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Forming norms: informing diagnosis and management in sports medicine
  1. J N Baldwin1,
  2. M J McKay1,
  3. C E Hiller1,
  4. E J Nightingale1,
  5. N Moloney1,
  6. N Vanicek2,
  7. P Ferreira1,
  8. M Simic1,
  9. K Refshauge1,
  10. J Burns1,3,
  11. on behalf of the 1000 Norms Project Consortium
  1. 1Faculty of Health Sciences, Arthritis and Musculoskeletal Research Group, The University of Sydney, Lidcombe, New South Wales, Australia
  2. 2Department of Sport, Health and Exercise Science, University of Hull, Hull, UK
  3. 3Paediatric Gait Analysis Service of New South Wales, Sydney Children's Hospitals Network (Randwick and Westmead), New South Wales, Australia
  1. Correspondence to J N Baldwin, Faculty of Health Sciences, Arthritis and Musculoskeletal Research Group, The University of Sydney, 75 East Street, Lidcombe, NSW 2141, Australia; jennifer.baldwin{at}sydney.edu.au

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Clinicians aim to identify and distinguish harmful from harmless abnormalities.1 In sports medicine, measures of physical function such as strength, balance and joint flexibility are used as diagnostic tools to identify causes of pain and disability, and monitor progression in response to an intervention. Comparing results from clinical measures against ‘normal’ values guides decision-making regarding health outcomes. Understanding ‘normal’ is therefore central to appropriate management of pain and disability.

Dividing populations into ‘normal’ versus ‘diseased’ largely overlooks the heterogeneity of the healthy population.2 Particularly as disease, pain and sickness are expected occurrences of being human, understanding ‘normal’ at each stage of the lifespan is essential to avoid the medicalisation of usual life processes.3 However, ‘normal’ is difficult to clarify and definitions are dependent on context.

In clinical settings, ‘normal’ is used in various ways and this can lead to confusion. ‘Normal’ is used to describe both an average and a disease-free state. Normal as the average may mislead, because it does not necessarily reflect normal physiology.4 For example, overweight and …

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