A2it/i hJournalOf Editor-in-Chief Dr Peter N. Sperryn MB, FRCP, FACSM, DPhysMed

Editors iF iid f Surgery: Mr Paul G. Editorial Board Stableforth Prof. Dieter Bohmer, Prof. Qu Mian-Yu, MB, FRCS (Bristol, UK) MD (Frankfurt, Germany) MD (Beijing, China) Dr K.M. Chan, Dr Allan J. Ryan, Science: Dr Ron Maughan FRCS (Hong Kong) MD (Edina, Minnesota, USA) PhD (Aberdeen, UK) Dr David A. Cowan, Prof. N.C. Craig Sharp, BPharm, PhD, MRPharmS (London, UK) PhD (Limerick, Eire) Physiotherapy: Mr Julius Sim Dr Wendy N. Dodds, Prof. Roy J. Shephard, BA, MSc, MCSP BSc, MRCP (Bradford, UK) MD, PhD (Toronto, Canada) (Coventry, UK) Dr Adrianne Hardman, Prof. Harry Thomason, PhD (Loughborough, UK) MSc, PhD (Loughborough, UK) Mr Basil Helal, Prof. K. Tittel, MCh(Orth), FRCS (London, UK) MD (Leipzig, DDR) Statistical Consultants Dr G.P.H. Hermans, Dr Dan S. Tunstall Pedoe, Mr F.M. Holliday, MA, DLC, FSS MD, PhD, (Hilversum, Netherlands) MA, DPhil, FRCP (London, UK) (Loughborough, UK) Prof. Ludovit Komadel, Prof. Clyde Williams, Mr Simon Day, BSc (London, UK) MD (Bratislava, Czechoslovakia) PhD (Loughborough, UK) Prof. W.P. Morgan, Dr William F. Webb, EdD, (Madison, Wisconsin, USA) MB, BS (Sydney, Australia) Prof. Tim D. Noakes, MD, FACSM (Cape Town, South Africa)

Regional Corresponding Editors Belgium: Prof. M. Ostyn, Groupement Latine: New Zealand: Dr Chris Milne, MD (Leuven) Dr Francisque Commandre, MB, ChB, DipSportsMed (Hamilton) Brazil: Prof. Eduardo H. DeRose, MD (Nice) Pakistan: Dr Nishat Mallick, MD (Porto Allegre) Hungary: Dr Robert Frenkl, FPMR, FACSM (Karachi) Bulgaria: Dr Virginia Michaelova, MD (Budapest) Spain: Dr J. J. Gonzalez Iturri, MD (Sofia) India: Dr D.P. Tripathi, MD (Pamplona) Caribbean: Dr Paul Wright, MB, BS, MCCP (Patna) Thailand: Dr Charoentasn Chintanaseri, LMSSA (Kingston, Jamaica) Indonesia: Dr Hario Tilarso, MD (Bangkok) Cote D'Ivoire: Prof. Constant Roux, MD Jakarta) Uganda: Dr James Sekajugo, MD (Abidjan) Malaysia: Dr Ronnie Yeo, MB, Dip.SportsMed. (Kampala) France: Dr Pierre Berteau, MB (Kuala Lumpur) USSR: Dr Sergei Mironov, MD (Rouen) Maroc: Dr Naima Amrani, MD (Moscow) MD (Rabat)

The British Journal of Sports Medicine is an US mailing agents: Mercury Airfreight beyond that permitted by Sections 107 or 108 of international journal published quarterly in International Ltd, Inc., 2323 Randolph Avenue, the US Copyright Law. The appropriate fee March, June, September and December by Avenel, NJ 07001, USA. Second class postage should be forwarded, quoting the code number at Butterworth-Heinemann Ltd. paid at Rahway, NJ, USA. the end of this paragraph, to the Copyright Publishing, Editorial Production and Reprint US Postmaster Send address corrections to the Clearance Center, 21 Congress Street, Salem, MA Offices: Butterworth-Heinemann Ltd, Linacre British Journal of Sports Medicine c/o Mercury 01970, USA. This consent does not extend to House, Jordan Hill, Oxford OX2 8DP, UK Airfreight International Ltd., Inc., 2323 Randolph other kinds of copying, such as for general Telephone: +44 (0)865 310366. Facsimile: +44 Avenue, Avenel, NJ 07001, USA. distribution, resale, advertising and promotional (0)865 310898. Telex: 83111 BHPOXF G. Back For current and purposes, or for creating new collective works. issues: the 1992 volumes, Special written permission should be obtained these are Publisher: Charles Fry available from Turpin Distribution from Butterworth-Heinemann for such copying. Managing Editor: Sarah Graham-Campbell Services Ltd, at the address above. Complete For readers in other territories. Permission volumes or issues for years are Assistant Editor: Elizabeth Royall single earlier should be sought directly from Butterworth- Editorial Controller: Heather Walmsley available from Wm Dawson, Cannon House, Heinemann. Editorial Assistant: Alison Cherrie Folkestone CT19 5EE, UK Telephone: +44 (0)303 850101. Facsimile: +44 (0)303 850440. British Journal of Sports Medicine Address for submissions: see Notes for Authors. ISSN 0306-3674/93/$7.50 Subscription enquiries and orders in the UK and Advertising enquiries should be sent to Mark Butler, MTB Advertising, 11 Harts Gardens, Reprints: Readers who require copies of papers overseas should be sent to Turpin Distribution Services Ltd, Blackhorse Road, Letchworth, Herts Guildford GU2 6QA, UK Telephone: +44 (0)483 published in this journal may either purchase SG6 1HN, UK Telephone: +44 (0)462 672555. 578507. Facsimile: +44 (0)483 572678. reprints (minimum order 100) or obtain Facsimile: +44 (0)462 480947. Telex: 825372 Microfilm: A microfilm version of the British permission to copy from the publisher at the TURPIN G. North American orders should be Journal of Sports Medicine is available from following address: Butterworth-Heinemann Ltd, sent to Journals Fulfilment Department, 300 N. Linacre House, Jordan Hill, Oxford OX2 8DP, University Microfilms Inc., Zeeb Road, UK Butterworth-Heinemann, 80 Montvale Avenue, Ann Arbor, Ml 48106-1346, USA. Stoneham, MA 02180, USA. Telephone: + 1 (617) No page charges are levied by this journal. 438 8464. +1 Copyright: g) 1993 Butterworth-Heinemann Ltd. Facsimile: (617) 438 1479. Telex: All 880052. Please state clearly the title of the journal rights reserved. No part of this publication may be reproduced, stored in a retrieval system C) 1993 British Association of Sport and and the year of subscription. Medicine. or transmitted in any form by any means, Annual subscription (4 issues): UK and Europe electronic, mechanical photocopying, recording Office: Butterworth-Heinemann £88.00; rest of the world £92.00; private or Registered Ltd, otherwise, without the prior written 88 Kingsway, London WC2B 6AB, UK individuals certifying that copies are for their permission of Butterworth-Heinemann Ltd, or a personal use and not for their libraries, and that licence permitting restricted photocopying in the A member ofthe Reed Elsevier group copies are to be sent to their home address £37.00. United Kingdom issued by the Copyright 1E- Single copies: UK and Europe £26.40; rest of the Licensing Agency Ltd, 90 Tottenham Court Road, world £27.60. Prices include cost of postage and London, W1P 9HE, UK For readers in the USA. ISSN 0306-3674 packing. Copies sent to subscribers in This journal has been registered with the Australasia, Bangladesh, Canada, India, Japan, Copyright Clearance Center. Consent is given for Pakistan, Sri Lanka and USA are airspeeded for copying articles for personal or internal use, or for Composition by Genesis Typesetting, faster delivery at no extra cost. Airmail prices are the personal or internal use of specific clients. Laser Quay, Rochester, Kent. available on request. Payment must be made with This consent is given on the condition that the Printed by Cambridge University Press, order. copier pay the per-copy fee of $7.50 for copying Cambridge, UK Br J Sp Med 1993; 27(2) FIMS news

International Federation of Sports Medicine

The World Federation of Sports medicine at universities, and also ings, the significance of the discipline Medicine - some perspectives on with the legal problems. would be drastically reduced. its activities 6. To publish position statements on In common with other international aspects of sports medicine, e.g. the organizations such as UNO, UNESCO role of physical activity in preven- and WHO, FIMS shares the common Sports medicine as a science emerged tive health care, the benefits of weakness of lack of funding. The fees at the end of the 19th century in exercise, rehabilitation of athletes paid to FIMS by member countries are various European countries. In 1904 in and medical examination of ath- inadequate to meet our current de- Berlin, Mallwitz coined the phrase letes. mands, and as a direct consequence 'Sports Physician'. The International Some examples of the work done by insufficient information is being distri- Hygiene Exposition held in Dresden in the President of FIMS in 1992 include buted to members. However, we are 1911 was the stimulus for the first the following: tackling this problem, and in future official sports physicians congress ever will forward more information bulle- held, and took place in Oberhof, 20 March 1992: Inaugural paper and tins to national organizations. Distri- Germany in September 1912. At the welcome address of FIMS at the First bution will be the task of the national same time the first official federation Scientific Congress of the Asian Feder- institution. Nevertheless despite of sports physicians was founded. ation of Sports Medicine. financial constraints journals such as Finally FIMS was established in 1928 7 April 1992: Discussion with the World of FIMS and FIMS Journal were with 11 founder nations. Today FIMS Austrian Minister for Health in Vienna sent to all member nations in the past has a total of 90 member nations. concerning legislation for preventive few years. The most important tasks of FIMS medicine. Another problem faced by FIMS is are: 18 April 1992: FIMS Greeting at the representation at committee level. The opening ceremony of the First Sports Executive Committee is composed of 1. To uphold the interests of sports Medicine Centre of WHO in Tokyo, 14 nations, with four chairpersons of medicine and to cooperate with and introductory paper on preventive the Standing Commissions. When other similar international organi- medicine and exercise training. making a choice for representation we zations such as the World Health 24 April 1992: Introductory paper at must bear in mind that the whole Organization (WHO), the Inter- meeting of the Belgian Society of world must be represented. It is national Olympic Committee, the Sports Medicine in Brussels. impossible to select only international United Nations Educational, Scien- 5-10 May 1992: Participation in World scientists without due regard for the tific and Cultural Organization Consensus Congress on Physical Acti- necessity of representing the Third (UNESCO), the International Com- vity in Toronto, Canada. World. As far as possible we try to mittee of Sports Sciences and Phy- 14 July 1992: Malaga make a fair choice and combine all sical Education. cultural aspects on our representative 2. To represent FIMS at official national A practical example of the importance bodies. sporting events and at sports medi- of FIMS as a worldwide organization is FIMS is well aware of its weakness cine congresses. the recommendation on the topic of and strength. What every member 3. To develop guidelines for the edu- AIDS and Sports. This position state- nation should realise is that such a cation and training of sports physi- ment was initiated by FIMS and was uniform world organization exists for cians. passed after a meeting of FIMS with its benefit, and actively promote its 4. To provide a source of information WHO in Geneva on 16 January 1989. support of FIMS. The power of any on sports medicine for national Without FIMS such a recommendation world organization, including FIMS, is organizations. would not have been drafted. FIMS based on the all out support of each 5. To assist national sports medicine speaks as a powerful voice in the national member country. associations in their efforts to intro- sphere of sports medicine, and with- Wildor Hollmann duce higher qualifications in sports out its presence at international meet- President FIMS

76 Br J Sp Med 1993; 27(2) BASM news

British Association of Sport and Medicine I

There are now active regions covering Dr M. Read, Chairman BASM London government's restrictions on non- most of the UK. Most hold regular and South East Region steroidal gels. The concept behind the meetings, contact your regional Sport and Fitness Intermediate course is twofold) First, I Chairman for detail of events. London Bridge Clinic, London SE27, have always felt that insight into the UK techniques and training methods of a Dr Evan Lloyd, Chairman BASM variety of sport has been a neglected Scottish Region Dr K. Kaur, Chairwoman BASM East area of teaching in sports medicine. 72 Belgrave Road Midlands Region We have invited coaches to talk to us Edinburgh EH12 6NQ UK Department of General Practice Queens Medical Centre about sports ranging from gymnastics Dr R. Jaques, Chairman BASM South Nottingham NG7 2UH, UK and dance through to track and field. West Region Second, after organizing the weekend Charity Cottage At present Wales is split between the Advanced injury courses, Graham 2 The Row, Cranham Gardens South West and the North West Holloway and I realised that more Gloucestershire GL4 8HP, UK regions. There is no region covering formal instruction in joint examination interested was required. The Intermediate course Dr Colin Crosby, Chairman BASM the North East. If anyone is uses the delegates themselves as sub- Eastern Region in setting up a new branch in these jects, as opposed to the Advanced Highview Hill and Coles Farm areas, please contact the Honorary courses where patients with clinical London Road Secretary at the Department of Ortho- signs are brought as teaching aids! Flamstead, Herts AL3 8HA, UK paedics and Trauma, Queens Medical Centre, Nottingham NG7 2UH. In the March 1993 issue of the Dr P. Milroy, Chairman BASM North Journal there was a flyer for another West Region course to be held at La Santa in Brook House Farm The Educational programme has Lanzarote. This is the resort which Mill Lane expanded many fold over the last many of our top sports people use to Kingsley, Warrington WA6 8HH, UK years. Nancy Laurenson our Educa- prepare for their competitive seasons. tion Officer has worked extremely The centre copes with nearly 40 Dr G. I. Gardener Chairman BASM hard to ensure the smooth running of different sports, and has staff on site Region courses, and made them very enjoy- capable of giving instruction. The aim Whitehornes able in addition to being educationally of the course is to provide hands-on Butterton enlightening. We wish her well as she tuition for several sports, and educa- Newcastle, Staffs, UK starts maternity leave in June. It will tion on injury prevention. The warm Dr I. Adams, Chairman BASM be a struggle to maintain the very high weather, excellent facilities and enter- Yorkshire Region standards she has set. tainment will make for a wonderful Department of Accident and The highly successful Intermediate week. We are aiming to run the course Emergency course is planned to run again. Unfor- from 7 to 14 October. Sign up! Call the St James's University Hospital tunately the sponsorship that we had BASM office on 071-253 3244 for Beckett Street, Leeds LS9 7TF, UK last year has disappeared with the UK further information.

East Midlands Region, March 1993

Sports coaches, especially those region and the intention of the regional neck muscles became obvious when working with the young, should be committee is to have six lectures per g-forces were discussed. advised that joints must not be over- year. The next two will be on 1 April The consensus opinion on the even- stretched, particularly when opposing and 3 June 1993. ing was that it was a great success, as muscle groups have been unequally Earlier in the evening Dr Frank was shown by the warm applause at conditioned. So said Professor W. A. Newton from Silverstone enlightened the end of each presentation. Wallace at the inaugural meeting of the audience as to the stresses experi- The Chairman of BASM, Mr John the East Midlands Region of the enced by the modern racing driver. He King FRCS, spoke on knee injuries on British Association of Sport and reviewed the history of track racing, 1 April, with a demonstration by Ms Medicine at the City Hospital, Not- showing how the driver had now Judy Wright MCSP. Future meetings tingham on Thursday 18 February. become almost an integral part of the are planned for 16 September, 28 car. He demonstrated the unusual October and 9 December. Topics in- Professor Wallace of the Department driving position, with the driver sunk clude Asthma, Running injuries, of Orthopaedics at Queens Medical deep into the 'tub' around which the Watersports injuries and Footballing Centre, Nottingham, gave an enter- car is built. The driver works in a injuries. Details later, from: Dr Ian taining and instructive review of constrained environment and is ex- McGibbon, Honorary Treasurer, East sporting injuries to the shoulder to an posed to high g-forces. The stresses on Midlands Region, British Association audience in excess of 120. This turnout the internal organs are immense. of Sport and Medicine, Tutbury on 18 February, demonstrated the Typical training programmes were Health Centre, Tutbury, Staffs DE13 great interest in sports medicine in the discussed. The need for training of the 9NA, UK. Br J Sp Med 1993; 27(2) 77 Br. J. Sp. Med 1993; 27(2) From the journals

Sports medicine current awareness service

Prepared by Kathryn Walter and Nancy Laurenson at the National Sports Medicine Institute (NSMI) Library

The following summaries are taken validate the claims. In other cases, suprascapular nerve entrapment is an from a selection of recent journals research findings were extrapolated to uncommon disorder seen in throwing indexed in the NSMI database. A full inappropriate applications. For exam- athletes; radial tunnel syndrome com- listing is published monthly in Sports ple, biological functions of some non- monly affects tennis players but may Medicine Bulletin. essential compounds (e.g. inosine, also be seen in rowers and weight- carnitine) were interpreted as per- lifters; ulnar nerve entrapment is Copies of the complete articles are formance claims for the supplements. encountered in throwing athletes such available (price 15 pence per sheet Claims for others were based on their as baseball pitchers, tennis players subject to Copyright Law) from the ability to enhance hormonal release or and javelin throwers; ulnar tunnel Library, NSMI, c/o Medical College of activity. The authors recommend that syndrome is seen in cyclists and St. Bartholomew's Hospital, Charter- further research is conducted on this racquetball players; carpal tunnel syn- house Square, London EC1M 6BQ, group of athletes and their nutritional drome may be seen in sports that UK. (Tel: 071-251 0583). needs. The effectiveness and safety of require gripping, throwing, cycling or A study on The association of changes supplements merit further investiga- repetitive wrist flexion-extension; in physical-activity level and other tion. 'bowler's thumb' is the most common lifestyle characteristics with mortality The use of electricity in promoting digital nerve entrapment; sural nerve among men has been published by analgesia, resolving oedema, wound entrapment and, rarely, peroneal Ralph Paffenbarger and colleagues healing, re-education of damaged nerve entrapment is seen in runners; (New Journal of Medicine 1993; muscle, prevention of muscle atrophy and tarsal tunnel syndrome is an 328: 538-45). Harvard College alumni and muscle relaxation is described by uncommon condition described in who were aged 45 to 84 years in 1977 Robert Windsor and colleagues in runners, ballet dancers and basketball and who had completed lifestyle ques- Electrical stimulation in clinical prac- players. Diagnosis relies on a detailed tionnaires in 1962 or 1966 and again in tice (Physician and Sportsmedicine 1993; history and physical examination. In 1977 were classified according to 21: 85-93). The electrical modalities most cases non-operative treatment is changes between these two dates in clinically used in sports injury rehabili- sufficient and surgery is seldom recom- physical activity levels, smoking, tation differ mainly in the way they mended. blood pressure and body weight and combine the parameters of wave form, The use of orthotic shoe inserts has the relation of these factors to mortal- frequency, pulse width and ampli- become a popular adjunct in the ity between 1977 and 1985. Beginning tude. Transcutaneous electrical nerve treatment of overuse injuries such as moderately vigorous sports activities stimulation (TENS), high-voltage patellofemoral disorders, shin splints, was associated with a 23% lower risk pulsed galvanic stimulation (HVPGS) Achilles tendinitis, plantar fasciitis of death than not taking up mode- and interferential stimulation effec- and stress fractures (Gross ML and rately vigorous sport. Also associated tively reduce pain. TENS and HVPGS Napoli RC Treatment of lower extrem- with lower mortality was cessation of can be used for acute or chronic pain; ity injuries with orthotic shoe inserts: cigarette smoking, maintenance of interferential stimulation is primarily an overview Sports Medicine 1993; 15: lean body mass and consistently nor- indicated in acute or subacute soft 66-70). Inserts adjust the biomech- mal blood pressure. Findings on death tissue injuries or myofascial pain. anical variables associated with run- from coronary heart disease mirrored Interferential stimulation is more com- ning injuries and reduce the effect of those on death from all causes. fortable and in addition promotes soft high stresses produced by running Advertised claims on the efficacy of tissue healing, muscle relaxation and activities. Orthotic treatment is based Commercially marketed supplements oedema resolution. Minimal electrical on an understanding of complex coup- for bodybuilding athletes are re- noninvasive stimulation is a new ling of rotation of the lower extremity viewed by Katharine Grunewald and treatment concept purported to facili- with pronation and supination of the Robert Bailey (Sports Medicine 1993; 15: tate tissue healing. subtalar joint and accurate identifica- 90-103). Supplements include amino The aetiology, clinical signs and tion of the underlying biomechanical acids, boron, carnitine, choline, chro- symptoms and treatment of Nerve deficit. Orthotic fabrication is initiated mium, dibencozide, ferulic acid, gam- entrapment syndromes in athletes are by determining the neutral position of ma oryzanol, medium chain triglycer- described in a recent paper by Marko the foot and obtaining an accurate cast ides, weight gain powders, Smilax Pecina et al. (Clinical Journal of Sport of this position. Orthotics should be compounds and yohimbine. Many Medicine 1993; 3: 36-43). Specific syn- used as one facet in the overall performance claims made for the dromes related to individual sports are treatment programme - the use of supplements are not supported by detailed - thoracic outlet syndrome is proper conditioning and stretching are current research. In some instances, found in swimmers and throwers; equally important for injury preven- no published research was found to compression of the brachial plexus tion and treatment of specific injuries. may result from prolonged carrying of Most investigations on the effects of (© 1993 Butterworth-Heinemann Ltd heavy backpacks and is sometimes exercise on the immune system have 0306-3674/93/020140-02 referred to as 'backpack paralysis'; largely ignored intense anaerobic exer-

Br J Sp Med 1993; 27(2) 139 cise. However, two recent studies healthy individuals. Thus one could as expected; however, their standar- have examined the effects of a short ask if this method should be used to dized peak torque was also greater. bout of maximal effort on immune assess body composition or percen- This difference cannot be completely parameters. A. B. Gray and co-workers tage body fat in a sports person? explained by factors such as body size, compared the effects of 1 min of Is there a male counterpart to lean body mass and muscle cross- intense bicycle ergometry on circulat- 'athletes' amenorrhoea'? It appears sectional area. It is unknown whether ing leukocytes in trained and un- that weight loss and excessive training fibre type dominance could partially trained males (Anaerobic exercise can disturb reproductive function in explain the differences; there is no causes transient changes in leukocyte men, as has been shown in women, conclusive evidence that there is any subsets and 1L-2R expression Medicine although the research results are significant difference between slow and Science in Sports and Exercise 1992; somewhat equivocal. E. Randy Eich- and fast twitch muscle fibres in quad- 24: 1332-8). Significant changes in the ner describes the possible causal fac- riceps muscle of men and women. peripheral concentrations and propor- tors in Exhaustive exercise and libido This testing protocol could be used to tions of most leukocyte subpopula- in men: can you keep it up? (Sports compare quadriceps femoris muscle tions were observed irrespective of Medicine Digest 1992; 14: 5). Results of performance on an isokinetic dynamo- training status. Only trained subjects most studies of testosterone concen- meter with functional activities such as showed a significant decrease in the tration in athletes find that intensive the vertical jump or following a percentage of CD25+ lymphocytes exercise, for an hour or less, regardless plyometric training programme. following mitogen stimulation of if it is power or endurance based Physical training by adults in endur- peripheral blood 6 h post exercise, activity, tends to increase plasma ance activities such as distance run- while untrained subjects had a signifi- testosterone levels. How this increase ning, swimming, and cycling results cantly greater concentration and occurs is unclear. In contrast, con- in well defined anatomical, physio- percentage of CD8+ lymphocytes im- tinued exercise lasting a few hours or logical and metabolic adaptations mediately after exercise. A further longer tends to reduce testosterone which could collectively be termed the study (Nieman D. C. et al. Effects of levels. A review of 10 other studies 'fitness effect'. While these changes brief, heavy exertion on circulating suggests that the point where elevated follow a predictable pattern, the lymphocyte subpopulations and pro- testosterone concentration begins to mechanisms by which they occur are liferative response Medicine and Science fall often occurs after 2-3 h of con- not always well known. Whether in Sports and Exercise 1992; 24: 1339-45) tinuous exercise. How this fall occurs prepubertal children are as capable of examined blood samples before and is also unclear, yet possible contribu- improving maximal oxygen uptake 3 min and 1 h after 30 s of maximal tors include: (1) haemodilution; (2) from endurance training as adults is a effort on a cycle ergometer and found suppression of testicular function by debated question that has long in- rapid perturbations in circulating surges in blood cortisol; (3) suppres- terested exercise physiologists. It is, levels of natural killer cells and T sion of the hypothalamic-pituitary however, a significant one, since it lymphocytes without a corresponding axis, so as to inhibit the pulsatile bears importance for coaches and alteration in lymphocyte function. release of luteinizing hormone (which physical educators in providing safe Bioelectrical impedance and body drives the testicular production of training regimens. This issue is ex- composition (Lancet 1992; 340: 1511). testosterone). Other complaints re- plored in Trainability of the cardio- Data on the use of this straightfor- garding sexual function include low respiratory system during childhood ward, non-invasive technique for sperm counts and decreased libido. Of (Rowland T. W. Canadian Journal of short term assessment of body com- course not all studies of male endur- Sport Sciences 1992; 17: 259-63). It position suggests that impedance is a ance athletes have found such abnor- appears that studies examining the satisfactory and reliable method of malities in sexual function! trainability of children have been beset estimating total body water in children The stretch shortening cycle (SSC), a with methodological flaws that have who require critical cardiac care. Simi- functional contraction of muscle that precluded firm conclusions about lar conclusions have also been drawn occurs when a muscle contracts eccen- adult-child differences. Most studies by researchers who monitor changes trically (lengthens under tension) and of children that have involved adequ- in hydration status after cardiac then immediately contracts concentric- ate intensity, type and duration of surgery in adults. Their findings sug- ally (shortens under tension) is the training have demonstrated the same gest that the technique has potentially physiological mechanism involved in qualitative changes as would be ex- widespread applications to different plyometric training. Although this pected from adult subjects. However, populations, including patients with principle is well accepted little re- some information suggests that chil- chronic renal failure, congestive heart search has been performed to date dren may need a greater exercise disease, inflammatory bowel disease, examining The stretch-shortening cy- intensity than adults to trigger cardio- diabetes, growth hormone deficiency, cle of the quadriceps femoris muscle vascular adaptations to training. Other cancer and obesity. The theoretical group measured by isokinetic dyna- data raise questions regarding differ- understanding which supports bio- mometry (Helgeson K. and Gajdosik ences in autonomic influences in the electrical impedance states that the R. L. Journal of Orthopaedic and Sports heart and myocardial function in chil- only medium that can conduct electri- Physical Therapy 1993; 17: 17-23). dren that could relate to age- city within the body is water. Thus, Twenty-four subjects (19-35 years) dependent responses to training. the anhydrous nature of fat restricts were recruited including 12 men and Strenuous and unaccustomed re- the flow of electrical current to the lean 12 women, all free from current lower petitive, calisthenic-type exercise may body mass. However, bioelectrical leg extremity pathologies or injury. result in a syndrome known as exer- impedance is also used to predict lean Results showed a significant increase tional rhabdomyolysis. If the exercise body mass, the underlying assump- in peak torque and a decrease in time is accompanied by heat stress and tion being that there is a constant and to peak torque for a concentric contrac- dehydration a potentially severe com- known level of hydration in lean tion of the quadriceps muscle group plex may result between rhabdomy- tissue. This assumption could produce after an eccentric and isometric pre- olysis, myoglobinuria and acute renal an uncertain and large error in estima- load compared with a concentric con- failure. Priscilla M. Clarkson describes tion of lean tissue and hence fat tissue traction alone. Men could produce this syndrome in Worst case scenarios: as levels of hydration vary within greater peak torque than the women, exertional rhabdomyolysis and acute 140 Br J Sp Med 1993; 27(2) renal failure (Gatorade Sports Science spill over from the blood resulting in a plus an insufficient degree of acclima- Institute, Sports Science Exchange 1993; dark colour urine. In certain situations tization to heat are contributing fac- 4, No. 42). Exertional rhabdomyolysis myoglobin can precipitate in the tors. A viral infection or an attempt at is the degeneration of skeletal muscle kidneys and cause renal failure. The a novel diet manipulation before com- caused by excessive unaccustomed mechanism by which myoglobinuria petition may affect this condition. exercise. Symptoms include muscle can lead to acute renal failure is not Because severe cases of rhabdomyo- pain, weakness and swelling, myoglo- completely understood. However, lysis and kidney failure are rare, it is binuria, and increased levels of muscle kidney failure most often occurs when thought some individuals may have a enzymes and other muscle consti- heat stress and dehydration are pre- subclinical muscle disorder that only tuents in the blood. Myoglobin re- sent. A lack of physical conditioning becomes apparent when the above leased from damaged muscle cells may for the specific exercises performed conditions present.

Correspondence

Clenbuterol: a medal in tablet form? prevalent in the UK at the moment, especially among non-competitive recreational 'athletes'. Huw Perry MB Many of our clients who present themselves at drug West Glamorgan Health Authority, 36 Orchard Street, agencies for needles and syringes to administer their Swansea, SAl 5AQ, UK anabolic steroids, reported that, in the past, while taking only clenbuterol they experienced palpitations, tremor and Sir sweating. Before the last , few people had heard of Physicians seeing over-muscled young people (male and clenbuterol, the controversial drug that was responsible for female) should bear in mind that they may be taking most of the expulsions from the games. There seems to be anabolic drugs and be aware of the side-effects, or of the confusion about what class of drug it actually is. drug interactions which may exist, if the physician Clenbuterol is a sympathomimetic agent with Nt-agonist prescribes any medication for that individual. One of the properties. It is not a steroid but a substituted phenylethanol- less appreciated side-effects of clenbuterol is potentially amine with anabolic properties. There is no licence in the serious hypokalaemia which may result from P2-agonist UK for human use although it is used orally in Germany, therapy. Italy and Spain as a therapy for asthma. It has also been used as a bulking agent in animals. The literature contains no reputable scientific papers that show muscle-enhancing References effects in humans. Papers on animal studies do exist to 1 Sillence MN, Matthews ML, Spiers WG, Pegg GG, Lindsay show that clenbuterol does have an anabolic effect on both DB. Effects of Clenbuterol, ICT118551, and sotalol on the cardiac" 2 and skeletal muscle'7. The mechanism of its growth of cardiac and skeletal muscle and on 2-adrenoceptor skeletal anabolic effect has been suggested to be I- density in female rats. Naunyn Schmiedebergs Arch Pharmacol adrenoceptor mediated" 6 and the effects on cardiac muscle 1991; 333: 449-53. via a cyclo-oxygenase metabolite of arachadonic acid2. The 2 Palmer RM, Delday MI, McMillan DN, Noble BS, Bain P. favourable effect of clenbuterol on muscle growth is Maltin CA. Effects of the cyclo-oxygenase inhibitor, fenbufen, possibly also due to a specific increase in protein deposition on clenbuterol induced hypertrophy of cardiac and skeletal and not to changes in the water content of muscular muscle of rats. Br J Pharmacol 1990; 101: 835-8. 3 Perez-Lamas F, Sastre TF, Zamora S. Influence of dietary tissue3 4. Obviously one cannot automatically extrapolate protein level on growth: effect of clenbuterol. Comp Biochem these anabolic effects in animal studies to humans. Physiol [A]. 1991; 99: 671-5. However, it should be noted that clenbuterol has been used 4 Perez-Lamas F, Zamora S. The influence of clenbuterol on as a pharmacological ergogenic aid in sport on a wide- growth in rats. Comp Biochem Physiol [A]. 1991; 99: 242-4. spread basis for the past 21/2 years in the UK. Initially the 5 Bates PC, Pell JM. Action and interaction of growth hormone cost on the black market was approximately 135.00 pounds and the beta-agonist clenbuterol on growth, body composition sterling for 90-100 tablets, now it is down to approximately and protein turnover in dwarf mice. Br J Nutr 1991; 65: 115-29. 40.00 pounds sterling, showing the abundance of the drug 6 MacLennan PA, Edwards RH. Effects of clenbuterol and on the black market. In the past year I have spoken to at propranolol on muscle mass. Evidence that clenbuterol stimulates muscle beta adrenoceptors to induce hypertrophy. least 50 clenbuterol misusers, the vast majority of whom Biochem J 1989; 264: 573-9. were impressed by its anabolism, even when using it in the 7 Claeys MC, Mulvaney DL, McCarthy FD, Gore MT, Marple absence of other steroids. The current disclosure of DN, Sartin JL. Skeletal muscle protein synthesis and growth clenbuterol is an indicator of the huge amount of sporting hormone secretion in young lambs treated with clenbuterol. substance misuse (taken in megadoses) which is so J Animal Sci 1989; 67: 2245-54.

Br J Sp Med 1993; 27(2) 141 BASM Education Programme The British Association of Sport and Medicine holds Introductory, Intermediate and Advanced Courses in Sports Medicine annually. The Introductory Course held at Hall National Sports Centre, , is a one-week intensive course designed primarily for general practitioners and physiotherapists although suitable for all doctors with an interest in sports medicine. This course is generally a prerequisite for the Intermediate and Advanced Courses. PGEA approval is given for 5 days under the categories of 2.5 days Health Promotion and 2.5 days Disease Management. The Intermediate Course (Sports Specific Injury Management and Normal Examination of Joints) is also one week long and held at Lilleshall Hall National Sports Centre. This course concentrates on the proper examination of normal joints with regard to the management of sport specific injuries. There is a strong focus on the coaching and training involved in each sport. PGEA approval is given for 5 days under the categories of 2.5 days Health Promotion and 2.5 days Disease Management. The six Advanced Modular Courses are held at weekends at various locations throughout the country. These comprise three Injury modules which focus on the clinical examination, diagnosis and management of both acute and chronic injuries; treatment and rehabilitation programmes are also outlined. Two Exercise Physiology modules examine aspects of training and fitness assessment with respect to cardiorespiratory and musculoskeletal physiology. The final module, 'Medicine of Sport and Exercise' concentrates on a range of topical issues from 'Exercise in Elderly People' and 'Osteoporosis' to 'Update on Nutrition' and 'Diabetes and Exercise'. PGEA approval is given for each module. These courses provide the academic training necessary to sit the Society of Apothecaries Diploma in Sports Medicine as well as the Royal College of Surgeons and Physicians (Glasgow and Edinburgh) Diploma in Sports Medicine for medical practitioners.

Current Programme for 1993 Date Course Venue January 22-24 Advanced Physiology: cardio-respiratory physiology Bradford Royal Infirmary March 12-14 Advanced Physiology: musculoskeletal system Liverpool John Moores University April 2-4 Advanced Injury: Acute and Chronic Injuries to the RAF Wroughton Upper Limb (Swindon) April 25-30 BASM Introductory Sports Medicine Course Lilleshall Hall NSC (Shropshire) September 3-5 Advanced Injury: Acute and Chronic Injuries to the Milton Keynes Head, Neck, Spine and Pelvis General Hospital September 26 - October 1 BASM Introductory Sports Medicine Course Lilleshall Hall NSC (Shropshire) October 29-31 Advanced Injury: Acute and Chronic Injuries to the RAF Wroughton Lower Limb (Swindon) November 19-21 BASM Congress (Eastern Region) Cambridge Courses planned for 1993 November Intermediate Sports Medicine Course

Br J Sp Med 1993; 27(2) 143 Notes for Authors

Scope References The British Journal of Sports Medicine covers all aspects These should be indicated in the text by superscript of sports medicine and science - the management of Arabic numerals which run consecutively through the sports injuries; all clinical aspects of exercise, health and paper. The references should be grouped in a section at sport: exercise physiology and biophvsical investigation the end of the text in numerical order and should take the of sports performance; sports psychology; phvsio- form: author's names and initials; title of article; abbre- therapv and rehabilitation in sport; and medical and sci- viated journal title; y'ear of publication; volume number; entific support of the sports coach. page numbers. If in doubt authors should always write the journal title in full. References to a book should take Types of Paper the form: author's surname, followsed by initials; title of Original papers (not normally over 3000 words, full book in single quotes; editors (if any); volume number length accounts of original research) edition (if any); name of publishers; place of publication; Review articles (up to 4000 words, providing concise in- Xear of publication and page numbers. Where a paper is depth reviews of traditional and new areas in sports cited more than once in the text, the same superior medicine) numeral should be used on each occasion. e.g. Case reports (up to 1000 words, describing clinical case 21 Sperrvn P15. sport antd .\fclidwpic. London: Butterworth., 1NS3. histories with a message). 22 Ellitsgaard N and Warburg F. Mioveements causing ankle fractures in parachuting. fBr I S'port; .\tlcd 19Sq; 23: 27-4. 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Sperrvn, The Editor, the minimum amount of descriptive matter on graphs British Journal of Sports Medicine, Butterwvorth-Heine- and drawings but rather to refer to curves, points etc. by mann Ltd., 59 60 Grosvenor Street, London WViX 9DA, symbols and place the descriptive matter in the caption. UK. Three copies of each illustration are required and these All material submitted for publication is assumed to be should be numbered in a consecutive series of figures submitted exclusivelv to the British Journal of Sports using Arabic numerals. Legends should be typed in Medicine. All contributing authors must sign a letter of double spacing on a separate page but grouped together. consent to publication. The editor retains the customary Each figure should be identified on the back - figure right to style and if necessary shorten material accepted number and name of the author. Figures which have for publication. 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