Sports medicine is the medical care of athletes and treatment of sports injuries. In addition to medical doctors, it involves physiotherapists, podiatrists, massage therapists, nutritionists, first-aid practitioners, sports scientists and coaches. In New Zealand most of the cost of treatment for sports injuries from accidents is covered by the Accident Compensation Corporation (ACC). ACC does not cover sports injuries that result from gradual processes rather than accidents.
The following five sports were the most expensive for injury payouts by ACC between July 2010 and June 2011:
Rugby union, $56,188,339
Rugby league, $14,918,982.
New Zealander Arthur Porritt, a doctor and former Olympic sprint medallist, was a foundation member of the British Association of Sports and Medicine in 1953. Porritt encouraged Dunedin radiologist Norrie Jefferson to set up the New Zealand Federation of Sports Medicine (NZFSM) in 1963. The NZFSM worked to standardise sports injury treatment and establish training in sports medicine. The federation was renamed Sports Medicine New Zealand and by 2013 had 12 regional branches, with a national office in Dunedin. New Zealand has specialised courses in sports medicine at the Otago and Auckland medical schools.
Most injured athletes go first to a general practitioner or a physiotherapist. Sometimes athletes will then be referred on to a sports physician – a specialist in sports and exercise medicine. A large part of sports physicians’ work deals with musculoskeletal injuries. They also provide medical screenings, monitor athletes’ health concerns and check any medications athletes are taking. Some medications are banned in sport, unless the athlete gets a therapeutic use exemption.
At the 2008 Beijing Olympics New Zealand rower Mahé Drysdale came down with a severe bout of gastroenteritis just days before he was to compete. The normal treatment was intravenous fluid resuscitation, but before this could be administered the medical team had to obtain a therapeutic use exemption from the games authorities. The use of intravenous fluids was severely regulated at the Beijing games to reduce any opportunities for doping.
Sports physicians also carry out impairment assessments for injured athletes who are making claims to ACC. Sports physicians are in demand to act as team doctors for high-level sports teams such as the All Blacks (rugby), the Silver Ferns (netball) and New Zealand’s Olympic and Commonwealth games teams.
Many sports involve the risk of damage to tendons, bones or joints, with some injuries requiring orthopaedic surgery. Rugby player Michael Jones needed immediate orthopaedic surgery after severely damaging a knee during the 1989 test against Argentina in Auckland. Fellow All Black Dan Carter had to undergo ankle surgery in 2010 and a tendon operation in 2011. Cricketer Martin Crowe had a persistent knee injury throughout his career, and finally had the bone repositioned through major orthopaedic surgery.
Physiotherapists use a range of techniques, including exercise and massage, to identify and treat athletes’ health problems. They devise treatment programmes to enable rehabilitation from injuries and to help prevent future injuries. The importance of physiotherapists in modern sport was illustrated at the 2012 London Olympics, where the 31-strong health team accompanying New Zealand’s Olympic squad included 13 physiotherapists.
Massage therapy helps athletes recover from injuries. Massage promotes muscle relaxation, lowers the heart rate and blood pressure, and provides general stress relief. It is particularly useful for athletes in high-energy sports such as rugby, netball, cycling and athletics.
Sports nutritionists or dieticians design nutrition plans for athletes to help them maintain good health and maximum performance. Advice on vitamin and mineral supplement use has also become a major part of sports nutrition. Nutritional planning is particularly important when athletes are travelling overseas, where they are likely to encounter different conditions and foods. Nutritionist Christel Dunshea-Mooij devised high-carbohydrate diets for New Zealand rowers to enable maximum performance at the 2010 World Rowing Championships at Karapiro and at the 2012 Olympics in London.
In 19th-century New Zealand there was no recognition of specialised sports medicine. Injuries often occurred in sports such as rugby, cricket, boxing, cycling and horse racing. Sporting events did not have official doctors or first aid practitioners in attendance. If an injured athlete was lucky another athlete or a spectator might be a doctor. In the case of rural sports the nearest medical help could be a long way off.
The earliest recorded case of first aid being administered at a New Zealand rugby match was in Sydenham, Christchurch, on 4 July 1891. William Bowden, who had attended St John first-aid lectures, saw that an injured player had a broken collarbone. Bowden ‘immediately rendered first aid by what materials he had at hand, such as a cap folded for a pad under the armpit, a scarf from his neck for a bandage, etc.’1
In the late 1880s the Order of St John began first-aid training in New Zealand, increasing the likelihood that attendees at sports events could help injured players. By the 1910s St John brigades had become a regular presence at larger sporting fixtures. St John first aiders were known as ‘Zambuks’, a name taken from a well-known ointment for treating bruises and sprains. Early first-aid treatment was often fairly rudimentary, such as splashing water onto a minor injury, but methods have continually improved. St John provided the major medical care for events such as the 1956 Springbok tour.
From the 19th century sports clubs had ‘honorary surgeons’, often doctors who were club members, providing medical care on a voluntary basis. In the early 20th century doctors for New Zealand’s national sporting teams worked on a largely voluntary basis for home games and generally didn’t go on tour. When doctors did go overseas with sports teams, they lived on the same allowances as athletes.
Until 1964 the New Zealand Olympic team relied on doctors from the host country or on any team members or coaching staff who were also doctors. At the 1928 Amsterdam Olympics Arthur Porritt, team captain and medical doctor, treated the injured hand of boxer Ted Morgan, who went on to win a gold medal. The New Zealand team for the 1964 Tokyo Olympics was the first to have an official doctor, Renton Grigor. By 2012 the New Zealand health team at the London Olympics consisted of 31 health professionals, including doctors, physiotherapists and massage therapists.
Substantial medical support was needed when large sporting events were held in New Zealand. For events such as rugby tours, the 1974 Christchurch Commonwealth Games and the 1987 Rugby World Cup, medical back-up was mostly through the semi-voluntary efforts of doctors and St John personnel.
With the development of professional rugby from 1995, the All Blacks, and the provincial and the Super Rugby teams all recruited teams of health professionals.
New Zealand’s professional netball, football, rugby league and basketball teams all employ doctors, physiotherapists and massage therapists. The national teams for New Zealand’s major sports have similar arrangements.
Professionalism brings with it ethical dilemmas for doctors. Doctors may have to deal with pressure from coaches or managers to breach patient confidentiality or to clear athletes to play before they are ready.
Any severe impact that causes the brain to shake in the skull can result in concussion. Rugby match officials have a list of questions they ask a player to determine signs of concussion, looking for incorrect or slow answers:
What ground are you on?
Which team are we playing?
Who are you marking?
What is the score?
Which half is it?
Which team did we play last week?
Did we win the last game?
In the 19th and early 20th centuries most sporting codes paid little attention to injury prevention. Cricket players began using boxes (to protect their genitals) in the late 19th century, but did not adopt helmets until the 1970s. Until a law change in 1968 rugby players generally could not be replaced when injured. This meant badly injured players often continued with the game.
From the 1970s many sporting codes adopted protective gear and made rule changes to help prevent injuries. In rugby, for example, there were a series of changes to the laws of scrummaging to avoid back injuries. Concussion is also a serious issue in sports such as boxing and rugby. In 2013 a pitch-side concussion test was introduced to Super Rugby to prevent players from staying on the field after suffering concussion.
Drug cheating, commonly referred to as doping, is the use of banned substances to give athletes an unfair performance advantage. Doping is sometimes carried out by individual athletes, but often occurs with the complicity of team coaches and medical staff. Many performance-enhancing drugs have the potential to cause long-term health problems.
Drug Free Sport New Zealand (DFSNZ), which before 2006 was called the New Zealand Sports Drug Agency (NZSDA), works to prevent doping. DFSNZ bases its testing on an annual list of banned substances produced by the international body the World Anti-Doping Agency (WADA). Dave Gerrard, who retired in 2010 from seven years as chair of NZSDA, was also a member of the WADA Medical Committee. Wellington sports lawyer David Howman was director-general of WADA from 2003 to 2016.
The main classes of doping drugs are:
While detection methods exist for many drugs, peptides are difficult to detect as they match naturally occurring hormones. Drug detection agencies are involved in a continual struggle to develop new methods of detection as new drugs are devised.
In New Zealand DFSNZ is responsible for drug testing of athletes. DFSNZ can test any registered athletes in sports complying with the World Anti-Doping Code. National sporting organisations work with the DFSNZ to create a registered testing pool (RTP) of designated athletes from a range of codes. The athletes in the RTP make themselves available for random drug testing. Testing may occur directly after an event or on a random occasion out of competition. Urine or blood samples are taken from athletes to be tested for prohibited substances. If an athlete tests positive the case is taken to the Sports Tribunal of New Zealand, which decides whether there has been a violation and what penalty will be imposed. Penalties normally consist of a period of suspension from competition.
Athletes need to be aware of what medications they are taking for any health problems. Some medications may contain prohibited substances and require a therapeutic use exemption (TUE). Supplements can also be problematic as they can contain prohibited substances. DFSNZ operates an online service for checking the contents of medications and supplements.
The New Zealand Cycle Classic (NZCC) has to comply with tightened doping controls brought in by cycling’s international body, the International Cycling Union, in the wake of the doping scandal involving US cyclist Lance Armstrong. With stricter drug testing costing around $30,000 for each event, 2013 race organisers decided to cancel the Women’s Tour of New Zealand that traditionally followed on from the NZCC. The new testing standards made it too expensive to hold both races.
In the period from 2002 to 2010 less than 1% of the athletes tested by DFSNZ showed indications of using prohibited drugs. American and Australian tests over the same period found a similar rate.
The athletes whose cases came before the Sports Tribunal of New Zealand from 2004 to 2012 were from a range of sports including rugby league, cycling, bodybuilding, athletics, powerlifting, boxing, basketball and wrestling. About 60% of the cases that came before the tribunal were for the use of recreational drugs, with the remainder mostly for using performance-enhancing substances.
Athletes have been taking drugs to enhance performance since competitions began. 19th-century athletes were recorded using caffeine, alcohol and opium in attempts to improve their performance. New Zealand newspapers reported on doping in international cycling in 1908 and at the 1912 Olympic Games. Newspapers also debated the ethics of rugby players taking oxygen at half time to stimulate their play. New Zealand athletes did not have regular drug tests until 1989, immediately before the 1990 Commonwealth Games. Drug testing was initially supervised by the Hillary Commission and the New Zealand Olympic and Commonwealth Games Association. In 1995 the New Zealand Sports Drug Agency (NZSDA) was established; it became Drug Free Sport New Zealand (DFSNZ) in 2006.
Doping cases in sport are not all about human athletes. Racehorses have been doped to either make them run faster or to ruin the chances of a favourite winning. In 1930 the New Zealand Truth newspaper claimed that caffeine, strychnine, arsenic and cocaine had been used as stimulants for horses. ‘In years gone by it was almost an everyday occurrence to note racehorses being given “nips” of whiskey or brandy before racing, but now even this is barred!’1
There have been some prominent cases of New Zealand athletes who were caught out or confessed to doping. Commonwealth Games gold medal winning weightlifter Graham May confessed to using steroids (which had not been on the banned list at the time because there was no reliable test for them), but his offer to return his 1974 gold medal was declined. Discus thrower Robin Tait, another Commonwealth Games gold medallist, also confessed to taking steroids. Swimmer Trent Bray tested positive for the drug nandoline in 1999. He was eventually exonerated six months later by a Court of Appeal decision over the time taken to test his urine sample. In 2009 marathon runner Liza Hunter-Galvan was banned from competition for two years after being found to have used erythropoietin (EPO).
In 2004 New Zealand cyclist Stephen Swart admitted that when riding for the Motorola team in the 1995 Tour de France he and his team mates had taken EPO. Swart’s confession was to have wide-reaching consequences as one of his Motorola team mates was prominent US cyclist Lance Armstrong. The evidence Swart and others gave to the United States Anti-Doping Agency in 2012 led to Armstrong being stripped of the seven Tour de France titles he had won between 1999 and 2005.
Cyclist Stephen Swart said about taking performance-enhancing drugs: ‘I just didn’t feel comfortable with that. I regret I was put in that position and feel cheated in some ways, knowing that I had the ability to give more at a natural level but obviously that was subdued by what was going on. Maybe things can change and make it better for the generations in the future.’2
New Zealand cyclist Bruce Biddle narrowly missed out on a bronze medal for the 200-kilometre road race at the 1972 Munich Olympics. A few days after the race bronze medallist Jaime Huelamo of Spain was stripped of his medal after testing positive for the drug coramine. However, as Biddle himself had not been tested for drugs he was never awarded the bronze, despite being recognised as third place getter.
Athlete Nick Willis finished third in the 1,500 metres at the 2008 Beijing Olympics. The race winner, Bahraini Rashi Ramzi, was later found to have taken a banned substance and was stripped of his gold medal. In 2011 Willis was finally awarded the silver medal for the 2008 race.
Valerie Adams was disappointed to come second in the shot put at the 2012 London Olympics. Within days the gold medallist, Nadzeya Ostapchuk of Belarus, was found to have taken a banned substance. Adams finally received her gold medal at a ceremony in Auckland a month after the Olympics.
Hunt, Graeme. First to care: 125 years of the Order of St John New Zealand, 1885–2010. Auckland: Libro International for St John, 2009.
Mayhew, John. Doc Mayhew: rugby’s medicine man. Auckland: Hodder Moa Beckett, 2004.
Romanos, Joseph. Our Olympic century. Wellington: Trio Books, 2008.
Walsh, David. Seven deadly sins: my pursuit of Lance Armstrong. London: Simon and Schuster, 2012.