The World Championships were recently held in Leipzig , Germany . Here are some pictures I took at the event, apologies for the slightly poor quality of the camerawork! Barry Paul and I attended the event to go to a Medical safety commission meeting on safety in the sport. Issues covered included:
- The penetrating sabre injuries which Barry had voiced concerns about to the F.I.E three years ago. There have now been 6 cases of point injury caused by unbroken blades. The main causes are the increased stiffness in blades and the small surface area of the point; this has been compounded by the timing changes.
- The relative safety of the sport compared with other sports. We hope to help British fencing lower or stop further increases to it’s insurance premiums which will help keep membership fees down.
No other manufacture or reseller of fencing equipment was present at the meeting but we hope to post a full report to help all that missed out on the meeting catch up with these important findings. I must thank the organisers for their efforts. (The meeting was unfunded by the F.I.E) EXTRA DETAILS NOW ADDED ON THE 16th/11/2005
FIE MEDICAL SYMPOSIUM LEIPZIG 12 OCTOBER 2005
Brief report by Clare Halsted Hon. Medical Officer, British Fencing A very interesting, varied and useful programme, organised by Peter Harmer (FIE Medical Commission) and Axel Seuser (German National Team Physician), took place in the impressive Neues Rathaus during the World Championships. UK participants: Clare Halsted, Ziemek Wojciechowski, Tristan Lane , Barry Paul, Ben Paul, Herman Fenton ( International Therapy Examination Council Representative).
Summary
1.History of the FIE Medical Commission Jeno Kamuti (Hun)
Set up to deal with anti-doping matters.
1967 Montreal –first fencing doping controls.
Responsible for improving standards of medical cover at major events.
2.Current issues in anti-doping George van Dugteren (RSA)
Therapeutic Use Exemptions (TUEs) explained. Allow athletes to take a banned substance if it is essential for their health and does not have additional performance enhancing properties.
The importance of complying fully with the WADA (World Antidoping Agency) regulations for TUE applications was stressed. All countries need to follow the correct procedures: the abbreviated TUE form is for beta-2 agonists (eg salbutamol for asthma) and glucocorticosteroids by non-systemic routes (eg steroid inhalers for asthma) and is automatically approved if completed correctly; the standard TUE form is for all other banned substances.
Testing
Fencing considered a very low risk sport by WADA (World Anti-Doping Agency) – fewer tests would be allowed but politically not advisable.
Cost – in competition 200 euros/test out of competition 580 euros
Number of tests eg at J/C Worlds = 60 so significant cost
About 600 tests/year for the FIE
Results 20 ‘positive’ tests in past 2 years needing investigation – only one involved a sanction – a diuretic prescribed by the fencer’s doctor for a medical condition, in ignorance of the prohibited list.
GvD described the investigation, at his own instigation, of one case where boldenone (anabolic steroid) was detected but through a special test was shown to be endogenous (made in the body). This was the first such example in the world so a very important finding, thanks to George’s persistence.
The ADAMS – Anti-Doping Administration and Management System- is a web-based database management tool to help WADA, athletes and organisations involved with anti-doping to fulfil their obligations. This is not yet in operation for the FIE. (see WADA web site)
3. 4 Year Surveillance of Fencing Injuries in National Competitions in USA Peter Harmer (Aus)
Problems with reporting of fencing injuries described including:
What to record
How to classify severity of injuries
Exposure data essential otherwise figures meaningless –
Per 100 fencers no use
Many variables eg number of fencers, hours of fencing, type and
intensity of fencing activity
This study used the term athlete exposure (AE) where 1 bout = 2 athlete exposures (regardless of length of bout ).
Some sort of comparison with other sports then becomes possible.
Only injuries severe enough to stop the fencer continuing were recorded.
(NB this may be under-sensitive as some fencers may insist on continuing with a significant injury)
One reason for doing this study was a number of requests for statistics on the safety of fencing from clubs in the USA who were losing hall space as the insurers were refusing to provide insurance for ‘such a dangerous sport’!
Type of injury in order of decreasing numbers:
Strain sprain other contusion fracture
Subluxation/dislocation laceration
Site in same order
Knee thigh leg back ankle fingers
Hip wrist/hand shoulder
NB No follow up so initial evaluation may not always have been correct.
This is a very useful study indeed; huge numbers; clear definitions; well-quantified injury risk confirming that fencing is a very low risk sport.
These statistics can be used to show insurers that most other sports carry higher risks.
(Of course it must not be forgotten that one reason for this is the high standard of protective kit worn in the USA and many other countries).
The full study will hopefully be published or available on demand.
4. Case series –penetrating sabre wounds Peter Harmer
Peter presented 8 cases of non-broken blade penetrating injuries all to the hand or arm.
All fencers but one recovered fully.
Reasons for this type of unusual injury were discussed:
Type of action - advent of electronic apparatus for sabre invites more
attacks to hand?
Blade - now stiffer
- edge of tip is not burled but serrated to some extent
- shape –tip is curved so initial contact is with a ridge
- size – minimum 4mm max 6mm cf epee tip is 8mm
Handle - fingers/hand exposed more than other weapons
Implications
Enough cases to consider preventative action.
Eg Glove material/construction
Guard – could enclose the hand more?
Tip - alter size/shape
5. Fencing Injuries of Young Athletes Axel Jager (Ger)
A study in Germany from 1993 to 2000 involving 342 fencers
R handed 288 L 54
Acute and chronic injuries looked at.
Most common – knee followed by foot and ankle.
Different type of injury for front and back feet.
Not surprising as force on front foot can be 700 Newtons , on back foot 90 N.
(Sorry, full data not available as yet)
Causes
Flat feet
Too many competitions
Poor technique
Warm up games especially football!
Imbalance of spine and hip
Prevention
Good technique
Screen young fencers for existing problems
Weight training for 16+
Appropriate competition schedule
Rest time before competitions
There was some discussion about the use of special cushioning insoles, eg sorbithane, to help prevent problems. A study in Germany was mentioned that found that rubber insoles absorbed some of the energy then on releasing it altered the movement of the ankle joint ie this might have biomechanical consequences.
6. Mental training in Fencing Lothar Lins (Ger)
An excellent, clear, practical talk.
‘The will is as trainable as a muscle’ R Meissner
Mental Training involves
- goal setting
- competition-like situations
- psycho-regulation (effective relaxation & activation) – important on day of competition with frequent breaks.
- Ideomotoric training = visualisation but not as useful in fencing as some sports because the opponents vary so much
- training of aggression (remember what duelling was!)
- training of concentration
- mental preparation/planning pre-event eg what might interfere – cold hall, changes of piste
- mental solutions/strategies for typical situations eg last hit; priority at time
- coping with competition fears eg feared opponent; important home event
Goal setting
Must be realistic but a challenge.
Visualise achieving it – this reaches the subconscious –helps to lead to the goal.
Write it down = contract with yourself.
Break down into concrete steps.
Eg 17 yr old good enough for cadet, junior and senior events.
What is wanted – short or long-term success?
If senior success is the goal – do less at C/J level
But some short-term success provides motivation so balance needs to be thought out.
Planning for specific fencing situations
Last hit 14-14 suggestions
- 1 hit competitions
- add - each fencer must predict number of wins
- forfeit to pay if hit is lost
- have more than one strategy
- tell coach which strategy will be used then must stick to it
- tell opponent the strategy then must stick to it
- new strategy each time
Competition Fears
- concentrate on strengths
- remember previous successes
- start with simple actions
- use helpful routines (but be careful not to become too dependent on them)
- talk about the fears - makes them smaller
- think through the worst case scenario – fear can be diffuse, make it concrete then less terrible
- give the fear a place –literally –write it down, put it somewhere, leave it there (he gave a very funny example of this with a soft ball team facing a very strong team)
- change fear into aggression; channel the energy in the fear into action
So – NOT A VICTIM ANYMORE
Assuming a trained body – ‘Success will be decided inside the head’
How to apply all this – train the coaches, but sports psychologist may also be needed because of their different relationship with the fencer.
7. Biomechanics of Fencing Injuries Ryszard Szczepanski (Pol)
Applying physics:
Bones = levers Joints = pulleys Muscles = motors
Tendons = cables
Overall holistic view of the body needed to deal with fencing injuries.
This presentation focused on the foot as the source of many other problems.
80% abnormalities are with pronation.
With each step 3-10x body weight is taken by the foot.
75% propulsion comes from the big toe.
Walking on flat level surfaces is unnatural – the human foot and leg evolved to walk on natural, uneven surfaces.
Causes of fencing injuries
- malalignment in musculo-skeletal system
- joint instability
- over use syndrome
- gait dysfunction
- combination of hard flat surface, high impact, bad technique
- ankle/knee sprain improperly diagnosed/treated
Most common patello-femoral syndrome
tibial stress syndrome
Achilles peritendonitis
The importance of the complex sub-talar joint was stressed. It has 3 facets and moves in 3 planes at once allowing the normal foot to adapt very well to circumstances.
The examination of the foot and specific tests were briefly explained.
Treatment of many conditions, including hips, back, shoulders, neck, require
- correct diagnosis
- rest
- orthoses
- rehabilitation
(Shoulder problems often originate from opposite hip/foot)
The only type of orthoses used by Dr Szczepanski are specific soft, thermoplastic molded ones. He claims that these prevent/greatly reduce the risk of injury in fencers.
8. Motion Analysis of the Spine in Fencing Axel Seuser
Dr Seuser has 20 years experience looking at motion analysis of the spine.
Ultrasound + markers on the body are used to provide motion curves – this can detect abnormalities not yet visible to the eye and study the forces on specific joints with different activities.
One study looked at 30 fencers in the German team,
Mean age -16; fencing for 6 years on average
This analysis detected a range of problems eg scoliosis, shoulder rotation, pelvic tilt.
A high proportion had typical malfunction of the spine with overloading – they were given special training which produced a marked decrease in injuries.
9. Endurance Training in Fencing Jo Latsch ( Bonn Sport University ) This was more about testing than training methods. The impressive facilities at this university were first described. They carry out screening and annual checks on higher level athletes including: exercise ECG, echocardiogram, blood tests, ergometer as well as more specialised tests such as: spiro-ergometry (expensive, can be mobile); lactate testing; heart rate monitoring; treadmill tests; bleep test; heart rate variability.
Better endurance capacity helps fencers to win by allowing them to concentrate entirely on the fight, with no physical constraints.
So specific aerobic exercise testing of fencers was considered to be productive.
Heart rate variability (measured with specific technique) detects any type of stress on the body – can be used to show when an athlete has recovered sufficiently to start training again.
10. Manual Therapy Techniques Doug Rank ( USA )
The interesting strain-counterstrain technique for sports injuries was described as used with the USA fencers. It is based on the alteration of neuro-muscular reflexes in tissues, dealing with the tissue response to injury involving the muscle spindle or primary proprioceptive nerve endings. The technique stops inappropriate proprioceptive firing. Components - tissue texture changes
- local tender points (close to acupuncture points)
- decreased amplitude and quality of joint motion
(Apologies – my notes were not good enough to be able to go into any more detail)
Contributors
Jeno Kamuti President of the FIE Medical Commission until 2004
George van Dugteren Current President of the FIE Medical Commission
Peter Harmer Member of FIE MC
Axel Jager Member of DFB (German) Medical Commission
Lothar Lins Sports Psychologist
Ryszard Szczepanski Polish National Team Doctor
Axel Seuser German National Team Doctor
Joe Latsch Sports Scientist, Bonn Sports University
Doug Rank US National Team Therapist
We also managed to support some of our team who were fencing. Special congratulations must go the men’s foil team who came 10th and to Rebecca Ward our American Sabreur who at just 15 years old came 7th in the world and was part of the team that were crowned World Champions. Also congratulations to Podznyakov for getting the silver in the indervidual medals and putting in a amazing team performance to help Russia win the gold.
Ben Paul
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