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Opinions expressed throughout this journal are the Contents contributors own and do not necessarily reflect the views or policy of Sports Medicine (SMA). Members and readers are advised that SMA cannot FROM THE CEO______2 be held responsible for the accuracy of statements made in advertisements nor the quality of the goods or services advertised. All materials copyright. Sports Medicine in the 21st Century: Roald raises the bar On‑acceptance of an article for publication, copyright passes to the publisher. Publisher Sports Medicine Australia PO Box 237 Dickson ACT 2602 Dr J ______4 Tel: (02) 6230 4650 Fax: (02) 6230 5908 Will a Nobel ever be awarded to someone in sports medicine or science? Email: [email protected] Web: www.sma.org.au Circulation: 5000 ISSN No. 1032-5662 Editors DOPING IN SPORT______7 John Orchard Kerry Mummery Adam Firth: The new Australian Sports Anti-Doping Authority______7 Managing Editor Dominic Nagle Chief Executive Officer Adam Firth: The Mark French case______10 Gary Moorhead Subscription Manager Grant Schofield & Geoff Dickson: Ethics and doping: an issue of context___ 11 Joyce McClune Advertising Manager Dominic Feenan Design/Typesetting Levitate Graphic Design ANOTHER GOOD YEAR: Australian Sports Commission annual report______15 SMA State Branches ACT ACT Sports House 100 Maitland St Hackett ACT 2602 SEASONAL AND GEOGRAPHIC ANALYSIS OF ACL INJURY RISK Tel: (02) 6247 5115 IN AUSTRALIA______20 PO Box 724, Glebe NSW 2037 Tel: (02) 9660 4333 John Orchard, Ian Chivers and David Aldous Northern Territory PO Box 2331, Darwin NT 0801 Tel: (08) 8981 5362 Queensland BULLETIN______28 Sports House, 150 Caxton St, Milton QLD 4064 Tel: (07) 3367 2700 South Australia PO Box 219, Brooklyn Park SA 5025 Tel: (08) 8234 6369 Victoria and Tasmania 1st Floor, 120 Jolimont Rd, Jolimont VIC 3002 Tel: (03) 9654 7733 Western Australia Cover photograph: Australian Sports Commission PO Box 57, Claremont WA 6010 Tel: (08) 9285 8033 Subscription Rates 2003 Australia A$35 Overseas A$50 SMA members receive Sport Health as part of their membership fee Single copies and back copies A$15 (includes‑postage) PP No. 226480/00028 For subscriptions contact Joyce McClune Phone: (02) 6230 4650 Email: [email protected] F rom the C E O F rom the C E O

How have other So back to Professor Bahr. “The research showed that death Roald Bahr’s thesis can be summarised rates were similar for moderate and Sports medicine in the 21st organisations responded? quite simply. He believes that an highly fit men in all BMI categories, essential policy approach is one based and death rates for men with low Unfortunately, our messages appear on keeping ageing populations active fitness levels were higher regardless a little bit mixed and a little bit tinged for as long as possible. This will mean of their BMI category”. (Steven Blair with self-interest. Century: Roald raises the bar that the sports medicine practitioners’ “Fitness, Not Fatness is the Issue” The Australian Medical Association expertise in musculoskeletal WELL newsletter for Wellness, 1, II, Gary Moorehead (AMA) recently released a “Position medicine will become essential in Fall 1999.) Statement on Nutrition” which it pre- both maintenance of the increasingly Sports Medicine Australia has badged with the heading “Nutrition injury-prone ageing population and Chronic disease management by On the state government front, there made a great step forward with the How serious is this trend the Key in Fight Against Obesity also passing this information on to general practitioners with attendant are numerous initiatives, some of recent combined Conference. The Epidemic”. (“Nutrition the key in Fight other health professionals. The AIHW pathology tests and length of time in the increase in chronic which (like the work of the WA importance of the event can be Against Obesity Epidemic – AMA report cites an increase of 1.5 million spent in patient consultation have Premier’s physical activity taskforce measured in a variety of ways: disease? Position Statement on Nutrition” all increased substantially since and the “10,000 steps Rockhampton” in GP consultations giving patients www.ama.com.au/web.nfs/doc education or counselling about their • The enthusiastic response of 1998.(Australian Institute of Health The AIHW report quoted above project) are outstanding and probably 30/11/2005.) weight and nutrition, so there is some delegates (from all areas) who and Welfare (AIHW) “General (covering the years 1998-2004/2005) unique in the world. Other initiatives positive movement in this area, but attended the event. Practice Activity in Australia 2004- cited an increase in the treatment of (and governments) have a more The Dietitians Association of Australia it is probably timely that the DAA is 2005 report”.) chronic disease from 46% to 51%, an patchy effort, with re-inventing of the (DAA) responded with a gentle sledge • The desire of our conference moving to make sure that the GPs get increase in long consultations as a wheel, under-funding of interventions about how encouraging it was to see partners, the National Heart What has this to do with sports these messages right. proportion of visits from 7% to 10% and squabbles over intellectual the AMA taking “a more population- Foundation, the Department of medicine? and 5.6 million more pathology tests property. based public health approach” and Professor Bahr maintains that the skills Health and Ageing and the NSW According to Professor Roald Bahr, than in 2000-2001. (AIHW “General then proceeded to get stuck into Sporting Injuries Committee, to The Federal Government policy and knowledge of the sports medicine a keynote speaker at the recent Practice Activity in Australia”.) numerous errors of fact and detail that continue the partnership into the seems to be led by a back-bencher, and science practitioners will move SMA Conference -- which combined These increases are consistent with it identified in the document. (Claire future. Senator Guy Barnett from Tasmania, to the front line of healthcare. While sports science and medicine, physical other predictions made about the Hewat APD, Executive Director DAA. hardly as glamorous as expectations who seems to be a one-man band in • The speed and enthusiasm of the activity promotion and sports injury likely increase in chronic disease “Initial comments on the AMA Position of working with elite sporting teams, the area and the Government’s solo South Australian Government to prevention Conference – it has in Australia. The recent New South Statement on Nutrition. December 2005”) this work will be both plentiful and policy unit. provide support to sign up the everything to do with sports medicine! Wales Health futures planning project necessary. Could this be interpreted as a message Conference for Adelaide in October estimated an increase in diabetes Certainly what can be said about Professor Bahr, whose background to the doctors to “stay off our turf”? 2007. over the next twenty years of 176%. federal initiatives is that they are as a sports physician, sports injury SMA responded with a media release (Bellew, Bauman. Booth et al. focussed almost exclusively on But it is critical that we get • The fact that all our overseas epidemiologist and chair of Norway’s supporting the thrust of the AMA “Chronic Disease: the sleeping giant children. Federal Health Minister speakers want to come back in physical activity taskforce uniquely statement, but making the point that, the messages right. of health expenditure.” NSW Health Tony Abbott opened a one day forum 2007 (but maybe that was just a qualified him as a plenary speaker with obesity, it takes two to tango futures planning project 2005.) organised by Senator Barnett recently Messages such as: testimony to our partying!!!) at the Conference, made the – poor nutrition habits, but also a lack by stating “two thirds of Australian fundamental assertion that treating All of this is perfectly consistent of physical activity. • Weight control is a function of men and more than half the women the rising tide of chronic disease with the projected changes to the energy balance. When discussing are overweight or obese” - and then The President of the Australian will become an increasing part of all pattern of population in Australia as obesity, we must talk about spent the rest of his discussion on Association of Exercise and Sports sports medicine practice. (Professor the largest cohort of the population, nutrition AND physical activity. children. Increases in overweight and Science (AAESS), Dr David Bishop, Roald Bahr: “Redefining sports the babyboomers, enters old age. obesity in children are alarming, but editorialised in the latest (December • There is health benefit in physical medicine: from sprained ankles to What makes this even more alarming two facts stand out: 2005) edition of the Journal of Science activity WITHOUT any consequent clogged arteries.” Plenary Lecture, for health economists is that the and Medicine Sport (JSAMS) on weight loss. Australian Conference of Science and babyboomers, the largest cohort of 1. The babyboomers are going to be the role of physical activity versus Medicine in Sport, 13 October 2005.) the population, are also the most a crisis for the health system first, This latter point seems to get “specific, targeted, and prescribed and overlooked in the current stampede/ More importantly, Professor Bahr overweight and obese - and the exercise”. (Dr David Bishop. “If reaction to the obesity crisis. All focus asserted that a sports medicine and least physically active - cohort of the 2. The babyboomers also prove you physical activity is the answer, what seems to be on getting or keeping the science background uniquely qualified population. This will make them even cannot obesity-proof people in is the question?” JSAMS 8:4. December weight off, with little or no mention practitioners for this role. But, before more prone to chronic disease – a fact childhood. The babyboomers had 2005.) of the health benefit of increasing dealing with Professor Bahr’s claims, that is just starting to emerge from the an obesity rate in childhood of only While this paper makes some very physical activity even if there is no we need to set the scene in a little AIHW report. about 1%. (Professor Wendy Brown. good points, as with the AMA and change in weight. One of the leading more detail. How is the Government responding “Obesity: don’t just blame the kids DAA pieces, there is also a sense researchers in this area is Dr Steven to this crisis? (In Australia we should and food” SMA media release 1 of the exercise physiologists out Blair from the Cooper Institute in ask how are the “governments” December 2005.) Now it is 21%. there with the doctors and dietitians, Dallas, whose research findings are responding, because both state elbows thrusting, to be at the head of best summed up by the statement: and federal governments share the pack. responsibility for health.)

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world to making a unique discovery. 43(3), Spring 2000, pp. 406-448. Which diseases in sports medicine Secondly, even if your abstract is might be caused by infection? It is worth noting that the “New Germ rejected from your society’s annual The number one candidate, in my Will a Nobel ever be awarded to Theory” does not pose a threat to the conference (as it was – see the MJA view, would have to be “chondral importance of public health, because article for evidence), it doesn’t mean degeneration” in the knee joint, of the ability for microorganisms you won’t end up winning a Nobel in particular. How many times do someone in sports medicine or to evolve rapidly. For example, Prize for the research. Thirdly, you you see a patient go in for a knee the HIV virus is an infection which can be a touch on the eccentric (mad) arthroscope for a meniscal tear, and is known to mutate according to side, as Robin Marshall obviously in which the surgeon also finds grade its environment. In Africa, where science? By Dr J was when he drank a helicobacter 1-2 chondral degeneration in the joint, unfortunately sexual practices are solution to give himself gastritis, and followed by a rapid deterioration after not generally very safe, HIV is far it may actually help you be a great the arthroscopy? A year later another more virulent, as it is usually given It is a time for great celebration that breakthrough in the field of antibiotics) just won the FE Johnson Memorial scientist. Fourthly, you might do well arthroscopy is performed and this ample opportunity to spread from we have just had two Australian would rank as highly as any of the Fellowship of the NSW Sporting to think that infection could have time the patient has grade 4 chondral victim to victim, even if the victims medical doctors awarded the Nobel Nobel prizes awarded for medicine. Injuries Committee for 2005, whereas an undiscovered role in a common damage (that is, frank osteoarthritis) die relatively quickly of the disease. Prize for medicine and physiology Alexander Fleming is credited with Justin Paoloni has already won the condition where the ruling view is and a disability that will last a lifetime. The strains of HIV which are seen in (Robin Warren and Barry Marshall). discovering that the mould penicillium David Garlick Memorial Scholarship that is has no role. Of course, the ruling dogma is that Western countries have, by contrast, Their discovery was that the could inhibit the growth of bacteria, but for this work. the “early” chondral damage seen One of my all-time favourite articles become far milder, presumably due bacterium Helicobacter pylori is in the Australian Sir Howard Florey (who in the first arthroscopy constituted There was an IOC Olympic Prize I have ever read was called “A New to the widespread institution of safe fact the major cause of stomach has an institute named after him in a joint “weakness” that after further in sports science and medicine Germ Theory” written by Judith sex practices. Because there is less ulcers which can now be successfully Melbourne) is considered to have been “mechanical loading” deteriorated which was awarded every two years Hooper and published in The Atlantic opportunity for the virus to spread treated with antibiotics. Those of us most responsible for introducing the to frank arthritis. Yes, I believe that between 1996 and 2002, but not Monthly in February 1999. This from patient to patient, it ‘evolves’ in sports medicine should greet this antibiotic penicillin to clinical practice. early wear of the knee joint can later awarded in 2004 because of the article focused on the theories of to become more benign, as it would award with a similar level of elation become advanced wear, but in the Warren and Marshall deserve the withdrawal of sponsorship from the Greg Cochran and Paul Ewald, who be disadvantageous to kill its hosts that we felt, for example, when Cathy average patient this normally takes highest of our praises for making a Pfizer company. This award, if it is believe (via Darwinian theory) that before there was a chance to spread. Freeman won the 400 m at the 20-30 years. How come it can happen discovery which vastly improves a resurrected, may possibly be seen any common medical condition which Olympics. Admittedly the Freeman If, for example, the proponents of to some poor victims in under 12 common disease in clinical medicine, as the “Nobel” equivalent in sports has been around for generations gold might have warranted more the “New Germ Theory” are right months when they don’t run a single for being prepared to challenge science and medicine. Yet it would but which substantially reduces instantaneous joy in that the ‘event’ about Type-II diabetes, that it might step due to the fact that they have existing dogma about the causation only be an equivalent for as long as human fitness should be considered lasted less than a minute but there are involve an infectious agent, then it a knee effusion for the entire year? of peptic ulcer and, locally, for it was considered impossible for a an infectious disease until proven more than one hundred Australian would still be important to push the In my mind, the likely culprit is an conducting all of their work within sports medicine researcher actually to otherwise. For example, not only Olympic gold medallists yet only a public health message about exercise infectious agent and, sadly, the likely Australia (in the city of ). You win a real Nobel Prize. do they believe that peptic ulcer is dozen Australian Nobel Prize winners. and good nutrition. In a society source of entry to the joint is the should take any chance you get to caused by an infectious agent, they Those small-minded folk who think where there is a high population of initial knee arthroscopy itself. The only Australian Nobel Prize winners read about the story of Warren and assert that cardiovascular disease that I have tenuous grip on reality overweight and obese people, if an in medicine and physiology are: Marshall, including the free text in the must be too, along with diabetes, OK, some of you sceptics out there would probably suggest to me that infectious agent can cause diabetes Christmas edition of the Med J Aust at rheumatoid arthritis, Alzheimer’s who may actually be medicos who • Warren and Marshall in 2005 for sports medicine experts should stick in these people, from an evolutionary disease and many cancers, etc. have treated patients with chronic their discovery of Helicobacter http://www.mja.com.au/public/ to the task of proving to the Australian perspective it can afford to be a far effusion post-arthroscopy may be able pylori, issues/183_11_051205/van11000_ Government that we actually exist as a If you consider this concept to nastier agent, as the potential pool of fm.html distinct area of medicine before anyone to tell me that: • Peter Doherty (along with Rolf be preposterous, remember that victims is huge (and from the agent’s starts worrying about winning the Zinkernagel, a Swiss working With respect to the field of sports mainstream gastroenterologists have viewpoint it will not affect its spread 1. Whenever you have sent a knee Nobel prize for a sports medicine study. in Australia) in 1996 for their medicine, a recent Nobel award only accepted in the last decade that if a few victims die of the disease). In effusion in this scenario off for a Even though we tend to equate sports discoveries in immunology, has major relevance (Paul Lauterbur Helicobacter pylori causes peptic a society (which unfortunately is now culture it has always come back medicine with sports injuries, if we start and Peter Mansfield in 2003 for the ulcers. There is some evidence that a hypothetical one) where everyone negative AND • John Eccles (along with Hodgkin to think along the sports and exercise various chlamydia organisms are exercised regularly and ate moderate discovery of magnetic resonance 2. If you have ever happened to treat and Huxley of the UK) in 1963 for medicine paradigm, perhaps it won’t associated with cardiovascular disease, amounts of food, if you were a imaging). In 1998 three Americans a patient in this scenario with a his discoveries regarding nerve be long before we see an exercise although this has not yet been proven diabetes-causing virus you would (Furchgott, Ignaro and Murad) shared standard antibiotic (eg, Amoxil) cells, medicine Nobel laureate. Researchers to nearly the same degree as the quickly mutate to a more benign the Nobel Prize for medicine for their it hasn’t helped with the knee such as Jeremy Morris, Ralph helicobacter/peptic ulcer connection. form. It would be very costly to kill • Frank Macfarlane Burnett (along discoveries with respect to the role effusion. Paffenbarger and Stephen Blair must with Peter Medawar) in 1960 for his of nitric oxide in the cardiovascular For a summary of of the Atlantic your victims due to the difficulty in surely be close to that elusive Nobel http://www. This is where a read of the story of discoveries in immunology, and system. Their work has probably article, please refer to: finding replacement victims (given for their work proving that exercise can injuryupdate.com.au/forum/ Marshall and Warren is extremely inspired that of George Murrell and that the virus might need a high-fat • Howard Florey (along with Fleming prevent heart disease and cancer. showthread.php?p=1066#post1066. valuable. They only managed to Justin Paoloni who have discovered host environment in which to live). and Chain of the UK) in 1945 for culture Helicobacter pylori when that nitrates can improve the clinical If we switch back to Marshall and And for a more formal reference, try Therefore, even if there are infectious the discovery of penicillin. one of their plates was accidentally outcome of tendinopathy, which Warren, there are lessons for us to Cochran GM, Ewald P and Cochran agents that cause diabetes that we left in a laboratory over the Easter In terms of the impact on improving may one day be worthy of a major learn. Firstly, that you can be an K (“Infectious Causation of Disease: are yet to discover, we can limit their break. Normally in pathology if a the human condition, the discovery of international award in the field Australian and living and working in An Evolutionary Perspective) in spread by increasing rates of exercise culture is not positive after 48 hours, penicillin (which was the biggest ever sports medicine. George Murrell has Australia and still beat the rest of the Perspectives in Biology and Medicine and improving nutrition.

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the plates will be discarded and a by Vincent J, Podewell C, Franklin Achilles tendinopathy patients have negative result recorded. Helicobacter GW and Korn JH. This short cracked heels, presumably due to pylori managed to evade detection for PubMed abstract states that Kingella low-grade skin fungal infection The new Australian Sports many years because it takes longer (Moraxella) kingii, a gram-negative (see figure). A lot of the general than 48 hours to multiple on an agar bacillus, was isolated as the cause population also has low-grade fungal plate. When you think about it, based of septic knee arthritis in an adult. infection of the heel, but is it more on Darwinian theory, if you are an Three previous cases (one adult and common in Achilles tendinopathy Anti-Doping Authority infectious agent in modern times two children) of septic arthritis due to patients? I don’t know, but perhaps Adam Firth (such as a bacterium, virus or fungus) Moraxella species have been reported. one day in the future I will do a case- what would be the most important All cases have been characterised by control study to test this hypothesis, The year 2004-05 has been a landmark in Australia’s anti-doping effort, Chairperson Brian Sando says in the latest -– and characteristic you could evolve to difficulty in identifying the organism, and on another occasion I might treat probably the last -- annual report of ASDA before the Government turns it into ASADA, the Australian Sports Anti-Doping ensure your survival? The mainstream indolent clinical course and slow some of my non-response Achilles Authority. thinking is that “antibiotic resistance” response to antibiotic treatment. tendinopathy patients with Lamisil to Acting Chief Executive Kim Terrell points out in the report that the establishment of ASADA, implementing one of the biggest (or anti-viral resistance) is the major see how they go. Does this (underlined section) sound testing programs ever undertaken in Australia and the work on the 2006 will be high priorities for 2005- evolutionary defence mechanism that 06. For example, the Agency will conduct more than 7,000 drug tests in 2005-06 -- on average, that’s at least 19 athletes tested to you like the standard progress microorganisms have. What about every day of the year. of a post-arthroscopy patient with a inability to grow on an agar plate in chronic effusion? What if there are Sport Health here publishes extracts from the report on issues of special interest to its readers, such as no advance notice a pathology lab? Wouldn’t that be testing, trends in notifiable events and the prospects for an online athlete whereabouts system. actually dozens of organisms out a far more valuable characteristic there like Kingella kingii, which can to develop compared to antibiotic chew through knee articular cartilage resistance? If you are resistant to an but are difficult to identify and antibiotic, the humans will just hit you don’t respond to standard antibiotic On 23 June 2005 the Australian governing bodies in Australia sign on or other law enforcement agencies with a different antibiotic until they treatment? Apparently Kingella kingii Government announced its intention to use ASADA for such purposes. where relevant to a possible anti- nail you. However, if you refuse to to establish the Australian Sports doping policy breach; does not grow well in the laboratory It will be a condition of government conform to their belief that they must Anti-Doping Authority (ASADA), within 48 hours and if not transported funding and other support that • power to present the prosecution be able to see you grow within 48 which from early this year will take in blood culture bottles so, from sports submit all their anti-doping case before a tribunal (whether or hours on an agar plate in a pathology over from the Australian Sports a routine tap of the knee joint, a operations to ASADA, and ensure that not ASADA investigated the case). laboratory, they probably won’t even Drug Agency (ASDA) as Australia’s Kingella kingii infection will generally their members and staff cooperate This may include prosecuting know that you exist and therefore NADO under the World Anti-Doping return a negative result (just like fully with ASADA in the performance adverse analytical findings in won’t be throwing any antibiotics in Code (WADC), but with significant Helicobacter pylori used to do with of its functions. It will also be a respect of a sample tested by your direction in the first place. additional functions to ASDA in the peptic biopsies). For more info, read requirement that the sport accepts ASADA; and fight against doping in Australian If the bacteria (or other non-bacterial http://www.medterms.com/script/ any adverse finding of ASADA against sport. • the ability to publish results of any microorganisms) which are most likely main/art.asp?articlekey=33658. any of its athletes (or other persons to infect a knee after an arthroscopy The great thing about being involved hearing where it is in the public One of my personal areas of clinical No doubt ASADA is motivated at within the sport’s jurisdiction), happen to be resistant to amoxicillin in science is the thrill of watching interest. expertise is the treatment of Achilles least in part by the Australian cycling ensures that infraction notices are and don’t grow on agar plates, then our knowledge base evolve. Fifteen tendinopathy, and I occasionally think controversies of the past two years served on such persons and enforces The effect will be to have a common they can continue on their merry way years ago the internet didn’t exist and, about whether an infectious agent and the experiences in the United penalties imposed in accordance with procedure and consistent practices eating through the layers of articular 25 years ago, no one suspected that might be responsible for the failure States with the BALCO scandals. Its the sport’s anti-doping rules. The throughout Australian sport in hyaline cartilage whilst the doctors Helicobacter pylori was a common of Achilles tendinopathy patients enabling rules and regulations are Government has used purse string pursuing anti-doping rule violations who are supposed to be treating the cause of peptic ulcer. If you are to repair their degenerative lesions. not yet finalised and accordingly control to good effect in forcing all and enforcing anti-doping policies. patient nod their heads about the working in sports and exercise We know that tendon degeneration this article can only make comment Australian sports to sign on to the Consistency between and within inevitability of cartilage breakdown. I medicine, you are working in an area is very common (eg, the Jill Cook on some features that have been WADC and it can be expected that it sports can only be a positive thing in can remember a case from my intern which, despite its snubbing by the studies on patella tendons) yet we announced and in relation to such a will pursue use of ASADA with the reducing uncertainties that have in the year of a woman who had a persistent mainstream medical profession, is one know that many people with tendon body generally. same intent. past been seen in anti-doping matters effusion after a knee arthroscopy and which is critical to the advancement degeneration don’t get pain and in Australia and around the world. was stuck on my orthopaedic ward of human health. Maybe we won’t More specifically, in addition to many cure their own radiological for weeks due to severe knee pain. see a Nobel Prize-winning discovery ASADA’s powers ASDA’s existing powers, ASADA will The most significant new features tendinopathy spontaneously. Eventually the pathologists isolated in sports medicine in our lifetime, but have: of ASADA are its investigative Could it be that those who don’t Kingella kingii bacterium from maybe we will. What is assured is It has been confirmed that ASADA and prosecutorial functions. An spontaneously cure possibly have an • power to conduct investigations on her knee, but it was thought to be that there will be new and successful will replace ASDA in handling the independent, government-funded infectious agent responsible for the the basis of information acquired possibly a benign pathogen. ways to prevent and manage major responsibilities of sample collection body fulfilling such a role has been ongoing degeneration? I’m not saying from its drug testing and other sports injuries that are discovered in and testing, and education and sought by many sports organisations There is a case report which suggests that this is necessarily the case, but activities, or where it has received our lifetime, and that some of them advocacy. It will also play a role in in this country for some time as this may be a cause of septic I can hypothesise that it wouldn’t information from any other person, will be discovered in this wonderful policy development relevant to sports the burden of anti-doping policy arthritis in J Rheumatol (1981 May- be an in-your-face bacterium like or on its own initiative; country of ours. doping, and most significantly will enforcement distracts time and Jun;8(3):501-3): “Septic arthritis due Staphylococcus aureus, or someone act as the investigator and prosector • power to receive, use and disclose resources from developing their to Kingella (Moraxella) kingii: case would have already cultured it. of all allegations of anti-doping rule (where appropriate) information sport, their competitions and their report and review of the literature”, I regularly notice that many of my violations relating to sports whose from Australian Customs Service athletes. This is particularly the case

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with smaller sports that, dedicated as of Australian sport will welcome storage and chain of custody, or the an investigation before an allegation investigations in the Anderson Adequate resources they are to drug-free sport, lack the ASADA and happily hand over their possibility of contamination. These is made. inquiry and throughout appeal Having adequate resources is resources to undertake enforcement anti-doping enforcement to this are all matters that will be within the process but the question should be Individuals can be compelled to important from the point of view of proceedings without detracting from independent body. There is little responsibility of ASADA and the risk asked whether or not it should have give evidence before a tribunal or financial support, but also in securing their other core functions. Cultural doubt it should prove a positive step is that where one person (or group) is occurred before any allegations were court through the subpoena process. the services of sufficiently qualified issues also may arise where a sport, for Australian sport but, although responsible for collection and testing, made against the athlete concerned However, to reduce the burden on and experienced personnel within wanting to treat its athletes more details are presently thin, there are at and also prosecution, any mistake in the first place. While it should the tribunals (and potentially accused each of its core activities. While like family, is confronted with the least three issues that stand out at this made or matter overlooked at an be noted that the investigations on athletes), ASADA should be given most anti-doping rule enforcement prospect of having to prosecute early stage: early stage may remain uncovered. behalf of the ASC continued in great similar powers so that it has access to proceedings arise out of a positive them vigorously. ASADA will bring There should therefore be sufficient detail and at considerable cost to 1. independence of its functions and all available evidence before deciding sample, the cycling cases in Australia independence to that process. separation of functions and those the ASC even after the first hearing appropriate review mechanisms, whether or not to proceed with a and BALCO in the United States responsible for prosecuting an concluded in June 2004, it appears Adoption of the WADC provides prosecution. The Government appears show the potential complexity and 2. sufficiency of its powers to compel alleged violation must objectively that the assessment of all the evidence standardised anti-doping rules unlikely to provide such powers to breadth of anti-doping violations the giving of evidence, and test all evidence collected by others. known as a result of this thorough throughout Australian sport and the ASADA on the basis that it may be under the WADC. These types of Where necessary the prosecution investigation significantly altered the step towards centralising enforcement 3. level of resources. perceived as coercive. It is worth prosecutions lie outside the realm should provide useful evidence to the ASC’s earlier view as to whether any of anti-doping rule violations is noting that through requirements set of strict liability (as in the case of defendant or make a decision to not doping offence contrary to the ASC an obvious and sensible one. It Independence out in contracts with AIS scholarship positive samples) and require in some proceed with a prosecution. policy could be established. Clearly, provides the opportunity to develop ASADA will be responsible for sample holders those persons questioned in cases establishing intent and other it is preferable where possible that a specialised pool of knowledge and collection and testing, investigation of Of course there must also be a the Anderson inquiry were instructed elements to a standard that may be complete inquiry be undertaken experience in anti-doping matters potential doping offences and conduct procedure for external review of to do so completely and truthfully. seen as approaching the criminal prior to tribunal proceedings being that no individual sport is capable of of the prosecution. These functions decisions, as with all government For government to take the view that standard of beyond reasonable doubt. commenced. matching. The result should mean need to be sufficiently independent departments, and ASADA (like scholarship holders can be required to This standard is reasonable given the that enforcement becomes more of each other to ensure integrity and ASDA now) will be subject to the provide truthful statements in such an It is the view of this writer that effects on an athlete of a proven anti- efficient, consistent and accurate in accountability, as well as ensuring that Commonwealth Ombudsman, the inquiry but not the broader sporting ASADA should have power to doping rule violation but it highlights its outcomes across sports while at matters are given adequate inquiry Administrative Appeals Tribunal community in similar circumstances require sporting organisations to the need for ASADA’s investigative the same time removing a significant prior to any decision being made to and the Federal Court or Federal seems somewhat confusing. Given include in their anti-doping policies and prosecutorial personnel to include burden from individual sports. prosecute. Magistrates Court under the the seriousness of doping allegations requirements that athletes and athlete individuals with experience and Administrative Decisions (Judicial for an accused athlete and the support personnel cooperate fully and knowledge in investigating criminal Anti-doping rule enforcement can be Independence between investigators Review) Act 1977. Such review does consequences of doping to sport truthfully with ASADA investigations matters and correctly identifying, very complex and holds significant and prosecutors has rightly been however require a complaint or generally, there is a need to compel under threat of sanction. The collecting, handling, analysing and consequences to all those involved. reflected in criminal investigation and appeal to be made in respect of action the giving of truthful evidence at ASADA rules should then set out preserving evidence. Thus far, sports organisations have prosecution by the state (ie, police by ASADA and there may well be the investigation stage, with suitable specific procedure for appropriate been dealing with and learning about and crown prosecutors respectively). Of course, there must be sufficient costs in taking such legal avenues. checks and accountability procedures checks, objections and review in any anti-doping enforcement largely ‘on The rationale is that the evidence financial funding for ASADA to carry This again highlights the need for in place to ensure proper use of such individual case. the run’ as ad hoc matters arise within should be given independent review out its functions properly and in this adequate internal checks so as to power by ASADA. their sport. This has led to results that prior to prosecution to ensure that Another issue relating to evidence regard I note that the Government has reduce the risk of inappropriate action have at times been unsatisfactory, only matters with sufficient prospect The Court of Arbitration for Sport collection is the power to compel committed to this. An additional $5.87 in the first place. particularly in cases involving of success are brought before the (CAS) said in its French decision: the provision of a DNA sample. million is to be provided over the next allegations such as trafficking or use courts. This serves the dual functions Athletes are already compelled to four years for the establishment and Powers to obtain evidence “Such offences ought be investigated of prohibited substances based on of ensuring efficient use of court provide blood and urine samples for operation of ASADA, in addition to ASADA investigators must have the evidence other than a positive sample. resources and providing fairness in a thorough and timely manner testing and analysis under the anti- the existing approximately $35 million necessary powers to obtain evidence The cycling cases of 2004-05, and in to an accused by preventing many and pursued if there is a proper basis doping regime. The rationale is that allocation to ASDA over the same and where necessary to compel particular the French decision (see prosecutions unnecessarily being for doing so. This requires an assess- any loss of individual liberty is more period. It remains to be seen whether witnesses to provide evidence. ………on p??), provide lessons to instituted, such as with ‘witch hunts’. than offset by the public interest and there will be any level of ‘user pays’ Present indications are that ASADA ment of the evidence available and of those investigating and prosecuting An independent prosecution can individual health benefits of drug- with ASDA, particularly with the will not have expansive powers in the prospect of proving the case on the anti-doping allegations, and highlight evaluate the available evidence at face free sport. Why should these powers professional sports, but, as the ASC that regard for fear that it may be too the need for a prosecution to run value without being influenced by basis of that evidence according to the not be taken further to include the presently funds anti-doping policy coercive. This writer disagrees with more like a criminal prosecution, with experiences in the investigation that required standard of proof. Prosecut- provision of DNA samples in cases enforcement in any event through that view. Fears that the coercive specialist people undertaking ‘crime may cause bias, even where such bias ing authorities should not be dissuad- such as French? The provision of a its funding of individual sports, there power may be abused can be readily are good arguments for the majority scene’ investigation, questioning of is innocent or subconscious. ed from that course because of the risk DNA sample is less invasive than witnesses and evaluation of evidence addressed through processes of giving a blood or urine sample and of instances that ASADA to be fully Independent assessment of a case that their case might not be proved.” with good understanding of the objection and review to and by the accordingly the above rationale government-funded. against an athlete is also relevant As the CAS Award notes, the counsel evidentiary requirements to prosecute courts. Rules may also be developed should at least equally apply. Again, where there has been an adverse for the ASC in his closing submission the offence successfully. so that evidence provided under rules can be developed to ensure Adam Firth is a solicitor with the analytical finding in respect of a “properly submitted that the evidence compulsion cannot be used against that the sample may only be used for Law Office of Simon Rofe and a sample. The prosecution should did not prove that French had Initial observations the deponent. These measures purposes relating to an anti-doping director of the Australian and New ask the same questions a defendant committed a doping offence as defined can provide safeguards to protect rule allegation. Zealand Sports Law Association. Certainly the vast majority of those would ask relating to the integrity civil liberties while maximising the in the ASC Anti-Doping Policy.” That involved in the administration of the sample, including collection, usefulness of the evidence gathered in assessment arose from the further

 Sport Health VOLUME 23 – ISSUE 4 • SUMMER 2005-06  D oping in sport D oping in sport The Mark French Case Ethics and doping in sport:

Adam Firth an issue of context?

In December 2003 a plastic bucket, serious to an athlete, the standard of custody of the materials from What is sport? or the pursuit of excellence. This at a club level. Players are amateurs. used by Mark French and others as a of proof requires a higher level of the time that they were found until is very different from the full-time They play for no financial reward. waste bucket, and a bag were found evidence than an assumption based the time that they were analysed to Both Radford (1998) and Wright professional athletes who first and Indeed there will be a financial cost in a room previously occupied by upon written materials accompanying ensure that the materials were not (1998) argue that sport is more than foremost must make a living from for them simply to participate. It is French at the AIS cycling facility in a product. In this instance (as in contaminated or otherwise affected. entertainment and business. They their chosen profession. By and large our argument that media and personal Del Monte. The bucket was alleged to Eadie) it required analysis of the All these matters affect the reliability assert that there is some sort of this will depend heavily on results reactions to the use of banned contain prohibited substances. French bottles to determine whether or not of evidence before the CAS in matters deeper quality that defines sport. obtained on the sporting field. This substances at these different levels was served with infraction notices they did in fact contain a prohibited where a standard of proof above This quality is something beyond can be (and usually is) quantified should be quite different. alleging doping offences, including substance. mere balance of probabilities is winning, something more worthwhile. fairly easily in terms of winning and At first glance the use of banned for use of glucocorticosteroid and/ required because of the significant They argue that modern sport cannot losing. The aims of the amateur and Another evidentiary problem involved performance-enhancing substances or equine growth hormone (eGH) consequences by which an accused be understood simply as a profit- the professional will clearly be quite one of the needles in the bucket, seems completely wrong. The (both being prohibited substances); person is confronted. driven business open to the market different because the context is very which was shown to contain eGH. minority who are caught are labelled or alternatively being concerned in forces. Radford talks of ethical and different. Sport may have certain There was, however, no analytical Had the investigation been better by the media and public as cheats, prohibited doping use by others. In moral codes of conduct that are part qualities that distinguish it from other proof that it was French who actually performed it is to be hoped that which of course they are because June 2004 French was found at an of this deeper quality that makes forms of entertainment and business. used the needle, as compared to sufficient and reliable evidence they are breaking the rules of their initial hearing of the charge to have participation in sport “worthwhile”. However, these qualities really do another person, nor could it be would have been put before CAS to sport. However, a closer examination breached both the Cycling Australia Indeed this is the essence of the depend on the nature and context concluded with sufficient certainty prove the anti-doping rule violation of the issues behind banning certain and Australian Sports Commission amateur sports person: someone who of the sport. Heikkala (1993) and that the eGH was in the needle when or a decision made that there was substances reveals that this position is anti-doping policies and given is involved in sport for the enjoyment Volkwein (1993) both contend that, it was used and not subsequently insufficient evidence to successfully less clear cut. (among other consequences) a 2-year of the process. in certain situations such as many contaminated by another source prosecute the allegation. Either ban. French won his appeal of that professional sports, these qualities are while sitting in the bucket. As part scenario is preferred to what in fact Sport, however, is different things to decision in July of this year, after lost. Whether or not this is desirable is of his inquiry into these matters, the took place, which was a protracted different people. The context in which Why are certain effectively serving a year of the ban. questionable. The public, the media, Hon Robert Anderson QC had DNA process of some 18 months, with the sport operates and is contested and we as sports scientists can debate performance-enhancing French admitted injecting himself analysis undertaken on the bucket no doubt several hundred thousand makes a significant difference to the loss of the central qualities of with a substance called Testicomp materials. , and dollars or more in costs incurred, and what is acceptable and what is not. substances banned? sport at this level. However, the fact and placing the waste products in provided comparative significantly an athlete serving a ban This applies equally to behaviour on remains that at the professional level In a nutshell, substances may be the bucket. He named five other DNA samples but French did not. from competition for more than a and off the sporting field. Take, for 1 sport must maintain a business model. banned because they are illegal in cyclists as being involved in group- Of the 230 items in the bucket that year for an offence that ultimately was example, the professional foul. In most countries, they are not a food injecting sessions at Del Monte, were tested, 74 were from a single shown on appeal to not have been elite competition this might be seen and provide an unfair advantage or although he said he didn’t know what source DNA profile and seven were sufficiently proven. as quite acceptable behaviour to Context and ethics in sport 3 they are health harming. In 1996 Juan they were injecting. An information matched to Dajka . Four of the ensure that the player’s team secures Antonio Samaranch, then President of References It is our thesis that the context in leaflet that accompanied a used items yielded a mixed DNA profile, a victory. On the other hand, the the International Olympic Committee packet found in the bucket indicated which was consistent with having 1. Shane Kelly, Sean Eadie, Jobie Dajka, Brett Lancaster same action in the context of junior which a particular sport is played and . Other than Dajka (see note 3), (IOC), defined doping as: that Testicomp contained among its been contributed to by both the no action was taken against any of these cyclists, sport will more likely be considered influences the moral code that is ingredients Cortisonacetat Dil, which “unknown male” and Dajka. The and other evidence did not substantiate the claims. unethical, or “the wrong thing to accepted by the participants. An “Doping is cheating. Doping is akin 2. CAS (A4/2004) Partial Award 21 July 2004. In that is a glucocorticosteroid. However, needle shown to be containing the case, allegations were made against Eadie of do”. The point is that, depending extension of this hypothesis means to death. Death physiologically, no analysis was done of the bottles eGH was matched to the “unknown trafficking because a parcel addressed to him on the context, the unwritten codes that the illicit use of performance- by profoundly altering, sometimes contained tablets labelled as containing anterior of Testicomp to determine whether male”. The evidence did not show pituitary peptides (APP). CAS held that the case was of conduct will differ. Importantly, enhancing substances is seen as irreversibly, normal processes through not proved against him without analytical proof that a necessary part of “making a go” unjustified manipulations. Death or not they in fact contained the whether the needle was capped or the tablets contained APP. this must also mean that what sport glucocorticosteroid (or any other where in the bucket it was located. 3. This finding resulted in an investigation by the is about in different contexts has of many top level sports. Take the physically, as certain tragic cases in prohibited substance). Reliance was It was conceded that, if the needle Australian Olympic Committee against Jobie Dajka, implications for what the outcome of transparent professionalism evident in recent years have shown. But also which ultimately led to his non-selection to the simply placed on the leaflet together was at the bottom of the bucket near Australian Olympic team for bringing himself participation means to the athlete. the National Football League (NFL). death spiritually and intellectually, with the admission. The Court of to liquid residue found there, it was into disrepute in breach of his Team Membership Clubs are simply franchises that by agreeing to cheat and conceal Agreement by lying to the Hon Anderson QC In the amateur contest the athletes do Arbitration for Sport (CAS) in the possible that it could have become during the inquiry in saying to him that he did not run to make money. In this system one’s capabilities, by recognizing inject. not compete for money. They are in French case followed its earlier contaminated after use. outcomes and sponsorship depend one’s incapacity or unwillingness to it for the challenge, the enjoyment, decision in AOC v Eadie2, that for entirely on winning football matches. accept oneself, or to transcend one’s Further to the above, the CAS was and perhaps the attainment of other doping allegations, which are very Contrast this with a local soccer match limits. And finally death morally, critical of evidence of the safe chain ideals of sport such as fitness, health

10 Sport Health VOLUME 23 – ISSUE 4 • SUMMER 2005-06 11 D oping in sport D oping in sport

by excluding oneself de facto from state. However, this is no different that returning an athlete to a “normal” and big business that is the modern recreational bodybuilders may take 3. Develop performance-enhancing the rules of conduct required by all from any other member of the public. state is different. What about gains in Olympiad. Athletes compete in anabolic steroids because they feel substances that do not possess human society.” It is our contention that testing performance through elaborate and conditions of professional sport where that that is the only way they can any harmful side effects. This athletes specifically for illegal but non expensive training regimes and/or an Olympic gold medal is as good achieve the look of the drug-boosted effectively eliminates two of the More specifically WADA gives the performance-enhancing substances equipment? For example, if the as money in the bank. The future bodybuilders they see in magazines. three reasons utilised by the IOC rationale for a World Doping Code as: is an invasion of civil liberties. This danger of using red blood cell booster livelihood of the athlete and his/her Many would argue that this is the Medical Commission, and the “Anti doping programs seek to protect invasion is not offset by the gains erythropoietin (EPO) is that the blood entourage (including sport scientists) present situation in sport anyway. level playing field argument pales what is intrinsically valuable about made by the possibility of having becomes dangerously thick because is dependent upon producing results. into insignificance once the first Finally, athletes who choose not sport. This intrinsic value is often drug-free athletes. of the increased red cell mass, then The context in which the athlete and two issues are dealt with. If new to take performance-enhancing called the spirit of sport; it is the the other endurance boosters which support staff operate is vastly different substances could be produced drugs would find themselves at a essence of Olympism; it is how we Substances potentially harmful to have exactly the same effect need to from that sold to the public. which could provide the same competitive disadvantage and may play true. The spirit of sport is the health be examined. It is not uncommon for benefits without the side effects, Since the virtual abolishment of the feel pressure to engage in doping. celebration of the human spirit, body an elite athlete to achieve an elevated then there is little in the way This appears to be the key area, and amateur athlete in the 1992 and 1996 As mentioned above, critics would and mind, and is characterized by the haematocrit through altitude training, that can be done to distinguish we agree with this. Substances are , it is our opinion that argue that this is no different to the following values: altitude simulation or altitude tent them from substances presently banned because there is scientific the IOC has failed to come to terms present situation in many sports. In sleeping. All of these methods are not banned such as creatine 1. Ethics, fair play, and honesty evidence that they may be health with the effect this change has had on cycling, for example, it is the belief of expensive, not unilaterally accessible monohydrate or glycerol. harming. On the other hand, many the context in which business is now many athletes that it is impossible to 2. Health and potentially dangerous to health sports are inherently dangerous (eg, conducted. The rhetoric continues maintain a position at the top of the A change in the human condition in the same way as EPO. These 3. Excellence in performance motor racing, cycling, boxing) but from the IOC about the frontline sport drug-free. (Option 1 above) is never going differences here need to be defined they continue to enjoy participation. campaign against drugs in sport. But to happen -- morality cannot be 4. Character and education more clearly by the IOC Medical Training for most elite endurance until the real issues are dealt with, the Doping control that is effective legislated. Increases in penalties for and speed sports can be detrimental Commission and WADA. 5. Fun and joy present farce will continue. If the public continues to regard those caught doping are also unlikely to an athlete’s health simply because 6. Team work Black (1996) argues that societal the use of performance-enhancing to be effective. One way of moving of the physical and mental demands. welfare would actually be improved substances as unethical, then real morality back in the right direction 7. Dedication and commitment Training and competing at the highest The future of sport with drugs in sport unregulated. Black contingencies need to be put in might be a return to the amateur level may make the athlete more 8. Respect for rules and laws contends that a fairer contest and place. By real contingencies, we athlete. Because athletes would be susceptible to injury and illness. So what of the future of sport as improved access to medical advice mean doping detection procedures competing at a non-professional level 9. Respect for self and other It is well known, for example, we know it? What can be done, for athletes would lead to better that guarantee in the strictest letter of the context would change and the old participants that extensive endurance training if anything, to stem the use of overall outcomes. Similarly, it has the law that those who are doping ethics of sport might be applicable suppresses immune system function. performance-enhancing substances 10. Courage been argued that the above criteria that have a negative effect on sport? will be caught and appropriately again. It is difficult to see how this for banning certain substances are sanctioned. The large number of legal could happen given the nature of sport 11. Community and solidarity.” The substance is not a food and What can be done to return some of simply not reasonable in the context challenges to drug violations would as a consumer good. Legislating against provides an unfair advantage the ethos to top-level sport? A number We contend that the basis for banning of modern professional sport (Konig, of options and possible outcomes are suggest that this is unlikely. However, the professional athletes is fraught with If a substance has a performance substances, although sound in 1995, Volkwein, 1995). Professional discussed below. this scenario still seems to be the difficulties as history tells us. effect and it is not a food then it may athletes compete for money to make a principle, may suffer some problems most popular idea. Indeed all that Finding an effective testing procedure be banned. What are the reasons living. Winning is what they must do in practice. These are critically A free for all? needs to be developed is a method which is perfect and unbeatable is examined below. for banning non-foods that are on a regular basis. Losing with dignity Under this scenario the use of any whereby athletes do not take banned feasible but it is obviously many years performance-enhancing? The IOC may be the nice thing to do. Right performance-enhancing substance is substances. There are three possible off at best. Developing non-harmful Illegal substances Medical Commission argues that or wrong, this is the reality for many legalised. This situation is unlikely ways to stop athletes doping. substances is similar to developing performance-enhancing substances of our top sports people in what is Some substances (eg, marijuana) to work because publicly-funded effective testing procedures. The mean that athletes are unable to clearly a competitive and cutthroat 1. Change human nature. That is, are banned not because they are sports programs would simply not technology is clearly a long way off. compete on a level playing field. business. As sports scientists we can change the propensity to cheat, the performance-enhancing but because be tolerated by the taxpayer under Interestingly, the latter two options The level playing field argument debate the problems with such an need to achieve the end by any they are illegal in most countries. revolve around technology. is not sufficient. Perhaps the use these circumstances. Funding for means available. Change the belief Why should the IOC and sporting attitude. But this is the attitude of of some performance-enhancing sports programs would need to come that winning is the most important bodies concern themselves with many, if not most, elite athletes. substances pales into insignificance from the corporate sector. Athletes outcome of a sporting contest. this? Surely this would be a police Conclusions when you consider the entourages would then be competing for their matter in that country? Why are 2. Develop technology capable of that support modern elite athletes The paradox of the corporation rather than their country. The issue of ethics in modern athletes more in need of being 100% detection of illegal drug from some countries. The line taken This would destroy the concept of the professional sport is an issue of the “clean” of these illegal substances Olympics use. This would eliminate the by some is that non-foods are simply modern Olympics. Given the business context in which the sport is played. than others in the community? Surely, drug problem instantly as long as “not natural”. Performance gains An interesting paradox exists in the interests in the modern Olympics, this Doping, one of the most contentious workers such as pilots, bus drivers, the means to do so were freely from these substances are therefore marketing of the Olympic Games. is unlikely. issues in modern sport, is an ethical teachers or police for example are available. No athlete would take above and beyond what a human The Games are sold to the public as issue. As a result doping may be in a position where they hold more A second disadvantage would be that the drugs for competition purposes being might expect under “normal” the pinnacle of human excellence. regarded by athletes as acceptable responsibility in society than athletes? the role models that sport stars portray if they knew they were going conditions. What about cases where They have a “wholesome” feel replete under certain conditions. It is argued It is acknowledged that in certain would be unattainable without doping. to get caught and appropriately the substance is taken for therapeutic with national pride, tradition and that the conditions of professional situations it is not safe for competitors This may indirectly promote the use sanctioned. This technology would purposes? Surely, this induces an ceremonies. On the other side exist sport provide a suitable context for to be competing in an altered mind of performance-enhancing drugs in not stop recreational users who do unnatural state. However, some argue the politics, power plays, corruption lower level competitions. For example, not compete. doping to be acceptable. Interestingly,

12 Sport Health VOLUME 23 – ISSUE 4 • SUMMER 2005-06 13 D oping in sport A S C annual report

the Olympic movement is struggling The public’s unfavorable view of References with this concept as the emphasis health-harming but performance Black T. (1996). Does the Ban on Drugs in Sport Improve Societal Welfare? International Review for in the Games moves from amateur enhancing substances is unlikely the Sociology of Sport, Another good year: to professional sport. To solve the to change. Similarly, the financial Heikkala J. (1993). Modernity, Morality, and the Logic doping problem in modern sport rewards and “win at all cost” mentality of Competing. International Review for the Sociology of Sport, 28, several actions are needed. of elite sport are unlikely to change 355-363. in the foreseeable future. So the International Olympic Committee Medical Commission asc Annual Report Firstly, the IOC Medical Commission solution must be safe ergogenics or (1999). Definition of Doping. Retrieved January needs to develop a doping policy that 25, 2000 from the World Wide Web: http://www. safe use of ergogenics. Those athletes olympic.org/ioc/e/org/medcom/medcom_intro_ is defensible. The present reasons e.html who take performance-enhancing for banning substances are not Konig E. (1995). Criticism of Doping: The Nihilistic Side substances under this regime would of Technological Sport and the Antiquated View of necessarily sound in the context of the The year 2004-05 was another good at least be able to seek overt advice Sport Ethics. International Review for the Sociology Funding for sports professional athlete. Doping might be of Sport, 30, 246-260. year for Australian sport, say Chairman from experts. The experts would have controlled by changing human nature Miller AP. (1996). Drugs in Sport. The Journal of Peter Bartels and Chief Executive Officer The following table shows the allocations of grants to particular sports in 2004-05. an incentive to find out about the best Performance Drugs, 1(3), 106-112. and the attitude towards winning at Radford P. (1998). The Good, the bad and the ugly. Mark Peters, and a year of substantial usage and associated health risks of High Sport all costs. If history gives any clue to Sociology of Sport Online, 1, 1. Retrieved January achievement for the ASC itself. those substances. Although not an 25, 2000 from the World Wide Web: http://www. Sport AIS Performance Development Other* Total the future behaviour of the human brunel.ac.uk/depts/sps/sosol/pfr.htm ideal outcome because some athletes In the ASC annual report for 2004- Archery 558 500 310 000 25 000 3 000 896 500 race this appears an unreasonable Reuters. (1998, July 31)). IOC president calls for meeting will unnecessarily feel a need to take over drugs in sport. Retrieved January 28, 2000 05, they highlight “unprecedented Athletics 1 095 000 2 370 000 135 000 292 162 3 892 162 goal. Developing technology to substances in order to be competitive, from the World Wide Web: http://www.sportserver. levels of support from the Australian Australian football 200 000 111 000 200 000 60 000 571 000 ensure detection and sanctioning of com/newsroom/sports/oth/1998/oth/oly/feat/ the situation would at least be better archive/073198/oly70921.html. Government” for the role of the Badminton – 155 000 25 000 0 180 000 athletes involved in doping practices for the overall health of athletes than Samaranch JA.(1996). A Definition of Doping. World Australian Sports Commission in Baseball – 1 190 000 135 000 49 000 1 374 000 or producing effective and safe Judo Federation. Retrieved February 01, 2000 from the present high covert use of such the World Wide Web: http://www.worldsport.com/ enhancing Australia’s national sports Basketball 1 080 400 2 220 000 200 000 310 500 3 810 900 performance-enhancing substances substances. A better solution is only worldsport/sports/judo/doping/sp-do-01.html system. BMX – 89 000 80 000 102 000 271 000 both appear to be worthwhile goals. Volkwein KAE. (1995). Ethics and Top-Level Sport-A possible through a resolution of the Paradox? International Review for the Sociology of Bocce – 26 000 25 000 0 51 000 Technology is the key to the future of The 2005-06 Federal Budget provided present mismatch of public perception Sport, 30, 311-370. Bowls – 378 000 135 000 267 750 780 750 sport and sport scientists clearly have “significant additional funding to of sport ethics and the pressure to Wright L. (1998). The common ground between the Boxing 314 900 105 000 50 000 3 000 472 900 a role to play. philosopher and the sociologist. Sociology of Sport support national sporting organisations Calisthenics – 0 25 000 2 000 27 000 perform placed on our athletes by the On Line, 1, 1. Retrieved January 25, 2000 from the and high performance athlete World Wide Web:: http://www.brunel.ac.uk/depts/ Canoeing 657 000 1 235 000 100 000 0 1 992 000 same public. This will not be resolved development,” they report. in the foreseeable future. sps/sosol/pfr.htm Cricket 488 700 361 000 190 000 167 500 1 207 200 Associate Professor Grant Schofield and Dr “Of special note, the Budget included Croquet – 0 10 000 0 10 000 Geoff Dickson are at the Division of Sport funding to establish a training base in Cycling 1 196 700 2 280 000 110 000 71 000 3 657 700 and Recreation, Auckland University of Europe with accommodation, training Diving 445 500 470 000 25 000 0 940 500 Technology facilities and equipment storage, and Equestrian – 1 240 000 80 000 25 000 1 345 000 where high-quality sports medicine, Fencing – 30 000 25 000 0 55 000 sport science and other support services Golf (men) 196 750 242 000 60 000 120 000 618 750 can be provided to Australian athletes Golf (PGA) – – 60 000 0 60 000 training and competing in Europe. Golf (women) 196 750 201 000 20 000 65 000 482 750 “The primary purpose of the European Gymnastics 1 055 000 990 000 206 667 10 000 2 261 667 training centre is to facilitate consistent Handball – 30 000 – 0 30 000 and regular training and competition Hockey 964 200 3 240 000 156 667 190 000 4 550 867 in Europe by offering a high level of Ice racing – 65 000 5 000 0 70 000 support service, at a lower cost, that Ice skating – 52 000 10 000 0 62 000 Australian sports currently receive. The Indoor cricket – 219 000 15 000 0 234 000 ASC has entered into a partnership Judo – 385 000 15 000 10 000 410 000 with the Province of Varese in Karate – 158 000 25 000 3 000 186 000 northern Italy to develop a purpose- Lacrosse (men) – 0 25 000 7 500 32 500 built centre, design work on which Lacrosse (women) – 0 25 000 0 25 000 has commenced, and it should be Modern pentathlon – 40 000 – 0 40 000 operational in 2007. Motor sports – 277 000 60 000 0 337 000 Motorcycling – 308 000 60 000 0 368 000 “This is an innovative and exciting Netball 573 400 726 000 170 000 246 200 1 715 600 development for Australian sport, Orienteering – 76 000 60 000 0 136 000 which should provide distinct benefits Parachuting – 38 000 – 0 38 000 to our athletes in the lead-up to the Polocrosse – 61 000 60 000 0 121 000 2012 Olympic and Paralympic Games Pony clubs – 30 000 25 000 0 55 000 in London, and beyond.” Powerlifting – 32 000 5 000 0 37 000 Roller sports – 189 000 145 000 108 000 442 000 Rowing 1 392 700 3 070 000 80 000 0 4 542 700

14 Sport Health VOLUME 23 – ISSUE 4 • SUMMER 2005-06 15 A S C annual report A S C annual report

Junior Sport Framework • Good Sport Monitor — the Good research and development technical High Sport Junior Sport Sport Monitor program supports officer, a maintenance technical officer Sport AIS Performance Development Other* Total The ASC continued to provide safe, fun and nurturing junior sport and an office administrator. During 200 000 111 000 150 000 185 000 646 000 Another major area of interest in the leadership to national sporting environments by making resources the reporting period, Biomechanics Rugby union 200 000 111 000 170 000 150 000 631 000 ASC annual report for Sport Health organisations in adopting the Junior and strategies available to sporting had five postgraduate scholars and Sailing 393 000 2 270 000 135 000 210 000 3 008 000 readers concerns national junior sport, Sport Framework and developing clubs and organisations that can a PhD scholarship for the 12-month Shooting which incorporates the Active After- junior sport-specific policies. The ASC be modified and implemented to period, as well as two staff completing (association) – 1 160 000 70 000 10 000 1 240 000 school Communities program and other has been working closely with nine address inappropriate behaviour their PhDs. Skiing – 570 000 15 000 10 000 595 000 junior sport initiatives that help develop pilot national sporting organisations in junior sport. The pilot was Soccer 1 070 800 4 233 000 141 667 50 000 5 495 467 safe, fun and quality environments for during the development of their junior conducted in the ACT with four Sports Medicine Softball 373 600 1 302 000 150 000 208 000 2 033 600 sport for young people. sport policies. These nine sports sports: basketball, tennis, netball The department continued to deliver Squash 364 000 370 000 110 000 9 500 853 500 are swimming, netball, tennis, golf, and football. The results of the outstanding sports medicine services Surf lifesaving – 270 000 150 000 80 000 500 000 pilot will be made available for Active After-school football, basketball, hockey, wrestling to AIS and other elite athletes. Surf riders – 380 000 80 000 300 000 760 000 and volleyball. The policies and other sports to implement.” Research within Sports Medicine Swimming 1 089 900 3 265 000 110 000 275 000 4 739 900 Communities processes undertaken by these sports in 2004–05 focused on fatigue in Synchronised will be documented and shared with elite athletes, haematological and swimming – 60 000 – 0 60 000 The Active After-school Communities other sports. An additional 26 national Athlete and Coach Services biochemical screening of athletes, the Table tennis – 85 000 45 000 40 000 170 000 program, a major component of the sporting organisations have requested The report points out that the major interpretation of blood test results Taekwondo – 625 000 25 000 4 000 654 000 Australian Government’s Building a and received copies of the Junior responsibility of AIS’s Athlete and in elite athletes, tendon injuries and Tenpin bowling – 283 000 80 000 60 000 423 000 Healthy, Active Australia package, Sport Framework. Coach Services is to support such osteitis pubis. PhD-level research Tennis 447 700 165 000 150 000 220 000 982 700 is a four-year $90 million program areas as clinical disciplines and sports was conducted on the effects of a Touch – 251 000 135 000 110 000 496 000 launched in June 2004 to provide more Other initiatives science. Twenty AIS-employed staff range of alternative therapies on Triathlon 299 400 625 000 90 000 25 944 1 040 344 opportunities for primary school-aged were seconded to the Australian muscle soreness and inflammation. During the reporting period, Universities – 30 000 – 0 30 000 children to participate in structured Olympic Committee to support the The department forged strong links the ASC also continued with the Volleyball 1 000 600 1 130 000 60 000 100 000 2 290 600 physical activity in the after-school Athens teams. Staff also conducted with the new ANU Medical School, implementation of the following Water polo 953 500 1 435 000 60 000 0 2 448 500 timeslot. The ASC has employed 147 research to identify best practice which will lead to increased research initiatives: Water skiing – 331 000 20 000 4 750 355 750 staff at national, state and regional in elite athlete development and to opportunities in the future. Weightlifting – 320 000 20 000 30 000 370 000 levels to develop and implement • Out of School Hours Sports provide innovations to the AIS and Wrestling – 30 000 – 0 30 000 the Active After-school Communities Program — in partnership with Australian elite sport network, some Nutrition Other — deaf sports 25 000 – 0 25 000 program, the report says. VicHealth, Northern Territory of which were utilised at Athens. The AIS Recovery Bar program and Other — winter Health and the South Australian Some brief reports on activities of copies of Survival Around the World sports 370 000 – – 0 370 000 “Nineteen schools and out of school Office for Recreation and Sport, special interest to Sport Health readers (the third in the series of the AIS Dragon boat – – – 4 000 4 000 hours care services participated in the the ASC has been involved in follow: Survival cookbooks) were provided Ice hockey – – – 4 200 4 200 pilot program in term 1 of 2005. piloting out of school hours sports to all Australian Olympic sports Total 17 178 000 42 436 000 4 830 001 4 203 006 68 647 007 “The first phase roll-out of the Active programs in their respective states Biomechanics programs via Medical HQ. Both and territories. All the pilots are in received much positive feedback. *excluding Aussie Able grants After-school Communities program Biomechanics has continued its has been successfully completed, their final year, and the research cutting-edge reputation in the The department embarked on the last year of the four-year contract High Sport with 897 primary schools and out of and evaluation of the pilots will be areas of technique enhancement, Sport AIS Performance Development Other* Total made available on the completion with Deakin University, due to finish school hours care services nationally competition analysis and specialised of each pilot. These pilots have in December 2005. The AIS Sports Australian athletes – 197 600 – – 197 600 participating in the program in term 2 feedback procedures for the coach with a disability informed the development of the Supplement Program, managed of 2005. and athlete in a variety of AIS Australian Blind – 77 500 – – 77 500 Active After-school Communities sports. Biomechanics is organised by the Nutrition department, has Sports Federation “These schools and out of school program. All of the out of school into five streams, with each stream increased its recognition at national Riding for the – 80 225 – – 80 225 hours care services have received hours care services involved in the concentrating on servicing a particular and international level, with plans Disabled a total of $1,516,716 in grants to Victorian pilot have been invited sport (canoe/kayak, cycling, rowing, to expand its availability to national Disabled Winter – 45 000 – – 45 000 assist them in running the Active to participate in the Active After- swimming, and track and field). Each sporting organisations and the state Sports After-school Communities program. school Communities program. stream includes a biomechanist, a and territory institute and academy AUSRAPID – 87 775 – 3 000 90 775 of sport network. The Gatorade This first phase has engaged 37,557 • Active Australia Schools Network professional support officer and a Special Olympics – 45 000 – – 45 000 and Nestlé Fellowships in Nutrition children across Australia. — the ASC continued its postgraduate scholarship holder. In Deaf Sports – 99 200 – 28 443 127 643 continued to be successfully partnership with the Australian addition to focusing on these sports, Transplant – 55 850 – – 55 850 “Over 5,000 deliverers, including conducted. Council for Health, Physical Biomechanics provided access to all Paralympics – 5 750 000 – – 5 750 000 local club personnel, teachers, private Education and Recreation to assist other AIS sports for biomechanics Total 6 438 150 31 443 6 469 593 providers and students, have completed Performance Analysis the development of school–club services as required. the Active After-school Communities Performance Analysis supports *excluding Aussie Able grants links. The Active Australia Schools Cricket Australia funds a sub-stream Community Coach Training coaches in their observations and Network supports more than 1100 within the department and this Program. This training program has analyses of athlete performance member schools representing includes a professional support a strong philosophical approach that in training and competition. Staff metropolitan and non-metropolitan officer, a postgraduate scholarship incorporates strategies which ensure work with coaches to identify schools (including regional and holder and a PhD scholarship holder. children are maximally engaged in how innovations in information rural) around Australia. In addition to the above staff, the structured physical activity that is high and communications technology quality, fun, safe and inclusive. Biomechanics department has a

16 Sport Health VOLUME 23 – ISSUE 4 • SUMMER 2005-06 17 A S C annual report A S C annual report

can improve their effectiveness as originally developed for use in rowing Fellow, examining the differences Applied Sensors practice structure and operational Cooperative Research Centre for coaches. Staff work closely with and swimming were successfully between cyclists and triathletes in In January 2003, the AIS and the model for Physical Therapies at the MicroTechnology colleagues in Athlete and Coach modified for application in numerous electromyographic patterns of the Cooperative Research Centre for AIS. Investigations have also begun During 2004–05, the AIS continued Services to develop integrated other sports. lower limb. Physical Therapies’ MicroTechnology jointly funded into program practices in AIS sports its productive collaboration with approaches to performance second PhD scholarship position will and how sports can optimise the Physiology staff members assisted in a position to design and develop the Cooperative Research Centre for excellence. During the reporting examine the relationship between effectiveness of support services. the preparation of Australian athletes leading-edge software for coaches MicroTechnology. The fundamental period, Performance Analysis worked bicycle set-up and performance and for the Athens 2004 Olympic and and scientists. The success of these aim of this initiative is to develop with all AIS sports to deliver a injury. A collaborative PhD with National Elite Sports Research Paralympic Games, both as members projects, most of which involve unique unobtrusive monitoring variety of services. During 2004–05, Latrobe University has recently been Program of official scientific support groups acquisition and automated analysis equipment that can be used in Performance Analysis was also initiated, which will examine aspects travelling with national teams, and of data from sensors and video, During 2004–05, the National Elite training and/or competition. A major involved in developing a corporate of patellar tendinopathy. through the completion of special prompted the name Applied Sensors. Sports Research Program established highlight of the reporting period digital repository to store and share the AIS Sports-based PhD Scholarship was nearly daily use of the fourth projects such as the development Projects undertaken during the digital resources around the AIS Strength and Conditioning Program, and over 50 applications generation prototype equipment of methods to protect rowing boats reporting period include a system to Canberra campus. Strength and Conditioning continued were received from around the by AIS and national rowers, and from excessive water intake in analyse training data from sensors its proactive coordination of, and world. A total of 11 scholarships were occasional use in national and rough conditions. Cooling garments attached to swimmers, the successful Performance Psychology quality-assurance role for, AIS sports offered (and accepted) involving international regattas. The same produced through collaboration development of a three-dimensional With a greater emphasis on evidence- located in the states and in Canberra. nine universities and seven sports. equipment was used by kayakers and between AIS Physiology and RMIT video aid for computer-based skill- based practice in service delivery, the It also played a leadership role Scholarships were filled within sailors during training. Late in June University were used by Australian testing, refinements to a PDA-based Performance Psychology department with state and territory institute and the disciplines of physiology, 2005, a Melbourne-based company athletes during the lead-up to the trackside timing system for cycling has completed over a dozen academy of sport personnel in the biomechanics and physiotherapy. — SportZCo Ltd —signed an Olympics and Paralympics, as well as and analysis of GPS and sensor data projects with sports that quantify the ongoing development of national agreement to manufacture this unit, during Paralympic competition. from equipment attached to athletes, AIS research — through the National impact that mental skills have on protocols for testing and exercise which in order to retain a competitive boats and sleds. Projects commenced Elite Sports Research Program and performance. A substantial up-skilling A number of the sport-based PhD prescription to provide consistency advantage, will be one step below the during the period include a new the AIS/National Elite Sports Council’s of AIS performance psychologists that scholars completed their tenure and for elite athlete development. It fifth generation prototypes. generation swimmer-tracking system discretionary research program service sports has also seen a greater new scholars were recruited. A sport- has continued its role of service for competition and player tracking in — continued to deliver research Investment in SportZCo is an acceptance of psychological services based post-doctoral program was delivery for all Canberra-based sports Rugby Union. outcomes that are recognised for their extension of the Cooperative that deliver tangible results. established, enabling the retention of programs and provided management contribution to scientific knowledge Research Centre for MicroTechnology some of the graduating PhD scholars of all service providers for state-based Skill Acquisition servicing expanded and their practical application to the program, with SportsZCo holding the within the national sports system. programs. Staff were made available Technical Direction from focusing solely on AIS preparation of Australia’s elite athletes. intellectual property emanating from One of the PhD scholars received a to the Australian Olympic team to developmental programs to supporting Technical Direction provides leadership The AIS Research Publications collaboration between the AIS and the prestigious award from the organisers support a new initiative that provided some elite-level national sporting to Australia’s high performance sport Database at www.ais.org.au/research Cooperative Research Centre. With of the largest sports science/medicine Australian athletes with a recovery organisation programs. Research through national programs in athlete provides information on research minor adaptations, the fifth generation conference in the world. and gym facility. activity was aimed at identifying career and education, elite sports outcomes presented at conferences rowing device was found applicable avenues to further develop athlete Major areas of applied research and/or published by AIS researchers. Technical Workshop research, talent identification and to team sports players and initial perceptual motor skills outside of the included exercise immunology, laboratory standards, in addition to trials suggest scope for its use in any usual practice environment. To this environmental physiology, Technical Workshop staff provide benchmarking services and facilitating National Talent Search outdoor sport. The data generated enhancement of recovery from a high level of electronic and end, a three-dimension visual simulator discussion on topics of current interest. Throughout 2004–05, the National by the fifth generation units offer exercise-induced fatigue and mechanical expertise for all and a number of computer-based Talent Search program conducted a unprecedented detail and insight into refinement of methods for athlete departments within the Athlete vision training tools were developed Benchmarking, best practice and range of talent detection programs in numerous sports. assessment. Physiology staff also and Coach Services and Technical and implemented. Skill Acquisition also innovation partnership with state and territory played a leading role in a Talent Directions sections. In 2004–05, a The same is true of a device initially had a strong educational role through The Benchmarking and Innovation institutes and academies of sport, Search initiative aimed at enhancing priority was to research, design and produced for swimming but is now the supervision of sport-based PhD program takes a national leadership and directly through the AIS. New Australia’s competitiveness in the prototype equipment for the new AIS being used for hammer throw, scholars and ongoing involvement in a role in identifying future directions programs were conducted in the women’s skeleton event at the 2006 pool. This has included the mounting running, snowboarding, mogul skiing variety of coach education programs. for innovation and world-leading sports of sprint and endurance track Winter Olympics. system for the force measuring turn and skeleton. This device has the practice for the AIS. It achieves this and road cycling; heavyweight and wall, a video trolley system and a new potential to be used in all sports that Physiology by researching emerging technologies, lightweight rowing; sprint, slalom Physical Therapies force measuring start block. involve repeated jumping and rapid The Physiology department provided innovative service delivery methods, and wildwater canoeing; basketball; changes of direction. intensive support to a range of Post-Olympics, the Physical Other projects that the workshop operating strategies and management orienteering; triathlon; and women’s Therapies department has taken the AIS sports and national sporting has been involved with in 2004–05 systems within Australia and overseas. skeleton. These programs were The ASC’s annual report for 2004-05 organisations, with the pilot sport- opportunity to finetune servicing include the skeleton project, a conducted within a broad age group, During 2004–05, the program can be found at www.ausport.gov.au. based PhD scheme continuing to to AIS sports in the daily training ruggerised housing for a portable using a variety of Talent Search followed up a benchmarking study provide a vehicle for high levels of environment in Canberra, the display unit developed for the models, including the talent transfer on Physiotherapy and Soft Tissue direct interaction with coaches and states and within competition Performance Analysis unit, an approach for many of the older Therapy with an investigation into athletes. The capacity for effective environments. The benchmarking adjustable throwing frame for athletes athletes. the value-add of alternative physical monitoring of athletes in their normal process of the department continued with disabilities, adjustable load therapies, including chiropractic, training and competition environments throughout 2004–05 with the project bicycle pedal cranks, strain gauge osteopathy, podiatry, clinical Pilates was enhanced by the availability of nearing completion. A commitment transducer beams for Biomechanics and acupuncture. A third and final new equipment developed jointly to research has continued with and dynometer adaptors for a range report on Physical Therapies was with the Cooperative Research near completion of projects for of bicycles for Physiology. delivered on a proposed best- Centre for MicroTechnology. Devices the inaugural Beiersdorf PhD

18 Sport Health VOLUME 23 – ISSUE 4 • SUMMER 2005-06 19 A c L injury risk A c L injury risk

Table 1 - Major sports at risk for ACL injury in young males, along with estimated grass profiles for Seasonal and geographical various states of Australia State Major football code(s) Proximity to Grass profile Examples of common grass snowfields type(s) on community fields New South Wales Rugby league and union, soccer Close Mainly warm-season Kikuyugrass analysis of acl injury risk in Queensland Rugby league and union, soccer Very distant Warm-season Bermudagrass and Queensland blue couch South Australia Australian football, soccer Distant Mainly cool-season Ryegrass and annual bluegrass Australia John Orchard, Ian Chivers, David Aldous Tasmania Australian football, soccer Distant Cool-season Ryegrass and annual bluegrass Victoria Australian football, soccer Close Mainly cool-season Ryegrass and annual bluegrass 8 There are northern (warm-season) temperature , which is dropping over of ACL injury. As somewhat of a Western Australia Australian football, soccer Very distant Warm-season Kikuyugrass and and early-season biases for ACL the course of the season in outdoor control, the figures for females will be Bermudagrass injuries in the AFL that have been stadiums, but not in indoor stadiums. examined, with the expectation that ACT Rugby league and union, Australian Very close Cool-season Ryegrass, annual bluegrass, revealed by a long-standing reliable any northern (warm-season) state bias football, soccer Kentucky bluegrass, fescues. ACL injuries are particularly common injury surveillance system1-3. Recent would be minimal, as the higher risk Northern Territory Australian football and rugby league Very distant Warm-season Kikuyugrass and in the major football codes (Australian study has suggested that the sports that are popular with females Bermudagrass football, rugby league, rugby union, underlying explanation for these are generally not played on natural soccer) and in snow sports. They trends is the relative predominance of grass. The hypotheses to be tested also occur at a slightly lower rate in high-traction grasses in the northern with respect to the NRL data are that basketball, netball, volleyball and states and early in the football there will be warm-season and early- Comparisons of relative risks Table 2 – Grounds analysed in the NRL martial arts. ACL injuries are thought season3. Little is known about the season biases in a similar fashion to with 99% confidence intervals are to be very common in netball, State Ground Grass type relative risk of ACL injury at non- the AFL competition. performed using the Taylor series although the likely reason why this NSW Aussie Stadium, Sydney Bermudagrass and ryegrass professional level in Australia or in the expansion method12. is considered a higher risk sport in Telstra Stadium, Homebush Bermudagrass and ryegrass NRL competition. Australia (compared to basketball) is Methods This study also examined ACL Showgrounds, Homebush Bermudagrass and ryegrass Recently, many media commentators that it is played mainly by females, incidence data for natural grass Bermudagrass and ryegrass have claimed an increase in injuries on who have a much higher relative risk HIC data for cruciate ligament surfaces in the NRL to see whether or Leichhardt Stadium Kikuyugrass dry sporting fields, possibly caused by for ACL injuries than males9, 10. primary reconstructive surgery from not there is a northern (warm-season) OKI Jubilee Stadium, Kogarah Kikuyugrass and ryegrass drought in Australia and subsequent the decade July 1994 to June 2003 in bias, similar to that seen in the AFL. Brookvale Stadium Kikuyugrass and ryegrass The first section of this study water restrictions in major centres4, each Australian state and territory was Kikuyugrass and ryegrass examines available data for operations A player status for all first grade 5. Unfortunately there is no national downloaded from the website Energy Australia Stadium, Bermudagrass, ryegrass and performed on the cruciate ligaments players in the NRL was kept by the injury surveillance system in Australia Newcastle Kikuyugrass across Australia to see whether there author over the time period 1999- to investigate these claims. A national http://www.hic.gov.au/statistics/ WIN Stadium, Wollongong Bermudagrass and ryegrass is evidence of any northern (warm- 2004 inclusive, based on media sports injury insurance scheme, the dyn_mbs/forms/mbs_tab4.shtml. Bermudagrass and ryegrass, season) bias at the community level. reports of injuries. Where players 2003-04 some annual bluegrass Accident Compensation Corporation Estimates of the number of ACL injuries The item numbers which were were missing through injuries and (‘poa’) (ACC), exists in New Zealand6. in Australia can be made, as the Health assessed were 49536, 49539 and the diagnosis was available in the Express Advocate Stadium, Bermudagrass and ryegrass Although New Zealand has a superior Insurance Commission (HIC) provides 49542, which cover all primary media, a record of injury was kept. Gosford system of monitoring injuries that details of the number of item numbers cruciate ligament reconstructions. Media reports are definitely not 100% Toyota Park, Cronulla Bermudagrass and ryegrass occur in sport, its methods are not claimed for each procedure under Item 49551 was not included, which accurate, yet for serious diagnoses Queensland Suncorp Stadium Bermudagrass and ryegrass perfect because of lack of exposure Medicare in each of the states and is used for revision surgery for 49536, like ACL tears in professional sport ANZ Stadium Bermudagrass and ryegrass data (number of sports participants and territories of Australia each month, 49539 and 49542, where either the the accuracy probably approaches Dairy Farmers Stadium Bermudagrass matches played). There is also little 13 with data going back to July 1994. The first operation has failed or the ACL 100% . ACL injuries are so important ACT Ryegrass climatic variation between the different second section of the study examines has been re-injured. and serious (particularly the vast Melbourne Olympic Park Ryegrass regions of New Zealand to test any ACL incidence in the NRL competition Participation figures for various states majority which require immediate New Zealand Ericsson Stadium Bermudagrass. ryegrass and hypothesis based on geographical annual bluegrass to look at both the geographical were taken from the report by the surgical reconstruction) that, if a first differences. and temporal spread of ACL injuries ABS of Participation in Sport and grade player suffers one in a major In the United States, ACL injuries in occurring in first grade matches. Physical Activities 1999-200011. game, it is almost certainly reported the NFL show a strong early-season extensively in the media. Surface One hypothesis to be tested is that Population figures were taken from bias for matches played outdoors on characteristics for each stadium there will be a northern (warm- the Australian Census 2001. Astroturf, but not indoors7. There is were assessed by the primary author season) state bias for number of a small early-season bias for matches The ACT and Northern Territory (who as club doctor for the Sydney reconstructions performed in males, played on natural grass. The Astroturf are territories rather than states, but Roosters visited each ground once due to the popularity and high risk of data is consistent with the observation will be referred to as states for the per year on average) in conjunction the football codes, and the expected that shoe-surface traction on Astroturf purposes the data presentation and with Michael Finch, the ground risk that warm-season grasses in positively correlates with the ambient discussion. manager for Aussie Stadium (Table 2). Australia may pose a greater risk

20 Sport Health VOLUME 23 – ISSUE 4 • SUMMER 2005-06 21 A c L injury risk A c L injury risk

Results cooler states of Tasmania, Victoria, season (17.1/1000 games) and Table 3 – Primary cruciate ligament reconstructions performed in the private medical system in Australia over South Australia and the ACT. grounds with a kikuyugrass profile in the decade July 1994 - June 2003 The states and territories of Australia the early season (26.9/1000 games), Table 8 shows the percentage of State NSW VIC QLD SA WA TAS ACT NT Aust are listed in Table 1, along with the although kikuyugrass stadiums had various populations estimated to have Cruciate ligament 18822 12165 8145 5056 5580 671 1423 584 52446 most common football codes played, higher absolute rates of ACL injury. undergone cruciate reconstruction reconstructions proximity to snowfields and expected The relative risk for kikuyugrass over the decade July 1994-June Males aged 15-44 11869 7241 5113 2989 3456 404 794 352 32218 major grass types on football fields. compared to bermudagrass was 1.58 2003. Although there are many Females aged 15-44 5360 4017 2386 1763 1733 232 493 194 16178 (95% CI 0.80-3.11). The number of cruciate ligament assumptions and systematic errors reconstructions performed in the within these estimations, the errors There was however a strong early- Table 4 - Population for states of Australia (by state and for males aged 15-44), 2001 Census private system over the decade may be similar for each state. season bias, with 33 ACL injuries State NSW VIC QLD SA WA TAS ACT NT Aust 1994-2003 are listed in Table 3. The Table 9 shows the risk for each occurring in rounds 1-13 of the NRL Population (total) 6593840 4784260 3592503 1519607 1874670 483666 322089 197780 19368414 majority of these were in people state compared with the Australian season and only 16 occurring in Males aged 15-44 1358610 1006297 763135 307897 405864 91853 72743 51678 4058077 aged 15-44, with reconstructions averages (including 99% confidence rounds 14-26 or the finals (risk ratio Females aged 15-44 1367095 1026791 778122 304903 404386 95058 74477 47754 4098586 more common in males than females. intervals for the rows involving male 2.1, 95% CI 1.1-3.8). Population figures for Australia in and female reconstruction rates per Table 5 - Participation rates in high risk sports for males, by state, Australia 1999-2000 2001 from the Census data are listed high risk sport participant). These (Australian Bureau of Statistics) 11 in Table 4. figures show a significantly lower Discussion Males NSW VIC QLD SA WA TAS ACT NT Aust cruciate reconstruction rate in males Table 5 and Table 6 show estimates, The first section of this study Aussie Rules 12000 84400 10000 31600 25800 8000 2000 1500 184000 in Tasmania (compared to the rest for males and females respectively, examines Medicare data for cruciate Rugby total 85000 1000 35000 500 3000 0 4000 2500 121600 of Australia) with a similar trend of participation in those sports reconstruction in the various in Tasmanian females that was not Soccer 67500 26300 20900 14300 20200 4000 3400 1700 158200 considered to have a significant states of Australia. Medicare is nearly as strong. In males there is also TOTAL Outdoor football 164500 111700 65900 46400 49000 12000 9400 5700 463800 risk of ACL injury. For males, sports responsible for all insurance claims a significantly lower reconstruction Snow Sports 48300 38700 3000 3800 2000 1000 4100 500 106200 were grouped into high risk sports in the private hospital setting, rate in Victoria and, with respect TOTAL high risk sports 212800 150400 68900 50200 51000 13000 13500 6200 570000 (outdoor contact football codes which is where the majority of ACL to participation in high risk sports, Touch football 66700 2000 39300 1000 11200 2400 4600 2600 134700 and snow sports) and medium risk reconstruction surgeries take place. a higher rate in Queensland and Basketball 48700 98800 23800 21900 19800 3000 2400 1300 219700 (touch football, basketball, netball, ACL reconstructions are performed in Western Australia, neither of which is Netball 9800 10900 22400 1400 8700 900 1900 600 56500 volleyball and martial arts). For public hospitals on public patients, seen in females. Volleyball 21200 34300 13700 3800 11300 1000 2700 1600 90500 females, a single group of high risk but a waiting list of 1-2 years makes sports was created (netball, soccer, For the section of the study involving this option a difficult one for active Martial Arts 50700 39000 27800 6700 23000 1900 3500 1100 153600 Australian football, snow sports, ACLs occurring in the NRL, there sportspeople. Therefore many young TOTAL medium risk sports 197100 185000 127000 34800 74000 9200 15100 7200 655000 touch football, basketball and martial were 51 reported ACL injuries Australians who play the sports that TOTAL high-medium risk 409900 335400 195900 85000 125000 22200 28600 13400 1225000 arts). Participation numbers were occurring in first grade matches are at risk of ACL injury will either sports taken directly (or estimated, for (including representative matches have private health insurance to use if Table 6 - Participation rates in high risk sports for females, by state, Australia 1999-2000 shaded figures) from the ABS report11. and finals) over the period 1999-2004 they suffer an ACL injury or will pay (Australian Bureau of Statistics) 11 Participation data for other popular inclusive. There were eight in 1999, for the procedure privately using cash sports such as cricket, tennis, hockey, seven in 2000, eight in 2001, thirteen and/or the proceeds from alternate Females NSW VIC QLD SA WA TAS ACT NT Aust swimming, cycling, running, golf and in 2002, nine in 2003 and six in 2004. sports insurance. Table 11 shows Soccer 11200 7000 9600 1300 3600 800 500 200 34200 aerobics were not considered in this that private health insurance rates Snow Sports 34000 33700 2000 3000 1000 500 3400 0 77600 There was no obvious northern bias 14 analysis as the risk of ACL injury in are fairly similar in each state with Touch football 29200 1000 19000 500 2800 600 3500 1300 57900 present for ACL injuries (Table 10), these sports was considered to be in fact Tasmania having the highest with the rate of injuries at northern Aussie Rules 500 3300 500 400 300 100 200 200 5500 low. rate of private health insurance and venues (18.2/1000 games) being Basketball 31600 24000 10900 5000 16400 2000 1500 900 92300 Queensland the lowest. Table 7 shows the ratio of male to comparable to Sydney venues Martial Arts 56000 30000 30100 12500 15900 2100 2600 1100 150300 female reconstructions (among age (21.8/1000 games) and southern The HIC item number data also cover Netball 91100 80100 40900 32400 57500 9500 5700 2400 319600 group 15-44) in each state. There venues (23.4/1000 games). The ACL injuries that do not occur playing Volleyball 11500 12000 16900 4000 10800 500 1500 1900 59100 were more reconstructions performed highest individual stadium rates were sport (other than work-related or TOTAL high risk sports 265100 191100 129900 59100 108300 16100 18900 8000 796500 in males in every state, despite Ericsson Stadium in Auckland and traffic accident injuries) and PCL that the relative risk of ACL injury Parramatta Stadium, both of which reconstructions, although these would Table 7 - Ratio of cruciate reconstructions performed in males compared to females (ages 15-44) is known to be higher in females. have generally had a mixed grass be small in number, as most ACL for the decade July 1994 - June 2003 The explanation is almost certainly profile of annual bluegrass, ryegrass injuries are either sport- or work- ACL reconstruction rate NSW VIC QLD SA WA TAS ACT NT a participation bias, with males far and bermudagrass, although the ACL related and most PCL injuries are not for 15-44 more likely to participate in higher injury rates at both of these venues reconstructed. Male:Female 2.2 1.8 2.2 1.7 2.0 1.8 1.6 1.7 risk sports (Table 5 and Table 6). was not substantially higher than It is presumed that the majority of The male:female ratio was higher other grounds. sports-related ACL injuries occur in the warmer northern states of There was no significant in sports listed in the results. The Queensland, Western Australia and difference between grounds with majority of the high risk sports in New South Wales, and lower in the a bermudagrass profile in the early which males participate are played

22 Sport Health VOLUME 23 – ISSUE 4 • SUMMER 2005-06 23 A c L injury risk A c L injury risk

Table 8 - Rates of private cruciate reconstructions in various populations for the decade July 1994 - June 2003 on natural grass. Netball is probably Table 11 – Percentage of the population with private health insurance (2001),

NSW VIC QLD SA WA TAS ACT NT Aust the most common sport associated by state 14 with ACL injury in females in Australia Total population 0.29% 0.25% 0.23% 0.33% 0.30% 0.14% 0.44% 0.30% 0.27% State Capital city Rest of state and, although some games are played Males 15-44 0.87% 0.72% 0.67% 0.97% 0.85% 0.44% 1.09% 0.68% 0.79% NSW 50.4% 43.3% on natural grass, the vast majority are Vic 49.6% 41.0% Females 15-44 0.39% 0.39% 0.31% 0.58% 0.43% 0.24% 0.66% 0.41% 0.39% played on hard courts. Qld 45.4% 45.0% Table 9 - Rates of cruciate reconstruction per state compared to Australian averages The major confounder in this analysis, SA 50.5% 41.7% WA 53.9% 48.5% ACL reconstruction NSW VIC QLD SA WA TAS ACT NT in terms of trying to prove the comparison with hypothesis of a ‘northern bias’ for Tas 56.7% 43.0% Australian averages males in sports played on grass, would National 50.2% 43.5% Total population 1.05 0.94 0.84 1.23 1.10 0.51 1.63 1.09 be ACL injuries that occur during skiing and other medium risk sports, Males 15-44 1.10 0.91 0.84 1.22 1.07 0.55 1.37 0.86 a distinct trend for fewer cruciate (RR 1.31, 95% CI 1.26-1.37) such as basketball and martial arts. Females 15-44 0.99 0.99 0.78 1.46 1.09 0.62 1.68 1.03 reconstructions in males in states that There are some variations in the Males 15-44 (playing 1.04 0.93 1.12 0.93 1.02 0.48 1.22 0.89 Tasmania, which is the southernmost are further south (reconstruction rate contact football codes) figures by state for Australian females state of Australia, has a statistically of WA>SA>Victoria>Tasmania). Males 15-44 (playing high- 1.10 0.82 0.99 1.34 1.05 0.69 1.06 1.00 (Table 9), but in general these are significantly lower rate of private medium risk sports) The ACT has the highest overall risk less than the variations seen in cruciate reconstruction for males Males 15-44 (playing high 0.99 0.85 1.31 1.05 1.20 0.55 1.04 1.00 of cruciate reconstruction per head of males. The absolute rate of cruciate 15-44 playing high risk sports than risk sports) (0.96-1.02) (0.82-0.88) (1.26-1.37) (1.00-1.11) (1.14-1.26) (0.48-0.63) (0.95-1.14) (0.87-1.16) population, and this may be partially reconstruction in females is highest in all other states and territories. It also Females 15-44 (playing 1.00 1.03 0.90 1.47 0.79 0.71 1.28 1.19 (0.99- due to a higher proportion of the South Australia and the ACT (Table has absolute lower rates of cruciate high risk sports) (0.96-1.02) (0.99-1.08) (0.85-0.96) (1.38-1.57) (0.74-0.84) (0.60-0.84) (1.14-1.45) 1.44) population who are active males 8), which may partially reflect the reconstruction. This is unlikely to be from 15-44 and also a much higher popularity of the sports of netball and a bias due to Tasmania being a small proportion of the population who skiing respectively in these regions, state (in terms of either population ski. There may be a slight correlation although their rates for females are Table 10 – ACL injury rates by NRL ground or geography) as a low rate is between the fact that the ACT is a still higher than other states when not seen in the ACT or Northern Ground Predominant grass type(s) Matches ACL injuries Rate (n/1000 dry climate and is the region where participation rates are adjusted for. Territory. Proximity to snowfields team games) temperatures fall below freezing may possibly explain the higher rate There is a general trend of a commonly in winter and cool-season of ACL injury seen in the ACT than ‘warm-season bias’ for cruciate grasses that are more tolerant of the in Tasmania. In the bottom two lines reconstruction for males in Australia cold (such as Kentucky bluegrass Gosford Bermuda/ryegrass 36 2 27.8 of Table 9, rates of participation in in the states where Australian and fescues) may be more commonly Aussie Stadium Bermuda/ryegrass 159 5 15.7 snow sports were taken into account, football is the predominant male used. Kentucky bluegrass may be a Toyota Park Bermuda/ryegrass 76 2 13.2 but it is unknown whether this sport (WA>SA>Vic>Tas). This trend is higher risk grass for ACL injury than Telstra Stadium Bermuda/ryegrass 75 1 6.7 adjustment (simply assuming that a seemingly absent for females in these ryegrass because of greater thatching Dairy Farmer’s Bermudagrass 74 2 13.5 snow sport participant has a similar four states, supporting the hypothesis potential7, 15-17. There is no ‘southern’ Parramatta Bermuda/rye/annual 74 6 40.5 annual ACL injury risk to that of a that in Australia, warm-season grasses bias seen for ACL injuries in the US bluegrass football player) was sufficient. With are a risk for ACL injury in Australian National Football League and this may ANZ Stadium Bermuda/ryegrass 58 2 17.2 respect to the confounder of private football. be because Kentucky bluegrass is the Campbelltown Bermuda/ryegrass 41 1 12.2 health insurance rates, Tasmania has primary turfgrass used in the northern With respect to ACL injuries in the WIN Stadium Bermuda/ryegrass 39 0 0.0 the highest rate of private health parts of the USA where it, in fact, has NRL competition, an early-season bias Showgrounds Bermuda/ryegrass 32 1 15.6 insurance for all Australian states higher thatching rates18. In the USA, for ACL injuries is definitely present. Suncorp Stadium Bermuda/ryegrass 29 2 34.5 (Table 11) which would be expected the predominant grass types used for Since most grounds use either to lead to a higher percentage of Colonial (Telstra Bermuda/ryegrass 13 1 38.5 NFL football tend to be heavy thatch bermudagrass and ryegrass or kikuyu Dome) surgery being performed in the forming grasses and turf managers are and ryegrass, the cool-season species Newcastle Kikuyu/ryegrass 78 2 12.8 private system, if anything. Being encouraged to use thatch as a method of ryegrass is likely to be predominant Penrith Kikuyu/ryegrass 74 5 33.8 the coolest climate of all states in of providing extra cushioning for later in the season (late autumn and Brookvale Kikuyu/ryegrass 54 4 37.0 Australia with high rainfall, Tasmanian players19. early winter). Either the presence conditions are most suitable for Leichhardt Kikuyugrass 39 2 25.6 of rye later in the season or the ryegrass, which is probably the major From Table 9 it can be seen that OKI Jubilee Kikuyu/ryegrass 15 1 33.3 reduction in thatch through abrasion grass used on the vast majority of Queensland has lower absolute Ericsson Bermuda/rye/annual 78 7 44.9 related to regular use, or both, is/are football grounds in Tasmania. rates of ACL reconstruction than bluegrass likely to be responsible for the early- the Australian average but, because Canberra Ryegrass 74 3 20.3 Victoria, which is the second season bias for ACL injuries in the the proportion of males aged 15- Olympic Park Ryegrass 61 2 16.4 southernmost state, has a lower rate NRL3. There is minimal difference 44 playing high risk sports (football of ACL reconstruction in high-risk between both grass type and location and snow sports) is lower than in participation males (15-44) than and injury rates and location in the other states, the risk per male high South Australia and Western Australia NRL, hence it can be stated that risk sport participant is actually which is also statistically significant. there is no apparent northern (warm- significantly higher than in other states For the AFL-playing states, there is season) bias in the NRL. Ryegrass

24 Sport Health VOLUME 23 – ISSUE 4 • SUMMER 2005-06 25 A c L injury risk A c L injury risk

tends to produce less thatch than Figure 1 - A comparison of ryegrass (left; shinier, darker, less thatch, some way that community football grounds References 21. Gabbett T. Science of rugby league football: A review. Journal of Sports Sciences. 2005;23(9):961- bermudagrass (Figure 1) which may bare areas) and bermudagrass (right; lighter green, duller, thicker) on a are prepared. These may include 1. Orchard J, Seward H, McGivern J, Hood S. 976. Rainfall, evaporation and the risk of non-contact explain why it is associated with a NSW rugby league field promotion of ryegrass as a preferred anterior cruciate ligament injury in the Australian 22. Gabbett T. Changes in physiological and lower rate of ACL injury3, 15. species, watering of dry, hard grounds Football League. Medical Journal of Australia. anthropometric characteristics of rugby league 1999;170(7):304-306. players during a competitive season. Journal of and scarification of grounds with Strength and Conditioning Research. 2005;19(2):400- Although there are limitations in the 2. Orchard J, Seward H. Epidemiology of Injuries in 408. an excessive layer of thatch3, 15, 25. the Australian Football League, 1997-2000. British quality and quantity of data in the Journal of Sports Medicine. 2002;36:39-44. 23. Gabbett T. Incidence, site and nature of injuries Because of the cost of ACL injuries in amateur rugby league over three consectutive NRL component of the study, they 3. Orchard J, Chivers I, Aldous D, Bennell K, Seward seasons. British Journal of Sports Medicine. to the community, it is strongly H. Rye grass is associated with a lower rate of 2000;34:98-103. suggest that there is no evidence that non-contact anterior cruciate ligament injury than encouraged that a national ACL 24. Gabbett T. Incidence of injury in semi-professional either annual bluegrass or kikuyugrass bermuda grass in Australian football. British Journal register is developed with measures of Sports Medicine. 2005:704-709. rugby league players. British Journal of Sports compares favourably to bermudagrass Medicine. 2003;37:36-43. taken in the longer term to reduce the 4. Dasey D. Falling on hard times. Councils warn of with respect to ACL injury risk. sports injury risk on dry fields. Sun-Herald. June 20, 25. Orchard J. Is there a relationship between ground rate of ACL injuries. 2004, 2004: 3. and climatic conditions and injuries in football? Sports Med. 2002;32(7):419-432. Previous research from Conway et 5. Cox K. The drought breaks...arms, legs, wrists. Rock-hard sports fields fuel a plague of injuries. 26. Phillips LH, Standen PJ, Batt ME. Effects of seasonal al. (2003) using a similar data set to Sun-Herald. December 1, 2002, 2002: 9. change in rugby league on the incidence of injury. Br J Sports Med. 1998;32(2):144-148. the one in this paper, suggested that Conclusions 6. Orchard J, Finch C. Australia needs to follow New Zealand’s lead on sports injuries. Medical Journal of 27. Gissane C, Jennings D, White J, Cumine A. Injury , who are in summer rugby league football: the experiences • There was a strong early-season Australia. 2002;177:38-39. the most northern team in the NRL, of one club. British Journal of Sports Medicine. bias for ACL injuries in the NRL 7. Orchard J, Powell J. Risk of knee and ankle sprains 1998;32(2):149-152. had a similar rate of ACL injuries to under various weather conditions in American football. Medicine & Science in Sports & Exercise. 28. Gissane C, Jennings D, Kerr K, White J. Injury 20 competition over the period 1999- the rest of the competition . They 2003;35(7):1118-1123. rates in rugby league football: impact of change 2004. in playing season. American Journal of Sports found their rate of ACL injury for North 8. Torg JS, Stilwell G, Rogers K. The effect of ambient Medicine. 2003;31(6):954-958. temperature on the shoe-surface interface release Queensland to be 2.73 injuries per • No obvious geographical bias for coefficient. American Journal of Sports Medicine. 29. Orchard J, Seward H. Injuries on the decline: AFL 1999 Injury Report. AFL Record. 2000;89(5):29-32. 1000 player hours from 1998 to 2002, ACL injuries was seen in the NRL 1996;24(1):79-82. 9. Arendt E, Dick R. Knee injury patterns among men 30. Orchard J. The AFL Penetrometer study: work in and found this to be not significantly competition over the same time and women in collegiate basketball and soccer. progress. Journal of Science and Medicine in Sport. different from other teams20. period. NCAA data and review of the literature. American 2001;4(2):220-232. Journal of Sports Medicine. 1995;23:694-701. John Orchard, Ian Chivers and David Aldous With respect to risk of rugby league • In the ‘AFL’ states of Australia in 10. Arendt E, Agel J, Dick R. Anterior Cruciate Ligament are at the University of Melbourne injuries were analysed by stage of season grasses like kikuyugrass and Injury Patterns Among Collegiate Men and Women. injury in general (rather than for the community, for males there is Journal of Athletic Training. 1999;34(2):86-92. the season and month of the year, it bermudagrass. The confounding effect ACL injuries) at the various times a ‘northern’ bias towards greater 11. ABS. Participation in Sport and Physical Activities. of the season, most of this work was found that summer months had of the progressive reduction in thatch number of ACL reconstructions in Canberra: Australian Bureau of Statistics; 2000. a much greater correlation with risk depth over the season is also likely to 12. Hennekens C, Buring J. Epidemiology in Medicine. in this area has been published the warmer states (WA and SA) Boston: Little, Brown and Company; 1987. of injury than stage of the season26. be contributing to a lower ACL injury by Gabbett, who in the climate of compared to the southern states 13. Orchard J, Hayes J. Using the World Wide Web to South-east Queensland in Australia That is, injuries were more common rate in the second half of the season. (Vic and Tas), in a similar fashion to Conduct Epidemiological Research: An Example in the warmer months irrespective Using the National Basketball Association. Int has consistently found higher match Although this study has many details the trend already seen in the AFL. Sportmed J. 2001;2(2). of whether these months were at injury incidence towards the end of which are unknown, including 14. Lokuge B, Denniss R, Faunce T. Private health the start or finish of the season. • In the ‘rugby’ states there is no insurance and regional Australia. Medical Journal of the playing season in semi-professional accurate details about grass types Australia. 2005;182(6):290-293. 21-24 The ‘dry-season’ (summer) bias is evidence of a ‘northern’ bias. and amateur rugby league . This at venues throughout Australia, it is 15. Chivers I, Aldous D, Orchard J. The relationship of proportionally greater in backs, who Australian football grass surfaces to anterior cruciate is in contrast to the trends observed further secondary evidence that grass • The NRL data are more similar ligament injury. International Turfgrass Society tend to suffer non-contact injuries, in other football codes played in type may be responsible for fewer ACL to the data previously published Research Journal. 2005;10(1):327-332. 25 than in forwards, who tend to suffer 16. Aldous D, Semos P. Turfgrass identification and winter . Gabbett has found that the injuries occurring in certain locations for the US NFL, where there is contact-mechanism injuries27. Authors selection. In: Aldous D, ed. International turf intensity of matches increases towards (ie, ryegrass in the more southern also an early-season bias but no management handbook. Melbourne: Butterworth- who have noted an increased injury Heinemann; 1999:19-48. the end of the playing season and he states in Australia leading to lower ACL geographical bias. incidence in summer rugby league 17. McNitt A, Waddington D, Middour R. Traction attributes this increase in intensity as injury rates). It is noted that there are Measurement on Natural Turf. In: Hoerner E, ed. have attributed the dry-season • There is little evidence of a Safety in American Football: American Society for the likely cause of the increased injury many weaknesses and assumptions in Testing and Materials; 1997:145-155. (summer) injury bias to differences northern-bias for females for ACL incidence towards the end of the this analysis. It would be far preferable reconstructions in the community. 18. Dunn J, Diesburg K. Turf management in the 21, 22, 24 in the playing surface, particularly transition zone. Hoboken, NJ: John Wiley & Sons; season . The Gold Coast, where 26-28 for Australia to have a centralised 2004. hardness . Obviously historical Acknowledgements his studies have been conducted, sports injury surveillance system, as 19. Puhalla J, Krans J, Goatley M. Sports fields: a confounders (other changes in the Michael Finch, the ground manager for being a subtropical climate with a New Zealand does6, to monitor state manual for design construction and maintenance. way that rugby league was played Aussie Stadium, is acknowledged for his Hoboken, NJ: John Wiley & Sons; 1999. generally wet autumn, may not exhibit by state trends in injuries. pre- and post- shift to a summer assistance in determining the major grass 20. Conway L, Winter G, Maguire J. The comparative the same changes in grass composition incidence of anterior cruciate ligament rupture The ACL injury rate and overall injury types used on each of the major NRL between the North Queensland Cowboys and other as traditional autumn-winter football season) may have affected the results. rates in the AFL have been lower over venues. teams. Paper presented at: season in a cooler climate25. Notwithstanding that the NRL data Football Australasia: controversies in 2003, 2003; the past few seasons, possibly due Melbourne. presented in this study are unofficial Studies of rugby league injuries in to changes in preparation in grounds and may contain some minor the United Kingdom, where the once the risk factors associated with inaccuracies, they present further professional competition changed various ground conditions have evidence that the rate of ACL injury from a winter to a summer season been published3, 29, 30. It may be on grounds which are ryegrass in 1996, have consistently showed a possible to reduce the rate of ACL predominant (which includes most higher injury incidence in summer injuries in Australia, particularly in 26-28 NRL venues in the second half of than winter rugby league . When the northern states, by changes to the the season), is lower than for warm-

26 Sport Health VOLUME 23 – ISSUE 4 • SUMMER 2005-06 27 B ulletin B ulletin

• multi-modal physiotherapy can shown that hip abduction and external • have lower limb muscles which are restore imbalances in the onset of rotation strength is: more compliant. Knee injury research the medial relative to the lateral vasti; • lower in individuals with overuse Prevention of injury: Probably • patellar taping can reduce knee injuries, the most significant article to come patellofemoral pain, improve the • lower in females than males, out in the area of injury prevention is coordination of the vasti, and especially after puberty, and ‘Exercises to prevent lower limb injuries enhance quadriceps function, and in youth sports: cluster randomised • related to knee joint loading patterns • patellar bracing can reduce the controlled trial’ by Olsen O-E, Myklebust G, Engebretsen L, Holme Many factors contribute to the In this article, I will focus on, (i) declined at 25 degrees to the loads on the patellofemoral joint. Further research is being directed I and Bahr R in the British Medical successful management of management of patellar tendinopathy; horizontal) designed to load the towards the measurement of common There is much research underway Journal in 2005 (pp 330-449). This can musculoskeletal injuries. They include (ii) management of patellofemoral extensor mechanism maximally and clinical tests, including jumping and at present, both here in Australia be found on the internet using the the pathological process, and the pain; (iii) the role of ‘core stability’; performed with moderate tendon landing manoeuvres. and internationally. Current research searching program, PubMed’ or at: biological, biomechanical, physiological (iv) prevention of ACL injuries. So, pain may have greater benefits for projects include: 4. Anterior cruciate ligament injuries or biopsychosocial effects of our what does the research tell us? the injured athlete, although further http://bmj.bmjjournals.com/cgi/ interventions. Sports physiotherapy research is required. • evaluating the effectiveness of in- There is a strong gender bias with content/full/330/7489/449. 1. Effective treatment strategies for shoe orthotic devises, in isolation respect to anterior cruciate ligament is a craft that integrates all of these Furthermore, the research to Furthermore, there a number of patellar tendinopathy and in combination with a multi- (ACL) injury incidence, especially in factors and its quality in Australia is date suggests that ultrasound- researchers based at La Trobe modal physiotherapy intervention non-contact situations, with women acknowledged by peers and colleagues. Patellar tendinopathy is a significant guided sclerosing of surrounding University in Melbourne who are (Vicenzino); two to eight times more likely to While many patients benefit from the overuse injury, mostly encountered neovessels performed by experienced looking at ACL reconstruction; in sustain an ACL rupture. This bias has intervention of physiotherapists, it is by athletes who load their tendons practitioners (usually radiologists) • evaluating the timing of gluteal particular at the effects of different graft led to considerable research interest the role of science to try to ascertain with jumping activities. Its recalcitrant may also assist in reducing the pain muscles in individuals with types (hamstring or patellar tendon) on non-contact ACL ruptures. The (i) which treatments improve the pain nature makes it a frustrating condition associated with patellar tendinopathy patellofemoral pain (Cowan); on outcomes and biomechanics and research in this area has focused and disability experienced by patients, for the athlete and the physiotherapist. • using biomechanical models to also the effectiveness of different on intrinsic ligament and muscle (ii) which aspects of our treatments It has therefore been the focus of 2. Effective treatment strategies for evaluate patellofemoral joint stress rehabilitation programs on outcomes properties and the assessment of have the effect and (iii) mechanisms much research, both internationally patellofemoral pain (Powers); after ACL reconstruction. These biomechanics in activities known that underpin the treatment effects. and within Australia. researchers include Kate Webster, Patellofemoral pain is the most • investigating risk factors for to load the ACL (cutting, jumping Sports physiotherapy clinicians need Julian Feller and Randall Cooper. The main players here are (in common single diagnosis encountered patellofemoral pain in female and landing). Another group of to be aware of the recent science and Australia) Jill Cook (La Trobe by running athletes. It is typified by runners (Davis); and researchers hase been investigating scientific findings in order to enhance Where is the research? University), Karim Khan (OK, he anterior or retro patellar pain that is the role of exercises (mostly neuro- their craft. Integral to this awareness • evaluating motor unit works at the University of British aggravated by activities that load the muscular/balance type exercises) in Research into sporting injuries is an understanding that inherent in synchronisation in people with Columbia and lives in Vancouver, patellofemoral joint, including stair the prevention of acute knee injuries is benefiting from the boom in the structure of scientific studies (large patellofemoral pain (Hodges). Canada, but we still think of him ambulation, squatting, running and in general and ACL in particular. biomechanical modelling. In the past numbers, double-blinds, placebo, we have had to rely on the use of as one of us) and Craig Purdam jumping activities. Its prevalence, 3. ‘Core Stability’ plays a role in the control groups, etc) is the importance Main players: in Australia, David Lloyd surgically implanted strain gauges (not (Australian Institute of Sport). especially among recreational and development of knee injuries of the therapist-patient relationship Internationally, they are Roald Bahr sub elite athletes, has led to a large (The University of Western Australia), used too often -- for obvious reasons) and the presence of individual (Norway), Hakan Alfredson (Sweden) body of research dedicated to The term ‘core stability’ is used to Di Hopper (Curtin University), Adam to provide information on the loads differences. Furthermore, treatment and Louis Almekinders (USA). The understanding the cause of pain and describe the neuro-motor control of Bryant (University of Melbourne) and encountered by biological tissues during efficacy alone does not prove the main findings, earlier, identified to evaluating optimal interventions. the lumbar spine-pelvis-hip region. Julie Steele (University of Wollongong) physical activities. theoretical basis of the treatment. I am It has long been recognised by and internationally, Tim Hewett (USA), that patellar tendinopathy is not an As three-dimensional motion analysis fortunate enough to be asked to write The main players here are (in Australia) clinicians as playing an important role Roald Bahr (Norway), Edward Wojtys inflammatory condition but rather one systems become more readily an update on the research into sports Kay Crossley (ie, me), Sallie Cowan in many lower limb injuries, including (USA) and Scott McLean (USA). of degeneration. Current research is available and user friendly and with related knee injuries. This article will and Kim Bennell (at The University of knee injuries. The main problems investigating the source of pain and more accurate information about allow me to highlight the breadth and Melbourne), Jenny McConnell (The with researching this area have arisen Main Findings: the pathological processes, including University of Sydney) and Bill Vicenzino muscle forces, mathematical models quality of research in this area. from difficulties in defining and Oestrogen: Doesn’t appear to have the role of neovascularisation. and Paul Hodges (The University of can better predict the loads in relevant in measuring core stability. While a direct effect on the mechanical Over the past five years there has been Physiotherapy interventions were Queensland) and, internationally, Irene tissues. This information will greatly good quality research in this area properties of the ACL itself. May affect much research interest and output directed traditionally focused on eccentric Davis and Chris Powers in the United expand our understanding of all is still lacking, this is an area that is soft-tissue compliance and visco- at the optimal management of knee strengthening, with progressions guided States and Erik Witrouw in Belgium. injuries, including aetiology and developing substantial interest. elastic properties of muscles. injuries/conditions. When we are looking by maintenance of painfree environment. mechanisms of treatment effects. at sporting injuries, we have to be mindful Multi-modal physiotherapy Main players: in Australia, nil at Research pioneered by Alfredson led Compared to males, females: As physiotherapists, we need to be that often the funding for research into interventions that include vasti present; internationally: Tim Hewett , to changes in clinical practice and • run, land and cut with greater able to use this information, to help this area is quite limited. Furthermore, the retraining, patellar taping/bracing, Irene Davis and Michael Fredericson subsequent research to evaluate these hip muscle retraining and stretching/ valgus loading, us to devise better treatments and to numbers of individuals with the conditions changes. Currently, small RCTs and case (all in USA). mobilisation are commonly used by • demonstrate timing of muscle identify individuals who are most likely to be studied, while considerable to the series have indicated that: Main Findings: Hip muscle torque, physiotherapists. These have been activation that is less protective of to benefit from these interventions. treating practitioner and disabling to the measured with a hand held • eccentric quadriceps training can evaluated in well-controlled RCTs. the ACL, Dr Kay Crossley, BAppSc (Physio), athlete, do not necessary lend themselves dynamometer (hip abduction, external reduce patellar tendinopathy PostGradDip (Research), PhD. School to large randomised controlled trials Current research has shown that: rotation) is commonly being used as a • have greater torsional stiffness of symptoms; and. of Physiotherapy, is at The University of (RCTs). But, we can learn a lot from lower • multi-modal physiotherapy is surrogate measure for ‘core stability’: the leg in both the passive and the Melbourne and also practices at the Olympic levels of evidence, to help guide our • a decline squat exercise (where effective in reducing the symptoms Using these measures, researchers have active muscle state, and Park Sports Medicine Centre, Melbourne clinical practice. the feet are positioned on a board, of patellofemoral pain;

28 Sport Health VOLUME 23 – ISSUE 4 • SUMMER 2005-06 29 B ulletin C onference 2 0 0 5 For your library Conference 2005: An overwhelming success The Little Black Book of Sports Medicine Human Movement (297pp) Intended for active adults, with (414pp) Eds: M Trew and T Everett information about the basic structure Eds: TM Howard and JD Butcher and function of the musculoskeletal Published by Churchill Livingstone system and advice on how to exercise Published by Jones & Bartlett, distributed Elsevier it safely. Our combined conference in October Khan winning the Asics Medal valued University of Queensland, and Dr Jill by Elsevier ISBN 0443074461 2005 was an overwhelming success, at $5,000 for his paper Action Schools! Cook, the leading researcher from La ISBN 0763738654 Research Methods in Athletic Training with 1,115 delegates and 78 trade BC: daily physical activity increases Trobe University. th nd This is the 5 edition of a textbook (399pp) exhibitors attending. So, on behalf bone strength in prepubertal boys. The 2 edition of the Little Black Abstract submission for the 2006 on human movement that was first of the 2005 Organising Committees, A complete list of prizewinners is Book is out, with updated information BL Arnold, BM Gansneder and DH Perrin Conference is also open. To submit published in 1981. There is new I would like to thank all sponsors, published below. for physicians and support staff for Published by FA Davis, distributed by your abstract, please visit www.sma. material in each chapter indicating speakers, trade exhibitors and delegates diagnosing and treating injury and Elsevier For those who were unable to attend org.au/acsms/2006/ and click on the new research since the last edition who supported this year’s event. illness. the 2005 conference, the Organising appropriate link. Abstract sSubmission in 2001, with more examples of how ISBN 0803607784 theory relates to movement and more Evaluation forms and other anecdotal Committee of the 2006 Asics will close on 31 March 2006. Year Book of Sports Medicine 2005 A guide for certified and student feedback were overwhelmingly Conference of Science and Medicine text boxes and case studies. SMA looks forward to welcoming (426pp) athletic trainers to conducting, positive, with special mention made in Sport invites delegates to join them delegates to Fiji and encourages visits Ed. In Chief: RJ Shephard publishing and finding funding for of the quality of the keynote speakers in Fiji from 19 to 21 October 2006 to General Medical Conditions in the to www.sma.org.au/acsms/2006/ research and workshops. experience three intriguing days of Published by Elsevier Mosby Athlete (463pp) to obtain further information. conferencing that can be combined ISBN 0323021174 M Cuppett and KM Walsh The “experiment” of combining Alternatively, the conference Immune Function in Sport and Exercise with active or more passive leisure- ACSMS with the national physical secretariat can be contacted at Traditional format, with new Published by Elsevier Mosby (332pp) time activities. SMA is pleased to activity and sports injury prevention [email protected]. material on preventive medicine, ISBN 0323026230 Ed: M Gleeson report that Asics has increased its level conferences was also perceived as epidemiology, sports injury and of support in 2006 to ensure that an The objective here is to help the Published by Churchill Livingstone Elsevier adding substantially to the value of ergogenic aids and doping. exciting boutique event is developed. athletic trainer to recognise medical ISBN 0443101183 the overall event. 2005 Australian Sports conditions and to understand when to For those who have not been to Handbook of Fractures (442pp) Another textbook for students of This was highlighted in Roald Medicine Federation go for the doctor. Comes with a free ACSMS before, it is a multidisciplinary Eds: JA Elstrom, WW Virkus and AM exercise and sports science, this one Bahr’s opening address (Redefining DVD-ROM. meeting held annually for professionals fellows awards Pankovich dealing with the effects of exercise on sports medicine - from sprained with an interest or a specialisation immune function and susceptibility to ankles to clogged arteries) in which Published by McGraw-Hill Athletic Training and Sports Medicine in sports medicine, sports science, Best Paper Awards infection. he captivated the audience with ISBN 0071443770 (707pp) physical activity promotion and sports his immense knowledge and ASICS Medal - Best Paper Overall rd C Starkey and G Johnson injury prevention. In 2006 the theme The 3 edition in 10 years, this aims Pharmacology Application in Athletic understanding across all three areas. Karim Khan, University of British will be Sports medicine in paradise: to provide basic information on Published by Jones & Bartlett, distributed Training (235pp) Due to the overwhelming success Columbia perspectives from the Pacific. It will Action Schools! BC: daily physical classifying, diagnosing and managing by Elsevier BC Mangus and MG Miller of the 2005 event, Sports Medicine provide an excellent opportunity for activity increases bone strength in specific fractures, with material added ISBN 0763705365 Australia and the National Heart Published by FA Davis, distributed by delegates to keep abreast of the latest on radiologic evaluation and injury Foundation have agreed to organise a prepubertal boys This is the 4th edition of the Elsevier findings and developments in research. related athletic competition. repeat version in Adelaide from 13 to Co-Authors: H Macdonald, S Manske, “multipurpose, multicourse” text ISBN 0803611277 16 October in 2007. The program will include several K Reed and H McKay on management techniques for Practical Applications in Sports The aim here is to help athletic outstanding speakers from Australia ASICS Best Paper - Lower Limb orthopaedic injury, with such new SMA gives a special thank you Nutrition (545pp) trainers and allied health professionals and around the world, who are Jill Cook, Latrobe University features as clinical presentation, to major sponsors Asics, Tourism HH Fink, LA Burgoon and AE Mikesky understand how drugs work in leaders in sports medicine research Painful tendons with normal surgical technique and clinical Victoria, Australian Department the body, the indications and and practice. Confirmed speakers imaging: are they a true clinical Published by Jones & Bartlett, distributed technique boxes, rehabilitation of Health and Ageing and adverse effects on rehabilitation and include the Refshauge Lecturer, Dr diagnosis by Elsevier timelines and new material on the Department for Victorian participation, the types of drugs Tim Olds, the anthropometrist from Co-Author: P Malliaras ISBN 0763726575 therapeutic exercises. Communities, whose support ensured that are typically abused, the legal the University of South Australia. that we could mount a conference of ASICS Best Paper - Clinically The objective here is said to provide aspects of medicines and emergencies Invited speakers include Dr Peter The Healthy Body Handbook: A Guide to the highest calibre. We would also Relevant Conditions exercise and nutrition professionals involving medications. Fricker, Director of the Australian the Prevention and Treatment of Sports like to thank the Heart Foundation, Gabriel Ng, The Hong Kong with the latest research on diet Institute of Sport, Professor Stephan Injuries (336pp) the NSW Sporting Injuries Committees Polytechnic University and performance, with a focus on Rossner, the endocrinologist from DC Saidoff and S Apfel and Vichealth for their support. Therapeutic laser and running research, current guidelines and Huddings University Hospital in exercise promote tendo-achilles the practical application of the Published by Demos, distributed by Elsevier The ASMF Fellows Awards were once Sweden, Professor Wendy Brown, healing: a rat model information available. ISBN 1932603042 again a huge drawcard, Dr Karim the physical activity expert from The Co-Author: D Fung

30 Sport Health VOLUME 23 – ISSUE 4 • SUMMER 2005-06 31 C onference 2 0 0 5

ASICS Best Paper - Performance ASMF Fellows Award Best Young Special Categories Enhancement and Basic Science Investigator - Health Promotion Wendy Ey Women In Sport Award Daniel Green, The University of Corneel Vandelanotte, Ghent Kay Cox, The University of Western Western Australia University Australia Do skinfolds accurately assess changes Efficacy of a computer-tailored Type of exercise determines short and in body fat in obese adolescents? intervention for increasing long-term health benefits of a swim Co-Authors: K Watts, E Davis, physical activity in a sequential or and walk program in older women: T Jones, B Beeson, A Siafarikas, . simultaneous intervention mode the SWEAT 2 study Bell and T Ackland Co-Author: I de Bourdeaudhuij Co-Authors: V Burke, L Beilin, ASICS Best Paper - Health I Puddey, J Grove and B Blanksby Best Poster Awards Promotion Kylie Ball, Deakin University Queensland Academy of Sport Honourable Mentions Socioeconomic inequalities in leisure- Best Poster- Clinically Relevant Honourable Mention ASICS Best time walking: are poor environments Conditions Paper Performance Enhancement to blame Mark Watts, Brisbane Orthopaedic and Co-Authors: A Timperio, J Salmon, and Sports Medicine Centre Basic Science B Giles-Corti and D Crawford Tibial interference screw position Magnus Hagmar, Karolinska in soft tissue ACL graft fixation: University Hospital Sport and Recreation Victoria Best biomechanical considerations Endothelial function: is exercise more Paper – Injury Prevention Co-Authors: D Hayes, G Tevelen and important than estrogen in post- Leonie Otago, University of Ballarat R Crawford menopausal women? The risk management knowledge of Co-Authors: MJ Eriksson, basketball coaches and their influence AOK Health Best Poster C Lindholm, K Schenck-Gustafsson on the injury prevention strategies of Performance Enhancement and and A Lindén Hirschberg their player Basic Science Co-Authors: J Swan and S Ramage Karen Beatty, The University of New Honourable Mention AOK South Wales Health Best Poster Performance Best Young Investigator Awards Measurement of load during Enhancement and gymnastics training ASICS Best Young Investigator Basic Science Co-Author: A McIntosh - Lower Limb Deirdre McGhee, Unversity of Stuart Warden, Indiana University Journal of Science and Medicine Wollongong Knee ligament healing is accelerated in Sport Best Poster - Injury How does respiratory state and by low-intensity pulsed ultrasound Prevention measurement method affect brassiere and delayed by a non-steroidal anti- Tania Pizzari, La Trobe University size calculations? inflammatory drug Stress fractures of the base of the Co-Author: J Steele Co-Authors: K Avin, E Beck, second metatarsal in elite female Honourable Mention Wendy Ey M DeWolf, M Hagemeier and K Martin classical dancers Women In Sport Award Co-Authors: G Davidson and John Sutton Best Young Kathy Martin, WTA Tour S Mayes Investigator - Basic Science The WTA Tour Ten-Year Age Sonya Marshall-Gradisnik, Southern Sports Medicine Australia Best Eligibility and Professional Cross University Poster - Health Promotion Development Review Natural Killer cell numbers and Elizabeth Cyarto, The University of Co-Authors: V Burke, L Beilin, natural killer cytotoxic activity after Queensland I Puddey, J Grove and B Blanksby 6 weeks of testosterone enanthate Is the CHAMPS physical activity administration in health young males questionnaire for older adults reliable Co-Authors: S Rogerson, G Deakin, R in an older Australian sample? Meir, R Coutts, S Zhou and Co-Authors: R Dickinson, A Marshall R Weatherby and W Brown NSW Sporting Injuries Committee ASMF Fellows Best Poster - Health Best Young Investigator - Injury Promotion Prevention Vincent Learnihan, The University Rochelle Eime, University of Ballarat of Western Australia A controlled evaluation of a squash Influence of Data Scale in Walkability eyewear promotion strategy Analyses Co Authors: C Finch, R Wolfe, N Owen and C McCarty

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