Forming norms: informing diagnosis and management in sports medicine

Clinicians aim to identify abnormalities, and distinguish harmful from harmless abnormalities. 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 disease and disability. However, ‘normal’ is difficult to clarify and definitions are dependent on context. ‘Normal’ in the clinical setting is best understood as an appropriate state of physical function. 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. Clinicians use physical measures to assess physical function and identify disability. Accurate diagnosis hinges on access to ‘normal’ reference values for such measures. However our knowledge of ‘normal’ for many clinical measures in sports medicine is limited. Improved knowledge of normal physical function across the lifespan will assist greatly in the diagnosis and management of pain, disease and disability