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Sailing and Sports Medicine
Injuries occurring in sailing have been widely neglected over the years. Sailing medicine or sports injuries in sailing have only be taken seriously by physicians who call sailing their hobby. This was partly due to the fact, that sailing is certainly not a sport for the masses and also, until recently, sailing was not really considered a high profile sport.
However, the old view is changing rapidly. Big races like the “America’s cup” draw a massive audience on TV and attract big name brands and companies as sponsors.
Sailing as a professional sport has been taken more seriously and with it the injuries in sailing.
A very thorough study by Allen et al in 2000 (1, 2) showed that especially grinders and bowmen suffered substantial injuries. Top three anatomic locations of an injury were lumbar spine (16%), shoulder (16%) and knee (10%). This study has been carried out with contributions from all 12 America’s Cup teams.
Neville et al confirmed that grinders indeed had the highest overall incidence of an injury with 7, 7 %. Again they were looking at America’s Cup sailors. (3)
Anterior Cruciate Ligament Repair in an America’s Cup Sailor
Mid September 2006 the 32 year old grinder of the America’s Cup Team Germany presented himself to Alphaklinik, Munich with pain and swelling in the right knee.
He reported twisting his knee five days earlier during a training session in Valencia, Spain
and wanted to fly to Munich to seek advice of a Dr Jürgen Toft, the renowned knee specialist.
His right knee was swollen, bruised and had a rotation instability. Lachman, Pivot and anterior drawer test were positive. MR scan confirmed the suspected diagnoses of a torn anterior cruciate ligament.
Surgery was carried five days later. To replace the torn tendon, a donor patella tendon was used. As the patient is 188 cm tall and weighed around 103 kg, the surgeon felt it safer to use a donor tendon instead of using his own patellar or hamstring tendon. Also, as a grinder the patient exerts special force onto his knees, upper and lower legs and absolutely needs stability.
The patient was mobilized right after surgery and was given a Brace.
Since the clinic specializes in knee injuries and has it´s own physio-center, extensive therapy was started right away consisting of: physical therapy with manual treatment, ice, magnetic stimulation, matrix therapy, muscle stimulation, iontophoreses and lymph therapy. Medical supervision was conducted on a one to one basis in order to meet all the needs of a professional athlete.
The patient was given low dose NSAID`s for pain management and enzymes/homeopathic remedies to promote healing.
The patient left for the training camp in Valencia 4 weeks after surgery and is still continuously monitored.
Background
The examination of an injured knee is quite difficult and the signs of a torn cruciate ligament are quite subtle and require an experienced examiner to diagnose and an even better surgeon to repair.
Often, the patient escapes the right diagnoses and suffers for many months.
Fortunately, high performance athletes receive better medical attention. However, it still also depends on the sport. Everyone is aware of the risk of a torn ligament in soccer, Most often there is a one to one contact of the players or the player lands with a dramatic jump on a bent knee. Visible for everyone - on pitch and on screen.
Major difference in sailing: no witnesses, no exact injury reproduction. The other team members mostly are busy doing their job on the boat – and especially during a race – there is a high amount of speed involved.
Interestingly enough, the incidence of sustaining an injury during a training session is significantly higher than during sailing (8.6/1000 sailing hours versus 2.2/1000 sailing hours, respectively) (3) Neville names the decreased training intensity and the reluctance of the crew to indicate any injuries for fear of losing their position during the race.
This can be dangerous especially when a torn ligament is involved, as there are certain windows open for perfect surgical timing
(pictures with friendly permit from Alphaklinik in Munich, Germany)
The choices of material to replace the torn ACL of the patient include:
the patients own patellar tendon (80% worldwide), the patients own hamstring tendons (15%) and the use of a donor allograft tendon.
Using the iliotibial tract is also in use with promising results.
There are pros and cons to all the methods and the surgeon has to evaluate carefully the demands and needs of the patient. Only experienced or specialized surgical centers are recommended.
Also, taking care of the athletes is a increasingly demanding for the attending physician and should comprise regular assessments including: Medical check up´s, physiotherapy, conditioning programmes and also taking care of nutrition
For further information please visit: www.alphaklinik.com and www.physioroom.com
1,Allen JB, Dent D, Andrews JR, et al. Sports medicine injuries in the America’s Cup 2000. NZ J Sports Med. 2006
2,Allen JB. Sports Medicine Injuries in the America’s Cup 2000. In: Legg SJ, ed. Human performance in sailing conference proceedings: incorporating the 4th European Conference on Sailing Sports Science and Sports Medicine and the 3rd Australian Sailing Science Conference. Palmerston North, New Zealand: Massey University, 2003:45–6.
3, Neville V, Molloy J, Brooks J. Epidemiology of injuries and illnesses in America’s Cup yacht racing. Br J Sports Med 2006; 40:304–11.
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