by: Dr. E.B.S. Ramanathan - Ram Sethu

1. Name & Title

Dr. E.B.S. Ramanathan
MS FRCS FRCS orth Mch orth
Senior Consultant - Orthopedics & Sports Medicine
Muscat Private Hospital & Khoula Hospital

Currently Head of Arthroscopy and Sports Medicine unit in Khoula Hospital, Muscat. Actively involved with development of Sports Medicine in Asia as the Chairman of Scientific Commission, Asian Federation of Sports Medicine (AFSM). Represented Madras University in Hockey. Sports played now - Badminton, tennis and squash.

2. Adventure sport is all about mental and physical fitness. What is the best regimen to follow to ensure physical fitness?

Anyone interested in adventure sports must realize the consequences before participating. The incidence of injuries is high in adventure sports. This is not a sport for you to play and get fit! You must be physically FIT before you start because good physical fitness is the key to avoiding injury. Physical fitness can be achieved by regular exercises and general physical activity carried out throughout the year. The training should progress gradually and this is especially important as you get older. It is also important that all muscles and body parts that undergo intensive training should be given the opportunity to rest and recover. Similarly, after a break in training due to illness or injury it is important that a reasonable level of basic fitness is achieved before adventure sports are resumed.

Only good physical training will enable a sports person to build up his muscles, strengthen his bone structure and joints and improve his co-ordination enabling him to perform well in the chosen sport. This training should be accompanied by a generally healthy life style and a balanced diet.

3. Adventure sports inevitably means aches, pains, etc. It may be minor or major… But once we're hurt, the big questions are, one, how to choose someone to treat us and two, how to know what kind of health professional to choose?

Sports is great for fitness, makes you healthy and if you excel in it makes you a professional (read rich)! The flip side to sports is Injuries, which can sometimes ruin a career or put you out of action for long periods due to the nature of the injury or sometimes due to ill-advised or inappropriate treatment. When you are injured it is not always possible to find a Sports medicine expert immediately. If it is a major injury like a fracture or severe injury to the knee or shoulder then you should go to the nearest Emergency Trauma center or Emergency Room in a hospital. Once the initial assessment is done the trauma surgeon can deal with the fracture appropriately. However majority of sports Injuries are related to soft tissues like muscles and ligaments. Such injuries cannot be treated by the average physician who may miss major injuries of the ligaments and tendons. If you have access to a Sports medicine center or expert then that would be the first choice. Otherwise choose a doctor who is interested in sports or has some experience in treating such injuries. Orthopedic Surgeons are generally the best doctors to approach for initial treatment and if necessary he can refer you to a colleague specializing in Sports Injuries. Never feel shy to ask the doctor if he has dealt with such sports injuries and how often does he treat them.

A good Sports Medicine expert is the best choice because he will advise on preparation and training, prevention of injuries and illnesses, diagnosis and treatment of injuries, and rehabilitation and return to active participation in sports.

In Western countries certified athletic trainers (ATC), Physical therapists and General Practitioners with specific training in Sports Medicine form the first line of treatment for Sports Injuries. Unfortunately in Oman we have not reached that stage although now we do have some Physiotherapists specializing in Sports Injuries. The Asian federation of Sports Medicine (AFSM) has been educating general doctors through Team Physician Development courses. As the Chairman of the Scientific Commission of the AFSM we have been running these courses in Oman and other Asian countries.

WHAT CAN YOU DO AFTER AN INJURY? R I C E
R - Rest
I - Ice
C - Compression - with a bandage
E - Elevation to reduce the swelling

Apply Ice as soon as possible after the injury and continue for 48 to 72 hours. Do not apply the ice directly on the skin but put it inside a polythene bag or roll it in a thin towel and apply it two to three times a day, for 10 to 20 minutes each time. For chronic strains use ice after every workout. Ice helps to reduce the swelling by reducing bleeding. Use heat only after 3 or 4 days after the injury.

4. What is the level of preparedness required to indulge in any adventure sports? And what about right diet? Should consumption of water be the top priority?

As I had mentioned earlier, Adventure sports requires good physical fitness for performance and to avoid serious injuries along with mental toughness. It is not for the weak-hearted. Choose your sport carefully and ensure it suits your physical and mental aptitude. Personal characteristics such as temperament and maturity may affect the tendency to take or avoid risks.

Whether you like to climb Mt. Everest or walk across the Wahiba sands, you need to know how to fuel your body with right nutrients. A balanced and nutritious diet including adequate fluids, is a prerequisite for sporting activities. A good diet will not make an average athlete world class, but a poor diet will make a world class athlete average! Diets must be individualized and contain adequate calories according to the demands of the sport. Majority of the calories should come from Carbohydrates (60 - 70%) with low fat to facilitate high carbohydrate intake and contain adequate protein ( 1-2 gms of protein / kg body weight or 10 - 12 % of calorie intake).

Water is the most critical element in the diet especially in hot climates and endurance type activities. During moderate activity the body may lose 2000 ml per day but on a hot and sweaty day it could increase to 2000 ml per hour! For exercising upto one hour it is adequate to replace fluids with water but in longer activities and in hot weather, electrolytes (Sodium, Chloride, Calcium, magnesium etc.) lost in sweat may need to be replaced. Most of the sports drinks available in the market cater to this adequately. Generally fluid should be replaced by drinking small volumes frequently and cold beverages to reduce the core temperature. Thirst is not a reliable stimulus for fluid needs hence fluids should always be accessible. Hydrating for an event starts before the sport and continues during and after the event.

5. What should an adventure medical kit contain?

A standard medical kit will contain essential items to deal with medical and traumatic emergencies. It is not possible to take all medications that are required. However a basic kit should include simple pain killers like Paracetomol, Tylenol, NSAIDs like Brufen or Olfen, and a stronger analgesic like Tramadol (tablet and Injection). An antibiotic (Augmentin), anti-histamine (Claritine), eye and ear drops. Every medical kit should also contain Injection Epinephrine and Injection Methylprednisolone in case of anaphylactic emergencies. Anti-diarrhoeal tablets (Imodium), Antacid (Mucaine) and tablets for acidity (Zantac), Oral Rehydration sachets & fluids should form part of the kit especially in warm climates. A local anaesthetic solution with a suturing kit, gloves, variety of dressings including Bandaids, Tapes and bandages are always handy.

The kit should also have a variety of splints including finger splints, knee supports, cervical collars and Lumbar supports, straight splints for immobilization during transfer in case of fractures.

6. Can anyone get into adventure sports or should one possess certain physical traits..?

'Sports for all' is the slogan today but Adventure sports is only for the mentally tough and physically fit person. A basic level of physical fitness is mandatory along with an adventurous spirit. You must choose your sport carefully. If you have fear for heights then avoid mountain climbing / rock climbing. If swimming is not your forte then avoid water sports. If you are not thrilled by speed then motor rallying and downhill skiing are not for you. The list is endless but you need to exercise caution before you choose a sport that is suitable to your mental attitude and physical fitness. If you are not adventurous then stick to the regular sports.

7. Could you provide some tips - dos and don'ts - for all adventure sports wannabes?

AGE - affects the strength and resilience of the tissues and this begins to decline around 30 to 40 years. Reflexes also diminish with age. Keep this in mind if you are a late starter.

WARM UP - Insufficient warm-up may contribute to muscle and tendon injuries. This is well documented. Warm-up exercises are designed to prepare the body for the ensuing sporting activity and help to prevent injury and enhance performance. Warm up exercises should begin with movements of the large muscle groups and then more specialized exercises can begin. Tight muscles are prone for injury, hence stretching major muscle groups before sports is important.

EXPERIENCE - is important. Beginner's often suffer more injuries than experienced athletes. Taking lessons from a professional expert will go a long way to better your performance and avoid the early injuries.

EQUIPMENT - Make sure you use standard equipment.The equipment should be safe and adequate without defects. Appropriate protective gear like helmets and guards should be worn according to the demands of the sport.

DIET - A balanced and nutritious diet, including adequate fluids is a prerequisite for sporting activities especially in hot climates.

HEALTH PROBLEMS - Infections and flu-like illnesses increase the risk of complications such as inflammation of cardiac muscle. No athlete should participate in training or competition until his temperature has returned to normal after an illness.

GENERAL MEASURES - including sufficient rest and sleep, and avoiding alcohol, reduce the risk of injury.

Dr. E.B.S.Ramanathan
MS FRCS FRCS orth MCh orth