Organized medicine and athletics: The role of the American Medical Association committee on injury in sports

Organized Medicine and Athletics: The of the American Medical Association Committee on Injury in Sports ALLAN J. RYAN,* M.D., F.A.c.s., HYSICIANS in the United States have been as sportsmen and as medica advisers to athletes since the beginnings of organized athletics here. Until very recentIy there was no organized approach, however, on the part of medical associations or societies to the probIems of sports medicine. This is in distinct contrast to the situation in Europe where we11 defined programs have been in existence for so many years that this branch of medicine has become a specialty in itseIf. The origina suggestion for the estabIishment of a Committee on Injuries in Sports was made at a meeting of Trustees of the American MedicaI Association in December, 1953. Exploratory contacts were made and Ietters sent to interested physicians which resulted in the appointment of such a committee under the chairmanship of Dr. Augustus Thorndike of Boston in 1954. The First meeting of the committee took pIace in Chicago in June, 1956. Since that time the committee has met reguIarIy twice a year in different parts of the country and has undergone a few changes in its memhership. Fred Hein, PH.D., of the Bureau of Health Education, has served as secretary to the committee. Prior and subsequent to the First meeting considerable thought and discussion were devoted to the nature of the roIe which this committee shouId play. ShouId it be a passive spectator of events in the heId, noting progress and problems and answering requests, or shouId it take an active part in making inquiries itself, setting standards and shaping events in the process of its activities? The decision was graduaIIy reached to become active. Since then the press of developments has resuIted in constant ,vear-round activity conducted through Committee

Connecticut

the staff secretary and the chairman by correspondence with the committee members between meetings. AIthough it is perhaps a Iittle premature to speak about accompIishments in a f&Id in which so much remains to be done, the scope of the probIems with which the committee is deaIing may best be understood by considering what has been done and what is in progress. Most important of all in whatever has been attempted so far has been the enthusiastic response and exceIIent cooperation received from representatives of the sports worId, both amateur and professional, educationa institutions, and the members of the medica profession as a whole. One of the Iirst probIems which came to the attention of this committee was that of the apparently increasing number of serious and even fatal Injuries to the head occurring in football pIayers. Contact was made with a research program on the subject of protective headgear for al1 purposes being carried out at Cornell University under the direction of George Dye, PH.D. Discussion with representatives of the larger manufacturers of footbalI headgear folIowed, and subsequentIy a visit was made to the Iaboratory of sports medicine at lllichigan State University where headgear research was being carried out under the direction of Henr?Montoye, PH.D. Progress has been made, not as the result of this committee’s efforts but lvith its active encouragement in the production of a new, safer type of footbaI1 helmet. It is hoped for the future that a set of test standards will be arrived at to serve as guides for the manufacture of even safer heIrnets. In the meantime the committee is emphasizing to those concerned the importance of buying the best head protection avaiIable and of cultivating serious respect

P active

* Chairman,

Meriden,

Role

on Injury in Sports, Am&can

324

American

iLlcdic:~l Association. Journal

of Surgery.,

Volume

~8. September,

1y5y

Ryan for the treatment and aftercare of any ty.pe of injury to the head occurring during practice or a game. This approach to this particuIar probIem inaugurated the practice of making one meeting each year a visit to one of the university centers where active programs of research into the physioIogy of sports activities are being conducted. In 1958 the committee visited SpringtieId University where the program was arranged by Dr. Peter Karpovich in his laboratory. The committee hopes not onIy to keep informed of what is happening in such programs but aIso to encourage the deveIopment of new programs where appropriate facihties and qualified personnel exist. As the scope of its inquiries widened, the committee made contacts with the NationaI CoIIegiate AthIetic Association (N.C.A.A.), the National Association of Intercohegiate AthIetic Associations (N.A.I.A.A.) and the National Federation of High SchooI AthIetic Associations (N.F.H.S.A.A.). These contacts have been most rewarding because they are a11 bearing fruit. In the first instance the N.C.A.A. appointed a specia1 committee of its own on sports injuries and incIuded the chairman of the A. M. A. committee as one of its members. This committee has been very active since its inception in pIanning and conducting a nationa survey of footbalI injuries and another of training room faciIities. It is currently embarking on a cooperative study of training methods with the American Olympic Committee. It has cooperated with the A. M. A. in a survey of the use of amphetamine among athIetes and in the dissemination of “The BiII of Rights for the CoIIege AthIete” to a11 its member coIIeges. In these two Iatter projects the N.A.I.A.A. has Iikewise cooperated. “The BiII of Rights for the CoIIege Athlete” was deveIoped by the committee from an idea suggested by one of its members, Dr. Thomas B. QuigIey of Boston. It is reproduced here in its entirety because it represents the committee’s phiIosophy of correct conditions for participation in amateur athletic events. THE

BILL

OF

COLLEGE

RIGHTS

FOR

THE

ATHLETE

Participation in coIIege athletics isa priviIege involving both responsibilities and rights. The athIete has the responsibility to pIay fair, to 326

give his best, to keep in training, and to conduct himself with credit to his sport and his school. In turn he has the right to optima1 protection against injury as this may be assured through good technical instruction, proper reguIation and conditions of pIay, and adequate heaIth supervision. IncIuded are: Good coaching: The importance of good coaching in protecting the health and safety of athIetes cannot be minimized. Technical instruction leading to skiIIfu1 performance is a significant factor in Iowering the incidence and decreasing the severity of injuries. AIso, good coaching incIudes the discouragement of tactics, outside either the rules or the spirit of the rules, which may increase the hazard and thus the incidence of injuries. Good oficiating: The ruIes and reguIations governing athIetic competition are made to protect pIayers as we11 as to promote enjoyment of the game. To serve these ends effectiveIy the ruIes of the game must be thoroughIy understood by players as we11 as coaches and be properIy interpreted and enforced by impartia1 and technicaIIy quaIified officials. Good equipment and facilities: There can be no question about the protection afforded-by proper equipment and right facilities. Good equipment is now avaiIabIe and is being improved continually; the problem lies in the false economy of using cheap, worn-out, outmoded or iII-fitting gear. Provision of proper areas for pIay and their carefu1 maintenance are equaIIy important. Good medical cure in&ding: (I) A thorough preseason history and physical examination. Many of the sports tragedies which occur each year are due to unrecognized heaIth probIems. Medical contraindications to participation in contact sports must be respected. (2) A physician present at all contests and readiIy avaiIabIe during practice sessions. It is unfair to Ieave to a trainer or coach decisions as to whether an athIete shouId return to play or be removed from the game foIlowing injury. In serious injuries the avaiIabiIity of a physician may make the difference in preventing disability or even death. (3) Medical contro1 of the heaIth aspects of athIetics. In medica matters the physician’s authority shouId be absoIute and unquestioned. Today’s coaches and trainers are happy to Ieave medica decisions to the medica profession. They also assist in interpreting this principle to students and the public.

Organized

Medicine

and

AthIet,ics

This makes the first occasion on which consuhation has been sought with official representation of the profession on these selections. It represents an evident desire on the part of all concerned to see that our finest athletes get the best medical care. In June, 1958, at San Francisco the committee presented a symposium on athletic injuries, their prevention and treatment, at the invitation of the Council for the Scientific Assembly of the Annual Meeting of the American Medical Association. Guest lecturers covered topics from skiing to skin diving. The papers were subsequently accepted for publication in the Journal of the American kfedical Association.* In June, 1959, the committee cooperated in the presentation of a similar sy-mposium with the Section on Orthopedics at the annua1 meeting of the A. M. A. in Atlantic City.. For the future it is the hope of the committee that within the scope of the A. M. A. a national organization of physicians interested in the relationship between sports ant I medicine, whether as team physicians, research investigators, active participants or merely fans of sport, may be established. To this end it \r,iIl continue to encourage informal meetings, presentations in connection with established formal meetings and congresses, pubhcation of articles, essays and pamphlets? and active research wherever they may be carried out. In this way there can be deveIoped a program at least comparable and hopefuhy superior to any existing in other countries today.

A simiIar program for high schoo1 athletes has been outIined under the title of “ Protecting the Health of the High School Athlete.” This includes a series of proposed standards for safety- in competitive athletics and a guidebook for the hotding of IocaI, county or state wide conferences on this subject. The N.F.H.S.A.A. has fleen actively interested in this program and has further cooperated by conducting a sampling survey of heaIth practices connected with athletic participation in its schooIs. The monthly buhetin of this organization contains a column on health in reIation to sports which is prepared under the direction of this committee. CurrentIy there is under consideration a series of recommendations reIating to the participation of students at the junior high schoo1 Ievel in organized footbaII contests. As the result of severa inquiries and the specific interest of several members of the committee, a statement was issued through the A. ,Ll. A. News and both cohege athletic associations on the subject of “making weight” for wrestling and boxing events. Abuses of health involved in heroic weight reduction measures folIowed by- strenuous competition have sometimes resulted in serious illness. One member of the committee participated in the revision of an important pamphIet published by the Bureau of Health Education which is now entitled “Exercise and Fitness.” This has a broad circulation among persons working in the fieId of heahh, physica education and recreation. Emphasis is placed on the importance of appropriate exercise in producing and maintaining physical fitness. During the past year the committee has cooperated with the United States OIympic Committee in making recommendations of medica personne1 to serve at both coming winter and summer Olympic Games of 1960.

* Volume 169, pages 1405-1436, >larch 28, 1959. t Pamphlets and statements being distributed

by the

A. M. A. Committee on Injury in Sports: “Protecting the HeaIth of the Hieh School Athlete.” “Johnnv Makes the Team,” “Miking Weight,” “Tackle Foe
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