J O U R N A L O F T H E S A S P O R T S M E D I C I N E A S S O C I A T I O N SPOILS MISDICINI: V U L I N0 1 1986 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) osteoarthntic o f m ovem ent the osteoarthntic specific innovators in the field of antirheumatic medicine 1 Diclophenac sodium 1 100 m g I , , ( l u l l /)!e s r r i b t n g m/tim w/j w n « » jJirAW 'A' r i m fe q e H t s e r lo f CSba Ct awv[ i »M>' ■ ' ' Li .. . M, . KAft I tfi'l KT1 W relieves pain restores mobility k. oil one tablet p er day R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) CONTENTS JOURNAL OF THE S.A. SPORTS MEDICINE TYDSKR/F VAN DIES A - SPORTGENEESKUNDE- VERENIGING CIBA-GEIGY 12-13 WM EDITORIAL COMMENT Sports Medicine Journal Changes Hands A INTERVIEW Ian Holding on Squash Q RUNNING DIGEST Training-the Practice Part II Ej] LETTERS R l BOOK REVIEW FEATURE Guidelines fo rth e Pregnant Runner Pregnant Runners-Take Note! 53 PSYCHOLOGY Self-Administered Exertion Therapy: Its Effectiveness and Application — F^rt II SASCV NUUSBRIEF Waarom Lid van dieSASportgeneeskunde-vereniging SASMA UPDATE Why you should become a member of SASMA gj] NEWS FROM THE REGIONS F73 ABSTRACTS Editor in Chief DR C NOBLE MB BCh, FCS(SA) Associate Editors DR T NOAKES MB ChB, MD DR DAW IE VAN VELDEN MB ChB (Stell), M Prax Med(Pretoria) Advisory Board MEDICINE: Dr I COHEN MB ChB D ObSt, RCOC ORTHOPAEDIC TRAUMATOLOGY: DR P FIRER BSc (Eng) MB BCh (Wits) M Med (OrthoXWits) BRIG E HUGO MB ChB, MMed (Chir) Orthopaedics DR JC USDIN MB BCh, FRCS (Edin) CARDIOLOGY: COL DP MYBURGH SM MB ChB, FACC PHYSICAL EDUCATION: HANNES BOTHA D Phil (Phys Ed) GYNAECOLOGY: DR JACK ADNO MB BCh (Wits) MD (Med) Dip O&G (Wits) Front Coven Transparency courtesy of Image Bank. The Journal o f the SA Sports Medicine Association is exclusively sponsored by Ciba Geigy (Pty) Ltd. Thejournal is produced by Bates Hickman and Associates (Pty) Ltd., PO Box 783776, Sandton 2146. The views expressed in this publication are those of the authors and not necessarily those of the sponsors or publishers. MAY 1986 V O L1 .N 0 1,1986 Soortbe: Kardiort tserings- en Sport Injury and Ikxehabtirtasje Cardiac Rehabilitation Program Proaramme R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) rEDITORIAL COMMENTi ~ he SA Journal o f Sports T M ed icin e has a new n am e-Th e Journal o f the SA Sports Medicine Association. The reason for this is that we have a new sponsor-Ciba-Geigy (Pty) Ltd. In the present economic climate, spon­ sorship is extremely difficult to find and the journal must have the backing of sponsors. Boehringer Ingelheim (Pty) Ltd, our previous sponsor, decided to discontinue its support because of the downturn in the economy. On behalf of the Editorial Board and our readers I wish to thank the management of Boehringer Ingelheim for many years of support and the great kindness al­ ways shown to us. Having said this, we would like to heart­ ily welcome our new sponsors, Ciba- Ceigy (Pty) Ltd, with whom I am sure we will have a long and successful liaison. Ciba-Geigy is a pharmaceutical com­ pany which is already extremely well known in sporting circles The company has sponsored or helped to sponsor many previous sports medicine meet­ ings. O ver the years Ciba-G eigy products have helped large numbers of injured sportsmen. The company has also provided the medical world with several excellent publications in many fields including sports medicine. These publications have usually been illustra­ ted by Frank H Netter, undoubtably the finest medical illustrator in the world. This expertise will now be utilised in the Journal o f the SA Sports Medicine Association. Squash In this edition of the journal we have interviewed lan Holding, a medical prac­ titioner who is also probably the best squash player in South Africa. We wel­ come his valuable contribution. Squash has many followers, including medical practitioners, but it is a game not without risk. Northcoat assessed 50 players who died on the squash court or immediately after a gam e Scientific assessment has been unable to show MAY 1986 VOL 1, N 0 1,1931 SPORTS MEDICINE JOURNAL CHANGES HANDS Dr C Noble MB BCh, FCS (SA), Editor-in-Chief that squash was incriminated in their deaths It was not the squash that killed them but the state of their hearts Squash, being a very stressful activity, may have played a contributory role, but even this has not been adequately proven. Injuries Certain injuries are specific to squash while others may also occur in other sports. The most important specific in­ jury is related to the e ye-d am age oc­ curring as a result of the player being struck by either the ball or the racquet. As squash is played in a confined space, a player is more likely to strike his op­ ponent particularly at the "hack squash" level where many of the play­ ers still use tennis strokes, in tennis a player has to watch one's op­ ponent in front of him, but in squash a player has to look back constantly to see where his opponent is going to play the ball. Thus he is more liable to be hit by a squash ball on some part o f the body. A typical bruise is the most com­ mon injury-however, an eye strike may cause blindness Protective equipment has been manufactured for this pur­ pose, but unfortunately most players do not encumber themselves with this form of facial protection. The non-specific injuries related to squash commonly seen in practice are ruptured Achilles tendon, internal de­ rangement of the knee, backache and epicondylitis Most of these injuries are seen in the older squash player (over 30 years), the younger squash player hav­ ing muscular tears and occasional torn ligaments of the ankle, hand or knee There are two reasons for injuries in older players. Firstly, squash can be described as a load sport which means that pressure is exerted on certain 2 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) parts of the anatomy during the game The second factor is the ageing process. It has been clearly shown that after the age of 30 years the weakest parts of the musculo-skeletal system are the tendons specially close to the osseous attachment; not only this but the menisci tend to undergo degener­ ative change as well. The latter is fu r­ ther weakened by rotational loading which is part and parcel of the game of squash. Heavy loading of the lumbar spine which is an integral part of the movements o f squash with rapid flex­ ion and extension may cause weaken­ ing of the discs with resultant disc prolapse or weakening of the pars inter- articularis causing spondylolithesis which in itself provides additional load­ ing to the involved disc In rotator cuff syndromes such as bicipital and su- paspinatis, tendinitis as well as tears are not uncommon in the older squash player as well in view of this, many peo­ ple feel that squash should be a young person's game. This in my opinion is un­ fair as many sports played by the older athlete may result in similar injuries. The possible cardiovascular improve­ ment which may come from heavy en­ durance activity such as squash is an excellent reason for the older athlete to play It is important, however, to ad­ vise all squash players who develop symptoms referable to cardiac insuffi­ ciency such as chest pain, shortness of breath and palpitations to stop playing immediately and undergo a medical ex­ amination as it has been shown that nearly all sudden death victims on the squash court had symptoms before a fatal game. Early Season Rugby Injuries The rugby season is with us again. Un­ fortunately this will bring with it in­ numerable injuries, some of a severe nature, which will keep the medical professions busy once again. Immedi­ ately sports physicians should think of the prevention of these injuries. Unfor­ tunately many rugby players are not yet fit at the beginning of the season and therefore the chance of injury is greater. They should remember that in order to play rugby, one has to play the game properly. This involves off-season training and pre-season fitness peaking and then the practice of the game in the season. Unfortunately the first two fa ce ts-o ff-se a so n and pre-season training-are forgotten by many of our rugby players. They arrive at the start of the season grossly unfit, very often having done little or nothing off­ season. This results in numerous liga­ ment and tendon pulls as well as an in­ ability by the player to take heavy knocks with resultant further damage. Last year the fitness committee or­ ganised by the medical group of the iransvaal Rugby Football Union held a fitness symposium that was poorly at­ tended by coaches. It is doubtful that it will be arranged again. It is unfor­ tunate that rugby coaches believe they know all about rugby and fitness re­ quirements and therefore do not have to be taught anything. "unfortunately many rugby players are not yet fit at the beginning of the season and therefore the chance of injury is greater. They should remember that in order to play rugby, one has to play the game properly. This involves off­ season training and pre-season peaking and then the practice of the game in the season." Certain changes have taken place in the laws in order to reduce the incidence of injury in the g a m e -b u t this is not enough. One o f the major problems at all levels of rugby is the lack of strict­ ness applied to dirty play by the referee. Foul play can be eliminated only by applying the rules very strictly and by enforcing adequate punish­ ment. About 10 years ago when I first start­ ed seeing large numbers of runners with injuries I could not understand why so many of them had to run despite their injuries. To try to under­ stand the runners further I took up long-distance funning. Despite complet­ ing two Comrades Marathons and a number of standard marathons I was never "hooked" on running. I have had runners who have pleaded with me to run despite severe injury of such a nature that running was ex­ tremely painful. I have seen others who, having been forced to rest, have be­ come extremely depressed, some morose, some aggressive, but all show­ ing withdrawal symptoms similar to those in drug addiction. Other runners, however, despite very high weekly dis­ tances appeared not to be too badly af­ fected by the running. A few even wel­ comed an injury that prevented them from running a major race. It would ap­ pear that the personality type to a large extent determines who gets "hooked" It is extremely difficult to say if this is a true addiction. Over the last few years "endorphins", which are mor­ phia-like su b stan ce s, have been described by some Americans as "the poppies of the mind" have been blamed for "addiction" in runners. Although endorphins are increased by exercise, they have not been conclusive­ ly shown to be associated with addic­ tion. Although the clinical features are very suggestive that running can be addictive, there is no conclusive evi­ dence of true biochemical addiction. I would suggest that all doctors read the chapter on runners' high in Tim Noakes' The Lore o f Running for an excellent discourse on this rather fascinating subject. Running "Addiction" R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) INTERVIEW; IAN ON n 12 years of internation­ al-class squash, Springbok Ian Holding (30) has been hit in the face less than 10 times. Stitches were required on only three "I think the top players tend to hit the ball away from themselves into the corners," he says "Generally, to prevent most squash injuries, a player must move out of the way to give the oppo­ nent freedom to play the ball. The rules don't permit wild play". Dr Holding, who holds BSc (biochemis­ try and genetics) and MB BCh degrees from the University of the Witwaters- rand, has definite ideas about squash injuries. "Squash can basically be regarded as a contact sport which is one aspect of squash injuries. Secondly there are self- inflicted injuries resulting from the na­ ture of the game, state of fitness and HOLDING SQUASH the environment in which it is played. The confined space, not watching the opponent and bad technique (which results in the racquet going into a much greater arc than it should) cause players to be hit. “This tends to occur around the head. Injuries to the eyebrows and the face are generally common. The nose, teeth and lips could also be cut quite severe­ ly; he points out. "Eye injuries can be serious and the ball and the racquet can cause major injuries" "After playing your body needs a good number of hours to recover. This is par­ ticularly true of stretched muscles Technique and fitness will help to pre­ vent most musculo skeletal injuries. Heat exhaustion can be a problem and should be avoided by not playing when it is very hot and humid and by drink­ ing plenty of water before and during play Dr Holding is admirably qualified to dis­ cuss training, injuries, diet, competition and all the other facets of squash. Ten years ago he won his first SA Amateur event and was the youngest winner in 30 years He has four national titles to his credit and several Transvaal Open titles. In 1976 Ian reached the semi-finals of the World Amateur Championships in Britain and in the same year he was the only amateur to be placed in the last 16 in the World Championships He has scored several convincing wins over the world's leading players-the last being Stuart Dunport from New Zealand who is ranked fifth internation­ ally. On his "good days" Ian has beaten players ranked six, seven and eight in the world. However, he admits: "I have | always been limited by the fact that l have had a narrow peak at any stage of the season because of my univeristy studies. Probably one of my assets is the ability to peak at a certain stage". In a wide-ranging interview Dr Holding spoke to the Journal o f the SA Sports Medicine Association. Ouestion: Do you actually time your peak-actually work it out carefully? Holding: Yes, I work it out pretty care­ fully, very much like Bruce Fordyce peaks for the Comrades It is essential for me to peak for one or two events This explains why one can rise to great heights on some occasions and play averagely well at other times. Ouestion: This is obviously something which you would expect. Holding: Any athlete would expect this because you cannot be 100% fit the whole time or at 100% peak per­ formance I think this is something the administrators and officials sometimes forget about. This causes quite a lot of conflict between the athletes and the officials. Ouestion: Where are you working at present? Holding: I am a junior lecturer in Prof Tobias' Department of Anatomy at the Wits Medical School, it is a famous department with a great deal of histo­ ry. Working there gives me a great op­ portunity to get to learn about the structure of the human body. MAY 1986 VOL 1, N 0 1,193 4 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) practice partner is Cary Bental an en­ gineer and PhD post-graduate student who is my coach and trainer. In short, he engineers my squash training. He is a good standard player himself and is a good analyst of squash playing. Common training problems are over-' training and losing motivation. When one is tired you do not really get down to what you should be doing. It is very good to have a trainers input. I do a lot of mental training as well which in­ volves focusing on one event. Mental focusing is very important in terms of actually achieving what you set out to do. In your skill training as well, if you develop the ability to mentally visualise the stroke that you are going to per­ form before you actually go and prac­ tise it, you will acquire that skill much faster than actually getting on to the court and practising for a longer time. In other words one can do five minutes of mental training with 15 minutes of practice and gain more benefit out of doing that than say an hour of prac­ tice I find that most of the top athletes tend to do this They set a goal and ProSquash work through it and it becomes an ob­ tainable goal. Mental training also en­ sures that one is more self confident. Question; How much water should an in-training player drink? Do you have definite ideas about diet? Holding: it is essential to be adequate­ ly hydrated. Fluids should be taken be­ fore and during the event and after the game, fluids should be replaced by plain water. It is also important to know that your carbohydrate storage is adequate and that you have adequate glycogen. This should be sufficient to last the whole game. Your diet should be healthy and balanced. I tend to eat a vegetable based diet with hardly any red meat, which I replace with fish. You are basi­ cally what you eat. A mixture of le­ gumes and whole grains make this diet complete in proteins, and complex carbohydrates Ouestion: What of the future? Holding: Generally I enjoy the game but I might not be too competitive over the next couple of years However, I think it is important to carry on exer­ cising every day to stay healthy and fit. Question: lan could you describe your training programme for a major event? Holding: Ideally I try to plan my train­ ing around a yearly cycle, it is very much like the athletes would do. I do a good six months of background train­ ing which includes quite a lot of road running and court practising. At this stage the work is not very intensive. I concentrate on volume I would then also do some weight training. The ob­ jective is to develop stamina. Once the season arrives I do about three months of transition training and then increase the intensity of my training. I try to de­ velop a bit more speed and adapt the background training that I have done to the specific demands of squash. Con­ centrated playing and court training will help to sharpen my playing skills Question: When you are doing road training, what sort of distances would you cover? Holci . When I am playing squash as well, I tend to base my distances around five to eight kilometers, sometimes go­ ing up to sixteen, but I find that with an hour of squash it is more than ade­ quate. How l am feeling will determine whether I will run gently or attempt a time trial. There are times that I have clocked 17 minutes for a 5km time trial. I've recorded 28 minutes in an 8km trial. These are the preceding events that I would undertake They give one a mea­ sure of our fitness status There are also a number of court programmes which one can do. For ex­ ample, continuous running on the court simulating squash play. One can work for 30 minutes simulating squash without a ball but with the racquet-ac­ tually simulating the movements of play. This is quite important in the next three month period because fitness is basically specific to what you are doing. One should remember this. It is no good being really fit on the road when your muscles are not adapted to the squash movements. So a lot of time in the three month period is based on squash movements, stretching and the bending down as well as the very im­ portant twisting and turning move­ ments. At this stage I would also prob­ ably increase the weight training. General strengthening is so important that I work out three times a week at Sam Susa's gym in Hillbrow. I use heavy weights for general strengthening and train for about 40 minutes each ses­ sion. I find that this is quite important as it tends to keep one's co-ordination together If you have the general body strength you tend to co-ordinate bet­ ter when you become tired in a hard game When l start competition training for the next three months, I hardly do any road-running. I try to develop my speed with the court sprints and then play and practise much more My court Ma y 1986 VOL 1, N 0 1,1986 5R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) TRAINING - THE PRACTICE PART I Timothy D Noakes M B ChB MD Metropolitan Sport Science Centre, Department of Physiology, Univer­ sity of Cape Town Medical School and author of Lore o f Running (Oxford University Press) ntroduction fn the first part of this ar­ ticle on training, Dr Tim Noakes discussed start­ ing out, shaping, rein­ forcement control, sti­ mulus control, goal set­ ting, associative/disassociative strate­ gies and coping thoughts. He also exa­ mined the question as to whether middle-aged people should undergo an exhaustive medical evaluation before they start practicing. In the second part of the series the author of the recently -published bestseller, Lore o f Running, gives invaluable advice about the selec­ tion of appropriate running shoes shoe advice for the novice, anatomy of the running shoe, shoe choice for uninjured runners and related topics Choose Appropriate Running Shoes Once you have either cleared yourself, or your doc­ tor has given you the go- ahead to start running, the next step is to choose an ap­ propriate pair of running shoes This is easier said than done. The choice of running< shoes has become enor­ mously complex. The 1985 Shoe Survey by the South African Runner magazine listed 77 different running shoes for men and 10 for women; in the United States there are probably at least twice as many shoes from which to choose. Unfortunately this problem is com­ pounded further by the fact that we are still unable to define those minor individual differences in body structure which determine which shoes are best for a particular individual (Cavanagh, 1980). I feel that the choice o f the ap­ propriate running shoe is determined by two principal factors 1. Whether or not you are a novice 2. If you are not a novice, whether or not you are injured. i) If you are injured, whether (a) you run enough to warrant expensive shoes and (b) for what you want to use the shoes ii) If you are injured, what type o f in­ jury you have. Shoe Advice for the Novice It is always best to start running in a relatively modestly priced pair of shoes, bought from a reputable run­ ning shoe dealer. If after some months of running an injury occurs, the nature o f the injury will indicate what type of shoe is likely to help that injury and pre­ vent further similar injuries. But even if one is to enter that run­ ning shoe shop prepared to buy a modest running shoe, it helps to know something about the different fea­ tures of running shoes and how these features affect the performance of any particular model Nike Vortex Anatomy of the Running Shoe There are six major anatomical features of any running sh o e -th e outer sole, the mid-sple, the presence or absence of other devices either in the shoe (arch or shank supports) or in the mid­ sole (variable density mid-soles) which help reduce pronation, the nature of the shoe-last, whether it be straight or curve-lasted, and the degree of medi­ al and lateral mid-sole heel flares The Outer Sole The outer sole is that part of the shoe that comes into direct contact with the ground. Today, outer soles are made from a variety o f different materials and are of different designs. The main design variation is whether or not the sole has 'waffles'. Bill Bowerman filled a waffle toasting iron with urethane, producing the first outer sole with this characteristic p atte rn -h en ce the name. The most important feature of the outer sole is that it should not wear down too quickly, it should have the greatest durability in the areas of greatest wear, particularly at the out­ er heel edge This type of outer sole has been called the non-uniform outer sole The reason why very durable material is not used throughout the entire out­ er sole is that the more durable the material, the heavier it is Thus the non- uniform outer sole saves weight. The only benefit of a soft and therefore non-durable outer sole is that it pro­ vides additional cushioning which may be useful to those runners for whom e xce p tio n a l sh o ck a b so rp tio n is essential Waffles were originally designed for cross-country, not road running as they give better trac­ tio n on uneven gro u n d (Cavanagh, 1980). They also in­ crease shock absorp­ tion. However, waffles do not wear as well as flat- surfaced outer soles. The shoe I most use, the Nike Vector, does indeed have a waffle outer sole and I have grown to prefer this as much of my running is done on mountain trails where the superior traction of the waffle is a bonus But I also have a foot strike that generates very even wear across the entire sole and thus the waffles last the life of the shoe. A final point is that I do not believe that the outer sole wear at the heel should necessarily be repaired unless it threatens to go right through to the mid-sole. The heels wear in order to ac- commodate the natural heelstrike of the athlete. The athlete whose foot lands with the heel in marked supina- the heel. To repatch such a heel cons­ tantly prevents proper adaptation of the shoe to the athlete's particular heel­ strike pattern. MAY 1986 VOL 1, N 0 1,19^ R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) strike pattern. The important features o f the out­ er sole are durability and traction. The Mid-sole The mid-sole is the real heart of the shoe and is the feature of the shoe that I always no tice first. The most important feature of the mid-sole is the y degree of softness / or hardness There are three different func­ tions of the mid-sole: it must be strong enough to resist excessive inward rotation of the ankle (pronation) as the foot progresses from heelstrike to toe-off; it m ust be able to flex at a point about two-thirds from the heel, as the heel starts to come off the ground leading to toe-off. Prior to the mid-1970s, mid-sole material was made only from rubber which has dual disadvantages of being heavy and absorbing shock relatively poorly. In 1974, Jerry Turner of the Brooks Shoe Company contracted a chemical engineer, David Schwaber, to produce a lighter material with better shock-absorbing properties (Cavanagh, 1980). The result was a compound called ethylene vinyl acetate (EVA). Tiny gas bubbles are trapped in the EVA when it is cooled at high pressure; these bubbles make the material light and a good shock-absorber. The major disadvantages is that with wear, the tiny gas bubbles are expelled from the EV which flattens out, becomes hard­ er and absorbs shock less well. When the EVA compacts down unevenly either in the heel or mid-sole, the shoe distorts badly and this may be an im­ portant cause of injury. Another problem arises from the manufacturing process, it is difficult to produce EVA o f consistent hardness As a result the quality of the mid-sole can vary from shoe to shoe. For these reasons, it is essential that the prospective shoe buyer check the mid-sole hardness of all the shoes he buys and learns to use the thum b com­ pression test to test the mid-sole hard­ ness that best suits him. In this test the mid-sole at both the heel and forefoot is squeezed between the fingers of both hands and the rela- ness mid-sole is estimat­ ed The greater the degree of mid-sole indentation produced by this method, he softer the shoe and therefore also the more shock that shoe can absorb, owever the added shock absorption - hn.0lJ)? ht at f Pfic& the softer the shoe, the quicker it will tend to com­ pact down. Conversely, the less inden- MAY1986 VOL 1, N 0 1,1986 tation caused by the thumb c o m p re s s io n test the hard­ er the shoe, the less shock it will absorb, but also the less likely it is to compact down readily. I have already mentioned that the mid-sole m ust combine a capacity for shock absorption with that of control of ankle pronation and adequate flexi­ bility. Yet to some extent, two of these characteristics are mutually exclusive; an EVA which has good shock absorp­ tion will be soft and therefore have good flexibility but very poor pronation control, whereas EVA which provides good control of pronation will be hard, inflexible and have poor shock absorb­ ing characteristics In an attempt to compensate for these mutually-exclusive characteristics, shoe manufacturers have used mid­ soles of different hardness in different a re a s-a soft, shock absorbing materi­ al along the outer heel border and un­ der the ball of the foot to increase shock absorption and flexibility; a firm ­ er material along the inner border of the shoe, extending from heel to mid foot, to control pronation. By and large, these techniques have been successful. The only problem that has not been effectively answered is the mid-sole underneath the ball of the foot. This area does not absorb the highest forces during la n d in g -th a t is done by the h e e l-b u t it is exposed to moderately high pressure for much longer time. Thus it will tend to com­ pact down even more than the heel. Yet it m ight be so ft enough to allow flexibility. One attem pt to solve this problem was provided by the Nike Tailwind, first released in 1979. In this shoe the mid­ sole contained a series' of five poly­ urethane tubes extending from heel to forefoot into which freon gas was in­ jected at a pressure o f about three at­ mospheres (Cavanagh, 1980). While this shoe ultimately proved unsatisfactory because it had poor rearfoot control, its second, third and fourth generation offspring, the Nike Mariah, the Nike Odyssey and the Nike V series have clearly shown that the air sole does not compact down as does conventional EVA. However, in not one of these shoes does the air sole extend to the fore­ foot. If the air sole is present only in the heel, the EVA under the forefoot will still be prone to compaction in those runners who, like myself, land heavily on the forefoot. In summary then, the features of the mid-sole that require consideration are its hardness and whether or not it is .made of mixed material. As we shall see, those who require shock absorption in their running shoes because they have f r i g i d ' lower limb structure m ust look & \ for shoes with soft mid-soles; ‘ those with 'mobile' feet need V firm er shoes -v \ The Presence of Slip or \ Board-lasting During the construc­ tion o f running , shoes the nylon material that constitutes the shoe up- p e r-th e part that covers the f o o t -is stitched together and its lower part is glued onto the top of the mid-sole. If this part of the upper is stuck directly to the mid­ sole and no additional material overlies it, then the shoe is said to be 'slip-lasted: Alternatively, if a brown-coloured board overlies and hides the tucked-under portion of the upper, the shoe is said to be 'board-lasted'. Board-lasting increases the ability of the shoe to resist pronation. The board may extend from heel to toe, in which case the board-lasting is said to be con­ ventional lasting. The benefit of partial board-lasting is that it does not reduce flexibility in the forefoot, yet retains some ability to resist ankle pronation. In general, board-lasted shoes will benefit those runners who require shoes to control their excessive ankle pronation, whereas slip-lasted shoes are best for those with rigid feet which, re­ quires as much movement as possible. 7R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) Internal thermo-plastic heel counter which minimises excessive sub-talar jolntmovement External heel counter provides supportive base EVA mldsole designed to counter excessive pronatlon Inner sole which moulds to the runners foot and provides an extra shock-absorptlon layer. eel Counter With or Without Heel Stabilisers. The heel counter is made from a firm thermoplas­ tic m aterial th a t is moulded into the correct shape during a special heating process (Cavanagh, 1980). Some heel counters extend further on the inner than on the outer side of the shoe and, today, most are associated with special stabilising structures which tend to bind the heel counter more firmly to the mid-sole. The aim of the heel counter is to reduce ankle pronation. The athlete who requires a shoe that will limit his ankle pronation should obviously choose a shoe with a strong heel counter. There are two ways to test the strength of the heel counter. First, pinch the middle of the heel counter on its inner and outer edges between the thumb and the index In general it is held that a straight- lasted shoe, because it contains con­ siderable additional mid-sole material under the midfoot, will help resist an­ kle pronation and should therefore be used by runners who require such con­ trol. In contrast, the curve-lasted shoe is of benefit to those athletes looking for increased foot movement and shock-absorption. Such athletes usual­ ly have high-arched feet and tend to wear the outer edges o f their shoe soles and usually run with their toes pointing inwards (toeing-in). Medial and Lateral Mid-sole Heel Flares The mid-sole of the shoe at the heel is usually wider on both sides where it meets the ground, than where it meets the foot; in other words, it is flared from foot to ground. The flare on the inside of the shoe probably resists ankle pronation; the flare on the outside probably increases ankle pronation because it acts as a Additional arch supports systems are provided in some running shoes. By and large, these systems offer too lit­ tle to help runners who pronate exces­ sively but may assist those with only minor degrees of ankle pronation. The achilles 'protector is the exten­ sion of the material at the top of the heel counter. Although some suggest that this ‘protector may be the cause o f inflammation in the achilles tendon, I have not encountered this. However, should the protector cause discomfort, simply remove it as it does not affect the function of the shoe in any way. The way in which a shoe is laced may affect its comfort. The two most com­ mon lacing methods are variable width lacing, in which there are two rows of non-aligned eyelet holes, which allows the athlete to choose either a narrow­ er or a wider lacing system and speed lacing in which plastic D rings are sub-, stituted for the conventional leather eyelets. The friction between the plas­ tic and pressure distribution is said to ZX500 Adidas fingers of your dominant hand. Deter­ mine how much pressure is required to distort the heel counter towards the centre of the shoe Second, holding the heel counter as before, grasp the mid­ sole of the shoe in the palm of the other hand and determine how much torque is required to distort the heel counter to the inside or to the outside of the shoe The less distortion produced by these manoeuvres, the stronger the heel counter. Straight or Curved (Banana) Lasting. A straight-lasted shoe is one which, when viewed from below, is symmetri­ cal around a line drawn from the mid­ dle of the heel to the middle of the toe in contrast, the front of a curved banana or inflared-lasted shoe bends in­ side a line drawn from the middle of the heel to the middle of the mid-foot. lever forcing the foot inwards at heelstrike Thus it seems likely that the medial heel flare may be of value to runners who need control of ankle pronation, but the lateral flare is probably more of a hindrance than a help. Indeed when in the mid-1970's Nike introduced a shoe with an exaggerated lateral flare, the L D V 1000, a number of runners us­ ing the shoe developed the iliotibial band fric t io n syn d ro m e (Cava­ nagh, 1980). It seems probable that lateral heel flares will disappear sometime in the fu tu re Certainly the injured runner who uses a shoe with a lateral heel flare would probably do best to file that flare off. There are a number of other less im­ portant features worthy of note All modern shoe uppers are made of ny­ lon. Leather tends to stretch once wet and it needs to be dried slowly. be more even with the D rings. However, plastic D rings are hard and can cause considerable pressure on the top of the foot. A recent innovation in lacing has been the use o f Velcro strips in place of laces Finally, some shoes also have sup­ plementary lacing systems in which tabs at either the midfoot or the heel allow the laces the be attached to either the mid or rearfoot, or both. Final Considerations Having decided what model shoe one is going to buy, it is important to make sure the shoe fits Here four rules apply. First, a general rule is that the shoe should be bought slightly larger than the runners conventional shoes This is because the foot swells about one half size when he runs. A good test of whether the shoe is of the correct size is that the width of the index finger MAY 1986 VOL 1, N01,198< R R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) "All running shoes have a limited life expectancy-a probable maximum o f six months of dally wear-before their ability toabsorb shockor control the foot Is lo st So It Is advisable to change shoes about that often. " A question runners frequently ask is whether they should train in a shoe that is heavier than the ones in which they normally race I don't really think that the weight of the training shoe makes any real difference to the over­ all training effect. Distance and speed are what count in training and shoes should be chosen so that they are com­ fortable and protective Shoes for cross­ country racing can sacrifice some cushioning and should have a low heel to increase stability on uneven ground. Shoes for ultra-marathon races need more cushioning as do shoes used if one is training high mileages. Joggers who train less than three times a week, or who run less than 20 kilometres a week probably do not need the addi­ tional protection built into the very ex­ pensive running shoes, although they may should they become injured. As far as different brands or models of shoe are concerned if you are com­ fortable in a particular brand of shoe, you should stay with that shoe. I have found that I am comfortable in only a small range of shoes. Yet any number of other shoes which seem to have the identical characteristics as these shoes are, for no apparent reason, simply not comfortable (ContinuedonpagelO)C ibo-G eigy (Pty) L td P.O. Box 9 2 Isando 1 6 0 0 For full prescribing inform ation please re fe r to the M.D.R. MAY 1986 VOL 1,N 0 1,1986 Tenderness in any o f these areas in­ dicates, amongst other things, that the foot is being allowed to pronate exces­ sively and that a shoe with those fea­ tures that restrict ankle pronation should be worn. It is important not to race in shoes that are either too light or too worn out. The muscles normally provide a good measure of overall shock absorp­ tion during running, but near the end of a long race, they become too ex­ hausted to help, so that the shoe is left to absorb the shock unaided. A shoe that felt adequate at the start of the race may not be optimum when it must cope without the help of the muscles All running shoes have a limited life exp ectan cy-a probable maximum of six months of daily w ear-b efore their ability to absorb shock or control the foot is lost. So it is advisable to change shoes about that often. VotiarenQpIn sports injury and trauma. diclophenac sodium 50 mg (entericcoated tablets) Reg. Ho. K/3. i / 2 5 3 (Wet/Act 101/1965) 153 should be able to fit between the end of the longest toe (not always the big toe!) and the front end of the shoe upper. Second, the width of the shoe must be right and there must be sufficient height in the toe-box to allow free up- and-down movement of the toes. Ath­ letes with very wide or very narrow feet will need to look to manufacturers who offer shoes with different width fittings or will need to discover those manufacturers whose normal width range tends to be either broader or narrower than the average running shoe The most important width fitting is over the middle (bridge) of the foot. Third, the shoe m ust feel good im­ mediately you walk in it. A shoe that feels uncomfortable in the shop will only become even more so once on the road Fourth, the heel must not slip out of the heel counter at toe-off. Shoe Choice for Uninjured Runners Once the novice has been running for some time and has not experienced an injury, he becomes an uninjured non-novice runner and the choice of his second pair of shoes requires sever­ al new considerations. If the novice suffers an injury that may be related to his choice of running shoe, then he becomes an injured runner and his choice of shoe is determined by a different set of factors. Uninjured runners fall into two categories-those who are at risk of in­ jury but who are not yet running enough to become injured, and those fortunate few who can do whatever they like without ever becoming in­ jured. This latter group comes from ex­ perienced ru n n ers-th e ir choice of shoes can be made entirely without recourse to any of the information con­ tained here They could probably run barefoot if they trained for it. One way for the uninjured novice to check whether he may be injury prone, is to try the pinch test. The pinch test is effective because damaged tissues become tender to the touch long be­ fore they actually cause pain to be felt during or after running. A feeling of tenderness or discomfort when either v The Argus the Achilles tendon is pinched between the thumb and forefinger, or when firm pressure is applied along the bord­ ers of the shin-bone (the tibia) or the knee-cap indicates trouble If allowed to go unchecked, the result may be a de­ bilitating injury. 9R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) A rthritis/Running Link I refer to your article on the topic of the possibili­ ty o f a linkage between running and arthritis on page 5 of your issue No 29. You referred to a research study done by Caldwell and reported in The Physician and Sports Medicine of August 1984, in which a questionnaire study of swim­ mers and cross-country runners was carried o u t The statistics derived from that study showed no linkage between road-running and arthritis o f any kind. In this connection I would like to sound a note of caution when it comes to the elderly runner. Cartilage cells, like brain cells, die o ff progressively from skele­ tal maturity onwards. This does not mean that articular cartilage automat­ ically gets thinner in advancing years, but its capacity to regenerate itself reduces progressively, and becomes minimal in old age. Translating this in­ formation into practicalities, it follows that a young athlete easily regenerates cartilage as superficial attrition occurs; but in old age this ability is lost. A properly controlled scientific study is called for in order to determine whether or not athletically active older people are subject to a higher inci­ dence of osteo-arthritis than the more common sedentary members of that community. Until such a trial is con­ ducted, we should discourage people over the age o f 50 years from long­ distance cross-country running. I have had several patients with what appears to me to be unnecessary arthritis produced by overuse in old age; and this observation has been corroborated by colleagues abroad. Prof AW B Heywood, Department of Orthopaedic surgery, universi­ ty of Cape Town.Editor-in-Chief Dr Clive Noble re­ plies: There is no published evidence to show that running over the age of 50 in­ creases the rate of degeneration of normal joints. There is in fact evidence to the contrary. In a study o f former champion Finnish athletes1 it was found that advanced degenerative osteo-arthritic changes were found in 4% of the group but were present in 9% of the control group. Other studies2 indicate that the inci­ dence of osteo-arthritis is no higher in highly active sport persons than in the non-active population. Wally Hayward who is approaching 79 years of age had no evidence of osteo-arthritis despite years of running prodigious distances Furthermore there is evidence3 to support the belief that the absence rather then presence of normal weight bearing across a joint leads to degener­ ative changes similar to those found in early osteo-arthritis. To conclude, it has been established that a history of joint injury pre-empts osteo-arthritis, thus exercise on abnor­ mal joints could ultimately cause de­ generative osteo-arthritis It would pos­ sibly be wise to discourage any patient (regardless of age) with known joint damage, from excessive activities Thus it is my opinion that there is no need to discourage persons over the age of 50, with normal joints, from long dis­ tance running. References 1. Puranen and colleagues (1975). 2. Adams 1976, Bird eta/, 1980, Edm ond eta/, 1980, Murray Leslie eta/, 1977. 3. Palmoski et al (1980). 4. Murray Leslie et al, (1977). S p o rts Q u iz 1. Who beat Bjorn Borg in a Wimbledon final? 2. Who wrote the screenplay for Chari­ ots o f Fire? 3. What was President Eisenhower's favourite game? 4. Who was the first person to hit six sixes in an over of first-class cricket? 5. Complete the couplet "Float like a butterfly, sting like a bee 6. What US President was a keen jo g­ ger? 7. Which golfer recovered from a ta d car crash to win the US Open? 8. Who was a Wimbledon finalist at the age of 19 and again at 39? 9. Who won the 5 000 and 10 000 metres and marathon in the same Olympics? 10. What is the USAs premier sports magazine? From Utterly TriviaI Knowledge: The Sports game by David Robins (Penguin Books, 1985). paiejjsniii s u o d s oi- >)0deiez i!Lug '6 lieMssoa ua» -8 u e B o h u a a l j d j j e j A iu L u ir ’9 ass },ueo aAd s/m ib l im 3!M l u e o s p u e i) s ih '5 s j 0q o s p i a y j e o '17 J i o o •£ p u e p M u||O0 z 0ojugoi/\i u q o r t SJ0MSUV (Continued from page 9) In summary then, my advice for the uninjured runner is to stay with the shoes that he finds comfortable and to choose shoes that are appropriate for racing and training and for different distances* *Republished with the permission of Dr Tim Noakes, author of Lore o f Running (Oxford University Press). References BasslerTj. Marathons and im m unity to Athe­ rosclerosis. AnnaI o f the N ew York Academ y Of Sciences 1977; 301: 578-592. cavanagh P. The R unning Shoe Book. Ander­ son World, Moutainview, California 1980. Lobstein dd. Depression as a pow erful dis­ crim ination between physically active and sedentary m iddle age men. jo u rn a l o f Psy­ cho so m a tic Research 1983; 27; 6 9 -7 6 . Martin je. Behavioural m anagem ent strate­ g y fo r im proving health and fitness. Journal o f Cardiac Rehabilitation. 1984; 27: 6 9 -7 6 . Noakes T. Marathon running and im m unity to coronary heart disease; fact vs fiction. Clinics in Sp o rts Medicine; 3; 527-543. MAY 1986 VOL 1, N 0 1,19® R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) SPORTS MEDICINE Continuing Education Course-Provisional Programme Presented by the SA Sports Medicine Association. Venue: Bozzoli Hall, University of the W itwatersrand 8 - 9 August 1986 FRIDAY 8 AUGUST 08.00-08.40 Registration 08.40-08.50 welcome: SASMA President 08.50-09.10 Diet and the sportsman 09.10-09.30 Drugs and sport 09.30-09.50 Strength and fitness for sport Energy utilisation and fluid balance in marathon running 10.10-10.30 Heat injury and sport 10.30-10.50 Cardiac prehabilitation 10.50-11.00 Discussion 1 1 .0 0 -1 1 .1 0 T ea 11.10 -11.3 0 Cardiac rehabilitation 11-30-11.50 Heart disease and the sportsman 11.50-12.10 Psychiatry and sport 1 2 .1 0 - 1 2 . 2 0 Discussion 12.20-12.40 Film.-Heart 12.40-13.00 Lunch 13.00-13.20 Footbiomechanics 13.20 -13.40 Ankle injuries (soft tissue) Shin splints and other shin pain 14.00-14.20 Meniscal injuries 14.20-14.40 Anterior cruciate instability 14.40-15.00 Patello femoral injuries 15.00-15.10 Discussion 15.10-15.30 Film.-Injury 15.30-15.40 Tea A.G.M. SASMA DINNER: FRIDAY EVENING SATURDAY 9 AUGUST 1986 no'22- £9,20 Lumbar disc pathology 09.20-09.40 Shoulder injuries 09.40-10.00 Elbow injuries /In —10.20 Hand and wrist injuries 10.20-10.40 Discussion 10.40-10.50 ifca ^ 0 - 1 1 1 0 Sports injuries in the child i t 'in V i'ln Sport and the Pre9nant woman Physiotherapy of running injuries I ' m n Rehabilitation of knee injuries 1 £ '" }r Rehabilitation of muscle injuries 12.30-12.40 DISCUSSiOn Speakers: Speakers invited to present papers include Dr C Noble, Dr T Noakes, Dr P Firer, Brig E Hugo, Dr R Morris and Dr N Gordon. Registration: Registration: R120 per person for the course Send personal details and registration fees to: Mrs A Schuster R0. Box 55539 Northlands 2116. Supported by Ciba-Geigy (Pty) Ltd BM LITH O 30 970 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) Lore ©f Running by Dr Tim Noakes, Oxford university press Seldom have I had the opportunity of reading a more enjoyable and stimula­ ting book on sports medicine Not only is Dr Tim Noakes' book packed with in­ teresting and useful information on running but it is written in a style that makes for pleasant reading. Written at a medical level it had nonetheless been ardently read by many of the runners themselves, espe­ cially the "addicted ones". For me the section on running injuries was partic­ ularly interesting. Some of the treat­ ments suggested -su c h as a change of running sh oe s- are particularly innova­ tive for the stereotyped orthopaedic surgeon or sports traumatologist. It is a pity that new running shoes used in the treatm ent of running injuries can­ not be paid for by medical aid! I believe that every doctor, physiotherapist or podiatrist who treats running injuries should make himself familiar with this book. It is sometimes controversial and always thought provoking. Dr Clive Noble M B BCh, FCS (SA), Editor-in-Chief Sports injuries, Their Prevention and Treatment by Lars Peterson and Per Renstrom. Juta and company Ltd. 1986. The authors of this book, Lars Peter­ son and Per Renstrom, are two leading Swedish orthopaedic surgeons, both ex­ pert and widely experienced in treat­ ing sports injuries. Sweden has led the world for many years in sports science, and the origi­ nal Swedish edition of the book has been so successful that it is now being made available to the English-speaking world. This edition has been revised and updated, not only by the authors, but by an international team of English- speaking editors. Editors of the South African edition are Duncan Mitchell, Professor of Phy­ siology, University of the Witwatersrand and George Beaton, formerly Professor of Medical Education at the same university. Sports injuries is a handbook for physical educationists, coaches, trainers, physiotherapists, first-aiders, fieldside care specialists, serious sportsmen and sportswomen and anybody else con­ cerned with preventing and treating in­ jury in sports. Using plain language and clear dia­ grams, the authors systematically cover the parts of the musculoskeletal sys­ tem susceptible to injury in sport, show­ ing how the injuries happen, how to prevent them, and especially how to get an injured participant back into his or her sport safely and quickly. With an increasing number of peo­ ple taking part in both amateur and professional sport, there is now a great­ er demand for clear understanding of all types of injury; early and correct di­ agnosis; fast, efficient and effective treatm ent and a knowledge of preven­ tive and rehabilitative training. The 488 page Sports Injuries hand­ book gives clear, practical instruction and advice on: • Sports injuries by region including the back, neck, head, spine, arm, knee, lower leg, ankle, foot and trunk • Warm-up, stretching and taping • Good protective clothing and equip­ ment • Preventive and recovery training in a colour-illustrated 45-page section •Special child and adolescent activities • Sport for the handicapped. With over 240 colour photographs and X-rays, over 130 specially commis­ sioned full-colour diagrams and an ex­ tensive glossary, this comprehensive book will be indispensible to all those involved in sport and should be part of every kit bag. Sports Medicine in Primary Care by Robert C Cantu, Collier Macmillan international This compact volume is designed espe­ cially for general office practice. It ena­ bles physicians to write exercise prescriptions, dispense knowledgeable information on sports nutrition, coun­ sel patients on health, life-style and prevention of injury, treat common in­ juries in each organ system and identi­ fy indications for referring patients to an appropriate specialist. Describing the 240 page reference book the Journal o f Family Practice comments "... a well-written and illus­ trated book for all those in family prac­ tice who are interested in sports medi­ cine. It may be used as a textbook for medical students and resident physi­ cians or as a reference book for prac­ tising physicians:' The opinion of Physical Therapy m s-."... highly recommended for sports physi­ cal therapists because it provides a ver­ sion of the field o f sports medicine." Sp o rts M edicine, Sp o rts Science: Bridging the Gap. Edited by Robert C Cantu ana william J Gillespie, collier Mac­ Millan International. The Editors offer broad coverage of the medical, physiological and psycho­ logical assessments needed before ex­ ercise training. It deals with specific ex­ ercise programmes and with special considerations such as nutrition, dia­ betes, cardiac rehabilitation and the prevention, recognition and treatment o f sports injuries common among adults. Commented the New England Jour­ nal o f Medicine-."... a good book for the hospital medical library. It will be used by numerous specialists and physical therapists, also by trainers.." Contents include: psychology and sports-attitudes and beliefs in the prediction o f exercise participation, change agents in the psychology of running and behaviour modification. There are also chapters on biomechan­ ics, perspectives on the female athlete, sports nutrition and cardiac rehabilita­ tion. Ma y 1986 VOL 1, N 0 1,1986 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) rFEATUREi GUIDELINES FOR THE PREGNANT RUNNER he decision by Mary Decker-Slaney to co n ­ tinue running right up to the end of her pregnan­ cy has focused attention on the pregnant runner Ambitious "Queen Mary" will let nothing prevent her from returning to world middle-distance com petition-not even the birth of her first child. Unlike some top class women athletes who gave up running during pregnan­ cy Mary continues to put in 6 0 - 8 0 km per week with her doctor's consent. The 27-year-old mother-to-be told jour­ nalists: "The doctor says it is OK to do what I am used to But I get slower and slower and bigger and bigger. In his book Lore o f Running (Oxford University Press) the author Dr Tim Noakes discusses both the potential hazards and benefits of exercise dur­ ing pregnancy. Four potential areas o f concern must be considered: • Exercise compromises the blood flow to the developing foetus • Blood pH and lactate changes in­ duced by high intensity exercise may affect the foetus. • Maternal hyperthermia during exer­ cise may affect the foetus. • Maternal exercise increases the risk of premature labour Benefits of exercise What scientific evidence there is indi­ cates that exercise training during pregnancy increases physical fitness without detrimental effects, in the short term the mother feels bet­ ter and has more energy and suffers less of the common complaints that are associated with pregnancy, in par­ ticular, constipation, back pain and reduced energy Her weight gain is bet­ ter controlled. During labour the fit mother is better able to cope with whatever happens during delivery, in particular the possi­ bility of complications. Strong abdomi­ nal muscles aid the expulsion of the baby, and well-toned pelvic floor mus­ cles stretch better during delivery and recover more quickly Comments Dr Noakes: "However, these differences may be more psychological than physical. For in the only five such studies yet reported, co ntrasting results of the effects on training dur­ ing pregnancy on the outcome of labour was found. In three studies the labour and delivery of women who had exercised during pregnancy were no different from those who had not If anything, the exercising women were slightly more likely to develop delayed (obstructed) labour requiring Caesarean section than were the non-exercisers. But the numbers were small and no definite conclusions can be drawn. In contrast a Hungarian study of 172 athletes- 6 6 % of whom continued their sporting competition during the first three to four months of pregnan­ cy-show ed that these athletes had fewer complications than normal dur­ ing pregnancy and there was no in­ creased risk o f abortion. Labour and delivery were normal, except the rate o f Caesarian sections were half that of the control group as was the duration of the second stage of labour in the long-term the mother who has been active during pregnancy will find it easier to lose weight and to recover from the effects of the delivery and pregnancy Image Bank MAY 1986 V O L1 .N 0 1,19 12 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) he American College of Obstetricians and Gynae­ cologists gives pregnant runners the following useful information: • Before continuing with your running you should consult a doctor. Certain medical conditions preclude running during pregnancy. These may include placenta previa, multiple pregnancies, a history of miscarriages, a weak cervix, hypertension, anaemia, diabetes, or thyroid disease. • Don't try to start a more rigorous training programme. You should be prepared to cut back on intensity and distance. Don't push yo u rself to exhaustion. • Exercise at least three times a week for 20 to 30 minutes for maximum benefit. Your heart rate should be in the 120 to 140 range. After you stop running your resting pulse should be back to normal within 10 minutes Also remember that your resting pulse will rise during pregnancy. • You should drink plenty of fluids and avoid overheating. An increase in body temperature can harm the foetus, which has no mechanism to cool itself. Dehydration can interfere with blood circulation and may trigger premature labour. •Avoid aggressive competition and be­ come a fun-runner instead. If you feel that you are straining or becoming ex­ cessively fatigued you should stop run­ ning. You should also discontinue train­ ing if you experience breathlessness, dizziness, headaches, muscle weakness, nausea, chest pain or tightness, back pain or pubic pain. In these circum­ stances you should consult a doctor. •Slow, gradual stretching should be in­ cluded as part o f your warmup and cool down. Kegal's exercises for the pel­ vic muscles are also recommended, both prenatally and postpartem. • Don't try to lose weight by exercising during pregnancy. You should concen­ trate on a balanced diet to meet your caloric needs as well as the needs of your baby and your exercise. •Strenuous exercise, if done at all should not exceed 15 minutes in dura­ tion. • Do not run if you have a fever. •Do not run in hot, humid weather. This information is based on a recent ouiietin of the American College of Ob­ stetricians and Gynaecologists, 600 M a r v ^ d Ave, SW Washington, DC f0024 and research from the Melpo­ mene Institute, 316 University Ave, St Paul, Ml\l 55103. MAY 1986 VOL 1, N 0 1,1986 PREGNANT RUNNERS- TAKE NOTE Image Bank R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) SELF-ADMINISTERED EXERTION THERAPY: ITS EFFECTIVENESS & APPLICATION-PART II Van Niekerk, M b a (Hons) Psychology Schomer, H H BA (Hons) MA PhD Psychology Department o f Psychology, University o f Cape Town, Rondebosch, 7700. S ummaryhe authors have exa­mined the effectiveness of anxiety management training through physical exertion (running) and positive and negative imagery without an ongoing client- therapist relationship. Their study sug­ gests that self-administered exertion therapy, with its simple, cost-effective and readily amendable techniques is a valid and viable alternative means of al­ leviating certain forms of anxiety. It is hoped that their study will stimulate further research. Results The results obtained from the present experiment clearly indicate that a combination of physical exertion and positive and negative level without the presence of a facilitator. Ex­ perimenter effect was thus shown not to play any significant part in anxiety reduction. The data obtained from the experi­ ment was analysed by means of a 2-way Analysis of Variance (2-way ANOVA) with repeated measures on factor B Table 1 summarises the Analysis of Variance of the I PAT Langner Index and POMS re­ spectively. Significant F-interaction occurred at the 0,01 level i.e. anxiety scores did not change consistently over the four lev­ els of instruction as time proceeded. Simple Main Effects analyses of all three psychometric devices employed indicated that: (a) During the second and third week of the programme there were significant differences be­ tween the anxiety scores of the four groups (b) One week after termination of the programme the anxiety scores o f the four groups still differed signifi­ cantly. (c) Within each group, with the exception of Croup 4 (the control group), anxiety scores fluctuated sig­ nificantly over the five weeks Tukeys HS Pairwise comparisons re­ vealed th a t during the middle of the second week of the programme the anxiety scores of the group receiving a manual only was significantly less than those in the control group. It was Table I 2-way ANOVA with repeated measures on FactorB(tim e intervals) D V : Anxiety level IPATDATA ANOVA SUM MARY TABLE SOURCE SS df MS F -ra tio Between Subj. Subj.W C 4178.729 2616.793 2 32 1392.9097 113.02478 12.323932 Within Subj. B AB BXSW C 3954.9902 2339.3188 1798.1016 4 12 128 988.74756 194.94324 14.047668 70.385171 13.87724*' LANGNER INDEX DATA Between Subj. A Subj.W C 6103.9248 3527.8594 3 32 2034.6416 110.24561 18.455535 Within Subj. B AB BXSW C 4996.7886 3934.7622 2893.2578 4 12 128 1249.1971 327.89685 22.603577 55.265463 14.506414" POMS DATA Between Subj. A Subj. WG 2059.7338 4199.866 3 32 686.57794 131.24581 5.2312369 Within Subj. B AB BXSW C 1084.8675 1008.8215 2537.9124 4 12 128 271.21687 84.068459 19.82744 13.678865 4.2400056” ** p < 0,01 with factor A =m etho d of instruction a =0,01 0* F (12;128> MAY 1986 VOL 1, N 0 1,19® R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) only during the third week of the programme that the other experimen­ tal groups (i.e. the group receiving a manual and an audio-tape, and the group receiving a manual and an audio­ tape and a video-tape) exhibited signifi­ cantly less anxiety than the control group. On te rm in a tio n o f th e programme these trends were still evi­ den t i.e. the anxiety levels o f those in the experimental groups were still sig­ nificantly less than those in the control group Graphical representations of the anxiety reduction patterns can be seen in figures 1 to 3. In addition the above are expressed in relative percentage fluctuations in Figure 4. 54 52 50 48 46 u} 4 4 (D > 42 4 3 £ 40 •S 38 ^ § 36 34 32 30 28 Weekly Trials - r ®i B2 03 ba e5 Group 1 (Manual only) Group 2 (Manual plus Audiotape) Group3 (Manual, Audiotape plus Video) Group 4 (Control) Figure 1: Graphical Representation oftheiPATData Discussion The results suggest that anxiety reduction through physical exertion and positive and negative imagery can occur in the absence of an instructor. Contrary to expectation, the study shows that neither the maximal treat­ ment group (i.e. the group receiving a manual, an audio-tape and a video­ tape), nor the group receiving a manu­ al and an audio-tape as instruction ex­ hibited significantly more anxiety reduction than the minimal treatment group (i.e. the group receiving only a manual). Results revealed that neither rate nor amount of anxiety reduction |s positively correlated to complexity of instructional level. The results suggest that the manual alone was superior to combinations o f the manual, audio­ tape and video-tape in reducing state anxiety. Although it was hypothesised that r l e maximal treatm ent procedure would yield significantly more anxiety eduction than the other treatm ent aroups, results indicated that this did not occur. Video-tape pre-training did not significantly facilitate therapeutic outcome. These unexpected results could be attributed to a variety o f fac­ tors Contrary to the findings of Hilkey and Wilheim (1982), the results of the present study may be seen as a result of removing possible therapist rein­ forcement from the video-tape pre­ t ra in in g sessions. Sin ce th e ex­ perimenters were always present at these sessions in the Hilkey and Wilheim study, ascertaining the exclu­ sive effect of video-tape pre-training on therapeutic outcome is difficult. As­ suming that it is the video-tape pre­ training alone which enhances treat­ ment effects is fallacious. Postulating that learning the rules and principles that govern a particular behaviour is more conducive to be­ havioural or cognitive change then sim­ ply copying the behaviour, is an alter­ nate aetiological speculation to the cur­ rent findings The former method of learning forces one to restructure one's cognitions about anxiety. The latter method of learning, as happened in the maximal treatment group, can be seen as an imposition of ideas. This is not only counter-productive to adequate personal problem-formation (Roman- ovska, 1982), but also to the integration of the learned behaviour in the per­ son's repertoire of covert and overt responses Although it was hypothesised that the minimal treatm ent group would yield significantly less anxiety reduction than the maximal treatm ent group, the results refuted the hypothesis: rate and amount o f anxiety reduction was greatest in the group receiving only a manual. The role of self-attribution may be central to these findings, for they support indications from differ­ ent areas of self-attribution research that therapeutic outcome is influenced by the client's belief about the causes of behavioural changes Those subjects Ma y 1986 VOL 1, N 0 1,1986 B, B2 B3 B< B5 ----- --Group 1 (Manual only) ----- ! Group 2 (Manual plus Audiotape) ------ -Group 3 (Manual, Audiotape plus ( Video) r : : . Group 4 (Control)_____________ Figure 2: Graphical Representation o f Langner index Data — Group 1 (Manualonly) — Group 2 (Manual plus Audiotape) — •! Group 3 (Manual, Audiotape plus Video) ... I Group 4 (Control)____________ Figure 3: Graphical Representation of the p o m s Data in the group receiving only a manual as instruction believed that they had the sole responsibility for some action, that a successful outcome would be due to their personal competence and that their behaviour was not only voluntary but also internally mediated. As opposed to this, the subjects in the maximal and intermediate treatm ent groups could have perceived the audio­ tape as an external pressure. This led to a consciously or unconsciously medi­ ated opposition to treatment. The co­ operation necessary to achieve max­ imal treatm ent effects turns into ac­ tive opposition, i.e. reactance occurs (Kanfer & Goldstein, 1980). A further aetiological speculation for the superior efficacy of the manual is similar to that posed by Condry (in: Kanfer & Goldstein, 1980). The manual alone could have demanded the de­ velopment o f greater self-knowledge and self-exploration (to achieve treat­ ment effects) than the audio- and video-tape. This in turn could have led to the establishment of a durable in­ ternalised repertoire of the desired responses Condry argues that skills ac­ quired in this manner are better in­ tegrated into the individual's schema and hence more m ean in gfu l to him/her. This in turn leads to superior internalisation of complete repertoire of behaviours conducive to positive change. In the context of the research on forced compliance (which might tenta­ tively be postulated as one of the dy­ namics underlying the findings in Groups 2 and 3), Collins et. al., (in: Kanfer & Goldstein, 1980), called atten­ tion to the importance of the recogni­ tion of variables which are associated with the acquisition of skills under per­ ceived external manipulation may ac­ tually be antagonistic to the main­ tenance or internalisation o f such skills (Continued ori page 18) 15 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) In sports injury and trauma. Votta didophen For fu ll p r e s c r lb i R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) WAAROM LID WORD VAN DIE SA SPORTGENEESKUNDE- VERENIGING? [ ie SASCV staan nog in sy kinderskoene, maar groei r steeds in lidmaatskap. Aangesien heelwat po- t tensiele lede van die SASGV iets meer wil weet van die doelstellings van die vereniging, asook die persoonlike voordele wat hulle kan ver- kry uit lidmaatskap van die vereniging, wil ons graag die doelstellings van die vereniging uiteensit. Deur aan te sluit by die SASGV, word u deel van 'n groep kollegas met gemeen- skaplike doelwitte, nie net plaaslik nie, maar ook in die streke en op nasionale en internasionale vlak. Dit is 'n akademiese forum waar idees, sienings en ondervindinge gewissel kan word op 'n gereelde basis-'n netwerk van kolle­ gas dwarsdeur die land met wie u per- soonlik in aanraking kan kom indien no­ dig. Wat is die SA Sportgenees- kunde-vereninging? Die SA Sportgeneeskunde-vereniging (SASGV) is 'n professionele vereniging wat betrokke is by alle aspekte rakende die sportgeneeskunde. Aangesien die SASGV 'n subgroep is van die Mediese Vereniging van SA (MVSA), bestaan die lede uit geregistreerde mediese prak- tisyns wat lid is van die MVSA uit beide die private en openbare sektore. Aangesien daar soveel belangstellendes in sportgeneeskunde is wat nie lede van die MVSA is nie (beide medici en nie- medici) is daar voorsiening gemaak vir nierdie persone om geaffilieerde lede van die SASGV te word deur aan te sluit by diesportwetenskapafdeling van die Suid-Afrikaanse Vereniging vir Sport- wetenskap, Liggaamlike Opvoedkunde en Rekreasie (SAVSLOR). Geneeshere wat nie lede is van die MVSA nie, fisiotera- peute, liggaamlike opvoedkundiges ens moet voile lede van SAVSLOR word. So- aoende sal hulle name op die poslys 9eplaas word waardeur hulle die nuus- B t e f sal ontvang met al die informasie -3ngaande toekomstige vergaderings- Dlaaslik en internasionaal, asook alle PUblikasies van beide SASGV en SAVSLOR rakende sportwetenskap. may 1986 VOL A ansoeke om lidm aatskap m oet gestuur word aan: Die Sekretaris SASGV/SAVSLOR Kerkstraat 1131 Hatfield PRETORIA 0083 i i Deur aan te sluit by die SASCV, word u deel van n groep kollegas metgemeenskapllke doelwitte, nie net plaasllknle, maar ook In die streke en op nasionale en internasionale vlak." Wat is die Doelstellings van die Vereniging? Die doelstellings en doelwitte van die vereniging is: • Die bevordering van die wetenskap en praktyk van sportgeneeskunde • Om navorsing in sportgeneeskunde en sy vertakkings aktief te steun, te bevorder en aan te moedig. • Om onderrig en opleiding in sport­ geneeskunde aan te moedig. • Om kennis insake die diagnose, voor- koming en behandeling van sportbeser- ings te bevorder. • Om gereelde vergaderings te reel. • Om samewerking tussen alle belange- groepe in sportgeneeskunde te be- werkstellig. • Om die belange van sy lede te beskerm. • Om die voorafgaande doelstellings te bereik, mag die vereniging subgroepe in die lewe roep, wat kursusse kan reel om die kennis van sportgeneeskunde uit te bou. Wat is die Voordele van Lid­ maatskap van die Vereniging? Deur lid te word van die SASGV, sal u: • die geleentheid he om gereelde le- sings en werkswinkels by te woon insake sportgeneeskunde. • die geleentheid he om aan te sluit by plaaslike subgroepe • die joernaal gereeld ontvang (Tydskrif van die Sportgeneeskunde-vereniging.) • in staat wees om aktief deel te neem aan die tweejaarlikse nasionale kongres •'n forum he vir persoonlike kontak en die uitruil van gedagtes insake sport­ geneeskunde op 'n nasionale en inter­ nasionale vlak deur die vereniging se as- sosiasie met F I M S (Federation Inter­ nationale de Medicine Sp ortive-die In­ ternasionale Federasie vir Sport­ geneeskunde). • geregtig wees op verminderde in- skrywingsfooie vir kursusse en kon- gresse • deur u lidmaatskap sportgeneeskun­ de in Suid-Afrika bevorder deur koor- dinering van die aktiwiteite van 'n multi- professionele span van kundiges. In hierdie joernaal vind u 'n aansoek- vorm om lidmaatskap van die vereni­ ging vir u aandag. C a p e Tow n V e n u e fo r S p o rts M edicine C o n g re s s The 1987 congress organised by the SA Sports Medicine Association is to be held in Cape Town from April 14 to 16. Details of the programme are still to be finalised, but the main topics will be: • Exercise in health and disease. • Medical aspects of dance • Sports traumatology. At least four international speakers have been invited to participate. Further information will be published in future issues of the Journal o f the SA Sports Medicine Association. 1, N 0 1,1986 17 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) (Continued from page 15) he manual succeeded in Τ structuring the acquisi- tion of new behaviours in a way which encouraged subjects to accept re- sponsibility for comply- ing with the programme Both the audio-tape and video-tape failed to do this. Besides this, both these devices could have served as ex- ternal gauges of competence Failure to conform to the behaviours observed by the models and/or keep up with the narrator's instructions could have been anxiety-provoking initially-hence the greater amount of time needed to reduce anxiety Because these initial negative effects of modelling are not permanent, they cannot be said to be detrimental to the ultimate goal of the treatment, i.e. anxiety reduction. If however, time effective indices are con- sidered, the superiority of the manual is clearly evident: A fast, maximally ef- fective method which maintains a ju- dicious balance between client and hel- per (inanimate in this case) participa- tion in such a way that the client never perceives the helper as imposing objec- tive or strategies. Inferences drawn from these find- ings should, however, be tentative. Problems of experimental design, for example, subject population and the small number of subjects per group, limit the strength of the results. Difficulties in measuring the relatively complex phenomena of state and trait anxiety should foster caution in inter- preting the results. Also, any generali- sation of results from an investigation of anxiety in volunteer university stu- dents to other anxious individuals should be made cautiously. Procedures applicable to severely anxious students may not be applicable or appropriate to more severe anxiety-neurotics. The implications of this study are, however, vast when compared with mainstream psychotherapy and counselling. In our society, seeking counselling or psychotherapy for neurotic anxieties has arguably become a very middle- class activity. Many people (without the required opportunity, money and I or intelligence) are denied therapy for anxieties. Depth therapy (eg. Freudian and Neo-Freudian) requires clients to have a certain level of intelligence to qualify for intervention. Besides this, all therapies are so expensive that only those with the necessary financial resources can afford them. This study suggests that self- administered exertion therapy, with its simple, cost-effective and readily amendable techniques (as outlined by Schomer, 1979), is a valid and viable al- ternative means of alleviating certain forms of anxiety. It is the hope of the authors that this study will stimulate future research into the area of self- administered exertion therapy. Possible explorations may focus on main- tenance of self-administered treatment effects. A worthwhile endeavour for future research would be the develop- ment and evaluation of procedural vari- ations and modified instructional formats which would minimise dropout rate-a phenomenon which is notori- ously high in self-administered tech- niques. Definitely worth exploring is whether the group setting is a curative factor. Subjective evaluation indicated that this was not the case and the authors are of the opinion that work- ing through the treatment pro- gramme alone can be equally effective This hypothesis does, however, require further validation. References Bellack A s, Hersin Μ & Kazdin A E. (1982). in- ternational handbook of behaviour modifi- cation and therapy. New York: Plenum Press. Brown Ε F (1975). Bibliotherapy and its widen- ing applications. New York: Metuchen. Cattell R B, Scheier ι Η & Madge Ε Μ (1968). Handbook for the IPAT Anxiety Scale and Questionnaire National Bureau of Education- al and Social Research: south African Adap- tations and Norms. Pretoria: Government Printer. De Vries Η A (1981). Tranquilizer effect of ex- ercise: a critical review. Physician and Sports Medicine, November, 9, (11), 47-55. Driscoll Ρ (1976). Anxiety reduction using physical exertion and positive images. Psy- chological Record, 26, 86-94. Duckitt J & Broil τ (1982). Personality factors as moderation of the psychological impact of others, south African Journal of Psychol- ogy, 12, 76-80. Garfield, S.L. & Bergin, A.E. (Eds.). (1978). Hand- book of psychotherapy and behaviour change: an empirical analysis. New York: Wiley. Glasgow R E, Schafer L & O'Neill Η κ. (1981). Self- help books and amount of therapist contact in smoking cessation programmes. Journal of consulting and Clinical Psychology, 49, 659-667. Glasgow R E S Rosen M. (1978) Behavioural bibliotherapy. psychological Bulletin, 85, 1-23. Cross W F. (1966). Significant movement in comparatively short-term counselling. Jour- nal of Counselling psychology, 13, 98-99. Hilkey J Η & wilheim L. (1982). comparative ef- fectiveness of video-tape pre-training versus no pre-training on selected process and out- come variable in group therapy, psychologi- cal reports, 50, 1151-1159. Jannoun L. (1982). A self-help treatment programme for anxiety state patients. Be- haviour Therapy, 10,103 -111. Kanfer F Η & Goldstein A p. (Eds.). (1980). Help- ing people change. New York: Pergamon Press. Kostrubala, τ. (1976). The joy of running. New York: J Β Lippincott Co. Kovel J. (1976). A complete guide to therapy: from psychoanalysis to behaviour modifica- tion. Great Britain: Harvester Press. Croup 1 (Manual only) Croup 2 (Manual plusAudiotape) Croup 3 (Manual, Audiotape plus Video) f - rrr« IPAT Scale Langner Scale POMS Scale - 8 0 -70 - 6 0 -50 - 4 0 -30 - 2 0 - 1 0 0 +10 + 20 30 7Ό O) CL C Ο ΓΪ- o ' 3 Ο ω Figure 4: Overall Average Percentage Reduction in Anxiety Level Attributable to the AMT Programme MAY1986 VOL 1,N01,1986 18 WHY YOU SHOULD BECOME A MEMBER OF SASMA Τ he South African Sports Medicine Association, while still in its infancy, is growing in membership. As many potential mem- bers would like to know more about the objec- tives of the association as well as the personal advantages of becoming a member, we would like to explain SASMA's aims. By joining SASMA you immediately join a fraternity of your colleagues with common goals, not only locally but regionally, nationally and international- ly. We have organised an academic fo- rum where ideas, views and ex- periences can be exchanged on a regu- lar basis. If required, you can be brought into personal contact with a network of colleagues throughout the country.' What is the South African Sports Medicine Association? SASMA is a professional body involved in all aspects of sports medicine. Since the association is a subgroup of the Medical Association of SA (Masa), its membership is made up of registered medical practitioners of both the pub- lic and private sectors who are mem- bers of Masa. In view of the fact that there are many other interested parties who are not Masa members (medical or non-medical disciplines), provision has been made for these parties to become affiliated members of SASMA by joining the sports science section of the South African Association for Sport Science, Physical Education and Recreation (SAASSPER). Doctors who are not mem- bers of MASA, physiotherapists, physi- cal educationalists etc. will have to be- come full members of SAASSPER, their names will come on the mailing list whereby they will receive the newslet- ters containing all information relating to future meetings locally and interna- tionally as well as other publications of both SASMA and SAASSPER relating to Sport Science. Application to become a member of SASMA or SAASSPER should be sent to: The Secretary SASMA/SAASSPER 1131 Church Street Hatfield Pretoria 0083 i f By joining SASMA you immediatelyjoin a fraternity of your colleagues with common goals, not only locally but regionally, nationally and internationally. ' What,are the Objects of the Association? These are: •The advancement of the science and art of sport medicine. •To foster, promote, support, aug- ment, develop and encourage inves- tigative knowledge of sports medicine and its ramifications. •To encourage the teaching and edu- cation of the same. •To promote the knowledge of recog- nition, prevention and treatment of sports injuries • To hold and arrange periodic meetings. •To establish and maintain co-opera- tion between medical and other sciences concerned with sports medicine. •To protect the interests of its mem- bers. To represent and further the in- terests of sports medicine and to do all such other things as are incidental to or conducive of the above objects •To accomplish the foregoing objec- tives, the Association may establish sub- groups-and shall have.the power to car- ry on research, and establish courses to the advancement of the knowledge of sports medicine What are the Benefits of Join- ing the Association? By joining SASMA you will: • have the opportunity to attend regu- lar lectures and workshops in sports medicine. • have the opportunity of joining local sub-groups. • receive the Journal of the SA Sports Medicine Association • be able to actively take part in the bi- annual national congress. • have a forum for personal contact and exchange of ideas on a national and international level through the as- sociation with F I Μ S (Federation Inter- nationale de Medicine Sportive-the In- ternational Federation of Sports Medi- cine). • receive reduction of fees for courses and congresses. • promote the advancement of sports medicine in South Africa through co- ordinated efforts by a multidisciplinary team of experts. In this journal you will find an applica- tion form for membership for your information. MAY 1986 V0L1.N01,1986 19 NEWS FROM THE REGIONS ransvaal T S p o rts M edicine C o u rse The Executive of SASMA is to hold a sports medi­ cine continuing educa­ tion course in Johannes­ burg on August 8 and 9. The venue is the Bozzoli Hall at the University of the Witwatersrand. Although the course is to be held at general practitioners level, anybody who is interested may attend. Topics to be discussed include traum a­ tology. rehabilitation, cardiology, phys­ iology, sports psychology and others. Further details will appear in future edi­ tions of the Journal ofSA Sports Medi­ cine Association. For further information contact Mrs Audrey Schuster, P 0 Box 5539, North­ lands 2116 or telephone (011) 783-6635 Western Province The Western Province subgroup has scheduled the following meetings on various sports medicine related topics: May 7 Back Pain and the Athlete Dr C du Toit-Exam ination of the Back Dr C Irving-Exercises for the Back August 6: The Triathlone Phenomenon Dr C Irving-M edical Problems Dr T D Noakes-Training Principles and Equipment Dr D P van Velden-Position on the Bike November 6: Alternative Therapy and the Athlete, All meetings will be held at the UCT Postgraduate Medical Centre (Barnard Fuller Building, University of Cape Town Medical School, Lecture Theatre 4). En­ quiries should be directed to Dr C Irv­ ing Tel: (021) 419-1944. Abstracts Heat Illness is Approximately the Same for Men and Women During road races the frequency of heat illness is approximately the same for men and women. Recent American studies suggest that there are few differences between men's and women's responses to heat stress when they are matched V 0 2 max. Dr Emily M Haymes, Associate Profes­ sor of Movement Science and Physical Education at Florida State University in Tallahassee, reports that although ear­ ly studies showed that women are less tolerant of exercise in the heat than men, this may have been because the women had lower fitness levels. In hot, humid environments women have an advantage in losing heat be­ cause of their larger-surface-to-weight ratio, even though men lose more sweat," she adds. "Training lowers wom­ en's threshold for sweating and im­ proves their tolerance for exercise in the heat. During road races the fre­ quency of heat illness is approximate­ ly the same for men and women. E M Haymes The Physician and Sportsmedicine, Vol 12, no 3, March 1984. Su id -A frik a a n se S p o rtg e n e e sk u n d e Vereniging A P P L IC A T IO N F O R M A A N S O E K V O R M Full Member/Voile lid R25 Student M ember/Studente-lid R5 So u th African S p o rts M edicine A ss o c ia tio n Tel No/Tel N r ................MASA No/MVSA Nr Full M em ber Medical practitioners who are members o f M.A.S.A. Voile Lid: Mediese praktisyns wat lede van die M.VS.A. is. Student M em ber Medical stu- dents in clinical years. Sludente-lede: Mediese siudem e in hul kliniese jare. Appli­ cations for membership of SASMA should be sent to: The Secretary. SASMA. 1131 Church St. H aifieid. Pretoria. 0083 Cheques to accompany membership lorm. MAY 1986 V 0 L 1 .N 0 1,1 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. )