Health and Elite Sport

Is High Performance Sport a Healthy Pursuit?

Joe Baker, Parissa Safai, Jessica Fraser-Thomas, Joe Baker, Parissa Safai, Jessica Fraser-Thomas

• Publisher: Taylor & Francis
• Year: 2014
• Print ISBN: 9780415708661
• eBook ISBN: 9781134620081
• Edition: 1
• Topic: Medicine
• Subtopic: Sociology

Health and Elite Sport is the first book to critically examine the relationship between participation in high performance sport and health outcomes. Drawing on theory and empirical data from a wide range of disciplines, including sociology, developmental psychology, epidemiology, and physical education, the book explores the benefits and detriments of participation in elite sport for both individuals (athletes, coaches, spectators) and communities.

Written by a team of leading international sport researchers, the book examines key issues including:

• Talent identification and young athletes

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• Abuse in sport

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• Positive youth development through sport

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• Athlete health in periods of transition

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• Health, sport and the family

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• Health in professional sport

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• The Olympics, Paralympics and public health

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• Long term effects of participation in elite sport

Highlighting the connections and contradictions between high performance sport and health, the book also discusses the clear and important implications for our socio-cultural, political and developmental understanding of sport. Health and Elite Sport is fascinating and important reading for all students and researchers with an interest in youth sport, sports development, sport policy, sports coaching, exercise and health, physical education, the sociology of sport, or the sociology of health.

1 Sport and health of the high performance athlete

DOI: 10.4324/9781315885919-1

An introduction to the text

Parissa Safai, Jessica Fraser-Thomas and Joseph Baker

In the lead up to the 2014 Winter Olympic Games in Sochi, Russia, the Canadian Broadcasting Corporation (CBC) – the host television broadcaster for the Games in Canada – began unfurling a whole series of Olympic-related programming including promotional commercials, news coverage, journalistic-style mini-documentaries and a documentary called Road to the Olympics geared towards “showcasing a collection of Canada’s athletes heading to the Winter Olympic Games in Sochi, Russia” (retrieved from www.cbc.ca/player/Sports/ ID/2427918370/). While some of this pre-Olympic coverage examined the social and political issues surrounding the Games, including criticisms of the exorbitant US$50 billion price-tag for the Games and protests of Russia’s discriminatory anti-gay laws, much of the content of this pre-Olympic programming was geared towards introducing the public to Olympic athletes preparing for the Sochi Games, with particularly heavy emphasis on past and potential medal winners.

As social scientists who study health and sport, we were struck by the paradox of experiences that made up these Olympians’ journeys. We recognized their incredible physical capabilities of fitness, strength and skill, their psychological motivation, determination and focus, coupled with their widespread appeal as models of health, work ethic, sportspersonship and character. But we were also struck by the notable and consistent attention paid to pain and injury as part of each athlete’s personal story. Each segment of Road to the Olympics highlighted an individual athlete’s journey to the Sochi Games, offering viewers numerous examples of the joys of sport – the confidence that arose from being masterful in their discipline, the feelings of connection, belonging and camaraderie that developed from being a member of the Canadian Olympic team, or the pleasures associated with travelling around the world and having new experiences. The program was inspiring as a function of the very inspirational character of each athlete profiled. This should be of little surprise given the empirical evidence supporting high performance athletes’ embodiment of strong personal, psychological and social characteristics; research among top-ranking Olympic and international-level athletes highlights their sense of confidence in their capabilities, their unfaltering motivation and their tremendous work ethic, coupled with their strong sense of self-awareness and ability to remain optimistic and effectively use coping skills in the face of adversity (Durand-Bush and Salmela, 2002; Gould et al., 2002). These athletes have also been found to have an eagerness to learn, be creative and intelligent in the learning process, and show strong values and morals in their approach to elite sport.

However, in the Road to the Olympics, each athlete profile also included some mention of that athlete’s struggle with sport-related injury and ill health; in fact, the return to international sport after injury became a central narrative for the athletes profiled in the documentary. We, as viewers, were led through how that athlete became injured in sport, how they received medical care (most often surgery), how they engaged in long hours of intensive physical therapy to regain function and mobility, and then how they overcame their doubts or fears of re-injury or lessened ability as they re-entered high-level competition. Dramatic music, somber narration and stark images of the athletes on the surgical table or in the rehab clinic framed this sequence and provided a sense of gravitas for this narrative arc. Everything about the Road to the Olympics production made it easy to get swept up into the documentary’s celebration of these athletes’ perseverance through and recovery from pain and injuries in the pursuit of sporting success for themselves and for their nation at the 2014 Games. Simply put, there was no critical evaluation or discussion of the health and well-being of these athletes, specifically, or the healthfulness of the high performance sport endeavour more broadly; this in spite of our growing understanding of athletes’ immersion in sport’s “culture of risk” (Nixon, 1992) – a culture that sees the unquestioned acceptance, production and reproduction of health-compromising norms and practices (e.g., pain/injury tolerance) (see also Safai, 2013).

As editors in the last stages of drawing together a collection of essays on the relationship between health and high performance sport, athletes showcased in Road to the Olympics did not register as simply entertaining television but, rather, as a visual example of the very question this edited volume is attempting to unpack: is high performance sport a healthy pursuit? On the one hand, we witnessed stories of individuals who were confident, motivated, focused, persistent and resilient in spite of their pain and injuries; their injuries were seen as part of the sport process, which included adversity, that they were required to overcome in order to achieve their goals. On the other hand, we witnessed a complete absence of critical discussion of the tolerance of pain and injury by athletes and other sport participants (e.g., coaches, administrators, etc.) as part-and-parcel of the high performance sport experience; or the long-term consequences of multiple surgeries on knees and hips worn down by training regimes and competition schedules that may be more suitable for robots than for human beings; or the stress (and its toll on health) experienced by athletes and their loved ones (parents, spouses, families, friends) as they dedicate their bodies and minds to the pursuit of medal-winning performances. These stories provided another, very timely, reminder of the routine normalization and romanticizing of the pain and injury involved in the high performance sport process, yet it did so with no critical insight into the complex relationships between elite sport, health and healthcare.

Sport and our commonplace assumptions about health

This lack of critical discussion is not particularly surprising given other health-related messages we routinely hear in connection with such sporting mega-events as the Olympics or the FIFA (Fédération Internationale de Football Association) World Cup. A popular assumption among the public, reinforced by politicians and policy makers alike, is that high performance sport positively and enduringly influences sport and health for all. In fact, countries aspiring to host the Games must now include legacy plans as part of their bid submissions to the International Olympic Committee (IOC) – plans that outline how their hosting of the Games will provide long-term benefits to their community/region/country in such areas as “economic and infrastructural development, new housing, new sports facilities, and a more active and healthy population who would have been inspired to get out of their La-Z-Boys by the performances of top athletes from their country” (Donnelly, 2012). The IOC mandated the inclusion of a legacy plan in bid documents as of 2002 in recognition that the high costs of hosting the Games must be justified through such ‘social goods’. During the bid for the 2012 Games, promotional materials for London routinely touted that the Games would boost grassroots sport in the UK and make the nation “fitter and healthier” (Coalter, 2004: 91), and then Prime Minister Tony Blair went so far as to suggest that the 2012 Games would encourage a 10 per cent increase in sports participation across the UK.

This concept, commonly referred to as the ‘trickle down effect’– the belief that hosting or winning medals at a major games or mega-event positively trickles down to non-elite athletes and non-athletes and promotes participation and health for all – is grounded in theories of message framing in physical activity promotion that suggest positively framed messages delivered through optimal models of fitness (i.e., Olympic sport) are more effective (Berry and Spence, 2009; Latimer et al., 2008). While the trickle-down rhetoric is exceptionally popular, particularly in the lead-up to and during an Olympic year, research into this theory is relatively absent and empirical support for the theory is tenuous at best. In large systematic reviews of research and databases, Mahtani and colleagues (2013) conclude that there is little evidence to suggest increased participation in sport or health benefits following an Olympic Games. They note that such claims cannot be made or upheld without thorough evidence-based evaluation before, during and after such mega-events. McCartney et al. (2010) go further to suggest that until such evidence is procured and until long-term evidence-based evaluations are integrated into the design and delivery of major games, the costs of such events cannot be justified in terms of benefits to host communities.

Two major criticisms can be levelled at the trickle-down theory. The first is its lack of attention to the wide variety of social, cultural and structural factors necessary for full and equitable sport participation among participants. Trickle-down rhetoric assumes that all individuals will be in a position to and will want to increase their participation in sport following exposure to a major games (i.e., after being inspired), yet there is considerable evidence of the barriers for some individuals and communities around sport access and opportunity (Donnelly and Coakley, 2004; Donnelly and Harvey, 1996). Donnelly et al. (2010) have comprehensively examined the trickle-down effect theory and concluded that, despite the widespread assumption of a trickle-down effect, the effect is often in the form of increased interest (i.e., phone calls, email inquiries) in sport programs, while anecdotal accounts are often stories of already successful athletes being inspired by previous Olympians. In other words, the Games themselves are insufficient to lead to population level behavior change in the area of sport involvement.

The second major criticism rests in the intertwining assumptions that sport participation is a healthy pursuit for all people all the time and that high performance sport is the ideal of healthful sport participation. Both assumptions are problematic. With regards to the latter, we have already noted how elite athletes’ endurance of injuries, including long and difficult recoveries from injury, takes centre stage in mediated narratives. A critical assessment of these narratives highlights the reality that individuals who routinely push their bodies to the limit (and, oftentimes, beyond the limit) in training and competition experience tremendous bodily wear-and-tear as they pursue excellence; they are caught in a ‘sporting paradox’ where they are breaking down their bodies as they move up the competitive sporting ladder (Safai, 2004). In recent years, there has been growing public, research, media and government attention paid to sport-related injury and its prevention that is poking holes at the assumption that sport participation is healthy for all people all the time. In fact, several conditions are now considered ‘public health issues’ rather than taken-for-granted or inevitable features of sport participation, including (but not limited to): sport’s “culture of risk” (Nixon, 1992); injuries arising from bodychecking in youth hockey (Warsh et al., 2009); the increased rates of anterior cruciate ligament knee injuries among female athletes (Sokolove, 2008); and the short- and long-term consequences of concussion and other head injuries (Stern et al., 2011). Compared to previous generations, there is more active discussion and debate (although rarely heard during the bid process for or in the lead-up to an Olympic Games) among athletes, coaches, parents, healthcare professionals, sport governing bodies, researchers (from a wide variety of disciplines) and policy makers about the healthfulness of organized sport.

This should not be surprising given the rates of injury as a result of sports participation documented by researchers in various countries around the world. In Canada, drawing on 2009–2010 Canadian Community Health Survey (CCHS) data, Billette and Janz (2011) highlight that an estimated 4.27 million Canadians aged 12 or older suffered an injury severe enough to limit their usual activities and that 35 per cent of those injuries occurred during participation in some type of sports or exercise. Furthermore, they note that two thirds (66 per cent) of injuries among young people (aged 12 to 19) were related to sports; more than twice as high as working-age adults (29 per cent) and about seven times higher than seniors (9 per cent). A more recent Canadian Institute for Health Information (CIHI) (CIHI, 2012) study suggests that, in 2010–2011, more than 5600 Canadians of all ages were hospitalized (for at least one night) with serious injuries related to winter sports such as skiing, snowboarding, hockey and ice skating. The report highlights that, in the province of Ontario alone (where complete data were available), there were over 45,000 visits to emergency departments as a result of winter activities; an average of 285 emergency department visits a day. These figures do not include visits to a doctor’s office or deaths at the scene, and therefore the report’s authors emphasize that the total number of injuries is likely much higher (CIHI, 2012). The consequences of such injury rates are significant for the Canadian healthcare system in a variety of ways, including access to and usage of acute and long-term healthcare facilities, services and healthcare providers (including specialists). The economic burden associated with sport-related injury is notable as well; Smartrisk (2009) estimates that direct costs (healthcare costs arising from injury) and indirect costs (costs related to reduced productivity from hospitalization, disability and premature deat...

Table of contents

• Cover Page
• Half-Title Page
• Series
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• List of figures and tables
• List of acronyms and abbreviations
• Foreword
• 1 Sport and health of the high performance athlete: An introduction to the text
• Section I Health and the developing elite athlete
• Section II Elite sport participation over the lifecourse
• Section III From self to society: Select topics on the elite sport-health question
• Index