573: Dr. Sheree Bekker: A Contemporary Vision for Sports Injury Prevention

In this episode, Social Justice and Sports Medicine Research Specialist, Sheree Bekker, talks about social justice in sports, medicine, and research.

Today, Sheree talks about the conversations around physiology and injuries, and the different environments that affect the ACL injury cycle. How do clinicians implement the findings in the research?

Hear about Sheree’s qualitative research methods, the importance of recognising the social determinants of injuries, tackling systemic experiences, and get Sheree’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.

Key Takeaways

• “We have to recognise the human at the centre of those experiences.”
• “Gendered language that seems like everyday language in sport can be really harmful to both men and women.”
• “[Be] cognisant of, and [be] able to have those conversations with athletes, patients, people that you work with all the time about their social conditions of their lives.”
• “The social conditions of our lives play into our injuries and our rehabilitation.”
• “It is about not simply seeing rehab as a biomedical issue alone to solve, but thinking about it as socially, politically, and materially oriented is a practice that you might incorporate in your way of thinking.”
• “Injury prevention, and a contemporary vision for injury prevention, needs to be athlete-centred and human-focused.”
• “We need to have those uncomfortable conversations about our complex, messy realities.”
• “Context is everything.”
• “Sport isn’t neutral. It isn’t apolitical.”
• “We can start to ask these questions, start to have these conversations. The answers aren’t going to come tomorrow.”
• “These ripples will take some time.”
• “Connection is greater than competition.”
• “Hold on to the power of connecting with people who are at the same career stage and doing work with people who are at the same career stage as you.”

More about Sheree Bekker

Dr Sheree Bekker (she/her) was born in South Africa, grew up in Botswana, completed her PhD in Australia, and now calls Bath (UK) home.

She is an expert in ‘complexity’ and research that links social justice and (sports) injury prevention. She has a special interest in sex/gender and uses qualitative methods. This underpins her work as an Assistant Professor in Injury Prevention and Safety Promotion in the Department for Health at the University of Bath. At Bath, she is Co-Director of the Centre for Qualitative Research, and a member of the Centre for Health and Injury and Illness Prevention in Sport (CHI2PS), and the Gender and Sexuality Research Group.

Internationally, Sheree is an Early Career Representative for the International Society for Qualitative Research in Sport and Exercise, and a founding member of the Qualitative Research in Sports Medicine (QRSMed) special interest group.

In 2020 she was appointed as an Associate Editor of the British Journal of Sports Medicine, and in 2021 she was appointed Qualitative Research Editor of BMJ Open Sport and Exercise Medicine.

She completed a Prize Research Fellowship in Injury Prevention at the University of Bath from 2018-2020, and received the 2019 British Journal of Sports Medicine Editor’s Choice Academy Award for her PhD research.

Suggested Keywords

Healthy, Wealthy, Smart, Physiotherapy, Social Justice, Injury, Prevention, Gender, Sexuality, Physiology, Sociology, Environment, Research, Change,

Resources:

Anterior cruciate ligament injury: towards a gendered environmental approach

To learn more, follow Sheree at:

Website:          https://sites.google.com/view/shereebekker/home

Twitter:            @shereebekker

Instagram:       @sheree_bekker

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Read the Full Transcript Here: 

00:02

Hi, Sheree, welcome to the podcast. I'm so excited to have you on. I've been looking forward to this for a long time. So thank you so much for joining.

00:12

Thank you for having me. Karen. I am delighted to be talking to you today.

00:16

And today we're going to talk about some of now you had a couple of different presentations at the International Olympic Committee meeting in Monaco a few weeks ago, and we're going to talk about a couple of them. But first, I would love for you to tell the audience a little bit more about you, and about the direction of your research and kind of the why behind it. Because I think that's important.

00:43

Mm hmm. Yeah, I've actually I have been thinking about this a lot recently, over the course of the pandemic, and thinking about where my research and my work is going and why I'm so interested in in kind of social justice issues in sports injury research in Sport and Exercise medicine. And I guess for me, there are two reasons for that both of them related to my background. First of all, I was born in South Africa. And I grew up in Botswana. And I think, you know, growing up into countries that have interesting pasts, you know, South Africa having post of apartheid and Botswana having been a colonized country, I think I grew up in places where we were used to having difficult conversations about social justice issues on a national level. And I think, you know, that is something that has influenced me definitely in the way that I see the world. The second part for me is I studied human movement science at university. And my program was in a Faculty of Humanities and Social Sciences. And I didn't realize at the time that most people get their sport and exercise medicine, sports science, human movement, science training, in medical faculties, or in health faculties, whereas mine was very much social sciences and humanities. And I only realized this later that my training in this regard was quite different in terms of the way that I see the work that we do. And so now, I've landed here at the University of Bath, and I'm in a department for health. But once again, I'm back in a Faculty of Humanities and Social Sciences. So it's been a really, really nice connection for me to come back to these bigger social justice questions, I guess, that I'm interested, you know, in our field. So for me, that's really the why I think of why I do this work.

02:42

And, and kind of carrying along those themes of social justice and really taking a quat. Know, a quantitative, qualitative, sorry, qualitative eye, on athletes and on injury, let's talk about your first talk that you gave it at IOC, which is about the athletes voice. So take us through it. And then we'll ask some questions. So I'll, I'll shoot it over to you.

03:17

Yeah, so um, my first talk, the first symposium that I was involved in at IOC this year, we had titled The athlete's voice, and those of us who were involved with it, we're really proud to be able to get this topic, this kind of conversation onto the agenda in Monaco. I had so many people comment to me afterwards, that this was the first time that we've been able to have this kind of discussion at this specific conference. And, you know, previous editions, I think, have been very much focused on that biomedical that I was just talking about, given that it's Sport and Exercise medicine. And it was the first time that we've been able to bring athlete voice into this space. And so this symposium in my talk in particular, was really focused on qualitative research. Even though when we pitched the symposium, we kind of decided that we couldn't call it qualitative research, because it wouldn't have been accepted at the time. And, and now, it's amazing to me how far we've come that we can actually talk about qualitative research in these spaces. So what I spoke about, and what I was interested in is, you know, what are the kinds of different knowledges and who are the people that we might listen to in Sport and Exercise medicine and sports injury more broadly, that traditionally we maybe haven't scented and haven't listened to? And I was interested in those kinds of social meanings of injury and of injury prevention and how we might do things differently. So you know, for me, it was that Recognizing the value of alternative perspectives, and working across disciplines and advancing our research and practice in this way. And so that's really what I spoke about was, you know how we might do these things differently by actually listening to the people at the center of our work and listening to athletes themselves. And that was really the focus of that symposium.

05:26

And in looking through some of the slides from the symposium, some of the quotes that I'm assuming we're taking from the qualitative work are, gosh, they're kind of heartbreaking. So what do you do with that information once you have it, right? So you're conditioned not to quit, you turn off your emotions, you become a robot as soon as you step onto the field or the pitch or the court. So how do you take that qualitative research? And what do you do with that once you have it?

06:01

Yeah, so you know, my talk, the way I kind of structured my talk was to talk about how we generally do injury prevention. And what we generally do is we, you know, figure out what the issue is what the injury problem is, we develop an intervention, and then we implement that in intervention and hope that it works. And, and some, you know, that's the kind of general cycle that we use. And what I decided to do in my talk, which was only a 10 minute talk was to dedicate two of those minutes to a video that I showed, that was just set to music that flashed up all of these quotes from athletes. And there were quotes that I'd collected from a number of different sports, a number of different athletes and spaces over the years, that really speak about their experience in sports and these toxic environments, which is something that I think we tend to kind of put to the side, maybe sometimes and ignore, sometimes in sport, when we put sport up on a pedestal and only think about the good things that happen in sports. And those quotes are also, I guess, a throwback or connection to one of the other talks that I had at IOC, which is not something that I think we'll speak about today, but about safeguarding and recognizing safeguarding as an injury prevention issue. And so we had these, like two minutes of these quotes from athletes. And I think that video really signaled a palpable shift in the room in recognizing what athletes are actually saying, and what their experiences are in sport about needing to, I guess, you know, put their their kind of robot hat on and be this strong person within sport where they can't break down where they can't have injuries or anything like that. Otherwise, they're going to be the team. And just for us to come back and to recognize that humanity in that experience, within sport, I think is really, really important, especially when we're at a conference where we're talking about injury prevention and interventions, we have to recognize the human at the center of those experiences. And so for me, coming back to your question about what do we do with that information? I think that's really powerful information, in terms of how we think about what injury prevention is, and does. And I guess we always focus on bodies, and you know, body parts, the ankle, the knee, the hip, the growing. You know, that's, that's kind of been a big focus of injury prevention. And I think we often forget that injury prevention is and can be so much more than that. And that there are these social factors, or social determinants, that to play into injury and its prevention. So the social aspects of our lives in terms of, you know, abuse that might happen in these spaces, or just being exposed to toxic spaces, you know, how that does actually render us more susceptible to injury, and how that can thwart our injury prevention efforts in these spaces. So for me, it's about integrating both of those two things I think together, and that's what I'm kind of getting at with qualitative research.

09:19

And, and that leads me into something else I wanted to talk about, and that is a review from the British Journal of Sports Medicine that you co authored with Joanne Parsons and Stephanie Cohen, anterior cruciate ligament injury towards a gendered environmental approach. And what you just said, triggered in me something in in reading through that article was that there's intrinsic factors and extrinsic factors that can lead to injury and injury prevention programs, if done well, should incorporate both of those. Right but they often concentrate on the biomedical part of the The, whether it be strength training, or landing, or, you know, whatever it may be when we look at a lot of these injury prevention programs, but there are so many contextual issues and extrinsic issues that can impact any of those programs. So I'll kind of let you sort of talk through that a little bit and talk through some of the main points that you found in that paper. But gosh, it really gets you thinking like, Well, wait a second, it could be, like you said, if you are, depending on the environment in which you live, can have a huge impact. And it's, it's more than just, especially when it comes to girls and women, it's more than just oh, it's because you have your period. And that's why this happened. Or if your hips are wider, that's why you got injured, right? So go ahead, I'll throw it over to you. And you can kind of talk through that paper a little bit, and then we'll see what comes up.

11:04

Mm hmm. You know, I'm so happy to hear you say that, because I'm so I'm not a clinician, but it has been amazing to me to hear how this paper has resonated with clinicians and people working in this space in terms of your own experiences and what you see and what you hear from the people that you're working with. So yeah, you're absolutely right. I mean, this paper was born out of conversations that Steph and Joanne and I had in terms of how we were frustrated by I guess, the discourse around sports injury, particularly for girls and women, often being blamed on our physiology on our bodies, right. And to us, that seems like a bit of a cop out. And just to say, oh, you know, girls are more susceptible to ACL injury, because they have wider hips, so there's nothing that we can do about it, you know, so that's really pitched us that intrinsic risk factor that girls and women are just inherently weaker, or supposedly more fragile than boys and men, and there's nothing that we can do about it. So we're just going to have to kind of live with those injury breeds. Right. And, and we found that this kind of thinking had really underpins so much of the injury prevention work that we'd seen over the last 10 or 20 years. And we wanted to problematize this a little bit and to think through what those kind of other social and I would say structural determinants of sports injuries are. So I'm starting to talk about this idea of the social determinants of injury. So not just what are those intrinsic things, but actually, what are the what are the other other social modes, I guess, that we might carry that might lead to injury. So in this paper, we speak about how we, as human beings, literally incorporate I think, biologically, the world in which we live. So our societal or ecological circumstances, we incorporate that into our bodies. And so we can start to see how injury might be a biological manifestation of exposure to that kind of social load. So for girls and women, how our gendered experience of the world might render us more susceptible to injury, rather than just positioning ourselves as being more weak, or more fragile. So we were interested in how society makes us and skills in women more weaker, and more fragile. And so in this way, we speak about how you know, from the time that we're babies, girls are not expected to do as much physically we are brought up differently to young boy babies might be when we go through school and play sport in school, we play different kinds of sports, and again, you know, on average, or in general, and girls, goes out, you know, not encouraged to be as active and to do as much with our bodies as boys. And we then go in right to have this kind of that cumulative effect of less exposure to activities and doing things with our bodies. Actually, that is what leads to us being more susceptible to things like ACL injury over time. And this is carried on in the kind of elite sports space as well. So we see how girls and women's sports are devalued in so many ways and how we're not expected to do as much or to perform as well. Or to train as hard I guess, as boys and men So an example of this that actually happened a couple of weeks after we published the paper was the NCAA March Madness. I don't know if you remember, there were those pictures that were tweeted all over social media, about the women's division, only being supplied with one set of teeny, tiny Dunda. Whereas the men's division was given, you know, massive weight room with everything that they needed to be able to train to be able to warm up and do everything that they needed to do in that state. And the first that was just an excellent example of what we're talking about in terms of girls and women being expected to and actually being made, I guess, weaker than boys and men are in exactly the same sports spaces. And so that's kind of a rundown, I guess, of what we wrote about in the paper.

15:53

Yeah, and I look back on my career as I was a high school athlete, college athlete, and not once was it, hey, we should go into the gym and train with specific training programs, because it will help to make you stronger, maybe faster, better, less prone to injury, but the boys were always had a training program. You know, they always had a workout program. So I can concur. That is like a lived experience for me as to what training was like, comparing the boys versus girls college straight through or high school straight through to college. And yes, that March Madness thing was maddening. Pun intended. I couldn't you could not believe couldn't believe what we were seeing there. That was that was completely out of bounds. But what I'd like to dive in a little bit deeper to the article, not not having you go through everything line by line. But let's talk about the different environments that you bring up within the article, because I think they're important. And a little more explanation would be great. So throughout this kind of ACL injury paradigm, you come up with four different environments, the pre sport environment, the training environment, the competition environment, and the treatment environment. So would you like to touch on each of those a little bit? Just to explain to the listeners, how that fits into your, into this paper and into the structure of injury prevention?

17:31

Yeah, sure. So um, yeah, what we did with this paper was we take we take the the traditional ACL injury cycle, and that a lot of us working in sports injury prevention are aware of, and we overlay what we called gendered environmental factors on top of that, so we wanted to take this this site, call and think through how our gendered experiences and girls and women, again render us more susceptible, and over the course of a lifetime, or a Korean. And so starting with the pre sport environment, you know, that goes back to what I was just saying about girls and boys being girls being socialized differently to boys, when we're growing up. So that kind of life course effect, gender affects over the life course, in terms of what we're expected to do with our bodies. That really starts in that pre sport environment when we're babies and young boys and young girls. And then we track how that works throughout the ACL injury cycle. So moving into the next step, coming back to this NCAA example, you know, what the training environment looks like, and how it might be gendered in ways that we might not even pick up on. So another example here, and this is a practical example that we've given to some sports organizations, since then, is, you know, the kind of gendered language that seems like everyday language and sport that can actually be really harmful to both men and women. So for example, you know, talking about girl push ups, you know, that really does set a precedent for what we think about girls and women in sports spaces. When you say, Oh, you go over there and do some girl push ups, it really does render girls and women as being more weak, you know, weaker and more fragile than boys and men. So those kinds of gendered experience in sports spaces, and you're an example there is really key. But then we also talk about kind of during injury and post injury as well. And this comes more into the kind of rehabilitation space and so on how, again, expectations of girls and women's bodies might play into what we expect when we go through rehabilitation as well and, and how that plays into that ACL injury cycle of recovery, as well. So that's really for So it was overlaying gender, across all of those spaces. And I think that gives us a really powerful way of looking at ACL injury differently and to, to conceptualize what we might do both in injury prevention, but also once injury has happened to help girls and women differently.

20:20

And in reading through this paper, and and also going through the slides that you graciously provided on Twitter, of of all of your talks at IOC, as a clinician, it for me, gives me so much more to think about, and really sparked some thoughts in my head as to conversations to have with the patient. So what advice would you give to clinicians, when it comes to synthesizing a lot of this work? And taking it into the clinic, talking with their patient in front of them and then implementing it? Because some people may say, oh, my gosh, I have so much to do. Now, I have to read all of this. Now I have to incorporate this, do you know what I mean? So it can some be somewhat overwhelming. So what advice do you have for clinicians? Yes,

21:13

so I really do think and as I said earlier, I think a lot of what we're seeing here is what clinicians are doing all the time anyway, I think, especially people who are already connected to this kind of idea of this social determinants of health. And so I guess, for me, it is really just being cognizant of, and being able to have those conversations with athletes, with patients with people that you work with all the time, about their social conditions of their lives. So not again, not just reducing people down to bodies, but recognizing that people have you know, that the social conditions of our lives play into our injuries and our rehabilitation, and holding space for that, you know, when I'm teaching, that's what I say to my students all the time, but I know that that you know, this, and clinicians know this better than I do. You, you know, it's not just about saying to someone, go away and do these exercises, and come back to me when you know, that person might have a full time job with three kids to look after. And, you know, a lot of other things on their plate as well that that one exercise or exercise program isn't necessarily going to be the silver bullet or the answer to, you know, the way that they need to be dealing with that injury. So I think for me, it's again, that re humanizing and being able to have those those conversations and recognizing those social determinants of injury or recovery, and so on. And so I think for clinicians, it is about not simply seeing rehab as a biomedical issue alone to solve, but thinking about it as socially and politically and materially oriented as a practice that you might incorporate in your way of thinking. That's really it. It doesn't need to be any more than that. We don't need to complicate it. Any more than that.

23:10

Yeah. Perfect. Thank you for that. And as we start to wrap things up, is there a, are there any kind of key points that you want to leave the listeners with? Or is there anything that we didn't touch on that you were like, oh, I need I need people to know this. This is really important. Hmm.

23:36

Yeah, I think, you know, if we kind of connect the conversations that we've kind of had today with the different points that we've connected to, I think, you know, what I saw in IRC at the IOC conference in Monaco is I really felt especially on day one at that athlete centered symposium that we had, I really felt like a palpable shift in that room. And in the conversations that I've had afterwards, with people I've had so many people come up to me to say that, you know, that it was really inspiring, and it's helped them to be able to go away and have different kinds of conversations, incredibly have different kinds of conversations about the work that we're doing in injury prevention and in Sport and Exercise medicine more broadly. And so I really think that we need to focus on that idea that injury prevention and a contemporary vision for injury prevention needs to be athlete centered and human focused. And I think if we truly committed to this, I think the ways in which we develop our interventions, and the ways in which we might go about our work, more generally in Sport and Exercise medicine, in physiotherapy and so on, it needs to reflect the socio cultural, so meaning those social determinants of injury in cluding the ways in which things like sexism, and misogyny, and racism, and classism, and ableism, and homophobia and transphobia, how that all can and does actually lead to injury. I think those are larger conversations that we need to be having enough field that we've started to have very slowly, but they are difficult conversations to have. And we often cut them out when we only think about injury as a biomedical thing, again, only thinking about bodies. And so for me, I think those are the those are the thing that we now need to get uncomfortable, you know, about, we need to have those uncomfortable conversations about our complex, messy realities, and that we're dealing with that athletes are human beings, that these are our experiences of the world, that sport and exercise medicine needs to reflect that as well. In terms of our composition, we need to reflect the communities that we serve as well. And Tracy Blake talks about that often. And you know, those are the conversations that I'd like to see our field having going forward. And I do think there was a shift in being able to say those things at Monaco this year.

26:16

Yeah. And so what I'm hearing is, was the big takeaway for me from Monaco is context is everything. And we can't, we can no longer take that out. And focus, like you said, just on the biomedical aspect of this person in front of us as if they don't have past experiences and emotions and thoughts and fears and concerns. And context is everything. And for clinicians, it sounds like a challenge to start having these conversations at more conferences. I know it's this little kind of bubble of clinicians, but if it can start there, perhaps it can make a ripple out into the wider public and into having these conversations with your athletes and patients and not be afraid to have these difficult conversations, or to ask the probing questions to the person in front of you. Because they're more than just their ACL injury, they're more than just their back pain. So I think challenging clinicians to have these conversations, whether it be one on one like this, or within large groups at conferences, and then take that back to your, to your practice and really start living it and understanding that this can is as important, maybe, in some cases more important than the biomedical injury in front of you.

27:41

Oh, I could not agree more with that statement. I mean, something that I've spoken about a lot before is that, you know, sport isn't neutral. It's not a political. And it's the same for the work that we do. It's, you know, for far too long, it's been positioned as a neutral science thing that we do. And I think we're now starting to recognize the context around that, that our values and our principles and people's lives and experiences, you know, as you say, play as much as if not more of a role in their experience of sport, and injury, and rehab, and all of that. So I would agree with you completely, we need to be having more of these conversations, we need to recognize this within our research, we need to recognize this within our practice. And we can't keep going on as if you know, none of so if we can remove all of that from the practice of working with human beings and being human beings as well. You know, all of this is connected for me. And as you know, as we're seeing now, it's for all of us who work in this space, once we start to have these conversations, we can start to ask different questions, we can start to think about things differently. And I think that that's really powerful for the future of our work in this space.

28:55

Yeah. And I think it's also important to remember that we can start to ask these questions start to have these conversations that the answers aren't going to come tomorrow. So that instant gratification that has become the world that we are now living in that if it doesn't happen within the next couple of days, that means it's not going to happen, but that these ripples will take some time. Yeah, absolutely.

29:19

And, you know, so a lot of my work is in complexity theory. And what I say about that is, you know, there probably are not going to be hard and fast answers here. But it will bring up new considerations and it will bring up I think, I'd like us to move away from this idea that we can solve things, but actually move closer towards the idea that this is an ongoing practice. And that that's always going to be I think, more powerful for me when we see things like injury prevention as a process or a practice. That's not necessarily going to solve things. But that is you know, really To the context in which we live in our lives is an ongoing thing. And I think that's what we brought into the ACL injury cycle. Papers. Well,

30:09

yeah, I think it takes away from the clinician as being the MS or Mr. Fix it to, okay, we are layering ourselves into people's lives. And we need to be able to do that in a way that fits the person in front of us as best we can.

30:26

Yeah, exactly. Beautifully said exactly. We can't necessarily solve those things for them. But these provide considerations, things that we can do. And yeah, we can move with that.

30:39

Yeah, absolutely. Well, Cherie, thank you so much. I mean, we can go on and talk for days on end about this stuff. And perhaps when one of these days we will we'll have a bigger, wider, broader conversation and and make it go on for a couple of hours, because I'm sure it will bring up a lot of questions, maybe some answers, and perhaps some changing of minds when it comes to injury prevention and what our role is as clinicians. So thank you so much, where can people find you?

31:13

Thank you, Karen. And I love that I think broader conversations are so helpful in this space. So people can find me on Twitter at Shree Becker, that's probably the best place to find me. I'm always over there and happy to have broader conversations with everybody. So please come and find me on Twitter.

31:32

Perfect. And we'll have links to everything, including the paper that we're talking about. From BDSM. We'll have links to everything at the show notes at podcast dot healthy, wealthy, smart, calm. So one question left that I asked everyone and that is knowing where you are now in your life and in your career? What advice would you give to your younger self?

31:51

Oh, so that's a really good question. And it's I think it's my Elan series, again, connected to what we saw in Monaco. And something that I've said for many years now is connection is greater than competition. And something that I live in that I feel like I wish I had done earlier is to hold on to the power of connecting with people who are at the same career stage and doing work with people who are at the same career stages as you especially someone who has and is an emerging researcher, or researcher clinician in this space, because I think the exciting new conversations that we're seeing in this space are coming from people who are you know, recently merging, I guess, in these researchers faces and so it's okay to collaborate rather than being in competition with people who are doing great work in your area. So that would be my advice.

32:54

I love it. I love it and couldn't agree more. So Sheree, thank you so much for coming on. Thank you again. I appreciate it.

33:02

Thank you so much, Karen. And everyone. Thanks

33:04

so much for tuning in and listening and have a great couple of days and stay healthy, wealthy and smart.