Beat Disability-By Embracing It

Contributed By Dr Wajid,

Orthopedic Surgeon , Pakistan Cricket Board Consultant

The Aga Khan University Hospital

Source : http://www.dawnnews.tv/weekly/dmag/archive/070311/dmag8.htm

Article Written By SJ and Dr Wajid

SPORTS medicine is difficult to define because it is not a single specialty, but an area that involves healthcare professionals, researchers and educators from a wide variety of disciplines. Its function is not only curative and rehabilitative, but also preventative, which may actually be the most important of all. A Sports Medicine specialist – either an orthopedist or a primary-care sports medicine expert – is usually the leader of the sports medicine team, which also includes physicians and surgeon specialists, physiologists, athletic trainers, physical therapists, coaches, other personnel, and, of course, the athlete.

Until the second century, when the first team doctor, Galen, was appointed to the gladiators, the physician only became involved when there was an injury.

Today, in the United States of America, doctors wishing to specialise start with a primary residency program in family practice, internal medicine, emergency medicine, pediatrics, or physical medicine and rehabilitation, and then generally obtain one to two years of additional training through accredited fellowship (subspecialty) programs in sports medicine. Physicians who are board-certified in family practice, internal medicine, emergency medicine, or pediatrics are then eligible to take a subspecialty qualification examination in sports medicine.

Additional forums that add to the expertise of a sports medicine specialist include continuing education in sports medicine, and membership and participation in sports medicine societies. Sports medicine has been a recognized subspecialty of the American Board of Medical Specialties since 1989. Currently there are more than 70 sports medicine fellowships and approximately one thousand certified sports medicine specialists in the United States.

Sporting glory is something which most nations want to achieve. In the nearly 60 years of Pakistan’s existence, we have had our fair share of international sporting success. Arguably this is one field in which Pakistan has achieved more than in any other field! Pakistan’s success has been mainly in three sports – one individual and two team events, namely, hockey, squash and cricket – with some success in other individual events like snooker, wrestling, weight-lifting etc. at regional and international levels.

Pakistan has an enviable record of success in international hockey arena. We first participated in the 1948 London Olympics and were placed fourth on the table. We won an Olympic silver in 1956 and the crown itself at the 1960 Rome Olympics, repeating the feat in 1968 and 1984.

Moreover, we have had four world hockey championship titles (1971, 1978, 1982 and 1994) in addition to the seven Asian crowns – 1958, 1962, 1970, 1974, 1978, 1982 and 1990. Add to them the three Champions Trophy titles – 1978, 1980 and 1994 – and we can see beyond doubt that Pakistan was among the top few till mid-1990s.

Similarly in squash, the Khans from Pakistan have ruled the game single-handedly for a long time, starting with Hashim Khan’s British Open title in 1951 and then achieving the impossible – ten consecutive British Open titles from 1982 to 1991 by the one and only Jahangir Khan. Hashim Khan won the title seven times in all, while Jansher Khan did it six times and Azam Khan, four times. Not only that, Jahangir Khan won the World Open crown for eight times. But the glory years of Pakistan Squash also came to an end in the 1990s.

Pakistan’s cricketing success has been a bit more chequered. We played our debut Test match in 1952 and our first success came in only the second Test. In the shorter version of the game, who could forget the historic six on the last ball in Sharjah by Javed Miandad in 1986. The 1992 World Cup success, of course, was the stuff dreams are made of, but that also represents our last hurrah on the world stage. Since then we have not been able to stamp our authority like we used to do on global sports. Things are much better in cricket than what they have been like in hockey and squash, but in absolute terms it may be argued with some justification that we have receded in cricket as well since the 1990s.

It is interesting that most of the nation’s sporting achievements were secured when the country was getting over the initial troubles after Partition and we had very little in the way of infrastructure, training and facilities for our sportsmen. Perhaps it was shear determination and the will to succeed that helped our sportsmen bring all those laurels. But that is also a reflection on the way I which international sporting activities were conducted then and the manner in which they are managed now. Our sportsmen made it big till the world remained amateurish in approaching sports. Once the world moved forward and went for scientific approaches and professional training regimes to achieve sporting excellence, we failed to follow suit and the result is that we have stopped winning as consistently as we used to do. In fact, we have stopped winning for most part.

In the modern world, competitive sports demand high level of fitness that can only be acquired through a punishing training regime. Modern athletes push the boundaries of physical tolerance of their bodies to its limits to gain the competitive edge. This is due to the fact that unlike previously now success or otherwise is measured in hundredth of a second. A change of minimal percentage point in performance is enough to make a telling difference; the difference between winning a gold medal or nothing. This level of competitiveness by its very nature exposes them to injuries.

The world is not beating us in sporting skills as much as it is beating us because of poor training regimes and the resultant lack of fitness

An athlete’s technical ability and skill in his or her individual sport is of paramount importance, but it is of no use if the player gets injured. With the rapid proliferation of dedicated sports channels, commercialism and increasing endorsements from business, professional sports is turning into big business, thus demanding more and more from athletes to generate more and more heroes. This exposes them to various injuries and unless preventive and curative methods are adopted, their careers may end prematurely.

Injuries to these competitive athletes can be grouped into three distinct groups:

Injuries due to: Sports Equipment; Direct Contact; or Repetitive Stress

Those caused by sports equipment include the ones that result when, say, the ball hits a batsman, or a hockey stick strikes a player. These injuries have been minimized over the years due to the development and widespread use of appropriate protective gear – helmet, shin guard etc. – and sporting regulations like discouraging bouncers in cricket and penalizing lifted balls in hockey. However, such injuries can not be and have not been eliminated.

In the second group are injuries arising out of direct contact between players or a player slipping or tripping during running. Perhaps this is the most difficult to control of all injuries, if not impossible because in almost all field sports, players have to run at very high speeds and change their direction suddenly which puts extra pressure on physique. Likewise, collision between fielders in cricket or between players in other field games can, and do, cause players to fall and injure themselves.

The third group covers the most common injuries in sports. Professional athletes have to train very hard for long stretches of time. For each particular sport there are specific body areas which are more vulnerable – shoulder joint in swimmers and bowlers, spine in gymnasts and so on. Such sportspersons are more prone to stress-related injuries. These injuries can be minimized and adequately treated with appropriate rehabilitation and good techniques under the supervision of qualified trainers and physiotherapists.

In cricket, we generally see shoulder afflictions, glenoid labrum injuries, cuff tendonitis and shoulder dislocations. Other injuries among cricketers include muscle pain and spondylolythesis in the back, as well as several ankle injuries including ankle sprains, stress fractures, ankle tendonitis and the subluxation of the tendon. Ideally speaking, every athlete at the top level needs to have – and generally does have – a general fitness training program tailor-made in accordance with his own profile. In the absence of such a specific training programme, the chances of injuries are that much higher.

In modern day sports, there are a lot of professionals involved in the care of an athlete. They include orthopedic surgeons, sports medicine specialists, nutritionists, physiotherapists, and even sports psychologists, to name a few.

With scientific developments coming at fast pace, newer techniques are being used to improve the skill levels of international athletes and sportspersons. Unfortunately, most of these are not available in our country even though the popularity of various sports among the masses in general and the youth in particular has been on a steady rise. In fact, it is much more in the subcontinent than in most other parts of the world. It is necessary to have such facilities if we wish to compete at the international level and achieve success like we used to do in the past. The world, we need to understand, is not beating us in sporting skills as much as it is beating us because of poor training regimes and the resultant lack of physical fitness.

There are less than ten qualified Sports Medicine physicians in Pakistan today. A general lack of understanding on the part of the government as well as private sports associations and organizations about the important role Sports Medicine can play to find, train and groom the vast human potential means young doctors are discouraged to specialise in this particular field of medicine.

The government as well as the various sports federations, organizations and bodies can, and should, effectively use proper and professional pre-qualification methods to screen the potential talents to produce sportsmen and athletes at par with global standards. It may also help in saving the careers of many outstanding talents which otherwise get wasted due to an acute lack of professional and qualified medical help. The wastage of talents, as we all know, is limited to the mainstream sports like cricket and hockey, but encompasses all fields of sports. This highlights the need for an effective induction of Sports Medicine in the country for the development of sports along professional lines.

Beat Disability-By Embracing It

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Sports Medicine and the Developing World- Case scenario: Pakistan