ABSTRACT
If the ‘rational exploitation of science and medicine in the pursuit of competitive success’ thesis is correct, one would expect this to be directly reflected in both the organizational commitment to medicine (and hence the provision of sports medicine), and the everyday utilization of biomedical actors in the resolution of the issues which those in the sporting world consider problematic (hence the practice of sports medicine). Yet, as outlined in Chapter 7, the majority of the provision of sports medicine is based on minimal economic investment, which results in a limited and low-skilled service. From this standpoint we continue a narrative of the medicalization of sport as relatively restricted, with sports medicine physicians far from central to the achievement of sports organizations’ goals. In contrast to what we now know of the provision of sports medicine, studies of the pain and injury experiences of athletes initially built on the view that performance was ‘an important part of the raison d’être’ of sports medicine (Waddington 1996: 185). For instance, in his pioneering work, Howard Nixon (1992: 128) contended that ‘sportsnets’ (the ‘webs of interaction’ that constitute the lived reality of sports clubs and include coaches, managers, medical staff, other athletes, spectators, administrators and investors) effectively conspired to coerce athletes to play through pain and with injury because competitive success is the priority of those most powerful in such figurations. But these studies also offered something of a paradox, for whilst sociologists have traditionally positioned medicine as a ubiquitous and imperialistic social institution (see Chapter 2), sports physicians often occupied relatively weak or subordinate roles and were relatively impotent actors within the broader power structure of sport. A picture emerged therefore of medical actors as neither very powerful nor autonomous in their practice. Indeed Walk argued that a central implication of Nixon’s work on sportsnets, the culture of risk, etc., was that, ‘medicine is practiced differently, more competently, and/or more ethically in nonsports contexts’ (Walk 1997: 24). There are two broader sets of ideas that help us to understand this specific state of affairs: an Eliasian sociology of knowledge, and healthcare delivery trends indicative of a contemporary challenge to medical dominance.
