PHYSIOTHERAPY THEORY and PRACTICE

http://informahealthcare.coin/ptp ISSN: 0959-3985 (print), 1532-5040 (electronic) Physiother Theory Pract, 2014; 30(5): 329-337 © 2014 Informa Healthcare USA, Inc. DOI: 10.3109/09593985.2013.876692

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QUALITATIVE RESEARCH REPORT

Sportiness and masculinities among female and male physiotherapy students Tone Dahl-Michelsen, PhD Centre for the Study of Professions, Oslo and Akershus University College of Applied Sciences, Oslo, Norway

Abstract

Keywords

This article explores the gendered innportance of sportiness in terms of students' judgments of themselves and their classmates as suitable physiotherapy students. The article is based on observations and qualitative interviews with students attending clinical skills training classes in the first year of a bachelor's degree program in physiotherapy in Norv\/ay. The analysis focuses on sportiness as a display of masculinity and is inspired by Connell's concept of multiple masculinities. The findings demonstrate sportiness as a shared common value among students. However, it was also found that there are two main typologies: (1) hyper-sportiness; and (2) ordinary sportiness. Male students judged as possessing hyper-sportiness are acknowledged as particularly suitable physiotherapy students and assume a hegemonic position in the student milieu. Female students who adapt hyper-sportiness have the potential to assume a hegemonic position, but tend not to do so. Female students with an ordinary level of sportiness have no particular problems in being identified as suitable physiotherapy students, whereas male students do encounter such problems. The article demonstrates how physiotherapy students' sportiness is more complex than previously known, particularly concerning differences in how female and male students are acknowledged in terms of perceived suitability as physiotherapy students. Additionally, this work shov^is a continuity of historical lines with respect to how sportiness is embedded in gender within the physiotherapy profession.

Gender, physiotherapy students, sportiness

Introduction No formal requirement exists for students to be interested or skilled in sports in order to be accepted into a bachelor's degree program in physiotherapy. However, previous research has found that sports are associated with physiotherapy students. Two studies found that physiotherapy students tend to be highly engaged in sports and physical activity (Öhman, Solomon, and Einch, 2002; Öhman, Stenlund, and Dahlgren, 2001). In addition, another study reported that students in upper secondary school considered being sporty a fundamental requirement for pursuing an education in physiotherapy (Greenwood and Bithell, 2005). These studies also noted that men are significantly more likely than women to pursue an education in physiotherapy because of their interests in sport and physical activity (Öhman, Stenlund, and Dahlgren, 2001) and to believe that physiotherapists need to be sporty (Greenwood and Bithell, 2005). The finding that men relate the educational choice of physiotherapy to interest in sports to a greater extent than women corresponds with the gender segregation that exists in the choice of specialization within the physiotherapy profession. That is, sport physiotherapy is dominated by males (Dahl-Michelsen and Leseth, 2011 ; MacLean and Rozier, 2009; Öhman, Stenlund, and Dahlgren, 2001).

Address correspondence to Tone Dahl-Michelsen, PhD Research Fellow, Centre for the Study of Professions, Oslo and Akershus University College of Applied Sciences, Postboks 4. St. Olavs plass, 0130 Oslo, Norway. E-mail: [email protected]

History Received 2 August 2012 Revised 30 October 2013 Accepted 22 November 2013 Published online 10 January 2014

As the previous research is mainly quantitative, a qualitative study was conducted in order to further explore how sport and gender are interconnected within students' social acceptance into a physiotherapy program. In this study, I use the concept of sportiness, including sport both as performance and as a form of representation. Sportiness captures both the view of oneself as sporty and the recognition as such by others. Being sporty involves that one participates in sports or physical activity. Thus, being sporty connotes activeness. Sportiness is also strongly based on the view of sport as historical and cultural representations of masculinities (Bornholdt, 2010; Mosse, 1996), but performed by both females and males. The concept of sportiness as performative derives from the perspective of gender as performative actions, which is known as "doing gender" (Butler, 1990; West and Zimmerman, 1987). Gender as performative actions implies how females and males display norms of masculinity and femininity, as well as how these gender scripts can be transcended. In other words, females can, to a certain degree, behave in a masculine manner and still be socially accepted, and males can, to a certain degree, behave in a feminine manner and still be socially accepted. Thus, this perspective implies no fixed connections between females and femininity and males and masculinity. However, to be viewed as appropriate, the "doing" must be seen as acceptable for normal behavior for females and males in the actual field (Nordberg, 2005; Paechter, 2003a, b, c, 2007; Solbrœkke and Aarseth, 2006). The concept of sportiness also captures associations among sports, masculinity, and physiotherapy (Dahl-Michelsen and Leseth, 2011; MacLean and Rozier, 2009; Rozier, Thompson,

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Table 1. Characteristics of the participant observations. Course Title Functional Assessment and Manual Skills Massage and Palpation

Hours obs.

Period

Semester

No. students

Female students (%)

Male students (%)

68 15

May-June. 2010 November. 2010

Second First

55 110

42 (76) 76 (69)

13 (24) 34(31)

Shill, and Vollmar, 2001; Sudmann, 2009) as formed within the historical context of physiotherapy (Haugen, 1997; Johansson, 1999; Ottosson, 2007, 2008). The focus on .sportiness as gendered is also inspired by Connell's theory of masculinities (1995, 2005). This theory provides a conceptual model that demonstrates relations among masculinities; Hegemonic, subordinated, complicit, and marginalized masculinities represent the construction of various ma.sculinities within a hierarchy (Connell, 1995, 2005). Hegemonic masculinity implies domination and is the top position within the hierarchy of masculinities. The position of hegemony is central because it structures practice in such a way that what dominates becomes hegemonic and what is hegemonic dominates within the actual field (Karlsen, 2011 ; Lagestad, 2011 ; Lorentzen, 2006; Lykke, 2008). Subordinated masculinity is dominated by hegemonic masculinity, whereas complicit masculinity supports hegemonic masculinity. In example, complicit masculinity is a position occupied by those who do not fully achieve the hegemonic position but still benefit from it. Marginalized masculinity is subordinated and as indicated by the label, at the bottom within the hierarchy of masculinities. The hierarchy of masculinities thus provides the following direction of positions: hegemonic; complicit; subordinated; and marginalized. In the present article, I also attend to female masculinities, which often fall outside Connells theory (Halberstam, 1998). The inclusion of female masculinities provides opportunities to use Connell's (1995, 2005) conceptual model for masculinities as an analytical tool that includes both female and male students' performances of sportiness. That is, elaborating on the relations of different gendered positions within a hierarchy of sportiness performed by both female and male students. The aim of this article is to explore how the importance of performing sportiness is gendered in terms of students' judgment of themselves and their classmates as suitable physiotherapy students. The following research questions are posed: (1) How do female students and male students perform sportiness as they qualify to become physiotherapists?; and (2) How does sportiness intersect with gender in the positioning of female students and male students as suitable physiotherapy students?

Methods This article is based on participant observations and interviews, and forms part of a study focusing on the social process that physiotherapy students undergo as they qualify to become physiotherapists in the physiotherapy education. The participant observations were conducted in first-years skills training classes in one of Norway's four bachelor's degree programs in physiotherapy, and the empirical material included interviews with students who participated in the skills training classes. However, the participant observations and the interviews contributed different empirical data, as described in the subsections below. Participant observations in skills training classes Participant observation is particular suited for exploring tacit aspects of knowledge that are largely taken for granted (Fangen, 2010; Hammersley and Atkinson, 2007). Participant obsetvation, therefore, was chosen to provide opportunities for viewing

the informal and social aspects of the process students undergo to become physiotherapists. The observations were conducted in two periods in which I followed two different courses and two different cohorts of students (Table 1). Students were informed both orally and in written form about the project. They signed an informed consent form. All students in the classes participated. In the skills training classes, I engaged in determining the interactions in these classes. During Functional Assessment and Manual Skills, sportiness was displayed as an important aspect of the social process students undergo to be acknowledged as suitable physiotherapy students. As there were limited opportunities for longer conversations with students in the skills training clas.ses, interviews were also conducted outside of classes. I also carried out another period of observations in a different course (Massage and Palpation); there, I was able to observe another and larger cohort of students than in the course of Functional Assessment and Manual Skills. However, sportiness was displayed as important among students in similar ways across the two courses. Interviews The interviews provided opportunities to explore sportiness as presented in talk (Järvinen and Mik-Meyer, 2005). The empirical material included 16 interviews with eight female students and eight male students from the skills training classes in the spring semester of 2010. All who were asked to participate in the interviews accepted the invitation and signed an additional informed consent form. The interviews (50-70 min) were recorded on digital audiotape and transcribed by the author. The three main study topics (Appendix 1) were drawn from an Interview guide that also covered other topics for a project focusing on the informal and social process that physiotherapy students' undergo to become physiotherapists. Although the interview guide was semi-structured (Kvale and Brinkmann, 2009), the interviews were largely informal conversations (i.e. open-ended questions were asked in different sequential order in different interviews) (Fog, 1994). Students were selected to be interviewed on the basis of the following four criteria: (1) Gender: To give equal voice to female and male .students the same number of female and male students were included; (2) Age: To capture variations based on age within the class, the age band observed among the students were included. The students were between 19 and 35 years old; (3) Sportiness: Both students perceived to be particularly sporty and those perceived to be less sporty were included. This categorization was based on perceptions of their bodily appearance and the degree of their itivolvement in discus.sions about sport and exercise in the skills training classes; and (4) Expressiveness of students: The classes included "active" female and male students and "passive" female and male students. The active students spoke more frequently, more loudly, and more animatedly than did the passive students. Both active female and male students and passive female and male students were selected to be interviewed. The criteria of gender and age were decided upon ahead of the observations, whereas the criteria of sportiness and expressiveness of students were decided upon during the observations.

Sportiness and masculinities among students

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In summary, the selected participants for the interviews eapture the variations observed among the students in the classes.

groups in which I participate. This approaeh is viewed as communicative validity (Kvale and Brinkmann, 2009).

Analysis of empirical material

Findings

According to Patton (2002), qualitative analysis often begins as an inductive analysis, transforming into a deductive analysis that is more explicitly theory driven. The analysis conducted for this article followed a similar pattern and an initial analysis started out in the clinical skills training classes and in the interviews. For example in the clinical skills training classes, key words and short sentences regarding what occurred in the class were jotted down. These notes eased the process of writing fieldnotes later in the analysis (Emerson, Fretz, and Shaw, 1995; Patton, 2002). The interviews were conducted as natural conversations, meaning that follow-up questions were asked in relation to the students' answers to the open-ended questions. Hence, an initial analysis also began in the interview situation. The interview guide was developed during the interview process. For example, when I realized that the students themselves often noted the question of the possibility of physiotherapy students not to be involved in sports and exercise, I included this as a question in the interview guide and began asking more directly in the interviews subsequently conducted if the interviewee considered this as a possibility. The inclusion of this question was based on the initial analysis that was carried out during the interview process. The process of transcribing the interviews was also part of the initial analysis. The empirical material was then analyzed in a three-step process, which is described in Table 2.

The findings are organized into five subsections. The first subseetion is primarily based on data from the observations with some data from the interviews. The remaining subsections are more exclusively based on data from the interviews. The characteristics of the interviewed students and their sportiness are outlined in Appendix 2. The five subsections are related to one another as follows: The subseetion of the fellowship and the dividing line of sportiness give a broader picture of how sportiness both unites physiotherapy students and also however acts as a dividing factor among the students. The last four subsections elaborate in more detail how sportiness becomes a dividing factor for physiotherapy students. That is, these sections describe how students perceive themselves and one another as differently suited to become physiotherapists based on how sportiness is performed.

As part of a necessary validation of my interpretations of the material, I discussed the empirical data and suggestions for possible interpretations with other researchers of various research

The fellowship and the dividing line of sportiness Sportiness played a crucial role in students' aeknowledgment of themselves and others as suitable physiotherapy students and was self-evident to the physiotherapy students. Their performance of sportiness was particularly noticeable in the skills training classes in terms of their manner of speaking, their behavior, their engagement in sport and training, their use of sports equipment, their wearing of sports clothing, and so on. For example, many students brought their sports bags to class because they had been playing sports or exercising before the skills training class or were planning to do so afterward.

Table 2. Analytical process, three steps. First step Observation The notes written in classes consisted of keywords and short sentences; they were transformed into a document on the computer representing various aspects of sportiness that had been described in the notes from the classes

Interview The transcribed materials were read several times and events and actions relevant to sportiness were marked. The relevant parts of each interview were moved into a new document containing the sportinessrelated material from all interviewed students.

Analytical focus The concept of sportiness was used as an analytical lens.

Observation The stories written in the second step of analyses of the interviews guided the examination of the data gathered from the observations that aimed to explore how students positioned themselves and others in the classes observed.

Analytical questions When and how is sportiness important in students' acknowledgment of themselves and others as suitable physiotherapy students? When and how is the importance of sportiness negotiated?

Second step Interview The material identified in step one was analyzed more closely and a short story of each interviewed student was written.

Third step Observation and Interviews The data from the observations and the interviews were now in the same document. The analysis focused on identifying the differences and similarities in the performed sportiness of female and male students. To capture variations, comparisons were made between the group of female students and the group of male students and within the group of female students and within the group of male students.

Analytical questions What similarities and differences were displayed between the group of female students and the group of male students in terms of the sportiness performed and their positioning as suitable physiotherapy students? What similarities and differences were displayed within the group of female students in terms of the sportiness performed and their positioning as suitable physiotherapy students? What similarities and differences were displayed within the group of male students in terms of the sportiness performed and their positioning as suitable physiotherapy students?

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In every class I attended, the students talked about sports and exercise. The students sometimes engaged in general conversations about sport (e.g. televised soccer matches) or discussions about sports equipment. However, they primarily discussed the sports and exercise activities that they had recently participated in or planned to do that day. They discussed the degree of difficulty of the activities and whether or not they were challenging. Stiffness resulting from these activities was also a hot topic. The students also frequently touched each other's muscles and discussed their own musculature and that of their classmates. For example, I often heard one student exclaim to a classmate, "Oh, check out these muscles." Then, other students would approach the bench where the two first students had begun talking so that they could join the discussion, which often extended to other related topics including sports, musculature, and stiffness. Many of the students had visibly well-trained bodies, which, as apparent from the appreciative comments (e.g. "check out these muscles") and glances exchanged among the students, awarded them status in the student milieu. The students wore sportswear inspired by the surf and skate cultures; however, the students also wore other types of casual clothes that are popular with presentday youth culture. During the interviews, nearly all the physiotherapy students mentioned their relationship to sports and exercise without being prompted. When asked questions about the possibility of being a physiotherapy student without possessing a particular interest in sports and exercise, the students regarded these questions as odd. This points to how obvious the link between physiotherapy and sport was for the students. Thus, it seemed to be regarded as an important aspect of becoming a physiotherapy student and of becoming a future physiotherapist. One interviewee (George) commented; "Actually, all here are sporty I think ... and if you are not sporty, I guess you will become sporty because that is what it is about all the time here." This interview excerpt demonstrates how students acknowledged all their classmates as sporty and the necessity of becoming sporty if one was not already. The complexity surrounding sportiness shows that sportiness not only is a marker of fellowship among students, but it also represents a divide between .students viewed as suitable physiotherapy students and those considered unsuitable or less suitable. In general, the interviewed students perceived lifelong involvement in sports as a quality that makes an individual suited to become a physiotherapist. Disinterest and a lack of involvement in sports and exercise were viewed as making an individual unsuited to become a physiotherapist. One student (Marcus), who had been involved in sport all his life (i.e. he had played soccer since he was able to walk) and who still exercised 6 days a week (mostly playing soccer but also exercising at a fitness center), made the following commented about a female acquaintance in another physiotherapy program: I know a physiotherapy student who has never been into any sport or been involved in .sporting. Honestly, I do not understand why she wants to become a physiotherapist.... I think she even sees it herself - that it is not natural without that [sport] background. This excerpt clearly demonstrates how individuals with a lack of performed sportiness are acknowledged to be unsuited as physiotherapy students. Students with a sports background and those who played sports and exercised a lot viewed themselves as having an advantage compared to those without such characteristics. The following two excerpts from interviews with one male student (Oscar) and one female student (Celine) also demonstrate how students with a sports background drew a dividing line

Physiother Theory Pract. 2014; 30(5): 329-337

between themselves and students without a sports background. These interview excerpts also illustrate differences between male and female students in how this line was drawn. The male student, Oscar, de.scribed the situation as follows: If I compare female and male students . . . I will say that some of the best students in the class definitely are males. Of course, there are also amazingly clever females.... I think some of the males merely manage better because they have [a] previous education [in sport sciences]; we have an education from NIH [the Norwegian School of Sport Sciences] and have taken courses in anatomy and physiology before.... When you, in a way, have double [the amount of education], then you understand the subject better than the others. This sounds terribly arrogant; it is awful to hear oneself say this, but it is the truth. This interview excerpt also exemplifies how male students, simply by acknowledging themselves as "the best students," adopt a hegemonic position. By contrast, females are positioned as "amazingly clever" but not "the best." Celine, one of the female students with a high-level sports background, made the following comment: When they [teachers] demonstrate on the patient's body [student in the role as a patient], then I understand it [how to bodily perform the techniques]. And that is maybe because I, with my sports background, am used to understanding [it] this way, so then I can do it. But that probably is difficult for those [without a sports background] who do not have such an understanding of movement. Celine's description of her situation illustrates how she, as a sporty female student, viewed herself as having an advantage because her previous sports background provided her with another way in which to understand movement. The advantage associated with a previous sports background constitutes a dividing line between sporty physiotherapy students and those who are less sporty. Based on her background as a high-level athlete, she could have assumed a position as "the best"; however, in this study, female students did not occupy such a position. The ordinary-sporty students used the concept of "sportspeople in the class" when they talked about students being particularly sporty. Thus, this concept marked the dividing line between ordinary-sporty students and hyper-sporty students. Both ordinary-sporty students and hyper-sporty students participated in the construction of the dividing line between them. However, hyper-sporty students were the ones most involved in this construction. It is important to point out that students who were considered less sporty were not inactive. They also trained physically; however, their earlier experiences with physical activity did not involve sport to the same extent as those viewed to be hyper-sporty. Male students' dominance of hyper-sportiness Comparisons among the students demonstrated how one group of students appeared to "be in their element". Male students who were acknowledged as hyper-sporty (i.e. viewed by themselves and others as particularly sporty) were distinguished by a particular dedication to sports in terms of their background in sports and their future plans of working within top-level sports. This dedication is apparent in the following excerpt from an interview with one male student (Henry): I have been active and sporty ever since I was a little boy. I have always played soccer and done sport. Sport has been a

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part of my life always, . , , I chose the sport program in seeondary school and continued on to a basic course in sport and onto NIH, So this was very relevant to physiotherapy, I think, , , , Afterward, I will take the master's [degree] in sport physiotherapy,.. I have a desire and a plan to work within the Olympia Top Team, This kind of strong and clear engagement in sport was typical for male students who performed hyper-sportiness. Their high level of self-confidence and unwavering belief in themselves distinguished them from the other interviewees. Although the students were aware that only a limited number of positions are available for physiotherapists at the top level of sports (e,g, the Olympia Top Team), each hyper-sporty male student interviewed for this study believed that he was "the right man for the job," When conducting interviews with these students, I made a point of mentioning to them that only a few physiotherapy jobs are available in sports at the elite level. This competitive job market situation, however, did not worry these male students. One of them (Oscar) laughed and said, "If only one job, still there is one to have that job, [Laughs] This is the way you have to think," This way of positioning was not apparent among female students. Females students' performance of hyper-sportiness A comparison of female and male students who performed hypersportiness demonstrated both similarities and differences. Akin to their male counterparts, these female students possessed an interest in sport that made it somewhat self-evident for them to pursue an education in physiotherapy. The female students who performed hyper-sportiness also expressed a desire to work within sports. This desire is evident in the following excerpt from an interview with a female student (Maria): I have played handball all my life, ,,. I went into the sport program in upper seeondary [school], and then I started the [bachelor's degree] program in physiotherapy . . . I have been to physiotherapists quite a lot myself, and I have seen how they work ... The opportunity to work with athletes maybe later on in [the] future [seems appealing to me], . . . I want to be able to do different things during a [work] week. Maybe work two days in the clinic [private clinic] and two days with babies [in public healthcare] and then one day as a sport physiotherapist. However, the female students did not express the same plans and aims for working within top-level sport as the males did, A dedication to work within sport was clearly expressed among hyper-sporty male students but not among hyper-sporty female students. The most striking difference between female and male students who performed hyper-sportiness is that male students expressed self-eonfidence and dedieation while females did not. Female students' dominance of ordinary sportiness Comparison within the group of female students initially demonstrated that female students without a particular interest in sports did not experience any particular difficulty in being aeknowledged by themselves and other students as suitable physiotherapy students. One female student (Bettina) described her situation as follows: I have done jazz ballet and show dance, but now I only go to the fitness center for aerobic and weight training, . , , I am interested in the body and such but maybe more in illness, , . . Some people in the class are very dedicated to sport, but I think, "OK then, they can have a master's [degree] in sport

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physiotherapy, and I will take something different, something that is more my way," This interview excerpt shows how Bettina's goal of becoming physiotherapist is different from that of students who were hypersporty. The group of female students who performed ordinary sportiness did not plan to work within sport-related physiotherapy in their future, Elisabeth, a female student with a background in dance, described her plans for the future as follows: I am not sure actually [about the future as a physiotherapist], I believe I want to teach, so I think I could do a 50-50 job, I think I want to work in a clinic, a private clinic or something, and then I could teach [movement classes and find a teaching position in physiotherapy education]. That would be exciting, Elisabeth's plans for the future exemplify how those students who performed ordinary sportiness were more focused on exploring opportunities outside the field of sports when they described their plans for the future as physiotherapists but were less sure of their future as physiotherapists, Male students' performance of ordinary sportiness Comparisons within the group of male students demonstrated that male students who performed ordinary sportiness strived to be aeknowledged as suitable physiotherapy students. These male students typically practiced sports as an ordinary leisure aetivity during childhood and young adulthood, similar to the way in which the female students performed ordinary sportiness. They did not enter the sport program in upper secondary school or attend the NIH, They stated that working with top-level athletes or healthy people such as themselves, is not their objective. These students previously gained competence from fields such as danee and theater. They viewed this experience as relevant for their professional competence as future physiotherapists, but they did not yet envision how this relevance would manifest. One male student named Andreas deseribed his situation as follows: I have been interested in combat sport since I was quite young, , , , In upper secondary [school], I did weight training. . . . From the time I was seven until I finished upper secondary [school], I performed in theater, , , , I like being in [physiotherapy] education even though I think it is strange to be in physiotherapy [education] after doing such things as drama, , . , To be honest, I am not sure if I will be a "physio-physiotherapist" if you see what I mean [i,e, a "real" physiotherapist] or if I will use this [education] in something that I do not yet know what is. Interestingly, Andreas's admission of his doubt as to whether he would become a "physio-physiotherapist" demonstrates an understanding that he, as a male performing ordinary sportiness, strove to occupy a legitimate position in the physiotherapy program. Hyper-sporty male students and ordinary sporty male students also described very different future career plans in physiotherapy. For example, they differed in their responses to the following interview question: What do you think you will be doing in 5 to 10 years? The male students who performed hypersportiness typically answered, "I see myself working with the Olympia Top Team or with the national soccer team," By contrast, those performing ordinary sportiness typically answered, "That is a very difficult question,,,, Honestly, I do not know." This difference in responses between the male students who performed hyper-sportiness and the male students who performed

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ordinary sportiness also illustrates the extremes between the analytical typologies of hyper-sportiness and ordinary sportiness. Discussion The findings in this article show the complexity of the gendered importance of sportiness in terms of students' judgment of themselves and their classmates as suitable physiotherapy students. All the participating students seem to grasp the importance of sportiness in the construction of a professional norm in physiotherapy. They use sportiness as a way of identifying students as suitable for physiotherapy; sportiness becomes an aspect of the process by which individuals become physiotherapy students and future physiotherapists. According to Heggen (2008) the successful development of a profession depends on the individuals involved in the profession coming together and agreeing on some common values or symbols. Students' acknowledging of sportiness as required to qualifying to become a physiotherapist illustrates an agreement upon sportiness as a common value. Thus, students are included in a fellowship where they are all acknowledged to be suitable physiotherapy students. However, the intersection of the professional norm of sportiness and gender norms in this field also results in a division of students where the students are differentially positioned as suitable physiotherapy students within a hierarchy of sportiness. The two main typologies: 1) hyper-sportiness; and 2) ordinary sportiness demonstrate respectively hegemony and subordination in terms of Connell (1995, 2005). Students positioning within the hierarchy of sportiness might be interpreted and explained in light of Connell's conceptual model of various masculinities, as presented in the introduction of the article. Eirst, the male students who performed hyper-sportiness made their particular type of sportiness natural and essential for suitable male physiotherapy students to perform; they positioned themselves as "born to be physiotherapists". These male students thus constitute the professional norm of sportiness and were involved in "doing gender" (Butler, 1990; West and Zimmerman, 1987) in line with the expectations of gender norms in this field. By their performing of the professional norm and the gender norm, these students had the opportunity to adopt hegemonic masculinity (Connell, 1995, 2005), which allowed them to build prestige and credibility as physiotherapy students. Second, the female students who performed hyper-sportiness did not fully assume the hegemonic position; instead they performed complicit masculinity (Connell, 1995, 2005). This implied that they contributed to establishing hyper-sportiness as a fundamental element of hegemonic masculinity in this field while not assuming the hegemonic position. In conclusion, this position was reserved for males performing hyper-sportiness. These female students seemingly met the criteria for the top position with respect to the professional norm of sportiness. However, they adapted it to the gender norms (i.e. the gender norms prevented them from assuming the hegemonic position). Third, the professional norm of sportiness as subordinated masculinity (Connell, 1995, 2005) was constituted by the female students who performed ordinary sportiness. However, their suitability as physiotherapy students was not specifically questioned. As they did not break the gender norm it was not necessary for female students to perform hyper-sportiness to be viewed as suitable (female) physiotherapy students. Their interests in non-sports aspects of physiotherapy and their lack of intention to work within sports were viewed as natural and not something they had to defend. Therefore, they could be considered suitable physiotherapy students without performing hyper-sportiness. However, they did not fulfill the professional norm in such a way that they could achieve the top position

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(i.e. they were not acknowledged as the most suitable physiotherapy students). Eourth, the male physiotherapy students who performed ordinary sportiness encountered the greatest challenge in being acknowledged as suitable for the physiotherapy profession in this study. They occupied the positions of marginalized masculinity, as defined by Connell (1995, 2005). By not occupying a position of hyper-sportiness, these male students seemingly not only broke with the professional norm by failing to fulfill the standard for the top position but also broke with the gender norm(s) in this field. Why physiotherapy students seemingly perceive sportiness as required to become physiotherapists and as a core in physiotherapy might be further understood by examining the historical roots of the physiotherapy profession. As established in Sweden in 1813, the physiotherapy program only allowed men. Women were not allowed in the educational program before 1864. Eemales were educated in exercise for the healthy (sports and gymnastics) and in exercise for the unhealthy (physical treatment). Male students were additionally educated in military gymnastics (feting) (Ottosson, 2007, 2008). Physiotherapists and instructors in physical education shared the same educational program until 1934. Additionally to separate the programs, a man had to become an instructor in physical education before he could enroll in the physiotherapy program, whereas a woman did not (Bergman and Marklund, 1989). According to Ottosson (2008), these aspects were aimed to avoid men to become physiotherapists and were related to how physicians (particularly, orthopedists) wanted physiotherapists to be females, who would subordinate them. Today, the physiotherapy profession is concerned to increase the rate of male .students (Öhman, 2001; Ottosson, 2008). There is seemingly a historical line of strong associations between sports, gender, and physiotherapy. Based on the findings in this article, it can be claimed that informal requirements exist today with respect to interests and skills in order to be viewed as acceptable within the educational program of physiotherapists. These informal requirements are gendered in ways that makes it particularly natural for male students to assume the hegemonic position by performing hyper-sportiness. Additionally, it is difficult to occupy a legitimate position as a suitable male physiotherapy student if ordinary sportiness is adopted. There also seems to be similarities between the situation of female physiotherapists in the educational program from 1864 and the situation of female students who today perform hypersportiness. They were both regarded as competent physiotherapists, but did not fulfill the hegemonic position in the field. In 1864, females did not take part in military gymnastics and sports (fencing). Suggestively, as illustrated in Appendix 2, differences exist today in terms of female students having less previous education within sports compared to male students. The position of female students performing ordinary sportiness seems to have more in common with the situation of physiotherapy students after the separation of the program of physiotherapists and physical training instructors in 1934. At this point, physiotherapy developed from being primarily a male profession with its own science incorporating the world famous and acknowledged system of Ling gymnastics to become gradually a female profession where male physicians dominate the physiotherapist (Ottos.son, 2008). The development of physiotherapy into a subordinated and female profession has seemingly resulted in less need for sportiness to be perceived as necessary for female students. Implications The findings of the present article suggest that students emphasizing sportiness might limit opportunities for diversity in

DOI: 10.3109/09593985.2013.876692

terms of students' motivations for becoming physiotherapists. Body and movements are defined as core elements within physiotherapy (UFD, 2004; Webb et al, 2009). However, there are different and competing perspectives regarding how the body and movement should be understood and focused within physiotherapy (Nicholls and Cheek, 2006; Nicholls and Gibson, 2010; Wikström-Grotell and Eriksson, 2012). Sportiness is easily associated with body and movement; however, based on the findings from previous research (Dahl-Michelsen and Leseth, 2011 ; Greenwood and Bithell, 2005; Öhman, Solomon, and Finch, 2002; Öhman, Stenlund, and Dahlgren, 2001) and the findings in this article, a need exists for questioning whether the association of sportiness with the core in physiotherapy is too exaggerated by students, preventing necessary diversity within physiotherapy. As physiotherapy is a health profession that involves working with diverse patients, ranging from healthy to unhealthy, there is a need for students to have different and varied motivations for entering the physiotherapy profession. Thus, I suggest that those who teach, design, organize, and administer physiotherapy education programs be aware of how sportiness contributes to students' perceptions of whom is the most suited to study physiotherapy. To encourage variety and diversity, physiotherapy education programs may need to work on broadening the ideals of the profession in terms of facilitating varied motivations of students' process of becoming physiotherapists. Future studies By extension of this article, one important question is whether opportunities for developing varied professional identities within physiotherapy education are too limited. The findings of this article could be further expanded by examining how students' perceptions of sportiness as a requirement to become a physiotherapist and their ideas about the need for competence in sport and physical activity are addressed in the educational setting. Are such perspectives and ideas being confirmed or challenged? Additionally, how students' perceptions of the importance of sportiness as a core competence in physiotherapy relates to other competences that they perceive as necessary to be qualified as future physiotherapists should be investigated. Future explorations of these themes can contribute important knowledge for the development of physiotherapy education.

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four males would not have been enough to achieve saturation (i.e. when further interviews do not bring up new important knowledge) (Kvale and Brinkman, 2009). Similarly, an increased inclusion of females to match a percentage-based number of eight males would have resulted in 24 interviews of female students, which would have been excessive in achieving saturation. In this qualitative and explorative study, the students were intentionally selected for the interviews in order to represent the variations observed among students in the classes - not to represent the numerical distribution of females and males. Notably, though male physiotherapy students and male physiotherapists are a minority, they do not fee! that they are (MacLean and Rozier, 2009). The findings in this article confirm this by showing how the hyper-sporty male students were not marginalized by being a numerical minority. The ordinarily-sporty male students, however, were marginalized. This seemed to occur, not because they were a numerical minority, but because they did not perform hyper-sportiness and thus were not able to achieve hegemonic masculinity. Conclusion This article addresses how performing sportiness is important for acknowledgment as a suitable physiotherapy student. The article demonstrates how physiotherapy students' performances of sportiness are more complex than previously known. That is, students share sportiness as a common value that unites them as physiotherapy students. However, the intersection of the professional norm of sportiness and gender norms also results in a different positioning of the physiotherapy students within a hierarchy of sportiness. Furthermore, the article shows how there is a continuity of historical lines with respect to how sportiness is embedded in gender within the physiotherapy profession. Acknowledgments I would like to extend my appreciation and gratitude to the participants and the reviewers for sharing their time and insights. I would also like to thank Anne Birgitte Leseth, Kari Nyheim Solbraekke, and S0lvi Mausethagen for their constructive feedback and valued support.

Declaration of interest The author reports no declarations of interest.

Methodological considerations Of the 16 students interviewed in this study, nine are quoted as contributing to the findings in this article. Of these nine students, four males were identified as hyper-sporty, two females were identified as hyper-sporty, two females were identified as ordinary sporty, and one male was identified as ordinary sporty. The number of students quoted within the four different positions of sportiness is in line with how hyper-sportiness dominates the field and also with respect to how the hierarchy of sportiness is organized with hyper-sporty male students occupying the top position, followed by hyper-sporty female students, ordinarysporty female students, and ordinary sporty male students. However, in an exploratory qualitative study, the numbers are not the focus; it is important to remember that hyper-sporty, ordinary-sporty, and the different positions within these two typologies are used analytically in the present article and are not fully mutually exclusive. Moreover, these typologies form a continuum, meaning that students do not fully occupy a fixed position. Instead, they move along a continuum of sportiness. Furthermore, the number of eight female and eight male students interviewed is not representative for the actual number distribution in the classes, which would, based on percentages, have been twelve females and four males (Table 1). Interviews of

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Appendix 1. Topics addressed in the interview guide

Main question

Possible follow-up questions

Background

As an introduction, please tell me a little about yourself.

How old are you? Where are you from? What did you do befbre entering physiotherapy education?

Reasons for choosing physiotherapy education

Please tell me why you want to become a physiotherapist.

What is important for a physiotherapist to master? What competences are important for physiotherapists to have? In which areas of physiotherapy are you interested in working? What competences are needed for such a job? Do you think you can get such a job? In which areas of physiotherapy do you not see yourself working and why?

Perceptions about the future of physiotherapy and about themselves as future physiotherapists

What will physiotherapy, in your opinion, be like in the future? What do you think you will be doing in 5 to 10 years?

What types of knowledge will be important for you to have as a physiotherapist of tomorrow? What kind of job will you have? Will you continue your education? What types of education do you plan to have acquired at this stage in your career?

Topic

Sportiness and masculinities among students

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