Koichi WATANABE

Sports
Medicine

Contents of “Sports Medicine”

Lecture Title Key Words

Sports medicine in Japan and the world, medical issue
1 Introduction
in event management
2 Sudden death, medical screening by aging

3 Internal Medicine Conditioning, gender issue

4 Practice of internal sports medicine

5 Sports injury and trauma, updates

6 Orthopedics Practice in an operating room

7 Practice in an operating room

8 Basis for athletic prevention and rehabilitation

Athletic
Athletic prevention and rehabilitation including oriental
9 Prevention and
sports medicine
Rehabilitation
10 Practice of massage, taping, and another interventions

1
 Conditioning in sports

Psychological

Physical Environmental
• Remove fatigue and recovery • Heat balance etc.
• Sleep
• Nutrition
• Find and treat illness

Condition

Everything necessary for aiming best performance.

Overreaching Overtraining
Undertraining Overload

Slight Slight Optimal Physiological

physiological performance physiological maladaptation
adaptation improvement and and under
without and positive performance performance
performance physiological achievement
Several weeks
change adaptation
Several days to months to
Minimum Minimum to weeks to recover
recovery time recovery time recover

Overwork
Staleness

2
 Urbanization and Heat Illness

• Heat island phenomenon Sapporo, Nagoya, Osaka,

• Center for Global Fukuoka

Environmental Research Tokyo

Mean of sea surface
temperatures around Japan

• Years when the largest 17 locations

upward anomalies were

recorded globally （1st-5th
places）
• +0.71℃ in 100 years
• 1998: +0.22℃
• 2010: +0.19℃
• 2005: +0.17℃ http://www.data.kishou.go.jp/climate/

• 2009, 2006, 2003, 2002:

+0.16 ℃

Heat Balance

Raising body Lowering body

temperature temperature

From Outside Production in Heat

Sweating
of the body the body dissipation

Ambient Hyperthyroidism,
temperature obesity, exercise

3
 Skin and Sweat grand

• Sweat glands
• 2-3 million sweat glands
• Active sweat glands: about 1/3
• Eccrine and apocrine glands Sebaceous
• Constituents gland

• Water Epidermis
• Na chloride: about 0.65%
• Urea: 0.08%
• Lactic acid: 0.03% Subcutaneo
us tissue Sweat
• Sweating: Exercise causes gland
profuse sweating in short time.
• Like sea water, sweat contains Hair root Adipose tissue
not only water but also Nerve
minerals such as salt, iron, zinc,
and others. Structure of Subcutaneous
• 100ml sweat secretion = -1 deg. Tissue
body temperature

• Systemic disorders due to manage

Heat Illness heat balance of the body
Input = Output
• Heat cramps: Predominantly due to
electrolyte imbalance
• Cramps with severe pain
• Frequently occurs in the muscle groups used
in exercise
• Heat syncope: Predominantly due to
Heat- decrease in water
stroke • Transient circulatory failure and cerebral
ischemia due to the decrease in circulating
blood volume cause unconsciousness and a
drop in blood pressure.
Heat
Exhaustion Input ＞ Output
• Heat exhaustion
• Weakness, dizziness, headache, vomiting, and
Heat Heat
other dehydration symptoms
cramps syncope • Heat stroke
• High body temperature (41-42°C), headache,
dizziness, etc.

4
 Climate and Heat Illness

Ambient temperature WBGT

• Daily maximum temperature
Cases/day • 28℃〜 : Warning, refrain from
Sapporo
practice
Sendai

Saitama

Chiba
• 32℃〜 : Cancellation of the event
• WBGT:Wet bulb globe
23 wards of
Tokyo

temperature is helpful for heat

Other areas in
Tokyo

illness prevention
Yokohama

Kawasaki

• Outdoors:
• 0.7 × wet bulb temp. +
0.2 × black bulb temp. +
Daily maximum temperature (°C) 0.1 × dry bulb temp.

http://www.nies.go.jp/health/HeatStroke/
• Indoors:
• 0.7 × wet bulb temp. +
0.3 × black temp.

Number of transports due to heat illness (persons) Maximum WBGT (average of 6

cities, °C)
Number of transports due to heat illness,
2013
Maximum WBGT, average of 6 cities, 2013

Days
Septembe
June July August
r
Number of emergency cases due to heat illness: Fire and Disaster Management Agency
(figures indicate the number of deaths [2013]), WBGT: Ministry of Environment

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5
 Age Distribution of Heat Illness

• 4 peaks
• Infants
Daily living, work, exercise
• Adolescents
Females
Males • Middle age
• Elderly
Deaths by heat illness

Work • Death from heat

Exercise
illness
• Increases at ages
70 and over
• Female deaths
• Infants
Age groups • Elderly

Sources: Otsuka Pharmaceutical website, cumulative numbers in 1968-2004.

Nakai: Japanese Journal of Biometeorology 30：170,1993, supplemented with additional data.

11

Japan Sports Association Exercise Guidelines

for the Prevention of Heat Illness (1994)

Ambient
Temperature WBGT Exercise Guidelines for the Prevention of Heat Illness
(typical case)

Ambient temperature becomes higher than skin

As a rule,
Over 35℃ Over 31℃
cancel exercise temperature when WBGT exceeds 31℃. Cancel
exercise unless special circumstances exist.
Since the risk of heat illness is high, avoid intense
activities and exercise with high heat burden such as
31-35℃ 28-31℃ High alert endurance running. If you do exercise, take breaks
often and drink water. Weak and unacclimatized
persons should cancel exercise.
Since the risk of heat illness increases, take breaks
28-31℃ 25-28℃ Alert often and drink water. Take breaks generally every 30
minutes in intense exercise.
Fatal accidents due to heat illness can take place.
24-28℃ 21-25℃ Caution Watch out for the signs of heat illness and drink water
often between activities.
Although the risk of heat illness is normally low,
appropriate water intake is necessary. Take caution, as
Under 24℃ Under 21℃ Generally safe
heat illness can occur even under this condition in an
event like citizen marathon.

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6
 Sports and heat illness Number of Participants Rate per year per 1
(data from Australia) cases in 2 (×1000 persons) million people
years (excluding those aged
under 15)

Triathlon 5 30.4 82.2

Softball 10 75.6 66.1
Lawn bawls 20 364.7 27.4
Cricket 14 696.7 10.0
Running 16 1181.1 6.8
Golf 14 1282.6 5.5
Angling 402.6 3.7
Cycling 5 1471.8 1.7
Tennis 4 1407.3 1.4
Football 4 1670 1.2
Walking 9 6808.1 0.7
Swimming 2383.1 0.6
Other 16
Total 133 12850.7 5.2
Journal of Science and Medicine in Sport (2008) 11, 40-47

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Age Team bat & Individual Target and

stick endurance precision

0-14 21.9 ** 0.0

15-24 31.3 14.3 0.0
25-34 18.8 21.4 **
35-44 18.8 39.3
45-54 ** ** 14.7
55-64 0.0 ** 11.8
65-74 0.0 ** 41.2
75- 0.0 0.0 29.4
Total (32) (28) (34)
Journal of Science and Medicine in Sport (2008) 11, 40-47

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7
 Number of Cases of
Heat Illness by
Sports Discipline
Japan, 1970-2005
Otsuka Pharmaceutical website

Sports discipline Cases Cases during running

Baseball 65 23
Mountaineering 29 0
Marathon race 26 26
Running 21 21
Rugby 20 2
School event, summer camp, sports day, etc. 18 0
Soccer 17 7
Opening ceremony of Inter-high and other games 16 0
Judo 16 6
Kendo 14 2
Golf 12 1
Tennis 10 2
Volleyball 6 3
American football, basketball, softball 5 each 3
Boat, wrestling 4 each 2
Training, drilling, handball, table tennis 3 each 3
Gateballl, judo, sumo, physical education class 2 each 2
Aikido, cheerleading, triathlon, hockey 1 each 4
Total 315 107

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Factors of Heat Illness in Middle Aged and

the Elderly
Features of middle aged and the
elderly Countermeasures
• Dehydrated body composition • Maintaining water in the body
• Impairment of sense of thirst • Frequent water intake
• Refrain from alcohol drinking
• underlying diseases or condition
such as • Enhancing heat dissipation
• Obesity reaction through making
• Diabetes exercise habit
• Use of diuretics • Whether this intervention is
useful or not should be
• Past habits: alcohol, smoking scientifically proven

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8
 Type of Sports discipline
Individuals Environment
and form of exercise

Indoor / Outdoor
Age, sex
Temperature
Individual / Team

Summer / Winter Physical condition

Rules
Humidity
competitive level
Weight Control

17

Type of heat illness in sports

Heat Exhaustion
6.4

21.1 Heatstroke
40.4
(sunstroke)
Heat syncope

32.1 Other

Journal of Science and Medicine in Sport (2008) 11, 48-51

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9
 Management Strategy of Heat Illness in Sports

Assessment of
severity
Prevention •Level of
•Education consciousness
Transporting
•Wearing •Pulse, blood
appropriate pressure •Cool area
clothing •Body temperature •Ventilation

Checking Cooling,
environmental drinking water
condition •Sodium
•WBGT supplementation

•Heat index

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Hydration strategy for mild cases

The role of hydration Water intake

• 0.1-0.2％ salt water is recommended.
• See ingredient labeling of commercial
Cooling beverage
by water or ice • “Sodium: 40-80 mg (in 100 ml)” on the label
• When the amount of activity is high,
particularly if exercise lasts 1 hour or more,
beverage Containing 4-8% sugar helps
prevent fatigue
For example, diluted sports drink.
• Alcohol, tea and coffee containing caffeine
Storage water for have diuretic properties
and are likely to cause dehydration.
sweat

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10
 Hypothermia
Digestive
Rectal temperature Consciousness Shivering Heart rate ECG
tract
35 - 33°C
Normal (+) Normal Normal Normal
(mild)
33 - 30°C Elongated
Indifference (-) Slight decrease Ileus
(moderate) waveform
30 - 25°C Confusion, Marked
(-) Osborn-J wave Ileus
(severe) hallucination decrease
25 - 20°C Coma, Muscle Marked Atrial
Ileus
(critical) apparent death rigidity decrease fibrillation
Less than 20°C Almost Muscle Atrial
Lost Ileus
(extreme) certainly dead rigidity fibrillation

• Heat conductivity Substance

Temperature Heat
• When there is a temperature ［℃］ conductance
difference of 1 ℃ across a 1-m Water 10 0.582
thick slab, heat conductivity is Ice 0 2.2
the amount of heat flowing
through a 1 m2 area of the slab Aluminum 0 236
in 1 second. Iron 0 83.5
• Gases < Liquids < Solids Copper 0 403
• External environment Silver 0 428
• Ice Dry air 0 0.0241
• Water Dry wood 18～25 0.15～0.25
• Air Glass Room temp. 0.55～0.75

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Women’s Participation in Sports

• Women’s participation in sports has been increasing since about
1970
• FIFA expects more female players than males in 2010 （Davis,
2005)
• The English Football Association (1921)
• “The game of football is quite unsuitable for females and ought not to
be encouraged”
• Data from 1952-2006 Records at Olympic Games and World
Championships
• Events that last for 10-60 seconds
• Running
• Swimming
• Speed skating
• Gender difference decreased in the 1970s and 80s, but increased
thereafter
• Power difference of 45% in swimming and 20-30% in other
disciplines
Seiler S.et.al: The fall and rise of the gender difference in elite anaerobic
performance 1952-2006, MSSE, pp534-540, 2007

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 Age-related Changes in Sex Hormones

Testes: Testicular hormones (androgens)

Ovaries: Ovarian hormones (estrogens)
Hormone levels

(Free) Testosterone

Estradiol

10 15 30 40 50 Age

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Effect of Estrogens
Its role: Prepare the body for Pregnancy and Childbirth

Anatomical Differences in the Pelvis Head of

the femur

Front Top Bottom Side Shaft of 125°

the femur or
Shorter less
femur
Male
Female

Femal
Male
e

Q-angle

Anatomical Differences in Leg

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 Development of the genital system
(primary sex characteristics) … begins around age 10

Vagina

Fallopian
tube

Uterus

Uterus

Ovary

Birth Birth
Age Age

Changes in ovarian Changes in the lengths of the

and uterine weights uterus, fallopian tube, and vagina

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Menstruation

Menstruation: Periodic bleeding

from the endometrium that occurs Hypothalamus

at intervals of about a month and

stops naturally within a limited
Pituitary gland
number of days
Feedback

Purpose of menstruation:
Ovulation and pregnancy Follicle-stimulating hormone
Luteinizing hormone

Organs showing cyclic changes Follicular hormone

(Estrogen)

with menstrual cycles: Brain Ovary Corpus luteum hormone

(Progesterone)

(hypothalamus, pituitary gland), Uterus

ovaries, uterus, vagina

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 Changes during Menstrual Cycle

Sexual cycle Ovulation

Basal body
temperature

Hypothalamus

Cycle of Central
Nervous System Pituitary
gland

17OH-progesterone
Ovarian hormone
Estradiol

Ovarian Cycle
Progesterone

Ovarian
follicle
Endometriu
Uterine/Vaginal m (stratum
functionale)
Cycle

27

First Menstruation

Arrival of menarche → Around 12 years old

Height at menarche by age Weight at menarche by age

Weight (kg)
Height (cm)

All All
cases cases
Age Age at Age at
menarche menarche

A body fat percentage of 17% or more is considered a prerequisite for

menarche （Reid RL et al. 1987)

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 Normal Ranges for Menstruation
Cycle period
• 25-38 days
• Luteal phase: about 14 days

Duration of menstruation
• 3-7 days

Menstrual blood loss

• 20-140 ml

Menarche
• 12 years old in average

Menopause
• 50 years old in average

Ammenorhea
• Primaly: 18 y.o.<
• Secondaly: interval 90 days <

29

Menstrual Cycle and Athletic Condition

Early week 1

Bad
Early week 2
Good

Mid-cycle

Late week 1

Menstrual
phase

Unrelated

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15
 Athletes and Eating Disorders
Weight loss for body appearance or
participation in a sport
→ Strict food restrictions → Habituation
Abnormal Eating Behavior (%)
Degree of obesity
Subjects
(%) Binge
Self-induced vomiting Laxatives, diuretics
eating

High school students 90.5±9.7 7.5 1.7 0.0

2-year college students 96.3±9.2 8.3 0.4 2.0

Splinters 94.0±5.3 28.6 3.6 3.6

Middle/long distance 94.0±6.4 39.3 7.1 3.1

Gymnasts 95.0±9.7 57.1 28.6 10.7

Rhythmic gymnasts 97.3±8.5 24.6 12.3 1.7

Causes: Unsatisfactory performance, pressure of expectations by coaches, desire

for slimness (body image problem), sporting disciplines where body shape may
affect scores, etc.

31

Female Athlete Triad (FAT)

RED-S: Relative Energy Deficiency
• The three conditions associated with female athletes
• Low “Energy availability”
• Include Abnormal eating behavior (eating disorders)
• 15-62％ of female athletes
• “Menstrual disorders (e.g., amenorrhea)”
• Amenorrhea in 3.4-66％
• “Osteoporosis”
• A study in Norway comparing elite female athletes and
control women
• 5.4-26.9% of athletes were reported to have 2 of the 3 conditions.

• References:
• Birch K. BMJ. 330(7485):244-246, 2005.
• Torstveit MK, Sundgot-Borgen J. Br J Sports Med. 39(3):141-147, 2005.

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 Sexuality
Aspects of sexuality Male Female

1) Sex of chromosomes ４６ＸＹ ４６ＸＸ

2) Sex of gonads Testes Ovaries

3) Sex of body shape

(appearance)
Sex of external genitalia Penis Clitoris
Sex of internal genitalia Seminal vesicles, Vagina, uterus
prostate gland
Secondary sex
characteristics Facial hair Breasts

4) Sex of mind ？

33

Femininity Test
(Sex Check)

From the standpoint of fairness in competitive

sports, the following should be excluded from
female sports events.
① Those who are using an anabolic steroid
② Those who have been masculinized due to
medical abnormality (e.g., disease)
③ Those who are biologically regarded as males
→ Determined by the sexuality of sex
chromosomes

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 Unequal separation of Sex Chromosomes

(Ovum) (Spermatozoa)

Normal

Nondisjunction

35

Assignment 3
Please summarize characteristic and difference of
heat illness between youth and elderly.
Please discuss about the gender problem in sports.

• Please make your essay by word file

• 1-2 page of A4 size
• Please make your file title as
Student Number_Your name_A3
• Submit to “MANABA”
• Deadline : by 31 July 2021

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