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Softball Injuries

The number one recreational sport in Canada is softball. Between the men's, women's and co-ed leagues we flock out to the park after work and on weekends to play a little(or a lot of)softball. This is a great sport that gets many people outside for sport and recreation. Unfortunately the fun is sometimes affected by injury. Statistics show that there is a 7% injury rate per game. In other words there are 7 injuries for every 100 games played. The majority of injuries occurred while sliding into bases. This accounts for almost three quarters of the injuries. This makes sense when we consider the rapid deceleration of the body into a stationary bag which in most cases is nailed into the hard ground. Most of the injuries were to the ankle region in fractures or sprains. Knee injuries are also not uncommon while upper extremity injuries less common.

The next most common acute injuries I see in the baseball season is pulled muscles. The most frequent is the hamstring muscle with the quadricep not far behind. Baseball is an unusual sport in that you may be relatively sedentary for a long period of time and then ask your body to go at it's top speed as you run the bases or chase a ball in the field. The cold unprepared muscle can not tolerate this sudden increased demands and tears. These injuries are not uncommon even in the pros( Rickey Henderson's Hammy). From an overuse point of view the most common problem is in the shoulder where you will get rotator cuff tendinitis. Often you may feel your arm go on one particularly hard throw. The usual scenario is a gradual onset of pain in the shoulder that keeps getting worse and worse whenever you throw.

The following are my recommendations to prevent injuries in softball.

1/ The most common problems are sliding into a fixed base. In a study in Michigan they reduced the injury rate to 1 injury in 517 games or 0.2 injuries per 100 games. This is far less than the figures quoted above. Therefore the main thing we can do to prevent injuries in baseball is to use break away bases.

2/ Get in shape. Too many people go out to play without the proper conditioning. This can help to avoid both the acute muscle pulls and the overuse injuries.

3/ Practice before you play. Go out and throw, hit, field, and run in practice so you are prepared for game situations.

4/ Avoid alcohol before and while you play. This distorts your judgment and can lead to injury.

5/ Warm up well before you play. A slow jog followed by long slow gradual stretches for the arms and legs. If you experience long periods of inactivity during the game you may have to re warm up to keep your body prepared.

6/ Wear proper shoes for baseball which are not worn out.

7/ Make sure that the field you are playing on is safe and in good condition. Baseball is a great game and one that many play. It does not take much to avoid most of the injuries which allows us to continue to enjoy ourselves.

Nerve Injuries

You have to have nerves to be involved in sports. Whether you are watching or playing sport is constantly testing your nerves. While these nerves are stressful it is the actual nerves that go from the brain to the muscles and tendons that can be injured in sport. Although we mostly talk about bones, tendons and muscles that are injured in sport, we also see problems to the nerves. The nerves can be affected by actual injury to the brain and spinal cord. In this article I will deal with the peripheral nerves that are more superficial and prone to direct trauma. Nerves can be damaged by actual cutting of a nerve, compression of a nerve, or by traction or pulling on a nerve. The ability of the nerve to recover is dependent on the amount of damage to the nerve and which particular nerve is damaged.

The following are the most common nerve injuries that I see form participation in sport. 1/ CARPAL TUNNEL SYNDROME: This is the most well know nerve injury. It is common not only in sport but in the work place as well. Sports that depend on a lot of wrist flexion are prone to developing this problem. Weight lifting, rowing, rock climbing, and racquet sports are good examples of sports that are prone to this. The athlete will complain of tingling in the thumb and next two fingers. There may be pain in the wrist and weakness or incoordination noticed in the hand. 2/ ULNAR NERVE: This nerve can be a problem in the wrist or elbow. At the wrist it is most commonly injured in cycling and therefore called cyclists palsy. The nerve is compressed by the long duration of pressure on the nerve as you hand is obviously constantly on the handle bar.

There will be tingling in the last two fingers and incoordination in the hand. The elbow is a much more prone area to irritate the ulnar nerve. This is the nerve that when hit we say we were hit in the funny bone. The nerve can be injured by direct trauma but more commonly by repetitive stress on the nerve by a throwing athlete or racquet sport players. The symptoms are similar when the nerve is affected at the wrist except that there will be more weakness in the hand. BRACHIAL PLEXUS The bundle of nerves that go from the neck to supply the arm is called the brachial plexus. These nerves can be injured by traction on the nerves if the head and neck is violently pushed to one side. You will get a sharp pain down the arm. These are common in football and rugby and called burners or stingers.

They are usually reversible but can be a problem if recurrent. Back packers palsy is caused by continuous pressure on the brachial plexus from pressure by the shoulder strap as it goes over the armpit. This can cause more permanent damage to the nerve and/or a longer recovery. WINGED SCAPULA I commonly see damage to the nerve that supplies the muscle that controls the shoulder blade. This causes the scapula(shoulder blade) to flail out. It is usually caused by virus and recovers by itself over time. It does not cause any serious problems except by the way it looks, but biomechanically it may affect the shoulder in high level athletes. MERALGIA PARASTHETICA A small nerve in the groin can often cause problems.

This is only a sensory nerve and will not cause any muscle problems. You will feel a numbness or pins and needles on the front of the thigh. PERONEAL NERVE There is a superficial nerve on the outside of the knee that is easily damaged. This can cause the muscles that move the foot up and out to be weak. This is one of the main causes of a foot drop. These are a few of the more common nerve injuries that you can experience playing sports. If you have any problems with loss of strength, sensation or an unusual nerve, burning type pain, do not be nervous, but see your doctor to find out what the problem is.

To Move Or Not To Move

As I have stated in the past Sport Medicine is the newest and fastest growing field of medicine. I am often asked "" What have you learnt the most by treating athletes. The advantage of treating elite athletes is that we truly see how the body behaves in the most highly motivated people. The elite athlete is willing and has the time to spend on his body to see what works the best. As the car manufacturers use race cars to model their production models after, we too use the elite athlete to model our treatments for the masses of weekend warriors. After any injury I must decide what the exact nature of the injury is and how I am going to treat it. In the early stages the most important question is whether to immobilize the injured area or keep it moving.

The thing we have learned the most is that over all we ideally like to keep things moving as much and as safe as possible. The body is made to move and performs better when it is kept moving. You may ask ""What is wrong with immobilizing an injury while it heals?"" When I was in medical school I remember being taught that and ankle sprain bad enough to treat is ankle sprain bad enough to cast. Thus most ankles that we treated were placed in a cast for six weeks. When the cast came off we saw a shrivelled up limb with a stiff ankle attached to it. We then had to work very hard to get that stiff ankle moving and rebuild the muscles that were lost. The person would not get back to their activity for another six weeks.

Today, that same person is placed in a brace for the ankle that protects the damaged ligaments while at the same time allows them to move the ankle and even walk on it as soon as it feels comfortable. Therapy is started immediately to maintain the mobility, strength, flexibility, and the bodies joint balance. We slowly and carefully progress the rehabilitation of the ankle to full function and have the person back to full activity in four to six weeks. The person who wants to be really careful with their body may ask "" Is there any harm in placing my ankle in a cast to protect and make sure that my injury does in fact heal properly?"" The fact of the matter is that you actually will make it worse by using the cast.

We know that after even three weeks of immobilization there is a about a 30% weakening of the tendons and ligaments around the joint. If we look microscopically at the damaged ligaments, we see that the cells are all scattered and disorganized in the ligaments that were kept immobile, while the cells are all lined up in a organized fashion in the ligaments that we allow controlled motion. The soft articular cartilage that lines and protects the bone relies on movement to keep it nourished. With prolonged immobilization there may be damage to the joint surface that may be permanent.

These same principles apply to other joints such as knees. We avoid casting and immobilizing knees not only after injury but after knee surgery as well. The recovery from knee surgery is much faster when we do not cast the knees. We can now have our athletes back as soon as four months after major knee surgery where not long ago it was a year minimum before `even the highest level athletes were back to playing. I have learned that the best way to treat injuries is to keep them moving as much as possible. Certain injuries such as fractures still must be immobilized to ensure proper healing. Otherwise we preserve the bodies function, promote better healing and get you back on the field sooner by keeping it moving.

Carpal Tunnel Syndrome

The infamous carpal tunnel syndrome. This common malady is so commonly diagnosed that it seems that anyone with wrist pain is labelled as having this syndrome. Although this occurs in sports it is more apt to occur in the workplace. This is the main problem that is now being diagnosed in this new category of RSI (Repetitive Strain Injury) . While many of these cases are not true Carpal Tunnel, the problem is usually easily diagnosed and treated. The main sports that may cause this problem are those that use the wrist a lot such as racquet sports, rock climbing, golf, etcetera. For obvious reaons it one of the most common injuries in the wheelchair athlete. The carpals are the eight small wrist bones that allow the hand to move in many different directions. On the palmer side of the wrist there is a tunnel created.

Through the tunnel go the nerves and tendons to the hand. If there is compression of the nerve in this tunnel, the median nerve will be compressed causing the symptoms. The main symptoms are tingling and numbness in the thumb and next two fingers . This classically occurs at night when you are sleeping. As you sleep the wrist is bent compressing the nerve. In the middle of the night it will wake you up.`Once awake you will straighten your wrist and the tingling will gradually go away as the pressure on the nerve is relieved. As the syndrome goes on without treatment, you may start to get weakness in the hand. The problem is diagnosed initially from the classic symptoms described above.

To confirm the diagnosis a test is done to measure the function of the median nerve. When you truly have the syndrome the test will show a slowing of the nerve function. The treatment of this syndrome is relatively simple. The first thing is to modify your activity to avoid activities that cause repetitive flexion of the wrist. Often I will prescribe a wrist splint to wear during those activities to prevent the wrist from flexing and eliminate the pressure on the nerve. It is important to wear the splint at night as this is when a lot of the symptoms occur. Physiotherapy can be of some benefit. Some people may respond to an injection of cortisone to reduce the swelling and inflammation around the nerve. If it does not respond to the above measures, a small operation is performed to relive the pressure on the nerve. The recovery is relatively fast and you should get back to full activity within several months. Carpal Tunnel Syndrome is the most popular and prevalent of all the peripheral nerve injuries in sport and the work place. When properly diagnosed it is easy to treat successfully and quickly.

Robert's Neck

The hopes of the Calgary Flames in the play offs suffered a severe blow when it was announced that Gary Roberts was again having problems with his neck and would not be able to play in the paly offs. The Flames who had a disastorous start ot the season were coming on strong once Roberts was back in the line up. What is worse for Gary personally is that this may be the end of his great career. He has now undergone two surgeries to cure the pain in his neck and the dysfunction of his arm. We hear a lot of the severe neck injuries in hockey that have tragically rendered several athletes quadriplegic from breaking their neck in contact sports such as hockey or football and even more commonly from diving into shallow water or pools. This will be the topic of a future article. More commonly and fortunately less severe are the chronic neck problems that plague athletes. Gary Roberts has pain in his neck and dysfunction in his arm from an irritation of a nerve in his neck.

The nerves that supply the arms come from the neck. It is not uncommon for these nerves to be irritated. We have all heard of sciatica which is pain in the legs from a nerve being irrtitated in the lower lumbar spine, but we hear a lot less of the cervical or neck nerve irritation. When one of the nerves of the neck is irritated or there is pressure on these nerves it can cause pain in the neck and/or arm, numbness or tingling in the arm and hand, and weakness in the arm. Depending on which nerve is irritated, the weakness and numbness will affect different parts of the arm. The spinal cord exits off the brain and goes down through the vertebrae of the spine. The nerves that supply the arm that signal the muscles and the sensation of the arm come out between a small opening between the vertebrae. The nerve can be pinched by the disc between the vertebrae herniating out from between the vertebrae and putting pressure on the nerve.

The other most common way for one of the nerves can be pinced is from a norrowing of the hole that the nerve exits through by boney overgrowth or spurs on the bone. Often it is a combination of the two that causes enough pressure on the nerve to cause the problem. The athlete will usually complain of pain in the neck and some pain down the arm. In the worse case scenarios the pain will be all the way down to the hand. The neck will be quite linited in its mobility due the protective spasm of the neck muscles and they will have noticed weakness in the arm. Depending on the severity of the problem you can usually isolate the problem with listening carefully to where the pain and numbness is and then a thourough physical examination. A x-ray of the neck will determine if there is any boney abnormalities which may be causing a problem. Degeneration of the cervical spine is a relatively normal part of aging especially if the athlete has suffered a previous injury to the neck.

Often we can see narrowing of the hole where the nerve exits from bone spurs or due to disc degeneration where the vertebrae are crunched closer together. If the pain is persistent and the best diagnostic test is an MRI examination where we see not only the bones but also the soft tissues which may be causing the problem like the nerves and discs. Whenever a nerve is not functioning we take this very seriously as it may cause permanent dysfunction. The athlete must be very careful playing contact sports and if severe enough will limit all sports where the neck has to move. It is crucial that the person see a qualified neck therapist to treat the neck. Techniques are initially used to reduce the inflamation around the nerve and to relieve the mechanical pressure on the nerve. The athlete is then instructed very carefully on a neck strengthening and postural program to prevent recurrences. It is only in severe cases that do not get better especially if there is weakness in the arm that we consider surgery. I do not know Roberts exact problem, but it must be disouraging to have a recurrent problem which has limited his career. Now, most of us do not have to take the abuse on the body that occurs in profressional hockey, and almost all of these cervical nerve problems can be controlled with treating the problem early with quality care.

Teenage Tragedy
""Hidden Killer Strikes Tragedy"" was a recent headline in USA Today. The article went on to say that 12 teenagers in the United States have died from this hidden killer in the last year. This has been a trend over many years with no change. In fact in a six month period from August, 1995 to February, 1996 there were 14 such deaths among student athletes between 13-18. What is this hidden killer? These young athletes are dying from abnormalities in the heart that they are born with and are not discovered until it is too late. Some of these were not even high level athletes and died in gym class although most did happen to athletes more heavily involved in sports. The incidence is also almost exclusively in males although a about 10% of the cases are female. The cause of these deaths is from congenital abnormalities of the heart. The majority of heart problems is a thickening of the heart muscle.

 Other abnormalities in the heart that can cause death is a malformation of the small arteries that supply the heart muscle with blood and oxygen, diseased or deformed valves between the heart chambers. Because these problems are congenital and have been there from birth they are very hard to pick up in our teenage athletes. Although there may be some indications of problem, most teenage athletes assume they are healthy and may not seek medical advice. this can be disastrous. Nonetheless there are certain factors which might indicate a problem and should be investigated if any of these are present. They are: 1/ Fainting episodes 2/ Sudden chest pain 3/ High blood pressure 4/ High or uneven heart rate 5/ Family history of heart disease 6/ Family history of sudden death at a young age from heart or unexplained causes.

The question is if there is anything we can do to prevent these deaths. Although the numbers of these young athletes is quite low compared to the total number of athletes is even one preventable death acceptable. In Canada there are not any guidelines or regulations to examine our young athletes. Many of our athletes compete without medical clearance. The American Medical Association recommends that all athletes be given a physical by a licensed physician before participating in sports and many States have requirements set up to ensure this is done. The big question by the authorities is if it is cost effective to thoroughly screen all athletes with a physical exam, an electrocardiogram, and an echocardiogram(ultrasound of the heart to check the wall thickness and the valves).

To do all these tests is not only quite expensive but would be quite demanding on the services which are already in Canada in very tight demand. It simply could not happen with the present day medical system in Canada. I have performed pre-season physicals on many competitive athletes and while the vast majority are normal, I am always surprised with how many abnormalities I do turn up. Most of these are not life threatening but nonetheless have an impact on that athlete. I recommend that all high school athletes receive a physical examination at the very least on entering high school and even yearly after that especially if there is any change in potential heart symptoms are other injuries. This would not be able to determine all athletes at risk but it sure would pick up some of them. I, for one would be quite upset if one of my children died in activities that they enjoyed the most by this ""hidden killer"" if this was a preventable occurrence.

High Performance

There is not an athlete in the world that would not like to perform better. We are all looking for ways to improve our performance. Can we run harder, skate faster, jump higher, be more agile, be stronger are the main questions that athletes want to know. What is the magic to being a better athlete. The fact that athletes spend billions of dollars on unsubstantiated claims of vitamins and supplements let alone the illegal drugs they use to enhance performance shows that they will go to any means to get the edge. The fact of the matter is that the most important thing is proper training. We know that if athletes train properly they will accomplish all their goals stated above. The problem is proper knowledge to do the right training and the proper motivation to train as frequently and diligently enough to obtain the results that you want.

It has always been my frustration to see all the athletes I see a year tell me how much they want to improve but do not have the access to the proper training facility or advice. Traditional health clubs are geared for the masses and do not have the programs specific enough for high performance. They also do not have the personal with the knowledge and expertise to train these athletes at the level they require. I initially opened my sports clinic ""The Sports Medicine Specialists"" to provide athletes of all ages with the expertise and environment to service their unique demands. There they receive the highest level of treatment and advice to return them to their sport. For the same reason we are now opening ""The High Performance Specialists"" This is an elite training centre which will train The Toronto Maple Leafs and all athletes who want to be a better athlete and compete at a higher level.

The program has several main component which are key to being a better athlete. The first and most important is SPEED. You can increase your speed in several ways. You can increase your stride length, stride power, and stride frequency. Utilizing a high speed skating and/or running treadmill you will be amazed how you can improve your speed with structured training. In most sports the most important element is explosive speed to accelerate away from opponents. A small improvement in this explosive speed makes you a lot better athlete. The second element is POWER. Different athletes need different forms of power in different parts of their body. A basketball player needs tremendous power in their legs to jump higher than their opponent. A skier also requires although a somewhat different form of power in their legs.

Their are very few sports that do not require power from their shoulders and arms. The key is to develop this power specifically for the sport or sports that you are competing in. The program must train powerful muscular contractions in response to rapid dynamic loading or stretching of an athletes muscles. The third component is AGILITY AND REACTION TIME. Key elements of athletic performance are the abilities to react to a given stimulus and the agility to change direction of the body or body parts rapidly under control. This ties the whole program together so the athlete utilize the increased speed and power in the most efficient way. A personalized weight training program to develop STRENGTH is important to provide a firm base to be able to perform the high level rigorous training.

If you want to compete and perform at a higher level than you must train with the latest training techniques and equipment. The ""High Performance Specialists"" at 486-9850 will allow you to be the best that you demand of yourself to be. This is the official training centre for The Toronto Maple Leafs. It will provide the same elite training for athletes of all ages and of all sports. The proper training will allow you not just play but COMPETE.

Big Bad Bursa

The dreaded BURSITIS. So often we go to the doctor with pain and we are told we have a bursitis. The thought of this diagnosis conjures up all sorts of bad things and are we left with a chronic problem. I often hear tales like ""My grandmother had bursitis and she was almost crippled with it."" Is this bursitis so bad and why do we hear so much about it? There are many bursa in the body. Most of these are around joints. A bursa is a very thin fluid filled sac whose primary function is protection and lubrication between two moving areas such as a tendon over a bone. Most of the time these bursa function very well and we do not even know they exist. A bursa can be irritated in two main ways. If a bursa is traumatized such as if you fall on your knee, it will fill up with fluid.

The other way you can get a swollen bursa is from repetitive rubbing of the bursa such as a tendon going back and forth over the bursa. There following are the main areas where you get bursal inflammation: SHOULDER: This is the most common place where we see bursitis diagnosed. The bursa here lies between the ball and the top of the shoulder. The bursa is pinched between the two bones when the arm is raised overhead. The bursa usually is irritated secondary to a rotator cuff tendinitis. Once the bursa is inflamed it occupies the tight space between the two bones and you feel pain whenever the arm is raised past 60 degrees. ELBOW: This bursa sits over the tip of the elbow and swells up from a direct blow to the elbow on a hard surface and thus very common in hockey.

The patient will come into the office with a golf ball type swelling at the tip of the elbow. HIP: The bursa most commonly affected in the hip is directly over where the hip protrudes on the outside of the leg. It can be injured by a direct fall on the hip. More often it becomes irradiated by the repetitive stress from the tendon going back and forth over it. KNEE: There are several bursa around the knee. The most common is the bursa just over the kneecap. This is called ""Housemaids Knee"" It comes from direct pressure over the bursa and swells up over the patella like the elbow bursa. ANKLE: The bursa in the ankle is inflamed from direct pressure from a shoe or boot. This so called ""pump bump"" is a small bump on the back of the heel and common in athletes wearing a hard boot such as skaters or skiers.

There is also a small bursa behind the Achilles which gets inflamed mostly in dancers as the bursa gets pinched when the dancer goes on pointe. Bursa do not provide functions such as tendons and joints; therefore when they are injured they may cause pain, but they do not cause dysfunction or lead to long term problems. We place most bursal problems into the nuisance category. The bursa must first be protected from further trauma. This is by modified activity, better or properly worn equipment, and/or extra padding worn over the affected bursa. If the problem is bad enough physiotherapy is prescribed. The inflammation is reduced in the bursa by various modalities such as ultrasound. Ice is also used to reduce the swelling. Sometimes it is a inflexibility or muscle imbalance that needs to be corrected. If the bursa is persistent I often will have to drain the fluid from the bursa and rarely have to inject cortisone into the bursa to prevent it from swelling again. Well, this big bad bursa is not really that bad. Poor granny must have more problems than a simple bursitis. Like any problem the sooner it is taken care of the easier it is to get rid of the problem.

Donovan's Dilemma

Our best hope for Olympic gold in Atlanta this summer is Donovan Bailey, the 100 meter sprinter. He won the world championship last year and is ranked among the world's best. These highly tuned athletes have to be firing on all cylinders to have the best chance to perform at the highest level. Any alteration in their gait, timing or strength will affect them when milliseconds separate first from last. Unfortunately Donovan Bailey has been suffering from a hamstring injury. These are an occupational hazard for a sprinter. All sprinters experience these in their career and they all will heal, but will it be in time for the big race. The hamstring muscle is the large muscle that starts at the buttock and goes down the back of the leg and inserts just past the knee. If you grab your leg in the back below your buttock you are grabbing your hamstring. This is the same pose you will see an athlete take when they have injured their hamstring.

The hamstring is the most common muscle that is strained, pulled, or torn. This is caused by a violent stretch or more commonly by a rapid contraction of the hamstring. I classify this as a sprinters injury as the rapid contraction when sprinting is the usual mechanism of injury. In the summer I see a lot of torn hamstrings from water skiing. As the skier is pulled forward out of the water the ski can catch the water throwing the body forward and there is a violent stretch to the hamstring, the other main mechanism of injury. The hamstrings almost always tear at the junction where the tendon joins the muscle. In a child before puberty the hamstring will pull off the bone or pull a small piece of bone off the pelvis. We rank hamstring injuries in three degree's with a first degree being a minor strain and a third degree a total tear of the hamstring.

The treatment of the injury and the recovery time will depend on the severity of the injury. In a second degree injury or greater I can palpate a gap in the muscle where it is torn. There will be bruising on the skin area below the tear. The bruising will not be visible for several days after the injury and can be quite dramatic. In the worst cases the leg is bruised from the buttock all the way down towards the ankle. Initially, you want to limit the injury and control the swelling. So often you will hear someone tell someone to stretch it out after they hurt their hamstring. This is the worst thing you can do. You already have a muscle that is torn and by stretching that torn area you can only tear it more. Not only should you not stretch it out immediately, you should not begin to try and get your flexibility back by stretching for five to seven days.

Obviously you should not continue the activity and ice should be applied for 15-20 minutes every 11/2 to 2 hours. Your injury should then be assessed by a sports physician. In a severe third degree injury surgery may be required but fortunately we rarely see tears that bad. The doctor will grade your injury and give you a time line when you can go back to your sport. Therapy is started as soon as possible. Initially the therapist will work to reduce the inflammation. Your doctor may prescribe anti inflammatory pills for the same reason. The next step is to slowly get the flexibility and strength back in the hamstring muscle. It is extremely important to stretch very slowly and to hold your stretches for 1-2 minutes. The hamstring muscle loses it's strength very quickly so a specific program is designed to get the strength back in the muscle.

The therapist then starts you on functional training with slow jogging and progresses to faster running and finally to sprinting. I call the hamstring muscle the most finicky muscle in the body. If not treated properly it remains weaker and tight. So often an athlete returns too quickly only to reinjure their muscle. This sets up a vicious cycle of injury-rest-weakness-return to sport-reinjury. Not only that but the performance goes down as the muscle can not function properly. As you can see Donovan is in a real dilemma. The pressure to heal his hamstring while at the same time training at the highest level so when he hits the starting blocks in Atlanta he has full confidence that his hamstring will be totally healed. He has to work very closely with his coach and therapist to ensure he will have returned to full strength power and timing to allow him to compete with the best in the world.

Male or Female

Atlanta, July 1996, the finals in the woman's 100 meters. The woman in all her glory is later disqualofied as being a male. Shamefully ""she"" who has lived her life always as a female has to cope with the embaressment of not only losing her medal but the whole rest of her life. Is this scenario possible? How often has in fact a male masquaraded as a female for the glory that comes with Olympic victory. While the Olympic spirit still lives, the monetary rewards of Olympic sucess now play a major role in the event. Females are narowing the gap in performance between males, but do we ever think that perhaps that female Olympic champion is in fact a male. Since the 1930's there have been several anecdotal reports of athletes competing as females who were later identified as males.

The most recent of which was in 1966 when the winner of the woman's downhill ski event, after a subsequent medical examination had surgery and pronounced a male. He then actually married and fathered a child. In fact, the majority of cases involved a situation where there was ambiguity of the genitalia. Although the extra male hormone may have been an advantage, it is unlikely that these females actually knew about this and sought to use this as an advantage. To set the record straight the option of gender or sex verification was talked about in the early 60's. The first so called""sex test"" was performed at the European Track and Field championship in 1966. All female athletes had to parade naked in front of a panel of female physicians. Unexpectedly five world class athletes chose not to compete.

This was repeated at several events, but the process was rejected by the athletes. At the Olympics in Mexico City,1968 there was a new test introduced. A smear from the inside of the cheek was taken from all female athletes. A chromosome analysis was done on all these smears. If the test was positive further more definitive testing was to be done. Unfortunately there is an unacceptable high false positive rate. The affect on these females who are in fact legitimate and are told that they may be not is obviously quite dramatic and makes this test not appropriate. In 1990 it was recommended that all male and female athletes undergo a standardized medical in their own country by an accredited physician. The purpose of this examination was to ensure satisfactory physical status for competition and would include simple inspection of the genitalia.

Although this proposal was accepted it was essentially dropped in 1992 due to lack of uniformity between countries. Presently, the IOC(International Olympic Committee) uses a new test which is highly specific for the Y chromosome found in males. This is taken from a swab from the inside of your cheek and has similar problems as the chromosome smears taken from these same samples in the 1968 Olympics. The Canadian Academy of Sport Medicine( our National association of Sport Medicine Physicians) have recently come out with a position paper calling for the elimination of all gender identification. The basis for this recommendation is that with a combination of communal dressing rooms, clothing worn by females today, visualized urine sample taken for drug identification make it extremely unlikely a male could masquerade as a female.

Although a female who has a Y chromosome must be identified for health reasons alone(a medical exam is recommended for all athletes), a person raised as a female even though they potentially may have some advantage of having an increase in male hormones should be allowed to compete as the sex they were raised as. So, as you watch the Olympics this month, enjoy the events for what they are. Let us catch the athletes that cheat by using performance enhancing drugs and let the others compete in the spirit of fair sport.

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