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Sport, Professionalism and Pain: Ethnographies of injury and risk Sport, Professionalism and Pain considers these and other pertinent concerns as it questions whether, in the world of modem sport, it is the participants themselves or the sport’s administrators who exert more control over athletes’ well-being. It is asserted that because of the distinctive nature of sport, the power to transform medical practice and application of sports medicine lies not with physicians but within the practices of sport itself. Sport, Professionalism and Pain bridges a perceived space in the literature between medical anthropology, medical sociology and sport studies, examining issues such as: • the relationship between sports medicine, the body and culture; • the power struggle between sport administrators and participants; • the historical transformation of sports medicine. P.David Howe is a Senior Lecturer in the Anthropology of Sport in the School of Sport and Leisure at the University of Gloucestershire. Sport, Professionalism and Pain Ethnographies of injury and risk P.David Howe LONDON AND NEW YORK First published 2004 by Routledge 11 New Fetter Lane, London EC4P 4EE Simultaneously published in the USA and Canada by Routledge 29 West 35th Street, New York, NY 10001 Routledge is an imprint of the Taylor & Francis Group This edition published in the Taylor & Francis e-Library, 2005. “To purchase your own copy of this or any of Taylor & Francis or Routledge’s collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk.” © 2004 P.David Howe All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data A catalog record for this book has been requested ISBN 0-203-45326-3 Master e-book ISBN ISBN 0-203-76150-2 (Adobe eReader Format) ISBN 0-415-24729-2 (hbk) ISBN 0-415-24730-6 (pbk) For my parents M.D. and T.S.P. with love Contents PART I List of illustrations ix Acknowledgements x Introduction 1 The cultural nexus: sports medicine and the commercial body 1 2 3 10 Investigating sports medicine: medical anthropology in context 11 The beginnings of sports medicine 12 Forms of sports medicine 21 Medical anthropology and sport 22 The development of chemical performanceenhancement 25 Public use of sports medicine 29 Summary 30 Amateur pastime to professional spectacle 32 Amateur versus professional 33 Professionalism and Welsh rugby 35 Television and the commercialisation of sport 46 Why sponsors want sport 49 Summary 52 Sporting bodies: mortal engines 53 The body and social theory 53 Pain and the body 65 Summary 69 vi PART II Pain, injury and the culture of risk 4 5 6 PART III Pain and injury: signal and response 71 The concept of pain 72 Medical practice and the nature of pain 77 Positive pain and training 84 Pain in relation to risk 86 Summary 87 The importance of injury in the commercialised world of sport 88 Two types of injury 89 Regulating sports injury 91 Mismanagement and misdiagnosis 92 Time 95 Absence from participation due to ‘illness’ 98 The impact of politics and commercialism on injury treatment 101 Summary 104 Risk culture as a ‘product’ 105 Risk and culture 105 The risk of using illicit drugs 107 Lay knowledge, socialisation and risk 109 Elite-participant social networks 114 Risk and the ideal body 116 ‘Imperfect’ bodies 118 The risk cycle 120 Summary 123 Theory into practice 7 70 125 Distinctive community: the Welsh rugby club 126 Injury statistics: a comparison of evidence 127 vii Injury in Valley Rugby Football Club 131 Talk of pain and injury at Valley RFC 138 Summary 144 Elite distance runners 145 Cultural context 146 Structuring the season 148 Zatopekian pain 149 Pain threshold 153 Management of injuries 156 Summary 160 Bodily dysfunction: the Paralympics as an arena for risk 161 Cultural context 146 Classification 165 Managing classified bodies 167 Technology 170 Medicine and the impaired body 172 Impairment, pain and injury 175 Summary 177 Conclusion 178 Appendix I Changes in the laws of rugby union: amendments to the laws of the game to be implemented in the Northern Hemisphere from 1 September 1996 187 Appendix II Changes in the laws of rugby union: amendments to the laws of the game effective as of 4 November 1996 189 Appendix III High-risk situations in rugby union 193 Appendix IV Pain relief 196 Contents of the medical kitbag as used at Valley RFC 197 Notes 198 8 9 Appendix V viii Bibliography 203 Index 221 Illustrations Figures 2.1 3.1 6.1 7.1 7.2 Continuum of sporting involvement The flexible sporting body Sports-based cost culture Injury through match time Players’ positions at the scrum 34 60 122 128 137 Tables 7.1 Frequency of injury by position 7.2 Frequency of injury by position, Valley Rugby Football Club 7.3 Comparison of injury at two positions, Valley Rugby Football Club 7.4 Comparison of injury at three positions 132 133 133 134