Editorial Ln this issue we focus on issues encountered by teams travelling to compete overseas in International competi­ tion. Dr Wavnc Diesel, chief physiotherapist for the South African Olympic team at the 1996 Olympic Games at Atlanta - an event which lie describes as the greatest experience of his life and one that he woidd highly recom­ mend to anyone - has kindly co-ordinated contributions form physiotherapy colleagues who work with our National cricket and soccer teams. Together with his own contribution these articles provide an interesting insight into the role of the physiotherapists who travel with national teams. This issue is rounded off with contributions from Judith Johnson, a dietician in private practice who discusses: Nutritional Challenges for Olympic Athletes and by Professor Tom Redly and his colleagues who discuss Jet Lag. Professor Reilly from Liverpool is one of the leading authorities on Jet Lag and the co-author of the definitive book on the topic. His contribution explains the physiological basis for this complex condition and provides prac­ tical ways in which the negative effects of this condition on athletic performance, might be reduced. Travelling with International teams is perhaps the greatest challenge to any professional involved in Sports Medicine and Sports Scienccs. Hopefully, the expertise shared in this issue of the Journal will further enhance the quality of services we can provide to our teams travelling to International competitions. Professor Tim Noakes Editor My thanks to the Editors of the South African Journal of Sports Medicine for affording me the honour to be guest editor of this issue of your Journal. I would like to introduce this issue by paying special tribute to all my colleagues who have worked tirelessly, and often very much behind the scenes to entrench the role o f the physiotherapist in Sports Medicine. The fruits of our efforts can be seen from the fact whereas no physiotherapists travelled with our team to the 1992 Barcelona Olympic Games, a contingent o f 5 South African physiotherapists was present at the Atlanta Games. This change has occurred because of calls by both the athletes themselves as well as the sports administrators to include physiotherapists in the team. Clearly the athletes and administrators would not have requested our presence had it not been for the excellent work done by our profession in the handling of sports injuries at all levels, including those that occur to our elite athletes. Working and travelling with sports teams appears both glamorous and a wonderful way to see the world. The physiotherapists who have contributed to this edition have all toured extensively with the most prominent of our National sports teams. In our articles we share our views on some of the pro’s and cons of travelling with our respective national teams. Craig Smith was perhaps the first South African physiotherapist to work with a National team. He was appointed to the National cricket team for their first tour to India in 1991; he has been a consistent and important member of that team ever since. David Becker and Steve Felsher have worked with our soccer World Cup hopefuls, the Bafana Bafana for some years and will likely have the experience of their lives at the World Cup in France in 1998. I, on the other hand had the huge honour of heading up the physiotherapy teams to the 1995 All African Games as well as the 1996 Olympic Games. Having read these articles I can certainly relate to both the rigors and delights of travelling with a sports team as their physiotherapist. A message to those physiotherapists contemplating getting involved with a sports team: “ Should you be given the opportunity to become involved, grab it with both hands. Don’t seek the limelight and your rewards will come from the appreciation and performances o f the team. And perhaps most importantly, do it because you enjoy it!” Gel n relief Wayne Diesel Guest E ditor SPORTS MEDICINE SEPTEMBER 1997 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 e t a M a x A COMPLETE METABOLIC SYSTEM FOR ALL APPLICATIONS PORTABLE V 0 2 MAX The MetaMax ergospirome- try system makes it possible to test a person in places where it was until now, impossible. At 1,8 kilograms using a specially designed backpack the MetaMax can be carried by persons to obtain measurements under real conditions. Data can be transmitted to a PC via telemetry or stored for further analysis in its data logger. It can of course also be used stationary in a lab. EXERCISE TESTING The MetaMax system allows you to measure simultane­ ously all cardiac and pul­ monary data. Including O2 consumption, CO2 output, temperature and pressure, ECG, heartrate, spirometry, blood pressure, skin temper­ ature and calorimetry. Advanced software running under Microsoft Windows displays the captured data graphically and numerically and allows for personalised reports. HILHORST INSTRUMENTS CC Phone 021 524 806 E-mail,: hilhorst@iafrica.com We also supply: WOODWAY Treadmills, LODE Ergometers, CARDIO PERFECT ECG Systems 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. ) mailto:hilhorst@iafrica.com .......................................... ..... V O L U M E 4 Editors P ro f TD Noakes D r M P Schivellnus Editorial Board D r M E Moolla Dr P de Jager D r J Skowno Dr P Schwartz P ro f R Stretch D r C de Ridder P ro f B C Andrews D r E W Derman M r R H Farman Dr R H Mars D r C A Noble International Advisory Board Lyle J Micheli Associate Clinical Professor of Orthopaedic Surgery Boston, USA Chester R Kyle Research Director, Sports Equipment Research Associates California, USA P ro f H C Wildor Hollmann President des Deutschen Sportarztebundes Kohi, West Germany Howard J Green Professor, Department of Kinesiology Ontario, Canada George A Brooks Professor, Department of Physical Education California, USA Neil F Gordon Director, Exercise Physiology Texas, USA Edmund R Burke Associate Professor, Biology Department, University of Colorado Colorado, USA Graham N Smith Physiologist Glasgow, Scodand NUM BER 3 SEPTRMRFp 1 9 9 7 CONTENTS Editorial W Diesel Travel and body clock disturbances J Waterhouse, T ReiUy, G Atkinson Travelling with teams W Diesel 10 The SA cricket team - The physiotherapists 14 viewpoint C Smith Physiotherapy in South African soccer D Becker, S Felsher 18 Nutritional challenges for Olympic athletes - 20 A review article J Johnson Hie Editor The Soutfi African Journal of Sports Medicine P O B o x 115, New lands 7725 PRODUCTION Andrew Thomas PU B LISH IN G Glenbarr Publishers cc Private Bag X I 4 Parklands 2196 Tel: (O i l ) 442-9759 F ; l x : ( O i l ) 880-7898 a d v e r t i s i n g Marika de Waal/Andrew Thomas REPRODUCTION Output Reproduction PR IN TIN G INCE o n - t h ^ n relief Editors, the Advertisers or the PubhsheiS “ T " 0t necessariJ>' shared by die ------------ ------------ ------------------- ‘_________________ • reproduced without the written consent of the Publishers. SPORTS MEDICINE SEPTEMBER 1997 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. ) Travel and body clock disturbances J. Waterhouse, X. Reilly and G. Atkinson r _ . , T. » t t t t School o f H um an Sciences, Liverpool John Moores University, Liverpool, U K is explained. INTRODUCTION Competitive sport is now recognized on a global scale and people at many levels, from the Olympic Games’ athlete to the recreational runner, have the opportuni­ ty of competing abroad. Travelling to strange places for purposes of competing in sport might seem attractive; in reality it makes great demands on team managers, coaches, and athletes, irrespective of a trip abroad for a single competition or preparations for a prolonged tour. Problems are encountered as a result ot crossmg time zones which are very different in nature from the ‘travel-fatigue’ after flying north or south, or after long journeys in cars or buses. Regular walks on the plane, some stretching and static exercises will all help in minimizing this form of fatigue during this latter type of journey, and a refreshing shower or a good night’s sleep will be totally restorative. This is not the case after quickly crossing time zones, either coast to coast in Australia or North America, across Europe or Asia, or trans-oceanic flights. Then the problem is longer lasting and called ‘jet-lag’ . It has been described recently by Reilly et al.1 It is based upon abnormal tim­ ing of circadian rhythms, described extensively by Minors & Waterhouse,2 the importance of these to ath­ letes being reviewed by Atkinson & R eilly3 The present review concentrates also on counter measures that can be used to minimize the detrimental effects of jet-lag. THE PROBLEM Time zones Because the earth is spinning on its axis, for anybody standing on the earth’s surface the sun rises in the east and sets in the west and is at its highest point in the sky at noon by local time. These events must occur in the UK after they have taken place in countries to the east and before they have taken place in countries to the west. In order to resolve this problem, the world has been divided into 24 time zones centred around Greenwich and separated by lines of longitude 15 apart. These time zones determine the relationship b e t w e e n Greenwich Mean Time (GMT) and local time, those to the east of the UK being advanced and those Address correspondence to: G. Atkinson PhD, School of Human Science, Liverpool John Moores University, Mountford Building, Bvrom Street, Liverpool L3 3AF, UK. Tel: +44 151 231 2376; Fax: +44 151 298 1261 to the west being delayed. Consequently, at the same moment it might be mid-day in the UK but, by local time, 16h00 hours in Afghanistan, 21h00 hours in Japan, 07h00 hours in New York and 03h00 hours in Los Angeles. Travelling to the east, therefore, means you ‘lose time’ (in the sense that part of the day appears to have been lost), and to the west that you gain it (in the sense that you can relive some hours). For the seafarer or passenger on a cruise liner the biological implications of time zones are not very important. The rate of travel and of crossing time zones is slow enough to be accommodated easily Sailing to New York, for example, entails putting the clock back 1 or 2 hours per day; in effect the traveller who stays up late may have a lie in and still be on schedule by changing to local time. Jet-lag By contrast, problems arise when you cross several time zones in a short space of time. Jet travellers suf­ fer from a combination of symptoms, collectively known as ‘jet-lag’. The symptoms vary between indi­ viduals in details o f their nature and severity, but include some or all of those s h o w n in Box 1. Jet-lag is accompanied by a general malaise, a sense of feeling and acting ‘below par’ . This is especially important in athletes who generally want to maintain their training habits or continue a systematic build-up for a forthcoming contest. r Only a few studies have dealt specifically with sports performance after time zone transitions. | Studies upon rugby players and American footballers j indicate a poorer performance in the days immediate- j ly after the flight, particularly if the match was played i during the night in the visitors’ home time zone. Such effects are important for serious competitors and agree with results from closely controlled laboratory simula­ tions of time-zone transitions. These simulations and , field studies show that there is a loss of sleep and a general decline in motivation and physical and mental , performance - in particular, the normal daytime peaks I are blunted. The severity of jet-lag symptoms is greater after eastward compared to westward flights, the syndrome affects the old rather more than the young, and depends on the number of time zones crossed rather than the distance travelled. As a rough guide, jet-lag lasts, in days, up to the number of time zones crossed after an eastward flight and about half of the number after a westward flight. The severity of the symptoms may be related to menstrual cycle phase. Disruptions of the menstrual 4 SPORTS MEDICINE SEPTEMBER 1997 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. ) cycle in female travellers have been linked to distur­ bances in melatonin secretion. Higher melatonin levels in the Scandinavian winter compared with summer values have an inhibiting effect on lutenizing hormone. As a consequence, ovulation might not occur during that cycle.' The extent to which the menstrual distur­ bances accompanying travelling across multiple time zones in themselves alter athletic performance is uncertain. As well as time-zone transitions, there are other changes that are associated with a long-haul flight, amongst which are: 1. A change o f customs, including food 2. The personal discomfort associated with travel 3. The loss of sleep caused by the flight schedule 4. Anxiety owing to the sports meeting in the new time zone. Box. Symptoms associated with the phenomenon o f jet-lag Fatigue during the new daytime, and yet inability to sleep at night. Decreased mental performance, particularly i f vigi­ lance is required. Decreased physical performance, particularly with regard to events that require stamina or precise movement. A loss of appetite, coupled with indigestion and even nausea. Increased irritability, headaches, mental confusion and disorientation. These factors contribute to the general disruption, but most are essentially over within 48 hours. By con­ trast, jet-lag can last for 5 days or longer. Additional reasons why the above factors are not a sufficient explanation of jet-lag are: a. The problems arise also when returning home. b. The problems do not arise when flying a long way south but without crossing many time zones, from London to Lagos (Nigeria) for example. c. The problems do not depend much upon whether it is a day or night flight, i.e. the amount of sleep lost during the flight. d. The problems depend far more upon time zone changes rather than culture changes (compare flights from the UK to New Zealand and Central Africa, for example; jet-lag is far worse after the former flight). e. The problems can be reproduced In laboratory based experiments. In this case, none of the other factors applies; the only change is in the local time. These findings, particularly (e), and all other stud­ ies on circadian rhythms, confirm the view that jet-lag is a function of the abnormal relationship between the new local time and body time. Such problems will per­ sist until the individual has synchronized fully to the new time zone. The body clock A large amount o f experimental data12 indicates that humans possess a ‘body clock’, located in the ase o f the brain. This is responsible for adjusting our physiology and biochemistry to the normal pat­ tern ol daytime activity and nocturnal sleep and recovery. The clock achieves this by exerting effects throughout the body via controlling the nervous sys­ tem, hormones and body temperature. As a result of its actions, the body clock causes mental and phys­ ical performance, alertness and motivation to be high in the daytime, and it facilitates getting to sleep and remaining asleep during the night by reducing most neural activity, body temperature and adrenaline secretion. Importantly, it also helps to prepare for sleep at night and activity during the daytime by initiating the changes in physiology and biochem istry an hour or so beforehand. This drowsiness is promoted in the evening before sleep onset, and adrenaline and body temperature rise in the morning before waking up. Three properties o f the clock are important. First, it is an inexact timekeeper, tending to run slow with a period greater than 24 hours (this is why we tend to go to bed later and have a lie-in in the mornings at weekends and during holidays). Second, and related to this, it is normally adjusted to an exact 24-hour period by several rhythms in the environment. In humans in industrialized soci­ eties these rhythms are much influenced by social norms and include light/dark, feeding/fasting, social interaction, mental and physical activities. The third property of the body clock that is impor­ tant is that it is slow to adjust to changes in our lifestyle. This resistance to change is normally ben­ eficial, since it means that the body clock does not adjust inappropriately. For example, i f we go to the cinema in the daytime, the clock does not adjust to the ‘night’ nor does it adjust to the ‘day’ i f we get up to have a snack at night. This inertia o f the body clock, which is beneficial in these circumstances, is inappropriate after a time-zone transition. There will be a mismatching between body time and local time as illustrated for a subject who has just flown eight time zones to the east (Table 1) and this is the origin o f jet-lag. Table 1 Mismatching between local and body times immediately after a flight from UK to Hong Kong New local time Requirement Body Time Desire 0800 hours Waking 2400 hour Going to sleep 1600 hours Peak activity 0800 hours Beginning to wake 2400 hours Retiring 1600 hours Peak activity When the circadian rhythms o f body tempera­ ture, physical and mental performance are consid­ ered, then they show this effect clearly.8 Thus, in the above example o f an eastward flight across eight time zones, minimum body temperature tends to fall near midday local time and the maximum body temperature during the night (instead o f nor­ mal times of 05h00 and 20h00 hours, respectively). As a consequence o f the links between temperature, sleep and mental performance, sleep will be d iffi­ cult to achieve and maintain at the new night-time and the fatigue that w ill result w ill give rise to neg­ ative feelings, including irritability and headache. SPORTS MEDICINE SEPTEMBER 1997 5 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. ) Mental and physical performance and mood will deteriorate not only because they are talcing place at times too far removed from the circadian peak, but also because the subject is imable to sleep prop­ erly. Differences between flights Accepting this desynchrony between body time and local time as the main cause o f the problems, and knowing some o f the properties of the body’s timing system, we can understand why jet-lag is worse after an eastward flight. Adjustment to a westward flight requires individ­ uals to go to bed and wake up later, and their body clock to delay; by contrast, adjustment to an east­ ward flight requires going to bed and rising earlier, and advancing the body clock. Going to bed earlier than is habitual is not likely to be conducive to get­ ting a good sleep. Circulating adrenaline levels and body temperature are too high and the individual lias not been awake long enough to become tired. The resulting poor sleep is inadequate prepara­ tion for the next full day and the problem is made worse by the fact that by the time the body is ready to sleep the new local time indicates that is time to get up for the next day! By contrast, after a west­ ward flight the increase in time spent awake before the new bedtime will tend to promote sleep and to offset the fact that it is being attempted when the body temperature and plasma adrenaline levels are rising. More sleep is obtained after a westward than an eastward flight, therefore, even though it still tends to finish too soon. In addition, the body clock can delay more easily than advance, probably because it tends to run slow unless adjusted each day (see above). As a result, eastward flights, which require the clock to advance, are associated with a longer resynchro­ nization time than the ones to the west but crossing the same number o f time zones. Also, after a flight to the antipodes, where the time shift approaches 12 hours, adjustment is almost invariably by delay o f the body clock. ADVICE From the above, it must be clear that a full training schedule and peak athletic performance require adjustment to the new time zone. In addition, the problems can be reduced by suitable planning before the flight and actions during it. Before the flight I f it is possible to do so, flights should be sched­ uled so that athletes arrive well in advance o f com­ petition. One day for each time zone crossed does leave a margin o f safety, even for competitors trav­ elling eastward. Attempts to find the most convenient travel schedules are encouraged. Consider departure from regional airports if appropriate and also alternative carriers. An individual’s routines prior to depar­ ture, on the plane and after arrival can be planned once the itinerary is established. In consequence the trial and error element in coping with jet-lag will be reduced. In the week prior to departure it may be possible to adjust the time o f rising and going to bed, the adjustment depending on the direction o f flight. A change o f more than 2 hours is unlikely to be pro­ ductive since this would interfere with the pattern of social and domestic engagements during the day and clashes with time cues from the environment, for example light. The advantage o f this solution is that it enables the traveller not only to retain some semblance of normality dining the days just before the journey but also enables the focusing o f thoughts on the process o f adjustment to the new time zone. In con­ nection with this, altering training times for a few days prior to travel to take into consideration the time o f competition in another time zone is known to be beneficial.'’ During the flight Once flight times are known, a routine on the plane may be planned. In daytime flights it will be neces­ sary to stay awake, keep mentally active and per­ haps watch the in-flight movie. On long-haul flights that entail travelling during the night it will be nec­ essary to get some sleep on the plane. The timing of this may be decided in advance and some meals on board can be missed. Transit or transfer episodes en route should also be taken into consideration. It is advisable to set one’s watch to local time at the next point o f landing, once on board the plane; in a single-haul flight this would be the local time o f the country o f destination. This helps the traveller to ‘ tune into’ the new local time straighl-away and to adjust behaviour accordingly. In order to compensate for the dry air on board flight, copious rehvdration is advised. Fruit juices are best; fizzy drinks should be avoided. Alcohol should not be taken, since it acts as a diuretic caus­ ing loss o f fluid. Caffeine (in coffee) also stimulates water loss and its arousal effect on the central ner­ vous system means it should not be taken i f sleep is desired. One suggestion has been that the last meal prior to the time allotted for sleep should be high in carbohydrates and low in protein in order to induce drowsiness (this is because carbohydrates provide the substrate for serotonin, a neurotrans­ mitter which regulates sleep). This same line o f reasoning indicates that caffeine and a low-earbo- hydrate high-protein breakfast would help raise the level o f arousal and prevent a relapse into sleep. Athletes may feel s tiff or cramped because of their restrained posture on board flight. They can perform static exercises for arms, trunk or legs whilst in their seats. Also, they can walk down the aisle of the plane frequently and do flexibility or stretching exercises occasionally at the back o f (he plane. This will also serve to remind the athletes that the primary purpose o f the trip is for sport and not tourism. British sports teams travelling to Australia have used sleeping pills to induce sleep whilst on board. Although drugs, such as benzodiazepines, are effec­ tive in getting people to sleep, they do not guaran­ tee a prolonged period asleep. Besides, they have not been satisfactorily tested for subsequent resid­ ual effects on motor performances such as sports skills. Studies on British Olympic athletes travel­ ling to training camps in Florida (a 5-hour time- zone transition) have failed to show any beneficial effects o f benzodiazepines on jet-lag.1 A prolonged nap at the time the individual feels drowsy (presumably at the time that he or she would have been asleep in the time zone departed from) is to be avoided - it simply anchors the rhythms at their former phases and so resists the 6 SPORTS MEDICINE SEPTEMBER 199J 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 u Z a M M" g "Kmn alpr0,gn U1.) TransAct t n I m e got acute pain and inflammation covered. flurbiprofen 40 tng 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. ) adjustment to the new time zone.10 Immediately after the flight In the days immediately after a flight across sever­ al time zones, when the body clock is not adjusted to the new local time, there will be a window o f time during the day when the period o f high arousal associated with the time zone just left overlaps with the arousal high point at the new local time. This window may be predicted in advance and should be utilized for timing of training practices in the first few days of'arriving. Observations on footballers travelling eastward from the U K to Oceania (Australia, New Zealand and Papua New Guinea) indicate that late-morning training sessions suited players best over the first days, however." Since such a time corresponds to night in U K time, this indicates that other factors, such as absence of fatigue, are important also. The comments (above) relating to the use of hyp­ notics and naps will apply also to the first days in the new time zone. Other drugs that act as central nervous system stimulants might be useful. Thus, caffeine (in coffee) and theophylline (in tea) can increase alertness. Promoting adjustment The major concern, however, is to promote adjust­ ment o f the body clock. Several methods have been suggested, differing in their feasibility and in the extent to which they might have side-effects that adversely affect athletic performance. The three main suggestions are as follows: The timing and composition of meals It has been argued that high-protein breakfasts pro­ mote alertness and that high-carbohydrate evening meals (vegetables, potatoes, rice, bread, pasta, desserts, etc.) promote sleep.12 The theoretical grounds for this include the effects upon plasma amino acids that such meals would have and, thence, the uptake o f the amino acids into the brain, their incorporation into neurotransmitters, and the release o f the neurotransmitters. High-pro­ tein meals (meat, cheese, eggs, etc.) undoubtedly raise plasma tyrosine, but whether this promotes the release o f catecholamines by the activating sys­ tems o f the brain, and so promote alertness, is less clear. Similarly, high-carbohydrate meals promote the concentration o f plasma tryptophan, but whether this stimulates the raphe nucleus and sleep is also uncertain.1’ There is evidence that electroencephalographic waves show some changes in athletes on a carbohydrate-only diet, but effects on the quality o f sleep have not been demonstrated. The method was promoted in the USA under the title ‘President Reagan’s Anti-jet-lag D iet’ . Scientific tests o f the efficacy o f the diet are few and poorly designed. Even so, a variant o f this pro­ posal has been marketed. It consists o f two types of pills, one to be taken in the morning and the othei- . in the evening. Each pill is a mixture o f substances, the morning p ill containing tyrosine and the:. - evening one, tryptophan. The accompanying litera^fg j ture does not enable a judgement to be made on the-;i scientific evaluation o f these preparations. Besides, tryptophan achieved bad publicity in the early 1990s owing to impurities found in commercially available products and its use is no longer recom­ mended. Melatonin capsules In normal circumstances melatonin from the pineal gland is secreted into the blood stream between about 21h00 and 07h00 hours. It can be regarded as a ‘ dark pulse’ or ‘internal time cue’ . Several studies have shown that melatonin capsules taken in the evening by local time in the new zone reduce the symptoms of ‘jet-lag’ .14 This is an important finding, but there are some caveats. 1. Jet-lag, as defined in these studies, has concen­ trated on subjective symptoms; we do not know if there would also be improvements in mental and physical performance, and in motivation to train hard - or even i f there would be further decrements. 2. It is not clear i f melatonin produced its effect by promoting adjustment of the body clock or by some other means (increasing a sense o f wellbe­ ing or the ability to sleep, for example). Recent work suggests that melatonin should adjust the body clock, but this requires careful timing of ingestion according to whether you wish to advance or delay the clock.1S Thus, melatonin taken in the evening (on body tim e) will advance the body clock and in the morning will delay it. 3. Melatonin is only just becoming commercially available (largely in the USA) and the results from many clinical trials are still awaited. In summary, more information is required before melatonin can be recommended. Bright light exposure and physical activity Bright light (that is, o f an intensity found naturally but not normally indoors) can adjust the body clock. The timing o f exposure is crucially important1017 and is the opposite o f that for melatonin ingestion; thus, bright light in the morning (05h00-llh00 hours) on body time advances the clock and bright light in the evening (21h00-03h00 hours) on body time delays it. As part o f this treatment, there are also times when light should be avoided (those times which produce a shift o f the body clock in a direction oppo­ site to that desired). Table 2 gives times when light should be sought or avoided after different time- zone transitions; the timing w ill vary as the body- clock adjusts. Table 2 The use of bright light to adjust the body clock after time zone transitions Bad local times Good local times for exposure to for exposure to bright light bright light Time zones to the west 4 h 0100-0700* 1700-2300t 8 h 2100-0300* 1300-1900f 12 h , 1700-2300* 0900-1500t . Time zones to the east 4 h 0100-0700t 0900-1500* 8 h 0500-1100f 1300-1900* 10-12 h Treat this as 12-14 hours to the west * Will advance the body clock; t w ill delay tlie body clock; note that this is because the body clock adjusts to delays more easily than advances. 8 SPORTS MEDICINE SEPTEMBER 1997 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. ) Even though ‘bright light’ is o f an intensity nor­ mally not achieved in domestic or interior lighting, light boxes and visors are now available commer­ cially that produce a light source o f sufficient inten­ sity. Light visors, in particular, might prove a useful addition to one’s luggage. Since outdoor lighting is the obvious choice, it would be natural, therefore, to consider training outdoors - that is jogging, a brisk walk, a swim or a game o f tennis, for example - when light is required, and to relax indoors when it should be avoided. This raises the question whether physical exercise and inactivity can, in some way, add to the effects o f light and dark, respectively. Current evidence is not conclusive. For the first few days in the new time zone, train­ ing sessions should not be all-out efforts. Skills requiring fine co-ordination are likely to be impaired and this might lead to accidents or injuries if, for example, games players conducted sessions with the ball too strenuously. Where a series o f tournament engagements is scheduled, it is useful to have at least one friendly match during the initial period, that is before the end o f the first week in the overseas country. Subject to these caveats, exercise for athletes is recommended also since it helps them psychologically in their prepara­ tions for competition. In practice, therefore, to combine exposure to bright light and exercise, and to combine dim light and relaxation, would seem practicable. However, there is very little evidence to suggest that exercise by itse lf will alter the speed o f adjustment o f the body clock. To a large extent it might be considered that to adjust as fully as possible to the lifestyle and habits in the new time zone would be the best advice. This is not always the case in the first day or so after the flight. Consider a westward flight through eight timezones. To delay the clock requires bright light at 21h00-03h00 hours body time and its avoidance at 05h00-llh00 hours. By new local time, this becomes equal to 13h00-19h00 hours for bright light and 21h00-03h00 hours for dim light (see Table 2). It can be seen that natural daylight and night would provide this. Consider, by contrast, a flight to the east through eight time zones. Now light is required 05h00- llhOO hours body time (13h00-19h00 hours local tim e) and should be avoided 21h00-03h00 hours body time (05h00- llhOO hours local time). That is, morning light for the first day or so would be unhelpful and tend to make the clock adjust in the wrong direction (though afternoon and evening light are fine). The timing o f exposure to bright light is critical on the first days after the flight. After a couple o f days, when partial adjustment has occurred, it is then advised to adjust the timing o f the light exposure towards that o f the local inhabitants, so that the visitors’ habits become fully synchronized with those o f the locals. CONCLUSION By preparing for time-zone transitions and the dis­ turbances they impose on the body’s rhythms, the severity o f jet-lag symptoms can be reduced. There has been little success in attempting to predict good and poor adapters to long-haul flights. Athletes are generally better than non-athletes in coping with jet-lag and they tend not to suffer as much. The fact that an individual escapes lightly from symptoms on one occasion is no guarantee that he or she will do so again on the next visit. The disturbances in men­ tal performance and cognitive functions have conse­ quences not only for sports performers but also for management and medical staff travelling with the team, who by no means have immunity against jet- lag symptoms. An awareness o f the dynamic biolog­ ical adjustments that the body is making means that the adverse effects and discomfort associated with jet-lag can be countered to some degree. It is important to allow time for the slow adjustment o f the body clock, and to be patient whilst this process is taking place. Until it has, performance will be poorer and will seem harder to achieve. Adherence to the advice above will minimize these frustra­ tions. References 1. R e illy T, A tk in s o n G, Waterhouse J. B io lo g ica l rhythms and exercise. O xford: O xford University Press. 1997. 2. M inors DS. Waterhouse JM . C ircadian rhythms and the human. B ris to l: J oh n Wright. 1981. 3. A tk in s o n G, R e illy T. C ircadian va ria tion sports performance. Sports Med 1996; S I : 292-304. 4. O C onnor P J , M organ IK A th le tic perform ance follow in g rapid traversal o f m u ltip le time-zones. Sports M ed 1990: 10: 20-30. 5. R eilly T. H u m a n circadian rhythms and exercise. C rit Rev Biom ed E n g 1990; 18: 165-180. 6. Shephard R . Sleep, biorhythm s and human performance. Sports Med 1994; 1: 11-37. 7. K a rm a M. L a itin en J, P a rtin en M, Savanto S. The effect o f fo u r- day round trip flig h ts over 10 tim e zones on the circa d ia n varia­ tio n o f salivary m elatonin and co rtiso l in a ir-tim e flig h t a tte n ­ dants. E rg on om ics 1994; 37: 1479-1489. 8. Wegmann 11. K le in K . J e t-la g and aircrew scheduling. In : Folkard S, M onk T. eds. Hours o f work. Chichester: Joh n Wiley 1985: 263-276. 9. Jehue R , Street D , H uizenga R. Effect o f tim e zone and gam e tim e changes in team perform ance: N a tio n a l F oo tb a ll League. Med Sci Sports Exerc 1993; 25: 127-131. 10. M inors DS. Waterhouse JM . A n ch o r sleep as a synchroniser o f abnorm al routines. In te rn a tio n a l J o u rn a l o f C hronobiology 1981, 7: 165-188. 11. R e illy T, M e llor S. J e t-la g in student rugby league players f o l­ lowing a non-m axim al tim e-zone shift. In : R e illy T. Lees A, D avid s K , M urphy W, eds. Science and Football. London: E & F N Spon. 1988, 249-256. 12. Graeber R . Sing 11. Cuthbert B. The im pact o f transm eridian flig h t on deploying soldiers. In : Johnson L, Tepas D , Colquhoun P. eds. B iolo g ica l rhythms, sleep and shift work. Lancaster: M T P Press 1981; 513-537. 13. Leathw ood P. Circadian rhythms o f plasm a am ino acids, brain neurotransm itters and behaviour. In : A re n d t J. M inors D, Waterhouse J. eds. B io log ica l rhythms in clin ica l practice. B ris to l: J oh n W right 1989; 136-159. 14. A re n d t J, A ld house M, E n glish J, M arks V, F o lk a rd S. Some effects o f je t-la g and th eir a lle via tio n by m elatonin. Ergonom ics ■ 1987; 30: 1379-1393. 15. Lewy A , A h m e d S, Jackson J. La th am R. Sack R . M elatonin shifts human circa d ia n rhythms according to a phase response curve. C hronobiol In t 1992; 9: 380-392. 16. Czeisler C, K rona u er R , A lla n J. B rig h t lig h t in d u ction o f strong (ty p e 0 ) resetting o f the human circadian peacemaker. Science 1989: 244: 1328-1333. 17. M inors D, Waterhouse J, W irz-Justice A . A human phase response curve to light. N eurosci L e tt 1991; 133: 36-40. □ R eprinted with perm ission, Sports Exercise and In ju ry (1 1 9 7 ) 3, SPORTS MEDICINE SEPTEMBER 1997 9 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. ) Travelling with teams W Diesel INTRODUCTION The purpose of this article is to highlight some impor­ tant and practical hints on ‘qualities’ of the individual physiotherapist, appropriate equipment, daily rou­ tines, and remuneration. The views expressed in this article arc entirely my own and do not necessarily reflect the views of either my colleagues or profession­ al bodies to which I belong. The ‘ideal’ physiotherapist Not everybody is suited to travelling with sports teams. Certain physiotherapists may prefer the relative ‘com­ fort’ of their practices were everything is at then- dis­ posal and help is close at hand. Other physiothera­ pists, myself included, enjoy the challenge of travelling and having to make spontaneous decisions. One thing, however, is certain that the glamour associated with travelling with a National sports team is short-lived. This type of work is certainly not for the feint-hearted or oversensitive. Recall the press coverage the medical team received in Atlanta, if you need any convincing. It has been said, and written, that the best a medical team can hope for is not to get mentioned during a tour! Physiotherapy, like any other medical profession, has its specialities. The treatment of sports injuries is constantly evolving and physiotherapists need to con­ stantly keep up to date with new trends. It is about time that physiotherapists ‘specialised’ in the treat­ ment of sports injuries were recognised as such. Perhaps a Nationally accepted accreditation pro­ gramme is the solution. I will cover this area at the end of the article. Having now travelled with several different sports code, I have come to the conclusion that there are cer­ tain physiotherapeutic techniques or skills which are essential. Perhaps one of the most important skills is massage. Irrespective of what team I have travelled with, the majority o f my ’treatment’ time is spent mas­ saging. Massaging may be requested by the sport per­ son for general relaxation; pre-event stimulation; post- event muscular stiffness; and even during an event. If done correctly certain massage teclmiques can also be used to effectively treat some chronic soft tissue injuries i.e. deep transverse friction’s, deep longitudi­ nal massage, myofascial release and trigger points. The way in which a pre-event [stimulatory! massage is given varies between sports. Apart from focusing on different muscle groups, the medium through which the individual is massaged may also change. On the one extreme I have used ‘foul-smelling’ oil (arnica, tiger balm, nutmeg) on hockey players who swear by its ‘magic’, whereas many swimmers simply will not allow you to use any oil or powder whatsoever. Swimmers prefer to be massaged over loose fitting clothing. The reason for this, according to the swimmers, is so that their ability to ’feel’ the water is not affected after hav­ ing ‘shaved’. Manual therapy, involving Maitland techniques which includes joint manipulation, rales as a close sec­ ond to massage as far as taking up treatment time goes. Manipulative therapy, assuming it is done at the appropriate time and for the right reason, can and does lead to remarkable reduction in symptoms. A third vital skill necessary is stretching. Knowing when, and how, to use the various stretching techniques, such as PNF; neural; static; and dynamic, is important. Travelling with multi-code sports teams e.g. Olympics, challenges the physiotherapists knowledge o f stretch­ ing since each code requires a unique series of stretch­ es. Just as training is sports-specific so is stretching. Electrotherapy, despite its proven effects in treat­ ment of soft tissue injuries such as those commonly encountered in sport, does not feature as prominently as ‘hands-on’ techniques. This is mainly because it. is simply not practical to travel with much more than a simple combination (ultrasound and interferential) unit. Acupuncture, 0 1 1 the other hand is rapidly becom­ ing more and more popular in the treatment of spoils injuries. This, I am sure will feature prominently in future tours because of its obvious case of transport and popularity amongst sports persons. Part and parcel of travelling with sports teams is allowing injured athletes to continue to participate. Clearly the extent of the injury will determine whether or not an injured athlete may or may not participate. However, the decision is not always an easy one. Hence, the athlete and physiotherapist may have to rely quite heavily on strapping to see them through the next match or event. As in the case of stretching, each sports codc has its preferences when it comes to strap­ ping. A gynmast’s ankle cannot be strapped the same way as you would strap a rugby player’s ankle. The gymnast needs to be able to point her toes and walk on a narrow beam thus heavy strapping would obviously be inappropriate. Extended tours, anything longer than 0 1 1 c week, will at some stage require the physiotherapist to imple­ ment rehabilitation programmes for the injured ath­ letes. Almost without exception the physiotherapist ‘inherits’ a wide range of chronic low level injuries. This means that even before the tour has started some of the athletes will have an injury of soils. In these instances the physiotherapist must continue with an existing programme or even be required to initiate one. Thus a sound knowledge o f strength training and phys­ ical rehabilitation principles will also be o f great bene­ fit to the physiotherapist. In cases where the tour may last several weeks even non-injured athletes will derive benefit from strength training. Often this is done in conjunction with the coach or fitness trainer. The physiotherapist should also be able to treat minor medical problems such as abrasions, blisters etc. as well as the more major problems such as frac­ tures, dislocations, and spinal injuries. Tliis knowledge is perhaps more important for physiotherapists who 10 SPORTS MEDICINE SEPTEMBER 1997 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 very one fe e ls pain at some time . R o b e f t . i o o • S i g n i f i c a n t a n a l g e s i c , a n t i - i n f l a m m a t o r y a n d a n t i p y r e t i c a c t i o n . • R a p i d t h e r a p e u t i c r e s p o n s e e n s u r e d ' . • A v a i l a b l e in A c t i o n P a c k 1 5 ’s a n d S u p p o s i t o r i e s 12 ’s. 3 Flurbiprofen lOOmg « X . ♦ rabbi* I(K) mp. orts Exerc 1994: 26: ( 1 ) 81-88. 15. R o b erts K M . N ob le E G . Hayden D B . T a y lo r AW. Lipoprotein lipase a ctiv ity in skeletal muscle and adipose tissue o f m arathon runners a fter sim ple and com plex ca r­ bohydrate rich diets. E u r J A p p l Physiol 1988: S7: 75-80. 16. New sholm e E A . C on trol o f m etabolism and the in tergration o f fuel supply for the m arathon runner. In : K n uttgen H G. Vogel J A . Poortm a n s J R (e d s ) B iochem istry o f Exercise. Hum an K in etics Publishers Inc. Cham paign. 1983: 144- 150. 17. Van Zy l CG, Lam bert EV. Hawley J A . Noakes T D . Dennis SC. Effects o f m edium chain triglyceride ingestion on fuel m etabolism and cycling performance. J A R 1 9 9 6 :8 0 (6 ) -.2217-2225. 18. K a n te r MM. W illiam s M H . A n tioxid en ts. C a rnitin e and Choline as pu ta tive ergogenic aids. In t J Sj>orls N u tr 1995: 5: S120-31. 19. Lukaski HC. M icron u trien ts (m agnesium , zinc and cop­ p er) : A r e m ineral supplem ents needed fo r a th letes? In t J S ports N u tr 1995: Suppl ( 5 ) : S74-83. 20. Balsom P D . Soderlund K . E k b lom B. Creatine in humans with special reference to creatine supplem entation. Sports Med 1994; 18 ( 4 ) : 268-280. 21. G reenh a ff P L . Creatine and its applica tion (ts an E rgogenic A id . In t J Sports N u tr 1995: Suppl ( 5 ) : S 10 0 -1 10. CD 22 SPORTS MEDICINE SEPTEMBER 1997 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. ) G LEN BARR PECIALIST PUBLICATION GLENBARR PUBLISHERS Private Bag X14, Parklands 2121. Tel: (011) 442-9759 Fax: (011) 880-7898 SOUTH AFRICAN JOURNAL OF SPORTS MEDICINE vol a Nd C July IB M S 0 / > f r , R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) ENROLLMENT FORM I am interested in attending the FIRST South African Podiatry C ongress on O ctober 4, 1997, at the Volkswagen Conference Centre, Midrand. FIRST NAME: ............................................... SURNAME: .................................................... TITLE: ............................................................. AD D R E S S :....................................................... ................................. CODE: ........................ TEL: ........................... FAX: .......................... If you wish to present a paper, please send your resume and presentation to the S.A.P.A. Executive P.O. Box 1011 Rosettenville 2130 to arrive not later than September 1, 1997. Assisted travel for accepted papers. COST S.A.RA. member R100,00 Non-S.A.P.A. members R140,00 Receipt given on request. Only cheques or postal orders. All paym ents to be made to the S.A. Podiatry Association. I enclose my cheque of R ............................. Post to: Mckenzie Dickerson Int. P.O. Box 53101 Troyeville 2139 Tel: (011) 402-3240 • Fax: (011) 402-0164 Final programme will be posted to all dele­ gates August/September. THE SOUTH AFRICAN PODIATRY ASSOCIATION The FIRST South African Podiatry Congress October 4, 1997 Volkswagen Conference Centre M id rand 08:00 - 18:00 O v e r 20 Supplier Exhibits for the Podiatry Profession Refreshments & 4-course lu n c h BEST PAPER AWARD Congress organized by M ckenzie Dickerson International 24 SPORTS MEDICINE SEPTEMBER 1997 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. ) OAS/TO / CMPS BA Tired of Hotels? In the heart o f Camps Bay this beautiful villa invites you to share its panoramic sea & mountain views. 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