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 1000 Systematic teachings of exercise therapy
BC)
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 century Described treatment of ankle sprains and
AD) boxing wounds
First rowing regatta (Venice 300 AD) Birth of the ‘sacred’ boat race (later
cherished and idealized at Eton)
Avicenna (979-1037 AD), father of Relevant writings during post-crusade
Islamic Medicine period
First cricket game (UK, 1250)
Bergerius (1370 - 1440)
Geronimo Mercuriali (1530- 1606)
Benjamin Franklin (1706-90)
First Rugby Union game (Rugby School,
1823)
Oxford-Cambridge Boat Race (1829)
Edward Hitchcock MD (1854)
John Morgan’s paper on longevity of old
oarsmen (mid 19th century)
Modern Olympic Games (1896)
Death of Lazaro, a Portuguese runner,
from heat stroke after Stockholm
marathon (1912)
Paris Olympic Games (1924)
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)
Regular exercises for children
First illustrated book on sports medicine
Recommended resistance exercises
America’s first college team physician
Benefits of exercise scrutinized
Greek doctors in attendance at marathon
Physical exams subsequently required
for marathoners
First US team doctor in attendance
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)
 Today sports medicine has evolved into a respected discipline with dedicated associations, colleges,
institutes and literature in most countries.

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