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Sports Medicine Section


( it is useful to read this text along with GALLERY Sporting Injuries)

“YouTube and Wikipedia, built by individuals (not institutions or governments)
has provided more education, since their beginnings in 2005/07,than all the great
universities over the last 500 years( YT with 3 billion views in January, 2008,
alone and W with 10 million articles from volunteers- a tribute to global civic
Editorial, Sept.,

Chapter 66

The urbanized sophisticate of today sits with laptop computer on knee, skype on, iphone by
ear, cable TV in view yearning for the open sports field or canoeing in Patagonia . Sport
fulfils our primitive biological need to hunt, fight, use tools (and food gather) (Fig. 1).
Sport has, in fact, come to play an increasingly more important role in modern society. It
happened this way (Fig. 2).
Planet Earth is 4, 600 million years old. Initially there as no oxygen; UV radiation (not
blocked by an ozone barrier) stimulated photosynthesis to produce organic molecules
(from H2O, CO2, NH3). 3,500 million years ago, anaerobic metabolism developed. The
original organisms released O2 into the atmosphere and eventually aerobic metabolism
developed (2,600 million years ago).
Nucleated unicellar organisms appeared 1,500 million years ago (the eukaryote). It
contained the ATP-ADP energy system.
Large animals appeared at 700 million years; with the first primate at 60–70 million
years. When the dinosaurs disappeared; mammals, flowing plants and birds appeared.

Evolution (modified Darwinian theory) is the gradual accumulation of genetic variants
(from mutations and chromosomal re-arrangements) with the nature selecting the “best”

Hominids arrived 5 to 20 million years ago and Australopithecus at 4 million. This was a
major step as an upright posture with bipedal gait freed the hands to use tools (and so the
brain expanded). Then followed H. Habilis, H. erectus (hunters, food gatherers, used fire),
H. sapiens. Neanderthalensis (tribes and common language) and modern man
H.sapiens sapiens – 50,000 years ago).

Modern man’s success is due to his brain, upright, posture, use of tools (opposition of the
thumb) and speech (language). Unfortunately the same mind has an urge to self-

Outdoor activities (hunting, food gathering) have been an essential part of our development
for millions of years and so constitute an important part of even modern man’s emotional,
social and intellectual well-being.

Organised sporting competition has three major milestones and several main events
(Fig. ). Firstly, in the Ancient Calendar, there is evidence that the Egyptians exercised
(5000 BC) and had running rituals at Memphis (3800 BC); also the Chinese Emperors
encouraged their subjects to exercise daily with weights (3600 BC), secondly the Olympic
Games; The Ancient (Greek) Games (776 BC) and the Modern Games (1896). Olympic
competition introduced idealism (with devotion to Zeus) into sport with a celebration of
mind and body (by the Greeks) and the ability to rise above politics (Modern Games). Sport
not only served a fundamental biological need of man but also to elevate us to a higher
plane of idealistic behaviour. Thirdly the great English

Public Schools recognized early (before Baron Pierre de Coubertin) the civilizing influence of
organised sport. In the eighteenth and early nineteenth centuries their school pupils (the
future masters of the British Empire ) often behaved violently towards their Headmasters
and teachers with school riots not uncommon. (Lord Byron with co-conspirator school-
mates laid explosives at Harrow to blow-up the new Headmaster Butler in 1805). Organised
sports subverted their energies into enterprises of co-operation and heroicism on the
football field (Eton Wall Game) and the water (rowing). Squash was first played at Harrow
School (1817) and Rugby at Rugby School (1823). The same schoolboys went up to
University and sport continued (First Oxford Cambridge Boat Race 1829). British Colonies,
existing and previous, developed sporting prowess to maintain status and a means of
successful competition with mother England (US Football, NZ Rugby Champions, West
Indies Cricket, Australian swimming and tennis).
All schools and universities now have organised athletic events as an important part of the
In the Third World , improved standards of nutrition and overall health are leading
teenagers to sport (First Asian Games, 1951).
The International Federation of sports Medicine (FIMS) was initially founded in 1928 in St
Moritz . It serviced as a catalyst for other groups despite the difficulties of the European
Wards (WWI, WWII). The American College of Sports Medicine was established in 1954 and
one of the first Sports Medicine Departments at the Lake Placid (USA) in 1982.

Various interest and special groups have either their own Olympic Games (First Paraplegic
Games 1948, Veterans Games, Fireman’s Games, Doctor’s Games (Medic-O-Games, 1997).

The care of the sick and injured athlete was initially left to interested orthopaedic surgeons
(O’Donoghue and Hughston) and general practitioners. In 1983 when the author was
treating thousands of injured(over 10,000) and sick downhill snow skiers there was little
written to guide me in the particular care of skiers. A Ski Injury Clinic was therefore
established in Perisher Valley , Australia in 1983. Today the discipline of Sports Medicine has
evolved as a specialty with dedicated associations and literature, Colleges of Sports
Medicine and Sports Specific Institutes in the most countries.

The care of athletes is now in the hands of physicians dedicated to their needs almost 1800
years since the work of Claudius Galen as physician to the gladiators in Pergamum (Fig. 4).

Fig. 3
Sports History Main Events
Main Events

Bowling Game ( Egypt , 5000 BC)

Exercise with weights (Urina, 3600 BC)

Chariot races ( Greece , 1500 BC)

Ancient Olympics (776 BC)

Run of Pheidippedes
( Marathon to Athens , 490 BC) ▬▬▬▬▬ Heroism Inspired
Olympic Ideals

First Rowing Regatta ( Venice , 300 AD) Birth of the “Sacred” Boat Race
▼ (later cherished
and idealized at Eton and
First Cricket Game ( UK , 1250) St Bedes

Rugby Union Game ( Rugby , 1823)

Oxford-Cambridge Boat Race (1829)

First Ski Club ( Australia , 1861)

Modern Olympic Games (1896)

4 Minute Mile R. Bannister, (1954) “Physiological barrier” broken (“a
glimpse of
▼ the greatest freedom that
a man can ever know”)
Berlin Olympic Games by Nazis (1936) Nazi political perversion of

Terrorism at Munich (1972) Terrorism at Games

Black Boycott, Montreal Games (1976) Politics at Games

Olympic Competitors keep End of Amateurism
Sponsorship money (1981)

Ben Johnson, 100 m, banned (1988) “End” of drugs for performance

“Unified Team” at Barcelona (1992) “End” of Communist Domination of

Coca-Cola Games in “Beginning” of corporate control of sports
Atlanta 1996 (?started LA

Medic-O-Games ( Australia , 1997) Idealism stored to medicine through

Sydney 2000 Games Idealism of 1896 almost restored

Beijing 2008 Games Return of State show case production of Games;
though good will retained by the enthusiasm and integrity of the Chinese

The Future

The ultimate goal of competition is the breaking of world records. Despite
supposed physiological barriers to better performance records continue to fall.
Roger Bannister in 1954 broke the 4 minute mile barrier and crashed through the
“physiological limits” to his performance but it was really a psychological barrier
he overcame. Glenn Cunningham, the miler of the 1930s, had regularly run sub-4
minute miles in practice sessions.

The basic structure of the human machine coupled with improved training
techniques and tactics, rules, equipment, numbers and nutrition of competitors
will ensure an endless breaking of records.

Here are my predictions for 2020 and beyond. Future sports trainers will be
training their athletes in environmental cocoons to minimize adverse effects of
ecosystem pollutants on performance; techniques for extending anaerobic and
aerobic potential will be developed by genetic bio-engineers; athletes will
undergo biomechanical alterations to their bodies to enhance performance
(lengthen femurs and create metatarsus adductus (pigeon toes); peripheral
brains (bio-computers) will be implanted to alter personality (an psychological
barriers, and to enhance neuromuscular and cardio-respiratory performance) and
design engineers will improve sporting equipment and facilities to better
performances and limit injuries (fast cycles, safer helmets, better splints, spring-
loaded basketball courts to minimize impact). These advances will be based on
sound science and a commitment to the study of performance parameters.
Though, as at 2008, drug use by athletes remains a big problem.. All this against
a background of terrorism, global warming and global financial mis management.

These bio-advantages will be available and only regulations will determine their
use. Human beings may be cloned and developed for sporting spectacles (much
the same as ancient schools of gladiators) or “ordinary: athletes will have their
bodies adjusted (much the same way we have plastic surgery, or artificial joint
surgery) to enhance their enjoyment of sport as an adjunct to their daily living.
Already the All Blacks (NZ Rugby) are, in practice, pre-selecting a genetic
prototype for successful competition (large players of Polynesian extraction). We
will adjust to these varying standards/level of competition in much the same way
we abandoned the absolute necessity of amateurism in sporting competition
(Fig.3).Some say, that with cloning and the replacemement of ‘worn’ organs and
joints, we may well be the last generation which has to ‘die”.
Our philosophical acceptance will depend upon whether they will in general,
improve the “human lot”.

The future of sports medicine, although daunting, will truly be spectacular.