Sport and Disability

Howard L Nixon II. Handbook of Sports Studies. Editor: Jay Coakley & Eric Dunning. 2000. Sage Publishing.

Disability and Handicap in Society

The term ‘disability’ often has a different connotation in sport than in the larger society. To be disabled in sport typically means that an athlete is out of action for a while and is named on the ‘disabled list.’ Thus, the reference is to a temporary restriction of an athlete’s opportunity to participate. Disability can mean something entirely different in relation to sport, however. The term can refer to persons with permanent disabilities that restrict the use of certain physical or mental capacities and participation in certain kinds of activities but do not necessarily prevent involvement in sport. For example, a person who is paralyzed and relies on a wheelchair for mobility is permanently physically disabled but also can be a serious wheelchair road racer, competing regularly in races across the United States. In this case, disability does not necessarily imply being out of action as an athlete. Thus, a person can be disabled in society, but not be disabled in certain kinds of sports or sports roles.

We can see from the preceding paragraph that some definitions are needed to clarify the basic terminology for discussion of disability and sport. Impairment, disability and handicap should be distinguished first (see Nixon, 1991: 2-15). An impairment is a biomedical condition—that is, an organic or functional disorder that underlies a disability or handicap. Its existence implies that something is missing or deviant in a person’s physical, physiological, or mental make-up. Impairment can result from disease, an accident, or a defective gene. Impairments generally are distinguished in terms of physical, organic, emotional, sensory, mental, learning and speech conditions.

People with impairments that have persisted for several months or more are considered disabled when their impairment hinders their ability to use certain skills, carry out certain tasks, or participate in certain activities or roles. Impairments are the basis for disabilities, but people who are impaired are not necessarily disabled. The extent to which impaired persons are disabled depends on the nature of the task, role, or activity demands of the situation and how they relate to impaired persons’ capabilities. Thus, disability is situational, and the amount a person is disabled depends on how much a situation demands skills that a person has or does not have.

Being handicapped is a social phenomenon. A disabled or impaired person is handicapped when he or she is cast into an inferior status merely on the basis of being impaired or disabled. The relationship of a person’s impairment and disability to his or her personality and to the resources and social attitudes in a particular situation affects role performance. When environments or relationships do not accommodate or adapt to impairments or disabilities, handicapping may result. Thus, handicaps are like disabilities in that they are the result of how people construct environments, relationships, or roles; they are not inevitable results of impairments. Handicaps more than disabilities, however, incorporate negative value judgments of the social or moral worth of impaired persons. These discrediting judgments constitute stigmatization, with the discredited impairment or disability—which is the stigma—serving as the defining quality of a person’s identity.

An example from sport should help clarify the distinctions among the terms just presented. Joan was born with an eye disease that produced a retinal deficiency and is visually impaired. As a result of the retinal deficiency, Joan cannot play baseball or softball because she cannot see the movement of the ball in the field or at bat. Thus, in baseball or softball played by conventional rules, she is visually disabled. When peers poke fun at Joan or treat her as inferior because she cannot see or play softball with them during recess or in physical education classes at school, she is handicapped. Joan is not disabled or handicapped in these cases merely because she cannot see very clearly; she is disabled because the rules of the game structure it to require the ability to follow a silent ball in motion. Joan is handicapped because her peers believe she is inferior to them because she cannot see or play ball with them. If a beeper were placed inside the ball and another player or coach called out the path of the ball as it headed toward her, she would be able to participate in the game—called ‘beep baseball’—and would no longer be severely disabled in relation to it. If peers viewed her with respect for her effort instead of with scorn because she happened not to be able to see, she no longer would be handicapped.

People with impairments and disabilities have been accustomed to being handicapped and treated as members of a deviant minority group (Stroman, 1982; Nixon, 1984a). Deviant status has meant that disabled persons have been relegated to a position outside the mainstream. Minority status has meant that disabled persons as a stereotyped and stigmatized category or group have been accorded degraded status, little power, and few opportunities for economic advancement or success.

In mainstream sports, injuries are very common and tend to be expected as a normal part of the sports experience (Nixon, 1993a). A number of injuries are serious enough to prevent athletes from competing. Thus, temporary disability is relatively common in sport, especially at the highest and most serious levels of competition. Despite its relative prevalence, disabled status in sport has shared some of the stigma of disability in the larger society. The labeling and segregating process that has accorded disabled persons deviant or minority status is illustrated by an injured football player who must appear at practice wearing a highly visible red cross or other stigmatizing symbol of inactivity or disability. Thus, in sport and in society, people with disabilities frequently experience degrading, demeaning, inferior and generally unsympathetic treatment merely because they are disabled. While high-status members of sports teams and society may at least initially have enough social credit to offset tendencies toward handicapism for a while, they ultimately may feel the sting of the handicapism embedded in society.

This handicapism involves patterns of prejudice and discrimination built into the attitudes, rules, regulations and laws by which organizations, communities and society normally operate. When coaches accord encouragement and respect only to active players, subtly or explicitly tell players that ‘real men’ play hurt, and relegate injured players to visibly stigmatized status on the sidelines, they are intentionally or unintentionally displaying negative attitudes toward disabled players and undermining their status. The fact that athletes became injured as a result of physical sacrifices for the good of the team typically has little impact on how they are treated when they are disabled because the culture and structure of sport are oriented toward keeping players in action. The unwillingness of coaches to consider candidates with permanent disabilities and rules that prohibit athletes with certain disabilities from trying out for teams also illustrate handicapism in sport.

In this chapter, we will explore what is currently known about disability and handicap in sport and how sport disables athletes. In considering these topics, the definitions and conceptual distinctions previously presented should be kept in mind. Bear in mind that relatively little sociological research has focused on permanently disabled persons and sport and that despite their prevalence in sport, injuries, pain and disability only began to attract attention among sport sociologists during the 1990s.

Disability and Handicap in Sport

Disability and Sports Performance

The essence of sport is organized physical competition in which opponents use their natural physical endowment and the physical skills they have developed through training and experience to perform physical tasks more proficiently than their competitors in an effort to win. In some cases, such as boxing, football, rugby, hockey, and wrestling, physical contact is an expected part of the competition. In others, such as basketball, baseball, soccer and road races, physical contact occurs, but is often outside the rules. In sports such as tennis, physical contact is not part of the competition even though competitors directly interact with one another, while in sports such as crew and events such as high jumping, competitors do not directly interact and compete in parallel fashion or against a standard such as a clock or a height. Since sports competitions are varied and can have complex formal and informal structures, the adaptations needed to accommodate persons with certain kinds of impairments within a sport and across different sports may be varied and complex.

When a sports role emphasizes or requires certain physical or mental capacities and no adaptation or accommodation is made to compensate for impairments related to those capacities, persons with such impairments will be disabled in that sports role. For example, blind persons are disabled in sports or sports roles requiring vision, such as ball sports or sports such as boxing or wrestling in which a competitor has to fend off an attacking opponent. People who cannot use their arms or legs are disabled in sports requiring the use of those impaired limbs. Although disabilities have an objective dimension and imply some restriction of activity or performance, people with disabilities can play sports that do not require the impaired abilities or parts of the body or are adapted to minimize the significance of particular impairments. For example, in the former case, many popular individual and team sports, from tennis to football, can be played without restriction by people who cannot hear. In the latter case, blind people can wrestle as long as the competitors maintain physical contact throughout the match. It is also possible that a person disabled for one type of role in a sport may be able to play another role in the same sport. It is not unusual for baseball players in the twilight of their careers who no longer have the arm strength or mobility to play center field or shortstop to perform competently at first base, which does not emphasize either of those qualities. The designated hitter role has also extended the careers of many baseball players who could not play the field any more, but still were able to hit. While sports and sports roles currently exist that allow people with impairments, disabilities, or declining skills to participate in sport, many sports and sports roles continue to present substantial barriers to participation for such people.

Barriers to Participation and the Exclusion of Disabled Persons from Sport

Many sports are structured in ways that prevent persons with certain kinds of disabilities from participating. In fact, the highest levels of competition in sport, such as intercollegiate, Olympic, or professional sports, may require types of physical endowment and degrees of proficiency that only an elite few can attain. Yet even at the non-elite and recreational levels of sport, people with various disabilities find barriers to participation.

Sports often require modifications of their structure, equipment, or facilities for people with impairments to be able to surmount the barriers to participation that disable them in those sports. The types and amount of adaptation or accommodation required to make a sport accessible to people with disabilities may depend on whether the competition is integrated or segregated. Resistance to adaptation of a sport is an important factor in preventing disabled persons from participating. For example, if wrestling did not have a special rule to accommodate blind competitors, it would be very difficult for them to compete fairly against sighted opponents. Few mainstream sports make accommodations to permit accessibility for persons with disabilities. Thus, physically talented athletes with disabilities typically have to display their athletic talents in segregated competitions against other disabled competitors. Indeed, in some cases such as the Special Olympics, competition has been ‘controlled’ (Coakley, 1994: 84-7) so that fellowship and pride in the display of physical skills are valued more than competitive outcomes. In other settings, highly competitive athletes with disabilities compete alongside non-disabled athletes in parallel competitions, such as wheelchair racers in marathon road races.

Controlled Competition: The Case of the Special Olympics

The Special Olympics Sport Program was established in 1968 by the Kennedy Foundation, with the help of the Chicago Park District, and quickly grew to become the world’s largest sports program of training and competition for mentally retarded individuals (Songster, 1986). The First International Special Olympic Games took place in Chicago, where over 1,000 mentally retarded athletes from across the United States and Canada competed in track and field and swimming. By the 1980s, the program involved more than one million athletes and thousands of coaches and volunteers from the United States and 60 other countries in summer and winter events, and included over 20 officially approved and demonstration sports, ranging from aquatics to weight lifting. The Special Olympics remains the world’s largest program of physical fitness, sports training and sports competition for people with mental retardation. The Developmental Sports Skills program was created to expose severely and profoundly mentally retarded people to physical fitness and sports activities. Nearly one million people take part in the Special Olympics in every state of the United States and in over 140 other countries (Gran-Net Communications, 1995).

The Special Olympics philosophy emphasizes the values of physical fitness, courage, joy, sharing, maximum effort, fairness in competition, friendship and family togetherness (Songster, 1986). Its motto is ‘Let me win but if I cannot win, let me be brave in the attempt.’ Underlying this philosophy is the assumption that controlled sports competition can make everyone feel like a winner, which is assumed to build self-confidence, self-esteem and a sense of achievement. Furthermore, Special Olympians who display such qualities are assumed to destigmatize their mental retardation by getting other people to focus more on their abilities than their disabilities. Awards such as ribbons or medals are given to every competitor to convey their actual level of performance and to enhance their pride of achievement. Special Olympians, who are eight years old or older and generally have an IQ of 70 or less, compete against others of roughly equal ability, based on age, gender and prior sports experience. A major goal of the Special Olympics is for participants to move on to regular sports programs. Participants in regular interscholastic or intramural sports cannot compete in the Special Olympics.

Although Special Olympics officials and organizers have seen this program as a vehicle for participants to enter the mainstream of society free of the stigma of their disability (Songster, 1986; Whitman, 1995), others have questioned its potential for achieving this goal (Orelove and Moon, 1984; Orelove et al., 1982). For example, after identifying several benefits of the Special Olympics, Orelove and Moon (1984) argued that this program hurt the mainstreaming of mentally retarded people by promoting handicapism and segregation. They recognized that the Special Olympics could enable mentally retarded participants to experience success, increase their social contacts in a supportive environment, and improve their physical skills. They also saw the benefits of parental involvement with their child and widespread community involvement in the Special Olympics. At the same time, they contended that organizing the Special Olympics as a segregated program focused public attention on the disability rather than ability, which was contrary to the professed goals of the organizers. That is, the notion of equal physical or sports ability was only applied in relation to other mentally retarded people. As long as mentally retarded children, youths and adults are only compared with each other, they will not be given other, less restrictive recreational opportunities. That is, they will be handicapped by a philosophy of segregation, which may be intended to protect them in controlled competition. To the extent that such restriction of opportunity occurs, the attainment of another professed goal of the Special Olympics, to propel participants into regular sports programs, will be thwarted. Orelove and Moon also observed that fund-raising practices that induce pity, sympathy, or the need for charity encourage a protective attitude that can handicap people who are mentally retarded and seek more independence and respect. Furthermore, they argued, segregated activities give mentally retarded people little practice in routine mainstream interactions and little motivation to seek such experiences.

From the Special Olympics to the Paralympics

With limited research, we cannot draw any clear conclusions at this point about the direct effects of the Special Olympics on the ‘mainstreaming’ or integration of people with mental retardation. Some evidence has been cited, however, indicating that participation in the Special Olympics elevates levels of social competence, self-esteem and physical fitness (Shriver, 1995/1996).1 It is evident, too, that advocacy activities, legislative initiatives, court decisions and ‘normalization’ and deinstitutionalization movements on behalf of people with mental retardation and other impairments have increased the legal rights, visibility and participation of these people in the mainstream of society in the United States and other nations (Labanowich, 1988; Nagler, 1993; Stroman, 1989; West, 1994). We have even seen athletes with disabilities on Wheaties cereal boxes, a site where some of the most prominent American sports heroes have been displayed (Nixon and Frey, 1996: 222-3).

Opportunities for outstanding athletes with physical and sensory impairments to compete at a high level and achieve some visibility have been provided by the Paralympics, which have developed into a counterpart of the Olympic Games. The Paralympics grew out of the International Wheelchair Games organized at Stoke Mandeville Hospital in England in 1948 by Dr Ludwig Guttmann, who organized his Games to coincide with the 1948 London Olympics (Dukes et al., 1995a). Although these sports competitions have been segregated, unlike marathons in which wheelchair racers compete, they have little resemblance to the Special Olympics. Athletes are intensely competitive and highly serious about their sport, and the competitions are advertised for elite athletes with physical or visual impairments. Athletes must meet strict qualifying criteria to be selected for their national teams and be allowed to compete in the Paralympics. The guiding philosophy of the Paralympic movement is to provide these elite athletes with athletic opportunities and experiences equivalent to those of their elite able-bodied counterparts in sport (Dukes et al., 1995b).

Held first in 1960 in Rome shortly after the Rome Olympic Games and limited only to wheelchair athletes, the Paralympic Games have evolved into an event sponsored by four different international federations: the Cerebral Palsy International Sports and Recreation Association (CP-ISRA); the International Blind Sports Association (IBSA); the International Stoke Mandeville Wheelchair Sports Federation (ISMWSF); and the International Sports Organization for the Disabled (ISOD). The latter organization has control over sports for amputee athletes as well as athletes with a variety of other impairments, including dwarf athletes (Dukes et al., 1995a). The four member federations are joined together under the auspices of the International Coordinating Committee of World Sports Organizations for the Disabled (ICC).

The tenth Paralympics in 1996, held in the host city—Atlanta—of the 1996 Summer Olympics, involved approximately 100 nations, 17 sports (including 14 Olympic sports) and 2 demonstration sports over a ten-day period. The 1996 Paralympic Games were about one-third the size of the Olympic Games, with approximately 4,000 athletes, 1,000 coaches and team staff members, 1,500 officials and technical personnel and 15,000 volunteers. These Games are officially recognized by the International Olympic Committee (IOC) and are governed by the International Paralympic Committee (IPC) (Labanowich, 1988; Dukes et al., 1995b).

Paralympic sports may include minor modifications of the rules to accommodate the disabilities of competitors. Athletes are classified into competitive units by a three-step process: medical classification with certifiable disabling conditions; functional classifications according to levels of functional ability such as balance, coordination, movement, and motor skills; and functional classification by sport to determine functional ability within particular sports. Combining the four basic categories defined by the four international federations with the different functional classifications results in approximately 700 Paralympic sporting events, compared to the approximately 330 events in the Olympic Games (Dukes et al., 1995c).

Cook (1995) sought to dispel misconceptions about the Paralympics and their participants by challenging ten popular myths about the Paralympics. Her analysis clarifies the nature of these competitions and important facts about the athletes as people with disabilities. For example, she pointed out the distinction between the types of participants in the Special Olympics and the Paralympics, the elite nature of Paralympic athletes, and the separate identities of the Olympic Games and the Paralympics. In fact, the increasing involvement of people with varied types and degrees of disabilities in many different sports below the elite international and national levels (Hamel, 1992; Sherrill, 1986) has very likely contributed to changing attitudes about the capabilities of these people and added to the interest in sport and physical recreation among people with disabilities.

Issues of Competition and Integration

At the elite level, the growth of the Paralympic movement alongside the increasing visibility of wheelchair sports has increased interest in integrated sports among elite athletes and their advocates (Brasile, 1990; Labanowich, 1988; Lindstrom, 1992; Paciorek et al., 1991). Labanowich (1988), for example, has criticized the Paralympics because it has been segregated from the mainstream and because it has segregated athletes with different types of impairments from each other. He argued that disabled people in general challenged these types of restrictions of their opportunities. He also argued that elite disabled athletes aspired to participate alongside and against able-bodied athletes at the highest levels of their sports, including the medal sports of the Olympics. He saw wheelchair sports, with their mix of competitors with different categories of physical impairment, such as spinal paralyzed, amputees and cerebral palsied, as a model for integration.

The general approach to integration has been to include disabled athletes in competitions for able-bodied athletes. The participation of wheelchair racers in marathon road races, such as the Boston Marathon and the New York City Marathon, is an example of this approach. Although George Murray, Craig Blanchette, Doug Heir, and a number of other wheelchair racers have achieved international prominence in such competitions, they also have faced some resistance from race organizers, based mainly on questions about safety, spectacle and authenticity (Brandmeyer and McBee, 1986). Organizers have claimed that wheelchairs create dangerous risks for runners, and that serious accidents could occur on wet and uneven pavements at high speeds. Some also have been concerned that participants in wheelchairs might be more concerned about conveying a political message about the capabilities and rights of disabled persons than about competing in a race, which could turn their races into spectacles (Nixon and Frey, 1996: 223). The serious attitudes and high levels of accomplishment of wheelchair racers as athletes have silenced many of these types of criticisms, but the issue of integration remains salient both in the mainstream and in disabled sports realms.

Efforts by the Sport for the Disabled movement to integrate medal events of the Olympic Games have met resistance (Brasile, 1990; Labanowich, 1988; Lindstrom, 1992). Results from Brasile’s (1989) survey of disabled and non-disabled basketball and track and field participants showed that more disabled participants expressed higher overall participation incentive levels. His survey also showed that among quadriplegic respondents, more severely disabled respondents had higher mean scores than less disabled respondents on social affective and social integration incentive measures. Brasile (1990) suggested that these latter results might mean that sports participation may be especially valued for its possible social reintegration benefits by athletic participants who are most severely disabled. Perhaps less disabled athletes feel less stigmatized and are more content to participate in competitions with other disabled athletes, especially if the competition is intense and at a relatively high level.

Lindstrom (1992) pointed to a paradox that emerged with the development of elite sports programs for disabled athletes. On the one hand, eligibility for sport for athletes in various disability categories was conceived with the idea that being disabled created a disadvantage in competition with able-bodied participants, which was rectified by sports involving only disabled athletes. Yet some athletes in these categorical or segregated sports have become so proficient that they are capable of competing on relatively equal footing against able-bodied athletes in certain sports. At the same time, the disability eligibility criterion in certain sports for disabled athletes is set at a low enough level to permit minimally disabled persons to participate. Thus, Lindstrom (1992) identified three types of integration situations for policy consideration:

  • Athletes who are not significantly disadvantaged by their disabilities in competitions with able-bodied athletes, as in the case of former Major League pitcher Jim Abbott, who has one hand;
  • Athletes with minimal disabilities who are not generally seen as disabled persons but who qualify for certain disabled sports, such as people with circulation defects in a lower limb or with a cruciate ligament injury who are eligible for sitting volleyball in the Paralympics or World Championships;
  • Able-bodied athletes in sports adapted for athletes with disabilities.

The first situation also includes disabled athletes who are able to compete against able-bodied athletes with minimal adaptations of the sport, as in the case of blind wrestlers. This situation and the case of disabled athletes who compete in mainstream sports without any accommodations are likely to involve talented disabled athletes who represent a very small proportion of the athletes in their sport and generally create little controversy. They are more likely to inspire admiration or awe, but probably have little effect on general attitudes and behavior toward people with disabilities because they are seen as exceptional cases.

Over the past two decades, newspapers, popular books and magazines, and academic publications, have given attention to disabled athletes in competitions with able-bodied athletes (Nixon, 1989, 1994a). For example, many sports fans are familiar with the stories of one-armed Major League outfielder Pete Gray and one-armed Major League pitcher Jim Abbott. Stories have also been written about athletes with a variety of other disabilities competing in high-level integrated sports, including deaf college basketball players (Keteyian, 1985) and professional boxers (Cook, 1987) and amputee triathletes and marathoners competing against able-bodied opponents (Iole, 1988; Young, 1989). In addition, blind and visually impaired athletes have successfully competed with and against outstanding sighted athletes in triathalons, wrestling, judo, karate, swimming, crew, track and field, marathons, powerlifting, gymnastics, tandem cycling, sailing, basketball, soccer and football (Becker, 1988; Buell, 1986; Cordellos, 1981; Ludovise, 1988; Sullivan and Gill, 1975; Whiteside, 1992; Young, 1989). The stories of these athletes reflect their strong desire to compete at high levels of sport and achieve recognition as athletes rather than as athletes with disabilities.

Strong motivation to compete often is necessary to overcome a variety of personal and social barriers to participation in mainstream sports. For example, the resistance of many mainstream sports to mixing disabled and able-bodied athletes, as with wheelchair racers and runners, and especially, the resistance to adapting mainstream sports to open them up to athletes with various disabilities has limited the number of opportunities for disabled athletes in mainstream sports. The Disabled Sports movement itself has also at least implicitly resisted such forms of integration. Organizations such as the IPC have sought to preserve the identity and status of the Paralympics as sport for disabled athletes, which for them has meant reinforcing a segregated sports model (Lindstrom, 1992).

Brasile (1990) proposed that having able-bodied athletes compete in wheelchairs against disabled athletes in wheelchairs was a novel approach to integration, which made the disabled athletes and their sports the agents of integration. However, critics of this notion (for example, Lindstrom, 1992) have argued that having athletes with minimal disabilities and able-bodied athletes compete in sports for disabled athletes places substantially disabled athletes at a competitive disadvantage and may result in minimally disabled and non-disabled athletes squeezing them out of opportunities to compete at high levels. Lindstrom (1992) proposed that trying to integrate majority-group able-bodied athletes into sports developed and adapted for minority-group disabled athletes amounted to reverse integration that effectively undercut the original rationale for creating the sports for disabled competitors. Concern about relegation of disabled athletes to second-class or minority status within sports constructed for them or their exclusion from competition altogether raises a question about when and how athletes with disabilities generally can be effectively integrated into mainstream sports without being disadvantaged by their impairments or disabilities.

In an analysis of the mainstream sports integration of people with disabilities, Nixon (1989, 1994a) showed how integration efforts can be complicated by a mismatching of structural aspects of sports and the abilities of participants with disabilities. This analysis also demonstrated conditions under which persons with disabilities can succeed in sport and achieve broader social integration through sport. Genuine integration is not simply having disabled and able-bodied athletes participate in the same sport or event (see Labanowich, 1979; Nixon, 1984b; Sherrill, 1986). By ‘genuine integration’ of disabled and able-bodied athletes is meant here that: (a) interaction is not affected by stigma, prejudice, or discrimination; (b) disabled competitors do not feel deviant, inferior, or specially favored because they are disabled; and (c) disabled athletes’ impairments and disabilities are recognized and accepted but do not disable these athletes in competition or handicap them in interaction with their able-bodied counterparts. In general, genuine integration occurs when interaction between disabled and able-bodied athletes does not involve stigma or handicapping or avoidable disability.

Genuine sports integration occurs when there is appropriate integration (Nixon, 1984b). Appropriate integration refers to conditions when the personal sports-related attributes, abilities and backgrounds of participants with disabilities match the structural parameters of the sports situation. Included among the parameters of sports structure that could affect competitions involving disabled and able-bodied athletes are: (a) the type of sport; (b) the amount of adaptation or accommodation to disability; and (c) the degree or intensity of competition. An important aspect of efforts to match disabled athletes to particular sports is to determine the degree of actual limitation or disability of disabled athletes in specific roles and situations in the sport. Structuring sports to provide appropriate integration can be especially difficult when an impairment, such as hearing or seeing, is invisible or hard to measure (Nixon, 1989, 1994a). The basic principle for genuine and appropriate integration of disabled athletes in mainstream sports is the matching of the abilities of these athletes to the demands of the various situations likely to be encountered in their role in a sport. When disabled athletes are able to meet the demands of their sport, they can compete on an equal basis with able-bodied athletes and increase the likelihood of avoiding or minimizing impairment or disability-related stigmatization and handicapping.

The principle of ability-role matching applies to sports participants who are not normally considered disabled as well as to disabled participants. Any person could be inappropriately integrated in a sport when he or she is grossly deficient—or unable or disabled—in the performance of his or her role in that sport and in the social skills needed to interact effectively in the sport. People who are not competent to meet the demands of their sports and related social roles risk disapproval, blows to their self-esteem and, if they are otherwise disabled, a reinforcement of stigma and their sense of being handicapped. Under such conditions, interaction beyond sport is also likely to be adversely affected. Competition always carries certain social and emotional risks associated with losing. The risks are compounded for disabled competitors in more intensely competitive environments, which could amplify unacknowledged performance disabilities or amplify unaccommodated performance disabilities for which there are no accommodations in equipment, rules or the physical demands of the sport itself. Thus, inappropriate integration could result from a poor fit between an individual’s competitive motivation, abilities and skills, and the motivation, abilities and skills required by a particular sports role. Inappropriate integration in sport could lessen chances of genuine integration of disabled and able-bodied people outside sport by reinforcing negative or demeaning conceptions of disabled people that stigmatize and handicap them. On the other hand, appropriate integration could facilitate genuine integration by generating respect for the abilities and skills of disabled people and ‘normalizing’ them.

A basic premise underlying this reasoning is that disabled and able-bodied people interact comfortably and with mutual respect in and out of sport when both are able to handle the performance and interaction demands of their respective roles. Nixon (1989, 1994a) offered case study evidence to provide a provisional empirical justification for this reasoning. Some (for example, Hahn, 1984) have questioned whether disabled people benefit from integration when it involves emulating or adjusting to able-bodied achievement values that generally have not accommodated the special needs of people with impairments and disabilities. Yet, disabled athletes themselves have shown that they want opportunities to compete in elite mainstream sports, and some have distinguished themselves with outstanding performances. The Sports for the Disabled movement, leading up to the Paralympic Games, has met the goals and needs of many other disabled athletes, and its categorical and segregated structure has been staunchly defended by the leaders of this movement. The Special Olympics and other less competitive models of sport have met the needs of other disabled people. The notion of appropriate integration implies that people with disabilities ought to have opportunities for sports participation that match their motivation, abilities and skills, just as able-bodied people have. Thus, an opportunity structure that best meets the sports needs and interests of disabled people includes a continuum of options in different sports, ranging from relatively uncompetitive recreational sports where ‘everyone is a winner’ to highly competitive elite sports where only a very talented few are selected or earn the right to compete. Battles over which sports model is most appropriate for disabled people reflect disagreements in the mainstream of society over the amount and types of emphasis to place on competition and achievement values and over whether disabled people benefit more from trying to adjust to institutionalized roles in the mainstream, having mainstream society accommodate to their special needs, or staying within segregated realms where roles have been developed especially for them and their sense of difference is minimized.

Disablement through Sport

We have been considering how persons with permanent disabilities participate in sport. The idea that people who are disabled can participate in sport, especially at elite levels, contradicts the idea that an athlete who is disabled must be placed on a disabled list and held out of action. We have observed that disabilities are defined in terms of specific role and situational demands, which means that a person who is viewed as disabled in society due to physical, sensory, or mental impairments, still may be able to meet the demands of a role in a particular sport. In some cases, the sport may be adapted to accommodate for a disability, as in the case of wrestling for blind people; in others, the disabilities of athletes are essentially irrelevant to the demands of the sport, as in the case of deaf basketball players.

While disabled people may be able to compete successfully in sport at very high levels, sport also may disable people through serious injuries that make it difficult or impossible to continue to perform in that sport or even meet the demands of other kinds of roles in society. Sport as a cause of disablement through chronic pain and injuries is a troubling social issue that will be the focus of the remainder of this chapter.

The idea that sport disables participants is contrary to a popular belief that sport promotes health and fitness (Edwards, 1973; 119-20, 325-8). The reality is that for high-level athletes, sports participation can be a source of chronic pain (Brody, 1992; Kotarba, 1983), and for professional athletes in sports such as football, it may even reduce longevity (Breo, 1992; Huizenga, 1994; Munson, 1991). Although the reality of physical risks, pain and injuries is understood to be part of the experience of athletes at all levels, sports cultures and socialization often minimize, normalize, or glorify this reality (Curry, 1991; Curry and Strauss, 1994; Frager, 1995; Huizenga, 1994; Kotarba, 1983; Messner, 1990; Nixon, 1993a, 1993b; Sabo, 1986; Stebbins, 1987). In fact, a ‘sport ethic’ that emphasizes the need for serious athletes to accept risks and play through pain appears to be an important cultural influence on athletes (Hughes and Coakley, 1991).

‘Positive deviance’ describes cases where conformity to this kind of ethic is so intense, extensive, or extreme that the behavior exceeds conventional expectations for effort or commitment (Ewald and Jiobu, 1985). Athletes who engage in positive deviance are not deviant in the sense that they are violating the rules of sport; their deviance is instead a case of being overzealous in conforming to the norms or ‘ethic’ of the sports culture. Hughes and Coakley (1991) hypothesized that athletes are especially vulnerable to pressures to overconform to norms of the sport ethic such as accepting risks and playing with pain when they have low self-esteem, have identities tied to sport and rely heavily on sport for social mobility and status.

Athletes are socialized to accept pain and injuries as a normal part of sport because pain and injuries happen so frequently in sport. For example, in one study of nearly 200 male and female varsity athletes at a medium-sized NCAA Division I institution (Nixon, 1993b, 1994b, 1996a, 1996b),3 80 per cent said that they had been seriously hurt in sport, and over 66 per cent said they had been disabled by sports injuries for two weeks or more on at least one occasion. The amount of pressure to play with pain and injuries is indicated by the findings that 94 per cent of the athletes who had been seriously injured said they had ‘played hurt,’ about half of these athletes said they felt some influence from significant others to play hurt, and over 90 per cent agreed with the statement that ‘being an athlete means that you have to be willing to accept risks.’ A high percentage of these athletes also agreed with statements about the difficulty athletes have in quitting, even after serious injuries; the need for athletes to push themselves to their physical limits; and the expectation that athletes have to play with an injury or pain sometime. In addition, many agreed with the popular slogan ‘no pain, no gain.’ Overall, a majority of the surveyed athletes agreed strongly or with reservations with 20 of 31 statements indicating a willingness to play hurt. When these results are coupled with the finding that over 45 per cent of the previously injured athletes reported lingering effects of their injuries, we can see that athletes are highly vulnerable to chronic pain and lingering or permanent disability as a result of their sports involvement.

Sports Status and Gender Effects on Pain and Injury-related Attitudes and Behavior

Being a lineup regular increased the likelihood of having lingering effects of sports injuries and of having more injuries. Males and holders of an athletic scholarship had more surgeries for athletic injuries, and males were more likely than females to be significantly disabled by sports injuries for periods of weeks or months. Athletes were most likely to talk to athletic trainers and doctors about their pain and injuries when they seemed sympathetic and caring. They also were more likely to seek medical attention when their coaches seemed sympathetic and caring, but they tended to avoid or conceal their injuries from authorities, such as coaches, trainers and doctors, when these people were seen as likely to push them to play hurt.

Although males were more inclined to express tough attitudes about risk, pain and injury and to feel pressure from coaches and fans to play hurt, no gender differences were found in help-seeking or avoidance behavior regarding injuries (Nixon, 1996b). In fact, male and female athletes in this study did not significantly differ on most measures of pain and injury attitudes and behavior. Males may experience more injuries and more serious disabilities because the intensity of contact or violence in male sports is greater. Males may differ in certain attitudes, such as toughness, and feel more pressed to play hurt because they are generally more intense about their sports involvement and feel a greater need to affirm their gender identity through physical risk-taking. Thus, the gender differences in pain and injury attitudes and behaviors found in this research may reflect residual effects of traditional stereotypical Western or North American socialization into manhood through sport.

Another study, based on in-depth interviews with a small sample of Canadian adult male athletes, revealed that serious injury typically was seen as a masculinizing experience (Young et al., 1994). These men tended to accept physical risk in sport and not to question their past injuries and the continuing pain and injury they caused. Although the men saw it as masculinizing, elite female athletes in Western Canada were also found to be willing risk-takers who were relatively unreflective about the implications of playing with injuries (Young and White, 1995). These two studies suggest that the few but noteworthy gender differences in pain- and injury-related attitudes and behavior found among Division I college athletes in the United States may disappear or narrow substantially at higher levels of sport. That is, both male and female athletes may feel the effects of a culture of sport that tells them to take physical risks and play hurt. Unless coaches, trainers, or doctors appear sympathetic and caring when they are hurt, these athletes may risk a series of disabling injuries that could lead to chronic pain or lifetime disability.

The notion that physicality and injuries in sport are associated with masculinity is belied by increasing evidence to the contrary from women’s sports. Another study revealing the inaccuracy of this notion was conducted by Theberge (1993). Her research showed that for members of an elite Canadian women’s ice-hockey team playing at the highest AA level in their country, pain and especially injury were taken for granted as part of their sport. The women did not fight on the ice because penalties were too severe, but the manner of play was still highly aggressive. Despite rules against intentional body checking, players frequently unintentionally and intentionally used their bodies and body contact, colliding with opponents and crashing against the boards, to maneuver for position. The intense and aggressive style of play resulted in numerous injuries affecting virtually all the main parts of the body. Among these women, as it is among men studied in elite amateur and professional sports, players measured their ability partially in terms of their capacity to stay in the game and even play well in spite of pain and injuries. Thus, the physicality that leads to pain and injuries was defined by these female hockey players as an important dimension of their sport, indicating the lack of gendering of these qualities in sport at high levels of competition. Not surprisingly, the trainer was routinely present in the locker room of the team that Theberge studied.

Pain and Injury from the Student Trainer’s Perspective

An interview study of 22 male and female undergraduate and graduate students enrolled in an athletic training internship program at a large NCAA Division I university showed the kinds of social relations involving trainers, coaches and athletes in regard to the handling of pain and injuries (Walk, 1994). Athletes demeaned the student trainers and tried to avoid their services, but they also used the student trainers to help them fake injuries, avoid highly demanding workout sessions, and misuse athletic training and medical services in other ways. At times, student trainers formed alliances with athletes to circumvent the wishes of sports authorities. At other times, the student trainers formed alliances with staff trainers to deal with the resistance of athletes and coaches to their provision of medical services. These alliances reflect the complicated tensions surrounding medical treatment in sports networks on college campuses—and elsewhere in sport (see Nixon, 1992).

A universally held belief among the trainers was that serious injuries were an inevitable part of sport. While the acute injuries in sports such as football and hockey did not surprise the student trainers due to their intensity of violent contact, the number of seemingly avoidable chronic overuse injuries, such as stress fractures and bursitis, in these and other sports surprised them. The student trainers observed that the athletes were aware of the risks of chronic or later-life disabilities from their sports participation, but they seemed willing to accept these risks. As in the case of athletes, acceptance of the inevitability of injuries as ‘part of the game’ was necessary for trainers to justify their involvement in sport.

One means for trainers to deal with the injury issue was to encourage the use of protective equipment as a preventive measure, which conveyed the message that anyone could get hurt. They realized, however, that they had little power to force athletes to use such equipment or to take other preventive actions. To the extent that athletes downplay their own chances of being seriously hurt (see Breo, 1992), they are unlikely to engage in such preventive or precautionary behavior. Student trainers also noted the general unwillingness of athletes with chronic injuries to quit sport despite the risk of arthritis and other disabling conditions. In a number of cases, injured athletes pushed themselves too hard during rehabilitation and recovery, and contributed to the chronic nature of their injuries and re-injuries. Few seemed to question the costs of recurrent and serious sports injuries. Most of the trainers believed that the reason athletes stayed in sport despite pain and the risk of permanent disability was ‘love of sport.’ Another reason that athletes may have stayed in sport was that trainers were reluctant to advise them to discontinue participation. Indeed, the general orientation of medical personnel affiliated with sports organizations tends to be to return athletes to action.

Retirement, Injuries, Disability, and the Role of Medical Personnel

Chronic pain and injuries are a major reason for the end of athletic careers, and athletes in more combative and violent sports are likely to be more damaged by their sports involvement (Huizenga, 1994; Nixon and Frey, 1996: 201-3). College athletes whose careers are ended by injury may also suffer emotional or psychological damage from their injury. Research by Kleiber and Brock (1992) showed that five to ten years after the end of their athletic careers, college athletes who aspired to play professional sport and suffered a career-ending injury had lower self-esteem and life satisfaction than their counterparts with professional orientations who did not have their careers ended by injury. Their research also showed that there was no difference in self-esteem or life satisfaction between former college athletes whose careers were ended by injury and those whose careers did not end by injury when the athletes were not seriously oriented toward a professional sports career. These former athletes who had a low professional orientation had levels of self-esteem and life satisfaction approximately equal to the level of athletes with a high professional orientation who did not suffer a career-ending injury.

A study conducted for the National Football League Players Association (NFLPA) and reported in a five-part series in the Chicago Sun Times (Hewitt, 1993a, 1993b, 1993c, 1993d, 1993e) focused on the post-career consequences of sports injuries for athletes who reached the professional level. This study considered whether former NFL players thought their careers were worth the pain and injuries they suffered. It surveyed 645 players whose careers covered the period from the early 1940s to 1986.

Although every NFL player is injured every year, many players end their careers with an injury, and the NFL replaces its 1,650 players every four years, only approximately one-third of the players carried the optional NFLPA-negotiated career-ending injury coverage. According to Miki Yaras, director of benefits for the NFLPA, her efforts to sell the insurance to players were complicated by players’ perceptions that they will escape serious injury. She observed that the players tended to be macho young men who thought of themselves as invincible. She further noted that the players often made the mistake of assuming that the NFL would take care of them if they experienced a career-ending injury (Breo, 1992). The realization of their mistake often comes when players retire and face a lifetime of costly disability.

More than one-third of the former players in the NFLPA survey indicated that they had retired as a result of a disabling injury, and almost two-thirds indicated that they had a permanent injury from football. Despite public statements by many of the players that they would play again despite their injuries and disabilities, the responses to the survey showed that most recently retired players have expressed increasing doubts about the value of the physical damage from football. This pattern of increasing doubts may reflect the fact that professional football became more violent and disabling between the early years and the 1970s. The percentage of retired players who said they had a permanent injury from football rose from 38 per cent for those retiring before 1959 to 60 per cent for those retiring in the 1960s and then to a peak of 66 per cent for those retiring in the 1970s. The figure for the late 1980s was 65 per cent, and based on an update of the survey, the preliminary figure for 1993 was 61.1 per cent. The update also revealed that the percentage of players who said the main reason they retired was a disabling injury increased from 37 per cent in 1990 to 41.4 per cent in 1993. The disabling injury rate in the NFL in the 1990s was over three times the injury rate for workers in the high-risk construction industry. Furthermore, the average length of life of NFL players is 62 years, which is 10 years shorter than the average lifespan of American males. According to Hewitt (1993a), the NFL challenged these statistics, but whether or not they are precise indicators of changes in injury rates, the pattern they indicate is clear. Injuries have become more severe and costly over the history of the NFL.

Although professional athletes today (for example, Stebbins, 1987) may be more inclined than elite amateur athletes (for example, Young and White, 1995; Young et al., 1994) to question the value of physical sacrifice for their sport, there still is evidence that professional football players continue to take serious risks with their bodies and health (Huizenga, 1994). Perhaps in the late stages of their career and in retirement, the costs of chronic pain and disabling injuries become more apparent. In recent years, a number of former professional athletes have sued for multimillion awards to compensate for the disabling effects of sports injuries. The largest award in suits against team doctors in North America by 1995 was $5.5 million, which former professional hockey player Glen Seabrooke won in a suit against the former orthopedic physician for his team, the Philadelphia Flyers (Nocera, 1995). Due to an excessively demanding and painful rehabilitation program without proper medical monitoring following surgery, he developed a condition called ‘reflex sympathetic dystrophy.’ This condition left him without use of his left arm and shoulder and with chronic pain that offered no prospect of relief.

The tendency of team medical personnel to downplay or ignore chronic or acute pain and other indicators of potentially debilitating conditions often stems from the difficult role strain that team doctors and trainers typically face (Huizenga, 1994; Smith, 1994). These medical personnel are torn between responding to the demands of their employer to keep players on the field and to their ethical commitment in medicine to attend to the long-term health needs of players as patients. A former NFL team physician, Robert Huizenga, commented that the tendency to feel like a member of the team often subtly affects one’s decisions as a doctor (Nocera, 1995: 82). Doctors often succumb to pressure from owners and management to rush players back into action, despite medical doubts about their readiness to play. The clearest case of conflict of interest in this regard involved Dr Arthur Pappas, an orthopedic surgeon and part-owner of the Major League baseball team Boston Red Sox, who lost a $1.7 million judgment to a Red Sox player, Marty Barrett. Barrett’s lawyers argued that Pappas’ medical judgment was clouded by his financial interest in the club and its drive to earn a place in the American League Championship Series (Nocera, 1995). When the power of owners, management and coaches dictate the conditions of medical treatment of athletes, the athletes become very vulnerable to unintentional or intentional medical malpractice. Thus, athletes can be disabled by the physical strains, pressures and contact of the contest on the field or by the inadequate, inattentive or incompetent medical treatment of the pain and injuries produced on the field of play. When their disability forces retirement, they often must wait 35 or more years to begin receiving their sports pension.

Health, Drugs, and Sport

The prevalence of drug use of various kinds in high-level amateur and professional sport has been highly publicized over the past decade, with stories ranging from the steroid use of sprinter Ben Johnson, which cost him an Olympic gold medal, to the deadly cocaine experimentation of basketball star Len Bias, the ultimately deadly lifelong alcohol abuse of baseball legend Mickey Mantle, and the doping of Soviet bloc Olympic athletes (Nixon and Frey, 1996: 116-20). The NFLPA survey revealed that former players used a variety of drugs, including novocaine, cortisone, anti-inflammatories, amphetamines, caffeine tablets, alcohol, steroids, marijuana and cocaine, to cope with injuries or to enhance performance. Nearly 10 per cent of the players said they did not know what drugs they were taking. The sources of prescription drugs for more than half of the players were the team doctor and trainer (Hewitt, 1993b). Former NFL team physician Robert Huizenga speculated about the linking of the use of steroids and other performance-enhancing drugs to chronic injuries and disability on the basis of his first-hand observations inside the locker room (Huizenga, 1994; Smith, 1994). The dilemma for athletes in responding to team or peer pressure to use drugs is that they lack the medical expertise to question a doctor’s judgment, they are discouraged from seeking medical opinions not authorized by the team physician, and their judgment is often colored by the intense desire or perceived need to get back on the field (Huizenga, 1994).

Children, Youths, Injuries, and Disability

Serious injuries and disabilities are not confined to athletes at the university, elite amateur and professional levels of sport. For example, it has been estimated that approximately 25 per cent of the 8 million participants in secondary and high school sports programs in the US experience some kind of injury (National Institutes of Health, 1992: 3). Government support for efforts to reduce the incidence and severity of injuries in scholastic sports programs has been motivated by both the physical and financial costs of these injuries. The costs of personal injury and product liability insurance, for example, have escalated with the increasing incidence of injuries, especially severe injuries. Thus, injuries have become a major factor in athletic budgets in American schools and colleges, and we can assume that this portion of budgets has grown as participation in interscholastic and intercollegiate athletics has grown with the increased number of female participants since legislation prohibiting gender discrimination in school programs was passed in 1972 (Nixon and Frey, 1996: 260). Furthermore, growing interest in sports such as soccer and the attraction of larger and more aggressive athletes to such sports have contributed to increased numbers of injuries. According to the US Consumer Product Safety Commission, in 1994, 1.3 per cent of the 162,115 soccer players treated in hospital emergency rooms had to be admitted to the hospital, and 1.3 per cent of the 425,000 football players given emergency room care had to be hospitalized. The National Electronic Injury Surveillance System of the US Consumer Product Commission also estimated that the number of soccer injuries in the United States increased from nearly 140,000 in 1990 to over 162,000 in 1994, which is nearly a 16 per cent rise. A major cause of soccer injuries, up to 25 per cent, has been field conditions (Birch, 1995). Many knee injuries in indoor soccer have been attributed to the hard artificial turf.

The high injury rates in male contact sports are easy to understand. Perhaps surprisingly, though, a girls’ non-contact sport, crosscountry running, was found to produce the highest injury rates in a 13-year study (from 1979 to 1992) of 18 high school sports and 60,000 participants in the Seattle area (reported in Bloom, 1993). Approximately one of every three female cross-country runners was injured, with tendinitis of the knee, shin splints, ankle sprains and stress fractures of the leg the most frequent injuries. Injured runners averaged two injuries per season, and the incidence rate was 61.4 injuries per 100 runners. Boys’ cross-country running ranked fifth in injury rates, with a rate approximately two-thirds of the girls’ rate. The second-, third- and fourth-ranked sports for injuries were football, wrestling and girls’ soccer. Among the factors thought to contribute to the high injury rates for female cross-country runners are the lack of fitness for this sport, which is staged during the later months of the year, after a summer layoff and the pressure to train harder to earn the increased recognition and opportunities for college athletic scholarships that have become available for female athletes. Anatomical and physiological factors also seem to contribute to females’ greater susceptibility to certain kinds of injuries, such as stress fractures.

Other studies (for example, Murray, 1992) have shown generally comparable patterns of injuries across sports, with the incidence of injuries for females less than for males due to the smaller number of female participants but with the rates of injury about the same for females and males in high school sports. The main injury ‘agent’ has been contact with another person, in about half the cases; and the proportion of injuries in practices and contests has been found to be about the same (Murray, 1992). Relative injury rates in practices and contests vary according to the degree to which practices simulate contests. For example, in wrestling and basketball, practices often closely approximate actual matches or games, while in football, players usually tackle dummies and have limited and less intense physical contact with teammates in practice (Powell, 1992).

It has been estimated by a sports medicine researcher (Requa, 1992) that, on average, approximately one of three high school athletes, or about 2 million athletes, will have at least one time-loss injury during a season. About one-quarter of these injuries is likely to result in a visit to a physician. An estimated 2-3 per cent of these injuries result in hospital visits and 1-2 per cent in hospitalizations. Since injury rates decrease with age, the junior high school rate is likely to be less than the high school rate. Injury rates in youth sports programs outside the school are very difficult to estimate, but one survey of nearly 1,000 adult San Francisco Bay area exercisers involved in more than 100 competitive sports and recreational activities (Alvarado, 1992) indicated that the highest injury rate was sustained by in-line skaters, at 20 per 1,000 hours of activity (20/1,000). The injury rate per 1,000 hours for competitive sports was 16, which was twice the average rate of injuries, with basketball 18, racquetball 14, volleyball 9 and tennis 8. Individual activities, including walking, exercise equipment and bicycling, had fewer total injuries than group activities and sports, 10 per 1,000, but running was an exception, with an injury rate of 16. People with prior injuries were more likely to sustain injuries again than other people were to sustain a first injury, indicating that even in recreational sports, there may be a tendency to downplay the significance of past injuries. Furthermore, although we expect more and more serious injuries to occur at more competitive and intense levels of highly organized sports, a large number of injuries are likely to occur in unsupervised and relatively unorganized physical recreation and sports activities because of the large number of casual participants (Requa, 1992).

US government officials have sought better injury data collection to improve the surveillance system for injuries and facilitate the implementation of measures to reduce injuries. One of the obstacles to establishing effective surveillance systems is the liability issue. Some experts have suggested that better injury data could invite more lawsuits and that data supplied by insurance companies may be unreliable as it could be contaminated by the financial interests of these companies, which is to reduce the amount they must pay for injury claims (National Institutes of Health, 1992: 4). Obtaining accurate injury data has been made problematic in part because of the social factors in sport that make the treatment of injuries difficult, that is, factors such as athletes who hide injuries so that they can continue to play, coaches who encourage athletes to overlook pain and injuries so they continue competing and athletes who exaggerate pain and injuries to avoid workouts.

In developing useful surveillance systems for assessing the rates and effects of sports, it is important to focus on long-term effects. Most studies have concentrated on short-term effects and have overlooked re-injury and long-term effects (Requa, 1992). One study of ankle sprains in 84 young athletes (Smith and Reischl, 1986) revealed that 70 per cent had sustained an ankle sprain, and 80 per cent of those who had been injured had sprains on more than one occasion. At the time of the study, 50 per cent still showed residual symptoms and 17 per cent said they were participating even though their actions were still affected by their injury. It is evident from these results that playing hurt begins with young athletes and that the foundation for chronic and potentially disabling conditions can begin very early in an athlete’s career. Understanding the factors contributing to playing with pain and injuries in childhood and youth should help ameliorate the long-term disabling consequences of sports injuries. Sociologically, an athletic environment that offers encouragement of athletes to talk realistically about their pain and injuries, to seek medical attention when it is needed, and to take an appropriate amount of time for healing and rehabilitation seems especially relevant to the reduction of unnecessary chronic pain and disability from sport. In addition, athletes seem less likely to risk injury when they avoid overtraining, which sport psychologist William Morgan called ‘the disease of excellence’ (quoted in Phinney, 1988). Perhaps surprisingly, Morgan proposed that recreational bicyclists may be more prone to overtraining than elite riders because recreational cyclists may have more difficulty fitting their rides into their daily schedules and may ride too many miles when they are able to get on their bicycle.

Conclusion

The risks of pain and injury cannot be eliminated from sport, especially at the higher levels of sport that are implicitly structured to produce pain and injury through highly intense and often combative competition. Yet unless the authority of sports medicine practitioners is independent of coaches, owners and other sports management personnel, the welfare of athletes will be unnecessarily at risk. Furthermore, unless the rules of sport are constructed and enforced to eliminate excessively violent or risky actions, athletes will risk severe and chronic pain, injury and disability every time they step on the field of play. When athletes are driven by the Sport Ethic, sports authorities, or their personal motives to overtrain or play hurt, they will put themselves at risk of serious and continuing pain, injury and disability. Sports officials who fail to address the physical safety and well-being of athletes or who put athletes at risk by irresponsibility or incompetence are likely to find themselves in court as targets of lawsuits, especially in the United States. Thus, future research should focus not only on collecting better medical data about pain, injury and disability in sport. It also should examine the cultural and social conditions of sport that contribute to high rates of pain, injury and disability production; the reactions of athletes to the consequences of acute and chronic pain, injury and disability; the attentiveness of sports officials to pain, injury and disability in sport; and the role of legislators, public officials and the courts in making sport safer.

For athletes considered able-bodied, chronic disability typically portends or represents the end of their athletic career. For other athletes with permanent disabilities, who are labeled disabled persons, sports careers are pursued despite the disability or in competitions where disability is minimized or adaptations are made for it. The contrasting meanings of disability in conventional sport and in disabled sport reflect the different ways that physical abilities are seen and interpreted in relation to sports performance in different sports settings. Two of the most striking developments in sport since the mid-1970s have been the increasing involvement and levels of performance of people with permanent disabilities. A major issue today regarding the involvement of disabled people in sport is how or whether they should be integrated (Hoffer, 1995). A variety of models of segregated and integrated sports involvement for disabled athletes exist today, reflecting to some extent the different abilities and goals of these athletes. The effectiveness of these different sports models in meeting the needs of disabled athletes with different abilities and goals should be a focus of future research. This research should also explore the conditions under which rules, practices and facilities can make different sports more accessible to people with disabilities and more compatible for integrated competition involving both disabled and able-bodied athletes. Although the Special Olympics model has positive benefits for participants, we must be mindful of the desire of many highly skilled and ambitious disabled athletes to achieve the attention, respect and money that able-bodied athletes often risk their bodies to earn (Hoffer, 1995).