I had a thought-provoking moment while listening to a podcast (cyclingsnews.com, 26 March 2009). David Millar, the 32-year-old 2007 British National cycling road-racing champion, was interviewed about his accident in the last stage of the 2009 Paris-Nice race a few weeks earlier during which he crashed and broke his collarbone. Not that breaking a collarbone was particularly unusual, as this is the second most common injury sustained by cyclists crash- ing in pelotons – skin lacerations are the most common under such circumstances. What I found unusual was the manner in which Millar discussed the management of the injury. He spoke with confidence about his injury and how it differed from the collarbone injury of Lance Armstrong. He explained how he had consulted at least 10 specialists for an opinion on how to best treat the injury so that he would be ready to ride in the Tour de France starting on 4 July. After obtaining 5 different opinions he settled for the ‘tight rope’ procedure and recruited a specialist in Sheffield, UK, who had done 50 such operations in 2008. Al- though this procedure requires 4 weeks of immobilisation, Millar chose this method over the other methods that had a quicker recovery time but poorer long-term prognoses. The point to this detailed explanation is that it heralds a new era in sports medi- cine where specialist practitioners are held accountable and their records and experience carefully examined before a deci- sion is made about utilising their services. This scenario has in- triguing consequences, particularly in team sports where there is usually one doctor who serves the whole team, and a coach who may put subtle, or not so subtle, pressure on the doctor to accelerate the treatment of the injured player. Sooner, rather than later, an incident involving a high-profile injured player will be the catalyst for the credentials of the doctor managing the case to be exposed. It does not take much insight to see that a sharp legal brain will have a field day with this, particularly if the skills of the doctor or other support staff do not meet the highest standards. On the point of standards, this edition of SAJSM includes the latest consensus on the management of concussion injuries. The document represents the consensus view of scientists and practitioners who attended the meeting in Zurich in November 2008. This is an important document and therefore we have taken the unusual step of publishing it in SAJSM, free of copyright restriction, even though it will also be published in 10 other journals around the world (American Journal of Sports Medicine, Journal of Science and Medicine in Sport, Journal of Athletic Training, Physical Medicine and Rehabilitation, Journal of Clinical Neuroscience, Scandinavian Journal of Science and Medicine in Sport, Physician and Sports Medicine, British Journal of Sports Medicine, Clinical Journal of Sports Medicine, Journal of Clinical Sports Medicine (Japanese journal) and Neurosurgery. As explained in the preamble to the document (page 36), it has been developed for the use of physicians, therapists, certified athletic trainers, health professionals, coaches and others involved in the care of injured athletes, whether at the recreational, elite or professional level. This approach of preparing consensus documents for managing an injury/condition within sports medicine is gathering momentum. Perhaps it is time to do a stock take of all the controversial management practices in sports medicine and systematically prepare consensus documents on management, with input from the best practitioners in the world. This certainly will lower the risk of a disgruntled athlete instigating legal charges against any medical service provider for not using best practice medicine. Mike Lambert Editor-in-Chief Athlete/doctor relationship – is the knowledge base shifting? 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? SAJSM voL 18 No. 3 2006 57 editoriAL pg57.indd 57 9/21/06 12:15:22 PM editoriAL 34 SAJSM voL 21 No. 2 2009