Discussions about evidence-
based practices in sports medi-
cine often include the ques-
tion whether practitioners who 
interact regularly with athletes 
should be guided by science, or 
whether scientists should take 
heed of what these experienced 
practitioners are doing and then 
set out to prove whether their 
approach is beneficial or not. As 
far as I am concerned the an-
swer is a no-brainer. My view is 

based on the fact that there are well over 70 international journals 
dedicated to sports medicine/exercise science. The top journals pub-
lish over 100 papers per year. While many of these research studies 
fall into the category of ‘basic science’, with limited applicability for 
reducing the risk of injury or improving performance, many studies 
have outcomes which are applied and can guide clinical practice. 
Most top quality journals have a section at the end of each paper 
which highlights and summarises the practical applications of the 
study. There is so much information on a variety of topics in sports 
medicine and exercise science that any treatment or intervention can 
be guided by evidence derived from experimentation. However, this 
view of science guiding practice is not shared by everyone. This is 
demonstrated by the gap which exists between the evidence derived 
from experimentation and the practice of some support staff when 
dealing with athletes. Consider for example the practice of cold- 
water immersion after training and competition. A recent survey 
showed that 83% of the support staff of elite rugby players in South 
Africa used cold-water immersion for managing recovery after 
matches.

1
  This practice occurs despite the evidence from a vari-

ety of studies being equivocal
2
 or even negative from an adaptation 

perspective.
3
 Another example is the use of anti-inflammatory drugs 

where the use of these drugs for muscular injury far exceeds the 
recommendations based on scientific evidence.

4
 Does this mean 

that the quality of the science is poor and does not mimic the ‘real-
life’ conditions, or does it mean that the practitioners have their own 
agenda which occurs independently of scientific findings? The an-
swer to this question needs some debate – failure to close the gap 
between science recommendations based on a scientific approach 
and the actual practice of the support staff will impede development 
and deprive the athlete of the best available treatment.

On another note, this first edition of the journal in 2010 brings 
about the changing of the guard. We have to bid farewell to the 
editorial board who have served the journal in an admirable way for 
12 years. Our sincere thanks go to Professors Maurice Mars, Yoga 
Coopoo, Kathy Myburgh, Tim Noakes, Geoff Rogers and Kit Vaughan, 
who have contributed to the journal in various ways. Their collective 
wisdom, experience and status have made a valuable contribution 
to the development of the journal.  The new guard has a tough act 
to follow! We welcome to the editorial board the new members 
Dr Kerith Aginsky (University of the Witswatersrand), Dr Theresa 
Burgess (University of Cape Town), Dr Richard de Villiers (Drs Van 
Wageningen and Partners, Somerset West), Dr Lize Havemann-Nel  
(North West University), Dr Christa Janse van Rensburg (University 
of  Pretoria), Dr Louis Holtzhausen (University of the Free State), 
Professor Frank Marino (Charles Sturt University, Australia) and  
Dr Babette Pluim (Royal Netherlands Lawn Tennis Association, 
Netherlands). The collective skill of this group should serve the next 
phase well, as the journal develops further and meets the changing 
demands of the profession. With the new editorial board we also 
have a new relationship with the British Journal of Sports Medicine. 
This relationship allows us to publish  ‘editor’s choice’ articles which 
have previously been published in the British Journal of Sports 
Medicine. We have included two such papers in this edition of the 
journal (‘Non-steroidal anti-inflammatory drugs in sports medicine: 
guidelines for practical but sensible use’, and ‘Eccentric loading for 
Achilles tendinopathy strengthening or stretching?’) – both papers 
are excellent and make a valuable contribution to narrowing the gap 
between science and practice, as discussed above.

Mike Lambert
Editor-in-Chief

References 
1.    Van Wyk DV, Lambert MI. Recovery strategies implemented by sport sup-

port staff of elite rugby players in South Africa. South African Journal of 
Physiotherapy 2009; 65(1):1-6.

2.    Bleakley CM, Davidson GW. What is the biochemical and physiological 
rationale for using cold-water immersion in sports recovery? A systematic 
review. Br J Sports Med 2010; 44(3):179-187.

3.    Yamane M, Teruya H, Nakano M, Ogai R, Ohnishi N, Kosaka M. Post-
exercise leg and forearm flexor muscle cooling in humans attenuates en-
durance and resistance training effects on muscle performance and on 
circulatory adaptation. Eur J Appl Physiol 2006; 96(5):572-580.

4.    Paoloni JA, Milne C, Orchard J, Hamilton B. Non-steroidal anti-inflamma-
tory drugs in sports medicine: guidelines for practical but sensible use. Br 
J Sports Med 2009; 43(11):863-865.

Narrowing the gap between science and practice

A topic which is receiving 
much publicity as I write 
is the banning of  5 skinny 
models from participating 
in the Madrid fashion week. 
Madrid’s regional govern-
ment imposed the rules ‘to 
protect the models as well as 
teenagers who may develop 
anorexia as they try to copy 
underweight catwalk stars’.

1
 

They used a body mass  
index of  18 as their cut-

off  value. The ‘anti-thin’ move has been criticised in Paris 
and New York, two of  the world’s leading fashion centres.  
However, in Italy the move was supported by the mayor who 
intimated that she would like to apply the same rulings when 
the fashion show moves to Milan.  

The motive for imposing the ban is noble, as the ‘skinny 
trend’ is not showing signs of  abating. A recent report by 
the British Medical Association identifies a link between the 
images of  ‘abnormally thin’ models that dominate television 
and magazines, and the increase in cases of  anorexia 
nervosa and bulimia.

2
 The incidence of  anorexia is at an  

all-time high with predictions of  0 - 5% of  all females having 
eating disorders. While eating disorders were previously 
usually regarded as a female syndrome, the situation is 
changing with a steady increase in the number of  men being 
diagnosed with eating disorders. A recent estimate predicts 
that of  the 60 000 people with eating disorders in the UK, 
10% are male.

2
 This trend can most likely be explained by 

the contemporary lean, hungry look of  male stars. To get a 
snapshot view of  changing body beautiful images of  different 
eras one only has to compare the ‘hunks’ of  the 1960’s movies 
(i.e. Sean Connery as James Bond) to modern day hunks to 
see how the masculine image has changed. Marilyn Monroe, 
with her curvy body shape in the 1950s would probably be 
regarded as too fat for a leading role 50 years later.  

While the organisers of  the fashion shows should be 
complimented for taking a bold stand against their skinny, 
unhealthy-looking models, they can be criticised for the way 
in which they have gone about it. Using a body mass index of  
18 as a cut-off  value is inappropriate and may penalise some 

models who live normal healthy lives. Instead of  this approach 
the organisers should establish a structure that evaluates the 
health status of  the models including their eating, sleeping 
and substance abuse habits and make decisions accordingly. 
The information on how to do this is available; it just needs 
to be applied.

This third issue of  the journal for 2006 has 4 interesting 
papers. The first paper by Professor Mars and colleagues 
examines the cooling of  skin, subcutaneous fat and muscle 
with an icepack, at rest and after short-duration exhaustive 
exercise. This study produced some interesting results with 
important clinical applications. The next paper by Ian Cook 
examines the accuracy of  different types of  pedometers. It is 
well known that people who use pedometers are encouraged 
to be more physically active, so therefore there is great 
value in making pedometers available to the general public. 
However, the enthusiasm to make and distribute pedometers 
has exceeded the concern about their accuracy. This study 
addresses this point with a comprehensive research design. 
The results make a valuable contribution to the literature.  

The third paper, by Dr McHardy and colleagues from 
Macquarie Injury Management Group, Macquarie University, 
Sydney, Australia, is a clinician’s perspective of  the modern 
and classic golf  swing. This paper is relevant to sports 
physicians, biokineticists and physiotherapists and provides 
a clear analysis of  the different types of  golf  swing and their 
possible link to injury, particularly lower back pain.  

Finally the paper by Dr Draper and her colleagues 
describes the state of  the fitness industry in South Africa. 
This comprehensive study gathered data from 442 facilities 
around the country. The data provide an important benchmark 
for the state of  the industry and will make a significant 
contribution to the development of  perceived weaknesses in 
the industry. 

Mike Lambert
Editor-in-Chief

1.   Milan fashionistas fear Spanish skinny model ban. news.yahoo.com/s/
nm/20060914/od_nm/italy_models_dc (accessed 18 September 2006) 

2.   The changing shape of  the model. news.bbc.co.uk/1/hi/uk/769460.stm (ac-
cessed 18 September 2006)

Skinny fashion – a role for sports medicine?

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