Understanding overuse injuries in rhythmic gymnastics: A 12-month ethnographic study

Highlights

• Overuse injuries in rhythmic gymnastics are not only caused by physical factors.

• Cultural values and unwritten norms influence gymnasts’ attitude towards pain.

• Mental toughness behaviours can have negative influences on gymnasts’ health.

• Poor communication between gymnasts and coaches causes misunderstandings.

Abstract

Objectives

This study aimed to gain an in-depth understanding of overuse injuries in rhythmic gymnastics from a psychosocial perspective. More specifically, it examined how sport culture impacts overuse injuries.

Design

To develop an understanding of the culture of rhythmic gymnastics and gymnasts’ behaviour within the context of this culture, ethnography was the chosen method and written product of this research.

Method

A 12-month ethnography was conducted in an elite rhythmic gymnastics club in Italy, with 43 participants, consisting of 16 gymnasts, three female coaches, one physiotherapist, 22 parents, and the club’s president. Eight qualitative methods of data collection were used to provide rigor and depth. Following data transcription, a thematic analysis was conducted to identify the emergent themes. Findings are presented using ethnographic creative nonfiction for ethical, theoretical and practical reasons.

Results

Two stories were created portraying the same training session through the eyes of a gymnast and her coach. The stories reflect the differences in the interpretation of the same situations and the cultural norms, values and behaviours that influenced the occurrence and experience of overuse injuries.

Conclusions

This study extends research on overuse injuries in three ways: (a) it honours athletes as social agents by exploring the intersection between psychology and sociology, (b) it uses a rigorous methodology to elicit a more in-depth understanding of overuse injuries, and (c) it adopts an innovative form of representation to increase the accessibility of the findings to non-academic audiences.

Introduction

There are many benefits from participating in competitive sport. These range from personal (e.g., psychological well-being, physical competence) to social benefits such as social integration and social acceptance (e.g., Findlay and Coplan, 2008, Neely and Holt, 2014). Nevertheless, a few researchers have started to suggest that there might be a darker side to sport, and that the environments that athletes inhabit may damage their health (e.g., Douglas and Careless, 2015, Theberge, 2008). For example, a sport culture that solely rewards winning can lead athletes to set unrealistic expectations and adopt extreme performance-enhancement practices, which can result in overtraining, injury, and burnout (Douglas & Carless, 2015). Yet, understanding the darker side to sport, and how it can damage athletes’ health has received limited attention. One prevalent and significant physical health consequence that has received limited research attention is overuse injuries. This type of injury has been found to be highly prevalent in sport, particularly in endurance and aesthetic disciplines (Clarsen, Myklebust, & Bahr, 2013). Despite the high prevalence of overuse injuries, very little research has been conducted to understand athletes’ experiences of overuse injuries and the social environments in which they occur. This study aims to address this gap by understanding the culture of a sample of sportspeople vulnerable to overuse injuries.

Understanding sport cultures that perpetuate overuse injuries and honouring athletes as social agents is important and timely. First, researchers have started to explore the intersection between the psychology and sociology of sport (McGannon & Smith, 2015). One of the benefits of examining this intersection is that it can provide psychologists with a contextualised understanding of the influence of the social-cultural realm on athletes’ psychological experiences. Rather than perpetuating a distinction between people’s minds and the social world, this approach to research demonstrates athletes’ experiences may derive from the surrounding environment (McGannon & Smith, 2015). Second, overuse injuries have been found to be prevalent across a breadth of age groups and competitive levels in sport (e.g., Liston et al., 2006, Stracciolini et al., 2015). Therefore, it is important that researchers seek to better understand overuse injuries in order to enrich athletes’ experiences of sport and the environments they operate in. Lastly, overuse injuries can have undesirable short- and long-term consequences for athletes. For example, researchers have found overuse injuries to lead to early retirement and long-term chronic pain (e.g., DiFiori et al., 2014, Maffulli et al., 2010), as well as physical growth disturbance and joint deformity (DiFiori et al., 2014). Yet, despite these negative outcomes, it is surprising there is such a dearth of research to help sport science and medicine professionals better understand the occurrence and experience of overuse injuries. Understanding athletes’ and coaches’ experiences of overuse injuries and the environments in which they occur will strengthen our position as sport and exercise psychologists to explore the possibility for individual and social change.

A few researchers have recently begun to explore overuse injuries from a psychosocial perspective (e.g., Tranaeus et al., 2014, Van Wilgen and Verhagen, 2012). These studies observed overuse injuries to be dynamic and complex, and not simply due to an overuse of the joint, muscle, or tendon. For example, Tranaeus et al. (2014) and Van Wilgen and Verhagen (2012) used one-shot semi-structured interviews and identified a number of non-physical factors related to overuse injuries across various sports (e.g., indoor floor hockey, swimming, volleyball). These factors included culture, stress, staleness, passion, and identity, which reinforces the importance of considering both the person and the environment. Despite their contribution to the literature, the studies concluded with the need for a greater depth of understanding of overuse injuries to safeguard athletes’ well-being. Indeed, we still do not fully understand the dynamic nature of overuse injuries, and how sport culture influences their occurrence and experience.

One tradition in qualitative inquiry that was developed to understand the culture of a particular group from the perspective of its members is ethnography (Krane & Baird, 2005). Although there are many definitions of ethnography which are challenging to distinguish between, Bryman (2012) characterised ethnography as a research method in which the researcher: (a) is immersed in a social setting, (b) makes regular observations of the behaviours in that setting, (c) listens to and engages in conversations and interviews, (e) collects documents about the group, (f) develops an understanding of the culture of the group and people’s behaviour within the context of that culture, and (g) writes up a detailed account of that setting. Indeed, ethnography is not only a method of research, but also a written product of that research (Bryman, 2012, Krane and Baird, 2005). In the last decade a number of sport and exercise psychology researchers have embraced ethnography and the focus of their works has spanned through different areas of sport psychology. For example, research included investigating issues surrounding the supply of sport opportunities to young men from inner-city areas (Holt, Scherer, & Koch, 2013), examining the rehabilitation experiences of athletes suffering for a spinal cord injury (Smith, 2013), and understanding the organizational functioning of a sport organization (Wagstaff, Fletcher, & Hanton, 2012). With the preceding discourse in mind, this study aims to adopt ethnography to develop an in-depth understanding of overuse injuries in rhythmic gymnastics. Specifically, it aims to examine how sport culture impacts overuse injuries.