How can I strengthen safeguarding in sports as team physio and team doctor?

Clénin German E.^1,2, Phillips Nicola^3,4
1 Sportmed. Zentrum Ittigen b. Bern, Switzerland
² SEMS, Sport and Exercise Medicine Switzerland, Bern
³ Cardiff University, UK
⁴ Association of Chartered Physiotherapists in Sport and Exercise Medicine, UK

Abstract

Operating as physiotherapist and doctor in the field of sports requires deepened knowledge and clinical skills in sports physiotherapy and sports medicine, specific information on the field being supported, a clear commitment to the duty of care and social skills. It is furthermore indispensable to clarify and be aware of the role of team physio and team doctor as well as to invest in good preparation. The article highlights these points and provides a suggested list of recommendations about do’s and don’ts for team physios and team doctors.

Zusammenfassung

Die Tätigkeit als Physiotherapeut/in und Arzt/Ärztin im Bereich des Sports erfordert vertiefte Kenntnisse und klinische Fertigkeiten in der Sportphysiotherapie und Sportmedizin, spezifische Informationen über die zu betreuende Sport­art, ein klares Bekenntnis zur Fürsorgepflicht und Sozialkompetenz. Darüber hinaus ist es unerlässlich, die Rolle des Teamphysio- und Teamarztes/ärztin zu klären und sich ihrer bewusst zu sein sowie in eine gute Vorbereitung zu investieren. Der Artikel hebt diese Punkte hervor und enthält eine Liste mit Empfehlungen für Do’s und Don’ts für Mannschaftsphysios und Mannschaftsärzte/innen.

Schlüsselwörter: Safeguarding, Fürsorgepflicht, Sozialkompetenz, Rolle des Teamphysio, Rolle des Teamarztes, Prävention von Missbrauch

Introduction

Our principal role as healthcare practitioners in sport is to preserve the health of the athlete, both physically and mentally. We have a duty of care to manage this effectively in the often challenging environment that we work in.
Despite the obvious diagnosis and injury or illness management, as well as an advocacy role if onward referral is needed, there are a variety of other contexts where both doctors and physiotherapists become involved. These could vary from chaperoning for doping control, inputting into fitness to travel or compete decisions, to observing behaviours amongst coaches or parents.
Operating as physiotherapist and doctor in the field of sports requires deepened knowledge and clinical skills in sports physiotherapy and sports medicine, specific information on the field being supported, a clear commitment to the duty of care and social skills. It is furthermore indispensable to clarify and be aware of the role of team physio and team doctor as well as to invest in good preparation. The article highlights these points and provides a suggested list of recommendations about do’s and don’ts for team physios and team doctors.

Knowledge and clinical skills in sports ­physiotherapy and sports medicine

A solid education as a sport physiotherapist or sport physician is the first part of the foundation to professionalism. Subsequent development lies in the specific knowledge and skills acquired by broad and deep professional experience in the field of sports.
Part of this education integrates knowledge about safeguarding in order to prevent maltreatment. Maltreatment in sport can take many forms and can be experienced by any athlete at any time. Furthermore certain athlete groups are at a higher risk: the child athlete [1], the elite athlete, athletes with a disability, and athletes who identify as LGBTQ (lesbian, gay, bisexual, trans-sexual, queer) [2]. The responsibility of safeguarding athletes is the task of everyone involved in athletes’ lives, including parents, teammates, coaches, physicians, physiotherapists, psychologists, nutritionists and other allied health professionals including sport scientists, organisations, and governments [3].

Specific information on the field of sports and ­expectations of the different actors

Expectations of clinicians when working in sport are similar to mainstream practice but the context and therefore the focus is different. Sport disciplines all have their own course of events, procedures, standing orders, often even practising their own language with technical terminology. This is characteristic for each sport discipline, very clear for all insiders but outside typical language and behaviours. This sport speci­ficity extends to typical injury patterns due to the needed repetitive movement in training and competition in order to be successful.
In sport an athlete centred focus is fostered and often all efforts are focussed towards a specific goal, such as, finals or major events. The ability to ensure ethical practice in such environments of time constraints and other performance pressures, is highly demanding. Although this is challenging, it remains a critical skill to develop as a sports physician or physiotherapist.

Duty of care and social skills

Part of our duty of care is not only to provide the best possible treatment for athletes we support but also to speak up if observing any negative behaviours. This could involve potentially dangerous coaching practices but also suspected abuse of any kind, whether physical, sexual, emotional or neglect. This ability to speak up and withstand possible pressure and not to fear possible repercussions also needs training [4,5].
Another part of our duty of care is to foster an open and empathetic communication with athletes and coaches. This can sometimes create conflict, as we need to protect the medical confidentiality and provide privacy where possible, both visual and auditory, which can again be challenging in a sporting environment. It can be particularly challenging in sporting environments that involve children [1], or where the culture of that sport discourages challenging the status quo by speaking up [6].

Role of the team physio and team doctor

As health professionals with a strict code of conduct as part of a licence to practise, doctors and physiotherapists are a trusted member in a sport/team. They are there for athlete well-being first and foremost and considered “neutral” regarding implications of injury decisions in a competition situation. Doctors and physiotherapists see athletes at their peak of confidence following achievement but also at their most vulnerable. This places a high level of responsibility that reaches further than a focussed treatment of specific conditions.
Although involved in performance and recovery, the overriding rule is “to do no harm”. This can sometimes be challenging in a sporting context at any level but particularly in a high performance environment.
It is important to be aware of these possible conflicting loyalties or conflicts of interest when supporting athletes. A blind loyalty towards sport bodies or federations, ignorance, protectionism, and denial, could lead to intentional or unintentional complicity and perpetuation of maltreatment [2].

Preparation is crucial

Preparation prior to working within a team includes planning across a range of requirements, from ensuring the appropriate equipment is available to managing clinical spaces, as well as managing accessible times linked to training and competition schedules. Identifying the medical services provided by the event organisers, as well as local emergency medical facilities is an important aspect of this preparation. Where possible, meeting the people responsible improves readiness for emergencies.
Consideration of expectations of the sport and the environment allows practitioners to anticipate likely challenges and manage identified risks. This requires an element of self-organisation, which facilitates the ability to improve the safety and accessibility of the environment for athletes, as well as manage their own well-being.

Do’s for safeguarding in sports

The table below highlights some key tips to consider when embarking on any work with a sports team or national governing body. They are derived from discussion at workshops held at the SEM Switzerland Annual Conference, Interlaken, November 2023.

Corresponding author

Clénin German
Dr. med., Chief Medical Officer Swiss Ski Freestyle,
Verbandsarzt Swiss Orienteering und Swiss Athletics,
Sportmedizinisches Zentrum
Bern-Ittigen, Switzerland
german.clenin@smzbi.ch

References

1. 1. Bjørnseth I, Szabo A. Sexual Violence Against Children in Sports and Exercise: A Systematic Literature Review. J Child Sex Abus. 2018 May-Jun;27(4):365-385. doi: 10.1080/10538712.2018.1477222. Epub 2018 Jun 7. PMID: 2987775.
2. Mountjoy M, Brackenridge C, Arrington M, Blauwet C, Carska-Sheppard A, Fasting K, Kirby S, Leahy T, Marks S, Martin K, Starr K, Tiivas A, Budgett R. International Olympic Committee consensus statement: harassment and abuse (non-accidental violence) in sport. Br J Sports Med. 2016 Sep;50(17):1019-29. doi: 10.1136/bjsports-2016-
   096121. Epub 2016 Apr 26. PMID: 27118273.
3. Edwards C. Athlete Maltreatment in Sport. Clin Sports Med 43 (2024) 173-186.
4. Wheatley L, McKeon G, Pebole M, Wells R, Rees S, B Ward P, Rosenbaum S. Gender-Based Violence is a Blind Spot for Sports and Exercise Medicine Professionals. Sports Med. 2023 Aug;53(8):1491-1493. doi: 10.1007/s40279-022-01742-8. Epub 2022 Aug 4. PMID: 35925492.
5. Fortier K, Parent S, Lessard G. Child maltreatment in sport: smashing the wall of silence: a narrative review of physical, sexual, psychological abuses and neglect. Br J Sports Med. 2020 Jan;54(1):4-7. doi: 10.1136/bjsports-2018-100224. Epub 2019 Oct 25. PMID: 31653778.
6. Gattis C, Moore M. A conceptual analysis of maltreatment in sports: A sport social work perspective. Front Sports Act Living. 2022
   Nov 3;4:1017308. doi: 10.3389/fspor.2022.1017308. PMID: 36406770; PMCID: PMC9669431.