Sports practitioners, athlete welfare and duties of care: A case study of the professional practice of hamstring management in English professional rugby union

The management of hamstring injuries is complex and involves many processes and procedures. Specifically, within in professional sporting contexts there is a plethora of research that focuses on the scientific underpinnings of the management of hamstring injuries, from assessment, diagnosis, treatment, rehabilitation and injury prevention. However, little is known about how hamstring injuries are managed within the wider context of professional sports work and athlete welfare. Within recent years, knowledge is emerging on how to optimise rehabilitation following acute hamstring injury (Thorberg, Ishoi and Krommes, 2017 cited in Ishoi, Krommes, Husted et al., 2020). Within elite sport athletes will have a multidisciplinary team to provide a wide range of management strategies that are focused on returning them to play in the safest, shortest time. This thesis will focus on technical expertise and scientific knowledge and working as a multidisciplinary team and interrogate the management of hamstring injuries in elite English Rugby Union. From this thesis we will be able to build on the scientific knowledge we already have to ensure the best possible care for our athletes both in terms of processes and procedures. In this research, I adopt a Constructivist-Interpretivist approach, similar to Scott & Malcolm (2015); Arnold et al., (2019) and Kerai, Wadey, & Salim (2019) to unearth how practitioners in elite English Rugby Union treat and manage first time acute hamstring injuries. The aims of the thesis were to: 1) explore how practitioners work to manage hamstring injuries in elite English rugby union in terms of technical expertise and scientific knowledge, and within a multidisciplinary team, and 2) Discover how hamstring injuries were managed in elite English Rugby Union from a doctor, physiotherapist, and strength and conditioning point of view.

This thesis adopts a qualitative Mixed Methods Research (MMR) design, comprising the collection and analysis of data collected via thirty-five semi structured face-to-face interviews and completion of a questionnaire with 13 doctors, 11 physiotherapists and 11 strength and conditioning staff. Specifically, I adopt a Constructivist-Interpretivist approach to explore how doctors, physiotherapists and strength and conditioners in elite English rugby union reflect upon and perceive their treatment and management of first-time acute hamstring injuries. Whereas previous studies have focused primarily on the mechanics of injury treatment, a qualitative MMR approach affords complete in depth and comprehensive understanding of some of the issues evident within professional practice. Practitioner responses were coded using thematic content analysis and analysed under the themes technical expertise and scientific knowledge (TESK) and multidisciplinary teams (MDT). Verbatim quotes from the practitioners are included to highlight key areas that both support and disagree with the literature.

This thesis concludes that the management of hamstrings injuries in elite English Rugby Union is varied from a doctor, physiotherapist, and strength and conditioning staff perspective. During the management of hamstring injuries practitioners show how they apply their high level of technical expertise and scientific knowledge to all aspects of the management process. We see that many practitioners use pain and symptoms to guide their treatments and rehabilitation rather than set timeframes highlighting that they apply technical expertise and scientific knowledge during the injury management process.