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| | | | | | | | Chapter 1 Sport and medicine - the human race (a philosophical aside) | | | | Eugene Sherry - Introduction
- When it happened
- Why it happened
- How it happened
- What will happen
Introduction
Sports medicine is concerned with the care and the potential performance of the athlete. It requires a comprehensive approach; unlike the fragmentation seen in technological medicine this century (today’s medical students know more about T4 cell levels than a simple Colles’ fracture). These principles of care were established by Herodicus of Selymbria (at time of Socrates) and Claudius Galen (131-201 AD) 1.. They emphasized training, diet, massage and a medical approach to athletics.
Galen’s contribution to scientific medicine was monumental. He placed the clinical instructions of Hippocrates on a sound experimental basis; for 1500 years his works dominated medical knowledge. He was a true sports medicine practitioner (the father of sports medicine). Pontifex Maximus made him physician to the gladiators in the Pergamon arena in Asia Minor (158-161 AD) and he published his methods of treatment (among his 500 known works). It is well to set Galen’s contribution among others.
R B Birrer Sports Medicine for the Primary Care Physician 2nd Edition CRC. 1994 | | | | When it happened
A history of significant sports medicine events is outlined: | Event | Significance | | Bowling Game (Egypt, 5000 BC) | | | Exercise with weights (Urina, 3600 BC) | | | Chariot races (Greece, 1500 BC) | | | Chinese book of Gung Fu (Circa 1000 BC) | Systematic teachings of exercise therapy | | Text of the Hindu Atharva - Veda (Circa 1500 BC) | | | Ancient Olympics (776 BC) | | | Run of Pheidippedes (Marathon to Athens, 490 BC) | Heroism inspired Olympic ideals | | Herodicus of Selymbria (time of Socrates 469-399 BC) | Emphasized medical gymnastics | | Iccus of Tantrum (444 BC) | First treatise on athletic training | | Claudius Galen (131-201 AD) | Father of Sports Medicine | | Quintes of Sumerian (circa 4th century AD) | Described treatment of ankle sprains and boxing wounds | | First rowing regatta (Venice 300 AD) | Birth of the ‘sacred’ boat race (later cherished and idealized at Eton) | | Avicenna (979-1037 AD), father of Islamic Medicine | Relevant writings during post-crusade period | | First cricket game (UK, 1250) | | | Bergerius (1370 - 1440) | Regular exercises for children | | Geronimo Mercuriali (1530- 1606) | First illustrated book on sports medicine | | Benjamin Franklin (1706-90) | Recommended resistance exercises | | First Rugby Union game (Rugby School, 1823) | | | Oxford-Cambridge Boat Race (1829) | | | Edward Hitchcock MD (1854) | America’s first college team physician | | John Morgan’s paper on longevity of old oarsmen (mid 19th century) | Benefits of exercise scrutinized | | Modern Olympic Games (1896) | Greek doctors in attendance at marathon | | Death of Lazaro, a Portuguese runner, from heat stroke after Stockholm marathon (1912) | Physical exams subsequently required for marathoners | | Paris Olympic Games (1924) | First US team doctor in attendance | | International Federation of Sports Medicine (FIMS) founded by Sr. Moritz (1928) | | | Berlin Olympic Games (1936) | Nazi political perversion of Games | | First Paraplegic Games (1948) | Sport for all | | First Asian Games (1951) | Reflecting improved standards of nutrition and health | | American College of Sports Medicine founded (1954) | | | 4 minute mile by R.G. Bannister (1954) | ‘Physiological barrier’ broken (3 min 59.4 sec), ‘glimpse of the greatest freedom that a man can ever know’ | | President’s Council (Eisenhower, 1956) on youth and fitness | US Governmental efforts to promote physical fitness through sport | | American Academy of Orthopaedic Surgeons establish Committee on Sports Medicine (1962) | Formalization of orthopaedic surgeons’ long-term involvement with care of athletes | | Terrorism at Munich Games (1972) | Terrorism at the Games | | Black Boycott, Montreal Games (1976) | Politics at the Games | | Olympic competitors keep sponsorship money (1981) | End of amateurism | | Ben Johnson, 100m sprint, banned for steroid use (1988) | ‘End’ of use of drugs for performance enhancement | | ‘Unified Team’ at Barcelona (1992) | ‘End’ of communist domination of Games | | ‘Coca-Cola’ Games in Atlanta (1996) | ‘Beginning’ of corporate control of sports (? started in LA 1984) | Today sports medicine has evolved into a respected discipline with dedicated associations, colleges, institutes and literature in most countries. | | | | Why it happened Modern wom (woman/man) seems obsessed by sport (both as spectator and participant). Only 25-30% regularly compete in sports. This is not surprising. The health benefits of regular exercise are well documented (decreased: coronary artery disease, HBP, non-insulin dependent diabetes, colon cancer, anxiety, depression, death rates) and all responsible medical practitioners promote it as ‘the easiest way to preserve health’. In fact, there is a concern that we aren’t doing enough participant sport (<50% of children ages 10-17 years regularly exercise, only 10-20% of adults aged 18-65 years vigorously exercise and <80% over age 65 years) In Developing countries lack of exercise with tobacco and alcohol seem likely to create a health catastrophe by the year 2020. Whilst sporting fitness/prowess is important, we maybe creating modern nations of fit but godless morons (note declining church attendance and literary levels in developed countries) The downtown city gym is the cathedral of this modern age. The appeal and realism of ‘Beavis and Butthead’, two illiterate adolescent US movie characters is worrisome. US educators have already sounded the alarm bells about the lack of competitiveness from lack of education in a knowledge-based global economy. Certainly sporting events can serve other needs. The Roman Emperors staged elaborate and costly gladiatorial shows (264 BC - 325 AD) to entertain and appease the masses so that they could maintain political control. The Circus Maximus in Rome (1st century BC) held up to 150 000 spectators; 2 000 gladiators and 230 wild animals were billed to die in one such show. This century the Nazis (Berlin, 1936) and Communist regimes (1956 - 1988) used the Olympic Games as spectacles to showcase and legitimize their systems of social control. More recently, the corporate sector is using the Games for financial advantage (LA 1984, Atlanta 1996). It is thought that the Sydney 2000 Games will be the ‘Green Games’ - to promote an ‘ecological’ approach to progress.
1 J. Bloomfield. PA Fricker. KD Fitch. Science and Medicine in Sport. 2nd Ed. Blackwell science 1995. P xiii
2 R B Birrer Sports Medicine for the Primary Care Physician. 2nd Ed. CRC 1994 p. v.
3 C J L Murray AD Lopez. Evidence - Based Health Policy - Lessons from the Global Burden of Disease Study. Science 274 Nov. 96 - pages 740 -743. | | | | Although Baron Pierre de Coubertin’s statement that ‘the Olympic movement tends to bring together in a radiant union of all the qualities which guide mankind to perfection’ appears naive and idealistic it is not unreasonable to want to use sport to improve the ‘human lot’ and make it more ‘bearable’ for all. But why use sport as this vehicle? We need to look further back (in fact, 4 600 billion years ago). | | | | How it happened
Whom evolved this way. Planet Earth is 4,600 million years old. Initially there was no oxygen. UV radiation which was not blocked by an ozone barrier stimulated photosynthesis to produce organic molecules from H2O, Co and NH3.
- Anaerobic metabolism developed 3,500 million years ago.
- These original organisms released O2 into the atmosphere and anaerobic metabolism developed (2,000 million years ago). Nucleated unicellular organisms (the eukaryote with the ATP-ADP energy system) arrived 1,500 million years ago.
- Large animals appeared at 700 million years; the first primate at 60-70 million years after the dinosaurs disappeared; mammals, flowering plants and birds appeared.
- Hominids arrived 5 to 20 million years ago. Australopithecus at 4 million years. Upright posture with bipedal gait freed the hands to allow the use of tools (and so the brain expanded). So followed H. Habilis, H. erectus (hunters and food gatherers who used fire), H. Sapiens Neanderthalensis (formed tribes and used common language) and modern man (H. Sapiens sapiens 50,000 years ago). Modern wom’s success is due to bipedal gait (sea to land), upright posture (head to the sky), the use of tools (with opposition of the thumb), and the brain and speech (with universal interests). The orthopaedic markers of this progress are the foot, spine and thumb/hand.
- The above steps (evolution) occurred according to modified Darwinian theory, which states that the gradual accumulation of genetic variants (from mutations and chromosomal re-arrangements) allows nature to select the ‘best’ variants.
It’s clear that outdoor activities of hunting and food gathering have been an essential part of our development for millions of years and so constitute an important part of even modern wom’s emotional, social and intellectual well-being. The urbanized sophisticated may sit with laptop computer on knee, mobile phone by ear, dictaphone in hand, cable TV on view but yearns for the open sport’s field to fulfil a primitive biological need (the Wild Wild Web, the Internet, cannot meet all our needs) to hunt (deer stalking, fishing), fight (bull as in Bull fighting, wom as in boxing, environment as in mountaineering) and to use tools, (Formula one car racing, snow skiing) i.e. to compete/confront.
1 Years of Promise: A Comprehensive Learning Strategy for America’s Children. Carnegie Corp. New York Sept. 1996.
2. P. Astrard 1994 Introduction - Man as an athlete. In M Harries et al. Oxford Textbook of Sports Medicine p 1-10
3 Ernest Hemingway said he only lived to Fight,Write and to Make Love.From Papa Hemingway
AE Hotchner 1986 William Morrow&Co
| | | | Organized sporting competition can be shown to have three major milestones.
1. The Ancient calendar with: Egyptian (exercises 5000 BC, running rituals at Meriphis 3800 BC), Chinese (Emperors encouraged subjects to exercise daily, 3600 BC), Indian (text of Hindu Atharva-Veda) and Islamic (Avicenna’s writings) events.
2. The Olympic Games - the Greco-Roman tradition with the Ancient Games (776 BC) and the Modern Games (1896). Olympic competition introduced idealism (dedicated to the Glory of Zeus - the mind, body and spirit of man) with a celebration of the mind and body (by the Greeks) and the need to rise above politics (the Modern Games). Sport functioned to elevate wom to a plane of idealistic behaviour above our biological needs.
3. The Great English Public Schools recognized (before Baron Pierre de Coubertin) the civilizing influence of organized sport. It served to subvert the energies of their school pupils (the future masters of the British Empire and the Western World) into enterprises of co-operation and heroism on the football field (Eton Wall Game) and the water (rowing). The same schoolboys went up to University (Oxford-Cambridge Boat Race, 1829) and out to the Colonies (where sporting powers developed to maintain status and successful competition with mother England - US football, NZ rugby champions, West Indies cricket, Australian swimming and tennis). All schools and universities eventually established athletic events as an important part of their curriculum.
What will happen
Sport will play a critical part in our future. The scientific endeavours of this century have been directed at military conquest (nuclear bombs) wealth accumulation (commerce) and medicine (disease treatment and prevention). ‘All research leads to biomedical advances’. Sports medicine will showcase the achievements of medical science. The health problems of the world (the Global Burden of Disease) are currently in respiratory infections, diarrhoea, peri-natal problems, depression, and heart disease. The risk factors for these problems are no food, no water, no sanitation, no exercise, no safe sex, too much tobacco and alcohol use, HBP, drug use, and air pollution. By the year 2020 the health problems (from older populations and the rise of the developing regions) will be: heart disease, depression, road accidents, strokes, lung disease; all largely attributable to occupation, alcohol and tobacco use. Many of these problems can be related to the destruction of our environment (rapid population and industrial growth) in the following way:
- Urban air pollution (oxides).
- Water pollution (waste products).
- Food contamination.
- Nuclear weapons (pollution)
- Wars (destroyed ecosystems)
- Loss of ozone in atmosphere (UV radiation)
- Global re-warming (vector born diseases such as malaria, droughts, floods, starvation).
- Deforestation (with infectious disease epidemics).
- Failure of the modern city (urban homelessness, poverty, underclass, collapse public health infrastructure). TB is at the highest rate in history. Overall health is no better than hunter/food gatherers of prehistory times. The benefits of our civilization are only bestowed upon the privileged few with an urban under-class and the developing world as sick as the Irish city dwellers of the 1830s and not much better off than the hunter/food gatherers of the Stone Age
1 J Daie R Wyse Editorial Science 274 Nov 96 p. 701.
2 CJL Murray AD Lopes Evidence - Based Health Policy - Lessons for the Global Burden of Disease Study. Science 274 Nov. 96 pages 740-743.
3 MN Cohen Health and the Rise of Civilization Yale University 1989 We need to see some order to see our way forward. Today there are basically two classes of countries - The Developed (wealthy western-styled democracies existing on national debts and cable TV) and the Developing (with widening wealth gap, either few or outrageous prospects and either courted by the multi-glomerates or dependent on the World Bank). The citizens of these countries fall into four groups - can’t stop (the super achievers, names found in Encyclopaedia Britannica), can cope (solid citizens who uphold the system and pay tax), won’t cope (criminal groups) and can’t cope (mentally and physically handicapped who need help). ‘Can’t stop’ will plan and ‘can cope’ will carry out an answer to these problems.
We must protect our environment otherwise our children will be playing sport in a planetary junkyard. Sport may help us. It can modify risk factors (i.e. protect the body) by allowing and encouraging us to:
- reduce alcohol and tobacco use
- avoid physical inactivity
- avoid the need for illicit drug use
- prevent hypertension and depression (documented)
In fact, the benefits of sport may be taken further to protect the environment. If the purpose of sport is to enhance our health then it is irrational and dangerous to exercise in a polluted environment (the environment is the main determinant of our health - food, water, clean air). Urban runners have been found to have elevated blood lead levels (> 2.51 *mol/L) despite decreased levels for the average American from the use of lead-free petrol1.
Urban athletes inhale above average quantities of air pollutants (resp. minute volume increases up to 20x) which bypasses the nose filter with an open mouth2. These pollutants are either reducing or oxidant form of smog. The reducing forms (carbon fuels) consist of smoke particulate, SO2 or SO3 and may cause bronchospasm with respiratory infection, viral myocarditis (especially in children in big cities). The oxidant forms (vehicle exhausts with sunlight) are CO (can be lethal in elderly and possibly the young in competition, swimming times are slower when levels > 30 ppm), hydrocarbons, ozone and nitrogen oxides (impair respiratory system, seen in competitive cyclists on open roads). Skaters have developed chemical pneumonitis from the nitrogen oxides given off by propane fuel-propelled resurfacing machines. Swimmers have exposure-dependent chloroform blood levels (from chlorination, a suspected carcinogen). Team doctors have needed to monitor and advise on levels (nitrogen oxide levels danger >58 ppb; use air pollution index from weather bureau; cancel events when necessary; move to air-conditioned venues; check ventilation facilities).
1 W O Roberts. Environmental Concerns. In ACSM’s Handbook for the Team Physician. Williams and Williams 1996. p. 185-187. Athletic events should only be staged in cities and countries with a commitment to safe and clean environments. The culture of sport may need to develop a new creed: Protect my body and my environment. There should be an awareness of the need of ecological compatibility of athletic performance with the environment in which the event is held. The Sydney 2000 Olympic Games plan to use this approach. A ‘Medic-O-Games’ could go further to provide a forum for medical doctors to discuss the health and environmental problems facing us and to participate in Olympic Sporting events themselves.
The sporting events of the future will be called upon to serve these greater human needs and in increasingly spectacular ways. I predict that the circus masters of the future (political leaders, corporate bosses, media moguls, cable TV proprietors) will stage these shows (Olympics and gladiatorial shows) and accomplish it these ways:
- Sports medicine will be used to showcase the advancements of medical science.
- World records (the ultimate goal of competition) will continue to be broken by improved training techniques, tactics, equipment, and nutrition.
- The athletic ‘machine’ will be trained in environmental cocoons to avoid the adverse effects of pollutants on performance. Genetic bioengineers will develop techniques to extend anaerobic and aerobic potentials. The Human Genome Project is already underway decoding the genetics of disease and soon the genetics of deviant behaviours and human enhancement.
- Peripheral brains (bio-computers) will be implanted to alter personality and psychological barriers and to enhance neuromuscular and cardio-respiratory performance. The Internet is already coding and expanding our current knowledge database; it will facilitate scientific inquiry and invention. Fractal geometry will be the powerful mathematical tool for the scientists of the next century along with quantum-computers.
- Design engineers will improve sporting equipment and facilities to better performance and lessen injuries (faster cycles, safer helmets, better splints, spring-loaded basketball courts to minimize impact problems).
- Athletes may undergo biomechanical alterations to their bodies to enhance performance (lengthen femurs, create metatarsus adductus , ‘pigeon toes’).
- Human Beings may be cloned and developed for sporting spectacles. Already the All Blacks (NZ Rugby) are in effect pre-selecting a genetic prototype for successful outcomes (large players of Polynesian extraction) .
Our philosophical acceptance of these things will depend upon whether we consider that such ventures improve the ‘human lot’. We are entering a daring age in which NASA has established the ‘Origins’ program to tackle, scientifically, the big questions of life (origins of life and structure in the universe / life beyond earth) .
Sports medicine faces a new millennium with great expectations and on an ambitious scientific foundation.
1 Although the superb performance of All Black C.Cullen in the All Black-Wallabies game in Melbourne on26 July 1997 in Melbourne would suggest otherwise
2 EJ Chaisson 1997 NASA’s New Science Vision Editorial Science 275 p 735
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