Fluid Intake in Ultra-runners can affect the fittest too

SO marathon runners are actually at risk at the carefully placed water stations? 


Exercised-Associated Hyponatremia affects marathon runners, particularly those finishing in over 4 hours.


What about the fittest of our runners-the Ultrarunners?

Increased fluid intake can also lead to foot swelling, as demonstrated in the paper by Cejka et al in the Journal of International Society of Sports Nutrition (see JSSN 2012 paper ). This was shown in ultra runners, and the measurement of swelling was determined by plethysmography-the use of Plexiglas® vessel with the internal dimensions of 386 mm length and 234 mm width with markings in millimetres on the external surface. These dimensions were chosen so that any foot size of a male runner would fit in the vessel. 


Other markers such as haematocrit, urine specific gravity, urine and body mass. The numbers tested were a respectable seventy-six, and all were 100km plus ultra marathon runners. 


After one such race, the ‘100 km Lauf Biel’ (www.100km.ch) in Biel, Switzerland, foot swelling was demonstrated, and the authors concluded that this was as a direct result of increased fluid intake during the race. 


In case of fluid overload leading to an increase in the feet volume, the authors had hypothesized that there would be an association between changes in plasma [Na+] and the feet volume and a higher prevalence of exercise-associated hyponatraemia or EAH: in accordance with our hypothesis, fluid intake was related to the change in feet volume, and we found an association between the change in plasma [Na+] and the change in the feet volume. 


In addition, four subjects (5.3%) developed asymptomatic exercise-associated hyponatremia (EAH) with plasma [Na+] between 132 and 134 mmol/L.


The most important finding in this study was that fluid intake was significantly and positively related to the change in the foot volume, where an increased fluid intake was leading to an increased volume of the foot. Both the change in the foot volume and fluid intake were significantly and negatively related to running speed. Faster runners were drinking less during the race, and their foot volume tended to decrease.



The conclusions therefore are stark for the slower runners in the field: slower running speed was associated with an increase in the foot volume and the change in foot volume was negatively correlated to the change in plasma [Na+]. 


Therefore, fluid overload occurred in slower runners and was responsible for the development of oedemas in the foot. In addition, post-race plasma [Na+] decreased in those runners. 


The data supports the finding that fluid overload is the main risk factor for developing EAH, albeit in this one race all were without symptoms. The outcome is not the same in all cases.

Water Stations in the Marathon-how much is too much fluid?

Marathon season: London this weekend, Edinburgh next month. 
Many more take place in Europe & North America over the next few months as the temperatures increase.
So it makes sense to be hydrated? But how much is too much of that good thing-water?

Despite years of advice to the contrary, it appears that thirst may, after all, be the key indicator as to when runners should take fluids on board: including the International Marathon Medical Directors Association (IMMDA).


Ross Tucker, exercise physiologist & consultant scientist to the Sport Science Institute of South Africa states that the thirst mechanism is controlled primarily by the sodium level in the blood. With almost half of runners drinking to a preset schedule or consuming as much as possible according to Loyola Chicago University research (Winger, Dugas & Dugas Br J Sports Med. 2011 Jun;45(8):646-9. Epub 2010 Sep 28), it would appear that this advice to listen to the body is falling partly on deaf or misguided ears.


But does this potential excess fluid lead to impaired performance, or real danger?


in 2002, the Boston marathon was exposed as having 13% of its runners may have suffered from hyponatraemia, a condition where over-hydration dilutes the sodium levels, and in serious cases this leads to brain swelling, seizures and life-threatening complications-or worse as four female runners have died of this condition after participating in marathons. This was not hearsay-it was published data in the New England Journal of Medicine of April 2003!

However the cases of runners overdoing the water on marathons had actually been documented firstly in 1985 by Dr Tim Noakes, whom published  "Water Intoxication: A Possible Complication During Endurance Exercise Med Sci Sports Exerc. 1985 Jun;17(3):370-5 ." in which he and his co-authors  Goodwin, Rayner, Branken & Taylor wrote that the condition appears to be caused "by voluntary hyperhydration." 


In 2001, Dr. Noakes was invited by the International Marathon Medical Directors Association to write an "Advisory Statement on Fluid Replacement During Marathon Running" . In the paper, he recommended that marathoners drink 400 to 800 milliliters/hour (13.5 to 27 fluid ounces). 


Dr. Noakes's advice touched off a firestorm, as it was basically 50 percent lower than the widely quoted recommendations of the American College of Sports Medicine, the National Association of Athletic Trainers, and other sports medicine groups, which have generally advised endurance athletes to drink 600 to 1200 ml/hour (20 to 40 ounces).


Chris Almond MD was the main author of the NJEM article in 2003, and his conclusions noted that out of 488 runners, 63 werre clinically hyponatramic after the race. 
His team also identified three triggers:  

• 1) weight gain during the marathon from excessive fluid consumption
• 2) a finishing time slower than four hours
• 3) very small or very large body size

Of these, the first was the most important. "The strongest single predictor of hyponatremia was considerable weight gain during the race," the study concluded. 


Another significant finding: A sports drink doesn't protect you from hyponatremia.

 "In our subjects, we didn't find that consuming sports drinks was any different than consuming water," Dr. Almond said. "Sports drinks are mostly water themselves, and contain only small amounts of sodium." This is backed up still further by Tucker. He states that 


"The sodium content of a sports drink helps attenuate the drop in blood sodium levels, but not by much. People who drink too much could probably get away with drinking 1.4 litre/hour of sports drink, but only 1.2 litre/hour of water. But it's a moot point - the root cause is still overdrinking, and that's what should be avoided."


The American College of Sports' Medicine Guidelines were updated in 2007, and they do not recommend any specific volumes of fluid, and certainly not taking on as much fluid as is possible. They do still adhere to the oft-quoted definition of 'excessive dehydration' as being greater than 2% body weight loss from water deficit-despite the evdence not always showing this as the threshold for problems.


Yet some athletes appear to tolerate these levels of dehydration better than other, and often the athletes at the front in marathon races will lose 3-4 kilograms according to Ross Tucker. 


He suggests that the athletes who"lose the most fluid are often the winners – which makes sense because they're running the fastest, and hence have the highest sweat rate. And when you are running along at 3 min/km, you don't have the time to drink all that much either- you'll see they sip water or sports drink every few kilometres, but that's it. There's none of this 'one litre per hour' doctrine that others are following."


Some form of predictive monitoring may be of some benefit, such as weighing-in prior to runs in advance to establish some form of predicted losses due to fluid. This form of 'customised sweat-test' is however, oversimplified, and also too dependent upon environmental onditions which may differ completely from race conditions.


NOW  when we live in an age when runners keep right on to the end of the road for their charity or friends & family, they do so increasing the risks the longer they take-if they keep taking the fluids.

Four Games, Seven Flights: how could that affect the brain after concussion?

Carey Price is a professional Ice Hockey Goalkeeper.
He spent part of last month experiencing headaches. 

They didn't go away.


His Montreal Canadiens Team Doctor then announced he would be unavailable for the last three remaining matches of the season since he had been diagnosed with mild concussion.


The Club Press Release of April 4th then suggested that Price had been injured in a collision with David Desharnais during a drill on March 20th.

It is since this date that the headaches started, and since that date that Price has played four professional games. He has also flown seven times. How do those match up with a concussive event with ongoing symptoms? What effect can they have on the brain & the player's health?

The local newspaper, the Montreal Gazette filed a story about how it was up to players to be honest about concussive events.


http://www.faceoff.com/hockey/teams/montreal-canadiens/players+honest+about+concussions/6412404/story.html

The paper's assertion is that there was a delay between the initial contact and Price’s decision to tell the team’s medical staff that he was still having headaches. 


These were not reducing in intensity or duration or frequency indicates the National Hockey League’s program to identify and treat concussions simply will not work if the players don’t recognize the fact they are injured. Or if they don't actually inform the staff whom may be able to assist in the decision making process for the good of the player and the team. Oh, and the sport?

For certain in professional sport, there is the reality that players hate being injured, hate being out of the team lineups and hate missing matches. The result is a macho culture that sees players attempting to hide injuries.

Mathieu Darche

The Gazette also raises the issue of Mathieu Darche, whom they suggest is as bright a player as you’ll find in pro hockey. He experienced headaches for a week before he sought medical attention, then was diagnosed with inner-ear infection,yet he still had symptoms after the infection cleared up, and he acknowledged he had concussion-like symptoms.

Head coach Randy Cunneyworth noted that it was difficult to differentiate between concussion symptoms and flu symptoms, which is why Darche, Tomas Kaberle and Scott Gomez are all listed as suffering from upper-body injuries and Ryan White is listed as a flu victim.

The Gazette has written something in conclusion that all of us working in sports' medicine with professional sports' teams would acknowledge:


Perhaps it is better to err on the side of caution when dealing with head injuries. Good for the players & management to understand that too.

NFL demands Unruly & Ejected fans sit an exam before getting back to the game! Lessons for Europe?

WOW!

This is a novel approach to crowd control! If ejected at an American Football match, an NFL fan will have to sit a four hour online course, then achieve a 70% pass mark! 

What are the consequences if they try to get into any other National Football League (NFL) stadia without the exam pass mark or without taking the course in 'good behaviour'? They will be arrested!

Exclusive NY Post article

One of the 14 topics of the course is entitled "skills for becoming less impulsive and improving judgment", and another five deal with alcohol. 

Dr Ari Novick, is a licensed psychotherapist, and developed the course in addition to one he runs for Major League Soccer. 

He states: "We're not trying to squash anyone's passion. We're just trying to say don't be violent."

Novick began sampling the program in 2010, employing his conduct classes at MetLife Stadium in East Rutherford, N.J., and Gillette Stadium in Foxborough, Mass.

Can YOU pass the test? Check out the website HERE

Daniel DeLorenzi, security chief of MetLife Stadium - the shared home of the New York Giants and Jets - also demands a letter of apology before allowing re-entry if the crowd goes wild. He estimates 25 fans are ejected each year from the Giants-Jets game alone, and about 500 in total per year.

Denver Broncos fan arrested

He said: "Most of the time, they apologise for their behaviour." He reckons on  about 25 percent of the ejected fans never take the course and they make the “unforgiven” list: this contains the name, photo and seat number of every booted fan. 

According to the report, security guards comb the stands for the “unforgiven,” and 10 have been caught in the stadium and arrested for trespassing.

Arrest at Arizona Cardinals match

The classes are an effort to stem the rising tide of ugly stadium behaviour that has included everything from bare-knuckle brawls to lewd Jets fans who screamed obscenities at women until they exposed their breasts in a rude Gate D tradition at the old Giants Stadium.

Novick takes $55 (£35) for each test taken, with charities receiving the remainder such as Mothers Against Drunk Driving and the HERO Campaign for Designated Drivers.

With racism still evident from the stands across Europe in football in advance of the European Championhips in Poland & Ukraine? 

Should we be worried? Theo van Seggelen, the secretary-general  of FIFPro seems to think so. Union chief fears racism in Poland and Ukraine

Do YOU think this novel approach could work in football in Europe, or in South America? 

Titantic Efforts on board & in life - Richard Norris 'Dick' Williams: a Survivor!

Richard Norris 'Dick' Williams was a bona fide sportsman turned genuine hero of the Titantic disaster exactly 100 years ago, on April 15th, 1912. 

Nowadays 'sporting hero' is an overused term, particularly when referring to well-paid professionals simply doing their everyday job.

A century ago, the promising 21 year old tennis player Williams was travelling first class with his father, Charles Duane Williams, on the voyage to the USA. Williams came through a series of hair-raising scrapes to make it out alive.

He and his father, Charles Duane Williams, were travelling first class on the liner when it struck an iceberg setting in motion the well-known 2 hour ordeal of taking on water, splintering and splitting before stern then bow sank over 2 miles down to the bottom of the Atlantic. Shortly after the collision, Williams freed a trapped passenger from a cabin by breaking down a door. 


He was reprimanded by a steward, who threatened to fine him for destroying White Star Line property, an event that inspired a scene in James Cameron's film Titanic (1997). Williams remained on the doomed liner almost until the very end. At one stage Williams' father attempted to get a steward to fill his flask. The flask was given to Norris Williams and remains in the Williams family.

After being washed overboard by a wave that also took off Colonel Archibald Gracie and Second Officer C. H. Lightoller along with several others, the 21 year old Williams made his way to the Collapsible A Lifeboat holding on to its side for quite a while before getting in. When Williams entered the water he was wearing a fur coat which he quickly discarded along with his shoes. 


Those in Collapsible A who survived were subsequently transferred to Lifeboat 14 by Fifth Officer Lowe. Although abandoned by the Carpathia, Collapsible A was recovered a month later. Amazingly, on board the lifeboat was the discarded fur coat which was returned to Williams by White Star.

After his rescue by the Carpathia, Williams was still not out of trouble: doctors told him that his injuries following the survival ordeal & period in the water were so severe that they would have to amputate both his legs. 

 Williams, who did not want his tennis career to be cut short, opted instead to work through the injury. The choice worked out well for him: later that year, he won his first U.S. Tennis Championship, in mixed doubles, and went on to win many more championships including the Wimbledon doubles title in 1920 . 

Williams served in the United States Army during World War I and was awarded the Croix de Guerre & thr Legion of Honour. After the war he continued playing championship tennis, and during 1924 Olympics, at the age of 33 (and with a sprained ankle), Richard Norris Williams became a Gold Medallist in the mixed doubles. 


He went on to captain several winning Davis Cup teams from 1921 through 1926 that included two Davis Cup victories amazingly with fellow survivor Karl Behr . At 44 he retired from Championship Tennis.

 Tennis Record

Williams, a noted Philadelphia investment banker, was President of the Historical Society of Pennsylvania. 

He was inducted into the International Tennis Hall of Fame ((Newport, Rhode Island)) in 1957.

He died in 1968, aged 77.

Full  archive of Williams

Concussion Litigation versus NFL & NCAA: A Conference hears of 'Fraudulent Concealment & Negligence'

The Annual Conference of the Sports & Recreation Law Association was held recently in Greensboro, North Carolina.

Three professors, (Linda Sharp, University of Northern Colorado; Jodi Baker, University of the Pacific; and Peg Ciccolella, University of the Pacific) presented “A Whack on the Side of the Head: Concussion Litigation versus the NFL and NCAA”  


The professors evidently spoke provocatively, noting that the “plaintiffs’ likelihood of success will be enhanced by showing the NCAA’s explicit knowledge of the medical seriousness of concussions" but had actively concealed additionally failing to act on the contemporary knowledge. They added:"It will be difficult for the NCAA to claim ignorance given its partial funding of a 2003 study and its own 2010 legislative plan for concussions.” 
They also explored the themes of unjust enrichment and medical monitoring.

The presentations at the Conference (www.­srlaweb.­org) were examining short and long-term effects of concussions on football players as well as pending “concussion” lawsuits against the NFL and the NCAA and what their potential outcome might be.

Sharp, Baker, and Ciccolella noted that the first study was completed on the cumulative effects of concussions in American football players in 2002. “Historically, the athletic community has downplayed and overlooked the severity of the effects of concussions,” they wrote in a summary of their presentation.

Pending litigation against the NFL  from 21 separate actions in six different states was addressed ( for background read SPACE report on ex-players sue NFL over concussion) :  “Allegedly, all of these retired (300 plus) players suffered numerous concussions which were improperly diagnosed and treated throughout their careers leading to current symptoms related to traumatic brain injuries,” they wrote. “Further, the complaint alleges that the players were not warned by the defendants of the risk of long-term injury due to concussions and that the league-mandated equipment did not protect the players from injury. The causes of action stated in the complaint include negligence, fraud, strict liability, and failure to warn. The plaintiffs’ chances of success are enhanced by comparing the NFL’s actions to the lawsuits against the tobacco industry alleging that the NFL engaged in a pervasive, fraudulent cover-up of the data showing links between concussions and cognitive decline (Culhane, 2011).”

The two concussion lawsuits filed against the NCAA last Autumn in federal court (N.D. Ill) were also examined, scrutinising the action taken by former football players who claimed that they suffered repeated concussions. “They alleged numerous failures of the NCAA to protect players from medical risks associated with repeated concussions,” they wrote. “Causes of action in these suits include negligence, fraudulent concealment, and unjust enrichment.”

Links to SPACE coverage of the Concussion issue from last year including an explanation of what actually occurs in the brain are here: SPACE links to concussion blog titles

A recent youth concussion bill had been proposed in Wisconsin aiming to establish and develop guidelines & provide information to educate coaches, student-athletes and their parents about the risk of concussion and head injury in youth athletic activities. It has, however, been stalled in the state's senate. (read SPACE report on how concussions can affect children & younger athletes)

Rules for removing individuals who are suspected to have sustained a concussion or head injury from play were to have been created, and the bill would also require that these same individuals be evaluated by and receive written clearance from a trained health-care provider before returning to play.

The bill is supported by the NFL, the Green Bay Packers and a variety of medical groups who plan to hold a news conference later this month in order to bolster support for the bills final passage.

Watch this SPACE for developments in this currently 'hot' topic area in sports law as well as the medical profession.

Chris Hoy 'Last Chance Saloon' Ride KEIRIN FINAL 2012 Video

WOW! What a race @chrishoy enjoyed in the Keirin at the UCI World Track Champs at the weekend in Melbourne!


It was the 25th medal Chris Hoy has won in Track World Championships, and was memorable for the improbable finish!

If you have not witnessed the race, enjoy it here: 

He describes the race conclusion best himself here when talking to BBC Sport's Jill Douglas: "I'd given up - not physically, but I thought the chance of winning had gone by the time I hit the back straight with half a lap to go," .

"Normally I'd go around the outside and put my foot down but I'd lost momentum. It was one last chance - I've never gone up the inside before in my life, it's a real last-chance saloon - I couldn't believe the door opened and I managed to get through. In some ways I'm very lucky, but very grateful to have won.

Chris Hoy, Gold Medallist

"World titles are all special, every single one you remember, but this is particularly special because it's the last meaningful race I'll have before the Olympic Games. It's a great confidence boost and hopefully I'm showing my rivals I can win from any position."

It is now just under 16 weeks till the Cycling events at the Velodrome in the Olympics in London. 

Here's hoping for more occasions & images like this.

Happy Easter! A dose of sport science over in France...

Happy Easter from all at Space Clinics! Easter Sunday was Day 4 of the tournament, and Kelburne faced Austrian team Arminem.

Here's Ross...

Arminem appeared technically very good in training, and had beaten Whitchurch in their opening game. As long as we (Kelburne) didn’t lose by 2 or more goals we would top the group, and play (probably the hosts Lille) in the final. 

Yesterday Arminem lost to the Italians Roma, who Kelburne had beaten 5-1 in the opening game. The Austrians have played extremely defensively in their last two games, continuing to play a half court system (Everybody in their half), even when a goal down and Roma had two players sin-binned, gifting them a two man advantage! Interesting philosophy.

Prior to the match I was presented with written permission to enter the field of play with my treatment bag. I felt this was unnecessary as I was happy to take the officials at their word. Interestingly the day before they had refused to give me their refusal to enter the field of play with the treatment bag in writing for fear of medical-legal reprisals when asked. The game got of to a pretty slow start with both teams testing each other out, and the Austrians having the better of the opening exchanges. Kelburne were forced to concede their first short corners of the tournament, but held strong defensively, and were able to go into the break 1-0 up courtesy of a sensational Chris Nelson strike.  After the break Kelburne looked to secure their lead through an Alan Forsythe penalty after an Austrian had blocked a Willie Marshall shot on the line with his foot. Shortly afterwards Kelburne were reduced to 10 men following a poor tackle by Ross MacIntire. During his period in the sin bin the Austrians were able to pull a goal back, before Kelburne restored their two-goal advantage via Michael Christie. Further indiscipline by Kelburne saw twice more reduced to 10 men as both Bremner and Johnnie Chrisite were sin binned in debatable circumstances. During these periods the Austrians were able to press home their numerical advantage scoring twice more, with the game finishing a tense 3-3.  

The result means that Kelburne progress to the tournament final vs TBC. For a much more comprehensive match report please see http://www.scottish-hockey.org.uk/ when it becomes available. 

On the injury front, barring a few bumps and scrapes all the lads appear in good condition for the final. The player with the Hamstring injury has also improved significantly and may attempt some light jogging tomorrow. Another player who was used sparingly due to a Hip adductor problem, has was reluctantly called upon due to the tight match situation, and came through the game relatively intact. Now that’s the business end of the blog out the way, I thought I’d go off topic on a ramble.

Having never blogged before this trip, I didn’t quite know what to include in my reports back from Lille. Stephen had asked me to try and keep things interesting, with comments on what we Physio’s actually do on a trip, and anecdotes of what it’s like for the ‘team’, and how Sports' Science is involved.

This is probably as most people don’t have the opportunity to experience such trips. If you’ve read my previous threads, you’ll be aware I’ve mentioned things like, fitness assessments, injury management, medical legal issues, as well as talking about the daily routine of a team on tour, not to mention the bureaucracy  and logistics involved in the running of the tournament. 

Today I’m going slightly off topic and I’m going to talk about two very different things. Firstly the often ignored impact on players and support staffs’ family life.  Secondly I’ll briefly mention nutrition, having witnessed what I can only describe as a biblical plague of locusts descending upon the hotel and restaurants here in Lille.

I thought I’d mention the impact on family life, as this is an aspect of elite/professional sport often over looked. The issue may be pertinent to me today as I’m missing the chance to hunt for Easter eggs with my two year old. That said I’m also missing the chance to be woken at 5am with her jumping up and down on the bed. I won’t lie, when I woke up I quite fancied going home. Partly for the Easter egg reason and partly because I was knackered after working from 8am to 12 pm, two days in a row and getting up at 5am the day before. I’m sure some of the guys with family are feeling the same way, though it’s not something that we talk about. However these things shouldn’t be ignored in the long run as the psychology of the athlete may be affected.

Performance may be adversely influenced or more importantly it may affect the mental health of the athlete. This is an area of interest with recent reports of famous footballers and cricket players either quitting sport or more dramatically attempting or committing suicide due to the pressures of life outside of the sports field.

This mood got me thinking as to how often do we switch on the TV and watch our team play in Europe, only to switch it on again a couple of days later and watch them playing again else where sometimes in another, or on a public holiday such as New Years Day or Boxing day? It’s something we take for granted. We don’t appreciate that our favorite sports people have to travel from A to B and fit training in between. It may be justifiable for the professionals, but these lads from Kelburne have trained 6 days a week (including institute training), to enable them to be physically conditioned to be able to play at a high level of competition 4 days in a row. They have had to fit this around day jobs/studies, and give up family time to be here to play. 

Many of them represent Scotland at various levels, and will soon be in training for the international season in the summer. On returning from the World League this September the domestic season will already be underway, and those involved will be back in action at club level having had no break.  This will understandably require a huge level of dedication and support from the home front. I felt this was something worth mentioning, even to cause pause for thought, and allow you to appreciate the level of commitment the players and other athletes demonstrate to even compete at such events, and understand the non-sporting pressures that affect them. Even the person who finishes last at the Olympics this summer will have paid a huge price in their personal life, and demonstrated a huge level of commitment just to compete.

Before signing off for today I’ll very briefly mention nutrition, and maybe shatter a few people illusions about athletes diets. It’s true that when training it is important to have the correct diet. Too much body fat will reduce speed, as you have to shift unnecessary weight.  Not enough protein and muscle won’t fully repair. Too few or too many calories and weight will rise or fall out of a desirable range for optimal performance. In a tournament like this all that goes out the window and it’s eat as much as your body demands! I have personally witnessed over the last few days, the squad descend upon the breakfast buffet and literally clean it out. If you came down for breakfast after the boys had been, forget it. The whole process lasted approximately 2-3 minutes, and was executed in a methodical and clinical precision. Nothing was left. What wasn’t eaten at the tables was squirreled away (to the managers annoyance) for snacks later. Dinner was no different. The players were given a budget of how much they had to spend on food at the restaurant. Mathematic equations with the price list were done, deals made and most the squad (somehow) conjured two main courses each, ignoring the starter.  This was a well-drilled and savvy squad with the experience to obtain the maximum amount of food from a minimal budget. I was impressed.

In a tournament situation your body does not have time to repair damage or refuel diminished supplies of fuel sources i.e carbohydrates and creatine (used in the resynthesis of the phosphagen energy system). I remember from my time in Football that when in European competition, teams will play 3 games in a week. Domestic match at weekends, and European games mid-week. 

Physical performance diminished as time went on. That is to say, total distance covered by players reduced each game, as did the time spent sprinting, however slow jogging increased. In summary, recovery of our fuel systems is vital to peak performance. Our boys are playing 4 games in four days, not the three in a week that you so often here Football managers bemoan when complaining about fixture congestion. 

Calories are not an issue, as when playing as regularly as they are, and eating as often as they are, the players metabolisms are at full speed, and the calories will be burnt off. Another interesting consideration is hydration though I know Stephen has interesting theories on this, that I am sure will be mentioned in other Blogs. 

I’m not sure if I’ll blog after the final tomorrow, in fact I’m sure I won’t. The boys have a night out planned you see. If you want to check the results click here http://www.eurohockey.org 

Fingers cross we win!

Perhaps some form of communication will come later in the week once Ross returns.

Officiating by the book...does common sense go out of the window sometimes?

 Read on to relate to the athletes whom have days on the road competing, and the medical staff following a match one day with another the day after. 

Day 3 in France and Match day 2, against the Welsh team Whitchurch got off to a much smoother start then yesterday. The previous night my room/clinic was buzzing with activity, with myself treating the players until about midnight, whilst the coaching staff viewed and tagged key events in the Whitchurch vs Arminem game which the Austrians had won 1-0. 

This information would be analysed and presented to the players at the pre-game meeting. What was very evident was the slow pace of the game, with the video speeded up-to 160% of normal pace appearing like normal match pace. This information suited Kelburne who play a high paced style of game. There were no major player fitness concerns other than the hamstring injury yesterday, but the pre-tournament fitness plan meant we intended to rest a number of players or use them sparingly if possible. This meant we were operating with an effective squad of 13 including the substitute goal keeper, though we had an actual bench of 15 players.

The match started well with Kelburne taking an early lead through a Alan Forsythe penalty which he had won himself, after being uncermoniously floored in the D. Shortly after there was a head knock to one of the Whitchurch players which sparked a second confrontation with tournament offiicials in two days. 


Not having a physio available I was shouted onto the pitch by the umpire to assist the Whitchurch player, only to be told by the officials that medical staff were not allowed treatment bags on the pitch unless it was a serious medical emergency. I inquired in plain Scottish as to how I was supposed to know how serious an injury a player had sustained prior to assessing him. To be fair the official agreed with me but was merely following the instruction given to him by the tournament director. 


This sparked a short debate which concluded with me telling the official, and him agreeing, that I would continue to use my medical bag for the remainder of the game and we'd discuss the situation later. 

GOAL for Kelburne!

As the game continued Kelburne went into the break 2-1 up courtesy of a second goal by Alan forsythe. The second half went well for the Scottish club and Kelburne ran out 5-2 winners with Johnny Christie, Willie Marshall and Mark Ralph adding to the score sheet, the last two from penalty corners. 

Immediately after the game the medical-legal debate regarding medical treatment of players on the pitch raged on, with the match officials asking me to present my point of view to the Tournament Director in person, and later a second official of unknown standing. Both officials were adamant that neither I nor any other medical official were allowed a treatment bag on the field of play. 


His rationale was the rules he was given by the European governing body for Hockey, and not what I felt was common sense. His interpretation of the rules were that I was to run on the pitch and assess the player, and then run off the pitch again to collect my equipment if the injury was serious enough. This in my opinion was less than satisfactory and could have potentially catastrophic or fatal consequences in certain situations. 

The Fabrice Muamba situation was fresh in my mind as were my own personal experiences with Phil O'Donnell. My argument was that I should have the right to assess and determine how serious an injury was, and not a non-medically trained umpire. Not having the bag with me, and running off the pitch again left a potentially seriously injured/unconscious athlete unattended possibly with an unstable neck injury/fracture/airway, and potentially delayed important treatment.

This whole scenario was eventually resolved after a very heated debate about the rules and the wording/interpretation of them. Diplomacy is never my strong point, especially with an emotional official with a latin temperament, but in the words of the great Brian Clough, "We talked for about it for about twenty minutes, and then decided I was right". The result of this disagreement was that all medical officials would be allowed to carry their equipment onto the field of play when summoned by the umpire. 


About an hour after the discussions I was approached and thanked for challenging the Tournament Director on this point by the second official present in the debate, who then informed me that as a result of our exchanges, the rules had been changed for the remainder of the tournament. He also informed me that an official report would be written and submitted to the governing body. 


Their recommendation would be that I had identified a serious loop hole in the rules regarding player safety, and that this needed urgent review. I was pretty pleased with this result because as a physio, ultimately player safety is paramount and is our responsibility no matter which team they play for. If a prolonged heated exchange in France helped improve player welfare for the remainder of the tournament or hopefully in the future in European hockey then I feel that I've made a positive contribution.

Returning back from the match my 2-3 hour post match treatment clinic opened, and the players were treated and patched up prior to dinner. No doubt after dinner I will have a series of visitors wanting further attention. 

Another Day, Another Match! More to come...check out the SPACE blog!