1. BY
DR. JUSTICE PATANI AKPOTU
(MBBS, MSc. Sports Medicine – UPH)
REGISTRAR
DEPT OF FAMILY MEDICINE
NDUTH, OKOLOBIRI

2.  DEFINITION/INTRODUCTION
 PECULIARITIES OF SPORTS MEDICINE
 DIMENSION OF SPORTS MEDICINE
 EXERCISE PHYSIOLOGY
 HEALTH BENEFITS OF EXERCISE
 FITNESS FOR SPORTS AND OTHER PHYSICAL
ACTIVITIES
 AREAS OF INTEREST IN SPORTS MEDICINE
 PROHIBITED SUBSTANCES AND MEDICATIONS IN
SPORTS (DOPING ISSUES)
 SUPPLEMENT USE IN SPORTS
 COMMON SPORTS INJURIES AND THEIR MANAGEMENT
 THE SPORTS PHYSICIAN’S MEDICAL BAG
 CHALLENGES OF SPORTS MEDICINE IN NIGERIA
 CONCLUSION
2

3.  SPORTS: An activity involving physical or mental
exertion and skill especially one regulated by set
rules in which an individual or team competes
against another or others.
 SPORTS MEDICINE: Branch of medicine that is
concerned with exercising individuals.
 It is a branch of medicine that deals with
physical fitness and treatment and prevention of
injuries related to sports and exercise.

4.  PHYSICAL FITNESS: This is defined as a set of
attributes that are either health or skill-related. The
degree to which people have these attributes can be
measured with specific tests. For e.g Copper test for
Referees.
 EXERCISE: Is a subset of physical activity that is
planned, structured, and repetitive and has a final
or an intermediate objective the improvement or
maintenance of physical fitness.
 PHYSICAL ACTIVITY: Any bodily movement
produced by skeletal muscles that results in energy
expenditure. Physical activity in daily life can be
categorized into occupational, sports, conditioning,
household, or other activities.(NCBI)

5.  Sports Medicine deals with the gamut of processes
involved with identification, harnessing and
optimizing the potential of athletes from the cradle
to the podium (concept of high performance).
 It used to be limited to just treatment of injured
players but sports medicine has evolved over the
years.
 Presently sports medicine is commonly referred to as
performance medicine.
 TALENT ALONE CAN’T GUARANTEE podium
performance
 Sports Medicine/Science is the emerging critical
success element/factor to achieving podium finish.

6.  Sports medicine involves the care of patients with illnesses
and injuries related to sports and exercise. Both
orthopedic and medical conditions affect a wide spectrum
of patients during sports and recreational activities.
 The field of primary care sports medicine has emerged
over the past 30 years as a leader in the comprehensive
care of athletes, teams, and exercising individuals.
 The role of a sports medicine physician is to promote the
health and safety of exercising individuals, prevent injury
and illness, optimize function, and minimize disabilities
that would preclude sports participation.
 Sports medicine physicians work closely with a
multidisciplinary team of health care providers.

7.  Performance is critical
 Exercising individuals have peculiar needs and
their bodies have undergone certain
physiological adaptations
 Time is critical
 Ethical issues
 Doping issues

8.  Multidisciplinary in nature
 Requires a lot of team work
 Intra group cohesion
 Inter group cohesion
 Requires managerial skills beyond medicine

9. There are two forms of exercise, anaerobic and aerobic.
 Anaerobic consists of short sprints and resistance
training, in order to promote strength, speed, and
power.
 Aerobic involves longer endurance training and requires
more oxygen to maintain.
 Both forms are dependent on the ability to deliver
oxygen effectively, and there are several adaptations to
the cardiac, respiratory, and hematological systems that
occur to optimize performance.
 In addition, regular exercise results in physiological
adaptations of the heart that are important to
understand when managing athletes.

10.  Increased Cardiac Output - > heart rate and stroke volume.
Systolic blood pressure increases with increased work, and
blood is shunted from splenic and GI organs to the
muscular system.
 Increased coronary artery perfusion from an increase in
perfusion pressure and coronary vasodilation.
 Sympathetic nervous system stimilation results in a release
of catecholamines to further increase coronary perfusion.
 Regular activity result in long-term changes of the
cardiovascular system.
 Specific changes in the heart are referred to as the “athlete’s
heart.”

11.  These changes consist of increased left ventricular
mass, increased left ventricular wall thickness, and
increase in left ventricular end diastolic volume .
 Echocardiogram-based studies have also shown an
increase in the size of interseptal and posterior walls
of the heart as well as larger ventricular diameter.
 For reasons that are not completely understood, well
trained athletes have reduced sympathetic activity
and increased parasympathetic activity resulting in
baseline bradycardia.
 Cumulatively, these changes ultimately allow for
higher stroke volumes at a lower heart rate.
 RESPIRATORY SYSTEM: Increase in tidal volume
followed by increased respiratory rate to improve
ventilation. Over time with regular physical activity,
the respiratory system can adapt with an increase in
maximal voluntary ventilation.

12.  Oxygen delivery can also be affected by the hematologic
system and the body’s ability to carry and deliver oxygen
to the working tissues.
 Red blood cells (RBC) contribute to oxygen delivery via
three important mechanisms.
 (1) They are a source of nitric oxide which causes
vasodilation and increases blood flow to tissue.

 (2) As the oxygen-carrying cell of the body, an increase in
the number of RBC will enhance oxygen delivery.
 (3) The viscosity of blood, which is partially affected by
RBC membranes and their deformability, affects the
velocity of blood through the microvasculature.
 It is thought that the sequelae of exercise-dehydration,
lactate production, and hypoxia-impair blood viscosity
during actual episodes of exercise, ultimately results in a
decrease of whole blood viscosity in the resting athlete
and thus supports tissue oxygenation .

13.  The main fuel source during exercise is lipid and
carbohydrate breakdown from adenosin
triphosphate (ATP) and glucose within the
muscle.
 Because of this, there is an insulinin dependent
uptake and utilization of glucose during
exercise, which can help improve overall
glycemic control.

14.  1. Exercise is a primary intervention to promote
health.
 2. Improves outcomes for many chronic
diseases, including diabetes, hypertension,
obesity, and depression.
 3. Exercise training results in increased
parasympathetic (vagal) tone and a subsequent
more rapid decrease in heart rate after exercise,
lower resting and submaximal heart rates, and
increased heart rate variability.

15.  Reduced systolic and diastolic blood pressure
 Decreased low-density lipoprotein levels
 Increased high-density lipoprotein (HDL) levels
 Reduced triglyceride levels
 Reduced obesity
 Increased maximal volume of oxygen utilization
(VO2 max)
 Increased insulin sensitivity
 Improved fibrinolysis and lowered levels of
fibrinogen,
 Reduced arterial stiffness and improved arterial
compliance, and increased heart rate variability.
 Exercise also improves myocardial function,
including increased contractility, faster relaxation
rates, enzymatic alterations, increased calcium
availability, and improved autonomic and hormonal
function.

16. Women
 There are gender-specific benefits to exercise
that the family physician should know.
 Weight bearing activity can increase bone
mineral density and decrease the risks of
fracture in postmenopausal women.
 Studies have shown regular exercise to decrease
prolactin and progesterone levels resulting in
decreased fatigue, enhanced concentration, and
improved premenstrual symptoms of low back
pain, pelvic pain, anxiety, and depression.

17. The Female Athlete Triad:
 In 1992 the American College of Sports Medicine first
described the female athlete triad as disordered eating,
amenorrhea, and osteoporosis.
 This definition was updated in 2007 to include dysfunction
related to energy availability, menstrual function, and bone
mineral density. Then in 2014 and most recently in 2018,
this topic was expanded further by the International
Olympic Committee to be described as relative energy
deficiency in sport, or RED-S. RED-S refers to “impaired
physiological functioning caused by relative energy
deficiency and includes, but is not limited to, impairments
of metabolic rate, menstrual function, bone health,
immunity, protein synthesis, and cardiovascular health”.
 This low energy availability coupled with the physical
and mental stress of training can lead to menstrual
irregularity .
 Finally, this low energy state results in the decrease in
insulin growth factor and hypoestrogen leading to low
bone mineral density .

18. Pregnancy
 Exercise in pregnancy provides many benefits to include lower risk
of gestational diabetes, enhanced sleep, reduced physical
discomfort, maintenance of appropriate weight, improved mental
health, and higher APGAR scores.
 The American College of Obstetricians and Gynecologists (ACOG)
found that that there were no reports of exercise-induced
hyperthermia leading to teratogenic affects.
 ACOG’s current recommendations in regard to exercise during
pregnancy are as follows.
1. Achieve regular moderate-intensity exercise for at least 20–30 min
or more on most days of the week.
2. Avoid exercise requiring the supine position after 12 weeks’
gestation due to increased risk of obstruction of venous return.
3. Avoid activities that carry with them a risk of abdominal trauma.
 In summary, women who were previously healthy prior to pregnancy
can continue with their training programs during pregnancy.
 Women with significant cardiac or respiratory disease or
complications with the pregnancy should be monitored carefully
during exercise.

19. Elderly
 For those demanding a specific skill set, age categories
often start at 50 years. For the general public, geriatric
classification starts at age 65 with 65–75 being young
old, 75–85 being middle old, and over age 85 being very
old.
 The health benefits of physical activity in reducing
cardiovascular events, diabetes, and improving bone
health continue through the lifetime, and as such elderly
patients should be encouraged to continue to be
physically active.
 As a person ages, cardiovascular function declines
resulting in a decrease in maximal heart rate, impaired
compliance in diastole, incomplete emptying in systole,
and reduced inotropic response to sympathetic input.
This can affect the elderly’s activity tolerance level as well
as put them at increased risk for arrhythmias and heart
failure.

20. The other major physiologic change in the mass,
strength, and endurance – which can lead to a decline
in functional ability and flexibility putting the elderly at
an increased risk of injury and falls.
 Older adults should strive for the same multimodal
exercise goals as stated above for all adults, but with
special interest placed on balance training.
 Family physicians should assist their geriatric
patients in understanding how their chronic medical
conditions affect their ability to participate in regular
activity and modify accordingly as their abilities
allow.
 Ultimately, a simple goal of being more active than
sedentary throughout the day is an easy one to
advocate to your patients.

21. PEDIATRICS
 The CDC estimates that 18% of children 6–11 years old and 21% of
adolescents aged 12–19 were obese. It is now a public health concern to
encourage children and adolescents to participate in physical activity in
a healthy and beneficial way.
 Children should participate in at least 60 min of vigorous aerobic
activity daily. Resistance training such as tug of war, rope climbing, or
push-ups should be incorporated three non-consecutive days per week.
 Preschool children’s growth and development is enhanced by regular,
daily physical activity.
 The benefits of following these recommendations include healthy body
composition, increased development of bone mass, improved self-
esteem, and decrease in anxiety and depression.
 Early sports specialization has become topic of interest in the pediatric
population. Early sports specialization is commonly defined as the
participation in one sport at the expense of participation in other sports.
 Over the past 20 years or so, there has been a shift in the focus of youth
sports from a recreational, learning environment to one of competition
and dedicated training in order to achieve excellence, scholarships, and
even future careers as a professional athlete.

22.  Physical Activity Guidelines
• Data over the last several decades clearly support the
benefit of regular physical activity on improving
obesity, cardiovascular disease, metabolic syndrome,
bone health, and mental health.
• The United States Department of Health and Human
Services (HHS) recently reviewed national and
international data relating to physical activity and
health.
• Their 2018 update continues to recommend the
average adult engage in at least 150 min a week of
moderate-intensity (brisk walking) or 75 min a week of
vigorous intensity (light jogging) exercise.
• Increased health benefits are gained when engaging in
moderate-intensity physical activity for at least 300
min a week. Muscle strengthening of all major muscle
groups two times per week is also encouraged.

23.  Components of exercise prescription include
the following:
 (a) Type of activity,
 (b) Frequency,
 (c) Duration,
 (d) Intensity,
 (e) Resistance training,
 (f) Flexibility training, and
 (g) Warm-up and Cool-down.
 Encourage adherence to an exercise program.

24.  An exercise prescription should include mention of the following:
 1. The type of activity: This should take into account a patient’s medical status,
level of fitness, interests, available exercise facilities, climate, and geographic
 location.
 2. The frequency of exercise: The current recommendation is for people to
exercise on most, preferably all, days of the week.
 3. The duration of exercise: People should engage in 20 to 60 minutes of
continuous or intermittent aerobic activity throughout the day.
 4. The intensity of exercise: Moderate-intensity exercise, exercising at a level
equal to 65% to 75% of a person’s maximum heart rate, is recommended. Several
methods may be used to calculate the proper intensity. These include the
following:
 a. The formula commonly used to measure the maximal heart rate is 220 minus
age. This formula, however, underestimates the maximum heart rate, especially in
people older than age 55 years.
 b. The “talk test” can be used to avoid exercising at too high an intensity. People
should exercise at an intensity that permits being able to carry on a conversation.
 c. Exercise intensity can also be measured in METs. A MET is the resting metabolic
rate or the amount of oxygen consumed at rest, which is approximately 3.5 mL
O2/kg per minute. METs are determined by treadmill testing.

25.  Flexibility training: Although there is a lack of evidence for
benefit of flexibility exercises in the prevention and treatment
of musculoskeletal injuries, it is still recommended to stretch
major muscle and tendon groups, four repetitions per muscle
group, a minimum of 2 or 3 days per week. Static stretches
should be held for 10 to 30 seconds.
 Warm-up and cool-down periods: Before and after exercise,
there should be a 5- to 10-minute period of stretching and
low-level aerobic exercise.
 As stated previously, there is a lack of evidence for the
benefit of flexibility exercises in the prevention and treatment
of musculoskeletal injuries. Exercise should be performed on
all or most days of the week. Exercise does not have to be
continuous for health benefits to be gained. Short bouts of
exercise throughout the day are just as beneficial as
continuous exercise.
 Resistance training is recommended for all adult age groups.
Increasing the intensity of exercise does reduce the risk of
coronary artery disease.

26.  Resistance training or weightlifting: Resistance training
results in lower heart rate and blood pressure response
to any given load and can improve aerobic endurance.
Weight training reduces risk of coronary heart disease.
 The recommendation is a minimum of 8 to 10 exercises
involving major muscle groups performed 2 or 3 days
per week with a minimum of one set of 8 to 12
repetitions. For older people, 10 to 15 repetitions at
lower resistance is more desirable because muscle
strength declines by 15% per decade after age 50 years
and 30% per decade after age 70 years.
 The goal is to lift weight that is 70% to 80% of one
maximum lift. Contraindications to resistance training
are unstable angina, uncontrolled hypertension,
uncontrolled dysrhythmias, uncontrolled chronic heart
failure, severe stenotic or regurgitant valvular disease,
and hypertrophic cardiomyopathy.

27.  1. Pre-competition Medical Assessment
(PCMA)
 2. Injury Prevention
 3. Travelling with teams
 4. Doping in sports
 5. Nutrition/supplements
 6. Sports Psychology

29.  The IOC consensus
statement on
PCMA/PHE in 2009
describe it as a
comprehensive
evaluation of the
athletes’ current health
status and risks of
future injury or disease
 Tool for periodic health
evaluation and
monitoring in athletes.

30.  To ensure optimum
medical health
 Ensure optimum
musculoskeletal
health
 To plan injury
prevention strategies
 To obtain baseline
data
 To develop
understanding with
the athletes
 Education

31.  There are basically 2
models of PCMA
 American Model
 European Model
 IOC and various
international
federation/SMD
developed their models
based on either of the
models + and
incorporate their
peculiar needs within
thier available
resources.

32.  American Model:
 Thorough medical
history + Physical
evaluation
 Further Investigations
and Cardiac screening
are done as indicated
 12 Lead Resting ECG
not a routine
 Clearance can be
issued if no adverse
findings

33.  European model:
 Thorough Medical
History + Physical
Evaluation
 12-Lead Resting ECG
 Positive findings on
ECG will lead to
further Tests (Stress
ECG,ECHO etc )
 Clearance to
participate will be
issued based on
findings

34.  American model :
 Cost effective
 It’s Efficacy in detecting
Heart problems in doubt.
 In a series of 134 deaths in
the USA,115 hearts were
examined,correct diagnosis
was only made in (1) 0.9%
of the athletes.
(Aspetar.com)
 European Model
 Mostly state
sponsored/compulsory
 ECG is relatively
affordable in Nigeria
 The Italian screening
programme showed
significant in incidence
rate of SCD
 With 90% reduction in
mortality (Harshil et
al,2018)

36. STRATEGIES IN INJURY PREVENTION
Know the Sport
Know the Athlete
Know the Environment
Know the Coach

37.  Everyone who works in any capacity with
sports is concerned and must accept a
degree of responsibility for safety.
 Trained and professional medical people
need to be aware of biomechanical and
medical factors of fundamental sport.
 Medical practitioners have to understand
the physical and psychological needs of
people involved in sport at recreational
or competitive levels.

38. A. INTRINSIC FACTORS ( inherent to the
athlete)
i. Non modifiable factors
- Age - maturation and Ageing
- Gender - Female athlete
- Genetic

39. A. INTRINSIC FACTORS
ii. Modifiable factors (Biomechanics, Muscle
strength, flexibility
-Lower extremity mal-alignments
e.g.
high/low riding patella
genu valgum & varum
pes planus/cavus
ankle hyper-
pronation/supination
Leg length discrepancy
-Muscle Strength ….weakness
-Decreased flexibility
-Previous injury- joint instability
-Skill level- sports specific
technique, postural instability
-Physical fitness-(muscle
strength/power, VO2max,

40. B. EXTRINSIC FACTORS : ( factors not inherent to
the athlete)
 Training errors – inappropriate training intensity,
non-optimal technique
 Inappropriate playing surface- pitch, flooring or
courts
 Excessive load on the body – number of repetitions,
speed of movement
 Environmental conditions – heat/cold, humidity,
altitude, excessive wind
 Poor or inappropriate sports equipment – worn shoes,
faulty rackets, substandard shin guard
 Human factors –team mates, opponents,
referee/umpire
 Ineffective rules, violent play
 Nutrition

41. Facts to bear in mind:
 Injury is inevitable in sport
 Best approach is to
minimize/avoid the predisposing
factors – (intrinsic and extrinsic)
 Efforts to prevent sports injury can
be effected at -Primary
(individual) level
-Secondary (group)
level
-Tertiary (society)
level

42. Direct or Indirect sports injury prevention at individual level
◦ pre-season medical/pre-competition examination
◦ warming up, stretching and cooling down prior and after
exercise
◦ preventive muscle conditioning
◦ flexibility training
◦ proprioceptive training
◦ sports specific training,
◦ avoidance of abrupt changes in training methods
◦ avoidance of sudden increase in training intensity and
volume
◦ correction of alignment abnormality of lower limbs-?
orthotics
◦ proper and adequate nutrition
◦ use of appropriate protective equipment, taping, shin
guard, mouth-guard e.t.c.
◦ avoidance of doping

43. Sports injury prevention at group level
Group information and education
dissemination through
Lecture, seminars for coaches and
athletes about:
importance of warm up, cool down
and stretching,
adherence to rules (fair play rule),
harmful effects of drugs, alcohol and
tobacco

44. These are efforts taken at society level to
prevent sports injury
◦ political decision to change the flooring of
a sports hall or re-grassing of soccer pitch
◦ legislation to ban all punches/hits to the
head in boxing
◦ Legislation on water breaks in very hot
weather in outdoor games……this may be at
the level of International Federations.

45. BIOMECHANICS
Biomechanics can be considered
the evaluation of sports
techniques, e.g. running, swim
strokes, jumping, bracing, etc.
correct biomechanics provides
efficient movement and is likely
to reduce injury risk.
Non corrective movement always
be considered to produce non
traumatic sports injuries. Faulty
biomechanics may result from
static (Anatomical) or functional
abnormalities.

48. SUMMARY OF BASiC STEPS TO PREVENT A SPORTS INJURY:
•Develop a fitness plan that includes cardiovascular exercise,
strength training, and flexibility. This will help decrease your chance
of injury.
•Alternate exercising different muscle groups and exercise every
other day.
•Cool down properly after exercise or sports. It should take 2 times
as long as your warm-ups.
•Stay hydrated. Drink water to prevent dehydration, heat exhaustion,
and heat stroke.
•Stretching exercises can improve the ability of muscles to contract
and perform, reducing the risk for injury. Each stretch should start
slowly until you reach a point of muscle tension. ...

49.  Performance in Mind

50. While others are
thinking of
 shopping
 Pleasure
 Estacode /DTA
 Tourism
We think performance

51. Travelling with team and providing medical support
is a very challenging task.
 it needs more than just professional skill
 It needs strong interpersonal skills
 Personal coping mechanism
 You must be innovative

52.  Team Doctor
 Team Physio
 Nurse
 pharmacist
 Masseur
 Nutritionist
 Psychologist
 etc

53.  The most important
aspect of team travel
to aid performance is
proper detailed
preparation

54.  S-self
 O-officials
 A. athletes
 P. paper work
 T. travel
 I. Immunuzation
 L. location
 T. talk to team
 E . Equipment
 Dr . Dr’s bag

55.  Destination climate
 Destination weather
 Accommodation.
 Pollution level
 Food
 Vaccination
requirement
 water

56.  Security
 Custom requirement
 Local medical support
 Embassy
 Doping requirement
 TUE’s
 Recovery facilities
 consumables

57.  Team members and
official travel fitness
( PCMA for both
players and officials)
 Advice the team on
jet lag
 Advice the team on
food on the road and
basic simple hygiene

58.  Jet lag
 Travel fatigue
 Travelers diarrhea
 Upper respiratory
tract infection
 Malaria
 STD
 DVT

59.  This occurs when
the body is unable
to adapt rapidly to
the time zone shift,
so the normal body
lose catch with the
environment.
 It is benign and self
limiting.

60. Jet lag Travel fatigue
 Poor sleep
 Daytime fatigue
 Confusion
 Loss of appetite
 Headache
 Tiredness
 Disorientation.
.General body ache
without fever

61.  Individual difference
 Number and direction
of the time zone
 Age
 Health status
 First timer
 Stress
It is estimated that it
takes about one day
per time zone for
circadian rhythm to
resynchronize

62. In flight
 Pre travel sleep
schedule
 Timed light
exposure and
avoidance plan
 Timed melatonin
intake
 Maximize hydration
 Minimize diuretics
such as alcohol
 Flight compression
socks
 Walk around ,stretch
and warm up

63.  Optimize travel
route
 Stop over (45mins
every 3hrs)
 Good food on
board.
 Hydration
 Stretching
 sleep

65.  “The most important thing in the Olympic
games is not winning but taking part;
 the essential thing in life is not conquering
but fighting well” Pierre de Coubetin (1863 –
1937), Father of modern olympics.

66.  In 1995, Sports Illustrated asked 198 aspiring
US Olympians;
 Would you take a banned performance
enhancing substance if you were guaranteed
to win and not get caught?
 195 said YES, only 3 said NO.

67.  Then, when asked,
 Would you take the same undetectable
substance if it would contribute to winning
every competition for 5 years, then result in
death?
 Over Half still said YES!!!

68.  There is a permanent race among those who
are going to invent new doping
substances/methods and various ethics
committees that are searching for effective
methods to detect them.
 The common use of doping products and
methods have several consequences which
impacts not only on an athletes health but
also on the image of sports.
 Therefore , doping in sports is banned due to
ethical and medical reasons.

69.  The Code is the fundamental and universal document
upon which the World Anti-Doping Program in sport is
based.
 The purposes of the World Anti-Doping Code and the
World
Anti-Doping Program which supports it are:
• To protect the Athletes’ fundamental right to participate
in doping-free sport and thus promote health, fairness and
equality for Athletes worldwide, and
• To ensure harmonized, coordinated and effective anti-
doping
programs at the international and national level with
regard to the prevention of doping.

70.  The spirit of sport is the celebration of the human spirit, body and
mind. It is the essence of Olympism and is reflected in the values
we find in and through sport, including:
• Health
• Ethics, fair play and honesty
• Athletes’ rights as set forth in the Code
• Excellence in performance
• Character and Education
• Fun and joy
• Teamwork
• Dedication and commitment
• Respect for rules and laws
• Respect for self and other Participants
• Courage
• Community and solidarity
The spirit of sport is expressed in how we play true.
Doping is fundamentally contrary to the spirit of sport.

71. PREVALENCE
 Over 1,000,000 Americans have used
anabolic steroids, 250,000 of them
adolescents.
 Over 100 Nigerian athletes have tested
positive for doping since 2002- Chijioke
Jannah 2017 publication.
 Blessing Okagbare banned for 11yrs (HGH)
 Bayelsa State Wrestling athletes (3)

72.  A drug is defined as a chemical substance used to
treat , cure, prevent, or diagnose a disease or to
promote well being.
 Doping means taking drugs to improve or enhance
sporting performance.
 Doping is defined as the occurrence of one or more
of the Anti- Doping Rule Violation (ADRV) set forth
in article 2.1 through 2.10 of the WADA code.
 It is a growing problem in sports.

73.  According to Galen and Philostratos, various
performance enhancing substances were used in the
beginning and end of the Third century BC.
 Athletes used mixtures of strychnine, cocaine, heroin,
caffeine to boost performances until cocaine and
heroin became available only by prescription in the
1920s.
 In 1928, the International Athletics Federation (IAF)
after multiple doping incidents in competitions, was
the first International federation to ban doping in
competitions.

74.  In the 1930s, strychnine were replaced by
amphetamines which served as stimulants
of choice for athletes.
 The Soviet Olympic team first used male
hormones in the 1950s, so as to increase
their strength and power.
 First doping case was recorded during the
Winter Olympics of 1972, Sapporo Games.
West Germany ice hockey player tested
positive for the banned substance
Ephedrine.

75.  Desire to be the best at all cost; winning brings
financial rewards.
 Making the most of a short sporting life
 Influenced by others (peers, coaches etc)
 Better results lead to better sponsor and
endorsement contracts.
 To recover from injury more quickly or to mask
pain

76.  Willing to risk cheating for public acclaim.
 The will to win overrides moral conscience.
 Desire to meet expectations of others.
 Natural ability is not good enough.
 Ignorance (Strict Liability Rule)

77.  ANABOLIC AGENTS
- Exogenous anabolic androgenic steroids such as
Androstenediol, Closterbol, Danazol.
- Endogenous anabolic androgenic steroids such as
Dihydrotestosterone and Testosterone. Other anabolic agents
like clenbuterol and tibolone etc
 PEPTIDE HORMONES, GROWTH FACTORS, RELATED
SUBSTANCES AND MIMETICS.
Eg Erythropoirtin (EPO), gonadotrophins, Human growth
hormones, etc
 BETA -2-AGONISTS:
E.g. Salbutamol, Salmeterol, Terbutaline etc.
- Except inhaled salbutamol max 1600mcgs over 24 hours in
divided doses not to exceed 800mcgs over 12 hours from any
dose.
- Inhaled salmeterol; max 200mcgs over 24 hours

78.  HORMONES AND METABOLIC MODULATORS
 E.g Anastrozole, Tamoxifen, clomifene ,
Insulin etc
 DIURETICS AND MASKING AGENTS
E.G Furosemide, Desmopressin, plasma
expanders, Spironolactone, Hydrochlorothiazide
, Probenecid etc.

79.  STIMULANTS
e.g Amphetamine, cocaine, ephedrine (when
conc. in urine >10mcgs per milliliter,
epinephrine (not prohibited in local admin e.g
nasal, ophthalmogic)
 NARCOTICS/OPOIDS
E.g Pethidine, Morphine, Pentazocine etc
 CANNABINOIDS
E.g cannabis, hassish, marijuana
 GLUCOCORTICOIDS
E.g Bethamethasone, Dexamethasone,
Prednisolone etc

80.  BETA BLOCKERS:
E.g Labetalol, Acebutalol, Nadolol,
Propranolol, Metoprolol.
 PROHIBITED IN SPORTS LIKE ARCHERY,
SHOOTING, DARTS, GOLF ETC.

81.  Ephedrine: used as decongestants.
 Pentazocine, morphine, pethidine: Pain killers.
 Prednisolone, Salbutamol, Bethamethasone,
Dexamethasone – Steroids. Anti inflammatory.
 Epinephrine – systemic administration.
 Tamoxifen, Clomifen- hormones to induce
ovulation.
 Insulin and Insulin mimetics
 Frusemide: Used in heart failure.

82.  Caffeine-
 Nicotine-
 Codeine
 Hydrocodone
 Tramadol – Will be included in list of banned
substances effective 1st January, 2024.
 Belong to the monitoring list

83.  One of the key principles of anti- doping is to
protect athletes health
 An athlete who needs any medication on the
prohibited list must obtain a therapeutic use
exemption certificate
TWO CRITERIA NEED TO BE MET FOR TUE TO BE GRANTED
1. The use of the drug or method should not result in
performance enhancement beyond a return to normal health
2. There is no reasonable therapeutic alternative to the use of the
prohibited substance or method.
 TUEs can only be gotten in advance except in emergency cases
or exceptional circumstances.

84. 1. Presence of a Prohibited Substance or its Metabolites or
Markers in an Athlete’s Sample.
2. Use or Attempted Use by an Athlete of a Prohibited
substance or a Prohibited Method.
3. Evading, Refusing or Failing to Submit to Sample Collection
by an Athlete.
4. Whereabouts Failures by an Athlete.
5. Tampering or Attempted Tampering with any Part of Doping
Control by an Athlete or Other Person.
6. Possession of a Prohibited Substance or a Prohibited Method
by an Athlete or Athlete Support Person

85. 7. Trafficking or Attempted Trafficking in any
Prohibited Substance or Prohibited Method by an
Athlete or Other Person.
8. Administration or Attempted Administration
by an Athlete or Other Person to any Athlete In-
Competition of any Prohibited Substance or
Prohibited Method, or Administration or
Attempted Administration to any Athlete Out-of-
Competition of any Prohibited Substance or any
Prohibited Method that is Prohibited Out-of-
Competition

86. 9. Complicity or Attempted Complicity by an
Athlete or Other Person Assisting, encouraging,
aiding, abetting, conspiring, covering up or any
other type of intentional complicity or Attempted
complicity involving an anti-doping rule
violation, Attempted anti-doping rule violation or
violation of Article 10.14.1 by another Person.
10. Prohibited Association by an Athlete or Other
Person.
11. Acts by an Athlete or Other Person to
Discourage or Retaliate Against Reporting to
Authorities.

87. The consequences of an anti doping rule
violation may include;
 The disqualification of results, stripping of
medals
 In 1988 Seoul olympics Ben Johnsons gold
medal was withdrawn because he used the
steroid stanozolol.
 BAN - Imposition of a period of ineligibility
 Financial sanctions

88.  athletes want to find a competitive edge to help
them go faster , train longer , recover quicker or
be stronger
 medications are for people with specific health
issues not for healthy athletes:
STEROIDS/TESTOSTERONE: Athletes take steroids to
make their muscles big and strong BUT THEY CAUSE:
 Acne
 Male pattern baldness
 Increased risk of liver damage and cardiosvascular
disease
 Causes mood swings
 Increased aggression
 Makes one suicidal

89. Effect of steroids use in Men
 Shrinking testes
 Breast growth
 Decreased sperm production
Effects of Steroids use in Women
 Deeper voice
 Excessive facial and body hair
 Abnormal menstrual cycle
 An enlarged clitoris

90. STIMULANTS:
They are used to heighten the competitive edge.
Side effects include:
 Insomnia
 Anxiety and Aggression
 Weight loss
 Increased risk of stroke
 Increased and irregular heart beats
 Problems with coordination and balance
 Involuntary shaking and trembling
 Risk of heart attacks and stroke

91. OPIOIDS (NARCOTICS):
They may help pain and quick recovery from injury.
Side effects include:
 Weakened immune system
 Decreased heart rate
 Suppressed respiratory system
 Loss of balance , coordination and concentration
 Narcotics are also highly addictive and the athlete
becomes dependent on them.

92. HUMAN GROWTH HORMONE AND PEPTIDE
HORMONES:
They make muscles and bones stronger and
recovery faster. BUT CAUSES:
 Acromegaly (protruding forehead, brow, skull and jaw)
which can not be reversed.
 Enlarged heart which can lead to high blood pressure
and heart failure.
 Damage to liver, thyroid gland and vision.
 Crippling arthritis.

93. MASKING AGENTS
Some athletes cheat by using diuretics and other
substances to cover-up the signs of using banned
substances.
Side effects include:
 Dizziness and fainting spells
 Dehydration
 Muscle cramps
 Drop in blood pressure
 Lose of coordination and balance
 Confusion and moodiness
 Develop cardiac disorder

94. BLOOD DOPING AND ERYTHROPOIETIN (EPO):
Erythropoietin enhances oxygen use by the body
therefore helps with muscle strength and endurance.
Side effects includes:
 Causes blood viscosity leading to blood clots
 Weakness
 High blood pressure
 Risk of heart attack and stroke
 Risk of pulmonary embolism

95. MARIJUANA
Marijuana, cannabis, pot is banned. Use in any quantity
has potential to impact negatively on athletes
performance and health. Side effects include:
 Reduce memory, attention and motivation.
 Learning disabilities
 Weakened immune system
 Lung diseases
 Throat cancer
 Leads to psychological and physical dependence.

96. • Supplements (also called food supplements or
nutritional supplements) are products designed to
give you nutrients that might be missing from your
diet.
• They are usually taken as tablets, capsules or
powders, or as a liquid.

98. Most supplements are multivitamins and minerals.
Some common supplements include;
 Vitamin B12- keeps nerve and blood cells
healthy, make DNA and prevent anemia.
 Folic acid- reduces birth defects when taken by
pregnant women.
 Calcium- strengthens bone
 Fish oil- supports heart health.
 Vitamin A- Slow loss of vision.
 Zinc- promotes skin health and slows vision loss.

99.  Its illegal for companies to make claims that
supplements will treat, diagnose, prevent or
cure diseases, says Dr Millstein.
 Side effects; Rashes, shortness of breath,
diarrhoea, severe joint and muscle pain,
slurred speech and haematuria.

100.  Some may contain banned substances not
disclosed on the label
 Vitamin K supplements can interact with
anticoagulants.
 Some herbal supplements can cause liver
damage.
 Beta-carotene and vitamin A can increase risk
of lung cancer in smokers.

104.  Sports nutrition deals with the health maintenance
and performance improvement of the athlete.
 Emphasizes the energy, nutrient and fluid needs of
the athlete.
 Appropriate nutrition:
- complements training and recovery
- enhances training adaptations
- reduces the risk of injury and illness

105.  Determined by the intensity, duration and
frequency of training sessions / competition.
 Increased intake and / or reduced expenditure:
overweight
 Reduced intake and /or increased expenditure:
unexplained underperformance syndrome / over
training

106.  Maintenance of energy balance: key to health and
performance
 Decrease in available energy:
- impaired hormone
- immune and
- metabolic functions and fatigue.
- irreversible loss of bone mass resulting in increased
risk of traumatic or stress fractures.
- hormonal changes in the female athlete can lead to the
disruption of a normal menstrual cycle.

107. Dietary Sources of Energy
Macronutrients
Carbohydrate
 most important source of energy for the body. Most
efficiently utilized of all energy sources.
 simple carbohydrates: occur naturally in foods eg
fruits, vegetables, milk
 complex carbohydrates: whole grain, yams, rice,
wheat, potatoes, beans and cassava products
 Carbohydrate intake should be adjusted for
size of athlete: heavy athlete; and sport /
event: strength, speed, endurance; high
intensity training
 Requirements: 45% - 65% of total food
intake depending on physical demands of the
sport.

108. Protein
Not a main energy source
Important for structure and function in the body
Essential for tissue repair after intense activity
complete protein: contains all amino – acids
needed by the body; obtained from meat, fish,
poultry, milk.
incomplete protein: lacks one or more of the
essentials amino acids obtained; mainly from
plants -beans, water leaf / vegetables, rice.
essential amino acids cannot be made in the body.

109. Fat
 protect internal organs; maintain cell membranes
regulate hormones; source of fat – soluble
vitamins ; important energy source
unsaturated fats: omega 3 & 6 fatty acids; fish;
olive oils, nuts
saturated fats: important component of dietary
fats / storage fats: animal sources

110. Nutrition strategy
 Pre- event meal: 1 – 4 hours period before
competition. Should contain enough
carbohydrates to sustain activity
 During event: readily absorbable carbohydrate
combinations; bananas, water – melon, energy
gels, energy bars and drinks (sports drinks)
smoothies.
 Post event: carbohydrate stores should be
replenished immediately after the event; protein
intake within 1 hour post event if possible

111. Micronutrients
Play important roles in athletes’ health; needed in
small amounts; act as coenzymes / cofactors in
energy production: involved in haemoglobin
synthesis; bone health; immune function: provide
antioxidant activity: ROS > antioxidants = oxidative
stress vitamins
Vitamins
 cannot be manufactured in the body; must be
obtained from food or supplements
 water – soluble: 9 (8 Bs ; C)
 fat – soluble: 4 (A; D;E; K)
 coenzymes

112. Minerals
Potassium, sodium, calcium, iron, zinc: important
in muscle function; fluid balance and bone health
and enzyme cofactor
obtained from vegetables, cereals, salt, milk and
milk products
Chronic intake of high doses may involve risks

113. Dehydration
 poor hydration results in poor performance.
 dehydration of 2% of body mass can significantly
affect performance.
 effects include: hypovolemia and hypernatraemia
manifest as reduced stroke volume, altered
sweating, fatigue, exercise – associated collapse.
endurance events: marathons; triathlons; cycling
competitions
aggravated by hot weather
Fluid Balance
Water 60% adult human body
balance vital for health

114. Hydration Strategy
 athletes should be well-hydrated before, during
and after activity
 water is appropriate for fluid replacement
 for activities lasting more than 2 hours,
electrolyte replacement is advised
 weight gain from excessive drinking should be
avoided during activity.
 cold drinks are suggested in hot conditions
 sports drinks containing sodium are useful for
events such as marathon, and for stop- starts eg
football, sprinting etc
 energy drinks should be avoided

116.  Secure haemostasis with cotton
 Clean area with antiseptic solutions
 Suture of open and gapping
 Dress with antibiotic solution or gel
 Analgesics
 + antibiotics to prevent infection

117.  Ice pack
 Cool area
 Analgesics
 Reduce usage of the affected area

118.  If open fracture then secure haemostasis
 Immobilize with a splint
 Reduce movement of fractured limb
 Refer to hospital

119.  Types
◦ Heat edema
◦ Heat Cramps
◦ Heat Syncope
◦ Heat Exhaustion
◦ Heat Stroke

120.  Risk factors for Heat Illnesses.
◦ Lack of acclimatization
◦ Inappropriate clothing
◦ Febrile conditions
◦ Lack of conditioning

121. % of Body Wt
as Sweat
Physiological Effects
2% Impaired performance
4% Capacity for muscular work
declines
5% Heat exhaustion
7% Hallucinations
10% Circulatory collapse and Heat
Stroke

122.  Is the mildest form of heat related illness.
 Presents as pedal swelling after exercise in
the heat.
 Swelling due to pooling of blood because of
vasodilatation.
 Resolves most of the time.

123.  Present as painful spasms of mostly lower
limb muscles.
 Many muscles can be affected.
 More common in unconditioned players.
 Treatment
◦ Ice massaging (Kneading) of the affected muscle.
◦ Stretching the affected muscle.
◦ Fluid intake
◦ Rest

124.  In severe cases, intravenous IV fluid may be
necessary.
 May also give hyponatraemic salt solution.
 Frequent heat cramps may be warning signs
of impending heat exhaustion.

125.  This is a collapse after cessation of exercise.
 Player is hot, dehydrated.
 More common after exercise without cool
down.
 Treatment: Resuscitation, cooling,
Intravenous fluids if not responding.

126.  Presents as limitation of exercise with
profound sweating.
 The player becomes so tired that he can not
continue with exercise.
 Temp high 38.5 or more.
 Treatment: Resuscitation, cooling,
rehydration (oral or I.V)
 Prevention

127.  This is a medical emergency
 Core body temperature at least 40.5
 Clinically presents with neurological and
circulatory impairment.
 Patient may suffer multiple organ damage.
 If not promptly managed, mortality may be
high.
 Requires emergency management.

128. SUMMARY OF BASIC
MANAGEMENT
 Remember Heat Exhaustion not recognized and
treated promptly can lead to HS.
 Quick assessment and movement to shady cool
area.
 Immediate initiation of rapid and effective
coolong is crucial.
Cooling
 Can be external
 Ice or Cold-Water Immersion
 Ice packs under the axillae, on groin
 Ice towels
 Fanning
 Can be Internal
 Cold IV fluids, Ice-slurry fluids, Cold Lavage
 Using both methods more effective.

129.  Sports concussion is defined by the Consensus
Statement on Concussion in Sport (5th
International Conference on Concussion in Sport
held in Berlin, October 2016) as “a traumatic
brain injury induced by biomechanical forces.”
 Concussion can result from direct force to the
head or to anywhere on the body with resultant
forces transmitted to the head. Any loss or
alteration of consciousness requires a complete
examination.

130.  Concussion is the most commonly occurring
sports-related brain injury, but the clinician
must consider epidural hematomas, subdural
hematomas, subarachnoid hemorrhages, diffuse
axonal injury, and intracerebral hematomas in
the differential diagnosis.
 Suspicion of intracranial bleeding, lethargy,
emesis, worsening headaches, neck injury,
bowel or bladder incontinence, and focal
neurologic signs should elicit prompt referral to
a hospital with a neurosurgical service.

131.  Patients should be observed closely by the physician
or a responsible party and kept at rest because
exercise may exacerbate the symptoms. Relative
cognitive rest may also be necessary. After a
concussion, a protocol of graduated return to play
with progressive functional exercise is
recommended to occur over several days.
 Each rehabilitation stage should progress only if the
athlete is symptom free as he or she advances
through a day of no activity, light aerobic exercise,
sport-specific exercise, noncontact training drills,
and full-contact practice before returning to play.
Ultimately, individual clinical judgment should be
the deciding factor in return to play.
 MGT: ABC OF RSUSCITATION, Referral to hospital if
unconscious.

132. The Sports Physician’s bag is a kit containing
various items used for first Aid and sideline
treatment.
Contents Of A Medical bag
 Cotton wool
 Suture
 Surgical plaster
 Clinical thermometer
 Iodine
 Hydrogen peroxide
 Plastic (surgical/waterproof) 20 individual
wrapped, sterile, adhesive, water proof dressings
of various size.
 2 sterile eye pads with attachment

133.  Hand gloves (latex and sterile)
 Tweezers
 Vaseline
 Toilet soap
 Penicillin ointment
 A pair of scissors
 Disinfectants (dettol or savlon)
 Sterile gauze
 Sam splint for fracture immobilization

134.  Bandage (crepe, roller, triangular)
 Scissors
 Cervical collar
 Gentian violet (GV)
 Kidney dish
 BP apparatus
 A pair forceps and razor blade.
 Ice pack

135.  It is still novel in Nigeria
 Lack of investment in Sports medicine.
 Conflicts between coaches, management staff
and sports physicians.
 Lack of sports physicians/manpower

136.  Primary care sports physicians need to
understand the fundamentals of sports
medicine for the holistic care of the exercising
patients.
 Sports is now a money spinner globally
therefore sports medicine physician should have
the knowledge and skills to aid in performance
of their athletes.

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