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Beyond the orthodox/CAM dichotomy: Exploring therapeutic decision making, reasoning and practice in the therapeutic landscapes of elite sports medicine

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journal contribution
posted on 10.03.2020, 13:58 authored by Katie CoveneyKatie Coveney, Alex Faulkner, Jonathan Gabe, Michael McNamee
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.

Funding

ESRC grant ES/K010956/1

History

School

  • Social Sciences

Department

  • Communication, Media, Social and Policy Studies

Published in

Social Science & Medicine

Volume

251

Issue

April 2020

Publisher

Elsevier BV

Version

VoR (Version of Record)

Rights holder

© The Authors

Publisher statement

This is an open access article under the CC BY license (http://creativecommons.org/licenses/BY/4.0/).

Acceptance date

27/02/2020

Publication date

2020-03-04

Copyright date

2020

ISSN

0277-9536

Language

en

Depositor

Dr Katie Coveney. Deposit date: 10 March 2020

Article number

112905