Editor-in-ChiefDr Peter N. SperrynMB, FRCP, FACSM, DPhysMed

EditorsSurgery: Mr John F. DooleyFRCS, FRCS(C), (Hillingdon, UK)

Science: Dr Ron MaughanPhD (Aberdeen, UK)

Physiotherapy: Mr Julius SimBA, MSc, MCSP(Coventry, UK)

Statistical ConsultantsMr F.M. Holliday, MA, DLC, FSS(Loughborough, UK)Mr Simon Day, BSc (London, UK)

Regional Corresponding EditorsBelgium: Prof. M. Ostyn,MD (Leuven)

Brazil: Prof. Eduardo H. DeRose,MD (Porto Allegre)

Bulgaria: Dr Virginia Michaelova,MD (Sofia)

Caribbean: Dr Paul Wright,LMSSA (Kingston, Jamaica)

Cote D'Ivoire: Prof. Constant Roux,MD (Abidjan)

France: Dr Pierre Berteau,MD (Rouen)

Editorial BoardProf. Dieter Bohmer,MD (Frankfurt, Germany)

Dr K.M. Chan,FRCS (Hong Kong)

Dr David A. Cowan,BPharm, PhD, MRPharmS (London, UK)

Dr Wendy N. Dodds,BSc, MRCP (Bradford, UK)

Dr Adrianne Hardman,PhD (Loughborough, UK)

Mr Basil Helal,MCh(Orth), FRCS (London, UK)

Dr G.P.H. Hermans,MD, PhD, (Hilversum, Netherlands)

Prof. Ludovit Komadel,MD (Bratislava, Czechoslovakia)

Prof. W.P. Morgan,EdD, (Madison, Wisconsin, USA)

Prof. Tim D. Noakes,MD, FACSM (Cape Town, South Africa)

Groupement Latine:Dr Francisque Commandre,MD (Nice)

Hungary: Dr Robert Frenkl,MD (Budapest)

India: Dr D.P. Tripathi,MB, BS, MCCP (Patna)

Indonesia: Dr Hario Tilarso,MD (Jakarta)

Malaysia: Dr Ronnie Yeo,MB (Kuala Lumpur)

Maroc: Dr Naima Amrani,MD (Rabat)

Prof. Qu Mian-Yu,MD (Beijing, China)

Dr Allan J. Ryan,MD (Edina, Minnesota, USA)

Prof. N.C. Craig Sharp,PhD (Limerick, Eire)

Prof. Roy J. Shephard,MD, PhD (Toronto, Canada)

Prof. Harry Thomason,MSc, PhD (Loughborough, UK)

Prof. K. Tittel,MD (Leipzig, DDR)

Dr Dan S. Tunstall Pedoe,MA, DPhiJ, FRCP (London, UK)

Prof. Clyde Williams,PhD (Loughborough, UK)

Dr William F. Webb,MB, BS (Sydney, Australia)

New Zealand: Dr Chris Milne,MB, ChB, DipSportsMed (Hamilton)

Pakistan: Dr Nishat Mallick,FPMR, FACSM (Karachi)

Spain: Dr J. J. Gonzalez Iturri,MD (Pamplona)

Thailand: Dr Charoentasn Chintanaseri,MD (Bangkok)

Uganda: Dr James Sekajugo,MB, Dip.SportsMed. (Kampala)

USSR: Dr Sergei Mironov,MD (Moscow)

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Br. J. Sp. Med 1993; 27(3)

From the journals

Sports medicine current awareness service

Prepared by Kathryn Walter and Jayne Makepeace at the National Sports Medicine Institute(NSMI) Library

The following summaries are takenfrom a selection of recent journalsindexed in the NSMI database. A fulllisting is published monthly in SportsMedicine Bulletin.

Copies of the complete articles areavailable (price 15 pence per sheetsubject to the Copyright, Designs andPatents Act, 1988) from the Library,NSMI, c/o Medical College of StBartholomew's Hospital, Charter-house Square, London EC1M 6BQUK (Tel: 071 251 0583).The ideal training program achievesoptimal adaptations without theathlete succumbing to an overtrainedstate. Recent research has focused onplasma uric acid as a possible measurefor diagnosing training states. Thisresearch and its metabolic rationale isreviewed by David Pyne in Uric acidas indicator of training stress (SportHealth 1993; 11: 26-7). The value of uricacid monitoring depends on regulartesting and comparison on an indi-vidual basis. Measurement of uricacid, at rest and after intensive train-ing two to three times per week, isnecessary to provide beneficial infor-mation. Microsampling of blood fromthe finger or ear lobe and the use ofportable analysers could be effective inmonitoring athletes during periods ofheavy training.

Iliotibial band (ITB) syndrome, anoveruse injury resulting from recur-rent impingement of the ITB tendonon the lateral femoral epicondyle, hashistorically been considered an injuryindigenous to runners. However, arecent paper by James C Holmes et al.(Iliotibial band syndrome in cyclists,American Journal of Sports Medicine1993; 21: 419-24) reports 61 cases ofITB syndrome in cyclists of all levelsover a period of 6 years. Nonoperativetreatment of ITB includes stretching,icing, rest and oral NSAID. Additionalmeasures specific to cyclists consist ofbicycle adjustments which should bedirected toward correcting misalign-ments between the cyclist and bicycleand training modifications, including

©D 1993 Butterworth-Heinemann Ltd0306-3674/93/030211-02

a reduction in mileage. For cyclistsrequiring operative intervention, theauthors describe a new surgical techni-que for excising or releasing the distalITB. This involves excision of anelliptical piece of the distal posteriorband off the lateral femoral epicon-dyle.The treatment of ITB syndrome is

also described by John G. Aronen andothers in Practical, conservative man-agement of iliotibial band syndrome(Physician and Sportsmedicine 1993;21(6): 59-69). A two-phase conserva-tive regimen is advocated: Phase I isaimed at treating intial symptoms andinvolves NSAIDs, icing, stretchingand using a knee immobilizer andcrutches; Phase II focuses on return toactivity - the patient continues thestretches and runs to the point offeeling ITB tightness but not pain.An exploratory study of the motives

of British adults to participate in sportand exercise is reported by BasilAshford and others in Participants incommunity sports centres: motivesand predictors of enjoyment Uournal ofSports Sciences 1993; 11: 249-56). Aquestionnaire interview (336 respon-dents) was conducted in six commun-ity sports centres in Leicester. Subjectswere presented with 15 motives forsports participation and asked to indi-cate their level of agreement on a5-point scale. The three most com-monly endorsed motives were tomaintain health, develop physical fit-ness and aid relaxation. Factor analysisrevealed a set of factors associatedwith performance (assertive achieve-ment and sports mastery and perform-ance) and well-being (physical andsociopsychological well-being). Analy-sis of results revealed significantgender and age differences in thesefactors: men showed greater motiva-tion than women in respect of per-formance whilst age differences wererevealed mainly in terms of socio-psychological well-being. Further re-search in this area is needed to aidpromotion of community-based pro-grammes and optimize participationlevels.

Robert D. Kersey reports the extentof Anabolic-adrogenic steroid use byprivate health club/gym athletes in a

recent issue of Journal of Strength andConditioning Research (1993; 7: 118-26).A 22-item questionnaire focusing onstrength training habits, AAS know-ledge/use and demographic informa-tion was administered to 185 anony-mous subjects at five health clubs/gyms in the southwestern UnitedStates. Results indicated that about15% have used or are using AAS - alower rate than described in previousstudies. Of the AAS users, the prim-ary source for the drugs was through afriend/coach, the most commonlyused drugs included Testosterone,Dianabol, Anadrol, Deca-durabolinand Winstrol and the most commonmotive for their use was "to getbigger".A major British study from the

Centre for Research on Drugs &Health Behaviour (Anabolic steroiduse in Great Britain: an exploratoryinvestigation, Pirkko Korkia and Ger-ry Stimson, March 1993) revealed that7.7% of 1669 questionnaire respon-dents in 21 British gyms reportedanabolic steroid use at some time.Again, most were introduced to AS bytheir friends and the primary motivesfor use were to increase muscle massand size, to increase strength and to beable to train harder and longer.The emerging popularity of weight

training as a conditioning technique,competitive sport and recreationalactivity among children and adoles-cents has significant implications forthe occurrence of musculoskeletal in-juries such as fractures, dislocations,spondylolysis, spondylolisthesis, in-tervertebral disk herniation and men-discal injuries of the knee. (Weighttraining injuries: common injuriesand preventative methods, Mazur L.J. et al., Sports Medicine 1993; 16:57-63). Although injuries can occurduring the use of weight machines,most appear to happen during theaggressive use of free weights in suchexercises as the dead lift and benchpress. Prepubescent and older athleteswho are well trained and supervisedhave low injury rates in strengthtraining programmes. Important pre-ventive measures include mainten-ance of equipment, warm-up routinesand proper techniques.

Br J Sp Med 1993; 27(3) 211

Recent Olympic games have beenheld in cities notorious for air pollu-tion, a problem which was perhapsmost evident in Los Angeles, the hostcity of the 1984 Games. Rod Cedaroreviews the potential hazards encoun-tered by athletes when training andcompeting under adverse atmosphericconditions in Environmental factorsand exercise performance: a review.II. Air pollution (Excel 1992; 8(3):161-6). The four air pollutants whichappear to have the most pronouncedadverse effects on optimal athleticperformance are carbon monoxide,ozone, sulphur dioxide and particulatepollutants and these are discussed indetail. The effects of inhalation de-pend on factors such as the dosage,concentration of pollutant in the in-spired air, temperature and humidityof the ambient air and the rate ofinspiration. The author makes a num-ber of recommendations centredaround timing, location, intensity andduration of training to decrease theeffect of air pollution on performance.Two consecutive papers in a recent

issue of Journal of Orthopaedic and SportsPhysical Therapy (JOSPT) focus onelbow problems encountered by thethrowing athlete. In the first James R.Andrews and others discuss the dif-ferential diagnosis of specific patholo-gies (Physical examination of the throw-er's elbow, JOSPT 1993; 17: 296-304).An extensive knowledge of functionalanatomy is necessary for physicalexamination of the elbow. The compo-nents of an elbow examination includeinspection/observation, palpation ofbony and soft tissues, ROM assess-ment, resisted muscle testing, neuro-logic testing and special tests such asthe Tinel test, tennis elbow sign, ulnar

collateral ligament stability testing,valgus extension overload test andradiocapitalla chondromalacia test.Other tests include radiographic ex-amination, such as CT arthrogram andMRI testing. In the second paper therehabilitative process for various in-juries is described. Progressive phasesinclude (I) immediate motion (to re-establish pain free ROM, decreasepain and inflammation and retardmuscular atrophy); (II) intermediateexercise (to improve mobility, strengthand endurance and neuromuscularcontrol of the elbow complex); (III)advanced strengthening activities (e.g.plyometrics, eccenteric contractions)and (IV) return to activity. (Wilk K. etal., Rehabilitation of the elbow in thethrowing athlete, JOSPT 1993; 17:305-17).A lack of agreement among profes-

sional sports nutritionists was exposedin a recent questionnaire survey byAnn Grandjean (Practices and recom-mendations of sports nutritionists,International Journal of Sport Nutrition1993; 3: 232-42). Although subjectswere in broad agreement on topics ofwater and electrolytes, their opinionson protein requirements and simplesugars varied; this could be due in partto the lack of or relative recency ofscientific data.Wenche Rasch and Michael Cabanac

have found that wearing headgearduring exercise can reduce head heatloss and hinder the body's selectivebrain cooling (SBC) mechanism (Selec-tive brain cooling is affected bywearing headgear during exercise,Journal of Applied Physiology, 1993; 74:1229-33). They performed two experi-ments, the first to measure effects ofheadgear on head heat loss and the

second the effects on general tempera-ture regulation. For each experiment,four subjects had two sessions on acycle ergometer, the first withoutheadgear and the second wearingeither a headband or a woollen cap.From the first experiment it was foundthat caps significantly reduce headheat loss, whereas headbands do not.By measuring head skin temperaturesit was found that both forms ofheadgear hinder the selective braincooling mechanism. The results of thesecond experiment indicated thatperipheral heat loss does not increaseto compensate for the reduction inheat loss from the brain whilst wear-ing headgear.

Previous studies on the effects if lifestressors on athletic performance havebeen concerned with endurance andstrength performance, whereas a re-cent study by Gary Felsten and KathyWilcox (Relationships between lifestress and performance in sports:much theory, but very little data,Journal of Sport Behavior, 1993; 16(2):99-110) shows the effects of life stresson mental concentration andprecisionmovements in figure skaters. In thestudy 15 figure skaters aged 8-17 yearswere assessed weekly for four weeks.Both daily hassles and skating stres-sors were evaluated using question-naires. Skating performance was ratedby each student's coach rather thanbeing evaluated by performance in acompetitive situation, thus competi-tion stress was eliminated. The resultsshow that higher daily stress, skatingstress and total stress were eachassociated with poorer performance.The limited data gained from thisstudy are consistent with theorecticalexpectations.

.212 Br J Sp Med 1993; 27(3)

URGENT ANNOUNCEMENTThe London office of BJSM is closed. ALL communications should now beaddressed to:

BRITISH JOURNAL OF SPORTS MEDICINEButterworth-HeinemannLinacre HouseJordan HillOxford OX2 8DP, UK

BJSM direct phone: +44 (0)865 314512BJSM direct fax: +44 (0)865 314557

All enquiries to: SUE DEELEY, Publisher, Medical Journals

i

BASM Education Programme (9The British Association of Sport and Medicine (BASM) was formed in 1952, by Sir Adolphe Abrahams and Lord Porritt as theprofessional representative body in this field of medicine. One of the objectives of the organization is to provide education formember professionals.BASM education is the responsibility of an Education sub-committee. In order to encourage development of the regionalprogramme the committee includes representatives from each region. The employment of a professional full-time EducationOfficer, made possible 5 years ago by a grant from the Sports Council, has allowed a greatly expanded and improvedEducation programme. The Education Officer is responsible for coordinating the National and Regional programmes.At National level, the courses form an integrated programme approved by the Sociaty of Apothecaries for entry to their

examination for a Diploma in Sports Medicine. The courses are also of great help to those doctors aiming to sit the CombinedRoyal Colleges of Scotland Diploma.The first Introductory course in Sports Medicine was held in Loughborough as a one-week residential course in 1975.

Introductory courses are now established as twice yearly events at the National Sports Centre, Lilleshall, Shropshire. TheIntroductory course has expanded and improved so that it is now a very general digest of sports medicine covering aspects ofphsyiology, nutrition, fitness testing, sports psychology, practical demonstrations of stretching and warm-up, andresuscitation. This is in addition to the management of sports trauma. The lectures are pitched at providing not just anintroduction but leading to broader knowledge. The Introductory courses have been hugely successful, and have an activesocial agenda.The Intermediate course is a more recent addition to the timetable. It is also a week long residential course and has twofold

aims. The principle of managing a sporting injury depends not only on treating the injury, but also on searching for theaetiology of the injury from the sport itself. The physician must have a working knowledge of the training and technicalaspects of the sport in which his patient participates. The Intermediate course includes lectures from leading coaches whodiscuss the role they play and methods of prevention of injury. Doctors and physiotherapists who are involved with caringfor a variety of sports talk on injuries and rehabilitation related to that sport. The course then goes on to focus upon a jointand improve examination techniques using the delegates as subjects. This was found to be necessary following experiencegained in running the advanced injury module courses, where some delegates had difficulty in demonstrating examinationtechniques and eliciting some clinical signs.The Advanced Sports Medicine courses were organized following the development of the Apothecaries Diploma, in which

prominent BASM members played a large part. These courses have been developed on a modular concept, running over sixweekends a year at venues around the country. The injury modules include lower limb, upper limb, and trunk and spine.The programme includes lectures on advanced examination technique, and provides carefully selected patients with clinicalsigns for delegates to develop hands-on experience. The injury lectures provide a greater depth of knowledge of treatment ofsporting injury than the Introductory course. The physiology weekends are separate cardiovascular and musculo-skeletalmodules. There are lectures, and modules also include practical demonstrations and discussion of physiological testingtechniques. The advanced medicine course deals with 'medical' aspects of sports medicine such as disorders of thecardiovascular, respiratory and other organ systems.The latest addition to the schedule is the La Santa hands-on course; this course develops the practical sporting theme of the

Intermediate course. Many of our national teams use the facilities at the La Santa sports complex on Lanzarote (one of theCanary Islands) for pre-season training. The hands-on course makes use of coaching staff from the complex to gain practicalskills and knowledge of a number of different sports. The course includes lectures, formal coaching sessions and some leisuretime!BASM regions cover the nation, and provide contact at local level and are an essential part of the Association. The regions

are becoming increasingly active, holding regular evening or weekend clinical meetings. In the last year the East Midlands,West Midlands, London and South-East, and Yorkshire have been established. Addresses of the Regional Chairman werepublished in the June 1993 issue of the British Journal of Sports Medicine. The regions take turns in hosting the BASM AnnualCongress and Annual General Meeting.There is a waiting list for the Introductory courses and we hope to expand the number offered. Further expansion of our

programme will require employment of more people. There has been a problem with the Advanced courses, with peoplehaving to travel long distances for an intensive weekend, particularly when many of the courses have been held in the Southof England. The recent Advanced physiology modules have both been held in the North to balance this, and BASM Scotlandhave offered to hold a lower limb module next year. There are now a number of centres offering courses and qualifications,and an increasing number of doctors and physiotherapists taking them. Closer liaison with other bodies providing educationis a means of reducing some of the fragmentation of sports medicine in the country. One of our tasks for the future will be toprovide continuing education for those who have gained diplomas. A Diploma in Sports Medicine should not be seen as theultimate objective, any more than the Fellowship or Membership of one of the Royal Colleges is in another specialist career.Australian sports medicine specialists have now established a separate College of Sports Physicians (ACSP). The ACSP setsits own fellowship which comes at the end of a training programme. We have a long way to go.

Roger Hackney FRCS, Hon. SecretaryGraham Holloway FRCS, Asst. Hon. Secretary

See overleaf for details of 1993 courses

Br J Sp Med 1993; 27(3) 213

Date

January 22-24

March 12-14

April 2-4

April 25-30

September 3-5

September 26 - October 1

October 29-31

November 19-21

November

Current Programme for 1993CourseAdvanced Physiology: cardio-respiratory physiology

Advanced Physiology: musculoskeletal system

Advanced Injury: Acute and Chronic Injuries to the UpperLimbBASM Introductory Sports Medicine Course

Advanced Injury: Acute and Chronic Injuries to the Head,Neck, Spine and PelvisBASM Introductory Sports Medicine Course

Advanced Injury: Acute and Chronic Injuries to the LowerLimbBASM Congress (Eastern Region)

Courses planned for 1993Intermediate Sports Medicine Course

Venue

Bradford RoyalInfirmaryLiverpool JohnMoores UniversityRAF Wroughton(Swindon)Lilleshall Hall NSC(Shropshire)Milton KeynesGeneral HospitalLilleshall Hall NSC(Shropshire)RAF Wroughton(Swindon)Cambridge

214 Br J Sp Med 1993; 27(3)

CORRECTION

There was an error in the BASM News section of the June 1993 issueof the British Journal of Sports Medicine.

The address given for Dr M Read, the Chairman of the London andSouth East Region should have read:

Dr M ReadLondon Bridge Clinic1 St Thomas StreetLondonSE1 2PR

LL

Notes for Authors

ScopeThe British Journal of Sports Medicine covers all aspectsof sports medicine and science - the management ofsports injuries; all clinical aspects of exercise, health andsport: exercise physiology and biophvsical investigationof sports performance; sports psychology; phvsio-therapy and rehabilitation in sport; and medical and sci-entific support of the sports coach.

Types of PaperOriginal papers (not normally over 3000 words, fulllength accounts of original research)Review articles (up to 4000 words, providing concise in-depth reviews of traditional and new areas in sportsmedicine)Case reports (up to 1000 words, describing clinical casehistories with a message).

RefereeingAll contributions are studied by referees whose namesare not normally disclosed to authors. On acceptance forpublication papers are subject to editorial amendment. Ifrejected, papers and illustrations will not be returned.Authors are solely responsible for the factual accuracy oftheir papers.

ManuscriptsAuthors are urged to write as concisely as possible.Four copies should be submitted, typed on only oneside of the paper (quarto or A4) in double spacing with amargin of 30mm at the top and bottom and on bothsides. Papers should be arranged in the following orderof presentation: title of paper; names and qualificationsof the authors; address of the place at which the workwas carried out; an abstract of the paper (100-200 wordsin length); 4-6 keywords; the text; acknowledgements(if any); references; tables; abbreviated title for use as arunning headline; captions to figures (on separate sheetof paper).

IllustrationsDrawings and graphs should be on heavy wvhite papercard or blue-lined coordinate paper using black ink.Label axes appropriately and clearly. Please use a selec-tion of the following symbols: +, x,-, , , A, U, 0,A, v. Photographs should be of fine quality, largeglossy prints suitable for reproduction and the topshould be indicated. Negatives, transparencies or x-rayfilms should not be supplied, any such material shouldbe submitted in the form of photographic prints.Authors are asked where possible to draw diagrams toone of the following widths, including lettering,168 mm, 354 mm. During photographic reproduction,the diagrams are reduced to ' 2 their size. The maximumdepth at drawn size is 500 mm. Authors are asked to usethe minimum amount of descriptive matter on graphsand drawings but rather to refer to curves, points etc. bysymbols and place the descriptive matter in the caption.Three copies of each illustration are required and theseshould be numbered in a consecutive series of figuresusing Arabic numerals. Legends should be typed indouble spacing on a separate page but grouped together.Each figure should be identified on the back - figurenumber and name of the author. Figures which havebeen published elsewhere should be accompanied by aform of permission to reproduce, obtained from theoriginal publisher.

ReferencesThese should be indicated in the text by superscriptArabic numerals which run consecutively through thepaper. The references should be grouped in a section atthe end of the text in numerical order and should take theform: author's names and initials; title of article; abbre-viated journal title; year of publication; volume nuLmber;page numbers. If in doubt authors should always writethe journal title in full. References to a book should takethe form: author's surname, followed by, initials; title ofbook in single quotes; editors (if an!v); volume number'edition (if any); name of publishers; place of publication;year of publication and page numbers. Where a paper iscited more than once in the text, the same superiornumeral should be used on each occasion. e.g.21 Sperrvn P\. 8 pvort andA lcdwinw. London: B3Ltterworths, 1983.22 Ellitsgaard N and Warburg F. .MovemenV11ts cau1sing, anlkle

fractures in parachuting. Pr I A8p)rtI.\C'J 1989; 23: 27 9.TablesTables should be tv ped on separate sheets together witha suitable caption at the top of each table. Column head-ings should be kept as brief as possible, and indicateunits of measuremnent in parenthesis. Tables should notduplicate information summarized in illustrations.FootnotesFootnotes should be used sparingly. They should be in-dicated by asterisks (X), daggers (t), and double daggers(t), in that order. In the manuscript, a footnote Should beplaced at the bottom of the page on which it is referred toand separated from the main text by a horizontal lineabove the footnote Foottnotes to tables should be placedat the bottom of the table to which they refer.Drugs, Abbreviations and UnitsDrugs should be referred to by their approved, not pro-prietarv, names, and the source of any new or experi-mental materials should be given. If abbreviations areused these should be given in full the first time they arementioned in the text. Scientific measurements shouldbe given in Si units, but blood pressure should continueto be expressed in mmHg.ProofsAuthors are responsible for enIsuring that all manu-scripts (whether original or revised) are accurately typedbefore final submission. Two sets of proofs will be sentto the author before publication, one of which should bereturned promptly (by Express Air Mlail if outside UK).The publishers reserve the right to charge for anychanges made at the proof stage (other than printerserrors) since the insertion or deletion of a single wordma! necessitate the resetting of wvhole paragraphs.SubmissionFour copies of the complete manuscript and illus-trations should be sent to Dr P. N. Sperrvn, The Editor,British Journal of Sports Miedicine, Bu tterwvorth-Heine-mann Ltd., Linacre House, Jordan Hill, Oxford OX28DP', U K.All material submitted for publication is assumed to besubmitted exclusively to the British Journal of SportsMedicine. All contributing authors must sign a letter ofconsent to publication. The editor retains the customaryright to style and if necessary shorten material acceptedfor publication. Manuscripts will be acknowvledged onreceipt. Authors should keep one copy of theirmanuscript for reference. Authors should include theirnames and initials and not more than one degree each.