SOUTH AFRICAN JOURNAL OF SPORTS MEDICINE SPORTGENEESKUNDE

JOURNAL OF THE S.A. SPORTS MEDICINE ASSOCIATION TYDSKRIF VAN DIE S.A. SPORTGENEESKUNDE-VERENIGING

National Advisory Board Editor in Chief: VOLUME 7 NUMBER 1 FEB/MARCH 1992 Clive Noble Associate Editors: Prof ID Noakes Dawie van Velden Advisory Board: CONTENTS Traumatology: Etienne Hugo Physiotherapy: Editorial Comment Joyce Morton Health care for the future sportsmen o f South Nutrition: Africa ...... 3 Mieke Faber Biokinetics: Cricket Martin Schwellnuss Epidemiology: Cricket injuries while on tour with the South Derek Yach African team in India - C Smith ...... 4 Radiology: Alan Scher Physiology Notes Pharmacology: Notes on muscle spindles - M Frescura ...... 9 John Straughan

) Physical Education: .

2 Hannes Botha Nutrition 1

0 Internal Medicine: Macro-nutrient intake of various athletes as 2 Francois Relief d reported in the literature - M Faber ...... 11 e t a

d International Advisory Board

( Physiotherapy

r Lyle J Micheli e A review of the McConnell approach to the

h Associate Clinical Professor of s i management of patellofemoral pain - l Orthopaedic Surgery b Boston, USA J Morton ...... 17 u P Chester R Kyle Restriction of ankle and foot movements using e

h Research Director, Sports

t the standard elastic ankle guard - 1 Seels, Equipment Research Associates y J Begley, F Futcher and J Mitchell ...... 20 b

California, USA d e Prof HC Wildor Hollmann t n President des Deutschen News a r Sportarztebundes SASMA News ...... 25 g

e Koln, West Germany c

n Howard J Green e c

i Professor, Department of l

r Kinesiology e

d Ontario, Canada n George A Brooks u

y Professor, Department of Physical JOURNAL OF THE SOUTH AFRICAN a Education SPORTS MEDICINE ASSOCIATION w e 269 WEST AVENUE t California, USA a Neil F Gordon HENNOPSMERE

G VERWOERDBURG, 0157

t Director, Exercise Physiology e

n Texas, USA

i SASMA b Edmund R Burke a Photographs courtesty o f the Image Bank S

Associate Professor, Biology y

b Department, University of

The Journal of the S A Sports Medicine Association is published by Medpharm Publications, 3rd d Colorado Floor Noodhulpliga Centre, 204B HF Verwoerd Drive, Randburg 2194. PO Box 1004, Cramer- e c Colorado, USA view 2060. Tel: (011) 787-4981/9. The views expressed in this publication are those of the authors u and not necessarily those of the publishers. d Graham N Smith o r Physiologist p e Glasgow, Scotland Printed by The Natal Witness Printing and Publishing Company (Ply) Lid R M e d ic A l e r t SPEAKS FOR YOU WHEN YOU CANNOT ) . 2 1 0 2

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FORy MORE INFORMATION, CONTACT YOUR DOCTOR OR PHARMACIST b

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r A PROJECT OF THE LIONS OF SOUTHERN AFRICA p

e PARKE-DAV R EDITORIAL

HEALTH CARE FOR THE FUTURE SPORTSMEN OF SOUTH AFRICA

In order to make progress in any field of number. medicine, research at both clinical and Obviously the level of good health care scientific levels is necessary. Sports for all sportsmen is the most desirable but medicine is in the same situation. Often unfortunately the champions are in an elitist established techniques have to be dis­ category and may well require a higher level carded as newer ones take their place. Ideas of medical skills and investigations. There become out-moded because careful clinical is no way, for example, that a top class or scientific investigation shows that they sportsman with a torn meniscus can and are incorrect. Unfortunately, the newer in­ should have to wait for a hospital bed as is vestigations are often expensive and in the the situation in state social medicine which South African context, they may be too ex­ often happens at the present stage. pensive for the general public. The future holds interesting prospects For example, Magnetic Resonance Im­ for sportsmen and sports medicine. aging (MRI) is utilised worldwide (in the ) . developed countries) as an accurate diag­ Dr Clive Noble, MBBChB, FCS (SA). 2

1 nostic tool in most parts of the body. This Editor-in-Chief 0 2 investigation costs in excess of R1 000 in d e

t South Africa. a

d But it may be necessary, e.g. using the (

r MRI Scan it has been shown that in anterior e h

s cruciate ligament tears of the knee joint, i l

b bone on the lower end of the femur may also u

P be damaged. e Retrospectively arthroscopic surgery, in h t

y itself an expensive technique, has been b shown to make diagnoses of internal de­ d e t rangements of the knee with far greater ac­ n a curacy than before. Not only this but r g surgical treatment through the arthroscope e c

n has markedly reduced the incidence of e c

i osteoarthritic damage to the joint caused by l

r previous open surgical techniques. This will e d cause a tremendous reduction in long term n u

morbidity and the possibility of having an y a expensive total knee replacement in the w e future. t a At the present stage more and more black G

t athletes are joining medical aids and will be e n i able to afford first world medicine. Newer b a legislation may well greatly increase this S y b d e c

u ------3 d SPORTGENEESKUNDE VOL. 7 NO. 1 o r p e R CRICKET

CRICKET INJURIES WHILE ON TOUR WITH THE SOUTH AFRICAN TEAM IN INDIA

C Smith

Keywords: International tour, cricket injuries, physiotherapy.

ABSTRACT

This paper briefly discusses the injuries encountered and their management during the South African Cricket Team's inaugural 8 day tour of India in November 1991. The team consisted of a squad of 14 players and the team physiotherapist. The tour marked the return of South Africa to the international cricket arena after 21 years of isolation. The most commonly injured area was the lower limb (64%) with the bone/ joint structures accounting for 7 (50%) of the injuries. Continued research and interest in this field will contribute towards a better understanding and management of cricket related injuries. ) .

2 INTRODUCTION plex motor skills of the crick­ will in turn have the effect of 1

0 eter (batsman)4 and anthro­ further increasing the opportu­ 2 Cricket is a sport which is pometric profile and body com­ nity to investigate the area of d e t widely played throughout this position of cricketers.5-6 A fair injuries associated with tou­ a d

( country and the world, yet un­ amount of other published ring international teams, as the r

e like running, cycling, swim­ material on cricket injuries al­ research on cricket injuries in h s

i ming or rugby, little research ready exists in the literature, South Africa has, up till now, l b has been done on the varied mostly eminating from Aus­ been confined to domestic u P

aspects of the game. However, tralia.7'12 Even so, very little level.4 The purpose of this e h the last few years has demon­ data has been captured on cri­ brief paper is thus to report on t

y strated a growth of interest in cket injuries associated with the injuries which were en­ b

d cricket which has specifically touring teams with only one countered during the South e t resulted in a recent spurt of publication known to be re­ African Cricket Team's inau­ n a r local paper publications. The ported on this topic.1 gural 8 day tour to India during g

e specific areas looked at include Hopefully, this is changing November 1991 and to form a c n the injuries related to cric­ in South Africa, as its cricket base for further data collection e c i

l ket, ‘•2-3 injuries associated officials have championed and research on cricket injuries r

e with cricket tours,1 the com- South Africa's return to the in this country. d

n international arena with full u membership status in the In­ BACKGROUND y a ternational Cricket Council. w

e Craig Smith, BSc Physiotherapy, t This now means that South Within a day o f deciding that a Bsc (Med) (Hons) Sports Science.

G Africa can embark on tours to the South African cricket team t e other countries and play host to was to tour India for 3 one-day

n UCT Sports Injuries Clinic, i touring countries, increasing intema-tionals, the author was b University o f Cape Town. a

S the exposure o f its players to informed that he was to tour

y international competition. This with the team as physiother- b d e c 4 ------u SPORTS MEDICINE VOL. 7 NO. 1 d o r p e R CRICKET G IV E THEM A SPORTING CHANCE AGAINST PAIN

apist. The next two days were spent at high speed organising equip­ ment and making necessary arrange­ ments before the team met together for the first time. Only one practice was possible before departing for India. On arrival in Calcutta, the first stop, the team had two days to recover, adjust to the culture shock, acclimatise and practise before the first test match. In all, 3 one-day test matches were played with rest days inbetween each match. None of the players presented with any injuries which may have prevented them from playing the first match. Before each practice session and match, the squad went through a warm-up period of jogging, arm loosening exercises and stretching to main-tain or improve their flexi­ bility and prevent further injury. All the players were active partici­ pants in their provincial cricket pro­ grammes and thus did not require )

. any form of exercise to improve 2

1 their state of fitness. In soft tissue injuries... 0

2 FROBEN lOO helps restore early

d patient mobility e INJURIES AND t a TREATMENTS d # Convenient 15 tablet, 5 day ACTION PACK ( r e # Suitable for competitive sportsmen and women h For the purposes of this paper, an s i l injury was defined as any condition b # Effectively relieves pain u which required physiotherapy or P

e medical treatment. Eight of the # Effectively relieves swelling h t players received treatment while 6 y # Peripheral action avoids injury abuse in sport b players did not. The coach received d e

t treatment for his shoulder which n Rx Froben 100 t.d.s. a had been operated on a week prior r g

to departure (not included in the e Also available in suppositories. c data). There were a total of 14 n e c separate injuries which required i l

r treatment. Dividing the injuries e d into anatomical areas, 64% were to n u the lower limbs, 14% to the upper y

a limbs, 14% to the head and neck w

e and 7% to the trunk and back. t Flurbiprofen Flurbiprofen 100mg a There were 7 bone/joint injuries, 3 G

t involving tendons, 1 muscle injury, e n

i 1 ligament injury and 2 soft tissue b

a injuries (bursitis and haematoma). S Four injuries occurred while bat- y BOOTS b

PHARMACEl'TICALS (PTY) LTD d 4 0 Electron Avenue, Isando 1600 e c u d SPORTGENEESKUNDE VOL. 7 NO. 1 5 Your game plan agalnsf pain o r p e R CRICKET

Table 1: Anatomical injury profile other player whose position involved much catching of the Anatomical Site ball sprained the distal inter- Head and neck (14%) 2 Upper limbs (14%) Hand 1 phalangeal joint of the little Fingers 1 finger. His function in the Trunk and back (7%) 1 team necessitated that he play Lower limb (64%) Hip 4 Thigh 1 all games and he was treated Knee 2 with ice, joint mobilisations, Lower leg 1 laser and ultrasound. Ankle 1 Total 14 Two players developed symptoms arising from the Injured Structures cervical spine. One complained Bones/joints 7 Muscles 1 of unilateral headaches with Tendons 3 retro and supero-orbital eye Ligaments 1 pain. This was treated with Soft tissue 2 mobilisations to the upper cer­ Total 14 vical spine and acupressure to relieve pain and tension in the ting, 4 as a result of bowling straining supplementary mus­ surrounding muscles. The and 6 while fielding. One player cles of the same limb. The symptoms were completely was treated for 5 separate second reason is that the venue relieved after 2 days. The other injuries, three players for 2 in­ for the final game was an ath­ player flared up a troublesome juries, and 5 players for a single letics stadium which included a cervical spine injury which injury. Only 1 injury was tartan running track within the had plagued him for a few considered a major injury which field of play. These two play­ years. His injury was related ) . ers fielded near to the boundary 2 prevented the player from to his bowling technique where 1

0 playing again on the tour. for most of the game and thus upon delivery of the ball he 2 The most common site in­ had to, at times, field the ball d would thrust his neck from the e t jured was the hip region where by running on the tartan track. neutral position to right side a d It is proposed that the activity ( 4 injuries occurred. One-player flexion and then sharply back r

e developed a minor psoas bur­ of having to quickly start run­ to left side flexion when re­ h s sitis which was treated with ning and then stop to field the i leasing the ball. He experi­ l b ice, ultrasound and laser. He ball as well as changing direc­ enced pain and tension in the u P

did not request any further tion while using spiked cricket trapezii, levator scapulae and e h treatment for this injury as he boots on the tartan track may rhomboides muscles and which t

y could play again without pain. have lead to the hip injuries was also aggravated by poor b

d The other hip injuries involved involving the psoas and rectus sleeping posture. He too re­ e t two players during the last femoris tendinous insertion

n sponded favourably to spinal a r game, one straining his right sites. mobilisations and soft tissue g

e psoas tendon and left rectus Two hand injuries were ob­ acupressure. c n femoris tendon and the other served. One player received a One of the bowlers presented e c i player his right rectus femoris blow with the cricket ball to his l with a history of mild Scheur- r

e tendon. right hand while batting, re­ mann's disease and complained d

n Two reasons exist to ex­ sulting in an undisplaced crack of lumbar discomfort, stiffness u plain the cause of these inju­ fracture of the base of the sec­ and tension in his low back y a ries. Firstly, both player had ond metacarpal bone. He was muscles. He was treated regu­ w e t other minor injuries involving forced to withdraw from the larly with soft tissue massage a the same limb. These injuries team for the final game and his G and acupressure to relieve the t e may have subconsciously hand was strapped for the muscle tension, spinal mobili­ n i caused the players to compen­ duration of the tour and treated sations and ultrasound. Em­ b a sate for the use of their injured daily with ice, laser and anal­ S phasis was also placed on warm­ y muscles by overexerting and gesics when required. The up back exercises before he b d e c u 6 ------d

o SPORTS MEDICINE VOL. 7 NO. 1 r p e R CRICKET GIVE THEM A SPORTING CHANCE AGAINST PAIN

bowled and stretching his hamstring muscles. Two players had injuries invol­ ving the knee joint. One player received a blow with the ball through the protective padding to the patella femoral joint while the other had a grade 1 medial collateral ligament sprain. Both responded well to treatment. One player was struck on the ankle with the cricket ball resulting in periosteal and su­ perficial soft tissue bruising. He was treated with ice, ultrasound and laser therapy. Another player sustained a slight strain to his calf muscle which was treated with cross-friction massage, ultrasound and laser stimulation. Finally, one other player was struck on the thigh through his padding leading to a superficial haematoma. This too was treated with ice, ultrasound and laser.

DISCUSSION) .

2 In soft tissue injuries... 1

0 FROBEN 100 helps restore early 2 The injuries associated with the patient mobility d

Southe African cricket teams' inau­ t

gurala 8 day tour to India have been # Convenient 15 tablet, 5 day ACTION PACK d ( presented. A total of 14 injuries r

e # Suitable for competitive sportsmen and women

wereh encountered with only eight of s i thel players requiring treatment. % Effectively relieves pain b

Althoughu the tour was brief in dura­ P

% Effectively relieves swelling

tion,e these injuries need to be re­ h t ported to supplement the already # Peripheral action avoids injury abuse in sport y b

existing, yet limited data on cricket d

injuries.e t

n Rx Froben lOOt.d.s. In comparison with other tours a r g

of similar nature, the number of Also available in suppositories. e

injuriesc appear to be quite low. On n e

ac previous tour of 5 weeks to this i l country,1 a total of 40 injuries were r e

incurredd at an incidence of 2,5 in­ n

juresu per player. This tour encoun­

teredy 14 separate injuries at an a

incidencew of 1 injury per player. e t Flurbiprofen 100mg Flurbiprofen

Thisa statistic seems to be a lot lower G

thant the previously documented tour, e

yetn if the incidence of injury on the i

previousb tour is assessed for only a S those players who were injured, A k BOOTS y

b I'HAKMAL'Kl TIl'AI.S IPTY) LTD then it appears closer at 1,8 per

d 4 0 Electron Avenue, Isondo 1600 e c

u SPORTGENEESKUNDE VOL 7 NO. 1

d Your game plan against pain o r p e R CRICKET

Table 2: Physiotherapy treatment modalities viously reported tour's unpub­ lished data,1 showing that 25% Players treated 8 of the injuries resulted from T reatments given 31 batting, 39% bowling and 36% Treatment modalities fielding. The study on cricket Electrical: Interferential 1 injuries during the domestic Ultrasound 9 Laser 9 season3 found that 42% of inju­ Total 19 ries occurred while batting, 33% whilebowling, whileonly 19% Manual: Mobilisations from fielding. Peripheral joints 8 Spinal joints 6 For the 8 players treated, 31 treatments were given using Massage 74 treatment modalities (Table Non-specific 5 Cross-frictions 2 2). The most common modali­ Acupressure 10 ties given were those involving Total 31 manual treatment techniques, Strapping 5 followed by electrical modali­ Ice 14 ties, ice and then strapping Exercises 3 procedures. Injections (Voltaren) 2 Total 24 CONCLUSION Total treatment modalities 74 As cricket in our country can now only go from strength to player. The other point which limbs, 32% to the upper limbs, strength, it is hoped that this ) .

2 needs to be considered is that 20% to the head and 18 % to the data will contribute towards 1

0 this tour was almost one fifth back and trunk. These figures the scientific pool of evidence 2

d the duration of the previous were slightly varied for less that already exists regarding e t tour and only 3 matches in total serious injuries with 27% to the the game. If the standard of a d

( were played. lower limbs, 43% to the upper cricket is to be maintained and r e Table 1 shows that the inci­ limbs, 16% to the head and improved, then so too must the h s i dence of injury was found to 14% to the back and trunk. input from research support l b be greatest in the lower limb What can be inferred from this philosophy. The physical u P

(64%) followed by the head these figures is that the inci­ demands of the game and the e h

t and neck (14%) and the upper dence of injury to the different unnecessary injuries which are

y limb (14%). The trunk and areas of the body encountered so often suffered need to be b

d back were least involved con­ during domestic cricket and minimised, especially when e t

n tributing only 7% of the inju­ while on tour may differ quite competing for ones country at a r ries. The previous cricket tour1 considerably and thus special international level. This can be g

e demonstrated similar results preparation should be made for achieved through player and c n with most injuries occurring in this. These results also suggest coach education, as well as the e c i l the lower limb (46%), followed the need for specific and indi­ medical management team r e by the upper limb (27%), the vidualised programmes to be keeping abreast with the latest d n back and trunk (19%) and the prepared for each player during scientific trends and informa­ u

y head and neck making up 8% the off-season and before em­ tion. Hopefully this short paper a of the injuries. barking on international tours will add to the already existing w e t Stretch's3 data on cricket of any nature. knowledge and also remind us a

G injuries appears slightly differ­ Batting and bowling each not to forget that "the message t e ent and more evenly spread, as accounted for 29% of the inju­ of modern sport is that you n i

b he showed that in serious inju­ ries with fielding making up ignore science at your own a

S ries during the domestic sea­ the remainder (43%). These peril".4 □ y

b son, 30% were to the lower figures compared with the pre­ References on request. d e c u 8 ------d

o SPORTS MEDICINE VOL. 7 NO. 1 r p e R PHYSIOLOGY NOTES

NOTES ON MUSCLE SPINDLES

M Frescura

Did you ever think that volun­ tary muscular movements are driven by a servomechanism similar in many respects to the automatic feedback system employed to control power- assisted steering in a car?1 I shall endeavour in this article to demonstrate such a view point through a brief discus­ sion of the role of muscle spindles. Muscle spindles are muscle sense organs located amongst the fibres of a muscle with an important role in controlling

) muscular movement. They are . 2

1 composed of long thin bundles 0

2 of modified muscle fibres d

e with sensory nerve endings t a attached to a non-contractile d ( central region. Spindles and r e

h main muscle fibres are inner­ s i l vated by independent motor Figure 1: Schematic diagram of muscle showing a muscle b u nerve fibres (Figure 1). spindle and nerve pathways to and from the central nervous P

e The sensory endings of the system (CNS). h t

specialised central region are y b

excited by being stretched. d e Stretching initiates a dis­ stretch reflex. The spindle can be relieved (Figure 4) and no t n charge of nerve impulses to the be stretched either by a stretch further nerve impulses will be a r g central nervous system which in the main muscle as when an discharged. The spindle, in e c produces an automatic con­ extra load is imposed on a effect, is sensitive to the dif­ n e muscle already bearing a ference in length between it­

c traction in the main muscle - a i l

weight (Figure 2) or by a con­ self and the main muscle fibres. r e traction of the contractile By this sensitivity it behaves d n component of the spindle (Fig­ as a misalignment detector for u

y ure 3). The stretch reflex automatic compensation. a M Frescura w mechanism will cause the main Human muscles, in general, e t a Medical Researcher muscle to adjust its contraction can be shown to be under the G appropriately. When contrac­ influence of the stretch reflex t MRC e

n PO Box 19070 tion of a spindle is followed by whenever engaged in steady i b TYGERBERG 7505. a contraction of the main contractions of a voluntary na­ a S muscle, the stretch on the sen­ ture. This invaluable self­ y b

sory region of the spindle will regulating property of a muscle d e c

u ------9 d SPORTGENEESKUNDE VOL. 7 NO. 1 o r p e R PHYSIOLOGY NOTES

Figure 2: A stretched muscle Figure 3: Contraction o f the Figure 4: Contraction o f the main (long arrows) stretches the sen­ contractile spindle ends (short muscle (long arrows) relieves the sory region o f the spindle dis­ arrows) also stretches the sensory stretch on the spindle (short ar­ charging a nerve impulse (dotted region discharging a nerve im­ rows) silencing the nerve impulse. arrow line). pulse (dotted arrow line).

enables it to adjust auto­ steering wheels, shortening of 1. Notes on the physiology of matically to changes in load. It the main muscle to turning of muscle contraction - SAJSM, ) .

2 is the muscle spindle sensor, by the road wheels, with the volume 6, No 4. 1

0 monitoring length differentials spindle sensory ending acting 2. Isometric and isotonic muscle 2

d between itself and the main as the misalignment detector. contractions - SAJSM, e t

a muscle which confers this A subject can demand of his Volume 6, No 5. d (

subconscious self-regulating muscles either a certain limb r e property on our muscles. position or a rate of change of h s i

l During continuous move­ limb position and his demands b u ment, the spindle contracts at will be automatically met by ERRATUM P the desired rate so that its his muscle servo. e h t sensory endings will only be Notes on the

y physiology of muscle b excited if the main muscle does

d REFERENCES contraction

e not keep up with the spindles. t n Contraction of the spindle ef­ 1. PA Merton. In: Readings from a r fectively drives the main SA Journal of Sports g Scientifice American. Freeman: Medicine e San Francisco, 1972.

c muscle by means of the stretch Vol 6 No 4. n e reflex which switches on more c i l

contraction if the rate of short­ r e ening loses synchrony with the d In the last paragraph of n spindle. the above mentioned u

y In summary, the stretch Notes on muscle spindles is article, the word a

w reflex controlled by the spindle the last in a series of three "asynchronously" was e t is an automatic feedback re­ articles written by M Frescura erroneously printed as a

G "synchronously". sponse, a follow up servo­ PhD, Medical Researcher at t e mechanism analogous to MRC, Tygerberg. n i We apologise to our b power-assisted steering in a a readers and the author. S The first two articles in the car. Contraction of the spindle y

b corresponds to turning the series were titled: d e c u 10 ------d SPORTS MEDICINE VOL. 7 NO. 1 o r p e R NUTRITION

MACRO-NUTRIENT INTAKE OF VARIOUS ATHLETES AS REPORTED IN THE LITERATURE

Mieke Faber

Athletes tend to experiment more than 55 % of the energy as marized the nutrient intake of with different dietary regimes carbohydrates while the carbo­ female athletes. She found that to find the optimum athletic hydrate intake of strength ath­ female athletes consumed on diet. There is however, no letes was as low as 40% E. the average 15% protein, 36% evidence that such special die­ Brotherhood4 has summa­ fatand49% CHO. Therewere, tary regimes improve perform­ rized the nutrient intake of however, big variations in en­ ance. Dietary studies have athletes as reported by several ergy distribution between dif­ indicated that there is extreme authors. This summary shows ferent athletes.4 5 When repor­ variability in the dietary in­ that there is a wide range of ting nutrient intakes athletes takes of athletes.1'3 energy intake between athletes. can not be grouped together, Van Erp-Baart et aP stud­ In general they appear to be but each specific activity group ) .

2 ied the nutrient intake of vari­ high energy consumers, al­ should be studied separately. 1

0 ous endurance and strength though some of the energy in­ 2

d athletes. Male athletes had a takes seem to be surprisingly e t mean energy intake ranging low. Endurance athletes con­ CYCLISTS a d

( from 12,1-24,7 MJ/day. Fe­ sume at least 50 kcal/kg/day, r e male athletes had an energy while those involved in inter­ In contrast with the study of h s

i intake ranging from 6,8-12,9 mittent or high power activity Van Erp-Baart etaP who found l b MJ/day. Male endurance ath­ sports consume less than that female cyclists consumed a u P

letes had the highest energy 50 kcal/kg/day. It should how­ high energy diet, another study e h intake while female strength ever, be kept in mind that the reported low energy intakes in t

y athletes had the lowest energy latter athletes can weigh be­ highly trained female cyclists. b

d intake. A protein intake of tween 20 and 50% more than This study reported an energy e t 1,2 g/kg body weight for men the endurance athletes.4 Barr5 intake of 85% of the RDA. n a r and 1,0 g/kg body weight for summarized the nutrient intake Sixty percent of the energy g

e women is recommended. Most of female athletes and she intake was supplied by carbo­ c n of the studied athletes fulfilled came to the conclusion that hydrates, 14% by protein and e c i l these recommendations. Cy­ female athletes consume on the 26% by fat. Normal albumin r

e clists and runners averaged average 2069 kcal. Brother­ levels indicated that the pro­ d

n hood4 summarized that athletes tein intake was 1,1 g/kg body u consume approximately 16% weight in this study was suffi­ y a of the energy as protein (al­ cient to meet the protein needs w e t though in some cases it was as of these athletes.6 Higher en­ a Mieke Faber

G high as 36%E), 36% of the ergy intakes of 26282 kJ per t e Research Institute for Nutritional energy as fat and 46% of the day have been reported in male n i energy as CHO. This is in cyclists. These male cyclists b Diseases a

S Medical Research Council agreement with the values were shown to have a nibbling

y found by Barr5 when she sum­ eating pattern, characterized b d e c u ------11 d

o SPORTGENEESKUNDE VOL 7 NO. 1 r p e R NUTMTKON

by frequent eating and drink­ consumed a diet low in fat (less support normal growth.15 One- ing.7 than 30% E), Faber et aP third o f dancers reported found that body builders con­ having eating problems (self- sumed a diet high in fat (up to reported anorexia nervosa or BODY BUILDERS as high as 46% of the energy in­ bulimia).16 Dancers believe that take). Before a competition carbohydrates are high energy It has been found that body body builders cut down on their foods. The carbohydrates in builders follow a high energy fat intake. Their fat intake be­ their diets are mainly simple diet.8,9 In the study done by fore a competition was as low rather than complex carbohy­ Kleiner et aP the mean energy as 15%-16% E for men and drates. 15 intake of male body builders 13%-14% E for women.9,10 was 5739 kcal, with the highest This high protein, low fat in­ energy intake a very high 19760 take was maintained through ICE SKATERS kcal. However, directly prior the consumption of mostly to a competition body builders white chicken meat, lean fish, Another group of athletes for cut down on their energy in­ egg whites and white tuna whom thinness is a require­ take. The mean energy intake canned in water. Very few ment, are ice skaters. In a of males before a competition body builders consumed red study done on competitive ice was 2347 kcal and that o f fe­ meats or dairy products before skaters it was found that the males 1535 kcal.10 a competition.10 female skaters had a very low Although it has been found Faber et aP reported that energy intake (55% o f the that body builders consume a body builders consume a diet RDA). The lowest energy in­ high protein diet (as high as high in cholesterol due to a high take was a very low 373 kcal 31 % E ),8,9,11 a high percentage egg intake (up to as high as per day. Forty-eight percent of of these athletes supplemen­ 3992 cholesterol mg per day). the females had EAT scores ) .

2 ted their diets with high protein The maximum cholesterol in­ within the anorexic range. 1

0 powders.9,12 Compared to take o f body builders studied These low energy intakes and 2

d other athletes with similar en­ by Kleiner et aP was 9393 mg high EAT scores were not e t ergy intakes, body builders per day. In contrast with this, found in the male ice skaters, a d

( consumed a high protein diet Baldo-Enzi et aln reported a indicating that male and female r e expressed in terms of g protein much lower cholesterol intake ice skaters should be studied h s i per kg body weight. This can in body builders (477 mg). This as separate groups. The author l b of this study concludes that u be explained by the use o f extra lower cholesterol intake was P protein supplements.3 Before also reported before a competi­ this study has shown the need e h

t a competition body builders tion.10 for nutritional education for y follow a higher protein diet competitive ice skaters.17 b

d (34% E for males and 26% E e t

n for females). For the males BALLET DANCERS a r and the females respectively, GYMNASTS g

e these protein intakes equal 2,4 Female ballet dancers con­ c n

e and 2,0 gm of protein per kg sumed too little energy. The Another sport where leanness c i l body weight.10 It has been mean energy intake of female is considered as an essential r e stated that body builders fol­ ballet dancers was 71,6% of requisite is gymnastics. Not d n low an even higher protein in­ theRDA. An alarming 20% of only should she be lean for u

y take months prior to a competi­ the dancers consumed less than practical reasons, but also for a

w tion (40-50% of the energy in­ 50% of the R D A .14 These low aesthetic reasons. In order to e t take).13 energy intakes are not only maintain these low body a

G Conflicting data regarding seen in adult dancers, but also weights young female gymnasts t e the fat and cholesterol intake of in adolescent dancers. Ado­ have reported a low energy in­ n i

b body builders has been repor­ lescent dancers consumed an take of 1552 kcal.18 A group of a

S ted. While Baldo-Enzi et alu average of 350 kcal less each older gymnasts (mean age 19,2 y

b reported that these athletes day than is recommended to years) also averaged a low d e c u

d 12 ------o SPORTS MEDICINE VOL. 7 NO. 1 r p e R NUTRITION

energy intake. Their mean ners averaged a fat intake of runners and sedentary con­ intake o f 1827 kcal per day did 40,8% E (SD = 6,7) for the trols, the study by Nieman et not meet the RDA for energy males and 41,4% E (SD = 5,8) alli indicated that runners con­ intake.19 Gymnasts have re­ for the females. Carbohydrate sumed far less energy as fat and ported to have a lower energy intake expressed in terms of more energy as CHO as the intake than inactive controls, percentage of total energy in­ general population. The male but expressed as kcal/kg body take for the male and female runners averaged 30,9% E fat weight there was no difference runners were 39,8% E (SD = and 51,8% E CHO while the between the gymnasts and 7,7) and 39,5% E (SD = 6,9) females averaged 32,0% E fat controls.20 Their energy dis­ respectively.23 These high fat and 52,7% E CHO. These tribution has been reported to intakes were confirmed by lower fat intakes and higher be 15,3% E protein, 47,7 % E Manore et aP5 in female run­ CHO intakes by runners were CHO and 36,0% E fat.18 This ners, but they found that the confirmed by a later study.26 kind o f energy distribution was female runners had a slightly Cholesterol intake for males as also found in a group o f high higher CHO intake of approxi­ well as females fell below the school gymnasts.21 The young mately 50% E. Deuster et aP4 recommended maximum of female gymnasts studied by reported an even higher CHO 300 mg per day.18,26 The cho­ Benardot et aP2 reported a intake of 55 % E in highly trained lesterol intake and the intake slightly higher carbohydrate female runners, accompanied of saturated fatty acids of the intake (approximately 53% E) by a lower fat intake o f 32 % of runners were much lower than and a slightly lower fat intake the energy intake. Kirsch et aV the cholesterol and saturated (approximately 32% E). There not only confirmed the higher fatty acid intake o f the average was however, a wide variation energy intake in runners as American population.18 in CHO intake, ranging from compared to sedentary con­ When asked about the 97,7 to 377,8 g/day. Only two trols, but they also found that changes that they have made in ) .

2 o f the gymnasts did not meet cyclists have a higher energy their diets since they have 1

0 the RDA for protein. intake than runners. The total started running, the runners 2

d energy intake o f the runners stated that they consumed e t and cyclists exceeded the basic more fruits, vegetables, whole a d

( RUNNERS metabolic rate of 103% and grains, poultry and fish and r e 250% respectively. Although less red meat, eggs, salt and h s i Runners reported significantly the study of Nieman et alli fats.18 The high fibre intake by l b higher total energy intake than confirmed the higher energy highly trained runners reflected u P

sedentary controls. The male intake in runners (2526 kcal for the consumption of large quan­ e h males and 1868 for females) as tities of fruits and vegetables.24

t runners averaged an energy

y intake of 2950 kcal while the compared to the average popu­ Although none o f the runners b

d female runners averaged 2386 lation, these differences were studied by Manore et aP5 were e t

n kcal per day.23 This range of very small, especially for men vegetarians they generally a r energy intake by female run­ (4% for men and 16% for consumed less than 3 oz of g

e ners were also reported by women). However, their en­ meat, fish or poultry per day. c n Duster et aP4 The leaner run­ ergy intake fell below the levels In a study done on the feeding e c i l ners consumed 40-60% more recommended by the Food and patterns of endurance athletes, r

e kcal/kg than the fatter controls. Nutrition Board for men and it was found that runners d

n The increased calorie intake by women doing light work (2700 showed a nibbling pattern, u and 2000 kcal respectively). characterized by frequent eat­ y runners appeared to be primar­ a ily from fats and carbohydrates, Energy intake, expressed in ing and drinking.7 w e t however, expressed in terms terms of kcal per kg bodyweight a

G of percentage energy distribu­ increased with an increase in t e tion, there was no difference km run per week.18 Although SWIMMERS n i

b between the carbohydrate and Blair et aPi as well as Pate, et a

S fat intake of the runners and the aP6 could find no difference in Young female swimmers con­ y energy distribution between sumed 21,5% more energy than b sedentary controls. The run­ d e Continued on page 16 c u ------13 d

o SPORTGENEESKUNDE VOL. 7 NO. 1 r p e R [S3] Relifen 500 tablets 500 mg nabumetone. Reg no R/3.1/265 ) . 2 1 0 2

d e t a d (

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e h t

y b

d e t n a r g

e c n e c i l

r e d n u

y

a When your patient’s in pain, your first nabumetone, a non-steroidal anti-inflammatory, w

responsibilitye is to take away that pain. Quickly. proven in numerous double blind studies to be as t

Effectively.a effective as other benchm ark N SA ID s. Yet its G

t But doing so could lead to unacceptable gastro­ route of action is totally different. e n

intestinali side effects and combination therapy. Relifen is a non-acidic pro-drug. In the b

a But now, ten years of precisely targeted stomach, it is relatively inactive. It is absorbed S

moleculary research have produced a highly effective, from the duodenum, into the portal blood supply b

non-acidicd anti-inflammatory. Finally, in the liver, it is metabolised into a potent e c Relifen. Each tablet is made of 500 mg inhibitor of prostaglandin synthesis. u d o

Referr package insert for full prescribing information. Further information is available from our Medical Department. Smith Kline Bcecham Pharmaceuticals P O Box 347 Bergvlci - p e R Relieving his pain is pretty sporting of you, old chap. But do you have to get him high on acid? ) . 2 1 0 2 d e t a d ( r e h s i l b u P e h t y b d e t n a r g e c n e c i l r e d n u

y The active metabolite penetrates the synovial a fluid to reach the inflamed site, giving effective relief w e t of s\ mptoms. a G

Excretion is by the kidneys, so gastro- t e •nti stinal damage through biliary recirculation and n i

b reflux is unlikely. a S

For effective relief from pain and inflammation, y b with less chance of gastro-intestinal discomfort, you

d SB e now have an ideal choice. Relifen. c B e e c h u d ^ " "''-I tin- SB logo art- trademarks. Phar^ ceuZ% *m o r p e R NUTRITION

sedentary controls. The swim­ bution was 15,5% E protein, ues reviewed by Brotherhood mers consumed 2468 kcal per 46,8% E CHO and 38,6% E (1984). In this review the die­ day.27 This kind of energy fat.28 tary intake of shotputters (as intake was confirmed by a reviewed by Sal tin) and discus study done by Tilgner and throwers (as determined by Schiller28 who found that VOLLEYBALL PLAYERS Ward et al) are reviewed. The swimmers consumed 2493 kcal energy intake of these athletes which was also higher than the The dietary intake of female was higher than that reported energy intake of non-athletes. high school athletes between by Short and Short.1 The In a later study however, it was the ages of 13 and 17 was shotputters averaged an ener­ found that swimmers did not determined. Eighty-one per­ gy intake of4300 kcal while the have a higher energy intake as cent of the athletes indicated discus throwers averaged an compared to inactive controls.20 a concern with their weight, energy intake of 4663 kcal. Percentage energy distribution while 73% wanted to loose Where the track and field ath­ was similar for the swimmers weight. That might be why letes as studied by Short and and the controls namely 49 % E they averaged a low energy Short1 consumed a diet that to 54% E carbohydrate, 33 to intake o f 1799 kcal (84 % of the fulfilled the requirements for a 35% E fat and 12 to 15% E RDA). Their energy intake prudent diet,32 the throwing field protein.27-28 was lower than other teenage athletes consumed a diet that girls in the United States. Food was high in fat (44% for the consumption analysis showed shotputters and 40% for the BASKETBALL PLAYERS that of total servings, the milk discus throwers) and low in and meat groups accounted for CHO (42 % for the shotputters Male basketball players only about 10% each and that and 39% for the discus throw­ averaged a daily energy intake more than 30% came from the ers). ) . of 3558 kcal while female bas­ "others" group.30 2

1 ketball players averaged a 0 2 daily energy intake of 1730 SUMMARY d e t kcal. Both males and females FIELD ATHLETES a

d averaged similar energy distri­ It is therefore clear that there is (

r butions. The energy distribu­ One study reported the macro­ a wide variation in the macro­ e h

s tion for the males was 17% E nutrient intake o f male field nutrient intake o f athletes. i l

b protein, 34% E fat and 48% E athletes. They averaged an When studying the nutrient u

P CHO while that of the females energy intake of 3528 kcal. intake o f athletes it should e

h was 16% E protein, 32% E fat They had an energy distribu­ always be kept in mind that t

y and 52% E CHO. Protein was tion of 13% E protein, 28% E conflicting results have been b generally higher than neces­ fat and 55% E carbohydrates.1 reported for some athletes. It d e t sary. Some of the men had It should, however, be kept in should also be kept in mind that n a very high cholesterol intakes mind that these field athletes the athletes diet before a com­ r g (as high as 1482 mg per day). were grouped together with petition may differ from the e c

n Both men and women had track athletes. It was also not usual eating pattern. Brother­ e c

i low fibre intake. This reflected state whether the field ath­ hood (1984) summarized the l

r the limited consumption of letes were jumpers or throw­ nutrient intake of various ath­ e d whole grains, fruits and ers. This is important to keep letes and came to the overall n u

vegetables.29 in mind since, although no die­ impression that national die­ y a tary differences have been re­ tary customs have the pre­ w e ported, it was found that these dominant influence on the ath­ t a HOCKEY PLAYERS athletes differ in anthropomet­ letes' diet. He came to. the G t ric measurements.31 The die­ conclusion that there-is no evi­ e n i Field hockey players aver­ tary intakes o f throwing field dence that athletes follow a b a aged a daily energy intake of athletes might be more accu­ more healthy diet than less S

y 1956 kcal. Their energy distri­ rately displayed by those val­ active people. □ b d e c

u 16 ------d SPORTS MEDICINE VOL. 7 NO. 1 o r p e R PHYSIOTHERAPY

A REVIEW OF THE McCONNELL APPROACH TO THE MANAGEMENT OF PATELLOFEMORAL PAIN

Joyce Morton

If one asked a number of phys­ pain, but by patients with medial side. iotherapists of the ways in chronic anterior knee pain. Should there be any mal­ which they treat Chondromala­ Chronic, needless to say, be­ alignment of the patella caus­ cia Patellae or Patellofemoral cause it takes so long to get an ing altered mechanics, then the pain, their answers would be appointment. patella cartilage is at risk to varied from mobilization of the injury. patella, quadriceps strengthe­ The physiotherapist divides ning exercises either isotonic BIOMECHANICS OF THE her examination into two parts. )

. or isokinetic, faradic stimula­ PATELLOFEMORAL The first is the subjective ex­ 2

1 tion of the vastus medialis, JOINT amination where the patient's 0 2

electrical modalities such as pain is identified and its be­ d e laser and ultrasound, ice or The normal patella with the haviour pattern is noted. Past t a specific muscle stretching. As knee fully extended, lis later­ and present history is included. d ( the aim of all physiotherapy ally and does not touch the The patient's shoes and sports r e

h treatment for this condition is femoral condyles. As the tibia shoes must routinely be exam­ s i l to achieve a full range and pain flexes on the femur, the patella ined for any abnormal strike b u free function of the joint, if any moves medially and at 45 de­ pattern. P

e of the above modalities achieve grees the maximum surface In the objective examination h t this, then the aim of treatment contact with both femoral many factors are taken into y b

has been meet. However, if condyles is made within the consideration including obser­ d e this is not the case and the trochlear notch. As the knee vation of the patient standing, t n McConnell approach is not continues to flex, the patella walking and running. One is a r g

known to you, then you may again moves laterally so that at looking at the alignment o f the e c find the following of interest. full flexion the lateral femoral lower limb, foot posture and n e

c Jenny McConnell, an Aus­ condyle is covered by the pa­ structure, the tibia-femoral joint i l tralian sports physiotherapist, tella. The femur and patella are and the patella-femoral joint. r e

d first advertised her approach in separated by the articular The patellofemoral joint n

u the mid 1980's. It has subse­ cartilage of the patella. reaction force is the force cre­ y quently become popular The patella is stabilized by ated when the patella is pressed a w throughout a greater part of the the quadriceps tendon above, against the femur. This force e t a physiotherapy world. I was the patella tendon below, the increases with flexion of the G amused to discover how much

t lateral retinaculum, vastus knee from 0.5 times the body e

n it is used by the British physio­ lateralis and the iliotibial tract weight in walking to 3-4 times i b therapists in the NHO. Not, on the lateral side and by the the body weight when ascend­ a S obviously, by too many sports­ medial retinaculum and the ing or descending stairs and y b men and women with acute vastus medialis oblique on the 7-8 times the body weight dur­ d e c u

d ------:------17 o SPORTGENEESKUNDE VOL. 7 NO. 1 r p e R PHYSIOTHERAPY

ing squatting. Pain and joint stances they are equidis­ range is carefully noted during tant. the testing of these move­ ments as they are most likely to 4. Patellar Rotation can be be painful. calculated using the infe­ As it is possible that the rior pole of the patella as pain may be referred from the the guide. If the pole moves mid lumbar spine, this too is medially the patella has assessed. Tightness of struc­ rotated internally and if the tures are checked and include pole moves laterally then rectus femoris, iliotibial band, the patella has rotated ex­ hamstrings, gastrocnemius and ternally. soleus. The normal Tibia- femoral examination as well as Finally the quadriceps muscle all movements of the patella- itself is examined with particular Taping technical to control patella femoral joint are moved pas­ emphasis on Vastus Medialis lateral glide, medial tilt and internal sively and compared to the Oblique. Vastus Medialus rotation. other leg. The fact that the consists of two parts. The proxi­ medial plica may cause symp­ mal has large fibres directed toms must not be forgotten. vertically and only deviating Other clinical evaluations 15 to 18 degrees from the long tella due to tight deep are carried out including meas­ axis of the femur. The distal lateral retinacular fibres. urements of the following with part named Vastus Medialis the knee fully extended and Oblique (VMO) has smaller 3. An incorrect rotation of the relaxed: fibres which are more horizon­ patella associated with a ) .

2 tal, deviating 50 to 55 degrees weak VMO. 1

0 1. The Q angle. This is the from the femoral axis. They 2

d intersection of a line drawn form the bump readily seen and Her treatment consists of e t from the anterior superior palpated when the quadriceps mobilization to stretch the late­ a d

( iliac spine through the contracts strongly with the leg ral retinaculum, physiotherapy r e middle o f the patella, and a in full extension. The VMO modalities for pain, stretching h s i line drawn from the tibial muscle is also seen on dissec­ of tight structures and re­ l b tubercle through the middle tion , to originate partially from training of the VMO. At the u P

of the patella. The normal the adductor longus muscle and same time, the patient is taught e h angle is between 13 and 15 the adductor magnus tendon.

t to strap his patella in such a

y degrees. Greater or lesser Although there are numer­ way as to correct abnormal tilt­ b

d degrees may be the cause ous factors such as an incorrect ing, rotation and gliding. The e t of patella cartilage degen­ n Q angle which may create car­ tape is applied very firmly and a r eration. tilage trauma leading to Patel- is kept in position for a few g

e lofemorral pain or Chondroma­ hours a day. Longer may cause c n 2. The Patellar Glide is the lacia patellae, Jenny McCon­ breakdown of the skin. e c i l passive movement of the nell postulated that the reasons Finally the VMO is trained r e patella either laterally or may also be: to contract first in a non-weight d n medially. bearing programme of exer­ u 1. A lateral gliding of the pa­ y cises. The instruction to the a 3. The Patellar Tilt is the tella due to tightness of the patient is to tighten the medial w e t comparison of the height of lateral structures such as quadriceps by using the ad­ a

G the medial facet of the pa­ the iliotibial band and the ductors isometrically with t e tella to the lateral facet of lateral retinaculum and a extension of the knee and slight n i

b the patella in relationship weak VMO. external rotation of the hip. a

S to the underlying femur. Training is then progressed to y Under normal circum­ 2. A lateral tilting of the pa- b weightbearing with the knee d e c u 18 ------d

o SPORTS MEDICINE VOL. 7 NO. 1 r p e R PHYSIOTHERAPY SUBSCRIPTION TO SPORTS MEDICINE

flexed to 30 degrees, the body weight over the foot and the foot itself in mid Dear Doctor, position but slightly supinated. It is ex­ tremely difficult to train this muscle The characteristic that distinguishes a profes­ without contracting vastus lateralis. By sional from an educated person is the professional flexing the hip, rectus femoris is partly person's desire and responsibility to stay abreast inhibited. For this reason the exercises of the development of his or her field of expertise. are first done in sitting position. The halflife of our professional knowledge is Once the patient can successfully about 3 years, and for this reason it is vitally contract and hold the contraction of the important to continuously refresh and supplement VMO with 30 degrees of knee flexion, our knowledge. the exercises are progressed to 75 de­ Sports Medicine, the official mouthpiece of the grees knee flexion, then half squatting, SA Sports Medicine Association, has over the three quarter squats and stairs with the years become a treasured source of knowledge muscle working both concentrically and for the health care professional in the sports eccentrically. Finally functional exer­ medicine arena. The journal features not only cises are performed while concentrating original research papers and articles by leading on contracting the VMO. specialists in sports medicine, but also current Physiotherapists are often accused of news and relevant abstracts. lack of research and although this is Your subscription to Sports Medicine is an often true, in this case, on perusal of the investment in your future of the health care literature, there seems to be adequate profession. We count on your continued support. evidence to support the success of this type of treatment as one way of dealing with Chondromalacia Patellae. A clini­ ) . Name: 2 cal trial of the McConnell Programme 1

0 for 116 patients produced excellent to 2 Address: d good results within five treatments of 86 e t percent of patients and these results were a d

( maintained for one year after cessation r e of the treatment. Sceptics will argue that h s

i it is impossible to alter patella tracking l b by taping. However it is seen in the u

P C ode:...... Tel: literature that the taping must be part of e h the programme in order to obtain good t

y results. b

d The subject of the McConnell ap­ Enclosed please find my cheque/postal order e t payable to SASMA for:

n proach to the management of Chron- a r dromalacia Patella, is on the programme g

e of the forthcoming congress of the Inter­ • R75 for FULL MEMBERSHIP to SASMA c n national Federation of Manipulative (This includes receiving Sports Medicine e c i free o f charge). l Physical Therapists to be held in Amer­ r e ica this year. I look forward to hearing • R75 for ASSOCIATE MEMBERSHIP to d n the outcome of the papers presented SASMA u there. If anyone would like more infor­ (This includes receiving Sports Medicine y a mation about the McConnell approach free o f charge). w e t contact The Chairman, Sports Interest • R50 for STUDENT MEMBERSHIP to SASMA a (This includes receiving Sports Medicine free G Group, South African Society of Physio­ t e therapy, 7 Nyala Road, Amanzimtoti of charge). n i 4125. • R27,50 + VAT (R30,25) for subscription to b a Sports Medicine. S

y References on request. b d e c u ------19 d

o SPORTGENEESKUNDE VOL. 7 NO. 1 r p e R PHYSIOTHERAPY

RESTRICTION OF ANKLE AND FOOT MOVEMENTS USING THE STANDARD ELASTIC ANKLE GUARD

I Seels, J Begley, F Futcher and J Mitchell

ABSTRACT

A pilot study was conducted to compare the range of movement of ankle dorsiflexion and plantarflexion, and foot inversion, without and with the use of a standard elastic ankle guard. A sample of nine normal, healthy, physically active, Caucasian males, aged 19 to 21 years, with no history of ankle injuries, was used. The results of this study showed no significant differences (p = 0,05) between the ankle and foot movements performed without and with the use of the ankle guard in any of the basic movements measured. It was concluded that the standard elastic ankle guard does not significantly restrict these movements and, therefore, is not effective for this purpose in the preven­ tion and/or rehabilitation of ankle injuries. ) . 2 1 0 2 d e t a d ( r e h s i INTRODUCTION frequently seen.1'7 In the re­ normal basic ankle and foot l b habilitation of such injuries, movements of dorsiflexion, u P

The increased participation in patients are often advised to plantarflexion and inversion in e h various sporting activities to­ use the standard elastic ankle physically active subjects, t

y day's society is concomitant guard. This regime of therapy without and with the use of a b

d with an increase in sport-re­ implies that the ankle guard standard elastic ankle guard, e t has a dual function: to prevent with the aim of establishing its

n lated injuries. Ankle injuries, a r particularly lateral ligament excessive movement so as to effectiveness in the rehabilita­ g

e complex sprains, are the most promote healing during the tion/prevention of ankle inju­ c n initial stages of rehabilitation, ries. e c i l and to prevent excessive r e movement on return to normal d

n sporting activities, thereby MATERIALS AND u Jeanette Mitchell preventing a recurrent injury. METHODS y a However, the question arises: w e Department o f Physiotherapy t does the ankle guard suffi­ Sample selection a University o f the Wirwatersrand

G ciently restrict the basic ankle

t Medical School e and foot movements and en­ To obtain the sample for this n 7 York Road i hance ankle stability? study, questionnaires were b Parktown a

S This pilot study was designed distributed to 75 Caucasian JOHANNESBURG 2193 y to measure and compare the males between the ages of 19 b d e c

u 20 ------

d SPORTS MEDICINE VOL. 7 NO. 1 o r p e R PHYSIOTHERAPY

and 21 years, randomly selected from third-year medical and allied medical classes at the University of the Witwaters- rand, Johannesburg. Of the 48 questionnaires returned, 22 indicated that the subjects were healthy and physically active, with no previous ankle inju­ ries. However, only 15 of these subjects were prepared to participate in the study. On examination of their ankles, it was found that a further six subjects had to be eliminated Figure 1: Neutral position of ankle and foot due to above average ankle circumference (the range ac­ cepted for this study was 17- 23 cm) (n = 2) and hypermo- bile ankle joint movements (n = 4). The final sample con­ sisted of nine subjects, with an average age of 20,4 years. Informed consent was obtained from each of the subjects prior ) .

2 to commencement of the study. 1 0 2 Testing procedure d e t a d

( The subjects were each tested r

e in three sessions: h s i l b • Session I Figure 2: Measurement of ankle plantarflexion u P

Each subject followed a e h warm-up programme con­ t

y sisting of cycling on an b

d exercise cycle for three e t minutes at a speed of 120 ankle and foot movements possible cross-contami­ n

a on the dominant side. These nation of undetected skin

r revolution per minute and g

were ankle dorsiflexion, infections and to ensure

e a workload of 400 kilopond- c ankle plantarflexion, and ease of application of the n metres per minute. There­ e

c inversion of the foot, each ankle guard. The guard i after, the muscles of the l r posterior and anterior of which was measured. was applied according to e

d the manufacturer's speci­

n compartments of the domi­

u • Session 2 fications and each subject nant leg were stretched for y again performed the re­ a 30 seconds each. The foot The following day, each w quired ankle and foot move­ e subject participated in

t was passively circumduc­ a ted for the same period and the same warm-up pro­ ments, as above. G

t gramme. The dominant

e then placed in a warm foot n foot was dried well and • Session 3 i bath for up to 30 seconds, b a after which the subject powdered with a fungicidal The same procedure as that S powder to prevent any of Session 2 was repeated y performed the required b d e c u ------21 d SPORTGENEESKUNDE VOL. 7 NO. 1 o r p e R PHYSIOTHERAPY

the following day.

Measurement procedure

All measurements were taken with each subject reclining in the half-lying position on a plinth. The dominant leg was flexed at the hip and knee and the leg supported below the knee on a re-education board, on a stool. The neutral position of the limb as regards rotation at the hip or knee was main­ tained by applying manual Figure 3: Measurement of ankle dorsiflexion pressure to the leg just above the ankle. Prior to each meas­ urement, the neutral position of the ankle and foot was deter­ mined using an L-shaped alu­ minium piece, strapped to the foot with non-elastic adhesive tape, and an adjustable triangle (Figure 1). The following movements ) . were then measured three times 2

1 and the mean value obtained: 0 2 d e

t • Plantarflexion a

d The maximum plantarflex­ (

r ion of the ankle joint was e h

s measured using the adjust­ i l

b Figure 4: Measurement offoot inversion able triangle as shown in u

P Figure 2. e h t

y D egrees • Dorsiflexion b 50 In order to measure the d e t maximum dorsiflexion of n 40 a the ankle joint, a right- r g angled foot board was e 30 c

n placed against the sole of e c i 20 the foot and the subject was l

r asked to perform the move­ e d 10 ment. The distance be­ n u

tween the footboard and y 0 a Dorsiflexion Plantarflexion Inversion the upper end of the L- w e Movements shaped aluminium piece t a was measured (Figure 3).

G S e ssio n 1 S e ssio n 2 S e ssio n 3 HM9 CZH t The degree of dorsiflexion e n i was then calculated using

b Figure 5: Ankle and foot movements a trigonometric ratios, viz. S

y sin 0) = opposite side/ b d e c

u 22 - - — — - d SPORTS MEDICINE VOL. 7 NO. I o r p e R PHYSIOTHERAPY

Table 1: Ankle and foot movements ence (p = 0,05) between the ankle and foot movements per­ Dorsiflexion Plantarflexion Inversion formed with and without the A B C A B C A B C use of the ankle guard. Neither was there a significant differ­ Sample mean 17,9 17,6 18,6 41,8 40,2 41,7 35,4 36,8 34,2 ence between those move­ (degrees) ments performed during Ses­ S.D. 4,0 4,9 4,1 2,0 2,5 1,9 4,3 9,0 7,9 sions 2 and 3. (degrees)

DISCUSSION AND CONCLUSIONS

Comparison of ankle and hypotenuse. measurement procedure was foot movements during statistically analysed using the Sessions 2 and 3 • Inversion Wilcoxon signed-rank test, to Because the inversion in- establish if there was a signifi­ The fact that no significant dif­ j ury of the lateral ligament cant difference (p = 0,05) be­ ference was shown between complex of the ankle oc­ tween the various ankle and any of the ankle and foot move­ curs most often when the foot movements with and with­ ments performed during Ses­ foot is rotated inwards while out the use of the ankle guard sion 2 and Session 3 indicates in plantarflexion, this posi­ (Sessions 1 and 2). The data that there was no demonstra­ tion of the foot and ankle collected in Session 3 were ble change in the state of the was taken to represent in­ similarly compared with that ankle guard during the period ) . version for the purpose of from Session 2 (both involving that these measurements were 2 1

0 this study. In order to the use of the ankle guard) to taken. 2 measure inversion of the establish if there was any sig­ d e t foot, the subject's heel was nificant change in the degree of Comparison of ankle and a d placed on an A5 sheet of ankle and foot movement which foot movements with and ( r paper and a movable lamp may have been attributed to e without the use of the ankle h s positioned so that the light changes in elasticity of the ankle guard i l b cast a sharp image of the guard with time and use. u P

arm of the L-shaped alu­ The fact that there was no sig­ e h minium piece on the paper. nificant difference demonstra­ t

y The subject first plantar- RESULTS ted in dorsiflexion, plantar­ b

d flexed the ankle and a line flexion or inversion movements e t was drawn along the sha­ The means and standard de­ of the ankle and foot, without n a dow on the paper. The foot viations for the sample (N = r and with the use of the ankle g was then inverted and a e 9), for each of the ankle and guard, suggests that the stan­ c n second line drawn over the foot movements (dorsiflexion, dard elastic ankle guard does e c i shadow (Figure 4). The plantarflexion and inversion) not restrict these basic move­ l r angles made between the are shown in Table 1. The data e ments significantly. These d two lines were measured, obtained for the movements n findings concur with those of u using a protractor. This performed without the ankle M alina, e ta l( 1962)8, Myburgh y a measurement was taken guard (Session I) and for & Vaughan (1984)9, Myburgh, w e t as the degree of inversion movements with the ankle guard et al (1984)10 and Rarick, et a of the foot in each subject. worn (Sessions 2 and 3) are a /(1962).11 G t

e shown in Table 1 and Figure 5. This implies that the pre­ n i Data management On statistical analysis of sumed function of the ankle b a these data, it was found that guard, that is to prevent or re­ S

y The data obtained by this there was no significant differ- strict excessive ankle and foot b d e c u ------23 d SPORTSGENEESKUNDE VOL. 7 NO. 1 o r p e R PHYSIOTHERAPY

movements, is not effectively ACKNOWLEDGEMENTS treated ankle sprains. Amer J carried out. Therefore, this Sports Med, 1977; 6: 248. 3. Garn SN & Newton RA. Kinaes- pilot study concludes that the The authors would like to thank thetic awareness in subjects with standard elastic ankle guard the subjects who participated multiple ankle sprains. PliysTher, cannot be used effectively for in the study, as well as Mr B 1988; 68(11): 1667-1671. this purpose in the rehabilita­ Seels and Mr J Crawford for 4. Glick JM, Gordon RM & Nishim- ito D. The prevention and treat­ tion of the common ankle inju­ suggesting the means to ment of ankle injuries. Amer J ries nor in contributing to the measure and record the ankle Sports Med, 1976; 4: 136-141. prevention of recurring ankle and foot movements studied. 5. Gross MT. Effects of recurrent sprains. This study was approved by the lateral ankle sprains on active and passive judgements of joint posi­ However, a possible role of Committee for Research on tion. Phys Ther, 1987; 67(10): the elastic ankle guard may be Human Subjects, University of 1505-1509. to assist in the control of post­ the Witwatersrand, Johan­ 6. Kay DB. The sprained ankle: Cur­ trauma swelling in the initial nesburg. rent therapy. Foot ankle, 1985; 6(1): 22-28. stages of rehabilitation. Fur­ 7. Lassiter TE, Malone TR & Garrett thermore, the ankle guard may WE. Injury to the lateral ligaments supplement proprioception by of the ankle. Ortliop Clinics N REFERENCES stimulating sensory receptors Amer, 1989; 20(4): 639. 8. MalinaRM, PhagenzLB& Rarick around the ankle, hence mak­ 1. Balduini FC, Vegso JJ, Torg JS & GL. The effect of exercise upon Torg E. Management and reha­ ing the patient more aware of measurable supporting strength of bilitation of ligamentous injuries to the injured body part, and con­ cloth and tape ankle wraps. Res the ankle. Sports Med, 1987; 4(5): Quart, 1962; 34(2): 158-165. sciously try to prevent exces­ 364-380. sive movement and possible 2. Brand RL, Black HM & Cox JS. further injury. The natural history of inadequately Other references on request ) . 2 1 0

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3mbH,u Germany. side effects and precautions are available on request. d o r p e R SASMA NEWS

THINK GLOBALLY, ACT LOCALLY

Prof Tim Noakes President SASMA

cine has a common origin: A gists, Psychologists, Exercise At present the challenges and group of enthusiastic doctors/ Scientists, etc. The result is opportunities for the develop­ athletes get together to discuss that Sports Medicine in those ment of Sports Medicine in this how their hobby (sport) relates countries has achieved credi­ country have never been grea­ to their profession (medicine). bility amongst the scientific ter or more exciting. For most of these enthusiasts, and academic communities and AsofMarch 1992, the South their interest in sports medi­ is moving rapidly to being ac­ African Sports Medicine cine is peripheral to how they cepted as a medical speciality. Association will be invited to earn their livings in medicine. In addition because the Asso­ become a full member of the Two different models of ciations have evolved princi­ International Federation of Sports Medicine Associations pally to aid athletes not doc­ Sports Medicine (FIMS). It is have evolved at least in the tors, they have also gained the a tribute to our former Presi­ West, with a third possible credibility and support of the dents, Drs Clive Noble, Etienne model arising in Eastern Eu­ athletes. Hugo and Dawid van Velden rope. The third model is that pro­ that finally we have achieved In the first, the Association vided by the former Eastern

) this breakthrough. Of related is more of a "club" with an European countries, in particu­ .

2 interest is the invitation to Dr exclusive membership. The lar the former East Germany 1 0

2 Martin Schwellnus to serve as principal function of the "club" (German Democratic Republic

d the African representative on seems to be to insure that the -GDR). In that country, Sports e t a the Educational Committee of interests of its members are Medicine thrived not so much d (

FIMS. This provides an im­ served; the service that the because of a strong scientific r e portant opportunity for our "club" offers to the athletes is background, but because it was h s i l Association to be of assistance entirely peripheral to its role in the political mission of that b

u to the development of Sports satisfying the needs o f its country to succeed in sport. As P

e Medicine throughout Africa. members. Such organizations a result whatever resources h t

The other source of excite­ are not likely to gain either necessary to achieve that goal y

b ment is the possibility of academic credibility or the sup­ were dedicated to that pur­ d

e Olympic and other internatio­ port of their countries' athletes. pose. The end result was that, t n nal competition in the near This model is a recipe for dis­ of all countries, it was probably a r

g future and the demands and aster and must be avoided at all the athletes from the GDR and e

c opportunities that will arise as costs. other East European countries n e a result. The second model is the who received the most scien­ c i l

type exemplified by what has tific and medical support. r e happened in the United States The basis for a successful d n t h e c u r r e n t and Canada. In these coun­ Sports Medicine programme is u

y POSITION OF SPORTS tries, Sports Medicine has the right combination of the a

w MEDICINE IN SOUTH evolved with a very strong sci­ following factors: dedicated e t AFRICA COMPARED entific and clinical background practitioners who are commit­ a G

TO OTHER SIMILAR led by persons who are re­ ted to the help of athletes; a t e COUNTRIES spected as leaders in their strong scientific basis for the n i b medical fields either as Ortho­ work so that academic credibil­ a S

In all countries, Sports Medi­ paedic Surgeons, Cardiolo­ ity can be achieved; a basis for y b d e c ------25 u SPORTGENEESKUNDE VOL. 7 NO. 1 d o r p e R SASMA NEWS

professional sport so that doc­ still needs to be done. promote our speciality to tors can be employed full-time the benefit of all in this in the profession; and political Negative factors country. will that sport is important to the national interest. • There is no official national Sports medicine is a global With this background, it is political mission to make enterprise and if South Africa appropriate to consider how international success in is to make its mark at an inter­ South Africa currently ranks sport an important priority national level, we must pool and what needs further im­ in this country. Until this our resources. provement. happens, state funding for sports medicine and the exercise sciences, on a IMMEDIATE PLANS TO THE CURRENT decent scale, will not be ADDRESS THESE ISSUES POSITION IN SOUTH priority. AFRICA As the famous Chinese prov­ • There is no teaching of erbs states, "A journey of a Positive factors sports medicine in the thousand miles must begin undergraduate medical with a single step". Here are • South Africans do live in a curriculum which is, un­ the single steps that we will "sports-mad" society in fortunately, an indirect be emphasizing in the next 2 which sport enjoys a high measure of the importance years: profile including and most that our colleagues in aca­ importantly, at schools. demic medicine ascribe to Further development of our our interest. Journal • The standard of training of ) . The Journal will take on more 2 doctors and the profes­ • We do not yet have a sports 1

0 sionals allied to medicine, medicine programme that of a Continuing Medical Edu­ 2 is very high so that any leads to specialist qualifi­ cation flavour. It will become d e t potential recruits into the cation ir. this discipline. In more substantial and pub­ a d Sports Medicine discipline the long term this must be lished on a more regular basis. ( r

e are likely to have been addressed. In the short Whilst most of the effort for h s highly trained, disciplined this development will come i term we need to develop l b and very competent in their the concept of group multi­ from the full-time academics, u P

work. disciplinary practices in it is hoped that members will be e h sports medicine. encouraged to contribute t

y • South Africa is about to material for publication. b

d enjoy the benefits of a re­ • There is no really profes­ e t turn to international com­ sional sport in this country. Increasing the activities of n a

r petition and this is likely to Nor are many of our sports the regional committees g

e be followed with increased administrators sufficiently c n public support of, and in­ professional to be planning At present the Association has e c i terest in sport and there­ ahead in particular by in­ active regional committees in l r

e fore also in Sports Medi­ vesting in scientific the Southern Transvaal d

n cine. studies in their sports. (Chairman: Dr Joe Skowno),. u Northern Transvaal (Chairman: y a • South Africa has a viable • We have the problem of re­ Dr Uli Schmidt), the Orange w e t Sports Medicine Associa­ gional and ethnic parochi­ Free State (Chairman: Dr Ras a

G tion with its own Journal. alism. We must work very Venter) and the Western Cape t e Furthermore, scientific hard to eradicate these (Chairman: Dr Wayne Der- n i research in sport does at negative influences which man). We hope to extend these b a

S least have a firm base in will get in the way of our branches to Natal and the

y this country, although much real mission which is to Eastern Province in the near b d e c u 26 ------d

o SPORTS MEDICINE VOL. 7 NO. 1 r p e R SASMA NEWS

future. provision of sports medical An important objective of the Regional branches can only care on a regional basis to the Southern Transvaal Regional be successful if they are sup­ athletes preparing for those Sports Medicine group will be ported by members from all the Games. The Association is to establish a roster of emer­ major groupings making up our presently in consultation with gency sports care personnel in Association including physio­ the Federation of Movement the Southern Transvaal. The therapists, biokineticians, ex­ Sciences (formerly SAASPER) aim is to train doctors and ercise scientists and doctors. who have been given the physiotherapists to deal with mandate to develop this pro­ any emergency one might rea­ Upcoming congresses gramme. sonably encounter during any sports activity. The idea is to In collaboration with the South supplement existing first aid African Rugby Football Union REPORT BACK FROM services currently available at the Association will be holding THE REGIONS most large sporting occasions, a two day congress on April 9th and not to replace them. The and 10th, 1992. Topics that Southern Transvaal - Dr aim will be to work with St will receive special attention Joe Skowno Johns and Noodhulpliga who will be traumatology and sports supply general medical care nutrition. The Southern Transvaal Re­ and ambulance services. Dr The Association's next In­ gional Branch of the South Skowno has expressed the ternational Sports Medicine African Sports Medicine opinion that the Sports Medi­ meeting will be on the week of Association held three meet­ cine Association should be ac­ the 9 -13th March 1993 in Cape ings in the latter half o f 1991. tively involved in the estab­ Town. The last one on November 6th lishment of an independent During the year, a series of was particularly well attended, body to co-ordinate doping ) . regional meetings on Olympic with over 60 people present. control in South African sports. 2 1

0 Sports Medicine will be co­ The subject under discussion Any doctors who are actively 2 ordinated. was management and rehabili­ involved in this area are en­ d e t tation of shoulder injuries. Drs couraged to contact Dr a d Pierre Roussouw and Bryan Skowno. Dr Skowno's address ( r

e Extending ties with Noll discussed the anatomy, is PO Box 67196, Bryanston h s pathology and management of 2021. i colleagues in the professions l b allied to Medicine rotator cuff and instabilities. A u P

practical demonstration of ex­ e

h Physiotherapist and members amining a patient with supras- t

y of the other professions allied pinatus impingement syn­ b

PARKE-DAVIS

d to medicine make an important drome was given. Mrs Joanne e t contribution to our Associ­ Sklaar covered rehabilitation MEDICAL 10 n a r ation. most comprehensively. An ROAD RACE g

e The rights of these collea­ encouraging feature of the c BOOSTS n gues will be discussed at the evening was the tremendous e c i amount of audience participa­ VICTORIA l next Annual General Meeting r e in March 1993. tion. HOSPITAL FUND d

n Meetings held in 1992 to u Development of a regional date include: y a Olympic Sports Medicine w e t programme Alternative medicine in The popular Medical 10 Road a

G sports injuries Race, sponsored and hosted by t e Should South Africa be repre­ 22 January 1992 Parke-Davis, a division of n i sented to any great extent at The modem approach to Warner-Lambert SA (Pty) b a ankle injuries Ltd, for the forth consecutive S the Barcelona Olympic Games,

y there will be a nekl for the 11 March 1992 year, took place of 7 December b d e c u ------27 d

o SPORTGENEESKUNDE VOL. 7 NO. 1 r p e R SA SM A N EW S

1991. The 10 km Medical 10 Road Race for medical doctors and 3 km fun run for cardiac rehabilitation patients, known as Heart Throbs, started and finished at Parke-Davis' head office in Retreat. For the first time this year, there was an entry fee of RIO. Agreed to last year by 300 entrants who completed a ques­ tionnaire, it was decided that the proceeds of this year's race would be earmarked for the Victoria Hospital Casualty Unit Fund. Earlier this year, Parke-Davis announced their Seen at the finish o f the popular Parke-Davis Medical 10 Road, Race are, (l-r): Dr Adrian Morrison from Victoria Hospital, Dr Helmut decision to come to the aid of Elmau and Dr Kelly Seymour, medical director of'Warner-Lambert 5/1 the hospital and this event is (Pty) Ltd. part of their on-going effort to raise the R 1,3 m required to re­ build the casualty unit. Approximately 228 medical doctors and 70 Heart Throbs completed the Medical 10 handicap was presented to Dr outstanding actual time of 33 ) .

2 Road Race and 3 km fun run re­ Francois Hofmeyr from minutes and 6 seconds and Dr 1

0 spectively. This year runners Wynberg who completed the Lana van Zyl, the first female 2

d were again handicapped 30 10 km run in a time of 31 runner to cross the finishing e t seconds per year of age from 40 minutes and 7 seconds. For the line in an actual time of 43 a d

( upwards. first time in the history of the minutes and 29 seconds. r e A Metro helicopter, Pri- race, gold medals were awar­ The Heart Foundation of h s

i Med Ambulance as well as ded to the first male as well as Southern Africa nominated l b medical staff from Victoria female on handicap and medals Edwin King to receive the Ian u P

Hospital were on stand-by for were presented to Dr Hofmeyr Taylor Memorial Award which e h the first time this year, contrib­ and Dr Clare Stannard from is presented annually to the t

y uting to the high standards that Rondebosch. most deserving cardiac reha­ b

d have come to be expected of the Silver and bronze medals bilitation patient. e t for second and third positions During the awards presen­ n Parke-Davis Medical 10 Road a r Race. on handicap for males were tation, Ian Robertson, market­ g

e At the prize giving breakfast presented to Dr Eric Bateman ing director of Parke-Davis, c n following the race, Councillor from Rondebosch and Dr Rob­ commented, "We've received e c i

l Bronnie Harding accepted a bie Truter medical superinten­ a record number of entries for r e cheque on behalf of Victoria dent of Tygerberg Hospital this year's race and we would d

n Hospital. Ian Robertson, mar­ respectively, while medals for like to thank all doctors who u keting director of Parke-Davis the second and third female took part for their much- y a and Tim Largier, managing runners were awarded to Dr needed financial support. We w e t director of Warner LambertS A Lana van Zyl and Dr E God­ also thank those who made a

G (Pty) Ltd, awarded prizes to dard respectively. further donations to Victoria t e winners in various categories. Gold medals for the fastest Hospital today. We look for­ n i

b The specially designed male and female runners were ward to an equally successful a

S Medical 10 floating trophy for presented to Dr Andrew Leary 1992 Medical 10 Road Race." y

b the fastest runner overall on who completed the race in an d e c u 28 — — d

o SPORTS MEDICINE VOL. 7 NO. 1 r p e R