J O U R N A L O F T H E S A S P O R T S M E D I C I N E A S S O C I A T I O N 51*01375 itJIED IC IN IE 5P O R TG I= M = l= 5 K U N D I T Y D S K R I F V A N DI E S A S P O N E E S K U N D E - V E R E N I G I N G •Aerobic Dance •Thought Strategies • Osteochondritis Dissecans • physiotherapy— Runners 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. ) Reg. h o J h r. tV5 1 / 2 5 5 W e V A c t 101/1965) In sports in ju ry__ and trauma. ■ Clinically well to le ra te d , Geigy U c a l l y e f f e c t i v e , n OldtffelMC uiitm 51 ag Voltaren GT 50 Geigy coated tablets) nts treated worldwide* •Statistics o n fileR 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. ) JOURNAL OF THE S. A SPORTS MEDICINE ASSOCIATION TYDSKRIF VAN DIES A SPORTOENEESKUNDE- VERENIOINO EDITORIAL COMMENT Plaster Casting or Not? INTERVIEW Comrades — Adequate Medical Care? FEATURE Thought Strategies of Long Distance Runners PENSEES Some Sporting Reflections FEATURE Aerobic Dance Injuries ULTRAMAN Ultraman Peaks SASMA UPDATE SASMA News BOOK REVIEW Drugs and Performance in Sports PHYSIOTHERAPY COLUMN Management of Long distance Runners by Physiotherapy REVIEW Osteochondritis Dissecans NEWS Editor in Chief DR C NOBLE MB BCh,FCS(SA) Associate Editors PROFTNOAKESMBChB.MD DR DAWIE VAN VELDEN MB ChB (Stell), M Prax Med(Pretoria) Advisory Board MEDICINE: Dr I COHEN MB ChB D ObSt, RCOC ORTHOPAEDIC TRAUMATOLOGY: DR P FIRER BSC (Eng) MB BCh (Wits) M Med (OrthoXWits) BRIC E HUGO MB ChB, MMed (Chir) Orthopaedics DR JC USDIN MB BCh, FRCS (Edin) CARDIOLOGY: COL DP MYBURCH SM MB ChB, FACC PHYSICAL EDUCATION: HANNES BOTHA D Phil (Phys Ed) GYNAECOLOGY: DR JACK ADNO M B BCh (Wits) M D (Med) Dip O&G (Wits) Front Cover. Transparency courtesy o f Colour Library. The Journal o f the SA Sports Medicine Association is exclusively sponsored by Ciba-Geigy (Pty) Ltd. The journal is produced by Commedica PO Box 3909, Rand burg 2125. The views expressed in this publication are those of the authors and not necessarily those of the sponsors or publishers. V S p o rtb e s e rin g s - en S p o rt In ju ry an d K a rd io re h a t> ilfta s« 1 C a rd ia c R e h a b ilita tio n P ro g ra m P ro g ra m m e 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. ) 'EDITORIAL COMMENT\ PLASTER CASTING OR NOT? CLIVE NOBLE MB CHB. FCS (SA) laster of Paris casting has for many years been syn­ onymous with orthopaed­ ics There was even a say ing usedbythejuniordoctors "when in doubt put it in plaster" Certainly today plaster casting isstill an essentialpartoffracturetreatments.lt hasalso been used in a variety of ligamen­ tous injuries All degrees of ligamentous instability have been treated by cast im­ mobilisation. The twojoints particularly involved have been the knee and ankle. The period of immobilisation varied from a few days to many weeks In the light of re­ cent investiga­ tions one has to decide whether plastercastingis really necessary inall ligamentous injuries. There is even a strong opi­ nion that it may bedetrimentalin some cases. As long agoas1966 it was shown that ap proxim ately 80% of ankled ligament injuries got better no m a tte r what form of treat­ ment was given. Practical experience has shown us that movements of an injured joint that has been immobilised inacastwilltakeabout twice as long to recoverasan injured joint that has not been immobilised. Even today many doctors still immobilise a knee withahaemathrosis. By doing this significant internal derangement may bemissed.Thismay lead to failure of ade­ quate and correct treatment. As an ex- ampleanavulsed fragment which could have been accurately replaced now smoothsoff and this becomes impossi­ ble. Similarly badly torn ligaments which required surgery may be left in a weak­ ened state. contributingfactortothedevelopment of osteoarthritis on the longer side. Other workers have not been in agreement Hult4 investigating Swedish factory wor­ kers found no differences in theincidence of leg length discrepancy in workers com­ plaining of backache. Fisk & Biagent5 also found thata moderatedegreeof leg length discrepancy played little if any part inthein- cidence of backache. In runners leg length discrepancy of even minor nature has been blamed for inju­ ry of back, hip and leg. None of these in­ vestigations had a real scientific basis. Subotnich6 has stated that a 1/a inch leg length discrepancy in a runner is more liabletocause injury than a V leg length discrepancyinanon- active person. Cross'7 investigation of a group of mara­ thon runners found that 49% had leg length discrepancy of 5mm or more. He concluded that his study provided no justification for the routine use of lifts (in theshoe) to equalise smaller amounts of leg length discre­ pancy in runners. He also concluded that runners with struc­ tural discrepancies of 1cm and more can function quite handsomely without any need forequali- sation of leg lengths. We obviously need more knowledge Wouldn't this be an excellent project for astudent/physiotherapist/doctor?^ References 1. Rush W.A, Steiner H A , Am J. Roentgen Ra Ad Ther., 5 6 : 616-6231946. 2. NicholsPJ.R. BrMed. J 1:1863-69 1960 3 Cofton J.P Trueman GE. Canadian Medical Alloc J. 1 0 4 : 791-799 1971 4. Hult L. Acta Orthop. Scand. 24: 30-31 1954 5. Fisk J.W. Biagent M.C. NZ Med. J. 8 1 : 477-4801975 6. Subotnik SJ. Ortho SoortsPhys Ther. 3 : 11-161981 7. Cross R.H. Am J. Of Sp. Med. 1 1 : 121-123 1983. N 0 1,198£1M ARCH 1988 VO L 3, Besides stiffness of the joint resultant muscle weakness may preventthe player from rapidly returning to his sport. Re­ injury if he returns to sport too soon, may also occur. There is a growing tendency to only use plastercastingtofracturesandaftersur- gery. Rapid rehabilitation using physio­ therapy and an intensive exercise pro­ gramme would appear to be the treat­ ment of choice in most sports injuries. LEG LENGTH DISCREPENCIES In the last editorial I mentioned a Kinesthesiologist who told most of his patients they had a leg length discrepan­ cy and proceeded to treat them with a yellow page insert in theirshoes. I believe it is more important to assess scientifical­ ly if a leg length discrepancy has sig­ nificance in causing injury especially in marathon runners. In 1946 Rush & Stainer1 found a higher in- cidenceof back pain in army recruits with leg length discrepancy. Nichols2 in 1960 found that 22% of airmen complaining of lower back pain had a leg length dis­ crepancy of 12,5mm or more, compared to 7% in a control group. Crofton and Trueman5 felt that a leg length discre­ pancy V2 inch to 1 inch (2.54cm) was a 2 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. ) INTERVIEW, COMRADES ADEQUATE MEDICAL CARE? ntroduction: s the medical care at the Comrades Marathon good enough? This has been worrying many runners as well as their doctors for some tim e To answer this query we put a number of questions to Dr J. Codlonton. VO L 3, N 0 1,1988 D rNoble How many runners do you anticipate taking part in Comrades this year Dr Codlonton It is unlikely to be in excess o f 12 000 runners. D rNoble We believe that an analysis of the collapsed athletes was started in the medical tent last year. What is the objective behind this research? Dr Codlonton In fact we have been monitoring many parameters over the past 10 years. Our main objectives are to attem pt to: * improve the quality o f medical care at the end o f the Comrades Marathon * provide runners with feedback about problems which occur during the race which would help them to decrease the magnitude o f their problems. DrNoble What werethe most common problems encountered in the medical tent last year? Dr Codlonton The most common problems encoun­ tered are related to dehydration and to heat-stress injury amongst a host o f many other minor injuries. DrNoble. What causes these problems? Dr Codlonton These problems are caused by runners whoarejustuninformedasregardslong distance running and have as a result Poor drinking habits: eg. drinking too late drinking too little drinking the wrong kind o f fluids They don't take cognisance o f adverse warning signs o f distress. 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. ) "once again it Is up to the runner to determine his own capabilities. Possibly the running clubs could encourage their runners to have E.c.c:sdone." which can be obtained from running magazines and running clubs. Comrades organisers however will endeavourtocommunicateinformation acquired over the years which would benefit the runners in anyway by way o f articles in jou rn a ls and lectures throughout the country. Dr Noble Do you think that more stringent q u alifyin g regulations should be introduced? DrGocJlonton From a medical point o f view, I do think thatmorestringentstandardsshouldbe introduced. It is my belief that many o f the runners have not learn t to run longer distances. More longer distanced races should beintroducedinthiscountry and should be made part o f the qualifying regulations for the Comrades DrNoble It is suggested that runners could be tested if they were unsureoftheirfitness Will this ever take place? DrG odlonton Unlikely— not by Comrades. Once again itisuptotherunnertodeterminehisown capabilities. Possibly the running clubs could encourage their runners to have EC.Cs done. Once over the age o f 30 and especially over the age o f 50. Dr Noble Should theorganisershavethepowerto take runners out of the race who are obviously in no fit state to continue? D rC odlonton I would say definitely "Yes", but it is not likely that anyone would ever have the authority to do so. DrNoble If the ambient temperatures and humidity are too high, should the race not be postponed for one day? D rC odlonton A definite no — i t would be an impossibility to get everyone back again the following day DrNoble Shouldn't different coloured flags be instituted to warn runners of prevailing heat conditions eg. red flag signifying dangerously hot weather? D rC odlonton Yes: a heat-stress m o n itorin g thermometer has been used in thelast three Comrades with colour coding warnings. DrNoble What contingency plans do you have this year should the number of runners requiring medical attention increase, especially over the 'busy period? DrC odlonton We intend to increase the number o f medical staff available proportionate to the number o f entrants for Comrades for 1988. Secondly the inclement weather may be the cause of many of these problems. DrNoble What should runners be doing to avoid these problems? D rC odlonton Self education is the most important factor in counter-acting problems A runnershouldhaveknowledgeofhisown capabilities Heshould have knowledgeof how much to drink and when. He should take cognisance o f adverse warning signs within himself. He should take cognisance o f the prevailing weather conditions. DrNoble How many runners required medical attention in 1987? What percentage was this of the total Comrades runners? D rC od lonton 555 runners collapsed in a serious condition in 1987 i.e. were on drips — ±4,8% o f the total number o f runners who participated. DrNoble Were there adequate medical facilities and medical staff to cope with these runners? D rC odlonton Generally, yes, except for a busy stretch when a large concentration o f runners collapsed in a short period o f time ie. at a rate o f one runner every 11 seconds. These runners were how ever all attended to eventually DrNoble Will Comrades organisers launch an education programme at any stage? D rC odlonton It is unlikely as this does not fall within the framework o f the Comrades organisers. It is the duty o f the runners themselves to acquire the necessary knowledge, 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. ) FEATURE THOUGHT STRATEGIES OF LONG­ DISTANCE RUNNERS DR HEIN HELCO SCHOMER. BA(HONS) MA PhD Lecturer in the Department of Psychology and Guest Lecturer in the BSc(Med) (Hons) Sport Science Course, Department of Physiology Medical School, University of Cape Town, South Africa. r A BSTRACT This study involved the recording o f beginner average and superior marathoner thought ver- __________ baiizationsduringtraining sessions o f diverse intensities, the development o f a func­ tional classification system o f the run­ ners' thoughts within the broad associa­ tion/dissociation framework, and the content analysis o f the recorded thought texts The results indicated that proportional increases in the amount o f associative thinkingarerelatedlinearlytoincreases in perceived training intensities, this rela­ tionship holding for all groups o f marathoners. The qualitative differ­ ences within the associative thought patterns o f the superior marathoners, and the im plica tions for op timal psycho­ logical prepara tion in regard to cognitive strategiesduringtrainingarediscussed. INTRODUCTION Sport psychologists have recently begun to focus on the cognitive processes of athletes,speculatingonhowthequality orquantity of theirthoughtsmight con­ tribute to theirexcellent performances. Conclusions drawn so far have been clouded over by rather unsystematic ac­ counts of subjective experiences and views. Research into the mental strategies adopted by long-distance runners to cope with the immense effort involved incompleting a marathon hastill now re­ lied entirely on pre- or post-event ques­ tionnaire data (Morgan & Pollock, 1977; Freischlag, 1981; Summers, Sargent, Lev­ ey &Murray, 1982; Okwumabua, Meyers, Schleser & Cooke, 1983; Weinberg, Smith, Jackson & Could, 1984.) Nowhere before has the continuous th o u g h t flow o f runners been documented. The aim of this investiga­ tion was to record and analyze instan- taneousthought processes of marathon runners during the full length of their training runs and to set up a functional classification system that cou Id be used for future manipulations of runners' thoughts. According to Morgan and Pollock'sd977) associative/dissociative mental strategy classificationwhichhasformedthebasis of most research into the cognitive ac­ tivities of marathoners during long­ distance racing and training, elite marathoners associate, effectively read­ ing their body and modulating pace ac­ cordingly, whereas non-elite runnersdis- sociate from any painful, sensory cues. However, as runners have to expose themselves to successive approxima- tionsof their relative physiological toler­ ance in order to procure aerobic condi­ tioning (Ryder, Carr & Herget, 1976), as­ sociative cognitive strategiesarenot per­ ceived by the author to be exclusively practised by elite long-distance runners. It is hypothesized that an increase in as- sociativethinkingisdirectly related toan increase in training intensity regardless of the running statusof the athlete It is further hypothesized that there will be qualitative differences within the as­ sociative cognitive strategy displayed by marathon runnersof differing running status. METHOD Subjects The novice group was made up of 12 highly unfit individuals who had volun­ teered to participates a 7-month moni­ tored training programme leading up to their first marathon. The 10 subjects in the average group had a minimum ex­ perience of two completed marathons and race times between 3 and 4 hours for males and V h and 41/2 hours for females The superior group consisted of 9 high­ ly competitive marathon runners with race times below 3 hours for males and below 31/2 hours for females Six of these runners were rated aselite South African marathoners with race times of 2:17,2:17 and 2:23forthemales,and 242,2:52and 2:56 for the females. Apparatus A light-weight micro-cassette recorder was carried by the subjects in a specially designed belt around their waist. The Borg scale (Borg, 1978) enabled the m a r c h 1988 v o l 3, n o 1,1988 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. ) marathoners to rate theirtraining inten­ sity afteracognitivestrategy recording. Procedure Subjects were instructed to speak whatever came to their minds during training runs and could utter their thoughts in sentences, phrasesor words Strict confidentiality wasassu red. After a cognitive strategy recording the run­ ners were asked to ratetheir level of per- ceivedtraining intensity withthehelpof theBorg scale. Onaverage, every individu­ al carried the recording apparatus four times, the first two recordingsgenerally being regarded as familiarization trials. The transcribed recordings, which omit­ ted the identity of the runner as well as the declared training intensity, weresur- veyed for recurrent thoughts on task- related and task-unrelated material. Ten themecategories were proposed — (1) Feelings and affects: Thoughts on general sensations of the body, like feel­ ings of vitality or fatigue, with no men­ tion of specific body parts, (2) Body monitoring: Thoughts with specific men­ tion of anatomy or body physiology, like breathing rhythm and heart beat, (3) Command and instruction: Emphatic self-regulatory instructions to whole body or specific body parts, (4) Pace monitoring: Verbalized feedback on cur­ rent running performance with respect totime,distance,andspeedofpacing,(5) Environmental feedback: Thoughts about the weather, temperature, and noise levels etc, (6) Reflective activity: Thoughts on pastandfutureissues relat­ ed to training and racing experiences, (7) Personal problem solving: Issues of an in- trapersonaland interpersonal nature in­ cluding reflective introspection and be­ lief system evaluation,(8) Work: Thoughts spent onjob.workand careeropportuni- ties, (9)Course information.- Descriptions about scenery that are of no conse­ quence to pace, (10) Talk and conversa­ tional chatter Directspeech with other runners, and unintelligible or inconse­ quential, extraneous chit-chat. The most concise intelligible cognitive ex­ pression (sentenceorphrase)that could be understood when isolated was de­ fined as the recording unit and was enumerated by asinglecognitivestrate­ gy category abbreviation. A frequency count of the category abb reviations in a completely content analyzed text was then transformed into percentages of occurrence and raw data tables were compiled. RESULTS A Kruskal-WallisOne-WayAnalysisof Var­ iance was executed on the associative thoughtcategory data. An insignificant statistical difference was recorded (H=4,581; df = 2; p > 0,05), i.e. thesuperi- ormarathonersdid not manifesta preva­ lence for the associative cognitive strate­ gy. A multiple regression model was used in the analysis of the proportions of ac­ tivity time assigned to categories of ac­ tivity. The overall pattern emerging across the analysis was that association gave remarkably strong linear correla­ tions in all analyses within and across the groups of subjects. The analysis showed acleartendency in theratingsof training intensity to be related linearly to the thecorrelationcoefficients lend strong support to the authors contention that regardless of the marathoners running status a high training effort can only be achievedandmaintainedsafelyandeffi- ciently by adopting a predominantly as­ sociative cog n iti ve strategy. These find­ ings do not agree with Morgan and Pol­ lock's (1977) original investigation in specified a c tiv ity com ponent proportions DISCUSSION Proportional increasesintheamount of associativecognitivestrategygohandin hand with increasesinresultanttraining run effort ratings This relationship holds within and across all the groups of marathoners. Theapparentstrengths of which it was concluded that elite marathoners adopted the associative c og n itive s tra te g y due to th e ir phenomenal physical condition, whereas non-world class runners preferred to dis­ sociate from the painful sensorv feed­ back received from their bodies during a race. The hypothesized qualitative differences within associative thinking in relationto MARCH 1988 VO L 3, NO 1,1988 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. ) training intensity are evident as follows: Body monitoring showsa substantial ef­ fect on perceived training intensity from an average marathonerstatus upwards, while the role of the general affective feedback diminishes in its relation to per­ ceived training intensity at a high run­ ning status. This statistically significant differenceisthemostdistinctivecharac- accordingly. No "altered states of consciousness" or "runner's high" were reported in thecog- nitive strategy recordings, which sup­ ports thesimilarfinding by Sacks, Milvy, Perry and Sherman (1981). Runners' dis­ sociative thinking appeared goal- directed and intentional. The research project concentrated exclu- of thinking (Gilhooly, 1982), thinking is seen as the manipulation of symbols both within working memory and be­ tween long-term and working memon/. The manipulations are understood to conform to rules stored in long-term memory Rules selected from long-term memorydependonwhichgoalsarecur- rentandonthecontentsoftheworking memon/. This i m plies that the psycholog­ ical side of a runner is as accessible to training as the physiological side As effort ratings advanced, sentence structures and narrations became rudimentary and unadorned. Ericsson and Simon (1980) stated that the most important condition under which ver­ balization can be expected to be an ac­ curate account of cognitive activity is that the verbal report has to be made concu rrently with the task-related men­ tal activity. According to them,only infor­ mation in focal attention, that is informa­ tion in the w orking m em ory, is "verbalizable". Cognitive strategy training, guiding the runner to assimilate, or in thecase of the superiorrunnerfoster.theexactingbody monitoring technique is expected to yield a substantial improvement in the athlete's capacity to heighten his/her training intensity without the risk of in­ jury, and in the long-term enhance his/her aerobic conditioning and race times However, it must be emphasized that psychological training can only be seen to complement the marathoner's present physical capabilities Association when practised at high training intensi­ ties may be seen to "fine-tune" physical aptitude by allowing physical skills to be exhibited and extended optimally. References Borg,Gd978) Simple rating methods forestimation o f perceived exertion. In G Borg (Ed.), Physical work and e ffo rt (pp 3947) Oxford Pergamon Press Ericsson, K A & Simon, H A (1980). Verbal reports as data Psychological Review, 87,215-251 Freischlag, i (1981) Selected psycho-social charac­ teristics o f marathoners International Journal o f Sport Psychology. 12,282-288 Ci I hooly, KJ (1982) Thinking Directed, undirected and creative London Academic Press Morgan, W P (April 1978) The mind o f the marathoner. Psychology Today, pp 3849 Morgan, W.P & Pollock, M.L (1977) Psychologiccharac- terization of theelite distance runner Annalsofthe N Y Academ y o f Sciences, 301, 382403 Okwum abua.TM , Meyers, AW., Schleser, R & Cooke, C i, (1983) Cognitive strategies and running perfor­ mance — an explorative study Cognitive Therapy and Research. 7, 363-369. Ryder, H.W, Carr, H J. & Herget, P (1976) Fu ture perfor­ mance in footracing Scientific American, 234, 109-119 Sacks,M.H,Milvy,P,Perry,SW & Sherman, LR (1981) Mental status and psychological coping during a 100 mile race In M.H Sacks & M.L Sacks (EdsJ, Psychology o f running (pp 166-175) Champaign, IL Human Kinetics Summers, ±1, Sargent, Gi, Levey, A i & Murray, K.D (1982) Middle-aged non-elite marathon runners A profile Perceptual and MotorSkills, 54,963-969 Weinberg, RS,Sm ith,!, Jackson, A & Gould, D (1984) Effect o f association, dissociation and positive self- talk strategies on endurance perform ance Psycho­ m o to r Learning. 9,25-32 m a r c h 1988 v o l 3, n o 1,1988 teristicofthesuperiorrunners'thought profile — specificity through thorough skill practice Morgan (1978) suggested that average runners employ dissociation to negoti­ ate a temporary pain zone Marathoners in this study preferred to deal with pain or discomfort associatively by talking about the symptoms, instructing them­ selves to relax and by adjusting pace sively on the recording of cognitive strategies during training runs as it is in the training phase thatan athlete has to approximateandconstantlytesthis/her potential for the real event(Ryder et al., 1976). Experienced runners pointed out that there is very little room for innova­ tion and implementation of untried ideasduringa race Itisof interestto note thataccording totheserial modal model 7 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. ) SOME SPORTING REFLECTIONS PROFESSOR T IM NOAKES MB ChB MD or as long as I can remem­ ber, sport has been an im­ portant component of my life. One of my earliest sporting recollections as an eight or nine year old, was sharing the national humiliationofdevastatingdefeatatthe hands of the touring Australian crick­ eters. Rugby entered my consciousness at a somewhat later stage, with the visit of the 1960 All Blacks and the Springbok tour to Britain the following year, in or­ der to follow the latter tour and not withoutsome risk, Ismuggledasmall ra­ dio into boarding school. Like most youngsters with an insecure ego, l recog­ nized that international rugby was war, and that our national superiority was conf i rmed by thesuccess of those South African teams. Today I frequently run, swim or cycle with the local survivors of those Springbok teams; they remain as heroic to me today as did their exploits heard on that small radio by an impres- sionableyouth nearly three decadesago. My own sporting talents were, at best, lit­ tle betterthan average; I represented the higher cricket and rugby teams at my schoolsbutwent nofurther. In reflection, I preferred the cut, the thrust, and the tactics of rugby; crick­ et I found less appeal­ ing because of the prolonged periods of tedium spent fielding or waiting to bat. I never learned to ac­ cept those passive hours when one was unable to influence materially the out­ come of the game The greatest change in my sporting life came at the end of 1964. Beginning inthe early 'sixties, two renegade Californians, 'Grubby' Clark and Hobie Alter, began ex­ periments aimed at producing a lig h t­ weight material to replace the balsa wood then used inthe manufacture of surf­ boards. To prevent de­ tection by others working on the same project,Clarkand Alter were forced to work at night in their and othergarages spread across Southern California. Finally, by theend of the 'fifties, they perfected the first polyurethane foam blanks from which lightweight surfboards could be made. ThefirstconsignmentofClarkblanksar- ri ved in Cape Town probably in late 1962 i - j J~ '■ ■ -. - forshaping by Alter'slocal alter ego, John Whitmore. By 1964, Whitmore surf­ boards made of Clark foam were prized asmuchbythelocalsurfinggremmiesas arePorsches by today's Yuppies. Surfing had become the major recreational ac­ tivity for the non-aligned renegades at many Cape Town high schools. Amongst the small group of mavericks with whom Isurfed.threesubsequently became international rugby players; another, the classical high school 'failure', has since received the State President's award on two occassions — the first for braver/; thesecond received last yearfor being South Africa's top exporter; two others have achieved financial success in top management positions; theseventh married my Professor of Surgery's MARCH 1988 VO L 3, N 0 1,1988 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. ) daughter, and the eighth overcame a heroin addiction, probably the second greatest danger faced by a surfer; second only toan encounter with a Great White. I have always wondered whethersurfing attracts the more creative, less subser­ vient mindsandwhetherthat is why it is oftenconsideredasubversive activity, as it was by some of my teachers in the en­ lightened'sixties. The important lesson I learned insurfing and from dai ly contact with that group of free-thinkers, was that I preferred an individual sport to team sports. I disco­ vered that the individual sport allowed me to study myself in a way not possible in any other activity that I had ex­ perienced either then or have ex­ perienced subsequently. After school and two years spent in the army and overseas, I started rowing and running. Asdescribed in Loreof Running, these sports taught me that my perso­ nality profile is that of thesecretive, am­ bivalent, inquisitive ectomorph. Ilearned too that my body needed regularatten- tionandthatwithproperpreparationit could beaskedtodothingsthat my logi­ cal mind would consider impossible Thus I learned the dangers of setting goals that were too low, and of the need to ac- ii,The Important lesson I learned In surfing and from dally contact with that group o f free­ thinkers, was that I preferred an Individual sport to team sports. I discovered that the Individual sport allowed me to study myself In a way not possible In any other activity that I had experienced either then o r have experienced n subsequently." deck hands". I have often wondered why somanyofmycolleaguesareconvinced that individually they each represent one-half of the total Universal comple­ ment of geniuses. I learned tootheimportanceof honesty; in individual sports there is no one to blame but yourself. Finally running gave me the time neces­ sary for the mental solitude to be crea­ tive, to write a book on running, to plan and developa research programme, and toponderthespiritualcomponentoflife More recently but especially after the publication of The Lore, my sporting goalshavealtereddramatically.No longer do I consider it necessary to run in com­ petition to discoverthe optimum train­ ing methods, orthefluidsthatshould be drunk before and during competition, or the effects of different diets on perfor­ mance. These questions must now be answered more definitively by others in thelaboratory.Mycompetitiveenergies that l previously lavished on sport must now be directed to academic goals, to produce good students and good research. I have learned that the measure of one's academic contribution, at least at my non-genius level, is not one's writ- ingsorone's research, butone'sstudents m a r c h 1988 v o l 3, n o 1,1988 whose giftsare greater. In the immortal words of one University Chancellor — "There are at any one time, only one or two supremely intelligent human beings aliveontheearth.Therestofus,Yaleand Stanford graduates included, are only So I now believe that I have run hard enough for long enough. Itistimeto accept the limita­ tions of age and to choose the easier sporting path; the path of sport for health, not peak sporting p erfor­ mance. So l have learned to cycle and to swim, activi­ ties which are less demanding thanis running on the ag­ ing musculo-skele- tal system but which are equally taxing on the heart, the lungs and the metabol­ ism. Sport then has given me a hobby andaprofession.lt has been my most diligent and de­ manding teacher You may under­ stand why I con­ sider sport to be such an important human activity and why I believe that as doctors we must ensureourowncontri- bution to the promotion of sport by striv­ ing to provide, as an absolute minimum, optimum medical care to the sporting community. cept noth i ng less than my a bsolute best. Next I discovered my physical limitations asanathleteand learned that weall have both intellectual and physical limitations that must be faced and accepted with humility and without malice to those 9R 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. ) AEROBIC DANCE INJURIES Based on talk given by d r . GORDON ir v in g at the t r a u m a 87 s y m p o s iu m organised by the Red Cross Society in Port Elizabeth on 27.11.87. T oo many the term aerobics conjures up an image of a Jane Fonda-like figure dressed in leopard leotard with matching leg warm­ ers and lipstick. Although such individuals certainly are found in aerobic dance classes around the country, the average exer­ ciser is far removed physically from this lithe, fit stereotype. However, nomatter what physique the exerciser has, the mental self-image the aerobic dancer conjuresupofhimorherselfmaybe oneofaTarzan-likeora Victoria Principal-like figure. In the attempt to become like their idols, the dancer may go to great lengths, exer- cisingsixormorehoursa week, whilst starving on the latest fad diet. This combination of fre­ quent high intensity, sometimes incorrectly performed exercise, togetherwith diets low in essential minerals and i i in the attempt to become like their idols, the dancer may go to great lengths, exercising six o r more hours a week, whilst starving on themM latest fad diet calories creates a variety of injuries. THE PRINCIPLE CAUSES OF AEROBIC INJURIES ARE: 1. Overuse— repetitive stress of soft tis­ sues and bone creates microtrauma which, if insufficient time is given for recovery may pre­ cipitate mu­ scle tears, tendonitis, orstressfractures Repeated movements which stress ana­ tomically malalignedjointsmay causese- vere irritation necessitating a long layoff. One way of self monitoring and avoiding some of the overuse problems is to use what I call, the educated thumb tech­ nique: Pressure of the thumb orfingers down the medial and posterial medial aspect of the tibia may reveal a tender­ ness, duetoeitherperiostitisorstressof the cancellous bone. This is commonly referred to as shinsplintsandiscaused by excessive rotational and compressive forces acting around the tibia. If this medial tibial stress syndrome is getting worse, indicated by an increased tender­ ness on tibial pressure, the individual should reducethe high impactjumping and running part of the aerobic class. Non-weight bearing exercises such as cy- clingorswimmingshouldbesubstituted until theshin isfeeling less 'delicate: When the tibia is no longerfeeling excessively 'delicate' full aerobic classes can be re­ sumed. Such self monitoring together with relative rest could save the par­ ticipant much future suffering and perhaps extensive and usually totally unnecessary tests and treatments. 2. Muscle Imbalancesand inflexibil­ ity — Women as a group are far more flexiblethanmen.Thiscreatesproblems in programme design and injuries The hyper-flexible female tends to have an MARCH 1988 VO L 3, N 0 1,1988 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. ) increased incidence of joint discomfort when joints are taken beyond their nor­ mal range of movementduringstretch- ing. The more inflexible males tend to have a higher incidence of acute and chronic muscle strains The regularjog- ger with his inflexible calves and ham­ strings has an increased predisposition to tears when stressing them in the un- familiaraction of aerobic dance routines 3. Im proper Training— whilst various organisations are attempting to address the problem of inadequate instructor training, there is still a woeful lack of knowledge, or poor utilisation of knowledge, by many instructors The poli­ cy of some gyms to designate a promis­ ing club member as an instructor and, with the minimum or no training, place him onthe podium can causenumerous problems Many exercises appear to be designed because it gives the feeling of fatigueorstressin certain portionsof the instructor's or instructress's anatomy. These'designerexercises'are given with scant regard forthe impossible contor- tionsand abnormal joint positions that otherlessflexibleorfit members of the class have to get into. 4. Poor Technique — Exercises which are safe when done with control may be­ come damaging when incorrectly or rapidly performed. The lower back is oftenthefirstto complain asfacetjoints and soft tissue structures are placed un- derstressExerciseswhichcausetheback to arch while attempting to strengthen theabdominalmusclesare 'killers' asfar asthelumbarspine is concerned. i i Exercises which cause the back to arch while attempting to strengthen the abdominal muscles are killers 'as for as the lumbar spine Is concerned. ’ Repetitive flexion and rotation exercises done at high speed for long periods of time, load and unload the spinal struc- M AR CH 1988 VO L 3, N 0 1,1988 tures and also cause pain and damage 5. HardSurfacesand Im proper Foot­ w e a r— whereas few would argue that bare concrete floors probably create more orthopaedic stresses, there is no good evidence that wooden or sprung- wooden floors or a mat on a concrete floor are any different regarding the numberortype of injuries (Garrick et al 1986). There is also controversy about the correct type of footwear, a recent survey showing running shoes to be perhaps more effective than aerobic shoes in preventing injuries. THE INSTRUCTOR'S PROBLEMS The instructor whilst usually a caring type individual has certain constraints when structuring classes. These con­ straints include: 1. Set Time — In 30-45 minutes the in­ s t r u c t o r s togivea'good class'. A'good class' often means a combination of pools of sweat accompanied by groans from lactate induced, local muscle ex­ haustion. Run over time and there are moans as the next class isdelayed. Finish before time and there are moans that peoplearenotgettingtheir moneys worth, irrespective of the workload completed within that time 2. Different Ages, Abilities and Sexes o f participants — Cateri ng fo r classes of both sexes, whose ages may vary I from teens to elderly, with fit- . Inesslevelsfromtotallyunfitto I J l fitcreatesalmostinsurmount- / //able difficulties Go too slow or / / / toofastandmoansaresureto followandadissatisfied client is not good publicity for thegym. 3. Lack o f Knowledge— Both practical and theo­ retical knowledge may be unattainable or costly for the indivi­ dual instructor. As yet in South Africa there are no mandatory re- 11R 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. ) quirementsforanytype of aerobic dance qualification. Until the general public become aware of the existence or meaning of such training certificates the onus on education will rest squarely on the con­ science or ability of the instructororgym owner. SOME PROPOSED SOLUTIONS 1. instructor Training — Vital to the safe run­ ning of aclass should bea well informed, caring indi­ vidual. The instructors knowledgeshould not only include howtoexercise cor­ rectly but also basic dietary principles to inform and edu- catetheanorexicpersonalities found at any gym. (Fig 8). 2. An Additional instructor— An extrainstructorshouldbe present at all classes to correct alignment faultsintheparticipantsorchangeexer- ciseswhilsttheyareexercising. In particu­ lar, abdominal exercises should be perfor­ med with the low backflaton the ground. Performingfullsit-upsallows theilio-psoas muscle to act as a lever at its origin on the lowerlumbarvertebraThisplaces excessive strainson both thefacetjointsand soft tis­ sue of the spine and may cause back pain. At thesame timea full sit-up does not have any more training effect forthe abdominal muscles than asimpleshoulderraiseto30 degrees (Fig 9) or a twist cu rl (Fig 10). 3. Grading of Classes— Classesshould be graded into beginners, intermediate and advanced. Thisgrading should allow participants togoupordown depending on ability or injury. a.ParticipantWlonitoring— Selfmon itoringtechniquessuchas the'educa­ ted thumb' (see earlier) and teaching people how to taketheirpulsesareim portant tech­ niques which should be taught. Monitoring the pulse rate ensures' that an adequate level of activity is maintained during theaerobicphase of aclassandalsoenablestheparticipantto pick up irregularities of the heart rate If thenumberofectopics(extra beats) oc­ curs more frequently than six per minute, medical advice should besought. S.ProgrammeDesign— Aclassshould f i t be well thought out and preferably choreo­ graphed prior to performance Movements should be sequenced so muscles don't suffer imbalances and jointsattain a wide rangeof motion. If us­ ing handorwristweights0,5-1kg should be themaximum used. Ankle weightsare potentially dangerousandshould not be used. Low impact aerobics (where one footisalwayskeptonthegroundtotryto decrease stresses caused by repetitive jumps) should be used for low fitness or injury susceptiblegroups. Repetition of exercises enables the participant to de­ velop a sense of what the exercise cor­ re ctly perform ed feels like. The programme design will obviously be in­ fluenced by all the factors previously mentioned. If there are three points I would encourage an in­ structor to commit to mem­ ory, these would be: 1.The Body IsaSlowAcco- m odatortoStress— One should not cater for the fittest individual in the class but bring every­ body gradually up to a standard of acceptable fitness. 2. Rest may be a Four Letter w ord , but Rela­ tive Rest is im portant— Most injuries improve by avoiding the stressful exer­ cise which precipitated it and substituting another ex­ ercise for the time being. 3.PainisYourFriend-Pain should always be regarded as a reminderthatthe body is being damaged and itshould betreated with respect, not ignored. The above suggested solutions have several draw backs which can be sum­ marised in three words, EXPENSE, EX­ PENSE AND MORE EXPENSE. A t present South Africansenjoy exceptionally cheap aerobic dance classes and there are few regulations limiting the giving of such classes So the cost of education, extra in­ structors and individualising program­ mes becomes prohibitive for the gym owner. It is therefore unlikely that the type of injury seen in ourclinics will alter significantly in the nearfuture Aerobic dance classes have enriched the quality of life of thousandsof South Afri- cansand there is no reason todoubt they will continue to do so. However it is the responsibility of all those who take such classes to ensu re the exercises are done correctly and safely. Education of both in­ structor and pupil would do much to decrease the problems and increase the pleasure of this important form of exercise. iwouldliketothankThe Back School (Pty) Ltd for use of their illus­ trations in this article 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. ) ULTRAMAN PEAKS D he Ultraman series re­ ached a point of high drama during the Iron Man Triathlon in Feb­ ruary when Pretoria's Nic Bester excelled to gain an overall lead in the competition. But fortune failed to smile on his Pretoria club-mate Piet Mare, who fell out of the multi-event competition when he retired in great pain from Iron Man with 18km to go in the marathon. Mare, who was in Ultraman contention among the top 10, spent the night in hospital because of problems with his kidneys. He has been advised to stay away from any form of physical exer­ cise for at least two months. This has come as a bitter blow for the talented triathlete, who has a string of Iron Man gold medals to his name It means that he will not receive his R2 000 prize money for winning the Vasbyt 160km cycle tour, which was one of four compulsory events in the series The other three are the Hansa Duzi canoe marathon, the Iron Man and the Comrades Marathon at the end of May. The four voluntary events are the JSE 50km, the Midmar Mile swim, the Argus Cycle tour (this Saturday) and the Two Oceans marathon over Easter. Mare's demise means that Natal's Keith Ellerker, who finished on his rear wheel at the Vasbyt, will be awarded the R2 000 for first Ultraman home in the ride. Bester, meanwhile, continues to as­ tound with his uncanny all-round ability. He claimed fourth position in the Iron Man, which took in a 20km canoe at Hartebeespoort Dam, a 96km cycle and a standard marathon to Sandton (42,2km). Bester came out of the water among the top 20 canoeists, then powered his way through the field to Voortrek- kerhoogte in the cycling, which he fol­ lowed up with a superb 2hr 56min marathon to claim fourth behind Rock- ey Montgomery, Henk Watermeyer and Gerhard Uys. The Midmar Mile earlier saw George Janos move up to third position and Duzi king Graeme Pope-Elis slip down to 6th in the top 10 ratings But a mighty effort by "The Pope" in Iron Man, saw him shoot straight back up to 3rd in the Ultraman after a 6th at Iron Man. Janos hung in grimly to claim 8th at Iron Man and now lies fourth overall in Ultra Man. The Victoria Lake Club triathlete is de­ termined to creep up in the ratings in March when he tackles the Argus cycle tour in Cape Town. Janos' cycling has improved dramatical­ ly this year and he should get away from The Pope in the Cape mountains, along with Bester. Then the dice will be on for second and third spots in the final run-in to the Ultraman competition when the field takes on the Two Oceans 56km road race with the grand finale, the Com­ rades Marathon. FOR FURTHER INFORMATION, PLEASE CONTACT TRACEY MAWER OF SPORTS INTERNATIONAL AT (011) 883-3333. 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. ) ' ‘v V 4¥ A \ u r n UrLIA/c SASMA NEWS SASGVNUUS he South African Sports Medicine Association recognized the need for scientific information and training methods for the very popular long distance running events, notably the world known Comrades Marathon, and devoted the forthcoming Sports Medicine Congress to the various medi­ cal and physiological aspects of running. The growing popularity of this sport alarmed the medical community be­ cause the facilities to treat the vast num­ bers of casualtiesarenot always optimal. Itisalsoimpossibletoruleoutallcasesof possible myocardial infarctions, and it is expected that some cardiac emergen­ cies might occur. Dehydration, heat dis­ orders, and overhyd ration aretheother problems that have to be taken care of. DR. D.P. VA N VELDEN Most of the medical and physiological problems of running can be prevented. The varioustopics presented by experts in theirspecificfields will inform the ath­ letes, theircoachesandtheorganizersof the possible hazards that might occur Detailsofthecongressaretobefoundin the Journal, or may be obtained from: Margaret Simpson Continuing Medical Education University of Natal RO. B O X 17039 CONCELLA4013 Tel: (031) 254211 or Dr. R. Rathgeber, Tel: (031) 561-1777 In die tydskrif verskyn daar ook instruk- sies vir skrywers vir artikels wat aange- bied word vir publikasie in die Suid- AfrikaanseSportgeneeskunde Tydskrif. Dit dien ook vermeld te word dat artikels wat gepubliseer word in die Suid- AfrikaanseSportgeneeskundeTydskrif, kwalifiseer vir subsidiedoeleindes van navorsingsuitsetteviruniversiteitesoos omskryf indie NASOP02-014(87/07)vers- lag. Ons hoop dat dit akademiese geneeshere sal motiveer om the pub- liseer in ons tydskrif insake onderwerpe rakende sportgeneeskunde. Op hierdie wyse sal dit die standaard van die in- houdelike van ons tydskrif kan verhoog, sodat die publikasie van groter nut kan wees virdiegene wat belangstel in hierdie terrein. Ons poog ook om die artikels so tort as moontlik te hou, want ‘n besige Al- gemene Praktisyn het net nie tyd om languitgerekteartikelsteassimileernie. Dit is een van die hoofdoel witte van die Sportgeneeskunde vereniging om sy lesers op hoogte te hou van belangrike mediese en fisiologiese aspekte van sportbeoefening. Kommentaar en bydraessal verwelkom word. 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. ) W O K REVIEWm _ DRUGS AND PERFORMANCE IN SPORTS B y RICHARD H. STRAUSS, M.D., WB Saunders Company. 1987 pp 221. r f the numerous books on Sports Medicine that ap­ pear daily on the market, this book can be considered asoneofthemost useful guides on the effect of drugs and performance aids on athletic achievement for the practising physician, in the era where so many patientsondrugs take part in some form of exer­ cise or even competitive sport, doctors shou I d be awa re of the i n- fluenceofthevariousprescribed medications on exercise perfor­ mance. Even healthy peoplecon- sult their doctors on various aspects of ergogenic aids in sport, as well asnutrition, dietary supplements and fluid and elec­ trolyte replacement in sport. Doctors treating competitive athletesshould'also be aware of chemical substances that are banned during athletic com peti­ tion,and prescribeasafealterna- tive, oradvise his patientson the adverse effects of doping in sport. This book evaluates the use of pharmacological, biological and psychological methods thatare used in attempts to improve sports performance, including I discussions of harmful side ef­ fects and how common thera­ peutic drugs can affect athletic prowess The topics covered in­ clude objective information on nutrition, oxygen transport enhance­ ment, anabolic steroids, stimulants and depressants,drug testing, psychological aidsand therapeutic drugs in sport and exercise. The contributors are all well known experts in thefield of clinical and sports medicine, and the text is clearly directed to the medical profession and sport scientists, although coaches, sportsmen and sports administrators would also find this book very informa- toARCH 1988 V O L 3, N 0 1,1988 ' 'it win answer ali the questions on which drugs— if any— enhance or impair performance ’ In South Africa, drug use by ath­ letes is frequently in the news, anditisimportantforphysicians and other health professionals to have ready access to themedical andscientificinformation about such use Thefirst section of the book deals with drugs and their perceived or real enhancement of athletic performance, and the second section discusses the ef­ fects of therapeuticdrugson ac­ tive individuals — especially on their musculoskeletal and cardi­ ovascular systems. Ifound this book very applicable to the South African situation, and would recommend it to any doctor who cares for athletes and patients with a keen interest in exercise. It will answer all the questions on which drugs — if any— enhanceor impair perfor­ mance, whether there are any harmful side effects and what the ethical implications are. Reviewer: DrD. van Velden C linical S p o rts M ed icine by Robert C Cantu 1984230 ppCollierMacMillan Clinical Sports Medicine pub­ lished by the Collier Macmillan Press, Toronto, Canada is edited by RobertC Cantu M.D. It isa book containing selected papers presented atthe Annual Meeting of the New England Chapter of the American College of Sport- medicinein 1982. Each chapter is written by a different author which gives much individuality. Unfortunately the extreme variation in subject material means that the book lacks cohesion. The section on Han­ dicapped Sports is unusual and most interesting. This is not a book for the casual sports medicinedoctorbutismeantfortheen- thusiastorthedoctorwithaspecialised interest. Reviewer DrC. Noble MBBCh FCS(SA) 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. ) AQUA AEROBICS IS SAFER erobicsisanexcellentform of exercise and is very popular. However, it is not suitable foreveryoneand recently an alarming number of in- jurieshascometothefore With this in mind, and having discussed with medical and paramedical profes­ sionals, the attributes of water therapy, physical sports instructor, Tommy Rashed has developed aqua aerobic exercises. Tommy told Medical Observer that the concept involves a carefully co-ordinated exercise routine carried out in a swim­ ming pool. "The water adds exertion to the exercises, butatthesam etimesupportsthebody and relieves the joints of unnecessary pressure and possible injury" As a physical sports instructor, which in­ cluded scuba diving, Tommy Rashed who trained and qualified in Israel and now lives near Pretoria has observed with in­ terest the overwhelming popularity of these aqua aerobic exercises which he has introduced at the Hoogland Health Hydro. 'A wide variety of people are now hap­ pily participating in exercise "Thisincludesallagegroups, both young and old, as well as people of all fitness levels. "Some people;' said Tommy, "were soover- weightthattheycouldnotpreviouslyex- ercise, but much to their astonishment are now fully participating in aqua aero­ bic exercises." People whoarenowenjoying this include those who had not previously partaken of exercise because of certain injuries sustained eitherf rom other formsof ex­ ercise or sport or because of medical problems. ExplainedTommy:"Withaquaaerobicex- ercisealltheobjectivesofregularexercis- ing are not only achieved, but are en­ hanced by the fact that the water is work­ ing directly onto the skin, muscles and cellulite giving obvious beneficial results "We believe this to be an up and coming trend in popularexercising, not only for people already participating in exercise, v w m p e n fo In sports injury and trauma. didophenac sodium 50 mg (entericcoated tablets) Reg. Ho. K/5.1/255 (W et/A ct 101/1965) C ib a -G e ig y (Pty) Ltd P .O . B o x 92 Isond o 1 6 0 0 F o r full p re s crib in g n fo rm o tio n p leose re fe r to the M .D.R. but alsoina large numberof people who have previously been excluded from ex­ ercising due to injuries and medical problems." Due to theoverwhelming demand, Tom­ my Rashed hascompleted an audiotape cassetteoftheseexercises, which ismade pleasurable, too, becauseofthetranquil background music. M ARCH 1988 VO L 3, N 0 1,1988 These tapes can be obtainedby writing to Tommy Rashed atthefollowing address: P. 0. Box 34203, Erasmia 0023. The price of the tape "Aqua Aerobic Exercises" is R18,00 plus postage and packing. A c k n o w le d g e m e n t: The Medical Observer — Oct 1987 16R 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. ) 'HERAFY. MANAGEMENT OF LONG­ DISTANCE RUNNERS BY PHYSIOTHERAPY BY CARY M . SOBEL BSc. (Physiotherapy) Rand. to the numberof years of running experi­ ence, the finishing times he wishes to , achieve, and hisprevioushistoryof injuries, .. has a bearing on the approach to both in- \ 4 *SEVERITY&TYPEOF INJURY The physiotherapist assesses the extent of the injury, and modifies Ma r c h 1988 VOL 3, N 0 1,1988 ecause of the popularity of long-distance running in this country, the doctor is increasingly being faced w ith injured runners. Often the runner is ad­ vised by a doctorto lay-off foran extended period toallowan injury to recover Whilethis advice will benefit the patient, 'rest is a dreaded 4-letter word to most runners The demands that are placed on the runner to consistently cover mile­ ages as high as 50-120kmsper week in preparation for the Comrades Marathon, make the runner re­ luctant to stop running even fora very short period. Sports Physiotherapy, which today offers a dynamic and aggressive approach, en­ ables runners to continue their training without too long an interruption. No longer is physiother­ apy a palleative applica­ tion of heat and mas­ sage, but rather a holistic approach to effective injury management. *CAUSE OF INJURY Each running injury has an identifiableandtreatablecause, and unless that cause isisolated and treated, a complete cure will not result. This cause may take the form of Biomechanical Abnormality, incor­ rect training methods, incorrect orcollapsed shoes, over-useorover- loading. Explanation of the mecha­ nism of the injury to the runner will educatehimregardingtherootofthe problem and equip him to avoid re­ currences the runner's training programme |§| accordingly The runner can usually continue f running but only to the point where he actually starts to feel discomfort. A more severe case may ne­ cessitate only a few days rest if treatment is administe­ red promptly An accurate assessment of how long a runner needs tobe'offtheroad'isimpor- tant as the runner will be more agreeable to curtail all running if he knows that this isa temporary measure for a pre-determined num­ b erof days Absolute rest is prescribed only in thecase of astress frac­ ture, tendonitis with crepitus, or a severe muscle rupture * ASSESSMENT OF THE RUNNER fheassessmentoftherunnerasto 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. ) jury and patient. The beginner, still undergoing musculo­ skeletal adaptation in his first 9-18 months typically picks up injuries such as Iliotibial Band Friction Syndrome, 'Run­ ner's Knee; and Shinsplints. The more seasoned runner incorporat­ ing speed, hills, and higher mileages into his training programme, would tend to pick up injuries such as chronic ham­ string and calf muscle tears. Theinjuredbeginnermayonlybeableto run for 15 minutes before the pain be­ comes severe enough to stop running; whereas the seasoned runner may be able to runan’e a s y^ k m marathon with a 'niggling' hamstring injury. * ACTIVITY DURING RECOVERY The runner, if made to rest completely while injured, will becomecardiovascular- ly unfit as well aslosingmusculo-skeletal conditioning. An alternative sport which will not aggravate the injury should be prescribed forthe injured runnerduring recovery. Dependingon thetype of injury, theru n- ner may be able to partake in cycling, swimming, or canoeing. Stretching and strengthening exercises not affecting the injured site, must not be neglected during recovery. *CORRECT SHOE PRESCRIPTION The assessment of the patients feet while standing barefoot, running gait with and without shoes, and the wear pattern of existing shoes playsan impor­ tant part in theoveralltreatmentof the runner. Thisassessmentwillestablish the type of foot of the runner (high-arched, normal,orflat-foot); whether he has the correctshoetosuithisfoot,andthecon- ditionof the shoe Based on these examinations, a correct shoe prescription may be made. Inserts forth e runner's shoe may help the con­ dition in the early stages For example, heel raises may be recom­ mended forcalf strain and achilles tendo­ nitis lateral wedges for Iliotibial Band Fric­ tion Syndrome, and medial wedges for 'Runner's Knee'. Used asa temporary measure toalleviate symptoms, the runner can be 'weaned' o ff these supportsas healing takes place In the event of recurrence of the injury, these supports could become a perma­ nent solution. CORRECT TRAINING PROGRAMME Most injuries in distance runners are chronic overuse injuriescaused by doing to o much, too fast, too soon'. Therunner'strainingprogrammeshould be carefully examined and broken down into the5 different variables which must be modified in the event of injury. These are the frequency of runs per week, total weekly distance, pace of run­ ning, running surface and gradient. A gradual progression of the different variables and the continual monitoring of how the runner is coping forms the basis of a good training programme. * DEEPTRANSVERSE FRICTIONS ThistechniqueasdescribedbyCyriaxhas become the treatment of choice for both acute and chronic injuries. Adapted tothesiteandstageof the inju­ ry, Deep Transverse Friction is used for muscle, ligament and tendon injuries i i CAUSE OF INJURY Each running Injury has an Identifiable and treatable cause, and unless that cause Is Isolated and treated, a complete cure will not re su lt" Cross Friction Massage, according to Cyri- ax, must begivensufficiently deeply and vigorously across the affected fibres to the correct spot with sufficient sweep. With Deep Transverse Friction, rapid results are seen after only a few treat­ ment sessions. CORRECTIVE STRETCHING EXERCISES Stretching is a very useful means of in­ jury prevention and of promoting heal­ ing of an injury. Training causes muscles to become in- flexibleandshort,andthe very act of run­ ning produces relative muscle im­ balances which can result in injury. Gentle stretching during the repair phase of an injury will tend to remodel thefibresofamuscleorligamenttearin the direction of loading. Stretchingshould bedoneslowly with no bouncing, taken to the point of slightdis- comfortand held for 15-30 seconds. * STRENGTHENING EXERCISES Strengthening exercises play an impor­ tant role in preventing muscle im­ balances. Exercises can also be used to correct patella 'maltracking'— for exam­ ple, in'Runner's Knee: Corrective strengthening exercises to an injured structure will promote adequate and complete healing. *ANTI-INFI_AMMATORY MODALITIES The Sports Physiotherapist is equipped with modern machines which are excel­ lent modalities for the reduction of in­ flammation, pain relief, and the promo­ tion of healing. Modern equipment includes interferen­ tial therapy, didynamic current, cura- pulse and the conventional Ultra-sonic. *"SELF"-TREATMENT Active participation by the patient apply­ ing self-treatment at home, not only ac­ celerates the healing process but also has a psychological benefit as the patient feelsthatheisdoingsomething positive towards his own recovery. Thephysiotherapistshouldexplainhow to make and apply an effective ice-pack, which can be applied for 20-30 minutes 2-3timesdaily.Stretching&strengthen- ingexercisesathomeshouldbeactively encouraged. *RETURN TO RUNNING As it isimpossibleto know howthe injury will respond in the initial stages, a trial period is essential when attempting to return to running. A fla t grass field is optimal as this allows for minimal stress and ample cushioning. The runnershould run completely'pain- free' on alternate days building up at 5 minute increments from 15 minutes to 50 minutes. If, however, pain develops running should be stopped immediately. With this holistic approach to both inju- ryand patient, the Physiotherapist plays an invaluable part ingettingthepatient onto th e road' to re c o v e ry .^ References 1. Cyriax, J. (1977) Textbook o f Orthopaedic Medicine 9th Ed itio n BailliereTindall, London 2 8-35 2. Noakes,T.D.d985)/.ore o f running, Oxford Univer­ sity Press (Publishers) Cape Town. 325-396. l.5obe\.- — - 0 « 4 tM M M o n > M 'W m A *^Ucrr*ni*»**-i»ooa«vn wpnn* *• n x r ^ K ' n i ^ M i N o n M N O o r lalunMffioutomanMMRKMPOMWQnkraowora. SPORTS PROCEEDING BOOK Please note if you were a registered delegate atthesecond Sports Medicine Congress during 1987, the cost for the proceedings was included in your regis­ tration fee Intheeventthatyou havenot yet received your copy, please contact Medical Tribune at (011) 803-4745. Doc­ tors whodidnotattendthe Congress can obtain proceedings from Medical Trib­ une at a cost of R20,00. Suid-Afrikaanse Sportgeneeskunde Vereniging APPLICATION FORM AANSOEKVORM Full M em b er/V o ile lid R 25 S tu d e n t M e m b er/S tu d en te*lid R5 South African Sports M edicine Association H um an M o v e m e n t a nd Leisure A T im e o f C ha nge 29 Ju n e — 1 Julyl9 8 8 Civic centre, Klerksdorp Presented by The South African Association fo r Sport Science, Physical Education and Recreation In collaboration w ith the City council of Klerksdorp Biennial National Congress international Symposium on Research in Sports Science, Movement Education, Recreation and Tourism and Exercise science PROCRAMMETHEMES SPORTS SCIENCE The nature of sports science Sports science at the service of sports practice Needs of sports practice as priority in research Report on research MOVEMENT EDUCATION View of the future of education View of the future of training Movement education in practice Research in movement education RECREATION AND TOURISM Planning of sports and recreation centres Parks and playing areas Crisis management and communication Research needs and advantages The future of tourism and legal limitations Research in the Black market Report on research EXERCISE SCIENCE Exercise programme leadership and planning The fitness industry in perspective Biokinetics, science of the future? Myths and misconceptions Report on research Forfurtherinformation please con tact:- The Director, SAASSPER, Hatfield Forum West, Second Floor, 1067Arcadia Street, Hatfield Pretoria 0083 Tel: (012)43-5594/5/6 LOGO DESIGN COMPETITION SPORTS M E D IC IN E 5PCRTGIENIEIE5KUNDIE M ARCH 1988 V O L 3, N 0 1,1988 Tel No/Tel N r ................ M A S A No/M VSA N r ................ Fuft M em ber Medics* oraesitioTerrew+io are members ol M A S.A. Voile Lid: k ‘fi ;•>itf 0f*ic!i£.yV'-s w ilt iodo Vdilsi.*» M.V.S.A •: Student M em ber M ■ di s n id e r ie s clinical years Studente-lede: M ediate •r'hi:'>‘i '-''ess Jare ADpi-caiioaafOrmefnbershtoolS A S M AshouiaDe&entio 'n o .u’ d y $ -A S M A . nal'itj.U FOru,Ti WttSf, 1067A rcadUS lJt1*)' P r e io a rC-Bl Cdeques *o accompsnvme-nbersrup form The SASMA logo is due for a revamp! Readers of the Sports Medicine are en­ couraged to try their hand at design­ ing a new and exciting logo for SASMA. A prize of R200 and a mystery gift is in the offering for the best design. Send in your colour artwork together with your name, address and telephone number to: SASMA c/0 SPORTS MEDICINE P 0 Box 3909 RANDBURG 2125 Closing date: 15 June 1988 1st SOUTHERN AFRICAN CONFERENCE ON SUICIDOLOGY Theme: Evaluation, treatment, prediction and prevention. 2nd/3rd SEPTEMBER 1988 ELANGENI HOTEL DURBAN contact people: Scientific Programme: Professor L. Schlebusch, Head; Sub- Department of Medically Applied Psy­ chology, Department of Psychiatry: Faculty of Medicine, University of Na­ tal, Durban. P.O. Box 17039, Congella, 4013. Tel: (031) 254211 X 324. Organizational Aspects: Mrs. Margaret Simpson, Department of Continuing Medical Education, P.O. Box 17039, Congella, 4013. Tel: (031) 25-4211 x 327. 20R 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. )