Sports medicine

Participation in sports can strengthen the body's cardiovascular system, improve stamina, and provide a sense of physical well-being. However, sports canalso result in injury. Sports medicine concerns itself with preparing athletes to compete at an optimal level while avoiding injury, and with managing anyinjuries that do occur. Sports medicine practitioners can be both physiciansand paramedical staff. In some cases, they are involved in developing helmets and other protective gear for athletes.

One of the earliest practitioners of sports medicine was the Greek physicianHerodicus, who developed therapeutic diets and exercise regimes for athletesin the 5th century B.C. The first team physician was Galen, who in 157 trained and treated gladiators competing in public games. Despite these early examples, sports medicine did not come into its own until the 20thcentury. The first textbook on the subject was published in 1910, and the term "sports medicine" was coined in 1928, when 33 team physicians attending theWinter Olympics in St. Moritz, Switzerland, met to establish the International Assembly on Sports Medicine. The practice of "doping"--trying to improve performance with drugs or other substances--was first reported in 1939, and the use of anabolic steroids to improve muscle mass and performance was first reported among Russian athletes in 1954. Athletes from numerous other nationsquickly adopted the practice. The sports drink Gatorade was first used in 1965, in a test on the University of Florida football team, which achieved a winning season.

Performance in many sports has improved dramatically during the 20th century;however, the extent to which sports medicine has contributed to those improvements is subject to debate. In many cases, improved techniques and trainingmethods were developed by the athletes themselves, with physiologists and other experts studying the developments after the fact. However, some improvements are directly attributable to sports medicine, including the benefits of carbohydrate-rich diets and proper fluid balance, which were discovered in basic research during the 1930s and 1940s.

Roger Bannister, the first human to run a sub-four-minute mile, was a medicalstudent who studied the mechanics of running and developed a scientific training program. Bannister nonetheless seriously underestimated the capabilitiesof the human body. He believed that breaking the four-minute barrier would consume an athlete's oxygen reserve several yards before the finish line, andthat he would have to complete the race in a semiconscious state. However, when Sebastian Coe ran the same distance in 3:49 in 1979, he was described as looking "almost relaxed" and "hardly gasping." It is clear that the barriers to improved athletic performance are sometimes psychological.

Some of the principal advances made by sports medicine have been in the treatment of acute sports injuries. For example, techniques developed to treat shoulder problems including dislocations and problems with the rotator cuff andacromioclavicular joint proved so successful in athletes that they are now employed in mainstream medical practice.

Some injuries result from overuse and can be prevented by adjusting the athlete's training schedule or correcting bad technique. If no changes are made, permanent injury may follow, forcing retirement from the activity. Sometimes,rule changes can help. For example, junior baseball players in the United States may now make only a limited number of pitches per season, to prevent an overuse condition known as "Little Leaguer's elbow."

In recent years, there has been considerable interest in a variety of performance "enhancers" said to make athletes stronger, bigger, or faster.

Anabolic steroids, now disallowed in many sports, have been used by weight lifters and track-and-field athletes. They are similar to the natural hormone testosterone and can increase the size and strength of muscles. However, steroids also have serious side effects including heart disease, liver cancer or other liver damage, which far exceed any benefits obtained. It is worthwhile to observe that world records in the shot put were relatively stagnant duringthe late 1960s and 1970s, a period when many shot putters are believed to have used steroids. Similarly, growth hormone is believed both ineffective and dangerous, and is not permitted in many sports.

In 1999, Mark McGwire of the St. Louis Cardinals hit a record 70 home runs while using the supplements androstenedione and creatine. However, research results reported that same year found that androstenedione did not increase strength, but might instead promote heart disease, cancer, and enlarged breasts.Studies of athletes taking creatine have been inconclusive; some show minor improvements, others a detrimental effect. Long-term effects of the supplementare unknown.

Other so-called "enhancers" considered ineffective include ginseng, amino acids, coenzyme Q10, protein, and chromium picolinate.

One substance that may actually work is caffeine. Two cups of coffee taken before exercise has been shown to improve endurance. This effect does not occurduring hot weather, and caffeine can be dangerous to persons who have heartdisease.

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