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You used that position of trust that you had in the most vile way to abuse children. You violated the oath that you took, which is to do no harm, and you harmed them selfishly.

Judge Rosemarie Aquilinar, in the trial of Larry Nassar

On 22 November 2017, Dr Larry Nassar, former team physician for the US Olympic gymnastics team, admitted to using his position to sexually abuse underage girls. More than 250 victims reported assaults. In the words of one of his victims, ‘… Larry is disgusting. Larry is a MONSTER and not a doctor’.1 Attorney John Manley identified three institutions that ‘miserably failed’ to protect children under their care: USA Gymnastics, the US Olympic Committee and Michigan State University.2

This tragic case of sexual abuse in sport clearly demonstrates the necessity for clinicians to not only be aware of their own professional boundaries and codes of conduct, but also be proficient in the prevention, identification and treatment/management of disclosures of harassment and abuse. Most postgraduate sport medicine training programs do not include athlete safeguarding in their curriculum as a required competency. The objectives of this chapter are thus designed to fill this gap in education. Readers will gain an understanding of the following relevant topics in athlete safeguarding:

  • what is harassment and abuse in sport

  • types of harassment and abuse (non-accidental violence)

  • delivery mechanisms of harassment and abuse

  • the scientific base underpinning the field of harassment and abuse in sport

  • the consequences of harassment and abuse for athletes, the entourage and sport

  • prevention principles of harassment and abuse

  • clinical management of allegations of harassment and abuse.


Harassment and abuse in sport is rooted in failed leadership where there is an abuse of power within an organisational culture with inadequate athlete protection policies and attitudes of passive indifference, denial or silence.3 All forms of harassment and abuse arise when there is an actual or perceived inequality of power and trust in the relationship between the individuals concerned. The International Olympic Committee (IOC) has developed a conceptual model to demonstrate the cultural context, the forms of harassment and abuse, the mechanisms and the impacts.

To facilitate an understanding of the terminology of the field, in its consensus statement on harassment and abuse in sport the IOC adopted agreed definitions (see box below).

Two more terms in frequent use in the field are ‘violence’ and ‘safeguarding’. The range of the various forms of physical, sexual and psychological abuse in sport is often referred to as ‘non-accidental violence’, or simply ‘violence’, to be consistent with the terminology used by other advocacy agencies in the field of safeguarding, including UNICEF and Safe Sport International.5 In some countries, ‘safeguarding’ is the term used to refer to all aspects of the ...

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