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Work It. Make It. Do It. Sports injuries at the Olympics: an overview from past games and future directions

27 Sep, 16 | by BJSM

 Engagement, Evidence, & Practice Blog Series

By Nirmala Perera (@Nim_Perera)

Examining the changing profiles of injuries provides opportunity for insight, and potential to better embed innovative injury prevention strategies and advances in sports medicine.

bjsm-blog-cover-w-soccer-ball

Photo courtesy of Mario Bizzini (@SportfisioSwiss)

Athletes from over 200 nations gather every four years for the Olympic and Paralympic Games to celebrate sport, culture, fair play and international cooperation on sport’s biggest stage. I like many of you BJSM blog readers who watched the Rio Olympic (#Rio2016) coverage saw the myriad of injuries and illness captured and broadcast by the media, from fractures and dislocations to diarrhoea and subsequent collapse. At elite level, top players and teams are separated by a very small margin. Injuries and illness affect athletes’ ability to train, complete and can even shatter their dreams of gold. Injury prevention therefore, could be considered ‘legal’ performance enhancement.1 2

Work It. Make It. Do It. Makes Us: Faster. Higher. Stronger.

The Olympic motto Citius, Altius, Fortius (Latin for “Faster, Higher, Stronger”) inspires athletes to reach new heights, changing the nature of the sport over time. The Olympic Games are the pinnacle of many athletes’ careers. They aspire to successfully compete at the games. Injuries and illness can be the cost of striving for athletic greatness. Protecting athletes’ health is therefore, important to maximise performance and chances of success. Current profile of injuries in a sport might be different to injuries suffered by athletes participating the same sports in the past as rules, techniques and equipment evolve. Additionally, elite athletes enter sports much earlier and some continue to compete for longer. Consequently, sports medicine and injury prevention has to evolve with the athlete and their sport.

Injury and illness surveillance of Olympic athletes

The number one priority for the IOC and its Medical and Scientific Commission is protecting the health of the athletes3. Injury surveillance therefore, was initially established by the IOC during the 2004 summer games in Athens and was limited to team sports4. In 2008  injury surveillance was expanded to include all athletes participating in the  Beijing Summer Olympics5 and subsequently the 2010 Winter Olympics in Vancouver6; 2012 London Summer Olympics7, and 2014 Sochi Winter Olympics8. For the first time, injuries in 2012 London Paralympics were reported9 10.

The overall injury rate has remained similar over the last two summer Olympics (9.6% in Beijing5, 11.0% in London7). In addition, 7.2% athletes suffered an illness such as infections to respiratory and gastrointestinal tract during London Olympics. Female athletes were 1.6 times more likely to be ill than their male counterparts7. It is likely that these figures will remain comparable in #Rio2016.

Olympic pains:  the most common injuries by sport, nature and mechanism of the injury

Photo courtesy of Mario Bizzini (@SportfisioSwiss)

Photo courtesy of Mario Bizzini (@SportfisioSwiss)

Football, taekwondo and handball topped the injury list in both Beijing and London. Field hockey and weightlifting, also in the top 5 sports with the most frequent injuries in Beijing5 were ousted by BMX and mountain biking in London7.

Fractures, ligament ruptures and dislocations were the most common types of injury during the Beijing games5. The most common injuries for the London games were ligament sprains, muscle strains, fractures7. Head/neck/face, hand/wrist/fingers and lower back were the most frequently injured regions at #London2012. Interestingly, most of the diagnosis examinations performed at  #Rio2016 Polyclinic at the Athletes Village were to the knee, lumber region and ankles.

Overuse was the second common cause of  injuries in Beijing5. And, it was the most common injury mechanism in London. However, 68% of the reported overuse injuries did not require time-loss from the sport7.  High prevalence of overuse injuries signals to the repetitive nature of elite sport. Elite players are selected on the strength of the key sports specific skill. Many hours of practice are required for athletes to achieve mastery, which necessitate repetitive activities potentially associated with overuse and recurrent injuries. Particularly if training regimes are poorly managed.

Cupping: why athletes use it?

Techniques to manage pain of overexertion such as myofascial decompression (i.e. cupping) to improve healing and release muscle stress attracted a heightened media coverage in #Rio2016. Cupping has shown to provide effective pain management but the evidence is of poor quality and subject to bias. Exact mechanism of cupping is unclear; it may work by ‘counter irritation’ or by ‘placebo effect’. Yet, athletes turn to drug-free methods such as cupping as an alternative to medications possibly because the anti-doping regulations.

Injury prevention research into practice

Nine IOC research centres of excellence work alongside sporting organisations and key stake holders, striving to develop and implement effective preventive and treatment measures for injuries 3. For example, in Beijing5 49.6% of the injuries resulted in an inability to compete, this was reduced to 35.0% in London7. This might be due to advancement in sports medicine where management strategies such as activity modifications/restrictions and analgesia may have delay treatment or prolong recovery until the end of the games, particularly for overuse injuries. The latest research innovations developed by preeminent international authorities in sport injury and illness prevention will be showcased at the IOC World Conference on Prevention of Injury and Illness in Sport in Monaco (#IOCprev2017). In addition, the IOC supports the #BJSM Injury Prevention and Health Protection issues to further enhance knowledge translation to protect the health of both professional and amateur athletes.

 

References

  1. Raysmith BP DM. Performance success or failure is influenced by weeks lost to injury and illness in elite Australian track and field athletes: A 5-year prospective study. J Sci Med Sport 2016;19(10):778-83. doi: 10.1016/j.jsams.2015.12.515
  2. Hägglund M WM, Magnusson H, et al. Injuries affect team performance negatively in professional football: an 11-year follow-up of the UEFA Champions League injury study. Br J Sports Med 2013;47(12):738-42. doi: 10.1136/bjsports-2013-092215
  3. Engebretsen L BR, Cook JL, et al. . The IOC Centres of Excellence bring prevention to Sports Medicine. Br J Sports Med 2014;48(17):1270-75. doi: 10.1136/bjsports-2014-093992
  4. Junge A LG, Pipe A, et al. . Injuries in Team Sport Tournaments During the 2004 Olympic Games. Am J Sports Med 2006;34(4):565-76. doi: 10.1177/0363546505281807
  5. Junge A EL, Mountjoy ML, et al. . Sports injuries during the summer Olympic games 2008. Am J Sports Med 2009;37(11):2165-72.
  6. Engebretsen L SK, Alonso JM, et al. . Sports injuries and illnesses during the Winter Olympic Games 2010. Br J Sports Med 2010;44(11):772-80.
  7. Engebretsen L ST, Steffen K, et al. . Sports injuries and illnesses during the London Summer Olympic Games 2012. Br J Sports Med 2013;47(7):407-14.
  8. Soligard T SK, Palmer-Green D, et al. . Sports injuries and illnesses in the Sochi 2014 Olympic Winter Games. Br J Sports Med 2015;49(7):441-47.
  9. Willick SE WN, Emery C, et al. The epidemiology of injuries at the London 2012 Paralympic Games. Br J Sports Med 2013;47(7):426-32. doi: 10.1136/bjsports-2013-092374
  10. Derman W SM, Jordaan E, et al. . Illness and injury in athletes during the competition period at the London 2012 Paralympic Games: development and implementation of a web-based surveillance system (WEB-IISS) for team medical staff. Br J Sports Med 2013;47(7):420-25. doi: 10.1136/bjsports-2013-092375

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Nirmala Perera (@Nim_Perera) is a health practitioner, an epidemiologist and a PhD scholar at the Australian Centre for Research into Injury in Sport and its Prevention (@ACRISPFedUni). She is the @IOCprev2017 #SoMe campaign coordinator.

 

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Crossingtheline Summit – Let’s Talk About Athlete Retirement

31 Aug, 16 | by BJSM

By Fiona Wilson

Crossingtheline (crossingthelinesport.com) is an exciting new initiative launched by a group of ex international athletes, led by Gearoid Towey (four time Olympian and World Champion rower). Its purpose is to provide a platform and resource to support athletes in retirement. Boxing legend Sugar Ray Leonard famously quoted, “Nothing could satisfy me outside the ring… there is nothing in life that can compare to becoming a world champion, having your hand raised in that moment of glory, with thousands, millions of people cheering you on.” Mental health issues in athletes have raised their head in the media recently as more athletes are being frank in describing their problems. However, perhaps a greater matter is mental and physical health concerns in those who are retired; or indeed those forced to retire precisely because of such problems.

Inaugural Crossingtheline Summit

I had the pleasure of leading the medical panel at the inaugural summit of Crossingtheline in May 2016; held in Dublin. The meeting was very athlete-focused with an emphasis on providing a forum for discussion around athlete retirement. Delegates were an unusual and interesting mix of athletes, physios, team managers, coaches, doctors, psychologists and any others who were involved in sport. The greatest asset of the summit was the choice of speakers from a diverse group of sports; some with catastrophic tales to report regarding their sporting experience and their subsequent retirement.

Gaylene Clews (psychologist) Greg Louganis (diver, Olympic Champion, USA), Fiona Wilson (physiotherapist) Ben Johnson (100m runner, Olympian, Canada)

Gaylene Clews (psychologist) Greg Louganis (diver, Olympic Champion, USA), Fiona Wilson (physiotherapist) Ben Johnson (100m runner, Olympian, Canada)

Greg Louganis (diver and four time Olympian and 5x medallist) described his inner torment of coping with (poorly managed) mental illness, dealing with being a gay athlete in an environment hostile to diversity but most significantly his story around living with HIV. Many of us will remember him hitting his head on the diving board in front of billions of TV viewers at the 1988 Olympics; he went on to win a gold medal. What we were unaware of was that he had a ‘secret’ HIV diagnosis and as he bled into the pool he knew the significance of his troubling secret; he would not have been admitted into South Korea for the Games if he had made his diagnosis evident. His subsequent years have been troubled by mental and financial troubles. He now has made progress in all areas, is an amazing example of living well with HIV, is married to a supportive partner and is an advocate for providing support for athletes, particularly as they transition into retirement.

As many of us who watched the 100m final of the Seoul Olympics, and its subsequent fallout as the winner Ben Johnson tested positive for doping, I had a clear opinion that dopers get what they deserve. It was actually a humbling experience to meet Ben Johnson and listen to his story. As clinicians we learn not to judge patients; smokers, obese, addicts etc. Yet we have a very different opinion of athletes. Those who have been immersed in doping cultures tell us that we need to try and understand athletes’ motivation if we really want to deal with what has become a seemingly unsolvable problem. Ben Johnson reported that he found himself in a culture where doping was normal, where he had tested positive previously and had his results ‘covered up’ by his sponsors and where he was convinced this was normal and a level playing field for all. He was blackmailed by his coach and significantly for him, tested positive for a substance at Seoul that he says he wasn’t taking. He doesn’t deny doping, but just not that substance. A very powerful part of the summit was a one-on-one interview of Ben Johnson by a journalist who has been a zealot in his rally against doping in cycling; Paul Kimmage. The general discussion before was that “Kimmage will give him a really tough time”. He didn’t. He let him tell his story as he argued that we need to accept that doping in sport is an epidemic, which will be better explained by understanding motivation. Kimmage presented the analogy that “Ben, what you are describing is that you have been stopped by the cops for speeding and as he is writing out your ticket, you watch other cars speeding by”

Niall Quinn, ex-Irish football international, Arsenal and Manchester City player and subsequent successful chairman of Sunderland also made a strong contribution to the summit. He frankly described his battle with depression upon retirement describing it as a ‘death within your life’. He reported the sobering statistic that almost half of Premier League footballers visit bankruptcy and 33% are divorced within three years of retirement. Yet there is limited support for these individuals. He has launched an initiative call ‘Catch a Falling Star’, now linking with Crossingtheline to support athletes with financial, medical and psychological advice.

Battle Wounds

My input was to host a panel discussing ‘battle wounds’. A particular interest of mine is that athletes are a vulnerable group of patients, sometimes because of their celebrity status but often because they have become a commodity that can be replaced when it’s broken. Brendan de Gallai (ex-lead dancer with Riverdance) discussed the fear of injury as a dancer. “You would be replaced by the understudy who might do a better job than you for one night as they are fresh and then you are in jeopardy”. John Carter, ex-professional rugby player (and now a psychotherapist with an interest in the athlete experience) described his history of six shoulder surgeries (same shoulder) which ultimately failed, leading to retirement. He reported a lack of empathy and inclusion in treatment decision-making and the feeling of being a product. This is no reflection on the clinicians managing him but perhaps the way sport has become. We don’t treat athletes how we treat other patients; we rush to operate sometimes and we have quite a patriarchal approach. Hands up, I have done this myself.

When we give a patient bad news, we have been provided with training. Palliative care and certain areas of medicine are excellent at this. Yet when we tell an athlete that they must retire because of injury, we have a limited body of knowledge to guide us. The athlete is about to have the very thing that defines them as a person removed and will experience a ‘kind of death’ yet we are somewhat flippant about its effects. This is becoming more common in the professional era and in some cases is based on what ‘might’ happen as in the case of TBI or ECG screening where the decision is not palpable to the athlete. Gaylene Clews (psychologist and ex-world number one triathlete) discussed the neuroscience behind the athletes’ response to both injury and retirement being akin to withdrawal from addiction and that this is very poorly understood. Indeed, we do have a problem with addiction in this population, not just to alcohol, gambling and other well-reported aspects but tragically to prescription pain medication in an effort to deal with chronic injury. Addiction to such medication has been described as reaching concerning levels with a number cases in the USA in retired footballers recently captured in the media (see crossingtheline.com for media report).

Support for all athletes

I will continue to advocate for support not just for the superstar athlete as a vulnerable person but even more so for when they fall off the radar and are now immersed back into everyday life. Sports medicine support should be available beyond retirement providing the quality of support we afforded these humans when they were everyone’s heroes. A number of sporting bodies are now recognising this issue and athletes should be encouraged to seek support, particularly from retired players unions. The next summit is planned in April 2017, Dublin.

Crossing the line can be found at crossingthelinesport.com

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Fiona Wilson is an Assistant Professor in the School of Medicine, Trinity College Dublin and a Chartered Physiotherapist. Former lead physiotherapist to Rowing Ireland. Presently a clinician and researching measurement in sports medicine, low back pain and exercise in chronic disease.

 

 

 

Sainsbury’s 2013 School Games – inspiration and aspiration for young athletes and practitioners alike

2 Dec, 13 | by Karim Khan

Sport and Exercise Medicine: The UK trainee perspective, a monthly blog series

By Dr Ritan Mehta

 

sainburbyI recently worked at the Sainsbury’s School Games in Sheffield, which was an extremely enlightening experience. Having worked at the Olympics and Paralympics in 2012 I was keen to build on my experience at a multi-sport games and applied for the Sainsbury School Games. I wasn’t sure what to expect and whether it would live up to the incredible experiences of London 2012.

When I finally arrived on the induction day I realised the enormity of this event and how important it was for young aspiring athletes. The event took place in Sheffield with the university set-up as a replica version of an Olympic Village, fit with a polyclinic, restaurant, team accommodation and games room.

The Games took place at eight venues and included twelve future and current Olympic and Paralympic sports: Athletics, Badminton, Cycling, Gymnastics, Judo, Hockey, Swimming, Volleyball, Table Tennis, Fencing, Rugby Sevens and Wheelchair Basketball.  The games were completed with opening and closing ceremonies.

Over 1600 of the UK’s elite young athletes and a small delegation from Brazil took part in the games, aspiring to follow in the foot steps of several alumni of previous School Games who went on to represent Team GB and win Olympic and Paralympic medals.

The Sainsbury’s School Games emulates the Olympic and Paralympic games experience for the young athletes.  It also does this for the support staff, volunteers and definitely for the medical team. For those who have not worked at a major multi-sport games this is an incredible introduction to what a major games entails, in a well organised and well supported setting. The Chief Medical Officer, Dr Stephen Chew and Chief Physiotherapist Officer, Saskia Blair, brought together an excellent, diverse and knowledgeable medical team who worked well together to keep the athletes healthy and manage any medical problems that arose. In total there were 12 doctors and 17 physiotherapists on hand covering each of the different sports, as well as the polyclinic. The medical team was assisted by paramedics at each venue to provide emergency pitch-side support.  A wide variety of injuries and illnesses were seen throughout the games ranging from anterior cruciate ligament tears to facial fractures. I was fortunate to cover gymnastics, which was a novel and enjoyable experience. The strength, agility and flexibility of these young athletes was outstanding. We saw the typical overuse injuries seen in adolescent athletes such as Sever’s Disease Osgood Schlatter’s Disease, and multiple shoulder problems and ankle injuries.

When working with young athletes one must always be aware of their overall wellbeing and not just concentrate on their injuries. The pressures from coaches, parents and the athlete themselves can often cause as much of a problem as injuries.  As part of the medical team induction day we were fortunately provided with CPD training by the safeguarding children team. This really helped to increase our awareness of other issues surrounding the younger athlete. The safeguarding team were also on hand at every venue to provide support when required.

This was an incredible experience and one that I would encourage all budding and experienced Sport and Exercise Medicine doctors and physiotherapists to apply to take part in next year. It provides excellent insight into the pressures on young athletes to perform, the intensity of a multi-sport games and an opportunity to work in a variety of sports settings, potentially both strengthening and broadening one’s skill set.

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Dr Ritan Mehta is a final year Sport and Exercise Medicine Registrar in London. He works for Watford Football Club, the England U23 Women’s Football team and as a GP with specialist interest in MSK/Sports medicine.  He is an Honorary Module Leader and Clinical Lecturer on the MSc in Sport and Exercise Medicine at QMUL.

Dr James Thing co-ordinates “Sport and Exercise Medicine: The UK trainee perspective” monthly blog series.

Valerie Adams – Greatest shot putter ever talks about her physio & sports medicine team / And you can get the Aspetar Journal (96 pages) hard copy for free!

22 Oct, 13 | by Karim Khan

This interview was published in the Aspetar Sports Medicine Journal and is reproduced with the kind permission of Aspetar – Qatar Orthopaedic and Sports Medicine Hospital.

Just email journal@aspetar.com with the address you want the excellent Aspetar Sports Medicine Journal sent to and you’ll join 1000+ on the subscriber list. No junk mail, no selling your details – just this excellent high-quality content journal that has emerged from Qatar (now in Volume 2).

Valerie Adams Aspetar coverINTERVIEW WITH VALERIE ADAMS

Her career speaks for itself: two Olympic Games gold medals, two Commonwealth Games gold medals, two World Indoor Championship gold medals and four World Championship gold medals. In 7 years, there has been only one time when New Zealand shot putter Valerie Adams didn’t take home gold, and even then it was a silver. In the world of track and field, she was the first woman to win four back-to-back individual world championships. When it comes to shot put, she is the most successful shot putter (man or woman) of all time.

How did she get there? A combination of discipline, pain and very little downtime. Here the 29-year-old tells Nick Cowan about her love of competition and great support team.

Tell us about some of your career highlights.

Highlights for me have been the 2008 Beijing Olympic Games where I won a gold medal, the 2001 World Youth Championships which was my first big win, 2011 World Championships in Daegu where I equalled the championship record with a personal best throw of 21.24 m and the London Olympics last year – eventually!

What is your current training programme?

My training programme consists of two sessions a day. I do a lot of weight lifting, throwing, plyometrics, medicine ball work, a lot of specific training for throwing the shot and recovery and rehab on top of that.

My coach, Jean-Pierre, designed an eccentric-concentric machine that we use for base training in Switzerland. There are no machines like this in New Zealand and so we travel to Switzerland to start new phases. This type of training enables me to get maximal strength and get a real base under me, in contrast to normal training in the gym.

With the athletic schedule the way it is, do you ever get any downtime?

I get about 4 weeks off in October when the season’s done, that’s it.

My holiday period is basically just the month of October and, thankfully, it’s a good month for me. I get to party because it’s my birthday and I try and be a ‘normal’ citizen for that month.

You spend most of the year living outside of New Zealand. What’s it like to live away from your home?

It’s just part of life and it’s something that I’ve chosen to do. My career as an athlete won’t last for the rest of my life so I’m giving it my best shot while I can. It’s good to be away from New Zealand because there are no distractions, meaning there’s more time to train and recover.

And Europe this is where the competitions are, so it makes more sense to be based here instead of New Zealand.

What would you say is the toughest part about the sport of shot put throwing?

Every aspect of it is challenging.

Have you ever had an injury that threatened your career?

In 2006 I had shoulder surgery. I had two cm cut from my clavicle because of overuse. It didn’t stop my career as such, fortunately, because it happened in the off season and I was able to get without it interfering in any competitions.

I’ve been quite lucky in that I haven’t had to skip a season through injury so far. That’s down to having a great physio and also the support team who have been able to manage me.

Then again, I’m not the kind of athlete to stop for anything. My pain threshold is very high, I’m an animal like that and I love to compete very much. I’ll do anything to compete, pain or no pain. But pain is just part of an athlete’s life.

How do you treat an acute injury?

Basically I call my physio, Louise Johnson. She’s been working with me since day one; we’ve worked together for 14 years. She assesses the situation from near or far and we try and get the help we need immediately. It can be hard if I’m overseas but she runs the show and gets help to me as soon as possible.

I am pretty good at self-managing but she calls the shots on doctors and scans and I just have to listen to her.

Who makes up your medical support team?

I work on a day-to-day basis with my physio, Lou. She’s my right-hand man, the person who is on my phone’s speed dial. It’s very important to have a good relationship with someone like that.

I don’t travel with a doctor. Because my physio knows me so well, she knows what I need and what to do when things come up. But I do have a doctor, chiropractor and massage therapist and as far as ay medical conditions are concerned, those are the people that look after me.

Who makes the decisions around your health?

It’s a team approach but I basically have the last choice. The doctor’s opinion will usually have the biggest impact but then again I have both a sports doctor and a general practitioner who I see.

What is your relationship like with your coach?

My coach is awesome! He’s saved my career and made me a better athlete than ever. With his training and planning I’ve been able to save my back from injury. It’s very important that he is kept in the loop on everything. If you’re a team, there’s nobody kept in the dark.

He’s a very hands-on coach. He likes to know what’s going on and will adapt things accordingly – which is very important – as opposed to shutting down on you. I’ve been lucky to work with my coach, Jean-Pierre.

Do you follow any injury prevention programmes?

No, not at the moment.

Do you follow a nutritional strategy?

I don’t follow any nutritional programme but do have supplements to take. I work with High Performance Sport New Zealand who help me figure out what to take pre- and post-competition. As far as eating is concerned I look after myself.

Do you find much difference in the medical treatment you receive when you travel, compared to back home in New Zealand?

This is only my personal experience, but I have found that European physios are not as hands on. In Europe they tend to give you a lot of stretching and exercise and ask you to come back in a few days. I prefer to feel like I’m getting more benefit from hands on work.

What do you think the athletic world can learn from New Zealand?

I think it goes both ways. In New Zealand, we have to fight all our own battles because we’re stuck at the bottom of the world – we have to research what the rest of the world is doing. We do well for a small country but I think we have our own strategies which work for us. Of course, there are things in Europe that we could benefit from. For example, their technology tends to be slightly better.

 

Dr. Chris Milne, BJSM Editorial Board Member, receives Queen’s Service Medal for Achievement.

3 Oct, 13 | by Karim Khan

chris_milneDr. Chris Milne, BJSM Editorial Board Member, was recently awarded the Queen’s Service Medal for achievement in Sports Medicine. Demonstrating ‘meritorious service to the Crown’ is no small feat. Some of Chris’ notable contributions to Sports Medicine include: President and Chairman of Sports Medicine New Zealand, President of Australasian College of Sports Physicians, and team doctor for several New Zealand Olympic and Commonwealth Games teams. He currently practices at Anglesea Medical Centre and is the Medical Director for Rowing New Zealand.

When asked how he felt about the award, Chris said “This recognition is an honour. I also feel grateful to have worked with so many talented athletes, physicians, and physios along the way. It is great for our relatively new medical specialty to have gained recognition in this way, and I look forward to continuing to make a contribution.”

We look forward to it too!

 

A Sensational Experience as a Physiotherapist in Colombia for the World Games 2013

16 Aug, 13 | by Karim Khan

By Laura Partridge, member of the Association of Chartered Physiotherapists in Sports and Exercise Medicine,  www.physiosinsport.org

From anticipation to preparation

Following their qualification at last years World Championships in Japan, I eagerly anticipated – for over 10 months – accompanying the Great Britain Ultimate Frisbee squad to the World Games. The World Games, one of the prestige events under the patronage of the Olympic Games, offers a fantastic vehicle for demonstrating sports prior to their selection for inclusion in the Olympic Games. Over 5000 athletes descended on the Colombian city of Cali for a week of sports ranging from squash to rugby sevens and rhythmic gymnastics to sumo wrestling.

colombia yogaI joined the squad for an acclimatisation camp in the mountains outside Cali at the end of July. Having never attended a camp of this nature, I was excited to see how it was run and how the athletes managed their pre- competition preparations. There were training, recovery and relaxation programs, strategy meetings and treatment clinics to occupy our time in this truly incredible location. The magical scenery provided the most breath-taking training environment and the hostel rooftop is definitely the most idyllic location from which I have delivered a Yoga class.

After an electric opening ceremony in the sold-out 26,000-seater stadium and a moving speech from Jack Rogues, President of the IOC, the games commenced with fantastic crowd attendances for matches. This was unlike anything previously experienced by most of our athletes. Despite a disappointing performance from Team GB in the ‘Flying Disc’ competition there was a great deal to be learnt from my time at the competition.

During the games: Physiotherapy and beyond

Through the scale of the games (both in physical size and in terms of pressure on the athletes) I gained new skills in managing players both physically and psychologically. I also feel much more confident in collaborating with the medical services provided by the local organising committee. Despite language barriers and cultural differences in treatment, I established the level of the medical cover the organising committee could provide. Having worked with the players for three years, I felt prepared going into the games and thankfully, unlike previous games that resulted in numerous fractures, concussions and suspected C-spine injuries, we did not sustain any serious injuries. That our athletes escaped with only soft tissue injuries was a blessed relief.

Demands on me as a physiotherapist during the competition were mostly centred around acute soft tissue ‘POLICE’ injury management. Taping and massage skills were frequently called upon but, as expected at such events, duties extended beyond the reaches of the typical treatment modalities. My daily responsibilities ranged form the pastoral to the medical: I ensured all players made it to meal times, encouraged players to monitor their hydration levels through self urine checks, prepared post-match ice baths in the fabulous stadium facilities, and also accompaned athletes to doping control tests. Individual’s compliance with the elements of recovery strategies has greatly improved since I began working with GB Ultimate three years ago and they demonstrated exceptional athlete behaviours throughout the tournament.

GB disc team

 Key learnings/recommendations

This multi-sport event was an excellent experience to progress my skills as a Sports Physiotherapist. My recommendations for anyone travelling to such an event in the future are:

  • Plan for every possible eventuality
  • Make sure you take plenty of treatment kit
  • Make connections with other countries medical teams before you depart as they are often a great resource in emergencies
  • As soon as you arrive establish the medical facilities with the local organising committee and how to access these in an emergency (not just during playing times)
  • Know your athletes really well; the pressures of such a large scale event can make people react very differently and having a good relationship with them really helps in a crisis.
  • Learn some of the local language- it will get you a long way.
  • Be prepared to be a mum, best friend, sounding board, shoulder to cry on, person to rant to as well as a water carrier before you are a Physiotherapist
  • Enjoy every minute of it!

Those physiotherapists looking to gain similar experiences should look to those sports that participate in the World Games to gain invaluable skills at this IOC Umbrella event. Researching which sports are involved and offering your services through the NGB’s offers a great opportunity to boost your confidence and your CV. GB Ultimate is always looking for more therapists to become involved and CV’s can be forwarded to georgiewinborn@gmail.com

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Laura Partridge is a Physiotherapist working at Headley Court Defence Medical Rehabilitation Centre for Lower Limb Rehabilitation.

 

Injury prevention, advances and challenges of the international paralympic committee, and countdown to the next games

7 Aug, 13 | by Karim Khan

Mr. Bean on the pianoIt has been 12 months since Rowan Atkinson plonked the piano with his umbrella to Chariots of Fire in the London Olympic Games Opening Ceremony. Wikipedia says he is worth 85 million pounds, loves cars, has retired ‘Mr Bean’ and has been married to Sunetra Sastry for 23 years. But I digress already.

Now, Professor Lars Engebretsen and Dr Kathrin Steffen, the Injury Prevention and Health Protection (IPHP) editorial team, provide you valuable Olympic content. In 2013’s June and September (forthcoming) issues, you can discover how to prevent and identify injuries, and also learn more about the personpower needed to service major events.

Photo courtesy of Nick Webborn

Photo courtesy of Nick Webborn

In the June 2013 issue, the inspiring and redoubtable Dr Nick Webborn grabbed my attention with his evocative description of his London Paralympic experience. ‘The wall of sound that resonated around the stadium literally made the hairs on the back of my neck stand up.’ Equally importantly he highlights advances in the field and the challenges that face the International Paralympic Commitee (Read Nick’s article HERE).

Enjoy the June 2013 issue, and anticipate the September offerings (which BJSM’s 13 member societies can enjoy via OnlineFirst). For those who insist on reminsicing, the June 2012 issue broke all records for IPHP downloads.

The good news is that there are only 192 days until the next Olympic Games – BJSM will preview the sports medicine of the Sochi Olympic Winter Games in a future IPHP issue. Keep a track of injury prevention and athlete health protection via BJSM – and our special quarterly IPHP issues supported by the International Olympic Committee.

And while we are on things Olympic, injury prevention and memorably occasions – remember the 2014 IOC World Conference on Prevention of Illness and Injury in Sport. Follow @RoaldBahr for regular updates but hold the dates right now. The biggest collection of experts in sports medicine and physio in the one venue for the year – and perhaps years on either side. This 2014 Conference is April 10-12 in Monaco; there is an exclusive post-conference advanced team physician course for just 80 clinicians April 14-16 in Mandelieu. France. Explain it as onnce in a lifetime – cutting-edge education & fun with immediate clinical application. The conference of 2014.

Insights from the 2012 Paralympic Games

28 Sep, 12 | by Karim Khan

By Dr Dinesh Sirisena

Sport and Exercise Medicine: The UK trainee perspective (A twice-monthly Guest Blog)

Billed by the official television broadcaster as the main event following the Olympic Games ‘warm-up’, the Paralympics have surpassed all expectations and will undoubtedly change perceptions of disability sport in Great Britain. For most, it has been an awakening as to what these athletes can achieve.

Working at the games

Having worked at both the Olympic and Paralympic Games this summer, I gained insights into the international sporting events.  While both were enjoyable, the Paralympics have been somewhat humbling. Especially when witnessing some of the adversities that the athletes have overcome in their bid to become champions.

Based at the Olympic stadium during the Paralympic Games, I was exposed to challenges different to those at other multi-sport athletics events.  With the variety of track and field competitions occurring simultaneously, one is always conscious of giving all events equal attention.  This is challenging at best, but with additional functional impairments and variations within each category, these athletes were at greater risk of injury compared to able-bodied athletes.  Where this was particularly evident was during the F11/12 (visually impaired) triple jump event; unable to visualize where they were aiming, athletes would veer across the track and land dangerously close to the edge of the sandpit.  Additionally, athletes in the T31-38 events (cerebral palsy) could have quite variable degrees of disability.  For some, simply completing the race was an achievement.

From the field of play perspective, it meant planning and rehearsing moulages to ensure our skills were kept sharp and that we worked seamlessly within the team.  Inventing worst-case scenarios, such as wheelchair crashes and extracting seated athletes, kept the training challenging and meant we were confident to deal with any situation.

In addition to the sport, I was privileged to be present at the opening and closing ceremonies.  Uninitiated in Paralympic ceremonies, it was particularly unnerving when fire and water hazards were mixed in with Paralympians and dancers somersaulting through the air.  Although it meant little respite for the medical team, it was a true spectacle and was memorable for all.

The Legacy

With the catchphrase “inspire a generation”, for some, the 2012 Games will do exactly that.  Built on the pledge that sport can inspire, change and improve lives, an NHS document in 2009 stated that the Games would change health beliefs and practices by targeting unhealthy behavior and reducing levels of physical inactivity in London and indeed nationwide.

An additional objective was to inspire the next generation of athletes.  By introducing families to sports, the Games brought to the limelight those events that are infrequently televised and made them centre-stage, seeding ideas for our future athletes.

Personal thoughts

Whether these ambitions will materialize depends on numerous factors beyond our control as doctors.  Nevertheless, many of my patients have witnessed the Paralympics and I will endeavor to build on this interest and enthusiasm towards sport, encouraging people to be more active in their daily routines.  Whether it will involve taking up a new sport or simply considering cycling to the station instead of taking the bus, I am optimistic that the Paralympics were a step in the right direction.

Irrespective of the legacy ambitions, the Paralympics showed us what can be achieved despite adversity.  With personal sacrifice and self-belief, these athletes have brought their individuality and sport to the forefront of our consciousness, leaving little doubt that they are indeed elite sports people and not simply individuals with a disability.

 

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Dr Dinesh Sirisena is a Sport and Exercise Medicine Registrar in London.  He is an Honorary Clinical Lecturer at Bart’s and the London Medical School and is Team Doctor at AFC Wimbledon.

Dr James Thing co-ordinates “Sport and Exercise Medicine: The UK trainee perspective” monthly blog series.

London 2012, the highs, the lows and……the Legacy: A UK trainee perspective

31 Aug, 12 | by Karim Khan

By Dr Ritan Mehta

Sport and Exercise Medicine: The UK trainee perspective (A twice-monthly Guest Blog)

 

We have just witnessed the ‘Greatest Show on Earth’.  Over 10,000 athletes from 204 National Olympic Committees competed in 26 sports in a total of 39 disciplines at the London 2012 Olympic Games.  Whether you are a sport enthusiast or not, there was an attraction to the Olympics that one could simply not resist. If it wasn’t the exhilarating sport on offer, there was also the torch relay and the fascinating opening and closing ceremonies.

The Highs

On a personal note the Olympics were an incredible high in my life. When I first thought about working in Sport and Exercise Medicine (SEM) I would never have dreamt of working at an Olympic Games, never mind at one staged in my home city. It was an amazing experience, witnessing great sporting achievements at first hand.

My role involved being a Field of Play Retrieval Team Member at the Olympic Stadium. I was fortunate to be sitting trackside, looking out for and assisting in the safe and timely retrieval of injured athletes.  Each shift involved working with different individuals from a variety of clinical backgrounds. The ability of teams to bond and work effectively and quickly together was outstanding.  There was also room for some continuing professional development (CPD) consisting of specialist lectures by well renowned experts on topics ranging from hamstring injuries and exercise associated collapse  to concussion and knee assessment .

From a sporting point of view, the Games had countless highs but for me there were a few defining highlights.

  1. The three gold medals for Team GB in 46 minutes on the first Saturday night will go down in history as one of the best ever nights of sport in Great Britain.
  2. The fastest man in the world, Usain Bolt winning the 100m, 200m and the 4x100m finals.
  3. The young, inspirational 15 year old swimmers Ruta Meilutyte and Katie Ledecky winning gold medals, showing their generation what can be achieved through dedication and hard work.
  4. The cycling legends, Sir Chris Hoy winning his sixth Gold Medal and Bradley Wiggins becoming the most decorated British Olympian. They, together with the GB cycling team, have inspired the nation to get back on the bike.

The Lows

The Games did not pass without its problems. Sport is about fair play and competing on a level playing field. The Chinese, Indonesian and Korean players expelled from the Olympics for match-fixing surely showed the ugly side of sport.  One hopes that this will not be allowed to happen again. Performance enhancing drugs and sport are never far apart but with only three positive tests during this Olympics, it was one of the cleanest Games. This however does not tell the whole story. The World Anti-doping Agency reported that over 100 athletes were prevented from competing prior to the games because of doping offences. One must also question whether the limited number of positive tests indicates a reduction in athletes using performance enhancing drugs or whether they are simply getting better at hiding it. This is discussed at length in Dr Peter Brukner’s guest blog: Drugs and the London Olympics.

Comparisons have frequently been made between Olympians and Footballers with the criticism for the latter group. I would question why the racism accusations against Luis Suarez and John Terry have made front page news when there were also three Olympic athletes who were censured for racism, including Petras Lescinskas who was fined £2500 for making Nazi Salutes and Monkey noises when the Lithuanian basketball team played Nigeria, which has barely made the news at all. The International Olympic Committee is commended for making an example of these cases and helping the worldwide fight against racism in sport.

The legacy

Legacy has been a key part of the London 2012 Olympics ever since the Games were awarded in 2005. Every individual has their own thoughts as to what the Olympic legacy really means.  I wanted it to inspire people to take up physical activity in an attempt to reduce the growing obesity epidemic. I was also hoping that it would be a catalyst for the development and sustainability of Sport and Exercise Medicine as a medical speciality.

Strategies have been put into place to encourage individuals to take up physical activity, which I believe will help, at least in the short term.  Time will tell whether this will continue in the long term.

What will happen to Sport and Exercise Medicine?

As a trainee in SEM I am worried about the lack of NHS consultant posts being developed and even more troubled by the lack of new trainees coming onto the training scheme. This topic is raised by Liam West in his BJSM podcast [link to come] .There is a lot of work being done behind the scenes and a £30 million capital grant to develop a National Centre for Sport and Exercise Medicine (NCSEM) is a step in the right direction. I am however left wondering whether the funding and drive for SEM will continue once the Olympics and Paralympics have passed.

The Olympics has been a truly memorable experience for all involved. I am fortunately not yet suffering from Post Olympic Depression Syndrome as I eagerly await working at the biggest Paralympic Games the world has seen starting on 29th August 2012.

For those who can’t make the Paralympics but need a sports medicine fix – remember that the BASEM conference is on November 22 and 23, 2012. Just 100 days to go!

References

Peter Brukner on Drugs and the London Olympics.

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Dr Ritan Mehta is a General Practitioner, Specialist Registrar in Sport and Exercise Medicine and Club Doctor for Watford Football Club.

Dr James Thing co-ordinates “Sport and Exercise Medicine: The UK trainee perspective” monthly blog series.

Guest blog: Do athletes with prosthetic limbs have an unfair advantage over able-bodied athletes?

5 Aug, 12 | by Karim Khan


 

 

Abhishek Chitnis

3rd Year Medical Student

Keele University

Email: v0z55@students.keele.ac.uk

The use of prosthetic limbs in medicine has helped many patients over millennia lead a more comfortable life, enabling them to continue their activities of daily living as well as to compete in sport. In developing countries, prosthetic limbs are mainly used because of amputation due to trauma related injuries such as those suffered in conflict or road traffic injuries.[1] By contrast, in developed countries, the main cause of lower limb amputation is atherosclerosis, which may be affiliated with diabetes.[2] In the UK alone there are about 5000 new major amputations yearly, usually occurring in those who are sixty years old (or above),[1] making the use and development of prosthetics vital in the 21st century.

For athletes, this may be especially important as it could help them lead a normal life having being born with congenital limb problems. Other athletes who have suffered major trauma related injuries may want to continue competing in sports, and the development of prosthesis helps them achieve their goals. However, technological developments in sport can be controversial and this article aims to review any discrepancies as to whether or not technology creates an unfair advantage for the Paralympian, when competing against able-bodied Olympic athletes.

The history and development of prosthetics

Prosthetics have been used for over 3000 years, from the Egyptians where a prosthetic toe made of wood and leather has been discovered, to armoured knights who used prosthetic arms and legs in battle. In the sixteenth century Ambroise Paré invented prosthetics with joints, allowing prosthesis to become more functional.[3] And its not only humans who use prosthesis; elephants and horses that have been injured in accidents have also been given prostheses to help them move around!

Prosthetic limbs have evolved over time to use more advanced materials such as plastics and carbon-fibre composites. These materials make the prosthesis lighter, stronger and more realistic enabling the patient to engage in a full range of normal activities.[3]

Prostheses for athletes; the Flex-Foot

For athletes, possibly the most important development in prosthetic limbs has been the development of the energy-storing Flex-Foot, a carbon-fibre prosthesis with a heel component. Studies have shown the Flex-Foot provides amputees with a natural ankle motion and gives up to 84% of energy return rate to every step taken,[4] resulting in lower energy expenditure and an enhanced gait efficiency.[4] This value may seem high, but in comparison, the energy return rate of a natural limb is about three times higher at 241%.[4]

The Flex-Foot however only conserves energy at higher walking velocities and it does not seem to provide any major advantages for less active amputees. In a recent study to find the benefits of the Flex-Foot when compared with a conventional prosthesis, results showed that amputees had a lower induced disability when walking in a variety of different situations with the Flex-Foot than with conventional prostheses.[5]

Another study showed that amputees walking with the Flex-Foot had a lower heart rate and a lower VO2 (maximal oxygen uptake) than amputees walking with normal prosthesis[4], enabling them to walk for longer distances before tiring.

Case study; Oscar Pistorius

The above studies show that the Flex-Foot was the best type of prosthesis for athletes but the application of this technology has been controversial, as demonstrated by the much-heralded Oscar Pistorius or ‘Blade Runner’. The double amputee Paralympic runner who uses the “Cheetah” Flex-Foot (Figure. 2), a sprinting variant of the Flex-Foot without the heel, was eligible to qualify in the men’s 400 m sprint in both the 2008 Olympic and Paralympic Games. This begged the question; do Pistorius’ Cheetahs provide him with any advantage over biological limbs?  Or are they needed to maximise his performance and to overcome any compensatory consequences his disability creates?

Pistorius was born with absent fibulas in both legs due to a congenital condition and at the age of 11 months he had a transtibial (below-knee) amputation to remove both legs. During his time at school, Pistorius competed in a number of different sports, including rugby, water polo, tennis and wrestling. At 17 he discovered athletics and he went on to win gold in the men’s 200m during the 2004 Paralympic games.

However in 2007, the International Association of Athletics Federation (IAAF) asked for an assessment to be carried out to find out whether the prostheses Pistorius used gave him any undue advantage. The study[6] found that at a given speed, the Cheetahs he used consumed 25% less energy than the runners he was compared to. This would mean Pistorius would have a much lower muscular demand, enabling him to run faster and for longer periods of time before he got tired.

Interestingly, as the normal Flex-Foot was found to give an 84% energy return compared to 241% of a natural limb, it was found that the Cheetahs energy return was three times higher than of a natural limb. The consequence of this would mean that Pistorius would be able to run at the speed with much lower energy expenditure.

The study also found Pistorius displayed a much lower vertical motion than able-bodied runners, meaning he lost less energy during the landing and take-off phase of running. This lead to the finding that the Cheetahs only lost 9.3% of energy during the stance phase of running compared to 41.4% in the biological leg. This meant that Pistorius had a much lower physiological and metabolic workload, giving him a large mechanical advantage over a biological leg. Pistorius argued the case stating the disadvantages he faced with his prostheses including running in the rain (giving him lower traction on the track), wind (which blew his prostheses sideways) and the fact that he needed more energy to start running than other competitors. However, the IAAF found him to breach rule 144.2 “any technical device … that provides a user with an advantage over another athlete not using such a device”,[6] subsequently barring him from competing in any IAAF events including the 2008 Olympic games.

He consequently appealed and in May 2008 just before the Olympics, the Court of Arbitration for Sport (CAS) overturned the IAAF’s ban stating that there was insufficient evidence that Pistorious’ prostheses provided him with any sort of metabolic advantage over able-bodied competitors. It also concluded that the IAAF did not consider Pistorius’ disadvantages through the race.  This allowed Pistorius to try and qualify for the Olympics, but however in the end he could not meet the required qualifying time.

However in November 2009, a new study[7] concluded that athletes with a Flex-Foot, similar to one Pistorius used had no advantage over able-bodied competitors. The running mechanics of a number of athletes was tested as they sprinted on a treadmill and the results showed that prosthetic limbs didn’t generate as much force against the ground as biological legs.

Only single amputees were tested so that their prosthetic and biological limbs could easily be compared. The treadmill that the athletes ran on measured the force, called ground reaction force (GRF), each limb generated as it struck the belt; the greater the force, the higher the speed. It was found that at all speeds, athletes produced a 9% lower GFR in their prosthetic limb than their biological limb. In an able-bodied competitor this would mean a 9% drop in their top speed. It was also found that there is no difference in swing times between the prosthetic and biological limbs, meaning that even though prostheses are lighter than biological legs, amputee sprinters don’t move their legs any faster than able-bodied sprinters. To back up this data, the men’s 100m Olympic and Paralympic finals were analysed and again no significant difference in the swing times of their legs was found.

Pistorius argues that thousands of other runners also use the same prosthetic legs as him, without getting anywhere near his times, and that his times have been steadily improving since 2004 since he first got his Cheetahs blades not because of advances in technology, but due to his relentless training and improved technique. His sporting motto is “You’re not disabled by the disabilities you have, you are able by the abilities you have”. This tells us Pistorius feels his impairment does not affect his physical functioning and that to him; competition is as much mind, as it is matter.

In 2011 Pistorius qualified for the world athletics champions in South Korea with a time that would have placed him in fifth place the 400-metre final at the Beijing Olympics. He is currently contesting for a place in the South African sprinting team that will compete in London 2012 Olympics.

Pistorius is not the first disabled athlete who attempted to compete in both the Olympic and Paralympic Games; several have done so before. Natalia Partyka, a table tennis player, was born without a right hand and forearm and competed in the 2008 Olympics and Paralympic games in Beijing and the wheelchair archer, Neroli Fairhall, the first ever paraplegic competitor, participated in the 1984 Olympic Games in Los Angeles and has also competed in several Paralympic Games.

When debating technological developments in sport, it is also important to consider equal access to the technology. For example, Abebe Bikila, an athlete from Ethiopia who ran barefoot, won the Olympic marathon in 1960. How much faster could he have run with the technology to absorb the ground reaction forces and improve friction? Similarly, who knows how much faster other amputees could run if they had access to Pistorius’ Cheetahs, of which access is limited due to their expense. This situation is more problematic for athletes in developing countries, where the funding for new technology is hard to obtain.

Another issue to consider is have the technological development of Pistorius’ Cheetahs lead to his steadily improving times, or it down to his sheer grit and determination as he so claims. If this is due to the former, one can argue: ‘Who’s going to win the gold medal, the athlete or the scientists who have developed and improved the prosthesis?’

Some have reasoned that historical continuity is crucial, so current athletes can be compared to past athletes and achievements can be understood in context. Allowing Pistorius to compete with his existing Cheetahs does not allow this, as he cannot be compared to past sprinters, which represents a break in historical tradition. Others have made the point that “Natural” athleticism should be exhibited, to preserve the essence of a sport. Using a prosthesis represents a much more significant change than using contact lenses or improving your diet.

Psychological issues must also be contemplated; amputees have often gone through stressful and life changing events, often at an early age, which may put a strain on their psychological well being. For example, they may have issues surrounding their body image, self-pity and frustration. Does the use of a prosthesis help amputees overcome any disadvantage that they have suffered psychologically?

Final thoughts

The evolution of prosthetics has led to specialised limbs being developed for athletes, causing controversy to develop as amputees strive to compete against able-bodied athletes with their specialised limbs. Despite the debate, the ruling regarding Oscar Pistorius’ case was the right one. The prosthesis was primarily developed to attempt to restore loss of function in the Paralympian and there have been both studies for and against whether this prosthesis provides him with any advantage over able-bodied athletes. The fact that studies have not shown irrefutable evidence that Pistorius’ Cheetahs give him an advantage, allowing Pistorius to compete in able-bodied competition would constitute providing him fair opportunity to compete. Because of this uncertainty, Pistorius has rightly been given the sporting ‘benefit of the doubt’ and has been eligible to compete in the Olympic Games, given that he meets the required qualifying time. However, more research is required before any conclusive evidence is drawn as to whether prostheses do in fact give amputees an advantage or not. Until then, the question as to whether Pistorius is disabled, or too abled, remains.

The technological development of prosthesis has had a far-reaching impact worldwide, including in war stuck Sierra Leone where people regularly play amputee football. As prosthesis get more functional and advanced, it can be questioned as to whether or not using a prosthesis completely removes an amputees disability, as they now provide the opportunity for amputees to perform activities to the normal range (or even to a greater range), than a normal human being. This can be debated, but one thing is clear; prosthesis are bridging the gap between the disabled and able bodied.

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Abhishek Chitnis is a 3rd Year Medical Student at Keele University. He has a keen interest in Sports and Exercise Medicine and hopes to pursue it as a future career. Abhishek can be contacted via email at v0z55@students.keele.ac.uk

All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

References

  1. Marks LJ, Michael JW. Science, medicine, and the future – Artificial limbs. BMJ 2001;323:732-735.
  1. Kelly BM, Pangilinan PH, Rodriguez GM, et al. (2009) Lower Limb Prosthetics <http://emedicine.medscape.com/article/317358-overview> (Accessed 04.05.2012).
  1. Thurston A. Pare and Prosthetics: The Early History of Artificial Limbs. ANZ Journal of Surgery 2007;77:1114-1119.
  1. Nolan L. Carbon fibre prostheses and running in amputees: a review. Foot and Ankle Surgery 2008;14:125-129.
  1. Alaranta H, Kinnunen A, Karkkainen M, et al. Practical Benefits of Flex-Foot(TM) in Below-Knee Amputees. JPO 1991;3:179-181.
  1. IAAF. Oscar Pistorius – Independent Scientific study concludes that cheetah prosthetics offer clear mechanical advantages. 2008.  <http://www.iaaf.org/news/printer,newsid=42896.htmx>  (Accessed 04.05.2012)
  1. Grabowski AM, McGowan CP, McDermott WJ, et al. Running-specific prostheses limit ground-force during sprinting. Biology Letters 2010;6:201-204.

Figure 1. Oscar Pistorius running against able-bodied athletes at the Norwich Union British Grand Prix 2007. Adapted from http://www.foxnews.com/story/0,2933,289450,00.html, 2012.

See also BJSM Online First paper by Professor Lippi – click here

See @ScienceofSport on Twitter and blog: TheScienceofSport for detailed discussion

See website ‘Only a Game’ discuss the topic: Argues for Pistorius running.

 

 

 

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