SPORTS MEDICINE

This section of the website is intended to provide information on some common sports medicine operations and conditions.

Please click on the links to the left to find out more about a particular condition or procedure.

We have also included printable patient info handouts on sports medicine topics. Click on the links below to find out more.

	Dr Best's patient information handouts
	Dr Bathgate's patient information handouts
	Dr Cusi's patient information handouts
	Alcohol And Physical Performance
	Does Sex Affect Physical Performance ?
	Head Injury In School Rugby
	Use Of Padded Clothing In Rugby

ALCOHOL AND PHYSICAL PERFORMANCE

Does alcohol effect physical performance? Can I have a drink after a game? Can I have a couple? What is “a couple”? What about training or having a drink mid-week? What about when I am injured?

These are all reasonable and relevant questions and again there is some good information in Sports Medicine literature available.

Alcohol (ethyl alcohol / ethanol) is available in various forms, generally beer, wine and spirits. Traditionally alcohol content per drink is measured in grams or “standard drinks”. For example...

1 middy of beer = 1 small glass of wine = 1 nip of spirit = 10 grams. The World Health Organisation defines alcoholism as a daily use of greater than 60g/day. This dependency on alcohol is tragic in an individual but many other alcohol-related disorders are mentioned in the medical literature. These include: dependency, acute intoxication, withdrawal syndrome and alcohol intolerance.

Once consumed, alcohol is rapidly absorbed in the gut then metabolized (broken down) by enzymes in the liver. The liver can be trained to metabolize alcohol with regular alcohol use. The by-products of this process still may cause permanent tissue damage (in the liver, nervous system and the heart). Gut absorption is faster on an empty stomach. That is why unaccustomed alcohol consumption on an empty stomach “goes straight to your head” and may contribute to intolerance and behavioral problems – disinhibition, aggression, rowdiness, etc.

The physiological and chemical effects of alcohol have been studied in recreational sportspeople. In a British study, moderately trained individuals were tested before and after a night of consuming between 5 and 10 standard drinks (average of seven). The beep test was the parameter for aerobic effort and anaerobic performance was tested with repeated 15 meter sprints and burpees (yes, burpees!). The pre-alcohol tests were 1 week before he post-alcohol tests. While there was no statistical difference with anaerobic performance, aerobic performance deteriorated by up to 23% (average 15%). Other functions such as mental performance, balance and fine movements were all negatively affected by alcohol.

Additionally alcohol can suppress appetite and generally causes inferior sleep quality, dehydration and an increased swelling when injured. Sexual performance may be impaired, although footballers tend not to discuss this openly.

In summary:

• Avoid alcohol with any injury which effects your training or playing (in particular lower limb injuries and concussion).
  
• Check if any medications interact with alcohol (eg anti-inflammatories and some antibiotics).
  
• Plan your alcohol use – make sure you are rehydrated and carbohydrate repleted before consuming alcohol. Wherever possible, consider low alcohol alternatives.
  
• The ‘better time' to drink is the day after a game (eg lunch) or earlier in the week.
  
• The maximum recommended limit for men is 4 standard drinks a day.
  
• Binge drinking is extremely damaging. The liver may take up to 3 weeks to recover and physical performance is negatively affected in the short term.
  
• Don't drink and drive.

Matt Shirvington, the Australian sprinter, was reported in the press stating he had decided to give up alcohol until after the Olympics because recovering from a night out could take up to 3 or 4 days for his training to get back to normal again.

DOES SEX AFFECT PHYSICAL PERFORMANCE?

Across most professional sports, the topic of sex and physical performance is discussed and theories flourish. Conflicting theories are only slightly clarified by recent medical evidence.

A recent literature review of sex before competition was summarised in an editorial of the Clinical Journal of Sports Medicine. One view expressed is that athletes should abstain from sex for important competitions because the act of ejaculation may draw testosterone from the body and weaken the athlete. Conversely, other views suggest that the relaxation factor following sex is beneficial to the athlete and may enhance performance.

One study from the 1960s measured maximum effort grip strength the morning after sex in 14 married male athletes, and again measured grip strength following at least six days of abstinence. There was no difference. Other unpublished data from researchers at Colorado State University in 1990 measured grip strength, balance, reaction time, aerobic power and lateral movements. Sex did not affect any of these parameters. A 1995 study suggested that sex 12 hours prior to testing had no affect on aerobic power and recovery from exercise.

Therefore, one might conclude that sex prior to competition is unlikely to affect performance in a negative way. It has been shown that ‘normal' sexual activity between married partners expends only 25-50 calories (similar to walking up two flights of stairs). The lack of negative physiological effect is understandable.

All authors concluded that more research is required and agree that the psychological factors are the most important to measure – aggression, motivation, alertness, anxiety and attitude towards competition.

A common, practical view is that maintaining your normal routine before significant sporting events is important and a good night's sleep, with or without sex, is critical.

HEAD INJURY IN SCHOOL RUGBY

Head injury in sport has progressed enormously in its understanding, particularly over the last few years. Initially road trauma and boxing and finally American football attracted the majority of attention to head injuries. The long held view was that if there was no loss of consciousness (LOC) then the injury was not severe. We know now that this is not so. Medical professionals were sometimes puzzled as to why an athlete could remain unwell even though his “scans” were normal.

The term concussion has a broad definition. In the 1960's the American College of Neurosurgeons offered a definition which included symptoms and wording such as temporary unsteadiness, dizziness and giddiness. These are symptoms which many experienced both playing and training for rugby. Concussion is the only injury which has a higher rate in schoolboys compared to professional rugby (20% v 6% of total injuries).

We know that the brain is protected in the vault of the skull and it is bathed in a chemically rich fluid (CSF). We know that sudden trauma will jolt the brain within the skull. Some authors compare a violent head injury to throwing a pile of jelly against a brick wall. Despite this, the key to the degree of damage appears to be the position of the head.

Human and animal studies have shown that rotational forces (such as a blow to the chin) cause more severe damage than front-on blows. In addition, blows to the temporo-parietal region (above the temple), are more likely to cause concussion. Poor tackling technique is now implicated following studies where video-analysis of concussion injury was used (but obviously some of these may be accidental).

With a better understanding of injury through Neuro-Psychometric Testing (NPT) the pathophysiology (injury and mechanism) of head injury and possible long term problems are better appreciated. NPT is a series of tests to assess cognitive function. This includes speed of thinking, assimilation of information, memory recall and concentration under pressure. Computerised testing is more common with elite teams. A common simple ‘pen and paper” test is the Digital Symbol Substitution Test (DSST) and is also very effective. Pre-seasonal “normal” values provide a baseline measurement.

Three final points to help you take any future head injuries seriously:

• If you have these symptoms tell your parents and your coach and seek medical treatment immediately.
  
• If you are regularly getting dazed when you are the tackler then seek to have this addressed. A video of those episodes may be helpful. Nobody is beyond improving their technique.
  
• Headgear has not been shown to protect against concussion but new research being conducted with the IRB (International Rugby Board) may show otherwise. This research is in progress and we hope to bring you the results soon.

USE OF PADDED CLOTHING IN RUGBY

There has been recent discussion in rugby circles, medical and administrative, as to whether or not certain padded garments are protective against injury. This has been more topical following a recent publication in the a recent British Journal of Sports Medicine. This was a study of Scottish rugby players. The investigators reported an increase in injuries at the tackle phase of play, which they partially attributed to the wearing of padded clothing. The authors claim that padded clothing may give a player a psychological advantage in making them feel less vulnerable, and therefore they would enter the tackle with greater force to the detriment of the opposing player. Similar claims have been made by individuals who feel that the game is developing into an American football / rugby league hybrid.

Is there any substance to this view?

Certainly, mouthguards have been shown to reduce the risk of dental injury and possible concussion. A custom-made mouthguard is the most effective. Make sure you always have at least two; make sure you have a mouthguard and dental check once per year. Player clothing such as jerseys and shorts are obviously protective and necessary. As a team physician, I certainly would have a lot of trouble watching some players compete without them!!

Headgear reduces the risk of laceration, but there is no evidence that this reduces the rate of concussion. Shoulder padding reduces the risk of superficial injury, but there is no evidence that it reduces the rate of more serious injury such as dislocation, rotator cuff contusion, clavicle fractures or more severe AC joint sprains. In comparison to rugby league and AFL, AC joint sprains in sub-elite rugby players are much more common. The dramatic increase in serious rotator cuff injury during 1996 – 1999 in elite Australian rugby players compared to other codes may reflect the increase demands on the shoulder girdle through scrummaging, the lineout and ruck-and-maul phases. It has been shown that clavicle fractures are less common on soft grounds, so it stands to reason that more outer arm padding would ‘cushion the blow'. Perhaps shoulder padding should be extended to cover the outer upper arm (deltoid).

Preliminary studies suggest that the wearing of padded clothing does not make players feel indestructible. The subjects studied were from a large schoolboy rugby group. Research into player attitudes at the elite level is not available.

Finally, the commercial aspects of padded clothing use and its marketing is significant. Despite this, it is imperative that independent and unemotional research be conducted in all these areas to ensure that player safety is maintained at all levels of rugby.