Editor-in-ChiefDr Peter N. SperrynMB, FRCP, FACSM, DPhysMed

Editor EmeritusDr Henry Evans Robson

Boff __ w s _~~~Al

A _ r AV

EditorsSurgery: Mr Paul G.StableforthMB, FRCS (Bristol, UK)Science: Dr Ron MaughanPhD (Aberdeen, UK)Physiotherapy: Mr Julius SimBA, MSc, MCSP(Coventry, UK)

Statistical ConsultantsMr F.M. Holliday, MA, DLC, FSS(Loughborough, UK)Mr Simon Day, BSc (London, UK)

Regional Corresponding EditorsBelgium: Prof. M. Ostyn,MD (Leuven).

Brazil: Prof. Eduardo H. DeRose,MD (Porto Alleg).

Bulgaria: Dr Virginia Michaelova,MD (Sofia).

Caribbean: Dr Paul Wright,LMSSA (Kingston, Jamaica).

Cote D'Ivoire: Prof. Constant Roux,MD (Abidjan).

France: Dr Pierre Berteau,MD (Rouen).

Groupement Latine:Dr Francisque Commandrd,MD (Nice).

Editorial BoardDr David A. Cowan,

BPharm, PhD, MRPharmS (London, UK)Dr Wendy N. Dodds,

BSc, MRCP (Bradford, UK)Dr Adrianne Hardman,PhD (Loughborough, UK)

Mr Basil Helal,MCh(Orth), FRCS (London, UK)

Dr G.P.H. Hermans,MD, PhD, (Hilversum, Netherlands)

Prof. Ludovit Komadel,MD (Bratislava, Czechoslovakia)

Prof. W.P. Morgan,EdD, (Madison, Wisconsin, USA)

Prof. Tim D. Noakes,MD, FACSM (Cape Town, South Africa)

Hong Kong: Dr K.M. Chan,FRCS (Hong Kong).

Hungary: Dr Robert Frenkl,MD (Budapest).

India: Dr D.P. Tripathi,MB, BS, MCCP (Patna).

Indonesia: Dr Hario Tilarso,MD (Jakarta).

Malaysia: Dr Ronnie Yeo,MB (Kuala Lumpur).

Maroc: Dr Naima Amrani,MD (Rabat).

Prof. Qu Mian-Yu,MD (Beijing, China)

Dr Allan J. Ryan,MD (Edina, Minnesota, USA)

Prof. Roy J. Shephard,MD, PhD (Toronto, Canada)

Prof. Harry Thomason,MSc, PhD (Loughborough, UK)

Prof. K. Tittel,MD (Leipzig, DDR)

Dr Dan S. Tunstall Pedoe,MA, DPhil, FRCP (London, UK)

Prof. Clyde Williams,PhD (Loughborough, UK

Dr William F. Webb,MB, BS (Sydney, Australia)

New Zealand: Dr Chris Milne,MB, ChB, DipSportsMed (Hamilton).

Pakistan: Dr Nishat Mallick,FPMR, FACSM (Karachi).

Spain: DrJ. J. Gonzalez Iturri,MD (Pamplona).

Thailand: DrCharoentasnChintanaseri,MD (Bangkok).

Uganda: DrJames Sekajugo,MB, Dip.SportsMed. (Kampala).

USSR: Dr Sergei Mironov,MD (Moscow).

Publishing Director: Charles FryManaging Editor: Mary KormdorfferExecutive Editor: Nick MowatEditorial Assistant: Anne ThomasProduction controller: Margaret Elson

Advertisement Information: Displayadvertisement space is offered withn theBritish Journal of Sports Medicine with acomprehensive range of advertisementoptions available. Loose and bound-ininserts are also invited. For furtherinformation please contact Mark Butler.

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Meeting report

FIMS World Congress of Sports Medicine,Amsterdam 1 990British Association of Sport and Medicine

Honorary Secretary's Report

Three officers represented BASM: DrDan Tunstall Pedoe (Chairman), DrPeter Sperryn (Vice Chairman), andDr Peter Thomas (Honorary Secret-ary). For the first time, the committeewas able to put up a fund to reimbursein part members' congress fees.Fourteen BASM members applied intime for this support. A further twentyor so British delegates were spottedmaking it our best congress turn-outsince Oxford in 1970.The ten countries of the North-West

Europe Chapter of FIMS held theirannual meeting at the sumptuouscountry Hotel Kasteel de Vanenburg,an hour out of Amsterdam on the daybefore the congress. A useful ex-change of ideas, particularly on educa-tion, was followed by a memorableevening's dinner and entertainment.BASM is to host next year's chaptermeeting in conjunction with theannual congress at Windermere, 8-10November, 1991.At the council of delegates, it was

unfortunate that Dr Peter Sperryn,who had chaired the education com-mission for six years, missed electionto the committee. BASM will nowhave to hold a watching brief over thenext couple of years until the nextopportunity to get one of our members

The social side of AmsterdamWhy is it that after such a congress thememories are often hazy? Has thebrain been flooded with facts, or is itthe anticlimax returning to the grind-stone? A few mental images remaindear, induding one or two of themany social activities arranged by theDutch.There was the dark horse of the

British party - 'Right, right again andleft at the first canal for the red lightdistrict, but I've only been there onceten years ago!'. And one member ofthe party had to be restrained fromvisiting every night ('only to look', ofcourse) and had to confine himself topolishing his chat-up technique on the

PresidentVice Presidents (3)

General SecretaryTreasurer

Executive Committee (8)

FIMS ELECTIONS, 1990Prof. W. Hollmann (FRG)F. Commandre (France)Qu Mian Yu (China)P. Renstrom (Sweden)P.N. Sperryn (GB)A. Bouzayen (Tunisia)

E.H. DeRose (Brazil)J.J.G. Iturri (Spain)A.W. Parker (Australia)C. Roux (Cote D'Ivoire)C. Condoulakis (Greece)S. Silvi (Italy)H. Knuttgen (USA)C. Christodoulakis (Cyprus)K.M. Chan (Hong Kong)M. Sentissi (Maroc)El Eshawi (Saudi Arabia)

Elected unopposed60 elected55 elected43 elected40 not electedwithdrew

unopposed58 elected11 not elected4847474441383433

Not electedO'Brien (Eire) 28; Hermans (NL) 24; Fowler (Can) and Sperryn (GB) = 21; Parker (Australia) 20;Mironov (USSR) and FrenkI (Hung) and Dirix (Bel) = 18; Komadel (Cz) 17; Raas (Austria) andTripathi (India) = 10; Iwane (ap) and Felten (Lux) = 7; Lazar (Pol) 1.onto the executive.

It was interesting to meet a growingnumber of doctors now doing sportsmedicine full-time under the title of'Sports Physician'. With the exceptionof very few countries, there appears tobe no standard specific training to-wards academic qualifications in

waitresses in each restaurant.Another British delegate took so

long finding his way to the loos while'meeting the Dutch' he was almostlocked in the hall.The cyde trip arranged for us on the

Wednesday was an excellent mix ofsport health and medicine (the con-gress theme) even if the medicine wasin the form of amber fluid. Well, it wasa very hot day and we all neededplenty of Heineken to replenish fluidloss. But why do the Dutch have theirbrakes on the pedals! This form oftechnology was almost too much for acouple of Canadians approaching aroad junction at speed.One of the most impressive displays

was at the congress reception where

sports medicine. However, the Dutchhave taken a strong lead with Govern-ment backing as have the Finns.Surely the time has come for GreatBritain to follow their example?

Peter L. ThomasHonorary Secretary, BASM

the waiters stood no chance againstthe pincer attack of the hungry Britishdelegates who cleared more trays thananyone else. This provided the neces-sary energy to browse round thenautical museum next to the recep-tion.The jazz night ensured variation in

the cultural experience after hurriedvisits to some of the excellentmuseums in Amsterdam, and theNorwegian delegate fully deservedher award for stamina on the dancefloor.By the way, at her instigation we

have challenged Norway to a game ofunderwater rugby in Athens in '94 -any volunteers?

Anonymous Bosh

Br. J. Sports Med., Vol 24, No. 3 143

Br. J. Sp. Med; Vol 24, No. 3

Pheidippides goes to Amsterdam

Sunday found the FIMS Commissionsinevitably late and depleted the morn-ing after the North-West EuropeChapter's lavish out-of-town mansionmeeting. Coffee helped the day drifton to the rising din of greeting shoutsbetween long-lost friends rolling up toregister next to the trade show. This isthe nub of a real congress - reunionprecedes formality. Perhaps FIMS'works best as an introduction agency!A couple of minutes face-to-face beatsany amount of letter-writing - thatrudimentary art-form among sportsdoctors!Most of our hotels were an easy

stroll from the RAI Congress Centre,whose surrounding verdure and sun-ny canals constantly beckoned. Thearrangements were a model of friendlyefficiency.. Hospitality scaled thelegendary Dutch heights on severaloccasions, but it really is a pity thatcongresses are nowadays so expen-sive. Is it really best that we pay ahefty premium for professional orga-nizers but can't attend without agrant?Came the evening; nine hundred

delegates from seventy countries filedinto the theatre for the grand opening.To our delight, an attractive younglady in the guise of Minister of Healthproceeded to give a tour-de-forcewhich might have shamed our own

Scenes from the FIMS Congress 1990

-~~~~~~~~~~~~~~~~4© 1990 Butterworth-Heinemann Ltd0306 4179/90/030144-04

Government, had any of it bothered toattend a world congress concernedwith the theme of sports medicine inour society.She stated her policy of complete

support for sports medicine due to the'worldwide recognition of the benefitsof sport on health'. She sought qualitycontrol of sports medicine standards,supported NASM's hiring of profes-sional staff and active- education

144 Br. J. Sports Med., Vol 24, No. 3

Scenes from the British Journal of Sports MedicineEditorial Board Meeting held at the Apollo Hotel,Amsterdam (sponsored by the publishers -Butterworth-Heinemann Ltd).Above right, a lavish meal was enjoyed by all present.Board members present: Top left (from left) Kai MingChan (Hong Kong), Eduardo and Regine de Rose (PortoAllegre), Nishat Mallick (Karachi)Above (from left) James Sekajugo (Kampala), SergeiMironov (Moscow), Ludovit Komadel (Bratislava)Right (from left) Charles Fry (Butterworth-Heinemann),Qu Mian-Yu (Beijing), Constant Roux (Abidjan)Below (from left) Bill Webb (Sydney), Dan Tunstall-Pedoe(London), Roy Shepherd (Toronto), Robert Frenkl(Budapest)Right (from left) Nick Mowat (Butterworth-Heinemann),Paul Wright (Kingston)

Br. J. Sports Med., Vol 24, No. 3 145

programmes to stimulate mass partici-pation in sport and to control itsnegative side effects such as dopingand injury. It was indeed salutary tocompare our neighbour's attitude withthat of the British Government.The FIMS President from K6ln,

Prof. Wildor Hollmann then fascin-ated us with his cycle ergometer ridethrough the archives, with Frau Holl-mann at the projector. His history ofwork physiology led to an impas-sioned plea for more exercise. 'Onlyphysical training can make man com-ply with natural living in a modemmechanized age'. More and moreinvestigations show the advantages ofexercise, including immunity andcerebral blood flow. Pheidippideswondered why, if there were over2000 ambulant coronary rehab groupsin West Germany, there were so fewin Britain. Prof. Hollmann condudedwith a call for the undergraduatemedical syllabus adoption of sportsmedicine because of its importance tomass exercise and health as well as toelite sports in which many werestretched to their limits. Top sportmust be closely monitored and sportsmedicine is a safety factor.

In the best Dutch tradition, 'Profes-sor Doc' then made a number ofappearances to leaven any tendency topomp. His sleight of hand produced arange of substances, catalysts andfluids. Rabbits did strange thingsconcerned with an international jour-nal and the good professor gave oureditor helpful advice on coping withrejected papers. From there on, asthey say, it was all go.A full programme of topics to attract

all shades of academic interestincluded traumatology and rehabilita-tion, medicine and cardiology,physiology and training. Open forums

Above, the Apollo Hotel; above left, the waiters bore an uncanny resemblance totwo Dutch Sports Mediane luminaries; Kurt Tittel a Board Member from Leipzigproviding impromtu entertainment

included mental training, sports medi-cine - hobby or profession? and a jointsession with international federationson team doctors' duties. Tutorialgroups were introduced on clincialand physiological subjects. Onewonders if the commercial vogue toenlarge and sell these conferences toperhaps too many different factionsdoesn't just get in the way of simplecommunication. We stuff too manysimultaneous sessions into the prog-ramme, so you end up with a franticmultitude sweating around at thedouble trying to cram everything intonext to nothing and finding it increas-ingly difficult to actually meet people,or rather pin them down. What is thepoint of traversing the globe to findthat you have an interest in several ofthe parallel sessions but must missmost of them?Meanwhile, a multinational cast

from 68 member countries maintainedProfessor Doc's high tone of slapstickin the traditional ritual known as theFIMS Council of Delegates. Veteransfondly recall the rout of the officers atthe 1980 Riot of Rome. Feelings ran sohigh at the 1982 Conflict of Vienna,where we were introduced to thedemocratic novelty of a formal vote foran unopposed candidate, that theentire voting procedure was over-hauled. The '86 Brawl of Brisbane sawthe Parliamentarian resign as theLatins simply voted not to follow therules and FIMS discovered the blocvote as well as the instant paymentscheme for the subs of one's proxyvotes. On this occasion, Pheidippides'favourite vignette was of his Latinneighbour's laborious longhanding ofa pencilled list across his ballotpaper some two hours before all thecandidates were known! The coarsehumour of a dubious cabaret attended

the cognt as the audience caught on tothe voting patterns and started shout-ing them out correctly in anticipationof each candidate! Bloc voting deliversthe goods at the cost of lost credibility.Like the parent sighing yet again for awayward child, one hopes that FIMSwill one day earn the respect of thosewho seek a worldwide sports medicalfraternity who are capable of puttingthe ideals of service in the cause aboveself-advantage for the claque.

Lavish entertainments were laid on.Pheidippides remembers a particularlyjolly night in the Breughelhuys Res-taurant with food, music and enter-tainment flowing freely and the pun-ters' vanity being such that a verytalented caricaturist was kept busyknocking us off at about three minutesa head! Premature hilarity at anycolleagues' discomfiture would surelybe rewarded by an even more fittingline slashed through one's favouritefoible! 'Meet the Dutch' parties andevening canal cruises were enjoyedand the Journal managed to assembleno less than twenty-one members for aboard meeting insinuated into amemorable dinner at the Apollo atwhich the waiters bore an uncannyresemblance to Dutch sports medicineluminaries.World congresses also bring the

aficionados out to play, and whilePheidippides was perforce single-minded in his pursuit of sports medic-al contacts and esoterica a decent wayuptown, fellow members were study-ing exotica in a celebrated area ofnocturnal rubor further downtown. Ayoung colleague has, mercifullywishing to keep the pressure offPheidippides, keenly offered to sub-mit something crisp on this on anotherpage.

Pheidippides

146 Br. J. Sports Med., Vol 24, No. 3

Vignette scientifique

A roving reporter, the 'Observateur M'decine Sportive' presents a personal view of thesessions held at the XXIV FIMS Congress in Amsterdam

Lactate testingWhat V02 Max was for the '60s andmuscle fibre type was for the '70s,lactate testing is a' la mode for the '80s.The desire for a measurement, a valueor a figure, whether precise or not isthe great unsatisfied need in medicineand human physiology. A serumcholesterol level that predicts that all iswell with the coronaries, a dietaryfibre intake (daily in grams) are exam-ples of targets to be aimed at in theprevention of disease. As the percentVO2 Max provided a goal in sport, sothe lactate 'threshold' gives the athleteand coach a measure of the success orotherwise of training. The session inthe Congress devoted to lactate testinggenerated considerable discussion andapparent agreement on one point.That was that the word 'threshold' asapplied to lactate testing should beabandoned. At least that is what thechairman sensed from the discussion.One school of thought considered

that it was the intensity of exerciseleading to a plateau level of plasmalactate concentration (which indicatesthat lactate input and output in theplasma are equal) was the correcttarget - though there was debate onwhether the level should be consistentfor three, four, or more minutes beforeit could be considered a plateau.Others considered that the plateaushould be the normal resting valueand any rise above this basal valuewas, for their sport, acceptable.The difference between lactate

levels obtained in the laboratory andthose in the field was emphasized. Inthe field it was pointed out that suchvariables as wind speed, environmen-tal temperature, competition, etc.could account for differences betweenindoor and outdoor values.There are two different methods for

assessing plasma lactate and it seemsthey may not give comparable read-ings when tested on the same sample.However, is the absolute value of verymuch interest when what is beingsought is the level of activity thatproduces a plateau?

It seemed from the large number ofareas of disagreement that lactate willbe the flavour of the 90's as well as thelate 80's.

Observateur MWdecine Sportive

Nutrition and sportA session of the Congress addressingthis aspect of sports medicine wasopen to local dietitians and coaches,etc. The presentations were conse-quently in rather general terms andhad there been discussion they wouldindeed have induced controversy,especially with a more scientific/medical audience. The talks that werepresented, together with a few addi-tions are to be published as a separatebook, but it is worth mentioning someof the points made during this session.Carbohydrate intake is, as every one

knows, essential, especially in eventslasting longer than one-two hours.But it was stressed that post-exercisecarbohydrate consumption is impor-tant, especially if the athlete has tocompete again within 24 hours. Forthis purpose 50 g of carbohydrateshould be ingested every two hourspost-exercise. Sucrose (sugar) or aglucose polymer (not glucose per se)are suitable, but not fructose. It maynot be easy to convince the competitorin this situation to digest anything.

It seems that in prolonged exerciseprotein is used, perhaps as an energysource, and that there is a negativenitrogen balance for two-three daysafter severe exercise. If this finding isconfirmed it would be comparable tothe discovery reported about 60 yearsago that following injury there isalways a negative protein balance,whether the injury is traumatic or dueto cold surgery. The speaker felt thatincreased protein intake would there-fore be of value in prolonged exercise.There is considerable evidence toshow that extra protein is of no valuein the ebb state of protein balance afterinjury.The problem of getting energy into

endurance sportspersons was consi-dered by assessing gastric emptying.Exercise up to 75 percent VO2 Maxdoes not affect the rate of gastricemptying it was stated. Though in-creasing concentrations of glucose de-lay gastric emptying, up to 17 percent(as malto-dextrose) in fact deliversmore glucose for absorption in thesmall intestine despite the reducedrate of leaving the stomach.A hypothesis that muscle shortage

of the amino-acid glutamate, brought

about by exercise, was responsible forthe immuno-suppression seen inathletes was well presented but lackedmuch scientific support. It could bemisleading especially when the speak-er agreed that glutamate by mouthwould be of little value and could bedangerous. The wisdom of presentinga hypothesis which, though exciting,needs considerably more experimentalsupport, to a lay audience could bequestioned.A similar, rather speculative account

of free-radicals in exercise was pre-sented with thinly veiled threats thatinadequate intakes of vitamin E mightlead to cancer was also, in yourcorrespondent's opinion, unwise tosuch an audience. It is just possiblethat the speaker, who is an employeeof a multi-national vitamin producingcompany, may have been over-enthusiastic.A good account of gastro-intestinal

symptoms during and after enduranceevents was given but little in the wayof evidence for the aetiology or pre-vention and treatment of such condi-tions apparently exists.

Finally, it was obvious that inpractically all the talks in this sessionthe only athlete considered was theone involved in endurance or pro-longed events. This group of peopleform a relatively small proportion ofthe total numbers taking part in sport,even if prolonged training for shorterevents is considered. Perhaps themetabolic changes are easier to moni-tor in extreme exercise, but does thismean that in less severe activity thereare no nutritional/metabolic problemsor that the methods of measurementare not yet sufficiently precise?

Observateur MWdecine Sportive

Sports medicine - hobby ora profession?The XXIV Congress of FIMS devoted ahalf day to a discussion of thisquestion. Speakers from Finland,Australia, East Germany, Ireland,Netherlands and Belgium gave briefaccounts of the situation in theircountry with reference to sports medi-cine. It became clear that nationalattitudes (i.e. financial support) varied

Br. J. Sports Med., Vol 24, No. 3 147

from the very efficient and compre-hensive medical coverage of sport inEast Germany to Belgium whose repre-sentative accepted that it was a hobbyin his country. The UK was notrepresented, and your correspondentseemed to be the only UK participantpresent, despite the current interest inthis country in training doctors insports medicine, and in the setting upa National Sports Medicine Institute.One of the delegates suggested that

training in sports medicine shouldtake four years in order to give itcredibility, while others suggested ayear. The usual and unoriginal com-ment that it should be included in thetraining of medical students was dulymade but roused no response at all.Could it be that more people arerealizing that the curriculum is alreadyovercrowded?

To the uninitiated it could seem thattraining in sports medicine can be nomore specialized than training ingeneral practice. Sports medicinemakes demands on many aspects ofspecialized medicine with perhapsorthopaedic surgery and soft tissuemedicine occupying pride of place.But as the programme of the Congressshowed, cardiology, behaviouralmedicine, nutrition, etc. all haveaspects which are of particular rele-vance to the sportsperson.Do the experts really consider that

in four years a medical graduate can beall these things, or are they saying thatall this time is needed to train some-one in the 'general practitioner' modeof sports medicine. Surely there is noevidence that those with an interest insports medicine need such a long timeto be educated?

One aspect not touched on in thisdiscussion on hobby or profession wasthe market forces in this area. Howmany doctors can make the kind ofliving they expect from being a sportsmedicine GP full-time, or indeed anorthopaedic surgeon, or physician,whose sole duties are concerned withsports injuries especially with the kindof NHS cuts currently taking place?

It seems that sports medicine maywell have to be a hobby for medicalprofessionals - a hobby that certainlyshould have material rewards, but ahobby in the sense that the surgeon,physican, etc. has a special interest inthat he/she may well have had person-al experience and therefore has anunderstanding of and an interest insport.

Observateur Medecine Sportive

News

Congratulations to our member since1975, Dr A.L. Whiteson, on beingawarded an OBE in the BirthdayHonours, 1990.

The organizers of the World StudentGames in Sheffield, July 14-25, 1991,invite the services of sports medicinedoctors to share duties at the Games.Contact: Mr. Jenkinson-Graham,World Student Games, 4 ClaremontPlace, Sheffield S10 2TB, UK.

BASM member, George Borden, re-membered from our Loughboroughcourse days, has established a regularteaching connection with the USSRsports medicine authorities. He hascompleted ten Russian trips since 1981and *is developing programmes inUSSR and other east European states.Contact him at Virginia Com-monwealth University, VCU Box 2003,Richmond, VA 23284-2003, USA.

The Sports Council's Sports Scholar-ship Scheme, now in its tenth year,continues to fund PhD research in linewith its policy of 'encouraging thedevelopment of expertise in sportsresearch and improving the quality of

research information available toathletes and coaches'. The latestgrants are to Southampton University,for study of the effect of the EducationReform Act on PE teaching and to theSchool of Sport and Exercise Studies atBirmingham University to study theeffects of viral illness on sports per-formance.

Newsnip 1

Our member, Dr. Simon Petrides, ofMilton Keynes, reports the followingsad tale.

'I was attending the ultra-distanceworld championship in MiltonKeynes, where runners aim for thegreatest distance covered in 24 hours.My attention was drawn to a Hunga-rian runner whose shorts had, un-known to himself, gradually metamor-phosed from an Eastern bloc grey to alurid red colour. I invited him to stepout while I investigated.He was wearing very loose fitting

nylon running shorts with an evenlooser fitting inner which had pro-duced abrasions around his foreskin.These were bleeding profusely butwere abated by a few smears ofVaseline. While I was consideringfurther preventive measure, anotherrunner dropped out of the race and,moved by compassion, offered mypatient his own mo.re supportive cot-ton underwear. This achieved therequired result - the Magyar went onto complete over 130 miles (208km.).

I am sorry I couldn't take photos,but hope this brief account will drawattention to this distressing, but re-markably painless condition."

Newsnip 2

Forget joggers! The Independent informsus that after the deaths of no less thanseven Dutch cyclists of 'heart failure'in two years, new dope tests are to beimposed, especially in connectionwith new stimulants.

148 Br. J. Sports Med., Vol 24, No. 3

From thejournals

Sports medicine current awareness service

Prepared by Kathryn Walter and Nancy Laurenson at the London Sports Medicine Institute(LSMI) Library

The following summaries are takenfrom a selection of recent journalsindexed in the LSMI database. A fulllisting is published monthly in SportsMedicine Bulletin.

Copies of the complete articles areavailable (price 15p per sheet subjectto Copyright Law) from the Library,LSMI, c/o Medical College of St Barth-olomew's Hospital, Tel: 071 251 0583.

Specific therapeutic exercise proce-dures utilizing basic anatomical andbiomechanical information are out-lined in a recent paper entitled Prop-rioceptive neuromuscular facilitation(PNF) and modified procedures foranterior cruciate ligament (ACL) in-stability (Engle RP and Canner CG,Journal of Orthopaedic and Sports PhysicalTherapy 1989 December, 11(6),230-236. General concepts of neuro-muscular rehabilitation in the ACL-deficient knee and the application ofspecific techniques are discussed. Theauthors believe that manual treatmentapproaches are superior to mecha-nized treatment because it gives thetherapist greater control to evoke morespecific motor responses appropriateto the specific instability associatedwith ACL problems.Homeopathy is a 200 year old

medical system utilising safe, gentleand natural medicines for the treat-ment of acute and chronic illness andinjury. Steven Subotnick describesmany of the different homeopathicmedicines which can be used prior tosurgery and for podiatric sports in-juries in The utilization ofhomeopathic medicines in podiatricsports medicine (British Journal ofPodiatric Medicine and Surgery, 1990January, 2(1), 4-6. Proficiency in acuteprescribing, whereby the symtoma-tology of the homeopathic medicinesis matched to the acute symptoma-tology of the patient is relatively easyfor the podiatrist to attain. In contrast,chronic prescribing is a far morein-depth and detailed science wherebythe highly skilled and trainedhomeopath matches the symptoma-tology of the medicine to the totality ofthe patient.

Although bicycle helmets have beenrecommended as a preventativestrategy, few studies have examinedthe efficacy of helmets in actual cyclingmishaps. Richard Wasserman andRobert Buccini conducted a question-naire survey of 191 recreational bicyc-lists who reported having fallen andstruck their heads in a cycling accident(Helmet protection from head injuriesamong recreational bicyclists, Ameri-can Journal of Sports Medicine, 1990January/February, 18(1), 96-97). Fiftyseven percent of riders were wearinghelmets during the mishap. Helmetwearers were significantly older thannon-wearers and experienced signifi-cantly fewer skull fractures (1 percentversus 11 percent) and facial soft-tissue injuries (5 percent versus 18percent). While this study lends addedsupport to the use of appropriate headprotection among recreational cyclists,the real problem appears to be how toget bicyclists to wear bicycle helmets?The economic implications of sports

injuries are investigated in Medicaltreatment and costs for sports-relatedinjuries in a total population (de LoesM, Intern Tonal Journal of Sports Medi-cine, 1990 February, 11(1), 66-72). Aone-year prospective study of acutesports injuries in a Swedish municipal-ity with 31620 inhabitants revealed atotal of 571 injuries (17 percent of allinjuries) in 28 different sports; 65percent of the injured were males.Sports injuries accounted for 3 percentof all acute visits and there werealtogether 1 083 outpatient visits. Forty-four patients were hospitalized: theproportion of inpatient care due tosports injuries was 0.7 percent and themean length of stay in hospital 3.9days. The total amount of sickleavecompensated for sports injuries (3477days) was 1.2 percent of all dayscompensated in 1984. The overallmean cost per injury was US $335.Individual sports (motorcycling, down-hill skiing and equiine sport) weremost costly, the dearest of the teamsports ranking only fifth (handballfollowed by soccer).The total energy cost of physical

activity has two components (a) theenergy expended during the activity

itself and (b) the postexercise energyexpenditure while the metabolic rateremains elevated above the pre-exercise level. The, magnitude andduration of this 'exercise postexerciseoxygen consumption' (EPOC) follow-ing exercise of varying intensities andduration is reported in Effect ofexercise intensity and duration inpostexercise energy expenditure (Sed-lock DA, Fissinger JA and Melby CL,Medicine and Science in Sports andExercise, 1989 December, 21(6), 662-5).Ten trained male triathletes performedthree cycle ergometer exercises; highintensity-short duration (HS), low in-tensity-short duration (LS) and lowintensity-long duration (LL). Postexer-cise V02 was measured continuouslyuntil baseline V02 was achieved. Theduration of EPOC was similar for HSand LL and both were significantlylonger than the EPOC following LS.However, total net caloric expenditurewas significantly more for HS than foreither LS or LL. Exercise intensity wasshown to affect both the magnitudeand duration of EPOC, wheras theexercise duration affected only theduration of EPOC. EPOC may be ofsome value for weight control.Golf is enjoyed by participants of

various ages and physical conditions.Apart from isolated case reports, golfinjuries have received little attentionin the literature. In a recent paper byJohn R McCarroll et al., the results of aquestionnaire survey investigatingtypes and frequencies of injury inamateur golfers are reported (Injuriesin the amateur golfer, Physician andSports Medicine, 1990 March, 18(3),122-6). Of 1144 respondents, 708 (62percent) had sustained one or moreinjuries. Among men, the most com-mon site of injury was the lower back;among women it was the elbow.Excessive practice and poor swingmechanisms were the most commoncauses. Suggestions for injury preven-tion indude a combination of properswing mechanisms, controlled prac-tice routines and maintaining goodphysical condition.Understanding the mechanics of the

golf swing has implications for opti-mising performance as well as injury

Br. J. Sports Med., Vol 24, No. 3 149

prevention and rehabilitation. In Elec-tromyographic analysis of theshoulder during the golf swing (PinkM, Jobe FW and Perry J, AmericanJournal of Sports Medicine, 1990 March/April, 18(2), 137-40) it was revealedthat the infraspinatus and supraspina-tus act predominantly at the extremesof shoulder range of motion, 'thesubscapularis and pectoralis majorduring acceleration, the latissimusdorsi during forward swing and theanterior deltoid during forward swingand followthrough. The middle andposterior deltoids appear to be rela-tively noncontributory, without anyspecific timing patterns.Some medical practitioners and

physiotherapists are turning the use ofkinesiology in their muscular therapytreatment reports Sue Warren in Kine-siology - the new muscle therapy(Running Magazine, 1990 March, Issue107, 50-53). Kinesiology, a recentimport from America, is the study ofmuscular movement and has dev-eloped from a combination of chirop-ractic with chinese acupuncture tech-niques. Some kinesiological techni-ques such as the knee reflex test andoptic musde reflex to light have beenused in Western practice for years. Inbasic applied treatment it employs theuse of the meridian energy system andacupressure points in trying to main-tain or restore the body to its naturalbalance. For instance, athletes oftenpresent with pain caused by reactivemusdes, where one amongst a set ofmusdes becomes over energized caus-ing the other musdes in the group tobe used inappropriately. By releasingthe over-taut muscle, the others can beused properly and pain if often in-stantly removed. The acceptance ofkinesiology is a major problem: thetheories of Western orthodox medi-cine do not consider the existence ofthe energy system.A review of plyometric training is

presented by Phil Lundin (Track andField Quarterly Review, Winter 1989,89(4), 37-40) in an article whichexamines the physiology underlyingplyometrics training and the effects onmusde strength and jump perform-ance. Plyometrics can be described asa 'shock' method of strengtheningmuscle for athletic performance andconsists of a rhythmical hybrid ofeccentric plus concentric activitywhich loads the elastic and contractilecomponents of muscle. The neuro-muscular apparatus of muscles incor-porating inherent proprioceptive re-flexes can be singled out as the mostimportant factor in speed-strengthactivities where plyometric traininghas its primary impact. From the

limited and rather controversial litera-ture to date it appears that depthjumps from a height of 0.8 and 1.1metres are most effective with thelower height maximizing speed inswitching from yielding to overcomingwork and the greater height emphasiz-ing maximum dynamic strength.Further research is necessary to clarifywhat constitutes optimal variablessuch as the number of sets, repetitionsor the role of recovery in depth jump-ing as well as the use of additionalweights especially in 'horizontal' and'stationary' plyometric drills such ashopping, boundingandlegtuckjumps.

In a follow-up article Plyometrics:think before you leap (Track and FieldQuarterly Review, Winter 1989, 89(4),41-43) Joseph Horrigan and DavidShaw discuss the practical implica-tions of plyometric training. Legiti-mate concerns involve the improperuse and lack of information surround-ing plyometrics. Specifically, itappears that the number of injuries areincreasing due to coaches, athletesand trainers who do not prescribespecific, safe and progressive trainingprogrammes.

In a study to determine whetheranthropometric factors account forgender differences in anaerobic pow-er, JL Mayhew and PC Salm measuredbody composition, somatotype,isometric strength and neuromuscularfunction and performed 4 anaerobicpower tests in untrained subjects (82men and 99 women). (Gender differ-ences in anaerobic power tests, Euro-pean Journal of Applied Physiology, 1990March, 60(2), 133-8). Men were signi-significantly different from the womenin all strength, power and neuromus-cular measurements except reactiontime and all anthropometric and soma-totype dimensions except ectomor-phy. Strength and anthropometricdimensions were similarly related toanaerobic power values within eachsex. Removing the influence of anthro-pometric strength and neuromusclardifferences by analysis of covariancereduced, but did not remove, thesignificant differences between thesexes. The authors condude thatalthough anthropometric factors havea relatively large influence on genderdifferences in anaerobic power, otherfactors may also be operating in shortterm explosive power performance.A related artide by Jean Barrett

Holloway and Thomas R Baechleentitled Strength training for femaleathletes: a review of selected aspects(Sports Medicine 1990 April, 9(4),216-228) advises that although thereare baseline differences in musclemass and absolute overall strength

and power, women and men respondto strength training in very similarways. Unit for unit, female muscletissue is similar in force output to malemuscle tissue and there is someevidence to support similar, propor-tional increases for the sexes instrength performance and hypertro-phy of muscle fibre relative to trainingstatus. Strength training can alsoprovide beneficial alterations in bone,body fat and self concept in women.There is no evidence that womenshould train differently than men, andtraining programmes should be tai-lored for each individual.Fructose 1,6-diphosphate (FDP)

plays an important regulatory role inenergy metabolism. Administration ofexogenous FDP under conditions inwhich glycolysis is impeded (acidosis,hypoxia and ischemia) has beenshown to accelerate ATP production,prevent glycogen breakdown, stimu-late glycogen synthesis and synthesisefree fatty acids. The possible occurr-ence of these effects during exercisewas investigated in Effect of fructose1,6-diphosphate infusion on the hor-monal response to exercise (Myers J etal., Medicine and science in Sports andExercise, 1990 February, 22(1),102-105). Ten trained males under-went 1 hour of continuous exercise at70 percent V02 max followed by 20W.min-1 increments to exhaustion.Immediately prior to testing eitherFDP or placebo was infused in arandomized double-blind crossoverfashion. No differences were observedin heart rate, blood pressure, gasexchange data, perceived effort, orglucose, insulin, free fatty acid, lac-tate, beta-hydroxybutyrate, glyceroland glucagon concentration at rest,during exercise or upon exhaustion.These observations are in contrastwith the previous reports of thebioenergetic effects of FDP.

Digestive disorders of athletes arereviewed by Frank Moses in The effectof exercise on the gastrointestinaltract (Sports Medicine, 1990 March, 9(3),159-172). Exercise has a wide varietyof effects upon the gastrointestinalsystem. These symptoms range fromaggravation of gastro-oesophageal re-flux to effects upon gastric emptying,intestinal transit, colonic function,hepatic blood flow and drug metabol-ism and, notably, gastrointestinalbleeding. The study of the digestivetract during exercise is in its infancy.The awareness of symptoms andclinical difficulties encountered by ac-tive individuals should provoke addi-tional study of gastrointestinal phy-siology of the active individual inhealth and disease.

150 Br. J. Sports Med., Vol 24, No. 3

BASM Education Programme

Date

1990

February 9-11

March 23-25

April 29-May 4

June 29-July 1

September 28-30

September 30-October 5

November 23-25

November 30-December 2

January 25-27

1991

April 28-May 3

September 29-October 4

November 8-10

Course Venue

Advanced Medicine I

Advanced Physiology II

Introductory Course

Advanced Injury Module I

Advanced Injury Module II

BASM Introductory Sports Medicine Course

BASM 1990 Annual Congress, Saunton Sands Hotel,Braunton, North Devon, UK. Details from: Dr PeterThomas, Hon.Sec. BASM, Reading Clinic, 10 EldonRoad, Reading RG1 4DH, UK. Tel: (0734) 502002

Advanced Physiology I

Advanced Injury Module III

Introductory Course

Introductory Course

BASM 1991 Annual Congress, Lowwood Hotel,Windermere, Cumbria, sponsored by LederleLaboratories. Details from: John Clegg, Birch Lea, 67Springfield Lane, Eccleston, St. Helens, Merseyside,WA10 5HB, UK. Tel: (0744) 28198

Br. J. Sports Med., Vol 24, No. 3 209

LSMI

BOAMC

Lilleshall

Hillingdon

Wroughton

Lilleshall

BOAMC

Wroughton

Lilleshall

Lilleshall

Notes for Authors

ScopeThe British Journal of Sports Medicine covers all aspectsof sports medicine and science - the management of-sports injuries; all clinical aspects of exercise, health andsport; exercise physiology and biophysical investigationof sports performance; sports psychology; physio-therapy and rehabilitation in sport; and medical and sci-entific support of the sports coach.

Types of paperOriginal papers (not normally over 3000 words, fulllength accounts of original research)Review articles (up to 4000 words, providing concise in-depth reviews of traditional and new areas in sportsmedicine)Case reports (up to 1000 words, describing clinical casehistories with a message).

RefereeingAll contributions are studies by referees whose namesare not normally disclosed to authors. On acceptance forpublication papers are subject to editorial amendment. Ifrejected, papers and illustrations will not be returned.Authors are solely responsible for the factual accuracy oftheir papers.

ManuscriptsAuthors are urged to write as concisely as possible.Three copies should be submitted, typed on only oneside of the paper (quarto or A4) in double spacing with amargin of 30 mm at the top and bottom and on bothsides. Papers should be arranged in the following orderof presentation: title of paper; names of the authors;address of the place at which the work was carried out;an abstract of the paper (100-200 words in length; 4-6keywords; the text; acknowledgements (if any); refer-ences; tables; and abbreviated title for use as a runningheadline; captions to figures (on separate sheet ofpaper).

IllustrationsDrawings and graphs should be on heavy white paper!card or blue-line coordinate paper using black ink.Label axes appropriately and clearly. Please use a selec-tion of the following symbols: +, x, a, O, A, V, MI ,A, V. Photographs should be of fine quality, largeglossy prints suitable for reproduction and the topshould be indicated. Negatives, transparencies or x-rayfilms should not be supplied, any such material shouldbe submitted in the form of photographic prints.Authors are asked where possible to draw diagrams toone of the following widths, including lettering,168 mm, 354 mm. During photographic reproduction,the diagrams are reduced to ½h their size. The maximumdepth at drawn size is 500 mm. Authors are asked to usethe minimum amount of descriptive matter on graphsand drawings but rather to refer to curves, points etc. bysymbols and place the descriptive matter in the caption.Three copies of each illustration are required and theseshould be numbered in a consecutive series of figuresusing Arabic numerals. Legends should be typed indouble spacing on a separate page but grouped together.Each figure should be identified on the back - figurenumber and name of the author. Figures which havebeen published elsewhere should be accompanied by aform of permission to reproduce, obtained from theoriginal publisher.

ReferencesThese should be indicated in the text by superscriptArabic numerals which run consecutively through thepaper. The references should be grouped in a section atthe end of the text in numerical order and should take theform: author's names and initials; title of article; abbre-viated journal title; year of publication; volume number;page numbers. If in doubt authors should always writethe journal title in full. References to a book should takethe form: authors' surname, followed by initials; title ofbook in single quotes; editors (if any); volume number/edition (if any); name of publishers; place of publication;year of publication and page number. Where a paper iscited more than once in the text, the same superiornumeral should be used on each occasion. e.g.21 Sperryn, P. N. SpoA and Medicine Butterworths, UK 198322 Ellitsgaard, N. and Warburg, F. Movements causing ankle frac-

tures in parachuting. Br 1. Sports Med 1989, 23, 27-29

TablesTables should be typed on separate sheets together witha suitable caption at the top of each table. Column head-ings should be kept as brief as possible, and indicateunits of measurement in parentheses. Tables should notduplicate information summarized in illustrations.FootnotesFootnotes should be used sparingly. They should be in-dicated by asterisks (*), daggers (t), and double daggers(t), in that order. In the manuscript, a footnote should beplaced at the bottom of the page on which it is referred toand separated from the main text by a horizontal lineabove the footnote. Footnotes to tables should be placedat the bottom of the table to which they refer.Drugs, Abbreviations and UnitsDrugs should be referred to by their approved, not pro-prietary, names, and the source of any new or experi-mental materials should be given. If abbreviations areused these should be given in full the first time they arementioned in the text. Scientific measurements shouldbe given in SI units, but blood pressure should continueto be expressed in mm Hg.ProofsAuthors are responsible for ensuring that all manu-scripts (whether original or revised) are accurately typedbefore final submission. Two sets of proofs will be sent tothe author before publication, one of which should bereturned promptly (by Express Air Mail if outside UK).The publishers reserve the right to charge for anychanges made at the proof stage (other than printerserrors) since the insertion or deletion of a single wordmay necessitate the resetting of whole paragraphs.SubmissionThree copies of the complete manuscript and illus-trations should be sent to Dr P.N. Sperryn, The Editor,British Journal of Sports Medicine, Butterworth Scien-tific Ltd, PO Box 63, Bury Street, Guildford, Surrey GU25BH, UK.All material submitted for publication is assumed to besubmitted exclusively to the British Journal of SportsMedicine. All authors must consent to publication. Theeditor retains the customary right to style and if neces-sary shorten material accepted for publication. Manu-scripts will be acknowledged on receipt. Authors shouldkeep one copy of their manuscript for reference. Authorsshould include their names and initials and not morethan one degree each.