Going up or going down. We give you a choice. You can explore the difficulties of supervising sport diving in Scotland and the outcome of systematic medical screening (page 375). Find out what happened to all those medical certificates! Or, you can study the physiological makeup of people who climb walls (page 359). Perhaps they need to be certified.

If it is injury you want, we have plenty in this issue. In particular, we present the harmful effects of contact sport at the highest level. Top level sport doesn't sound very attractive when you review the long term sequelae of playing professional soccer (page 332). The effect of professionalism on rugby football does not present a happy picture either (page 348). And, it seems intuitively wrong that we should have to present data on how to reduce the effect of impact on football headgear (page 337). Sport in the extreme.

Exercise for health sounds more attractive. Osteoarthritis used to be considered a good reason to rest. Reduce the abuse of the joints. No longer. Indeed, exercise may even be a considered a component of treatment (page 326). Chronic arthritis produces muscle wasting, compounded by immobility, but exercise can help reduce these changes. Exercise therapy, adapted from the training programmes of elite athletes, can be used to help patients with common medical conditions. Sport changing practice.

Exercise in paraplegia (page 322). Another radical treatment. Most of us think of voluntary muscle activity; physiotherapy and rehabilitation and, ultimately, sport and exercise. But, this is electrically stimulated involuntary activity to encourage movement in large muscle groups. Without long term hope of functional rehabilitation, this is the promotion of large muscle activity for generic health related benefits. Sport challenging current concepts.

And we didn't mention the Olympics once ...