A high rate of injury during the 1995 Rugby World Cup

Objective. To determine the frequency and nature of injuries sustained by the 416 players from 16 countries participating in the 1995 Rugby World Cup played in South Africa in May/June 1995.Methods. The study was a prospective analysis of all injuries requiring medical attention during that competition. Data were collected by the match doctors on duty at each of the venues at which the matches were played. Data were collated and analysed.Results. There were 48 preliminary and 7 final-round matches. Of a total of 70 injuries during the tournament, 58 occurred during the preliminary matches (frequency 30 injuries per 1 000 player hours); the frequency was somewhat higher during the 7 final-round matches (43 injuries per 1 000 player hours). Overall injury frequency was 1 injury every 0.8 matches during the preliminary and 1 every 0.6 matches during the final-round matches. Thirty per cent of injuries were to ligaments, 27% were lacerations and 14% were muscle strains. The lower limb accounted for 42% of all injuries, the upper limb for 29% and the face for 17%. Fifty-six per cent of injuries occurred during the tackle phase of play, 23% during the ruck and maul, 11 % during open play and 9% during foul play. The scrum and line-out together contributed only 1% of all injuries. Loose forwards suffered 25% of all injuries; centres and wings 20%; prop forwards and half-backs 16% each; locks 14%; hookers 7% and fullbacks 3%. One player suffered a paralysing spinal cord injury during a preliminary match. The incidence of catastrophic neck injuries in the tournament was therefore 4.6 per 10 000 player hours.Conclusions. The frequency of injury in this competition is the highest yet recorded in any group of rugby players. The risk of rugby injury is therefore greatest in the best players in the game, challenging the view that superior fitness, skill and experience can reduce the risk of rugby injury. In contrast, the larger size, greater speed and superior competitiveness and commitment of the best rugby players in the world would explain why they are at the highest risk of injury. The high frequency of injury in international rugby has implications for: (I) the frequency with which such matches should be played; and (il) the number of players needed to complete a season of international rugby

Exercise and the heart : effects of exercise training on coronary artery disease and on myocardial function, metabolism and vulnerability to ventricular fibrillation

There is epidemiological and experimental evidence suggesting that exercise training may reduce the mortality rate from coronary heart disease, in particular the sudden death rate, and that it may improve the peak functional capacity of the heart. This thesis includes experimental work that is relevant to both these questions

Avoid adding insult to injury - correct management of sick female endurance athletes

Objectives. To evaluate the efficacy of Ringer’s lactate, isotonic saline and hypertonic saline on the clinical and biochemical recovery of athletes with exercise-associated hyponatraemic encephalopathy caused by fluid overload. Methods. We retrospectively reviewed serial blood sodium concentrations (Na+) and qualitative signs of recovery and time to recovery in two healthy menstruant females hospitalised with dilutional exercise-associated hyponatraemic encephalopathy after withdrawal from the 2011 Comrades Marathon (89 km) and Argus Cycle Tour (109 km). Results. Improvements in blood Na+ did not occur with intravenous administration of Ringer’s lactate solution, but did occur with administration of isotonic and hypertonic saline. Qualitative improvements in mental status were not quantitatively related to the biochemical value of blood Na+ or subsequent return to normonatraemia. Conclusions. Hyponatraemia should be suspected in all female athletes presenting to the medical area of endurance races with vomiting, altered mental status and a history of high fluid intake. If a diagnosis of exercise-associated hyponatraemia with cerebral encephalopathy is confirmed, the treatment of choice is administration of an intravenous bolus of hypertonic saline. Administration of Ringer’s lactate should be discouraged, as this does not correct Na+ and appears to delay recovery

A commentary on the intellectual health of the nation

The record of high-quality research at South African universities is not as impressive as we may have thought, according to some international rankings. Whatever we might think of these assessments, we have to take them seriously. We suggest ways in which our universities and other institutions of higher learning might raise the level of their game

The effects of heat stress on neuromuscular activity during endurance exercise

This study analysed the effect of hot (35 C) and cold (15 C) environments on electromyographic (EMG) signal characteristics, skin and rectal temperatures and heart rate during progressive endurance exercise. Eight healthy subjects performed three successive 15-min rides at 30%, 50% and 70% of their peak sustained power output and then cycled at increasing (15 W/min) work rates to exhaustion in both 35 C and 15 C environments. Skin and rectal temperatures, heart rate and EMG data were measured during the trials. The skin temperatures were higher and the subjects felt more uncomfortable in the hot conditions (Bedford scale) (P<0.01). Rectal temperature was slightly, but not significantly, higher under hot conditions. Heart rate was significantly higher in the hot group (between condition P<0.05). Peak power output (267.4€67.7 W vs. 250.1€61.5 W) and time-toexhaustion (55.7€16.7 min vs. 54.5€17.1 min) (COLD vs. HOT) were not different between conditions. There were no differences in integrated EMG (IEMG) or mean power frequency spectrum between conditions. Rating of perceived exertion increased similarly in both conditions over time. Although the hot conditions increased heart rate and skin temperature, there were no differences in muscle recruitment or maximal performance, which suggests that the thermal stress of 35 C, in combination with exercise, did not impair maximal performance in this study

Peak rates of diuresis in healthy humans during oral fluid overload

Objective. To determine whether rates of intestinal fluid absorption and renal diuresis can match high rates of fluid ingestion in healthy humans exposed to oral fluid overload, thereby preventing the development of hyponatraemia either by reverse sodium movement across the intestine (the Priestley-Haldane effect) or by expansion of the extracellular fluid volume.Methods. Changes in renal function and in plasma chemical measurements in response to an oral fluid overload (0.9 - 1.8 1/ h x 3 h) were investigated in 6 healthy control subjects at rest, and in a subject with a history of exercise induced symptomatic hyponatraemia, during both prolonged (160-minute) exercise and at rest.Findings. All control subjects gained weight (2.7 ± 0.2 kg, mean ± standard error of mean (SEM)) because the rate of oral fluid intake exceeded the peak rate of urine production (778 ± 39 rnl / h). Blood volume rose by 7.1 (± 0.5)% and plasma sodium concentrations fell progressively from 144 ± 2.6 to 136 ± 1.1 mmol/ 1 (P < 0.05) in the control subjects. Plasma potassium and angiotensin II concentrations were unchanged and creatinine clearance was normal ( -125 rnl/min). Free water clearance reached a maximum of 11.2 ± 0.9 rnl/min after 2 hours. The increase in body mass could be accounted for by calculated or measured changes in extra- and intracellular fluid volumes. Similar changes were measured in the subject with a previous history of symptomatic hyponatraernia.Conclusion. The rate of intestinal fluid absorption appeared to match the rate of oral fluid ingestion and there was no  evidence of fluid accumulation in the intestine with reverse sodium movement from the extracellular space into intestinal fluid. The results of this study are therefore at variance with the Priestley-Haldane hypothesis and suggest that reverse sodium movement did not contribute to the hyponatraernia induced by oral fluid overload in these subjects. Rather it appears that humans may have a limited capacity to excrete fluid at rates in excess of -900 rnl/ h in response to higher rates of oral fluid intake. When the rate of intestinal fluid absorption matches the rate of fluid ingestion and exceeds the kidneys' maximum capacity for fluid excretion, the excess fluid accumulates in the extra- and intracellular fluid compartments, inducing the dilutional hyponatraemia of water intoxication. These findings may have relevance to other clinical conditions in which hyponatraemia develops in response to high rates of oral or intravenous fluid provision

Caffeine ingestion does not alter performance during a 100-km cycling time-trial performance

This study analyzed the effect of caffeine ingestion on performance during a repeated-measures, 100-km, laboratory cycling time trial that included bouts of 1- and 4-km high intensity epochs (HIE). Eight highly trained cyclists participated in 3 separate trials - placebo ingestion before exercise with a placebo carbohydrate solution and placebo tablets during exercise (Pl), or placebo ingestion before exercise with a 7% carbohydrate drink and placebo tablets during exercise (Cho), or caffeine tablet ingestion before and during exercise with 7% carbohydrate (Caf). Placebo (twice) or 6 mg · kg-1 caffeine was ingested 60 min prior to starting 1 of the 3 cycling trials, during which subjects ingested either additional placebos or a caffeine maintenance dose of 0.33 mg · kg-1 every 15 min to trial completion. The 100-km time trial consisted of five 1-km HIE after 10, 32, 52, 72, and 99 km, as well as four 4-km HIE after 20, 40, 60, and 80 km. Subjects were instructed to complete the time trial and all HIE as fast as possible. Plasma (caffeine) was significantly higher during Caf (0.43 ± 0.56 and 1.11 ± 1.78 mM pre vs. post Pl; and 47.32 ± 12.01 and 72.43 ± 29.08 mM pre vs. post Caf). Average power, HIE time to completion, and 100-km time to completion were not different between trials. Mean heart rates during both the 1-km HIE (184.0 ± 9.8 Caf; 177.0 ± 5.8 Pl; 177.4 ± 8.9 Cho) and 4-km HIE (181.7 ± 5.7 Caf; 174.3 ± 7.2 Pl; 175.6 ± 7.6 Cho;p less than .05) was higher in Caf than in the other groups. No significant differences were found between groups for either EMG amplitude (IEMG) or mean power frequency spectrum (MPFS). IEMG activity and performance were not different between groups but were both higher in the 1-km HIE, indicating the absence of peripheral fatigue and the presence of a centrally-regulated pacing strategy that is not altered by caffeine ingestion. Caffeine may be without ergogenic benefit during endurance exercise in which the athlete begins exercise with a defined, predetermined goal measured as speed or distance

Acute renal failure in four Comrades Marathon runners ingesting the same electrolyte supplement: Coincidence or causation?

Objectives. To evaluate common factors associated in the development of acute renal failure (ARF) in Comrades Marathon runners. Methods. This was a retrospective case series of 4 runners hospitalised post-race with ARF in the 89 km 2010 Comrades Marathon. The outcome measures were incidence of analgesic use, levels of creatine phosphokinase (CPK) and degree of electrolyte supplementation (sodium, potassium, calcium and magnesium). Results. The incidence of ARF was 1/4 125 runners. They presented with rhabdomyolysis (mean admission CPK of 36 294 IU) and hyponatraemia (mean admission blood sodium level of 133 mEq/l). All had ingested an analgesic during the run (3 ingested a non-steroidal anti-inflammatory drug) and the same readily available anti-cramp electrolyte supplement. The average amount of supplemental sodium (452 mg), potassium (393 mg), calcium (330 mg) and magnesium (154 mg) ingested via this particular electrolyte supplement before and during the run did not exceed the recommended upper limits of daily intake. Three of the runners were Comrades Marathon novices. Conclusions. There is a continuing need to clarify the specific cluster variants that cause ARF in Comrades Marathon runners, as the risk factors appear to have evolved since the first case described over 40 years ago

Modelling perception-action coupling in the phenomenological experience of “hitting the wall” during long-distance running with exercise-induced muscle damage in highly trained runners

Background “Hitting the wall” (HTW) can be understood as a psychophysiological stress process characterised by (A) discrete and poignant onset, (B) dynamic interplay between physiological, affective, motivational, cognitive, and behavioural systems, and (C) unintended alteration of pace and performance. A preceding companion article investigated the psychophysiological responses to 20-km self-paced treadmill time trials after producing exercise-induced muscle damage (EIMD) via a standardised muscle-lengthening contraction protocol. Methods A 5-step procedure was applied determining the extent to which the observed data fit the hypothesised cause-effect relationships. Running with EIMD negatively impacts performance fatigability via (A) amplified physiological responses and a non-adaptive distress response and (B) deterioration in perceived fatigability: increase in perceived physical strain precedes decrease in valence, which in turn precedes increase in action crisis, eventually dissolving the initially aspired performance goal. Results First, haematological indicators of EIMD predicted increased blood cortisol concentration, which in turn predicted increased performance fatigability. Second, perceived physical strain explained 44% of the relationship between haematological indicators of EIMD and valence, which in turn predicted increased action crisis, which in turn predicted increased performance fatigability. The observed data fitted the hypothesised dual-pathway model well with good model-fit indices throughout. Conclusions The hypothesised interrelationships between physiological strain, perception, and heuristic and deliberative decision-making processes in self-regulated and goal-directed exercise behaviour were applied, tested, and confirmed: amplified physiological strain and non-adaptive distress response as well as strain-perception-thinking-action coupling impact performance fatigability. The findings provide novel insights into the psychophysiological processes that underpin the phenomenological experience of HTW and alteration in pacing behaviour and performance

Hominin tracks in southern Africa: a review and an approach to identification

Three Late Pleistocene hominin tracksites have been reported from coastal aelioanites in South Africa. Two have been dated to 124 ka and 117 ka , and the third is inferred to be 90 ka. There are no other globally reported sites for probable Homo sapiens tracks older than 46 ka. Given this documented record, a search for further hominin tracksites in southern Africa may well yield additional positive results. However, this is a field that demands scientific rigour, as false positive tracksites (pseudotracks) may occur. Criteria have been developed for the identification of fossil vertebrate tracks and hominin tracks, but these are specific neither to southern Africa nor to aeolianites.An important caveat is that the tracks of shod humans would not fulfil these criteria. Preservation of tracks varies with facies and is known to be suboptimal in aeolianites. An analysis of the tracks from the three documented South African sites, along with pseudotracks and tracks of questionable provenance, allows for the proposal and development of guidelines for fossil hominin track identification that are of specific relevance to southern Africa. Such guidelines have broader implications for understanding the constraints that track preservation and substrate have on identifying diagnostic morphological features.Palaeontological Scientific Trust (PAST)JNC201