The CAS has ruled that the British Olympic Association cannot exclude dopers who have served their bans from future Olympic teams. The decision pushes Dwain Chambers back into the spotlight. He has kept a low profile over the past few months, although his agent, barrister Siza Agha, has been eloquent on his behalf:

“Redemption is an integral foundation… of any democratic society. It is not recognised in dictatorships, Greek mythology and the British Association bylaw.”

Well, the BOA bylaw has been deemed “noncompliant” with World Anti-Doping Agency rules. If Dwain Chambers runs the qualifying time and achieves a top-two finish in the 100m trials, he will be given a spot on the British team.

In the words of head coach Charles Van Commenee, Chambers is “a  likeable guy and a damned fine athlete.” His willingness to share his story has helped anti-doping efforts and dissuaded other athletes from making the same mistakes. A home Olympics swansong would represent an unexpected chance for redemption on the running track. Although probably still Britain’s fastest man at thirty-three, Chambers would be outside shot to reach the 100m final. It has been his misfortune to get caught in the crossfire of an overheated and complex debate.

The question of what sanctions to impose upon drugs cheats is understandably an emotive one, particularly for the clean athletes who spend years pushing their bodies to their natural limits. Sebastian Coe and Daley Thompson, two of the senior statesmen of British athletics, have been outspoken in their support for lifetime bans.

Such a stiff sanction would be difficult to enforce. If you want to impose a lifetime ban, which will destroy an athlete’s career, then the proof of their guilt needs to be pretty devastating. For a variety of reasons, doping control scientists are not yet able to establish such a secure verdict in most cases. More frequent and stringent testing would help, but we should be wary of sacrificing the right to privacy in the name of clean sport.

There is also a strong case for distinguishing between accidental and deliberate cheating, particularly in cases like LaShawn Merrit’s. The 2008 Olympic 400m champion tested positive for a banned steroid and was given a short ban, as the court was convinced that he took it inadvertently when he tried the male enhancement product Extenze.

WADA has done part of its job by bringing consistency to doping sanctions, it now needs to consider whether these sanctions are tough enough. The vast majority of athletes and fans want competition on a level playing field. I hope that’s what we see in London this summer.

For BJSM podcast with WADA head Alan Vernec and Deputy Editor Babette Pluim click here. (Follow @DocPluim)

See also leading Sports Ethics expert Mike McNamee’s 2011 comments on doping and sport here

And discussion of the challenges of doping test (for B-2 agonists) in asthma here

Guest Blog By Nick Smallwood

Mo Farah knows the fine line between success and failure. At the World Athletics Championships last summer, he missed out on 10,000m gold by a quarter of a second. A few days later, he sprinted down the finishing straight to win the 5000m by 0.28secs.

In championship distance races, which tend to be slow and tactical, the margins are sometimes even slimmer. The thrilling 10,000m duel between Paul Tergat and Haile Gebreselassie in Sydney was decided by nine hundredths of a second – less than the margin of Usain Bolt’s 100m triumph in Beijing.

In Beaverton, Oregon, Mo Farah is working hard in preparation for London 2012, running up to 120 miles a week. Eat, sleep, run, repeat. After the disappointment of fourth place over 3000m at the World Indoors in Istanbul, Farah said: “I’ve got to keep my head down and keep training twice as hard.”

The problem is, the competition will be doing the same; pounding the trails in the thin mountain air.

But Farah and his coach Alberto Salazar have a few tricks up their sleeve in Tracktown USA. No mountains? No problem. Mo sleeps in an altitude tent, fine-tuning his cardiovascular system while he sleeps. Sore legs? Then Mo can jump into a $75,000 Hydroworx pool, and knock out a few more miles on an underwater treadmill. Fatigue is scientifically assessed using metrics such as blood lactate content. This helps to reduce the risk of overtraining.

To boost recovery, Mo hops into a cryogenic chamber, cooled to -104c. Extreme caution is advised in using this particular training aid; US sprinter Justin Gatlin gave himself frostbite when he stepped into a chamber wearing sweaty socks. Cold therapy is not without risk and its effectiveness is hotly disputed. But like his coach, Farah leaves no stone unturned in the search for those crucial fractions of a second.

When Africa-based runners leave London with a clutch of medals, the question of whether the expensive training aids at the Nike sponsored Oregon Project give its athletes an unfair advantage may seem irrelevant. The World Anti Doping Agency (WADA) has investigated the Oregon Project and concluded that everything is above board. Like it or not, the unrelenting search for competitive advantage is part of professional sport.

WADA continues to monitor the use of altitude tents, which allow athletes the perfect combination of sea-level training and life at high altitude. Ultimately, if a training aid is legal and there is a suggestion that it will boost performance, someone will be trying it.

Yet for all the innovations in training methods, running remains a simple sport at heart. The most important ingredients for success are hard work, talent and a pair of running shoes.

Related papers in BJSM:

What is the biomechanical and physiological rationale for using cold-water immersion in sports recovery?

Funky treatments in elite sports people: do they just buy rehabilitation time?

Sports and exercise medicine—specialists or snake oil salesmen?

Respiratory physiology: adaptations to high-level exercise

Guest blog by Professor Lars Engebretsen

Photo by Aktivioslo, Flickr CC

The recent World Championship in Snowboard in Oslo, Norway led me to the question in this blog’s title. I am a sports doc with extensive experience in treating high level athletes in almost all kinds of sports (except Aussie rules football and cricket).

Since 2000, I have been involved in studies aiming at preventing sports injuries. We have targeted football (soccer), team handball and Alpine skiing and have had some success.  Newer sports however, keep popping up. Almost like the doping hunters  - often being too late to prevent new, effective performance drugs – it seems that we are too late to prevent injuries in some of the new sports.  I was reminded of this during the recent Snowboard Championship in Oslo: new venues for cross, half pipe and slope style situated beautifully in the Oslo countryside. The first days had bad weather and difficult light and there were some serious injuries- not life threatening, but nevertheless serious.

I have noticed a similarity with the last few Olympic games: the venues get bigger, the athletes better trained and with ever increasing abilities. Unfortunately, there is also an increase in injuries. The numbers from Vancouver showed that 35% of snowboard cross and 13% of half pipers experienced injuries.

What can we do to prevent these? We can count injuries, identify risk factors, study how to reduce these and aggressively implement our knowledge. In the meantime, the sporting venues get larger and more challenging and knowledge from our studies become yesterday’s news. I know that the majority of the athletes appreciate the danger, but I am not sure that the top leaders of the sport have the same awareness.

I need ideas to help the athletes operate in a safer environment- any ideas?

Note that the BJSM publishes 4 issues a year dedicated to Injury Prevention and athletes’ Health Protection (IPHP). You can find these issues of BJSM by clicking here. The next IPHP issue will launch in June and will focus on Olympic Sports. IPHP issues are published as part of BJSM’s partnership with the International Olympic Committee.

Nik Zoricik dcath: News story here. (added March 10th). Updated March 15th

Related Articles

Bakken A, Bere T, and Bahr R et. al. 2011. Mechanisms of injuries in World Cup Snowboard Cross: a systematic video analysis of 19 cases. Br J Sports Med. 45:1315-1322 Published Online First: 15 November 2011.

Lars Engebretsen L and  Steffen K. 2009. Warm up The importance of sports medicine for the Vancouver Olympic Games. Br J Sports Med. 43:961-962.

J Torjussen J,  and Bahr R. 2006. Injuries among elite snowboarders (FIS Snowboard World Cup). Br J Sports Med. 40:230-234 .

Engebretsen L, and Bahr R. 2005. Injury prevention – Leader An ounce of prevention? Br J Sports Med. 39:312-313.

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Lars Engebretsen MD PhD is a professor and director of research at Orthopaedic Center, Ullevål university hospital and University of Oslo Medical School and professor and co-chair of the Oslo Sports Trauma Research Center. He is also Chief Doctor for the Norwegian Federation of Sports, and headed the medical service at the Norwegian Olympic Center until the autumn of 2011. In 2007 he was appointed Head of Science and Research for the International Olympic Comittee (IOC). Professor Engebretsen is Editor of the IPHP issues of BJSM (Injury Prevention & Health Protection)

Guest Blog by Dr Pria Krishnasamy

The UK trainee perspective (The BJSM blog features the trainee perspective every two weeks)*

As I edge closer to the crossroads of my own career, I muse aloud as to where Sport and Exercise Medicine (SEM) is heading?  Is the majority of our workload going to involve musculoskeletal medicine or should the young generation coming through break free from the current mould and realize the vision of Exercise Medicine that the Faculty (FSEM) have fought so hard to promote and to what our specialty owes its existence?  I feel the urge to answer the call of cynics …

It is hard to believe bygone statements like these (in the caption) in current times.  However, I should say that Sir William Arbuthnot Lane started promoting exercise, fruit and vegetables and bran cereal as an answer to bowel problems in 1925, a good 40 years ahead of his time.  We now know that exercise should be undertaken at a sufficient intensity to make one at least moderately breathless.  Those who have gradually built endurance over time can be encouraged to perform vigorous intensity activity.  My mission is to spread the word of exercise and share a way in which SEM will develop.

“My Best Move” is a pilot project to encourage exercise prescription in primary care for long-term conditions.  The project was initiated to help Department of Health (DoH) recommendations to be translated into primary care practice.  General guidance is sometimes just not enough and physical inactivity remains one of the five big risk factors for long-term conditions equal in importance to smoking, obesity and hypertension.  Since its introduction, the project has been greeted with much enthusiasm in the primary care sector and the extra boost and guidance in the form of training is being welcomed.  It is hoped that this will start a new wave in the community that will lead to more active lifestyles despite any chronic conditions that individuals may have, without them feeling hindered by their conditions.

Taking this vision forward, an Exercise Center of Excellence is needed.  A place where both able bodied and persons with disabilities, no matter what long term conditions they have, are able to be seen and given specialist care to enable them to live life to the fullest.  By tailoring individual exercise prescription and rehabilitation according to patients needs, the aim is to enhance quality of life, improve absenteeism and return individuals to work, which will reap significant economic gains.

Everyone needs to start taking ownership of their own health and start making small gains rather than relying on the policymakers, the health service or their doctor.  The gains, after all, are to one’s own health and well-being.

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Dr Pria Krishnasamy is a Sport and Exercise Medicine Registrar in London and enjoys long walks in the countryside, martial arts, playing tennis, and dinners with good friends.

Dr James Thing co-ordinates “Sport and Exercise Medicine: The UK trainee perspective”  which runs every two weeks.

Guest blog By Dr Matthew Stride

The UK trainee perspective (A monthly BJSM blog feature)*

The year 2012 represents a pivotal time for the speciality of Sport and Exercise Medicine. Time will tell whether the Olympic and Paralympic Games will leave any significant lasting ‘legacy’ on the health of our nation.¹ However there is no doubt that the subsequent months after the Games will represent the strongest test for the integrity and future of the speciality.

Consultant SEM Physicians were envisaged, when the training program was inaugurated in 2007, to be instrumental in delivering the legacy. Now five years on, if this is going to come to fruition, there has to be a greater shift towards health promotion and a greater acceptance of exercise medicine than there is currently. As it is primarily through this role that SEM consultants are likely to be (and arguably should be) employed in the not too distant future.²

The SEM curriculum has a greater emphasis on the role of regular exercise for health and chronic disease management than in other countries.³ This includes public health training, knowledge and experience of exercise physiology, exercise testing and exercise prescription in health and disease states, in both the primary and secondary care setting. It is this training and expertise in exercise medicine that is unique to the SEM curriculum and separates us from any other speciality. Musculoskeletal medicine and sport injuries are a comparatively smaller part of the curriculum, yet continue to be by far the largest focus of interest and expertise (the ‘traditional’ Sports physician.) There seems to be a marked, noticeable disparity between curriculum content and SEM physicians who currently specialise in exercise medicine. This imbalance may be largely driven by the historical context of the speciality development. However if this continues then deliverance of the post games legacy may not happen and the speciality training program may not last for much longer.

Exercise medicine needs greater emphasis and acceptance if more SEM Consultants are to be employed in the NHS.⁴ Exercise medicine is an integral part of the training and cannot be dismissed. After all, its inclusion helped the speciality to gain recognition and led to the supposed governmental promise that SEM physicians will be trained to ensure the games leaves a lasting legacy on the health of our nation.

References

1. London 2012: Legacy. A Position Paper from the Faculty of Sport and Exercise Medicine. Available at
2. Sport and Exercise Medicine. A Fresh Approach.
3. Cullen M.  Crossroads or threshold? Sport and exercise medicine as a specialty in the UK. Br J Sports Med 2009;43:1083-1084.
4. O’Halloran P, Tzortziou Brown V, Morgan K et al.The role of the sports and exercise medicine physician in the National Health Service: a questionnaire-based survey. Br J Sports Med. 2009;43(14):1143-8.

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Dr Matthew Stride is a Specialist Registrar in Sport and Exercise Medicine. He is now in the final year of the training program in the London Deanery. He is currently based at Homerton University hospital and has been made an honorary research fellow at Imperial College. He is also a football club doctor.

Guest Blog By Dr. Richard Weiler

Sport and Exercise Medicine (SEM) has been evolving rapidly around the globe and is gaining mainstream recognition. In the United Kingdom it formally began life in 2005, when the Chief Medical Officer at the time, Liam Donaldson, pledged to develop the specialty as a commitment to the London 2012 Olympics. 2012 has arrived and the specialty of Sport & Exercise Medicine is slowly gaining a foothold in the publicly funded UK National Health Service (NHS).

Photo courtesy of M+MD, Flickr CC

We have an established Faculty of Sport & Exercise Medicine and a fairly comprehensive and evolving 4-year specialist training programme. There are currently about 50 specialist trainees in training across the country and about 10 doctors have become specialists in SEM in the last couple of years.

Challenging economic climates have resulted in new measures being implemented by the government. ‘Market forces’ have been suggested as a means to ensure funds are targeted locally and efficiently for patient needs. This has resulted in an urgent need for the fledgling SEM specialty to justify its existence and demonstrate patient benefit and cost effectiveness in order to establish new SEM services and maintain existing services. Not easy for something that has only existed for a few years. A major obstacle when speaking to those holding the funds is the lack of understanding about what SEM specialists can offer the NHS. Is it about elite sport, athletes and the Olympics or is it about exercise, gyms and running?

The truth is mostly ‘none of the above’ for the general population, so late in 2011 we published an NHS Information Document, explaining what an SEM specialist offers the NHS and NHS patients. This is broadly based on education, research, musculoskeletal, sports medicine, physical activity for prevention of chronic disease and physical activity prescribed in the treatment of chronic disease (exercise medicine).

We hope this peer reviewed NHS Information Document, endorsed by all the key UK organisations in the SEM field, will be helpful to our colleagues and fellow MDT members both in the UK and around the world.

The rest as they say is history, or in the wise words of Master Yoda “Always in motion is the future.”

Click here for NHS Information Document: Sport & Exercise Medicine. A Fresh approach

The publication involved the collaboration of too many people to thank individually, but the co-authors, whom were all SEM trainees at the time of writing, all deserve individual mention (in no particular order). Natasha Jones, Kate Hutchings, Matt Stride, Ademola Adejuwon, Polly Baker, Jo Larkin and Stephen Chew.

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Dr Richard Weiler has been working with NHS North West and the Department of Health on various projects to develop Sport and Exercise Medicine on the NHS

Three exciting updates from the frontlines of health promotion through physical activity.

Illustration by Liisa Sorsa, 23.5 hours video

First, congratulations to Professor Steven Blair for winning the Bloomberg Manulife Prize for the Promotion of Active Health. This international competition celebrates a researcher whose work promises to broaden understanding of how physical activity, nutrition or psychosocial factors influence personal health and well-being.

Professor Blair has tirelessly raised awareness of the burden of low fitness. His dedicated data gathering and adroit analysis has allowed him to deduce that physical inactivity is the biggest public health problem of the 21st century. His 2009 editorial in BJSM shares this title and has been downloaded more than 20,000 times (available free online).

To read more about the award, follow this link to the Globe and Mail.

Secondly, after garnering global attention, Mike Evan’s videos 23.1/2 hours is being translated into multiple languages. Sports Medicine colleagues will ensure the video can be enjoyed by speakers of Arabic, Spanish, Chinese, and Italian. And there will likely be more offers to come.

This will further enable the first physical activity ‘YouTube sensation’ – 23 1/2  - to promote behaviour change, while recognizing the physical activity challenges in a wide range of countries.

While 1.6 million hits demonstrates 23.1/2’s current success, translation into multiple languages may take this video to the ‘next level’ with a goal of 10 million views!

The video has already gained international traction as shown by the breakdown of views per country: US 844, 664, Canada 320, 000, UK 61, 345, Australia 49, 100, India 32,000, Netherlands 14, 977, Singapore 13,761, Germany 13, 345, Malaysia 11, 986, Sweden 11,589, Israel 11, 387, Saudi Arabia 10, 786, Mexico 10, 607…and the list goes on.

If you haven’t watched the video yet, check it out here (and note Steve Blair’s fun cameo at around 2 minutes 50).

And a third exciting sign of progess was Scotland appointing a physician to head their campaign against physical inactivity.

Doctor Andrew Murray (@docAndrewMurray) – who clearly has to differentiate himself from his colleague “Andy Murray” (@andy_murray).

The more important of the two, although seemingly not by # of Twitter followers, Doctor Murray, makes the point that “having a low level of fitness is equivalent in risk to having diabetes, smoking, and being obese combined”. BJSM likes that emphasis – amazing but true. All the best in the job DocAndy – we look forward to interviewing you for a BJSM podcast (with subtitles).

For more information on this check out the BBC article: GP runner Andrew Murray given sports education role

So – things are moving in the right direction – let’s all take up the cudgels and promote, promote, promote. Remember that Kotter said transformational changes takes 10 times as much communication as you expect it will need (plus 7 other things: see BJSM article on Kotter’s eight-step programme for transformational change).

Related BJSM publications

Rhodes RE and Dickau L. 2011. Moderators of the intention-behaviour relationship in the physical activity domain: a systematic review . BJSM. Published Online First: 25 Jan, 2012.

Burton NW, Khan A, and Brown WJ. How, where and with whom? Physical activity context preferences of three adult groups at risk of inactivity. BJSM. Published Online First: 20 Jan, 2012.

Bauman A, Titze S, Rissel Cand Oja P. 2011. Changing gears: bicycling as the panacea for physical inactivity? BJSM 45:761-762. (Free online!)

Khan, KM. 2009. Mid-year review: physical inactivity universally accepted as the biggest public health problem of the 21st century, shoulder exam challenges, and progress against the scourges of anterior knee pain and ACL injuries. BJSM, 43:469-470. (Free online!)

Are you aware of (or part of!) an outstanding team project or initiative in the UK that promotes physical activity and the improved care of athletes?

We want to know about it.

Photos of 2011 award winners courtesy of BMJ

The 2012 BMJ Group Improving Health Awards has a new category geared at Sports Medicine Practitioners. The award for Sport and Exercise Team of the Year “recognizes teams making a valuable contribution to promoting physical activity, improving the care of athletes or medical services to the sporting community.” The wide acceptance criterion includes projects focused on the elite, disabled, and/or the amateur athlete. It also welcomes initiatives geared at public health promotion through physical activity.

With over 643 nominations received last year, the BMJ Awards is a high profile event. It draws a diverse nominee group and audience. Fiona Godlee, editor in chief of the BMJ, characterizes the event as great opportunity to celebrate ‘unsung heroes,’ acknowledge the importance of partnerships, and to share in excellence.

Judging Criteria

The panel of expert judges will be looking for the team project or initiative that most demonstrates;

• A clear strategy.
• Measurable improvement in physical activity participation, health care in athletes or management of illness or injury in the sporting community.
• These teams should demonstrate a commitment beyond what would normally be expected in their role.

For more information on categories, judges, and tickets go to the BMJ Improving Health Awards website.

Or submit your nomination NOW (the deadline is only one month away).

Let’s all take this opportunity to celebrate leaders in the field and raise the profile of Sports and Exercise Medicine.

BJSM e-letter by:

Gerhard Ruedl and Wolfgang Schobersberger

E-letter for: Kathrin Steffen, Lars Engebretsen. The Youth Olympic Games and a new awakening for sports and exercise medicine. BJSM. 2011; 45: 1251-1252 (Warm up)

Photo courtesy of IYOGOC

Do we really want to see our young promising talents go through a major injury at one stage into their career?

Definitely no!

However, in competitive alpine skiing, snowboarding and freestyle, the risk to get major head and anterior cruciate ligament injuries is indeed high [1-4]. Therefore, training focussing on injury prevention should start at an early age and should go along with the athletes’ career. To implement evidence based preventive measures, however, it is of utmost importance to investigate first of all data on occurrence and severity of injuries according to the 4-step model of injury prevention research [5].

At this point of time, there is little data available concerning the injury risk of youth elite athletes competing in winter sports [6, 7]. Therefore, we will conduct a systematic injury and illness surveillance on young elite athletes participating in the 1st Winter Youth Olympic Games in Innsbruck/Austria in January 2012.  Let us work together to get meaningful data as a basis for further research on injury risk factors and injury mechanisms and finally on injury prevention strategies among young elite winter sport athletes.

We are glad to welcome you in Innsbruck!

References
(1) Pujol N, Blanchi MP, Chambat P. The incidence of anterior cruciate ligament injuries among competitive alpine skiers.  Am J Sports Med 2007; 35: 1070-4.
(2) Florenes TW, Bere T, Nordsletten L et al. Injuries among male and female World Cup alpine skiers. Br J Sports Med 2009; 43: 973-8.
(3) Florenes TW, Nordsletten L, Heir S et al. Injuries among World Cup freestyle skiers. Br J Sports Med 2010; 44: 803-8.
(4) Florenes TW, Nordsletten L, Heir S et al. Injuries among World Cup ski and snowboard atlethes. Scand J Med Sci Sports. 2010 Jun 18 [Epub ahead of print].
(5) Bahr R, Krosshaug T. Understanding injury mechanisms: a key component of preventing injuries in sport. Br J Sports Med 2005; 39: 324-9.
(6) Steffen K, Engebretsen L. The Youth Olympic Games and a new awakening for sports and exercise medicine. Br J Sports Med 2011; 45: 1251-52.
(7) Steffen K, Engebretsen L. More data needed on injury risk among young elite athletes. Br J Sports Med 2010; 44: 485-9.

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Gerhard Ruedl is a Senior Researcher at the Department of Sport Science, University of Innsbruck, Austria

Wolfgang Schobersberger is the Chief Medical Officer of Winter Youth Olympic Games in Innsbruck; Institute for Sports Medicine, Alpine Medicine & Health Tourism Innsbruck/Austria

UKsem was the first conference to have a ‘Moneyball’ panel session; attendees voted with their feet that this should happen again. What’s ‘Moneyball’? The unabridged term refers to Michael Lewis’ book of that name. It’s about a baseball team who performed much better than they should have by recruiting cheap players who didn’t have the ‘look’ of top draft picks but whose statistics were impeachable. The implication is that an astute statistician may help to recruit this type of player whereas a ‘sport expert’ might be fooled by intangibles – the style, the charisma, pedigree – but in the end things that don’t predict success as well as the carefully analyzed data. The concept was in the news in Australia just today.

In the sports medicine setting, Dr John Orchard raised raised the concept in 2009. He’d read the book (didn’t wait for the Brad Pitt movie) and figured that team physios and team sports physicians could augment team performance. This appreciation, literally valuing of the sports medicine / fitness team would lead to great salaries for those individuals. At the conference Moneyball session, Liverpool Football Club’s Peter Brukner estimated that many soccer/football clubs in the English Premier League have annual player salaries over 100 million GBP but pay less than 0.5% of that for ‘maintenance’ – the sports medicine team. Seems crazy and I suspect that in Formula 1 the investment in the ‘asset’ would be much higher.

Security sit - ready for action - at Liverpool vs. Chelsea, November 20, 2011

Also in the UKsem session was power lawyer Mary O’Rourke, QC, who is clearly a pre-eminent sports lawyer in the UK. She emphasized the risk that sports physicians are at when taking care of players who might be earning over 100,000 GPB per week. Is your personal liability insurance in place for the 40 million GPB or so you might be sued for?  I didn’t realize that as Dick Steadman operates in Colorado, the legislation in that stats caps any medicolegal claim at $10 million. In the UK, there is no cap. Food for thought for both players, and physicians. Lots of players have value greater than $10 million.

There was also an introduction to the idea of clincians using agents to help them get better deals in this new world. Clinicians valued more = larger contracts = need for help with negotiation and for digging out the good gigs. Makes sense.

A great idea for future conferences in the UK and beyond. I can see it traveling very well at AMSSM in Atlanta 2012, the VSG (Netherlands), Australia, Switzerland, South Africa, and among the ECOSEP member countries.

For a detailed movie review and background to Moneyball click here please.

And on the subject of Liverpool Football Club, it seems like Brad Pitt is a fan!