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 SPCICTS MIEDICINIE SPCRTGIENIEIESKUNDIS T Y D S K R I F V A N DI E S A S P O R T G E N E E S K U N D E - V E R E N I G I N G % • Spinal injuries • Rugby Safety Rules • Hypnotherapy • physiotherapy— Machines V VOL 3 N 0 2 1988Re pr od uc ed b y Sa bi ne t 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. ) freedom to walk, jump, run and work 5 s t e o a RtS ' TIS: C L I N I C A L 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. ) JOURNAL OF THE S A SPORTS MEDICINE ASSOCIATION TYDSKRIF VAN D IES A. SPORTGENEESKUNDE- 4 - 6 VEREN/O/NO Q EDITORIAL COMMENT S a fe ty in Rugby E | f e a t u r e H y p n o th e ra p y SASMA UPDATE A n tiro o k P ro g ra m N odig E l CONGRESS S p o rt Psychology Congress EZ3 PHYSIOTHERAPY COLUMN In ju ry R e h a b ilita tio n W ith M achines E9 FEATURE Spinal Cord Injuries In R ugby Players n GLANSARTIKEL 'n S ta p to g Op Pad Na Cesondheid |Q ULTRAMAN Big B e tte r 'B e s te r EE1 ARTICLES G uidelines f o r A u th o rs LETTERS E d ito r in C h ie f DR C NOBLE MB BCh, FCS(SA) A ss o cia te E d ito rs PROFT NOAKES MB ChB, MD DR DAW IE VAN VELDEN M B Ch B (Stell), M P rax M e d (P re to ria ) A d v is o ry B o a rd MEDICINE: D r I COHEN MB ChB D O b st, RCOC ORTHOPAEDIC TRAUMATOLOGY: DR P FIRER BSc (Eng) MB BCh (W its) M M e d (O rth o X W its) BRIG E HUGO MB ChB, M M e d (Chir) O rth o p a e d ic s DR JC USDIN MB BCh, FRCS (Edin) CARDIOLOGY: COL DP MYBURGH SM M B ChB, FACC PHYSICAL EDUCATION: HANNES BOTHA D Phil (Phys Ed) GYNAECOLOGY: DR JACK ADNO MB BCh (W its) M D (M ed) D ip O&G (W its) Front Cover. Transparency courtesy o f Colour Library. TheJournaloftheSA Sports Medicine Association is e x c lu s iv e ly s p o n s o re d b y C iba-G eigy (Pty) Ltd. T h e jo u r n a l is p r o d u c e d b y C o m m e d ic a c c P O B ox 3 9 0 9 , R a n d b u rg 2 1 25. T h e vie w s e x p re s se d in th is p u b lic a tio n a re th o s e o f t h e a u th o r s a n d n o t n e c e s s a rily th o s e o f t h e s p o n s o rs o r p u b lis h e rs 1 4 - 1 6 SPORTS INJURY REHABILITATION PROGRAMME CIBA-GEIGY 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 COMMENTa SAFETY IN RUGBY CLIVE NOBLE MB CHB. FCS (SA) “ I afety in rugby — legal aspects and new rules Rugby is a collision sp o rt. _____________ | This m eans t h a t t h e v e ry n a tu re o f th e gam e predis­ poses to in ju ry a n d s o m e tim e s s e rio u s in - j u r y S ta tis tic a lly i t has b ee n sh ow n th a t s e rio u s in ju ry is fo rtu n a te ly u n c o m m o n . R e ce ntly th e re have been charges o f as­ s a u lt laid a g a in s t one p la yer by a n o th e r. W ith a g ro w in g p u b lic awareness c o n ­ c e rn in g litig a tio n , th e In te rn a tio n a l Rug­ by B oard have re m in d e d responsible a u th o ritie s to see t h a t all reasonable steps be ta ke n to m in im iz e th e possibili­ t y o f b e c o m in g a d e fe n d a n t in a la w s u it by id e n tify in g and p ro m u lg a tin g "safe p ro c e d u re s" These "safe p ro ce d u re s" should includ e D th e p ro v is io n o f w r itte n m ateria l a n d th e show ing o f s a fe ty film s 2) A rra n g in g fo r a perso n a d e q u a te ly tra in e d in F irst Aid to be p re s e n t a t every m atch. 3) Coaches m u s t te a ch s a fe ty te c h n iq u e s in ru g b y a nd e n su re p ro p e r c o n d itio n in g ta k e sp lace fo reve rypla yer. 4) S a fe ty e q u ip m e n t s h o u ld be p re s e n t a n d in s p e c te d re g u la rly to m a k e s u re itis capable o f p ro v id in g th e fu n c tio n fo r w h ic h it is desi red. All e q u ip m e n t should be re c o n d itio n e d and replaced w h e n ap­ p ro p ria te 5) Basically everyone responsi­ ble f o r su p e rvis io n o f ru g b y s h o u ld be aware o f th e m ech a nics o f th e cervical s p in e in ju rie s a n d th e d a n g e rs ig n s w hich o fte n p re ce d e ce rvical co m p lica tio n s. Players s h o u ld be w a rn e d t h a t low ering th e ir heads and c h a rg in g in to an o p p o ­ n e n t, o r d iv in g in to a m au l o r ruck, can cause fr a c tu r e o r d is lo c a tio n o f th e c e r­ vical spine a n d re s u lt in q u a d rip le g ia 6 )P la y e rs s h o u ld b e o fs u ita b le b u ild a n d ade q ua te ly p re p a re d fo r th e p o s itio n fo r w h ic h th e y are selected. They sh ou ld r e p o r t any p reviou s neck in ju ry o r c o n ­ g e n ita l a b n o rm a lity . These s a fe ty p ro c e d u re s a re n o t o n ly im ­ p o r ta n t to avoid litig a tio n b u t are also fu n d a m e n ta l in th e e d u c a tio n o f any ru g ­ by team . A t th e p re s e n t sta g e in S outh A fric a , we are in so m e instances, a long way fr o m a chieving basic s a fe ty p ro c e ­ d u re s A t school level fo r example, m an v 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. ) i t n o t be a g o o d idea fo r th o s e boys w h o donotplay rugby,forvarious reasons,to Ib e p ro p e rly tra in e d and to a ccom p an y I th e ir te a m to all gam es as one o f th e £ a m ,n c o e d u c a tio n a l schools, th e g irls m ay fill th e ro le o f F irst Aiders. In m any cases, s a fe ty e q u ip m e n t is e n tire ly lack­ ing o r a t school level, is o n ly a v a ila b le fo r th e 1st and 2 n d te a m games. In som e provinces, proper c o ach in g in s a fe ty nrocedures and c o rre c t selection o f play- ere is e n tire ly lacking a t t h e low er levels o f clu b ru g b y and schools ru g b y It is n o t u n c o m m o n fo r a player to be p u t in to th e f r o n t row o f th e s c ru m u n tra in e d and w ith a neck like a chicken. It m u s t be re m e m b e re d t h a t m o s t o f th e s ig n ifi­ c a n t neck inju rie s take place in th e low er levels o f rugby. RULE CHANCES For m any years, ru g b y rules were to an ex­ te n t, v a stly u n a lte re d as re ga rds s a fe ty p roce du re s Fortunately, a t long last, th e In te rn a tio n a l Rugby B oard (I.R.B) have woken u p to th e in h e r e n td a n g e r s o f ru g ­ by and via th e ir m edical c o m m itte e , are n ow w o rk in g to w a rd s m a k in g th is g r e a t gam esafer. New rules will beap plica b le in S outh A fric a o n ly fr o m n e x t ye a r w h ich w illim p ro v e s a fe ty a n d in c lu d e D a llta c k - les above s h o u ld e r h e ig h t w ill be pe n a l­ ized. This ru le was in itia lly c h a n g e d so th a t referees co u ld d ecide f o r th e m - selvesif th e y th o u g h t t h a t t h e h ig h tack­ le was d a n g e ro u s o r n o t. U n fo rtu nately, som e h o rre n d o u s h ig h tackles w e re le f t unpenalized. T h is w illb e a n e x c e lle n tru le 2 ) T o u c h ju d g e s s h a llp o in to u tfo u l play. This is an a m e n d m e n t o f a re c e n t ru le th a tto u c h ju d g e s m a y p o in to u tfo u lp la y . U n fo rtu n a te ly , m a n y to u c h ju d g e s seemed to g o b lin d ,e v e n a tp ro v in c ia la n d in te rn a tio n a l level, w h e n o b v io u s fo u l play o c c u rre d in f r o n t o f th e m . If p ro p e r­ ly applied, th is will be an e x c e lle n t ru le 3) The scrum w ill now be a lte re d so t h a t th e e n g a g e m e n t o f f r o n t rows in th e s crum will be staggered. This m eans th a t t h e f r o n t rows w ill in itia lly CROUCH, th e n th e y will TOUCH th e ir o p p o n e n t. Follow­ ing th is th e y will PAUSEand th e n th e y will ENGAGE T h is m e a n s th a tth e in itia tio n o f th e scrum w ill be m o re c o n tro lle d in­ stead o f th e p re s e n t c h a rg in g in to one a n o th e r. This o b vio u sly has m e rit, b u t w h e th e r it w ill s to p severe neck inju rie s re m a ins to be seen. In essence, w ill th is s to p collapsing o f th e scrum ? T h ere are th re e m a in fa c to rs w h ic h a re responsible f o r neck inju rie s in s e t s crum m in g a) th e s ta b ility o f th e s crum b) th e e x te n t, dura- tio n a n d d ire c tio n o f th e fo r c e a c tin g on th e necks o f th e f r o n t ro w and c) th e s tr e n g th o f th e necks o f t h e f r o n t row. This n ew ru le m ay well h elp to g ive th e s c ru m m o re s ta b ility because m o re o fte n th a n n o t, th e s c ru m collapses be­ fo r e th e ball has been p u t in. S ta g ge rin g th e fo r m a tio n o fth e s c r u m m a y a ls o b e necessary. T his m eans t h e f r o n t rows w o u ld g o d o w n firs t, th e n th e locks and th e n th e lo o s e fo rw a rd s Only e x p e rim e n ­ ta tio n and s c ie n tific analysis will p rovide th e answ er here. As re ga rds th e e x te n t, d u r a tio n a n d d ir e c tio n o fth e fo r c e s a c t- in g o n th e necks o f t h e f r o n t row, o nly th e last n a m e d has been ta ckle d , i.e. th e hips o fth e s c r u m m e r m u s tb e lo w e r th a n h is s h o u ld e rs This w ill p re v e n t, to so m e ex­ te n t,c o lla p s e o f th e s c ru m . If th e fo rc e s a c tin g on th e neck o f th e f r o n t ro w are to o g re a t, th e n collapse will o ccurd esp ite th e s ta b ility o f th e scrum . This is m o s t likely to o c c u r in th e lo w e r level ru g b y in schools, w h e re th e necks a n d b a c k s o f th e f r o n t ro w are n o t s tro n g eno u gh . It sh ou ld th e re fo r e be co n sid e re d t h a t a t th is level o f rugby, th e fo rc e s co uld be re du ced by decreasing th e n u m b e r o f players e n g a ge d in th e s c ru m eg. a fiv e m a n scrum . We have s h o r t lin e o u ts so w h y n o t fiv e m an scru ms? As rega rds th e d u ra tio n o f th e scrum , th e lo n g e r it lasts, th e m o re d a n g e r o f co lla p se Scrum s s h o u ld n o t be allowed to g o d o w n u n til th e s c ru m h a lfh a s th e b a lla n d is n e a d y fo r th e put-in. As rega rds neck s tre n g th , all p la y e rs ,fro m th e m o s tju n io r, s h o u ld be g ive n exercises f o r neck and back s tr e n g th n o m a t te r w h a t p o s itio n th e y p la y .4 )W h e e lin g o fth e s c ru m w illo n ly a l- Io w a 9 0° tu rn . Itis u n c e rta in w h e th e r th is w ill have a s ig n ific a n t e ffe c t o n s a fe ty in th e scrum . T he fo rc e d w h e el ie. w h e re th e o ne f r o n t ro w stops p ush in g and moves rapidly backwards, is d angerousin t h a t itm a k e s th e s c ru m unstableThesig- n ific a n c e o f w h e e lin g o f th e s c ru m will s till have to be fu lly e lucidated. 5) Players e n te rin g th e loose scrum m u s t have th e ir s h o u ld e rs h ig h e rth a n th e irh ip s T h is is a g o o d ru le in p re v e n tin g excessive fle x io n fo rc e to th e n e c k b u titw illb e e x t r e m e ly d if f ic u lt to a p p ly it. W ith th e changes I have m e n tio n e d above, it appears t h a t g o o d prog ress is b eing m ad e in s a fe ty in rugby. JUNE 1988VOL 3, NO 2,1988 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. ) _ FEATURE DESTRUCTI BEHAVIOUR PATTERNS DR C TREVOR MODLIN MB, BCh. (W ftwatersrand) — anagem ent o f de­ structive behaviour patterns in a sports­ man by hypnothe- rapy 1 THE PROBLEM A t th e t im e o f th is c a s e s tu d y , M rX wasa 28 y e a ro ld hockey p la yer His a b ility was n e v e r In q u e s tio n — he played a t Senior m ter-Provincia i level and as fa r as his skills, fitn e s s , m o t iv a t i o n a n a ta c t ic a l know ledge o f th e gam e were concerned he was n o t lacking — indeed, he had fe w p eers H ow ever he had n e v e r achieved th e u lrim a te a c c o la d e o fa S p rin g b o k C a p H e is m te llig e n ta n d h a s fu llin s ig h tto th e e x te n trh a th e subjected h im s e lf to a b ru ­ ta lly h o n e s t self-appraisal and ca m e to th e c o n c lu s io n th a t w h a ^ h e ld h im back fr o m fu ll re c o g n itio n was his lack o f e m o ­ tio n a l c o n tro l on th e fie ld He a d m itte d th a t a n e r r o r b y him self, a te am -m ate. o r a n e rro rb y a n u m p ire u pse t h im s o m u c h th a t d e sp ite his u n d e rs ta n d in g b e fo re and a fte r th e game, he lo s t c o n tro l w hile o n th e fie ld He b ecam e fr u s tr a te d and a n g ry and th is aggression was d e s tru c ­ tiv e to his o w n game, th e te a m e f f o r t and in v ite d sh arp re a c tio n fr o m u m p ire s As P rofessor P o tg ie te r has p c in te a o ut, M r x placed u n re aso n ab le d e m a n a s on h im s e lf fo r p e rfe c tio n T h is d e m a n d ex­ tended to h is te a m m a te s a n d th e p e rfo r m a n ce o f th e u m p ire s h is SUBCON­ SCIOUS resoonse (fo r he was fu lly aware a fte r th e fa c t b u t unable to m ain ta in self c o n tro l in th e h e a t o f th e m o m e n t' was aggression w h ic h once displayed te n de d to escalate w ith th e n e x t in c id e n t 2. DISCUSSION WITH MR X We e x p lo re d d if fe r e n t ways o f h a n d lin g his p ro b le m — even to th e m a tte r o f ac­ ce p ta n ce o f his a lre ad y s ig n ific a n t a c h ie v e m e n ts and t h a t a S p rin gb o k Cap m ig n t be beyond hi m a t th e age o f 28 His m o tiv a tio n h eld sway — he d ea rly want- e o a ia s t o p p o r tu n ity H y p n o s is w a s th e n discussed as a m eans o f tre a tm e n t, in p a rtic u la r th e n a tu re o f hypnosis, his e xpe cta tion s and th a t o f m y ow n A course o f th re e o n e - h ou rsessions JUNE 1988 VOL 3. NC 2 1988 was agreed to w ith an opportunity to th e n review p rogress 3. THE FIRST SESSION Such was his m o tiv a tio n t h a t hypnosis was ind u ce d w ith lit t le d if fic u lty using eye fix a tio n The level o f tra n c e was deep­ en ed by a reve rse a rm le v ita tio n and fu r- th e r d ee p en e d by a reverse c o u n td o w n A t th is s ta g e he was in a m e d iu m tra n c e and i th e n p roceeded w ith Hartland's Ego R e in fo rc e m e n t P a tte r He was th e n asked w h e th e r o r n o t ms subconscious m in d fe lt h e c o u ld a lte r his im p u lsive b e h a v io u r on th e fie ld o f play His a u to -m o to r response b e in g a ffir m a ­ tive, d ire c t su gg e stio n s w e re th e n m ade t h a t m th e e v e n t o f an in c id e n t t h a t w o u ld p reviou sly have re su lte d in loss o f c o n tro l, hissu bco n scio usm ind w ould im ­ m e d ia te ly be a le rte d to th a t fa c t and R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) a u to m a tic a lly a c t w ith m a x im u m c o n ­ tr o l It was suggested t h a t th is c h o ic e o f p o s itiv e c o n tro l w o u ld re su lt in a fe e lin g o f g re a t p ow er and c o n fid e n c e Protec- tiv e su g g e s tio n s w e re th e n m a d e as re ­ gards non-clinical h y p n o s is and he was give n a f u r t h e r suggestion to allow ra pid in­ d u c tio n f o r t h e n e x t session. He was th e n ta u g h t to 'wake' h im s e lf u p 4. THE SECOND SESSION The p a tie n t re p o rte d a fe e lin g o f w e ll­ b eing since t h e last session. Hypnosis was ra p id ly in d u ce d and in te n ­ s ifie d to a d e e p level. This session was larg ely r e p e titiv e e x c e p tth a t i t wasalso su gg e sted t h a t n o t o n ly w o u ld his sub­ conscious m in d respond favourably, b u t t h a t EACH s u b s e q u e n t in c id e n t w o u ld f u r t h e r re in fo rc e th is p o s itiv e response n o t o n ly a ta n e m o tio n a l level b u ta ls o a t th e le v e lo fh is s k ills A N D h is e n jo y m e n to f th e game. Using im agery, he was asked to re m e m - b e r a g a m e in w h ic h h e h a d re s p o n d e d in th e Old' fa sh io n to s tre s s He was asked to replay s p ecific incidents w ith his n ew ca p a b ilitie s and re p o rte d t h a t he coped c o m fo rta b ly w ith o u ta g g re s s io n . A t th is tim e a n d w ith his a g re e m e n t, a te c h n iq u e fo rs e lf-h y p n o s is was suggest­ ed, he was awoken and re q u e s te d to in­ d uce self-hypnosis. This he achieved a d m ira b ly and he was g ive n a ta p e to use u n d e r self-hypnosis on a daily basis 5.THETHIRD SESSION M rX re p o rte d t h a t th e league g a m e he had played since th e last ses­ sion w a s 'fa n ta s tic and th a tte a m -m a te s a n d o p p o - s itio n m e m b e rs had c o m m e n te d on his p e r fo rm a n c e This had d o u b ly e n c o u ra g e d h im t h a t he was m akin g p ro g re s s This session was once m o re a re p e a t w ith th e a d d itio n o f im a g e ry t o im p ro v e his skills and his 'vision' on th e field. Im agery wasalso used to visualise a n d fe e lth e s e n s a tio n o fw in - n in g and th e c o n fid e n c e t h a t resulted. Hewas encouraged to in d u ce se lf­ hypnosis, if o n ly fo r a fe w '8 8 VOL 5, NO 2. 19S8 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) m inutes, p r io r to a g a m e and c o n c e n ­ t r a t e o n e g o - r e in f o r c e m e n t a n d c o n fid e n c e 6. TOP-UP SESSION 36 h o u rs b e fo re he was d u e to leave fo r th e Inter-P rovincial T o u rn a m e n t, he d e ­ v e lo pe d a g ro in s tra in d u rin g a tra in in g session. T h isw asasevere b lo w to h is c o n - fid en ce. This session th e re fo r e c o n c e n ­ tr a te d on a te c h n iq u e o f pain c o n tro l w hich h e co u ld apply underself-hypnosis He was am azed to fin d t h a t he co u ld in fa c t achieve th is co m p letely. N e v e rth e ­ less, he was w a rn ed to use th is o n ly fo r th e d u ra tio n o f each g am e and he was p re s c rib e d an a n ti-in fla m m a to ry a g e n t and re fe rre d f o r p h y s io th e ra p y p r io r to h im leaving f o r th e to u rn a m e n t. 7. RESULTS I was roused fr o m sle e p a t 1,30am sixdays la te rb y th e te le p h o n e . A v e ry h appy and obviously in e b ria te d M r X w a s o n th e lin e H e h a d p la y e d a b lin d e ro f a to u rn a m e n t and... had been selected fo r th e 'Bok' Squad. It was one occasion I d id n 't m in d being w oken up by a d ru n k e n p h o n e call! 8. OBSERVATIONS W hile th is case s tu d y w o rk e d to p e rfe c ­ tio n , th e re are m a n y p itfa lls in th e a p p li­ c a tio n o f h y p n o th e ra p y in sp o rt. Points to consider: 1. It is im p o r ta n t t h a t th e th e ra p is t is au fa it w ith th e s p o r t f o r m a x im u m advantage. 2. It is im p o r ta n t t h a t a re alistic discus­ sion ta k e p la c e p r io r to h y p n o th e ra p y : to o m an y s p o rts p e o p le e x p e c ta mira- c le o fm u m b o - ju m b o th a tw ill rem o ve all th e irp ro b le m a re a s a n d m ake th e m kings. 3. It m u st n o t d e tra c t fr o m th e necessa ry d e d ica tio n . 4. It is im p o rta n t, if o n e is to help and n o t be d e s tru c tiv e , t h a t h y p n o th e ra p y is u n d e rta k e n in c o n s u lta tio n w ith th e coach — especially in th e area o f skills 5. The m ain s tr e n g th o f h y p n o th e ra p y , I feel, is in t h e area o f b u ild in g c o n fi­ dence. N o t in an a rro g a n t fashion, b u t w ith q u ie t and sure in n e r s tre n g th w h ic h w ill allow th e s p o rts p e rs o n to p e r fo r m a t an o p tim a l level. ^ BIBLIOGRAPHY P r o f J P o tg ie te r — 'R a s io n e e l-e m o tie w e te r a p ie v irs p o r tlu i.' — J. o f SA S p o r ts M e d ic in e Assoc. Vol 2 N o 4 JUNE 1988 VOL 3, NO 2,1988 6R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) A SASMA r ANTIROOK PROGRAM NODIG! T he m ain o b je c ts o f th e S outh A frican S ports M edi­ cine A ssocia tion are th e a d v a n c e m e n t o f t h e science and a r t o f s p o rts m edicine, a nd to fo ste r, p ro m o te , s u p p o rt, a u g ­ m e n t, develop and e nco u ra g e investiga­ tiv e k n o w le d g e o f sp orts m edicineand its ra m ific a tio n s . T h e S p o rts M e d ic in e jo u r- nal p rovides an ideal fo r u m to publish o rig in a l research a rticle s in s p o rts m e d i­ cine and to d is s e m in a te k n o w le d g e in th e fie ld o f h e a lth p r o m o tio n th r o u g h e x e r- cise a nd a h e a lth y lifestyle. W eare p ro u d to ackno w le dg e t h a t m o re and m o re o rig in a l re s e a rc h a rtic le s a re o ffe re d fo r p u b lic a tio n in th is jo u rn a l. It is o f p a rtic ­ u la r s ign ifica n ce to ta ke n o te o f th e fa c t t h a t th is jo u m a lq u a lifie s fo rs u b s id ie s fo r research o u t p u t fo r u n iv e rs itie s as o u t­ lined in th e NASOP 02-014 (87/7) re p o rt. This will m o tiv a te academ ics in S outh A fric a to pub lish th e irre s e a rc h fin d in g s in th e S p orts M edicine J o u rn a l to th e m u tu a l b e n e fit o f all o u rm e m b e rs in th e m edical and para-m edical fie ld c o n ­ cerned w ith th e practice and a d m inistra ­ tio n o f s p o rt in o u r c o u n tr y We w o u ld like to keep o u r a rtic le s as s h o r t a n d In fo r ­ m a t iv e as possible, and a im e d a t th e General P ra c titio n e r involved in th e to ta l c a re o fth e a th le te T h e re g u la rc o n trib u - tio n s o n n u tr itio n and p h y s io th e ra p y in o u r jo u rn a l f u lfil a g re a t need on m o re s c ie n tific in fo rm a tio n and co -o p era tion w ith th e s e re sp e ctive fie ld s o f in te r e s t D ieS portgeneeskundeV erenigingbeyw - e r h o m ook v ir die b e v o rd e rin g van g e s o n d h e id d e u r d ie a a n le e r van gesonde lew ensgew oontes, en w il h om graag a m p te lik skaar by d ie instansies soosb yvoo rbe e ld d ie s A Mediese Navor- singsraad, die Nasionale K ankerverenig- ing en die Nasionale Raad v ir Rook en Gesondheid in Suid-Af rika, asook die Hart- stigting d e u r die p ub lie k bew us te m aak van d ie g e s o n d h e id s g e v a re w a td ie ro o k - g e w o o n te inhou. S p o rtlu i is n ie a lty d be­ wus van die o n m id d e llik e n adelige ef- fekte w a t die rook van s ig a re tte h e t op JUNE 1988 VOL 3, NO 2,1988 h u lle s p o rtp re s ta s ie s nie. Soveel as 16% van die to ta le h e m o g lo b ie n van 'n s tra w w e ro ke r kan v e rb in d wees m e t ko olstofm onoksied van sigaretrook, en is dus nie beskikba a r v ir die tr a n s p o r t van s u u r s t o f n ie . Die a f f i n i t e i t v a n hem o glo bie n v ir koolstofm onoksied is ± 250 m e e r as die v ir s u u rs to f en die ka rb o k s ie h e m o g lo b ie n vla k ke keer eers 4 8 u u rn a d ie s ta a k v a n r o o k te r u g n a d ie van nie-rokers. D iechroniese hipoksem ie van die roker, veroorsaak 'n polisitem iese respons w a t beteken d a t rook 'n stim ulu s is to te ri-tro p o i'e s e . 'n V erdere k o m p lis e re n d e fa k to r v ir die s p o rtm a n is d a t k o o ls to fm o n o k s ie d die s u ursto fd isso siasieku rw e na links ver- s k u if w a t ve ro o rsaa k d a t m in d e r s u u r­ s to f beskikbaar is vird ie p e rife re w e e fse ls as gevolg van d ie g ro te r a ffin ite it va n d ie h e e m v irs u u rs to fb in d in g .A I bogenoem - de fa k to re h e t 'n n adelige e ffe k o p aer- obiese m e ta b o lis m e en sal s p o rtp re s ta ­ sies d ie n o o r e e n k o m s tig n a d e lig bei'nvloed.1 S u id -A frik a b e n o d ig 'n o m v a tte n d e a n ti- ro o k p ro g ra m w a ts a l v o o rk o m d a tjo n g m ense begin rook, die re g te van nie- ro kers sal b eske rm en ro ke rs w a t graag w ilo p h o u .s a lb y s ta a n .2 In d ie lig van d ie f e it d a t ro o k die fisieke w e rk v e rm o e van s p o rtl ui n e g a tie f bein- vloe d,aso o kdie ge son d he idsb en a de lin g w a t passiewe ro ok v ira lle p e rs o n e inhou, h e t d it m iskien ty d g ew ord d a t ro o k by a lle sp o rtb y e e n k o m s te ,b y n a m e b in n e n - shuise b y ee n ko m ste by wyse van wet- g ew in g verb ie d word. Die WereldGesond- heidsorganisasie h e t 7 A p ril 1988 as die W ereld Rook Verbode dag v e rk la a r— d it is 'n g u id e g e le e n th e id v ir die Suid- A frika a n se S p o rtg e n e e s k u n d e Vereni- g in g o m h o m te s k a a rb y d ie p o g in g s v a n d ie in te r n a s io n a le g e s o n d h e id s o r- g a n is a s ie o m d ie g e s o n d h e id e n le w e n s - k w a lite ite van al die lede van ons bevolk- in g te v e r b e te r! 1. J M o o re -G illio n , T C Pearson. S m o k in g a n d P o ly c y th a e m ia . B M J 1 9 8 6 ,2 9 2 :1 6 1 7 -1 6 1 8 . 2 .G S T o w n sh e n d ,D Y a c h .A n ti-sm o kin g le g isla - tio n - a n in te rn a tio n a l p e rs p e c tiv e a p p lie d to S o u th A fric a . S A M J 1 9 8 8 ,7 3 :4 1 2 -4 1 6 . 7R 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. ) SPORT PSYCHOLOGY CONGRESS EPORTON THE PARTI­ CIPATION IN THE IVTH INTERNATIONAL CON­ GRESS OF SPORT PSYCHOLOGY T h e IV th In te r n a tio n a l Congress o f S p o rt Psycho-^ logy, orga nise d by th e A ssociation p o u r la Recherche en Psychologie du S port, to o k place a t th e U n iversite Libre de B rux­ elles, 3-6 N o v e m b e r 1987. A p p ro x im a te ly 100 dele­ gates re p re s e n tin g 29 c o u n trie s a tte n d e d th e fo u r day p ro ­ g ram m e. It was th e aim o f th e congress to p ro v id e researchers w ith a fo r u m to p re s e n t th e ir la te s t research fin d in g s and s ti­ m u la te discussion on f u tu r e d e ­ v e lo p m e n ts and tre n d s in s p o rt psychological research and practice. The c o n ­ gress fo c u se d on th r e e m ain areas o f co n c e rn to s p o r t psychologists: (1) stress and a n x i­ e ty; (2) p sych o lo g i­ cal aspects o f suc­ cess and failure; and (3) m o to r learning, p e rc e p ­ tio n and decision m akin g in th e s p o rtin g arena. All in all 40 papers w e re read, 40 p o s te r sessions held, and 2 ro u n d ta b le e vening dis­ cussions convened. The ro un d tableeveningdiscussionscon- vened by tw o o f th e m o s t o u ts ta n d in g A m e ric a n s p o r t psychologists, P r o f B.C. O g ilvie a n d Prof. R. N ie de ffer, p ro v id e d th e h ig h lig h ts o f th e congress. Delegates m ade goo d use o f th e rare l o p p o r tu n ity to d raw on th e rich e xpe rie n ce and deep in s ig h t o f th e tw o prese n ­ ters. It becam e a p p a re n t how y o u n g a fie ld o f research and a p p lic a tio n s p o r t psych o lo g y s till is and th e im m e n s e scope fo r f u tu r e d e v e lo p ­ m e n t. The m o s t im p o r ta n t p o in ts e m e r­ g in g fr o m th e discussions were: (1) The psychological h e a lth and well-being o f th e a th le te o r s p o r t p a r tic ip a n t is o f p rim e co n c e rn to th e s p o rt psychologist. This c o n ­ c e rn m ig h t well place th e p s ych o lo g ist a t odd s w ith th o s e o f s p o r t p ro m o te rs and m a n a g e m e n t. (2) A th le te s and s p o rt p a rtic ip a n ts d o n o t a p p ro a ch psycholo­ gists toseek 'th era p y': A thletes and s p o rt p a rtic ip a n ts are in te re s te d in psycholo­ gists p ro v id in g th e m w ith s p ecific skills, like re la x a tio n te c h n iq u e s to cope w ith c o m p e titio n stress and /or c o g n itiv e s tru c tu re s to m a in ­ ta in h ig h m o tiv a tio n levels. (3) Psychologists o p e ra tin g in th e s p o rtin g arena sh ou ld n o t d e lu d e th e m s e lv e s a b o u t fin a n c ia lg a in .T h e p ro v is io n o f s p o rt psy­ chological services can o nly beseen asan a d d itio n a l avenue o f p rofe ssion a l prac­ tice, n o t th e m ain o r o n ly area o f p ra c tic e The p a p e r p re s e n t­ ed by th e d elegate fr o m S outh Africa, Dr. H elgoS chom er, UCTDept. o f Psychol­ ogy, e n title d "Cogni­ tiv e s tra te g ie s and th e p e rc e p tio n o f tra in in g e ffo r t o f m a ra th o n runners" was v e ry well received, g e n e ra tin g lively de­ b ate w ith th e s tro n g re c o m m e n d a tio n t h a t th e research in to c o g n itiv e s tra ­ tegies th r o u g h o n -th e s p o t re c o rd in g be e x te n d e d to o th e r e n d u ra n ce s p o rts so th a t m o re possible cog n itiv e tr a in ­ ing p ro g ra m ­ m es be generated. T h ere were no signs o f any n a tu re t h a t th e presence and p a rtic ­ ip a tio n o f a d ele ga te fr o m S outh A fric a p re s e n te d any p o litic a l (or o th e rw is e ) concern. The fin a n c ia l assis­ ta n c e g ra n te d by theHSRC fo r th e p a rtic ip a tio n in th e congress is g ra te ­ fu lly acknowledged. J JUNE 1 9 8 8 VOL 3 ,N 0 2 ,1 9 8 fReprod uc ed b y Sa bi ne t G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) THE WRAPS ARE OFF! S m i t h + N e p h e w HEALING IN MDUR HANDS S m ith a n d N e p h e w L t d ., 30 G illitts R o a d , P in e to w n 3610. HOW ELASTOPLAST*POROOS ELASTIC ADHESIVE BANDAGE GIVES CONTROLLED COMPRESSION AND FLEXIBLE SUPPORT W h e n t r e a t m e n t d e m a n d s a b a n d a g e t h a t gives c o m p r e s s i o n a n d f le x i b le s u p p o r t , y o u r f irs t c h o i c e m u s t b e E l a s t o p l a s t P o r o u s E l a s t i c A d h e s i v e B a n d a g e . T h e s e c r e t o f t h e e f f e c t i v e n e s s o f E l a s t o p l a s t P o r o u s E la s tic A d h e s i v e B a n d a g e lies in its e x c e p t i o n a l l e n g t h w a y s s t r e t c h a n d r e g a i n p r o p e r t i e s w h ic h e n a b l e it to b e a p p l i e d w it h t h e c o r r e c t t e n s i o n t o giv e c o n t r o l l e d c o m p r e s s i o n . T h e s e s a m e s t r e t c h a n d r e g a i n p r o p e r t i e s g ive fle x ib le s u p p o r t a l l o w i n g p a t i e n t m o b i l i t y a n d full p a r t i c i p a t i o n in r e h a b i l i t a t i o n p r o g r a m m e s . D e v e l o p e d f o r S o u t h A f r i c a n c o n d i t i o n s , E l a s t o p l a s t P o r o u s E l a s t i c A d h e s i v e B a n d a g e is id eal fo r s t r a p p i n g s w o ll e n o r s p r a i n e d j o i n t s , v a r i c o u s v e i n s , leg u lc e r s a n d f o r o t h e r s u r g ic a l a n d o r t h o p a e d i c p u r p o s e s . T h e s o f t fluffy e d g e s o f t h e b a n d a g e h e l p to a v o i d c u t t i n g a n d m a r k i n g th e s k in . A n d a l t h o u g h a d h e s i v e , t h e b a n d a g e is p o r o u s , a l l o w i n g t h e s k in to b r e a t h e a n d s w e a t a n d e x u d a t e t o e s c a p e . It is f e a t u r e s like t h e s e , c o u p l e d , w ith b a c k - u p s e r v ic e a n d s t r a p p i n g t e c h n i q u e t r a i n i n g p r o g r a m m e s t h a t h a v e m a d e E l a s t o p l a s t P o r o u s E l a s t i c A d h e s i v e B a n d a g e y o u r first c h o i c e f o r t h e p a s t 5 0 y e a r s . N o w t h e w r a p s a r e o f f, a s k f o r it b y n a m e w h e n y o u n e e d c o n t r o l l e d c o m p r e s s i o n a n d s u p p o r t . * R e g i s t e r e d T r a d e M a r k 2 2 1 4 4 4 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. ) INJURY REHABILITATION WITH MACHINES M CSIFFM Sc, PhD C om m unication Studies Division, University o f th e W itw atersrand JUNE 1988 VOL 3, NO 2,198* 10 o n s id e ra b le re lia n c e is p la c e d o n m achine-based re h a b ilita tio n by p h y s io ­ th e ra p is ts o r t h e ir c o l­ leagues in g ym n a sia . A p h y s io th e ra p y p ra c tic e is o fte n re g a rd e d as c o m p - p le te o n ly i f th e la te s t c o m p u te r- c o n tro lle d is o k in e tic d e v ic e isavailable. A g y m n a s iu m is view ed as p r im itiv e u n ­ less it c o n ta in s c o m p lic a te d , c h ro m e - p la te d , v a ria b le re sista n ce m a c h in e s o r m u lti-p u rp o s e s ta tio n s . C lie n ts are im p re sse d , business flo u ris h e s and th e r e seem s lit t le need to c ritic iz e th e s y s te m .T h e q u e s tio n o f s c ie n tif­ ic a lly e v a lu a tin g th e s e devices, how ever, s till rem ains. To a n sw e r th is q u e s tio n , i t is neces­ sa ry to r e m e m b e r t h a t th e a im o f m usculoskeletal re h a b ilita tio n in p ar­ tic u la r is r e s t o r a tio n o f f u lls tr u c tu r - al a n d f u n c t io n a l s t a b ilit y a n d m o b ility to th e p a tie n t. In s p o rts m e d ic in e th is e n ta ils p re p a rin g th e a th le te to re g a in th e s tr e n g th , e n ­ durance, fle x ib ility , speed and a g ility q u a litie s s p e c ific to th e s p o r t he o r she plays. In th is re sp e ct, m a ch in e s a re o fte n p re s u m e d to be s a fe r and m o re e ffe c tiv e th a n a n y o th e rc o n d i- tio n in g m o d a litie s , d e s p ite th e fa c t t h a t no w e ll-c o n tro lle d s tu d ie s have y e t s h o w n is o k in e tic o r o t h e r m achines to be s ig n ific a n tly s u p e rio r to th e tr a d itio n a l p h y s io th e ra p y m e th o d s u s in g P N F fp ro p rio c e p tiv e n e u ro m u s c u la rfa c ilita tio n ) o r W est­ m in s te r pulleys. WHY MACHINES? M achines w e re d e v e lo p e d to c a te r f o r th e lu c ra tiv e USA b o d y b u ild in g m a rk e t, w ith t h e ir a p p lic a tio n in p h y s io th e ra p y fo llo w in g later. One machine, th e is o k in e tic 'C y b e x 'e m e rg e d b o th as a s tr e n g th o r to r q u e te s tin g device and as a re h a b ilita tio n m achine. All m a ch in e s have been c o m p a re d w ith fr e e w e ig h ts by t h e ir m a n u fa c tu re r s and p ro n o u n c e d to b e s a fe r.m o re s p a c e and tim e e ffic ie n t, and m o re e ffe c tiv e in e n h a n c in g s tre n g th . Som e m achines, such as Cy bex, N a u tilu s and Universal w e re d e s ig n e d to va ry th e re sista n ce t h r o u g h o u t th e ra n g e o f m o v e m e n t, s in c e th e fo rc e w h ich can be e xerte d by any m u s c le g ro u p v a rie s w ith jo in t a n g le a n d m e c h a n ic a l leverages. T h is fe a tu re w a s c la im e d to m ake v a ria ­ b le o r a c c o m m o d a tin g re s is ta n c e m achines s u p e rio rto fre e w eights, since " th e re sista n ce o ffe r e d by w e ig h ts re ­ m ains c o n s ta n t t h r o u g h o u t th e ra nge o f any m o v e m e n t". MACHINES AND PHYSICS A c c o rd in g to N ew ton's S econd Law o f M otio n , co nsta n cy o f fo r c e o r resistance is im p o s s ib le f o r any load w h ic h is ac­ c e le ra te d f r o m re s t and d e c e le ra te d back to re st again. M oreover, fo rc e p la te analysis by th e a u t h o r has sh o w n t h a t th e tr a in e e r e g u la r ly a n d q u ite u n c o n s - c io u s ly a lte rs th e a c c e le ra tio n o f a fr e e w e ig h t, th e re b y a u to m a tic a lly p ro d u c ­ ing a c c o m m o d a tin g resistance. This ty p e o f a c c o m m o d a tio n isphysiological- ly m o re d e s ira b le th a n th e p re d e te r­ m in e d v a ria tio n s im p o s e d by N a u tilu s a nd Universal in p a rtic u la r, as it is m e d i­ a te d via th e n e u ro m u s c u la r a p p a ra tu s o f th e ind ivid ua l. Iso kin e tic devices such as Cybex, K inco m and M in iG ym are also s u p e rio r in th is re g a rd , since th e ir resistance issim ila rly d e te rm in e d by th e response o f t h e tra in e e ISOKINETIC MACHINES Iso kin e tic m achines, th o u g h th e y ap­ p e a r to be s ta te o f th e a r t to phys­ io th e ra p is ts , a ls o s u f fe r fr o m m a jo r lim ita tio n s . Firstly, is o k in e tic c o n tra c - tio n rarely, ife ver.isa n a tu ra l m o d e o f o p e ra tio n fo r h u m a n m usclesandex- tra p o la tio n o f is o k in e tic te s ts to con- c e n tr ic a n d e c c e n tr ic c o n tr a c tio n is o f d u b io u s v a lid ity . P ro b a b ly m o re s e r io u s is th e f a c t th a t th e r e is a tim e lag b e tw e e n in itia tio n o f m o v e m e n t and re sis ta n c e p ro d u c e d by th e m achine. F u rth e rm o re , te r m in a tio n o f each m o v e m e n t on an is o k in e tic m a c h in e d o e s n o ts im u la te th e s a m e n e u r o m u s c u la r r e fle x p a t te r n s w h ic h o c c u r in fr e e m o v e m e n t o r m o v e m e n t a g a in s t w e ig h ts o r pulleys. Is o k in e tic m a c h in e s also disp la y m a jo rm e c h a n ic a l d eficiencies. Anal- y s is b y th e a u th o ra n d o th e rw o rk e r s reveals t h a t t h e Cybex, f o r instance, is a t no speed e n tir e ly is o k in e tic , a d e fe c t w h ic h b e c o m e s p a rtic u la rly s e rio u s a th ig h e r s p e e d s T h e p r o p r i- o c e p ti ve c o n tro l e v e n ts e lic ite d u n ­ d e r th e s e c o n d it io n s d i f f e r d ra m a tic a lly fr o m th o s e o c c u rrin g in fre e m o v e m e n t,s o it is a d v is a b le th a t is o k in e tic tr a in in g fo r m a v e ry lim i­ te d p a r t o f th e r e h a b ilita tio n process. In a d d itio n , m o s t is o k in e tic m a ch in e s do n o t o ffe rth r e e - d im e n s io n a l m o tio n o r sequential c o n c e n tric -e c c e n tric m uscle c o n tra c tio n . Finally, n o n e o f th e m y e t is a ble to o p e ra te a t t h e v e ry h ig h speeds associated w ith th e im p u ls iv e changes in d ire c tio n p ro d u c e d in m o s ts p o rts . In o th e r w ords, is o k in e tic m a ch in e s m ay 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. ) play a ro le in re h a b ilita t­ ing c o n tra c tile m uscle tissue, b u t are se rio u s ly lim ite d in c o n d itio n in g so ft tissues w h ic h s to re a n d re le a s e e la s tic e n e r- gy. Iso kin e tic m a ch in e s w e re in n o v a tiv e o v e r 15 years ago; th e K incom a n d s im ila r m a c h in e s have rem oved som e lim i­ ta tio n s , b u t th o s e c o n ­ te m p la tin g th e purchase o f isokine tic m achines should w a it fo rth e c h e a - per,m oreadvanced m ac­ h in e s w h ic h m o d e r n c o m p u te r te c h n o lo g y w ill no d o u b t p ro d u c e in th e n e a r fu tu r e . MACHINES IN GENERAL It has a lr e a d y b e e n shown th a t accom moda- tin g o r va riable resist­ ance occurs w h e th e r c w eights, pulleys o r special m achines claim ed to o f f e r th is exclusive fe a tu re . One a d va n ta g e is p ro v id e d by fre e w e ig h ts and pulleys, n a m e ly t h a t each tra in e e can va ry th e resistance according to his s p ecific n eeds T h e c a m s o rle v e rs o fm a c h in e s a r e b u iltto s u itth e a v e r a g e person (w hatever th a t m ig h t be) and can­ n o t be a lte re d f o r t h e individual. The m ajor advantages and disadvantages of m a c h ine slie in th e f a c t t h a t m achines isolate a lim ited n u m b e ro f muscle groups in a specific plane o f o pe ra tio n . If co n d i­ tio n in g o f a p a rtic u la r inju re d m uscle is desired in one d ire ction , th e n m achines can be useful. However, vo lu n ta ry m uscle a ction involves concentric, e ccen tric and isom etric c o n tra c tio n allied w ith p ro p rio ­ ce p tive c o n tro l over several degrees o f th re e d im e n s io n a l fre e d o m , co n d itio n s w hich no m achines caneven vaguely p ro ­ v id e In particular, m achines im pose little dem and on th e balanceand co ord in a tion m echanism s necessary fo r all sp orts m ovem ents, so th a t m achine re ha bilita ­ tio n shouId f u m ish o n ly a Iim ite d p a rt o f th e sp ectru m o f c o n d itio n in g m odalities This m eans t h a t ade q ua te re h a b ilita tio n ca n n o t be achieved by m eans o f simple, m o n o p la n a rf lexion-extension on Cybex, Universal o rN a u tilu s machines, fo rexa m - Pte R eturn to fu ll s tru c tu ra l and fu n c tio n ­ al s ta b ility and m o b ility necessitates flexion-extension, a d d u c tio n -a b d u ctio n and ro ta tio n a l co n d itio n in g : in o th e r words app lica tion o f th e PNF p rinciple tnat prescribes spiral/diagonal p a tte rn s augmented by r e c r u itm e n to f th e neces­ sary stre tc h reflexes PNF, fre e w eights ana pulley systemscan achieve this* b u t no m achines can, despite th e g re a t co s t o f th e latter, MACHINES AND SAFETY jt i s o f t e n presu m ed th a t m achines are saterthan fre e weights, d esp ite th e fa c t JUNE 1988 VOL 3, NO 2,1988 thisclaim . Certainly, m achinescan besafer fo r a person w hose balancing o r p ro p ri­ o cep tive capabilities are seriously im ­ paired, b u t th e p h y s io th e ra p is t w ould hard ly prescribe w e ig h ts o re v e n d y n a m ­ ic m o v e m e n ts w h e n is o m e tric s o r fara- dism m ig h t be th e p re fe rre d p rim a ry tre a tm e n t. Obviously, one m u s t be fam i- lia rw ith th e m e rits a n d deficiencies o f all tr e a tm e n t modalities. Some m achines are p o te n tia lly m o re h a rm fu l th a n th e e q u iva le n t w e igh ts o r pulley exercise For instance, m o s t bench- press, seated-press, 'pec-deck; seated leg- press and leg extension m achines con­ strain one to co m m e nce m o v e m e n t near th e w eakest biom echanical p osition fo r th e re le van t joints. M oreover, these m achines usually d o n o t a llo w o n e to p re - s tre tc h th e muscles o r p ro v id e a reserve o f elastic energy in th e collagenous tissue f o r t h e initial acceleration phase Force on s tru c tu re s o f th e lu m b a r spine is usually g re a te r w h e n using th e seated press and back-extension m achines as com pared w ith th e free-weights standing press and d e a d lift respectively. Machine leg-curls d on e p ron e on f la t benches can hype rexten d and dam age th e lu m b e r spine, w h ile f ull-range m achine leg-presses can cause h yperflexion in ju ry to th e s a m e region. Num erous machines pose sim ilar hazards to th e body, so i t is essential fo r th e phy­ siotherapist, b io k in e tic is to rg y m in s tru c ­ t o r to th o r o u g h ly u n d e rs ta n d th e kinesiological p a tte rn s im posed by any m achines w h ich m ig h t be used fo r re­ h a b ilita tio n o r n o rm a l tra in in g . MACHINES AND EFFICIENCY Machines can be very e ffic ie n t in tra in in g isolated m uscle groups, b u t h ig h ly in e ffi­ c ie n t in co n d itio n in g th e b o d y in te r m s o f th e n u m b e ro f machines required to o ffe r ade q ua te c o n d itio n in g o f even a single jo in t. Despite th e adver­ tisin g claim s o f m a n u fa c ­ turers, it requires a fa r g r e a te r v a r ie t y o f m a c h in e s th a n fr e e w e igh ts to achieve th e same th ree-dim ensional tra in in g e ffe c t on th e s o f t tis s u e s , n e u r o ­ m uscu lar system s and p r o p r io c e p tiv e m e c h ­ anisms o f th e body. Obvi- o usly, t h is is m o s t b e n e fic ia l t o t h e m a n u fa c tu re r, and n o t th e p a tie n t. CONCLUSION This a rtic le was n o t in­ te n d e d t o o f f e r a th o ro u g h analysis o f th e very extensive fie ld o f m achine re ha bilitatio n: instead its purpose was to a c q u a in t th e re h a b ili­ ta tio n professional w ith th e scopeand lim itations o f p opulartrain- ing devices in a fie ld in w hich a lm o st all th e available in fo rm a tio n is p ro d u c e d by th e m an u fa ctu re rs o f machines. It needs to be appreciated t h a t a lm o s ta llm a c h in e s a re c o stly and in general in fe rio r to fre e w e ig h ts and pulley devices in o ffe rin g b road s p e c tru m c o n d itio n in g o f th e m uscu loske le ta l and n e u ro m u s c u la r system s If m achine re h a b ilita tio n is desired, th e n thesystem o f choice isstili pulleys: th e y are cheap, durable, e x tre m e ly versatile, safe and able to c o nd itio n three-dim ensionally using th e well-proven principles o f PNF. Pulley systems can also be co nve rte d into d y n a m ic (Isotonic-) te s tin g m achines by th e a d d itio n o f stra in gauges o r ac­ ce le rom e te rs a tta c h e d to a m in ic o m p u ­ ter, a m e th o d used successfully by th e autho r. O th e r m achines can be useful in isolating p a rtic u la r m uscle grou ps and p ro vid in g v a rie ty in tra in in g , b u t th e y should never be th e sole m eans o f rehabi­ lita tio n o r testing. The final c rite rio n is n o t a c o m p u te r p rin to u t, b u t a re tu rn o f th e a th le te to fu lly fu n ctio n a l, pain-free, long­ te rm p a rtic ip a tio n in his sp ecific sport. References M o s t o f t h e in f o r m a t io n w a s d e r iv e d fr o m t h e a u th o r 's p r e s e n t a tio n s a t t h e fo llo w in g c o n fe re n c e s : 1 .S iffM C ,T h e e rg o n o m ic s o fp h y s ic a ltr a in in g d e v ic e s a n d te c h n iq u e s : S e c o n d W its In d u s ­ t r ia l E n g in e e r in g C o n f. S c h o o l o f M e c h a n i­ cal E n g in e e r in g , U n iv e r s ity o f t h e W it- w a te r s r a n d : 4 -5 Feb 1 987. 2. S iffM C ,T h e b io m e c h a n ic s o f s a fe ty in e x e r­ cise. S e c o n d S A S p o rts M e d ic in e C o ngress, C a p e Tow n. 14-16 A p r il 1 9 8 7 3. S iffM C , T h e p h y s io lo g ic a l a n d b io m e c h a n i- c a lfo u n d a tio n s o fs a fe ty in e x e r c is e A n n u a l C o n v e n tio n o f N a tio n a l S t r e n g t h & C o n d i­ tio n in g Assoc(NSCA), Las Vegas, USA. 2 6 -2 8 J u n e 1 9 8 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. ) SPINAL CORD INJURIES IN RUGBY PLAYERS A.T. SCHER, MB, ChB, DMRD PROFESSOR AND HEAD DEPARTMENT OF RADIOLOGY UNIVERSITY OF STELLENBOSCH AND TYGERBERG HOSPITAL TYGERBERG 7505 REPUBLIC OF SOUTH AFRICA R outine radiological examination o f the cervical spine — an aid in the preven­ tion ofseriousspinal cord injuries in rugby players. In 1 9 8 3 1 re p o r te d o n a ru g b y player w h o had su stain ed cervical spinal c o rd in ju ry in th e a b s e n c e o fa n y fra c tu re o rd is lo c a - tio n , b u tc o n s e q u e n t u p o n severe c e rv i­ cal disc d e g e n e ra tio n , (Scher 1983). This, to g e th e r w ith th e o b s e rv a tio n t h a t ru g ­ by players show ed X-ray changes o f se­ vere d eg e ne rative disease o f th e cervical spine,suggested th a t players w e re p ro n e to an e a rlie r o n s e t o f d e g e n e ra tiv e dis­ ease C o n firm a tio n o f th is su pp o sitio n as in v e s tig a te d by X-raying th e cervical s p in e o fa n u m b e ro fa s y m p to m a tic c lu b players (Scher 1988). The re su lts in d ic a t­ ed th a to ld e r ru g b y players, in p a rtic u la r th o s e w h o play a s tig h tfo rw a rd s , arelike- ly to have developed p re m a tu re c h a n g e s o f d e g e n e ra tiv e disease, Fig. 1. The pres­ ence o f th e s e changes is o f m o re th a n a cad e m ic in te re s t, as th e risk o f spinal cord in ju ry is increased in th e presence o f d e g e n e ra tiv e disease. U n d er th e se c ir­ cumstances, th e s p in a lc o rd is vu lnerable to d a m a g e a fte r hyperextension in ju ry to t h e head o r neck, even in th e absence o f any fr a c tu r e o r d is lo c a tio n (Scher 1983). T h e m a jo rity o fth e s e in ju rie s o c c u rin th e presence o f ce rvical spondylosis, (Scher 1976). The c o rd is p in ch e d b e tw e e n th e d e g e n e ra te v e rte b ra l discs and osteo- p h y te s a n te rio rly and p r o tr u d in g redun- d a n tfo ld s o flig a m e n tu m fla v u m p oste ­ r io rly A p a rt fr o m d e g e n e ra tiv e c e rv ic a l spine cervical spine o f a 30 year old lock forward. Note the large poste- riorosteophyticspur(arrcwed) projecting into thespinal canal. vical spine o f an asymptomatic rugby player. disease, o th e r c o n d itio n s o f clinical im ­ p o rta n c e m a y be e v id e n t. These include fu s io n o f th e v e rte b ra l bodies o r evi­ dence o f a c o n g e n ita lly n a rro w spinal canal. Fusion o f th e v e rtic a l b od ies e ith e r con- g e n ita lo ra c q u ire d , decreases th e flexibil­ ity and n o rm a l range o f m o v e m e n t o f th e cervical sp in e and predisposes to ­ w ards tra u m a , Fig. 2. In an in v e s tig a tio n in to th e rela tion sh ip betw e en cervical fu ­ sion and spinal c o rd injury, I show ed th a t su b je cts w ith fu s e d v e rte b ra e w e re p ar­ tic u la rly p ro n e to h y p e re x te n s io n s p in a l c o rd injury, even in th e a b s e n c e o f ra dio ­ logical evidence o f v e rteb ra l in ju ry (Scher 1979). This in v e s tig a tio n also showed t h a t serious in ju ry co u ld re s u lt fr o m m in o r tra u m a s such as s im p le falls. Som e in d ivid u a ls have c o n g e n ita lly nar­ ro w spinal canals, placing th e m a t g re a t m R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) r i s k o f spinal c o rd injury, i f th e s a g itta l d i­ a m e t e r o f th e cervical canal a t any level is 10m m o r less, th e n any a d d itio n a l nar- ro w in g d u e tD tra u m a o r o th e r processes, win a lm o s t c e rta in ly re s u lt in s p in a l c o rd dam age W ith d ia m e te rs o f 10 - I3m m , high risk is p resent. (W olfe e t al 1956). In v ie w o fth e a b o v e fin d - ings and p o t e n t ia l dangers, th e necessity fo r routine radiological exam ination o f th e c e rvi- calspineof all ru g b y play­ ers is e vid en t. It w o u ld not be unre asonable to suggest t h a t all ru g b y players, p a r tic ip a tin g regularly in cl ub orsocial rugby, u n d e rg o ra diolog­ ical e x a m in a tio n o f th e cervical spine a t least once d uring th e irp la y in g career. A lim ite d radiological ex­ a m ination o f th e cervical spine need c o nsist o f only a single lateral view. This is te c h n ic a lly a s im ­ ple, rapid, inexpensive (only o ne X-ray film is needed) e x a m in a tio n and does n o t expose th e p layertoexcessiveirradi- ation. U tilising th e c rite ria p re ­ v io u sly discussed, th e r a d io g r a p h s c a n be evaluated fo r th e pres­ ence o f th e fo llo w in g changes: a) Presence o f cervical v e r t e b r a l fu s io n s , e ith e r congenital orac- quired. b)The presence o f a c o n ­ g enitally n a rro w spinal canal. O A ny changes o f d e ­ g e n e ra tiv e disease d)Evidence o f previou s vertebral fr a c tu r e Awareness o f th e pres­ ence o f these changes will enablea player, in co n ­ sultation with his Medical Practitioner, to decide w hether to c o n tin u e his active ru gb y career. If sig­ n ific a n t c h a n g e s are present, and p a rtic u la rly if nis playing p o s itio n is th a t o f a tig h t fo rw a rd , he will be well advised to either cease play i ng o r to change his playing posi­ tion to o n e w h e re he is •ess exposed to cervical stress. References I.Sher a t . Cervical s p in a l cord injury w ith o ut evi- clenceof fra rtu re o r dislo­ cation. S A fr Med j 1976; JUNE 1988 VOL 3, NO 2,1988 | 5 0 :9 6 2 2. S c h e r AT. C e rv ic a l s p in e fu s io n a n d t h e e f ­ fe c ts o f in ju ry . S A f r M e d J 1 9 7 9 : 5 6 :5 2 5 . 3. S ch e r A T .S e rio u s c e rv ic a l s p in e in ju r y in t h e o ld e r ru g b y p la y e r.S A fr M e d J 1 9 8 3 : 64:138. 4. S ch e r AT. P r e m a t u r e o n s e t o f d e g e n e ra tiv e disease o f t h e c e rv ic a l s p in e in r u g b y players. (S u b m itte d f o r p u b lic a tio n ). 5 .W o lfe B S ,K h iln a n iM & M a lis L .T h e s a g itta ld i- a m e te r o f t h e b o n y c e rv ic a l sp in a l canal a nd its s ig n ific a n c e in c e rv ic a l s p o n d y lo s is J M t Sinai H osp 1 9 5 6 ; 2 3 :2 8 3 . A 4 V - 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. ) U STAPTOG OP PAD NA GESONDHEID AVERMEULEN, B.SC. FISIOTERAPIE HFH WEICH, M.D., F.A.C.C. Departem ente Fisioterapie, Tygerberg Hospitaal en Interne Ceneeskunde (Kardiologie Eenheid), Fakulteit Ceneeskunde Universiteit van Stellenbosch en die Bayer Kliniese Navorsingseenheid/ A BSTRACT The C a rd io lo g y u n i t o f th e D e p a r tm e n t o f In te rn a l M edicine o f th e 'Faculty o f Medicine', U n iv e rs ity o f S tellenbosch, u n d e r th e le a d ersh ip o f P ro fe s s o r HFH Weich, in c o -o p e ra tio n w ith th e D e p a r tm e n t o f Physiotherapy, Tyger­ b e rg Hospital, ow e th e ir su cce ssfu l c a r­ d ia c re h a b ilita tio n p ro g ra m m e to th e fa c t t h a t p a tie n ts are e ffe c tiv e ly m o t i­ v a te d a n d e n c o u ra g e d to b e c o m e f i t a n d t o s t a y f it th ro u g h re g u la r walking. A suc­ ce ssful re h a b ilita tio n p ro g ra m m e c u l­ m in a te s in a c lim b u p Table M ou n ta in . These h ik in g tr ip s were in tro d u c e d in 1982 as p a r t o f th e ir re h a b ilita tio n p ro g ra m m e S ix ty -fiv e p e rc e n to fth e p a - tie n ts w h o p a rtic ip a te d in re h a b ilita tio n a re s till a c tiv e ly involved. The d r o p o u t r a te is lo w in c o m p a ris o n w ith o th e r s tu d ie s u n d e rta k e n b o th lo c a lly a n d overseas. INLEIDING EN AGTERGROND D it is alom bekend d a t'n p asie n t na 'n har- taanval psigiese p ro b le m e o n d e rv in d , v e ra lg e d u re n d e d ie e e rs te d rie w e k e tu is w a n n e e rh y g e w o o n lik b e g in o m 'n n u w e beeld van h o m s e lf asiem and m e t 'n hart- letsel, o p te bou. 'n V erskeidenheid van p ro b le m e m ag o n ts ta a n ,o n d e ra n d e re : — swak m e n s e v e rh o u d in g s — o o rg o d s d ie n s tig h e id — to e v lu g n e e m t o t d ra n k — o o rm a tig e o e fe n in g Com m y s e lf te b e w y s l — te bang o m enig e a k tiw ite it te o n d e rn e e m — a n g s e n depressie — verlies aan libido, ste rkte , e n e rg ie en o n a fh a n k lik h e id 123 M e t d ie re g te le id in g v e rw e rk pasiente h ie rd ie p ro b le m e makliker. Cereelde oefen ing v e rh o o g 'n m ensselig- gaam like sowel as geestelike welsyn. W etenskaplikes w a t die sie lk u n d ig e uit- w e rk in g van 'n g e re e ld e o e fe n p ro g ra m b e s tu d e e r h e t,a-5-6 h e t o p g e m e rk d a t na- m a te m e n s e fik s e rw o rd ,w o rd h u lle m e e r — o p e n h a rtig — o n ts p a n n e — na b u ite le w e n d — s e lfo n d e rh o u d e n d — v e rb e e ld in g rv k — vol s e lfv e rtro u e — stabiel Navorsing h e t aan die lig g e b rin g d a t o efe n in g d o e ltre ffe n d e ra s kalm eerm id- dels s p an n in g v e rm in d e r.3 6 D it is ook bekend d a t oefeni ng 'n persoon: — e m o sion e el p o s itie f instel — se angs, s p a n n in g en depressie v e r­ m in d e r — se slaap en o n ts p a n n in g b e v o rd e r — se e n e rg ie la a t to e n e e m — se v ita lite itv e r h o o g — se k o n s e n tr a s ie , u it h o u v e r m o e , p o s tu u r, v o o rk o m s , s e lfb e e ld en sosiale aanpassing ve rb e te r. O efe n in g v e rh o o g dus die k w a lite it van le w e 57-8 Die re g te leiding is v a n d ie u ite rs te b e la n g v ir v o lk o m e re h a b ilita s ie Die v o o rd e le van fisieke fik s h e id w o rd g e b ru ik o m psigiese fiksheid teverkry. 'n O m vattende o e fe n p ro g ra m , d e u rd ie D e p a rte m e n te Fisioterapie, T ygerberg Hospitaal en In­ te rn e Geneeskunde, (K ardiologie Een­ heid) Fakulteit Geneeskunde, Universiteit van Stellenbosch, is ingestel. Die sukses v a n d ie re h a b ilita s ie p ro g ra m is te d a n k e aan 'n d o e lg e rig te m o ti veringsaksie o m p asiente aan te m o e d ig o m f iks te w o rd en daarna fik s te bly. Die p ro g ra m begin in die hospitaal, gaan o o r in hoofsaaklik s ta p o e fe n in g e tu is t o t d ie p a s ie n t in- skakel by 'n o e fe n p ro g ra m in die hospi­ taal w a a rn a h y "u itp a s s e e r" t o t gereelde tu is o e fe n in g e e n b e rg k lim u its ta p p ie s . o n g e v e e rtw e e weke, w a n n e e rd ie pa­ s ie n t o n ts la a n w o rd , w o rd van hom verw ag o m 2 0 0 m e te r te stap, asook e e n s te ltr a p p e te k lim . 2 .S e k o n d e r e r e h a b ilita s ie (O efen- p r o g r a m tu is e n In g lm n a s iu m in h o s p ita a l) Tuis w o rd hy aangem oed ig o m daagliks te g a a n s ta p .H y beg in m e t 200 m e te r en sta p dan elke dag 50 m e te r verder, JUNE 1988 VOL 3, NO 2,19ffl OMVANG VAN KARDIALE REHABILITASIEPROGRAMME l.P r im e r e r e h a b illt a s ie d n te n s ie w e e e n h e id e n s a a l) B e d ru s w o rd v ird ie e e rs te d rie d a e n a , 'n h a rta a n v a l v o o rg e s k ry f, asook ' k a lm e e rm id d e ls o m te v o o rk o m d a tn m o o n tlik e s p a n n in g s to e s ta n d /n a d d i- sionele las o p sy h a r t sal plaas Die pa­ s ie n t w o rd wel to e g e la a t o m se lf te e e t en a a n g e m o e d ig o m sy to n e te be- w eeg en d ie p a sem h aling soe fe n in g e te doen. Na o n g e v e e r'n ve rd e re 5 dae m ag die pasient, indien d aa rgeen kom- i plikasiesisnie,begin u its itin n gemak- stoel. Eers v a n a f dag 5 t o t 6 m ag die p a s ie n t b egin s ta p Daarna w o rd die h oeveelheid o e fe n in g w a t hy to e ­ g e la a t w o rd , daagliks v e rm e e rd e r. Na 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. ) c n d a th y m e td ie e e rs te o p v o lg b e s o e k een k ilo m e te r m e t gem a k kan stap. qndra die p asien te een k ilo m e te r kan % p, w ord hy a a n g e m o e d ig o m elke dag een m in u u t la n g e rte stap, to td a t h v v i r 30 minute aaneen kan stap Binne 6 weke b e h o o rt hy 3 t o t 4 kilo­ m eter p e r dag te stap. O ngeveer hier- die tvd w ord 'n insp an n in g s-e lektro- ka rd iog ra m (EKC) u itge voe r. In Tyger- berg Hospitaal w ord die oefenm g- stoets o p 'n tra p m e u l vo lgens die Bruce-protokol g e d o e n .; W anneer die p a s ie n t v ir die oefen- klasse g e k e u r w ord, m o e t die kai oloog, volgens die re s u lta te van die inspannings-EKG, v ir d ie p a s ie n t n veilige to e la a tb a re m a k s im u m hart- spoed bepaal. Tydens die oefenings- kiasse w o rd g e p o o g d a t h ie rd ie pols- spoed nie o o rs k ry w o rd nie. Di6 g ro e p g e ke u rd e pasien te o e fe n d rie k e e rp e rw e e k ,o n d e rto e s ig ,in d ie hosp itaa l. 'n G e n ee she e r m e t 'n volledige resussitasietrollie, n fis io te r- a pe u t,'n nehabilitasiesusteren'ndieet- ku nd ig e is a lty d by die oefensessie te e nw oo rd ig .'n Maatskaplike w erkeris ook o n m id d e llik beskikbaar o m aan- d a g a a n e n ig e m a a tsk a p lik e p ro b le m e teskenk. Pasiente m e t in fe rio r infarksies w o rd v ie r weke p o s t in fa rk s ie na d ie oefen ing kla s g estuu r, te rw y l diegene m e ta n te rio re n m ee rg eko m plise e rde infarksiesses weke p ost infarksie nadie klasse gaan. Die redes v ir die vroe e in­ s is t in g is o m die la n g n ie -a k tie w e tyd - p e rk tu is te v e rk o rt, o m d ie p a s ie n t in d ie o efen kla s te k ry v ir m o re le onder- s te u n in g v o o rh y te ru g k e e rn a s y w e rk en o m k o n ta k te m aak m e t a n d e r pa- fiE S U U A T E VAN 1 0 0 P A S IE N T E WAT VANAF • 8 4 - 1 9 6 7 VIR S T A P T O G T E G O E D G E K E U R IS 09; V E R H U IS siente b in n e die groep. D ie o e fe n p ro g ra m bestaan u it vie ro p - w a rm in g s o e fe n in g e w a a rna die pa­ s ie n t v i r 'n v a s g e s te ld e t y d 'n ro n d te -o e fe n in g doen, w a t saam- gestel is u ittie n is o to n ie s e o e fe n in g e Op vasgestelde k o n tro le p u n te w o rd die p a s ie n t se p o ls te m p o gekon- troleer, s o d a t d it nie die m a ksim u m toelaatbare h a rts p o e d o o rs k ry n ie in- dien d it h o e r is, m o e t die p a s ie n t eers rus. N a m a te die p a sie n t fik s e r w ord, kan hy die ro n d te -o e fe n in g m e e rm a le in die vo o rg e s te ld e ty d herhaal. Die oefeningsessie w o rd afgesl u it d e u r v y f m in u te o p 'n sta tie s e fie ts te trap. Die ty e w a t v ir die ro n d te -o e fe n in g e to e g e la a t w o rd , w o rd in ta b e l I voor- gestel: m eka a r nod ig in 'n g ro e p s v e rb a n d om m e k a a rte m o ti ve e re n 'n g roe psg e eso p te bou. O n d e rv in d in g h e t o ok g e to o n d a t die o o rg ro te m e e rd e rh e id van die pasiente, veral d ie w a to o rm a s s a is, n ie b e la n g s te l o m t e d r a f nie en d a t sta p v ir h u lle 'n be- te r aan va arb are a k tiw ite it is Daarom is in 1982 b e s lu it o m m aan- T A B E LI: ONTLEDiNC VAN RONDTE-OEFENINGE AifJE 1988 VOL 3, NO 2,1988 W e k e In o e f e n p r o g r a m 1 2 3 4 5 6 - 7 8 - 9 10-11 1 2 -1 3 Tyd (m in u t e ) Geen b e p e rk in g Geen b e p e rk in g Geen b e p e rk in g Geen b e p e rk in g 10 15 20 25 30 3. T e rs ie re r e h a b iilta s le (L a n g te r- m y n s t a p p r o g r a m ) Na v o lto o iin g van d ie o e fe n k u rs u s (3 t o t 4 m aande) w o rd die p a s ie n t w e e r aan 'n inspannings-EKG o n d e rw e rp . Hulle v o rd e rin g w o rd nagegaan en 'n n uw e m a k s im u m to e la a tb a re h a rt­ spoed w o rd bepaal vo lg e n s s ta n - d a a rd p ro s e d u re Die p asien te kan dan v o o rtg a a n m e t d ie o e fe n p ro g ra m , m a a r h ulle o e fe n s o n d e r toesig. Hulle k o n tro le e r hul eie h a rts p o e d en is v ir h u ls e lf verant- woordelik. TOTSTANDKOMING VAN DIE STAPTOGTE O n d ervinding h e t getoo n d a t die pasient as in d iv id u d ie m ee ste van sy p ro b le m e b y vo o rb e e ld kardiale neurose, v e rw e rk o f o o rk o m h e t te rw y l s y fa m ilie tu is nog p ro b le m e d a a rm e e o n d e rv in d het. Dik- wels w o rd die p a s ie n t tu is soos 'n breek- b are kle in kosbaarheid behandel, te rw y l h y e in tlik fis ie s te n volleg e reh a bilite e rd is. Pogings m oe s dus aangew end w o rd o m ie ts a d d is io n e e lb y d ie o e fe n in g k la s s e te voeg o m h ie rd ie p ro b le m e te o o rb ru g . V o o rlig tin g d e u rm id d e l van lesingseen keer p e r m aa n d en g ro e p sb e sp re kin g s w a td ie w e d e rh e lfv a n 'n h a rtp a s ie n tk a n byw oon, h e t h e e lw a t gehelp, m a a r d it was nog steeds nie g e n o eg n ie Die pasiente w ou o ok graag v e rd e r as n e t d ie o efen kla s vorder. Hulle w ou uitdag- ings he s o d a t h ulle aan h u ls e lf en die fa m ilie k o n b e w y s d a th u lle te n v o lleg e re ­ h a b ilite e rd is en 'n n o rm a le lewe kon lei. O n d ervinding h e t getoo n d a t die m eeste van die p asien te v o o r h ulle harta a nva l v a n n a tu re n ie g e n e ig w a s o m o e fe n in g e o p eie in is ia tie f te d oe n nie, en d a t die o e fe n p ro g ra m van 3 t o t 4 m aa n de nie g e n o eg was o m hul lewenswyse p e rm a ­ n e n t te v e ra n d e r n ie Die p asiente h e t H o e v e e ih e id r o n d te s 1/2 ro n d te -o e fe n in g ro n d te -o e fe n in g Voile ro n d te -o e fe n in g en sta p Voile ro n d te -o e fe n in g en d r a f Een voile ro n d te ± 2 ro n d te s ± 3 ro n d te s ± 4 ro n d te s ± 5 ro n d te s delikse s ta p to g te te organiseer. Stap- to g te w o rd a an g en a am g em a ak s o d a t die p a s ie n t d it as 'n m aklike en aanvaar­ b are m a n ie r sien o m saam m e t sy gesin ty e in die v ry e n a tu u r d e u r te b rin g . Die p a s ie n t w o rd d us aan iets b lo o tg e s te l w a a rin h yw e rk likb e la n g s te l.w a th y s a a m m e t sy gesin kan g e n ie te n w a t m eeraan- v a a rb a a ris as a n d e r v o rm s van stra w w e f isieke a k tiw ite ite Die s ta p to g te dien as 'n o n tv lu g tin g in die vrye n a tu u r o m na die p a s ie n ta s g e h e e lo m te s ie n .n a a m lik lig - gaam , siel en g ee s Die re su lta te m e t hie r­ die b e n a d e rin g is ind rukw ekke n d. Die p asiente w o rd volgens die re su lta te v a n d ie tw e e d e in s p a n n in g s-E K G g e k e u r v ir die s ta p to g te . E lke d e rd e S a te rd a g v a n e lk e m a a n d k o m die p asiente m e t fa m ilie en v rie n d e b ym e ka a r v ir die u its ta p p ie Hulle stap tu sse n 12 t o t 20 k ilo m e te r p e r dag. 'n G e n e e she e ren fisio te rap e utverg e se ldie g ro e p elke keer. D ie s ta p to g w o rd afges- lu itm e t'n g e s e llig e b ra a i.D ie u its ta p p ie s h e t m e t v e rlo o p van ty d u itg e b re i van s le g s 'n g e w o n e s ta p to g n a m o e ilik e k lim - roetes en selfs naw eekuitstappies. Die p ra g tig e berg w e reld van die Boland leen h o m t o t vele a n d e r sko usp ela gtig e dag u itstap p ie s w a tg o e d b e n u t word. Die u its ta p p ie s d ie n as 'n spesiale u itd a g in g v ird ie pasient o m te k a n b e w y s d a th u l hul p ro b le m e v o lk o m e o o rk o m het. RESULTATE VAN OEFENPROGRAMME Slegseen s te rfg e v a l h e t in d ie oefenklas vo o rg e k o m s e d e rt die re ha bilitasiep ro - g ra m in 1974 begin is. D ie o o rle d e n e k o n te n sp yte van a ktiew e resussitasie nie b y g e b rin g w o rd n ie S ta tis tie k e to o n 'n s ty g in g v a n d ie a a n ta l p asiente w a t s e d e rt 1984 aan die s ta p ­ to g te deelneem : 1984 — 1 4p a s ie in te 15R 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. ) 1985 — 25 pasiente 1986 — 41 p asiente 1987 — 65 pasiente G e e n o n g e v a lle o fs te rfte s is n o g ty d e n s d ie s ta p to g te o n d e rv in d nie. Die re su lta te van 100 ope e nvo lg e nd e pa­ siente w a t v a n a f 1984 t o t 1987 v ir die s ta p to g te g o e d g e k e u r is .w o r d in fig u u r (D a a n g e to o n . BESPREKING VAN OEFENPROGRAMME Navorsing o o r d ie hele W ereld to o n d a t d ie p rim e re en sekondere rehabilitasie- fases goed is, m a a r d ie tersie re re­ h a b ilita s ie w o r d v e rw a a rlo o s .12 Die s ta p p ro g ra m is b e s o n d e rg o e d in d ie ver- band, w a n t d it gee aandag aan daa rdie fa se t van rehabilitasie w a t h e lp o m d ie pa­ s ie n t se lew enswyse p e r m a n e n t te verander. Vyf-en-sestig p e rs e n t van die p asiente w a t by die p ro g ra m ingeskakel word, hou d a a rm e e vol en nee m nog steeds a k tie f daaraan deel. In ve rg e ly k in g m e t a n d e r s tu d ie s 12 is d ie u itv a ls y fe r van 35% baie la a g .D ie re d e v irh ie rd ie la e u itv a ls y fe ris , vergeleke m e t a n d e r s tu d ie s plaaslik en oo rse e 12 w a a rskyn lik te d an ke aan die fe it d a t sta p in die n a tu u r v ir p asiente m e tk a rd ia le p ro b le m e n ie v e rv e lig is n ie en d us m e e r aanva arb aa r is as a n d e r s tra w w e r fisie ke a k tiw ite ite . S odoende sorg d it v ir b e te r p a s ie n t sam ew erking. Die redes v ird ie s ta k in g van 28% van die pasiente kan to e g e s k n /f w o rd aan werks- o f v e rv o e rp ro b le m e , o f d a t d ie p asiente voel h ulle g ee n v e rd e re re h a b ilita sie n o ­ d ig h e t nie. Van d ie 4% wa t o o rle d e is, is 1 % d o o d as g evolg van 'n m o to ro n g e lu k , nog 1% d o o d as g evolg van kom plikasies na 'n la p a ro to m ie v ir 'n p e p tie se ulkus. Die res iso o rle d e a sg e vo lg van komplikasies van hul h a rtle ts e l. Pasiente in d ie te rs ie re re ha bilitasiefase is g e n e ig o m te v o lh a rd e n v e rk ie s o m per­ m a n e n t deel te wees van d ie g ro e p o m m e k a a rts m o tiv e e rty d e n s d ie s ta p to g te D itd ie n a s 'n b ro n v a n in s p ira s ie v irn u w e p asiente w a t to e tr e e t o t d ie rehabilita- siep rog ra m . Na d ie u its ta p p ie s voel d ie p asiente sp re e kw o o rd e lik'tin to p o f th e w o rld" Die fa m ilie en v rie n d e sien h ul w e d e rh e lf/ vader, m o e d e r o f v rie n d as ie m a nd w a t w e e r'n geso n de n o rm a le lewe kan lei en d it b rin g hulle as fa m ilie en v rie n d e baie n ad e r aan m ekaar, in baie gevalle baie n a d e ra s v P o rd ie in fa rk s ie . Di t is v e rb ly d e n d o m te sien d a t n a m a te d ie p asiente fik s e r w o rd , h u lle w e e r hul s e lfv e rtro u e h e rw in . Na v o lto o iin g van die kursus is hulle gew oonlik goed aange- pas, vol s e lfv e rtro u e en m eestal b e te r a f as v o o r hul hartaanval. Ons s tu d ie s h e t ook die vo lg e n d e bevestig: — p asiente is m e e r o n ts p a n n e — v e rb e te rin g van w e rksitua sie — v e rb re d in g van le w e n su itkyk — e e t en le e f m e e r gesond — lib id o en s la a p p a tro o n v e rb e te r Hulle is a s 'tw a re n u w e m e n s e . Hulle hele le e fw y s e v e ra n d e r p e rm a n e n t, d ie k w a lite it van h ul lewens w o rd verbeter. Soos'n pasient een k e e rty d e n s 'n groeps- besp rekin g o p g e m e rk het: "M y h a rta a n ­ val is d ie beste d in g w a t n og o o it m e t m y k o n g e b e u rh e t!" 1. W eich HFH. Die p a s ie n t m e t 'n h a rta a n ­ val. D o m in e e e n d o k te r b y d ie siekbed. N C Kerk U itg e w e rs, 1 9 8 2 9 0 - 96. 2. H a c k e tt, T h o m a s P, C assem N ed H. Psy­ c h o lo g ic a s p e c ts o f r e h a b ilita tio n a fte r m y o c a rd ia l in fa rc tio n . R e h a b ilita tio n o f t h e c o ro n a r y p a tie n t, 2 4 3 ■ 252. 3. P ric e H, O b e l TLP, S c h o tt M illa r RN. Psy­ c h o so c ia l a s p e c ts o f c a rd ia c -p a cin g . S A M e d ie s e T yd skrif, A p r il 1 9 8 0 :580 - 582. 4. M e tr o p o lita n H o m e s T ru s t Lewens. 'n G esonde gees in n g e s o n d e liggaam . Fiks v ir d ie le w e (p a m fle t). 5. C u re to n TK. Im p ro v e m e n t o f p sych o lo g ­ ical s ta te s b y m e n a s o f e xe rc is e fitn e s s p ro g ra m s . J o u rn a l o f A s s o c ia tio n fo r p h ysical a n d m e n ta l R e h a b ilita tio n 17, 1 9 6 3 14 - 17. 25. 6. M ichael D. S tress a d a p ta tio n th r o u g h ex­ e rc is e R ese arch Q u a r te r ly 28, 1957, 50-54. 7. H ig g e n s JB. M e t fik s h e id k o m jy verder. R e h a b ilita tio n in SA, J u n e 1981, 59 • 62. 8. B e s te r CL, M e y e r SA. Die te ra p e u tie s e w a a rd e v a n s p o rt. R e h a b ilita s ie in SA. D e s e m b e r 1 9 8 2 : 7 8 - 83. 9. Le ste r FM, S h e ffie ld LT, Reeves TJ. Elec­ tr o c a r d io g r a p h ic c h a n g e s in c lin ic a lly n o r m a l o ld e r m e n fo llo w in g n e a r m ax­ im a l a n d m a x im a l e x e rcise C ircu la tio n 36 . 5, 1987. 10. S h e ffie ld LT, M a lo o f JA, S a w y e r JA, Rort- m a n D. M a x im a l h e a r tr a te a n d tre a d m ill p e r fo r m a n c e o f h e a lth y w o m e n in rela­ tio n t o age. C ir c u la tio n 5 7 . 79, 1978. 11. W e ich HFH. O e fe n p r o g r a m na m io k a rd i- ale in fa rk s ie T h e S A jo u r n a l o f Continu­ in g M e d ic a l E d u c a tio n Vol 3, N ovem ber 1985. 61 - 69. 12. D is h m a n RK. E xercise C o m p lia n c e : A n e w v ie w f o r p u b lic h e a lth . Physician and S p o r ts m e d ic in e Vol 14, n r 5, M ay 1986 . 1 2 7 - 1 4 2 ^ JUNE 1988 VOL 3, NO 2,15 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 BIG BETTER BESTER' This g ru e llin g c o m p e ti­ tio n c o m p ris e d th e fo l­ lowing: C o m p u ls o ry e ve n ts : Vasbyt 160km Cycle Race Hansa Duzi Canoe M ara­ th o n Sunday Tim es/Leppin Iron Man Comrades M a ra th o n O p tio n a l E vents JSE. M a ra th o n M idm ar Mile Swim Argus Cycle Race TWO Ocean's M a ra th o n The ULTRA MAN COMPETITION has f i ­ nally d raw n to a close w ith a sigh o f relief fr o m m an y a c o m p e tito r no doubt! Praise m u s t be m e n tio n e d to all th o s e c o m p e tito rs successfully c o m p le tin g th e C om rades M ara th o n. A special m ention to one o f o u r STARS — NICK BESTER f o r his m a g n ific e n t display o f guts and d e te rm in a tio n . To q u o te th e majestic Fordyce: "I was a t one stage worrying a b o u t M ark Page, b u t m y se­ conds w a rn ed m e ra th e r to w o rry about Bester w ho was racing m e all th e way_" Besters tim e f o r th e C om rades was in incredible 5:39.00 w h ic h e a rn e d h im a full 100 p o in ts and th e ULTRAMAN TI­ TLE. PRISCILLA CARLISLE was th e fir s t lady h o m e n a rro w ly m issing h e r silver medal in a tim e o f 7:30:39. N e v e rth e ­ less, this p e rfo rm a n c e by Priscilla se­ cures h e r f i r s t place in th e lady's c o m ­ petition. The veteran's c o m p e titio n proved to be both in te re s tin g and e x tre m e ly close­ ly contested. A s ta g g e rin g 34 veterans “ including a lady, Carol H o n ne yse tt, wni be collecting m edals The m ain race througho ut th e c o m p e titio n was be­ tween tw o s tro n g , c o m m itte d and ex­ trem ely ta le n te d a th le te s - Graem e rope-Ellis and G e o ff M a tth e w s These tw o trojans b a ttle d to th e v e ry end, only to see T h e Roper take th e honours y F l 3 C om rades tim e o f 6:36:30 and 696,05 p o in ts 9 iv in g h im an incredible 3 rd p o s itio n overall. W > e ts were th e Nam e o f th e Game, es- PCt ^ A k1,0 th is ve a rs ULTRAMAN COM- “ and le t a t h o u g h t be _ apdreq r o r th o s e c o u ra g e o u s a th le te s NO 2,1988 w h o a tte m p te d th e C om rades b u t fa ile d to fin is h th e 89,9km route. The Sponsors, Ciba Geigy, and th e o r ­ ganisers S ports In te rn a tio n a l w ould like to c o n g ra tu la te all th o s e c o m p e tito rs w h o can d e se rve d ly call th e m se lve s "ULTRAMEN" (and LADIES!). ULTRAMAN LADIES POSITIONS 1 Carlisle Pricilla 2 Meakerjane 3. 8antock5ally 4. Bargate Karen 5. LaingChancelle 6. Leonard Annemarie 7. Eardley Sandra Margot 8. Honneysett Carol 494.60 483.83 479.41 406.45 390.31 377.29 221.87 Vet 122.27 OVERALL POSITIONS LISTING NAME Pos JSE Vasbyt Duzi Midmar ironman Argus 2 Oceans Comrades Total Bester Nicolaas 1 100.00 99.81 92.27 7780 100.00 100.00 96.49 100.00 766.37 OeJager Pierre 2 84.72 9945 7661 61.52 98.74 97 39 100.00 81.50 699.93 Graeme Pope-Ellis 3 85.22 92 81 100.00 51.43 9705 94.07 93.38 82.09 69605 Fletcher Cordon 4 75.55 83.89 90.71 81 35 80.28 9368 98.56 82.96 686.98 Janos George 5 92.02 96.71 87.41 67.15 93.47 98.07 8021 67.48 682.52 Matthews Geoff 6 81.77 90.77 81.90 78.87 86.58 92.24 85.46 7306 670.56 Moolman Martin 7 73.54 99.35 7373 60.06 91.24 99.85 85 35 71.01 654.13 VanderMerweSam 8 74.55 88 78 8084 10000 72 87 93.43 75 30 57.95 643.72 Van derMerwe Martin 9 77.05 89 75 8084 7898 77.69 93.43 75.18 69 31 642.23 LochnerLochi 10 80.82 96.51 58.48 32.22 90 46 94.61 83.98 76.71 613 79 Van Tonder Phillip 11 84.02 97.76 86.64 31.80 8740 94.61 72.60 55.60 61043 Britten Steve 12 61.28 88.74 5749 86.22 71,77 9252 72.16 72.10 602 28 Wiimot Michael 13 6670 84.10 8716 4969 78.76 94.84 7170 68.29 60124 Jones Stan 14 76.14 8416 49.50 86.22 8205 89.42 74 46 5662 598.57 UysRoget 15 70.25 90.41 74.34 70.63 6726 91 24 72.03 59 30 595.46 Williamson Nome 16 81.14 89.30 4361 7738 78.46 86.58 89.87 43.56 58990 Poole Kenneth 17 8171 71.37 51.74 58.25 72.34 90.98 8926 6956 585.21 BothaMax 18 75.06 665 0 73.58 56.30 6945 8453 79.10 72.79 57731 Benson lan 19 80.69 94.47 74 74 550 83.31 9551 58.29 66.55 559.06 Cooper Colin 20 78.70 84.82 5676 2463 77 30 91.42 84.47 56.92 555.02 NICK BESTER 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. ) INTERNATIONAL CONGRESS IN CAPE TOWN T The South African Rugby Board in c o n ju n c tio n w ith th e South African Sports M edicine Associa­ tion is arranging an Inter- ___________ national Congress on In­ ju r ie s in R u gby a nd o th e r C o ntact Sports. This Congress will be held in Cape Town, a t th e Cape Sun on 21, 22 and 23 March 1 98 9 and will fo rm p a rt o f th e South African Rugby Board's C entenary Celebrations. A provisional p ro g ram m e has been drawn-up: I TRAINING FITNESS Basic principles The Rugbyplayers approach to fitness Coaches assessment o f fitness Biokinetic approach to fitness Fitness in Boxing Fitness in Soccer Fitness in th e older p a rticip an t The psychologist's role in S port Diet and Food Selection in build Aerobics in train ing II RISKS IN CONTACT GAMES Statistical review o f injuries Injuries in Boxing Injuries in Soccer III INJURIES IN RUGBY Risks in Rugby Statistical Review International Statistical Review SA School Rugby Statistical Review Senior Rugby Discussion 1. Rugby Football union 2. Scottish Rugby union 3. Irish Rugby fo o tb a ll union 4. Welsh Rugby union 5. Australian Rugby football union 6. New Zealand Rugby football union 7. Federation Francaise de Rugby IV SPORTS INJURIES AND THEIR TREATMENT A. HEAD INJURIES — Diagnosis o f concussion — T re a tm e n t and evaluation B. NECK INJURIES Serious spinal injuries in sport C ervical spinal injuries — diagnosis/X-rays Transport o f injured patients Cervical spine in ex-players C. FACIAL INJURIES Pattern o f Facial Injuries T re a tm e n t o f M andibular and M axillar injuries D. MOUTH — TEETH Teeth injuries The use o f m outhguards in — Boxing/Rugby The making o f a m o uthguard E. EYE AND EAR INJURIES Injuries to Eyes Ear H aem atom a F. INJURIES IN ABDOMEN, THO­ RAX KIDNEYS AND GENITAL ORGANS Thorax and Abdominal Injuries Renal injuries Injuries to Genital organs G. SHOULDER GIRDLE INJURIES S houlder dislocations Acromioclavicular injuries H. UPPER LIMB INJURIES Arm and Elbow Injuries to wrist, hand and fingers in contact sports I. KNEE INJURIES A n atom y o f th e knee Evaluation o f th e knee Injuries patterns Diagnosis o f knee injuries The use o f th e arthroscope R e h a b ilita tio n a f t e r k n ee injuries J. ANKLE INJURIES Diagnosis o f ankle injuries T re a tm e n t o f Injuries Rehabilitation o f ankle injuries K. MUSCLE, NERVE AND SOFT TISSUE INJURIES Muscle injuries T re a tm e n t o f muscle injuries Cramps in leg muscles Derm atological problem s in Rugby INJURIES AT THE SITE OF THE IN­ JURY On th e field In th e Boxing ring Role o f th e Referee M inim um 1st Aid requirem ents Use o f local Anaesthetics VI FIRST AID SERVICES O rganization a t a m ajor stadium Duties o f First aids Training o f Personnel Accident services VII PREVENTION OF INJURIES Training and Fitness S trapping and Taping Pads and Braces Rugby Boots and Studs P rotective aspects in Boxing VIII TOURING SIDES IX INSURANCE OF PLAYERS X REHABILITATION Role o f Physiotherapy Role o f Biokinetics Rehabilitation o f serious injuries In addition to this, tim e will be set aside fo r a South African Knee and Ar­ throscopic Society Symposium and sessions fo r fre e scientific papers For any prelim inary enquiries please contact: Sally Elliott, Post Graduate Educational Centre, University o f Cape Town. Tel: (021) 47-1250. FIRST NATIONAL CONGRESS OF THE SOUTH AFRICAN PHYSIOTHERAPISTS ACUPUNCTURE ASSOCIATION Incorporating: THE FIRST NATIONAL CONGRESS OF COMPLEMENTARY THERAPIES Royal Hotel, Durban.- 27/28 th August 1988 For enquiries please contact: Mr. C Liggins, Chairman, physiotherapy! School, King Edward Vlll Hospital, Private I Bag Congella 4013. Tel: (031) 25-3511} Ext 416.; Marga ret Si m pson, Continuing! Medical Education Unit, U n iv e r s i t y o f N a | tal. Medical School, PO Box 17039 Congel-j la 4013. Tel: (031) 25-4211 Extn. 327 JUNE 1988 VOL 3, NO 2, 18 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 SCIENTIFIC ARTICLES 1 The Journal o f th e South African Sports Medicine Association publishes original and reviewarticlesfrom all dis­ ciplines relevant to Sports Medicine. The Journal aims to cater fo r th e diverse interests o f m em bers o f th e medical and para-medical professions and th e sporting public interested in th e scientific and medical aspects o f sport. 2. Material subm itted fo r publication in th e JSASMA is accepted on condition th a t it has n o t been published else­ where. All nam ed authors m ust give signed consenttopublication,andthe JSASMA does not hold itself reponsible forstatem ents m ade by contributors 3. All subm itted articles should be o f ap­ propriate scientific value and should have practical application in sports medicine. Articles may be w ritte n in AfrikaansorEnglish. The contributions wil I be critically reviewed by a t least one appropriate referee whoisaspecialist in th e field o f th e s u b m itte d material. This review will be passed on a double­ blind approach (both a u th o r and referee will remainanonymoustoeach other). The referee's com m ents will be sent to th e a u th o r to g e th e r w ith th e evaluation o f o n eof th e Editors Accep­ tance o f th e papers fo r publication is based onoriginality and quality o f th e work as well as on th e clarity o f in­ terpretation. The papers will be pub­ lished in th e order o f acceptance and not in th e order o f submission. The publisher reserves copyright and reproduction rights o f all published material, and such material may not be reproduced in any form w ith o u t th e publisher's w ritte n permission. All manuscripts to be directed to: d o o E d ito r' J o u rn a l o f SASMA, PO Box 3909, Randburg 2125. Preparation of the manuscript H^?wScripts should be typew ritten, ouble-spaced onsheetsof uniform size, n o ^ rg e rth a n 21x29.7cm (DIN A4) w ith a ^ f 9in on th e le ft AN contributions to be subm itted in duplicate (one original w ith illustrations suitable fo r reproduction and tw o com plete copies including copies o f figures and tables). Only theoriginalcopy will bere tu rn e d to th e author(s) in case o f revision or rejection. The cover page o f th e m anuscript should list th e following inform ation: (i) Concise b u t inform ative title (ii) Key words (maxim um 5-8) (iii) Author(s) initials and name(s) (iv) Nam e and location o f institution w here th e investigations were car­ ried o u t (v) N a m e a n d a d d re s s o fth e a u th o rto whom communicationsconcerning th eco n trib u tio n should bedirected (iv) Acknowledgementsof research sup­ p o rt and research gran ts The second page o f th e m anuscript s h o u d in c lu d e o n lyth e title o fth e artic le w ithout reference to th e author's names or affiliations. JUNE 1988 VOL 3, NO 2,1988 The th ird page o f th e m anuscript should give an abstract o f th e scientific contents o f nom ore than 200 wordsand notexceedingonedouble-spaced ty p e ­ w ritte n page. The text o f them anuscriptshould bear- ranged as follows: An introd uction describing th e pur­ pose o f th e work in relation to otherw ork in th e same field. Material and Methods: Describe th e selection o f th e observational or ex- perim entalsubjects clearly. Id e n tify th e methods, apparatus and procedures in sufficientdetailtoallow otherw orkersto reproduce th e results. The Results should be presented con- cisely.Thestatistical m ethod used should be named. Authors m ust express units, quantities, and form ulas according to th e recom m endationsoftheSystem e In­ ternationale (SI units). All measurements should begiven in m etric units The Discussion should emphasize th e n e w a n d im p o rtan ta s p e cts o fth es tu d y and th e Conclusions t h a t follow fro m them . The practical implications o f th e study should be emphasized. Illustrations and tables Figuresconsistof all m aterial which can­ n o t be set in type, such as photographs and line drawings. (Tablesare not includ­ ed in thisclassif ication and should n o t be submitted as photographs). In nocircum- stancesshould original X-Ray films befor- warded:glossyprintsmustbesubmitted. Tables and legends fo r illustrations should be ty p ed onseparatesheetsand should beclearlyidentified.Tablesshould carryRomannumerals,thus:l,ll,llletc,and illustrations Arabic numerals, thus: 1,2,3 etc. Tables should be self-explanatory and bear a short tit le Abbreviations used should be explained in th e legend or a t th e bottom o f th e table. Illustrations should be labelled with th e nam e o f th e firs ta u th o ra n d th e illustration num ber on th e top left-hand corner o f th e back side. References Referencesshould be inserted in th e te x t assuperior numbers, and should be list­ ed a t th e e n d o f t h e a r t ic le in numerical order Donotllstthemalphabetlcally. It is th e author's responsibility to verify references fro m th e original sources. Referencesshould b e s e to u tin th e V a n - couverstyle, and only approved abbrevi­ ations o f journal titles should be used; consulttheJanuaryissueofindexM edl- cus(N Q l,P art1)fo rth e se d e tails Names and initialsof allauthorsshould begiven unless th e re are m ore than six, in which case th e first th re e names should be given followed by ’e t al‘. First and last page num bers should be given eg. 1. NoakesTD. Heartdisease in m arathon runners: a review. Med Sci Sports Exerc 1987;19:198-194. Book references should be set o u t as follows: 19R 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. ) 1. Peterson l , R e n stro m P. S ports Injuries. T h e ir p re v e n tio n and tr e a tm e n t, 1st ed. South Africa: Justa and Co Ltd, 1986. 2. O ldridge NB: Com pliance w ith exercise p rog ram s. In: Pollock ML, S c h m id t DH, eds. H e a rt Disease and R e h a b ilita tio n (ed 2). New York, Jo hn W iley & Sons, 1986:629-646. i f The more practical articles, review articles, papers presented at congress etc, do not need to comply with such strict guidelines" PRACTICAL ARTICLES The m o re p ra c tic a l articles, review a r­ ticles, papers presented a t congress etc, do n o t need to c o m p ly w ith such s tr ic t g uid elin e s — Length L en g th o f th e s e c o n trib u tio n s s h o u ld n o t how ever exceed 5-6 pages ty p e d in d ou b le spacing. All c o n trib u tio n s are to be s u b m itte d in duplicate. Illustrations & Tables BAA/ head & sh ou ld e rs p h o to o f th e author(s) s h o u ld a c c o m p a n y a rtic le Slides & p rin ts , graphs, ta b le s e tc on e ith e r c o lo u r o r B/W w h ich w o u ld c o m ­ p le m e n t th e a rtic le are w elcom ed. Ta­ bles should c a rry Rom an num erals and illu s tra tio n s A rabic n um e rals th u s 1,2,3 e tc References As fo r s c ie n tific a rtic le s SI’ CISTS M IEDICINI S P C R T G G N I iliS K U N D I t ¥ t unutin grr« « * . < # • - / ••ocrT* **•*-«» V'.-.O Mir.K . - Of v ir + u & i H yi a w t - fU 'I H W B J m _ failure coooio win m u n in your name n ir o v w liom trw matting Mn. - - - - - - ' • -• :• :W * ' a f w m > mt'i'. mot ite* . t w o eosc -iX*C";/rcor!L.* I na leti u sou naiaat om cm tedoen. m i unaamouromatie* van ate posiys oew rw w oro □rrmg-Ojr'T-iyiM . . . . . .,, |V, .. n ; P lease N o te : if you have n o t re tu rn e d e ith e r o f th e re p ly paid cards in se rte d in th e tw o p re v io u s e d itio n s o f th e Sports M edicine Journal, y o u r nam e will u n fo r tu n a te ly be re m o v e d fr o m th e m ailin g list. A c t Now! Dear Editor I w o u ld like to re p ly to Clive Noble's editorial c o m m e n t on a lte rn a tiv e m e d i­ cine in th e 1987 Vol. 2 No. 4 issue in w hich he discussed th e Zola Budd saga. I w o u ld like to answ er so m e p o in ts raised by Clive Noble, w ith re sp e c t to th e heel l i f t assessm ent d escribe d in th e a rtic le Firstly, w h a t was n o t m ad e clear was t h a t th e p r a c titio n e r tr e a tin g Zola Budd was a c h iro p ra c to r, and he used a te c h n iq u e called A p p lie d Kinesiology, w hich is th e use o f m anual m uscle te s t­ ing to evaluate b o d y fu n c tio n th ro u g h th e d y n a m ic s o f th e m usculoskeletal system. A p p lie d K inesiology is th e fa s te s t g ro w in g h e a lth system in th e w o rld today, a nd it is e x tre m e ly ac­ c u ra te in assessing s tr u c tu r a l balance. W hen assessing w h e th e r a heel l if t is re q u ire d o r n o t, th e p ro c e d u re is fa r fr o m a h it and m iss m e th o d . Secondly it m u s t be u n d e rs to o d t h a t w h e n th e re is a s h o r t leg on o n e side o f th e body, all th e p o s tu ra l w e ig h t bea rin g muscles on th a t side will te s t weak. This is e xtre m e ly easy to d e m o n s tra te Once all p o te n tia l p ro b le m areas are a d ju s t­ ed and c o rre c te d , f o r example, pelvis, spine, knees and fe e t, c e rta in m uscles will be te s te d on th e side o f th e b o d y w h e re th e s h o r t leg is suspected w ith th e p a tie n t lyin g on his back. W hen all m uscles te s t s tro n g , th e sam e muscles will be re te s te d w ith th e p a tie n t s ta n d ­ ing up. If th e m uscles b e c o m e weak, th e re is in d ic a tio n t h a t th e balancing s u p p o rt o f a l if t is needed. The p a tie n t can be te s te d w ith lifts o f va ry in g h e ig h ts u n d e r th e suspected d e fic ie n t sides, w ith th e in d ic a to r m uscles being re-tested fo r s tre n g th e n in g . W hen th e o p tim u m a m o u n t o f l i f t fo r th e p a ­ t ie n t is fo u n d , all th e in d ic a to r muscles will in s ta n tly s tre n g th e n . F u rth e rm o re , it should be n o te d t h a t tw o ty p e s o f leg le n g th im b a la n c e m ay be p rese nt. One is an a n a to m ic a l and th e second is a physiological. An a n a to m ic a l s h o r t leg re fe rs to a leg ALETTERS t h a t is a c tu a lly a n a to m ic a lly s h o rt w hereas a physiological s h o rt leg jj s h o rt due to a s tru c tu ra l p ro b le m such as a p elvic ro ta tio n . The physiological s h o r t leg w ill re spond to th e norm al c h iro p ra c tic c o rre c tio n a n d th e re will be no n ece ssity f o r a heel lift, except in very, v e ry e x tre m e cases where th e re is a severe p elvic p rob le m , in these cases th e app lica tion o f a heel lift is n o rm a lly o n ly a te m p o ra ry measure to allow th e p a tie n t to re co ve r fro m th e acute phase o f back pain. The usual m uscle te s tin g p ro ce d u re s w ould have been used to e valuate w h e th e r o r n o t th e l if t was necessary. This w o u ld also answ er Clive Noble's s ta te m e n t where he claim s t h a t a n u m b e r o f th e cases tre a te d by Ronald H o ld e r have had s c ie n tific a lly a ccura te ra diolo gica l leg le n g th m e a s u re m e n ts t h a t revealed equal leg lengths. The case t h a t responds b e t te r to th e a p p lic a tio n o f a heel l if t is th e ana to m ­ ical s h o rt leg, w h ic h I can o n ly assume m u s t have b ee n Zola Budd's problem . However, it m u s t be n o te d t h a t n o t necessarily are all anatom ical s h o rt legs tre a te d w ith heel lifts as v e ry o fte n th e b o d y is able to a d a p t and com pensate f o r th is d e fic it. A gain in th is case a leg le n g th d iffe re n c e show ing up on X-rays w ill n o t have th e associated weakness o f m uscle te s tin g , indeed an applica­ tio n o f a heel l i f t in th is case w o u ld be d e trim e n ta l. It m u s t also be p o in te d o u t th a t th e use o f heel lifts is n o t c o m m o n in c h iro p ra c tic and A p plie d Kinesiology. P rob a bly 95% o f all p a tie n ts respond to th e c h iro p ra c tic a d ju s tm e n ts and m uscle b ala ncing p ro c e d u re s and do n o t need a heel lift. One fu rth e r p o in t is th a t we in th e chiro­ p ra c tic p ro fe s s io n fe e l m o s t s tro n g ly t h a t i f rule 92 was d on e away w ith and th e M edical and C h iro p ra c tic p ra c ti­ tio n e rs were allowed to w o rk to g ethe r, th e p a tie n t w o u ld be th e w inner. Yours sincerely D r Frans K r o m h o u t. W h a t d o th e read ers th in k ? Suid-Afrikaanse Sportgeneeskunde Vereniging APPLICATION FORM AANSOEKVORM Full Member/Volle lid R25 Student Member/Studente-lid R5 Name/Naam: ... Address/Ad res: South African Sports Medicine Association Tel No/Tel N r . .............. M A S A N o/M V SA N r . Full Member. M edicalpracm ionerfS vvhoarem em D efsof M.A.S.A Voile Lid: M e d ie s e p ra k tis y n s w a tie d e v a n d ie M V S .A is Student M em ber Medical s tudents m c lin ica l years. S tu d e n te -le d e :M e d ie s o s iu d e n ie in h u ik iin ie s e jare. Applic ations for m em bership of S.A.S M .A s h o u ld b e s e n tto The Secretary. S. A.S.M. A.. Hatfield Forum West. i067A rca d ia S tre e t. Hatfield. P retoria0083 C hequesto a cco m p a n ym e m b e rsh ip lo rm JUNE 1988 VOL 3, NO 2,1 20 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. )