The study of the growth, structure and organization of sport medicine in Canada links together a number of key themes in the sociology of sport including the contradictions between sport's supposed healthfulness and its "culture of risk," high performance sport and the ideology of excellence, and the institutionalization of the medicalization of sport. Using a combination of documentary (archival and policy) research and semi-structured, in-depth interviews with key informants, this study explored the socio-historical development of the field of sport medicine in Canada and contextualized its development, as framed by the healthcare system, within and in relation to the high performance sport system. This study also explored sport medicine's "system of professions" and considered the development, professionalization and institutionalization of sport medicine occupational groups (e.g., physicians, athletic therapists, sport physiotherapists) within and in relation to high performance sport. Findings of the study demonstrate that sport medicine in Canada, including the occupational groups that comprise the field, developed as part of an emerging ideological shift in sport where excellence has become code for high performance. Furthermore, the legitimization of sport medicine as 'needed' and 'necessary' support service for elite athletes reinforces the institutionalization of the medicalization of sport, and has been supported and subsidized by the state even though it contradicts the Canadian healthcare system's tenet of universal accessibility.