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Researchers are increasingly examining the tenuous relationship between participation in high performance sport and health, and yet IOC-sanctioned and popular discourse around the Olympics remains replete with references to the supposed healthfulness of the Games. Using the 1968 Mexico City Games and the 2008 Bejing Games as bookends, this paper explores national and international media coverage of athletic performance in relation to health and well-being. Three central narratives emerged: (1) pain, perseverance, and the pervasiveness of the “culture of risk” in high performance sport; (2) the performance imperative in the face of the challenges and anxieties of the environment; and (3) the presence and emerging sophistication of sports sciences/scientists in determining health. Resume. Alors que les chercheurs examinent d’un oeil de plus en plus critique la relation tenue qui existe entre le sport de haute performance et la sante, les propos emanant du CIO et le discours populaire demeurent bondes de references au caractere bienfaiteur des Jeux pour la sante. Utilisant les Jeux de Mexico en 1968 et de Bejing en 2008, cet article explore la couverture mediatique nationale et internationale des performances athletiques en ce qui a trait a la sante et au bien-etre. Trois fils directeurs emergent: 1) la douleur, la perseverance et l’importance de la « culture du risque » dans le sport de haute performance; 2) l’imperatif de la performance devant les defis et les anxietes liees au milieu; et 3) la presence et la sophistication grandissante des sciences/scientifiques du sport.

This case study examines the relationship between the “culture of risk” and the negotiation of treatment between sport medicine clinicians and student-athletes at a large Canadian university. The evidence acknowledges that a “culture of risk” was reinforced under certain circumstances during negotiation, but was also tempered by the existence of a “culture of precaution” that worked to resist those influences. The dialectic between the cultures of risk and precaution reveals some of the tensions inherent in negotiations between clinicians and patient-athletes, and helps to complicate the notion of a “culture of risk.” Another aspect (one that has rarely if ever been examined) of the negotiation of treatment is also considered—the promotion of “sensible risks” by clinicians to injured athletes.

Background Return-to-play (RTP) decision-making is required for every injured athlete. However, these decisions often lead to conflict between sport medicine professionals, athletes, coaches and sport associations. This study explores differences in professionals’ opinion about which criteria should be used for RTP decisions, and who is best able to evaluate them. Methods We surveyed Canadian sport medicine physicians, physiotherapists, athletic therapists, chiropractors, massage therapists, athletes, coaches and representatives from three sport associations. The 10 min online survey asked respondents to rate criteria as mandatory to irrelevant on a five-point Likert scale, and to indicate which profession was best able to evaluate the criteria. Results In general, medical doctors, physiotherapists and athletic therapists were considered best able to assess factors related to risk of injury and complications from injury. Each clinician group (except sport massage therapists) generally believed their own profession has the best capacity to evaluate the criteria. Athletes, coaches and sport associations were considered to have the best capacity to assess factors related to competition (desire, psychological and financial impact and loss of competitive standing). There remained considerable heterogeneity both between and within stakeholder groups. Conclusions We found that differences in approach to RTP decisions were generally greater within versus between-stakeholder groups. If shared decision-making is to become the norm in clinical sport medicine, we need to begin a discussion on which discrepancies are due to lack of training (resolved through education) or scientific knowledge (resolved through research) or simply reflect the divergence of personal/societal values.

1. Introduction: The Social Science of Sports Medicine Dominic Malcolm and Parissa Safai Part I: Sports Medicine Conceived 2. The Role of Physiology and Cardiology in the Founding and Early Years of the American College of Sports Medicine Jack W. Berryman 3. From Voluntarism to Specialization: Sports Medicine and the British Association of Sport and Medicine Neil Carter 4. From Rehabilitation Patients to Rehabilitating Athletes: Searching for a History of Sports Medicine for Athletes with Disabilities Fred Mason Part II: Sports Medicine Organized 5. Women Professional Athletes' Injury Care: The Case of Women's Football Joseph A. Kotarba 6. Public Health, Elite Sport and "Risky Behaviours" at the Canada Winter Games Victoria Paraschak 7. The Benefits and Challenges of Complementary and Alternative Medicines for Health-Care in Sport Elizabeth C.J. Pike 8. Challenges to the Implementation of a Rationalized Model of Sports Medicine: An Analysis in the Canadian Context Nancy Theberge Part III: Sports Medicine Practices 9. Docile Bodies or Reflexive Users? On the Individualization of Medical Risk in Sports Lone Friis Thing 10. Sports Medicine, Client Control and the Limits of Professional Autonomy Ivan Waddington 11. Making Compromises in Sports Medicine: An Examination of the Health-Performance Nexus in British Olympic Sports Andrea Scott 12. Sports Physicians and Doping: Medical Ethics and Elite Performance John Hoberman Part IV: Sports and Medicine Contested 13. Doctors Without Degrees Michael Atkinson 14. Pre-Participation Screenings in Sports: A Review of Current Genetic/Non-Genetic Test Strategies Arno Muller 15. Sports Medicine Beyond Therapy: Genetic Doping and Enhancement Yoshitaka Kondo and Mike McNamee