SAJSM vol 18 No.1 2006 3 The South African Sports Medicine Association (SASMA) is undergoing a renaissance with a realignment of their vision and a drive to boost membership. The necessity of having a strong sports medicine association is probably more important now than ever before. The sad deterioration of the standard of sport in South Africa and the attempt by some politicians and administrators to hijack sport to fulfill their own agendas is at a critical level. The contribution of SASMA to ensure that the situation does not spiral out of control needs to be clarified. Among the many goals of SASMA, perhaps one of the most important is to provide a vehicle for continuing education so that the members are able to maintain a high level of service provision to patients, athletes and coaches. This high level of service needs to adhere to the principles of best practice. This is perhaps easier said than done. For starters, what constitutes best practice when dealing with high-performance elite teams? This question was raised and discussed on numerous occasions at the recent Sports Medicine Conference in Cape Town. While there was general agreement that the term ‘best practice’ described a procedure or method that consistently resulted in the desired response, there was less agreement on how this could be achieved. Some delegates put forward the view that best practice was synonymous with the concept of evidence-based practice, which in turn strives to apply information gained from scientific experimentation. Most trained scientists would concur with this view, while at the same time expressing concern that the scientific process needs to be interpreted and applied accurately. Failing this, the system crumbles. While in a clinical setting the inappropriate use of various medical treatments may have life-threatening consequences, the same does not apply to the application of various modalities for training and recovery in sport. Therefore there is less scrutiny of these methods and a general muddling of what is based on the personal experience of a practitioner versus what can be considered best practice as a result of supporting scientific evidence. Consider the practice of recovery after training and competition – inadequate recovery is listed as one of the major obstacles in attaining optimal performance. 2 While many researchers have attempted to define the ideal recovery strategy, 1 the research on recovery strategies is limited for the following reasons: (i) often untrained people are exposed to a gruelling exercise protocol and then studied with the expectation that they will respond similarly to elite athletes – we know this is not the case; (ii) the protocols used to induce fatigue are not sufficiently specific to the demands of a sport; and (iii) the markers of recovery used in research (i.e. creatine kinase activity in the blood, pain, performance) are not necessarily valid markers of recovery. Furthermore, the types of experiments which have a high believability factor are the randomised double-blind placebo- controlled trials. Unfortunately these trials are almost impossible to conduct with elite professional athletes. For these reasons the body of scientific information which can be applied to the management of athletes and players after training and competition is limited. This has led to the support staff placing a greater emphasis on personal preferences and experiences of their colleagues when deciding on best practice principles. Under these circumstances there is no alternative. However, there should be extra vigilance when these practices are used. Consider for example the use of cold-water immersion of players after training and competition. This practice is based in the theory that inflammation which occurs after hard training and competition is a negative biological consequence and therefore should be prevented – while this logic may be correct when used to treat injured muscle and soft tissue in the acute phase of injury, does it really apply to training-induced stress? A recently published study would suggest not. 3 This study examined the training-induced adaptations in a group of subjects who had their trained limbs exposed to cold-water immersion after every training session – surprisingly, this treatment reduced the training-induced adaptations, leading the authors to conclude that the muscle hyperthermia associated with training, and which is blocked by exposure to cold-water immersion, is an important biological stimulus for inducing training adaptations. This is just an example of how treatments may be misused in the absence of good convincing data. It is unlikely that this will change in the foreseeable future. Therefore there is no simple solution other than encouraging practitioners and service providers working with sports participants to have open minds and communicate with colleagues, be alert for dogmatic viewpoints, and be aware of pseudo-science being used to promote extreme viewpoints. SASMA can assist in this ongoing education role providing the regions become strong and vibrant. Mike Lambert Editor-in-Chief 1. Barnett A. Using recovery modalities between training sessions in elite athletes: does it help? Sports Med 2006; 36: 781-96. 2. Smith DJ. A framework for understanding the training process leading to elite performance. Sports Med 2003; 33: 1103-26. 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: 572-80. Best practice in high-performance sport 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 SaJSM voL 20 No. 3 2008 63 Editorial.indd 63 10/17/08 11:14:15 AM