Medical care of the South African Olympic team — the Sydney 2000 experience

Objective. This descriptive study was undertaken to report the medical care and injuries sustained by the ath-j letes and officials of the South African Team at the 2000 Olympic Games and to provide data for planning future ί events. Setting. Retrospective review of medical records at the ί


Introduction
The 2000 summer Olympic Games in Sydney Australia was clearly the largest event in sporting history and South Africa was represented by the largest team of athletes and officials ever to leave these shores.In accordance with the size of the team and in keeping with International Olympic Committee (IOC) allocations, the medical team was the largest ever to be assembled for the South African team competing at the Olympic Games.As space on the medical team is very limited, the correct balance of medical service provision remains a difficult endeavour. 1,2 total, the medical team comprised 13 members including 4 sport physicians, 7 physiotherapists, a sports psychologist and an athletic trainer/biokineticist trained in massage therapy.One physician and 1 physiotherapist were seconded to the soccer team and they accompanied this squad until the latter were eliminated from the competition and returned home.The statistics from this squad are not included in this report.This report describes the preparation programme of the Olympic athletes and also describes the nature and profiles of the consultations for both the athletes and officials.The objectives of this report are therefore to examine the delivery of medical services and to provide data for planning of medical support to future multi-coded sports events of this nature.

Methods
The medical records and histories of athletes were obtained through clinical evaluation opportunities during the work-up in the Operation Excellence programme and at the 3 preparation camps provided by the National Olympic Committee of South Africa (NOCSA).
At each opportunity a hardcopy medical record was completed and the data transferred to an electronic database.This

SPORTS MEDICINE DECEMBER 2003
Reproduced by Sabinet Gateway under licence granted by the Publisher (dated 2012) medical database was taken to Australia.
Athletes were defined as the members of the team engaged in competition and officials were defined as team or athlete coaches, team managers, team technical staff, administration officials, medical staff and National Olympic Committee members.
We used data from patient files and medical and physiotherapy encounter forms to determine the use of the medical services.Data were collected over 26 days, starting when the team arrived in Australia (4 September) until the end of the Olympic Games (30 September).The nature of injury, medical complaint, or treatment was recorded on a specially designed encounter form, at the time of examination or treatment by the examining physician.The datasheets were collected, and retrospective analysis was performed using the encounter forms and patient files.
The term 'injury' was defined as any complaint that required medical diagnosis and management.Acute injury was defined as any new injury that required medical or physiotherapy intervention and was subsequently graded 1,11 or III.Grade I injuries required on-field intervention but the athlete was able to continue competition or training, grade II injuries required that the athlete be removed from participation or training for less than 48 hours, and with grade III injures the athlete was unable to participate in training or competition for more than 48 hours.Chronic injuries were defined as either pre-existing injury or an acute injury requiring ongoing medical evaluation and management.

Olympic preparation programme
Medical and scientific preparation of the team began in 1999 with some members of the potential Olympic squad joining Operation Excellence, the preparation programme of NOCSA.Athletes underwent medical and scientific evaluations both regionally (between January 1999 and March 2000) and at three camps: the first in Cape Town in March 2000, the second in Durban in June 2000 and the third in Johannesburg in September 2000.
The nature and number of evaluations are listed in Table I.
In total over 251 individual medical assessments and screening procedures were conducted between January 1999 and departure for the Olympic games.Over 130 athletes from 15 different codes were assessed during this time.The programme included not only medical but also dietary, physiological, psychological and dental evaluations.

Consultations and treatments during the Olympic Games
Ih total 129 athletes from 12 sports codes and 70 officials travelled to Sydney.Eighteen soccer players and 6 officials left Sydney the day after arriving to play at the various venues around Australia and their medical evaluation data are therefore not included in this report.
Three hundred and forty-eight formal medical consultations were conducted in the 27-day period between 4 and 30 September.Of these consultations 79% (275 consultations) involved athletes and 21% (73 consultations) involved officials.The daily rate of consultations averaged 13 per day.This figure does not include informal consultations by the doctors in the physiotherapy rooms, patients consulted at the fieldside, at the poolside, at the track or at other venues.Furthermore, the rate of daily medical consultations during this period is shown in Fig. 1.It is noted from this figure that there were two distinct periods of increased rates of consultation, namely for 2 days after arrival, and during days 17 through 23.The nature of the main complaints requiring medical consultation is displayed in Fig. 2. Sixty-nine per cent of all consultations resulted from a medical (non-injury) complaint, whilst 31% of all consultations were due to injury.The main medical complaints were respiratory (16%), neurological (16%) and ENT (18%) in nature.Acute and chronic injury accounted for 17% and 14% of consultations respectively.Data detailing acute and chronic injury and the anatomical distribution of the complaint are listed in Tables II and III.
Skeletal muscle strain injuries and ligamentous sprain injuries accounted for 30% and 24% of all acute injuries, whilst contusion injuries constituted 26% of all acute injuries.Lacerations, abrasions and acute tendon injuries accounted for the remainder of the acute injuries.The most common anatomical areas injured acutely were foot and ankle (20%) and wrist and hand (20%).Knee injuries accounted for 14% of injuries and the lower leg 10%.Eighty per cent of the acute

SPORTS MEDICINE DECEMBER 2003
Reproduced by Sabinet Gateway under licence granted by the Publisher (dated 2012) skeletal muscle injuries accounting for 19% of the injuries.Only 6% of chronic injuries were bony injuries.
The most common anatomical sites injured were foot and ankle (31%), shoulder (16%) and knee (16%) whilst lower back pain accounted for 13% of chronic injuries.

Imaging studies and specialist consultations
Fourteen X-rays, 8 soft-tissue high resolution ultrasound investigations, 1 CT scan and 7 MRI scans were performed by the Sydney Olympic Committee for the Olympic Games (SOCOG) medical imaging department for the South African team during the 27-day period.Two orthopaedic opinions were sought and provided by SOCOG clinical services.

Discussion
The medical team in support of Team South Africa for the Sydney 2000 Olympic Games was in a fortunate situation as the majority of the athletes were examined in the regional evaluations and pre-Olympic camps in preparation for the event.Indeed, 251 such medical evaluations were performed in the Operation Excellence programme.This programme provided the South African athletes with the opportunity for medical intervention that is not provided as routine care in the

Fig. 2. Percentage of consultations due to injury or various medical complaints during the Sydney 2000 Olympic Games
injuries were classified as grade I injuries, 14% as grade II, and 6% as grade III injuries.
• 11 The first important finding of this study was there were about 13 formal medical consultations per day during the Olympic Games.This figure is similar to those reported by the medical teams of other countries. 1412Although the total number of consultations was 348 for the duration of the Games, this figure did not include 'informal' consultations that occurred at the fieldside, poolside and trackside.Had these consultations been added the figure might have been far larger.
The second important finding of this study is that the majority of consultations were not due to injury.Indeed, a large percentage of consultations were related to ENT complaints (18% of consultations) and respiratory complaints (16% of consultations).This finding occurred despite a thorough allergy detection and management programme which was instituted 3 months prior to the Olympic Games in response to the high pollen counts which were detected around the Olympic Village in springtime 38 and the finding that nearly 60% of the South African Olympic team had an atopic disposition. 56It is therefore possible that a much higher number of consultations for ENT and respiratory complaints could have occurred had the prevention programme not been instituted.
Although 31% of all consultations were due to sports injury, the vast majority of these were of minor severity.Despite the comprehensive preparation programme, chronic injury accounted for 14% of all consultations of the medical team.Therefore the goal of taking a completely injury-free team to this event was not achieved as chronic injuries were present despite rehabilitation provision for a year prior to the event.This finding supports the role of the travelling biokineticist in the medical team who is able to treat athletes in different phases of rehabilitation during a long competition.
Assessment of the injury and medical statistics allows for good planning when considering the choice of a medical team for a multi-coded sporting event. 12In retrospect the allocation of 3 sports physicians to the 111 athletes and 70 officials on the team was adequate.Thus the ratio of 1 doctor for every 50-60 team members as suggested by the IOC is correct.Due to the profile of consultations depicted in Fig. 2, team physicians should ideally have good skills with respect to both injury diagnosis and management and general sports medicine.Indeed, good skills with respect to ENT, respiratory and neurological aspects of sports medicine are important.With respect to sports injuries, knowledge and skills in the management of mostly soft tissue injury, particularly of the foot and ankle, wrist and hand, and the knee regions are also important.
As noted in Fig. 1, medical staff should anticipate a high number of consultations upon arrival at the destination as many athletes and officials present with signs and symptoms of jet-lag.This is probably only seen in sports events when many time-zones have been crossed during travel to the destination. 9A further peak in the number of consultations is noted as the track and field competition gets underway, and other sport disciplines enter their final phase of competition.
In conclusion, this study describes the medical care provided to the athletes and officials of the South African team to the Olympic Games in Sydney 2000.Injury and illness rates were comparable to those noted in other teams.The analysis of the nature of consultations suggests that it should be a prerequisite for doctors travelling with a team to multi-coded events to have a broad knowledge of both medical and injury management of athletes.Furthermore, a sound knowledge of the management of soft tissue injury, particularly in the hand and wrist and foot and ankle regions is an important prerequisite for the personnel of the medical team.

TABLE I . Medical and physiological services provided to 130 athletes during Operation Excellence prior to Sydney 2000 (N) Services Regional Camp 1- Cape Town Camp 2 - Durban
WS = workshop.