I would like to thank Dr Shrier for his letter and make a couple of
comments in reply.
First, I would like to emphasise the point I was making in my
original letter. When discussing an ill-defined procedure, as exemplified
by 'stretching', it is important to be precise about what is being done to
what, when and for how long for comparisons to be made or for valid debate
to proceed.
I would like to thank Dr Shrier for his letter and make a couple of
comments in reply.
First, I would like to emphasise the point I was making in my
original letter. When discussing an ill-defined procedure, as exemplified
by 'stretching', it is important to be precise about what is being done to
what, when and for how long for comparisons to be made or for valid debate
to proceed.
Second, I agree that further studies need to be done but care must be
taken with exact definitions. I have heard it suggested that, in the
context of slalom kayaking, both over stretching and under stretching
might be contributory factors in shoulder injury. In a complex
biomechanical system, both statements may be equally true depending on
what one is considering in the kinetic chain.
I cannot resist the temptation to join the debate on sports doctors’
resuscitation skills [1,2]. The study by Thompson et al [3] suggested that there
is a perceived need amongst Sports specialists for first aid skills. However
I received no response to my letter concerning this, [4] which indirectly posed
the question, ‘should doctors who attend aquatic sports be able to deal with
a suspected cervical...
I cannot resist the temptation to join the debate on sports doctors’
resuscitation skills [1,2]. The study by Thompson et al [3] suggested that there
is a perceived need amongst Sports specialists for first aid skills. However
I received no response to my letter concerning this, [4] which indirectly posed
the question, ‘should doctors who attend aquatic sports be able to deal with
a suspected cervical spine fracture and recover the casualty?’ Obviously, that
is the task of a lifeguard in the same way that first aid at non-aquatic events
is the task for a first-aider but perhaps doctors should be competent first-aiders
and/or lifeguards. This was never in the medical school curriculum and perhaps
that should change. At least first-aid training is part of sports medicine courses
but I would like to suggest that lifeguarding should also be included. I would
also suggest that all doctors at aquatic events should hold the NPLQ, NBLQ or
at least bronze medallion and bronze cross of the RLSS or overseas equivalent.
Should any sports medicine course want advice on this they should contact the
RLSS at River House, High St., Broom, Alcester, Warwickshire, B50 4HN (http://www.lifesavers.org.uk/). I would
be happy to help out but would make 2 stipulations; everyone on the course should
feel obliged to join the RLSS and they should sponsor me for my next fund-raising
event for the RNLI!
Paul Schur
References
(1) Lavis M, Rose J, Jenkinson T. Sports doctors’ resuscitation skills under
examination: do they take it seriously? Br J Sports Med 2001;35: 128-130.
(2) Bottomley MB. Sorts doctors’ resuscitation skills under examination-additional
facts. Br J Sports Med 2001;35: 283.
(3) Thompson B, McNally O, Neill SO et al. What is a sports medicine specialist?
A pilot study. Br J Sports Med 2000;34: 243-4.
(4) Schur P. What is a sports medicine specialist? Br J Sports Med 2000;34: 474.
Lavis et al [1] seek to explain the poor results obtained by
candidates undertaking the Bath University diploma in sports and exercise
medicine as a failure of the candidate to take the subject seriously. They
expect the standard to be comparable to “that required of a candidate
completing the same task on an ATLS, PHTLS or ALS course.”
A candidate undertaking any of the above courses, or a...
Lavis et al [1] seek to explain the poor results obtained by
candidates undertaking the Bath University diploma in sports and exercise
medicine as a failure of the candidate to take the subject seriously. They
expect the standard to be comparable to “that required of a candidate
completing the same task on an ATLS, PHTLS or ALS course.”
A candidate undertaking any of the above courses, or any of the
British equivalents run by the British Association for Immediate Care
(BASICS) such as the Pre-Hospital Emergency Care certificate, will have
completed a 3–5 day course. The courses are intensive learning
experiences comprising of lectures, skill stations, trauma moulage,
cardiac care scenarios and continual assessment.
By comparison, my experience of the Bath Diploma Course is that its
teaching relies of a small section in one of the modules, less than half a
day of practical teaching tacked on to one of its clinical weekends and
then for the students to direct themselves.
For a subject that quite rightly results in outright failure for the
candidate if they fail to demonstrate competency, resuscitation skills
attract very little attention from the course. This may be sending the
wrong message to candidates and better results from the examination of
resuscitation skills may be obtained if the course included more intensive
instruction on the topic.
[1] Lavis M, Rose J, Jenkinson T. Sports doctors resuscitation skills
under examination: do they take it seriously? Br J Sports Med 2001; 35;
128-30
Waddington et al.[1] have highlighted an important issue in the context of
sport injury management. However, this article, like many others,
provides erroneous information and percpetions of 'qualified
physiotherapists'. In the UK a physiotherapist must be State Registered
(CPSM at present) to work in the NHS. A physothrapist does not need to be
'chartered' - i.e. a Member of the Chartered Socie...
Waddington et al.[1] have highlighted an important issue in the context of
sport injury management. However, this article, like many others,
provides erroneous information and percpetions of 'qualified
physiotherapists'. In the UK a physiotherapist must be State Registered
(CPSM at present) to work in the NHS. A physothrapist does not need to be
'chartered' - i.e. a Member of the Chartered Society of Physiotherapy. To
get state registration requires proof of adequate level and type of
eduction, whether here or abroad.
In the context of sports therapy, we now have up and coming
designated Sports Therapists, who are registered with their own Society.
These therapists are educated in the HE sector, emerge with Hons Degrees
and an excellent training in sports injury management &
rehabilitation. Hoepfully they will soon achieve full state registration
also.
Pat Turner
Reference
(1) Hay C. Club doctors and physiotherapists. Br J Sports Med 2001;35:207.
I enjoyed reviewing for this journal very much and can only hope that more journals will use a similar electronic system.
Having waited over 16
weeks to hear from a different journal, I think that the electronic system provides an
excellent service to the authors.
The helmets worn in ice hockey - what is their specification and
composition?
They look like canoeing-type and very thin plastic, if so, it
is no wonder head injuries continue. The players need padded helmets more
like motorcycle crash helmets to withstand the knocks with a layer of
polystyrene or other shock absorbing material.
Does BJSM even use its review process? Being a runner and running
trainer and scientist, I am embarrased about this article.[1] The news
*running is unhealthy* quickly went the round. Here in Germany it already
was in TV text, in several online newspapers (with headlines like 'Run
into Osteoporosis'), and has reached internet discussion boards. It will
supposedly appear in printed matter starting tomorro...
Does BJSM even use its review process? Being a runner and running
trainer and scientist, I am embarrased about this article.[1] The news
*running is unhealthy* quickly went the round. Here in Germany it already
was in TV text, in several online newspapers (with headlines like 'Run
into Osteoporosis'), and has reached internet discussion boards. It will
supposedly appear in printed matter starting tomorrow.
The authors measured bone mineral density in female endurance
runners. What, if there was no correlation between running and bone
mineral density? No paper! There was no non-running group for comparison.
What, if there was no correlation between running distance and bone
mineral density? No paper!
Fortunately, there was a correlation.
The results of the regression analyses suggest that the bone mineral
density of the lumbar spine and femoral neck are controlled by different
parameters. They also suggest that aging alone increases the bone mineral
density in the lumbar spine at ages from 18 to 28, whereas it decreases in
the femoral neck from age 18. Does anybody believe this?
The suggested effects of running on bone mineral density are in the
range of the standard deviations of the measurements. If they even
existed, they would be overprinted by the much stronger effects of other
parameters (according to the regression equations), i.e. age.
The regression equation regarding the bone mineral density of the
femoral neck leads to manifold surprising results. For example, that the
entire suggested effect of running would be compensated by a half Mg fizzy
tablet per day.
This paper is a perfect example of pseudo-science. The Press turns
its 'suggestions' into 'truths'. Thousands of female runners are made
feeling insecure. It's embarrassing.
Reference
(1) M Burrows, A M Nevill, S Bird, and D Simpson. Physiological factors associated with low bone mineral density in female endurance runners. Br J Sports Med 2003;37:67-71.
The Italian requirement that all professional and amateur athletes
obtain medical certification of their ability to participate in their
chosen sport dates from 1950.[1] In 1971 and 1982 this mandate was
reinforced by specific legislation of the Italian Ministry of Health,
covering both competitive and non-competitive participants.[2]
Consequently, large numbers of symptom-free and ostensibly health...
The Italian requirement that all professional and amateur athletes
obtain medical certification of their ability to participate in their
chosen sport dates from 1950.[1] In 1971 and 1982 this mandate was
reinforced by specific legislation of the Italian Ministry of Health,
covering both competitive and non-competitive participants.[2]
Consequently, large numbers of symptom-free and ostensibly healthy young
Italians have undergone ECG and echocardiographic screening, with the
intent of avoiding sudden, exercise-induced cardiovascular death.[3,4]
Such procedural norms are in striking contrast with those of other
countries such as Canada, where it is maintained that the constraints of
Bayes theorem limit the value of laboratory cardiovascular testing in
symptomless young athletes.[5,6] Indeed, it is argued that by
generating an undesirable number of false positive responses, such a
policy creates much unnecessary anxiety, and leads to unnecessary warnings
against exercise, effectively worsening the individual's prognosis.
In their most recent article, Pigozzi and associates [1] speak of the
efficacy of the Italian screening programme, although they admit to an
alarming 40% of false positive results from ECG testing. Corrado and
associates [7] found that 9% of Italian athletes had "abnormal" ECGs, and
were required to undergo the additional expense of echocardiographic
screening; on the basis of the latter investigation, it appears that 2%
were barred from athletic participation.
Plainly, there is a unique opportunity to compare the health
consequences of the Italian approach with that of other countries who
believe that detailed laboratory examination is unwarranted. Are there
fewer episodes of sudden exercise-induced death per 100,000 hours of
competitive and non-competitive athletic activity in Italy than elsewhere?
And which approach gives the smaller number of unnecessary cardiac
neuroses?
To my knowledge, no one has yet made such an analysis, and in its
absence I would suggest it is premature to conclude that the Italian
"state law is noteworthy for the positive results that it has produced."
References
(1) Pigozzi F, Spataro A, Fagnani F, et al. Preparticipation
screening for the detection of cardiovascular abnormalities that may cause
sudden death in competitive athletes. Br J Sports Med 2003;37:4-5.
(2) Decree of the Italian Ministry of Health, February 19, 1982.
Norme per la tutela dell'attività agonistica. Gazetta Ufficiale 1982: Mar
5: 63.
(3) Maron BJ, Shirani, J, Poliac LC, et al. Sudden death in young
competitive athletes. JAMA 1996; 276: 199-204.
(4) Maron BJ. Considerations for preparticipation cardiovascular
screening in young competitive athletes. In: Shephard RJ, Åstrand PO, (Eds)
Endurance in Sport, 2nd ed. Oxford, Blackwell, 2000; Pp. 667-681.
(5) Shephard RJ. The athlete's heart: Is big beautiful? Br J Sports
Med 1996;30:5-10.
(6) Shephard RJ. Medical surveillance of endurance sport. In:
Shephard RJ, Åstrand PO, (Eds) Endurance in Sport, 2nd ed. Oxford,
Blackwell, 2000; Pp.653-666.
(7) Corrado D, Basso C, Schiavon M, et al. Screening for hypertrophic
cardiomyopathy in young athletes. N Engl J Med 1998; 339:364-369.
We cannot help but note the correlation between the results of this study
of female athletes,
and the study conducted on male long distance runners in Denmark [1].
We propose that sunshine might be the common factor driving the observed bone loss in these
two,
apparent...
We cannot help but note the correlation between the results of this study
of female athletes,
and the study conducted on male long distance runners in Denmark [1].
We propose that sunshine might be the common factor driving the observed bone loss in these
two,
apparently disparate, sets of
athletes.
The secosteroid hormone 1,25-dihydroxyvitamin-D (1,25-D) is a
potent stimulator of osteoclast activity [2], and
excessive levels of 1,25-D have a direct effect on
BMD [3].
1,25-D is manufactured by skin keratinocytes upon exposure to
sunlight [4].
Sunscreens have no measurable effect on the
amount of 1,25-D produced by solar exposure [5].
Endurance runners are clearly exposed to unusual amounts of direct sunlight during
both practice and competition, and we believe that excessive concentrations of 1,25-D could
well have been an unconfounded variable in this study.
We would urge
measurement of the level of this hormone during
any future study of BMD in outdoor athletes.
References
(1) Hetland ML, Haarbo J, Christiansen C. Low bone mass and high bone
turnover in male long distance runners. J Clin Endocrinol Metab 1993 Sep;77(3):770-5. Pubmed Abstract
(2) Manolagas SC. Birth and Death of Bone Cells. Basic Regulatory
Mechanisms and Implications for the Pathogenesis and Treatment of
Osteoporosis. Endocr Rev 2000 Apr 01;21(2): 115-137. Publisher Full
Text.
(3) Adams JS, Lee G. Gains in Bone Mineral Density with Resolution of
Vitamin D Intoxication. Ann Intern Med 1997 Aug 1;127(3):203-6. Publisher Full
Text
(4) Marshall TG, Marshall FE. New Treatments Emerge as Sarcoidosis
Yields Up
its Secrets.Clinmed 2003 Jan 27;2003010001 Full Text
(5) Marks R, Foley PA, Jolley D, Knight KR, Harrison J, Thompson SC. The
effect of regular sunscreen use on vitamin D levels in an Australian
population. Results of a randomized controlled trial. Arch Dermatol 1995
Apr; 131(4): 415-21. PubMed Abstract
The presence of false positive ECGs is without doubt a limit to the diagnostic capability of this investigation in the contest of cardiovascular screening of athletes.
These abnormal ECG appearances result mainly from the morphological
adaptations of the heart to training and to the actual sport practised.
For example, endurance athletes show a higher rate of ECG abnormalities
than athletes practising ‘tec...
The presence of false positive ECGs is without doubt a limit to the diagnostic capability of this investigation in the contest of cardiovascular screening of athletes.
These abnormal ECG appearances result mainly from the morphological
adaptations of the heart to training and to the actual sport practised.
For example, endurance athletes show a higher rate of ECG abnormalities
than athletes practising ‘technical sports’ such as sailing, horse riding
or pistol shooting. Cardiac adaptation is correlated with training time
and training intensity. Furthermore, males and young athletes present more
frequently such anomalies, possibly a consequence of their more marked
training-induced cardiac adaptation capability.
In recreational athletes, these morphological adaptations are reduced or
assents, as consequence of the lower the cardiovascular stress and the
effects of training on the heart.
Pelliccia et al recently showed that ECG has a high negative predictive
value (96%), showing that a normal ECG (as indeed it does in non-athletic
individuals) is able to discriminate with a high index of accuracy the
presence of cardiovascular anomaly.[1] On the other hand, an abnormal ECG
points towards a heart problem and further investigations.
This is confirmed by Basso et al, who showed that it is possible to
identify, using electrocardiography, subjects with hypertrophic
cardiomyopathy, a cause of sudden death in athletes.[2] These individuals
were not allowed to take part in competitive sports, and, eight years
after the electrocardiographic diagnosis, did not present with sudden
cardiac death.
Therefore, the identification of subjects at risk and the proscription of
competitive sports activity seem to be the right strategy to prevent
sudden cardiac death. Pre-participation screening for the detection of
cardiovascular abnormalities used in Italy has up to now shown to be an
effective tool to prevent cardiovascular accidents in this context.
References
(1) Pelliccia A, Maron BJ, Culasso F, Di Paolo FM, Spataro A, Biffi A,
Caselli G, Piovano P. Clinical significance of abnormal
electrocardiographic patterns in trained athletes. Circulation 2000; 102
(3): 278-84.
(2) Basso C, Thiene G, Corrado D, Buja G, Melacini P, Nava A. Hypertrophic
cardiomyopathy and sudden death in the young: pathologic evidence of
myocardial ischemia. Hum Pathol 2000;31(8):988-98.
Editor,
I would like to thank Dr Shrier for his letter and make a couple of comments in reply.
First, I would like to emphasise the point I was making in my original letter. When discussing an ill-defined procedure, as exemplified by 'stretching', it is important to be precise about what is being done to what, when and for how long for comparisons to be made or for valid debate to proceed.
S...
I cannot resist the temptation to join the debate on sports doctors’ resuscitation skills [1,2]. The study by Thompson et al [3] suggested that there is a perceived need amongst Sports specialists for first aid skills. However I received no response to my letter concerning this, [4] which indirectly posed the question, ‘should doctors who attend aquatic sports be able to deal with a suspected cervical...
Dear Editor
Lavis et al [1] seek to explain the poor results obtained by candidates undertaking the Bath University diploma in sports and exercise medicine as a failure of the candidate to take the subject seriously. They expect the standard to be comparable to “that required of a candidate completing the same task on an ATLS, PHTLS or ALS course.”
A candidate undertaking any of the above courses, or a...
Dear Editor
Waddington et al.[1] have highlighted an important issue in the context of sport injury management. However, this article, like many others, provides erroneous information and percpetions of 'qualified physiotherapists'. In the UK a physiotherapist must be State Registered (CPSM at present) to work in the NHS. A physothrapist does not need to be 'chartered' - i.e. a Member of the Chartered Socie...
Dear Editor
I enjoyed reviewing for this journal very much and can only hope that more journals will use a similar electronic system.
Having waited over 16 weeks to hear from a different journal, I think that the electronic system provides an excellent service to the authors.
Dear Editor
The helmets worn in ice hockey - what is their specification and composition? They look like canoeing-type and very thin plastic, if so, it is no wonder head injuries continue. The players need padded helmets more like motorcycle crash helmets to withstand the knocks with a layer of polystyrene or other shock absorbing material.
Dear Editor
Does BJSM even use its review process? Being a runner and running trainer and scientist, I am embarrased about this article.[1] The news *running is unhealthy* quickly went the round. Here in Germany it already was in TV text, in several online newspapers (with headlines like 'Run into Osteoporosis'), and has reached internet discussion boards. It will supposedly appear in printed matter starting tomorro...
Dear Editor
The Italian requirement that all professional and amateur athletes obtain medical certification of their ability to participate in their chosen sport dates from 1950.[1] In 1971 and 1982 this mandate was reinforced by specific legislation of the Italian Ministry of Health, covering both competitive and non-competitive participants.[2] Consequently, large numbers of symptom-free and ostensibly health...
Dear Editor
We cannot help but note the correlation between the results of this study of female athletes, and the study conducted on male long distance runners in Denmark [1]. We propose that sunshine might be the common factor driving the observed bone loss in these two, apparent...
Dear Editor
The presence of false positive ECGs is without doubt a limit to the diagnostic capability of this investigation in the contest of cardiovascular screening of athletes. These abnormal ECG appearances result mainly from the morphological adaptations of the heart to training and to the actual sport practised. For example, endurance athletes show a higher rate of ECG abnormalities than athletes practising ‘tec...
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