S O U T H A F R I C A N J O U R N A L O F SPORTS MEDICINE SPORTGENEESKUNDE 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 IA T IO N T Y D S K R IF V A N D IE S.A. S P O R T G E N E E S K U N D E -V E R E N IG IN G N a tio n a l A d v iso ry B o a rd E d ito r in C hief: C live N oble A sso cia te E d itors: P r o f I D N oakes D a w ie van Velden A d visory B oard: Traumatology: Etienne Hugo Physiotherapy: Jo yce M orton Nutrition: M ieke F aber Biokinetics: M artin Schwellnuss Epidem iology: D erek Yach Radiology: Alan Scher Pharmacology: John Straughan Physical Education: Hannes B otha Internal M edicine: F rancois R e lie f In tern a tio n a l A d v iso ry B oard L yle J M icheli Associate Clinical Professor o f Orthopaedic Surgery Boston, U SA C h ester R K yle Research Director, Sports Equipment Research A ssociates California, U SA P r o f H C W ild o r H ollm ann President des D eutschen Sportarztebundes K oln, W est Germany H o w a rd J Green Professor, Department o f K inesiology Ontario, Canada G eorge A Brooks Professor, Department o f Physical Education California, U SA N eil F G ordon Director, Exercise P h ysiology Texas, U SA Edm und R Burke A ssociate Professor, B io lo g y Department, U niversity o f Colorado Colorado, U SA G raham N Smith P hysiologist G lasgow , Scotland V O L U M E 7 N U M B E R 1 FE B /M A R C H 1992 CONTENTS Editorial Comment Health care for the future sportsmen o f South Africa ........................................................................ 3 Cricket Cricket injuries w hile on tour with the South African team in India - C Smith ......................... 4 Physiology Notes N otes on muscle spindles - M Frescura ........... 9 Nutrition Macro-nutrient intake o f various athletes as reported in the literature - M Faber ................. 11 Physiotherapy A review o f the McConnell approach to the management o f patellofemoral pain - J Morton .................................................................. 17 Restriction o f ankle and foot movements using the standard elastic ankle guard - 1 Seels, J Begley, F Futcher and J M itchell ................. 20 News SASM A N ew s .................................................. 25 J O U R N A L O F T H E S O UT H AFRICAN SPORTS M E D IC IN E ASSOCIATION 2 6 9 W E S T A V E N U E H E N N O P S M E R E V E R W O E R D B U R G , 0 1 5 7 SASMA Photographs courtesty o f the Image Bank T h e J o u rn a l o f th e S A S p o r ts M e d ic in e A s s o c ia tio n is p u b lis h e d b y M e d p h a r m P u b lic a tio n s , 3 rd F lo o r N o o d h u lp lig a C e n t r e , 2 0 4 B H F V e rw o e r d D riv e , R a n d b u r g 2 1 9 4 . P O B o x 1 0 0 4 , C ra m e r- v ie w 2 0 6 0 . T e l: (0 1 1 ) 7 8 7 - 4 9 8 1 /9 . T h e v ie w s e x p re s s e d in th is p u b lic a tio n a re th o s e o f th e a u th o rs a n d n o t n e c e s s a rily th o se o f th e p u b lis h e rs . Printed by The Natal Witness Printing and Publishing Company (Ply) Lid 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 d ic A l e r t SPEAKS FOR YOU WHEN YOU CANNOT 49$ Medic Alert FOR MORE INFORMATION, CONTACT YOUR DOCTOR OR PHARMACIST ® # A PROJECT OF THE LIONS OF SOUTHERN AFRICA PARKE-DAV 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. ) EDITO RIAL HEALTH CARE FOR THE FUTURE SPORTSMEN OF SOUTH AFRICA In o rd er to m ake progress in any field o f m edicine, research at both clinical and scientific levels is necessary. Sports m edicine is in the sam e situation. Often established techniques have to be dis­ carded as new er ones take their place. Ideas becom e out-m oded because careful clinical o r scientific investigation shows that they are inco rrect. U nfortunately, the new er in­ vestigations are often expensive and in the South A frican context, they may be too e x ­ pensive for the general public. F o r exam ple, M agnetic Resonance Im ­ aging (M R I) is utilised worldwide (in the developed countries) as an accurate d ia g ­ nostic tool in most parts o f the body. This investigation costs in excess o f R1 000 in South A frica. But it may be necessary, e .g . using the MRI Scan it has been shown that in anterior cru ciate ligam ent tears o f the knee jo in t, bone on the low er end o f the fem ur may also be dam aged. R etrospectively arthroscopic surgery, in itself an expensive technique, has been shown to m ake diagnoses of internal d e­ rangem ents o f the knee with far g reater a c ­ curacy than before. N ot only this but surgical treatm ent through the arthroscope has m arkedly reduced the incidence o f o steoarthritic dam age to the jo in t caused by previous open surgical techniques. This will cause a trem endous reduction in long term m orbidity and the possibility o f having an expensive total knee replacem ent in the future. At the present stage m ore and m ore black athletes are jo in in g m edical aids and will be able to afford first w orld m edicine. N ew er legislation may well greatly increase this num ber. O bviously the level o f good health care for all sportsm en is the most desirable but unfortunately the cham pions are in an elitist category and may well req u ire a higher level o f m edical skills and investigations. T h ere is no w ay, for exam ple, that a top class sportsm an with a torn m eniscus can and should have to w ait for a hospital bed as is the situation in state social m edicine which often happens at the present stage. T he future holds interesting prospects for sportsm en and sports m edicine. Dr C live N oble, M BBChB, FCS (SA). E d ito r-in -C h ief --------------------------------------------------------------------------- 3 SPO RTG ENEESKU N DE VOL. 7 NO. 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. ) CRICKET CRICKET INJURIES WHILE ON TOUR WITH THE SOUTH AFRICAN TEAM IN INDIA C Smith Keyw ords: International tour, cricket injuries, physiotherapy. ABSTRACT This paper briefly discusses the injuries encountered and their management during the South African Cricket Team's inaugural 8 day tour o f India in November 1991. The team consisted o f a squad o f 14 players and the team physiotherapist. The tour marked the return o f South Africa to the international cricket arena after 21 years o f isolation. The most commonly injured area was the lower limb (64%) with the bone/ joint structures accounting for 7 (50%) o f the injuries. Continued research and interest in this field will contribute towards a better understanding and management o f cricket related injuries. IN T R O D U C T IO N Cricket is a sport which is widely played throughout this country and the world, yet un­ like running, cycling, sw im ­ ming or rugby, little research has been done on the varied aspects o f the game. However, the last few years has demon­ strated a growth o f interest in cricket which has specifically resulted in a recent spurt o f local paper publications. The specific areas looked at include the injuries related to cric­ ket, ‘•2-3 injuries associated with cricket tours,1 the com- Craig Smith, BSc Physiotherapy, Bsc (Med) (Hons) Sports Science. UCT Sports Injuries Clinic, University o f Cape Town. plex motor skills o f the crick­ eter (batsman)4 and anthro­ pometric profile and body com ­ position o f cricketers.5-6 A fair amount o f other published material on cricket injuries al­ ready exists in the literature, mostly eminating from Aus­ tralia.7'12 Even so, very little data has been captured on cri­ cket injuries associated with touring teams with only one publication known to be re­ ported on this top ic.1 Hopefully, this is changing in South Africa, as its cricket o fficia ls have cham pioned South Africa's return to the international arena with full membership status in the In­ ternational Cricket Council. This now means that South Africa can embark on tours to other countries and play host to touring countries, increasing the exposure o f its players to international competition. This will in turn have the effect o f further increasing the opportu­ nity to investigate the area o f injuries associated with tou­ ring international teams, as the research on cricket injuries in South Africa has, up till now, been confined to domestic lev el.4 The purpose o f this brief paper is thus to report on the injuries which were en­ countered during the South African Cricket Team 's inau­ gural 8 day tour to India during Novem ber 1991 and to form a base for further data collection and research on cricket injuries in this country. B A C K G R O U N D Within a day o f deciding that the South African cricket team was to tour India for 3 one-day intema-tionals, the author was informed that he was to tour with the team as physiother- 4 --------------------------------- SPO RTS M E DIC IN E VOL. 7 NO. 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. ) CRICKET GIVE THEM A SPORTING CHANCE AGAINST PAIN apist. The next two days were spent at high speed organising equip­ ment and making necessary arrange­ m ents b efo re the team met together for the first tim e. O nly one practice was possible before departing for India. On arrival in C alcutta, the first stop, the team had tw o days to recover, ad ju st to the culture shock, acclim atise and practise b efo re the first test m atch. In all, 3 one-day test m atches w ere played with rest days inbetw een each match. N one o f the players presented with any injuries w hich may have prevented them from playing the first match. B efore each p ractice session and m atch, the squad w ent through a w arm -up period o f jo g g in g , arm loosening exercises and stretching to m ain-tain o r im prove their flex i­ bility and p revent fu rth er injury. All the players w ere active p artici­ pants in their provincial cricket p ro ­ gram m es and thus did not require any form o f exercise to im prove their state o f fitness. IN JU R IE S A ND T R E A T M E N T S F o r the purposes o f this paper, an injury w as defined as any condition which required physiotherapy or medical treatm ent. Eight o f the players received treatm ent w hile 6 players did not. T he coach received treatm ent for his shoulder which had been operated on a w eek prior to dep artu re (not included in the data). T h ere w ere a total o f 14 separate injuries w hich required treatm ent. D ividing the injuries into anatom ical areas, 64% w ere to the low er lim bs, 14% to the upper lim bs, 14% to the head and neck and 7% to the tru n k and back. T h ere w ere 7 b o n e/jo in t injuries, 3 involving tendons, 1 m uscle injury, 1 ligam ent injury and 2 soft tissue injuries (bursitis and haem atom a). F o u r injuries occurred w hile bat- SPO RTG E N E ESKU N D E VOL. 7 NO. 1 5 In soft tissue in ju rie s ... FROBEN lOO helps restore e a rly patien t m obility # Convenient 15 tablet, 5 d a y A C T IO N PACK # Suitable for competitive sportsmen and women # Effectively relieves pain # Effectively relieves swelling # Peripheral action avoids injury abuse in sport Rx Froben 100 t.d.s. Also available in suppositories. BOOTS P H A R M A C E l'T IC A LS (PTY) LTD 4 0 Electron Avenue, Isando 1 6 0 0 Your gam e plan agalnsf pain Flu rb ipr ofe n 10 0m g 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. ) CRICKET T a b le 1: Anatom ical injury profile Anatomical Site Head and neck (14%) 2 Upper limbs (14%) Hand 1 Fingers 1 Trunk and back (7%) 1 Lower limb (64%) Hip 4 Thigh 1 Knee 2 Lower leg 1 Ankle 1 Total 14 Injured Structures Bones/joints 7 Muscles 1 Tendons 3 Ligaments 1 Soft tissue 2 Total 14 ting, 4 as a result o f bow ling and 6 while fielding. One player w as treated for 5 separate injuries, three players for 2 in­ ju rie s , and 5 players fo r a single injury. O nly 1 injury was considered a major injury which prevented the p layer from playing again on the tour. T he m ost com m on site in­ ju re d w as the hip region w here 4 injuries occurred. One-player developed a m inor psoas b u r­ sitis w hich w as treated with ice, ultrasound and laser. H e did not request any further treatm en t fo r this injury as he could play again w ithout pain. T he o th er hip injuries involved tw o players during the last g am e, o n e straining his right psoas tendon and left rectus fem oris tendon and the o th er p layer his rig h t rectus fem oris tendon. T w o reasons exist to ex ­ plain the cause o f these inju­ ries. F irstly , both p lay er had o th er m inor injuries involving the sam e lim b. T h ese injuries m ay h a v e s u b c o n s c io u s ly caused the players to co m p en ­ sate fo r the use o f th eir injured m uscles by overex ertin g and straining supplem entary m us­ cles o f the sam e lim b. T he second reason is that the venue for the final gam e w as an ath ­ letics stadium w hich included a tartan running track w ithin the field o f play. T h ese two p la y ­ ers fielded near to the boundary for m ost o f the gam e and thus had to, at tim es, field the ball by running on the tartan track. It is proposed that the activity o f having to quickly start ru n ­ ning and then stop to field the ball as well as changing d irec­ tion w hile using spiked cricket boots on the tartan track may have lead to the hip injuries involving the psoas and rectus fem oris tendinous insertion sites. T w o hand injuries w ere o b ­ served. O ne p lay er received a blow with the crick et ball to his right hand w hile batting, re ­ sulting in an undisplaced crack fracture o f the base o f the sec­ ond m etacarpal bone. He w as forced to w ithdraw from the team for the final gam e and his hand w as strapped for the duration o f the to u r and treated daily w ith ice, laser and an al­ gesics when required. T he o th er p lay er w hose position involved much catching o f the ball sprained the distal inter- phalangeal jo in t o f the little finger. His function in the team necessitated that he play all gam es and he w as treated w ith ice, jo in t m obilisations, laser and ultrasound. T w o p la y e rs d ev elo p ed sym ptom s arising from the cervical spine. O ne complained o f unilateral headaches with retro and supero-orbital eye pain. This w as treated with m obilisations to the u pper cer­ vical spine and acupressure to relieve pain and tension in the surrounding m uscles. T he sym ptom s w ere com pletely relieved a fter 2 days. T he other p lay er flared up a troublesom e cervical spine injury which had plagued him fo r a few years. H is injury w as related to his bow ling technique w here upon d elivery o f the ball he w ould thrust his neck from the neutral position to right side flexion and then sharply back to left side flexion when re ­ leasing the ball. He ex p eri­ enced pain and tension in the trapezii, levator scapulae and rhom boides m uscles and which w as also aggravated by po o r sleeping posture. He too re­ sponded favourably to spinal m obilisations and soft tissue acupressure. One o f the bowlers presented w ith a history o f mild Scheur- m ann's disease and complained o f lum bar disco m fo rt, stiffness and tension in his low back m uscles. H e w as treated reg u ­ larly w ith soft tissue m assage and acu p ressu re to relieve the m uscle tension, spinal m obili­ sations and ultrasound. E m ­ phasis was also placed on warm­ up back exercises before he 6 ------- ------------------------------ SPO RTS M E DIC IN E VOL. 7 NO. 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. ) CRICKET GIVE THEM A SPORTING CHANCE AGAINST PAIN bow led and stretching his ham string m uscles. T w o players had injuries in vol­ ving the knee jo in t. One player received a blow with the ball through the pro tectiv e padding to the patella fem oral jo in t w hile the other had a grade 1 m edial collateral ligam ent sprain. Both responded well to treatm ent. O ne p layer was struck on the ankle w ith the cricket ball resulting in periosteal and su­ p erficial soft tissue bruising. He was treated with ice, ultrasound and laser therapy. A nother player sustained a slight strain to his calf m uscle w hich w as treated with cross-friction m assage, ultrasound and laser stim ulation. F inally, one o ther p lay er was struck on the thigh through his padding leading to a superficial haem atom a. This too was treated with ice, ultrasound and laser. D IS C U S S IO N T he injuries associated with the South A frican crick et team s' inau­ gural 8 day to u r to India have been presented. A total o f 14 injuries w ere encountered w ith only eight o f the players requiring treatm ent. A lthough the to u r was b rief in d u ra­ tion, these injuries need to be re­ ported to supplem ent the already existing, yet lim ited data on cricket injuries. In com parison with o ther tours o f sim ilar nature, the num ber o f injuries appear to be quite low . On a previous to u r o f 5 weeks to this c o u n try ,1 a total o f 40 injuries w ere incurred at an incidence o f 2,5 in­ ju re s per player. This tour enco u n ­ tered 14 separate injuries at an incidence o f 1 injury per player. This statistic seem s to be a lot low er than the previously documented tour, yet if the incidence o f injury on the previous tour is assessed for only those players w ho w ere injured, then it appears clo ser at 1,8 per SPO R TG E N E ESKU N D E VOL 7 NO. 1 In soft tissue in ju rie s ... FROBEN 100 helps restore e a rly patien t m obility # Convenient 15 tablet, 5 d a y A C T IO N PACK # Suitable for competitive sportsmen and wom en % Effectively relieves pain % Effectively relieves swelling # Peripheral action avoids injury abuse in sport Rx Froben lOOt.d.s. Also available in suppositories. A k BOOTS I'HAKM AL'Kl T Il'A I.S IPTY) LTD 4 0 Electron Avenue, Isondo 1 6 0 0 Your gam e plan against pain Flu rb ipr ofe n 10 0m g 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. ) CRICKET T a b le 2: Physiotherapy treatment m odalities Players treated 8 T reatments given 31 Treatment modalities Electrical: Interferential 1 Ultrasound 9 Laser 9 Total 19 Manual: Mobilisations Peripheral joints 8 Spinal joints 6 Massage Non-specific 5 Cross-frictions 2 Acupressure 10 Total 31 Strapping 5 Ice 14 Exercises 3 Injections (Voltaren) 2 Total 24 Total treatment modalities 74 player. T h e o th e r p o int which needs to be considered is that this to u r w as alm ost one fifth the duration o f the previous tour and only 3 m atches in total w ere played. T ab le 1 show s that the inci­ dence o f injury was found to be greatest in the low er limb (64% ) follow ed by the head and neck (14% ) and the upper lim b (14% ). T h e trunk and back w ere least involved co n ­ tributing only 7% o f the in ju ­ ries. T h e prev io u s crick et to u r1 dem onstrated sim ilar results w ith m ost injuries occu rrin g in the lo w er lim b (4 6 % ), follow ed by the u pper lim b (2 7 % ), the back and trunk (19% ) and the head and neck m aking up 8% o f the injuries. S tre tc h 's 3 data on cricket injuries appears slightly d iffe r­ ent and m ore evenly spread, as he show ed that in serious inju­ ries during the dom estic sea­ son, 30% w ere to the low er lim bs, 32% to the upper lim bs, 20% to the head and 18 % to the back and trunk. T h ese figures w ere slightly varied for less serious injuries with 27% to the low er lim bs, 43% to the upper lim bs, 16% to the head and 14% to the back and trunk. W hat can be inferred from these figures is that the inci­ dence o f injury to the d ifferent areas o f the body encountered during dom estic cricket and w hile on tour may d iffer quite considerably and thus special preparation should be m ade for this. T hese results also suggest the need for specific and in d i­ vidualised pro g ram m es to be prepared for each player during the off-season and before em ­ barking on international tours o f any nature. Batting and bow ling each accounted for 29% o f the inju­ ries with fielding m aking up the rem ainder (43% ). T hese figures com pared with the p re ­ viously reported to u r 's unpub­ lished d a ta ,1 show ing that 25% o f the injuries resulted from batting, 39% bow ling and 36% fielding. T he study on cricket injuries during the dom estic season3 found that 42% o f inju­ ries occurred while batting, 33% w h ile b o w lin g , w h ile o n ly 19% from fielding. F o r the 8 players treated, 31 treatm ents w ere given using 74 treatm ent m odalities (Table 2). T he m ost com m on m odali­ ties given w ere those involving manual treatm ent techniques, follow ed by electrical m odali­ ties, ice and then strapping p rocedures. C O N C L U SIO N As crick et in o u r country can now only go from strength to strength, it is hoped that this data will co n trib u te tow ards the scientific pool o f evidence that already exists regarding the gam e. I f the standard o f crick et is to be m aintained and im proved, then so too must the input from research support this philosophy. T h e physical dem ands o f the gam e and the unnecessary injuries w hich are so often suffered need to be m inim ised, especially when com peting for ones country at international level. T his can be achieved through p lay er and coach education, as well as the m edical m anagem ent team keeping abreast with the latest scientific trends and in fo rm a­ tion. H opefully this short paper will add to the already existing know ledge and also rem ind us not to forget that "the m essage o f m odern sport is that you ignore science at yo u r own p e ril" .4 □ References on request. 8 -------------------------------------- SPO R TS M E DIC IN E VOL. 7 NO. 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. ) PHYSIOLOGY NOTES NOTES ON MUSCLE SPINDLES M F re sc u ra Figure 1: Schematic diagram o f muscle showing a muscle spindle and nerve pathways to and from the central nervous system (CNS). Did you ev er think that v olun­ tary m uscular m ovem ents are driven by a servom echanism sim ilar in m any respects to the au tom atic feedback system em ployed to control pow er- assisted steering in a c a r? 1 I shall en d eav o u r in this article to dem o n strate such a view point through a b rie f discus­ sion o f the role o f muscle spindles. M uscle spindles are m uscle sense organs located am ongst the fibres o f a m uscle with an im portant role in controlling m uscular m ovem ent. T hey are com posed o f long thin bundles o f m odified m uscle fibres with sensory nerve endings attached to a non-contractile central region. S pindles and main m uscle fibres are in n er­ vated by independent m otor nerve fibres (F ig u re 1). T h e sensory endings o f the specialised central region are excited by being stretched. Stretching initiates a d is­ ch arg e o f nerve im pulses to the central nervous system which produces an autom atic co n ­ traction in the main m uscle - a M Frescura Medical Researcher MRC PO Box 19070 TYGERBERG 7505. stretch reflex. T he spindle can be stretched either by a stretch in the main muscle as when an ex tra load is im posed on a m uscle already bearing a w eight (F igure 2) o r by a co n ­ traction o f the contractile com ponent o f the spindle (F ig ­ ure 3). T he stretch reflex m echanism will cause the main m uscle to adjust its contraction appropriately. W hen co n trac­ tion o f a spindle is follow ed by a contraction o f the main m uscle, the stretch on the sen­ sory region o f the spindle will be relieved (F ig u re 4) and no fu rth er nerve im pulses will be d ischarged. T h e spindle, in effect, is sensitive to the d if­ ference in length betw een it­ self and the main m uscle fibres. By this sensitivity it behaves as a m isalignm ent d etector for au tom atic com pensation. H um an m uscles, in general, can be shown to be under the influence o f the stretch reflex w henever engaged in steady co n tractio n s o f a voluntary na­ ture. T his invaluable self­ regulating pro p erty o f a m uscle ------------------------------------------------------------------------------ 9 SPO R TG E N E ESKU N D E VOL. 7 NO. 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. ) PHYSIOLOGY NOTES Figure 2: A stretched muscle (long arrows) stretches the sen­ sory region o f the spindle dis­ charging a nerve impulse (dotted arrow line). Figure 3: Contraction o f the contractile spindle ends (short arrows) also stretches the sensory region discharging a nerve im­ pulse (dotted arrow line). Figure 4: Contraction o f the main muscle (long arrows) relieves the stretch on the spindle (short ar­ rows) silencing the nerve impulse. enables it to adjust au to ­ m atically to changes in load. It is the m uscle spindle sensor, by m onitoring length differentials between itself and the main muscle which confers this subconscious self-regulating pro p erty on o u r m uscles. D uring continuous m ove­ m ent, the spindle contracts at the desired rate so that its sensory endings will only be excited if the main muscle does not keep up with the spindles. C ontraction o f the spindle e f­ fectively drives the main m uscle by m eans o f the stretch reflex which sw itches on m ore contraction if the rate o f short­ ening loses synchrony with the spindle. In sum m ary, the stretch reflex controlled by the spindle is an autom atic feedback re ­ sponse, a follow up serv o ­ m e c h a n is m a n a lo g o u s to pow er-assisted steering in a car. C ontraction o f the spindle corresponds to turning the steering w heels, shortening o f the main m uscle to turning o f the road w heels, with the spindle sensory ending acting as the m isalignm ent detector. A subject can dem and o f his muscles either a certain limb position o r a rate o f change o f limb position and his dem ands will be autom atically met by his m uscle servo. REFERENCES 1. PA Merton. In: Readings from Scientifice American. Freeman: San Francisco, 1972. Notes on m uscle spindles is the last in a series o f three articles w ritten by M F rescu ra P h D , M edical R esearcher at M R C , T ygerberg. T he first tw o articles in the series w ere titled: 1. N otes on the physiology o f muscle contraction - SAJSM, volum e 6 , N o 4. 2. Isometric and isotonic muscle c o n tr a c tio n s - S A J S M , V olum e 6, N o 5. ERRATUM Notes on the physiology of muscle contraction SA Journal o f Sports Medicine Vol 6 No 4. In the last paragraph of the above m entioned a rticle , th e w o rd "a syn ch ro n o u sly" w as erroneously printed as "s y n c h ro n o u s ly ". W e apologise to our readers and the author. 10 -------------------------------------- SPO R TS M EDICIN E VOL. 7 NO. 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. ) NUTRITION MACRO-NUTRIENT INTAKE OF VARIOUS ATHLETES AS REPORTED IN THE LITERATURE M ieke F ab er A thletes tend to experim ent with d ifferen t dietary regim es to find the optim um athletic diet. T h ere is how ever, no evidence that such special d ie­ tary regim es im prove p erfo rm ­ ance. D ietary studies have indicated that there is ex trem e variability in the dietary in­ takes o f a th le te s.1'3 Van E rp -B aart e t aP stud­ ied the nutrient intake o f v ari­ ous endurance and strength athletes. M ale athletes had a mean energy intake ranging from 12 ,1 -2 4 ,7 M J/day. F e ­ m ale athletes had an energy intake ranging from 6 ,8 -1 2 ,9 M J/day. M ale en durance ath ­ letes had the highest energy intake w hile fem ale strength athletes had the low est energy intake. A protein intake o f 1,2 g /kg body w eight for men and 1,0 g /k g body w eight for w om en is recom m ended. M ost o f the studied athletes fulfilled these recom m endations. C y ­ clists and runners averaged Mieke Faber Research Institute fo r Nutritional Diseases Medical Research Council m ore than 55 % o f the energy as carbohydrates w hile the carb o ­ hydrate intake o f strength a th ­ letes was as low as 40% E. Brotherhood4 has sum m a­ rized the nutrient intake o f athletes as reported by several authors. This sum m ary shows that there is a w ide range o f energy intake betw een athletes. In general they appear to be high energy consum ers, al­ though some o f the energy in­ takes seem to be surprisingly low. E ndurance athletes co n ­ sum e at least 50 k cal/k g /d ay , w hile those involved in in ter­ m ittent o r high pow er activity sp o rts co n su m e less than 50 k cal/k g /d ay . It should h o w ­ ever, be kept in mind that the latter athletes can weigh b e ­ tween 20 and 50% m ore than the endurance ath letes.4 B arr5 sum m arized the nutrient intake o f fem ale athletes and she cam e to the conclusion that fem ale athletes consum e on the average 2069 kcal. B rother­ hood4 sum m arized that athletes consum e approxim ately 16% o f the energy as protein (al­ though in som e cases it w as as high as 3 6 % E), 36% o f the energy as fat and 46% o f the energy as C H O . This is in ag reem en t with the values found by Barr5 when she sum ­ m arized the nutrient intake o f fem ale athletes. She found that fem ale athletes consum ed on the average 15% protein, 36% fa ta n d 4 9 % C H O . T h ere w ere , h ow ever, big variations in en­ ergy distribution betw een d if­ ferent ath letes.4 5 W hen repor­ ting nutrient intakes athletes can not be grouped together, but each specific activity group should be studied separately. C Y C L IST S In co n trast with the study o f V an E rp-B aart e ta P who found that fem ale cyclists consum ed a high energy diet, another study reported low energy intakes in highly trained fem ale cyclists. This study reported an energy intake o f 85% o f the RDA. Sixty p ercent o f the energy intake w as supplied by carb o ­ hydrates, 14% by protein and 26% by fat. N orm al album in levels indicated that the p ro ­ tein intake was 1,1 g /k g body w eight in this study w as suffi­ cient to m eet the protein needs o f these a th lete s.6 H igher en ­ ergy intakes o f 26282 kJ per day have been reported in m ale cyclists. T hese m ale cyclists w ere shown to have a nibbling eating pattern , characterized ------------------------------------------- 11 SPORTGENEESKU N DE V O L 7 NO. 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. ) N U T M T K O N by frequent eating and drink­ in g .7 BO D Y B U IL D E R S It has been found that body builders follow a high energy diet.8,9 In the study done by Kleiner et aP the mean energy intake o f male body builders was 5739 kcal, with the highest energy intake a very high 19760 kcal. H ow ever, directly prior to a competition body builders cut down on their energy in­ take. The mean energy intake o f males before a competition was 2347 kcal and that o f fe­ males 1535 k ca l.10 Although it has been found that body builders consume a high protein diet (as high as 31 % E ) ,8,9,11 a high percentage o f these athletes supplemen­ ted their diets with high protein pow ders.9,12 Compared to other athletes with similar en­ ergy intakes, body builders consumed a high protein diet expressed in terms o f g protein per kg body weight. This can be explained by the use o f extra protein supplements.3 Before a competition body builders follow a higher protein diet (34% E for males and 26% E for fem ales). For the males and the females respectively, these protein intakes equal 2 ,4 and 2 ,0 gm o f protein per kg body w eig h t.10 It has been stated that body builders fo l­ low an even higher protein in­ take months prior to a com peti­ tion (40-50% o f the energy in­ take).13 Conflicting data regarding the fat and cholesterol intake o f body builders has been repor­ ted. W hile Baldo-Enzi e t a lu reported that these athletes consumed a diet low in fat (less than 30% E ), Faber e t aP found that body builders con­ sumed a diet high in fat (up to as high as 46% o f the energy in­ take). Before a competition body builders cut down on their fat intake. Their fat intake be­ fore a competition was as low as 1 5 %-16% E for men and 1 3 % -14% E for w om en.9,10 This high protein, low fat in­ take was maintained through the consumption o f mostly white chicken meat, lean fish, egg whites and white tuna canned in water. Very few body builders consumed red meats or dairy products before a com petition.10 Faber e t aP reported that body builders consume a diet high in cholesterol due to a high egg intake (up to as high as 3992 cholesterol mg per day). The maximum cholesterol in­ take o f body builders studied by Kleiner e t aP was 9393 mg per day. In contrast with this, Baldo-Enzi e t a ln reported a much lower cholesterol intake in body builders (477 mg). This low er cholesterol intake was also reported before a competi­ tion .10 B A L L E T D A N C E R S Fem ale ballet dancers con­ sumed too little energy. The mean energy intake o f female ballet dancers was 71,6% o f th eR D A . An alarming 20% o f the dancers consumed less than 50% o f the R D A .14 These low energy intakes are not only seen in adult dancers, but also in adolescent dancers. A do­ lescent dancers consumed an average o f 350 kcal less each day than is recommended to support normal grow th.15 One- third o f dancers reported having eating problems (self- reported anorexia nervosa or bulimia).16 Dancers believe that carbohydrates are high energy foods. The carbohydrates in their diets are mainly simple rather than com plex carbohy­ drates. 15 IC E SK A T E R S Another group o f athletes for whom thinness is a require­ ment, are ice skaters. In a study done on com petitive ice skaters it was found that the fem ale skaters had a very low energy intake (55% o f the R D A ). The low est energy in­ take was a very low 373 kcal per day. Forty-eight percent o f the females had EAT scores within the anorexic range. These low energy intakes and high EAT scores were not found in the male ice skaters, indicating that male and female ice skaters should be studied as separate groups. The author o f this study concludes that this study has shown the need for nutritional education for com petitive ice skaters.17 G Y M N A ST S Another sport where leanness is considered as an essential requisite is gymnastics. Not only should she be lean for practical reasons, but also for aesthetic reasons. In order to maintain these lo w body weights young female gymnasts have reported a low energy in­ take o f 1552 k ca l.18 A group o f older gymnasts (mean age 19,2 years) also averaged a low 12 --------------------------------- SPORTS MEDICINE VOL. 7 NO. 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. ) NUTRITION energy intake. Their mean intake o f 1827 kcal per day did not meet the R D A for energy intake.19 Gymnasts have re­ ported to have a low er energy intake than inactive controls, but expressed as kcal/kg body weight there was no difference between the gymnasts and controls.20 Their energy dis­ tribution has been reported to be 15,3% E protein, 4 7 ,7 % E CHO and 36,0% E fat.18 This kind o f energy distribution was also found in a group o f high school gym nasts.21 The young female gymnasts studied by Benardot et aP2 reported a slightly higher carbohydrate intake (approximately 53% E) and a slightly low er fat intake (approximately 32% E). There was however, a w ide variation in CHO intake, ranging from 9 7 ,7 to 3 7 7 ,8 g/day. Only two o f the gymnasts did not meet the R DA for protein. RUNNERS Runners reported significantly higher total energy intake than sedentary controls. The male runners averaged an energy intake o f 2950 kcal w hile the female runners averaged 2386 kcal per day.23 This range o f energy intake by fem ale run­ ners were also reported by Duster et aP4 The leaner run­ ners consumed 40-60% more kcal/kg than the fatter controls. The increased calorie intake by runners appeared to be primar­ ily from fats and carbohydrates, however, expressed in terms o f percentage energy distribu­ tion, there was no difference between the carbohydrate and fat intake o f the runners and the sedentary controls. The run­ ners averaged a fat intake o f 40,8% E (SD = 6 ,7 ) for the males and 41,4% E (S D = 5 ,8 ) for the females. Carbohydrate intake expressed in terms o f percentage o f total energy in­ take for the male and female runners were 39,8% E (SD = 7 ,7 ) and 39,5% E (SD = 6,9) respectively.23 These high fat intakes were confirmed by Manore et aP5 in female run­ ners, but they found that the female runners had a slightly higher CHO intake o f approxi­ mately 50% E. Deuster et aP4 reported an even higher CHO intake o f 55 % E in highly trained female runners, accompanied by a lower fat intake o f 32 % o f the energy intake. Kirsch et aV not only confirmed the higher energy intake in runners as compared to sedentary con­ trols, but they also found that cyclists have a higher energy intake than runners. The total energy intake o f the runners and cyclists exceeded the basic metabolic rate o f 103% and 250% respectively. Although the study o f Nieman et a lli confirmed the higher energy intake in runners (2526 kcal for males and 1868 for females) as compared to the average popu­ lation, these differences were very small, especially for men (4% for men and 16% for w om en). However, their en­ ergy intake fell below the levels recommended by the Food and Nutrition Board for men and women doing light work (2700 and 2000 kcal respectively). Energy intake, expressed in terms o f kcal per kg bodyweight increased with an increase in km run per w eek .18 Although Blair et aPi as w ell as Pate, et aP6 could find no difference in energy distribution between runners and sedentary con­ trols, the study by Nieman et alli indicated that runners con­ sumed far less energy as fat and more energy as CHO as the general population. The male runners averaged 30,9% E fat and 51,8% E CHO w hile the fem ales averaged 32,0% E fat and 52,7% E CHO. These low er fat intakes and higher CHO intakes by runners were confirmed by a later study.26 Cholesterol intake for males as w ell as females fell below the recommended maximum o f 300 mg per d a y .18,26 The cho­ lesterol intake and the intake o f saturated fatty acids o f the runners were much lower than the cholesterol and saturated fatty acid intake o f the average American population.18 W hen asked about the changes that they have made in their diets since they have started running, the runners stated that they consumed more fruits, vegetables, whole grains, poultry and fish and less red meat, eggs, salt and fats.18 The high fibre intake by highly trained runners reflected the consumption o f large quan­ tities o f fruits and vegetables.24 Although none o f the runners studied by Manore et aP5 were vegetarians they generally consumed less than 3 oz o f meat, fish or poultry per day. In a study done on the feeding patterns o f endurance athletes, it was found that runners showed a nibbling pattern, characterized by frequent eat­ ing and drinking.7 SWIMMERS Young fem ale swimmers con­ sumed 21,5% more energy than Continued on p a g e 16 -------------------------------------- 13 SPORTGENEESKUNDE VOL. 7 NO. 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. ) [S3] Relifen 500 tablets 500 m g n a b u m e to n e . Reg no R / 3 . 1/265 W h en y o u r p a tie n t’s in pain, y o u r first responsibility is to take aw ay th a t pain. Q u ick ly . Effectively. B ut doing so could lead to unacceptable gastro­ intestinal side effects and co m b in atio n th erap y . B u t n o w , ten years o f precisely targeted m olecular research have p ro d u c e d a highly effective, n o n-acidic an ti-in flam m ato ry . Relifen. Each tablet is m ade o f 500 m g n ab u m eto n e , a n o n -stero id a l an ti-in flam m ato ry , p ro v en in n u m e ro u s d o u b le b lind studies to be as effective as o th e r b en ch m ark N S A ID s. Yet its ro u te o f action is to tally different. Relifen is a non -acid ic p ro -d ru g . In the stom ach, it is relatively inactive. It is ab sorbed from th e d u o d e n u m , into the p o rtal b lo o d supply F inally, in th e liver, it is m etabolised into a p o te n t in h ib ito r o f pro stag lan d in synthesis. R e f e r p a c k a g e i n s e r t f o r fu ll p r e s c r i b i n g i n f o r m a t i o n . F u r t h e r i n f o r m a t i o n is a v a il a b le f r o m o u r M e d ic a l D e p a r t m e n t . S m it h K lin e B c e c h a m P h a r m a c e u t i c a l s P O B o x 3 4 7 B e r g v lc i - 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. ) Relieving his pain is pretty sporting of you, old chap. But do you have to get him high on acid? T h e active m etab o lite pen etrates th e synovial fluid to reach the inflam ed site, giving effective relief of s \ m ptom s. E xcretion is by th e k id n ey s, so g astro - •nti stinal dam age th ro u g h biliary recircu latio n and reflux is unlikely. F o r effective relief from pain and inflam m ation, with less chance o f g astro -in testin al d isco m fo rt, y o u now have an ideal choice. Relifen. ^ " " ''- I t i n - SB l o g o art- t r a d e m a r k s . SB B e e c h Phar̂ c e u Z % * m 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. ) NUTRITION sedentary controls. The swim ­ mers consumed 2468 kcal per day.27 This kind o f energy intake was confirmed by a study done by Tilgner and Sch iller28 w ho found that swimmers consumed 2493 kcal which was also higher than the energy intake o f non-athletes. In a later study however, it was found that swimmers did not have a higher energy intake as compared to inactive controls.20 Percentage energy distribution was similar for the swimmers and the controls namely 49 % E to 54% E carbohydrate, 33 to 35% E fat and 12 to 15% E protein.27-28 BASKETBALL PLAYERS M a le b a s k e tb a ll p la y e r s averaged a daily energy intake o f 3558 kcal w hile fem ale bas­ ketball players averaged a daily energy intake o f 1730 kcal. Both males and females averaged similar energy distri­ butions. The energy distribu­ tion for the males was 17% E protein, 34% E fat and 48% E CHO w hile that o f the females was 16% E protein, 32% E fat and 52% E CHO. Protein was generally higher than neces­ sary. Som e o f the men had very high cholesterol intakes (as high as 1482 mg per day). Both men and women had low fibre intake. This reflected the limited consumption o f w h ole grains, fruits and vegetables.29 HOCKEY PLAYERS Field hockey players aver­ aged a daily energy intake o f 1956 kcal. Their energy distri­ bution was 15,5% E protein, 46,8% E CHO and 38,6% E fat.28 VOLLEYBALL PLAYERS The dietary intake o f female high school athletes between the ages o f 13 and 17 was determined. Eighty-one per­ cent o f the athletes indicated a concern with their weight, w hile 73% wanted to loose weight. That might be why they averaged a low energy intake o f 1799 kcal (84 % o f the R D A ). Their energy intake was lower than other teenage girls in the United States. Food consumption analysis showed that o f total servings, the milk and meat groups accounted for only about 10% each and that more than 30% came from the "others" group.30 FIELD ATHLETES One study reported the macro­ nutrient intake o f male field athletes. They averaged an energy intake o f 3528 kcal. They had an energy distribu­ tion o f 13% E protein, 28% E fat and 55% E carbohydrates.1 It should, however, be kept in mind that these field athletes were grouped together with track athletes. It was also not state whether the field ath­ letes were jumpers or throw­ ers. This is important to keep in mind since, although no die­ tary differences have been re­ ported, it was found that these athletes differ in anthropomet­ ric measurements.31 The die­ tary intakes o f throwing field athletes might be more accu­ rately displayed by those val­ ues reviewed by Brotherhood (1984). In this review the die­ tary intake o f shotputters (as reviewed by Sal tin) and discus throwers (as determined by Ward et al) are review ed. The energy intake o f these athletes was higher than that reported by Short and Short.1 The shotputters averaged an ener­ gy intake o f 4300 kcal w hile the discus throwers averaged an energy intake o f 4663 kcal. W here the track and field ath­ letes as studied by Short and Short1 consumed a diet that fulfilled the requirements for a prudent diet,32 the throwing field athletes consumed a diet that was high in fat (44% for the shotputters and 40% for the discus throwers) and low in CHO (42 % for the shotputters and 39% for the discus throw­ ers). SUMMARY It is therefore clear that there is a w ide variation in the macro­ nutrient intake o f athletes. When studying the nutrient intake o f athletes it should always be kept in mind that conflicting results have been reported for som e athletes. It should also be kept in mind that the athletes diet before a com ­ petition may differ from the usual eating pattern. Brother­ hood (1984) summarized the nutrient intake o f various ath­ letes and cam e to the overall impression that national die­ tary customs have the pre­ dominant influence on the ath­ letes' diet. He came to. the conclusion that there-is no ev i­ dence that athletes follow a more healthy diet than less active people. □ 16 -------------------------------- SPORTS MEDICINE VOL. 7 NO. 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. ) PHYSIOTHERAPY A REVIEW OF THE McCONNELL APPROACH TO THE MANAGEMENT OF PATELLOFEMORAL PAIN Joyce Morton If one asked a number o f phys­ iotherapists o f the ways in which they treat Chondromala­ cia Patellae or Patellofemoral pain, their answers would be varied from mobilization o f the patella, quadriceps strengthe­ ning exercises either isotonic or isokinetic, faradic stimula­ tion o f the vastus medialis, electrical modalities such as laser and ultrasound, ice or specific m uscle stretching. As the aim o f all physiotherapy treatment for this condition is to achieve a full range and pain free function o f the joint, if any o f the above modalities achieve this, then the aim o f treatment has been meet. H ow ever, if this is not the case and the M cConnell approach is not known to you, then you may find the follow ing o f interest. Jenny M cConnell, an Aus­ tralian sports physiotherapist, first advertised her approach in the mid 1980's. It has subse­ q u en tly b e c o m e p o p u la r throughout a greater part o f the physiotherapy world. I was amused to discover how much it is used by the British physio­ therapists in the NHO. Not, obviously, by too many sports­ men and women with acute pain, but by patients with chronic anterior knee pain. Chronic, needless to say, be­ cause it takes so long to get an appointment. BIOMECHANICS OF THE PATELLOFEMORAL JOINT The normal patella with the knee fully extended, lis later­ ally and does not touch the femoral condyles. As the tibia flexes on the femur, the patella m oves medially and at 45 de­ grees the maximum surface contact with both femoral condyles is made within the trochlear notch. As the knee continues to flex, the patella again m oves laterally so that at full flexion the lateral femoral condyle is covered by the pa­ tella. The femur and patella are separated by the articular cartilage o f the patella. The patella is stabilized by the quadriceps tendon above, the patella tendon below , the lateral retinaculum, vastus lateralis and the iliotibial tract on the lateral side and by the medial retinaculum and the vastus medialis oblique on the medial side. Should there be any mal­ alignment o f the patella caus­ ing altered mechanics, then the patella cartilage is at risk to injury. The physiotherapist divides her examination into two parts. The first is the subjective ex­ amination where the patient's pain is identified and its be­ haviour pattern is noted. Past and present history is included. The patient's shoes and sports shoes must routinely be exam­ ined for any abnormal strike pattern. In the objective examination many factors are taken into consideration including obser­ vation o f the patient standing, walking and running. One is looking at the alignment o f the lower lim b, foot posture and structure, the tibia-femoral joint and the patella-femoral joint. The patellofemoral joint reaction force is the force cre­ ated when the patella is pressed against the femur. This force increases with flexion o f the knee from 0 .5 times the body weight in walking to 3-4 times the body weight when ascend­ ing or descending stairs and 7-8 times the body weight dur­ ---------------- :---------------------- 17 SPORTGENEESKUNDE VOL. 7 NO. 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. ) PHYSIOTHERAPY ing squatting. Pain and jo in t range is carefully noted during the testing o f these m ove­ m ents as they are most likely to be painful. As it is possible that the pain may be referred from the mid lum bar spine, this too is assessed. T ightness o f struc­ tures are checked and include rectus fem oris, iliotibial band, ham strings, gastrocnem ius and soleus. T h e norm al Tibia- fem oral exam ination as well as all m ovem ents o f the patella- fem oral jo in t are m oved pas­ sively and com pared to the o th er leg. T he fact that the medial plica may cause sym p­ tom s m ust not be forgotten. O ther clinical evaluations are carried o ut including m eas­ urem ents o f the follow ing with the knee fully extended and relaxed: 1. T h e Q angle. T his is the intersection o f a line draw n from the an terio r superior iliac spine through the m iddle o f the patella, and a line draw n from the tibial tubercle through the middle o f the patella. T he norm al angle is betw een 13 and 15 d egrees. G reater o r lesser degrees may be the cause o f p atella cartilag e deg en ­ eration. 2. T h e P ate llar G lide is the passive m ovem ent o f the p atella eith er laterally o r m edially. 3. T he P atellar T ilt is the com parison o f the height o f the m edial facet o f the p a­ tella to the lateral facet o f the p atella in relationship to the underlying fem ur. U n d e r n o rm al c irc u m ­ stances they are equidis­ tant. 4. P atellar Rotation can be calculated using the infe­ rio r pole o f the patella as the guide. If the pole moves medially the patella has rotated internally and if the pole moves laterally then the patella has rotated e x ­ ternally. F inally the quadriceps m uscle itself is examined with particular em phasis on V astus M edialis O blique. V astus M edialus consists o f two parts. The proxi­ mal has large fibres directed vertically and only deviating 15 to 18 degrees from the long axis o f the fem ur. T h e distal part nam ed V astus M edialis O blique (V M O ) has sm aller fibres which are m ore h o rizo n ­ tal, deviating 50 to 55 degrees from the fem oral axis. They form the bum p readily seen and palpated when the quadriceps contracts strongly with the leg in full extension. T h e V M O m uscle is also seen on dissec­ tion , to originate partially from the adductor longus m uscle and the adductor m agnus tendon. A lthough there are n um er­ ous factors such as an incorrect Q angle which may create ca r­ tilage traum a leading to Patel- lofem orral pain o r C h o n d ro m a­ lacia patellae, Jenny M cC on­ nell postulated that the reasons m ay also be: 1. A lateral gliding o f the p a­ tella due to tightness o f the lateral structures such as the iliotibial band and the lateral retinaculum and a w eak VM O . 2. A lateral tilting o f the pa- Taping tech n ical to co n tro l p a te lla la te ra l g lid e , m ed ia l tilt a n d internal rotation. tella due to tight deep lateral retinacular fibres. 3. An incorrect rotation o f the p atella associated with a weak VM O. H er treatm en t consists o f m obilization to stretch the late­ ral retinaculum , physiotherapy m odalities for pain, stretching o f tight structures and re­ training o f the V M O . At the sam e tim e, the patient is taught to strap his p atella in such a w ay as to co rrect abnorm al tilt­ ing, rotation and gliding. The tape is applied very firm ly and is kept in position for a few hours a day. L o n g er m ay cause breakdow n o f the skin. F inally the V M O is trained to co n tract first in a non-w eight bearing p ro g ram m e o f ex er­ cises. T he instruction to the patient is to tighten the medial q uadriceps by using the ad ­ d u c to rs is o m e tric a lly w ith extension o f the knee and slight external rotation o f the hip. T rain in g is then p rogressed to w eightbearing with the knee 18 ------------------------------------------------------------------- SPO RTS M E DICIN E VOL. 7 NO. 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. ) PHYSIOTHERAPY flexed to 30 d egrees, the body w eight o v er the foot and the foot itself in mid position b ut slightly supinated. It is e x ­ trem ely difficu lt to train this m uscle w ithout co ntracting vastus lateralis. By flexing the hip, rectus fem oris is partly inhibited. F o r this reason the exercises are first done in sitting position. O nce the patien t can successfully co n tract and hold the contraction o f the V M O w ith 30 d egrees o f knee flexion, the exercises are progressed to 75 de­ grees knee flexion, then h alf squatting, three q u arte r squats and stairs w ith the m uscle w orking both concentrically and eccentrically. F in ally functional ex er­ cises are p erform ed w hile concentrating on co ntracting the V M O . P hysiotherapists are often accused o f lack o f research and although this is often true, in this case, on perusal o f the literatu re, there seem s to be adequate ev idence to support the success o f this type o f treatm ent as one way o f dealing w ith C hond ro m alacia Patellae. A clin i­ cal trial o f the M cC onnell P rogram m e for 116 patients produced excellent to good results w ithin five treatm ents o f 86 p ercen t o f patients and these results w ere m aintained for one year after cessation o f the treatm ent. Sceptics will arg u e that it is im possible to alter patella tracking by taping. H ow ever it is seen in the literature that the taping m ust be part o f the p ro g ram m e in o rd er to obtain good results. T h e subject o f the M cC onnell a p ­ proach to the m anagem ent o f C hron- drom alacia P atella, is on the program m e o f the forthcom ing congress o f the In ter­ national F ed eratio n o f M anipulative Physical T herapists to be held in A m er­ ica this year. I look forw ard to hearing the o utcom e o f the papers presented there. I f anyone w ould like m ore in fo r­ mation about the M cC onnell approach contact T h e C h airm an , S ports Interest G roup, South A frican Society o f P h y sio ­ therapy, 7 N y ala R oad, A m anzim toti 4125. References on request. SUBSCRIPTION TO SPORTS M ED IC IN E Dear Doctor, The characteristic that distinguishes a profes­ sional from an educated person is the professional person's desire and responsibility to stay abreast o f the development o f his or her field o f expertise. The halflife o f our professional knowledge is about 3 years, and for this reason it is vitally important to continuously refresh and supplement our knowledge. Sports M edicine, the official mouthpiece o f the SA Sports M edicine Association, has over the years becom e a treasured source o f knowledge for the health care professional in the sports medicine arena. The journal features not only original research papers and articles by leading specialists in sports medicine, but also current news and relevant abstracts. Your subscription to Sports M edicine is an investment in your future o f the health care profession. W e count on your continued support. Name: Address: C o d e :......................... Tel: Enclosed please find my cheque/postal order payable to SASM A for: • R75 for FU L L MEMBERSHIP to SASM A (This includes receiving Sports M edicine free o f charge). • R75 for ASSOCIATE MEMBERSHIP to SASM A (This includes receiving Sports M edicine free o f charge). • R50 for STUDENT MEMBERSHIP to SASMA (This includes receiving Sports M edicine free o f charge). • R 27,50 + V AT (R 30,25) for subscription to Sports M edicine. ----------------------------------------------------------------------------- 19 SPO R TG E N E ESKU N D E VOL. 7 NO. 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. ) PHYSIOTHERAPY RESTRICTION OF ANKLE AND FOOT MOVEMENTS USING THE STANDARD ELASTIC ANKLE GUARD I Seels, J Begley, F F u tc h er and J Mitchell ABSTRACT A pilot study was conducted to compare the range o f movement o f ankle dorsiflexion and plantarflexion, and foot inversion, without and with the use o f a standard elastic ankle guard. A sample o f nine normal, healthy, physically active, Caucasian males, aged 19 to 21 years, with no history o f ankle injuries, was used. The results o f this study showed no significant differences (p = 0,05) between the ankle and foot movements performed without and with the use o f the ankle guard in any o f the basic movements measured. It was concluded that the standard elastic ankle guard does not significantly restrict these movements and, therefore, is not effective for this purpose in the preven­ tion and/or rehabilitation o f ankle injuries. IN T R O D U C T IO N T he increased participation in various sporting activities to ­ d a y 's society is concom itant with an increase in sp o rt-re­ lated injuries. A nkle injuries, particu larly lateral ligam ent com plex sprains, are the most Jeanette Mitchell Department o f Physiotherapy University o f the Wirwatersrand Medical School 7 York Road Parktown JOHANNESBURG 2193 frequently s e e n .1'7 In the re ­ habilitation o f such injuries, patients are often advised to use the standard elastic ankle guard. This regim e o f therapy im plies that the ankle guard has a dual function: to prevent excessive m ovem ent so as to prom ote healing during the initial stages o f rehabilitation, and to p re v e n t ex cessiv e m ovem ent on return to norm al sporting activities, thereby preventing a recurrent injury. H ow ever, the question arises: does the ankle guard suffi­ ciently restrict the basic ankle and foot m ovem ents and en ­ hance ankle stability? This pilot study was designed to m easure and com pare the norm al basic ankle and foot m ovem ents o f dorsiflexion, plantarflexion and inversion in p h y sic a lly ac tiv e su b jects, w ithout and with the use o f a standard elastic ankle guard, with the aim o f establishing its effectiveness in the reh abilita­ tion/p rev en tio n o f ankle inju­ ries. M A T E R IA L S A ND M E T H O D S Sam ple selection To obtain the sam ple for this study, questionnaires w ere distributed to 75 C aucasian males betw een the ages o f 19 20 -------------------------------------- SPO RTS M EDICIN E VOL. 7 NO. 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. ) PHYSIOTHERAPY Figure 1: N eutral p o sitio n o f ankle an d f o o t and 21 years, randomly selected from th ird -y ear medical and allied medical classes at the U niversity o f the W itw aters- rand, Johannesburg. O f the 48 q uestionnaires returned, 22 indicated that the subjects w ere healthy and physically active, with no previous ankle inju­ ries. H ow ever, only 15 o f these subjects w ere prepared to participate in the study. On exam ination o f their ankles, it was found that a further six subjects had to be elim inated due to above average ankle circum ference (the range ac­ cepted for this study was 17- 23 cm) (n = 2) and hyperm o- bile ankle jo in t m ovem ents (n = 4). T he final sam ple co n ­ sisted o f nine subjects, with an average age o f 2 0 ,4 years. Inform ed consent was obtained from each o f the subjects prior to com m encem ent o f the study. T esting procedure The subjects w ere each tested in three sessions: • Session I Each subject follow ed a w arm -up program m e co n ­ sisting o f cycling on an exercise cycle for three m inutes at a speed o f 120 revolution per m inute and a workload o f 400 kilopond- m etres per m inute. T h ere­ after, the m uscles o f the p o s te rio r and a n te rio r com partm ents o f the d o m i­ nant leg w ere stretched for 30 seconds each. The foot was passively circu m d u c­ ted for the sam e period and then placed in a w arm foot bath for up to 30 seconds, after which the subject perform ed the required ankle and foot m ovem ents on the dominant side. These w ere ankle dorsiflexion, ankle plantarflexion, and inversion o f the foot, each o f which was m easured. • Session 2 T he follow ing day, each su b ject p articip a ted in the sam e w arm -up p ro ­ gram m e. T he dom inant foot was dried well and pow dered with a fungicidal pow der to prevent any p o ssib le c ro s s -c o n ta m i­ nation o f undetected skin infections and to ensure ease o f application o f the ankle g uard. The guard was applied according to the m an u fa ctu rer's speci­ fications and each subject again p erform ed the re­ quired ankle and foot move­ m ents, as above. • Session 3 T he sam e p rocedure as that o f Session 2 w as repeated Figure 2: M easurem ent o f ankle p lan tarflexion ----------------------------------------------------------------------------- 21 SPO R TG E N E ESKU N D E VOL. 7 NO. 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. ) PHYSIOTHERAPY F ig u re 3 : M easurem ent o f ankle dorsiflexion F ig u re 4 : M easurem ent o f f o o t inversion 5 0 4 0 3 0 20 10 0 D o r s i f le x i o n P la n t a r f le x io n In v e rs io n M o v e m e n t s S e s s io n 1 HM9 S e s s io n 2 CZH S e s s io n 3 F igure 5: Ankle a n d f o o t m ovem ents 22 - - — — - SPO R TS M E D IC IN E VOL. 7 NO. I D e g re e s the follow ing day. M easu rem en t p rocedure All m easurem ents w ere taken with each subject reclining in the half-lying position on a plinth. T he dom inant leg was flexed at the hip and knee and the leg supported below the knee on a re-education board, on a stool. T he neutral position o f the limb as regards rotation at the hip o r knee was m ain­ tained by applying manual p ressure to the leg ju st above the ankle. P rio r to each m eas­ urem ent, the neutral position o f the ankle and foot was d e ter­ m ined using an L-shaped a lu ­ m inium piece, strapped to the foot w ith non-elastic adhesive tape, and an adjustable triangle (F ig u re 1). T h e follow ing m ovem ents w ere then m easured three times and the mean value obtained: • P lantarflexion T h e m axim um p lan tarflex ­ ion o f the an k le jo in t was m easured using the ad ju st­ able triangle as shown in F ig u re 2. • D orsiflexion In o rd er to m easure the m axim um dorsiflexion o f the ankle jo in t, a right- angled foot board was placed against the sole o f the foot and the subject was asked to perform the m ove­ m ent. T he d istance b e­ tw een the footboard and the upper end o f the L- shaped alum inium piece was m easured (F ig u re 3). T h e deg ree o f dorsiflexion w as then calculated using trig o n o m etric ratios, viz. sin 0 ) = opposite side/ 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. ) PHYSIOTHERAPY T a b le 1: A nkle and foot m ovem ents Dorsiflexion Plantarflexion Inversion A B C A B C A B C Sample mean (degrees) 17,9 17,6 18,6 41,8 40,2 41,7 35,4 36,8 34,2 S.D. (degrees) 4,0 4,9 4,1 2,0 2,5 1,9 4,3 9,0 7,9 ence (p = 0 ,0 5 ) between the an k le and foot m ovem ents p e r­ form ed with and w ithout the use o f the ankle guard. N either w as there a significant d iffer­ en ce betw een those m ove­ m ents perfo rm ed during Ses­ sions 2 and 3. D IS C U S S IO N A ND C O N C L U SIO N S hypotenuse. • Inversion Because the inversion in- j ury o f the lateral ligam ent com plex o f the ankle o c­ curs m ost often when the foot is rotated inwards while in plan tarflex io n , this posi­ tion o f the foot and ankle w as taken to represent in­ version for the purpose o f this study. In o rd er to m easure inversion o f the foot, the su b ject's heel was placed on an A5 sheet o f p aper and a m ovable lamp positioned so that the light cast a sharp im age o f the arm o f the L-shaped alu ­ m inium piece on the paper. T h e subject first plantar- flexed the ankle and a line w as draw n along the sha­ dow on the paper. T h e foot w as then inverted and a second line draw n o v er the shadow (F ig u re 4). T he angles m ade betw een the two lines w ere m easured, using a p ro trac to r. This m easurem ent w as taken as the deg ree o f inversion o f the foot in each subject. D ata m anagem ent T he data obtained by this m easurem ent pro ced u re was statistically analysed using the W ilcoxon signed-rank test, to establish if there w as a signifi­ cant d ifference (p = 0 ,0 5 ) b e ­ tween the various ankle and foot m ovem ents with and w ith ­ ou t the use o f the ankle guard (Sessions 1 and 2). T h e data collected in Session 3 w ere sim ilarly com pared with that from Session 2 (both involving the use o f the ankle guard) to establish if there w as any sig­ nificant change in the deg ree o f ankle and foot movement which may have been attributed to changes in elasticity o f the ankle guard with tim e and use. R E SU L T S T h e m eans and standard d e­ viations for the sam ple (N = 9), for each o f the ankle and foot m ovem ents (dorsiflexion, plantarflexion and inversion) are shown in T able 1. T h e data obtained for the m ovem ents perform ed w ithout the ankle guard (Session I) and for movements with the ankle guard w orn (Sessions 2 and 3) are shown in T able 1 and F ig u re 5. On statistical analysis o f these data, it w as found that there was no significant differ- C om parison o f ankle and foot m ovem ents during Sessions 2 and 3 T h e fact that no significant d if­ ference w as shown between any o f the an k le and foot m ove­ m ents p erform ed during Ses­ sion 2 and Session 3 indicates that th ere w as no d em o n stra­ ble change in the state o f the ankle guard d u rin g the period that these m easurem ents w ere taken. C om parison o f ankle and foot m ovem ents with and w ith ou t the use o f the ankle guard The fact that th ere w as no sig­ nificant differen ce dem onstra­ ted in dorsiflex io n , p lan tar­ flexion o r inversion movements o f the an k le and foot, w ithout and w ith the use o f the ankle gu ard , suggests that the stan­ dard elastic ankle guard does not restrict these basic m ove­ m ents significantly. These findings co n cu r w ith those o f M alina, e t a l ( 1962)8, M yburgh & V aughan (1984)9, M yburgh, e t a l (1 9 8 4 )10 and R arick, et a / (1 9 6 2 ).11 T his im plies that the p re­ sum ed function o f the ankle gu ard , that is to prevent o r re­ strict excessive ankle and foot ------------------------------------------------------------------------------- 23 SPO R TSG EN EE SK U N D E VOL. 7 NO. 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. ) PHYSIOTHERAPY m ovem ents, is not effectively carried out. T h erefo re, this pilot study concludes that the standard elastic ankle guard cannot be used effectively for this pu rp o se in the reh ab ilita­ tion o f the com m on ankle inju­ ries nor in contributing to the prevention o f recurring ankle sprains. H ow ever, a possible role o f the elastic ankle g uard may be to assist in the control o f post­ traum a sw elling in the initial stages o f rehabilitation. F u r­ th erm o re, the an k le g uard may supplem ent proprioception by stim ulating sensory receptors around the ankle, hence m ak­ ing the p atient m ore aw are o f the injured body part, and co n ­ sciously try to p rev en t exces­ sive m ovem ent and possible fu rth er injury. A C K N O W L E D G E M E N T S T he authors w ould like to thank the subjects who participated in the study, as well as M r B Seels and M r J C raw ford for s u g g e s tin g th e m ean s to m easure and record the ankle and foot m ovem ents studied. This study w as approved by the C om m ittee for R esearch on H um an Subjects, U niversity o f the W itw atersrand, Johan­ nesburg. REFERENCES 1. Balduini FC, Vegso JJ, Torg JS & Torg E. Management and reha­ bilitation o f ligamentous injuries to the ankle. Sports M ed, 1987; 4(5): 364-380. 2. Brand RL, Black HM & Cox JS. The natural history o f inadequately treated ankle sprains. Amer J Sports M ed, 1977; 6: 248. 3. Garn SN & Newton RA. Kinaes- thetic awareness in subjects with multiple ankle sprains. PliysTher, 1988; 68(11): 1667-1671. 4. Glick JM, Gordon RM & Nishim- ito D. The prevention and treat­ ment o f ankle injuries. Amer J Sports M ed, 1976; 4: 136-141. 5. Gross MT. Effects o f recurrent lateral ankle sprains on active and passive judgements o f joint posi­ tion. Phys Ther, 1987; 67(10): 1505-1509. 6. Kay DB. The sprained ankle: Cur­ rent therapy. Foot ankle, 1985; 6(1): 22-28. 7. Lassiter TE, Malone TR & Garrett WE. Injury to the lateral ligaments o f the ankle. Ortliop Clinics N Amer, 1989; 20(4): 639. 8. M alinaRM , PhagenzLB & Rarick GL. The effect o f exercise upon measurable supporting strength o f cloth and tape ankle wraps. Res Quart, 1962; 34(2): 158-165. O th er references on request thrombophob gel “ HIGH HEPARIN CONTENT' IN A CLEAR N0N-GREASY GEL BRINGS IMMEDIATE TISSUE PENETRATION - ALLEVIATES PAIN, BRUISING AND PROMOTES TISSUE HEALING. per lOOg: Hepann 20 000 i.u. Hexachtorophene O.ig © MORISTAN LABORATORIES Division of MORISTAN LIMITED 326 Marks Street, A/altloo, Pretoria. Jnder licence of Nordmark Arzneimittel 3mbH, Germany. Gel: |§T| G 1635 (Act 101/1965) Full details on composition, indications, contra-indicatic side effects and precautions are available on request. 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. ) SASMA NEWS THINK GLOBALLY, ACT LOCALLY P r o f T im N oakes President SASMA At present the challenges and o pportunities for the dev elo p ­ m ent o f Sports M edicine in this country have never been g rea ­ ter o r m ore exciting. A s o fM a rc h 1992, the South A fric a n S p o rts M e d ic in e A ssociation will be invited to becom e a full m em ber o f the International Federation o f S ports M edicine (F IM S ). It is a trib u te to o u r form er P resi­ dents, Drs Clive Noble, Etienne H ugo and D aw id van V elden that finally we have achieved this b reakthrough. O f related interest is the invitation to D r M artin Schw ellnus to serve as the A frican representative on the Educational C om m ittee o f F IM S . This provides an im ­ portant opportunity for our Association to be o f assistance to the developm ent o f Sports M edicine throughout A frica. T he o ther source o f ex cite­ ment is the possibility o f O lym pic and o th er in tern atio ­ nal com petition in the near future and the dem ands and o pportunities that will arise as a result. t h e c u r r e n t PO SIT IO N O F SPO R TS M E D IC IN E IN SO U T H A FR IC A C O M PA R E D TO O T H E R SIM IL A R C O U N T R IE S In all countries, S ports M ed i­ cine has a com m on origin: A g roup o f enthusiastic d octors/ athletes get together to discuss how their hobby (sport) relates to their profession (m edicine). F o r most o f these enthusiasts, th eir interest in sports m edi­ cine is peripheral to how they earn their livings in m edicine. T w o d ifferent m odels o f S ports M edicine A ssociations have evolved at least in the W est, with a third possible model arising in Eastern E u­ rope. In the first, the A ssociation is m ore o f a "club" with an exclusive m em bership. The principal function o f the "club" seem s to be to insure that the interests o f its m em bers are served; the service that the "club" o ffers to the athletes is entirely peripheral to its role in satisfying the needs o f its m em bers. Such organizations are not likely to gain either academ ic credibility o r the sup­ port o f their co u n tries' athletes. This model is a recipe for d is­ aster and m ust be avoided at all costs. T h e second model is the type exem plified by w hat has happened in the U nited States and C anada. In these coun­ tries, S ports M edicine has evolved with a very strong sci­ entific and clinical background led by persons who are re­ spected as leaders in their medical fields eith er as O rth o ­ paedic S urgeons, C ard io lo ­ gists, Psychologists, Exercise Scientists, etc. T h e result is that S ports M edicine in those countries has achieved cred i­ bility am ongst the scientific and academ ic com m unities and is m oving rapidly to being ac­ cepted as a m edical speciality. In addition because the A sso­ ciations have evolved p rin ci­ pally to aid athletes not doc­ tors, they have also gained the credibility and support o f the athletes. T h e third model is that p ro ­ vided by the fo rm er Eastern European countries, in p articu ­ lar the fo rm er East G erm any (G erm an D em ocratic R epublic -G D R ). In that co u n try , Sports M edicine thrived not so much because o f a strong scientific b ackground, but because it was the political m ission o f that country to succeed in sport. As a result w hatev er resources necessary to achieve that goal w ere dedicated to that p u r­ pose. T h e end result was that, o f all cou n tries, it w as probably the athletes from the G D R and other East E uropean countries w ho received the most scien­ tific and m edical support. T he basis for a successful S ports M edicine pro g ram m e is the right com bination o f the follow ing factors: dedicated p ractitioners w ho are co m m it­ ted to the help o f athletes; a strong scientific basis for the w ork so that academ ic cred ib il­ ity can be achieved; a basis for ----------------------------------------------------------------------------- 25 SPO RTG E N E ESKU N D E VOL. 7 NO. 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. ) SASMA NEWS still needs to be done. Negative factors • There is no official national political mission to make international success in sport an important priority in this country. Until this happens, state funding for sports medicine and the exercise sciences, on a decent scale, w ill not be priority. • There is no teaching o f sports medicine in the undergraduate m ed ical curriculum which is, un­ fortunately, an indirect measure o f the importance that our colleagues in aca­ demic medicine ascribe to our interest. promote our speciality to the benefit o f all in this country. Sports m edicine is a global enterprise and i f South Africa is to make its mark at an inter­ national level, w e must pool our resources. IMMEDIATE PLANS TO ADDRESS THESE ISSUES As the famous Chinese prov­ erbs states, "A journey o f a thousand miles must begin with a single step". Here are the single steps that w e will be emphasizing in the next 2 years: Further development of our Journal professional sport so that doc­ tors can be em ployed full-time in the profession; and political w ill that sport is important to the national interest. With this background, it is appropriate to consider how South Africa currently ranks and what needs further im ­ provement. THE CURRENT POSITION IN SOUTH AFRICA Positive factors • South Africans do live in a "sports-mad" society in which sport enjoys a high profile including and most importantly, at schools. • The standard o f training o f doctors and the profes­ sionals allied to medicine, is very high so that any potential recruits into the Sports M edicine discipline are likely to have been highly trained, disciplined and very competent in their work. • South Africa is about to enjoy the benefits o f a re­ turn to international com ­ petition and this is likely to be follow ed with increased public support of, and in­ terest in sport and there­ fore also in Sports M edi­ cine. • South Africa has a viable Sports M edicine A ssocia­ tion with its own Journal. Furtherm ore, scien tific research in sport does at least have a firm base in this country, although much • W e do not yet have a sports medicine programme that leads to specialist qualifi­ cation ir. this discipline. In the long term this must be addressed. In the short term we need to develop the concept o f group multi­ disciplinary practices in sports medicine. • There is no really profes­ sional sport in this country. Nor are many o f our sports administrators sufficiently professional to be planning ahead in particular by in­ v e s tin g in s c ie n t if ic studies in their sports. • W e have the problem o f re­ gional and ethnic parochi­ alism. W e must work very hard to eradicate these negative influences which w ill get in the way o f our real mission which is to The Journal w ill take on more o f a Continuing Medical Edu­ cation flavour. It will becom e more substantial and pub­ lished on a more regular basis. Whilst most o f the effort for this development w ill com e from the full-time academics, it is hoped that members w ill be en co u ra g ed to con trib u te material for publication. Increasing the activities of the regional committees At present the Association has active regional com m ittees in the S o u th ern T ra n sv a a l (Chairman: Dr Joe Skowno),. Northern Transvaal (Chairman: Dr U li Schmidt), the Orange Free State (Chairman: Dr Ras Venter) and the Western Cape (Chairman: Dr Wayne Der- man). W e hope to extend these branches to Natal and the Eastern Province in the near 26 ---------------------------------- SPORTS MEDICINE VOL. 7 NO. 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. ) SASM A NEWS future. Regional branches can only be successful if they are sup­ ported by members from all the major groupings making up our Association including physio­ therapists, biokineticians, ex­ ercise scientists and doctors. Upcoming congresses In collaboration with the South African Rugby Football Union the Association w ill be holding a two day congress on April 9th and 10th, 1992. Topics that w ill receive special attention w ill be traumatology and sports nutrition. The A ssociation's next In­ ternational Sports M edicine meeting w ill be on the week o f the 9 - 13th March 1993 in Cape Town. During the year, a series o f regional meetings on Olympic Sports M edicine w ill be co ­ ordinated. Extending ties with colleagues in the professions allied to Medicine Physiotherapist and members o f the other professions allied to medicine make an important contribution to our A ssoci­ ation. The rights o f these collea­ gues w ill be discussed at the next Annual General Meeting in March 1993. Development of a regional Olympic Sports Medicine programme Should South Africa be repre­ sented to any great extent at the Barcelona Olympic Games, there w ill be a n ek l for the provision o f sports medical care on a regional basis to the athletes preparing for those Games. The Association is presently in consultation with the Federation o f M ovement Sciences (formerly SAASPER) who have been given the mandate to develop this pro­ gramme. REPORT BACK FROM THE REGIONS Southern Transvaal - Dr Joe Skowno The Southern Transvaal Re­ gional Branch o f the South A frican Sports M ed icin e Association held three meet­ ings in the latter half o f 1991. The last one on Novem ber 6th was particularly w ell attended, with over 60 people present. The subject under discussion was management and rehabili­ tation o f shoulder injuries. Drs Pierre Roussouw and Bryan N oll discussed the anatomy, pathology and management o f rotator cu ff and instabilities. A practical demonstration o f ex ­ amining a patient with supras- pinatus im pingem ent syn­ drome was given. Mrs Joanne Sklaar covered rehabilitation most comprehensively. An encouraging feature o f the evening was the tremendous amount o f audience participa­ tion. M eetings held in 1992 to date include: Alternative medicine in sports injuries 22 January 1992 The m odem approach to ankle injuries 11 March 1992 An important objective o f the Southern Transvaal Regional Sports M edicine group w ill be to establish a roster o f emer­ gency sports care personnel in the Southern Transvaal. The aim is to train doctors and physiotherapists to deal with any emergency one might rea­ sonably encounter during any sports activity. The idea is to supplement existing first aid services currently available at most large sporting occasions, and not to replace them. The aim w ill be to work with St Johns and Noodhulpliga who supply general medical care and ambulance services. Dr Skowno has expressed the opinion that the Sports M edi­ cine Association should be ac­ tively involved in the estab­ lishment o f an independent body to co-ordinate doping control in South African sports. Any doctors who are actively involved in this area are en­ cou raged to con tact Dr Skowno. Dr Skowno's address is PO Box 6 7196, Bryanston 2021. PARKE-DAVIS MEDICAL 10 ROAD RACE BOOSTS VICTORIA HOSPITAL FUND The popular Medical 10 Road Race, sponsored and hosted by Parke-Davis, a division o f W arner-Lambert SA (Pty) Ltd, for the forth consecutive year, took place o f 7 December -------------------------------------- 27 SPORTGENEESKUNDE VOL. 7 NO. 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. ) S A S M A N E W S Seen at the finish o f the popular Parke-Davis Medical 10 Road, Race are, (l-r): Dr Adrian Morrison from Victoria Hospital, D r Helmut Elmau and Dr Kelly Seymour, medical director of'Warner-Lambert 5/1 (Pty) Ltd. 1991. T h e 10 km M edical 10 Road R ace for m edical doctors and 3 km fun run for cardiac rehabilitation patients, known as H eart T h ro b s, started and finished at P ark e-D av is' head office in R etreat. F o r the first tim e this year, there was an entry fee o f RIO. A greed to last y ear by 300 entrants w ho com pleted a q u es­ tionnaire, it was decided that the p roceeds o f this y e a r's race w ould be earm arked for the V ictoria H ospital C asualty Unit F u n d . E arlier this year, P arke-D avis announced their decision to com e to the aid o f the hospital and this event is part o f th eir on-going effo rt to raise the R 1,3 m required to re ­ build the casualty unit. A pproxim ately 228 m edical doctors and 70 H eart T hrobs com pleted the M edical 10 Road R ace and 3 km fun run re ­ spectively. This y ear runners w ere again handicapped 30 seconds p e r y ear o f age from 40 upw ards. A M etro helicopter, Pri- M ed A m bulance as well as medical staff from V ictoria H ospital w ere on stand-by for the first tim e this year, co n trib ­ uting to the high standards that have co m e to be expected o f the P arke-D avis M edical 10 Road Race. At the p rize giving breakfast follow ing the race, C o uncillor B ronnie H arding accepted a cheque on b eh alf o f V ictoria H ospital. Ian R obertson, m ar­ keting d irecto r o f P arke-D avis and T im L argier, m anaging d irecto r o f W arn er L am b ertS A (Pty) Ltd, aw arded prizes to w inners in various categories. T h e sp ecia lly d esig n ed M edical 10 floating trophy for the fastest ru n n er overall on handicap was presented to D r F r a n c o is H o f m e y r fro m W ynberg who com pleted the 10 km run in a tim e o f 31 m inutes and 7 seconds. F o r the first tim e in the history o f the race, gold m edals w ere aw ar­ ded to the first male as well as fem ale on handicap and medals w ere presented to D r H ofm eyr and D r C lare Stannard from R ondebosch. Silver and b ro n ze medals for second and third positions on handicap for males w ere presented to D r E ric Bateman from R ondebosch and D r R ob­ bie T ru te r m edical superinten­ dent o f T y g erb erg H ospital respectively, w hile medals for the second and third fem ale runners w ere aw arded to D r Lana van Zyl and D r E G od­ dard respectively. G old m edals for the fastest m ale and fem ale runners w ere presented to D r A ndrew Leary w ho com pleted the race in an outstanding actual tim e o f 33 m inutes and 6 seconds and D r L ana van Zyl, the first fem ale ru n n er to cross the finishing line in an actual tim e o f 43 m inutes and 29 seconds. T he H eart F oundation o f Southern A frica nom inated Edw in King to receive the Ian T ay lo r M em orial A w ard which is presented annually to the most deserving cardiac reha­ bilitation patient. D uring the aw ards p resen ­ tation, Ian R obertson, m arket­ ing d irecto r o f P arke-D avis, com m ented, " W e 'v e received a record num ber o f en tries for this y e a r's race and w e would like to thank all d o cto rs who took part for their much- needed financial support. W e also thank those w ho made fu rth er donations to V ictoria H ospital today. W e look fo r­ w ard to an equally successful 1992 M edical 10 Road R ace." 28 — — SPO R TS M E DICIN E VOL. 7 NO. 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. )