010), BMI > 25 (OR 4.74, 95% CI [1.61, 14.00], P=0.005), and elite sports participation (OR 3.28, 95% CI [1.09, 9.82], P=0.034). Lateral extent increased at 1:00-4:00 in males vs females (7.8-18.6 mm vs 1.6-9.1 mm, P < 0.0001). A 16% prevalence of distal cam lesions was found at locations with normal α, resulting in underestimation of radial extent by an average of 1.7 hours. There is a positive correlation between the alpha angle, lateral extent, and radial extent of cam lesions. FAI patients who were male, participated in elite level sports, and had a BMI > 25 had larger cam lesions. A larger alpha angle is a risk factor for cartilage damage. Patients may have distal cam lesions at locations with normal alpha angles, though their significance is unknown.

Abstract 14377: The Role of Allometric Scaling in the Association Between Professional Playing Career and Aortic Root Diameter Among Retired NFL Players

Introduction: While there is concern that participation in certain elite-level sports may increase risk for aortic dilation, clinical assessment of aortic root diameter (ARD) in professional athletes remains difficult owing to the lack of available normative data proportionate to anthropomorphic variables, which further complicates proper assessment of aortic disease during the post-professional life when risk factors may be greater. Thus, we examined the effect of allometric scaling on the association between ARD and professional football career length (NFLYrs) or playing position in retired National Football League (NFL) players. Methods: This cross-sectional study included 1,328 retired NFL players (mean age 53.1 ± 12.7 yrs; 54.6% Black) that participated in NFL Player Care Foundation health screenings. Two-dimensional echocardiogram was used to determine ARD at the sinus of Valsalva and indexed to body surface area (BSA) 0.6 (aortic root index; ARI). Multivariable-adjusted linear regression models were utilized to examine the association of playing position group and NFLYrs with ARD or ARI, after adjusting for traditional cardiometabolic risk factors. Results: The mean ARD and ARI of this study cohort were 33.0 ± 6.4 mm and 19.5 ± 3.8 mm, respectively. In regression models, NFLYrs was not associated with either ARD (B: -0.04, standard error [SE]: 0.04, p = 0.3496) or ARI (B: -0.03, SE: 0.03, p = 0.3177). Conversely, increasing ARD was associated with both Big (B: 1.12, SE: 0.53, p = 0.0340) and Big Skill (B:1.10, SE: 0.45, p = 0.0144) position groups, although this was attenuated to non-significance by allometric scaling of ARD (Big, B: -0.25, SE: 0.32, p = 0.4303; Big Skill, B: 0.22, SE: 0.26, p = 0.3978). Conclusions: NFLYrs was not associated with increasing ARD or AIH, suggesting that a longer professional football career did not potentiate larger aortic root size later in life. While football playing position was associated with increasing ARD, this association became non-significant upon indexing of ARD to BSA 0.6 , suggesting that allometric scaling may be necessary to appropriately assess aortic root diameter in these individuals. This underlines the need for further studies examining optimal allometric scaling methodologies in this population.

A Call for implementing minimum age condition to protect young athletes‘ human rights

Sport is considered a favorable activity for children. Through participating in sport, children can acquire several skills and develop character traits like cooperation, teamwork, resilience, and focus. Nevertheless, it has been argued that children’s rights might be violated in sport at an elite level, primarily due to the intensive training given at an early age. More specifically, it was reported that approximately 20 percent of children involved in competitive sports may be at risk of abuse, violence, or exploitation, while 10 percent may be at risk of extreme abuse. This paper focusses on the lack of international law provisions to protect children who participate in elite sports and hence argue for a more effective protection. This gives rise to the need for an enforcement mechanism in the International Convention on the Rights of the Child (CRC) specifically for elite-level sports. Thus, the international law could have a positive impact on domestic laws regarding young athletes in competitive sports. As a possible way through, this paper will examine the idea of imposing minimum age limit, including legal examples, as a potential solution to help protect children’s rights in sport.

The sports cardiology team: personalizing athlete care through a comprehensive, multidisciplinary approach

Abstract Background/Introduction Multidisciplinary teams (MDT) are an integral part of cardiology. In sports cardiology wide area of expertise is required to differentiate between extraordinary pathophysiological adaption and pathology. In Addition, expertise-based sports advice should be prescribed with great care considering the great impact on (professional) sports careers. Specific guidelines for the composition of MDT's for sports cardiology are currently lacking. We established a sports cardiology MDT in April 2020 (Amsterdam UMC), consisting of experts in the fields of sports medicine, cardiogenetics and paediatric cardiology, cardiovascular imaging and electrophysiology, with bi-monthly meetings. Cases were contributed from cardiologists or referred nationally for expertise with patients/athletes varying from recreational to elite-level sports. Purpose To describe our infrastructure and utilization of a sports cardiology MDT, and to justify the need for a sports cardiology MDT. Methods We retrospectively analysed all MDT reviewed cases (from April 2020 to April 2021), and collected follow-up data 1 year after initial MDT review. Data were classified according to type/level of sports. We compared diagnosis and/or reason for referral and sports advice at initial MDT application and after panel review. In addition we abstracted data on occurrence of cardiac symptoms and/or cardiac events, and adherence to sports advice. Results 112 cases underwent MDT review, with a mean age of 32 (SD 16.0) years. In total 12% were women, 38% professional athletes, and 30% engaged in high dynamic/low static sports. Reasons for referral were personalised sports advice in 48%, expert opinion in 28%, and abnormal ECG/CMR/CPX in 24%. The diagnosis was revised in 55% (n=61), main groups; 1) suspicion of (non-specified) cardiomyopathy (CMP) to no cardiac pathology in 20% (n=12), and 2) “cardiac abnormalities with no clear diagnosis” to “no cardiac pathology” in 36% (n=22) (Figure 1). Sports advice was revised to more personalized sports advice in 30% (n=34) (Figure 2), main groups; no restriction to no peak load/specific maximum load in 38% (n=13), and no restrictions to no competitive sports in 26% (n=9). At 1 year follow-up, the (sports) advice was adhered in 99,98% (n=111), and cases with no sports restrictions reported no cardiac symptoms in 99% (n=72/73), and no major acute cardiovascular events in 100% (73/73). No further revisions of diagnoses were found to have taken place. Conclusion Our experience with a comprehensive, sports cardiology MDT demonstrates that such an approach is feasible, and leads to more personalised treatment- and sports advice in athletes. Medium-term adherence to sports advice given is high. A team-based approach also leads to a higher percentage definitive diagnoses. Our findings serve as a proof-of-concept of the added value of the sports cardiology team in care for athletes and patients who wish to engage in sports and exercise. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): Dutch Olympic Committee*Dutch Sports Federation (NOC*NSF)Amsterdam Movement Sciences (AMS) Figure 1. Revised diagnosis before and after panel review (N=61)Figure 2. Revised sports advice before and after panel review (N=34)

Social-Economic-Political-Emotional (SEPE) factors regulate human growth

Background&#x0D; There is a recurring and seamless interaction between the biology of human development and the social-economic-political-emotional (SEPE) environment. The SEPE environment influences the quality of the material conditions for human biology and, simultaneously, human growth in height and other dimensions provide social and moral signals that provide information to community networks.&#x0D; Objectives&#x0D; This article reviews the role of SEPE factors in human growth, especially skeletal growth.&#x0D; Sample and Methods&#x0D; The meaning of SEPE is defined and shown to be related to individual and group prestige, to social identity, and to ego and task motivation. These influence dominance or subordination of communities and the material and moral conditions of societies. Historical and contemporary examples of SEPE effects on skeletal size are presented.&#x0D; Results&#x0D; Membership in a SEPE community impacts skeletal size in height and breadth. Higher SEPE classes are taller, lower SEPE classes are broader. In elite level sport the winners have more growth stimulation via the hormone IGF-1 even before the contest. These findings are explained in terms of dominance versus subordination and the Community Effect in Height hypothesis.&#x0D; Conclusions&#x0D; SEPE factor regulation of human growth is shown to be a more comprehensive explanation for plasticity in height than traditional concepts such as socioeconomic status and simple-minded genetic determinism. People belonging to upper SEPE class communities, the elites, know that they are superior and are treated as such by the non-elites. The material and moral condition for life operating through these community social networks provide positive stimulation for the elites and negative stimulation for the lower SEPE classes. These differences maintain the gradients in height between SEPE communities in human societies.