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 SPORTS MIEDICINIE Rugby Violence Condem Eddie King on Triathlons Sports Medicine Continuing Education Course 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. ) diclophenac sodium J L ^ m o pnrerir rnaied tablets For full prescribing information consult MDR or package insen or Ciba-Geigy (Oil) 929-9111 25mg enteric coaled tablets Reg. No. G/3.1/83 S3 o t l a n e n freedom to walk, jump, ft work I CIBA-GEIGY I SPORT INJURY f REHABILITATION 'pr o g r a m m e 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. ) 1 CONTENTS JOURNAL OF THE S. A. SPORTS MED/C/NE TYDSKRIF VAN DIE S. A. - SPORTGENEESKUNDE- VERENIGING CIBA-GEIGY 17-20 W M EDITORIAL COMMENT Rugby violence condemned E l INTERVIEW Eddie King on Triathlons H RUGBY DIGEST Scientific Physical Conditioning for Rugby 151 ABSTRACTS Water-Soluble Vitamins Not Safe in Megadoses HDL-C Concentrations in Female Athletes Treating Patella Tendinitis Learning to Play Tennis Without the Fear of Losing "High-lmpact" Aerobics May Be Hazardous to Your Health f£] FEATURE Potential Psychological Dangers of Jogging CE1 BOOKREVIEW F73 SASMAUPDATE International Speakers for 1987 Congress Sports Medicine Continuing Education Course [H RUNNING DIGEST Physiotherapy and the Long-Distance Runner Editor in Chief DR C NOBLE MB BCh, FCS(SA) Associate Editors DR T NOAKES MB ChB, MD DR DAWIE 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 (OrthoKWits) 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 Cover: Transparency courtesy of S A Sports Illustrated. The Journal o f theSA Spores Medicine Association is exclusively sponsored by Ciba Geigy (Pty) Ltd. The journal 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 Sportbeserings- en i Sport Injury and Kardiorehabilitasie | Cardiac Rehabilitation Program Programme AUGUST 1986 VOL 1, NO 2,1986 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. ) EDITORIAL COMMENL RUGBY VIOLENCE CONDEMNED Dr Clive IMOble MB BCh, FCS (SA), Editor-in-chief he recent Burger Gelden- huys rugby incident in which New Zealand cap­ tain Andy Dalton was punched from behind and suffered a broken jaw must, from a medical viewpoint, be condemned in the stron­ gest terms. One of the major aspects of the prin­ ciples of medical care is the prevention of injuries In South Africa dirty play has become part of the game. It is a fac­ tor which can be prevented by stricter control. It is about time that the great game of rugby be taken out of this sphere of barbarism. To a large extent the so­ lution is quite simple and calls for stric­ ter refereeing and far more severe punishment. It was interesting to note that the Welsh referee, Mr Roland, allowed no dirty play in test matches, largely due to the fact that he made it known that any player guilty of misconduct would be kicked o ff the field. At a recent high schools rugby game, l saw one player deliberately kick another. His punishment from the referee was to be sent to the "cooler box" — for possibly one minute — and then being allowed to play again. This is obviously inadequate punishment. i would like to see dirty play stamped out at grass-roots level and feel strong­ ly that such acts of violence on the rug­ by field should be penalised. Not only should the player be sent o ff the field but he should be unable to play for a number of games, depending upon the degree of violence involved. Should he commit further acts of violence, des­ pite such disciplining, then he should be banned for good. The school principal should take action against him as a per­ son who has grossly degraded the name of the school. A similar punish­ ment system should take place at senior level as well. Suitable touch judges should also be selected for all games. One of their main responsibilities would be to spot dirty play. The referee must be fully AUGUST -1986 VOL 1, NO 2, supported by rugby administrators in their condemnation of dirty play SASMA Continuing Medical Education Programme This programme, which is aimed at general practitioners will also be suita­ ble for physiotherapists and other in­ terested paramedics. The course will take place at Wits University on August 8 and 9. it is hoped that all doctors who are interested in sports medicine and who wish to gain further knowledge of sports medicine will attend. Topics to be discussed include sports traumatology, physiology, psychology, psychiatry and cardiology. It will be a comprehensive programme giving general practition­ ers a better insight into the manage­ ment of his sports patients. The general public has often consult­ ed alternative medical practitioners as they feel that many doctors do not have sufficient interest or knowledge to treat their sport problems, it is hoped that this congress will help to change this viewpoint. Comrades Marathon Injuries The Comrades Marathon has come and gone For those interested in sports medicine it was a busy time, especially pre-Comrades when many training in­ juries were reported. Most of these injuries are related to excessive training on bodies which have not adequately adapted to the stress­ es imposed upon them. Most practi­ tioners see at least four times as many novices as experienced runners with in- I juries due to Comrades training. The experienced runner appears to know his body and also is more capa­ ble of adapting to stress The beginner, fearing the 90 km run, tends to over­ do his training in order to make sure that he is fine on the day. I 2R 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. ) Unfortunately he often doesn't make the day due to injury. Shortly before the Comrades Mara­ thon such factors as correcting bio­ mechanical abnormality or even reduc­ ing the main cause of problems — ex­ cessive distance, speed or hill training — cannot be adequately implemented. To a large extent treatm ent must fol­ low the race. Such modalities as psysiotherapy and the application of ice are extremely helpful. However the use of cortisone and non-steroidal anti-inflammatory agents play a major role. it has become clear to me that there has been a drop in the injury rate, very possibly due to the excellent advice given by many experienced runners and clubs Adequate training program­ mes have also helped to prevent inju­ ries I only hope these will continue into the future VottanenfrIn sports injury and trauma. diclophenac sodium 50 mg y (enteric coated tablets)** Ciba-G Ho. hi/3.1/253 (Wet/Act 101/1965) 12 a-Geigy (Pty) Ltd P.Q, Box 9 2 Isa n d o 1 6 0 0 For full prescribing inform ation please refer to the M.D.R. ^ c U s fi9 8 6 VOL 1, NO 2,1986 Dangers of Aerobics With increasing leisure time available and a very definite tendency by the general population to improve the state and function of their bodies, aer­ obics has become a popular form of ex­ ercise Unfortunately, this has not been without problems The most significant has been the injury rate which even oc­ curs in such a well-controlled exercise programme as aerobics. Exercises such as repetitive touching o f the toes and excessive stretching, p articu larly o f the b a llistic type as o ccu rs in som e aerobic classes, overioadesthe ligam ents, m uscles and d iscs in the spine and creates p ro b lem s." Two factors are largely responsible As in all forms of physical fitness, the body has to adapt to the stresses imposed upon it. A common practice in aerobic classes is that the rank beginner com­ petes with the experienced exponent, thus loading his body and causing a multiplicity of injuries Chief among these are shin splints, patella injuries, and backache Backache is largely due to the second problem — that is executing movements which are out of the normal pattern. Abnormal loading results Exercises such as repeti­ tive touching of the toes and excessive stretching, particularly of the ballistic type as occurs in some aerobic classes, overloades the ligaments, muscles and discs in the spine and creates problems It is essential that all aerobic instruc­ tors/instructresses be given lectures in anatomy and bio-mechanics, as well as obtaining knowledge in the prevention and early treatm ent of injuries, in this way aerobics, with its fantastic physical rewards, will go a long way towards im­ proving the health of our nation without creating major disability. 3R 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; EDDIE KING ON TRIATHLONS he old adage that "you don't get older, you only get better" applies to triathlon champion Dr Eddie King. In the 1986 Iron Man triathlon "Tiffy" as he is known to his friends won in the record time of 7 hr 27 min 24 sec proving that he is one of the most outstanding en­ durance athletes in the world. The Delmas doctor-dairy farmer likes nothing better than a challenge and this is why he took up "tri-ing" or "rubber-braining" in the first place He recently told The Star.• "I watched the inaugural competition on television and saw the winner, Tim Cornish, look­ ing so fresh and good, he was absolute­ ly radiating energy and vitality. He then said in the interview that the triathlon would always favour the canoeists and said it would be many years before a specialist runner or cyclist won the event as canoeing was such a specialist sport. "So immediately I had a point to prove and I had something to aim f o r Between 1969 and 1974 King represented Western Province at track and cross country. In preparation for the gruelling endurance events to come in the years ahead he notched up his best standard marathon time of 2 hr 22 mins at Stellenbosch in 1971. in his debut triathlon in 1984 King finished fifth. Since then he has never looked back and added the 1985 and 1986 titles to his credits. If you have any Iron Man ambitions be prepared to train almost non-stop. For Eddie King training has become a way of life - not only for himself but for his wife, Tertia, and baby daughter Louise as well. Eddie has all the qualities needed for an endurance athlete. He is as lithe as whiplash, very determined when he has a set goal and pulls out all the stops when the going gets tough. These abil­ ities are self-evident when you consider that he takes less than 7Vi hours to cover 21 km of canoeing, 97 km of cy­ cling and, finally, a 42,2 km standard marathon. Triathlon stars must have under­ standing wives as Eddie readily admits He told a newspaper reporter: "I've got a very special wife and I know for a fact that if it wasn't for her I wouldn't have come anywhere near to achieving what I've done so far:' There is no opportunity for a train­ ing rest. When one Iron Man competi­ tion is completed he starts training for the next one in a year's time. His maxi­ mum training is about 25 hours a week averaging out at about 20. King manages to be a doctor, farm ­ er, agricultural mechanic, husband, father, athlete and friend to many sportsmen around the country. Tertia King believes the discipline of running the Delmas farm and Eddie's ability to function best under pressure have contributed to his triathlon suc­ cesses. "Whether you want to or not you have to start milking the cows at 6.30 am. Then there are many other respon­ sibilities including managing the farm workers. Eddie is responsible for repair­ ing anything that breaks - he is the family's handyman." In a recent inter­ view Dr King spoke to the Journal o f the SA Sports Medicine Association about his life, motivation, training methods and philosophy. "I graduated from the medical school at the University of Cape Town in 1975 and then followed a varied career path. Utilising creative incompetence I star­ ted breeding American Holstein milk cows in the Delmas district. Little did I realise it then but l would also be part of a new craze called tri-ing or rubber- braining. Nothing ever changes and all I want is to have lived well and to die well. As a teenager my father used to take me on hikes on his bushveld farm. I think he derived sadistic pleasure from reducing me to a physical and emotion­ al wreck and allowing me to become to tally disorientated and lost. Rounding each koppie he would say: T h e house is just around the next corner. Pushing yourself to the limit and then having to start all over again soon — this is part of the lunacy involved in AUGUST 1986 V 0 L1.N 0 2, 19M aR 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. ) triathlons. Training for the Iron Man competi­ tion is all sweat and no pleasure. Hear­ ing Bruce Fordyce say that his training is enjoyable makes me very envious. Starting to prepare for next year's event is usually the second day after this year's competition has been com­ pleted. Building up to 25 hours per week before the race dem ands sacrifice, compromises and a constant trade-off. I try to peak about three months be­ fore the race doing six hour training sessions once a week. This comprises two hours paddling followed by 3 to 3'A hours o f 90 km cycling and soon after that a 10 km run. Doing this totally alone forces one to depend on oneself. Towards the end of these sessions you feel like eating the grass on the side of the road. You hear skipping reels of rhyme flow through your brain: Jack be nimble, Jack be quick...' over and over again. This got me very worried at one stage and instead I tried to memorise Hamlet. I kept sheets of prose under my cycling top just in case I forgot a line But this can be very dangerous on a carbon fibre Vitus cycle at 40 km/hr The agony of such a long session real­ ly scares me although I try to experi­ ment with pain by concentrating on different parts of my body, blotting out my environment as best I can. Mind bending is certainly a fair description of my enterprise When the pain becomes unbearable and the weariness draws me down, I have a dream or fantasy in which I am flying effortlessly. If we don't have dreams what is there left for us. Competition: Competition at the top is certainly not between people but be­ tween individuals and the course l have to conquer the elements; something like fire and ice Fighting nature is more difficult and requires more imagination than beating people. Perhaps to do 90 percent of my training alone in the wild, open spaces does it for me At 37 I really can't com­ pete physically with the eternal spring' of youth and I think my forte has been reached. From now on the Springbok canoeists, cyclists and runners will have it more their own way. Transcending pain of course is all im­ portant in these events Experimenting with that pain and using it to one's own advantage — for instance masking fa­ tigue (because they are not the same) — is exhilirating when achieved People often wonder why we subject ourselves to this physical and mental onslaught As humans we are curious about just how far we can push our­ selves. We do not do this for the tele­ vision cameras or the feeling that af­ ter a race we have made love to thou­ sands of spectators, but rather that we have bettered ourselves and pushed the boat a little bit further up the beach! Training: Top world pro's like Molina, Scott and Tinley are doing 30 to 35 hours a week of intensive cardiovascu­ lar stress events — usually three events per day in three or more sessions — eg. a 16 km easy run in the morning fol­ lowed by an easy 90 km bike ride in the afternoon. Triathlons demand more from athletes than any other sport in the world. I often do three events in one day, leaving the run for last; 10 km into the run I frequently get that high in the sky hypoglycaemia feeling and really have to concentrate on finishing the run I never plan quality or anaerobic ses­ sions. I do them only when I feel good or when my body allows me to. The stress associated with the psy­ chological build-up to an interval ses­ sion is too much for me to handle and therefore l just let them happen — changing a long run into a Fartlek out­ ing as my psyche allows. I believe that only ballet dancers train as hard as tri- athletes. We are truly aerobic death machines. Age: T h e old order changeth, yielding place to new'. Certainly next year the younger guys will have it all their own way. But one should also not forget Carlos Lopes (37), the world marathon and the wonderful is still winning record-holder, Cary Player veteran golf Approach: really very little athletes as our become rubberised and such higher func- neglected. Overtaking Springbok canoeist Rory Pennefather in 1985 at 30 km into the run I said: 'Rory, this is the final ana­ lysis; the circle is now complete: This has no intended malice but seemed to have a stag- com petitions. "Psychology has to do with tri- brains yearly on x tions are gering effect as was evident on televi­ sion. My great fear is that I may be selling my soul for glory. Remaining true to myself and my ideal is very difficult. Motivation is my greatest problem. Get­ ting out o f bed in the morning is ex­ tremely hard. The day gets easier as it goes on but the initial force needed to exit from the womb into the cold and hostile world o f reality takes its toll every time. It seems that there is a very close relationship between motivation and stress. They are certainly inversely proportional. In my daily activities as stress increases I find it harder to kin­ dle the motivation so essential to proper training. I divide stress into three — namely work, social and sport. When the peo­ ple I work with in my medical practice don't understand my needs or pres­ surise me into longer hours my train­ ing always suffers. I feel that they don't seem to accept that one can do both well. For them success on the playing field necessitates poor work perfor­ mance. Equating me with a full-time professional who does not have fixed employment hurts very much. Similar­ ly family trauma o f any kind leads to stress and that can have a negative ef­ fect on athletic performance. I hasten to add that if it were not for my exceptional wife my sporting achievements would most certainly have amounted to nothing. She is the farm manager and carries the work pressures At peak times l only eat and sleep at the farm. Many authors seems to think that stress can have positive effects as well — but I have yet to become so enlightened. Life for me is a trade-off between the essential things I have to do and my 3 to 3'A hours a day of training. How long my life will be so full I don't know. Coming first is lovely but winning is the best, and in winning our lives as a whole count. Victory is a fickle thing — much like a woman's mind. It is always borrowed but never owned; elusive '“till the next race". 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. ) SCIENTIFIC PHYSICAL CONDITIONING FOR RUGBY M C Siff, BSc Hons MSc Neuromuscular Research Laboratory Physiology Department, University of the Witwatersrand, Johannesburg. he need for rugby train­ ing to evolve from a tradi­ tional art to a definite blend of science and art is long overdue Regret­ tably it has taken a great __ ___ deal of adverse media publicity on the unacceptable extent of serious injuries to convince the rugby fraternity that training of players and coaches has to become far more scientific The expertise for establishing a scien­ tific training methodology for rugby al­ ready exists in South Africa. There are outstanding exercise physiologists, sports doctors and experienced rugby strategists at institutions throughout this country, but fusion of their collec­ ted knowledge has not yet occurred. In addition, much relevant information may be extracted from the highly de­ veloped training systems used in Ameri­ can football and Soviet athletics Preliminary considerations Among the most important factors required for establishment of scienti­ fic rugby training are the following- 1. Training m ust be a year-round process An off-season lay-off followed by one to three months of intense pre- season training is a major reason for the generally low levels of fitness among our rugby players and the elevated incidence of injury during the early and late season periods 2. Specialist coaches are required for the different components of rugby training. Very few single coaches are equipped to handle strategic skills, kick­ ing skills, scrumming skills, strength training, psychological preparation, bio­ mechanical analysis, fitness testing and rehabilitation routines Ju st as there is a playing team, so there has to be an efficient coaching team comprising all relevant experts 3. Scientific speed-strength training has to be incorporated into every play­ ers programme It is not possible to en­ hance s ig n ific a n tly any player's strength and speed without sup­ plementary gymnasium training using appropriate exercises sequenced care­ fully in terms of total volume, average load intensity and restoration intervals As most gymnasium owners have no formal training in designing scientific supplementary conditioning routines, players should be provided with scien­ tific programmes prepared by experts and supervised by accredited gym in­ structors 4. Periodic scientific testing of the var­ ious components of player fitness is necessary. Ideally, a fitness screening session to test strength, speed, cardio­ vascular endurance and suppleness should be administered at the first practice of the season. Any player who fails this test should be excluded from official practices until he reaches an ac­ ceptable level of overall fitness 5. Rugby training sessions must be devoted largely to enhancing technical and strategic skills, rather than to im­ proving general physical fitness Rugby players must acquire the necessary fit- I ness in their own time and not waste an expert rugby coach's time in running physical training classes 6. All players must learn the skills of I running, falling, tackling and all aspects j of ball-handling. Efficiency of play and protection from injury depends on ac­ quiring high levels of neuromuscular skill in all types of movement encoun- ' tered in rugby for instance, any team AUGUST 1986 VOL 1, NO 2,19 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. ) all of whose players could drop-kick ac­ curately, would have a formidable ad­ vantage over another team with a few specialist kickers Needs Analysis An analysis of the specific fitness needs of forwards and backs is neces­ sary for the design of a scientific train­ ing programme Coaches need to un derstand the implications of the con­ tributions played by the three distinct energy systems of the body (aerobic, lactic acid, anaerobic) and the major muscle-fibre types Too many coaches devote unneces­ sary and counter-productive effort to A * in-season aerobic training, when it should be realized that the rugby play­ er never relies predominantly on aero­ bic energy mechanisms The benefits of aerobic training accrue during the off-season period In season aerobic training can diminish strength, speed and agility, while increasing one's sus­ ceptibility to overtraining injury and stagnation. An understanding of the rugby play­ er's needs may be gained by analysing the time devoted to different events during the typical rugby match. A French study reveals th e following statistics for the average game (1 ): •There are 80 sequences of action IfK'U ST 1986 VOL 1, NO 2,1986 lasting 27 minutes of actual playing tim e • There are an average of 40 scrums lasting up to a maximum of 20 seconds • Over 70% of rucks and mauls last five seconds and the remainder 6-10 se­ conds 85% of all sequences last less than 20 seconds 56% of all sequences last less than 10 seconds 32% of all sequences last less than 5 seconds • All top club level forwards cover an average o f 6 km; backs cover 4 km • 33% of the forward's distance is at top pace, whereas it is 50% for backs Since reliance on the aerobic system becomes dominant for sustained exer­ cise lasting more than about 1 2 min­ utes (2) it is clear that rugby players, irrespective o f position, require high levels of anaerobic and lactic acid sys­ tem fitness The main value of long- slow-distance (LSD) aerobic training lies in the off-season conditioning of ten­ dons, ligaments and cardiovascular sys­ tem to enable the player to cope with the in-season stresses of intensive in­ terval and strength speed activity. Peri­ odic low-value in-season aerobic ses­ sions each lasting no more than 15 minutes assist in enhancing recupera­ tion and maintaining an adequate lev­ el of cardiovascular fitness Period isation The overall long-term structuring of training to maximise performance to coincide with important matches is referred to as periodisation. Periodisa- tion recognises the fact that there are three major phases of all training: p re p a ra tio n , co m p e titio n , p o st­ c o m p e titio n (or tra n sitio n ). The preparatory phase may be broken down further to general physical prepa­ ration (GPP) and specialised physical preparation (SPP). GPP provides all-round physical con­ ditioning in stamina, speed, strength, suppleness and the other basic compo­ nents of fitness, while SPP concentrates on exercises which are more specific to the particular sport, such as scrum­ ming and kicking proficiency in rugby. Characteristically, the GPP phase may include participation in a variety of different or physical activities which provide low-intensity, all-round condi­ tioning. Participation in social basketball and volleyball would be eminently suit­ able for the rugby player's GPP, especial­ ly in the transition period from GPP to SPP The volume of exercise should be high during GPP and its intensity low, then a gradual transition to SPP should occur, during which the exercise volume must decrease and its intensity m ust increase. At the same time, in­ creasing emphasis should be laid on im­ proving the techniques required by the specific sport. The gradual overload principle is constantly adhered to through all train­ ing cycles to ensure that an adequate but not excessive increase in training stimulus is imposed on the body In­ dividual workouts should be alternated in terms of light, medium and heavy loading so as to ensure high efficiency for each match and maximum efficien­ cy for the most important matches Two successive heavy workouts should be avoided and no pre-match session should be too intense or too close to the match, unless it is devoted to light skills training. Supercompensation It should be remembered that any heavy loading temporarily exhausts the body's energy stores and causes a drop in strength, speed and endurance However, within a few days, the body not only recovers but can actually over- recover or "supercompensate" to pre­ pare the body for subsequent loading. However, if a strenuous training session is imposed before sufficient recovery has occurred, supercompen­ sation will be inhibited and overtrain­ ing, injury or depression may result The player will be compelled to rest or train inefficiently so that his performance will fluctuate between unplanned highs and lows A similar, though safer situation will be produced if subsequent strenuous training is imposed well after recovery has occurred. Supercompensation will be minimal and performance will diminish gradually. The maximum physical conditioning effect occurs if subsequent loading takes place between these two ex­ treme situations, imposed regularly a short time before full recovery is com­ plete In addition, every three weeks of heavy training should be followed by a fourth week of low volume, sub-maxi­ mal training to maximise supercom- pensation. Efficiency of supercompen- sation can be enhanced by use of res­ toration measures including massage, active or passive rest, electrostimula­ tion, saunas and similar physiothera­ peutic techniques Speed-Strength Training The rugby player is a contact sports­ man who requires high levels of strength, speed and muscular endur­ ance Therefore, bodybuilding type training is of limited value to him, par­ ticularly if it includes no explosive movements. Some of the methods of Olympic weightlifting training are far more suitable for rugby training, in fact, American football, similar in many ways to rugby, requires all its players to perform heavy, low-repetition power cleans to improve overall power. 7 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. ) odybuilding and power1 lifting training do not 9 ■ include phometric jump- ^ ing exercises used by • I m o st A m erican foot- bailers to enhance the explosive power neces­ sary for jumping, throwing, kicking and sprinting, A properly designed speed-strength programme necessitates a balanced sequence of isometric, concentric and eccentric slow and explosive exercise regularly varied to prevent stagnation and injury. (3). Structure of the Training Session Each training session should be a mi­ niature version of the periodisation sys­ tem: preparation, loading, transition. The preparation phase consists of a light general circulatory warm­ ing followed by general static flexibility manoeuvres and finally by specific flexibility procedures using static or PNF (proprioceptive neu­ romuscular facilitation) stretching to prepare sp e c ific a lly tho se muscle groups about to be used in the first exercise. The grad ual overload p rin ­ ciple is applied in the loading phase, with each a c tiv ity progressing from low to high intensity, with fewer re­ petitions being performed at high intensity. In^§ the gym nasium '' exercises are classi­ fied in terms of sets of a certain number of repeti tions with a prescri­ bed weight. On the rugby field sequences can be classified in terms of sets of a cer­ tain number of sprints, scrums and so on. The concluding transi tion (post-training) phase consists o f a gradual cool ing-down period similar in structure to the initial warm up/general flexibility phase. It can be particularly useful to integrate psychological pre­ paration (such as motivation, technique visualisation, relaxation and ideomotor training) into the preparatory and concluding i f p / phases of every workout. Selection of Supple­ m e n ta ry Exercises Exercises should be chosen to suit the needs of the indi­ vidual so as to enhance his speed-strength performance, functional suppleness, general fitness for his specific rugby needs and his resistance to in­ jury. Activities should never be permitted which are detrimen­ tal to performance or health. Coaches need to be made aware o f the fact that every exercise can be done incorrectly and that certain exercises are poten­ tially harmful. For instance, many tradi­ tional movements such as leg raises, bunny hops, straight-legged sit-ups, hur­ dler's stretch, running with partner on the shoulders, toe touching, star-jumps, press-ups with sagging lower back and ballistic stretches can be dangerous for vital structures of the body including ligaments, joints and nerves (4). Concluding remarks The above information by no means covers the entire extensive field of scientific physical conditioning for rugby. It does not address the indivi­ dual needs of forwards and backs, \ nor does it prescribe specific rou- \ tines for strength or stamina. .■ \ What it does attempt to do is ^ \ introduce the relationship be- v tween rugby training and relevant physiological prin- > ciples in an effort to in- crease awareness that ; scientific training can enhance perform ance and prevent injury. 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. ) WATER-SOLUBLE VITAMINS NOT SAFE IN MEGADOSES he assumption that the T water-soluble vitamins — B complex and vitamin C are non-toxic is inaccu­ rate. A cco rd in g to Carol Potera writing in The Physician Sportsmedicine, megadoses of B vitamins have been reported to cause peripheral neuropathies such .as numbness, ataxia and paralysis. Dr Robert 0 Voy, Chief Medical Officer and Director of Sports Medicine for the US Olympic Committee in Colarado Springs, United States, stated recently that although even severe cases of paralysis are usually reversable, he warned that 'the symptoms can go on a long time before they are linked to a vitamin". Added Potera: "B vitamins are known to produce other side effects. Ellen Coleman, a nutritionist at Riverside Cardiac Fitness in Riverside, Calafornia, described a runner who took 20 times the Recommended Daily Allowance (RDA) for niacin before a 10-kilometre race "He was bright red and itching and scratching", added Coleman, because niacin is a vasodilator. She also said that thiamine megadoses have caused an anaphylactic shock. In addition, two grams of vitamin C — the cold preventative dose — causes gastro-enteritis, diarrhoea, colitis, and kidney stones, according to Dr Voy. In some cases when the dose was sudden­ ly stopped, rebound scurvy occured. "What causes the side effects?' asked Potera. "At high doses, vitamins stop acting as vitamins and act instead as Pharmacological agents. For example, the toxicity of vitamin B6 (pyridoxine) |s probably related to its membership m the pyridine family, a group of neuro­ toxic drugs Impurities in vitamin prepa­ rations could also be responsible. The Food and Drug Administration allows synthesised vitamins to have a two per­ cent impurity level as long as the im­ purities are non-toxic at the RDA. But when taken in megadoses, the impuri- r|es can far exceed the limits of safety1: Potera, The Physician and Sports- rnedicine, Vol 14, No 3, March 1986. AUGUST 1986 VOL 1, NO 2,1986 HDL-C Concentration in Female Athletes Serum h ig h -d e n sity lipoprotein cholesterol (HDL-C) levels and percent HDL-C were significantly higher in nine female endurance runners, than in equal groups of female weight trainers and sedentary female controls, an American study has shown. Weight trainers and controls showed no significant differences in HDL-C and percent HDL-C Subjects who had higher HDL-C levels were more likely to be non- smokers who consumed little alcohol and did not use oral contraceptives. No significant dose-response relation­ ships were found for either runners or weight trainers when daily training du­ ration, weekly training frequency, and weekly mileage were correlated with HDL-C. A cross-group com parison showed that females who were non- sm okers, co nsum e d low weekly amounts of alcohol, and did not use oral contraceptives had higher HDL-C levels. Differences in group HDL-C con­ centrations were associated with specific training methods. D W Morgan, R J Cruise, B W Cirardin, V Lutz-Schneider, D H Morgan and M Wang. The Physician and Sportsmedi­ cine, Vol 14, No 3, March 1986. ideating patellar Tendinitis How serious is patellar tendinitis, also known as "jumpers' knee" (as is com­ mon in basketball players)? Tennis trainer Bill Norris, advises World Tennnis: "Basically, you have an inflammation of the ligaments in the bottom half o f your knee cap tendons, the patella. If your tendinitis is chronic, your knee is probably always sore, es­ pecially in the morning. The acute stage is marked by the skin feeling hot to the touch and may also be sore and stiff after heavy exercise." He points out that the condition must be treated conservatively. Use ice­ packs to reduce the temperature and swelling, and see a physical therapist or orthopaedist for galvanic, ultrasound or other electrical stimulation. "If you have such treatments continu­ ously — three or four days in a row — the blood supply to that area increases and the tendinitis is relieved", he adds. "On your own, try a whirlpool, hot baths or moist heat to help the circulation. Ask you physician about a patella brace: this band fits below the knee cap, reducing the pressure and al­ lowing you to play with a mini­ mum o f pain. But once again, rest and treatment are crucial to recovery, as is a visit to an orthopaedist and quali­ fied physical therapist'. |g f. 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. ) iV U i i . osteoaithntic o f m o vem en t the osteoarthritic specific innovators in the field of antirheumatic medicine Diclophenac sodium 100 mg I < .r (n ilp rescrib ing information r r tin • Mi 't fhiricage insert o r Q ba-Gpigy (<>lt >' •, ' •' «/// relieves pain restores mobilit1 on one tablet ^ p e r 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. ) >986 VOL 1, NO 2 1986 D earning to Play Tennis Without the Fear of Losing The secret of any game, the success of any game for a player, is to learn to play without the fear of losing. "If you create the attitude that you are not afraid of losing, the worst thing that is going to happen is that you may have a bit of a sleepless night," says Pan- cho Gonzalez, writing in World Tennis. "A lot of players make too much of the problem: they can't sleep, can't rest, can't eat, can't have fun. That's sup­ posed to be a disaster Gonzalez adds that if tennis has this effect on you, perhaps you shouldn't play the game — or you should switch to something else. Or perhaps you should stop playing games altogether, "But if you realise that all of us get beaten and that it is part of the game — because without being beaten, there is no room for improvement — you will be more relaxed. When you are more relaxed and playing better, you will win. "Of course, this is assuming that you are practising in the proper way during your training session. You already have the ability to play well; so just relax, go out and make ^ you r sh o t and recognise that even the great players have to contend with learn- ng how to lose." V o t t t t p p n t irW v v w J V I in sports injury and trauma. diclophenac sodium 50 mg (enteric coated tablets) Reg Ho. K/5.1/255 (Wet/Act 101/1965) E H C iba-G eigy (Pty) Ltd P.O. Box 9 2 Isando 1 6 0 0 For full prescribing inform ation please refer to the M.D.R. "High-impact” Aerobics May Be Hazardous to your Health American exercise authorities are recognising that "high-impact" aerobics can prove hazardous to students and instructors alike. According to Time magazine a recent survey of 1200 students showed that 43 percent had suffered injuries. Among 58 teachers the figure was an alarming 76 percent. Other studies show similar results. Few of the complaints seem to in­ volve serious damage to the back or the knees. More common are muscle aches and strains, usually of the shins and foot, which usually heal with rest. Unyielding floors, often carpet over concrete, are being blamed for the un- acceptably high injury rate Comments Time: “Few owners of facilities can af­ ford to install highly resilient but high­ ly expensive floating floors. Then, too, aerobics dancers often select the wrong footgear — for example, run­ ning shoes that cushion the heel rather than the ball of the foot. Another problem is poor instruction from both the celebrities on video­ tapes and the gorgeous­ bodied leaders at health clubs." Major failings said to be inade­ quate warm­ ups and cool downs, plus unflagging exhortations to do more, push harder and "go for the burn". Peter Francis, a biomechanics resear­ cher at San Diego University, maintains that an aerobics dancer lands with a force equal to three times her weight. "On slow-motion tape you see a rippling of the skin. That's just indicative of the shock wave travelling up the body:' The American College of Obstetri­ cians and Gynaecologists is concerned about potential dangers and is recom­ mending changes. The college urged less intense workouts and issued guide­ lines for the average exerciser Time reports that heart rate should not exceed 75 percent of the recom­ mended maximum; classes should be no more frequent than every other day; the aerobics portion should be limited to 30 minutes; and no more than four hops should be performed in sequence on the same foot. What is now being advocated is a gentler and increasingly popular form of aerobics that minimises jumping and jarring movements or eliminates them altogether Other erstwhile aerobics dancers are abandoning hard floor for water and hydro-aerobics. Time points out that the benefits are enhanced in water exercising limbs meet 12 times the resistance that they face in air. 11R 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. ) POTENTIAL PSYCHOLOGICAL DANGERS OF JOGGING Timothy D Noakes MB ChB MD Metropolitan Sports Science Centre, Department of Physiology, University of Cape Town Medical School and author of Lore o f Running (Oxford University Press) s the running revolution of the late 1970s took hold and as the literature describing its benefits grew, it was only natural that a counter-literature should develop. The major contention o f this counter- movement is that running is detrimen­ tal because it is "addictive" For the re­ mainder of this chapter we will con­ sider the arguments surrounding this running "addiction': One definition states that addiction occurs when involvement in an activi­ ty eliminates choice in all areas of life On this basis, an addiction must be dis­ tinguished from a habit, commitment or compulsion, none of which exclude all other activities. My experience is that the great majority o f runners are not addicted to the ex­ tent that running com­ pletely dominates all aspects of their lives. Rather, I believe their running fits the des­ cription of a compul­ sion and the term ad­ diction is inappropriate It should also be not­ ed that society is selec­ tive in its judgement of compulsions. As James Fixx (1977) has noted: "No one uses the word addiction when refer­ ring to people who spend ino rd in ate amounts of tim e mak­ ing money, playing at politics, or pursuing the opposite sex." Activities which Fixx suggests may be even more hazardous than "spend­ ing a quiet hour or two in a park or on a coun­ try road" But we should not allow Fixx's master­ ful English to disguise the possibility that run­ ning in a park for up to two hours a day could in fact be as much a behaviour disorder as is working twelve or more hours a day. A feature of an addictive state is that withdrawal symptoms develop when the addict cannot partake of his addic­ tion. Two authors have described the withdrawal symptoms which they con­ sider indicative of running's addictive's nature Psychologist William Morgan (1979), lists the following array of with­ drawal symptoms: "... Depression and anxiety are usually accompanied by restlessness, insomnia and generalised fatigue. Tics, muscle tension and sore­ ness, decreased appetite and constipa­ tion or irregularity often develop. In general, the benefits of vigorous exer­ cise are reversed... The scheduled daily run pre-empts important vocational and social commitments, causing work, family and friendships to suffer. In fact 12 addictive runners may totally alter their lifestyles to accommodate the priority of their running interest; this may in­ volve changes in diet, clothing, choice o f friends and even ca re e r Michael Sacks (1981) notes that the running addiction usually starts during a period of increased emotional stress In this regard, running is especially at­ tractive as it is in an easy skill to acquire and therefore provides a simple rapid solution to emotional distress. So powerful is this addiction that another writer has suggested that the United States Congress should enact legislation requiring the following warn­ ing to be displayed on all running shoes, shorts or books: WARNING: The Psychiatrist General has determined that jogging and running are hazardous to mental health and present a grave risk of contracting contagious quasirandomous wan- deritis(QW) or "jogging about". Sacks has emphasi­ sed particularly the psychological compo­ nent of these with­ drawal symptoms: "The ru n n in g a d d ic t is characterised by a com­ pulsive need to run at least once sometimes twice a day... if prevent­ ed from running, such runners become... pre­ occupied with guilty thoughts about how the body will decondi­ tion or deteriorate in some way. The running addict recognises the irrationality of those feelings and thoughts, but they are inescapa­ ble and can be relieved only by running:' W ith th is back­ ground, let us consider the arguments for and against this "running addiction" in more de­ tail. Tlirn to page 20 AUGUST 1986 VOL1.NO 2,198' 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. ) Executive Stress by Donald Norfolk, Arrow Books Stress, like nuclear energy, can be a power for good or a power for ill. The careers of many people are being cut short — by nervous breakdowns, heart attacks and the aptly named "executive burnout syndrome" — because they have not learned the secrets of stress management. Others, meanwhile are carrying out rich and exciting lives by harnessing the energising powers of stress arousal. Learning the basic survival tactics out­ lined in this book can make the differ­ ence between success and failure. There have been many recent develop­ ments in the field of stress research, which have been incorporated in the second edition of this book. Everybody is under some stress each day of their lives — whether from job worries, domestic crises, financial trou­ bles or plain anxiety about the future. Yet Norfolk maintains that stress can be a vital, positive force for enriching life and helping people realise their full potential. In this revised edition the author ex­ plains how to recognise the danger sig­ nals of too much stress — and how to harness this immensely potent force for your own benefit. The British publication The Economist called Executive Stress "a wise and vigorous handbook "for the individual who wants to come to terms with stress and to harness its positive aspects. This is a sensible book which can be read with profit not only by the harassed executive but by those who feel that the world is too much with them." Commented the Executive Post: "The book is informative and gives sound helpful advice in a very readable nar­ rative style... Its forte is its clear, lucid style and its sound, practical advice". Running w ithout Fear by Dr H Cooper, Bantam books Since the death of running guru Jim Hxx, the dangers of exercise have been hotly debated. jn his latest book Dr Cooper, an aero- Djc expert and Director of the Cooper uimc and Aerobics Centre in Dallas, pro­ v e s guidelines for his safe approach AUlJubi 1986 VOL1.NO 2 ,1986 to exercise, along with explanations of the various risks involved. The author writes that what we face today is widespread confusion and ig­ norance about exactly what exercise can or can't do. In Running Without Fear, he clears away the confusion and tries to set the record straight. "Exercise is absolutely essential to good health. It is the cornerstone for any complete effort to reduce the risk of heart attack and sudden death. It is also a major key to an energetic, long life", he states. "Above all I want to pro­ vide you with solid grounds to feel to­ tally confident as you fit aerobic exer­ cise into your own approach to good health and longer life. I want to show you how you can continue to run, swim, cycle, or dance and get the maximum health benefits of that aerobic activi­ ty without fe a r Dr Cooper offers guidelines on: • How to reduce the 11 "rules of risk" for developing heart disease • The danger and fallacy of the myth of invulnerability: that the more we ex­ ercise; the healthier we are •W hat constitutes a safe and effective stress test — plus the new Cooper Pro­ tocol, the state of the art procedure in stress testing developed at the Insti­ tute for Aerobic Research • Why the cool-down is the most dan­ gerous phase of exercise • How to avoid the Jim Fixx Syndrome • How, when, and where you are at risk during exercise • How to develop your own persona­ lised and safe exercise programme • Complete with illustrations, charts, self-evaluation tests, references, glos­ sary and index. It is easy to see why The Physician and Sportsmedicine magazine commented: "Many very good commonsense recom­ mendations for specific aerobic exer­ cises, with emphasis on safety". This book is helpful for the general public... and valuable for physicians. Being Human — A Day in the Life of the Human Body by David Bondanis, Century Pub­ lishing Company. In tracing the course of a day in the body's life this book transports us to an extraordinary inner world of electric nerve impluses, tensing muscles, pump­ ing chemicals and racing cells. The author, David Bodanis, describes movement, eating, anger, pain, desire, sex, contraception, relaxation, sleep and many other processes that might occur in an ordinary day. He writes with the vividness and clarity o f a thriller writer. Magical moments are highlighted — like the development of a heart in a four-weeks-old foetus — and more bi­ zarre phenomenon such as the mites that live in the spaces around the base of the eyelashes, shaped like crocodiles and with eight legs and wriggly bodies. Lavishly illustrated with unidue photo­ graphs, Being Human is truely fascinat­ ing. Tendinitis: It's Etiology and Treatment by Sandra Curwin and William D Stanish, Collier MacMillan International. Tendinitis: It's Etiology and Treatment is a compact and readable volume which covers tendon structure and function; the etiology, pathology and mechanics of tendinitis; tendon healing, and the role of exercise in treating the disorder. While focusing on the forms of ten­ dinitis that are most common (Achilles tendinitis, jumper's knee, tennis elbow), it also describes the other less fre- duently encountered forms (shoulder, elbow, wrist, groin, hamstrings, shin), in­ cluding signs and symptoms and tips for differential diagnosis It presents a unidue programme of exercises, describes how it is applied to the various types of tendinitis, and sur­ veys the results of 200 cases in which the programme was used. A concise yet thorough approach, combined with a careful review of the clinical literature and presentation of a clinically proven exercise programme, makes this an ex­ tremely useful book for physicians, therapists, trainers, coaches and ath­ letes. 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. ) SPORT I REHAB_______ PROGRAMME CIBA-GEIGY Final Phase Rehabilitation of Sports Injuries and the Role of Isokinetic Testing D r Etrcsia Prlrtsloo (M B C liB) P ro je c t le a d e r : Ciba-G eigy S jx m Injuries Rehabilitation Project, Institute for Sp u rts R esearch an d Training,- 1 iniversity o f Pretoria - f D r Etresict Prinsloa the author o f this article, photographed in her laboratory with Springbok rugby captain Naas Botha. S t n jr t c s I Kk fo> l s in g flu* C ]'b e xD a ta ttoctnitfim Co m pu ter i 1 I r t T rjfk m v injtitw s v , \ s p o n K e n c c s k tin iJ c , Dee! X. jowi f> v rye turn ti L Sfx/rthrsi'rinxs. Krtchcfsinxim itchcfstroam IfiTjItW ’i v lU J l'>"n No patient with a sports injury should resume his sport before being functionally rehabilitated — this could prevent rc-injurv to a great extent. The purpose o f functional rehabilita­ tion is to regain the following: 1. Functional muscle power 2 Cardiovascular fitness 3. Muscle endurance 4. Co-ordination and balance for sport specific activities ----------- 5. Suppleness. The handling o f a sports injury requires a multi-disci­ plinary rehabilitation team. The members include: the patient, doctor, physio­ therapist, biokinetieist and trainer. The injury may be divi­ ded into 5 phases, viz: 1. the prophylactic phase 2. the injury and first-aid phase 3. the treatment phase 4. the primary rehabilita­ tion phase 5. the secondary rehabilita­ tion phase. The physiotherapist is responsible for the very im­ portant primary rehabilita­ tion phase. This phase starts as soon as possible after injurs’ eg. while still in bed after surgery or immediately aftera soft tissue injury. The physiotherapist helps the patient regain his kinetic function. Once the patient is able to move with­ out pain the rehabilitation pro­ gramme continues. Now follows sec­ ondary rehabilitation during which the patient must be rehabilitated function­ ally. Tilts phase fells under the bio- kineticists ■— in conjunction with the physiotherapist and trainer. The principles o f functional rehabi- '' ‘ M litation are: 1. Evaluating the patient repeatedly to monitor progress 2. Exercising within pain limits 3- Progressively increasing resistance at which exercise takes place. An isokinetic test apparatus is ex­ tremely valuable in repeatedly evaluat­ ing a patient to monitor progresss. In knee injuries the first evaluation may for example be done when the knee is able to flex 90° without pain. Various cen­ tres in the country are in possession of an isokinetic test apparatus. e.g. 1 Military Hospital, Institute for Sport Research and Training (University o f Pretoria), University o f the Orange Free State, University o f Stellenbosch and University o f Port Elizabeth. The Cybex is an example o f an iso­ kinetic dynamometer— this apparatus is used to keep the speed at which a movement is executed constant while the resistance changes continually The muscle is under maximum load at each point in the extent o f the movement. However, when the patient is moving slower than the determined speed, no resistance is experienced. The appa­ ratus is therefore completely accom­ modating for pain and exhaustion. It is impossible for the patient to injure himself while being tested, because the less power he uses, the less the resistance. Everyday activities are carried out at an angular speed o f 60 °/sec while high intensity sports activities take place at 240- 300Q/sec. The speed at which a patient is tested, is thus determined by his requirements. The Cybex is designed to test 16 movement patterns, viz: shoulder - flexiontextension - ab/adduction - horizontal ab/adduction - internal and external rota­ tion at 90° abduction 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. ) SPORT IF REHABL _____ PROGRAMME CIBA-GEIGY elbow - flexiontextension forearm - pronation&upination w rist - flexionfextension - radiai/ulnary deviation hip - flexionfextension - ab&dduction - internal/external rotation knee - flexion/extension ribia - internal/external rotation ankle - plantar/dorsiflexion w ith knee 90° flexion - plantar/dorsi­ flexion with |" knee 0° flexion - in/evertion. The following values can be determined for each o f t he movement patterns and are valuable in drawing up an exercise programme: 1. maximum torsion 2. total effort 3-power per kg body mass 4,extent o f movement balance between anta­ gonist muscle groups The injured limb is com­ pared to the sound limb and may not differ from it by more than 7%, or the patient is not ready to resume his spon yet. The injured limb should, however, preferably lie strengthened until it is somewhat stronger than the sound limb. An exercise programme to be follow­ ed in agymnasium under proper super­ vision is given on the basis o f the above results. The patient should always exercise within pain limits. If he experiences any pain or swelling, die resistance and/ or extent o f movement should be re­ duced. However, if no pain or swelling is experienced, resistance at which movement takes place during isotonic exercise should be progressively increased with fevery exercise session. All the muscles in an injured limb must be exercised, e.g. in knee injury' the hip flexors and extensors, ab- and adductors as well as the gastrocnemius and soleus should be strengthened together with the quadriceps and hampese. The hampese usually heals quicker than the q uadriceps. A flexing programme for the hampese, quadri­ ceps, groin muscles, gastrocnemius and soleus should also be given. Considerable attention should be paid to proprioception and co-ordina­ tion. The patient with an injury o f the lower limb should initially exercise on a balancing board, and where the in­ jury' allows it, he should use a skipping rope. At the very end o f the rehabilita­ tion programme he could start jogging on a small trampoline. Sports specific activities should also be started at the end o f the programme. When the injured limb is 20 % weaker than the sound one, the patient can start running on a straight, even surface. Later, when he can achieve it without pain or swelling, he can start running faster for stretches, and later he can start 45 0 turns, and after that 900 turns and figure 8’s. When he can carry out all these activities without pain, the patient Is rehabilitated as far as humanly possible and is able to resume his sport. V * I AIx jiv right. The tremendous exertion which is required to measure maximum muscle load is clearly illustrated on the face o f Springbok rugby captain, Maas Botha. Alxjie left: A typical sports injury which can Ikfully rehabilitated after treatment has been completed. 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. ) INTERNATIONAL SPEAKERS FOR 1987 CONGRESS in this journal you will find the announcem ent of the second South African Sports Medicine Congress to be held at the Heeren- gracht Hotel, Cape Town, from April 14 to 16 1987. The preliminary programme is out­ lined, as well as some of the prominent overseas speakers that have already accepted invitations to participate in our congress. Please complete the in­ tention form if you are interested in at­ tending the congress, also if you intend to read a paper on a relevant subject. There has been tremendous support — both local and overseas — for the 1987 congress In the light of the dual­ ity of the internationally renowned speakers who have already accepted invitations, the organisers have every reason to believe that the congress will be a great success. Tydens die onlangse besoek van die SASCV aan 'n sporttroumatologiekon- gres in Munchen, Duitsland, was ons begroet met ongekende entoesiasme van die buiteland vir die bywoning van ons kongres Cesien in die lig van die uit- ers gunstige wisselkoers van die oor- sese geldeenhede teenoor die Suid- Afrikaanse rand, is Suid-Afrika tans 'n paradys vir die oorsese toeris Kaapstad bly 'n groot aantrekkingskrag vir enige besoeker en die weer tydens April be- loof ook om baie gunstig te wees — al- les faktore wat 'n besoek aan Kaapstad die moeite werd sal maak. Die organiseerders reel ook 'n baie in- teressante damesprogram wat dit die moeite werd sal maak vir afgevaardiges om hulle metgeselle saam te bring na die moederstad. Die offisiele dinee gaan gepaard met 'n dansvertoning wat baie mooi aansluit by die tema van die tweede dag van die kongresverrig- tinge Verdere toeligting insake die kongres sal in die tydskrif verskyn en gestuur word aan diegene wat die voorneme- vormpie terugstuur. I SPORTS MEDICINE Continuing Education Course-Provisional Programme Presented by the SA Sports Medicine Association. Venue: Bozzoli Hall, University of the Witwatersrand 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 09.50-10.10 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 11.00-11.10 Tea 11.10-11.30 Cardiac rehabilitation 11.30-11.50 Heart disease and the sportsman 11.50-12.10 Psychiatry and sport 12.10-12.20 DlSCUSSlOn 12.20-12.40 Film: Heart 12.40-13.00 Lunch 13.00-13.20 Foot biomechanics 13.20 -13.40 Ankle injuries (soft tissue) 13.40-14.00 Shin splints and other shin pain 14.00-14.20 Meniscal injuries 14.20-14.40 Anterior cruciate instability 14.40-15.00 PatBllo femoral injuries 15.00-15.10 DlSCUSSlOn .15.10-15.30 Filmlnjury 15.30-15.40 Tea A.G.M. SASMA DINNER: FRIDAY EVENING SATURDAY 9 AUGUST 1986 09.00-09.20 Lumbardisc pathology 09.20-09.40 Shoulder injuries 09.40-10.00 Elbow injuries 10.00-10.20 Hand and wrist injuries 10.20-10.40 DlSCUSSlOn 10.40-10.50 Tea 10.50 -11.10 Sports injuries in the child 11.10-11.30 Sport and the pregnant woman 11.30-11.50 physiotherapy of running injuries 11.50 -12.10 Rehabilitation of knee injuries 12.10 -12.30 Rehabilitation of muscle injuries 12.30-12.40 DlSCUSSlOn Speakers: Speakers invited to present papers include Dr C Noble, Dr T Noakes, Brig E Hugo and Dr R Morris Registration: Registration: R120 per person for the course Send personal details and registration fees to: Mrs A Schuster, RO. Box 55539, Northlands 2116. Sup p o rted by Ciba-G eigy (Pty) Ltd AUGUST 1986 VOL 1, NO 2,1986 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. ) / m m m m u t t i , / / PHYSIOTHERAPY AND THE LONG-DISTANCE RUNNER Clive H, Lipinski BSc (Physiotherapy) who has completed both the Comrades Marathon and Iron Man Triathlon. Introduction: I t is not uncommon that physiotherapists are sent referrals by medical prac­ titioners asking for heat, ______ | short wave diathermy and infra red all in the same prescrip­ tion, and this being directed towards the treatm ent of a sports related in­ jury. I am fortunate in that at least 80% of my patients are sports people In this article I propose to outline the role of the Sports" physiotherapist in both the treatment and management of the long-distance runner. My definition of a "sports" physiothe­ rapist is one that has an adequate knowledge of the sport ia training and competing as well as adequate equip­ ment for both the acute management of the injury and for the later rehabili­ tation of the sportsman back to com­ petitive sport. Role of the Sports Physiotherapist and the bong Distance Runner Often the first person the runner consults regarding his injury is the physiotherapist. I feel there is a varie­ ty of reasons for this: Firstly, a fellow runner may have been treated by the physiotherapist and recommended him, and secondly, the runner is afraid that his doctor does not see too many athletes and may tell him to rest. It is thus essential that the physio­ therapist can accurately assess the run­ ners problem, after obtaining permis­ sion from the runners doctor. The run­ ner is liable to exaggerate the symp­ toms and thus, both'accurate joint and soft tissue examinations must be done by the physiotherapist. Lets now look at the complete treat­ ment given to the long distance runner, presuming the diagnosis has already been established. £ 1. Advice (General) More often than not the runner has been given no advice by the medical practitioner re­ garding the injury. He may, for exam­ ple, know that he has a torn hamstring but that is about all. It is the physiothera­ pist's responsibility to f r n inform the runner about f the mechanism of the in- PSjf.#r jury, the methods of self treatment of the injury eg. ice packs, and the preventative mea­ sures that can be used. It may also be necessary here to ad­ vise the runner about the correct way to stretch. It may also be necessary to inform him about correct strengthen­ ing to facilitate the injury healing and to prevent a recurrence I also find it advanta­ geous to watch the runner in motion, both with and without his shoes on. "it will show whether the runner has excessive subtalar pronation or supination." 2. Foot and Shoe Assessment It is also essential that the physio­ therapist be able to find the neutral po­ sition of the runners foot in weight bearing and then examine for ab­ normalities I also find it advantageous to watch the runner in motion, both with and without his shoes on. 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. ) t will show whether the runner has excessive sub­ talar pronation or supina­ tion. I also use it to assess the medial rotation of the tibia in midstance phase to g e th e r with patella displacement Shoe assessment forms a large part o f the "complete treatm ent pro­ gramme". Often the runner is about to embark on buying a new pair of shoes (average cost R135) and because of his previous and most probably present in­ jury wants to buy the shoe that is most correct for his particular need. It is essential that the physiotherapist examine older pairs o f shoes to gauge running patterns. The shoe that the physiotherapist prescribes or advises to the runner must be correct for both the runner's style weight; distance that he wants to run and terrain that he wants to run on. Training Guidance The greatest fear is the severity of the injury. He is never quite sure when to resume training, how much he should be doing when he does resume training and on what surface he should run on. It is thus important that the physio­ therapist understand the nature and biomechanics of the injury so that cor­ rect advice as to training can be given. The physiotherapist should take into ac­ count the hardness of the terrain, the camber of the road and the topo­ graphy before setting out a training programme When treating South African long­ distance runners that are Comrades Marathon orientated, their injuries tend to be of severe overuse The physiotherapist treating the run­ ner must know how to reduce the run­ ner's distance to assist the injury heal­ ing, but at the same time must bear in mind the fact that the runner has to have completed sufficiently long runs so that he can complete the race It must also be remembered that the runner who attempts the Comrades Marathon is a very serious, committed person. Those at the back have all kinds of things on their minds. They dream of the houses they're building and the fight they had with their wives—anything to take their minds off the agony they're going through. But some of the front runners are a pretty odd lot too. I guess we re all a little mad: BRUCEFORDYCE. AUGUST 1986 VOL 1, NO 2,1986 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. ) A sudden severe decrease in running mileage could affect his whole psycho­ logical approach to the race. When a runner does need to stop running completely, eg. in the case of a stress fracture, it is necessary for the physiotherapist to recommend alternative methods of training. I usual­ ly suggest the runner train in a swim­ ming pool - by suspending himself with a lifejacket or such and then Tun­ ing on the spot, his feet o ff the pool surface The buoyancy of the water supports the stress fracture and the action simulates normal training. I also put the runner on a weight training programme that does not interfere with the injury. On the Spot Assessment When dealing with highly com ­ petitive long-distance runners, their in­ jury may sometimes only be elicited while running. Thus it is very difficult to accurately find the site of injury. At this stage the physiotherapist should go out and run with the runner so as to accurately locate the injury site as well as assess the movement that is causing pain. If the above is not possi­ ble, I usually advise the runner to go out on a gentle run and mark the pain­ ful area with a pen. I find it important that he does not palpate the area of pain, but simply marks it wi^h his pen. He should also note when the pain occurs and what increased or eased it. All this assists the physiotherapist in a more accurate as­ sessment and treatm ent of the injury. Treatment of the Injury As can be noted from steps one to four there has been no mention of the physical treatm ent of the injury. It is only now that the physical "hands on" treatment of the injury should begin. I believe that although the diagnosis has been established by the doctor, the actual modalities and methods of treatment should be left to the physiotherapist. Machinery and methods of dealing with running injuries and sports injuries as a whole are dynamic Machines such as interferential therapy; Curapuls (pulsed short wave .diathermy); dia- aynamic current and infra red laser are £ ® more modem modalities available ro tne sports physiotherapists together with the more established ultra sonic therapy. i i ^ u,|P|Tient such as the Orthotron r isokinetic strengthening, and allows.for a mixture between L*wKinet|c and isotonic strengthening, uinrwvs e jt ment of choice has become WDrous, deep cross frictions of the in- ~ as opposed to a gen­ tle relaxing massage. W S T 1986 VOL 1, NO 2,1986 When treating running injuries, the acute management by the physio­ therapist involves the stopping of bleeding into the affected area, the reduction of inflammation and or oedema and pain relief This is usually achieved by electrotherapy modalities, anti-gravity positioning and home advice Once the injury has passed the acute phase, the physiotherapist must now examine whether there has been loss of strength in the limb due to the in­ jury. Often an injury to the soft tissues leaves the runner with less flexibility and this the physiotherapist must as­ sess and correct where necessary. The progression of the runner back to full training during the injury phase must be gradual and well monitored by the physiotherapist. Although I usually completely curtail training only in three instances — namely — stress fractures, tendonitis with crepitus and severe muscle rup­ tures, I do however alter the runner's programme. This usually involves a decrease in dis­ tance, altering the pace, and a change of running environment and some­ times a change of terrain. I find that keeping the runner mobile throughout his injury, helps him cope physiologically and also assists me in my subjective ex- am in a tio n d u rin g th e follow ing treatments. Conclusion: No longer does a physiotherapist simply "rub" away the sports injury. The approach towards the management and treatm ent of running injuries has become dynamic and aggressive. 19R 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 argument T for a "running addiction” The biochemical argument This argument contends that run­ ning is addictive because it stimulates the release of certain hormones inside the brain, the endorphins or enkepha­ lins, which give the runner a pleasur­ able feeling while he is jogging — the so-called runner's high (Callen, 1983), The brain then becomes dependent on these pleasure-producing substances just as it does to other potentially- addictive substances like heroin, co­ caine, or morphine. But, like all addic­ tions, the euphoric feelings can only be maintained if the dosage (i.e. running distance) is continually increased. The psychological argument Other writers have noted that the withdrawal symptoms described by runners who are forced to stop running for a period of time are mainly of a psy­ chological, rather than a physical nature. The psychological withdrawal symptoms that they describe include guilt, irritability, anxiety, tension, rest­ lessness and depression. These writers also note that runners like myself tend to lay rather too much emphasis on the mental benefits of running and sug­ gest that this may indicate that such addicted runners use their running to cope with major underlying psycho­ logical problems. Victor Altshul (1981) suggests that if jogging is indeed able to mask anxiety and depression, as these runners testify, albeit for relative­ ly short periods, then it follows that many people with these psychological abnormalities will use running as an effective and cheap home-remedy. Like Sacks, Altshul also notes that compulsive running frequently starts in response to a major emotional up­ heaval. "My impression... is that if... a lean athletic man is consciously or uncons­ ciously contemplating divorce, there is at least a 75% chance that he is or will be a compulsive runner. Thus, I would claim not that running causes divorce, but rather that divorce, among other forms of human misery, causes run­ ning." A number of abnormal psychological states possibly present in addicted run­ ners are described below: i) Primary affective disorder Apparent evidence for the postulate that running m ight attract persons more likely to suffer from anxiety or depression comes from a study by a New York Physician, Dr Edward Colt and his colleagues (1981). In a group of sixty- one runners who were participating primarily ip a study of their physiology not their psychology, he found a high incidence of what is termed “primary affective disorder": Persons with this condition suffer from more anxiety and depression than is considered nor­ mal, and frequently require psychiatric assistance, including psychotherapy. Am ongst the group were some elite athletes who also showed this disorder. Colt concludes that this data indeed suggest that running may be particu­ larly rewarding for those runners with affective disorders. He also noted that some runners said they became "revved up" after very intensive train­ ing sessions and these workouts were frequently followed by insomnia. These symptoms, which I have certainly ex­ perienced, are said to indicate "hypoma- nia". One question that Colt suggests needs to be answered is what happens to competitive athletes when they re­ tire from competition’ Do they be­ come depressed? if so he asks, could this explain those suicides that occur in retired athletes7 ii) The athletic neurotic Psychological dependence on run­ ning may occur not only because it helps control primary affective disord­ ers, but also because it may provide an essential coping mechanism for those who have a neurotic fear of illness. Some indication for this was first provided by a Leeds psychiatrist. Dr Crawford Little (1969), in a paper that went largely unnoticed prior to the cur­ rent interest in running addiction. Little noted that amongst patients referred to him for the treatm ent of neurosis, 42% were completely unath- letic; they showed not the slightest in­ terest in any form of physical activity. However, 39% were the precise oppo­ site. These "athletic neurotics" seemed to over-value the importance of health and fitness and revealed an "inordinate pride" in their previous sickness-free progress through life and in their ex­ cess physical stamina, strength or skill. Subsequently, Little has concluded (1981) that athletic neurosis is not a trivial, short-lived illness. He suggests that while excessive athleticism is not in itself neurotic, because it does not cause any suffering in either the sub­ ject or his family, it can place the sub­ ject in a vulnerable pre-neurotic state, leading to manifest neurosis in the event of an appropriate threat. Despite this, Little considers that the overall benefits o f the exercise movement of the 1980s far outweigh the small danger that some athletic neurotics will be produced. Since re-reading Little's article, I have become more aware of the athletic neurotics. One recent example was the 45-year-old man who wanted to know whether or not he should take anabolic steroids to improve his muscle bulk and strength. My suggestion that, at his age, he shouldn't still be so vain was quite clearly-inappropriate, as his ath­ letic neurosis demanded that he go to inordinate ends to insure that he did not become weak, iii) The obsessive-compulsive athlete In its extreme form, "obsessive- compulsive" behaviour is characterised by a rigid, intensely focused attitude; preoccupation with technical detail; over-reliance on intellectuality with a loss of emotional responsiveness,- wor­ ry and marked self-criticism; over­ concern for moral and professional responsibility, with emphasis on what should be done; and constant routine activity performed with the use of a schedule and checklists. Running is attractive to the obses­ sive-compulsive because it provides a rigidly defined goal (such as running the Comrades Marathon) which justi- . fies a constant, routine activity (train­ ing) and preoccupation with detail (training methods, diet, shoes, reading this book, etc). (To be cont. in vol. 1 No. 3 1986) S u 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 So u th A frican S p o rts M edicine A ss o c ia tio n Full M em b er/V o ile lid R 25 S tu d e n t M e m b e r/S tu d e n te -lid R5 Tel No/Tel N r ................MASA No/MVSA N r . F u ll M e m b e r . Medical practitioners who are members of M.A.S.A. V o ile Lid: Medlese praktisyns wat lede van die m.v.S.a. Is . S tu d e n t M e m b e r Medical stu­ dents in clin ical years. S tu d e n te -le d e : Mediese studente in nul klinlese jare. A p p li­ cations for membership of SASMA should be sent to. T h e Secretary. SASMA. 1131 Cburcn St. Hat field, Pretoria. 0083. Cheques to accompany membership form. AUGUST 1986 VOL 1, NO 2,19 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. )