SOU TH AFR IC AN JO U R N A L OF SPORTS MEDICINE SPORTGENEESKUNDE J O U R N A L OF THE S .A . S P O R T S M E D IC IN E A S S O C IA T IO N T Y D S K R I F V A N DIE S.A. SPORTGENEESKUNDE-VERENJGIN G V O LU M E 6 NUM BER 1 MARCH 1991 CONTENTS E d ito r in C h ie f: C liv e N ob le A sso c ia te E d ito rs : P rofT D N oakes D a w ie v a n Velden A d v i s o r y B o a rd : T ra u m a to lo g y : E tienne H u go P h y s io th e r a p y : J o y c e M orton N u tr itio n : M iek e F aber B io k in e tic s: M artin S ch w elln u ss E p id e m io lo g y : D erek Yach R a d io lo g y : Alan S cb er P h a rm a c o lo g y : J o h n S tra u gh a n P h y sica l E d u c a tio n : H a n nes B otha In te rn a l M e d icin e: F rancois R e ti e f Editorial C om m ent The use of anabolic-androgenic steroids in sport ...................................................... .............. 2 Physiotherapy and the SA Sport Medicine Association .................................................. ........... 3 RUGBY The role of a system of two referees in the prevention of rugby injuries ......................... 4 Physiological profile of the senior South African rugby player ............................................. 7 CRICKET ' Sports injuries encountered on a five week international cricket tour .............................. 10 PHYSIOTHERAPY UPDATE The physiotherapy treatment of a hamstring tendon injury ..................................................... 16 EXERCISE-RELATED INJURIES The prevention of exercise-related injuries among South African army re c ru its: a re v ie w N UTRITION Fat in the diet 17 21 Photographs courtesy o f H H o fm e isic r a n d C Best S A S G V S A S M A P U B L I S H E D B Y T H E S O U T H A F R I C A N S P O R T S M E D I C I N E A S S O C I A T I O N H A T F I E L D F O R U M W E S T 1067 A R C A D I A S T R E E T H A T F I E L D P R E T O R I A , 00 8 3 T h e jo u r n a l o f th e SA S p o r is 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 Pu blicai io 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 rd D r iv e , R a n d b u r g 2 1 9 4 . T e l: (0 1 1 ) 7 8 7 -4 9 8 1 /9 . T h e vie w s e x p r e s s e d in ih is p u b lic a tio n a r e th o s e o f th e a u t h o r s a n d n o t n e c e s s a r ily th o s e o f th e p u b lis h e r s . P rim e d b v T h e N i u l W im c w P r im in g and P u b lis h in g C o m p a n y (P iv J L id S P O R T S G E N E E S K U N D E VOL. 6 N R . 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. ) OUR CONCERN ON THE USE OF ANABOLIC -ANDROGENIC STEROIDS IN SPORT A n ab o lic stero ids w ere sup p o sed ly used b y the G erm ans d u rin g W orld W ar II to increase aggressiveness and, sub ­ seq u en tly to that war, the Soviets began using them in athletes in the late 1940’s. The U n ited States started using them in the e a r ly 1950’s. Subsequently, the first syn th etic stero id , D ian ab o l (m ethandrostenolone) w as developed. T he m ost abused categ o ry of drugs to d a y is the group o f d rugs kn o w n as an ab o lic-an d ro gen ic steroids. A n a­ b o lic stero ids are d erivatio n s of the m ale horm one tes­ tosterone, and are used for recuperation for b o d y b u ild ­ ing. T he an ab o lic effect im plies the a b ility to prom ote tissue gro w th and/or repair. The androgenic effect im ­ p lies the a b ility to produce m ale seco nd ary sex character­ istics, ju st as does testosterone. The anabolic effect of these steroids does increase lean b o d y m ass and reduces the p ercentage o f b o d y fat if th ey are used in conjunction w ith con ven tio n al m ethods of stren gth train in g and b o d y b u ild in g . A d eq u ate caloric and d ie ta ry in tak e is necessary. The an ticatab o lic effect is one of great interest because the athlete can recover q u ic k ly from a hard w o rk o u t and train lo n ger and harder. A re w e m issing som e of the ben­ eficial m edical effects ? F rom a m edical p erspective, these drugs are seldom prescribed because of the rather serious and cum bersom e adverse effects such as acne, overaggressiveness, gyn o co - m astic, te sticu la r atrophy, liv er dysfu n ctio n , tum ors, ch o lestero l changes and h yp erten sio n in m ales, increases in facial and b o d y hair, deepening o f the voice, en large­ m ent o f the clito ris, sh rin k in g o f breast size and irreg u lar m en stru al cycles in fem ales, and acne, v iriliz atio n and prem atu re clo sure of the gro w th plates in adolescents. A s gevolg van die erns van die probleem , het die Suid- A frikaan se Sportgeneesku nde V ereniging dit n o dig ge- vind om ’n sterk standpunt in te neem teen die m isb ru ik van anaboliese stero'iede in sport. O ns is van m ening dat baie m eer gedoen m oet w o rd om jo n g mense op te voed insake die n ad elige effekte van hierdie m iddels. G eko n tro leerd e n avo rsin g op h ierd ie terrein is beperk, daar is in der w aarh eid slegs enkele sterfgevalle aangete- ken in die literatu ur. D it b rin g mee dat sportgeneeskun- diges se k re d ietw aa rd ig h eid in tw y fe l getrek w o rd . D ie feit is egter d at navo rsin g op anaboliese stero'iede in sulke hoe d o serin gs nie to egelaat sal w o rd nie, en gevo lgtrek- kings m oet gem aak w o rd op anekdotiese gevalle van steroied m isb ru ik . D it is te verstane dat atlete u it vrees v ir d issip lin ere optrede teen h u lle, nie genee is om v ry - w illig lik na vore te kom om oor gevolge te rapporteer nie. O p grond van ’n uitgeb reide lite ratu u ro o rsig , erken die Su id -A frik aan se Sportgeneeskunde V ereniging dat die anaboliese stero'iede w el sp ierk rag en spierm assa kan verb eter o n d er sekere om standighede, en dat daar ernstige n ew e-effekte mag voorkom in m ans, vrouens en adolessente. D ie veren igin g stem saam dat anaboliese stero'iedgebruik teen die reels van regverdige m ededing- in g in sport is, en dat daar streng opgetree m oet w ord teen atlete w at h ierd ie m iddels m isb ru ik om hulle sport- prestasies te verbeter. D ie Su id -A frik aan se Sportgeneeskunde V ereniging beveel v erd er aan dat atlete beter opgevoed m oet w ord en d at m eer navo rsin g ge'inisieer w o rd insake anaboliese stero ied m isb ru ik . ’n N asionale toetsprogram m oet in w e rk in g gestel w o rd w at deur alle sportliggam e onder- s k r y f w o rd . D ie m ediese geb ru ik van h ierdie m iddels m oet h ero o rw eeg w o rd , en daar m oet streng opgetree w o rd teen die verskaffers van hierdie potensieel skade- lik e m iddels in sup ra-terap eutiese doserings. D ie standpunt van ons V ereniging is niks nuuts nie - in die B y b e l w o rd daar in 2 T im o tius 2:5 die volgende w aarh eid k w y tg e r a a k : “’n A tleet w at aan ’n w e d stry d deelneem , kan die p rys w en slegs as h y volgens die reels m eeding. ” Su m m ary and Conclusions D oping in sports has a negative effect on sports in the; w id est sense of the w o rd and should be com batted on the b asis of ethical and m edical aspects. H ow ever, in com ­ b attin g d o p in g one should never lose sight of hum an d ig ­ nity. T his calls for a d iscrim in ato ry approach in w hich do p in g co n tro l should never be a p urpose in itself, but sh o uld be regarded as a p rotection of sports and its athletes. D r DP van Velden M B C h B , M Prax M ed A ssociate E ditor/M ede R ed ak teu r 2 SPORTS MEDICINE VOL. 6 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 AND THE SA SPORTS MEDICINE ASSOCIATION In 1980, The South A frican A ssociation for P h ysical E ducation and R ecreatio n (n o w kn o w n as the Southern A frican F ed eratio n for M ovem ent and L eisure Sciences) o rgan ized a conference in P ort E lizabeth. D rs Tim N o akes and D aw ie van Velden w ere requested to arrange a sym p o siu m as p art of the conference w hich w o u ld b rin g to geth er representatives of m edical and allied p ro ­ fessions w h o w ere involved in health prom otion and p h ysical a c tiv ity and w ere u sin g p h ysical exercise as a treatm en t m odality. O n the 20th J u n e 1980, D r T im N o akes w ro te a letter to the P resid en t o f the South A frican So ciety of P h y sio ­ therapy, M rs M o lly Levy, inv itin g nom inations for p h ysio th erap ists to speak at the sym p o sium . H e also o u tlin ed the three fold objectives of the m eet­ in g : i 1. to define the specific role of each group in the p ro ­ m otion o f South A fric a ’s health th ro ugh p h ysical ac­ tiv ity and the treatm ent o f disease; 2. to define the specific areas that each of these groups covered in the p ro visio n of health care to South A fri­ cans w h o w e re p h y sic a lly active eith er in sports or recreatio n ; 3. to prom ote co llab o ratio n and to co-ordinate the w o rk done b y these gro up s through the form ation of a m u lti-d isc ip lin a ry F ederation or A ssociation for R ecreatio n al and Sports Sciences and Sports M edicin e. D r N o akes ended his lette r w ith the fo llo w in g p ara­ grap h : “We g e n u in e ly feel that this m eeting w ill provide a re a lly im p o rtan t chance for everyo n e interested in rec­ reatio nal h ealth , to get to geth er and delineate th eir co l­ lective roles. We cannot em phasize stro n g ly enough how im p o rtan t w e feel y o u r co n trib utio n to this Sym posium and to o u r p roposed F ederation w ill b e ”. A s a resu lt of D r N o a k e s’ inv itation , M rs M o ira van O o rd t and M iss S a lly E ager presented papers relating to p h ysio th erap y, w h ile I w as asked to represent the South A frican S o ciety of P h ysio th erap y. I k n e w that this in itial m eetin g of d isciplines w as of great im portance to p h ysio th erap ists in South A frica. We w ere b eing given the o p p o rtu n ity to develop alongside the m edical profession in the service of sport, sportsm en and sports m edicin e in this country. I k n ew , too, the tre­ m endous co n trib u tio n s w h ich p h ysio th erap ists could m ake in the field. I hoped that from this early s y m ­ posium a perm anent association w o u ld be form ed. I still have a co p y of P ro f N o a k es’ letter and can re­ view w ith real satisfaction, the gro w th of the South A fri­ can Sports M edicin e A sso ciatio n (SA SM A ) and the gro w th of the relatio n sh ip betw een the A ssociation and the p h y sio th e ra p y profession. M a n y p roblem s w ere experienced in those early years but u n d er the rig h t leadership the Sports M edicine A s­ so ciatio n grew from strength to strength and is to d a y a th riv in g association. It w as a m om entous occasion w hen, at the A G M o f SA SM A in D urban in 1988, the consti­ tutio n w as altered to a llo w p h ysio th erap ists and biokine- ticians to becom e associate m em bers. A representative from each group w as asked to serve on the executive com m ittee. M em bers of these diverse groups w hich no w m ake up the A sso ciatio n , are able to share their know ledge th ro u gh the S ou th A frican J o u r n a l o f Sports M ed icin e. It is to me a p riv ilege to be given the o p p o rtu n ity to p ro ­ m ote, th ro ugh this jo u rn al, the role of the p h y sio ­ th erap ist in Sports M edicin e. P h ysio th erap y encom ­ passes a w id e scope, from the treatm ent o f the acute in ju r y to the final m edical rehabilitation of the sports­ m an so that he m ight re tu rn to his sport. T he profession of p h ysio th erap y has com e a long w ay and to d a y w e are seen to be am ongst the leaders o f sports m edicine in south A frica. It is thanks to the enthusiasm of leaders such as D r D aw ie van V elden, P resident of SA SM A , B rig. E ttiene H u go , Past President of SA SM A , M r C liv e N o b le, E ditor of the Sports M edicine Jo u rn al and P ro f T im N o akes, P resident Elect of SASMA. that w e are w h ere w e are today, and w e thank them . T hus at the end o f a decade of the gro w th of SA SM A , I can lo o k back and feel p ro ud that I w as present at its b irth. M rs J o yce M orton South A frican S o ciety of P h y sio th erap y R ep resen tative: SA Sports M edicine A ssociation SPORTSGENEESKUNDE VOL. 6 NR. 1 3 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. ) THE ROLE OF A SYSTEM OF TWO REFEREES IN THE PREVENTION OF RUGBY INJURIES JR Potgieter, JH Blaauw and JH Malan In the qu est for the prev en tio n of in ju ­ ries in ru g b y the referee has often been m entioned to geth er w ith the coach and m edical and p aram ed ical personnel as h aving an im p o rtan t role to play. H e is expected to a p p ly the law s co rrectly and fa irly w h ile also m ain tain in g the d iscip lin e n ecessary to curb foul play. In term s of in ju rie s, the referee is ex­ pected to fulfil a p reventative function. In spite of the co m p lexity of the gam e ru g b y and the dissatisfactio n w ith referees, w e p ersist w ith the use of one referee. T h is is in co n trast to m ost other team sports. O b servation o f the use o f tw o re­ ferees in ru g b y m atches at the U n iv er­ sity o f Stellenbosch led those involved w ith the gam e to becom e convinced of the benefits of such a system . It w as ar­ gued, am ongst o th er advantages, that the use of tw o referees w o u ld resu lt in a d ecrease in foul play. H ow ever, there w as no o bjective p ro o f that such a s y s ­ tem w o u ld be effective. Protagonists based th eir su p p o rt o f the system on com m on sense and in tu itio n . There w ere also in d iv id u als and groups w ho w ere not in favour of such an in n o ­ vation. It is again st this background that an em p irical inv estigatio n w as deem ed necessary. J R P otgieter, J H B la a u w a n d J H M alan I n stitu te o f S port a n d M o v e m en t S tudies U n iversity o f S tellen b o sch T he in cid en ce o f p e n a ltie s f o r f o u l p l a y w a s lo w e r in the ca se o f m a tch es h a n d led by tw o referees. T w e n ty five first league m atches p la yed in the second sem ester of 1990 at the U n iv e rsity o f Stellenbosch w ere ra n d o m ly m o nitored. Seven hostel m atches are u s u a lly p la yed on a F rid ay afternoon. F o r the p urpose o f this in ­ vestigatio n , four o f these m atches w ere co n tro lled b y a single referee and three b y tw o referees. A p ool of 12 first league referees w as used in the in v esti­ g ation. T h e y w ere appointed for all the m atches p rio r to the begin n in g of the semester. O w in g to w ith d raw als due to illness and o th er com m itm ents, altern a­ tive referees had to be used on som e oc­ casions. T he referees w ere not inform ed about the purpose of the investigation but w ere to ld th e y should experim ent w ith refin in g the system of double re­ fereeing. T h is, how ever, did not w o rk because the referees soon becam e aw are that th eir gam es w ere being m onitored for the p urpose o f co m p arin g the tw o system s. Students in th eir final y e a r of hum an m ovem ent stud ies w ere used on a v o l­ u n ta ry basis to m o n ito r the m atches. B ecause it involved a fair am ount of com m itm ent, o n ly a few students w ere used. T w o students w ere assigned to each m atch, one being so le ly reponsible for reco rd in g and p la y in g tim e w h ile the o th er recorded all the o th er in fo r­ m ation. A s o n ly trained students w ere inv olved in th is in v estigatio n , sub sti­ tutes co uld n o t be used w h en som e of these studen ts w ere un availab le due to illn ess or o th er com m itm ents. T his had an adverse effect on the num ber of m atches recorded. T he students received verb al as w ell as w ritten instru ctio ns regard in g the re­ c o rd in g p ro ced ures. A fte r - these had been discussed w ith them , th ey o b ­ served a video re co rd in g of a p rovincial ru g b y m atch. T he tape w as stopped at v ario u s stages to m ake sure that the stu ­ dents un dersto o d the pro cedure. The use o f the d ata sheet w as tested b y the m ain au th o r on three occasions before it w as finalised. Selected resu lts are presented in Table 1. The incidence o f penalties for foul p la y w as lo w e r in the case of m atches handled b y tw o referees. A l­ though this difference w as not stat­ is tic a lly sign ifican t (t = 0 ,4 6 2 ; p > 0,05) note sh o uld be taken o f the sm all num ­ ber of p enalties aw ard ed . H ow ever, it m u st be pointed o ut that the durations of these gam es w as 60 m inutes only. T he absence o f statistical difference is d icussed at the end o f the paper. Q u estio n n aires w ere d istrib u ted am ong coaches, first league p layers, first league referees and supporters (p referab ly com m ittee m em bers o f the hostel club s). R espondents had to in d i­ cate th eir preference for a system of single referees o r tw o referees. In an open ended qu estio n th ey had to p ro ­ pose p ossible advantages and d isad van ­ tages o f a system o f do ub le refereeing. 4 --------------------------------------------------------------------------------- SPORTS MEDICINE VOL. 6 NO. 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. ) Space w as also p ro vid ed fo r an y general com m ents. The results are presented in Table 2. It can be co n clud ed that a great m a­ jo r ity of p la y e rs, coaches and su p p o rt­ ers w ere in favour of the system of do ub le refereeing. F o u r of the 12 first league referees ind icated th at w ith re­ gard to p ersonal en jo ym en t and satis­ faction, th ey w o u ld p refer han dlin g m atches as a sin gle referee. H ow ever, all the referees are o f the opinion that the system o f do ub le refereeing w o u ld be in the best interest of the gam e. A ll tw elve referees w ere, therefore, in fa­ v o u r o f the system o f tw o referees. T he p erceived advantages of a s y s ­ tem of do ub le refereeing are presented in Table 3. It is sign ificant to note that a to tal o f 90 respondents o ut o f a possible 135 stated that a system o f do ub le re­ fereeing w o u ld decrease the incidence o f foul play. A ll the r e fe re e s are o f the opin ion that the system o f d ou b le re fe re e in g w o u ld be in the b est in terest T a b le 1 : Comparison between matches handled by a single referee and matches handled by two referees S in g le re fe re e n = 1 3 Tw o re fe re e s n = 1 2 M (SD) M (SD) Penalties for playing ball on the ground, obstruction and high tackles Players in coolbox Players sent off 2 (2,1) 0,07 0 1,6 (1,4) 0 0 T ab le 2: Preferences for a referees system of single or two In fa v o u r A g a in s t Total Referees Coaches Players Supporters 12 3 87(85%) 16 0 0 17(15%) 0 12 3 104 16 Total 118 17 135 o f the g a m e. O p p o sitio n to the system of tw o re­ ferees are u sa lly based on the fo llo w in g argu m en ts: • Too m uch w h istle w o u ld lead to an increase in stoppages and w ill nega­ tiv e ly affect the flo w o f the gam e. • R eferees w o u ld get in the w a y of p la yers. A lth o u gh the o n ly statistical difference betw een the tw o system s w as found in the n u m b er o f p enalties aw arded for off-side at the lin e-o u ts (t = 2 ,4 4 ; p < 0 ,0 5 ), there w as no evidence to su p p o rt the above argum ents. T he fact that tw o referees have been used over the past three seasons at the U n iv e rsity o f Stellenbosch could have co n trib u ted to the absence of statistical T ab le 3 : Perceived advantages of a system of two referees Decrease in the incidence of foul play (90) Infringements identified more effectively (50) Better control of the game (36) Greater impartiality and objective decision making (24) More flowing rugby (14) Deliberate infringements prevented (14) Off-side law applied more effectively (9) Decreased incidence of injuries (5) Improved standard of refereeing (3) Referee less in way of players (1) Referee less involved with spectators (1) Creates a feeling of trust between referee and players (1) differences. P la y e rs -m a y have becom e accustom ed to the system and p layed the gam e in a m ore discip lin ed m anner regard less o f w h eth er the m atch was co n tro lled b y one referee or tw o re­ ferees. A case in p o int is the fact that the inciden ce o f foul p la y has decreased d ra m a tic a lly over the past tw o years. The num b er o f first league matches p layed in the hostel league is approxi- -------------------------------------------------------------------------------------------- 5 SPORTSGENEESKUNDE VOL. 6 NR. 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. ) m a te ly 100 per season. In the 1989 sea­ son not a single case of foul p la y w as re­ po rted to this com m ittee. T he law s of the hostel league do not allo w the re­ feree an option and m ake it m an d ato ry for him to o rder a p la y e r from the field if he k ick s, tram ples or hits an appo- nent, regard less o f the seriousness of such action, m ak in g this absence o f d is­ c ip lin a ry actions even m ore rem arka­ ble. T his w as c e rta in ly not the case a few seasons ago. W h ile the stystem has been func­ tio n in g for three y e a rs at the U n iv ersity of Stellen b o sch , it is still in its infancy. The p o ssib ilitie s, however, have not been exploited and a great deal of refinem ent is still needed. A t this stage the system is not b eing used v e ry econ­ o m ic a lly since the d ivisio n of lab o u r be­ tw een the tw o referees is not being u til­ ised to the full. To date the system has functioned m o stly w ith both referees D ou b le r e fe r e e in g w ill d ecrea se the n u m b er o f in ju r ies th at a re a resu lt o f f o u l play. k eep in g the p la y b etw een them and m ore o r less lo o k in g at the sam e action from differen t angles o r view points w ith a lim ited divisio n o f labour. It is envisaged th at o th er m odels could be experim ented w ith , such as a system sim ila r to that used in b asketball. O ne of the local referees, for exam ple, handled a to u gh n o n -u n iv e rsity m atch w ith a co lleague in a n eigh b o u rin g town and reported that w hen tem pers began to flare one referee to o k control and handled the m atch in the no rm al w a y as a sin gle referee. H is colleague w as now co m p letely free to “lo o k for the tr o u b le ”. H e w as n o t concerned w ith the tech n ical aspects of the gam e b ut fo­ cussed his to tal attention on one specific aspect, n am ely the cause of the tro u b le. In fact, he id en tified the cu l­ p rit, o rdered him off the field and the gam e proceeded in an o rd e rly fashion. T h is in cid en t is an exam ple o f the p o ssi­ bilities in such a system . It w o u ld be naive to believe that do ub le refereein g is go ing to solve all pro b lem s and w ill c e rta in ly not prevent all ty p e s o f in ju ries. H ow ever, it is our firm b elief th at it w ill at least decrease the n u m b er o f in ju ries that are the re­ su lt o f foul play. T his b elief is based on com m on sense and on the subjective and o b jective o bservations m ade over the p ast three years. LA WO RELIABLE SPECIALISTS - INFRARED LASERS AL 609/4 Easy handling and exceptionally effective! The modulation is carried out by the Polyfrequency Spec­ trum, which contains all frequencies up to 50 000 Hz. The uncomplicated technology m akes this a softlaser for every kind o f treatment. A L 605/4 and A L 606/4 Pre-programmed Frequencies fo r the Specialist! Two sofitlasers are available for the classical ear acupuncture according to Dr. N ogier: A L 605/4 containing the original N ogierfrequencies; AL606/4 has been equipped with the augmented N ogier frequencies. The frequencies in both units can be varied by 30 %. AL 607/4 High-Tech fo r the Professional Medical Practitioner This softlaser offers an unmodulated permanent beam (D) as w ell as the Polyfrequency Spectrum (P) up to 50 000 Hz. A dditionally, every frequency between 0.1 and 9999 Hz can be selected in the Sinewave position (S ), w hich is assisted by a built-in crystal-controlled synthesizer. CONTACT SHIRLEY GODLEY AT: LA W O CC PO Box 95 Noordhoek 7985 Cape Town Tel (021) 89-2500 The concept o f LA SER (Light Am plification by Stimulated Emission o f Radiation) w as first discovered by Albert Einstein in 1916, but it w as not until 1950 that Downs and Shylaw first worked on E instein's theory to produce a crude form of LASER which culminated in the building o f aproper one by Meimon in 1960. The devices constructed today are sophisticated masterpieces o f M eim on's original and consti­ tutes the most exciting aid in medical and veterinary sciences today. Lasers fall into two categories nam ely hot Lasers used in surgery and cold Lasers used in m uscular-skeletal problems, ie. H elium , Neon and G allium A lum inium Arsenide D iox­ ide. The Lawo Infrared Laser is not only used extensively in beauty treatment, but also b y dentists, practitioners o f acu­ puncture, race horse breeders and physiotherapists, medical doctors and farmers. M ore in form ation ab ou t th e LAWO L aser ca n b e ob ta in ed f r o m S hirley G odley, m a n a gin g d ir e c t o r o f Lawo G eratebau in South A frica at telep h o n e (021) 89-2500 o r fa x (021) 89-1251. The laser is an anti-inflam m atory, decongestant, aseptic, plairiless red healing ligh t, portable and needs no direct power supply. Human Treatment Bones, muscles, jo in ts, nerves, wounds, pain therapy, skin problems. 6 --------------------------------------------------------------------------------- SPORTS MEDICINE VOL. 6 NO. 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. ) PHYSIOLOGICAL PROFILE OF THE SENIOR SOUTH AFRICAN RUGBY PLAYER JG Barnard and FF Coetzee I N T R O D U C T IO N T he status of elitism in ru g b y is d eter­ m ined b y the standards achieved d u rin g the p artic ip atio n in the specific com pe­ titio n season, alth o ugh certain norm s of basic fitness com ponents could be use­ ful to reflect the status of the player. D u rin g the last decade standards have been raised in in tern atio n al sports w h ich necessitate a greater un d erstan d ­ ing o f the attrib u tes re q u ired to p ro ­ duce o u tstan d in g perform ance. A fu r­ th er scien tific tech n ique that can be of assistance in p la y e r developm ent is th a t o f p ro filin g . C u rre n tly m a n y detailed p h y sio lo g i­ cal p ro files exist o f athletes w h o p a rtic i­ pate in a w id e v a rie ty o f sp o rtin g activ­ ities. A lth o u g h ru g b y is o u r N atio nal sp o rt, a dearth o f inform ation exists w ith respect to the p h ysio lo g ical ch aracteristics o f South A frican ru g b y p la y e rs. C o m p ariso n s o f test scores b y an y p la y e r w ith d ata from a n orm ative base elite p la y e rs enable strengths and w e a k ­ nesses to be id en tified . Selections and pro gram m es sh o uld then be structured th at tak e in d iv id u al p la y e rs ch aracteris­ tics into co n sideratio n . J G B a rn a rd a n d FF C o etz ee D ep a rtm en t o f P a ra m ed ica l S cien ces T echn ik on OFS P r iv a te B ag X20539 B lo e m fo n te in 9300. P U R P O S E O F T H E ST U D Y T he aim o f this stu d y is to b u ild up a n orm ative d ata base w h ich should be used for p ro filin g p u rposes. P R O C E D U R E S Subjects T his stu d y w as conducted over a period o f five ru g b y seasons (1981 - 1986). O ne h u n d red and seven sen io r p la yers (54 fo rw ard s and 53 backs) w ere se­ lected for this p ro ject represen tin g the best and second best team (C u rrie C u p w in n ers and ru n n er-u p ) for th at p a r­ tic u la r season. Methods A u n iversal test b attery w as therefore developed w ith respect to the anthro- p o m etrical, p h y sio lo g ic a l and m o to r ch aracteristics. T his test b atte ry com ­ p risin g sop h isticated electro n ic eq u ip ­ m ent w as designed and tested for re li­ a b ility and v a lid ity .4 W ith in 10 d ays after the C u rrie C u p final the w in n in g team w as tested. The p ro ced u re w as as fo llo w s: To register the nam e, age and p erform ance h isto ry of the p la y e r ; to d eterm ine standing h eig h t; b o d y m ass; v ital cap ac ity and forced e x p ira to ry volum e in one sec­ o n d ; an th ro p o m etrical m easurem ents for the determ in atio n of so m atotypes by the H e a th -C a rte r2 m ethod as w e ll as relative b o d y fat3; isom etric strength (grip and b ack ); iso kin etic strength (quadriceps/ham strings, b i­ ceps/triceps); sp rin t (electro n ical tim ­ ing o f 5 in term itten t m eter distances to a to tal of 23 m ); h o rizo n tal p o w er; o b liq u e step sp rin t (vertical disp lace­ m e n t); v ertical p o w e r; hip fle x ib ility (h a m strin g s); target th ro w in g (hand- e y e co o rd in atio n ); e q u ilib riu m (stabi- lo m ete r); p la te tap p in g (h o rizo n tal arm m ovem ent) and endurance ( V 0 2nux p re ­ d icted b y the in d irect 12 m in C oopers m ethod). T he final test b attery catered for 8 an thro p o m etrical m easurem ents, 3 p h y sio lo g ic al m easurem ents and 12 m o to r function tests. The average values o f the m easured , as w ell as the calculated variab les are given in Table 1. Results and discussions D etails o f the p h y sio lo g ic al, anthropo­ m etric and m o to r function test results are p resen ted in Table 1 w ith means o f standard deviatio n s for the forw ards and b ack -lin e groups. Body composition F o rw ard s differed sig n ific a n tly (p < 0,05) from backs in that th e y w ere taller (189 cm vs 177 cm ), h eav ier (101 k g vs 79 k g), had h ig h e r relative b o d y fat (15% vs 9 % ) and greater lean b o d y mass (86 kg vs 71 kg). A s w o u ld be expected, these fin d in gs are because o f the differ­ ent specific resp o n sib ilities required of the tw o groups in th eir respective p la y ­ in g p o sitions. B o d y m ass is v e ry im p o rtan t to for­ w ard s in the set scrum s, m auls and ru cks. The h eavier the p ack of fo r­ w ard s, the greater w ill be the inertia, m om ent o f in e rtia, the s ta b ility o f the scrum and the m om entum (provided th at speed is not n eg ativ ely affected). T his supports the need for evaluation o f b o d y ty p e and p o sitio n al sta b ility of the fo rw ards. Id e a lly a fro n t-ro w forw ard sh o uld be stro n g ly b u ilt, p a rtic u la rly in the back, shoulders and neck. -------------------------------------------------------------------------------------------- 7 SPORTSGENEESKUNDE VOL. 6 NR. 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. ) R U G B Y Table 1: Profile of the South African rugby player Variable (units) Rugby: Forwards (n = 54) Rugby: Backs (n = 53) X s X s Age (years) 23,9 3,1 23,6 2,7 Mass (kg) 101,2 13,3 78,8 7,9 Height (cm) 188,8 7,3 176,9 6,4 Area (m2) 2,436 0,185 2,089 0,142 Vital capacity (1) 6,8 0,7 5,7 0,9 VC/FEV,(%) 84,0 5,8 83,7 7,3 Body density 1,068 0,014 1,078 0,008 Body fat (Siri) 15,0 6,8 9,2 3,1 Endomorphy(cor) 2,8 1,12 2,1 0,61 Mesomorphy 6,6 1,1 6,0 0,9 Ectomorphy 3,4 1,3 2,3 0,6 Grip strength (kg) 76,7 10,9 67,9 8,8 Back strength (kg) 217,1 30,9 185,5 34,1 Knee extension (kg.m) 29,7 5,9 27,7 6,2 Knee flexion (kg.m) 19,3 3,3 16,4 3,5 Elbow flexion (kg.m) 5,8 1,0 4,6 0,8 Elbow extension (kg.m) 8,0 1,8 6,8 1,3 Sprint 0-23 m(s) 3,6 0,1 3,4 0,1 Margaria 0-2 m (s) 1,4 0,2 1,4 0,1 Sit & reach (cm) 6,9 9,1 9,6 8,8 Accuracy (15) 5,4 0,3 5,9 0,4 Balance (s) 14,2 0,2 13,9 0,2 Tap test (s) 8,4 0,2 8,3 0,1 Cooper (ml.kg1.m in1) 51,2 0,7 53,9 0,6 Where n = Number X = Mean s = Standard Deviation The higher relative body fat of the fo rw ard s m a y be an advantage because it acts as a buffer d u rin g b o d y contact, w h ile the fo rw ard s are subjected to far m ore b o d y contact than the back-line p la yers. H ow ever, the negative co rre­ lation betw een b o d y fat and m otor fitness test scores are also v e ry im p o rt­ ant. B o d y contact is a significant aspect of rugby. R e la tiv e ly large b o d y size is im p o rtan t, though m ore im portant for som e positions than others. The large b o d y size o f the p la y e r is a d efinite asset w hen co n sid erin g b o d y m om entum and b o d y contact, provided that the higher relative b o d y fat does not in ter­ fere w ith velo city to the extent that it ad versely affects m om entum . A ge T he average age (23,8 y rs) of the group was o ld e r than m ost o th er national or p rovincial team s. As in other sports, it n a tu ra lly takes tim e for p layers to de­ velop th eir m axim al po ten tial. Because of th eir increased v u ln e ra b ility to in ju ry through lack o f strength and/or inex­ perience y o u n g p la yers (un d er the age of 21 y e a rs) should be pro h ib ited from p la y in g ru g b y at senior level. M u s c u la r s t r e n g t h a n d p o w er S ign ifican t differences betw een for­ w ards and backs w ere found for the peak v o litio n al handgrips strength, and back strength (as there is a relationship betw een b o d y size and strength). G rip strength is v ery im p o rtan t to ru g b y p layers (backs and fo rw ards) w ho need it w hen b inding in the scrum s, rucks and m auls o r w hen han dlin g the ball. Back strength is a n ecessity for the ru gb y forw ards in the scrum s, rucks and m auls. N o sign ifican t differences w ere found betw een the absolute knee flexion and extension po w er as dem on­ strated b y th e C y b e x . F le x ib ility A sit and reach test w as used to assess ham strin g m uscle group and low er- back flexib ility. D ata differed sig n i­ fican tly betw een the tw o groups. An adequate level of fle x ib ility is im portant w hen forced to stretch and to prevent in ju ries to m uscles and associated tis­ sue. A n a e ro b ic p o w e r N o sign ificant difference w as found be­ tw een the tw o groups for the 23 m etre sp rin t or the M a rg aria test. As the M ar- garia test w as sim ilar in both groups the d ifference in p o w er scores w as caused b y the differences in b o d y w eigh t. D e­ spite th eir greater w eigh t, the forw ards w ere able to run as fast as the backs, w hich d em onstrates th eir leg power. A ero b ic c a p a c ity The aerobic cap acity tests includes V 0 2 m„ values derived from the 12 m in ­ ute C o o p er test. The V 0 2max values of this stu d y (m ean 52,5 m l. kg ', m in '1) are sim ila r to those of the B ritish ru gb y p la y e rs .4 Values reported for other SA E lite in term itten t-sp o rt athletes in d i­ cated (Table 2) that professional soccer, squash and field h o ck ey p layers exhibit greater aerobic cap ac ity than the ru gb y p la yers. D o c h erty5 has p ostulated that the aerobic versus anaerobic en ergy de­ m ands of a ru g b y p la y e r gam e v ary be­ tw een 85% and 15% and depend upon the p la y in g po sitio n . P layers spend ap­ p ro x im a tely 85% o f their tim e in low in ten sity ac tiv ity and 6% of the 15% (intense a c itiv ity ) is related to running and 9% to activ itities such as com peting for the ball ta ck lin g and p ushing. This indicates that the gam e is m ore an aer­ obic than aero b ic, sugg estin g the need for a greater em phasis on anaerobic fitness train in g. A cco rd in g to these authors train in g should focus on d evel­ o ping the p o w er of this m etabolic path- 8 ------------------------------ SPORTS MEDICINE VOL. 6 NO. 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. ) R U G B Y Table 2: Body composition and V 0 2max: A comparison between the SA senior rubgy player and data for SA elite athletes in other intermittent activity sports Study Age (yrs) Height (cm) Weight (kg) Body fat (%) vo2m„ (m l.kg’ .mirr1) SA Rugby 23,8 188,2 90,2 12,5 52,5 n=107 Hockey6 21,5 178,4 72,0 9,9 54,1 n= 28 Squash6 25,7 179,4 75,3 8,6 58,8 n= 18 Soccer6 21,8 174,8 72,0 9,2 55,2 n= 36 w a y since o n ly a few activites seem to extend b eyo n d a 10 second duration . T he ratio of p la y in g tim e and recovery tim e should be considered because their inten sity o f effort is esp ecially d e­ pendent on the a b ility to recover from anaerobic d u rin g the aerobic recovery phase. A erobic co n d itio n in g should therefore be em phasized. M u lt iv a r ia t e a n a ly s is A m u ltiv ariate an alysis used to com pute the findings of 725 m ales particip atin g in 28 categories represented b y 20 sports in South A frica sum m arize the fo llo w in g results that are im portant for ru g b y : The ru g b y -fo rw ard s scored the best in elbow flexion and backstrength - the poorest in V 0 2m„ and relative k nee- flexion and extensions and the highest in m esom orphy. C o n c lu s io n T his paper dem onstrates the use of ac­ tual p rofiles stru ctu red from m o rpho­ logical, m o to r fitness and p h ysio lo gical d ata in assisting the coach, selector or the ru g b y p la y e r to im prove the latte rs’ p la y in g ability. It should be em phasised that the authors do not believe in a single en tity o f P H Y S IC A L FIT N E SS. R u gb y d e­ m ands a different co m bination of func­ tio n al capacities and therefore, the fitness of an in d iv id u al must be specific to the p artic u lar task in h a n d .5 These norm s can be used to predict, w ith in lim its, aptitude for p artic i­ pation and to reflect shortcom ings in specific fitness com ponents, as w ell as im provem ent, th ro ugh specific training program m es. R EFER ENC ES 1. D e s p ir e ’s M , B a rn a rd J G , G e ld e rb lo m IJ a n d F e r r e ir a S. S p e s if ie k e m o to rie s e - en fik s h e id s k o m p o n e n te b y s p o r tlu i. SA T y d - s k n f v i r N a v o rsin g in S p o rt, L ig g a a m h k e O p v o e d k u n d e en O n s tp a n n in g , 3(1): 7 1-8 8 , 1980. 2. Heath BH and C a rte r JE L . A m odified so- m a to typ e m ethod. A m J p h y s A n th r o p , 2 7 : 5 7 -7 4 , 1967. 3. Siri W E . B o d y co m p o stio n fro m spaces and density, D o n n e r L ab o rato ry, medical p h y s ­ ics (U n iv e rity o f C alifo rn ia), 1956. 4. W illiam s C , Reid R and C au tts R. O b s e r­ vation o f the aerobic p o w e r o f un iversity ru g b y p la y e r and p rofession al soccer player. B n tJ s p o r ts M ed : 7: 3 9 0 - 3 9 1 , 1973. 5. D o c h e rty D , W enger H A and N eary P. T im e-m o tio n analysis related to the pysio - logical dem ands o f rugby. J o u r n a l o f H u ­ m a n M o v e m e n t S tu d ie s, 1 4 : 2 6 9 - 2 77, 1988. 6. D e sp ire ’s M . N ation al Research Project N o 1. The Q u an tificatio n o f Variables c o n trib ­ uting to P erform an ce in Top S p o rt in the R SA . U O F S , B lo em fo n tein , 1988. A . \ W La < > ----------------------------------- 9 SPORTSCENEESKUNDE VOL. 6 NR. 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. ) SPORTS INJURIES ENCOUNTERED O N A FIVE WEEK INTERNATIONAL CRICKET TOUR CA Smith A B S T R A C T ... .......... " ........... " ........ ~ ~ ' ......... ..... ’ ’ ] ! ' i i I K e y w o r d s : C rick et, I n ter n a tio n a l tour, co m m o n in juries, p h y sio th e ra p y i J I i The injuries incurred by 16 international cricketers while on a 5 week to u r have been recorded. The physiotherapy treatm ent fo r these injuries has also been briefly noted. The purpose o f this article is to make | ’ the medical team m anaging a cricket team (or any tou rin g sports team) m ore aw are o f the type and extent o f | com m on injuries to be expected on a tour. It was concluded th at it is im p ortan t to th o ro u g h ly screen each | player before undertaking an y tours o f this n ature to identify either present o r past injuries. Therefore, a i i treatm ent/training program m e fo r the players, w ith the aim of minimising the possibility o f re -in ju ry while ! on tour, can be advised. j IN TR O D U C TIO N T here is a con siderable am ount of lite r­ ature discussin g the com m on injuries associated w ith different elite sp o rts­ m en and th eir sp o rtin g a c t i v i t i e s . 4 H ow ever, the lite ratu re p ertain in g to the ty p e and extent of in ju ries incurred w ith sports team s w hen on to u r is sc a rc e .5 M o re specifically, although a fair am ount of p u b lish ed research on c rick et as a sport does e x ist,6’7,8’9’10 there is little evidence d escrib in g the injuries w h ich can be expected w ith a to urin g Intern atio n a] C ric k e t Team. T herefore, the aim o f this stu d y w as to h ig h ligh t the com m on in ju ries associated w ith an CA S m ith BSc P h y sio th era p y BSc (H ons) S ports S cien c e U CT/MRC B io e n e r g e tic s o f Exercise R esea rch Unit U C T M ed ica l S ch o o l O b s e r v a to r y C ape Town. in tern atio n al cricket team w h ile on tour, and thus assist w ith the p la y e r’s p rep aratio n for future such tours. B A C K G R O U N D Sixteen In tern atio n al cricketers visited South A frica on a 5 w eek tour, w hich included 1 five d a y Test m atch, 4 one d a y Intern atio n als and 3 three d a y p re ­ lim in a ry m atches again st provincial team s in South A frica. P rio r to d ep artin g from th eir hom e country, each p la y e r u n d erw en t a p h y sic al fitness exam ination. The exam in atio n consisted of m uscle po w er testing on a cyb ex , m easurem ent of o x­ y g e n u p tak e w h ile p ed allin g on a cycle ergo m eter and an increm ental running speed test on a tread m ill. Each p la y e r w as also exam ined b y a p h y sio ­ th erap ist, and in som e cases an o rth o ­ p aedic p h ysicia n . U n fo rtu n ately, the testing w as done too close to the tim e of d ep artu re, and the p la y e rs never had sufficient tim e to im prove the areas of fitness in w h ich th ey w ere considered w eak . The c ric k e te rs’ o w n dom estic season ended in Septem ber 1989 and to u r took place four m onths later in J a n u a r y 1990. The off-season b reak m eant that p la y e rs w h o did not m ain tain a reason­ able stan dard of fitness over this period did n o t start th e to u r in th e p h ysical co n d itio n th ey w o u ld have been in, had the to u r been clo ser to the end of th eir p la y in g season. A lth o u gh this could have co n trib u ted to som e p la yers in c u r­ rin g in ju ries e a rly on in the to u r w hen th e y w ere still not fu lly fit and con­ d itio n ed , it c o u ld also have w o rk ed in the team ’s favo u r b y assisting some p la y e rs to reco ver from a n y in ju ry of the p rev io u s season. EXERCISE A N D TR A IN IN G REGIMEN A fter arriv in g and before com m encing w ith the first m atch, the team had 6 d ay s t o a cclim a tis e t h e m s e lv e s t o the su rro u n d in g co n d itio n s, to increase th eir suppleness and flexib ility, th eir gen eral level of fitness and im prove th eir crick etin g sk ills, ie. b attin g, b o w l­ ing and field in g. From the b eginning, em phasis w as placed on stretching and w arm in g-u p e x e r c is e s b e f o r e th e p r a c ­ 10 --------------------------------------------------------------------------------- SPORTS MEDICINE VOL. 6 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. ) tise sessions and m atches, w ith the aim of keep in g the in ju ries on to u r to a m in ­ im um . P ractise sessions d u rin g the first w eek n o rm ally lasted b etw een 2 to 3 h o urs, som etim es tw ice daily. The ses­ sions started w ith a slo w w arm -u p jo g of 2 to 3 laps aro u n d the p la y in g field. T his w as then fo llo w ed b y stretching exercises fo r about 20 m inutes (the b i­ ceps, tricep s, d elto id s, trap ezii and la- tissim us d o rsi, qu ad ricep s, h am strings, g lu te ii, thigh abductors and adductors, the calf and abd o m in al m uscles). M o ­ b ility exercises fo r the sh o u ld er and hip jo in ts as w e ll as the entire spinal colum n w ere also perform ed. Stren gth en in g exercises, m a in ly for the leg, ab do m in al and sh o u ld er girdle m uscles w ere then done. These in ­ cluded sit-u p s, leg th ro w -d o w n s, leg a n ti-g ra v ity exercises and press-ups. Short sprints and m edium distance runs at 50 and 75% of m axim um w ere also perform ed. T he p layers then w en t to the nets to im prove th eir b atting and b o w lin g sk ills and finished off w ith field in g practise. U N D E R L Y IN G IN JU R I E S O N A R R IV A L Several p la y e rs arrived w ith u n d erlyin g in ju ries. Som e in ju ries w ere a resu lt of the p revious crick etin g season and others w ere of a m ore chronic lo n g ­ stan d in g n ature. A lth o u gh som e of the in ju ries w ere not as a d irect cause of the tour, th e y w ere aggravated b y the to u r’s inten se p ro gram m e, and thus w a r­ ranted treatm en t. F u rth erm o re, som e u n d e rly in g co nditions w h ich w ere re­ po rted rem ained asym p to m atic th ro u gh o u t the d u ratio n of the to ur and n ever req u ired treatm ent. A ll the u n d e rly in g in ju ries w ere assessed and repo rted b y the p h ysio th erap ist w ho had screened the p la yers p rio r to th eir dep artu re and w ere w ritten up in a short report for each player. Some p la y ­ ers w h o had m ore serious in ju ries w ere also exam ined b y an orth o p aedic su r­ geon. O ne p la y e r had had a rig h t knee ar­ th ro sco p y in 1989 for an osteochondral lesio n , and had recovered from this over the off-season. H ow ever, the in ­ ju r y w as re-aggravated in his first m atch, w h ich resulted in a syn o v itis. A fu rth er tw o w eeks of rest and treatm ent w as n ecessary before he could resum e p la yin g . A n o th er p la y e r w as found to have “gross degeneration of the left h ip ” on x -r a y coupled w ith a slig h t fixed flexion d efo rm ity and restricted abduction and m edial and lateral ro tatio n . These signs w ere not o v e rly relevan t, and the p la y e r o n ly dem o n strated m oderate in fle x ib il­ it y at the hips w ith stretch in g exercises. H e n ever com plained of pain o r d is­ com fort d u rin g exercise and w as able to p la y in all the gam es for w hich he w as selected. A n o th er p la y e r com plained of lu m ­ bar backache and stiffness. H is m edical report attrib u ted this to the presence of a 6th lu m b ar verteb ra w ith conse­ q u en tial loss of the no rm al lord o tic curve. M o b ility and stretch in g exercises fo r the th o raco lu m b ar region w ere given to the p la y e r to ensure he re­ m ained asym p to m atic. O ne of the b o w lers presented w ith a m in o r facet jo in t neck in ju ry w hich re­ covered w ith in the first w eek fo llo w in g m o b ilisatio n treatm ent. A n o th er p la y e r arrived w ith a h is to ry of a chronic righ t achilles ten d in itis. R e g u lar stretching helped keep the co n ditio n pain free u n ­ til the last w eek of the tour, but then team selection rath er than the in ju ry p revented the p la y e r p la yin g . L astly, one of the b o w lers had an asy m p to m atic un stab le osteitis pubis w h ich revealed a 1,5cm depression of the left p ubic ram i. H e insisted that it never tro u b led him w hen he bow led, and this rem ained tru e for the d u ration of the tour. IN JU R I E S A N D P H Y S IO T H E R A P Y T R E A T M E N T A to tal num b er of 40 separate injuries w ere recorded on the to u r (Table 1). T here w ere 8 m uscle in ju ries, 6 inv olv­ ing tendons, 5 ligam en ts sprains, 14 af­ fecting eith er bone or jo in t stru ctu res, 3 to n eu ral tissues, 3 to soft tissues and 1 o th er in ju r y in v o lv in g none o f the above structures. T here w e re 24 m in o r and 16 m ajor in ju ries. M in o r in ju ries w ere con­ sid ered to be those w h ich to o k 3 treat­ m ents or less to recover and w hich did not rule a p la y e r out from team selec­ tion. M ajo r in ju ries w ere those w hich w arran ted m ore than 3 treatm ents and m igh t have prevented a p la y e r from p la y in g . A ll 16 in d iv id u als w ere treated w ith 166 treatm en t sessions in to tal given, at an average of 10,4 sessions per player. Treatm ent m o d alities included electro­ th erap y ap paratus (in terferen tial, u ltra­ sound and laser), m anual p h ysio ­ th erap y techniques (m o b ilisatio n s, m assage, exercises and tap in g p ro ­ cedures) and lastly, ice. In to tal, 405 treatm ent m o d alities w ere used in the 166 attendances, at an average of 2,5 m o dalities p er session. The m ost com ­ m on m o d a lity w as u ltraso u n d , fo l­ lo w ed b y m assage, laser, m o b ilisations, ice, in terferen tial, strap p in g and exer­ cises being used least. Muscle Injuries T w o p la yers w ere treated w ith deep m assage fo r m uscle scarrin g and m ech­ anical tension in th eir sh o ulder girdle regio n . T hree p layers strained their quadricep s m uscle, tw o of them being m ild grade one strains w h ich responded to transverse friction treatm ent, the th ird tak in g slig h tly longer to heal as the p la y e r had p rev io u sly torn the m us­ cle. T w o h am strin g inju ries w ere in ­ cu rred , both the result o f old injuries being re-aggravated . Since the one p la y e r filled a k e y position (w icket keep in g) w hich kept p u ttin g strain on the m uscle and p layed in all the m atches, he did not have adequate tim e to rest and thus the in ju ry never healed com pletely. The o th er ham strin g in ju ry o n ly presented to w ards the end of the to u r and d id not lim it the p layer to m u ch extent. Both w ere treated w ith cross friction m assage, ice, straigh t-leg raise stretching, ultraso un d and laser therapy. The last in ju ry w as a m inor strain o f the calf m uscle w h ich re­ sponded to 2 treatm ent sessions of transverse frictions and ultraso un d. Tendon Injuries T he com m onest tendon injuries on t h e . to u r w ere fo u r groin strains, all of ------------------------------------------------------------------------------------— 11 SPORTSGENEESKUNDE VOL. 6 NR. 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] R elifen 500 tablets 500 m g N abu m eto ne. R eg . no . R /3.1/265. N ab u m eto n e. S m ith K line B eecham P h arm aceu ticals P O B ox 347 B ergvlci 2012 W hen y o u r p a tien t’s in pain, y o u r first resp o n sib ility is to take a w a y that pain. Q u ic k ly . E ffectively. But doing so could lead to unacceptable gastro­ intestinal side effects and com binatio n th erap y. B ut n o w , ten years of p recisely targeted m o lecular research have produced a h ig h ly effective, no n-acidic an ti-in flam m ato ry. R elifen. Each tablet is m ade of 500 m g nabum etone, a n o n-steroidal an ti-in flam m ato ry, proven in num erous double blind studies to be as effective as o th er benchm ark N SA ID s. Yet its route o f action is to tally different. R elifen is a n o n-acidic p ro -d ru g. In the sto m ach , it is relativ ely inactive. It is absorbed from the duo den um , into the p o rtal blood su p p ly. F in a lly, in the liver, it is m etabolised into a potent in h ib ito r of prostaglandin synthesis. R efer p ackage in sert for fu ll p rescrib in g in fo rm atio n . F u rth e r in fo rm atio n is a v ailab le from o u r M e d ical D epartm ent. 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? The active m etabolite penetrates the syn o v ial fluid to reach the inflam ed site, givin g effective relief of sym p tom s. E xcretion is b y the k id n ey s, so gastro ­ in testinal dam age th ro ugh b ilia ry recirculatio n and reflux is u n lik e ly . For effective relief from pain and inflam m ation, w ith less chance of g astro -in testin al d isco m fo rt, y o u now have an ideal choice. R elifen. Relifen and the SB logo arc trad em ark s. p h a / OG IL VY & M AT H ER , RI GH TF OR D SE AR LE -T RI PP & M AK IN 34 9 83 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. ) ; Table 1: In tern atio n al Touring C ric k e t Injuries 1990. ; I n ju r y S ta tis tic s M uscles 8 Tendons 6 , L igam en ts 5 I B ones/Joints 14 I N e u ral T issues 3 j Soft T issues 3 I O th er 1 ! T otal 40 P h y s io th e r a p y T re a tm e n t In d iv id u als treated 16 T reatm ents given 166 I Treatm ent m o d alities E lectro th erap y: In terferential 21 U ltraso u n d 99 L aser 61 T otal 181 M a n u al: M o b ilizatio n s V ertebral 27 P erip h eral 33 T otal 60 M assage Specific 78 N o n -sp ecific 5 T otal 83 Specific exercises 14 Strap p in g 16 Ice 51 T o tal T re a tm e n t M o d a litie s 405 16 p la yers received 405 treatm en t m o dalities, average 25,3 405 m o d alities in 166 treatm en t sessions, average 2,4. w h ich involved the adducto r longus tend o n o n th e left leg close to the ischial tu b e ro sity insertio n . T w o occurred e a rly on in the to u r and responded w ell to treatm en t w ith transverse frictions, u ltraso u n d and laser w h ile th e' other tw o occurred in the final w eek and had not fu lly healed b y the tim e the tour w as over. O ne p la y e r had a sm all gan ­ glion of his ab d ucto r p ollicis brevis ten­ don o f th e e ig h t w rist. It to o k 5 s e s s io n s of laser and ultraso u n d th erap y coupled w ith an ti-in flam m ato ry m edication to relieve the pain. L astly, one p la yer p resented w ith a grade one supraspina- tus tend o n itis. T w o treatm ent sessions w ith frictio n m assage and laser cured this injury. L ig a m e n t In ju rie s T w o p la y e rs com plained o f pain in the area of the soft ligam entous tissues su r­ ro u n d in g the sac ro iliac jo in t. O th er l i ­ gam entous in ju ries included the ante­ rio r ta lar fib u lar ligam ent and nearb y extensor retin acu lu m , the m edial co r­ o n ary ligam en t of the knee jo in t and the co raco clavicu lar ligam en t of the sh o ul­ der. F rictio n m assage com bined w ith u ltraso u n d and laser w ere used in no m ore than 3 sessions to treat each of these injuries. B o n e/ Jo in t I n ju rie s T hese w ere the m ost com m on injures observed on the to u r (Table 1). F irstly, n ig g lin g in ju ries to the sp in al colum n o ccurred at three lev els; cervical and th o racic facet jo in t in ju ries in tw o p la y e r and lu m b ar facet jo in t pain and stiffness inv olvin g four others. The sp i­ nal in ju ries responded w ell to m o b ilisa­ tion and in terferen tial therapy. O n e o f th e c o m m o n e s t in ju ries in crick et, those in v o lvin g the fingers, w ere seen in three p la y e rs . A dislocated d istal interp h alan geal jo in t (D IP) of the little fin ger w as im m e d iately reduced and req u ired 5 d ay s rest and padded strap p in g u n til the p la y e r co uld p la y again. A n o th er p la y e r w as h it w ith the ball on the end of the little fin ger re su lt­ ing in an im p actio n in ju ry to the D IP jo in t and lateral d isplacem ent of the te r­ m in al phalan x, confirm ed b y x -r a y an alysis. T he jo in t w as padded, strap p ed and im m o b ilised . A local an aesthetic injectio n w as adm inistered after the p la y e r insisted on retu rn in g to the field. A h airlin e fracture of the m id d le phalanx of the rig h t index finger occurred in the th ird player. The finger w as im m m o b ilised and w e ll padded, but never healed in tim e and prevented the p la y e r from p la y in g again on the tour. T w o elb o w in ju ries w ere also o b ­ served ; firstly, n o n -lo calised p ain in the olecranon region w h ere the involved stru ctu re co u ld not be c le a rly identified responded w e ll to m o b ilisatio n treat­ m ent, and secondly, a cap su litis w h ich presen ted w ith lim ited jo in t m ovem ent, pain and effusion. T h is w as treated s y m p to m a tic a lly to reduce the pain and sw e llin g and the effusion w as to be as­ p irated if it h ad n o t settled dow n once the p la y e r had retu rn ed hom e. T w o su b p erio steal h aem atom as w ere the re su lt of tw o p la yers being struck b y the b all, one on the rad iu s and the 14 --------------------------------------------------------------------------------- SPORTS MEDICINE VOL. 6 NO. 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. ) other on the tib ia. The sw ellin g in the forearm occurred in conduction w ith tendon crep itu s in the com m on exten­ so r d igito ru m tendons. T reatm ent con­ sisted of ice and ultraso u n d therapy. L astly, an u n d e rly in g o steochondral knee in ju ry w as re-aggrav ated on to u r and also p resen ted w ith a m ild effusion. The p la y e r needed tw o w eeks in itial rest and treatm en t before p la y in g again, and then fu rth er d a ily sym p to m atic treatm ent w ith in terferen tial th erap y and ice to reduce the sw e llin g and pain and enable him to p la y the o n e-d ay m atches. N eural Injuries T hree in ju ries presen tin g w ith neural tissue signs and sym p to m s occurred in conjunction w ith or fo llo w in g o th er in ­ juries. These com prised of adverse m echanical tension and friction s y n ­ drom e o f the sciatic nerve in the lo w er buttock in tw o p la y e rs and an adherent lum bar nerve ro o t in the lu m b ar spine of another. T h ey w ere treated b y m o b i­ lising and stretch in g the n eu ral and co n ­ nective tissue elem ents. Soft Tissue Injuries T w o p la y e rs developed soft tissue in ju ­ ries as a resu lt of b eing stru ck w ith the cricket ball. O ne p la y e r developed a para-n asal h aem ato m a on the side of the nose, and the o th er p la y e r developed a contusion on the calf. A n o th er p la y e r also had in term itten t pain in the gluteal region sim ila r to that of a g lu teal b u rsi­ tis. Treatm ent w as confined to laser and ultraso un d therapy, but did not provide com plete relief of the sym ptom s. O th er Injuries A su b u n gu al infection developed in a bowler, p a r tly from friction ru b b in g of the p la yers boot again st the toenail of the great toe. T he p la y e r m ade the necessary su rgical adjustm ents to his bo w lin g shoes and com bined w ith re l­ evant an tib io tic therapy, the infection had cleared up w ith in a w eek . C O N C L U SIO N The in ju ries associated w ith 5 w eek In­ tern atio n al C ric k e t to u r have been presented. The p h ysio th erap y treat­ m ent w h ich w as adm inistered is d is­ cussed. T he n um ber of in ju ries encountered (40) m igh t be co n sidered high w ith re­ spect to the to u r’s d u ra tio n of 35 d ays. Even so, 20% of these w ere as a result of re-aggrav ated in ju ries from the p re­ vious crick et season. T herefore, the 4 m onth b reak in b etw een the season and the to u r co uld have been b etter utilised to prepare the in d iv id u al p la y e rs, by gettin g them fit and therefore p rev en t­ ing an y recurrance of troublesom e in ju ­ ries. The to u r’s intense pro gram m e of 16 m atch d ay s and 14 practice d ay s m ight have co n trib u ted to a larg er volum e of in ju ries. T h is w as th o u gh t to have been prevented to som e extent b y the v ig o r­ ous stretch in g and w arm in g -u p ro u ­ tines w h ich preceded each practise ses­ sion and m atch day. The financial operation of a surgery can be a headache of major proportions. And to keep things from tailing apart you need more than a bookkeeper and a P.C. — with all the compromises inherent in generalised business software. You need a customised, single or multi-user system from NORIDATA. Not just because its more cost-effective than ordinary P.C.’s — but because its hardware and software are tailored specifically for your practice whether R EFER EN C ES 1. J o h a n s s o n C . In ju rie s in eiite orienteers, A m ] S p o r ts M e d 19 8 6 , 14(5), 4 1 0 - 4 1 5 . 2. K e lle r C S. The m edical aspects o f soccer in­ ju r y ep id em io lo g y, A m J Sports M e d 19 8 7, 15(3), 2 3 0 -2 3 7 . 3. Sm ith F H . Ice h o c k e y in juries, A m J Sports M e d 19 8 7, 15 (1), 3 0 -4 0 . 4. L o w d o n B W . In ju ries to in tern atio n al com ­ petitive su rfb o ard rid ers, J Sports M e d P hys F itness 1 9 8 7 ,2 7 ( 1 ) , 5 7 -6 3 . 5. W att J , B o tto m ly M B , and Read M TF. O ly m p ic athletics m edical experience, Seoul - person al view s, B r J Sports M e d 19 8 9, 2 3(2), 7 6 -7 9 . 6 . P ayn e W R , H o y G , and C la rs o n J S . W h a t research tells the cricket coach, Sports Coach 1 9 8 7 , 1 0 ( 4 ) , 17 -22 . 7. E llio tt B C , and F o ster D H . A biom echan i­ cal analysis o f the fro n t-o n and side-on b o w lin g techniques, J o u r n a l o f H u m a n M o v e m e n t S tu d ie s 1 9 8 4 , 10, 8 3 -9 4 . 8. Lillee D K . ‘The A r t o f Fast B o w lin g ’ C o l­ lins Publishing C o m p a n y 19 7 7 , S y d n e y 9. E llio tt B C , F o ste r D H and G r a y S. B iom e­ chanical and P hysical F actors Influencing Fast B o w lin g , A u stra lia n J o u r n a l o f Science a n d M e d ic in e in S p o rt 1 9 8 6 , 18 (1), 1 6 -2 1 . F o rw a rd G R . In d o o r crick et in ju ries, M e d J A u s t r m S , 1 4 8 (1 1 ) , 5 6 0 -5 6 1 . large or small — specialised, prescribing or dispensing. Supported by a nearby practice- management professional who has a world of experience in integrating computers with the medical profession. Computers that are compatible with other systems and expandable in the future without changing software. For the name of that practice- management professional (we have over 50 country-wide) call us at (011) 484-4392 now. Just a 15 minute no obligation demonstration will show you how easy it is to manage your practice painlessly. MedSolve South A frica's m ost used medical practice m anagem ent system . . . . . , a n d winner o f the C.S.A. 1990 Silver Aw ard f o r an exceptional established South A frican product. N O R ID A TA d i v i s i o n o f n o r i s t a n l i m i t e d P O BOX 31469 BRAAMFONTEIN 2017 cure the biggest problem in practice management. SPORTSGENEESKUNDE VOL. 6 NR. 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. ) P H Y S IO T H E R A P Y U P D A T E THE PHYSIOTHERAPY TREATMENT OF A HAMSTRING TENDON INJURY In t h e p a s t f e w y e a r s p h y s i o t h e r a p i s t s h a v e n o t i c e d an in c re a s e in t h e n u m b e r o f p a t i e n t s c o m p l a i n i n g o f p a i n , “ H i g h u p , at t h e t o p o f m y leg u n d e r m y b u t ­ t o c k , an d w h e n I ’m r u n n i n g , I feel th a t if I p u t m y f i n g e r i n t o t h e p a in , it w i l l h e l p , b u t it d o e s n o t ”. T w o d i f f e r e n t age g r o u p s c o m p l a i n o f t h e p r o b l e m . T h e f i r s t is t h e g r o u p o f s c h o o l c h i l d r e n w h o p a r t i c i p a t e in p r o ­ v i n c i a l a th le ti cs . T h e y ar e o f t e n h u r d l ­ ers a n d s o m e t i m e s s p r i n t e r s w h o h a v e l o n g h o u r s o f t r a i n i n g . A s can be e x ­ p e c t e d , t h e m o r e c o m m o n age g r o u p w i t h m i n o r d e g e n e r a t i o n o f t e n d o n s d u e t o age, is th e g r o u p b e t w e e n 4 5 an d 5 5 y e a r s . T h e s e p a t i e n t s ar e u s u a l l y l o n g di s t a n c e r u n n e r s . T h e s c h o o l c h i l d p r e s e n t s a h i s t o r y o f an a cu te i n j u r y , u s u a l l y c a u s e d b y i n ­ a d e q u a t e o r i n c o r r e c t w a r m - u p m e t h ­ o d s . T h e r e a s u d d e n o v e r l o a d o f the h a m s t r i n g m u s c l e , cr e a te s i m m e d i a t e p a i n in t h e a re a o f th e isc hia l tu b e r o s i t y . T h e o l d e r age g r o u p has a d i f f e r e n t h i s t o r y o f p a i n o c c u r r i n g g r a d u a l l y o v e r a l o n g p e r i o d o f r o a d r u n n i n g . B e c a u s e t h e p a i n m a y ra d i a t e d o w n t h e b a c k o f th e leg m a n i f e s t i n g in th e S i d e r m a t o m e , t h e p h y s i o t h e r a p i s t , d u r ­ ing h e r e x a m i n a t i o n , a l w a y s d i f f e r e n ­ tiates b e t w e e n an L5 /S 1 p r o b l e m an d a h a m s t r i n g i n j u r y . T h e n e r v e i n n e r v a t i o n o f t h e h a m s t r i n g s is S i . To d i f f e r e n t i a t e , o n e asks t h e p a t i e n t t o t o u c h his t o e s w h i l e k e e p i n g his k n e e s e x t e n d e d a n d f l e x i n g his hips. T h i s m o v e m e n t str es s e s t h e s t r u c t u r e s o f t h e l u m b a r s p in e . If t h e p a t i e n t r e ­ p e a t s th is m o v e m e n t w i t h his l u m b a r s p i n e e i t h e r f l a t t e n e d o r in a l o r d o t i c p o s i t i o n , t h e h a m s t r i n g m u s c l e is s t r e t c h e d . T h e r e ar e o f c o u r s e m a n y o t h e r e x a m i n a t i o n m o v e m e n t s w h i c h the p h y s i o t h e r a p i s t asks t h e p a t i e n t t o p e r ­ f o r m in o r d e r t o r e p r o d u c e t h e pai n. R e s i s t e d f l e x i o n o f th e k n e e s h o u l d r e ­ p r o d u c e t h e p a i n at t h e site o f th e h a m ­ s t r i n g t e n d o n , b u t d u e to t h e s t r u c t u r e a n d s i z e o f t h e m u s c l e an d t e n d o n , it d o e s n o t a l w a y s d o so. O n c e t h e p h y s i o t h e r a p i s t has d i a g ­ n o s e d t h a t t h e p r o b l e m is a h a m s t r i n g t e n d o n i n j u r y , t h e n th e t e n d o n is p a l ­ p a t e d a n d t r e a t e d w i t h t r a n s v e r s e f r i c ­ ti o n s . T h i s is a d e e p m a ss a g e w i t h the f o r c e at r i g h t an g le s t o t h e t e n d o n . It is a v e r y t i r i n g t r e a t m e n t f o r t h e p h y s i o ­ t h e r a p i s t a n d e v e n th e p a t i e n t u s u a l l y s y m p a t h i s e s . D i f f e r e n t el e c tr i c a l m o ­ da l i ti e s s u c h as u l t r a s o u n d an d l a z e r are a ls o u s e d in o r d e r to d e c r e a s e the i n ­ f l a m m a t i o n a n d e n c o u r a g e h ea li ng . In re s i s t a n t ca ses , if p h y s i o t h e r a p y d o es n o t i m p r o v e t h e c o n d i t i o n th e i n f i l t r a ­ t i o n o f t h e a re a w i t h a s t e r o i d i n j e c t i o n is the n e x t s te p o f f e r e d . T h e p h y s i o t h e r a p i s t d o e s n o t a l l o w t h e p a t i e n t t o p a r t i c i p a t e in s p o r t un ti l h e is p a i n f r e e a n d his h a m s t r i n g h a s r e ­ t u r n e d t o its o r i g i n a l s t r e n g t h , p o w e r a n d fl e x i b i l i ty . If a v a i la b l e , t h e p a t i e n t is t e s t e d o n an i s o k i n e t i c te s t i n g m a c h i n e in o r d e r t o a s c e r ta i n his q u a d r i ­ c e p s / h a m s t r i n g r a t i o s a n d p o w e r . H e is t h e n g i v e n a p r o g r a m m e o f i s o m e t r i c o r g y m n a s i u m e x e rc i s e s in o r d e r t o c o r r e c t his d e f i c ie n c i e s . T h e i s o k i n e t i c m a c h i n e its e lf , can be u s e d as a r e h a b i l i t a t i o n m a c h i n e as w e l l as a te s t i n g m a c h in e . O n c e he r e t u r n s t o his s p o r t , he can p r o t e c t t h e t e n d o n b y us in g a t h e r m a l s u p p o r t . T h e s e s u p p o r t s ar e m a d e f r o m a n y l o n n e o p r e n e an d ar e s i m i l a r t o a w e t s u i t m a t e r i a l , b u t ar e th in ne r. T h e y re t a i n t h e b o d y ’s n a t u r a l h ea t, e n s u r i n g a g o o d b l o o d s u p p l y t o t h e area. M o r e a n d m o r e t o p s p o r t s m e n are u s i n g these s u p p o r t s w h i c h ar e m a n u f a c t u r e d in S o u t h A f r i c a . T h e s p o r t s m a n w e a r s it b o t h w h i l e h e is p r a c t i c i n g a n d w h i l e he is p l a y i n g his s p o r t . It is a v e r y c h e a p a n d e f f e c t i v e f o r m o f p r o t e c t i o n f o l l o w ­ ing an i n j u r y a n d is a ls o a p r e v e n t a t i v e m e a s u r e . 16 ------------------------------ SPORTS MEDICINE VOL. 6 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. ) E X E R C IS E -R E L A T E D IN J U R IE S THE PREVENTION OF EXERCISE-RELATED INJURIES AMONG SOUTH AFRICAN ARMY RECRUITS: A REVIEW H J v a n Heerden IN T R O D U C T IO N T h e h i g h in c i d e n c e o f e x e r c i s e - r e l a t e d i n j u r i e s , p r i m a r i l y in th e f o r m o f o v e r ­ use s y n d r o m e s t o th e l o w e r e x t r e m i t i e s , is a u n i v e r s a l p r o b l e m a m o n g r e c r u i t s b e i n g s u b j e c t e d t o an i n t e n s i v e p h y s i c a l c o n d i t i o n i n g p r o g r a m m e (ba sic t r a i n ­ ing) o n e n t e r i n g t h e m i l i t a r y s e r v i c e . 1'3 In this r e s p e c t a v a r y i n g i n c i d e n c e has b ee n r e p o r t e d , w i t h A m e r i c a n a r m y 1 an d m a r i n e 2 r e c r u i t s s u f f e r i n g a 2 6 % an d 3 7 % ra te o f i n j u r y r e s p e c t i v e l y , a n d th e N e w Z e a l a n d 3 a r m e d f o r c e s d o c u ­ m e n t i n g an e x t r e m e 6 5 , 4 % in c i d e n c e o f “w o r k - r e l a t e d ” in j u r i e s . T h e p o s s i b i l i t y t h a t a s i m i l a r s i t u a t i o n m a y e xi s t in the S o u t h A f r i c a n D e f e n c e F o r c e ( S A D F ) w a s f i r s t s u s p e c t e d b y C i l l i e r s an d G o r ­ d o n , 4 w h o s u g g e s t e d t h a t t h e e f f i c a c y o f t he S A D F ba si c t r a i n i n g c e n t r e s m a y be l i m i te d d u e t o th e p a r t i c u l a r l y i n j u r io u s , n a t u r e o f t h e p h y s i c a l t r a i n i n g e m ­ p l o y e d . S u b s e q u e n t l y , G o r d o n 5 c r i t i c a l l y e v a l u a t e d t h e S o u t h A f r i c a n A r m y p h y s i c a l t r a i n i n g p r o g r a m m e in t e r m s o f fi t n e s s a t t a i n e d a n d i n j u r i e s s u s ­ ta in ed . R e s u l t s p u b l i s h e d f r o m this r e ­ s e ar c h r e v e a l e d u n s a t i s f a c t o r y gains in H ] van H eerden M A (Biokinetics) D epartm ent o f H u m a n M ovem ent Science University o f Zululand Private Bag X I 001 K w adlangezw a 3886 e n d u r a n c e f i t n e s s , 6 an d c o n f i r m e d the a f o r e m e n t i o n e d h y p o t h e s e i s b y n o t i n g a 3 7 , 9 % i n c i d e n c e o f e x e r t i o n - r e l a t e d i n j u r i e s t o r e c r u i t s d u r i n g basic t r a i n ­ i n g . 7 TH E A E T IO L O G Y A N D P R E V E N T IO N O F O V E R U S E IN JU R IE S In r e v i e w o f t h e p o s s i b l e caus es o f o v e r ­ u se i n j u r i e s t o t h e l o w e r e x t r e m i t i e s , n u m e r o u s r e s e a r c h e r s 812 h a v e i d e n ­ t i fi e d c e r t a i n c o m m o n f a c t o r s t h a t s h o u l d be c o n s i d e r e d w h e n d e v i s i n g a p r e v e n t a t i v e s tr a te g y . A c c o r d i n g the R e n s t r o m a n d J o h n s o n , 13 th e s e f a c t o r s c an b e cl a s s i fi e d i n t o th e f o l l o w i n g i n ­ t r i n s i c a n d e x t r i n s i c c a t e g o r i e s : In trin s ic fa cto rs E x trin sic facto rs P o o r p h y s i c a l fi tn e s s T ra in i n g su rf a c e s P r e v i o u s i n j u r y T r a i n i n g m e t h o d s E x c e s s i v e b o d y ma ss F o o t w e a r P h y s i c a l a b n o r m a l i t i e s ----------------------------------- 17 SPORTSGENEESKUNDE VOL. 6 NR. 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. ) A n y of the above m entioned intrin sic risk factors m a y be observed in the new m ilita ry recru it. A s a resu lt, strict co m ­ p u lso ry m edical exam ination and sub­ sequ ent graded health classification of recruits p rio r to the start o f basic train ­ ing, should p la y a m ajo r role in id en ti­ fy in g and p ro tectin g those w ith an in ­ herent or acquired pred isp o sitio n to in ju ry .2 T raining surface is another varied and com plex factor affecting in ju rie s ,14 and one that is difficult to stan dardize in and around basic train in g centres. T he association of the rem aining id en t­ ified extrinsic factors ie. train in g m eth- o d s8,9,14 and fo o tw e a r10,12 w ith overuse in ju ry, has received p ro m in en t focus in the lite r a tu r e .1517 T he reason for this being th eir frequen t im p licatio n and perhaps m ore im p o rtan tly, p a rtic u la rly from a m ilita ry p erspective, th eir am e­ n a b ility to m an ip u latio n for the p u r­ pose o f p rev en tin g in ju r ie s .18 A cco rd in gly, since G o rd o n s’ in itial exposition o f the p ro b lem atic high in c i­ dence of overuse in ju ries in the S A D F ,5’7 tw o m ajo r intervention strate­ gies have been considered, n am ely a re­ vision o f the South A frican A rm y p h ysical train in g p rogram m e and the m an ip u latio n o f m ilita ry footwear. W h ile the possib le corresp o n din g salu ­ ta ry effects on the p h y sic al fitness o f re­ cru its are c u rre n tly under in v esti­ g a tio n ,19 the im p lem en tatio n of these prev en tative m easures and th eir in flu ­ ence on the incidence of in ju ry, m erits fu rth er discussion. T R A IN IN G M E T H O D S P rio r to 1986, South A frican A rm y re­ cruits u n d erw en t a basic 10-w eek p erio d of pro gressive p h ysical con­ d itio n in g co n sistin g o f four phases o f increasin g in te n sity .20 F o llo w in g the re­ alisatio n o f the in ju rio u s nature o f this p rogram m e how ever, a revised cyclic - pro gressive p h ysical train in g p ro ­ gram m e21"23 w as im plem ented, w hich stip u lated that activities such as ru n ­ n in g, ju m p in g , route-m arches and d rill-tra in in g be lim ited to the absolute m in im um d u rin g ev ery th ird w eek of train in g. T his n ew p rogram m e was la rg e ly based on the p io n eering research o f S c u lly and B esterm an 24 in the U nited States A rm y, con cern in g the successful m an ip u latio n o f basic train in g p ro ­ gram m es as p ro p h ylactic m easure against the risk o f overuse in ju ries, and stress fractures in p articular, am ong re­ cruits. F O O T W E A R R E G U L A T IO N S The extrinsic aetio lo gical relationship betw een m ilita ry fo o tw ear and the risk of exertio n -related inju ries to the low er extrem ities am ong re cru its25"27 has been h ig h ligh ted . A s a resu lt, glo bal attem pts to m a n ip u late fo o tw ear have been con­ ducted in three spheres. F irstly the type o f co m b at b oot w o rn has been changed, alb eit u n su ccessfu lly.2 A ltern ativ e ap­ proaches w hich have how ever, proved to be successful in red u cin g injuries, are: • the alteratio n of w ear regu latio n of b o o ts;3 and • the p lacin g of the sho ck-ab so rbin g inn erso les insid e b o o ts.29'31 A ll three o f these approaches have been considered and experim ented w ith by the South A frican A rm y ,21'22 and c u r­ re n tly all ru n n in g activities d u rin g o r­ ganised p h ysical train in g p erio d s is c ar­ ried o ut in ru n n in g shoes w ith adequate sh o ck -ab so rb in g p ro p erties, and not in boots o r “ta k k ie s ” as w as the case in the p a st.21 F u rth erm o re, van H eerden e t a l,n and S ch w elln u s33 have re cen tly re­ p o rted the sign ificant reduction of overuse in ju ries am ong South A frican a rm y recruits b y the inco rp o ratio n of sh o ck -ab so rb in g innersoles w ith in com bat boots, thus m o tivatin g the possib le m a n d ato ry app licatio n o f this preventive m easure in the n ear future. A P P R A IS A L O F P R E V E N T A T IV E M E A S U R E S In a retrospective attem pt to appraise the p o ssib le p ro p h y lac tic effect of these interventio n strategies em p lo yed b y the SA D F , the inciden ce o f exertio n -re­ lated in ju ries am ong recruits as re­ p orted b y the stu d y o f G ordon e t aF carried o ut in 1982, can be com pared w ith another recent in v estigatio n 28'32 conducted five years later, after the in ­ tro d u ctio n o f the p re v io u sly discussed p reventative m easures. In these studies, a un ifo rm research p ro to co l was used con cern in g the d efinition and classifica­ tion o f in ju ry , as w ell as the m ethod of data co llectio n , thus allo w in g for a fa­ vo u rab le com parison. A s reflected in Table 1, both traum atic and overuse in ­ ju rie s, interp reted as b eing sustained in the presence or absence o f a sudden p re c ip itatin g event respectively, show ed a su b stan tial reduction from 1982 as opposed to 1987, in c o n trib u t­ in g to a total recru it in ju r y incidence of 37 ,9 % (p re-in terv en tio n ) versus 17,1% (p o st-in terv en tio n ). T he incidence of o veruse in ju ries, as d istrub ted over vario us an ato m ical sites of the lo w e r ex­ trem ities (F igu re 1), has h ow ever not altered m uch. T ab le 1: R ecru it type/ year in ju ry incidence and 1982+ 1987* I n ju r y ty p e % % Traum atic 7,5 1,1 O veruse 32,4 16,0 Stress fractures (4,1) (0,4) T o ta l 37,9 17,1 * G o rd o n 7 *van H eerd en e t a l . 32 % In ju ry incidence expressed as a percentage o f i the to ta l n u m b er o f recruits observed in stu d y ' () D enotes a subset o f in ju ry type C O N C L U S IO N It has been su gg ested 17 that the m ilita ry is an id eal m ilieu in w hich to conduct ep id em io lo gical research due to its con­ trolled n ature. A p ractical problem is, h ow ever, encountered w ith recruits w h o serve as subjects leavin g the service on com pletion of th eir period of co n s­ crip tio n . A s a resu lt, lo n g itu d in al data repo rtin g in ju ry rates from indep en ­ d ent stu d ies, as in this case, precludes 18 --------------------------------------------------------------------------------- SPORTS MEDICINE VOL. 6 NO. 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. ) FIGURE 1: IN C ID E N C E O F O V E R U S E IN J U R Y (% ) Thigh Foot Heel Ankle Achilles Lower Leg Knee ANATOMICAL SITE ■ 1982 U S 1987 an absolute com parative in terp re­ ta tio n .34 N o tw ith stan d in g this lim i­ tation, the observed data leads one to deduce that the in tro d u ctio n of the re­ vised South A frican A rm y p h ysical train in g p ro gram m e and acco m p an yin g adapted fo o tw ear regu latio n s, has b rought about a viable decrease in the risk o f exertio n -related in ju ries. A s a consequence, the efficacy of the SA D F basic train in g centres should be en­ hanced b y the dim inish ed loss of tra in ­ ing tim e and co rresp o n d in g cost of m edical care, w h ile recruits m ay derive the op tim um co n d itio n in g benefits presented d u rin g basic m ilita ry train ­ ing. R E F E R E N C E S 1. K o w a l D. N atu re and causes o f injuries in w o m en resulting fro m an endurance training p rogram m e. A m ] S p o rts M e d 1 9 8 0 ; 8 : 2 6 4 -2 6 9 . 2. Bensel C K . T he effects o f tropical leather com bat boots on lo w e r ex trem ity d isorders am ong M arin e C o rp s recruits. C loth in g , E q uip m en t and M aterials E ngineering L ab ­ o ra to ry , N atick A r m y Labs. Technical R e­ p o rt N o . 7 6 -4 9 -C E M E L , 19 7 6. 3. Sta c y R J, H u n g erfo rd R L . A m ethod to r e ­ duce w o rk -re la te d in juries d u ring basic train ing in the N e w Zealand A rm y . M ilit M e d 1 9 8 4 ; 1 4 9 :3 1 8 - 3 2 0 . 4. C illie rs J F , G o rd o n N F. E ffect o f the Sou th A fric a n A r m y ph ysical training in stru c to r cou rse on p h ysical w o r k capacity. S A J R e ­ search S p o rt, P h ysical E d ucation and R ecre­ ation 1 9 8 3 ; 6 (i) ; 3 5 -4 2 . 5. G o rd o n N F. E valuation o f the Sou th A f r i ­ can A r m y p h ysical tra in in g p ro g ra m m e: F it­ ness attained and in juries sustained. U n p u b ­ lished P h D (M ed) thesis. U n iv e rsity o f the W itw a ters ra n d , 1985. 6. G o rd o n N F , van R en sb u rg J P , M oolm an J , K ru g e r PE, R ussell H M S , G ro b le r H C , C illie rs J F . The Sou th A fric a n Defence F orce ph ysical training p rog ram m e: Part 1. E ffect o f one years m ilita ry training on en­ durance fitness. S A f r M e d ] 1 9 8 6 ; 6 9 ; 477 - 482. 7. G o rd o n N F , H ugo EP, C illie rs J F . The Sou th A fric a n D efence F o rce ph ysical train ­ ing p ro g ram m e: P art 1 1 1 . E xertion -related in ju ries sustained at an S A D F basic training cen tre. S A f r M e d ] 1 9 8 6 ; 6 9 : 4 9 1 - 4 9 4 . 8. Ja m es SL , Bates BT, O stern ig L R . Injuries to run ners. A m J Sports M e d 1 9 7 8 ; 6 :4 0 - 5 0 . 9. M cK en zie D C , C lem en t D B , Taunton JE . R u n n in g shoes, o rth o tics and in jures. Sports M e d 1 9 8 5 ; 2 :3 3 4 - 3 4 7 . 10 . N oak es T d. L o re o f R unning. C ape T ow n: O x fo rd U n iv e rsity Press, 19 8 5. 1 1 . S p e rry n P N . S p o rt and M edicine. L o n d on : B u tte rw o rth s, 19 8 5 . 12. N igg B M . Biom echanics, load analysis and sp o rts injuries in the lo w e r exrem ities. Sports M e d 1 9 8 5 ; 2 :3 6 7 - 3 7 9 . The views a n d opinions exp ressed a n d the findings co n tain ed in this p a p e r a re those o f the au th o r a n d sho uld not b e con strued a s a n o f­ ficial South African D e fe n c e Force position, policy o r decision, unless so des ig n ate d b y o th e r official docum entation. ‘TILC0TIL’ ROCHE Components: Tenoxicam Indications: S ym p tom atic treatm ent of the following painful inflam m ato ry and degenerative disorders of the musculoskeletal system: rheum atoid arthritis; osteoarthritis; ankylosing spondylitis; extra- articular disorders, e .g . tendinitis, bursitis, periarthritis, gouty arthritis (fo r tablets). Dosage: 20 mg once daily at the same time each day. The parenteral fo rm is used fo r one or two days. For treatm ent initiation in acute gouty arthritis 4 0 mg (2 tablets) once daily fo r two days followed by 20 mg once daily fo r a fu rther five days is recom m ended. Contra-indications: Known hypersensitivity to the drug. Patients in w hom salicylates or other nonsteroidal anti­ inflam m atory drugs (N S A ID s) induce sym ptom s o f asthm a, rhinitis or urticaria. Patients who are suffering o r have suffered from severe diseases of the upper gastrointestinal tract, including gastritis, gastric and duodenal ulcer. Before anaesthesia or surgery, ‘T IL C 0 T IL ’ should not be given to patients at risk of kidney failu re, or to patients with increased risk of bleeding. Concurrent treatm ent with salicylates or other NSAIDs should be avoided. Pregnancy and lactation. Precautions: Sim ultaneous treatm ent with anticoagulants an d /o r oral antidiabetics should be avoided unless the patient can be closely m onitored. Renal function (B U N, creatinine, developm ent of oedem a, w eight gain, e tc .) should be m onitored, when giving a NSAID to the elderly o r to patients with conditions that could increase their risk of developing renal failure. Packs: Tablets 20 mg: 1 0 ’s, 3 0 ’s. Vial pack containing 1 vial active substance and 1 am poule w ater for injection. SPORTSGENEESKUNDE VOL. 6 NR. 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. ) AT THE FIRST SIGN OF ARTHRITIC SYMPTOMS Make d E F IA m 600 mg OXAPROZIN your choice because of its effective anti-inflammatory action Deflam* 600mg improves patient’s mobility. Deflam* 600mg is well accepted by patients. Deflam* 600mg ensures patient compliance. D eflam * 600mg, is contra-indicated in patients in w hom acetylsalicylic acid or other nonsteroidal anti-inflam m atory medicines induce the syndrom e of asthma, rhinitis, nasal polyps urticaria, angioedema, and bronchospasm . This m edicine is not recom m ended for patients with an activ^ peptic ulcer, for use in children and patients who are hypersensitive tc oxaprozin. Peptic ulceration and gastro-intestinal bleeding have been reported in patients receiving oxaprozin. Use with caution in patients with intrinsic coagulation defects or sever* trauma, and in patients undergoing surgery. Also use with caution in patients with com prom ised cardiac, hepatic, and/or renal function, hypertension, or other conditions predisposinc to fluid retention. Elevated liver function tests m ay occur in rare instances. Renal function param eters m ay be elevated, although the risk of dim inished renal function develops mosi often in patients with com prom ised renal blood flow. Patients who develop visual com plaints during treatm ent should have an ophthalm ologic evaluation. ▲ »KR®MED FU" prescribin9 in,° rm at' ° n available on request from: -Registered Trademark A K R O M E D PRO DUCTS (Pty) Limited, PO Box 42, Electron Ave, Isando, 1600. Tel: (011) 974-8631 Reg. No. R/3 . 1/ 1ZS Co. Reg. 05/13586/07 Def. D/F 5690/912/BSR. times enlarged 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 r i t i o n FAT IN THE DIET M ieke F a b er In g e n e r a l, fats m a y be d e f i n e d as a g r o u p o f o r g a n i c s u b s t a n c e s w h i c h are g r e a s y t o t o u c h , i n s o l u b l e in w a t e r and are s o l u b l e in a l c o h o l o r ether. C h e m i ­ c a l l y s p e a k i n g fats a re o r g a n i c c o m ­ p o u n d s o f c a r b o n , h y d r o g e n a n d o x y ­ gen. T h e fats in f o o d ar e c a ll e d t r i g l y c e ­ ri de s ( n e u t r a l fats ). T r i g l y c e r i d e s a re e s ­ ters o f g l y c e r o l ( t h e w a t e r s o l u b l e c o m ­ p o n e n t ) a n d f a t t y a cid s w h i c h a re th e basic c o m p o n e n t s o f t r i g l y c e r i d e s . M o s t f a t t y acids in f o o d s are s tr a i g h t, e v e n - n u m b e r e d c a r b o n c h a in s , c o n t a i n i n g as f e w as 4 o r as m a n y as 2 4 c a r b o n a t o m s . S h o r t c h a in f a t t y acids c o n t a i n 4 t o 6 c a r b o n a t o m s , m e d i u m - ch a i n f a t t y a ci ds c o n t a i n 8 t o 1 2 c a r b o n a t o m s , a n d l o n g - c h a i n f a t t y acids m o r e th a n 1 2 c a r b o n a t o m s . F a t t y acids can be d i v i d e d i n t o s a t u r a t e d f a t t y acids, m o n o u n s a t u r a t e d f a t t y a cid s a n d p o l y ­ u n s a t u r a t e d f a t t y ac ids. T h e s tat e o f s a t u r a t i o n r e s u l t s f r o m t h e r a t i o n o f h y ­ d r o g e n a t o m s t o c a r b o n a t o m s in t h e basic c a r b o n c h a i n w h i c h f o r m s th e i n ­ d i v i d u a l f a t t y acid . A f a t t y acid in w h i c h all o f t h e c a r b o n a t o m s in th e ch a in h a v e t w o h y d r o g e n a t o m s a t ­ t a c h e d t o it is s a t u r a t e d . In u n s a t u r a t e d f a t t y a ci ds a d o u b l e b o n d is f o r m e d b e ­ t w e e n t h e t w o a d j o i n i n g c a r b o n a t o m s o f w h i c h h y d r o g e n a t o m s a re m is si n g. M o n o u n s a t u r a t e d f a t t y a cid s h a v e o n l y o n e s u c h d o u b l e b o n d a l o n g t h e c a r b o n cha in. If t w o o r m o r e d o u b l e b o n d s o c ­ c u r a l o n g t h e c a r b o n c h a i n o f t h e f a t t y M ieke Faber Research Institute fo r N ational Diseases Medical Research Council acid, it is c a ll e d a p o l y u n s a t u r a t e d f a t t y acid. A f a t t y ac id t h a t c a n n o t be m a n u f a c ­ t u r e d b y t h e b o d y an d m u s t t h e r e f o r e be o b t a i n e d f r o m th e d i e t is k n o w n as an e s s e n ti a l f a t t y acid ( E F A ) . L i n o l e i c ac id is t h e m a j o r E F A in t h e die t. T w o t o 3 % o f t h e e n e r g y i n t a k e s h o u l d be p r o v i d e d b y E F A , ie. a b o u t 2 t o 5 g r a m p e r d a y o f l i n o l e i c acid f o r an a d u l t. T w o to th ree p e r c e n t o f the e n e r g y intake s h o u l d be p r o v i d e d by E s sen tia l F a tt y A cid s T h e d e g r e e o f u n s a t u r a t i o n in a n y fat p l a y s an i m p o r t a n t r o l e in d e t e r m i n i n g its p h y s i c a l n a t u r e . Fat s c o n s i s t i n g o f p r e d o m i n a n t l y s a t u r a t e d f a t t y acids c o n t a i n i n g m o r e t h a n 1 4 c a r b o n a t o m s a re s o l i d at r o o m t e m p e r a t u r e , w h i l e t h o s e w i t h a h ig h p r o p o r t i o n o f u n s a t u ­ r a t e d f a t t y a cid s as w e l l as t h o s e c o n ­ t a i n i n g 1 2 c a r b o n a t o m s o r less are u s u a l l y l i q u i d at r o o m t e m p e r a t u r e a n d d o n o t s o l i d i f y e v e n at l o w t e m p e r a ­ t u r e s . V e g e t a b l e an d m a r i n e o i l ca n be h a r d e n e d a n d t u r n e d i n t o s o l i d fa ts b y h y d r o g e n a t i o n , a p r o c e s s in w h i c h u n ­ s a t u r a t e d f a t t y ac ids a r e c o n v e r t e d to s a t u r a t e d f a t t y acids b y t h e i n t r o d u c ­ t i o n o f h y d r o g e n i n t o t h e a v a i la b l e d o u b l e b o n d s o f u n s a t u r a t e d f a t t y ac id s. T h is e n a b l e s t h e m a n u f a c t u r i n g o f m a r g a r i n e . In t h e m a n u f a c t u r i n g o f v e g e t a b l e s h o r t e n i n g s a n d m a r g a r i n e s , s o m e , b u t n o t all, o f t h e d o u b l e b o n d s are h y d r o g e n a t e d . W h e t h e r f a t t y ac id is s a t u r a t e d o r u n s a t u r a t e d d e t e r m i n e s t h e e f f e c t o f th e fa t o n p l a s m a li p i d l e ve l s. W h i l e s a t u ­ ra t e d fa t ra ise s p l a s m a c h o l e s t e r o l , p o l y u n s a t u r a t e d fa t t e n d s to l o w e r it. A n y f a t t y acid w h i c h c o n t a i n s a d o u b l e b o n d ca n ex i s t in e i t h e r o f t w o g e o m e t r i c a l l y i s o m e r i c f o r m s . T h e y can be e i t h e r in t h e cis f o r m o r in th e tr a n s f o r m . In t h e cis f o r m t h e m o l e c u l e fo l d s b a c k u p o n i t s e l f at ea ch d o u b l e b o n d . In t h e tr a n s f o r m th e m o l e c u l e e x te n d s t o its m a x i m u m l e n g t h . T h e n a t u r a l u n ­ s a t u r a t e d f a t t y acids in f o o d e x i s t in th e cis f o r m . D u r i n g t h e h y d r o g e n a t i o n s o m e o f t h e f a t t y a cid s a re c h a n g e d f r o m t h e cis t o t h e t r a n s f o r m s , b u t b o t h f o r m s a re u t i l i z e d b y th e b o d y . Trans i s o m e r s o f p o l y u n s a t u r a t e d acids d o n o t h a v e e s s e n t ia l f a t t y ac id a c t i v i t y an d l a c k t h e a b i l i t y p o s s e s s e d b y cis i s o m e r s o f l o w e r i n g t h e l e v e l o f l i p o p r o t e i n s in p l a s m a . Fats ar e m i x t u r e s o f d i f f e r e n t t r i g l y ­ c e r i d e s . Fat s in f o o d c o n t a i n m i x t u r e s o f s h o r t - a n d l o n g - c h a i n f a t t y acids a n d o f s a t u r a t e d a n d u n s a t u r a t e d f a t t y acids. N o n a t u r a l fa t is m a d e u p c o m p l e t e l y o f e i t h e r s a t u r a t e d o r u n s a t u r a t e d f a t t y ac ids. A n i m a l fats c o n t a i n m a i n l y s a t u ­ r a t e d f a t t y ac ids. M o s t p l a n t fats c o n ­ ta in p r e d o m i n a n t l y p o l y u n s a t u r a t e d f a t t y ac ids. C o c o n u t o il is an e x c e p t i o n in t h a t it is a p l a n t fat m o s t l y m a d e u p o f s h o r t - c h a i n s a t u r a t e d f a t t y acids. A n o t h e r e x c e p t i o n is o l i v e oil w h i c h is ri c h in m o n o u n s a t u r a t e d f a t t y acids. Fats s u c h as bu tte r, m a r g a r i n e , la rd a n d o i l s a re k n o w n as v i s i b l e fats. T h is is, h o w e v e r , n o t t h e o n l y s o u r c e o f fat in t h e d i et . T h e f a t p r e s e n t in f o o d s s u c h as in m e a t , w h o l e m i l k , egg y o l k , a v o ­ c a d o a n d n u t s a re k n o w n as i n v i s i b l e fat o r s o m e t i m e s a ls o c a lle d h i d d e n fat. T h e p r i m a r y f u n c t i o n o f fa t in th e h u m a n d i e t is t o s u p p l y th e b o d y ’s m o s t c o n c e n t r a t e d s o u r c e o f e n e r g y . O n e SPORTSGENEESKUNDE VOL. 6 NR. 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. ) ^uraoTnoiM gram o f fat su p p lied 9 kcal. (P rotein and carb o h yd rates p ro vid e 4kcal/gram ). B ecause of the high en erg y d en sity of fat, high fat diets are alm o st alw a y s also high in en ergy so, except in the p h y si­ c a lly active, lead to obesity. Fat also p la y s a role in the sa tie ty value of food. M eals that are m oderate in fat content also have a g reater satie ty value than those that are lo w in fat. A n o th er func­ tion o f fat in the diet is as a carrier of fat-so lu b le vitam in s n am ely vitam ins A , D , E a n d K . T he am ount of fat in the diet varies greatly. In m ost pro sp ero us countries fat u s u a lly co n trib u tes 35 to 45% of the to tal energy. In som e p o o r countries the figu re is 15% o r even lower. It is dif­ fic u lt to state a m in im um requirem en t I t is also recom m en d ed that the intake o f sa tu ra ted f a t sh o u ld be d ecrea se to less than 10% o f the en erg y intake. for fat in tak e. Because there is a co rre­ lation betw een fat in tak e and p lasm a ch o lestero l levels and since elevated p lasm a ch o lestero l levels are associated w ith an increased risk o f co ro n ary ar­ te ry disease it is recom m ended that fat sh o uld not exceed 30% of the to tal d a­ ily en ergy in tak e. W hen fat intake is v e ry lo w (10% of to tal e n erg y) the v o l­ u m e of food that should be taken to m eet en erg y needs m ight becom e a p ro b lem , eg. in ch ild ren w h o are active and therefore have a high en ergy need, b ut w ith a sm all cap acity for food. It is also recom m ended that the intake of satu rated fat sh o uld be decreased to less than 10% of the en erg y intake. The use o f p o ly u n satu rate d fat should be in ­ creased to 10% of en ergy intake. This co uld be achieved b y su b stitu tin g the use of anim al pro d ucts w ith p lan t fats. The am ount of fat in lOOg edible food as w ell as the am ount of fat per p o rtio n of different types of food is listed in the table below . G ram s o f fat per lOOgm edible food as well as grams fat per po rtio n size Food Fat per lOOg P ortion size Fat per portion Food Fat per lOOg P ortion size Fat per portion sugar 0 1 teaspoon 0 cake 1 5 , 7 50g 7,85 vegetable 0-1 1/2 cup 0-1 doughnuts 15, 8 one 7,9 fruit 0-1 one 0-1 ice cream 16 ,0 1 scoop 6,4 rice 0,1 1/2 cup 0, 06 french fries 1 6 , 6 lOOg 1 6, 6 skim milk 0,2 250ml 0,5 cheese spread 2 1 , 2 log 2 , 1 2 breakfast cereal 0 , 3 - 3 , 4 1/2 cup 0 , 1 - 0 , 7 feta cheese 2 1 , 3 30g 6, 3 9 pasta 0, 4 1/2 cup 0,3 samosa 2 5 , 7 one small 10 ,7 9 dried beans, cooked 0,5 1/2 cup 0,5 fatt y p o rk 2 7 , 2 90g 2 4, 48 wh ite fish, eg. stock fish 0,8 90g 0,72 p o lo n y 2 8, 3 1 thin slice 4,53 haddock 0, 9 90g 0,8 1 fa tty mut to n 29 , 0 90g 26, 1 sole 0, 9 90g 0,81 fa tty beef 29 ,1 90g 2 6 , 1 9 2 % milk 1.9 250 ml 4,75 frank furte r 29 ,2 one 17,5 2 mussels 2 , 0 60g 1,2 chocolate 30,3 50g 1 5 , 1 5 oysters 2,2 60 g 1,3 2 niknaks 3 1 , 3 40g 12,52 white bread 2, 5 1 slice 0, 75 cheddar cheese 33,1 30g 9,93 w h o le milk 3,3 250m l 8,25 cream cheese 34 , 9 1 tablespoon 13,9 6 w h ol ew he a t bread 3,4 1 slice 1,02 wh ippin g cream 37 ,0 1 ta bl esp oon 1 1 , 1 medium fat fish, eg. snoek 3,7 90g 3,33 po tat o chips 40,3 10 nuts 9, 28 l o w fat cottage cheese 4,5 60g 2 , 7 peanuts 49 ,2 30g 14,7 6 trou t 4,5 90g 4,05 bacon 49,2 1 rasher 4,92 lean beef 6,1 90g 5, 49 sun fl o we r seeds 4 9 , 6 1 tablespoon 7,44 chicken, w h i th o u t skin 6 , 7 90g 6,03 peanut butter 5 1 , 1 lOg 5 , 1 1 eggs 11 , 2 one 5,6 mayonnaise 53,5 1 tablespoon 12,31 lean m utt on 12,3 ' 90g 1 1 , 0 7 walnuts 6 1 , 9 10 halves 1 8 , 5 7 chicken, w it h skin 12 ,6 90g 11 ,3 4 ha zel nut s 6 2 , 6 10 nuts 6, 26 fatty fish, eg. butterfish 13 ,0 90g 1 1 , 7 0 coco nut 64 , 5 1 tablespoon 7,74 lean p o rk 15, 3 90 g 1 3 , 7 7 brazil nuts 66 , 2 10 nuts 19 ,8 6 avocado 15,3 30g 4, 5 9 margarine 8 1 , 0 1 teaspoon 4, 05 cheese sauce 15 ,4 1 tablespoon 3,85 butter 8 1 , 0 1 teaspoon 4,05 pancake 15, 5 one 10,85 oil 100 5,0 22 --------------------------------------------------------------------------------- SPORTS MEDICINE VOL. 6 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. ) Harvard expert on sports injuries in children for Sports Medicine Congress at Sun City Big injuries to small athletes are frequently seen in clinical practice and are o f great concern to both the medical and sporting com munities. L y le J M icheli, Clinical Professor o f Orthopaedic Surgery at Harvard Medical School and Consultant to the Boston Children's Hospital and the Boston Back Centre w ill be participating in this year's Sports M edicine Congress to b e held at Sun City from 24-27 April 1991. Particularly w ell known for his contributions to the treatment o f spinal injuries, including the hip and pelvis, P rof M icheli has developed a special interest in strength for children to prevent sports related injuries. Other overseas guests at the Congress which focuses on prevention and rehabilitation o f sports injuries include w ell known physiologist, Barbara Drinkwater, cardiac exercise specialist P rof Ralph Paffenbarger and cardiac rehabilitation practitioner, D r Neil Gordon. Prof Drinkwater's research has concentrated on the female athlete, particularly with regard to the problem o f osteoporosis and maximizing bone mass in the premenopausal years. The them es o ft h e Congress include rehabilitation o f sports injuries, sport sp ecific rehabilitation o f specific rehabilitation and the role o f exercise in the rehabilitation o f various medical and psychological disorders. These include psychiatric disorders, organ transplantation, obesity, arthritis, hypokinetic disorders, physical disability and cardiovascular aspects. Registration forms are available from the Congress Secretariat, Sports M edicine A ssociation C ongress, PO Box 13206, C lubview , 0 0 1 4 or phone Riekie Labuschagne at (012) 6 6 3 -3290. SPORTS MEDICINE CONGRESS 24-27 APRIL 1991 NB: PLEASE DO NOT SEND ANY MONEY NOW PRELIMINARY REGISTRATION FORM I WISH TO: a) attend the Congress YES/NO b) present a paper on one o f the following topics: 1).......... 2) ........... YES/NO c) present a poster on one o f the following topics: YES/NO 1)....................................................................................... 2) ....................................................................................................... d) attend a workshop on one o f the following topics: (specify) YES/NO 1). 2). 3). 4). 5). e) present a workshop/s on the follow ing NAM E: .................................................................. INITIALS: ......................................... TITLE: POSTAL ADDRESS: ...................................... CODE: TEL (W ): ......................................... (H): SIGNATURE: .............................................. DATE: .............................................. Please forward this registration form to the fo llo w ­ ing address: Congress Secretariat Sports Medicine Association PO Box 13 2 0 6 CLUBVIEW 00 14 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. ) )©Mtdhi Mirncaim Sp©Et§ Medncnnn© Association!! >md=Afrikaans© SpojrtgemeestoiMe-Veireifiiigiifiig A S p e c ia lis i g r o u p o f ih e M A S A ( i n c o r p o r a te d a s s o c ia tio n not fo r gain ) ’n S p e s ia le g r o e p v an d ie M V S A (in g e ly f d e v e r e n ig in g s o n d e r w in s b e ja g ) Dear Doctor, PO Box 13206 CLUBVIEW 0014 February 1990 The characteristic that distinguishes a professional from an educated person is the professional person's desire and responsibility to stay abreast of the developments of his or her field of expertise. - The halflife of our professional knowledge is about 3 years, and for this reason it is vitally.important to continuously refresh and supplement our knowledge. 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