REVIEWS OF CLINICAL SPORTS MEDICINE

The Australian Pharmacist 

Professor Andrew McLachlan, Senior Lecturer, Faculty of Pharmacy, University of Sydney

Who wrote this book?

This Australian text has contributions from Australian and International experts in the fields of sport, sport clinics, academics, researchers, sports physicians, physiotherapists, surgeons, psychologists and nutritionists. Drawing the contributions from across a range of health professions is no mistake because the authors discuss sports medicine in the book using a multidisciplinary team approach for the prevention and management of medical problems in sport participants.

The Approach and Content

This book takes a systematic approach to sports medicine by dividing the chapters into 6 major categories which include a consideration of fundamental principles, issues related to regional medical problems (eg shoulder or ankle pain), optimising sporting performance, the needs of special groups of participants in sport, management of medical problems in sport participants and some logistical and practical aspects of sports medicine (including drugs and the ethics of sports medicine). This approach presents a readily useable format to the reader making this an excellent reference text on a range of cross disciplinary issues and management strategies. Central to the approach is to outline some key principles essential to the management of medical conditions in sports men and women. The principles of injury prevention, diagnosis, treatment and rehabilitation form the basis for extensive chapters. The chapters related to the consideration of sports men and women with special needs (eg diabetes and epilepsy) provide interesting reading and a valuable insight into the medical issues for an expanding base of participants in sport.

What about drugs?

To be useful information about drugs needs to be sound and in keeping with current trends in the quality of use of medicines across all areas of medicine. While this text has no specific chapter on the use of medicines in sports men and women there are sections on pharmacological management of pain and inflammation and the use of drugs in a range of chapter related to treatment of medical problems. To take one important example presented in Chapter 8, there is little attention provided to establishing a systematic approach to analgesia (eg using the Analgesic Guidelines or even the WHO guidelines). For example, paracetamol the first line analgesic receives little attention despite the fact it was the most widely prescribed drug in the Polyclinic at the Sydney 2000 games. Topical NSAIDs are mentioned here as being equally effective to systemically administered NSAIDs which is in contrast to the recommendation in the Australian Medicines Handbook 2000 which suggests that these treatments have the lower efficacy that both paracetamol and systemic NSAIDs. A balanced discussion of the use of NSAIDs is presented and includes both the benefits and the risks (which may be understated for the broader sport participant community). The key issue of avoiding the use of these drugs in people with increased risk of adverse effects (eg previous or active peptic ulcer disease) is not well documented. Furthermore, a table displaying NSAIDs in "common use" lists the product Ecotrin (Aspirin 650mg) which is no longer appropriate (or available). Selective COX-2 NSAIDs (eg celecoxib) played a significant role in sports medicine at the Sydney 2000 games and are being widely prescribed for sports men and women in the community. These drugs are only introduced in the book but I am sure the 3rd edition will provide more information relevant to sports medicine.

Drugs in Sport

Chapter 55 deals with drugs and the athlete and focuses on issues related to doping and the use of illicit drugs. The chapter brings the IOC banned drugs into a historical perspective with a practical focus of providing information relevant to the use of different agents. The use of many examples and a discussion of testing methods (eg for anabolic steroids) provides the reader with a broader understanding of this interesting area. A significant challenge for health professionals and sports participants is the use of supplements. A sound overview of this area is presented in this chapter and other places throughout the book.

Evidence based?

This book provides a list of recommended reading at the end of each chapter as well as a list of references cited in each chapter. However, the later is not consistent throughout this text to allow the reader to make their own assessment of the evidence base on which treatments and recommendations are made. It is also acknowledged that in drawing together a comprehensive text such as this that space is a premium.

What can this book offer the pharmacist?

This is a multidisciplinary text - designed to meet the needs of the Sports Medicine Team which is the approach advocated by the authors. Interesting is that there is no specific inclusion of the pharmacist in this team despite the important role that pharmacists played in the Polyclinic during the Sydney 2000 Olympic and Paralympic games. While this is disappointing, a clear role can be seen for allied health care professionals (such as pharmacists) contributing to the treatment or prevention of medical problems in sports men and women. Advice about the appropriate use of medicines and supplements is an obvious area of contribution of the pharmacist to the team.

The bottom line

At a RRP of $110 this text of over 900 pages with more than 90 pictures and probably hundreds of tables provides an excellent addition to the armory of the pharmacist interested in or working with sports men and women. A strength of this book is that it is not all focused on elite athletes who represented about 5% of  sport participants but much is relevant to the broader sport participants in the community.