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·SPORTS INJURIES

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·SPORTS
INJURIES
Prevention and
Active Treatment
CHRISTOPHER
WOODARD
Max Parrish London

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·PREFACE There have been textbooks published on the treatment of sports injuries, but none, 80 far as I am aware, that concentrates on the active treatment that is now winning more and more predominance over the more passive forms of treatment such us strapping, massage, electricity and heat. It is hoped that this book will be a help to club trainers, coaches, masseuns and physiotherapists in minimizing the time lost from sport by their patients through injury It is not meant to be a textbook for doctors, and throughout its pages I have been careful to make this clear, I have also been at pains to signpost the type of case which should be given expert medical attention, and not treated by unqualified hands I particularly wish to acknowledge the tremendous help I have had from Edward Bolton of the Edward Bolton Gymnasium in Paddington London He is entirely responsible for advising me about the strength-training exercises and in fact I owe any knowledge I have acquired in this particular branch of the subject entirely to the very pleasant hours I have spent in hus Gymnasium. Furthermore, I wish to thank him for the facilities put at my disposal in his photographic studio, where all my pictures were taken I would also like to scknowledge the patience and help of Mr Witts and Miss Dudley, and the continuous courtesy shown to me at all times by my Publishers My grateful thanks are due to Mr Don Shaul for his patience and skill in drawing the Illustrations in the text.

·First publlobed 1954
Second Edition 1954
HAY PALUDA AXD CO LTD
88 QUEEN ANNE ITAEIT
LONDONYI
Made cod potated in Great Britabo by
FILLIAN CLOW AD PON, LOUTDD, LOXON AND SECOLU

·CONTENTS i What is Active Treatmenti What happens when a muscle is torn - preventing Adhesions - the proper use of manage 17 2 Tuning up the Muscles Strength exercises - stretching and suppleners - the test for muscle tone - Warming up - crump and stitch 99 9 The Danger of Strapping A false sense of security - obstructing the drculation - mucle temalam annot be imitated 32 4 The Fallacy of Roller Riding Pedalling galost nothingners exhaustion and oxygen debt - muscle bulk Is not muscle strength 36 6 Diet and Dope Sugo for squash players - tumin and caffeln - beer wine and spirits - vitaminu end tontas - the ethics of mulzota - an oringo at ball-time - no short cuts to Atock 8 Self-Confidence and Stalonesa The importance of relaung - ser for the athlete perva'-when is the prime of lifel - Helght control - stulerer - Triety pot ret 61 7 Head und Neck Injuries Concuation - an ud ar plugi - eyes - dialocated jaw-cucked lips - broken Dose - manipulation of the Deck - exercha ·PHEFAOE Finally I have to thank Mr R. L. Hudson of Worthing for the set of pictures showing bow a cyclist uses lus back muscles with the different levels of handlebar (Fig 10) Too often in the past and still today - prevention and treatment of injury in sport has been a haphazard bruar ness If this book helps truners and coaches to understand the basic principles of their craft and to get their cusulties back on the track or field more speedly than before, it will have achieved its object. CR. W November 1969

·ILLUSTRATIONS IN HALF-TONE
Bettern pages of ad as
F10 1 Exercise for the back
. High-kicking exercise for the thighs
9 Method of everting the cyelld
4 Manipulation of the neck
6 Exercise for the shoulders
&_9 Strength truning exercises for the neck
10 Dropped handlebars effect on back and abdomen
11-16 General exercises for the back
18 Sacro-iliac marupulation
17 Special excrcise for sacro-iliac strain
18-21 Strength cxcraises for the back and arms
21-24 Strength exercises for the back and legs
26 Manipulation of the shoulder
26 Shoulder exercise
27-28 Strength exercises for the shoulder
29 Bruised Inuckle bandage protection
30–35 Strength exercises for the chest and arms
36 Strength exercise for the abdomen
37 Manipulation of the elbow
38 Special exercise for the forearm
39 Fingertup press-ups
40 42 Special exercises for the linee
43 Manipulation of the ankle
44 Exercise for the ankle

·CONTENTS 58 8 Back Injunes Twisted beck - Abrosids - lumbago - MLT-11 strain - lunbo-penal train - scutica - back muscles and cycling - manipulation - exerdses 69 9 Shoulder Injuries Inflammation of the capsule - fupraspinatus syndrome - scromio-davicular subluaaton-broken collar bone - dialocation - griza - manipulation - exercisea 78 10 Elbow, Wrist and Hand Injuries Teamı elbow - ulnar neurits - cracked and broken bones - mained wist - scaphold fracture - Colles fracture - stenosing vaginitis - sprained tomb bruised knucklas-mallet finger - dhalocations - teno synovite - mail forections - manipulation - exercives 89 11 Chest Injuries Inter-costal paln - aucked ribs - painful breathing - spotting blood - exercises 94 12 Abdominal Injuries Torn Albrus of the rectus abdominis - groin paln haematuria - exodes 98 13 Thigh Injuries Comuonest sito of torn muncles - troldance of strapplog - addle soreOCH - weating 101 19 Knee, Ankle and Foot Injuries Ligament injuries gydovit's - chondro-malacia petellie - myositis Ossificams - ahin soreness - stres fructure of the Abula - tore muscle of the calf - Achilles tendon - blisten - toe nails - plantar fucitls - apelltis - athlete a foot - mmipulation - xenda Appendix Injuries The Commoner Sports and their 196 Index 197 ·1 What is Active Treatment? At a recent medical conference, a well-knout surgeon was asked whether there was any sound, specialized ireatment for sports injunes llc replied that, stra gely cnough, medical sence was unablc to offer such specialized knowledge, and could really tell an injured athletc little morc about humaself than the average masscur or Osteopathi Hc went on to say that in 1948, when McDonald Bailey, the international sprinter, had tom a muscle, no doctor had been able to tell him what to do about it to assure his recovery and the various ones he saw all recommended a different treatment. Thu is not quite true, in fact McDonald Baley went on four years later to beat world records and rum better than he had ever done before, but it would not be out of place to show why the surgeon made these remarks In the past, the treatment of sports injuries has been completely haphazard, for which the medical profession is u much to blame as anybody Numbers of surgcony and physicians, both general and specialist, had no hesitation lo recommending trulment of a sports injury, although it was entirely outside their particular sphere They seemed utawure that there were, in the profession, specjalists with considerable experience in the treatment of such injuries. by their action they perpetuated the feeling amongst layo men that it does not matter who treat them for such things, and that the opinion of masseurs and osteopaths is u good u any other opinion

·ILLUSTRATIONS IN LINE
62
71
79
78
79
81
Lower back, showing typical areas of pain
Supraspinatus syndrome and tennis elbom
Acromioclavicular nubluxation
Dislocation of the shoulder
Area of pain in ulnar neuritis
Sprmg grip for band exercise
Scaphoid fracture of the wrist
Colles fructure of the radius
Stenosing vaginitus
Principal ligunents of the knee
Points of tenderness In the mee
Stress fracture of the foot, with metatarsal pad
Strupping for sprained ankle
89
83
BS
103
104
117
119

·WAT IS ACTIVE TREATMENT? 19 and therefore there is a wide interest in the trcatment which, for want of a better name, is referred to as 'active Everyone knows that if you dislocate your knce, or taar 1 arulage in it, the surgcon will probably take you into hospital and operate, equally, If a footballer falls heavily and twists his back, a slipped disc may be diagnosed and he may well be put into a pluster jacket for several months, or even have a major operation. But in ninety-ninc cases out of a hundred, active treatment would not only ensure far better end results, but would mean that the patient could conunue his active sporting career Sports Injuries fall into clearly defined categones for different sports Football has its tom muscles of the thigh and back, tom cartilages of the knee, spraincd ankles and bruscs Cncket has its fibrositis of the back and the characteristic groin injury of bowlers, who may also suffer from shoulder sprain. The great Larwood der cloped bruising of the ball of his foot, because of the speed of his run-up Leg-spin bowlers often pull the small tendons in their hands and this is proving a problem at present with the young Robins Peebles had to change his style of bowling because of it. Another injury characteristic of cricket is the blistered finger of the off-spin bowler one recalls the lojury to Ames Not that anything more than what was done could have been done in his case, but it must be stressed that there is usually an active treatment for such injuries A further example is the treatment of cut eyes and bruised knuckles in boxing The number of such injuries in sport is almost limitless and includes the problem of weight reducing to the jockey temperature regulation to the swimmer sugar intake to the player of fust ball games such as squash or tennis The taking of stimulant in the interval is another matter associated with injury The treatment of sporta imuries is dealt with systematically in Chapters 7 to 14, starting with the bead and neck ·12 SPORTS INJURIES It is the aim of this book to point out that there is a specific and correct treatment of all athlead injuries It is Intended as a guide to the various trutments that can be carried out by trainers or coaches at the place of injury and, what is perhaps more important, it points out the types of injuries that should only be treated in hospital, where there are facilities for proper observation and 10- vestigation, such as X-ray and orthopaedic treatment In most soft tissue injuries the first aim should be to prevent the formation of adhesions, and this can only be done by putting the limbs through a full range of stretching movement. It might be supposed that this requires specialized knowledge, but the fact that anyone who sets himself up as an osteopath can have great excess by doing just that, shows that perhaps it 18 not us difficult as it may at first appear in this book the straightforward manipulttions are described and no harm can be done by coaches leaming how to do them The one important thing to remember is that such manipulations should never be done if there is the remotest risk of the athlete having sustained any bone injury, or, in fact, anything more than a strain or torn muscle. If there is the slightest doubt, it Is misest to refer the cause immediately to a doctor for X-ray or other hospital treatment. To leam the technique of manipulation, however should prove of mestimable benefit to both trainers and coaches and enable them to trat ruch auses much us they do already but with a far pounder knowledge of what they are doing In these days of high transfer fees in soccer and other forms of commercialization of sport, greater importance must be attached to the treatineat of injuries, for it 13 obvious that within a week of a club paying an enormous fee, a player may be injured in such a way u to keep him out of the sport for the rest of his day. In the medical profession, there are divided opinions us to the best way of treatng the common injuries sustained in vinous sports ·PENAT II ACTIT TALATHIRTI and therefore there is a wide Intercit in the first and which, for want of a better name, lo referred 1011'rile Everyone knows that if you dulocal your loce, 1937 2 cartilage in it, the surgeon will probably tabr gira among horpital and operare, cqually, if I footlulle frá Bronze and twists his back, a 'slipped drac' may be disparminant he may well be put into a planter jacket for local months, or even have a major operation Nut in nineist on fairy out of a hundred, motive treatment would not only mour far better and resulu, but would mean that the polipas could continue his active sporting arter Sports injunes fall into dearly defined airfories for different sporu Football has iu tom musdes of the pich and back, torn cartilages of the knee, sprained anklst est bruises Cricket has les fibrosis of the back and alreadura acteristic groin injury of bowlers, who may also sures from shoulder sprain. The great Larunod developed btula ing of the ball of hus foot, because of the speed or his non Leg-pua bowlers often pull the small tcnions in their hands and this is proving a problem at present with the young Robins Peeble lead to change liis style of Lamling because of it. Another injury charactenstic of cracket is the blistered finger of the off-spin bowler, one recalls eine injury to Ames Not that enythung more than hlut has done could have been done in his case, but it must love stressed that there is wually an 'active treatment for suchi injura A further example is the treatment of cut eyes und bruised kmxkles in boxing The number of such mjuries un sport is almost limitless, and includes the problem of weigtit reducing to the jockey temperature regulation to the simmer sugu Intake to the player of fut ball-games such as squuh or tennis Tie taking of stimulants in the interval is mother matter associated with injury The treatment of sports Injuria is dealt with systematiclly in Chapter 7 to 14, starting with the head and neck ·at 12 SPORTS INJURIES It is the aim of this book to polat out that there is a specific and correct treatment of all athletic injuries It is intended us a gude to the various treatments that can be arried out by trainers or conches at the place of injury and what is perhaps more important, it points out the types of injunes that should only be treated in hospital, where there are facilities for proper observation and investigation, such u X-ray and orthopaedic treatment. In most soft-tissue injuries, the first air should be to prevent the formation of adhesions, and this can only be done by putting the limbs through a full range of stretching movement. It might be supposed that this requires specialized knowledge, but the fact that anyone who himself up as an osteopath can have great success by doing just that, shows that perhaps it 18 not as difbcult u it! may first appear in this book the strughtforward manipulations are described, and no harm can be done by coaches learning how to do them. The one important thing to remember is that such manipulations should never be donc uf there is the remotest nisk of the athlete having sustained any bone injury, or in fact, anything more than a strain or tom muscle. If there is the slightest doubt, it is wisest to refer the case immediately to a doctor for X-ray or other hospital treatment. To learn the technique of manipulition, however should prove of inestimable benefit to both trainers and coaches, and enable thera to treat such cases much us they do already but with a far sounder knowledge of what they are doing In these days of high transfer fees in Boccer and other forms of commercialization of sport, greater importance must be attached to the treatment of injuries, for it is obvious that within a week of a club paying an chormous fec a player may be injured in such a way u to keep him out of the sport for the rest of hu days In tho medical profession, there are divided opinions as to the best way of treating the common injunes sustained in various sports ·WHAT IS ACTIVE TREATMENT 16 One of our best tonown international sprinters was running in a 200-metre race when he suddenly fell with a severe tear in his nght hamstrings Although he was in great pain, he immediately made him trot round until he could do 80 without limping It took about an hour, but then he really had recovered his balance Next day we allowed him to run at three-quarters speed, and three days later be had recovered his full speed Eight days later he non in an international championship, and did his best time ever He had such a severe tear in his muscles, however, that three weeks later the back of his leg from thigh to heel was still black with bruising This gradually worked itself out - but because the damaged muscle fibres had been effectively separated from the healthy ones the effect on hus running was minimal. It should be remembered that the tom muscle fibres never grow again, but merely form fibrous tissue, and it is essential to separate this fibrous tissue from surrounding healthy muscle, and prevent it dinging If you reat the limb the fibrous tissue grows into all the surrounding healthy muscle, and then the process of separating it may be well-orgh imposible if the movement is started strught away then the fibrous tissue forms limited strands which are entirely separate from the healthy muscle fibres because the limb has been fully stretched before their formation, the patient does not suffer from twinges of pain us these fibrous strands pull on nerve endings, because they are longer than the muscle that is contracting It u eurentul not to put any form of heat or massage on the muscle for at least four days after the injury After thus time, however, it 11 often necessary to start massage Bleeding is liable to occur if it is started too early, but after four days the injury, if it were incised would show conalderable evidence of fibrous tissue formation, and the bruise would have gone quite solid Therefore there is no risk of further bleeding, and heat und musage will only ·14 IPORTS INJURIES and working down. On page 126 will be found a lot of the principal injunes to be expected in different branches of sport. Coaches, trainers and sportsmen may find this useful, m conjunction with the index, for quick reference to their own particular niks In the treatment of sports injuries it has always been considered necessary to immobilize limbs and joints in actre treatment, however, it is a cardinal principle that immobilization is seldom the nght course. If we bear in mund the fact that there is nothing more important to an athlete than to maintain the tone of his muscles, and preserve his balanced condition, then an mjury must be very severe before we treat it with any form of immobilization For instance, if an athlete tears a muscle of the thigh, and this is strapped up even for tivo or three days, his balance can be completely upset. The question we have to ask ourselves 18 which is more important, maintaming his balance or immobilizing the muscle? Experience shows that injured muscles can only be prevented from wasting by continuous movement. Just what does happen when a muscle gets torni First of all there is always bleeding, because the muscle fibres are destroyed The first aim should be to minimize this bleeding and therefore it is essential to get the muscle imder cold water u soon us possible One may be tempted to use mussage and heat, but common sense will show that this aan only lead to further bleeding It 18 equally wrong to use ice This causes spasm of the blood vessels in the muscle, which may be very difficult to recover from ind so cold water i. always better than ice The immediate treatment for a tota music, therefore is to minimize the bleeding with cold water, and then get it moving again gently so that the patient can recover his balance at Once If correct treatment is not arried out, there is considerable risk of developing a limp, which may still be visible weeks after the muscle is completely healed ·2 Tuning up the Muscles Strength in the human body can be convenicntly assessed It is well known that a hundred-yard sprint in ten seconds 1 a very good performance Sprint athlctes, however, unlike strength athletes, are not graded for this cvent. Body werght, height, length of the legs are of no consideration On the other hand, weight-lifting is graded To lift a barbell of three times as much as your own body weight from the floor, and stand up with it do that your back is crect, is an extremely fine feat of weight-lifung, and constitutes a performance equally as good us a ten-second hundred-yard sprint. I would personally class it as a superior performance. A bigger man Wing more weight would not actually be more efficient if he was lifting low than three times lila own weight. If the sprinter and strength athlete arc to be compared (which u pointless anyway) it would not be unfair to come down to basice And basics, to my mind, mean survival If a ten-second hundred-yard man and & three umes body weight dead-lift man were locked up in the same room to fight it out my money would be on the weightilfter 1 The strength cxercises illustrated in this book are in my opinion – and I speak from considerable personal experence of them - the best there are They do not constitute a course of exercises A selection of them, and indeed quite often come simple vination of them, can be made after It is quite deaded what is to be accomplished After 1 ·16 SPORTS INJURIES loosen things up and help to free the muscle from the bruise One slould not rub any sort of concoction into the skan of the damaged arcı, because that blocks the pores at just the part where cecretion through the skin helps to disperse the bruise (There is one exception to this rule, see P 108, Shex Splints ) The sooner you can put the limb through a full range of balanced movement, and really stretch it out, the better If you strap the limb, then you limit the free arculation through that area and prevent bealing from being us fast as it might be. You might think that it gives support to the limb, but it does not all it gives is a false sense of security If that leg needs support, then it is not ready to do the additional exercise that that support makes you think you can do You will never beat Nature to it, and Nature knows how much to do Recover your balance, correct your style run or erercise it in a relaxed a state as possible and it will make very quick progress to recovery In thousands of cases, I have never known anyone to re-tear a torn muscle this is because Nature protects ane, particularly in the damaged area, against such a recurrence In cases of torn muscles the general principle is - recover balance w soon as possible never restrict the arculation by strapping and avoid maonge or heat for four days for fear of fresh bleeding Stretch out the muscles us soon as possible and put them through a full range of normal movement.

·TUNING UP THE MUSCLES 19 there is no need, except on special occasions, for supplementary stretchmg and loosening work. Both jobs, strengthenung and stretching, are done at the same time Muscles, of course, are not immediately atrengthened, but are weakened, by exercise. Strength is acquired by a process of breakdown nourishment and rest. The exercises given in this book appear in two groups under cach section General Exercises and Strength Exerdises I call the latter Strength Exercises and Dot Weightlifang or Weight-truning exercises, because the main purpose of the movements is to produce increased strength and so to create more phyncal power This can be done in varying degrees depending largely on the individual requrements, and on whether he is prepared to spend suffident time in toqunng the standard set. In this way all sorts of people, even those of forty years of age or more who may never have been athletes in any sense of the word and who may not have taken any form of exercise for years an acquire a standard of physical strength to shame many youngsters who fancy themselves us athletes The business man or woman can be told if they are above or below par They can be advised of their condition, of the Improvement they could well make of the approximate time needed to effect much improvement. The athlete an be advised whether in view of hu general body power and always bearing his particular speciality in mind it would be wise for him to pay attention to certain weak spots, or to retire from competition for 2 time in order to take stock, to rest but not to lose touch, to get stronger but with a definute and carefully considered plan Mr E. A. Cameron, who pored for the photographs, has truned on groups of these exercises for forty months Taking into tocount that he was over thurty years of Age when he started, and that it has been a spare-ume activity, he has made considerable progress having become much more powerful and better developed He still improves ·18 SPORTS INJURIES this selection, the amount of work on each exercue (by this I mean the cract starting poundage multiplied by the exact number of repetitions), the frequency of the routine and additional advice regarding breathing rhythm and the time to be taken between the exercises and the geta or groups of each exercise these details would ll be required and very much required. A car might be a very good medium of getting from A to B, but unless the traveller can drve wall, much time would be wusted and much damige might be done to the car! No attempt is made to particulanze on details which are essentially personal To do 80 would, I feel, merely add to existing confusion It is perfectly practicable, however to generalize on the method of performance And the method of performance I favour 18 the most efficient one- -effiaent from a physical point of view, not from the military pont of view which unfortunately seems to pervade mort PT and jerk routines The performance is efficient and jogable if the heart and lungs are allowed to work quite freely and rhythmically Generally speaking it is best to take a breath as the greater amount of work in each movement is being done and to breathe out durmg the other half Ln most strength exercises only a few contmuous movement will be made at a time and it is therefore possible to get the breathing to a regular rhythun The rate of breathing should entirely dominate the rate of the movement in the cxercive The most efficient rate is soon apparent after practice There is nothing to be said for forced breathing The amount of work being done will soon indicate - it will of course be an automatic action - when deeper breathing is required In very bard work it u best to keep the mouth open (probably another spontaneous reaction in most athletes) and the face and neck free of strain and flush. The movements with very few exceptions abould be full action ones with full exterica and full contraction if thus becomes a habit in performing these strength exercises ·TUNING UP THE MUSCLES 19 there is no need, except on special occasions, for supplementary stretching and loosening work. Both jobs, strengthening and stretching, are done at the same time. Muxles of course, are not immediately strengthened, but are weakened, by exercise Strength 2cquired by a process of breakdown, nourishment and rest. The exercises given in this book appear in two groups under cach section General Exercises and Strength Exerautes I call the latter Strength Exercises and not Weight- Lifting or Weight-training exercises, because the main purpose of the movements is to produce increased strength and so to create more physical power This can be done in varying degrees, depending largely on the individuals requirements, and on whether he is prepared to spend suffiaent time in acquiring the standard set. In this way all sorts of people, even those of forty years of age or more, who may never have been athletes in any sense of the word and who may not bave taken any form of exercise for years can acquire a standard of physical strength to shame many youmgsters who funcy themselves as athletes The business man or worden can be told if they are above or below per They can be advised of their condition of the improvement they could well make, of the approximate time needed to effect such improvement. The athlete can be advised whether in view of his general body power, and always bearing his particular speciality in mind, it would be wise for him to pay attention to certun weak spoto, or to retire from competition for a time in order to take stock, to rest but not to lose touch, to get stronger but with a definite and carefully considered plan. Mr E. A. Cameron, who posed for the photographs, has truned on groups of these exercises for forty months Taking into account that he was over thirty years of age when he started, and that it has been a spare-time activity, he has made considerable progress, having become much more powerful and better developed He still improves ·20 SPORTS INJURIES An important principle to remember is that muscles that have been properly tied up and made one bundred per cent supple never tear Of course they will if they get a direct blow, but they do not just from normal exercise, no matter how strenuous it may be The best way of preventing one s muscles from giving uy sort of trouble us to stretch them through a wider range of movement than one s particular athletic activity may demand of them. Most people, far from over-stretching their muscles, do not stretch them enough, and thus do not get the maximum efficiency out of them. A muscle that has a wide atretch automatically develops a greater poter of contraction In some sports it is very important indeed to develop full range of movement at certain specific joints, and buld up the muscles concerned to a maximum cfficiency Diveri very often suffer from painful shoulders and wrists and what they all buckling arms as the result of not developing sufbaent strength in their arms It sometimes causes the back of their hands to strike their heads causing severe bruing Only exercise can build up such muscles, so that the joints do not buckle. Again whereas most of us can only extend our elbows, for instance to a range of 180 degrees some double-jointed people can go beyond this to about 200 degrees As you can imagine this is a disadvantage in sport like weightlifting, where performance depends on on ability to lock the joint. Such people have in other words, to put their limbs through a wide range to complete the weightlifting movement, and will always be at e disadvantage compared with the type of person who has the smaller range It 18 not a disadvantage in diving however uod can always be corrected by building up the muscles of the arms so that they are powerful enough to prevent buckling no matter how high the dive No man u perfectly fit for any sport unless be baus tumed up every muscle of his body to an equal state of suppleness The rugger player may have powerful legs just from play- ·TUNING UP TUE NOSOLES 21 ing rugger, but it is not wil he has really developed his back and abdomen u well, that he can daim to be getung maximum efficiency out of himself There are dozens of examples of this type of thing that one can give The cyclist has powerful legs, but often neglects his back The boxer, on the other hand, has great strength in his arms, but often less in hus legs Some exercises and forms of sport, however, could claim to tone up almost all the muscles of the body, and particularly to be recommended are swimming general gymnastics and wrestling What are these stretching exercises? An illustration of one will make others dear Let us suppose you are a cyclist who wants to build up the power of his back, just cycling will probably never do it, for one is always crouched over the handlebars But you still need a powerful back. The power will come into it by stretching the muscles, and then you will find that, far from cycling causing backache, the last place that gives out in a race is the musculature that you have bult up by special exercises Back stretchang eperase (Fig 1) Place a rug on a plinth or table Lie flat on the table on your back so that the edge of the table u at the level of the small of your back, with your head and shoulders hanging over the end Over your feet from the other end of the table, place a loop of leather strapping so that when you bend backwards over the end of the table, your feet are held firmly You could also have another strap round the table, and over your knees or just below them. The aim is to bend backwards as far as you can and recover to the sitting-up position, with your hands linked behind your neck, us many times as possible At first you will find that this cxercise makes your back and abdomen «che severely, and you will not be able to do it more than about ten times If you make a practice, however of doing the exercise every day, quite soon you will be able to work up to doing it fifty to one hundred times When you can do this, those muscles will be ten times us ·20 SPORTS INJURIES An important prindple to remember is that musdios that have been properly timed up and made one hundred per cent supple never tear Of course they will if they get a direct blow, but they do not just from normal excrcise, no matter how strenuous it may be The best way of prevent ing one : muscles from giving any sort of trouble is to stretch them through a wder range of movement than one 1 particular athletic activity may demand of them. Most people, far from over-stretching their muscles, do not stretch them chough, and thus do not get the maximum efficiency out of them A muscle that has a wide atretch automatically develops a greater power of contraction In some sports it is very important indeed to develop full range of movement at certain specific joints, and build up the muscles concerned to a maximum efficiency Divers very often suffer from painful shoulders and wrists and what they all buckling arms us the result of not develop ing sufficient strength in their arms It sometimes causes the back of their hands to strike their heads causing severe bruising Only exercise can build up such muscles, so that the joints do not buckle Agun whereu most of us can only extend our elbowa, for instance, to a range of 180 degrees some double-jointed people can go beyond thus to about 400 degrees As you can imagine this is a disadvantage in 1 sport like weightlifting where performance depends on an ability to lock the joint. Such people have in other words, to put their limbs through a wider mange to complete the weightlifting movement, and will always be at a disadvantage compared with the type of person who has the smaller range It is not a diædvantage in diving however, and can always be corrected by building up the muscles of the arms so that they are powerful enough to prevent buckling no matter how high the dive No man 18 perfectly fit for any sport mlets be hou tuned up every muscle of his body to an equal state of rupplenes The rugger player may have powerful legs just from play- ·TUNING UP THE MUSOLES 21 rugger, but it is not until he has really developed liis ck and abdomen as well, that he can claim to be getting sumum efficiency out of himself There are dozens of amples of this type of thing that one can give The chist has powerful legs, but often neglects his back. The ster, on the other hand, has great strength in his arms, ut often less in his legs Some exercises and forms of mort, however, could claim to tone up almost all the muscles of the body and particularly to be recommended re swimming general gymnastics and wrestling What are these stretching exercises? An illustration of ne will make others clear Let us suppose you are a yclist who wants to build up the power of his back just jcling wall probably never do it, for one is always crouched over the handlebars But you still need a powerful back. Ihe power will come into it by stretching the muscles, and hen you will find that, far from cycling causing backache, he last place that gives out in a race is the musculature chat you have bunlt up by special exercises Back stretching exercise (Fig 1) Place a rug on a plinth or table. Lic ilat on the table on your back so that the edge of the table y at the level of the small of your back, with your head and shoulders hanging over the end. Over your feet, from the other end of the table, place a loop of leather strapping so that when you bend backwards over the end of the table, your feet are held firmly You could also have another strap round the table, and over your knees or just below them. The aun is to bend backwards us far as you can and recover to the sitting-up position with your hands linked behind your neck, as many times as possible it first you will find that thus exercise makes ur b abdomen ache severely, and you will not more than about ten tuma If you cler, of doing the exercise every day, quit be able to work up to doing it fifty to one h When you can do to me muscles ill be make 1 ·LO SPORT: INJURIES An important principle to remember is that muscles that have been properly tuned up and made one hundred per cent supple never tear Of course they will if they get a direct blow, but they do not just from normal cicraise, no matter how strenuous it may be. The best way of preventing once murdes from giving uy sort of trouble is to stretch them through a wider range of movement than one 8 particular athletic activity may demand of them. Most people, fur from over-stretching their muscles do not stretch them enough, and thus do not get the maximum efficiency out of them. A muscle that has a wide stretch automatically develops a greater power of contraction. In some sports it is very important indeed to develop full range of movement at certain specific jomts, and build up the muscles concerned to a maximum efficiency Divers very often suffer from painful shoulders and wrists and what they call buckling arms as the result of not developing sufficient strength in their arms It sometimes causes the back of their hands to strike their heads causing severe bruising Only exercise can build up ouch muscles so that the joints do not buckle. Again whereus most of us can only extend our elbows, for instance, to a range of 180 degrees some double-jointed people can go beyond this to about 200 degrees As you can imagine, this is a disadvantage in a sport like weightlifting, where performance depends on an ability to lock the joint. Such people have in other words, to put their limbs through a wider range to complete the weightlifting movement and will always be at a dusadvantage compared with the type of person who has the maller range. It is not a dundvantage in diving however, and can always be corrected by building up the muscles of the arms so that they ure powerful enough to prevent bucklung no matter how hugh the dive. No man is perfectly fit for any sport unless he has tuned up every muscle of bu body to an equal state of ruppleness The rugger player may have powerful legs just from play- ·TUNING UP TOE MESCLES more work than they are accustomed to doing os, posters more accurately, more than ther ut tuned up to do 17ong you go suff at the beginning of the season, act to foi game, that stiffness is purels due to the fact that made have been creased for the first ume and lactic acd tas been liberated into them which has not been dispersed because the arculation through the area is so poor Making a muscle supple merely means improvingius arculation und mcreasing the contractility of its fibres Every muxle fibre huid blood supply, but unless the musde is conimuously worked, the small vessels to cach individual fibre become sealed off, and only those fibres that are used are fed with blood Timing up the muscle is the process of reopening all the sealed vessels so that every muscle fibre is fuauer mg und cvery blood vessel full of blood. In the perfecus fit athlete, one can detect a jelly-like consistency m his muscles when he is relaxed that is because they are full of blood. Equally when they are contracted, they are as hard as iron because of their strength and power The expert can detect the degree of fitness in an individuals muscles by feeling them and noting how soft they are when relaxed and how hard they are nhen contracted Truly supple muscle that is being constanty used never ha ang fat between its fibres, nor does it have subcutaneous fat overlying the muscle. So one can also estimate fitness by poching up the skin overlying muscle, and if one finds that there is only skin between one s fingers, this denotes that the underlying muscle us also well tumed up This is, in fact, the well-known pinch test for muscle tone It should be apprecated that it holds for every muscle of the body and not for any particular group of muscles Swimmers, even in first-class condition, require a thin layer of fat overlying their muscles because they are exposed to sudden immersion in cold water, if they lack this pad of fut, their muscles are more luable to go into spasms and crump up This layer of fut u quite thin but provides a very good ·오오 SPORTS INJURIES powerful as they were when you started, and in whatever game you play, this increase in potver can only lead to improvement in performance. You might think that nothing is to be gained by stretching the muscle through a ringe wider than norml, but if you have ever done such exercises you will know how benefcual they can be. The name principle holds for stretching all muscles. Let me give another example. A hurdler my want to cruise the power of his thigh muscles What better way of dong it than by hugh-lacking (see Fig 2), aming at being able to stretch the quadriceps muscle by backward leg-swing- Ing, as much as the hamstrings by forward high-kacking? A hurdler cannot claim to be getting marimum efficiency out of these muscles util he has learnt to do t vertical high kick. This stretchmg mechanism u also brought into play by the hurdler s favourite exercise of sitting with hus leg forming a right angle, placing a matchbox between hila lega, and bending his trunk and bead down to pick it up with his teeth. Very few men can do it because very few are rupple enough to stretch their muscles to such an extent. The foot exercises and higb-kunking that ballet dancers have to leam are perfect examples of the power produced by stretching Another illustration of how power and clich ancy can be increased in muscles is shown by sprint runnen Any first-class sprinter will tell you that he can soon get hu legs into shape and feel that he is getting mazmum efficiency out of them, but he will not develop maximum speed until he has brought into play the gluteal muscles of the buttocks and that can only be done when the legs have become super-tuned, and the glutei are called into action. Some sprinters estimate their state of fitness from the fact that their buttocks start aching and then they know that they are nearly there but of course it is not until those muscles cease to ache that they an rally claim to be fit. No muscle that is really tuned up ever aches Aching muscles are a sure sign that you are calling on them to do ·TUNING UP THE MUSCLES 23 more work than they are accustomed to doing, or, perhaps more accurately, more than they arc tuned up to do when you go stiff at the beginning of the scuson, after your first gume, that stiffness is purely duc to the fact that muscles have been exercised for the first time and lactic acid has been liberated into them which has not been dispersed because the arculation through the area is so poor Making a muscle supple merely means improving its circulation and Increasing the contractility of its fibres Every music fibre has its blood supply, but unless the muscle is continuously worked, the small versels to cach individual fibre becomo sealed off, and only those fibres that are used are fed with blood Timing up the muscle is the process of reopening Jl the scaled vessels so that every muscle fibre is functioning ind every blood vessel full of blood In the perfectly fit athlete, one can detect a jelly-like consistency in his muscles when he is relaxed that is because they are full of blood. Equally, when they are contracted, they are us hard as iron because of their strength and power The cxpert can detect the degree of fitness in an individuals muscles by feeling them and noting how soft they are when relured and how hard they are when contracted Truly supple muscle that is being constantly used never hus my fat between its fibres, nor dous it have subcutaneous fat overlying the muscle So one can also estimate fitness by pinching up the skin overlying muscle, and if one finds that there is only skin between one s fingers, this denotes that the underlying muscle is also well tuned up This is, in fact, the well-Honown pinch test for muscle tone It should be appreciated that it holds for every muscle of the body and not for any particular group of muscles Swimmers, even in first-class condition require a thin layer of fat overlying their muscle, because they are exposed to sudden ummernon in cold water if they lock this pad of fat, their muscles are more liable to go into spastis and cramp up This layer of fat is quite thin, but provides a very good ·24 SPORTS INJURIES temperature regulator Although swimmers and divers need this thin layer of fat, they should not imagine that they have any nght to curry any excess fat beyond this Indeed considering all types of sport, and the standards of fitness relative to each, I would say that swimmers and divers us a whole ure normally less fit than the general run of athlete. One cause of torn muscles is the habit of taking strenuour exercise suddenly and in an unaccustomed way when the muscles are not tumed up Obviously a sudden great strain on a muscle that has a sluggish blood supply is much more liable to do damage thm it would to a well tuned-up muscle with a good blood supply That is why such injuries are very common at the beginning of the season, especially in rugger teams The fact that rugger 18 more liable than soccer to produce toma muscles is accounted for by the tradition amongst rugger players that they should never take the game too seriously so any Iden of preliminary training has in the past been more or less taboo But this situation is fust changing and more and more rugger duba are realizing the importance of that preliminary training When one hears that one of the most famous athletes in the world has pulled a muscle as a result of not wurming-up before a nice, one can perhaps begin to apprecate the importance of wurming-up and the continued hapbazardness of training methods in this country In this particular ause the athlete was a miler and suddenly deaded to run in a quarter-mile race If he had paused to think, he would have known that there was an increased need to do warm ing-up because the quarter-mile requires a much more com centrated and explosive effort, imposing + much greater strain on the muscle than hu usmal distance. In warming-up the difficulty us to strike the happy medium between getting all your muscles into a warm and relaxed condition, and exhausting yourself It should be easy enough, but very few people set about it in the night way The tverige runner requires from twenty to thirty ·23 TUNING OP TILL MUSCLES minutes of study, reguar cxcrcise to warm up before a ruce There should be nothing all-out about it, but the lim should be to get the system ticking over , rather like warming-up the engine of a racing car The risk of injury to muscles is gready increased by inadequate warming-up, if athletes realized thus they would be much morc arcul Muscles dislike nuddco vanations of temperature, and we should be particularly areful about this The track-or fieldevents man would be well advised to go out in his track mit before competing and keep up a steady routine of joktrotting for twenty to thirty mimutcs umul his first cvent It is no use doing it earlier than this and Icaving an interval between your warming-up and your race You can cry easily cool down m a few minutes and then the warming-up will have done you more harm than good The object is to enter the competition in as alert a condition of body and mind us possible If the blood i really flowing freely through the muscles and you have a moderate su cat on you, you minimize the risk of Injury and you stand the best chance of consistently good performance The sily practice of waiting about on tracks and playingfelds cold and damp weather without adequate clothing is one which has probably led to more injury than anything else. Thu applies with equal force to half-time and other intervals of mactivity In the specialized sports, such as athletics, there is more need for warming-up than in most sports but Ideally, and with samufic trauung, there is an equal need for it in any sport. Yet who has seen any rugger or soccer team do adequate wartoing-up? Cyclists often offend against this rule, not only on the track but on the road They go out in all weathers wearing the fumsiest shorts and exposing their knees to all degrees of cold wd dampness One of the commonest complaints among cyclists is Easter Knee, which is caused by exposure to dump and cold Women are just u gulty us men In this respect there is absolutely no difference between ·96 SPORTS INJURIES the musculature of women and that of men, zod womens need for adequate warming-up is just as great as any mans In my carler illustration of the miler who tore a muscle by rumming 1 quarter-mile without adequate warming-up, I should have pointed out that there is a greatly increased risk of injury if you change your sport or your distance and do not warm up properly for it. With adequate wurmingup there is no increased risk of injury whatsoever, because if you are really fit all your muscles are equally ripple, and so long us you get the circulation working through them they will only react normally to the change of tension. The truly fit man can switch from one type of excuse to a totally different one without the slightest danger so long us he does adequate warming-up It has been suggested that some sports do not go with others that the muscle condition required for one is the opposite to that required for another People ay, for instance that cycling does not go with diving that rowing does not go with swimming that gymnastics do pot go with athletics that weightlifang does not with aquatic sports That is all bimkum If every muscle in your body is equally supple which it should be whatever your particular speciality then It does not matter what form of exercise you take - your muscles will enjoy taking it. As an example of this, a friend of mine recently rode a hundred miles on a bicycle at speed and then immedutely afterwards spent half an hour swimming vigorously in the sea. Because he was foundly fit, dot a single muscle reacted abnormally or painfully He suffered not the sughtert degree of stiffness He only felt gloriously and healthly tired Cramp and stitch are amongst the commonent of the pains of sport in fact, hardly any athlete goes through his career without at some time or other being afflicted in this way It is important to differentiate between the two More nonsense has been spoken on thu subject than on ·97 TUNING UP THE MUSCLES almost any other A well-Iononn BBC. sports comment tator ance mid that nobody know the cause of the curt of these pains That is very lar (rom the truth It is perfcals well known how these pains are used and how they can be ctured I would go further, and say that any athlete who suffers from camp or stitch is training incomaly Cromp is a spasm of muscles, most commonly of the thghi, calf or foot, due to the fact that they have been made to move through a range of movement that they are umaccustomed to The spasm can be brought on for instance, in dnving a car, by sudden braking, or cien, sitting next to the driver, by a sudden involuntary attempt to stop the car by jumming one s foot through the floor-boards i mention this because it is significant in understanding what causes cramp On such occasions the muscles are suddenly contracted in a way that they are not used to, and so the musde goes into spasm The only way to get the muscle out of spasm is by stretching it, and thus if a spasm draws your foot up towards your head it can be relieved by forang the foot away from you Another common cause of cramp is sudden exposure to heat or cold Muscles, as we have seen, dislike any sudden variation of temperature, and if they are continually irritated in this way it becomes in weasingly dificult to stop them going into cramp when ever the conditions they object to are repeated A year or two ago, on an Easter moming, I happened to be wuting for a friend on Putney Bridge He was an hour late, and during that period I counted something like 400 cydlit riding over the bridge, of whom more than threequarters were Wearmg shorts It so happened that sow had fallen earlier in the day and it sus cxtremely cold It is alto probable that most of those young riders were out on their cydes for the first time since the winter, and many of them were running a grave risk of suffering from cramp It u ruch conditionu that can do more harm to muscles than almost anything else If you are already apt to suffer from ·28 SPORTS INJURIES cump, the only way to avoid It us by avoiding sudden vanation of temperature, and by keeping yourself us warm a3 possible One of the factors involved is biochemical there u no doubt at all that you get less tendency to cramp If you have plenty of salt and calcium in your blood. You can increase the amount by taking white fish or any form of alcium food, and also by taking more alt in your food. Stitch is the same sort of spasm, but of a different type of muscle it most commonly occur, In fact, in the small muscles of the diaphraga and the stomach. The stomach, gull bladder, liver and other organs in the abdomen are supported by small muscles and ligaments, and if these organs are overloaded with food or bile they tend to go into the spasm causing stitch more frequently than other- Wise In some people the viscera are loosely supported and tend to swing about when they run, and thlo pulling on the small muscles may set off a stitch. As with cramp the pain can be qute easily cured by paying attention to the things that matter If the pain is due to loose viscera, then a routine of exercise to strengthen your abdominal wall will do the trick if it is because there is too much food in the organs, then obviously you need to find out what food muts you and probably eat less That is why I uy that nobody a bo is properly truned need ever suffer from cramp or stitch. It is useless to bend yourself up and hope to remove the stitch by squeezing it out of you, so to speak. That may relieve it temporanly but has not got to the root cause and thus you will get it agun 49 800n u you repeat the action that cured it The soundly truned man gets rid of these things as soon as he can by worlung out the ause intelligently It is foolish to continue nuffering unnecessarily but one hears of so muay cuses of athletes having to retire, particularly from crosscountry ruming because of this complaint They would never do so if they realized that the awe is stanng them in the face, and that it can be cured very easily ·3 The Danger of Strapping I attach so much importance to the subject of strapping, that I am giving it a chapter to itself Most books on the treatment of sports injuries contain practically nothing dse but mstructions on how to strap or support injuries m various ways with odd sorts of bandages The whole practice of strapping has been grossly overdone, and rather the encourage it, I have purposely avoided all mention of strapping in the treatment recommended in this book, except in the case of strapping for acutely sprained ankles I only recommend it there for the reasons explained, and because the ankle, being a weight-arrying joint, us liable to balloon up much more than other joints. I disapprove of stripping in principle, because it is impossible to apply it without causing an obstruction to the arculation. It is usually applied in order to support a stran or pulled muscle, but I should have thought that it was obvious that the area thus covered is the one place most needing a free arculation. For better than to give yourself any false sense of security by supporting it would be to exercise the part concerned, first gently and then more vigorously and then, if you get any reactionary swelling to elevate the limb until the swelling has gone down A little gentle masuage also helps Next time you exercise it you will find that it swells that little bit less and you can continue to move it so much longer Not only do trainers, corches and museuns apply ·28 SPORTS INJURIES cramp, the only way to avoid it is by avoiding midden variation of temperature, and by keeping yourself as warm u possible. One of the factors involved is blo-chemical there is no doubt at all that you get less tendency to wamp If you have plenty of salt and calaum in your blood You can increase the amount by taking white fish or any form of calcium food, and also by taking more salt in your food. Stitch is the same sort of spasm, but of a different type of muscle it most commonly occurs in fact, in the small muscles of the diaphragm and the stomach. The stomach, gall bladder, liver and other organs in the abdomen are supported by Imall muscles and liguments, and if there organs are overloaded with food or bile they tend to go into the spum cauung stitch more frequently than other- Wise In some people the viscera are loosely supported and tend to owing about when they rum, and this pulling on the small muscles may set off a stitch As with crump the pain can be quite easily arred by paying attention to the things that matter If the pain is due to loose viscer, then a routine of exercise to strengthen your abdominal wall will do the trick if it u because there is too much food in the organs then obviously you need to find out what food tuto you and probably eat less That is why I say that nobody who is properly trained need ever suffer from cramp or stitch. It is useless to bend yourself and hope to remove the stitch by squeezing it you 80 to speak. That may relieve it temporanly but has not got to the root cause, and thus you will get it again as soon u you repeat the action that caused it. The soundly trained man gets nd of these things us soon as he can by working out the cause intelligently It is foolish to continue suffering unnecessarily but one heart of so many cases of athletes having to retire particularly from cross country running because of this complaint. They would never do so if they realized that the cause u staring them in the face, and that it can be cured very easily out of ·THE DANGER OF STRAPPING 31 The excuse that is commonly made for this practice 1 that you can lay the strapping on so evenly that it acts as a sort of bolstered-up skin covering, and this can only do good by decreasing risk from further musclc injury But thus argument fails to take account of two vitally important facto One is that muscles are a different size when they are relaxed and when they are contracted, the other is that much more often than not the strapping is applied to tawed muscles, and whenever a muscle has been injured there u always some swelling This 1. liable to increase when vigorous exercise is continued, and so the strapping 18 luable to become overtight and lead to obstruction of the arculation in just the one part of your anatomy where you need as free a circulation as possible The only permissible form of strapping would be one that could be changed and ro-applied every few minutes. Some people go in for the most wonderfully complicated methods of strapping in which they try to imitate the stresses and strains, and the direction of pull, of the muscles concerned Thu fantastic idea comes from America. In my opinion it u absolutely impossible to imitate by such a method of support the normal stresses and strains of there muscles It strikes me as Incredible that anyone should imagine that you could remotely imitate the normal muscle actions by covering them with such supports, because there are so many factors involved Muscles are peculiarly senaitive things and they strongly dialıke any ummatural or arti ficual means of assistance. This fact is demonstrated by the euse mith which some muscles develop cramp mnd go Into spasm. It can often be due simply to the pressure of bed dothes, or making the minutest movement in a slightly ubalanced fushion As most of these athletes are amongst the most super-balanced creatures in the world I cannot believe that it can be anything but harmful to them to try to speed recovery from injury by such artificial means us strapping ·ܫܝ I 80 SPORTS INJORIES strapping much too frequently, but one often sces athletes in various sports applying it for themselves in a most unistelligent way In a recent weightlifting championship contest, I saw onc national champion wearing a bandage support on one wrist Another had it on both wrists Both these competitors showed considerable venou congestion in their arms Presumably they felt their wrists needed such support, but bullding up the strength of those wrists by natural and vigorous exercises would surely be better than any artificial aid. One could perhaps excuse the use of supports on both wrists, but certainly not an only one for that must Inevitably cause an upset in symmetrical balance, and to all athletes balance 18 of primary importance Another sport in which one sees this silly habit of wearing supports is boxing a good many boxers insist on wearing an elustic knee bandage. I have often asked them why they do it, and I always get the same answer that the knee is a bit unstable and this support prevents it from doing anything tricky But no trainer should allow hus man into the boxng ring unless he is soundly fit, for although strupping support may give a feeling of secunty in actual fact it always greatly increases the nisk of injury In football too there is an old establuhed practice of waanng support, but few footballers would do it if they realized its dangers Another group of people who have been misled into thinking that strapping support can help them are the International-class aprinters Their most common trouble is pulled or slightly struided muscles of the thigh, and 10 one sees them running in international nces with all sorts of weird criss-crous support round the injury As such sprinters are often amongst the most beautifully balanced individuals in the world their whole balance may be seriously affected by resorting to this device If you are going to support the one thigh, then you should support the other one too and then you get w near to in equal dustribution of changed tensions us you possibly can.

·THE FALLACY OF ROLLEN AIDINO 99 exhausted and unable to go on The reason why muscle exhaustion sets in is simply that the muscles are not getting enough oxygen, and thus cannot get rid of the waste products of muscle action quickly enough, so that lactic acid accumulates in them, poisons them, and makes them cease to function It is obvious that such an oxygen debt occurs sooner in roller riding than in ordinary cycling, because one can make greater effort in a shorter time. The fitter a man is, the longer he can keep going but it appears to me that almost anybody, fit or unfit, may consider himself qualified to have a go at roller nding, and rang This is very dangerous I have seen even the fittest of men vomit when an rollers, and this is only one of Nature s many ways of showing her disapproval Now why should a fit man vomit? The answer, which is tied up with thus question of oxygen debt, gets one to the root of why roller ricing 19 a bad form of sport In the first place roller nding 18 invariably done indoors, where there is nothing but dead air, no wind either in front or behind, and, in fact, no change of air throughout the proceedings Add in this dead ur the labouning, panting lungs are simply Crying out for orygen, and not getting it in the second place, not only is this atmosphere dead but the rollers themselves throw up any dust that may be about, and invanably a crowd of people stand around smoking cigarettes and adding to the prevailing stuffiness A third, purely mechanical, reason is the hunched crouching position of the rider and the continual thumping of the knees against the chest. This sometimes causes vomiting in time, and even severe gastritis I have found that roller nders suffer more than most people from houtenets, Bore throats and colds The dust und stuffocus of the atmosphere cause uitation to the throat, which is aggravated by panting and once the throat is tore they are far more likely to catch colds, or other in ·4 The Fallacy of Roller Riding Roller riding is much in vogue now, and has been for some little time, not only us a means of truning for cycle-racing proper, but as a sport in its own nght. But in my view it 18 useless for the one and downright dangerous for the latter For the benefit of the inintated, I should explain that in roller riding a bicyde framework - addle, frame, bandlebars and pedals - 28 fixed over a metal or wooden roller, which is made to revolve freely by rotating the pedalo Quite a cult has grown up with endurance tests sprints and so on. These roller cycles are not by any means the same as the machines used in hospitals and clinics for purposes of physiotherapy Those fixed cycles are correctly geared whereas roller cycles have little or no gearing and therefore provide insuficient resistance to In ordinary cycling certain resistances make themselves felt, such u those between the cycle and the road, and between the vamous bearingWithout these resistances, which are almost entirely absent in roller cycling tho nder becomes prematurely exhausted, and his legs, so to speak, nin wway with him. What exactly is exhaustion: We breathe air into the lung, and thus air, in the form of oxygen, supplies fuel to the various muscles of the body It is quite euy by overcxertion to develop an oxygen debt, uod If the blood becomes short of oxygen, then one becomes wided and the legs ·THE FALLACY OF ROLLER AIDING 96 recognized by doctors as a disease, is often found in rollercyclists, and as a result of it the individuals concerned have had to be advided to give up roller riding There is a psychological factor that weighs against roller nding, and that is the monotony It gives you no change of scenery, no variety at all, and I have often heard those who have done a lot of roller riding complain that three minutes on rollers feels like fifteen minutes on an ordinary cycle Thus shows what a tremendous amount of effort goes mto a very short period of time The danger of such monotony and concentrated effort is, of course, the development of staleness Staleness 18 purely mental in ongin and roller nding can produce it much quicker than anything else When the British cycle-racing team went out to New Zealand in 1980 they planned to do roller training on board ship I thought at the time that it might be a fairly adequate form of training, but experience showed that it was totally inadequate, and indeed il prepared our team for rond work or track racing To sum up roller nding has so many dangen attached to it that it should be discarded as a means of scentific traning for fitness It is an unnatural form of exercise, which can very easily over-expand the lungs and build up more muscle than Nature means you to have In addition it causes reang of the heart, development of an oxygen debt, and a muscle fatigue which is far from being a natural way of developing oneself It might be argued that ordinary cycling has, to a certain extent the same effects True, but it has also the advantages of providing fresh air, an ever-changing environment, and sensible resistances for the leg-muscles to work against. Roller nding is a stunt, unufe, unsound and insanitary Ordinary cycling, done sensibly to definite schedule and under wise supervision, can be one of the best forms, If not the best form of training for fitness ·SPORTS INJURIES fections, than they would be of their throats were sound. Another factor in this connection is the draughts that often prevail. As a method of truning for fitness, I am against roller riding I once uw two youngsters, one aged 14 the other 15, competing together on roller. The one was fit and strong the other far from it but the nature of the activity was such that the younger one wus able to ride himself into unconsaousness and he collapsed, I believe, through developing a serious oxygen lack in hus blood He went very bluc, and when I sounded hus heart I found it was racing at about 140 I felt it was disgraceful that he should be allowed to do this and afterwards he told me that he had never been on rollers before, and had done little or no cycle truning If things uke that are possible I feel most strongly that the sport should be discouraged Older people who have taken up roller nding will no doubt disagree with me, but there are good reasons why they, too should thunk twice before continwng with it. For one thing it bulds up large muscles, but muscles lacking in stamını or strength. Bulk of muscle is often misleading and this very explosive form of exercise builds up muscles which will never develop a natural strength Only riding against resistance can do this, and Reg Harris for instance, though he may be very fast on rollers, could never have developed noch speed by training on rollers only, nor would he have developed anything like the strength he poneses Thu is worth bearing in mind Then there is the suggestion that roller riding helps you to develop a large chent ind good lung expansion. But there are many better ways of doing this than on rollers and, in fact, rollers are an extremely unwise way of doing it It is quite easy to overstretch lung tune if you look upon your lungs us a balloon, or collection of little balloon, it lo qute easy to blow them up too quickly and too frequently, and thus weaken them. This condition ·DIET AND DOPE 97 are brown sugar, honey, tredie, and white sugar I do not recommend glucose powder because it usually gives fit men and women indigestion. It is, so to speak, a pre-digested form of rugu, and whereas it 18 all right for old ladics who cannot digest the sugar for themselves, it is not the sort of thing a normally fit person should need to take You may find, however fit you are, that you do not digest even sugar very easily in that case if you develop the shakes you may well have to stop playing for a few minutes while the sug takes effect. If, in training, you find that you have a habit of developing the shakes, you should take extra sugar an hour or two before playing this will enable you to get through any match without being affected in this way Know thyrell is the way the Greeks put it. Without knowing yourself your capabilities and your shortcomings, you cannot achieve fitness It may be a counsel of perfection, but I always recommend cutting out all tea and coffee. Besides containing the drug caffeine, both these drinks, whether taken hot or cold, have a tendency to raise the body temperature artifinally, which is not a good thing If, instead of tea and coffee, you make a habit of drinking fresh fruit drinks you will very soon find yourself fitter than you were It 18 also possible to drink too much milk in training Milk contains a very high proportion of fat, and if you drink a great deal of it you may find that the proportion of fat to sugar and protein lo too high As regards alcoholic drinks, you will never come to much harm so long as you keep off all opints Drink beer in moderation, and the red and white wines of Italy and France as much as you like These wines are natural foods and are always very nourishing The continental long-distance cyclists, even while ruang almost live on them and they reach a degree of fitness which one seldom sees here A common fault among athletes 18 taking insufficient Auid with their food Try to develop the habit of taking a ·er Diet and Dope A detailed study of dietetics would be out of place in this book. I propose to deal only very briefly with its cosentials Various authorities tell you to avoid thus and avoid that but the important thing to avoid u faddiness The sort of person who develops fads and fancies about food is often the sort of person who spends a lot of his time fussing about minor injuries Of course of you have any digestive disturb ance, whether indigestion or a skin acne, boils abscesses, *tyes or other septic foci, you must make every effort to discover the cause and remove it. It is frequently due to a dietary defiaency, the commonest cause of which is an - balanced diet with too much carbohydrate (sugar) in it. Thit us enly corrected by cutting down the sugar and increanng the fat and protein. As it is also often a ogn that the blood u over haated, a good augliary remedy is to take some form of alts either first thing in the moming or last thing at night. In some games particularly squash rackets one ererts oneself so furoualy that one becomes short of sugar developing a feeling known us the obukes This is due to the fact that the rugar in the blood has dropped below a certain level. I have irid elsewhere that the body cannot both digest food and take vigorous exercise at the same time, but sugar is something you can take in such a form that it can be easily absorbed and its effect felt almost instantaneously The best forms of sugar in order of digestibility, ·DIET AND DOPE S9 training You cannot beat Nature to it, and although you may get a temporary improvement in your performance by taking drugs they always take out of you a great deal more than they put in. If on no other grounds than plain common sense, I would never recommend anyone to take them. The only right method of getung supremely fit and putting up consistently good performances is the natural way - plenty of regular hard truning, with due attention to your particular speciality The simplest form of doping is the habit of taking strong ta or coffee. These both contain the drug affeine besides which tea contains tannin, Caffeine is a very effective stimulant and its effect during vigorous exercise may last up to half an hour On the Continent you can get tablets of caffeme of high concentration which have a similar effect to strychnine. They increase both your reaction time and also your visual and auditory acuity All human beings bave a reaction time which can be measured it is the time that one takes to respond to any particular situation Although it is only * minute fraction of a second, there is no doubt that thete drugi can make that time-lag shorter Not only that but caffeine and strychnine seem to enable you to see and hear things more quickly All this is very importmt indeed in racing, but, like so many drugs, these two will very soon completely wodermine your general health, and are bound to shorten your athletic career if you take them in any quantity Drugs of this kind have been commonly used in the past in cycle racing and I remember once, when I was investigating the use of druga in sport, watchmg a competitor on i Paris track injecting himself with a neat strychnine solution just before be raced. He had taken so much of it in his time that on this occanon he wu taking in a single dose in amount which would have killed a normal person Although he had not studied it scientifically, he found by experiment that it enabled him to react more quickly to ·98 SPORTS INJURIES glass of cold water or frut dank with your meals and ilso first thing in the morning and let thing at night. A fruit drink last thing at night is far better for a fit athlete than a glass of milk, For some years, efforts have been made to find some tonic-like preparation that athletes can take during trainmg to lessen the naks of loss of form, staleness, sleepless ness and the hundred and one things that so often hold things up Vanous milk compounds, vitamin mistures and blood tonics have been tried but none of them seemed at all reliable except an ox-liver concentrate that really does seem to be the answer Besides preventing the things I have mentioned, it also seems to increase one a resistance agunst the common winter cold. Perhaps it is not surprising that it should, for so many of the athlete o troubles start in the hver and If he tunes that up with a tonic he can espect to be at an advantage over others who do not. Thus liver concentrate also contuns the growth factor, which u essential to proper growth if he takes it his weight rcmains steady and no matter how much energy be uses it is replaced in extrı-quick time It also greatly reduces risk of exhaustion Although the subject of dope and doping my seem to have little to do with dietetics it is nocessary to mention it because of its connection with training Periodically, and in various sports cotopetitors get the idea that they can improve their performances by taking vious sorts of stimulants It has even been suggested that on some occasions teams have been doped in international events Although personally I have never known of a whole team being doped I have met qute a number of individual athletes who have been unog such stimulants very often with temporarily beneficial effects But any form of doping besides being wethical and very unsporting is also in the long rm bound to be detrimental to health. This subject is all related to the night mental approach to ·DIET AND DOPE 99 truning You cannot beat Nature to it, and although you may get a temporary improvement in your performance by taking drugs, they always take out of you a great deal more than they put in If on no other grounds than plain common sense, I would never recommend anyone to take them. The only night method of getting rupremely fit and putting up consistently good performances is the natural way - plenty of regular hard training with duc attention to your particular speciality The simplest form of doping is the habit of taking strong tea or coffee. These both contain the drug caffeine, besides which tea contains tarmin Caffeine 13 very effective tumulant and its effect during vigorous exercise may last up to half an hour On the Continent you can get tablets of caffeine of high concentration which have a similar effect to strychnine They increase both your reaction time and also your visual and auditory acuity All human beings have a reaction time which can be measured it is the time that one takes to respond to uny particular situation Although it 18 only a mamute fraction of a second, there is no doubt that these drugs an make that time-lag shorter Not only that, but caffeine and strychnine seem to enable you to see and hear things more quickly All this is very important indeed in ndng, but like so many drugs, these two will very soon completely undermine your general health, and are bound to shorten your athletic career if you take them in any quantity Drugs of this kind have been commonly used in the past in cyclo-racing and I remember once, when I was investigating the use of drugs in sport, watching a competitor on i Paru track injecting himself with a neat strychnine solution just before he raced. He had taken so much of it in hus time that on this occanon he wu taking in a single dose an amount which would have killed i normal penon Although he had not studied it fentifically, he found by cxpenment that it enabled him to reuct more quickly to ·40 SPOATS INJURIES any moves by his opponents There have been maandalous cumples of young and well-known athletes taking these drugs and although their performances have been wonderful for a short time, they have suddenly died of heart attacks or other complaints which, in the post-mortem have been found to be due to the effect of the drugs In the 1948 Olympic Games in this commtry & youmg foreign champion won his Olympic gold medal although it was obvious to the expert eye that he was racing under the influence of drugs There was nothing that I or anybody else could do about it because it is one of the most difficult things in the world to prove, and any open accusation might have involved an action for slander but in this particular instance, the boy trainer actually oud, within my hearing, that their one aim was to win this Olympic Medal that they would stop at nothing to do so and did not mind of the youmg champion himself never ruced again. Although he won that ttle, he has never since been anywhere near as good u be should have been. At that time he was an exceptionally fine athlete, in fact, I would have dessed hun as one of the greatest in the world, but because he was allowed to take drugs he never developed u be should have done His case should be an example to all athletes who are tempted to take stimulants Another common drug that has been used by athletes us benzedrine, which was the stuff unued to the troops during the wur prior to going into action or on prolonged mancuytes It wards off sleepiness and also acts as a general stimulant, but, like all other drugs its after-effects can be extremely harmful and certainly you lose much more than you gain by taking it. I always feel that dope was more wed in the past than it can ever be in the future. It was possible nearlier days for 1 doped athlete to beat his opponent, but nowadayo the likelihood of anyone who is under the in Auerre of drugs being able to defeat a xentifically trued opponent is becoming less and less ·any other DIET AND DOPE 41 There has been much talk lately about the taking of oxygen at balf-time in soccer and rugger matches There u nothmg new about this, however, for it has been tried for many years past, whenever boxers go to a place like Johannesburg, where the air is more rarefied than here, their managers always hope to save time in acclimatization by giving them oxygen. As always with attempts to bya pass Nature, little advantage is acquired No one would deny the psychological effect of orch attempts to boost a team, particularly if accompanied by much publicity and noise, but there is little if effect, and the results for obvious reasons, do not lust long To claim that a team might revive and become noticeably less tired with such treatment is pure imagination. It could only have a dramatic effect on someone who was far from fit. Trainers would be better advised to crisure that their teams are as fit us posnble by the time they enter competition. The vanous alcohols are often used as stimulants, but I need hardly pomt out that the effect of these on the liver u liable to lend to all sorts of digestive complaints So don t take a glass of sherry and a raw egg, or a tot of brandy or whisky, just before a race Take something that will be both nourishing and appetizing and give you the necessary psychological feeling of refreshment. The ideal mixture is a tumblerful of water flavoured with lemon or orange essence, to which is added as much rugar or honey us you like, and half a teaspoonful of salt You will never find anything more useful to you than that At half-time intervals, some terms impress the spectators by having some wonderful concoction taken out to them by their trainer This usually contains sherry or one of the other stimulants I have mentioned, but the habit of sucking an orange or a lemon is in actual fact for more reliable, and better for you, than anything else can be, except possibly the drink which I recommend above ·42 SPORTS INJURIES We have seen that caergy annot be replaced us it u expended, food which you take at any particular moment will not be converted into energy for several hours La fact, the body cannot both digest food and take vigorous exercise at the same time This is bome out by such an outstanding athlete us the Marathon rinner and world record holder, Jim Peters In the 26-mile nce he did not even moisten hus lips, and he took no sort of nourishment from begimming to end, because he knew that all the energy be called upon came from the store that he had built up in his liver during the previous weeks So what was important to him was the nourishing food that he ate in preparation for the race. An interesting point is that immediately he finished he was liable to feel very exhausted and hungry and for a long time he could not find any drink that he could take without feeling sick He finally found, however, that he could drink a mixture of blackcurrant juice, salt and water In certain sports, such as cycling, long-distance races become tests of endurance, and besides exhaustion onc may have to compete with pain particularly in the back. That has lcd some people to seek a drug that will act both as a stimulant and a painaller Such a combination is made commercially and contains benzedone und wspinn. But it 18 Impossible to justify even this degree of doping, pot only on cthical grounds, but because the nght way of guardmg agunst an aching back or an exhausted body v adequate and regular truning There are no short cuts to supreme fitness Anybody who hopes to find one would be better advised to give up sport and take to dominoes ·6 Self-Confidence and Staleness Nothing is more important to an athlete than the develop ment of complete self-confidence and so strong a belicf in himself and his own ability that nothing can deter him The greater the self-confidence, the less becomes the risk of injury The star performers in any sport are altvays those who injure themselves least This is because they learn to relax and to keep themselves perfectly fit. Of course there are certain games in whuch clumsy performance by others may involve risk to even the finest players, but because of the alertness of their minds and the agùity with which they move, they nearly alwayı escape the catastrophes which 30 often overtuke lesser performers No one can develop this supreme self-confidence if he is being worried by extraneous factors, such as personal or domestic problems You cannot put up a consistently good performance in sport without also having the ability to sort yourself out This psychological aspect of training 18 of fundamental importance you should never neglect the need to be yourself and to try and crpress your personality us you want to Any form of repression or frustration is luable to react on your athletic performance I do not mean to advocate licentiouspeh or loose living Far from it, because an ersentul corollary to true selfexpression is self-discipline This should take the form of regular habits, and, indeed, a regular truning routine, in which you keep stactly to any rules you get yourself This ·SPORTS INJURIES routine should never interfere with any form of normal behaviour, and mamed men and women should remember that a continuance of normal sexual relationships can only do good in helping them to achieve athletic fitnes One well-tonown athlete of my rcquaintance thought that it would be harmful for him to have any relationship with his wife within two or three weeks of an international event. He therefore tried to repress his natural urges, but he found that Nature had to get an outlet. He found this out the night before the great event, so that he was thoroughly demoralized and showed up very badly in hus ruce The supremely self-confident athlete lonown himself so well that he has no need to run risks like this He is always perfectly natural and, because he always has a regular routine of sleeping cating and other ordinary habits of behaviour, he enters his events in the confidence that there has been no change in his routine – nor anything to upset hlm. There are other factors to be considered in thl: quest for what one might call psychological fitness For instance, you cannot posably get down on your starting blocks feeling absolutely on top of the world unless you have had a thorough medical examination and been told that you are soundly it and free from any sort of infection So it u a good idea for every athlete to undergo a thorough medical examination at the beginning of every seaton. It is also important to know what sort of food aunts you and what sort does not, so that you can take normal meals at normal times and bonow that nothing will upset you before« ruce. A great many athletes find themselves ko worked up before a race that they can eat nothing They may even find themselves being violently sick. This shows 1 lack of self-confidence though it may also show a certain degre c rupenority over the type who is unboth mentally and physicallysluggish. When y 18 nervow state you produce an eten of ch tends to make you sick but also puts you CRO ·45 SELF-CONFIDENCE AND STALENESS into a state of awarmess and alertness There is no need to relax thus tension, because it is natural and beneficial, but it 18 important to work out what foods suit you and when and how to take them so that they do not causc sickness Youngsters sometimes feel ashamed at getting het up in this way, but it may help them to know that cvery great athlete does the same, no matter how calm he may be, or appear to be. Dr Frank Aaron used to suffer agonics from nerves before running, and he always tried to conceal it from everybody, unul he realized that everybody else was feeling the same way When he admitted to his fellow nummers how terrible he felt, and laughed about it with them, be found the problem became much less severe The areer of the great sprinter E. McDonald Bailey is a graphic example of the value of self-confidence For years he was always getung muscle trouble and all kinds of little things would upset him. His performances were most inconsistent and umeluable, not because of the state of hus muscles but because of the state of his mind He did not completely and wholly believe in his ability to beat the world. But when he did finally gain that supreme selfconfidence he caused to have muscle trouble, and run better than he had ever run before in the old days it could easily happen that some remark made by another athlete or one of the officials would so upset Mac that he would run badly, but nowadays he has such faith in his own fitness and ability that such things have cewed to worry him. That u, in fact, the ideal state at which all athletes should aim, McDonald Bailey is a living proof of another interesting point. Only ten or fifteen years ago it was generally believed that the sprinter's beat years were the carly twenties But Muc bus shown that his best years were in the thirties, thereby bearing out what is believed by those of ws who approach this subject xentifically that no human being develops fully until he is at least twenty-five years old Your bonu and your muscles continue to grow until ·SPORTS INJURIES routine should never interfere with any form of normal behaviour, und married men and women should remember that a continuance of normal sexual relationships an only do good in helping them to achieve athletic Atness One well-known athlete of my acquaintance thought that it would be harmful for him to have any relationship with his wife within two or three weeks of an international event. He therefore tried to repress his natural urges, but be found that Nature had to get an outlet. He found this out the night before the great event, so that he was thoroughly demoralized and showed up very badly in his race The supremely self-confident athlete knows himself so well that he has no need to run risks like this He u always perfectly natural and, because he always has a regular routine of sleeping eating and other ordinary habits of behaviour, he enters his events in the confidence that there has been no change in his routine - nor anything to upset him There are other factors to be considered in this quest for what one might call psychological fitness For instance, you cannot possibly get down on your starting blocks feeling absolutely on top of the world unless you have had a thorough medical cxamination and been told that you are soundly fit and free from any sort of infection. So it 18 a good idea for every athlete to undergo a thorough medical examination at the beginning of every season. It is also important to know what sort of food suits you ind what sort does not so that you can take pormal meals at normal times and loow that nothing will upset you before a race. A great many athletes find themselves so worked up before a nice that they can at nothing They may even find themselves being violently sick. This shows a lack of self-confidence, though it may also show a certain degree of athletic superiority over the type who is - emotional, and both mentallyand physicallysluggiah. When you get into this nervous state you produce un cices of adrenalm, which tends to make you sick but also puts you ·47 SELF-CONFIDENCE AND STALENESS state in less than two or three weeks If the varicose veins are very slight, and show themselves as a bluish motuing of the skin, you should ignore them altogether Athletes often worry about them when, if they did but know it, such things are quite harmless, and may be ignored Another form of varicosity is hacmorrhoids or piles There are usually caused by allowing yourself to get con stipated and straining No flt man ever takes laxatives or any form of aperient He gets his bowel into first-class working order in a natural way by eating natural laxatives in the form of fresh fruit. Although you may know plenty of people who smoke and seem to take no harm from it, the scientifically trained athlete and the person whose one aim is perfect fitness does not smoke The nicotine in tobacco may have only a small effect, but it u a cumulative one The connection between smoking and cancer of the lung and bronchial tubes is not yet established beyond doubt, though much research is being devoted to it but the fact that smoking affects the stamina is too well known to need comment The athlete who does not smoke will undoubtedly reach that extra pitch of fitness which would otherwise be beyond his reach Another common problem for athletes is infection by a cold or sore throat or anythug in the nature of catarrh, hay fever, flu, or the many other minor infections that beset w The answer is to continue steady training, but under no circumstances to do anything really exhausting like racing or talang part in an important competition While the infection is on you, there is always a risk of spreading it if you get over-exhausted You do not spread the infection by moderate truning – taking it up the road , u the cyclista would put it - instead, you tend to throw it off Many a time, by adopting such a routine an athlete has developed a good weat come bome to a hot bath and bed and by the morning been completely cured Another problem, or rena of problems, concerns the ·18 SPORTS INJURIES then, and, in fact, you are much more likely to develop experience, stamina and speed five or six years after you have reached this age of full growth. There is no physiological reason why w athlete should not go on improving hus performances in almost any sport up to the age of 10 or 45 Perhaps the sprinter in both track and cycle events might show a little slowing down by that age, but if he was able to continue a whole-time concentration on keeping fit, there is little or no reason to suppose he would deterorate I do not support the view that he need lose uy of his speed at all before he is about 40 Perhaps Mac will go on to prove me right in this respect. That you can develop stamina to an increasing degree nght into middle age is proved time and time agan Climbing Mount Everest was quite an exceptional example of endurance and required tremendous stamina on the part of the team concerned Yet although some of them were yoimg men, the leader was well Into middle age, and no one will deay he was able to play more than hus fair share in the expedition 8 efforts Jack Holden the great Marathon rummer retired at 48 while still supreme champion - not because he was unable to maintain his form, but in order that he might spend more time with his family I have already mentioned the importance of the periodic medical camination. This should be made the opportunity of seeing that such things us teeth are in good condition And if you tend to develop varicose veins then you should seek the doctor & advice about them. He will tell you that the fitter you get yourself the less protuberant they become and the less musince they will be to you. Unless they art very troublesome, they should be left entirely alone and there will be no need to do anythmg for them until long after your athletic career has finished. If they do happen to be very kevert - and this is very rare in my experience of young athletes - they can be injected and died then, of you truo properly after the operation, you can get back to a fit ·47 SELF-CONFIDENCE AND STALENEIS state in less than two or three weeks If the varicose veins are very slight, and show themselves as a bluish motumg of the skin, you should ignore them altogether Athictes often worry about them when, if they did but know it, such things are quite harmless, and may be ignored Another form of varicosity is haemorrhoids or piles These are wually caused by allowing yourself to get constipated and struning No fit man ever takes laxatives or any form of aperient. He gets his bowel into first-class working order in a natural way by eating natural laxatires in the form of fresh frunt. Although you may know plenty of people who moke and seem to take no harm from it the scientifically trained athlete and the person whose one aim is perfect fitness does not smoke The nicotine in tobacco may have only a small effect, but it is a cumulative one. The connection between smoking and cancer of the lung und bronchial tubes is not yet established beyond doubt, though much research is being devoted to it but the fact that smoking affects the stamina is too well knowa to need comment The athlete who does not smoke will undoubtedly reach that extra pitch of fitness which would otherwise be beyond his reach Another common problem for athletes u infection by a cold or sore throat or anything in the nature of catarrh, hay fever, fa, or the many other minor infections that beset us The answer is to continue atendy training but wonder no circumstances to do anything really exhausting like racing or talong part in an important competition. While the infection is on you, there is always a risk of spreading it if you get over-exhausted. You do not spread the infection by moderate trading - taking it up the road , us the cyclists would put it - instead, you tend to throw it off Muy 1 time, by adopting such a routine an athlete las developed a good sweat, come home to a hot bath and bed, and by the morning been completely cured Another problem, or series of problemos, concerns the ·16 SPORTS INJURIES then, and, in fact, you are much more likely to develop experience, stamina and speed five or six years after you have reached this age of full growth. There is no phyriological reason why an athlete should not go on improving his performances in almost any sport up to the age of 40 or 45 Perhaps the sprinter in both track and cycle events might show a little slowing down by that age, but if he wus able to continue a whole-time concentration on keeping fit, there u little or no reason to suppose be would deterorate. I do not support the view that he need lose any of hus speed at all before he is about 40 Perhaps Mx vill go on to prove me nght in this respect. That you can develop stamina to an increasing degree right into middle age is proved time and time again Climbing Mount Everest was quite an exceptional exumple of endurance, and required tremendous stamina on the part of the team concerned Yet although some of them were young men, the leader was well into middle age, and no one will deny he was able to play more than his fair share in the expeditions efforts Jack Holden, the great Marathon rummer, retired at 48 while still supreme chanpion - not because he was unable to maintain hus form, but in order that he might spend more time with his family I have already mentioned the importance of the periodic medical crammation. This should be made the opportunity of seeing that such things us teeth are in good condition. And if you tend to develop rincose veins then you should seek the doctor s advice about them. He will tell you that the fitter you get yourself the less protuberant they become and the less nuisance they will be to you Unless they are very troublesome, they should be left entirely alone and there will be no need to do anything for them until long after your athletic areer hw finished if they do happen to be very severe - and this u very rare in my experience of young athletes - they can be infected and tied then, If you train properly after the operation, you can get back to a fit ·SELF-CONFIDENCE AND STALENESS 19 Staleness is, in a way, the reverse side of the medal To avoid it, one must understand just what it is Basically it is a friental phenomenon, caused by monotony It shows iuclf ma great number of variations, and in many different ways of a physical outure. The athlete who goes stalc not only loves all interest in his sport, but he develops alceplessness, loss of appetite, headaches, nausca, listlessness, diarrhoca, constipation or other digestive disturbances As I have mid before, it does not occur in the properly trained person and it is a sure sign of wrong training Once it has developed, however, there is only one reliable way of overcoming it in a mmimum amount of time, and that is by introducing some alternative form of recreation and trying to take the mans mind nght away from his usual sport. Many trainers advise complete rest for a week or two, but this is extremely unwisc. When muscles are in a really supple condition, the expert can detect an almost micro xcopic deterioration in their tone after a single day : lay-off After a week o rest, the deteriontion can be detected by anyone and is a serious matter to the individual concerned, particularly if it has occurred a week or two before some big event Imagine i rowing Blue going stale about a month before the Boat Race If he rested, even for a week, It w inconceivable that he could recover his best form in time for the race, whereas if his interests were guided to new channels during that period and he continued to take adequate exercise, he would almost certainly be in perfect condition. The interests of the team have to be considered and the corch hus to weigh the pros and cons of taking a man away from the atmosphere of the team for a time I mention rowing men in this connection because there is no sport where atalegieas occurs 80 commonly I believe this is entirely due to the habit of changing corches at regular intervals during the traltung season, so that methods are changed too and one personal opinion i matched against another a practice which almost invariably ·18 SPORTS INJURIES control of one s weight. If you find yourself putting on Weight, there is only one way of reducing it scientifically, and that is by ating less food and taking more exercise You can wer extra dothes to make you sweat more, but you will never reduce by such means is turkush baths Thus holds for women as much as for men, just u the correct weight for a woman, u with a mm, is when the muscles are wholly free from fat. At present in this coumtry women do not train anywhere near hard enough and I do not know more than thirty or forty women athletes who carry no superfluous weight, to say nothing of other aspects of fitness Women must leam to do a great deal more training than they are doing at present. Another problem for women w whether or not to compete at the time of their periods Their best course is to treat the matter as a perfectly natural process and compete normally In a recent Olympic Games there was much concern for four women members of our team, and I was asked if I could give them injections to delay the onset of the period I considered such a suggestion most unethical, and was interested to see that these four girls finally performed better than any of the other. That bears out what I have many times proved to my own satisfaction, that Nature kaows much better than we do To sum up you cannot have complete self-confidence unless you are regular in your habits and understand your onn peculunities and idiosyncrasies You must know what food you can or camot at how much sleep you need and, really important, so organize your activities that your performance is never upset by flurry and muddle. I am thnking of a numer who though he disliked train long and complicated cross-country journey by nil to an athletics meeting an ad breathless with hardly time to chungs, and utterly falled to do hlmself justice. Thu kund of thing may seem trval but the experienced athlete knows the frustration produced and guards ugunst it. joumeys took a ·13 SELF-CONFIDENCE AND STALTIES Staleness is, in a way, the city ade of the medal To avoid it, one must understand just what it is Basically it is a menal phenomenon, caused by monotony It shows itself in a great number of variations, and in many different ways of a physical naturc The athlete who gocs stale not only loses all interest in his sport, but he dai clops sleeplessness, loss of appetite, headaches, nausca, listicssness, diarthoca, constipation or other digestiic disturbances As I have suid before, it does not occur in the properly trained person and it is a cure ngn of wrong training Once it has developed, hon ever, there is only one reliable way of overcoming it in z minimum amount of time, and that is by introducing some alternative form of recrcauon and trying to take the man s mund nght away from hua usual sport Many trainers advise complete rest for a week or tho, but this u extremely unwise. When muscles arc in a really supple condition, the expert can detect an almost microscopic deterioration in their tone after a single day a lay-off After a week's rest, the deterioration can be detected by anyone, and us a senous matter to the individual concerned, particularly if it hus occurred a week or two before some big event. Imagine a rowing Blue going stale about a month before the Boat Race If he rested, even for a week, it is inconceivable that he could recover his best form in time for the race, whereas if his interests were guided to new channels during that period, and he conunued to take adequate exercise he would almost certainly be in perfect condition. The interests of the team have to be considered, and the corch has to weigh the pros and cons of taking & man away from the atmosphere of the team for a time I mention towng men in this connection because there is no sport where staleness occurs so commonly I believe this is entirely due to the habit of changing coaches at regular intervals during the training season, so that methods are changed too and one personal opinion is matched agunat another - a practice which almost invariably ·48 SPORTS INJURIES control of one = weight. If you find yourself putting on weight, there is only one way of reducing it mentifically, and that is by eating less food and taking more cieTASC. You can wear extra clothes to make you sweat more, but you will never reduce by such means us turkuh baths This holds for women as much us for men just u the correct weight for 1 woman, a wth 1 man, u when the muscles are wholly free from fat At present in this country women do not trun anywhere near hard enough and I do not know more than thirty or forty women athletes who arty no ruperfluous weight, to say nothing of other aspects of fitness Women must leam to do a great deal more training than they are doing at present Another problem for women is whether or not to compete at the time of their periods Their best course is to treat the matter as a perfectly natural process and compete normally In a recent Olympic Games, there was much concern for four womer members of our team and I was uked if I could give them injections to delay the onset of the period I considered such a suggestion most unethical, and was interested to see that these four girls finally performed better than any of the others That bean out what I have many times proved to my om satisfaction that Nature knows much better than we do To sum up you cannot have complete self-confidence unless you are regular in your habits and understand your own peculianties and idiosyncrasia You must know what food you cun or camot eat, how much sleep you need and really important, so organize your activities that your performance la never upset by flurry and muddle, I am thinking of a runner who though he disliked trun journey took a long and complicated cross-country journey by rail to an athletia meeting arrived breathleus with hardly time to change and utterly fuled to do humself justice Thus kind of thing may xem thvial, but the experienced athletc knows the frustration produced, ud guards against it.

·7 Head and Neck Injuries The inpunes of the head that one comes across in sport require hospital treatment more often than not If there is any suspicion of concussion after a blow, it is most important to keep the individual quiet and in a dark room unul hc can be got into hospital Rugger players often sustain such an injury and are found wandering about the field not Inoaring what they are doing Even minor forms of concussion should immediately be taken to a quiet place and not allowed to continue to play, no matter how persuasive they may be about going on. If you have sustained concussion, it u dangerous to continue to play because any aggravation of it may lead to persistent headaches and black-outs Ear As These occur most commonly in boxing, and if there is any suspiaon whatever that such an injury has been sustained it must be thoroughly investigated by an ear nose and throat specialist Such injuries are very commonly Deglected, with the result that complications oocur, and deafness and other complaints arise quite unnecessarily If there w any likelihood of the ear having been damaged, always get it attended to by a specialist, because it is far better with 80 sensitive a mechanism to be safe than sorry Couliflower ears Again usually a boxers injury, though it may occur in the actum at rugger Owing to the nature of the anatomy of the ear, bleeding (bruing) may occur ·80 SPORTS INJURIES leads to trouble and undermines the athletes confidence. The ideal understanding between coach and athlete often takes months to develop, aod to break into it always occasions setbacks There are hundreds of ases where in athlete has been associated with a particular coach for years, and results have proved the value of nich an associabon. Although athletes obviously have to work at their own particular speciality, it is a mistake to believe that one should not introduce variety, and apend some time taking part in some other form of recreation. Of course this should not be allowed to cut into the time normally given to one a speciality, but the great majonty of athletes do require more varety than their one speciality gives them. Some sports have better counterparts than others but swimmig 18 an almost wiversal alternative, besides being one of the best forms of exercise for the use it makes of almost every muscle in the body Runners and cyclists are often afhud of it because they think it niffens their muscles. If you go swimming about once a month it will stiffen you up tomporarily but if, in your mining routine, you do it w in alternative to your speciality at least three times a week, you will very soon gain nothing but benefit from it. The idea that cold water auses any damage to muscles is pure fantasy You will only suffer stiffness while you remain un accustomed to it, and the same thing can be aid for any form of recreational athletics Of course it would be foolish to swim just before a tennis athletic or cricket match, for water gets into your eyes and cars and affects your balance and sight but that is no reason why swimming should not be a regular part of your training routine Walking u another very good besides affording an excellent form of mental relaxation. Again if it makes you sniff you are not as fit us you ought to be trainer, ·NEAD AND NECK INJURIES 69 Breased ges Brusing of the cyes Occurs very commonly in boxers and agun may be of the upper or lower lids or the nurrounding skin of the forchead and checks It is most Important to disperse the bruise as soon as possible or it develops into something very solid and persistent. Although the old-fushioned treatment of applying a steak was good a far more effective method is to knead the arca gently for twenty or thirty minutes with the middle finger and forefinger This is particularly useful in the cases of bruses below the eye The kneading should take the form of movmg the two fingers in small arcles over the brused aren, applying an increasing pressure if this is properly done, it will be seen to duperse the bruise, and in fact quite a severe bruise can be completely dispersed within a few minutes A trick that boxery and their truners use very commonly achieves the Ame end in a rather different way It consists of applying a mixture of milk and salt to the damaged area. The idea is that the milk makes a good lubricant for the kneading process and the salt draws off the serum or fluid in the bruise, once the pores are opened by the milk, which should be hot. Care should be taken to avoid letting the mixture get into the eye, where it will cause smarting Dislocation of the jou If there is any suggestion of a fracture or dislocation of the jaw, hospital treatment must be sought at once. No first-aider, trainer or masseur should ever attempt to reduce it himself, because it is an injury which can be accompanied by serious damage to nerve tissue and any imwise movement of the bone may lead to serious complications Of course a supporting bandage should be applied before the patient is moved into hospital Cracked lips This condition is included because it occurs 10 commonly amongst summer game players and can be a great Qurance to them It may be caused by sun, wind or cold. There is only one effective way of getting nd of it:

·59 SPORTS INJURIES between the slan and the cartilage of the lobo of the car and thus requires immediate treatment to prevent a cauliflower ear developing A doctor should be called in to draw off the blood and in its place inject 1 minute quantity of sclerosing material Manual pressure on the affected lobe for a few minutes after the injection of this flund has proved effective in preventing recurrence of the trouble Torn cars Sometimes the car gets bedly licerated and advice should always be sought from a doctor us to whether it needs stitches in it or not It is always very stupid to leave such a wound to gape Eor plugs Swimmers and divers are always faced with the problem of whether or not to wear ar plugs Nature has a perfect way of altering the pressure in the middle ear According to variations of pressure externally and unless there has been damage to the ear drum by direct trauma or 2 previous infection, they should not wear any form of ear plug By doing so they actually increase the risk of damage to the ear drum. Categes This is a common injury in boxers It may occur over the eye or under it. Because it is an injury that can be repeated many times in the same individual it is important to avoid stitches whenever posible This is becrusc, although stitches may close the wound effectively enough, they lead to the formation of scar tissue which may prove more easily tom than normal tissue Truner have developed the treatment of such injures to a fine art. They get the cut between their fingers dab it with i 1000 adrenalin solution to stop bleeding clean it up thoroughly with spirit or ether and then close the two edges of the cut u firmly us they can while they apply collodion. When it bus firmly set, they apply very small pieces of plaster icrow the cut, to make sure that it remains free from any risk of re-opening ·IIEAD AND NECR INJURICS 66 Braten hoses It is almost impossiblc after sustaining an injury of the nose to know at once whether it is broken or not, and if there is any doubt, it is best to get hospital treatment at once any bleeding is best controlled by firm presture over as wide an arca of the nose as possiblc, and this pressure should be made between the finger and thumb If you keep the pressure on firmly and cvenly for a very few minutes, most people s blood will clot and the bleeding will cease NECK The only conditions the need deal with in the neck are those in which damage to muscles has occurred so that adhesions have formed later, causing limutation of movement and pain. Broken bones in the neck, and such things as dislocations, must of course always be dealt with in hospital, but these lumiting injuries of the soft tissues can be quite casily and adequately dealt with by club masseurs They may ause fibrositic pun, and even a plain straightforward fibrositis is often best dealt with by the same procedure Manipulation of neck Figure 4 shows the movements to be made. The aim is to put the head through a full range of movement with the neck, so that uny adhesions or fibrous tissue are torn down and free movement restored This manipulation should of course not be attempted if there is any nsk whatever of there being any underlying bone damage Another type of injury which may cause complications of a manipulation is done 18 an old shrapoel wound or any other injury which has resulted in a small piece of metal being left in the neck. Otherwise the whole procedure w quite straightforward. Place the patient on his back with his head hanging over the plinth and resting on your knees as shown in the picture Get him perfectly relaxed and hold his head resting on your knees, but supported also by your hands The head ·SPORTS INJURIES get out of the habit of mousteamg your lips with your tongue, and before exposure to the elements, apply alive oil along the lips, but don t let it spread on to the face. Repeat the treatment as frequently us you can to uurt the lips being well covered with it continuously for at least four days The commonest cause of the trouble, besides the clements, us the habit of licking one , lips with the tongue, and any form of treatment with oil is useless unless this habit is stopped Betten tongue This is not an uncommon injury, but luckily the ague is ouch a good healing area that even a severe bite heals in a very few days A minor injury 18 best forgotten, but if there is much bleeding it will prove very difficult to stop, and the sooner a doctor u alicd in to stitch it up the better Particles in the eye Small particles that get into the eye may take up one of threc different positions, which can be quite canly differentiated A particle of dust in the lower hd can casily be removed with the corner of the handkerchief A particle of dust or gnt under the upper lid can anly be cffectively removed by everting the lid on a matchstick us shown in Figure s Put the matchstick on the upper lıd and then roll it up and over the lid so that the inside of the lid turns out. Although it looks as though it may be very wmcomfortable for the patient, it does not do him and will enable you to take the fragment out with the comer of a handkerchief The third group is that in which the fragment lies on the ball of the eye, and if you have failed to find it under the upper or lower lide you may see It - it may be very minute indeed - lying nght in front of the pupil and stuck on it. This is the type that must be taken to a doctor because only a doctor hu the instruments to remove it with ind in any case it cannot be removed until the eye has been mesthetized any harm ·HEAD AND NECK INJURILE Broken Roses It is almost impossible after sustaining an injury of the nose to knok at one whether it is broken or not, and if there is any doubt, It is best to get lospital treatment at once Any bleeding is best controlled by firm pressure over as wide an and of the nosc as possible and thus pressure should be made between the finger and thumb If you keep the pressure firmly and conly for a very fcu munutes, most people s blood will clot and the bleeding will cease NECX The only conditions we need deal with in the neck are those in which damage to muscles has occurred so that adlxsions have formed later, causing limitation of movement and pair. Broken bones in the neck and such things as dislocations must of course aware be dealt with in hospital, but these limuting injunes of the soft tissues can be quite casily and adequately dealt with by club masseurs Ticy may ausc fibrositic pain, and cven a plain straightforward fibrosion is often best dealt with by the same procedure Manipulation of Arc Figure 4 shows the movements to be made The un is to put the head through a full range of movement with the neck, so that any adhesions or fibrous tissue are torn down and free movement restored This manupulation should of course not be attempted if there is my risk whatever of there being any underlying bone damage Another type of injury which may cause complications of a mazupulauon u done is an old shrimel wound or any other injury whuch has resulted in a small piece of metal being left in the neck. Otherwise the whole pro cedure is quite strughtforward Place the patient on his back with his head hanging over the plinth and resting on your knees as shown in the plcture Get him perfectly relaxed and hold his head resting on your lovees, but supported also by your hands The head ·66 SPORTS INJURIEI and neck should be in a strught line with the body, which may necessitate rusing your knees to raise the head. Having got him in that position, turn bu head sharply first to the left and then to the nght as far as you can, then bend the head sideways to the left, and to the nght. Next force the head forwards on the neck and then us far back as you can. Very little expencace will soon show you if there is any limitation of movement in my direction, and if there is you should attempt to force the head through thu movement. IIEROISDI After such a manipulation, it is important to keep the neck well exercised One good exercise is to put the head through the following 12 movements, repeated several times Make sure you point out to the patient that it is most important to force the head fully through each movement as he makes it. 1 Look to the left. . Look to the front. 9 Look to the nght. 4 Look to the froot. 5 Bend the head to the left. 6 Look to the front. 7 Bend the head to the nght. 8 Look to the front. 9 Bend the head a far forwards 28 you an. 10 Look to the front. 11 Bend the head as far back u you can. 19 Look to the front. You will see that on each alternative number, that 19, 2, 4, 6 8 10 and 18 you look to the front that means you stand with your shoulders completely relaxed, your head und neck strught and looking strught ahead of you. numerous shoulder muscle ure Uso involved in any manipulation of the neck, it is always important to keep them well exercised too Alternate shoulder-shrugging 15 shown in Figure 6 is one way of doing this shrugging both shoulder together can also be done ITAENOTI EILAOISE. FOR THE NECI Figure 8 The shape of all heads being different, the neck strap u best made for the individual The body should be ·HEAD AND NECK INJURIES 57 positioned with a slightly arched back The licad should be lifted up and down in a full movement The same morco ment can be performed with the head turned to cither side The body should be kept still and the movement come from the neck joint. Figwe 7 Disc weights can be supported on the forehead by using a towel pad The arms are used only to maintain the position of the weights The head is lified from the bench until the chin almost touches the chest Best to liſt the full weight of the resistance for each repetiuon and therefore to momentarily relax the neck muscles in between while the head rests on the bench. The same movement can be performed with the head projecting over the end of the bench, but this is rarely necessary ather for strength or development. Figwe 8 The body should be kept quite firm and the back sughtly arched. Resistance 18 given to the downward pressure on the head After it has been pressed stcadily down it is best lifted up again without applied resistance The head should never be jerked down. Pressure is best given from both sides Figwe 9 The head 18 pressed down and lifted back much u before More pressure can be applied and more resia tance can be given. Again, pressure is given from both oldes ·8 Back Injuries For the purpose of classification of the injuncs of the back, it is best to divide the area into Upper, Middle and Lower, although there are, of course, injunes which occur to all three parts of the back. UPPER BADA Swimmers, rugger players and other bell-games players often twist their backs in the upper region, and as with muscle strain anywhere in the body the treatment is quite simple and has been given earlier in this book. As in other cases, immobilization should never be allowed the aim is to activate the muscles us quickly as possible stretch them out and get the circulation through them worlang normally Very often, when a muscle in this area is strained or tom, it feels us of something clicks nd the patient gets the impression that the cause of the trouble is a displaced bone in the spine I have known many back to be wrongly immobilized in plaster because of this whereas areful examination will show that the centre of the pain is not in the spine but in the musculature lateral to it, or even under the shoulder blades Injection of proctocaine into this tender spot will abolish all prove that the spine hus nothing directly to do with it. The best exercises for torn muscles in this area are given in the group of ciccines at the end of this chapter (P 66) They include pain and ·BACK INJURIES 69 that exercise the Inter-scapular muscles, the shoulder muxdes, and the neck muscles Fitrantus Although this condiuon occurs anywhere in the body where there are murdes, there is no doubt that the commonest site of it us betn een the shoulder blades, in the back, and, of course, in the neck. It is important to try and understand what auses fibrositis It is beliced to be due to a poisoning of muscle fibres by stagnant blood In other words, if you keep yourself fit, so that the circulation in your body is a hundred per cent, and so that all the muscles of your body are supple, it u qutc impossible to get fibrontio I think the reason why so many so-called athletes get it u because, whereas they exercise their legs and arms actively enough, they very often ignore their backs and almost pride themselves in having a suff back, or even a bull neck. Fibrositic muscles have a doughy, brawny feel, which is quite unlike a muscle that is tuned up People who Buffer from this complaint need only bring the affected muscles into play, and exercise them properly, to be rid of the condition altogether The exerases given at the end of this chapter will do that activating Besides the stagnation of the blood in the muscle fibres there u also the possibility that the blood itself is not us wholesome us it should be, and may be over-acid, or containing infective organisms which cause the trouble That w why it is so dangerous to take any violent exercise when one has a bout of Au or anything more severe of an infectrow nature because one spreads the bugs' all over oncs body and they have a habit of settling in muscles and causmg severe pain and even something worse MIDDLE DAOI The characteristic pain of the middle back is called Lumbago In actual fact it is no different from the fibrositu of the upper back. It is important, however, to low that it is ·60 SPORTS INJURIES lumbago and pot any of the things that I describe later u being mixed up with it, and which occur lower down the back. The one that it is always getting mistaken for in the middle of the back us the Slipped Dioc. Now the slipped disc is the fashionable complaint of the day, but 18 a thing that occur much more rrely than people realize Not long ago one of the most eminent surgeons in London told me that he reckoned that he saw about five per cent of so alled slipped disc cases in his region, and he operated on one per cent of that five per cent. As you can see this makes a very low percentage of the total cases The vast majonty of people who suffer from the sort of slipped disc that requres operating on are of the non-athletic type and If ever I get an athlete showing the signs of slipped disc, I always first of all recommend him to try the active treatment. It has to be an extremely severe case before any harm can be done by the active treatment, and I always wam them that if they notice anything like a footdrop or anaesthesu in any part of their lege then that is the time to report the matter and get it seen to immediately If however a patient complains of pain in that region of the back, sometimes shooting down the back of the legs to the knee, or even below, and he put on to the special back exercises he very soon throws off the trouble altogether I would always demand in X-ray of any serious case, but to immobilize an athlete is, I think, almost always wrong until one has at leut concentrated on the active routine for two or three to nx months. The exerases are given at the end of the chapter (P 65) The treatment of lumbago however, is different. It u due to a pousoning of the muscles by something in the blood, coupled with the fact that stagnant blood bas collected in them. Fibrositus of the upper back should always be activated, but with lumbago I recommend 24 hours in bed with a bot-water bottle and a really good sweat, taking ·BACK INJURIES 61 something like aspira in order to enablc one to alcep and forget the pain. Do not stay in bed longer than the 24 hours, no matter now difficult it is to get up next day Get up, and then start the vigorous cxcrcise routine, and you will have it out of your system in no time This treatment obviously we recommend itself only to people who are farly young One could not expect old ladies, or old gentlemen for that matter, to do it, and therefore the treatment for lumbago for them is different, but if you are an athlete, or fancy yourself u one, the correct way to get over a dose of lumbago - not that you ever ought to have got it in the first place - is a sweat in bed for 94 hours and no longer, and then go out and exercise it. LOWER BAOX It us in this region of the back that most of the troubles anse There are at least four conditions which most people confuse, but which are quite different. Fintly there is Sacro-Ilac strain, which occurs (uee the illustration on page 62) over the sacro-iliac joints, and often occurs us a result of a sudden violent twisting of the hips The best exercise for it is what we call the scissors, described later in the chapter (P 86) I find that wually it is best to manipulate the joints before the active treatment is commenced The pain is usually only localized to the area of the joints, and may be on one nde or both. No rurprise need be aused by the fact that, although the pain may be specifically in one or other sacro-ilac joint, on manipulation there appear more adhesions in the opposite one. This is because they are so closely related in the overall body mechanism that an initial strain of one very frequently auses reaction in the other Another condition that occur in this area 1Lombo- Sacral stran This is quite diferent from the former, and ·62 SPORTS INJURIES causes a pain across the middle of the back in the area illustrated, particularly when one bends backwards forably Very good exercises for this are described on page 68 LUMIAGO COMMON SITE OP MAIN DUL TO SUMED DISC LUMIO-SACRAL STILAIN SACAO ILIAC STWIN SCIATICA Common star of pain in the lower back The thurd and most important condition that gets mized up in this group is best known by the mame of Sciatica Sciatica pain occur along the route of the sciatic nerve, uod muy extend down the back and side of the thigh behind the knce, and down into the heel and sole of the feet I find in athletes that the ause is very often torn muscle or ad- ·BACA INJURIES 63 hesions deep to the necro-iliac joint, and it can be relieved by marupulation of that joint in the same way u onc dock for sacro-iliac atran If the sciatica is due to pressure on the nerve more centrally, by a slipped disc, then disinbution of the pain wl be wider, and the treatment, which at first should be active , sometimes, as I have said before, requires surgical interference There are those who hold the opinion that several months immobilization in a plaster jacket might settle the disc down mod lead to no recurrence of the trouble, but if you are an active athlete you are very likely to set it off agam in this way if you go on with your sport afterwards, and I therefore recommend the vigorous exercise routine If that makes matters worse, then there can be little queston that you will have to have the disc operated on Back muscles and cycling There has been much controversy as to whether one can develop a stronger back on a cycle with rused or dropped handlebars Figure 11 shows most condusively which is the better for producng power from the back. With nused handlebars, the first two photo graphs show that the back is not in a correct position for action. Photographs 9 and 4 show that as the handlebars are lowered 20 the back oruscles come more and more into play Equally, the photographs show that the abdominal muscles also are drawn in and used more with the lower bars There is no shadow of doubt that the cyclist, for full effidency requires to use the power of hus back for driving him along This information may distress some parents who are concerned that youngstent should not ride with low handlebars but although one might suppose otherwise, statistica do not show that more accident occur with dropped handlebars than rused ones One cannot nde a bicycle in a balanced fashion unless one keeps ode s head conunually rued and one s eyes looking ahead. A far ·64 SPORTS INJURIES worte danger than dropped handlebar is the habit some youngsters have of carrying speedometen und being so in tent on seeing what the speedometer is registering that they nm & grave nsk of hitting something for full efficency, however, on a cycle, there is no doubt that a great deal more power can be developed with the dropped handlebars and as un exercise for both back and abdominal muscles there is no doubt which is the better Manipulation of back. I am not describing this in detail because I do not believe it is a thing that should be done by anybody but qualified persons No back should be manpulated for a central pain or disability in any part of it before it has been X-rayed If the pain is in the region of the lumbar muscles, however, any stretch of those muscles putting them through a full range of movement, will pro bably relieve them. There is, however, one manipulation which can be done by truners and which can lead to great relief Manipulation of secouillac joint The Atcro-iliac joint may become painful owing to strun and the formation of adhesions in the region. If such adhesions have formed then they are best torn down by this very simple proceso Before doing the manipulation it is important to be sure that you are dealing with a smo-iliac strain. The pain is localized over the dimple arca on elther side of the spine in the upper part of the buttocks Nowhere else, and certumly not more central (see ilustration p 69) Lie the patient on his back and then put him on hu alde with the upper leg over the side of the table. Now force the upper shoulder away from you at the same time as you apply pressure downwards over the upper hup The weight of the leg hanging over the table coupled with your pres sure, will probably cause you to hear the adhesions tearing down in the jomt. You can repeat the process with the

·wue'tiboa
ULUI
I STIFTCHING TILE BACK AND ABDOMEN
I useful toning-up cxcrcise (P 91)
?STRETCHING TILE THIGHS with full backward as well as forward stretch (2)
SIU NEVOVE PARTICLES IDX THE EYL roll up the lid with a matchstick (p. 54)
T

·+ LOOIEXING STITT WECK MUSCLES (p. 54) Tum the patients head sharply to the left, then to the right twist it to the left, to the right bend it back force It forwarde. $ ALTERNATE SHOULDER SALOONA G to keep shoulder and Deck supple (p. 50)

·114 141
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ܕܬܝܪܪܝܝܝܠܪܝܚܐܚܝܢܝ
G" AECK EXERCISES Ilfting a reight by pulling motion (ig?) and pushung (right)
:
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B 9 AECK IXLOCISes the patient resist the pressure two macthods are down (p 57)
10 LOM HANDLET ens des clop the bacte muscles, and also dry in the abdomen (p. 3)

·TOX TIIE JACK AND AIDONEN The best general exercises for the back are very often the ane u those for the abdomen Figure 11 (ngt ind below) whom in exercure that benefits both Bend back from a kneeling position, touching to hoor with head und hands then try to ruire the body from the floor on the bands asd feet. Good balance is important for this certise which cffectively stretcher the abdominal muscles (see P 65) 18 *TRITCHING EXERCIST Thk u the reverse of Fig 1 the bands grup the Arp, and the legs, on erlanging the end of the table are alternately raised ind lowered (p. 65) H

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13 TON TUE AIDOMINAL WLICLTS from the first position, hold the ankles and pull
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CLIMBING DOWN THE WALL
are should be taken not to tilat the trunk (p. 65)
15 FONTHEDACK You should be able to bend as far back us you can forward (p 68)
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16 WANIPULATING THE FACAO ILIAC JOIXT by pressure on the hip and aboulder
PAY IN THE BACK
(SACROILIAC STRAIN)
fun aused by mro-Hoc etran la
loalized over the dimplc are on either
side of the spine in the upper part of
the buttocks Adheuns here do bo
broken down by the manipulation
shown above applying pressure to the
upper bip and shoulder (wee p. 64)
The twist thus imported forect the
point free A specul exercise for this
strun u hown in Fig 17 to the rest
und below. Lytog flat on the floor draw
up ench let at the hip alterately 4
rapidly 19 You an There is little
Apparent mon cmnent, u can be seen
from the three position of the beel in
relation to the paper (Kee p. 66)
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31XLNOUITEXCISFS
FOR TIIE DACK AKD ARMS
18 (bory and id) octhread pulley
A ciglat is ausprenkel over a muller
and litted by a direct downward pull
on the bar it is best to heel coilc
ally under the puller cable The
hands may be pored widely and
OICT the bar whach is pulled down
to the shouklers, or clore togetlxer
and under the lar pulling it to the
chest Breatlı out when the bar is
pulled down, and in it goch up
again to am length (eep (0)
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19 FCLLLLS FROM A DAR with band positions us aboic Welglits are ackled as neretary
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·16 MANIPULATINO TIE PACIO ILIAC JOIXT by presure on the hup and shoulder
PAIN IN THE LACE
(SACROILIAC STRAIN)
Pain caused by micro-illac strain La
localized over the dumple 2012 on either
side of the pene in the upper part of
the buttocks Adhesoms here an be
broken down by the manipulation
shown above applying pressure to the
upper hup and shoulder (sec p. 61)
The twist thus imported forces the
point free. Asperul exercise for this
stram la shown in Fig 17 to the right
und brlot Lying flat on the floor dno
up cach leg at the lup, altermately u
rapidly you en Tuete 1 little
apperent movement u can be ben
from the three poutrons of the heels in
relation to the paper (Keep 66)
IL

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STILNOTH EXERCISES
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29 (above) Thla can be done from a
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block and the other behind it. Try
all variation till you find the most
mntable one (see P 68)
44 (41) Lift the bar with the legs
only keeping the laps on the floor
Shoo with heck thould be nom
(p. 68)

·1
20 DE PRESS WITH DUNI NELL with lateral sway to exercise the side (p 67)
1
21 CLIAN AND Jeax The beri pulled to the cheat, then thrust up to arm length
2. THE LOWER JACK DOES THE WORK in this barbell lift wrth legs tright (P 67)
in 111

·1 3. BANDELL PRESS from the chest or shoukletu. Both are good for the shoulder muscles. This can be done sitting or standing and the hand spacing may be vaned us shown. **/ PROTECTING DRULIED EKUCKLES 29 The huchle of the middle finger metatarul bone which is more prominent than the others, often gets bruised In boxing The trouble will recur unless the damaged knuckle u protected from further noctu wlule the bruise is dispersing The best method of protecting it a shown here (see also p 8) Thick felt pds, thick enough to project beand the injured kruchle eien aben der pretrume are fixed on to the adjacent kraukles, and held in place by . bandage round the hand The jout should on mo acrout be immobilized give it exerase and makeuge right from the day of injury ·FO. STIFT SHOULDERT 25 From the start Ing pution (len) the manipulator should suddenly force the patient's arms is far back is posable at the same time moving titi sharply upwards, then donn. This will frce any minor adhenom in the joint (veep 6) $ TO KEEP THE 3110LLDERS surell force the elbows back and forwarb (p. 77) Y STRENGTHENING THE SIOELDEN the palmos fat uwards throughout the presi.

·-
1,
T. D.
.
39 ARH EXTRCISE
the chumb-bells are lifted to the shoulder with a curling atio
went
5: Table cut the shoulder is kept well down and the full weight Jlfted cach time (p 93)
1414 Punis
3
Dumbbell pullovers weights pulled to the chest or litted from the sider (ory)
of mung aliemately up and down (beloto) SC ABDOMINAL EYEXCISL Sec p 07
14
MIHI

·1
2
w
:37
30 CHEST PNENCISE lift the barbell to the thigha le donn and shift it to the chest
press up and lower repeatedly finally lower the bar to the abdomen and sit up (p. 12)
w 4 4 4
31 Bench press with sub-bells (p. 92) 32. Inclune press with dumb-belle. The tho
best posutions are shown abone (ngkel) nd beton (b) The press should be vertal.

·40. KWETS HEXDIKO withinees well apurt pxit them tlmrough a full range of movement.
IEE AID ANKLE
+1 Sund about a yard from the wall
and try to force your foot through it,
Looping the body upright and the Irg
straight. Loner and repeat
4. For thus you need . harig bed or
table, standing about two feet from Ux
ground. Try to lift it with the heel.
Lone and repeat (see p. 111)
43 KANIPULATING THE ANILE Let the patient le relaxed first force the toc inay
from the ankle then firmly up again best turn the foot outwards then inwards (p. 1935
-

·1
mm
97 MANIPULATIXO THE ELJOY
extend the forearm, keeplog the wrist fully flered
2
Atmi
ul
38 LLDO EXERCIAL
the weight pulls the am 01er belped perhape, as here (p. 89)
39 roa TOXING UP THE TORLAWN AND HAND prew-ups on the fingertips (p. 88)
Ji
NE

·66 BACK INJURIES other leg, as shown in Figure 16 The process may be very painful but if done just by manual pressure, can do nothing but good. EIEXCISES FOR THE BACK There is no need to separate the back into upper, middle and lower us far as the special exercises go The best general exercises for the back are very often the same as those for the abdomen hg 11 Onc erercise in this group is to kneel as shown in the photograph, bend back, arching your back and touching your head on the floor with your hands also on the floor u shown, then try straightening your legs and arms, arching your back even more This is a difficult exercise and must be done in complete balance. It is extremely effective, particularly in stretchung the abdominal muscles Another good exercise for the back and abdomen is the one described in Chapter 2 (Fig 1), and the reverse of it, which is us follows Fig 19 Lie on your back, getting hold of 2 strap with your hands your seat should be about three inches from the end of the plinth with your legs hanging to the floor Raise your legs from the ground so that they touch the plinth above your head, repeating the exercise as many times as you can. Fig 19 The next exercise is one in which you lie flat on your face with your arms down by your sides Raise the head and shoulders off the ground, stretching your hands out behind them, and at the same time raise your legs together straight off the ground Hold this position as long u you can and then grasp each ankle with the hands, keep ing the knees together Now brace the feet away from the hands without leaving go and with your head and shoulders thrown well back. Hold thu position u long u you an, and repeat. Fig 14 The next exercise is to stand about a yard away L ·sh TER LXERCISING THE ANILE inil 44 Looking straight alad, walk along Ant on the outside edge of your feet, ther on the inde next walk on tiptoe finally walk with the toes splayed upwards and outwards, then with the toes clared under Properly arried out, At thu e errige preserves the supplenes of the ankle jolnts, tou and Insteps (kec p. 123) FINIBU KAREL 110. BEE Tr? 5438.1?! !1!11113 istiti 17333935 020 中州 N HRAIN 9 In 1 113 111111 111711 III HI 173 13.345), 1111 iltit 3231 fifit? 1f111111 dit1 Glitt till Siti VIHrili MINIU HELLISI Litt. KHO AD101 14 ·BACK INJURIES 67 pulled to the shoulders, and the other in which the hands are touching and under the centre of the bar, which is pulled to the chest. The breathing rhythm 1 out when the bar is pulled down and in as it goes to arm s length Fig 19 Pullups The same two variations as in the Pulley are best used here and the body is pulled up and down whilst suspended from a bar Weights can be attached to the body Both movements should be as full as possible and the lower body kept relaxed The breathing rhythm is the same as for the Pulley Fug 20 Side press The start of the movement is similar to that of shot-putting From this position a combined arm press and lateral sway will extend the arm As soon as the arm is fully extended, the weight is returned to the starting position. The legs should be cxtended throughout but the sway might well be entirely lateral or slightly backward and well forwards Breathe in with the press Fig 31 Clean and jerk without foot movement or squat From the illustrated starting position the bar is pulled vertically upwards to the chest. A short knee-bend followed by powerful leg extension will drive the bar upwards, whereupon the arms extend and finish the movement with the bar at arms length overhead. Since it is an all-round movement, and depending on the poundage in use more or less, work can be purposely given to different parts of the body STRENGTH LIERCISES FOR THE BACK AND LEGO Fig 99 Dead lift from floor or raised base with legs straght The mdividual purpose of the crercise will determino the length of the movement. Generally speaking, the most advisable starting position of the back is as shown with the bar resting on a bench. The bar is pulled vertically upwards There is no need to lean back at all but it is best to nise the lower chest when the back is straight. The breathing rhythm w in us the bar 18 lifted und out u itu lowered ·66 SPORTS INJURIES from a wall with your back to the wall and climb down it. You start by falling back to the wall with your hands and rinng on your toes You will not be able to get far down the wall at first, but your aim is to get your hands and head down to the floor You should only go as far down as you can safely go without collapsing, und as far u you are sure you can climb back from. It u most important to keep the body completely symmetrical during this exercise any twisting of the trimk is dangerous and should be avoided The pictures show exactly how it should be done. mg 16 Another exerase is to stand with your feet alightly apart and bend backwards and forwards A really supple athlete should be able to bend as far back as he can forward and the um 18 to develop nich mobility If you remember that muscle i elastic tissue, then you will see how by gradually trying to stretch out your back muscles, you should be able to increase the range of movement in this exercise both forwards and backwards Mg 17 Special coercise for sacro-iliac strain. It is very difficult to illustrate this exercise, us there is very little apparent movement, but what movement there is can be seen by noting the position of the heels against the white paper Le flat on your back with your legs together and pull up each leg at the hip alternatively We call this exercise the slason and it is extremely good for any sucro-iliac strain. Once you have got the knack of the faster you do it the better at all times keeping the legs absolutely flat on the ground The more you can make your back ache in the region of the acro-iliac joint, the better STAINOTH EXERCISSS FOR THE BACK AND AINS Fig 18 Overhead pulley Best done kneeling vertically under the pulley able The body should be kept vertical throughout the pull There are two good variations, one in which the hands are spaced wide and over the bar, which is ·9 Shoulder Injuries Damaged shoulders are the bugbear of cricketers, fieldcrents men, and indeed almost all ball-game players The shoulder joint has a ligamentous covering, or caprule, all round it deep to the muscles and tendons, and this may become inflamed as a result of direct trauma or more frequently owing to suddeni unaccustomed overstretching Common speafic causes of this injury are ficking strains by bowlert in cricket and javelin throwers, but any form of Jarning is liable to cause it. The injury causes varying degrees of limitation of movement of the art owing to the pain. The important thing is to try and get the arm to a full range of movement at the shoulder us soon as possible, and in order to do this it is often necessary to obliterate the pain with injections of anaesthetic, because the pain 18 usually so severe 18 to mako it quite impossible without. One of the principal reasons why this joint proves 80 difficult to treat is because it is very easy to compensate for loss of movement in the shoulder joint by moving the shoulder blade and one can, to a large extent, mak the fact that one is not moving the arm at the shoulder Anyone who has injured his shoulder will know this and be able to demonstrate the fact when raising the arins sideways He may be able to get the urms to an equal level but a mirror will show that the damaged shoulder is higher than the other one, because the scapula on thu side is moving to spare the injured joint.

·68 SPORTS INJURIES The head should be kept rused at the start of the movement. Fig 99 Squatang worth berbell The barbell is rested on the shoulders The longer the movement of the squat, generally speaking the better More often than not, however, it is advisable to shorten it Much would depend on speafic requirements The heels are often best supported on a l' or 2' block. Sometimes it is best to squat on to a low bench or stool, sometimes on to the block that is to uy not to rest momentarily the full weight of the body and bar on the support between repetitions Sometimes it is best to support one heel on a block and place the other foot slightly behind keeping on the toes of this foot, and to keep this foot position in the equat. It is best to try all vanations and also to work with varying toe positions The breathing rhythm is out during the squat and in as the legs are extended. It is often necessary to take one or two additional breaths between repetitions Fig 34 Leg press Can be conveniently done on a machine. It 18 best done without, the bar bemg balanced on the insteps (shoes with heels) “The back 18 flat on the floor and the movement long provided the hips do not leave the floor too much. The breathing rhythm is in as the bar 18 pressed and out us it to lowered. A double breath to cach movement might wel be required ·SI1OULDER INJURIES 71 Supraspenatus Syndrome Pain in the region of the tendon of the suprusploatu muscle as it passes over the top of the shoulder joint is a very common cause of trouble The ten don may be stretched and strained and then a toothachy pain arises in the region, often spreading down into the arm along its outer border It can be a most persuatent pain, but can frequently be relieved in the same way as the apsulitis of the joint. It is another condition for which injections are frequently given. I do not recommend dlectrical or heat treatment for either of these conditions ALLA ON HINN SUMUMNATUS TOWE CHALLALLTIC ALEA OF UN ON OUTLI SD or HOW TO DOW doromso-claducular Subluxatron (Aartial dislocation) Thou an injury most commonly rustained by rugger and icehockey players owing to a direct blow on the shoulder region. The blow is usually a heavy but glancing one, hitting the tip of the shoulder so that the strain all comes on the joint between the collar bone and the acromion process of the shoulder blade The joint becomes swollen and painful and often makes it impossible to continue playing The swelling is quite characteristic, and localized to a ·70 SPORTS INJURIES These injuries would be far laus troublesome I the sufferer would try, immediately after injury, to get back the full range of movement in the shoulder joint A bowler amot, of course, mask the fact that be aamot bowl overarm with such an injury, and it is ntally important to him to get the full movement back at once If the condition is allowed to become chronic, it is almost inevitable that an operation becomes necessary in order to remove part of the apsule but in my personal experience this is very seldom necessary if the patient really perseveres with his cxercises Th should be of such a type that they force the urm through a full range of movements and prevent any muscle wuting The use of Indian clubs is particularly recommended for this purpose, but far better than not doing any cxermes because of not having Indian clubs, is a daily routine of arm swinging and raising combined with astride jumping Another good exeruse for an injury of the shoulder joint is to swing on the bad arm with the full weight of the body the hand gripping the top of a door Try to force the arm through the painful movements To show how effective thu treatment can be I recall how on the morning of a big inter-counties cricket match I was asked to see the captain of one side because he had Bustamed a very severe injury to bus shoulder I sud I would see him on condition that they let him play after treatment. I injected the joint and sent him om hus way Having put the arm through a full range of movements he went strught in to bat ind scored a century with ease, and be dever had any further serious trouble with it. That ruggests that it cannot have done him anything but good. It might be thought that this treatment would entail the risk of ausing a flare-up n the condition, but in my expenence it auses nothing but relief from the pain and the limitation of movement.

·SHOULDER INJURIES 79 for thu one, and I can best illustrate it by a specific example Recently one of our leading women bicycle racers crushed while road-racing and fell forward on to her face und chest. Her night shoulder took most of the force and there was considerable swelling over it. The diagnosis of acromioclavicular subluxation was made, and her arm was strapped as I have described in the illustration She was told to keep it immobilized for five to six weeks In actual fact she had not damaged this joint at all, though the wellug and bruising might have temporanly made it appear so She was taken out of the strapping on the fourth day in order to adjust it, and it was found that the swelling had gone. In fact she made a complete recovery within a week. Realizing how important it is to limit inactivity to a minimum, one can see how unnecessanly the effects of the injury would have been aggravated, had she had that strapping support on any longer for a flt athletic woman like that would have taken weeks langer to recover her muscle tone than to recover from the actual injury It is very rare for such a direct blow to subluxate the joint, and it wu umlikely in any case that she bad done so As I have said before, such an injury u wually due to a volent, glanang blow, not to a direct one. Broken collar-bones In the world of sport, I have found a singular lack of appreciation of the dangers of this particular type of injury If ever there is any suspicion that a collar bone has been broken first-aiders ind others should be made to understand that even slight movement of the arms can increase the damage done very considerably, and Buch injuries almays requre hospital treatment because the extent of the damage cannot be ascertained except by Xray Fragments of bone may have injured surrounding tissues, including the lungs, and only hospital staff have the facilities for discovering what that damage may be I well remember seeing a track cyclist crash at about 40 ·72 SPORTS INJURIES small area over the joint us Illustrated As with almost any joint in the body effugion of a small amount of fluid can be dispersed by exercise, but if in this case there is severe swelling, it is important to immobilize the shoulder and orm for a period of a weck until the swelling has settled down. Any risk of damaging it further within that week should be avoided at all costs, because recurrence of this condition can lead to a most impleasant and pernatent pain which woully reqwres operation to fix the joint, so that further movement cannot take place between the bones Such an operation is bound to affect the patient , balance and therefore his efficiency as a player ACROMIO CLAVICULAR SUILUOLATION Ara of telling In scromio clericular abluratio, with strapping for this injury abowo on opposite arm The injury tends to cause the shoulder to drop and the aim of the immobilization treatment to take the weight of the arm off the shoulder so that it is symmetral with the other side The illustration shows the form of stripping recommended for this jury and it will be seen that a pad u put over the point to prevent any fnction that might cause imtation to it. There is a type of injury which is sometimes mistaken ·&I1OULDER INJURIES 75 duced at once, but it must only be donc by a doctor It is important, however, that trainers and muscurs ahould know what thu dislocauon looks like, and the characteristic deformity caused by this injury is shown in the illustration If there is any nsk of any bones having been broken, the case must be taken to hospital at once, but if a doctor can be got to the spot where the injury has taken place, and can reduce it immediately, the patient will make a much speedier recovery than he would have done even if there had only been the delay of getting him into hospital Careful movement should be instituted as soon as the reduction has taken place. Dilocation shoulder, showing characteristic deformity Torn muscles Tom muscles in the area of the shoulder should all be treated by the active exercise routine recom mended in Chapter 1 Falls conang dep gratit In two sports, cycling and athletics I have seen very masty injunes suffered by athletes falling on their faces and shoulders on the gravel tracks These so-called burns can be very deep and very W. pleasant because almost invariably, a good deal of grit gets into the injury Much trouble can be saved however, If penicillin or ralphanilaonde tulle-grus 13 applied This 1:

·SPORTI INJURIES miles an hour He was knocked out and sustained mulaple abrasions Although I went straight over to see him and tried to prevent any harm being done to him util it was exertained what injuries he had swtuned, I was greeted by a first-aider holding the cyclists nght arm in the ur to show that it was not injured ind that he had not broken his collar bone The first aider had fuiled to observe that there was a piece of the collar bone sticking nght through the skin in the man s neck, and because he was unconsuous 10 one had appreciated the severity of hus injuries If that spike of broken collar bone had gone awards rather than outwards through the skin, the rusing of his arto might well have proved fatal to the injured man. If people were more aware of the need to reduce axy movement to a minimum after such an accident, there would be for fewer casualties from secondary shock or complications I am reminded of the occasion when an international sprinter, who was playing rugger, fell and broke his leg Because he was a very well-known person, he was immediately surrounded by all sorts of helpers but 80 conscious wu he of the vital importance of minimung any movement of the broken bones that he refused to allow anyone, even ambulance men or police, to touch um except according to his expliat Instructions He would not allow himself to be moved one Inch until splints had been placed round the injured limb, so that he could be lfted with the leg in exactly the position in which he had fallen, and that is how he arved in hospital. When the surgeon uw him, he said he had never seen a broken leg with so little damage to the soft tuues (muxlas etc.) and I was not surprised to bear afterwards that the bones knitted up so well, and the surrounding muscles were so little affected, that he got back to laternatiomal-class ninning Dislocation of the shoulder This is a common inury of sport A lot of trouble will be saved if the dislocation can be re- ·77 SHOULDER INJURIES ful, but the best are those that can be done by rhythmical over-arm swinging with Indian clubs Another crercise which helps to get past the painful limit of upward movement of the arm is swinging on a bar with the injured arm OT, if a bar is not available, swinging on a door, just making the um support the body weight. This will help to free the shoulder, but if in addition an attempt 18 made to bend the arm and raise the body, that is better still. It may be difficult to raise the arm to reach the top of the door, if not practically impossible, but it will help if you try to climb up the door with the fingers of the injured arm, helping it up with the other hand It does not matter how slowly you go once you are there you will find you can gnp with your hand and then you should try and make the arm support your weight. All ouch efforts will help to loosen the shoulder Another shoulder exercise (Fig 28) is to place the hands behind the neck with the elbows bent and first force the arms forwards with the elbows pointing forwards, and then as fur back as possible repeating the excruc a number of times STRENGTH EIERCISES FOR THE SHOULDERS AND ARMS Frig 37 The dumbbell press sitting The weight should be pulled to the shoulder and then, ting firmly on the stool with a straight back and the dumb-bells held well to the side with the palma faang each other throughout, the weight should be pressed to arm s length. It is not an easy movement but is the very best shoulder exercise Fig 38 The barbell presses from the chest or from the shoulder This an be done sitting or standing The hands should be spaced from shoulder width to medium wide or in the case of the press from the shoulders, to wide Best to breathe in us the bar goes to am : length, and out us it is lowered The body weight in the case of the standing press should be evenly dut buted over the whole of both feet.

·76 SPORTS INJURIES gauze soaked in vaseline and the antiseptic, and if spread on the wound several layers thick immediately after injury and left on for three or four day draws much of the grit and dirt out of the mury on to the gauze Other forms of treatment tend to leave the dirt in, and unless you get it out at once it may cause lasting dusfigurement. Mampulation of shoulder Effective mampulation of the neck, elbow, back and ankle can be caried out by club mas seurs, but the shoulder often proves to be much more difficult usually an effective manipulation can only be achieved under an amaesthetic. However, minor adhesions of the shoulder can be broken down by mampulation without inaesthetic. This takes two forms First, stand the patient with hus back to you and tell him to put his hands behind his neck. You stand behind him and put both your hands in front of his artos gripping his forearms us shown in Figure 25 Suddenly force his arms back as far as you can, at the same time lifting them both upwards and then sharply downwards attempting to get any movement you can opt of them while he keeps his hands behind bus neck. This will loosen the shoulders considerably The other manipulation is more for the shoulder joint itself Take the arm in your hand and ruse it odeways If there has been an injury to the shoulder joint, the patient may find it difficult to ruse it himself to a horizontal position and you sbould try and force it higher for ham. Your action my prove very painful, but you won t do it any damge and will merely be tearing adhesions down. EXEROJSES As in the case of all joints your um to put the limb.com cerned through a full range of movement and any variation of these in the case of the shoulder will prove bencficial Astride jumping with arms rising or any of the numerous exerdses taught to most of us in school will prove help- ·ELBOW, WRIST AND LAND INJURIES 79 strap nich an injury, and no good is done by rubbing in lotions or applying heat the latter only causes further effusion of fud and is liable to make matters tvorse The correct procedure is to exercise the forearm and wrist as much us pornble Any nsk of a sudden flicking or jaring movement of the arm should, however, be avoided at all costs The best way of exercising the affected muscles is by performing the special exercises described at the end of this chapter Only rarely does it become necessary to inject the localized area of pain with proctocaine Any increase in the swelling if there is any, should be dealt with by massaging the arm in elevation Aret of pain or palsy In ular deurlds When the pain of tennis elbos is on the inside of the arm, it may well be mistaken for an ulnar neuntis It is very important to differentiate between these two condi- Lions, because if you are suffering from a neuntis, it is absolutely essential to rest the limb This condition how- ·10 Elbow, Wrist and Hand Injuries Under this heading comes much the largest group of common sports injuries The very slightest strun to an upper limb will inca ate a player and wrong treatment can cause great delay in getting him back to action. Of the three areas we indude the elbow gives the most trouble. Whether the injury itself be remous or not, pain in this joint upsets the player and puts him nght off his stroke. Tennis elbow This is an injury common to tennis, golf, Javelin-throwing and all games in which racquets are used It 19 charactenzed by a pain ether on the inside or outside of the elbow joint, more commonly on the mer side (see illustration on p 71) It causes a weakening of the band grip and an aching pain in the forearm which muy prove catastrophic to one o performanco Although I have read recently in a medical journal that it is a most persistent complaint and difficult to dar up it is my own experience that if is correctly treated recovery follows within two or three weeks First of all, what causes it? It is usually due to a tearingoff of the bone-covenng and the attachment of the muscles to it on the humerw above the elbow and the pain aan be localized on pressure to the ridge of bone just above the elbow The knobs on either side of the elbow joint may be affected, but the tenderness there i wually due to involvement of the bone by the Inflammatory fluid opraadiog from above On general proaplos it is most important never to ·ELBOW, WRIST AND HAND INJURIES 81 against the loss of muscular condition that it may cause The better the athlete, the more fatal it is to him to allow any gross detenoration in muscle tone Of course, it la essential not to ert the other way so that a broken bonc 18 not immobilized long enough, for if non-mion once occurs it can become the worst problem of the lot. Sprained wrist This is a common injury amongst all racquet players, among rugger players because of handingoff, and among manoeists from tuming the paddle when using a feathered paddle It is an injury that can occur in almost any sport. It does not matter what the cause has been the treatment is the same as it would be for a sprained joint anywhere in the body These things are 80 often wrongly treated that I must first point out the don ts Don t strap them up and don t rest them dont treat them with heat, electricity or message. Do put them through graded exercises, gradually increasing the amount of work. If you cause any reactionary swelling, then elevate the limb for half an hour and try again ERO Whether the sprain 18 chronic or recent an excellent plan 18 to have a squash ball or a spring grip such as the one illustrated and keep squeezing it This exercises the muscles of the forearm and hand, moving the leaders and thus increasing the circulation through the joint, dusperring any flud and generally loosening it up I ·BO SPORTS INJURIES ever, is much rarer in athletes than tennis elbow, and as itu very simple to tell the difference there should never be any doubt us to which is which. Ulnar neuntus is caused by exactly the same things us tenms elbow, although it has to be a much more severe stretch to damage the nerve than that required to damage the muscles It 18 charactenzed by pain over the shaded part of the band in the illustration below the affected nerve only supplies half the third finger and the whole of the fourth. It sometimes causes these fingers to claw and may cause not only pain but weakness and wasting of muscles The pan of tennis elbow may spread through the forearm and hand but usually does not pick out any particular fingers The only way to treat the neuntis 18 by resting the limb for two or three weeks any appliation of massage or beat or electrical treatment will make it worse. Crached and broken bones A common injury in the region of the elbow joint is the knocking-off of little bits of the bones, particularly by tennis players The head of the radius or the ap of the knob of the elbow joint at the back or sides may all receive blows which break off these imall fragments The wisest thing to do if you suspect such an injury is to get it X-rayed. It is important to know whether the bone is broken or not if it is only a strun vigorous exercise is good for it, but if the bone is broken moderate movement only should be permitted This will crable the pauent to be back in trading within a very short time because movement of the muscles round a cracked bone, or round , fracture with no displacement, speeds up the bonitting of the bone and gets it back to normal all the more quickly becawe of the improved arculation through the area. In many hospitals there is a tendency to put these injuries into pluster of paru or immobilize them in other ways for much too long when the patient is an athlete, the duration of the immobilization should always be weghed ·ELBOW, WRIST AND AND INJURIES 81 against the loss of muscular condition that It may cause The better the athlete, the more fatal it is to him to alloty any gross deterioration in muscle tone Of course, it is estential not to ert the other way so that a broken bonc 18 not immobilized long enough, for if non-inion oncc occurs, it can become the worst problem of the lot Sprained torut This is a common injury amongst all racquet players, among rugger players because of handingoff, and among canoeists from turning the paddle when wing a fathered paddle It is an injury that can occur in almost any sport. It does not matter what the cause has been the treatment u the same as it would be for a sprained joint anywhere in the body These things are so often wrongly treated that I must first point out the don is Don t strap them up and don t rest them dont treat them with heat, electricity or massage Do put them through graded exercises, gradually increasing the amount of work. If you cause any reactionary swelling, then elevate the limb for half an hour and try again Whether the spraun i. chronic or recent, an excellent plan us to have a squash ball or a spring grip such as the one illustrated and keep squeezing it This exercises the muscles of the forearm and hand, moving the leaders and thus creusing the arculation through the joint, duperuing any fuld and generally loosening it up ·may become 82 SPORTS INJURIES Broken bones The bones in ths region also chapped as in the elbow, and only X-ray will confirm ruch durnage. Hospital treatment and advice is essential, though egun the period of immobilization should be made us short u possible ANWOHICAL NUFF Site of characteristic pain in apbold fracture of the wrist Scaphoid fracture There is a small bone in the hand called the scaphoid and this frequently gets broken in games like ice hockey in which direct trauma may occur The danger of breaking this bone in that it has a very poor circulation and 18 most difficult to treat 12 a result, because the two parts will not join together aguin, or at laut they do do much less willingly than most bones do This injury is characterized by pain in a localized area on the back of the hand at the base of the thumb between the tendons of the thumb in what us known as the anatomical snuff box. If you sustain this injury it is essential that it should be immoblized in pluster of Paris for at least twelve weeks, and during that period check X-says should be taken to see that imion i takong place in the event of nornimion occurring, it may be necessary to have the two bits of bone wired together It should be imposable to mistake this injury for 1 sprained wrist and no one need worry that because they have sustained a wrist injury it will prove to be thu gomewhat ularning and severe one Colles fractor Acompon accident in sport u for the wrist to be broken by a sudden fall on the outstretched hand Both bone map about an inch or less proximal to ·ELBOW, WRIST AND HAND INJURICS 89 the wrist, and the deformity it causes to the wrist and hand is absolutely characteristic. It alled the dinnerfork deformity, and is illustrated below if such an Colla fructure of the radus showing typical dloper fork deformity accident occurs, the forearm and hand should immediately be roughly splinted, without any attempt to straighten the bones, and the victim taken to hospital at once such a fracture can only be dealt with under an anaesthetic, and usually requires to be put into plaster of paris for about six weeks Sports in which thus accident may occur include Ke-hockey, skating and dancing STENOSING VAGINITIS Stenosing Vaginitus This lo a condition that also occurs on the back of the land at the base of the thumb Tic ·82 SPORTS INJURJES Broken bones The bones in thus region also may become chipped us in the elbow, and only X-ray will confirm auch damage Hospital treatment and advice u euentual, though agun the period of immobilization should be made us short us possible ANATOLICAL SHUT Site of characteristic pain in opbold fracture of the wrist Scaptad fracture There is a small bone in the hand called the saphord and thus frequently gets broken games like te hockey in which direct trum may occur The danger of breaking this bone is that it has a very poor arculation and is most difficult to treat as a result, because the two parts will not join together agun, or at least they do to much less willingly than most bones do Thus injury is characterized by pain in a localized area on the back of the hund at the base of the thumb between the tendons of the thumb in what i knoon as the anatomical stuff box. If you sustun this injury it is essenbul that it sbould be immoble Fized in plaster of paris for at least twelve wecks and during that period check X-rays should be taken to see that union is taking place In the event of noti-mion occurring it may be necessary to have the two bsts of bone wired together It should be impossible to mstake this injury for a sprained wrist and no one need worry that because they have nustained a wst injury it will prove to be this somenhat alarming and severe one Colles fracture A comtoon eccident in sport u for the wrist to be broken by a sudden fall on the outstretched Both bones map about an inch or less proximal to ·ELBOW, WRIST AND HAND INJURIES 83 the wrist, and the deformity it causes to the wrist and hand is absolutely characterstic. It is called the dircrfork deformaty, and is illustrated below If such an Cola fracture of the radlus showing typical dinner fork deformity acudent occurs, the forcarm and hand should immedlately be roughly splnted, without any attempt to straighten the bones, and the victim taken to hospital at once Such a fracture can only be dealt with under an anaesthetic, and unually requires to be put into plaster of paris for about six weeke. Sport in which this acadent may occur include Ice-hockey, skating and dancing STENOSING VAGINITIS Stenosing Pagraits This lo a condition that also occurs on the back of the hand at the base of the thumb The ·84 SPORTS INJURIES covenng of the leaders to the thumb becomes thickened and painful, the pain ruming into the forearm. It may be caused by creasing the thumb in an maccustomed faslion, and is not so auch esoarted with sport us with certain domestic occupation auch As dipping bedges, prado-playing and washing out dothes It is, in fact, hown us the washerwomen a complaint, but as it often ocaun in active athletes too it is important to get it properly treated. Phynotherapy wually proves weless and hospital treatment is necessary, it is a very minor operation to have the sherth acked with a knife, which frees the tendon and relieves the synaptoms Sprained thumb This is another very common injury and ugun should never be immobilized It is a very great temptation to apply a wonderful-looking piece of strapping, but all this can do is reduce the free arculation through the area and cause added stiffness. It is much better to exerme the thumb all you can, here again it w a good idea to keep a squash ball or spring hand grip (oce page 81) 20 your pocket and make a habit of squeenng it. If you ſence, or play tennis or squash, and want to continue to play, you cannot do your thumb any hurm, but if you strap it up in order to gain added support, you are merely giving yourself a false sense of security and by doing so are trying to speed up recovery faster than Nature u prepared to go always a bad principlo Brzed knedles This injury is common among boxers and can be a source of endless trouble It occurs most often in the knuckle of the metatuml bone of the scoood (middle) finger because this bone is more protuberant than the others Once bruising has occurred the um must be to preveat any re-bruinng, and this is not easy of the patient con tinuer his training It should be remembered that the bruise whether viable or loviaible, la bound to persist for at leut four or five weeks, and every care should be ·85 ELBOW, WRIST AND HAND INJURIES taken to prevent recurrence of the trouble for at Icast that peniod of time. Boxing may be continued, but only wearing specual pads in other words, no compeutisc boxing for six weeks These pads are of felt and are applied to the other knuckles so that they can take any pressure that might be applied to the hand Figure 29 shows the prinaple It is no use having felt that is only thick enough to protrude beyond the damaged knuckle when there is no pressure It must be so thick that even when pressure occurs it still protrudes more than the damaged knuckle Riglit from the day of injury, the joint should be moved and cxcrcised both actively and passively as much as possiblc The bruise will Bit there for months if any form of immobilization is practised, us of course it would anywhere else in the body The brilliant young boxer Sammy McCarthy was under treatment for eighteen months with this type of injury and the trouble was not finally put nght unul duc attention was given to avoiding further damage to his knuckles at all costs Trigger finger Forably stubbing the fingers may cause taaring of the extensor tendon from the bone at its insertion on the back of the finger, leading to the end bone forming a mallet deformity which gets caught up on everything It is no use hoping that this injury will mend itself, nor will physiotherapy help, it is necessary to extend the top of the finger and fix it in plaster of paris for several weeks until the extensor tendon joins up to the bond again. Fortunately wo little plaster is required that it is possible to continue ones sporting activities, though it would be unfair to use even thus amount of plaster as a weapon against one opponents! Duslocation of furgers and thumbs This 18 such a common injury especially in cucket and amongat wicket-keepers in particular, and so often the athlete likes to ignore the injury and deal with it himself, that it needs particular ·you have ignore the 86 SPORTS INJURIES mention. It 18 quite easy to get someone to give the digit 2 strong pull, when reduction of the bones ml occur If you can do thus yourself, well and good, but the important thing u to get it moving us soon as possible and to exercise it all you can without any delay Don t strap it up and don t splint it, but do get it moving at once If been unwise enough to allow the finger to remam dialocated for some time you ftce the fact that it will probably be necessary to have an operation on it to reduce it, and even in these cases movement 18 essential after the opera tion. To injury altogether is very stupid indeed, because such a joint, if not properly reduced, is almost bound to develop arthritic changes Teno-synopsis of wrist and hond Inflammation of tendon sheaths may occur as a result of strain in this aren, just as in any area, and is best treated by radiant heat and massage or electrical treatment. It is important, however, to keep the lumb moving and not to immobilize it while treatment is being carried out. The nok of over-ererasng it 19 very remote and most people tend to ert the other way and not exercise it enough. Nothing is to be guned by strapping Bustars of the palm of the hand and the fingers commonly occur amongst racquet players cricketers (bowlers and wicket-keepers) Oursmen and canoeists Spin bowlers get them between the fingers as a result of the fraction and they can become a chronic complunt. However, if steps aro taken, u for blusters in the sole of the foot to barden the skin of that area, then the risk of getting them can be reduced to a minimum. Once blusters have forged it is important to remove all dead skin and opera them immediately Treatment is described woder foot blisters (p 118) Infections of rails and fugers Paronychia Pulp nfectious Infections of the mail beds and tips of the fingert may be socuted with sports activity and there are things which ·87 WRIST AND AND INJURIES ELBOY, must be very carefully dealt with It is best to have the finger lanxed as early as posable and created under expert supervision Any carelessness about thesc minor things reflects itself in ones general fitness Pas-and-needles in hand This is a very common complaint amongst cyclists after a long-distance ndc Ir is duc to the habit of putting so much pressure on the handlebars that arculation is obstructed The trouble can be cured by aliering your style and malding sure of two things finsuy, that you do not put pressure on the hand for any prolonged period of time, and secondly, that you keep the wrist strught and not so that the hand is cither extended or flexed on it. If you remember that this is purely a ciretto Latory complaint, you will see how to cure it Another less common cause of this numbness and pins-and-needics is a slouchung scat, which causes the first rib or the collar bono to press on nerves and arteries in the neck, causing a similar obstruction to arculation This can be cured by correcting your style Mampulation of the elbow This is necessary if there is any Immutation of movement at the elbow and where the pain of termis elbow has become chronic owing to the formation of adhesion Hold the injured elbow in the left hand as shown in Figure 97 und bered the hand and the wrist so that it is fully flexed then sharply extend the elbow, keeping the wrist fully flexed us it was at the start. This causes a full stretch of the muscles concerned and will tear down any adhesions if they are present. IPERIAL EXERCISES With these exercises the um is to restore power in the forearm, wtest and hand. Get a tennis racquet or a weight such us is shown in Figure 38, and turn the arm outtyards, letting the weight of the racquet pull it further over than it ·88 SPORTS INJURIES would naturally go of its own volition. Someone can even help to force it back, u shown. Repeated pronation mod superaation of the forearm with such a weight is an excel lent toning-up exercise. Another exercise is to get an ordinary spring band grip (p 81) and keep it in your pocket, gripping it now and then at odd moments A little practice with this spring STIP - which can be acquired from any sports shop - will lead to an amazing recovery of power Among other simple exercises for toning up the forearm and hand 18 pressups on the points of the fingers as shown in Figure 39 Although at first it may seem very difficult, after a little practice you will soon find it is easy 25 R17 ordinary pressup STRENGTH TRAININO EXERCISES As the special strength truning exercises for the arms cannot be separated from the other parts of the amtomy, they are deschbed under Back Shoulders and Chest ·il Chest Injuries Injuries to the chest are not common in spon, and would only occur in senous accidents, croept for the following Inter-Costal Muscle Pan. As a result of a mysting or wrenclung movement of the chest wall it is quite cly to tear the fibres of the muscles between the ribs, and these can prove very painful I do not recommend any form of strapping as that tends to limit the movement of the muscles and prevents their speedy recovery Like muscles anywhere else in the body, they should be excused vigorously, and the best way of doing wùs is by deep breathing exercises Any immobilization will only tend to make them remain painful all the longer Cracked ribs Direct trauma aan, of course, product cracked or broken nibe, though the latter is usually due to crusliing and is usually accompanied by scverc shock. If cither a fructure or crack is suspected then immediate hospital treatment should be sought. If, however, only a crack is found or a break with minor displacement, it is far better to try to get back full movement than to resort to Immobilization. Even if you have only cracked the nb It is liable to be very painful, but there is no risk whatever tlut a cracked nb will sepante and pierce the lung in the rare aures when lung tuwue has been pierced by a broken mbit has occurred instantaneously The pain that such an accdent auses is more than sufficient to protect the individual ·90 SPORT: INJURIES against later or further injury The pain of a cricked nb is also sufficient for older people to requare immobilization, but for a fit and active athlete it u for better to continue training particularly deep breathing by improving the drculation through the area, union of the bone occurs all the quicker If there has been any gross displacement of bone, of course it is a very different matter, and requires the most expert surgical treatment feel pain Panful breathing A very common cause of indisposition at the beginning of the season is painful breathing It ocam in all sorts of athletic activity and is usually due to tulung unuccustomed exercise Most human beings only use about two-thirds of their lung tissue. If you suddenly go out for a five-mile run after a longish spell of mactivity, it is not surprising that you It is simply due to the fact that you have stretched tissue that has not been lately accustomed to such stretching You have probably filled with oxygen lung tissue that has been without oxygen for some time, and maturally it reacts accordingly It is similar to the feeling of smarting and tightness in the nostrils and thront when you go out of a warm room into the Ісу cold If this part of your anatomy which is being constantly used for breathing reacts m such a way, it is hardly surprising that the deepest parts of the lungs react painfully on sudden exposure to air After the exertion ceases, you are liable to develop a dry very tickly cough. This is merely due to the imtation, and should be ignored I have often heard of people imagining that they have developed some serious disease, or strained themselves because of this coughing but it is very common indeed and the cxplana tion is as simple as that. It is a good warming that you are not us ft u you ought to be When you are a hundred per cent fit you must automatically be using and accustomed to using all the lung tissue that you have got. Breathing u one of the most essential things for true effiaecy and ·91 CHEST INJURIES yet many athletes are poor breathers in training athletet, 1 lmays concentrate on thcir lungs before I start opearlize ing on any particular musclc development Sputing blood It is not at all uncommon, in 170* of the fact that compcutie divers may dive from a great height and at great speed, that afterwards they cough up Tull specks of blood, denoung that they have damaged lung tissue. Although it may seem rather alarming, there is no incident on record of any serious damage having been done In this was Presumably the shock of hitting the water sometimes reacts on the lung ussue, bruising it slightly, so that mumte traces of blood get into the mouth If ruch bruising has occurred, it is best to be arcful for a time and perhaps to do some decp-breathing exerciset, to increase the arculation through the lungs, and thus dire perse the brose in the minimal amount of time it would be quite wrong to advise rest, because all dat that could do would be to make the bruis sit there a lituc bit longer Bearing in mind the principle of dispersing bruiscs anywhere in the body, the wisest course is to increase the circulation by vigorous expansion of die lungo The best exercise is to try to burst a football bladder Anlaclı in ebony agarette holder to the mouthpiece of the bladder dont try the exercise with your lips directly in contact with the bladder mouthpiece or you will make them scry sore Breathe in through your nose, and out into the bladder By forcing air into the bladder, which puts up a resuntance, air is forced mto parts of the lungs such are not normally used Take long, deep breaths and not short, aballow ones, or you will make yourself dizzy because you tend to rebreathe your own ur This is also a good exercise to do after the scute stage of pneumonia, when you are out of hospital However, it should not be attempted without a doctor a permission. It will lead to a re-expannom of the collapsed lung tissue much quicker than any other exercise will ·99 SPORTS INJURIES STAENOTH EXERCISES FOR THE CHEST AND AANE Fig 30 Bench press with berbell The bar can be pontioned on the chest prior to the press us follows it is firat liſted in the standing portion on to the top of the thught with the performer atting on the bench. He then les back on the bench lifting the bar on to his chest. The press should be performed with vaned hand spacing, breathing in us the bar goes to arm & length and out as it is lowered. At the eod, lower the bar to the abdomen, putting the feet under the ndes of the bench and coming to your feet by continuing the sit-up action and by simultaneously pulling with the lego Fig 31 Bench press tenth dumbbell The weights can be positioned at the chest ope at a time by a shortened curling Action a shown. Should they be too heavy they can be positioned in much the same may us the barbell The tiro best pressing movements are with the palms facing to gether, closing the weights together as the arms extend and with the weights beld wide to the ade with the palms facing towards the feet, twisting the weights us the artig extend so that the weights close together again with the palms facing The breathog rhythun 18, again quiety in us the wesghts are pressed and out us they are lowered. Fig 39 Incline press wrth dumbbells The weights can be positoned at the chest by um and back action from their starting position on the floor on cither side of the feet. The two best pressing actions are the ame us on the boritontal bench and the breathing rhythm in the name. The weights are prewed vertically Fig 3 Incline ol wrth dumbbells The um anling uction u shown clearly in the photographs There should be no movement in the shoulder joint until the flexion of the upper arms is nearly complete The head is best kept slightly raised off the beach The breathing rhythm is in ·OS CHEST INJURIES as the weights are curled and out as they are Innered The palms can be kept uppermost throughout or they can face together at the start of the mostment and finish urgat most. The latter movement will ensurc full action for the biceps murde. Fig 14 Table cul The body should be positioned so thar the arm is at right angles when fully extended and fuli with the table. The weight is then curied until the forcarm us at nght angles to the table. The shoulder joint should be kept well down dunng the arling action so uut the armpit is in constant contact with the ubic The full ncight should be lifted from the table for each repcution, uur is to say there should be no rebound Fíg 85 Drombbell pulloters The arms should be kept ngidly strught and the wrists slightly turned inwards, and the body is flat on the floor In the first variation the weights are kept at nght angles to the body and pulled ACTORS the chest umul they touch. In the second die weighits are lufted from the thighs until they touchi (palms (acing) over the chest. In the third variation the position of thic durnb-bello (as shown) is interchanged and in order to effect this the weights are twisted as they are pulled In all movements the full Haght (le no rebound) should be liſted for each repetition. The palms are facing upward at the start of all movement. It is usually best to breathe in both as the weights ure naused and us they are lowered but thus double breath for each movement would depend on the mate of the exercise.

·12 Abdominal Injuries The most significant thing about the abdomen is that it is 13 1 rule the most neglected part of an athlete s anatomy Most athletes take no end of trouble to tune up thar leg and arms but grossly neglect their abdominal muscles, get these are very largely responsible not only for a correct balance but also for an ordered and efficient digestion. If the abdominal wall is lax, then the abdominal viacera cantnot possibly be as efflaent us they should be It is necessary to keep the lateral muscles of the abdomen tumed up too These are the external, internual and transverte obliques and the quadratus lumborum, and the special exercises for them are described under the exercise group in this section. Torn fibres of the retus abdominis This muscle is very oftea tora, particularly in rugger, and such a tear can be very painful indeed It usually tean off from its ongio at the sternum of breastbone it may tear at its insertion to the pelvis and then its pain is often mistaken for some internal trouble It is quite easy however to differentiate, because if you lie Alat on your back and raise your legs or your trunk - depending on whether the muscle ju torn at it upper or lower end - then you will find either that you annot ruuse your legs or trumk or that the runng of them us increaungly painful The treatment for this injury is the same us for anywhere else in the body and if you really stretch out the muscles with the exercises recomended, ·ABDOMINAL INJURIES 05 particularly those in Chapter 8, Back Injuries , it will very soon get night. There is, however, an injury which occurs sometimes in football players, and even morc commonly in boxers, in which fibres of this muscle are damaged very deep down inside the chest beneath the lower border of the nibs It is a most intractable pain, and even more commonly than the former trouble mistaken for other conditions It often occurs in the region of the gall bladder and it is really quite difficult to distingush the pain from that of gall- Needless to say, the treatment is totally different, because whereas the muscle injury requires exerase the gall-bladder condition must be treated by medical or surgical means bladder par Groun pan. Because of the locality, pain in the groun often causes more alarm than a similar pain elsewhere, yet it is frequently due to a very minor muscle strain that anywhere else would be treated almost without any anncty at all Just because you have pulled a muscle in this region there is no reason why you should rest it in fact, I know of no excuse for resting it. Recently a young nmner sprained his ankle and ran for some miles putting all hus weight on the other leg The ankle recovered, but he was left with a severe pain in his left groin. All sorts of people expressed thar opinions as to what this might be, and of course they suggested everything but the obvious because he had been thrown off his balance, he had put an added strain on his left groin muscles and they had reacted by straining too He was told to rest for a month, and of course the whole tone of his muscles deteriorated considerably During this time he had heat and electrical treatment on the affected part, and that too made the muscles fiabbier than ever He then met somebody who suggested that he should exercise it, but did not wem him that he would get 1 severe reaction having thed it, he very soon decided it ·96 SPORTS INJURIES could not be the nght treatment because it made the pain so much worse. That is just bow any muscle anywhere in the body would react to such treatment. He should have been told that the muscle would take some time to loosen up and regain its old Rippleness, and that he must expect some pain on the way The most important thing for bum was not to try to do anythnog very mergetic but first and foremost to recover his balance Thus would best be done by some gentle standing rummmg with full Imee bending, gradually increanng the number of times he did it, and then havag recovered ma cxact balance and putting an equal weight on both legs, he would be justified in going out ruming He would the very soon be able to get back the tone of the muscles and the pain would go out of them Haematura. It is not musual at the begiming of a season of training for an athlete to pass blood in bus water, in fact the urine may become dark red and thick. It has often happened in my experience, particularly amongst crosscountry runners and usually on the first training rum of the Beason It u urually of no agnificance at all, although it seems to cause a great deal of panic. The cause is probably that the kidneys are suddenly called upon to do more work u excretors than they are accustomed to, and temporanly full to cope with it The natural tendency is to go nishing off to a doctor to have the whole of one s urogenital system thoroughly investigated but this only has the effect of exaggerating 10 the patient & mind the seriousness of what has happened Haematuria by itself is of no ognificance at al. If it were due to kidney or any other disease, then there would be many other signs of trouble. The usual fear is of tuberculosu but of that were present, long before blood appeared in the urine there would have been other signs such a profuse swating and loss of weight If, after I run, your water is stained red, do not rest, but ·97 time- ABDOMINAL INJURIES continue your training routine It is very unlikely to occur again, but if it does - und if it appears worse than the first then is the time to go to a doctor and get it thoroughly investigated If this training form of haematuna occurs, dank plenty of water to wash out any debris that may remain empty the bladder, of course, just as soon as you want to - do not retain urine unnecessarily SPECIAL EXERCISES These are mainly described under Back, Neck and Client One of the most important ones is the forward and back- Ward trunk bending Next in importance comes the lonceling exercise (Fig 11) in which you bend the trunk back to touch the head on the floor Another one is to stand with your legs apart and twist your trunk sideways repeatedly, with or without arm action. STRENGTR TRAINING EXERCISES The best of these is described in Chapter 2, Tuning up the Musdes This is the sit-up on the table using straps A second one u described on p 66, and u the opposite of the last one Finally there is adc placing with the legs The body is supported by a weight, as shown in Figure 36 The legs should be kept quite straight and together, and placed from side to side.

·98 SPORTS INJURIES could not be the right trutment because it made the pain 80 much worse That 18 just how any muscle anywhere in the body would react to such treatment. He should have been told that the muscle would take some time to loosen up and regun its old suppleness, and that he must expect some pain on the way The most important thing for hum was not to try to do anything very energetic but first and foremost to recover his balance. This would best be done by some gentle standing running with full knees bending, gradually increasing the number of times he did it, and then having recovered his exact balance and putting an equal weight on both legs, he would be justified in going out running He would then very soon be able to get back the tone of the muscles and the pain would go out of them. Haematuria It is not unusual at the beginning of a season of training for an athlete to pass blood in his water in fact the unne may become dark red and thick. It has often happened in my experience, particularly amongst crosscountry runners and usually on the first training rum of the season. It is usually of no ngnificance at all, although it seems to cause a great deal of panic. The cause 18 probably that the kidneys are suddenly called upon to do more work u cicretors than they are accustomed to and temporarily fail to cope with it. The natural tendency u to go rushing off to a doctor to have the whole of one s urogenital system thoroughly investigated but this only has the effect of exaggerating in the patient mind the seriousness of what has happened. Haematuna by itself is of no aguificance at all. If it were due to kidney or uny other disease then there would be many other signs of trouble. The usual fear is of tuberculosis, but if that were present, long before blood appeared in the wine there would have been other signs such as profuse sweating and loss of weight. If, after a run, your water la stained red, do not rest, but ·TAIGN INJURIES 99 important to get the athlete on his fect and try to restore his balance. He has probably fallen violently and been in severe pain, and that has caused spasm of probably the whole group of muscles involved It is most important to walk him round until the spasm has wom off, and then get him to trot gently in us balanced a way us he can. This will probably take anything from 30 minutes to two hours Here are some important don is Don t strap the leg up that can only cause an obstruction to free circulation, no matter how carefully the strapping is applied Perhaps worse, it causes abmormal movement of the muscles when you try to walk him around Equally, don t massage the mudes, for reasons already given. Don t apply any form of lieat. Don t let him rest, but keep him moving, and get him free of the unbalanced constriction that has occurred Any pain can be relieved by taking Veginin, but do not try to relieve the pain either by local injection or by rubbing anything in. Injection is seldom justified in the area of the thugh, because a large area of muscle is always involved, if not by the actual tear certainly by the bleeding, and it would be impossible to inject the whole area involved Unless you can be sure of obliteratug all pain, injection 18 uselesa No one should ever be tempted to inject more than the most microscopic amoumts of amaesthetic (a murimum of 1 c.c.), and this would seldom be enough Next morning he will probably wake up with a very stiff leg and the sooner you can loosen that the better He should get back into his rumning togs and be made to run at a gentle, balanced pace and he will feel the leg becoming freer and freer By the afternoon he should be able to run quite furt, without a limp In fact the coming on of a limp is an indication of the progress of recovery the patient must not go any fuster than he can go without limping The next morning be will be freer of any suffness by the evening he should be able to run at three-quarters speed On the fourth day he should be able to run at full apeed.

·13 Thigh Injuries There is probably nowhere in the human body where muscle get torn more commonly than or the thigh. Thus u probably due to the fact that there are so many different muscles in that are involved in running, and, of course, liable to be demaged in the ball gumes ruch as rugger and soccer It would be difficult to say that any one rode was more commonly injured than another, although it is prob able that sprinters as a group, more often tear the ha strings than the quadriceps The care of these muscles is auch a vitally important matter thut it is worth while describing in detall exactly what the treatment of them should be First of all, they are too often wrongly treated, and made considerably work 13 2 result of that wrong treatment. I have already explained that when a muscle tears you get bleeding and therefore no form of heat or massage should be appued unul the risk of further bleeding has been removed, that wafter a period of about four days If a musde gets torn, the routine should be as follom. To minimize the bleeding, cold water should be applied other from a tap or with ket towels as soon as possible. Ice is not recommended because it auses too violent . contruction of the blood vessels which may lead to spasm and later in ischaemic Cold water applied from a top for 16 to 20 minutes is always adequate to stop any further bleeding, and the sooner it can be applied the better After that it is ·THIGN INJURIES 101 as possible, and reduce any tendency to acidity of the bowel by taking salto It 18 no good using ointments, because they just make the area dirtier Usc evaporant non-oily liquid, or talcum powder, instead Once the infection has started up, it is useless to take part in any of these sports until the condition has completely cleared up Further irritation or friction only tends to make it much worse, and a lay-off of three to four days, during which you keep the area well covered with a dry antiseptic dusting powder, will very often dear it up completely The tendency to develop this condition can be reduced to a minimum by wearing as few clothes as possible, preferably with silk next to the skin, but more important still is to wear the sort of clothes that do not ruck up and add to the friction. An additional complaint amongst oarsmen and canoeists 11 goreness of the bones they sit on, 1.6 the ischial tuberosities Some people are better padded than others and people who lack natural padding hercshould insist on nitung on a padded sent Dunlopillo is an excellent pad for this sort of thing Another common complaint in this part of one s anatomy 1 profuse sweating in the region of the groin, which becomes chronically sore. It is important to keep the aren as dean and dry as possible, and to prevent any imdue sweating by weanng light and loose-fitting underpants The tops and bottoms of these should not have elastic in thern Never use ointment on these sores, but apply antiseptic talcum powders ·100 SPORTS INJURIES I quoted (p 15) the classic example of the sprinter, who was treated in this way for 1 tear in the hamstrings, one of the severet muscle tears I have seen, and aght days after the injury did his best time ever Many people are afrud to activate these torn muscles too much, because of bruinng Bruwang does not matter in the least compared with freeing the healthy muscle tissues from any surround ing brwving or fibrous tissue formation. If you keep the limb moving, the damaged muscle fibres entirely separate themselves off from the healthy ones, and no permanent adhesions are allowed to form. Any lazinets or resting will crure everything to gum up, and every day it is left it becomes more difficult to free. In the case mentioned above, the patients leg wus absolutely black with brusing from thigh to heel, for at least three weeks after the injury However, after about the fifth day he was entirely free from any restriction of movement, and the brute just worked itself out without any inconvenience to him. As I have said before, I have never known exercise to cause a muscle to tear agan la the same place and I believe thus to be because Nature brings all sorts of defensive mechanisms into action to prevent such a recurrence After about the fourth day, massage and beat may speed up the healing process, but I find most frequently that the course of recovery is best left to Nature, and you are more liable to get a serback, such as #welling of the knee os ankle, if you try to take things faster than that Things like that are merely Natures way of wataing us that we are taking things too fast Saddle boreras Skat sormed This is a very common complaint amongst cyclista, onnmen, horsemen and chocists For more frequently than not, it is not due to any direct friction, but to profuse sweating in this region leading to undection of the hair follicies and consequent development of boils etc. The first thing to do is to keep the ret us dern ·KNEE, ANKLE AND FOOT INJURIES 109 tion for two or three vecks, and that is the time when the damage to the patients general condition 18, or is not, done. If, while he is in hospital, he is encouraged to do quadriceps exercises, so as to minimize the wasting of these muscles then he can make a complete recovery and be us good us ever he was in severe cases, the leg will be found to be locked after the accident, and no amount of pushing or pulling will enable you to straighten it. It can, in fact, only be straightened under an anaesthetic, and then has to be kept still uulit has settled down. If the knee locks and you are able to free it yourself, that is a sign that you should be able to get it back to normal without operation, by strengthening it with special exercises PIMUR LATNA WOLLENT CLUCIATI UGUAMD MIDA U OAMENT FIBULA TILA The knee joint consists of three principal ligaments medial lateral and cruciates When a cartilage gets torn these ligaments are nevitably affected too, but if you can strengthen them up after the accident and at the same time make the quadriceps muscles stronger, then in ninetynine cases out of a hundred stability is recovered without operation. The tendency in many clubs is to strap the knee up, lose all the tone of the muscles and ligaments, and reduce the stability to nothing that counts entails the risk of the knee becoming permanently ustable If, however, the ·14 Knee, Ankle and Foot Injuries There is no doubt that one of the commonest sources of trouble in the world of sport is the linee. We can all recall famous athletes whose careers have been seriously affected by their bees, but the treatment of them, wluch has been *o haphazard in the past, is very simple and straightforward. Unfortunately the knee joint is one of those joints which contain cartilages, and for this reason whenever any thing happens to the knee the quacks dub it a torn cartilage, Ho that the minute an athlete bas knee trouble, he fears the worst. A severely torn cartilage certainly requires in operation, and an athlete would be trell advised to have it taken out just as soon as it is severely torn. The expert can tell quite defimtely and simply to seek advice from an unqualified person is foolish, for only an expert can be relied upon to make a correct diagnosis Mung athletes fight aby of a surgeon on such an occasion because they are afraid of beving to have an opention, but no murgeon would operate upon an athlete except in absolute necessity It is only necesary m the case of severe teanng and as there are all degrees of tear fur more commonly than not the treatment us an active one that does not require operation. There is no reason to suppose that, after having the cartilage removed the athlete cannot be us efficient as he wus ulthough very often he is not, he could be if he were properly advised. The operation necessitates immobilia- ·*NEE, ANKLE AND FOOT INJURIES 109 tion for two or three weeks, and that is the time when the damage to the patients general condition 18, or is not, done. If, while he is in hospital, he is encouraged to do quadriceps exercises, 80 as to minimize the wasting of these muscles, then he can make a complete recovery and be as good as ever he was in severe cases, the leg will be found to be locked after the acadent, and no amount of pushing or pulling will enable you to straighten it. It can, in fact, only be straightened under an anaesthetic, and then has to be kept still until it has settled down. If the knee locks and you are able to free it yourself, that 18 2 sign that you should be able to get it back to normal without operation, by strengthening it with special exercises PEMUI LATOM UOLT. CLUCIATI UGAL MEDIAL U OAMENT PILULA TILA The Imee joint consists of three principal ligaments - medial, lateral and cruciates When a artilage gets torn these ligaments are inevitably affected too, but if you can strengthen them up after the scadent and at the same time make the quadriceps muscles stronger, then in ninetypune cases out of a hundred stability is recovered without operation. The tendency in many clubs is to strap the knee up lose all the tone of the muscles and ligaments, and reduce the stability to nothing that course entuls the risk of the knee becoming permanently unstable If, however, the ·10+ SPORTS INJORIES active routine is adopted from the start, although there may be one or tad recinraces of the trouble, it soon becomes 28 strong as the other knice. Medial and lateral ligament tears These are the commonest minor injunts of the line that we get and of the two the medial ligament 13 the one more commonly affected The pain 13 severe, and localized to a point over the ligaments, which is ather just at the joint level on the inside of the knee or at the same level on the outside. The amount of swelling vines from being localized to the are of injury to extending throughout the knee joint. The area of pain is usually very small, though TUR SATRIA KIHASTU KY MEDAL CITYLACZ Wuly MEDIAL UGANINI SALUTY TILA Point of tenderts at the toner elde of the knee It can be extensive Don t strap it ap don t rest it, but try and get back the movement and use the arcu lation through the area u soon as you can by doing rhythmical and balanced exercises. They are the mme u those recommended for toning up the knee after a catalage operation or displacement. If the pain u rufficient to make rhythmical movement impossible, then an wjection of arza cathetic might be justified Again, this only proves ·KNEE, ANKLE AND FOOT IN JUNIE 8 106 necessary in a very small percentage of cascs and it is far better to get back the stabıhty naturally by doing the hard work against the pain oneself than to rely on any such artificial aid Caate ligament injuries These occur as a result of stubbing one s foot into the ground very forcably, or having the leg forcibly extended It is perhaps one of the most serious injunes you an sustain in this area because the cruciate ligaments will probably not function again. So the alm must be to stabilize the knee by strengthening muscles and tendons to compensate for the weakened ligaments Synotitis Another very common condition of the lance is that of synovitis or swelling, which may occur anywhere in the front, sdes, or back of the knee Cyclists develop a condition of this sort, which they know as Easter Knec, caused by exposure to damp and cold, particularly at the begiming of the season. The knee reacts to the inaccustomed exercise by swelling up and becoming stiff and painful Other auses art continuous kanceling such as the housemad does, and all forms of wrenching or twisting which may damage the tissues A very good up, if arcumstances will allow it, is to lie on a beach with the leg entirely enveloped in sand, pour some se water on it and let the sun draw off the fluid. If you leave the knee encased in this damp and for half an hour, and then take it out, you will find that the fluid has dus appeared with dramatic suddenness The process can be imitated by uslog mand and salt with an ordinary heat lamp, but that u not wually available to ordinary folk. The drawing-off of the flud is a manifestation of the same principle U is followed in the use of salt and milk for boxes bruises (p 65) Synovitis of the knee is a condition which should never be strapped up, for obvious reasons knee strapping is bound to limit the circulation through the linee and that ·106 SPORTS INJURIES must be avoided. Nothing is guned by heat or massage, though after vigorous exercise it is a very good idea to elevate the leg, on the end of a sofa for example. The force of gravity will often rendove any traces of excess fluid that may have waumulated in the lazee Whenever Avid does form there, the sooner you can get nd of it the better, us once it goes sold, it is very difficult indeed to remove it. Small quantities however, can be completely harmleu, and are best ignored Chondro-malaca Patellar Thishugh-sounding name 13 given to a very common condition that anses wrongst cross country rummers It is a roughening of the undersurface of the kneecap bone due to the fact that the limb has been put through a limuted range of movement and wora rough in a limited arca. When the Imee moves the kneecap moves too, and can very easily become wom out, so to speak, in a certain area. If this area becomes roughened by excessive use it becomes extremely painful. It might be thought that rest would put it right, but all that does is to make it worse, so that it becomes a permanent disability The answer is to put the knee through a full range of movement, so that any debris and roughness of the joint is moved into a len sensitive part of the joint space and finally dispersed altogether Rummert who develop this condition should therefore practise a daily routine of 20 minutes to bulf an hour of standing rumming with full konces bendung coupled with a regular-paced 30g-trot nun each day of five to aght miles The pain usually comes on at about three miles and it is important to try and run through the painful stage, which may last from one to two mile It then esses and each time you do it, after reaching a certain peak, it will gradually die off Itu best not to race for two to three weeks after the condition, u It la quito sy to awe it to fare up agun by too strenuou a movement in long-distance running ·ANEE, ANKLE AND FOOT INJURIES 107 Afrontus Ostficans This is an injury that commonly occurs amongst football players as a result of direct trauma The player gets a sudden kick on the thigh, and excessive blceding occurs inside the bulk of the quadriceps or hamstring muscles It 11 sometimes possible to feel the blood cyst, and evacuate it with a syringe, but this should only be done by a doctor This is not often necessary, but if the bruise can be felt as a cyst then it is best evacuated at once and pressure applied for two days More often than not such bleeding as has occurred has become diffuse, and it is impossible to take it off After a week or two of the active routine, X-ray may reveal the fact that ossification is occurring in the murde. This might seem very alarming, but if vigorous exerase is continued then the ossification occurs only in damaged muscle which 19 entrely separated from any healthy active muscle fibres, and so becomes of minimal nunsunce E. McDonald Buley sustained thus injury very early on in bus athletic career, and has ever since carried a large mass of alafied muscle in his left bup joint region. One might suppose that this would be very damaging to his whole balance, and indeed prevent him ever becoming a really great sprinter Many people thought, when he sustained thus injury that it was the end of his active career However, it doo not seem to have done fum much harm, and if ossification is going to occur it will occur no matter what you do to prevent it. Some people form owsification much more readily than others, but if you continue the active routine after such an injury then it is seldom, if ever, that you cannot get back full function in spite of it If the injury occurs in the quadricepa, it is most important to get a full range of movement in the knee as soon as possible, by persistent full knees bending, stretching the quadriceps muscle Equally, if an injury has occurred in the hamstrings, high kicking with the knee fully stretched is most important.

·108 SPORTS INJURIES PerrastealHarmatoma It is often difficult to distinguish thu injury from the previous one. This is deeper, however because the bruise occurs between the bone and its covering, the periosteum X-ray will wually reveal it, and it is important to have the blood taken off by a doctor w early as possible It may prove difficult, in which case it way have to be left. The active routine again bolds, and it is more than ever important to free the surrounding muscles and maintain their tone Some schools of thought advise rest, and immobilization in plaster of pars This might be the landest way of treating an old lady, but is certainly no way to get an athlete back to full activity No harm whatever can be done by keeping him going and getting him back to full balance and muscle tone as soon as possible In these two conditions, it was for a long time thought that certain forms of treatment, including heat and moven ment, were table to cause an increase in the nizowt and degree of Ossification. It is now agreed that nothing can make iny difference to this, and that the degree of ossification depends on the individual Fractwo of the Patella This 18 qute a common injury in sport. It can be diagnosed by gentle digital pressure on the kucecap from which it can be felt that the bone 1x broken and it may be in many fragments I mention it because it is an injury włuch is commonly treated as a severely spruned Ince, but it should never be dealt with except in hospital Recently a description of how to strap thu injury appeared in a book, but it should never on any account be treated by a layman Shin swenk Shin splints One of the commonest pains amongst sprnter is a pain which develops in the region of the shun bone It is wually along its posterior border on the Inside of the leg It is not only painful to any vigorous Inovament but tender to touch, and it can be a most per nustent pain. The best way of dealing with it is to try to ·ANEE, ANKLE AND FOOT INJURIES 109 understand what it is Along the shaft of the shin bonc is the only place in the body where muscle anses near the surface Actually the bone is covered with a bone-covenng, or periosteum, and the muscle anses from thus in training and building up fitness, the tone of this muscle has to be gradually improved, and often it is very sensitive to an attempt to tone it up more quickly than it wants This results in the muscle fibres getung too powerful before they have become properly supple, so that the muscle tears off from the periosteum, or tears the periosteum off the bone To are it, you have to take things more steadily, and try to build up the suppleness of the muscle more gradually This is done by running more on the flat of the foot, which puts less of a strain on that muscle, and doing more regular, rhythmical, relaxed exercise You need to do a great deal of stends-paced running before you do any all out sprinting Shin soreness occurs most commonly in sprinters for the simple resson that they are the people who requre the most powerful and sudden contraction of these muscles But runners of all distances can get it, as many will know to their cost The only answer is to build up the tone of the muscle more gradually, and the pain will gradually die away It is another of Nature & ways of warning us that we are taking things too quickly This is madentally the only complaint for which I would recommend rubbing anything into the skin I find that rubbing in olive oil can speed things up and bring considerable relief The area may become swollen und inflamed, and only if it is inflamed 18 it necessary to rest it for a period but then it will be all the more difficult to cure Never strap it up or massage it. Equally, any form of heat, for reasons given previously in the book, are contra-indicated It can only be healed by adequate, correct and steady training and there is no short cut to that ·110 SPORTS INJURIES Stress fractures of the fibula. Although I describe stress fractures of the foot in the next section, there is a common type of stress fracture that occurs at the lower end of the smaller long bone of the leg, the fibula. It most commonly occurs in middle-distance nimers, and particularly in those who do their training on the road. It has some relationship with the camber of the road, and the fact that they nn in an unbalanced fashion necessarily putting more weight on one leg than the other, as a result of the camber The bono suddenly cracks 1700s, although the actual pun of it may develop only after two or three day. As with all stress fractures X-ray often does not show it for several days but the pain will increase and then the X-ray will show it quite clearly as a crack across the bone The treatment is similar to that for the other types of stress fracture. The athlete should continue gentle truning avoiding uneven surfaces and roads and not raang for three to four weeks He should continue a normal steady training routine, and the limb should not be stripped up in any way The movement and increased circulation through the area causes the bone to knit up very quickly, and it soon becomes the strongest part of one anatomy Naturally, as it is knitting and the surrounding ligaments and muscles are recovering their tone, you may get twinges of pain, but these are msignificant and there is little or no risk of causing any increase of damage unless you do something stupid like racing on an uneven road surface or jer the leg volently by z fil] Torn Muscles of Calf (Plantarus etc ) Sometimes muscles of the calf tear so suddenly in the middle of a race that it feels us if someone has shot you in the alf It wu always thought that such a tear only involved the long the plantanus muscle but this is not bome out by modern evidence, and it may be my muscle that does it. The treatment is the ume as for any pulled muscle elsewhere in the body and ·KNEE, ANALE AND FOOT INJURIES 111 the thing of primary importance is to correct balance as soon as possible. It wually occurs as a result of doing too much racing in spikes before you have done the necessary training SPECIAL EXEXOISES Any exercise which puts the knee through a full range of balanced movement is good and the one I recommend is standing running, alternated with full lences bending, hands on your knees, knees well apart, cyes to the front and level, and keeping your back strught (Fig 40) Another one is to stand a yard from a wall and try to force your foot through the wall with your leg straight. Repeat (Fig 41) Another one in this same group is to stand with your back to a bed or table, the bottom of which is about two feet from the ground Try lifting the table or bed, which should be unliftable, with the heel of the affected leg Agun, it is most important to do the exercise in as balanced a way as possible, keeping the trunk straight and lookmg to the front (Fig 42) STBENGTH TRAINING EXERCISES There are numerous exercises which can help the knees these are described under Back and Abdomen (Chaptera 8 and 12) ANILE. AND FEET The commonest injury to this part of an athlete s anatomy 1 strain of the Achilles Tendon. This is the tendon that anses in the muscles of the calf, and is inserted into the heel bone It very often becomes swollen and inflamed as a result of strun and this strain is often closely associated with bruising of the heel. It 18 sometimes quite impossible to distinguish the two condition because there is a very poor circulation in the beel, and if bruising occun it tends to track into the region ·119 SPORTS INJURIES of the Achilles tendon, which may already be inflamed itself as a result of the jarding that has caused the brusing of the heel A bruise anywhere in the body takes five or $1X weeks to work out, whatever one may do for it, but it takes ten to twelve weeks in the beel and ankle simply be cause of the thick, fibrous nature of the subcutaneous tissues in this region Prevention is always better than are, and my advice to any athlete dolog a lot of exercise on ius feet is always to pay particular attention to the sort of shoes he wear To have spongy rubber soles for trairung is sot enough. I advise an additional spall rubber beel-pad inade the shoes, otherwise, with the foot continuously banging down on the ground, bruising la liable to our Footballers, rigger players, and other ball-games players run the same risk, and they, too, should always wear spongy rubber pads inside their shoes. If, however, the condition of brwsing has already occured, it will always be found to be very persistent. The only treatment is to wear the spongy pads not only in one 8 sports shoes, but also in one s ordinary walking shoes or boots. Because only one foot is affected is no reason to wear only one pad that will only upset your balance and may well lead to strun in the other foot. The principle of avoiding strapping holds more for this area thun for simply because of the poor arculation It 2 bad enough without any added obstruction to a free flow of blood. Achilles tendon fatigue or strun, if it occurs independently of brwsing of the beel, us curucterized by a small localized area of pain in the tendon sheath. Many of the so-called ciperts think that it is a good thing to rest it, but if you do that, very soon after starting tnining agun the condt tion will recur No us in all other cases of soft-tusue tauries nothing is to be gained by immobilization or strapping Nature can get over the difficulty much better than any other method. Try to understand what has awod any other, ·119 KNEE, ANKLE AND FOOT INJURIES it, and then continue training, as oiding such things us too much trork on the tous if you are a sprinter, or too much banging down on thc fect if you are a ball-game player or muddle distance runner Sponge-rubber heclapads should be worn at all times It is important to appreciate that a far greater strain is put on the Achilles tendon when one is running on ons toes than when one is rimning on the flat foot Although it might appear that the tendon is more stretched when the foot u flat, in actual fact the strain on the tendon all comci in the action of keeping the heel off the ground So if Achilles tendon fatigue occurs all training alould be donc on the flat feet, and sprinters sliould avoid getung into their spikes except when absolutely noessary, for there igan the foot is immediately raised on to the tocs and an added strain is put on the tendon. To wear a rubber pad inaide the heels of your spikes is no excuse for doing a lot of training in them when the Achilles tendon is giving trouble There is another reason for never putting sponge-rubber pads inside spikes spiku need to be icry tight-fitung, and thus spongy rubber tends to make the lxcel move more than it would without it. I do not think heat, massage, or any form of clectrical treatment will relieve this condition. If it becomes particularly painful after exercise, any Auid in the tendon sheath or in the region of the ankle joint can quite casily be dispersed by lying on a sofa or bed, with the leg clevated. Even half an hour will cause the fluid to disperse quite considerably A temporary relief from pain if there 18 an important match on hand, can be brought about by injection of mnute quantities of anaesthetic in oil This is un expert job and should never be carried out by anybody but a qualified doctor of the numerous cases of Achilles tendon fatigue that I have dealt with, I have not injected more than about one per cent, and yet they always play or run, in spite of the condition, almost immediately ·114 SPORTS INJURIES While on this subject, it is importent to clarify an urgh ment often used by people who do not know the sentific reasons for using these injections They ny that Nature wams one of trouble by causing pain, and that it mut therefore be wrong to obliterate pain, even for a few hours because further damage 18 liable to be done while the part concerned is anaesthetred This is not borne out by prectical experience. In fact, by enabling the patient to co case the part concerned much good is done, and bearing m mind the principles of active treatment thus le not surprising Nature brings many protective mechanisms into play when a part is injured, and these are not in any way affected by the injection of the anaesthetic. That mimply deadens pain and has little or no other reaction on the tissues Thus while the pain 18 derdened the increase in the circulation through the affected area does nothing but good The vanous antibodies that protect the damaged parts are not in any way affected by the drug I believe these injections can be wrongly used, and frequently we indeed they are widely abused But for player in a first-class match, or in fact any match, to be refused much an injection on the grounds that it can do him no good us absod There 18 DO connection bere mth the udesirable practice of doping players I dealt with this subject of dope in Chapter 8 here I need only point out that injecting inaesthetic bas do comection with doping at all. It is used purely us a painkiller, to enable the patient to con tinue to excuse the damaged parts of bla anatomy In a wide experience I have never known it to do any harm. Blisters Blisters are one of the most tiresome foot ailments that athletes suffer from, but they are quite inexcusable if the subject of truning 18 approached with inteligence. Blisters do not occur except where there is friction, 30 all friction should be obliterated Weaning socks in one : running shocs always tends to auto trouble, and so will ·KNEE, ANILE AND FOOT INJURIES 116 badly fitting shoes. Many people have the habit of smothering their feet in petroleum jelly or some such oil This is dangerous because, although one may wear a certain pair of shoes and get away with it for a ume, the oil soon causes the shoes to lose their shape and then they become ill-fitting and blisters may casily occur Even first-class athletes err in this respect, and I have known Olympic athletes, particularly long-distance runners, to suffer from blisters The friction can be lessened by using talcum powder on the feet, and keeping them as dry as possible. It is quite easy to over-harden the feet, and cause worse blisters than ever, but as a routine for the average foot I recommend soaking the feet for ten minutes three times a day for two days in methylated spirits That will just harden them mough to prevent blisters in any middle-distance race If you have particularly soft and sweaty feet, then try soaking them for a bit longer, perhaps for four days It is the bort of thing that one must find the answer to oneself, or it may cause endless trouble and finally lead to reurement from sport. Some people have a habit of sorking socks in soap and letting them dry on the feet. This is quite practical for one particular race, but again leads to trouble because of the loss of shape of the shoes If you bear that risk in mind, and the danger of over-hardening the sole of the foot, then you will probably escape the trouble altogether However, it is one of those things that must be dealt with u soon u the trouble unses, or it can cause endless inconvenice. The quockest way of getting nd of blisters is as follows Open them and cut off all the overlying dead skin. Dont use an ointment on them, but simply a dry dressing They will apart und be quite painful for a few minutes, but will very room settle down. Obylowly one should not train on them of rice for a day or two, although with this treat- ·114 SPORTS INJORIES While on this subject, it is important to darify an argument often used by people who do not know the centic reasons for using these injections They ay that Nature warns one of trouble by cuning pain, and that it meat therefore be wrong to obliterate pain, even for a few boros, because further damage is liable to be done while the part concemed is anaesthetzed. This is not borne out by prictical experience In fact, by enabling the patient to co ase the part concerned much good is done, and bearing m mund the principles of active treatment this is not purprising Nature bringa many protective mechanisms into play when a part is injured, and these are not in any way affected by the injection of the anaesthetic That nmply deaders pain and has little or no other reaction on the tusues Thus while the pain is derdened the increase in the circulation through the affected are does nothing but good The various antibodies that protect the duranged parts are not in any way affected by the drug I believe these injections can be wrongly used, and frequently are indeed they are widely abused. But for a player in a first-class match, or in fact any match, to be refused such an injection on the grounds that it can do him no good is absurd There is no connection here with the udesirable practice of doping players I dealt with this subject of dope in Chapter 8 bere I need only point out that injectjog anaesthetic has no connection with doping at all. It 2 used purely us a pain toller, to enable the patient to continue to exercise the damaged parts of hus anatomy In * wide experience I have never know it to do any harm. Blusters Blisters are one of the most tresome foot ailments that athletes suffer from, but they are quite inexcusable if the subject of training is approached with intelligence Busters do not occur except where there is friction, so al? friction should be obliterated Wearing rocks in one s rmning aboes always tend to ause trouble, and so will ·ANLE, ANKLE AND FOOT INJURIES 117 the bone has cracked There are varying degrees of frac ture, md there may be no separation of the broken bone at all On the other hand, there may be wide separation More than one bone may be affected The treatment, however, us the same in all cases I do not recommend any form of immobilization, and certainly no athlcte should be put into plaster of pans for such a fracture. The Illustration Stres fracture of metatarsal bone with pad in position above recent fracture with separation below old fracture with callous formation and arm union shows how one can put a small triungular pad underneath the affected bone so as to re-form the arch and thus support it. The pad u kept on by two turns of Elastoplant, and then although the patient 18 not recommended to race or run, he can continue to walk and do any moderate training on the fats of his feet. Actually, if you increase the circulation through the foot you speed up the process of joining up of the bone Continuou X-ray checks should be made to ensure that bone muon is occurring I reproduce a picture of a recent ·116 SPORTS INJURIES ment it has to be a very severe blister to keep one off for longer than three days It is essenud to keep the opened blister clean, and if there is not of dirt getting into it again don t use ointment on it but an eviporant which dnes it, and a dry dressing impregnated with antiseptic powder Toc mals Another very common condition occurring mainly in rumen in bruising and tearing of the toe nails Much more attention should be given to keeping the nails always as short as possible. What often happens is that us the mail grows longer, in the act of nmning the shoe keeps on pulling it upwards unul finally the underlying tissue is so urritated that brinsing occurs As In the case of a bruise anywhere else in the body, it takes some weeks to work out, and can in that time ause endless inconvenience Prevention is better than aurre, but if this bruising how occurred and is at all severe it 10 best to have the mall taken off altogether rather than bear with it for several wecko, which in any case may seriously curtail truning This conditon is another crimple of something that never oocuri in wise truning There is no excuse for allowing it to happen, and if one is a member of a team it shows a complete lack of apprecation of one • duty to that team Toc capa, bandaging or padding may give temporary relief, but they are not to be recommended because they prevent the shoo from fitting properly and do not remove the cause of the trouble Stress fractures A much more common injury then is generally realized by a stres fracture of the small bones of the foot It to known as a march fructure because it occur in soldiers when they are marching due to forably strong the foot on the ground. It usually occur in the shaft of the second or third metatanal bone The bone maps acou very often without any warning pain, and for no apparent the pain may even not be felt for several days after renon ·INEE, ANKLE AND FOOT INJURIES 117 the bone has cracked There are varying degrees of fracture, and there may be no separation of the broken bonc ut all On the other hand, there may be wide separation More than one bone may be affected The treatment, however, is the same in all cases I do not recommend any form of Immobilization, and certainly no athlete should be put into plaster of paris for such a fracture The illustrauon Stress fracture of petupral bone with pad in position abort recent fracture with reparation belowo old fracture with allows formation und Arm union obow bow one can put a small triangular pad underneath the affected bone so as to re-fond the arch and thus support it. The pad is kept on by two turns of Elastoplast, and then although the patient is not recommended to race or run, he can contimie to walk and do any moderate truning on the flat of hus feet Actually if you increase the arculation through the foot you speed up the process of joining up of the bone Continuous X-ray checks abould be made to ensure that bone wion u Ocurring i reproduce a picture of a recent ·118 SPORTS INJURIES fracture of this kind, and then one showing the callous formation round the fracture site a fortnight later It is usually about a month before the patient can get back to full tran ing, and then he need have no fear that the bone will map agun because it is probably one of the strongest bones in his body People with protuberant second metatarala often sustain thus injury, though that is not the whole explanation and it may be due to brittleneat or continued strun Thw condition is often mistaken for an inflammation of the tendons and their sheatha in the upper part, or dorxum, of the foot. It shows the necessity for expert rupe vision of such cases, for If it were treated wrongly the result would disastrous to the athlete If it were treated as a teno-synovitis, and exercised by vigorous ankling movements, then non-imion of the fracture might occur and the whole structure of the foot be permanently affected. Plantar fasciitu This is a nasty, pulling, aching pain to the role of the foot, usually along the inner border of it, agun due to strun it wually occurs at the beginning of the season and 18 due to running too much on one s toch, though it may well be caused by any running, even if donc on the flat of the foot It is due to the muscles having be come atonic and fibrous the crerase causes an increase in arculton through the area, and the process of forciog blood into these muscles causes them to become tender and painful. There is no way of relieving this condition encept by continued training, doing w preferably on the flat feet on well padded, spongy soles if you rest it, as with so many of these complaints, you will only have to work through the painful stages when you get back to training ind any delay causes it to be that much worse when you come to it. The habit of wearing a pad of spongy rubber underneath the arch of the foot to protect the palaful area 18 not recommended, because it gives support to the mudas concerned and relieves them of the Deed to do work which ·KNEE, ANKLE AND FOOT INJURIES 119 they should do to get toned up By all means wear a pad under the heel, and a full-length sponge-rubber solc, but don t put any pad under the arch Medial and lateral ligament injuries on either side of the anklc joint there are strong ligaments which get tom and strained whenever the anklc is turned over forcibly cither outwards or inwards To strap the ankle up and immobilize it is contra-indicated just as in any other ligament injury, though if the injury is very severe it is necessary to have hospital treatment and to abide entirely by the treatment recommended there. With a moderate degree of injury of these ligaments the sooner you can get the ankle moving normally the better Increasing circulation will greatly dis perse bruising, and if there is any accumulation of Aud, half an hour s elevation of the limb, followed by exercise of a gradually increasing nature, will soon free the trouble To immobilize it in plaster, or rest it, will make the final loosening up all the more difficult. If you can get back on it quickly after the injury then you will make a much speedier recovery Very often people are left with a vestigial pain and limitation of movement some wecks or cven months after the injury, and this can only be corrected by adequate stretching exercises to tear down the adhesions that are caumg the trouble It is these ligaments that most commonly get damaged in a sprained ankle The main thing is to prevent owelling, which inviably occurs if there 18 any degree of injury This can be done by stripping the ankde evenly from ·120 SPORTS INJURIES the base of the toes to just below the knee, us strated. The strapping is not stretched on to the limb but just laid on without any attempt to put it on ughtly Once the swelling has occurred, of course, it is useless to put the strapping on, but if you can get it on before, then apply it for 48 hours in the way suggested Then gently create the ankle intill you feel it loosen up If the Elustoplast becomet very tight and the ankle starts to swell, elevate the limb for half an hour and try again. It will very soon be found that the strapping is quite comfortable and is com trolling any tendency to swell If the acuadent occurs in the middle of an important match, this is an occasion when an injection of amesthetic, the application of strapping, and a minute or two of gentle freeing movement will enable the player to get back on to the field, though if he tries to play very vigorously he must not be surprised that swelling occurs and that he has to rest nther longer than be otherwise would have done after the game. The strapping should come off at any rate two days later to enable one to exercise the joint as much as posmble. Recurrence of swelling is very rare and in any case can best be dealt with by vigorously massaging the lumb in eleveton. As soon as the furd has been dispersed, gentle exercase sbould be applied to that there is no prolonged stiffening Capsulates Swelling of the ankle joint can be verypamful, and the degree of pain is associated wth the degree of stretching of the apoide of the joint All joints have ach napsule, which forms a sleeve won the bood of the joint, Inside which is the lubricating fluid of the joint. If the joint gets damaged and inflammation occur 80 that the fuld content of the joint u increased, the capsule becomes atretched and the us what awes the pain. Manage with elevation diopertes the fluid, and this is speeded up by co-operation from the patient, who should try to move the joint as much as ·XNEE, ANKLE AND FOOT INJURIES 191 possible. Some people inject such injuncs with anacsthetic, but it is important not to inject deep to the capsule of the joint for even the most microscopical amount of anaesthetic fluid will ause any amount of increasc in the fluid in the joint space, and then later causc more pain than cer because of the stretching of the capsule Thesc anacsthetics, even in 01, do not last very long, and the pain when they wear off can be much more severe than when the injection was given. The art of being able to anaesthetize the capsulc without penetrating it is one which very few people have developed, and I do not recommend such treatment cxcept by doctors who have specialized in it Broter toes Sometimes players kick objects so hard that they break their tocs The ground may be very hard, and they may stub their foot into it and break a toc This 18 not as xerious an injury as it sounds and to immobilize the affected toe in a collodion dresing usually protects it sufficiently If the dressing is applied sensibly the patient may well be able to continue to play without missing any games Numbness of the feet The only sport in which this condition u commonly found 18 long-distance cycling It can only be caused by toe clips being too tight, or by the fect being too congested in the shoes It can always be cured by paying due attention to these matters and by realizing that the numbness is due to obstructed arculation. Burning feet are simply overheated feet Every effort should be made to cool them down by weanng thimer socks, and very often it helps to wear non-rubber shoes Sufferers from this complaint should smother their feet in talcum powder They will not gain any permanent relief by using ointments Athletes Foot (also known as Tired, or Fool Rot) Every athlete, at some time or other, gets this complaint, usually ·199 SPORTS INJURIES in the summer months It takes the form of itchog between the toes, with patches of sodden, dead, whate skin. It often becomes secondarly infected and spreads all over the foot, and scratching may arily spread it to the hands Here, it sbons itself in the form of little pimples, like blister, which Itch continuously It is initially aused by a fumguu wróch annot live on the dirtiest of stone floon, or even an dirty duckboards It does, however, thrive on towelling and mount ting So never stand about an either of these things, Dor On any form of such material, clean or dirty In fact, no chang ing-roots should ever have tondling or matting on the ground The following routine clears up the trouble. Lust thing at night, wash your feet thoroughly and dry between the toes Next, smother both feet, particularly between the toes, with a fungicide ointment. (The best is Whitfields which can be got from any chemist.) Now put cu a pair of bedsocks It does not matter how thick with olntment there get. Finally wash your hands thoroughly, payag particular attention to scrubbing the nails w the fungus gets under them. Next morning, agun wash your feet thoroughly, dry between the toes, and re-apply as much ointment as you like Now don a pair of dry socks. Scrub your hands again thoroughly Repeat thus routine morning and evening for about four days or wtil you think the condition has entirely deared up weanng the same pair of day socks and might socks for at least four days it is important to remember that the maght socku are a diferent pair from the day ones If your hands are particularly badly affected you may need to cover them with omtment and wear gloves at mght. You notice I advise carrying out thu routine on both feet. The condition never effects one foot without the other, though one may be more than the other Any fingrede ointment may do the trick It u the routine that counts If you arry it out krupulously there w no need to suffer from athletes foot.

·KNEE, ANXLC AND FOOT INJURIES IPS Manipulation of the arlle It is scry important to get complete relaxation before attempung this Tlic patient should lie flat on los back with his heels oitr the end of the plinth, but the leg must be resting on a soft cushion or rug First, gnp the foot with both hands, as shown in Fig 13, and force the toes away from the ankle, then forec them firmly up again still gripping the foot w7di both hands, trert it and then invert it. Sometimes gross adhesions are found. and you should not be satisfied with the manipulation until there is a full range of free movement FOOT AND ANKLE EXERCISES There are two prinapal groups of thesc First, sit with your knees crossed, force the upper foot away from you, tovards you, away from you, towards you, quite straight and frequently Next, imagine a clock face tuelve inches away from your foot and take the foot around thic clockface, always bringing the tocs us ncar to your head as possible at 19 o clock. Do the same movement anti-clockwise and repeat as many times us possible The other group consists of looking strught ahead and walking first on the outside of your feet, then on the inside, then up on your points, then with the toes splayed up and outwards then with the toes clawed under all these positions are shown in Figure 14 ·192 8PORTS INJURIES in the summer months It takes the form of itching between the toes, with patches of sodden, dead, wlute skin. It ofte becomes secondarly infected and spreads all over the foot, and cratching may easily spread it to the banda Here, it shows itself in the form of little pimples, like blisters, which Itch continuously It is initially cawed by a fugus which annot live on the dirtiest of stone floors, or even on duty duckboards It does, however, thrive on towelling and matung So never stand about on either of these things, nor on any form of such material, clean or dirty In fact, no chang- 10g-room should ever have towelling or matting on the ground The following routine clears up the trouble. Last thing at night, wash your feet thoroughly and dry between the tocs Next, smother both feet, particularly between the toes with a fingrade ointment. (The best is Whitfield 8, which can be got from any chemist ) Now put on a par of bedsocks It does not matter how thick with ointment these get. Finully wash your hands thoroughly, paying particular attention to scrubbing the nails as the fungus gets under them Next morning again wash your feet thoroughly, dry between the tows and re-apply as much ointment a8 you like. Now don a pair of dry socks Scrub your hands agun thoroughly Repeat this routine morning and evening for about four days or until you thank the condition has entirely cleared up, wearing the same pair of day socks and night socks for at least four days It is important to remember that the night socks are a different pair from the day ones If your hands are particulvly badly affected, you may need to cover then with ointment and wear gloves at night You notice I advise currying out this routine on both feet. This condition never affects one foot without the other, though onc may be worse than the other Any frumglade ointment may do the trick It lo the routine that counts If you curry it out supulowly there is Do Deed to suffer from athlete a foot ·ANEE, ANKLE AND TOOT 1XJUnits 145 Maxpulation of the anlle It is very important in fotonga plete relaxation before attempting the The patients would Le flat on his back with his heels att the end of the t'irth but the leg must be resting on a soft cushim of rug lirit, gnp the foot with both hands, as short in lis 49,57 force the toes akay from the ankle, then force them firmie up aguin still gripping the foot with both lando, cratit and then mert it sometimes gross adhicum are four), and you should not be sausfied #7th the manipulation wnul there is a full range of free morcment TOOT AND AXELE CIERCIELI There are two pnncipal groups of these First, it with your knees crossed, force the upper root away from you, towards you, away from you, towards you, quite straight and frequently Next, imagine a clock face iuclic inches away from your foot and take the foot around Ure clocklace, always bringing the tocs u ncar 10 your head as posible at 12 o dock. Do the same moi ement anti-dockwise and repeat us many times as possible. The other group consisus of looking atrught ahead and walking first on the outside of your feet, then on the inside, then up on your points, then with the toes splayed up and outwards tien with the tous clawed under all these positions are shown in Figure 44 ·192 SPORTS INJURIES in the summer months It takes the form of Itching betwear the toes, with patches of sodden, dead, white skin. It often becomes secondenly infected and spreads all over the foot, and scratching may easily spread it to the bande Here, it shows itself in the form of little pimples, like blisters, which itch continuously it is initially caused by a fingras which cannot live on the dirtiest of stone floors, or even on dirty duckboards It does, however, thrive on towelling and matung So never stand about on either of these things, nor on any form of such material, clean or dirty In fact, no changing-room should ever have towelling or matting on the ground The following routine clears up the trouble Last thong at night, wash your fect thoroughly and dry between the tocs Next, smother both feet, particularly between the toca with a fungicide ointment. (The best is Whitfield , which can be got from any chemist.) Now put on a pair of bedsocks It does not matter how thick with ointment these get Finally wash your handa thoroughly, paying particular attention to scrubbing the ruils us the fungus gets under them Next morning again wash your feet thoroughly dry between the toes and re-apply 23 much outment as you like Now don a pair of dry socks Scrub your hands agun thoroughly Repeat this routine morning and everung for about four days, or itil you think the condition has entirely cleared up, wearing the same pair of day rocks ud night socks for at least four days It u important to remember that the night socks are a different pair from the day ones If your hands are particularly badly affected you may need to cover them with ointment and wear glover at night. You notice 1 advise carrying out this routine on both feet. This conditon never affects one foot without the other, though one may be worse than the other Any fugiade ointment may do the trick. It is the routine that counts If you arty it out scrupulously there is no need to suffer from athlete foot ·THE COMMONER SPORTS AND THEIR INJURIES ATBLETICS, FIELD TRACK AND CROSS-COUNTRY WALKIXO - CLIMDIXO - MOUNTAINEERING - DANCINO Achillos tendon fatigue Limg pain Bustered feet Pintar fascitis Broken Abala Sacro-in strain Bruised to calls Sciacca Capsulitis Shin porene Chondromalacha patellac Shoulder Injuries Crump Sprained ankles Elbow strain Stitch Gruos Stress fracture of metatarla Groin pain Tom muda Hiematura Wrix Infuria Lumbo-teral strain JOXING - OYMNASTIOS - WRESTLINO - HEIGHT-LIFTINO Bitten tongue Eye injurla Broken noke Finger injuries Bruixa General auto Cauliflower ar Joint sprains Conculan Knuckle injuries Dalocated juw Muscle Inſurlas Ear Injuries Rlb injuries CRIOLET - BOWLS - CROQUET - IKITTLEJ Back injuries Groin strain Blister Hand injuries Cracked Up Shoulder strain OYOLINO - POLO OYOLIMO Abdominal strain Grna Bed train Numb feet Broken collar bone Guddle sorence Champ Shoulder injuries Euter mee 185

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·INDEX Acron, Dr Frank, 45 Abdomen, 94-7 tom muda in, 915 exercise for 37 Achilla tendon, 111-13 Acromio-clavicular subluxation, 71-3 Adhesion, 12 Alcohol, 57 Amesthetic injections, 19 119 114 191 Ankle, 188.ff., manipulation of 123 exercises for 199 Anmes, exercise for 68-7 77 91-9 Athletes foot, 191-2 Ear injurias 51-2 Earplugs 52 Easter konec 25 Elbow 80-81 manipulation of, 87 cxcrcises (or 87-8 Exhaustion, 52-3 Eye Injuries, st Feet, 121 mumbnaus of 191 stress fracture of metataruls 116-18 Fibrosits 58 Fibula stres fracture of 110 Fingeri, 86-6 Infection of nalls, 88 Foot rot (Ar Athletes foot) Fractures, 74 Back, 21 68f manipulation of 64 excrches for 65 Bailey e McDonald, 11 458 107 Bllaten, 114 116 Boxing, 19 50 52-3 84 Graza, 78-6 Groin 95-6, 101 Call, 110–11 Capoullis, 190-81 Catarrh, 47 Chest, 89ff. exercises for 91-3 Collar-bone, 73-4 Coocwalon, 51 Crump, 27 Cocket, 13 BOS Cyding 95 44,634 78 Hocinaturl., 96-7 Hacmorrholda, 47 Half-the refrealment at, 41 Hamstringe, 100 Hand, 88 87 Harti Reg, 34 Hat tratment, 16–16 86 Holden, Jack, 18 Juveli elbow 80 Jew dlalocation of 69 Koce, 109 Uguments of. 10-8 exetches for 111 Knetop 108 chondro-malacia 108 Diet, 29 S68 Diving 20 Drugs, Soft 197 ·SPORTS AND THEIR INJURIES ROWIXO - SCULLIXO - CANOZING Blisters Sprided wrists Saddle portrets AIDINO HUNTING - RORIZ RACIN - POLO Dllocations Tom muscles Suddle sortne Weight problem POOTBALL TUOIY AXD ALSOOIATION HOCKEY LAOXOISE - NETBALL SAIZJALL Acromlo-clavicular ribuntion Displaced cartilage of here Bitten tongue Myouitia anificans Broken collar borc Pertostrai bermatoma Broken kecap Slipped dia Bruises Stifica Copainoa Torn Ligumenta of kasee Crump Toru munca Twisted back Dulocadom SIATINO - $XI-180 - TORONOAKIXO - CURLIXO - MOLLIA SXATINO - ICE HOCKEY Acromioclavicular publuation Bruder Ankle Infura Tom mondta Broken collar-bone KACKETI - QUAIA IACKETS - TEKNIS - TAILE TENNIS - GOLT - BADMINTON - QUOITS - FLY FISHIYO Bilter Super lack Elbow Injuries Teosyrovitb Eye injura Tulated back shoulder injuria Ulnar neurita Spralped thumb Wrat lnfurter Stenosing vaginitis SNINMIXO - DVIX -WATCTOLO Bruled bands Eyt complaints Barcdding artis Muscle fofurles Caterih Spitting blood Temperatura regulation Crump complaints Ear injuries Twisted back 185

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·INDEX Konuckles, brudsed 84 Legs, exercises for 67-8 Lips, cracked, 594 Lumbago 58-60 Lumbo-acul grain, 60-61 Limge 90 91 spitting blood, in diving 91 Massage, 18-16 119 120 McCarthy Sammy 85 Menstruation, 48 Metataral stress fracture of 116-18 Mucle 14-18 20 23 tearing of 23-4 96-9 Myositis oxificans, 107 Shin sorenen, 108-9 Shoes, 119, 115 Shoulder 09 il. dhalocation 745 torni murda, 75 manipulation, 78 erercises, 76-7 Suipped disc, 13 69-606 Squash rackets, 56-7 Saleen, 1950 Stiffnen, 23 Sdtch, 28 Stripping 29-31 Sugar 56-7 Supraspinatus syndrome 71 Swimming 29-4 58 Synovitia, 105-6 Neck, 55 minipulation of 86-6 exercise for 66-7 Nose, broken, 65 Tennis elbow 71 789 Two-synovitis, 8C Thigh, 98 ff. Thumb 84 85 Tmes (Hex Athlete s foot) Toe ml, 116 Toes, 121 Tongue, 84 Oxygen, 99-3 ure of us restorative, 11 Perlosteal buematoma, 108 Peter, Jim, 42 Plantar fascitis, 118-19 Ulnar neuritu, 79 80 Varicose veins, 46–7 Riba, cracked, 89 90 Roller-riding 39-5 Rowing 40-50 Sacro-lec strat, 61 64 66 Saddle forenen, 100-101 Scletia, 61-2 Warming-up, 84-6 Weight control, 48 Welght-lifting, 30 Writt, 81-4 Colla fracture, 89-3 capbold fracture, 89 sterroging vaginitus, 83

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