South African Journal of Sports Medicine - Volume 25, Issue 2, January 2013

As this edition of the journal goes to press, the annual rugby youth tournaments begin around the country. These national tournaments provide an opportunity for the best young rugby players in the country to showcase their skills. In addition to catering for players of the under-13, -16 and -18 age groups, there is also a tournament for players from schools with special needs. The tournaments provide an opportunity for talent scouts representing schools, provinces and rugby academies to examine the skills of the players and offer contracts to those who they consider to be special.

Objective. To document the prevalence and nature of running-related musculoskeletal injuries among recreational half-marathon runners over a 12-month period (1 July 2011 - 31 June 2012).

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Methods. Data were collected from runners (N=200) who officially ran half-marathon road races during February - June 2012. Runners, whose participation in the study was dependent on voluntary informed consent, were required to complete a self-report questionnaire probing the prevalence and nature of running musculoskeletal injuries in the 12 months preceding recruitment. Probability was set at p≤0.05.

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Results. One hundred and eighty (90%) runners reported sustaining musculoskeletal injuries (p<0.001). The anatomical site most vulnerable to injury was the knee (26%), followed by the tibia/fibula (22%) and the lower back/hip (16%) (p<0.001). The intrinsic factors predisposing runners to musculoskeletal injuries were deviant quadriceps and hip flexion angles (p≤0.05).

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Conclusion. Recreational runners in our cohort sustained a high prevalence of knee, tibia/fibula and lower back/hip injuries.

Background. The potential performance-enhancement effect of pseudoephedrine (PSE) use has led to its prohibition in competition sports (urine concentrations >150 µg/ml). Data are, however, scarce regarding whether therapeutic PSE use enhances swimming performance.

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Objective. To investigate the effect of therapeutic PSE use on performance in aerobic and explosive sprint swimming events.

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Method. A double-blinded cross-over study design was used. Participants in the control group initially received a placebo and those in the experimental group received a divided PSE dose of 90 mg/d. Anaerobic power (50 m sprint) and aerobic (2 000 m) swimming testing was conducted at (i) baseline; (ii) after ingestion of a placebo or PSE; and (iii) after the groups were crossed over, following a wash-out period of 4 days, to determine changes in performance between trials.

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Results. The participants (mean age 44 years; N=7) were competitive masters swimmers with normal resting heart rates (68 beats per minute (bpm); standard deviation (SD) ±14) and blood pressures (BPs) (171 (SD ±27)/83 (SD ±16) mmHg). The use of PSE during the anaerobic swim test showed only a trivial chance (68%) of improvement, with a likely enhancement in systolic BP (86%). The aerobic swim test did not affirm performance enhancement as measured by time to completion (52% chance of a positive effect; 41% chance of a negative effect), nor did any other physiological variable of interest (peak heart rate and exercising BP) differ significantly from baseline results.

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Conclusion. The use of a therapeutic amount of PSE in short and endurance swimming trials did not appear to have any major ergogenic effect on performance.

Objective. To investigate changes in the physical fitness characteristics of elite women's rugby union players over a competitive season.

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Methods. Thirty-two elite women's rugby union players, all members of the South African Rugby Union High Performance Squad, were sub-divided into 2 positional categories of 17 forwards and 15 backs, respectively, and assessed pre-, mid- and post-competition season. Players underwent anthropometric (stature, body mass and sum of 7 skinfolds) and physical performance measurements (vertical jump, 10 m and 40 m sprint, 1 repetition maximum (1RM) bench press and multi-stage shuttle-run test). Analysis. A 2-factor analysis of variance was used to evaluate differences in physical fitness variables between and within playing positions over the competition season (p<0.01).

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Results. In both groups, no significant changes were detected in the sum of skinfolds, vertical jump height, 1RM bench press and multi-stage shuttle-run test scores throughout the season. However, sprint times (10 m and 40 m) significantly increased and then decreased for both groups between the early (pre- to mid-season) and later phases of the season (mid- to post-season), respectively.

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Conclusion. The results suggest that, for improvement in physical fitness, players need to train at higher loads, especially in the preparatory phase. Thereafter, they must take measures to actively maintain these gains throughout the competitive season. Direct supervision of their conditioning should be encouraged.

Background. Legend has it that endurance athletes who develop plantar foot pain during long-distance running frequently experience an eventual relief of pain due to a transient neuropraxia brought on by continued activity.

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Objective. To evaluate the nature of this legend, we assessed long-distance runners for the presence of sensory deficits before and after completion of an ultramarathon, expecting to find an induced neuropraxia and abnormal sensory results.

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Methods. Twenty-five adult participants of an ultramarathon were evaluated prior to their 50/100 km run and again upon completion of the race. Neurosensory testing was performed using a 10 g monofilament at 4 locations on each foot and a 128 Hz tuning fork at one location on each foot. The same techniques were used prior to, and at conclusion of the race.

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Results. We detected no neuropraxia or sensory deficits in any participant, despite reports by the same subjects that they had experienced the phenomenon during the race. While runners commonly report losing sensation in their feet during long runs, we were unable to demonstrate any sensory deficit with simple field-based testing.

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Conclusion. We believe that there is room for additional research to be performed using more sensitive means of neurosensory evaluation.

Underlying cardiac abnormalities are the main cause of unexpected death in athletes on field. These abnormalities have been associated with a previous history of syncope, a family history of sudden cardiac arrest (SCA), cardiac murmur, a history of over-exhaustion post exercise and ventricular tachyarrhythmia during physical activity. The timely diagnosis of susceptible athletes may assist with an appropriate management plan for these individuals, and allow for the prevention of premature death in sport. A young football player was screened for SCA risk using the fundamental components of the pre-participation examination (PPE) - essentially, a medical history, a resting and stress electrocardiogram, and an echocardiogram to support clinical findings. The case is submitted with consideration of the applicable literature to accentuate the importance of using PPE to prevent SCA in young athletes.

Breast cancer is one of the most common cancers worldwide, and statistics reveal that the number of women diagnosed with breast cancer in South Africa is increasing. As such, medical practitioners will treat an increasing number of breast cancer patients. Although increasingly effective treatments improve patient survival intervals, a significant number of patients experience psychological distress, at the time of diagnosis and sometimes well beyond the start of treatment. This can be attributed to the disease itself and to treatment side-effects. Historically, patients experiencing such distress have been treated with pharmacotherapy or have been referred for psychotherapeutic intervention. Although it is well known that physical exercise is beneficial to physical health, only recently, and comparatively, has the effect of exercise been recognised as beneficial to psychological well-being. Cancer patients are often advised to reduce physical activity to avoid cancer-related fatigue. Paradoxically, recent research shows that physical exercise, of the type and intensity appropriate for the ability of each patient, can in fact play a significant role in improving mood and aiding physical recovery. This opens up a valuable additional resource to augment patients' quality of life, both physically and psychologically. One precaution stands vitally important, however: the prescribed exercise regimen must be tailored to the physical capabilities of the patient.

SAJSM CPD June 2013