Skinny fashion – a role for sports medicine ?

sport has transcended barriers and unified the nation. Perhaps the most famous example is the Springboks winning the 1995 World Cup, followed by Nelson Mandela handing the trophy to François Pienaar and then the euphoria which swept the country for a short period. Indeed the importance of this moment has been captured in a soon-tobe-released movie, The Human Factor, directed by Clint Eastwood with superstar actors Morgan Freeman and Matt Damon playing Nelson Mandela and Francois Pienaar respectively. Subsequent to the 1995 event there have been episodic examples, prompting Nelson Mandela to make his famous quote: ‘Sport has the power to change the world, to inspire, to unite people in a way that little else can.’ However, just as sport has the power to unite the nation, so it too has the power to divide the nation. Consider the example of Caster Semenya, winner of the 800 m race at the World Athletics Championships in August 2009. The dominant way in which she won the race against the best in the world should have brought another glorious moment to the nation. Instead, information leaked out to the media that the IAAF were conducting a sex test to exclude a rare medical condition which might have given her an unfair advantage over the other female athletes in her race. This leaked report was the catalyst for a range of responses from politicians, commentators, administrators and gender rights activists. Politicians in particular seized the opportunity to launch their inflated egos into the public light, making absurd accusations and in the process further polarising public opinion. It seemed the media were not interested in the views of the expert medical practitioners and scientists, particularly after the president of Athletics South Africa was reported to have said: ‘Let me warn professors and scientists that the only scientists I believe in are the parents of this child. One scientist from a stupid university somewhere is going to erase the entire life of this girl.’ (www. Sport24.co.za, 2009-08-25).

Statements are often made about 'identifying talent' as a means of addressing the imbalances in the demographics of the players in the top representative teams.Politicians in particular make innuendos about coaches and administrators being selectively biased in their choice of certain players, at the exclusion of other players, hence slowing down transformation.
However, what they fail to consider when making these statements is that a coach depends on a winning team for the longevity of his job.Therefore it is disingenuous to think that a coach will place his or her job in jeopardy by not selecting the best players who can contribute to a winning team.Attributing the lack of transformation to the coaches and administrators is simply a cunning way of taking the focus off the real source of the problem.The real source of the problem has a wider context than merely being the bias of coaches and administrators.The real source of the problem can be attributed directly to the inequities that exist from childhood in different regions of the country.
Preparation begins at preschool, where the child should have access to healthy adequate nutrition and an opportunity to develop fundamental motor skills.If these basic conditions are not provided the child encounters a hurdle which persists through to adulthood.The talented sports stars who represent our nation do so because they have well-refined skills and have had the opportunity from a very early age to develop and sharpen their skills.The development of motor skills is sequential -if any layer of development is incomplete, the next layer will be affected.There are windows of opportunity in which skills are developed, and if these opportunities are bypassed, the chances of developing them at a later stage are limited.A recent study of the fitness of South African children has shown that children from poorer areas under-perform in tasks of physical performance compared with children from more affluent areas.
1 The differences can be attributed to the smaller size of the children from poor areas as well as underdeveloped motor skills.In this particular study the differences skills were noticeable in grade 1.
The most important training ground for skill development occurs at school.Until such time as all the schools have similar facilities and opportunities to participate in physical activity, our children will always have a range of developed skills which will persist through to adulthood.Suffice to say, it is highly unlikely a talented child coming from a deprived background will ever be able to compete equally with a talented child who has had an opportunity to develop his or her talent fully.There are many studies which demonstrate this.
To excel in high-level sport it is essential to implement a longterm athlete development programme.
2 This type of programme considers and caters for the unfolding need to develop skill.A wellconstructed long-term athlete development programme reduces the advantages that early maturation might have, 3 and results in a much larger pool of talented adult players from which the national team can be selected.Surely it is time that the political decision-makers faced the facts and addressed the problem of lack of transformation on the sports field by focusing attention on schools and ensuring that facilities in the poor schools are upgraded to match the facilities in the schools from more affluent areas.Failure to do so will ensure that the situation we currently have will persist into the next generation.Shifting the attention and blame to the coach and sporting federation is a cheap shot which exposes their ignorance and lack of understanding of the principles of talent development.
Sustainable changes are beyond the influence of the sporting federations, and remain firmly with the government, in particular the Departments of Education, Sport and Health.If the long-term athlete development model was understood and embraced by these departments, the concern of having national teams which do not represent the demographics of the general population will be a thing of the past.
This brings us to the contents of this edition of the journal.The concept of the long-term athlete development model is discussed with reference to rugby.The procedures adopted in South Africa are compared with the procedures of Australia and New Zealand.In addition the abstracts and posters presented at the 4th Clinical Sports Medicine Conference -Injury Preven tion and Protection of the Health of the Athlete, 13 -15 Oc tober 2010, Cape Town, are published in this edition.This edition also includes a paper which shows that the elite athletes drink much less than the recommendations suggest.Apart from making this finding this study also shows how important questions can be answered by substituting a large budget with a creative research plan.There is also a practical evidenced-based article on pre-participation screening for rugby players ('BokSmart: Pre-participation screening of rugby players by coaches based on internationally accepted medical standards').This paper was one of the papers commissioned by BokSmart.More excellent practical papers on injury prevention, rehabilitation and training for rugby can be found at www.boksmart.com.
Finally, Dr Maaki Ramagole co-ordinated the development of the SASMA position statement on managing athletes with disorders of sexual development (DSD).This document will serve as a guideline for managing disorders of sexual development in future and will avoid a repetition of the unpleasant situation we experienced last year.There are many interesting articles in this edition -we hope you enjoy the read!

Mike Lambert
Editor-in-Chief

Lack of transformation in sport and the long-term athlete development programme
A topic which is receiving much publicity as I write is the banning of 5 skinny models from participating in the Madrid fashion week.Madrid's regional government imposed the rules 'to protect the models as well as teenagers who may develop anorexia as they try to copy underweight catwalk stars'. 1 They used a body mass index of 18 as their cutoff value.The 'anti-thin' move has been criticised in Paris and New York, two of the world's leading fashion centres.However, in Italy the move was supported by the mayor who intimated that she would like to apply the same rulings when the fashion show moves to Milan.
The motive for imposing the ban is noble, as the 'skinny trend' is not showing signs of abating.A recent report by the British Medical Association identifies a link between the images of 'abnormally thin' models that dominate television and magazines, and the increase in cases of anorexia nervosa and bulimia.
2 The incidence of anorexia is at an all-time high with predictions of 0 -5% of all females having eating disorders.While eating disorders were previously usually regarded as a female syndrome, the situation is changing with a steady increase in the number of men being diagnosed with eating disorders.A recent estimate predicts that of the 60 000 people with eating disorders in the UK, 10% are male.
2 This trend can most likely be explained by the contemporary lean, hungry look of male stars.To get a snapshot view of changing body beautiful images of different eras one only has to compare the 'hunks' of the 1960's movies (i.e.Sean Connery as James Bond) to modern day hunks to see how the masculine image has changed.Marilyn Monroe, with her curvy body shape in the 1950s would probably be regarded as too fat for a leading role 50 years later.
While the organisers of the fashion shows should be complimented for taking a bold stand against their skinny, unhealthy-looking models, they can be criticised for the way in which they have gone about it.Using a body mass index of 18 as a cut-off value is inappropriate and may penalise some models who live normal healthy lives.Instead of this approach the organisers should establish a structure that evaluates the health status of the models including their eating, sleeping and substance abuse habits and make decisions accordingly.The information on how to do this is available; it just needs to be applied.This third issue of the journal for 2006 has 4 interesting papers.The first paper by Professor Mars and colleagues examines the cooling of skin, subcutaneous fat and muscle with an icepack, at rest and after short-duration exhaustive exercise.This study produced some interesting results with important clinical applications.The next paper by Ian Cook examines the accuracy of different types of pedometers.It is well known that people who use pedometers are encouraged to be more physically active, so therefore there is great value in making pedometers available to the general public.However, the enthusiasm to make and distribute pedometers has exceeded the concern about their accuracy.This study addresses this point with a comprehensive research design.The results make a valuable contribution to the literature.
The third paper, by Dr McHardy and colleagues from Macquarie Injury Management Group, Macquarie University, Sydney, Australia, is a clinician's perspective of the modern and classic golf swing.This paper is relevant to sports physicians, biokineticists and physiotherapists and provides a clear analysis of the different types of golf swing and their possible link to injury, particularly lower back pain.
Finally the paper by Dr Draper and her colleagues describes the state of the fitness industry in South Africa.This comprehensive study gathered data from 442 facilities around the country.The data provide an important benchmark for the state of the industry and will make a significant contribution to the development of perceived weaknesses in the industry.

Mike Lambert
Editor-in-Chief