Chapter 1

Sport and
medicine -
the human  
race (a
philosophical
aside)

Eugene Sherry

• Introduction

• When it happened

• Why it happened

• How it happened

• What will happen

Introduction
Sports medicine is concerned with the care and the potential performance of the athlete. It
requires a comprehensive approach; unlike the fragmentation seen in technological
medicine this century (today’s medical students know more about T4 cell levels than a
   
simple Colles’ fracture). These principles of care were established by Herodicus of
Selymbria (at time of Socrates) and Claudius Galen (131-201 AD) 1.. They emphasized
training, diet, massage and a medical approach to athletics.

Galen’s contribution to scientific medicine was monumental. He placed the clinical

instructions of Hippocrates on a sound experimental basis; for 1500 years his works
dominated medical knowledge. He was a true sports medicine practitioner (the father of
sports medicine). Pontifex Maximus made him physician to the gladiators in the Pergamon
arena in Asia Minor (158-161 AD) and he published his methods of treatment (among his
500 known works). It is well to set Galen’s contribution among others.

R B Birrer Sports Medicine for the Primary Care Physician 2nd Edition CRC. 1994

   
When it happened
A history of significant sports medicine events is outlined:

Event Significance
Bowling Game (Egypt, 5000 BC)
Exercise with weights (Urina, 3600
BC)
Chariot races (Greece, 1500 BC)
Chinese book of Gung Fu (Circa Systematic teachings of exercise
1000 BC) therapy
Text of the Hindu Atharva - Veda
(Circa 1500 BC)
Ancient Olympics (776 BC)
Run of Pheidippedes (Marathon to Heroism inspired Olympic ideals
Athens, 490 BC)
Herodicus of Selymbria (time of Emphasized medical gymnastics
Socrates 469-399 BC)
Iccus of Tantrum (444 BC) First treatise on athletic training
Claudius Galen (131-201 AD) Father of Sports Medicine
Quintes of Sumerian (circa 4th Described treatment of ankle
century AD) sprains and boxing wounds
First rowing regatta (Venice 300 Birth of the ‘sacred’ boat race (later
AD) cherished and idealized at Eton)
Avicenna (979-1037 AD), father of Relevant writings during post-
Islamic Medicine crusade period
First cricket game (UK, 1250)
Bergerius (1370 - 1440) Regular exercises for children
Geronimo Mercuriali (1530- 1606) First illustrated book on sports
medicine
Benjamin Franklin (1706-90) Recommended resistance exercises
First Rugby Union game (Rugby
School, 1823)
Oxford-Cambridge Boat Race
(1829)
Edward Hitchcock MD (1854) America’s first college team
physician
John Morgan’s paper on longevity Benefits of exercise scrutinized
of old oarsmen (mid 19th century)
Modern Olympic Games (1896) Greek doctors in attendance at
marathon
Death of Lazaro, a Portuguese Physical exams subsequently
runner, from heat stroke after required for marathoners
Stockholm marathon (1912)
Paris Olympic Games (1924) First US team doctor in attendance
International Federation of Sports
Medicine (FIMS) founded by Sr.
Moritz (1928)
 Berlin Olympic Games (1936)
First Paraplegic Games (1948)
First Asian Games (1951)
American College of Sports
Medicine founded (1954)
4 minute mile by R.G. Bannister
(1954)
President’s Council (Eisenhower,
1956) on youth and fitness
American Academy of Orthopaedic
Surgeons establish Committee on
Sports Medicine (1962)
Terrorism at Munich Games (1972)
Black Boycott, Montreal Games
(1976)
Olympic competitors keep
sponsorship money (1981)
Ben Johnson, 100m sprint, banned
for steroid use (1988)
‘Unified Team’ at Barcelona (1992)
‘Coca-Cola’ Games in Atlanta
(1996)
Today sports medicine has evolved into a respected discipline with dedicated associations,
colleges, institutes and literature in most countries.
Nazi political perversion of Games
Sport for all
Reflecting improved standards of
nutrition and health
‘Physiological barrier’ broken (3
min 59.4 sec), ‘glimpse of the
greatest freedom that a man can
ever know’
US Governmental efforts to
promote physical fitness through
sport
Formalization of orthopaedic
surgeons’ long-term involvement
with care of athletes
Terrorism at the Games
Politics at the Games
End of amateurism
‘End’ of use of drugs for
performance enhancement
‘End’ of communist domination of
Games
‘Beginning’ of corporate control of
sports (? started in LA 1984)

   

Why it happened

Modern wom (woman/man) seems obsessed by sport (both as spectator and participant).
Only 25-30% regularly compete in sports. This is not surprising. The health benefits of
regular exercise are well documented (decreased: coronary artery disease, HBP, non-insulin
dependent diabetes, colon cancer, anxiety, depression, death rates) and all responsible
medical practitioners promote it as ‘the easiest way to preserve health’. In fact, there is a
concern that we aren’t doing enough participant sport (<50% of children ages 10-17 years
regularly exercise, only 10-20% of adults aged 18-65 years vigorously exercise and <80%
over age 65 years) In Developing countries lack of exercise with tobacco and alcohol seem
 likely to create a health catastrophe by the year 2020. Whilst sporting fitness/prowess is
important, we maybe creating modern nations of fit but godless morons (note declining
church attendance and literary levels in developed countries) The downtown city gym is the
cathedral of this modern age. The appeal and realism of ‘Beavis and Butthead’, two illiterate
adolescent US movie characters is worrisome. US educators have already sounded the
alarm bells about the lack of competitiveness from lack of education in a knowledge-based
global economy. Certainly sporting events can serve other needs. The Roman Emperors
staged elaborate and costly gladiatorial shows (264 BC - 325 AD) to entertain and appease
the masses so that they could maintain political control. The Circus Maximus in Rome (1st
century BC) held up to 150 000 spectators; 2 000 gladiators and 230 wild animals were
billed to die in one such show. This century the Nazis (Berlin, 1936) and Communist regimes
(1956 - 1988) used the Olympic Games as spectacles to showcase and legitimize their
systems of social control. More recently, the corporate sector is using the Games for
financial advantage (LA 1984, Atlanta 1996). It is thought that the Sydney 2000 Games will
be the ‘Green Games’ - to promote an ‘ecological’ approach to progress.

1 J. Bloomfield. PA Fricker. KD Fitch. Science and Medicine in Sport. 2nd Ed. Blackwell science 1995. P xiii

2 R B Birrer Sports Medicine for the Primary Care Physician. 2nd Ed. CRC 1994 p. v.

3 C J L Murray AD Lopez. Evidence - Based Health Policy - Lessons from the Global Burden of Disease Study.

Science 274 Nov. 96 - pages 740 -743.

Although Baron Pierre de Coubertin’s statement that ‘the Olympic movement tends to bring
together in a radiant union of all the qualities which guide mankind to perfection’ appears
naive and idealistic it is not unreasonable to want to use sport to improve the ‘human lot’ and
   
make it more ‘bearable’ for all. But why use sport as this vehicle? We need to look further
back (in fact, 4 600 billion years ago).

  How it happened  

Whom evolved this way. Planet Earth is 4,600 million years old. Initially there was no
oxygen. UV radiation which was not blocked by an ozone barrier stimulated photosynthesis
to produce organic molecules from H2O, Co and NH3.
- Anaerobic metabolism developed 3,500 million years ago.
- These original organisms released O2 into the atmosphere and anaerobic metabolism
developed (2,000 million years ago). Nucleated unicellular organisms (the eukaryote with the
ATP-ADP energy system) arrived 1,500 million years ago.
- Large animals appeared at 700 million years; the first primate at 60-70 million years after
the dinosaurs disappeared; mammals, flowering plants and birds appeared.
 - Hominids arrived 5 to 20 million years ago. Australopithecus at 4 million years. Upright
posture with bipedal gait freed the hands to allow the use of tools (and so the brain
expanded). So followed H. Habilis, H. erectus (hunters and food gatherers who used fire), H.
Sapiens Neanderthalensis (formed tribes and used common language) and modern man (H.
Sapiens sapiens 50,000 years ago). Modern wom’s success is due to bipedal gait (sea to
land), upright posture (head to the sky), the use of tools (with opposition of the thumb), and
the brain and speech (with universal interests). The orthopaedic markers of this progress are
the foot, spine and thumb/hand.
- The above steps (evolution) occurred according to modified Darwinian theory, which
states that the gradual accumulation of genetic variants (from mutations and chromosomal
re-arrangements) allows nature to select the ‘best’ variants.

It’s clear that outdoor activities of hunting and food gathering have been an essential part of
our development for millions of years and so constitute an important part of even modern
wom’s emotional, social and intellectual well-being. The urbanized sophisticated may sit with
laptop computer on knee, mobile phone by ear, dictaphone in hand, cable TV on view but
yearns for the open sport’s field to fulfil a primitive biological need (the Wild Wild Web, the
Internet, cannot meet all our needs) to hunt (deer stalking, fishing), fight (bull as in Bull
fighting, wom as in boxing, environment as in mountaineering) and to use tools, (Formula
one car racing, snow skiing) i.e. to compete/confront.

1 Years of Promise: A Comprehensive Learning Strategy for America’s Children. Carnegie Corp. New York

Sept. 1996.

2. P. Astrard 1994 Introduction - Man as an athlete. In M Harries et al. Oxford Textbook of Sports Medicine p 1-

10

3 Ernest Hemingway said he only lived to Fight,Write and to Make Love.From Papa Hemingway

AE Hotchner 1986 William Morrow&Co

  Organized sporting competition can be shown to have three major milestones.

1. The Ancient calendar with: Egyptian (exercises 5000 BC, running rituals at Meriphis 3800
BC), Chinese (Emperors encouraged subjects to exercise daily, 3600 BC), Indian (text of
Hindu Atharva-Veda) and Islamic (Avicenna’s writings) events.
2. The Olympic Games - the Greco-Roman tradition with the Ancient Games (776 BC) and
the Modern Games (1896). Olympic competition introduced idealism (dedicated to the Glory
of Zeus - the mind, body and spirit of man) with a celebration of the mind and body (by the
Greeks) and the need to rise above politics (the Modern Games). Sport functioned to elevate
wom to a plane of idealistic behaviour above our biological needs.
3. The Great English Public Schools recognized (before Baron Pierre de Coubertin) the
civilizing influence of organized sport. It served to subvert the energies of their school pupils
(the future masters of the British Empire and the Western World) into enterprises of co-
operation and heroism on the football field (Eton Wall Game) and the water (rowing). The
same schoolboys went up to University (Oxford-Cambridge Boat Race, 1829) and out to the
Colonies (where sporting powers developed to maintain status and successful competition
with mother England - US football, NZ rugby champions, West Indies cricket, Australian
swimming and tennis). All schools and universities eventually established athletic events as
an important part of their curriculum.

What will happen

Sport will play a critical part in our future. The scientific endeavours of this century have
been directed at military conquest (nuclear bombs) wealth accumulation (commerce) and
medicine (disease treatment and prevention). ‘All research leads to biomedical advances’.
Sports medicine will showcase the achievements of medical science. The health problems of
the world (the Global Burden of Disease) are currently in respiratory infections, diarrhoea,
peri-natal problems, depression, and heart disease. The risk factors for these problems are
no food, no water, no sanitation, no exercise, no safe sex, too much tobacco and alcohol
use, HBP, drug use, and air pollution. By the year 2020 the health problems (from older
populations and the rise of the developing regions) will be: heart disease, depression, road
accidents, strokes, lung disease; all largely attributable to occupation, alcohol and tobacco
use. Many of these problems can be related to the destruction of our environment (rapid
population and industrial growth) in the following way:
- Urban air pollution (oxides).
- Water pollution (waste products).
- Food contamination.
- Nuclear weapons (pollution)
- Wars (destroyed ecosystems)
- Loss of ozone in atmosphere (UV radiation)
- Global re-warming (vector born diseases such as malaria, droughts, floods, starvation).
- Deforestation (with infectious disease epidemics).
- Failure of the modern city (urban homelessness, poverty, underclass, collapse public
health infrastructure). TB is at the highest rate in history. Overall health is no better than
hunter/food gatherers of prehistory times. The benefits of our civilization are only bestowed
upon the privileged few with an urban under-class and the developing world as sick as the
Irish city dwellers of the 1830s and not much better off than the hunter/food gatherers of the
Stone Age

1 J Daie R Wyse Editorial Science 274 Nov 96 p. 701.

2 CJL Murray AD Lopes Evidence - Based Health Policy - Lessons for the Global Burden of Disease Study.

Science 274 Nov. 96 pages 740-743.

3 MN Cohen Health and the Rise of Civilization Yale University 1989

We need to see some order to see our way forward. Today there are basically two classes of
countries - The Developed (wealthy western-styled democracies existing on national debts
and cable TV) and the Developing (with widening wealth gap, either few or outrageous
prospects and either courted by the multi-glomerates or dependent on the World Bank). The
citizens of these countries fall into four groups - can’t stop (the super achievers, names
found in Encyclopaedia Britannica), can cope (solid citizens who uphold the system and pay
tax), won’t cope (criminal groups) and can’t cope (mentally and physically handicapped who
need help). ‘Can’t stop’ will plan and ‘can cope’ will carry out an answer to these problems.
We must protect our environment otherwise our children will be playing sport in a
planetary junkyard. Sport may help us. It can modify risk factors (i.e. protect the body) by
allowing and encouraging us to:
- reduce alcohol and tobacco use
- avoid physical inactivity
- avoid the need for illicit drug use
- prevent hypertension and depression (documented)

In fact, the benefits of sport may be taken further to protect the environment. If the
purpose of sport is to enhance our health then it is irrational and dangerous to exercise in a
polluted environment (the environment is the main determinant of our health - food, water,
clean air). Urban runners have been found to have elevated blood lead levels (> 2.51
*mol/L) despite decreased levels for the average American from the use of lead-free petrol1.
Urban athletes inhale above average quantities of air pollutants (resp. minute volume
increases up to 20x) which bypasses the nose filter with an open mouth2. These pollutants
are either reducing or oxidant form of smog. The reducing forms (carbon fuels) consist of
smoke particulate, SO2 or SO3 and may cause bronchospasm with respiratory infection,
viral myocarditis (especially in children in big cities). The oxidant forms (vehicle exhausts
with sunlight) are CO (can be lethal in elderly and possibly the young in competition,
swimming times are slower when levels > 30 ppm), hydrocarbons, ozone and nitrogen
oxides (impair respiratory system, seen in competitive cyclists on open roads). Skaters have
developed chemical pneumonitis from the nitrogen oxides given off by propane fuel-
propelled resurfacing machines. Swimmers have exposure-dependent chloroform blood
levels (from chlorination, a suspected carcinogen). Team doctors have needed to monitor
and advise on levels (nitrogen oxide levels danger >58 ppb; use air pollution index from
weather bureau; cancel events when necessary; move to air-conditioned venues; check
ventilation facilities).

1 W O Roberts. Environmental Concerns. In ACSM’s Handbook for the Team Physician. Williams and Williams

1996. p. 185-187.

Athletic events should only be staged in cities and countries with a commitment to safe and
clean environments. The culture of sport may need to develop a new creed: Protect my body
and my environment. There should be an awareness of the need of ecological compatibility
of athletic performance with the environment in which the event is held. The Sydney 2000
Olympic Games plan to use this approach. A ‘Medic-O-Games’ could go further to provide a
forum for medical doctors to discuss the health and environmental problems facing us and to
participate in Olympic Sporting events themselves.
The sporting events of the future will be called upon to serve these greater human
needs and in increasingly spectacular ways. I predict that the circus masters of the future
(political leaders, corporate bosses, media moguls, cable TV proprietors) will stage these
shows (Olympics and gladiatorial shows) and accomplish it these ways:
- Sports medicine will be used to showcase the advancements of medical science.
- World records (the ultimate goal of competition) will continue to be broken by improved
training techniques, tactics, equipment, and nutrition.
- The athletic ‘machine’ will be trained in environmental cocoons to avoid the adverse
effects of pollutants on performance. Genetic bioengineers will develop techniques to extend
anaerobic and aerobic potentials. The Human Genome Project is already underway
decoding the genetics of disease and soon the genetics of deviant behaviours and human
enhancement.
- Peripheral brains (bio-computers) will be implanted to alter personality and psychological
barriers and to enhance neuromuscular and cardio-respiratory performance. The Internet is
already coding and expanding our current knowledge database; it will facilitate scientific
inquiry and invention. Fractal geometry will be the powerful mathematical tool for the
scientists of the next century along with quantum-computers.
- Design engineers will improve sporting equipment and facilities to better performance
and lessen injuries (faster cycles, safer helmets, better splints, spring-loaded basketball
courts to minimize impact problems).
- Athletes may undergo biomechanical alterations to their bodies to enhance performance
(lengthen femurs, create metatarsus adductus , ‘pigeon toes’).
- Human Beings may be cloned and developed for sporting spectacles. Already the All
Blacks (NZ Rugby) are in effect pre-selecting a genetic prototype for successful outcomes
(large players of Polynesian extraction) .
Our philosophical acceptance of these things will depend upon whether we consider
that such ventures improve the ‘human lot’. We are entering a daring age in which NASA
has established the ‘Origins’ program to tackle, scientifically, the big questions of life (origins
of life and structure in the universe / life beyond earth) .
Sports medicine faces a new millennium with great expectations and on an ambitious
scientific foundation.

1 Although the superb performance of All Black C.Cullen in the All Black-Wallabies game in Melbourne on26

July 1997 in Melbourne would suggest otherwise

2 EJ Chaisson 1997 NASA’s New Science Vision Editorial Science 275 p 735