The British Journal of Sports Medicine recognising and supporting sports physiotherapists globally

The British Journal of Sports Medicine (BJSM) is a leading outlet for sports physiotherapy research and serves many physiotherapy societies. The BJSM Physiotherapy Steering Committee was created to both guide the journal and empower the sports physiotherapy community to move forward and inspire future sports physiotherapists.

What is the role of sports physiotherapists within sports and exercise medicine?

Sports physiotherapists have become a key part of the sports and exercise medicine (SEM) landscape in past decades. Both clinically and academically, sports physiotherapists have elevated the standard of care provided across the spectrum of musculoskeletal medicine and integrated with other disciplines in SEM to raise the bar in patient-centred care. From elite athletes and weekend warriors to those living with chronic diseases, sports physiotherapists have embraced technology to provide high-quality clinical assessments, interventions and education, as well as using telehealth to provide access to expert care more broadly. These professional advances have been achieved by undertaking high-quality clinical research, including landmark clinical trials, systematic reviews and meta-analyses. Sports physiotherapists have led several influential consensus statements in SEM and become expert at adapting study designs from traditional medical and pharmacological formats to suit interventions such as exercise and manual therapies.

Sports physiotherapists are also trained to tackle global health challenges posed by both communicable and non-communicable diseases (NCDs). It is well established that morbidity and mortality associated with NCDs like diabetes, heart disease, depression and osteoarthritis can be positively influenced by regular exercise and physical activity.1 Recently, reports demonstrated the influence of exercise and physical activity in reducing the severity of outcomes following COVID-19 infection.2–4 Using evidence-based exercise as the core of injury prevention and rehabilitation is one of sports physiotherapists’ primary skill sets and can be readily applied to address many global health challenges.

How can sports physiotherapists continue to lead and inspire SEM for a positive future?

Despite many gains, there are challenges still to be resolved. Upskilling SEM clinicians globally and across disciplines to provide greater access to exercise for high-quality injury prevention, rehabilitation and general health needs our attention. We need to integrate physical activity promotion and exercise medicine better into all physiotherapy training programmes and ultimately, into clinical practice. Sports physiotherapists should continue to optimise people’s physical function, so they can exercise and play sport, using technologies like telehealth where necessary to maximise reach across communities. Sports physiotherapists need to support and encourage health funders and policymakers to remove barriers for people from lower socioeconomic groups to ensure equitable access to sports, exercise and rehabilitation. This might include improved access to transport to get to sports or rehabilitation facilities, the provision of equipment, the use of task-shifting approaches (training less specialised health workers to do tasks usually done by more highly trained workers) or bringing rehabilitation services to remote communities.5

Like SEM physicians, sports physiotherapists do not serve global communities equally. Marginalised groups, such as women, people with disability, members of the LGBTQIA+ (lesbian, gay, bisexual, transgender, questioning, queer, intersex, asexual, pansexual and allies) community, black, Indigenous and people of colour, communities from lower/middle-income countries (LMICs) and those in conflict zones, continue to be under-represented and underserved at all levels of SEM. For example, there are 0.08–0.24 physiotherapists per 10 000 citizens in Malawi, Nigeria and Zimbabwe, compared with 26, 14, and 7 physiotherapists per 10 000 citizens in Denmark, Australia, and Canada, respectively.6 Gendered, racialised and hierarchical societal norms lead to a privileged few dominating through greater representation as participants, clinicians, academics, journal editors, and decision-makers in SEM research and policy.7

Structural, social and cultural barriers exist that perpetuate this inequity. Although technology has improved exposure to sports physiotherapy education and expertise for clinicians, academics and patients globally, limited numbers of sports physiotherapists in lower-income countries have access to technology, meaning they cannot reliably access opportunities for remote learning. Notably, 25% of Central Africa and less than 50% of West Africa and South-East Asia have access to the internet compared with 98% in Northern Europe and 93% in North America.8

Our priorities for the future

While sports physiotherapists have been at the forefront of positive change within the broader SEM community, we also have a responsibility to support equity, diversity and be more inclusive of marginalised groups of clinicians, scientists and patients. The BJSM Global Mentoring programme ( https://bjsm.bmj.com/pages/bjsm-key-publishing-resources ) aims to advance research and diversity within the sports physiotherapy profession by assisting scholars with fewer resources and will enhance inclusion. The BJSM ‘Stamp of Approval’ only supports high-quality congresses with inclusive representation of faculty. But we need more action.

We need more qualified sports physiotherapists from marginalised groups.9 Sports physiotherapy congresses need to do more to promote inclusion, with strategies such as different registration rates for clinicians from LMICs, and inclusive panels not just based on gender but intentionally including speakers from marginalised groups. Sports physiotherapists should provide leadership to create a healthier world, where access to high-quality healthcare, sport and exercise facilities, and enablement of physical activity is not just for the privileged.10 We also have a responsibility to do our part in addressing the big challenges facing humanity, including the global health problems created by climate change, future pandemics and NCDs. As we work together, harnessing the power of social media for positive and inclusive messaging can also help drive the call for change and new priorities.

BJSM is committed to address the challenges discussed in this editorial. As the leading SEM journal, with its associated privileges and platform, BJSM together with the sports physiotherapy community has an enormous responsibility and potential to be a voice for marginalised groups. We must ensure equitable access to healthcare and healthy lifestyles, and to advance research relevant to health outcomes for all communities.