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Medical Support at the Olympic Games

Koji Kaneoka
Professor, Faculty of Sport Sciences, Waseda University/Chairman, Medical Committee, Japan Swimming Federation

As in the famous words of Coubertin that "the most important thing in the Olympic Games is not winning but taking part," the Olympic Games have significance in terms of participation. The significance of taking part only emerges, however, after making efforts and preparing fully to maximize the performance in the games. All of the national team players are elite athletes who have gone through tough competitions. For these players to achieve good results in tough close competitions, an all-out support system is also necessary. Support for players includes an improved practice environment where players can concentrate on their play, career support including job assistance, conditioning to control their physical condition just before competitions, and medical support, as the measures against injuries or chronic problems. In the London Olympic Games, a multi-support house was established to support the conditions of the players with the budget of the Ministry of Education, Culture, Sports, Science and Technology, which was reported as the "Multi-Support House That Contributed to the Winning of the Largest Number of Medals in History-The Front-Line Base Functioned in London" (Number, 811th issue, September 3, 2012).

I have worked in the medical support of competitive swimming as an orthopedic surgeon, sport doctor and member of the medical committee in the Japan Swimming Federation (JSF), and accompanied the national swimming team as a team doctor in the Sydney, Athens, and Beijing Olympics. The most important purpose of medical support in competitions is to avoid a decrease in the competitiveness of players due to injuries or chronic problems. Injuries are not common in swimming, but many swimmers suffer lower back pain. Swimming is generally used as an exercise to alleviate lower back pain, because it has little physical load. Top athletes, however, swim for nearly 10,000 meters every day, which puts a load on the lower back, causing various disorders. I have seen some athletes with lower back pain who had to withdraw from the Olympic race, or who shed tears because they could not perform well. Therefore, prevention of lower back pain is one of the important challenges of medical support.

The first thing to do to prevent disorders is to determine what causes lower back pain. Because lower back pain is a common, general symptom, many people do not seem to think deeply about its causes. There are two major types (pathologies) of lower back pain: one originating in the intervertebral disk and the other in the posterior joint (facet joint). These two account for 80% of lower back pain in athletes. The remaining 20% includes disorders in the sacroiliac joints, muscles, fascias and muscle attachment sites. Among these various pathologies of lower back pain, pain originating in the intervertebral disk persists and causes decreased competitiveness if it occurs right before the competition.

In the process of establishing measures to prevent intervertebral disk lower back pain, it became necessary to determine whether lumbar intervertebral disk disorders are actually common in competitive swimmers, and if so, to clarify how we can prevent them. For this purpose, I received a scientific research grant from the Ministry of Education, Culture, Sports, Science and Technology under the subject of clarification of the development mechanism of lower back disorders in competitive athletes, and the development of preventive measures. With this subject as the main theme of my laboratory, I have conducted research with students. From this research, we have obtained various results. We first found that the incidence of lumbar intervertebral disk degeneration (decreased water content) is actually high in competitive swimmers1) and the function of deep trunk muscles is important to stabilize the spinal column during swimming.2) Based on these results, we concluded that deep trunk muscles must be strengthened to prevent lower back disorders in swimmers.

Figure 1 Experiment for muscular activity analysis of deep trunk muscles

Deep trunk muscles are also known as core muscles and have recently been drawing attention. Various training methods have been devised for these muscles, but it is yet to be determined which is the most effective or efficient method. We thus tried to identify the training method that maximizes the activities of transversus abdominis and multifidus, which are representative deep trunk muscles, by an electromyographic experiment.3)

Deep trunk muscles are considered not only to have preventive effects against lower back disorders by stabilizing the trunk, but also to have various benefits, such as improving the competitive performance, helping prevent injuries in the lower extremities by improving balance, being useful as an exercise therapy for regular people with lower back pain as well as for athletes4), and being which is expected to be effective for the prevention of falls in elderly people. The resolution of issues in competitive sports spread widely to various areas and yielded by-products in such a manner, just as NASA's research results for space development led to the development of items that improved our life. An NHK TV program called Tameshite Gatten covered this topic and reported that regular people can take advantage of training methods that are used for top athletes.

No matter how valuable our research findings are, these findings would be meaningless unless we can utilize them and accomplish certain results. Cooperation among medical support staff is essential to utilize new findings for competitive swimming. This is the reason why the JSF holds medical staff meetings to promote communication among physicians, trainers, and support staff, aiming at the sharing of medical information. Such information is also delivered at workshops for coaches, leadership training sessions, and seminars for trainers sponsored by the JSF, allowing many swimming coaches to learn about the latest findings.

Physical trainers have taught and practiced training methods centered on deep trunk muscles for a long period for national team players in the London Olympic Games. We have also performed medical checks every year to check the status of the lumbar intervertebral disk and offer the results for Olympic candidates. In the swimming race of the London Olympic Games, all players were able to compete in the race in excellent conditions without experiencing loss of their competitiveness due to lower back pain. These supporting activities might have worked well.

Figure 2 An athlete doing deep trunk muscle training at camp just before the London Olympic Games

Figure 3 Instruction for deep trunk muscle training by a physical trainer

In the London Olympic Games, the media reported that Japanese swimmers won 11 medals (3 silver and 8 bronze), which is the largest number of medals since the war. The number of medals ranked second in the world after the United States. High school students played an active role and achieved remarkable results that give us hope for the next generation, as expressed in the London Olympic Games' slogan "inspire the generation." The continued efforts of players and the longtime passion of coaches led to excellent achievements. I also believe that the practice of medical support based on scientific evidence described here is another factor contributing to such excellent achievements.

The Olympic Games are battles among countries, and the results depend on each country's preparations and efforts toward sports. Excellent achievements in sports uplift the spirit of people and have positive psychological effects. Exploration of sport-related science deepens our understanding about our body and shows us how to lead a healthier life. Sport sciences will play a more significant role in the future.

Figure 4 A swimmer who won a bronze medal in the 100 m backstroke and medley relay and the author

References

1) Kaneoka K et al. "Lumbar Intervertebral Disk Degeneration in Elite Competitive Swimmers: A Case Control Study." The American Journal of Sports Medicine 35: 1341-1345, 2007.
2) Nakajima M, Miura Y, Kaneoka K. "Simulation of Lumbar Load and Behavior in Swimming and Its Experimental Verification." Biomechanism 18: 45-56, 2006.
3) Okubo Y, Kaneoka K et al. "Electromyographic Analysis of Transversus Abdominis and Lumbar Multifidus Using Wire Electrodes During Lumbar Stabilization Exercises." Journal of Orthopaedic & Sports Physical Therapy 40: 743-750, 2010.
4) Ota M, Kaneoka K et al. "The Effectiveness of Lumbar Stabilization Exercise for Chronic Low Back Pain-The Thickness and Asymmetry of Abdominal Muscles." Japanese Journal of Clinical Sports Medicine 20 (1): 72-78, 2012.

Koji Kaneoka
Professor, Faculty of Sport Sciences, Waseda University/Chairman, Medical Committee, Japan Swimming Federation

[Profile]
March 1988: Graduated from the School of Medicine and Medicinal Sciences, University of Tsukuba, resident at the University of Tsukuba
March 1998: Graduated from the Doctoral Program in Medicine, University of Tsukuba
April 1998: Medical Director, Department of Orthopedic Surgery, Tokyo KoseiNenkin Hospital
July 2000: Lecturer, Institute of Clinical Medicine, University of Tsukuba
April 2007: Associate Professor, Faculty of Sport Sciences, Waseda University
April 2012: Professor, Faculty of Sport Sciences, Waseda University

Certified orthopedic specialist, the Japanese Orthopedic Association; certified sport doctor, the Japan Sport Association; certified clinical instructor in spine and spinal cord surgery, Japanese Spine Research Society; certified physician in the spine and spinal cord disease, the Japanese Orthopedic Association; chairman, Medical Committee, the Japan Swimming Federation

[Accompanying activities in competitions]
Swimming team doctor, the 27th Olympic Games in Sydney, 2000
Swimming team doctor, the 28th Olympic Games in Athens, 2004
Swimming team doctor, the 29th Olympic Games in Beijing, 2008
JOC team doctor, the 30th Olympic Games in London, 2012

(As of April 2012)