Editor-in-ChiefDr Peter N. SperrynMB, FRCP, FACSM, DPhysMed

EditorsSurgery: Mr John F. DooleyFRCS, FRCS(C), (Hillngdon, UK)Science: Dr Ron MaughanPhD (Aberdeen, UK)Physiotherapy: Mr Julius SimBA, MSc, MCSP(Coventry, UK)

Statistical ConsultantsMr F.M. Holliday, MA, DLC, FSS(Loughborough, UK)Mr Simon Day, BSc (London, UK)

Regional Corresponding EditorsBelgium: Prof. M. Ostyn,MD (Leuven)

Brazil: Prof. Eduardo H. DeRose,MD (Porto Allegre)

Bulgaria: Dr Virginia Michaelova,MD (Sofia)

Caribbean: Dr Paul Wright,LMSSA (Kingston, Jamaica)

Cote D'Ivoire: Prof. Constant Roux,MD (Abidjan)

France: Dr Pierre Berteau,MD (Rouen)

Biflig s~r"0 V

-wA! _AI _ vr

Editorial BoardProf. Dieter Bohmer,MD (Frankfurt, Germany)

Dr K.M. Chan,FRCS (Hong Kong)

Dr David A. Cowan,BPharm, PhD, MRPharmS (London, UK)

Dr Wendy N. Dodds,BSc, MRCP (Bradford, UK)

Dr Adrianne Hardman,PhD (Loughborough, UK)

Mr Basil Helal,MCh(Orth), FRCS (London, UK)

Dr G.P.H. Hermans,MD, PhD, (Hilversum, Netherlands)

Prof. Ludovit Komadel,MD (Bratislava, Czechoslovakia)

Prof. W.P. Morgan,EdD, (Madison, Wisconsin, USA)

Prof. Tim D. Noakes,MD, FACSM (Cape Town, South Africa)

Groupement Latine:Dr Francisque Commandrd,MD (Nice)

Hungary: Dr Robert Frenkl,MD (Budapest)

India: Dr D.P. Tripathi,MB, BS, MCCP (Patna)

Indonesia: Dr Hario Tilarso,MD (akarta)

Malaysia: Dr Ronnie Yeo,MB (Kuala Lumpur)

Maroc: Dr Naima Amrani,MD (Rabat)

Prof. Qu Mian-Yu,MD (Beijing, China)

Dr Allan J. Ryan,MD (Edina, Minnesota, USA)

Prof. N.C. Craig Sharp,BVMS, PhD, FIBiol (Limerick, Eire)

Prof. Roy J. Shephard,MD, PhD (Toronto, Canada)

Prof. Harry Thomason,MSc, PhD (Loughborough, UK)

Prof. K. Tittel,MD (Leipzig, DDR)

Dr Dan S. Tunstall Pedoe,MA, DPhil, FRCP (London, UK)

Prof. Clyde Williams,PhD (Loughborough, UK)

Dr William F. Webb,MB, BS (Sydney, Australia)

New Zealand: Dr Chris Milne,MB, ChB, DipSportsMed (Hamilton)

Pakistan: Dr Nishat Mallick,FPMR, FACSM (Karachi)

Spain: Dr J. J. Gonzalez Iturri,MD (Pamplona)

Thailand: Dr Charoentasn Chintanaseri,MD (Bangkok)

Uganda: Dr James Sekajugo,MB, Dip.SportsMed. (Kampala)

USSR: Dr Sergei Mironov,MD (Moscow)

The British Journal of Sports Medicine is aninternational journal published quarterly in March,June, September and December by Butterworth-Heinemann Ltd.The British Journal of Sports Medicine covers

all aspects of sports medicine and science: themanagement of sports injuries; all clinical aspectsof exercise, health and sport; exercise physiologyand biophysical investigation of sportsperformance; sports psychology; physiotherapyand rehabilitation in sport; and medical andscientific support of the sports coach.

Publishing, Editorial Production and ReprintOffices: Butterworth-Heinemann Ltd, LinacreHouse, Jordan Hill, Oxford OX2 8DP, UKTelephone: +44 (0)865 310366. Facsimile: +44(0)865 310898. Telex: 83111 BHPOXF G.

Publisher: Sue DeeleyGroup Editor: David HughesEditorial Services Manager: Ian SalusburyAssistant Editorial Controller: Pat RobertsEditorial Assistant: Catherine Zank-McKelveyAddress for submissions: Dr P. N. Sperryn, TheEditor, British Journal of Sports Medicine,Butterworth-Heinemann Ltd, Linacre House,Jordan Hill, Oxford OX2 8DP, UK

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FULL COVnERAGE OF ALL ASPECTS OFSPORTS MEDICINE AND SCIENCE

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Br J Sp Med 1994; 28(1)

From the journals

Sports medicine current awareness service

Prepared by Jayne Makepeace at the National Sports Medicine Institute (NSMI) Library

The following summaries are takenfrom a selection of recent journalsindexed in the NSMI database. A fulllisting is published monthly in SportsMedicine Bulletin.

Copies of the complete articles areavailable (price 15 pence pey sheetsubject to the Copyright, Designs andPatents Act, 1988) from the Library,NSMI, c/o Medical College of StBartholomew's Hospital, Charter-house Square, London EC1M 6BQUK. (Tel: 071 251 0583).To attempt to throw some light on theissue of the trainability of children ameta-analysis of the literature hasbeen conducted by V. Gregory Payneand James R. Morrow (Exercise andVO2max in children: a meta-analysis,Research Quarterly for Exercise & Sport1993; 64(3): 305-13). They restrictedtheir analysis to experiments on chil-dren under 13-years old that deter-mined training effects on maximaloxygen uptake, measured by cycle ortreadmill ergometry. Results indicatedthat reported changes in maximaloxygen uptake are small to moderateand are a function of the experimentaldesign used: the training effect forpretest-posttest experiments wasfound to be half that of cross-sectionalstudies, indicating that the latter couldhave been affected by factors such assubject self-selection.

Blair G. Whitmarsh and Richard B.Alderman have investigated the Roleof psychological skills training inincreasing athletic pain tolerance (TheSport Psychologist 1993; 7(4): 388-99) inan experiment testing the pain-reducing effects of stress inoculationtraining (SIT). Forty-five enduranceathletes were tested to see if SITaffected how long they could maintainthe 'phantom chair' position. SITconsists of three stages - conceptuali-zation, skills acquistion with rehearsalan application with follow-through.Subjects were given either no SITtraining (control), skills acquisitiontraining only, or full SIT. Tolerancetimes of those in either SIT group weresignificantly greater than the controlgroup (F(4, 84) = 2.51, P < .048).

© 1994 Butterworth-Heinemann Ltd0306-3674/94/010065-02

These results suggest SIT may assistathletes in tolerating higher levels ofpain. Although subjects who had fullSIT were more realistic about thelevels of pain suffered than those whodid not, only the skills acquisitionphase was needed to increase per-formance.

Reports have shown that between15 and 62% of female athletes appearto show pathogenic weight-controlbehaviours. Thus many athletes are atrisk of developing what is termed the'female athlete triad' - disorderedeating, amenorrhoea and oesteopor-osis. Prevention and management isdiscussed by Aurelia Nattiv and Lyn-da Lynch in The female athlete triad:managing an acute risk to long-termhealth (Physician & Sportsmedicine 1994;22(1): 60-2, 65-8). The typical patientis an adolescent obsessed with beingthin because of the belief that perform-ance is linked with leanness. Theathlete may develop amenorrhea, de-creasing oestrogen levels which maylead to premature osteoporosis. Thepreparticipation physical exam is theideal opportunity to screen for ele-ments of the triad; signs of disorderedeating to watch for are a decreasedpulse rate, hypotension, hypothermia,parotid gland swelling, lanugo hair orirregular periods. The usual treatmentis improving nutrition, although areduction in training intensity may berequired and hormonal interventionmay be needed for the resumption ofmenstruation.Also addressing factors affecting

female athletes, Constance M. Lebrunreviews the Effect of the differentphases of the menstrual cycle and oralcontraceptives on athletic perform-ance (Sports Medicine 1993; 16(6):400-30). Retrospective surveys showthat 37-63% of athletes report thatperformance is not affected by thestage of the cycle, while 13-29%report an improvement during men-struation.) Best performance havebeen shown to be in the immediatepostmenstrual days, with the worstperformances during the premenstrualinterval and the first few days ofmenstruation. Premenstrual symp-toms have been shown to affectneuromuscular coordination, manualdexterity, judgement and reaction

time, but confounding variables mayinclude nutrition status and bloodsugar levels. During the luteal phasethere is a decrease in aerobic capacityand an increase in endurance perform-ance, and also reports of a decrementof isometric strength and endurance.Surveys on the effects of oral con-traceptives have shown that half thewomen did not notice any differencein performance and 8% even noted animprovement whilst taking contracep-tives, although recent investigationshave shown that they cause a slightdecrease in aerobic capacity andisometric endurance. Musculoskeletalinjuries are reduced, possibly becauseof a reduction of dysmenorrhoea andpremenstrual symptoms.The accuracy of using magnetic

resonance imaging (MRI) in the di-agnosis of knee injuries has beeninvestigated in a recent prospectivestudy (G. G. Q. Russell and others,Imaging studies in surgically provenchondromalacia patellae, Clinical Jour-nal of Sport Medicine 1994; 4(1): 11-3).The authors compared results of plainradiography, double-contrast and CTarthrography, and MRI in 21 patientswith a clinical diagnosis of chondro-malacia patellae, prior to surgery.Surgery confirmed the diagnosis in 16of the patients, and compared to thesediagnoses the arthrography was 65%accurate, with a sensitivity of 91% andspecificity of 33%. For the CT arthro-graphy accuracy was 67%, sensitivity3% and specificity 33%, and for theMRI the accuracy was 71%, sensitivity58% and specificity 89%. Thus MRIwas not significantly more accuratethan the other imaging modalities.Three years of registration, injuries,

infections and stretching behaviouramong 55 national class orienteers ispresented in a recent article by F.Johannsen and B. Stallknecht (Train-ing, injuries and infections amongelite orienteers, Scandinavian Journal ofMedicine & Science in Sports 1993; 3(4):273-8). Overuse injuries were foundto be the major problem, affectingtraining for an average of 35 days perrunner per year, compared with 7days for acute injuries and 10 days forinfections. The acute injuries weremainly direct traumas and ankle dis-tortions. Overuse injuries affecting the

Br J Sp Med 1994; 28(1) 65

knee region were the most numerous,but rear foot injuries affected trainingthe most. Stretching was not found toprevent injuries.Under certain circumstances aerobic

exercise may increase the productionof highly reactive oxygen radicals.Robert R. Jenkins discusses the subjectin Exercise, oxidative stress, andantioxidants; A review (InternationalJournal of Sport Nutrition 1993; 3(4):356-75). Oxygen radicals react withthe hydrogen from polyunsaturatedfatty acids, which themselves thenbecome radicals, reacting with otherfatty acids in the same way in a chainreaction. If radicals react with cellmembrance constituents they can alterthe membrane's integrity, and bydegrading synovial fluid they may beinvolved in joint injury. Substancessuch as vitamins E and C are part ofthe body's defences as they break thechain reaction by reacting with radic-als without becoming radicals them-selves, and vitamin supplementationhas been shown to augment thedefences. A recent study has ex-amined one aspect of this subject, theEffect of antioxidant vitamin sup-plementation on muscle function af-ter eccentric exercise (P. Jakeman & S.Maxwell, European Journal of AppliedPhysiology & Occupational Physiology1993; 67(5): 426-30). In a double-blindstudy, 24 subjects took either placebo,vitamin E or vitamin C (all 400 mg/day)21 days prior to and for 7 days afterperforming 1 hour of box-steppingexercise. Contractile function wasassessed by measuring maximalvoluntary contraction and the ratio ofthe force generated at 20 Hz and 50Hztetanic stimulation in the triceps surae

before and after the exercise and for 7days during recovery. Both recoveryof MVC in the first 24 hours post-exercise and the decrease in 20/50Hzratio of tetanic tension were signifi-cantly affected postexercise in subjectssupplemented with vitamin C but notwith vitamin E. Thus, prior vitamin Csupplementation may exert a protec-tive effect against eccentric-inducedmuscle damage.The nutritional needs and practices

of soccer players have been reviewedby Donald T. Kirkendall (Effects ofnutrition on performance in soccer,Medicine & Science in Sports & Exercise1993; 25(12): 1370-4). Soccer is aglycogen-depleting activity but thedelivery habits of soccer playersappear to be inadequate to replenishmuscle glycogen after a game ortraining session. As games are oftenscheduled from 24 to 72 hours apart,the players often go into the subse-quent game with less than adequatemuscle glycogen stores. The use of aglucose polymer supplement has beenshown to increase work volume andrate, but the main recommendation isthat soccer players have their foodselection habits reviewed.

Brian R. MacIntosh and others haveinvestigated a noninvasive techniquefor estimating the fibre type composi-tion of mixed muscle (Human skeletalmuscle fibre types and force:velocityproperties, European Journal of AppliedPhysiology & Occupational Physiology1993, 67(6): 499-506). They use the Hillequation, a mathmatical model de-scribing muscle force: velocity relation-ships, which, as the authors show,demonstrates that peak power andoptimal velocity should be predictive

of fibre distribution. To test the predic-tive powers of this method, peakpower and optimal velocity weredetermined from the results of iso-kinetic dynamometry on 31 subjectsby either direct measurement, linearregression, or fitting the data to theHill equation. The optimal velocityand peak power values were thenused in the Hill equation to predictmuscle fibre distribution, and theactual values subsequently determinedby biopsy of the vastus lateralis of eachsubject. The equation did predict fibrecomposition, with values calculated bythe Hill equation giving the bestcorrelation (r > 0.5 for peak power oroptimal velocity and percentage offast-twitch fibres).The physiological demands of sail-

ing at Olympic level have been investi-gated by Claudio Gallozzi and others(The energetic cost of sailing, MedicalScience Research 1993; 21(23): 851-3).The energy costs of sailing in aninternational regatta in undemandingweather conditions were measured infour athletes using the K2 Cosmed.This apparatus does not impair per-formance as it consists of only a facemask and jacket with waterproof dataanalyser-transmitter attached. Aver-age heart rate for each athlete rangedfrom 106-150 beats min-, with peaksof 190 beats min. Average oxygenuptake values ranged from 10.7 to20.5mlmin-1kg-1, with a maximumof 40mlmm-1kg-1. Unlike othersports with postural and directionaldemands, heart rate seems to beinfluenced by emotional factors ratherthan by oxygen uptake. The investiga-tors concluded that the energy cost ofsailing is low.

66 Br J Sp Med 1994; 28(1)

Br J Sp Med 1994; 28(1)

BASM news

British Association of Sport and Medicine

We regret to announce the death of our Patron, Lord Porritt. An obituary will appear in our June issue.

NEWS SNIPSAt the Extraordinary General Meeting of the Association held at the Forte Crest Hotel, Manchester Airport, onSunday, 16 January, 1994, the resolution that John H. Clegg be appointed as Honorary Secretary was carried ona show of hands and proxy votes. This appointment is subject to formal ratification at the 1994 AGM in Bristol.

The Porritt Fellowship, sponsored by the Sanofi Winthrop Foundation for research into accidents and injuriesrelated to sport, invites applications for the 1994 award by 31 March 1994. Details from the Royal College ofSurgeons, Lincolns Inn Fields, London WC2A 3PN, UK.

The 1993 Annual Meeting of the Association approved the formation of a Northern Ireland regional group ofBASM. The inaugural AGM will be held on Friday, 16 April, 1994 at 5.30pm, at the Belfast City HospitalPost-Graduate Centre, Details from the Acting Secretary, Dr Bruce Thompson, 28 Church Walk, Lurgan, Co.Armagh, BT67 9AA, UK.

Please note that all BASM central and regional diary and news items for publication must be sent to theHonorary Secretary for collation, NOT to the Journal or Editors. Please address diary and news items to:

Honorary Secretary, BASM,Mr John H. Clegg, JP, LDS, RCS Eng.,Birch Lea, 67 Springfield Lane,Eccleston, St Helens,Merseyside WA10 5HB, UK.Tel/Fax: 0744 28198

BASM MerchandiseLadies scarves

Sweatshirts

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Ties

Blazer badge

White with blue border and BASM logo - 27-inch squareNavy blue with fringe and BASM logo 54 x 9 inches (oblong)

White with large motif: medium 36-38 inches; large 40-42 inches; extra large 44 inches

Light blue with large motif: medium 36-38 inches; large 40-42 inches; extra large 44 inches

Single motifMulti motif

Wire - 4 inches highWire - 3 inches high

£5 + £1 p&p£5 + £1 p&p

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Lambswool fine knit vee neck or round neck with small motif; machine washableColours and chest size to order

Fine knit lambswool vee neck or round neck with small motif;machine washable

White short sleeve, small motifCollar size to order

Small motifColours and chest size to order

Small motifColours and chest size to order

£32 + £1 p&p

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For further details please contact: John H. Clegg JP LDS RCS Eng, Hon. Secretary, Birch Lea, 67 Springfield Lane, Eccleston,St Helens, Merseyside WA10 5HB, UK (Tel: 0744 28198)

Br J Sp Med 1994; 28(1) 67

BAS Eucation ProgrammeFor further details and application forms for any of the following courses please fill in your name/address, tick theappropriate boxes and return to: Education Officer, BASM, d/o National Sports Medicine Institute, Medical College ofSt Bartholomew's Hospital, Charterhouse Square, London ECiM 6BQ, UK. (Tel: 071 253 3244)

Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Education Programme -1994

D1 11-13 March

D 25-27 March

Li 10-15 April

13-15 May

D- 24-26 June

17-22 July

ElI 2-4 September

Li 25-30 September

D 6-13 October

D 28-30 October

D 6-11 November

D 18-20 November

Advanced Physiology Module: Musculoskeletal System Liverpool John Moores University

Advanced Injury Module: Acute and Chronic Injuries to the Upper Limb RAF Wroughton, Swindon

Introductory Sports Medicine CourseLilleshall Hall National Sports Centre, Shropshire (Residential)

Advanced Medicine Module: Physical Medicine of Sport and Exercise University of Bath

Advanced Physiology Module: Cardiorespiratory System St George's Hospital Medical School, London

Introductory Sports Medicine Course Lilleshall Hall National Sports Centre, Shropshire (Residential)

Advanced Injury Module: Acute and Chronic Injuries to the Head, Neck, Spine and Pelvis Milton KeynesGeneral Hospital

Introductory Sports Medicine Course Lilleshall Hall National Sports Centre, Shropshire (Residential)

Hands-on Practical Sports Injury Course Club La Santa, Lanzarote (Residential)

Advanced Injury: Acute and Chronic Injuries to the Lower Limb RAF Wroughton, Swindon

Intermediate Course: Sports Specific Injury Management and Normal Examination of Joints Lilleshall HallNational Sports Centre, Shropshire (Residential)

BASM Congress: (South Western Region) Redwood Lodge, Bristol

Provisional Education Programme -1995

LFI 20-22 January Advanced Physiology Module: Cardiorespiratory System St George's Hospital Medical School, London

Li1 10-12 March Advanced Physiology Module: Musculoskeletal System Liverpool John Moores University

LFI 24-26 March Advanced Injury Module: Acute and Chronic Injuries to the Upper Limb RAF Wroughton, Swindon

[]1 23-28 April Introductory Sports Medicine Course Lilleshall Hall National Sports Centre, Shropshire (Residential)

F1 12-14 May Advanced Medicine Module: Physical Medicine of Sport and Exercise University of Bath

F] 16-21 July Introductory Sports Medicine Course Lilleshall Hall National Sports Centre, Shropshire (Residential)

LFI 1-3 September Advanced Injury Module: Acute and Chronic Injuries to the Head, Neck, Spine and Pelvis Milton KeynesGeneral Hospital

LFI 24-29 September Introductory Sports Medicine Course Lilleshall Hall National Sports Centre, Shropshire (Residential)

Li1 28 September- Hands-on Practical Sports Injury Course Club La Santa, Lanzarote (Residential)

27-29 October

5-10 November

Advanced Injury: Acute and Chronic Injuries to the Lower Limb RAF Wroughton, Swindon

Intermediate Course: Sports Specific Injury Management and Normal Examination of Joints Lilleshall Hall

National Sports Centre, Shropshire (Residential)

68 Br J Sp Med 1994; 28(1)

LiLi1

AV vf Iw

Notes for AuthorsScopeThe British Journal of Sports Medicine cov ers all aspects of sportsmedicine and science - the management of sports injuries; allclinical aspects of exercise, health and sport: exercise phvsi-ology and biophvsical investigation of sports performance;sports psychology; physiotherapy and rehabilitation in sport;and medical and scientific support of the sports coach.

Types of PaperOriginal papers (not normally over 3000 vwords, full lengthaccounts of original research)Reviews articles (up to 4000 words, providing concise in-depthreviews of traditional and new%, areas in sports medicine)Case reports (up to 1000 words, describing clinical case

histories with a message).

RefereeingAll contributions are studied by referees whose names are notnormally disclosed to authors. On acceptance for publicationpapers are subject to editorial amendment. If rejected, papersand illustrations will not be returned. Authors are solelyresponsible for the factual accuracy of their papers.

ManuscriptsAuthors are urged to write as concisely as possible. Four copiesshould be submitted, typed on only one side of the paper(quarto or A4) in double spacing with a margin of 30 mm at thetop and bottom and on both sides. Papers should be arrangedin the following order of presentation: title of paper; names

and qualifications of the authors; address of the place at whichthe work was carried out; an abstract of the paper (100-200words in length); 4-6 keywords; the text; acknowledgeements(if any); references; tables; abbrexviated title for use as a runningheadline; captions to figures (on separate sheet of paper).For details of submission of the final revised version of the

contribution on disk, please consult the Guidelines for DiskSubmission, British Journal of Sports Meditcine, vo0lume 28,number 1, pp. 71-72, or contact Medical Journals Group,Buttenvorth-Heinemann Ltd, Linacre House, Jordan Hill,Oxford OX2 8DP, UK.

mlustrationsDrawings and graphs should be on heavy-N, white paper card or

blue-lined coordinate paper using black ink. Label axes

appropriately and clearly. Please use a selection of thefollowing symbols: +, x, Z, 0, 0, 7, vPhotographs should be of fine quality, large glossy printssuitable for reproduction and the top should be indicated.Negativ e<, transparencies or X-ray films should not besupplied, any such material should be submitted in the form ofphotographic prints. Authors are asked where possible todraw diagrams to one of the following widths, includingWttering, 168 mm, 354 mm. During photographic reproduc-ion, the diagrams are reduced to 1/2 their size. The maximumdepth at drawn size is 500 mm. Authors are asked to use theminimum amount of descriptiv e matter on graphs anddrawings but rather to refer to curves, points etc. by symbolsand place the descriptive matter in the caption. Three copies ofwch illustration are required and these should be numbered inaconsecutive series of figures using Arabic numerals. Legendshould be typed in double spacing on a separate page butpuped together. Each figure should be identified on the back-figure number and name of the author. Figures which haveken published elsewhere should be accompanied by a form ofpemission to reproduce, obtained from the original publisher.

ReferencesThese should be indicated in the text by superscript Arabicnumerals which run consecutively through the paper. Thereferences should be grouped in a section at the end of the textin numerical order and should take the form: author's namesand initials; title of article; abbreviated journal title; %ear ofpublication; volume number; page numbers. If in doubtauthors should always write the journal title in full. Referencesto a book should take the form: author's surname, followed byinitials; title of book in single quotes; editors (if any); volumenumber/edition (if any); name of publishers; place of publica-tion; year of publication and page numbers. Where a paper iscited more than once in the text, the same superior numeralshould be used on each occasion. e.g.21 Sperrvn PN. Sport Tad Medicine. London: Buttenrorths, 1983.22 Ellitsgaard N and Warburg F. Moxvements causing ankle

fractures in parachuting. Br 1 Sports MNed 1989; 23: 27-9.TablesTables should be typed on separate sheets together with asuitable caption at the top of each table. Column headingsshould be kept as brief as possible, and indicate units ofmeasurement in parenthesis. Tables should not duplicateinformation summarized in illustrations.

FootnotesFootnotes should be used sparingly. They should be indicatedby asterisks (*), daggers (t), and double daggers (t), in thatorder. In the manuscript, a footnote should be placed at thebottom of the page on which it is referred to and separatedfrom the main text by a horizontal line above the footnote.Footnotes to tables should be placed at the bottom of the tableto which they refer.

Drugs, Abbreviations and UnitsDrugs should be referred to by their approved, not proprietary,names, and the source of any new or experimental materialsshould be given. If abbreviations are used these should begiven in full the first time thev are mentioned in the text.Scientific measurements should be given in SI units, but bloodpressure should continue to be expressed in mmHg.

ProofsAuthors are responsible for ensuring that all manuscripts(whether original or revised) are accurately typed before finalsubmission. Two sets of proofs will be sent to the author beforepublication, one of which should be returned promptly (byExpress Air Mail if outside UK). The publishers reserve theright to charge for any changes made at the proof stage (otherthan printers errors) since the insertion or deletion of a singleword may necessitate the resetting of whole paragraphs.

SubmissionFour copies of the complete manuscript and illustrationsshould be sent to Dr P. N. Spemrn, The Editor, BritishJournal of Sports Medicine, Butterworth-Heinemann Ltd,Linacre House, Jordan Hill, Oxford OX2 8DP, UK.All material submitted for publication is assumed to besubmitted exclusively to the British Journal of SportsMedicine. All contributing authors must sign a letter ofconsent to publication. The editor retains the customaryright to style and if necessary shorten material accepted forpublication. Manuscripts will be acknowledged on receipt.Authors should keep one copy of their manuscript forreference. Authors should include their names and initialsand not more than one degree each.

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