South African Journal of Sports Medicine <p>The&nbsp;<em>South African Journal of Sports Medicine (</em>S. Afr. j. sports med)&nbsp;is a peer-reviewed journal that publishes original research articles, reviews, commentaries, letters and case studies on topics related to the disciplines represented by the <a href="" target="_blank" rel="noopener">South African Sports Medicine Association</a>. One volume is published a year with articles added as they are ready for publication.&nbsp;These disciplines include sports medicine, biokinetics, physiotherapy, exercise and sports science, dietetics and psychology. Material that is particularly unique and relevant to South Africa and its inhabitants are given preference; however, any other material of general interest and relevance will also be considered.</p> <p>&nbsp;</p> South African Sports Medicine Association en-US South African Journal of Sports Medicine 1015-5163 <p>The South African Journal of Sports Medicine reserves copyright of the material published. The work is licensed under a <a href="" target="_blank" rel="noopener">Creative Commons Attribution 4.0 (CC BY 4.0) International</a> License. Material submitted for publication in theÂ&nbsp;South African Journal of Sports Medicine is accepted provided it has not been published elsewhere. TheÂ&nbsp;South African Journal of Sports Medicine does not hold itself responsible for statements made by the authors.</p> The transition of the South African Journal of Sports Medicine <p>.</p> M Lambert ##submission.copyrightStatement## 2018-03-26 2018-03-26 30 1 1 1 Injury and illness profiles during the 2014 South African Ironman triathlon <p>&nbsp;</p> <p><span class="Apple-converted-space">&nbsp;</span><strong>Background: </strong>There is a need for ongoing scrutiny of injury and illness profiles of ultra-distance athletes. This study aimed to record the medical history, illness and injuries of athletes receiving medical attention during the 2014 Ironman South Africa (IMSA) triathlon, and to investigate the temporal presentation of medical encounters.<span class="Apple-converted-space">&nbsp;</span></p> <p><strong>Methods: </strong>This was a retrospective, cross-sectional study. All athletes who required medical attention at the main medical tent and all of the medical posts or mobile units along the route were included in this study A total of 2 331 athletes started the race. Data included age, gender, time and stage of the race when medical attention was required, pre-race medical history and medication use, illness and injuries treated, special investigations performed, and weather conditions.<span class="Apple-converted-space">&nbsp;</span></p> <p><strong>Results: </strong>Overall, 179 athletes (7.7%) required medical attention. The incidence of medical encounters was 7.8%. A significantly higher percentage of younger participants encountered medical problems (<em>P </em>= 0.04). Most patient encounters (80.1%) occurred after the race. The median duration of treatment was 26 minutes. Medication was used by 35.1% of patients during the race. The most common medical encounters were exertion-related (71.2%), gastro-intestinal (16.4%), dermatological (11.9%), musculoskeletal (9.6%) and cardiorespiratory conditions (2.4%).<span class="Apple-converted-space">&nbsp;</span></p> <p><strong>Conclusion: </strong>Medical encounters occurred more frequently in later stages of the race. Most medical conditions were exertion-related. Potential higher risk may be associated with medication use, recent illness, and in younger participants. Temporal stacking of medical personnel, planning of resources according to expected conditions, preventative measures for high-risk behaviour, and on-going data collection with comparable methodology are recommended.<span class="Apple-converted-space">&nbsp;</span></p> L Holtzhausen ##submission.copyrightStatement## 2018-03-26 2018-03-26 30 1 1 6 Concussion knowledge and attitudes amongst Stellenbosch University hostel rugby players <p>&nbsp;</p> <p><span class="Apple-converted-space">&nbsp;</span><strong>Background: </strong>Concussion occurs more frequently in contact sports, such as rugby, and is furthermore not fully recognised during play. It is also underreported in the literature, to medical personnel, or to coaches.<span class="Apple-converted-space">&nbsp;</span></p> <p><strong>Objectives: </strong>The objective of this study was to describe the knowledge about and attitudes towards concussion by Stellenbosch University hostel rugby players.<span class="Apple-converted-space">&nbsp;</span></p> <p><strong>Methods: </strong>The study focussed on gathering quantitative information through implementing a cross-sectional study design. One hundred and eighty Stellenbosch University hostel rugby players completed the modified Rosenbaum Concussion Knowledge and Attitudes Survey - Student Version (RoCKAS-ST). The RoCKAS-ST questionnaire is divided into three parts, namely, the evaluation of the Concussion Knowledge Index (CKI) and Concussion Attitudes Index (CAI), and a 16-symptom checklist.<span class="Apple-converted-space">&nbsp;</span></p> <p><strong>Results: </strong>The participants scored on average 75% in the CKI and 81% in the CAI. The correlation between CKI and CAI was r=0.14 which is considered a weak positive correlation.<span class="Apple-converted-space">&nbsp;</span></p> <p><strong>Discussion: </strong>The participants demonstrated sufficient knowledge of concussion and thus a safer attitude towards concussion. There were some concerning factors from the knowledge of the concussion questions and the symptoms that may have an effect on attitudes towards concussion.<span class="Apple-converted-space">&nbsp;</span></p> <p><strong>Conclusion: </strong>The study revealed that Stellenbosch University hostel rugby players have sufficient knowledge of what constitutes concussion, as well as the necessity of having safe attitude towards it. However, a small number of participants showed that they still may lack knowledge in certain areas concerning concussion.<span class="Apple-converted-space">&nbsp;</span></p> W Kraak ##submission.copyrightStatement## 2018-03-26 2018-03-26 30 1 1 5 A cross-sectional study of 2550 amateur cyclists shows lack of knowledge regarding relevant sports nutrition guidelines <p>&nbsp;</p> <p><span class="Apple-converted-space">&nbsp;</span><strong>Background: </strong>Amateur cyclists use a wide variety of supplements and nutritional substances to increase performance in addition to their training.<span class="Apple-converted-space">&nbsp;</span></p> <p><strong>Objectives: </strong>The intended nutritional supplement use, carbohydrate (CHO) use and hydration practices of amateur cyclists before, during and after endurance cycling were analysed. Evidence of ignorance regarding the use of sports supplements and CHO, as well as the disregard of hydration strategy was hypothesised.<span class="Apple-converted-space">&nbsp;</span></p> <p><strong>Methods: </strong>Amateur cyclists, of all age and sex groups, were requested to complete an online survey anonymously on the 2013 Momentum 94.7 Cycle Challenge website, a few days before the event.<span class="Apple-converted-space">&nbsp;</span></p> <p><strong>Results: </strong>Responses were received from 2 550 out of 30 640 race entrants (8%); representing a distribution of 75% males, 25% females, with the majority between 25 to 45 years old. Nutritional supplements were used by 59% of respondents, with 77% dose adherence, and 29% with supplement ingredient knowledge. Half of the respondents (48%) planned to carbo-load two-three days before the event, while only five percent used professional advice to scientifically calculate their carbo-loading requirements. CHO were consumed by 81% during the event. Hydration preferences during the race were sports drinks (59%) and water (22%); and after the race 45% preferred a sports drink and 40% water. Ingredients, taste, colour, and temperature were criteria used to choose a sports drink. Only 18% of respondents knew to use both colour of urine and thirstiness to determine post-race fluid requirements.<span class="Apple-converted-space">&nbsp;</span></p> <p><strong>Conclusion: </strong>The authors concluded that amateur cyclists had insufficient knowledge regarding nutritional supplement ingredients and usage, CHO requirements and carbo-loading practices, and hydration strategies before, during and after the event.<span class="Apple-converted-space">&nbsp;</span></p> D C Janse van Rensburg ##submission.copyrightStatement## 2018-03-26 2018-03-26 30 1 1 6 Stress fracture of the thoracic spine in a male rugby player: a case report <p>This case reports a stress fracture of the thoracic spine in a professional rugby player. This is a rare anatomical location for this type of injury in this population and has not previously been described. Physicians should be aware that performance of rugby specific movements may lead to rare stress fractures in certain anatomic locations.</p> A Shafik ##submission.copyrightStatement## 2018-07-02 2018-07-02 30 1 1 2 10.17159/4592 The determinants of overweight/obesity and blood pressure in rural South African women living in the Tshino Nesengani (Mukondeleli) village <p><strong>Background: </strong>The purpose of this cross-sectional study was to investigate whether bio-behavioural factors are associated with blood pressure and body composition in rural black South African women.</p> <p><strong>Methods: </strong>Data were collected on 200 African women living in the Tshino Nesengani (Mukondeleli) village, Limpopo Province using simple anthropometry, blood pressure, and validated self-reported questionnaires for sleep, physical activity, and sugar sweetened beverage (SSB) consumption.</p> <p><strong>Results: </strong>Six patterns of SSB consumption were determined by principal component analysis. Regression analysis showed that longer sleep duration (?9 hours/night) was associated with lower systolic and diastolic blood pressures; whilst principal component 2 (beer, wine, and sweetened tea) was associated with higher body mass index.</p> <p><strong>Conclusions: </strong>These findings highlight novel bio-behavioural contributors of blood pressure and body anthropometry in rural African women.</p> P Gradidge Phaswana Merling Emmanuel Cohen ##submission.copyrightStatement## 2018-08-02 2018-08-02 30 1 1 5 10.17159/5066 Anterior Cruciate ligament injuries of the knee: <p><strong><u>Abstract</u></strong></p> <p><strong><em>Background and problem statement</em></strong></p> <p>Anterior cruciate ligament injuries are common among athletes and the general public. These injuries may lead to significant absence from activity with an associated financial and social burden. No definitive association has been described between mechanism of injury and pathology to enable us to put preventative measures in place in order to limit these injuries.</p> <p><strong><em>Aim</em></strong></p> <p>To determine whether there is an association between the mechanism of injury and the pathology seen on a magnetic resonance imaging (MRI) scan in anterior cruciate ligament (ACL) injuries.</p> <p><strong><em>Methods</em></strong></p> <p>This was a cross-sectional analytical study. Eighty seven male patients with an ACL injury, who had an MRI scan of the knee within the last two years participated in this study. Participants were contacted to give consent that their information be used in this study. The mechanism of injury and the pathology seen on the MRI scan was noted and categorised into different mechanism of injury groups and associated pathology groups. Statistical analyses included summaries of the data and a test for association between mechanism of injury and pathology. Since there were multiple pathology responses to each mechanism, a modified version of the chi-square test for independence was used. A 5% level of significance was specified.</p> <p><strong><em>Results</em></strong></p> <p>MRI scans of ACL injuries indicated that the mechanism of a solid foot plant with rotation of the knee has a greater tendency to be associated with medial meniscal injuries (77%), and also a 54% possibility to be associated with lateral meniscal injuries. A solid foot plant with a valgus stress on the knee showed a higher incidence of associated medial collateral ligaments (MCL) injuries (41%) and femoral bone bruising (62 %). These two mechanisms of injury are the most common in ACL injuries and contribute to the clinical significance found in this study. The p-value was however not statistically significant (p=0.44, chi-square value=20.27, df=45) for any association between pathology and mechanism of injury.</p> <p><strong><em>Conclusion</em></strong></p> <p>Some injury mechanisms causing ACL injury were more common than others and also had more associated pathology. The most common mechanism of injury noted is a solid foot plant with either rotation of the knee or valgus stress on the knee. Strengthening tissue structures involved in those movement patterns that cause these mechanisms can possibly limit ACL injuries in athletes and the general public.</p> <p>&nbsp;<strong><em>Key words</em></strong></p> <p>Anterior cruciate ligament injury, mechanism, association, pathology, MRI scan, prevention.</p> G Linde Strauss ##submission.copyrightStatement## 2018-09-10 2018-09-10 30 1 1 6 10.17159/5265 The impact of anterior knee pain on the quality of life among runners in Ekurhuleni, Gauteng <p><strong>Background: </strong>Anterior knee pain (AKP) is the most common injury among runners and has a negative impact on the quality of life (QOL) of many athletes. <strong>Objective:</strong> To determine the impact of anterior knee pain on the QOL among runners in Ekurhuleni, Gauteng. <strong>Materials &amp; methods: </strong>A cross–sectional study design was used. A population of 73 runners with AKP were included. Participants included runners aged 13 to 55-year-old. The SF-36 questionnaire was used to collect data. Ethical clearance, permission from club managers and consent from participants were obtained. Data were collected over six weeks and analysed using SPSS. Descriptive statistics included frequencies, means, standard deviations and ranges. Inferential statistics included Spearman's correlation calculation. <strong>Results: </strong>The lowest QOL scores were found among: role functioning/physical (62), role functioning/emotional (59), energy/fatigue (59), emotional well-being (68) and pain scales (63). Males, youth and runners with least experience presented with lowest scores. Significant correlation was found between: role functioning/physical and experience (<em>p</em> =.030; <em>r<sub>s</sub></em> =-.221), role functioning/emotional and gender (<em>p</em> =.017; <em>r<sub>s</sub></em> =-.247) and race (<em>p</em> =.012; <em>r<sub>s</sub></em> =-.265), general health and experience (<em>p</em> =.021; <em>r<sub>s</sub></em> =-.239), energy/fatigue and race (<em>p</em> =.012; <em>r<sub>s</sub></em> =.264), emotional well-being and age (<em>p</em> =.020; <em>r<sub>s</sub></em> =.241), general health and gender (<em>p</em> =.013; <em>r<sub>s</sub></em> =.456), social functioning and age (<em>p</em> =.010; <em>r<sub>s</sub></em> =.271) and energy/fatigue and experience (<em>p</em> =.001; <em>r<sub>s</sub></em> =-.371). <strong>Discussion &amp; Conclusion:</strong> This study highlights the need to improve QOL among running population with AKP. Multidimensional rehabilitation programmes are recommended.&nbsp;</p> <p>Key words: anterior knee pain, quality of life, runners</p> S Kunene ##submission.copyrightStatement## 2018-09-18 2018-09-18 30 1 1 6 10.17159/4947 Preventing the seemingly unpreventable – challenging the return-to-play criteria for recurrent hamstring strain prevention <p>&nbsp;</p> <p>&nbsp;<strong>Background: </strong>Hamstring strains are one of the most common injuries in sport. Previous injury has been found to be one of the greatest risk factors associated with recurrent hamstring strains. Although rehabilitation programmes have been developed and implemented to aid safe and efficient return-to-play, the incidence of hamstring injuries has not decreased.&nbsp;</p> <p><strong>Discussion: </strong>As hamstring strains most commonly occur during the eccentric phase of muscle action, rehabilitation should focus on eccentric muscle strengthening. The L-protocol and the Nordic Hamstring Exercise protocol strengthen the hamstring muscles eccentrically. They have been found to be effective in decreasing the incidence of new hamstring strains as well as the rate of recurrence. This commentary therefore aims to suggest changes to the return-to-play criteria following hamstring strains to prevent the seemingly unpreventable.</p> N Craddock ##submission.copyrightStatement## 2018-03-26 2018-03-26 30 1 1 2 Building a robust athlete in the South African high school system <p>In the modern era of school sport, schools are faced with important decisions on how best to structure their programs to fit in the growing number of tournaments into the schools sports calendars. Furthermore, school sport has taken on a more professional and competitive feel, with the possibility of winning cash prizes as well as the live TV coverage of various tournaments it is plausible to believe that the pressure on coaches to win at this level has increased when compared to 10 years back.The intention of this article is not to disparage the South African school sport system but rather to create an understanding of best practice when considering high school athletes. As it has been the authors experience through working with numerous highs school athletes and presenting to various schools and educators on this topic that the current system or lack thereof is possibly not athlete-centered which may be detrimental to their development down the line<span style="font-size: 8.33333px;">.</span></p> W Lombard ##submission.copyrightStatement## 2018-07-06 2018-07-06 30 1 1 3 10.17159/2933 Neurologist at ringside-to be or not to be? <p><strong>Background:</strong> Ringside physicians are entrusted with the task of protecting the health and safety of combat sports (boxing and mixed martial arts) athletes. Ringside physicians come from various disciplines of medicine such as primary care, Internal Medicine, orthopaedics, sports medicine and even otolaryngology. There are very few neurologists who work as ringside physicians.</p> <p><strong>Discussion:</strong> Boxing and MMA are highly controversial sports for neurologists to be involved in for in these sports every punch and kick to the head is thrown with the intention of knocking the opponent out. Every punch and kick to the head is thrown with the intention to win via causing a concussion. Many neurologists thus feel it is unethical to support boxing by working as a ringside physician.</p> <p><strong>Conclusion</strong>: Boxing and MMA are universally thought to be detrimental to the brain and nearly all medical associations at various times have made calls to ban boxing and MMA altogether. While medical associations and physicians including neurologists may not support boxing or MMA, the presence of a neurologist ringside or cageside helps make these sports safer by protecting the health and safety of a combat sports athlete.</p> N Sethi ##submission.copyrightStatement## 2018-07-27 2018-07-27 30 1 1 2 10.17159/4255 Sacroiliac tuberculosis masquerading as mechanical lower back pain in a collegiate basketball athlete: a case presentation <p><strong>Background:</strong>Sacroiliac tuberculosis is a rare condition for which early diagnosis and effective management frequently proves challenging. This report describes a case that was initially overlooked due to its presentation and unreported constitutional symptoms.</p> <p><strong>Aim:</strong>To alert clinicians about skeletal tuberculosis, an often neglected diagnostic differential, which requires a high index of clinical suspicion, especially for patients from endemic areas.</p> <p><strong>Findings:</strong>This patient’s presentation (sports injury) and unreported constitutional symptoms resulted in a delay in the diagnosis and initial institution of treatment.</p> <p><strong>Implications:</strong>This report illustrates the importance of specifically asking about constitutional symptoms, even in sports injury settings and being mindful of infectious diseases or other chronic medical conditions, which may masquerade as common sports injuries.</p> M Moyaert ##submission.copyrightStatement## 2018-03-26 2018-03-26 30 1 1 3