SOUTH AFRIC AN JOU RN AL OF SPORTS MEDICINE SPORTGENEESKUNDE JO U R N A L OF T H E S.A. SPORTS M ED ICIN E ASSOCIATION T Y D S K R IF VAN DIE S.A. SPORTGENEESKUNDE-VERENIGING IS S N 1015/5163 VOL 5/NO 3 AUGUST 1990 PRICE R5.00 + GST Failure to com plete a long distance sea swim ❖ L ow er limb compartment syndrom es ❖ Protein in the diet 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. ) Nothin; will give yoj r h e u m a t o l o g y X..-VVW freedom to walk, jump, run and work S R I O OĴimpleHegimenimpleWe9imefi 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. ) SOUTH AFR IC AN JO U R N A L OF SPORTS MEDICINE SPORTGENEESKUNDE JO U R N A L OF T H E S.A. SPORTS M ED IC IN E ASSOCIATION T Y D S K R IF VAN DIE S.A. SPORTGENEESKUNDE-VERENIGING V O L U M E 5 N U M B E R 3 A U G U S T 1990 Editor in Chief: D r C Noble M B B C h, F C S fS A j A ssociate Editors: P rofT N oakes. M B C hB, M D Dr D awievan VeldenM B C hB (Siellj M Prax Med l Pretoria j Advisory Board: M e d ic in e : D r I Cohen M B C hB . D .O bsi. R C O G O r t h o p a e d i c tr a u m a io lo g y : Dr P Firer B S c (Eng). M B B Ch (W its/. ,\ I M ed (Oriho) ( Wits) Brig E Hugo M B C h B , M M ed (C hin O r i h o p a e d ic s : DrJC. Usdin M B B C h , F R C S (Edin) C a r d io lo g y : Col D P M y burgh S M M B ChB F A C C P h y s ic a l E d u c a tio n : ProfHannes Botha D P hil (Phys Ed) G y n a e c o lo g y : D r J ack A dno M B B C h ( Was/ .M D (Med), D ip O & G (W U s j CONTENTS Editorial Comment Ethical considerations in Sports Medicine ............ 3 Epidemiology A n epidem iological study o f failure to com plete a long-distance sea swim ........................ 7 Sports Injuries Low er Limb compartment syndromes ................ 10 Nutrition Protein in the diet ..................................................... 12 Physiotherapy Update Physiotherapy and the sprained ankle o f the sportsman ............................................................. 16 Soccer Soccer-W arm ing up and stretching SASMA Update FIMS World Congress o f Sports Medicine Report on the SAASSPER/SASM A Congress .. 22 P U B L I S H E D BY 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 P iu lu r /; m u m s y o f P h o t o fi l d Im a g e H d r k A S S O C I A T I O N H A T F I E L D F O R U .V t W E S T 1067 A R C A D IA S T R E E T H A T F I E L D P R E T O R I A . 00S3 T h e jo u rn a l o f th e SA S p o n s M e d ic in e A s s o c ia tio n is p u b lis h e d b y M e d p h a r m P u b lic a tio n s , 3 rd F lo o r N o o d h u lp lig a C e n tr e . 2 04B H F V e rw o e rd D r iv e . R a n d b u r g 2IV 4. Tel: ( 0 1 1) 787 -4 9 8 1 /9 . T h e v ie 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 l n e c e s s a r ilv th o s e o f th e p u b lish e rs . P n n i f d b v T h i - N . i u l W u n c w P r i m i n p j n d P u b lis h i n g C o m p a n v ( P i y ) L t d S P O R T G E N E E S K U N D E VO L 5. 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. ) r S Ten0xica.-n The first I.V. and I.M. 20mg once daily Parenteral Administration feh r ,-.•'Sell ior ta ns r':ec!.on 'JILCOTIL 20 mg ■ *OCHE *■ 1 I(R ' rt*C c » - *.*. w. L *< Z ^ iiX Z S S B S r ' tr 'iv s : : * Sto#ebe!cw25 r k e e p o u t o f ^^OFCHiLop^ 1.1s 01 composition in d ic a to r* contra-,ndicatons. s.de eitects aosaoe and Drecauimns . on request from ROCHE PRODUCTS ,P,yl L td , P O B o , 4589. j J L n e E S T o o Z n es 2 2 ,0 [S3] Reg. Nos. Vials: V/3. 1/238; H/34/128 TILCOTIL = Trademark ONCE Tilcotil Tenoxicam 20 mg Nonsteroidal Anri-inflam m atory D ru g RAPID ANTI­ INFLAMMATORY & ANALGESIC ACTION FOR THE TREATMENT OF SPORTS INJURIES * 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. ) gPlTORIAL ETHICAL CONSIDERATIONS IN SPORTS MEDICINE T h ere is a grow ing m u lti-d iscip lin ary interest in Sports M edicine in South Africa m ainly d u e to the following reasons: • It gives an o p p o rtu n ity to certain professional people to practice m edicine. In this g ro u p are those w hose m ain in terest is in the treatm en t an d rehabilitatio n of spo rts injuries. • To apply m edical know ledge to th e benefit o f s p o r t. F o r these people the challenge and interest is to use anatom y, physiology, biochem istry, etc. to develop and im prove train in g m eth o d s so that ultim ately p e r­ form ance can be im p ro v e d . • F o r the c o n trib u tio n sp o rt and exercise can m ake to m edicine. T h e in terest o f these people is to ap p ly the various aspects o f sp o rt and exercise - physical train in g , p a r­ ticip atio n , d iscipline - to help in m edical pro b lem s w h eth er as p rev en tio n , tre a tm e n t or rehabilitation. T h is has resulted in a w ide range o f people becom ing interested in th e d iscipline and practice o f Sports M edicine. U nfortunately, d u e to the diversion o f interests and grow ing body o f know ledge and expertise, it will never be possible to register a single m edical discipline such as a Sports M edicine Specialist. T h e em phasis should ra th e r be on teaching applied Sports M edicine to existing professionals in their respec­ tive fields to eq u ip th em b e tte r to m anage m edical p ro b ­ lems relating to sport and exercise. In this respect it will be possible to train a P rim ary C are Physician for general, p rim ary care of sp o rtsm e n , to give a p h y siotherapist a h igher degree in sports physiotherapy, o r to increase the know ledge o f an o rth o p ed ic surgeon in the field of sports traum atology. T h e universities in South Africa recog­ nised these n eeds, an d are beg in n in g to investigate the possibility to offer various post g rad u ate courses in sports m edicine. As w ith any new b ran ch in m ed icin e, the b o u n d aries of Sports M edicine has not b een , an d cannot be accurately defined. M edical practitio n ers and o th er professionals obtaining a h ig h er degree in spo rts m ed icin e, should for ethical reasons, confine th eir p ractices to th eir specific registered fields, be it in G eneral Practice, P h y siothe­ rapy, O rth o p e d ic s, B iokinetics, e tc ., w ith a special interest in sp orts m edicine. P ractitio n ers m ay not ad v er­ tise them selves as “ S ports M edicine Specialists”. Professionals registered by the M edical and D ental C ouncil, m ay not advertise a p a rtic u la r p erso n , in stitu ­ tion, rem edy o r te ch n iq u e. T h e m ain p rin cip le u n d e rly ­ ing all the ethical rules concerned w ith this su b ject, is that a d octor o r o th er reg istered p e rso n , m ay not seek to at­ tract p atients in a m a n n e r th at w ould give him an ad v an ­ tage over his colleagues w ith sim ilar qualifications. By the registration o f m edical qualifications, the SA M edical and D en tal C ouncil also pro tect the public by laying dow n m in im u m sta n d a rd s in a circu m scrib ed c u r­ riculum . T h e lay p u b lic can th u s be reasonably assured that th e professional concerned has a stan d ard o f aca­ dem ic train in g to be able to practice in his specific field. D it is van die uiterste belang d at alle p ersone wat be- trokke is by sp o rtg en eesk u n d e, sal op tree in belang van S P O R T S G E N E E S K U N D E VO L. 5 N R . 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. ) EDITORIAL sport en die sp o rtm an . D it sou du s oneties wees om sportgeneeskundige kennis te g eb ru ik tot nadeel van die sp o rtm an , soos byvoorbeeld die toediening van anabo- liese steroiede aan gesonde sportlu i m et die uitsluitlike doel om sportprestasies te v erb eter so n d er inagnem ing van die g esondheidsim plikasies wat so ’n p ro sed u re mag inhou vir die b etro k k e persoon. D it kom ook neer op die onregm atige bevoordeling van die sp o rtm an bo sy oppo- nente wat strydig is m et die reels van regverdigheid in sport. G eneeshere m oet hu lleself ook w eerhou om in hulle professionele hoed an ig h eid betro k k e te raak by adverten- sie veldtogte om sekere aspekte van “g e so n d h e id ” te be- v o rd er op so ’n w yse dat die betro k k e geneesheer hom self persoonlik onregm atiglik bevoordeel. M edici moet ook leer om flater w at die A ptekersprofessie gem aak het met die slagspreuk van “Jou A ptek er weet die b este” w at die aptekersprofessie tot ’n sekere m ate ged isk red iteer h e t. D aarenteen m oet die b ep erk in g s wat op geneeshere ge- plaas w ord m et b etrek k in g tot a d v erterin g , nie onredelik wees en te e n p ro d u k tie f inw erk op die p rak ty k van sport- geneeskunde as sodanig nie en sal d aar m et nuw e oe ge- kyk m oet w ord na die m ate van blootstelling wat mediese praktisyns mag k ry om hulle belangstellings en bekw aam - hede op ’n etiese wyse bekend te stel. D it is allerwee be- kend dat d aar w ereldw yd ’n verslapping is in die regula- sies betreffende ad v erterin g d e u r professionele persone. Die S p o rtgeneeskunde V ereniging stel dit hom ten doel om te waak oor die belange van sy lede en mee te help dat sportlui toegang het tot gespesialiseerde sp o rtg en eesk u n ­ dige d ienste tot voordeel van sport en g esondheid in die algem een. Vir hierd ie doel is ’n etiese kom itee in die lewe geroep w at sekere etiese aspekte in die belangeveld van sportg en eesk u n d e ondersoek om so ook sy lede van raad en daad te bedien insake die k o rrek te o p tred e o n d er be- paalde om standighede. Professionele persone m oet ook versigtig wees om in die o p en b aar u itsp rak e te lew er oor die o p tred e van se­ kere kollegas indien dit die integriteit van die betrokke kollega o n d e r v erd en k in g kan brin g o f by im plikasie ’n an d er professionele liggaam diskrediteer. Verskille van opinie in gen eesk u n d e sal d aar altyd w ees, m aar stand- p u n te m oet op ’n professionele wyse besleg w ord - in die geneeskundige veld is dit altyd gevaarlik om dogm aties te wees: jy mag m ore verk eerd bew ys word! S p o rtgeneeskunde bied interessante en verbeelding- ryke uitdagings - d it is ’n terrein w aarop d aar groot vor- d ering gem aak is oor die afgelope jare. A lleenlik d e u r we- dersydse e rk en n in g van professies en m u ltidissiplinere sam ew erking o n d e r b elan g h eb b en d es, kan die nuw e ho- risonne verken w ord. Dr. D awie Van Velden President: SA S p o rtg en eesk u n d e Vereniging GUIDELINE FOR AUTHORS S C I E N T I F I C A R T IC L E S 1. T h e J o u r n a l o f the S outh A frican Sports M edicine A ssociation p u b lish es original and review articles fro m all disciplines relevant to S p o rts M edicine. T h e jo u r n a l aims to c ater fo r th e diverse interests o f m em bers of the m edical and para-m edical professions and the s p o rtin g pub lic interested in scientific and m edical aspects o f sp o rt. 2. M aterial su b m itte d fo r p u b licatio n in the J S ASM A is accepted on c o n d itio n th a t it has n o t been p u b lish ed elsew here. All nam ed a u th o rs m u st give signed c o n sen t to p u b lic a tio n , and th e JS A S M A d o e s n o th o ld itself resp o n sib le fo rs ta te m e n ts m ade by c o n trib u to rs . 3. All s u b m itte d articles sh o u ld be of a p p ro p ria te scientific value and should have practical ap p licatio n in sp o rts m edicine. A rticles m ay be w ritte n in A frikaans o r E nglish. T he c o n trib u tio n s will be critically review ed by at least one a p p ro p ria te referee w h o is a specialist in the field o f the s u b m itte d m aterial. T his review wil be passed on a d o u b le -b lin d ap p ro ach (b o th a u th o r and referee will rem ain an o n y m o u s to each o th e r). T h e referee’s co m m en ts will be sent to the a u th o r to g e th e r w ith the evaluation o f o n e of the E d ito rs. A cceptance of the p ap er fo r p u b licatio n is based on o rig in a lity and q u a lity o f the w ork as well as on the clarity o f in te rp re ta tio n . T h e p ap ers will be p u b lish ed in the o rd e r of acceptance and n o t in the o rd e r of su b m issio n . T h e p u b lish e r reserves c o p y rig h t and re p ro d u c tio n rights o f all p u b lish e d m aterial, and such m aterial m ay n o t be re p ro d u c e d in any fo rm w ith o u t the p u b lis h e r’s w ritten p erm issio n . 4 ------------------------------------------------------------ S P O R T S M E D I C I N E V O L 5 N O . 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. ) GUIDELINES FOR AUTHORS All m an u scrip ts to be directed to: T h e Editor, Jo u rn al o f S ASM A , M ed p h arm P u b lications, 3rd F L o o r N o o d h u lp lig a C entre 204B H F Verwoerd D rive R a n d b u rg 2194. Preparation o f the manuscript M an u scrip ts should be ty p ew ritten , double-spaced on sheets o f uniform size, no larger th an 21 x 2 9 ,7 cm (D IN A4) w ith a 3-cm m argin on th e left. All co n trib u tio n s are to be su b m itte d in d uplicate (one original w ith illustrations suitable for rep ro d u ctio n and two co m ­ plete copies in clu d in g copies o f figures and tables). O nly the original copy will be re tu rn e d to the authors(s) in case of revision or rejection. T h e cover page o f th e m an u scrip t should list the following inform ation: (i) Concise b u t inform ative title (ii) K ey w ords (m axim um 58) (iii) A uthor(s) initials and nam e(s) (iv) N am e an d location o f institu tio n w here the investigations w ere c a r­ ried out (v) N am e and address o f the a u th o r to w hom co m m u n icatio n s co n cern ­ ing the co n trib u tio n should be d i­ rected (vi) A cknow ledgem ents o f research su p p o rt and research grants. T h e second page o f the m an u scrip t should in clude only the title o f the a r ­ ticle w ithout reference to th e a u th o r’s nam es or affiliations. T h e third page o f the m an u scrip t should give an abstract of th e scientific contents o f no m ore than 200 w ords and not exceeding one d o u ble-spaced type w ritten page. T h e text o f the m an u scrip t should be arranged as follows: An Introduction d escribing the p u rp o se o f the w ork in relation to o th er w ork in the same field. Material and Methods: D escribe the selection of th e observational or ex p eri­ m ental subjects clearly. Identify the m eth o d s, ap p aratu s and p ro ced u res in sufficient detail to allow o th er w orkers to rep ro d u ce the results. T h e Results should be p resen ted conci­ sely. T h e statistical m eth o d used should be n am ed. A uth o rs m ust express un its, q u an tities, and form ulas according to the reco m m en d atio n s o f th e Systeme In tern atio n al (SI units). All m easu re­ m ents shou ld be given in m etric units. T h e D iscussion should em phasize the new and im p o rtan t aspects o f the study and the C onclusions that follow from them . T h e practical im plications o f the study shou ld be e m p h a siz e d . Illustrations and tables Figures consist o f all m aterial w hich cannot be set in type, such as p h o to ­ graphs and line draw ings. (Tables are not in clu d ed in this classification and should not be su b m itte d as p h o to ­ graphs). In no circum stances should original X -R ay films be forw arded; glossy p rin ts m ust be su b m itted . Tables and legends for illustrations should be typed on separate sheets and should be clearly identified. Tables should carry R om an n u m erals, thus: I, I I, III etc, and illustrations A rabic n u m erals, thus: 1 , 2 , 3 etc. Tables should be self-explanatory and bear a short title. A bbreviations used should be explained in the legend or at the bottom o f th e table. Illustratio n s should be labelled w ith the nam e o f the first a u th o r and the illustration n u m b e r on the top left-hand co rn er o f the back side. References References should be in serted in the text as su p erio r n u m b e rs, and should be listed at the end o f th e article in n u m e ri­ cal order. D o not list them alphabeti­ cally. It is the a u th o r’s respon sib ility to verify references from the original sources. R eferences should be set out in the V ancouver style, and only approved abbreviations o f journal titles should be used; consult the Jan u ary issue o f Index Medicus (N o. 1, P art 1) for these d e ­ tails. N am es and initials o f a u th o rs should be given unless there are m ore than six, in w hich case th e first three nam es should be given followed by “et al”. F irst and last page n u m b e rs should be given e.g. 1. N oakes T D . H eart disease in m ara­ th o n ru n n e rs: a review . M ed Sci Sports E xerc 1987; 19: 194-198. Book references should be set out as fol­ lows: 1. Peterson L , R en stro m P. Sports In ­ jures. T h e ir p rev en tio n and tre a t­ m ent, 1st ed. South Africa: Justa and Co L td , 1986. 2. O ld rid g e NB: C om pliance w ith exercise program s. In: Pollock M L , S chm idt D H , eds. H eart D is­ ease and R eh ab ilitatio n (ed 2). New Y ork, Jo h n W iley & Sons, 1986: 629-646. “ The more practical articles, review articles, papers presented at congress etc, do not need to comply with such strict guidelines” PRACTICAL ARTICLES T h e m ore practical articles, review a r­ ticles, papers p resented at congress etc, do n ot need to com ply w ith such strict g u id elin es- Length L ength o f these c o n trib u tio n s should not how ever exceed 5-6 pages typed in double spacing. All co n trib u tio n s are to be su b m itted in duplicate. Illustrations & Tables B/W head and sh oulders p h oto o f the authors(s) shou ld accom pany article. Slides & p rin ts, g ra p h s tables etc on eith er colour or B/W w hich w ould com ­ plem ent th e article are w elcom ed. Tables should carry R om an num erals and illustrations A rabic n u m erals thu s 1 ,2 ,3 etc. References As for scientific articles. _____ _____________________________________________ 5 S P O R T S G E N E E S K U N D E VOL. 5 N R . 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. ) From Bencard REUFENn a b u m e t o n e the anti-inflammatory that improves functional mobility ^ ... j Marketed by Bencard Division of Beecham Phirmici ReoNo. 74/03968/07 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. ) EPIDEMIOLOGY AN EPIDEMIOLOGICAL STUDY OF FAILURE TO COMPLETE A LONG-DISTANCE SEA SWIM D Yach SUM M ARY A postal questionnaire survey was used to compare the characteristics o f swimmers who failed to com plete a 3 kilometer sea swim to those who completed the swim. Swimmers who failed to com plete the swim reported significantly higher rates o f headache and severe shivering compared to successful swimmers. Only previous participation in a cycling marathon was related to failure. Age, sex and body mass index being non-significant. I N T R O D U C T IO N In M arch 1988 nin ety -th ree sw im m ers took part in a 3.2 kfn sw im from Clo- velly to Sim onstow n. T h e usually w arm Indian ocean on th at day was m easured at 16°C. T h e p articip an ts included experienced sw im m ers, tri-athletes and casual sw im m ers. A high p ro p o rtio n of p articip an ts (24,7% ) failed to com plete the race and had to be rem oved from the w ater by the p atrolling crews. F ollow ­ ing the race, a great deal o f concern was expressed about th e need for w etsuits in fu rth e r sw im s. T h e aim of this study was to assess w h eth er those sw im m ers who successfully com pleted the event differed from those w ho d id not co m ­ plete th e event and to evaluate th e need for w etsuits in fu tu re events. M E T H O D S addresses, tim es (if they com pleted the sw im ), age and sex was obtained from the C ape Long D istance S w im m ing A s­ sociation, the organisers o f the event. All p articip an ts w ere m ailed a q u e s ­ tionnaire. T h e q u estio n n aire contained q uestions about th e d em ographic characteristics of sw im m ers, their height and w eight, th eir p rio r p a rtic i­ pation in a n u m b e r o f sp o rts even ts, w h eth er they had a n u m b e r o f sy m p ­ tom s, and th e ir a ttitu d es to w etsuits. T h e q u estio n n aires w ere m ailed b e ­ tw een ten days and two weeks after com pletion of the swim. R E S U L T S F o r the 70 who com pleted the sw im , tim es varied betw een 42.5 m in u tes and 153.5 m inutes (m e d ia n = 6 I ; in terq u an - tile range 50-68). A relatively high re ­ sponse rate to the q u estio n n a ire (75%) was obtained. T h e d istrib u tio n o f re­ sp o n d en ts and n o n -re sp o n d e n ts was sim ilar w ith respect to th e ir com pleting tim e as well as the p ro p o rtio n who did not com plete the swim . It was felt likely therefore, th a t the re sp o n d e n ts w ere represen tativ e o f all p a rtic ip a n ts (Table 1). F o r analysis, sw im m ers w ere initially divided into those w ho com pleted the swim and those who d id not com plete the swim. F u rth e r analyses split the gro u p of those who com pleted the swim into those w hose tim e was below the m edian tim e and those above the m e­ dian tim e for com pletion (i.e. 61 m in ­ utes). T h e age, sex and height d istrib u tio n s A com plete list o f all p a rticip an ts, their Table 1: Characteristics o f respondents versus non-respondents Time taken Respondents Non-respondents (%) All Derek Y a c h M B C h B (Epidemiology) M P H Centre fo r Epidemiological Research in Southern Africa (C E R S A ) S A M edical Research Council PC>Box70 T Y G E R B E R G 1505 < 5 0 minutes 12 2(14) 14 50-59 minutes 14 5(28) 18 60-74 minutes 20 7(27) 27 75 + minutes 5 5(56) 9 N ot com plete swim 19 4 (1 7 ) 23 TOTAL 70 23(25) 93 -------------------------------------------------------------------- 7 S P O R T S G E N E E S K U N D E VOL. 5 N R . 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. ) EPIDEMIOLOGY for those who com pleted and did not com plete the sw im w ere sim ilar (Table 2). T h e w eights o f those w ho com pleted the swim w ere 4 kg h igher and their body mass index as well was h igher than those who did not com plete the swim. T hese differences, however, w ere not statistically significant. T h e percentage p articipation in the 1988 P eninsula M arath o n and the 1987 R o b b en Island Relay C hallenge show ed no differences betw een those w ho com pleted and Table 2: Comparison o f demographic and sports participation charac­ teristics o f swimmers Completed Failed 3.2 km swim to compete (n = 53) (n = 17) Sex (percent male) 90.2 89.0 A ge* 29.9 (11.4) 25.8 (11.2) Height * 1.80 (0.1) 1.8 (0.1) Weight * 76 (13) 72 (23) Body Mass Index* 24 (2.6) 24.0 (5) Participation in + ’88 Argus Cycle Tour ** 26 (49) 15 (88.2) ’88 Peninsula Marathon 19 (35.9) 7 (41.2) ’87 Robben Island Relay Challenge 5 (9.4) 1 (5.9) ’87 3.2 km Glencairn- Simonstown swim 14 (26.4) 6 (35.3) n u m b er (percent) ** p = 0.004, W iicoxon test M edian (interquartile range) *** p = 0,007, W iicoxon test Table 3: Comparison o f demographic and sports participation characteristics o f swimmers w ho completed the 1988 3.2 km swim Variable * T im e <61 minutes Tim e >61 minutes Age (years) 25 (9.7) 33 (17) Height (metres) 1.8 (0.1) 1.8 (0.1) Weight (kilograms) 78 (13.5) 75 (13.3) Body Mass Index 24 (2.8) 24 (3.0) ’“'Median (IQR) Participation in + ’38 Argus Cycle Tour * 6 (24) 18 (69.2) ’88 Peninsula Marathon ** 5 (20) 12 (46.2) ’87 Robben Island Relay Challenge 4 (16) 1 (3.9) ’87 3.2 km Glencairn- Simonstown swim 9 (36) 5 (19.2) num ber (percent) p = 0.001, x 2 test ** p = 0.05, x 2 test those who failed to com plete the swim. T h e re was a statistically significant dif­ ference in the p ro p o rtio n o f those who com pleted th e A rgus Cycle Tour w ith 88.2% o f those w ho failed to com plete the swim having participated in the Tour com pared to 49% o f those who d id not. T h e ho u rs spen t train in g showed that there was a significant difference in the am ount of h o u rs spent train in g p a r­ ticularly w ith respect to cycling. A sim i­ lar tren d w ith respect to tim e taken tc com plete the sw im was found (Table 3). A m ultiple logistic regression yielded sim ilar results to the univariate a p ­ proach in th at only cycling was signi­ ficantly related to failure w hen age, sex and body mass index w ere controlled for. T h e sym ptom s o f sw im m ers who com pleted and d id not com plete the swim are show n in Table 4. It can be seen th at there was a statistically signi­ ficant difference betw een the groups w ith respect to headache. T h e highest pro p o rtio n being rep o rted am ong those who w ere unsuccessful. It should be noted that for all o th er sym ptom s the p ro p o rtio n was h ig h er am ong those w ho w ere unsuccessful. W hen the suc­ cessful com petitors w ere divided into two g roups according to the tim e that took them to com p lete, there w ere also statistically significant differences w ith respect to headache, difficulty talking and severe shivering w ith the highest propo rtio n s being re p o rted am ong the slowest com petitors (Table 5). 32.9% o f all particip an ts felt that w etsuits should not be allowed in swims. T h e re was no difference in re­ sponse to this q u estio n betw een those w ho com pleted and those w ho d id not com plete the sw im n o r was th eir a tti­ tu d e influenced by th e ir tim e taken to com plete th e swim. T h e re was a relatio n sh ip betw een the longest sea sw im com pleted and the su c ­ cess rate. All o f those w ho had com ­ pleted sw im s g reater o r equal to 5 km successfully finished the race, com pared to 90% o f those w ho com pleted a p rio r 3 km sea swim and 8% o f those w ho had sw um sh o rter distances in the sea. CO NCLUSIO NS N o p u b lish ed epidem iological studies 8 ------------------------------------------------------------ S P O R T S M E D I C I N E VOL. 5 N O . 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. ) EPIDEMIOLOGY Table 4: Symptoms o f swimmers * Completed the 1988 swim ( n = 53) Failed to com plete the 1988 swim (n=17) p-value M uscle cramps 15.7 33.3 0.109 Vomitting 1.9 0.0 .550 Disorientation 25.5 33.3 .522 Headache 7.8 33.3 0.008 Nausea 7.8 16.7 .286 Difficultly walking 45.1 66.7 .116 Difficulty talking 31.4 50.0 .158 Severe shivering 60.8 83.3 .081 Percentage w ithin group Table 5: S ym ptom s o f sw im m ers w ho com pleted the swim T im e < 61 Tim e minutes minutes (n=26) (n=27) M uscle cramps 12 19.2 Vomitting 0 3.9 Disorientation 24 13.8 Headache** 16 0 Nausea* 0 15.4 Difficulty walking 40 50 Difficulty talking** 16 46 Severe shivering** 40 80.8 0,1 < p < 0 . 0 5 p < 0 .0 5 Logistic to control Age, Sex, BMI Marathon R i Relay Cycle OR 14.0 OR = 9 from University 95% Cl (2.3 83.9) Completed (51) N ot (18) P Sex %male 90.2 89.0 .875 Age % > 27 yrs 54.9 44.4 .445 BMI % a 2 5 44.0 50.0 .943 Cycle tour 47.1 89.0 .002 Marathon 33.3 44.4 .339 RI relay 9.8 5.6 .503 have exam ined reasons for failure to com plete sw im s. C ape rep o rts u n d e r ex­ perim ental conditions have show n that respiratory reflexes and h y p o th erm ia at 4.7°C result in early failu re.(l'2) T h e increased in terest especially by tri-ath ­ letes in sea sw im s at te m p e ra tu res below 20°C, dem ands g reater atten tio n by researchers to d e term in an ts o f failure if deaths due to h y p o th erm ia are to be prevented. T h is stu d y shows that age, sex an d body mass in d ex w ere not re­ lated to the likelihood o f com pleting a swim at 16°C, nor the tim e taken to com plete it. T h e m ajor d e term in an t or factors related to a likelihood o f com ­ pleting are related to p rio r long distance sea experience and heavy p rio r partici­ pation in cycling (as a negative factor). T h e sym ptom s m ost able to d istin ­ guish betw een failure and success both in absolute and relative term s were headache and shivering. F u rth e r w ork is req u ired to d e term in e th e predictive value o f a headache w hile sw im m ing for severe h y p o th erm ia. T h is will certainly be o f use to athletes train in g for future events as well as p articip atio n d u rin g such events. It should be noted that all sw im m ers had to w ear com pulsory headgear. T h e im plications o f the study for fu tu re sw im s are th at stric te r attention may need to be played to en su rin g that p a rticip an ts, particu larly cyclists, in ­ crease th eir sw im m ing train in g . T h e need for w etsuits was not evaluated in this study. Since this event is part o f the tri-athlete circ u it, it m ay be advisable to suggest that w etsuits be w o rn at fu tu re events. F u rth e r research is re q u ired u s ­ ing m easures o f fat co n ten t to d eterm in e pred icto rs o f h y p o th e rm ia . AC K N O W LEDG EM EN TS T h e Cape L ong D istan ce Sw im m ing A ssociation for th eir assistance in co n ­ d u ctin g the study, P ro f T im N oakes for useful com m ents on an earlier draft of the m an u scrip t and th e sw im m ers for responding. REFERENCES 1. Editorial. Survival in Cold Water. B r Me d 7 1969; 1:459. 2. Keatinge W R , Prys-R oberts C, Cooper K E , H onour AJ, Haight J. Sudden Failure of Swimming in Cold Water. B r M e d J 1969; 1: 480-483. S P O R T S G E N E E S K U N D E VOL. 5 N R . 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. ) SPORTS INJURIES LOWER LIMB COMPARTMENT SYNDROMES Clive N obel j i \ A ) > Anterior Tibial compartment 1 0 ----------------------------------------------------------- S P O R T S M E D I C I N E VOL. S N O . 3 A N T E R IO R TIBIAL C O M P A R T M E N T S Y N D R O M E *** T h is c o n d itio n m ay be a surgical em ergency as m uscle death will ra p ­ idly occur, giving rise to V o lk m an n ’s Ischaem ic co n tra c tu re . S y m p tom s In th e severe trau m atic variety, often associated w ith fractu res o f th e tibia and fibula, th e sy m p to m s and signs include: • Pain • P allo r • P arasthesia • Pulselessness • Paralysis In th e exercise variety, th e sy m p to m s are usually o f a ch ro n ic n ature. • A cu te Rarely, this c o n d itio n m ay be acute w ith ex trem ely severe pain follow ed by loss o f fu n ctio n w ith in 4-6 h o u rs. P aralysis and anaesthesia o f the area su p p lied by th e involved p e ­ rip h eral nerve rap id ly ensues. • C h ro n ic T his is fo u n d c o m m o n ly in ru n ­ ners. P rogressive pain and te n ­ sion in th e c o m p a rtm e n t ensues on ru n n in g , and the fo o t loses d o rsiflex io n s tre n g th causing it to “s la p ”. Parasthesia (usually pin s and needles) m ay develop. C h ro n ic s y m p to m s usually follow severe unaccu sto m ed exercise. Signs • Tense, te n d e r a n te rio r c o m p a rt­ m e n t w h ich is m ark ed in acute cases. • M o st cases have dorsalis pedis pulse intact. • M o st cases have h y p eresth esia on the d o rsal aspect o f the first web. • S y m p to m s m ay be elicited by rap id an k le m ov em en ts w ith the p a tie n t lying supine. T h e lo w er leg is divided in to th ree fas­ cial c o m p a rtm e n ts: T h e in tero sseo u s m em b ran e divides th e leg in to an te rio r and p o s te rio r c o m p a rtm e n ts. T w o septa attach ed to th e fibula on its lateral aspect, fo rm a lateral co m p a rtm e n t. E x cep t fo r b lo o d vessels, nerves and te n d o n s leaving th e c o m p a rtm e n ts these areas are essentially closed spaces. T h e an terio r c o m p a rtm e n t is e n ­ closed by th e tibia and th e fibula on the sides, by th e in tero sseo u s m em b ran e p o s te rio rly and by a fascial layer a n te ­ riorly. T h e p osterior region is divided into p o s te rio r deep and p o s te rio r superficial c o m p a rtm e n ts by a fascial layer. T h e lateral c o m p a rtm e n t is based on the fibula and is sep arated from the o th e r c o m p a rtm e n ts by a n te rio r and p o s te rio r fascial bands. E ach c o m p a rtm e n t is su p p lied by one m a jo r vessel and nerve. T h e p re ssu re in th e arterioles is a b o u t 40 m m H g (m ercu ry ). C a p illary p ress­ ure is betw een 20 and 30 mg H g and ve­ n o u s p ressu re is 10-15 m m H g . M echanism o f injury A n y c o n d itio n w h ich raises the p re ssu re in th e c o m p a rtm e n t above 40 m m H g will blo ck the b lo o d flow to th e m uscles w ith o u t inclu d in g the m a jo r arteries. In s p o rt tw o c o n d itio n s m ay raise th e in tra c o m p a rtm e n ta l p ressu re, nam ely tra u m a and exercise. 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 Sports C o m p a rtm e n t s y n d ro m e s m ay o ccu r in any sp o rt, th e tra u m a tic variety being co m m o n in collision sp o rts. T h ey are m o re likely to o c c u r in as­ sociatio n w ith fractures. T h e exercise variety o f c o m p a rt­ m e n t s y n d ro m e s is co m m o n in e n ­ d u ra n c e sp o rts eg. long d istance ru n ­ ning. C o m p a rtm e n t s y n d ro m e s m ay o ccu r in eith e r sex b u t are fo u n d m o re co m m o n ly in m ales due to th e ir p a r ­ tic ip a tio n in collision sp o rts. Sites o f these sy n d ro m e s include: • th e a n te rio r tibial c o m p a rtm e n t; • th e p o s te rio r tibial c o m p a rtm e n t; and • th e lateral c o m p a rtm e n t (p e ro ­ neal). D ifferen tial d iagn osis A n te rio r shin splin ts (tibial stress s y n d ro m e ). In v estig a tio n s T his is usually an easy clinical diag­ nosis b u t c o m p a rtm e n t p ressu re stu d ies are valuable in co n firm in g th e diagnosis. T reatm ent A C U T E *** T h is is a surgical em ergency and fascio to m y sh o u ld be carried o u t as so o n as possible. T he skin incision m ay also have to be left o p e n as th e m uscle sw ells ex­ cessively. T h e skin incision m u st be th e len g th o f th e c o m p a rtm e n t. C H R O N I C Treat Cause R e d u c tio n o f activity • T h e ru n n e r sh o u ld im m ediately reduce his p ro g ra m m e and s h o u ld th e re a fter build up p r o ­ gressively; • A void hill ru n n in g . Treat R esu lt T h e m ark ed sw elling sh o u ld be tre a te d b y : • elevation; • icing; • n o n -ste ro id a l an ti-in fla m m a to ry d rugs. If th e c o n d itio n fails to re sp o n d to c o n servative tre a tm e n t, th en fascio­ to m y m ay be necessary. T h e A n te rio r T ibial c o m p a rtm e n t s y n d ro m e is fo u n d m ore c o m m o n ly in ru n n e rs. P rogressive pain and te n ­ sion in th e c o m p a rtm e n t ensues on ru n n in g , and th e fo o t loses dorsiflex- ion s tre n g th causing it to “s la p ”. P O S T E R IO R TIB IA L C O M P A R T M E N T S Y N D R O M E T his is n o t as c o m m o n an in ju ry as th a t o f th e A n te rio r T ibial c o m p a rt­ m ent. S y m p tom s Pain in th e p o s te rio r c o m p a rtm e n t d u rin g and after ru n n in g and injury. Signs Tense, te n d e r p o s te rio r c o m p a rt­ m en t fo llo w in g exercise o r traum a. D ifferen tial diagn osis P o s te rio r tibial stress sy n d ro m e . In v estig a tio n s • P ressu re te stin g will clarify the diagnosis; • B one scan is o ften positiv e in tib ­ ial stress sy n d ro m e . Treatm ent As fo r A n te rio r T ibial c o m p a rtm e n t sy n d ro m e . LA TER A L TIB IA L C O M P A R T M E N T S Y N D R O M E S ym p to m s T h e features are th e sam e as those fo u n d in th e o th e r c o m p a rtm e n t s y n d ro m e s except th a t th e pain is lo ­ calised o v er th e lateral co m p a rtm e n t. T his is an u n c o m m o n c o n d itio n . P ero n eal nerve co m p ressio n m ay cause w eakness of eversion. T reatm ent As fo r A n te rio r T ibial c o m p a rtm e n t sy n d ro m e . This article is rep rin ted fr o m “The M a n u a l o f Sports In ju r ie s ” b y C live N o b el. Posterior Tibial compartment - ------------------------------------------------------------------ 11 S P O R T S G E N E E S K U N D E VOL. 5 N R . 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. ) NUTRITION PROTEIN IN THE DIET M Faber P ro te in is an essential stru c tu re o f all living m atter. T h e cells in th e b o d y are in a d y n am ic state o f c o n tin u o u s d e ­ s tru c tio n and resy n th esis o f p ro tein w hich facilitates th e reg en eratio n of cells. T he p ro te in s in the b o d y are in ­ evitab ly d e p e n d e n t fo r th e ir fo rm a tio n and m ain ten an ce on th e p ro te in s in the diet. A lth o u g h p ro te in s are an essential life-fo rm in g and life-su stain in g in g red i­ en t o f the d iet, it w o u ld n o t be a p p ro ­ p ria te to state th a t p ro te in s are m o re im p o rta n t th an o th e r n u trie n ts. D iffe r­ en t n u trie n ts have d iffe re n t fu n ctio n s, all of w hich are im p o rta n t to m ain tain a h ealth y body. T h e fu n c tio n s o f p ro te in can be divided in to tw o m ain categories viz. p ro te in s necessary fo r g ro w th and m ain ten an ce, and p ro te in s th a t regulate b iological processes. P rotein s are necessary for g r o w th and m a in ten a n ce • p ro te in s c o n s titu te th e chief solid m a tte r o f m uscles, org an s and en- d o c rin e g la n d s ; • p ro te in s are m a jo r c o n stitu e n ts of skin, nails, h air and the m atrix of b o n es and te e th ; • p ro te in s are m a jo r c o n stitu e n ts of b lo o d cells and serum . P rotein s are in v o lv ed in and reg u la te biological processes • plasm a p ro te in s play a role in the reg u latio n of osm o tic p ressu re and w ater balance; M ie k e Faber, Research In s titu te fo r N u tr itio n a l Diseases, M edical Research C ouncil, Tygerberg. • the b o d y ’s resistance to disease is m ain tain ed in p a rt by an tib o d ies w hich are p ro te in in n atu re; • m etab o lic p rocesses are regulated by e n zy m es w h ich are p ro te in in n a tu re ; • m o s t h o rm o n e s are p ro te in in n a ­ tu re. U n d e r n o rm a l c o n d itio n s, these fu n ctio n s are m ain ta in e d , p ro v id ed th a t th e en erg y c o n te n t o f the d iet is adequate. S h ould c a rb o h y d ra te s and fat fail to su p p ly e n o u g h calories, th en p ro te in is utilised fo r energy. U n d e r these circum stances sy m p ­ to m s of p ro te in deficiency m ay ap ­ pear, even w hen th e am o u n t o f p r o ­ tein is adequate. P ro te in s are d istin g u ish ed from c a rb o h y d ra te s and fat by th e p re s­ ence o f n itro g en in the m uscle. It is m erely of this difference th a t the place o f p ro te in in the diet c a n n o t be replaced by c a rb o h y d ra te s o r fat. P ro te in s co n sist of u n its called am in o acids, w hich are linked t o ­ g e th e r to fo rm th e p ro te in m olecule. P ro te in s d iffer in the am o u n ts o f the vario u s am in o acids and th e ir a r­ ran g em en ts. T he q u ality o f the p r o ­ tein (also k n o w n as th e biologic value) is d e te rm in e d by th e sequence of th e am in o acids. T h e am ino acid c o m p o sitio n of th e p ro te in in eggs is som etim es used as a stan d ard against w hich th e q u a lity of o th e r p ro te in s are co m p ared . Egg p ro te in s, m o st of w h ich are alb u m in s in th e w h ite o f 1 2 ----------------------------------------------------------- S P O R T S M E D I C I N E VOL. 5 N O . 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. ) NUTRITION th e egg, have th e h ig h est biologic value o f all p ro te in s. T h e re are c e r­ tain am in o acids (th at are in d isp e n s­ able to life and g ro w th ) w h ich the h u m an b o d y c a n n o t m ake fo r itself. T hese are called th e essential am ino acids and th e y m u s t be o b tain ed fro m th e diet. T h e a d u lt h u m an b o d y can m ain tain n itro g e n o u s e q u i­ lib riu m on a m ix tu re o f these eight essential am in o acids, as th e sole so u rce o f n itro g e n . D e p e n d in g u pon th e ir ab ility to m ain tain life and p r o ­ m o te g ro w th , p ro te in s have been classified as eith e r co m p le te o r in ­ co m p lete. C o m p lete p rotein s c o n tain all th e es­ sential am in o acids in q u an tities su f­ ficient fo r m ain ten an ce o f th e tissues and fo r n o rm a l rate o f g ro w th . Such p ro te in s are said to have a high biologic value. T hese p ro te in s are of anim al o r i­ gin and include eggs, cheese, m ilk, m eat, p o u ltry and fish. In co m p lete p rotein s can be divided in to tw o classes: • partially in com p lete p rotein s can m aintain life, b u t th ey lack suf­ ficient a m o u n ts of som e o f the am in o acids necessary fo r g ro w th . T hese p ro te in s are o f p la n t origin and inclu d e p ro te in in cereals, le­ gum es and nu ts. • to ta lly in co m p lete p rotein s are in ­ capable o f replacing o r b u ild in g new tissues, and hence c a n n o t s u p p o rt life, let alone p ro v id e g ro w th . T hese p ro te in s inclu d e th e p ro te in s in gel­ atine. F ro m th e above classification, it can be seen th a t p ro te in s are eith e r of animal o r p la n t o rig in . W ith th e ex cep tio n of gelatin, all anim al p ro te in s are co m p lete and of high biological value. M o st p lan t p ro te in s (w ith th e ex cep tio n o f w heat- germ ) lack o n e o r m o re essential am ino acid in sufficient am o u n ts. T h e lacking am in o acid is k n o w n as th e lim itin g a m in o acid. T h e p ro te in s in w h eatg erm are, alth o u g h o f p la n t o rig in , o f high biologic value. N o t o n ly is anim al p r o ­ tein o f h ig h e r q u a lity than p lan t p r o ­ tein , b u t p ro p o rtio n a lly anim al foods c o n tain m o re p ro te in than p la n t foods. F ru it and vegetables have v ery low (if any) p ro te in c o n c e n tra tio n s. As a rule, less anim al th an p la n t p ro te in is necess­ ary to p ro v id e e n o u g h o f all the essen­ tial am in o acids. A lth o u g h p lan t p ro te in s lack certain am in o acids, th e ir role in the d iet sh o u ld n o t be u n d e re stim a te d . T he sh o rtag e o f th e lacking am in o acid can be o v erco m e b y ad d in g a n o th e r p ro tein w h ich c o n ta in s th e m issing am ino acid. T h e capacity o f p ro te in s to m ake g ood o n e a n o th e rs deficiencies is k n o w n as th e ir su p p lem en ta ry value. W hen an app reciab le a m o u n t o f p la n t p ro tein is fed w ith o n ly a small a m o u n t o f anim al p ro te in , th e q u ality o f th e m ix tu re is of A P P L I C A T I O N F O R RESEARCH GRANT To p ro m o te k n o w le d g e a b o u t th e role o f sugar in h e a lth a n d nutrition, th e South A fric a n Sugar A ssociatio n looks to th e s cie n tific c o m m u n ity for re lia b le a n d u p -to -d a te in fo rm a tio n . As p a rt o f this process, it supports scie n tific rese arch p ro je cts d e s ig n e d to c la rify issues w h ic h arise in this p u b lic terrain. The Sugar A ssociation a c ts o n th e re c o m m e n d a tio n s o f a Research A dvisor a n d Advisory Panel. Priorities for research fu n d in g b y th e A ssociatio n are; 1 Physical w ork, exercise or sport in re la tio n to d iet. 2. O besity a n d th e c o m p a ra tiv e role o f d iffe re n t d ie ta ry fa cto rs a n d form s o f exercise. 3. Causes o f d e n ta l caries a n d p e rio d o n ta l disease. 4. Diet in relatio n to d ia b e te s mellitus. 5. H yp e rlip id a e m ia s in re la tio n to diet. 6. G ly c a tio n o f proteins. Proposals in a n y o n e o f these priority fields will b e g iv e n co n s id e ra tio n . The research grants are a w a rd e d o n a 2 ye a rly basis. C o n tin u a tio n o f th e g ra n t for th e s e c o n d y e a r o f study is d e p e n d e n t on progress m a d e , as assessed b y th e Advisory Panel from a re p o rt s u b m itte d for this purpose. INSTRUCTIONS FOR PROPOSAL PREPARATIONS: In o rd e r to a llo w for a p ro p e r e v a lu a tio n o f proposals b y reviewers, th e fo llo w in g items should b e in c lu d e d : 1. O n e p a g e a b s tra c t o f th e p ro p o s e d p ro je c t (200-w ord m a xim u m ) 2. Short d e scrip tio n o f b a c k g ro u n d for p ro p o s e d p ro je c t research. 3. S u c c in c t s ta te m e n t o f p ro je c t o b je ctive s. 4. Short d e scrip tio n o f m e th o d s to b e used in pursuing ob je ctive s. 5. C le a ra n c e for th e research from a n A n im a l or H um an Review C o m m itte e if a p p lic a b le . 6. C urriculum v ita e a n d list o f fu ll-le n g h p u b lic a tio n s ove r th e last six years. 7. D e ta ile d b u d g e t (to in c lu d e th e p ro p o s e d b u d g e t for th e first a n d s e c o n d years o f study). NOTE: No funds a re p ro v id e d for m a jo r e q u ip m e n t (unit c o s t g re a te r th a n R2 000) or tra v e l costs, The d e a d lin e for proposals to b e s u b m itte d is 15 N o v e m b e r 1990. A p p lic a tio n form s are a v a ila b le from a n d . w h e n c o m p le te d , should b e re tu rn e d to: The Nutritionist, The South A fric a n Sugar A ssociatio n, PO Box 374, DURBAN 4000. Tel. (031) 305 6161. N either la te a p p lic a tio n s nor a p p lic a tio n s re c e iv e d b y facsim ile will b e a c c e p te d . ----------------------------SUGAR ASSOCIATION S P O R T S G E N E E S K U N D E VOL. 5 N R . 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. ) NUTRITION high value. F o r exam ple, cereal foods are usually low in an am in o acid called lysine, b u t m ilk supplies am ple a m o u n ts o f th e m issing lysine. T h u s, m acaro n i and cheese, cereal and m ilk o r b read and cheese are supplem entary. L ikew ise, a relatively small a m o u n t of m eat, egg o r cheese in a rice, n o o d le o r m acaro n i casserole is an effective c o m ­ b in a tio n . F o r th e b est use o f p ro te in fo o d s, so m e c o m p le te p ro te in shou ld be in clu d ed in each o f the meals o f the day, ra th e r th an allo tin g all o f it to one meal. Because o f th e s u p p le m e n ta ry effect, diets c o n sistin g e n tire ly o f a w ide v ar­ iety o f p la n t sources can adeq u ately m eet th e p ro te in needs o f h ealthy adu lts, p ro v id e d th a t th e d iet con tain s sufficient energy. T h is can be achieved b y ch o o sin g a variety o f p la n t foods (eg. legum es, cereals and n u ts) and fu r­ th e rm o re , a variety o f each kin d (eg. m aize, w h eat, oats and rice - all cereals; and so y a and o th e r d ry beans, peas and lentils - all legum es). P lan t fo o d s s u p ­ p le m e n t o n e a n o th e r exceptionally well. M o st n u ts have a high p ro te in c o n te n t. O f all the n u ts, p e a n u ts have th e hig h est p ro te in c o n te n t, b u t the p ro te in is in co m p lete. T h e sh o rtag e can be o v erco m e by ad d in g w h eat p ro te in . T h e re fo re , the p ro te in q u ality o f a pea- n u tb u tte r san d w ich is o f high value. T h e p ro te in in p e a n u ts can also be s u p ­ p lem en ted w ith th e p ro te in in m aize, rice, c o c o n u t and oats. Pulses have a h ig h er p ro te in c o n te n t th an cereals. Pulses lack th e essential am in o acid m e th io n in e , b u t are rich in lysine. O n th e o th e r h an d , w h eat p ro te in s lack ly ­ sine b u t su p p ly ad eq u ate a m o u n ts o f m eth io n in e . B ecause o f this, a c o m b i­ natio n o f pulses and cereals such as soyabeans and w h eat, rice and lentils as well as sam p and d ry beans m ay have a n u tritiv e value as g o o d as anim al p r o ­ tein. Pulses can also be su p p lem en ted by sesam e. It m u st be k e p t in m in d th at, in o rd e r to m ain tain th e su p p le m e n ta ry effect, th e s u p p le m e n ta ry foo d s m u st be in clu d ed in th e sam e meal. C o n ­ sum in g lentils fo r s u p p e r will d efinitely n o t su p p le m e n t th e rice value th a t was in clu d ed fo r lunch. It is re c o m m e n d e d th a t, u n d e r n o r ­ mal circu m stan ces, th e p ro te in in tak e o f h ealth y a d u lts sh o u ld be 0,8 g p ro te in p e r kg ideal b o d y w eight. A n ad u lt m an w eighing 70 kg and a w o m an w eighing 58 kg th e re fo re req u ire a b o u t 56 and 46 g p ro te in p e r day respectively. U n d e r n o rm al circu m stan ces by typical W esternised d iet su p p ly m ore than e n o u g h p ro te in and n o su p p le m e n ­ ta tio n o f th e d iet w ith special p ro te in - rich com m ercial p ro d u c ts is necessary. In clu d ed is a list o f th e p ro te in c o n ­ te n t o f certain foods. All values are given fo r 100 g edible p a rt o f the food item . T h e given values th erefo re give a good in d icatio n o f th e p ro te in c o n cen ­ tra tio n s o f d iffe re n t food item s. AVERAGE P R O T E IN C O N T E N T PER 100 g EDIBLE PART O F THE F O O D F ood item p rot(g) Food item p rot(g) skim m ed m ilk p o w d e r 36,2 venison, roasted 35,0 biltong, beef 34,3 lean m eat: beef, m u tto n , p o rk 29,5 chicken, light m eat o nly 28,9 tuna, canned in w ater 28,0 peanuts 26,0 p e a n u tb u tte r 25,2 cheese: cheddar, gouda, edam 24,9 fatty m eat: beef, m u tto n , p o rk 24,9 chicken, w ith skin 24,7 kidney, fried, lam b 24,6 sunflow er seeds 24,0 tro u t, steam ed 23,5 haddock, boiled 23,3 P ro N u tro 22,0 ham , sm oked 20,9 fish, steam ed 20,5 cheese: cam em bert, brie 19,8 abalone, crayfish 18,7 alm ond nuts 18,6 Special K 18,0 cottage cheese, fat free 17,3 cashew n uts 17,2 mussels, boiled 17,2 cheese spread 16,4 All bran flakes 15,1 tripe, cooked 14,8 w alnuts 14,8 b ra z iln u ts 14,3 puffed w h eat 14,2 feta cheese 14,2 vienna 14,0 cottage cheese, low fat 13,7 rye crisp bread eg R yvita 13,0 muesli 12,9 p o p c o rn 12,8 h a z e ln u ts 12,6 cottage cheese, creamed 12,5 eggs, boiled 12,1 weetbix 11,4 w holew heat crispbread eg Provita 11,2 soyabeans, cooked 11,0 m atzos 10,5 bread, w holew heat 9,9 flour, cake 9,8 p o lo n y 9,4 to p p ers, cooked 8,7 co rn flak es 8,6 bread, w hite 8,4 oysters, raw 8,4 lentils, cooked 7,8 cream cheese 7,6 b u tte r beans, cooked 7,1 evaporated m ilk 6,8 haricot beans, cooked 6,6 rice crispies 5,9 peas, cooked 5,4 baked beans 5,1 dried apricots 5,0 brussel sprouts, cooked 4,2 pasta eg m acaroni, spaghetti, noodles 3,4 skim m ed m ilk, w hole milk, b utterm ilk, y o g h u rt 3,3 mealie 3,3 dried peach, pear 3,1 broccoli, cooked 3,1 spinach, cooked 3,0 tastee w heat 2,9 raisins 2,5 b ro w n rice, cooked 2,5 w hite rice, cooked 2,0 vegetables 0-3 fruit 0-2 fats 0 sugar 0 14 ----------------------------------------------------------- S P O R T S M E D I C I N E VOL. 5 N O . 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. ) Is your patient being held prisoner to pain and immobility? There is a release... \ non-steroidal anti-inflammatory . RELIEVES PAIN „ -v< . REDUCES INFLAMMATl . RESTORES MOBILITY | . REDUCES THE COST Ol TRAUMA THERAPY Available nyw in three rfo: PANAMOR" - 25 TABLET PANAMOR* AT - 5 0 TABI AND INTRODUCING' PANAMOR® - 75 INTECji RELEASE FROM LEN N O N ^ ^ LIMITED lit s' m v Jic in c y o u o m affo rd »c irus* 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 UPDATE PHYSIOTHERAPY AND THE SPRAINED ANKLE OF THE SPORTSMAN P h y sio th e ra p ists like to tre a t so ft tissue injuries o f th e ankle as so o n as possible. F ew er th an 10% o f ankle injuries s h o u ld be tre a te d in P .O .P . L igam ents need to m ove b u t be co rre c tly s u p ­ p o rte d , h ence th e use o f strap p in g s o r a brace. T he aim s o f th e p h y sio th e ra p ist in th e acu te stage o f 48 h o u rs a r e : • to red u ce p a in ; • to red u ce sw elling; • to m in im ize th e size o f th e haem a- tom a. In th e su b acute stage after 48 h o u rs u n ­ til re so lu tio n , th e aim s a r e : • to achieve p ain -free and full jo in t range w ith as sm all and as m alleable a scar as p o ssib le; • to re -ed u cate p ro p rio c e p tio n ; • to re-e d u c ate m uscle pow er. R e so lu tio n is w h en th e p a th o -p h y s io - logical m echanism has tak en place. It m u st be re m e m b e red th a t ligam ents 3 take six w eeks to heal b u t to p s p o rts ­ m en usually resu m e th e ir s p o rt long b e­ fore this tim e. It m u st be rem em b ered th a t o th e r stru c tu re s such as capsule o r p ero n e i te n d o n s m ay have been injured as well. 16 S P O R T S M E D I C I N E VOL. 5 N O . 3 1 A p ain -free range is achieved w ith th e use o f tran sv erse frictio n s, pass­ ive and active m ovem ents. 2 P ro p rio c e p tio n is th e p e rs o n ’s ab il­ ity to a p p re h e n d changes o f p a rts o f th e b o d y w ith o u t th e aid o f sight. It is a balance o r rig h tin g reflex and it is lo st w hen th e ankle is inju red . R e-e d u c a tio n begins in th e s u b ­ acute stage w h ilst th e ankle is still stra p p e d . T h e p ro g re ssio n is from th e sim ple exercise o f stan d in g on th e in ju red leg and balancing w ith th e eyes closed, to exercising o n the w o b b le b o a rd . F ro m this b o a rd the p a tie n t p ro g resses to a n ew in v en ­ tio n , recen tly p a te n te d called the E x -o p e d . T h e stan d in g exercise on th e b o ard enables th e ankle to reach th e extrem es o f m o v em en t b u t sto p s excess m o v e m e n t th erefo re does n o t p u t th e ankle at risk o f re­ injury. P h y sio th e ra p ists th ro u g h o u t the c o u n try are using iso k in etic a p p a r­ atus. F irstly it is used to test th e p o w e r of th e o p p o sin g m uscles o f a jo in t eg. d o rsiflex io n (T ibialis A n te rio r) and p lan tarflex io n (G a stro c n e m iu s and Soleus) o r eversion (P ero n eu s L o n g u s and B revis) and inversion (T ibialis A n te rio r o r T ibialis P o s te ­ rio r). Secondly, it is used to re ­ ed u cated th e m uscles to th eir stre n g th . S tab ility o f a jo in t is n o t o n ly d e p e n d e n t on ligam ents b u t also o n stre n g th of m uscle. If the o p p o sin g m uscles o v er th e jo in t have th e c o rre c t p o w e r balance, th a t jo in t is stable. A lth o u g h iso k in etic m achines are n o t n ew , th e re has been a surge o f in terest in th em because o f the g ro w in g field o f sp o rts m edicine. D u rin g th e final stage o f reh ab ilitatio n , in o rd e r to re-e d u c ate the ankle to fu n c ­ tional fitness, a p lay er m u st practice m o v em en ts o f his s p o rt eg. a ru g b y back m u st ru n in zig -zag and figure o f eight p a tte rn s, h o p on alternative feet, and p ractice quick stops. O n ly if the ankle has gained its range, stre n g th and p ro p rio c e p tio n can the p la y e r re tu rn to his sp o rt. T h e ankle sh o u ld be assisted th ro u g h th e rest o f th e season by the use of a stra p p in g o r brace such as the p n e u ­ m atic brace filled w ith air cells. R e­ search has p ro v e d this to be a su p e rio r brace. 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. ) SOCCER SOCCER - WARMING UP AND STRETCHING G Jacobson and E Speechley Soccer has been played for m any years. T h ere are indications that it was played as long ago as 12 B.C. d u rin g the reign of the H an D ynasty in C h in a, p red o m i­ nately by the m ilitary in o rd e r to e n ­ courage discipline and c o m ra d e sh ip .1 A striking feature o f the gam e was th at the players used the severed head o f an enem y w arrior as the ball! N ow som e 2000 years later the p o p u larity o f the game has spread to such an extent that both m en and w om en on six co n tinents are playing th e gam e regularly and co m ­ petitively. In 1984, soccer surpassed ru g b y as the m ost p o p u la r sport in South A frica.2 T h e p o p u larity o f soccer has b ro u g h t w ith it an increase in the n u m b e r o f in ju ries, m any o f w hich can how ever be p revented by the adoption o f correct train in g principles. A recent stu d y 3 reco m m en d ed that ad eq u ate w arm u p and stretch in g program m es should be included into train in g p ro ­ gram m es, as this m ay lead to a decrease in the n u m b e r o f footballing injuries. W arm ing up and stretch in g are vital c om ponents o f any successful training program m e. WARMUP W arm ing u p increases the te m p e ra tu re of the body. T h is increased te m p eratu re results in the increased su p p ly o f blood and n u trie n ts to th e m uscle, and also causes the m uscle to con tract m ore ef­ ficiently. T h e increased tissue te m p era­ tu re that results from th e w arm u p re- Gary Jacobson B S c (Physiotherapy) W I T S BSc(M ed)(H ons) Sports Science U C T E va n Speechley B S c (Physiotherapy) W I T S duces the incidence o f m uscular injuries. A thletes w ho w arm u p before a m atch tend to be m ore m entally p re ­ pared for the g a m e .4. T h ree m ajor types o f w arm up can be used. Passive T h is type of w arm u p involves the w arm ing u p o f th e body by external m eans. In th e South African clim ate this is seldom necessary. H ow ever the player may benefit if he w ears a full track suit before playing as this m ay act as a w arm ­ ing up m edium . General T h is is the m ost com m on type o f w arm u p used. In this case, the b ody te m p era­ tu re is raised by the active, co-ordinated m ovem ent o f various m uscle g roups. Exam ples o f this type o f w arm u p in ­ clude jogging and arm c irc lin g . Specific T h is is possibly th e m ost beneficial form o f a w arm up . T h e body te m p e ra ­ tu re is raised by th e p erfo rm an ce o f the same m ovem ents th at are used d u rin g m atchplay only this tim e th e m ovem ent is perform ed at a slower, m o re leisurely pace. T h e advantage o f su ch a w arm up is that not only does it increase the tem ­ p eratu re o f the b ody parts d irectly in ­ volved in the activity, b u t it also acts as a dress rehearsal for th e m atch. Exam ples o f this type o f w arm u p inclu d e d rib ­ bling and h eadering the ball. HOW M U C H A N D HOW LONG? T h e w arm u p m u st be individualised according to the players physical capa­ bilities. C o n ditioned athletes regulate the am o u n t o f heat p ro d u ced d u rin g exercise very effectively, an d therefore probably re q u ire a longer an d m ore in ­ tense w arm u p .4 Bearing in m in d the re ­ strictions placed on th e p lay ers, a 15-20 m in u te pre-gam e w arm u p p erio d , should be ad eq u ate. T h ere should not be a rest interval betw een the w arm up and the m atch. T h e len g th o f tim e o f the w arm up m u st not be too long as this m ay tire th e players and resu lt in poor perform ance d u rin g th e m atch. An easy guideline can be used to assess w hen a player is sufficiently w arm ed up . A slight, b ut noticeable sweat (usually on the forehead) should be d etectable. STR ETCH ING An ad eq u ate w arm up p eriod should precede all stretch in g . It is incorrectly believed th at cold m uscles, being m ore plastic, are m ore likely to u n d erg o p e r­ m anent ch an g e, w hen stre tc h e d .5 T h e objective b eh in d stretch in g is to in ­ crease the len g th o f the connective tis­ sue (su p p o rtin g tissue a ro u n d th e m u s­ cle) perm anently, and to increase the length o f th e m uscle transiently. S tretching results in th e m uscle being m ore flexible, and as tight m uscles p re ­ dispose to injury,6 stretch in g may d e ­ crease the incidence o f m uscu lar and ten d in o u s injury. Flexibility is a co m p o ­ n en t o f fitness th at is h ealth , not skill re­ lated, and is defined as “th e range o f m ovem ent a ro u n d a specific jo in t”.7 F o u r types o f stretch in g can be p e r­ form ed;8 ballistic (b o u n cin g an d jerky) passive (the stretch is p erfo rm ed w ith th e assistance o f an o th er person) con- tract-relax (an isom etric m uscle con­ traction precedes th e stretch ) and static. Ballistic T h is stretch is p erfo rm ed w ith jerky, bouncing type m ovem ents. H ow ever -------------------------------------------------------------- — 17 S P O R T S G E N E E S K U N D E VOL. 5 N R . 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. ) SOCCER • A ssum e th e stretch ed position slowly. • M aintain the position for 30 - 60 seconds. C hange sides. R epeat two to three tim es. • A lternate m uscle g roups i.e. stretch the arm m uscles, then the leg m u s­ cles followed by the tru n k m u scu la­ ture. • Feel a stre tc h , not a pain. • N ever bounce d u rin g stretch as this causes the m uscle to contract w hilst being stretch ed and th ereb y p red is­ poses the m uscle to tearing. • Avoid high risk exercise e.g. neck circling, d o u b le straight leg raising, full sit ups (only sit u p to about 45 degrees) and straight leg sit ups (al­ ways ben d yo u r knees). Inju ries d isru p t the team , hence the team s perfo rm an ce can be affected. If these few sim ple guidelines are fol­ low ed, a great n u m b e r o f injuries can be prev en ted . R em em ber, it is not only necessary to w arm u p and stretch before p ractice, b ut also before a m atch. due to this b o u n c in g , a great deal o f te n ­ sion is p ro d u ced in the m u scle, and stretching the m uscle against this am ount o f ten sio n , increases the risk of in jury to the m uscle. F o r this reason ballistic stretch in g is not recom m ended. C ontract-relax T h is tech n iq u e com bines an isom etric contraction w ith a stretch i.e. the m u s­ cle to be stretch ed is co n tracted isome- trically for 5 to 10 seconds before being stretched. T h e p ro b lem w ith this tech ­ nique is th a t, n ot only does it req u ire a partner, b u t also a great deal o f skill, and therefore is easy to p erfo rm incorrectly. Passive In this type o f stre tc h in g , a p a rtn e r a p ­ plies additional p ressu re to the area b e ­ ing stretch ed , th ereb y increasing the am o u n t o f stretch on the m uscle. H o w ­ ever as the player h im self is not co n tro l­ ling the degree o f stre tc h , it is easy to overstretch the m uscle. Static T h is m ethod o f stretch in g allows the player to obtain the stretch ed position slowly, and once in this p osition, the stretch is m ain tain ed for a period of tim e. T h is tech n iq u e p ro d u ces the least am ount o f tension in the m uscle, and is therefore the safest m eth o d o f stre tc h ­ ing. S tretching can also resu lt in inju ry if perfo rm ed incorrectly. A few guidelines are detailed below , the p u rp o se o f w hich is to h ighlight the m ost im p o rtan t factors that should be consid ered w hen stretching. • Always w arm u p before. • D evelop a safe and effective ro u tin e, based on the needs of the gam e. • S tretch th ro u g h o u t th e season, b e­ fore and after a train in g sessio n . • S tretch before and after every 9 m atch. N o te : A stretching programme is avail­ able from most leading physiotherapists or medical practitioners. Figure 1 serves only as a guideline o f stretches, and a vast number o f alternate stretches can also be performed. REFERENCES 1. Conrad D , Sidaway R and W ilson B. World Cup ’78 - The game o f the century. Fontana Publishers U .K . 1978, 12-15. 2. Surve I, R anchod J and Kettles AN. Soccer Injuries. S A Journal o f Sports Medicine 2: 12-14,1987. 3. Surve I, Ranchod J and Kettles AN. Soccer Injuries. S A Journal o f Sports Medicine 2: 4-6,1987. 4. Sheelock FG. Physiological benefits of warm up. PhysSportsmed. 5. M urphy P. Warm up before stretching. Let­ ter in Phys Sponsmed. 6. Casperson P. Groin and H am string injuries. Athletic Training 17: 43-45, 1982. 14: 45, 1986.11: 134-138,1983. 7. Shellock FG , Prentice W E. Warm up and stretching for im proved perform ance and prevention of sports related injuries. Sports M edicine!: 267-278, 1985. Beaulieu JE. Developing a stretching pro ­ gramm e. PhysSportsmed9\ 59-66, 1981. Anderson B. Stretching. Shelter Publications USA. 1980,118-139. 18 ----------------------------------------------------------- S P O R T S M E D I C I N E VOL. 5 N O . 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. ) will give you >̂ ,v. more freedom to walk, jump, run and work 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. ) SOCCER 20seconds each leg touch chin on chest 60 seconds 30 seconds 25seconds each side 20seconds each leg 10seconds each leg hip m uscle achilles tendon back muscle ankle m uscles 10 times each direction 30seconds inner thigh 20 seconds touch e a r onto th e ground 20 ----------------------------------------------------------- S P O R T S M E D I C I N E VOL. 5 N O . 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. ) SOCCER back muscles 8-10 times Quadriceps (front of thigh) 20seconds ankle 30seconds each leg shoulder m uscles 10seconds each side 30 seconds each leg hamstrings 1 6 , l 7 a n d 1 8 a ll stretch th e arm and shoulder m usculature 15seconds 10 seconds each arm back m uscles 3 times 5 seconds R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) SASMA UPDATE D aw ie van Velden FIMS W O R L D C O N G R E S S O F SPO RTS M E D IC IN E 27 M A Y - 1 J U N E 1990 T h e 24th FIM S W orld C o n g ress o f S ports M edicine held in A m sterd am , th e N e th e rla n d s, was a very successful scientific m eetin g w ith th e th em e o f S p o rts, M edicine and H e a lth . F IM S is th e ab b rev iatio n fo r “ F ed eratio n I n te r ­ n a tio n al de M edicine S p o rtiv e ” th e I n ­ te rn a tio n a l S ports M edicine F e d e r­ atio n . T h e o rg a n iz a tio n was fo u n d ed in 1928, and to d a y FIM S is a w o rld w ide o rg a n iz a tio n w ith 83 m e m b e r n ations. T h is con g ress was a tte n d e d by fo u r m em b ers o f th e S o u th A frican Sports M edicine A sso ciatio n . T h e th ree areas o f scientific e n d e a v o u r in te rtw in e d in sp o rts m edicine, n am ely Sports, M edicine and H e a lth , w ere discussed fro m th e s ta n d p o in t o f card io lo g y and related in te rn a l diseases, o rth o p a e d ic s, p h y sio lo g y and biom echanics and the b eh av io u ral sciences. T h e relatio n s b e ­ tw een s p o rt and m edicine as w ell as s p o rt and h e alth w ere addressed in a w ell balanced p ro g ra m m e b y speakers fro m all o v er th e w o rld . Sports m edicine, as a fast g ro w in g b ran ch of m edicine needs a solid scientific basis and well d eveloped in te rn a tio n a l c o m ­ m u n icatio n . It was o u r o p in io n th a t the con g ress w ill be rem em b ered as a d e fin ­ ite step fo rw a rd in reaching these goals. T h e secretary general of FIM S, P ro f D E d u a rd o H e n riq u e de R ose from B razil, inv ited th e S outh A frican S ports M edicine A sso ciatio n , to app ly fo r af­ filiate m em b ersh ip . A fte r all these years o f iso la tio n , it is e n co u rag in g to see the w o rld w id e change in a ttitu d e n o t only to w a rd s th e “N e w S o u th A fric a ”, b u t to all the c o u n trie s o f th e w o rld , including th e so-called E ast B lock co u n tries. A h an d o f frien d sh ip is extended to a w o rld th a t has g ro w n sick and tired of w arfare. T h is congress p ro v ed to be a W orld F o ru m fo r th e p re se n ta tio n and discu ssio n o f advances and fu tu re tre n d s in sp o rts m edicine. We sincerely h o p e th a t FIM S w ill be able to accept o u r in v ita tio n to attend o u r fo rth -c o m in g in te rn a tio n a l Sports M edicine C o n g ress scheduled fo r 24-27 A p ril 1991 in Sun C ity, B o p u th a- tsw ana. T h re e S o u th A fricans p a rticip ated in th e scientific p ro g ra m m e , nam ely D r M artin Schw ellnus, D r Stinus B arnard and M rs A W enham . We are su re th a t S o u th A frica w ill be able to send a big­ ger c o n tin g e n t to th e next FIM S c o n ­ gress sch ed u led fo r 1994 in A th en s, G reece. R E P O R T O N THE C O M B IN E D SA A SSP E R /SA SM A C O N G R E S S 27-29 J U N E 1990 T h e S o u th A frican A sso ciatio n for S p o rts, Science, Physical E d u catio n and R ecreatio n (SA A SSPER ) held their N a tio n a l S y m p o siu m on w ell-being b e y o n d 2000 in c o lla b o ra tio n w ith the R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) SASMA UPDATE S o u th A frican S ports M edicine A sso ci­ ation (SA SM A ) in P o rt E lizab eth on 27-29 J une 1990. H ie rd ie g esam entlike aanbieding kan as ’n baie geslaagde o n d e rn e m in g be- skou w o rd , aangesien daar soveel areas van o o rv leu elin g is tu ssen sp o rtg e n e e s­ k u n d e en s p o rtw e te n sk a p . T y d e n s h ie r­ die k o n g res w as d aar ’n g ro o t b y d rae van fisio terap ie gew ees, w at u itstek en d aangevul was m et die o n d e rh o u d e n d e en leersam e in sette van G rah am Sm ith, b ek en d e fisio te ra p e u t van G lasgow , Engeland. D ie spo rtg en eesk u n d esessies was baie goed b y g e w o o n d e u r alle k o n g res- gangers. Temas w at g ro o t belangstelling u itg elo k h e t w as ch ro n iese siektes, ch ro n iese lae ru g p y n , ru g b y b eserin g s en o o rg eb ru ik b e se rin g s. O n s is daarvan o o rtu ig dat h ierd ie k o n g res ’n gesonde fo ru m geskep h e t vir alle belangheb- bendes in s p o rt om kennis in te w in vir die v o o rk o m in g , b eh an d elin g en reha- bilitasie van s p o rt- en o efen v erw an te pro b lem e. O n e o f th e hig h lig h ts o f this congress was th e p resence o f P ro f N iel O ld rid g e o f the U S A , th e P resid en t o f the A m erican C ollege o f S ports M edicine (A C SM ). N o t o n ly d id he c o n trib u te greatly to th e scientific p re se n ta tio n s, b u t he also discussed his view s on the fu tu re o f S p o rts M edicine in A m erica. Being a fo rm e r S o u th A frican and grad u ate from R h o d es U niversity, he has th o ro u g h u n d e rsta n d in g o f o u r country. T h e re cen t p ositive changes in o u r c o u n try have m ade it p ossible to ar­ range b igger in te rn a tio n a l congresses. We are c u rre n tly lo o k in g at the p o ssi­ bility o f h o ld in g th e fo rth c o m in g c o n ­ gress sch ed u led fo r 24-27 A p ril 1990 at Sun C ity, B o p u th a tsw a n a in co lla b o ra ­ tion w ith th e A C S M (A m erican C ollege o f S ports M edicine). T h is will surpass o u r p rev io u s con g ress in C ap e Tow n in in te rn a tio n a l p a rtic ip a tio n , because it will create th e o p p o rtu n ity fo r m any scientists to com e to S o u th ern A frica. W ith th e c u rre n t fav o u rab le exchange rate fo r foreig n ers, S outh A frica has be­ com e a m ajo r to u ris t attra c tio n as a congress venue! T h is congress w as th e biggest and m o st successful SA A SSPER congress ever, and w as m ade p ossible b y a very generous sp o n so rsh ip fro m T R A N S - N E T . T h e delegates w ere also e n te r­ tained on a very relaxing and in teresting social p ro g ra m m e , w hich included an u n fo rg e tta b le trip on th e A p p le Train. W h o w ill nev er fo rg e t th e icy rain and w ind w e had to face d u rin g this ride to L oerie station! It is also o f h isto rical in te re st th a t a p rev io u s SA A SSPE R congress held in P o rt E lizab eth ten years ago, w as o r ­ ganised b y th e c u rre n t P re sid e n t o f the S o u th A frican S p o rts M edicine A ssoci­ atio n . T h is was th e first congress w here a fo ru m w as created fo r delegates from th e m edical and n o n m edical p r o ­ fessions to discuss m atters o f m utual in terest. T h e th em e w as th e use o f exer­ cise as th e ra p y fo r v ario u s diseases and health related p ro b le m s. It is th u s very a p p ro p ria te th a t this excellent congress sh o u ld be th e c u lm in a tio n o f o u r efforts to ack n o w led g e th e m ulti d isciplinary a p p ro a c h to s p o rt exercise and health. T h e o rg an isers m u st be c o n g ratu lated on this very in fo rm ativ e congress. A N N O U N C E M E N T O F T H E F O U R T H N A T IO N A L SPO RTS M E D IC IN E C O N G R E S S T h e 4 th N a tio n a l S p o rts M edicine C o n ­ gress is scheduled fo r 24-27 A p ril 1990 in Sun C ity, B o p u th atsw an a. O u r th em e fo r th is congress will be R E H A ­ B I L I T A T I O N , and is held in close co l­ la b o ra tio n w ith th e P h y sio th e ra p y C o n g re ss, sch ed u led fo r 22-25 A pril 1991 in P re to ria . T h e first a n n o u n c e m e n t o f this c o n ­ gress will so o n be released. It is envis­ aged th a t we will a ttra c t great in te r­ natio n al p a rtic ip a tio n . R eh ab ilitatio n th ro u g h s p o rt and exercise has becom e increasin g ly im p o rta n t in the medical w o rld , and has w ide app licatio n s in the field o f th e health related sciences. It w ill be w o rth w h ile to diarize these d ates on n ex t years calender. T h is c o n ­ gress w ill be o n e o f th e m o st interesting scientific m eetings on the academ ic cal­ e n d e r fo r S o u th ern A frica. ‘TILCOTIL’ ROCHE Components: Tenoxicam Indications: S ym ptom atic treatm ent of the fo llo w in g painful infla m m a to ry and degenerative disorders of the m usculoskeletal system : rheum atoid a rthritis; o steoarthritis; ankylosing sp o n d ylitis; extra- a rticular disorders, e.g. te n d in itis, bu rsitis, p e ria rth ritis, gouty arth ritis (fo r tablets). Dosage: 20 mg once daily at the same tim e each day. The parenteral fo rm is used fo r one or tw o days. For treatm ent in itia tio n in acute gouty a rth ritis 40 mg (2 tablets) once daily fo r two days follow ed by 20 mg once daily fo r a fu rth e r five days is recom m ended. Contra-indications: Known h yp ersensitivity to the drug. Patients in w hom salicylates or other nonsteroidal a n ti­ infla m m a to ry drugs (NSAIDs) induce sym p to m s of asthm a, rh in itis or urticaria. Patients who are suffering o r have suffered from severe diseases of the upper gastrointestinal tract, including g a stritis, gastric and duodenal ulcer. Before anaesthesia or surgery, ‘TILCOTIL’ should not be given to patients at risk of kidney failure, o r to patients w ith increased risk of bleeding. C oncurrent treatm en t w ith salicylates or other NSAIDs should be avoided. Pregnancy and lactation. Precautions: Sim ultaneous treatm ent w ith anticoagulants a nd/or oral antidiabetics should be avoided unless the patient can be closely m onitored. Renal fu n ctio n (BUN, creatinine, developm ent of oedema, w eight gain, etc.) should be m onitored, when giving a NSAID to the elderly o r to patients w ith co n d itio n s that could increase th e ir 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 fo r injection. -------------------------------------------------------------------- 23 S P O R T S G E N E E S K U N D E VOL. 5 N R . 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. ) PO Box 13206 CLUB VIEW 0014 February 1990 Dear Doctor, 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. Sports Medicine, the official mouthpiece of the SA Sports Medicine Association, has over the years become a treasured source of knowledge for the health care professional in the sports medicine arena. The journal features not only original research papers and articles by leading specialists in sports medicine, but also current news and relevant abstracts. The publishing of Sports Medicine has been taken over by Medpharm Publications. The journal will be published quarterly namely, February, May, August and November. Due to the present rate of inflation SASMA are no longer able to distribute Sports Medicine free of charge and have reluctantly introduced a subscription fee of R20.00 per annum (Members of SASMA will continue to receive the publication free of charge). In addition to managing costs, this will enable the editorial board maintain a high quality editorial content and render a more effective service to you, the health care professional. Your subscription to Sports Medicine is an investment in your future and the future of the health care profession. We count on your continued support. Regards, CLIVE NOBLE EDITOR SPORTS MEDICINE X --------------------------------------------------------------------------------------------------------------------------------------------------------------- Name: .... ......................................................................................................................................... Address: ...................................................................... ........................................................... ........ Code: .................................................................. Tel: .......................... ...................................... Enclosed please find my cheque/postal order payable to SASMA for: • R30for FULL MEMBERSHIP* to SASMA (This includes receiving Sports Medicine free of charge) • R25 for ASSOCIATE MEMBERSHIP** to SASMA (This includes receiving Sports Medicine free of charge) • R25 for STUDENT MEMBERSHIP*** to SASMA (This includes receiving Sports Medicine free of charge • R20 + GST (R22,60) for subscription to Sports Medicine NOTE * Full membership: Medical practitioner who is a member of MASA ** Associate membership: Members of supplementary Health Service professions, registered with the SAMDC and who are members of their own professional associations • * * Student Membership: Medical students who are in their clinical years 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. )