PART 1

PRINCIPLES AND ETHICAL GUIDELINES
A. CompetenceSports medicine professionals must be knowledgeable, educated, and experienced
in the prevention and care of health problems, particularly those related to the sports
for which they are responsible. (See also Appendix 1, Olympic Movement Medical
Code.)
B. Sports Knowledge

Sports medicine personnel should have an in-depth knowledge of the sports
for which they are responsible, including rules of competition. They must also
understand the training process and the physical and mental demands training places
upon an athlete. An active, wellness-oriented lifestyle enhances this understanding
and improves rapport with coaches and athletes.
C. Conﬁdentiality

An athlete has the right to expect the medical staff to observe conﬁdentiality.
When serving as a team physician, the physician is responsible to the athlete, theteam administration and the coaches, so there must be clear guidelines concerning
the disclosure of medical information. Disclosures should be made only toresponsible personnel and only for determining the athlete’s ﬁtness to participate.
Ideally, medical information should be considered privileged, until the athlete gives
permission to release information to the team, the coach, or the media.
D. Communication

There must be mutual respect among all members of the medical staff and open
communication concerning roles and responsibilities. In addition, medical personnel
must communicate openly with coaches, athletes, parents, and family physicians.
E. Participation

The primary care team physician is responsible for determining an athlete’s
ﬁtness to participate. This may occur during the pre-participation examination orafter an injury is sustained in training or competition. The team physician may
decide to involve special consultants to assist in these decisions.
F. Coordination

The primary care providers are responsible for coordinating the health care process
among all persons involved in the sports programme, including the coach, other
health professionals and para-professionals, sports scientists, administrators, families
and family physicians, and the athletes themselves. Athletes must be instructed inhealth and safety practices and must bear a large degree of responsibility for theirown welfare.

PART 2

THE SPORTS MEDICINE TEAM
The sports medicine team is a group of health professionals whose major
responsibility is the health and safety of the athletes. The size and scope of the healthcare team depends upon its locale, availability of other facilities and personnel,
funding, and the number of athletes to be cared for.
A. Organisation

The health care team may be organised into a Primary Care Team and a
Secondary Support Team:PRIMARY CARE TEAM
Primary Care Sports Medicine Physician (M.D., D.O.)
Coaching Staff
Physiotherapist
Administration
SECONDARY SUPPORT TEAM
Medical Specialists
Internal Medicine/
Cardiologist
Orthopedist
Physical Medicine &Rehabilitation
General Surgeon
Ophthalmologist
Radiologist

Allied Health Professionals
Mental health practitioner
Podiatrist
DentistNutritionist
Nurse
Laboratory Personnel
Health educator
Legal consultant
Orthotist
Chiropractor

Scientists
Physiologist
Biomechanist
Strength coach

B. Responsibilities

1. Preventing Illnesses and Injuries
a. Pre-participation assessment of athlete’s health and ﬁtness.
b. Conditioning programmes—assess suitability and scientiﬁc rationale.
c. Safety factors—inspect and approve training surfaces, equipment andpersonal athletic gear.
d. Educate coach and athlete in safe practices (e.g. hygiene and safety).
e. Environmental monitoring—check ambient temperature and humidity,
assure that adequate ﬂuids are available and that athletes and coaches
are following safety guidelines.

CHAPTER 2. SPORTS AND MEDICINE

2. Evaluating and Treating Illnesses and Injury
a. Initial management
b. Referral network—a referral system with written policies and procedures
for referral must be in place.
3. Rehabilitation
Written guidelines must be in place covering an athlete’s return to activity,
including practice and competition.
4. Record-Keeping
Clear patient records, referral forms and consultation reports, and a daily
treatment log must be maintained.
5. Legala. Standards of care for sports medicine practices must be followed.
b. Consent for care must be clearly spelled out, and informed consent
obtained (in writing) for procedures; parental consent must be obtainedfor care of minors.
c. Conﬁdentiality of information and disclosure of information guidelines
must be in place.
d. Medications should only be prescribed with informed consent andexplanation of possible side-effects; avoid prescribing medications
banned by IAAF and the World Anti-Doping Agency (WADA).
References

1.

2.
3.
4.

5.

Herbert, D. L., and W. G. Herbert. Medico-legal issues. In ACSM’s Guidelines
for the Team Physician, R. C. Cantu, and L. J. Micheli (eds.). Philadelphia:
Lea & Febiger, 1991.
International Olympic Committee. The sports medicine team. In Sports
Medicine Manual, pp. 16-18. Lausanne: IOC, 1990.
International Olympic Committee. Olympic Movement Medical Code.
Lausanne: IOC, 2005.
Principles and Ethical Guidelines of Health Care for Sports Medicine.
World Med. J. 28:83, 1981. Re-printed in Sports Medicine Manual, pp. 14-16.
Lausanne: IOC, 1990.
World Medical Association Declaration on Principles of Health Care forSports Medicine. World Medical Association, Inc., Ferney-Voltaire, France,
October 1993.

PART 3

PRE-PARTICIPATION EXAMINATION
Every participant in sports should receive a thorough pre-participation medical
examination (PPE) by a knowledgeable sports physician. The examination may varydepending on the local system and administrative/legal requirements, but should
encompass a detailed medical history and complete physical examination. The IAAF
also recommends a physical examination prior to participation in major international
competitions.
A. Primary Objectives

There are several primary objectives in conducting the pre-participation
examination. These include:
1. Detect Potentially Disabling or Life-threatening Conditions (both medical andmusculoskeletal)
Such conditions are primarily cardiovascular, some of which may be clinicallysilent and not readily detected (see also Chapter 14, Part 1, Cardiovascular Evaluationof Athletes).
2. Screen for Conditions that Predispose to Illness or Injury
The PPE allows the physician to screen for medical and musculo-skeletal
conditions that may predispose to illness or injury during training and competition.
These may include acute or chronic conditions (especially those that have been
untreated), injuries that have not been completely rehabilitated, and congenitaldevelopmental abnormalities. Detection of these conditions allows for rehabilitationor other therapeutic interventions such as management of exercise-associatedasthma.
3. Meet Administrative Requirements
The PPE is conducted in order to meet administrative requirements of theappropriate sports or governmental agencies.
B. Secondary Objectives

1. Assess General Health
The PPE may be the only contact that the athlete has with a health care provider,especially those athletes with limited access to health care. Many young athletes
may have chronic and untreated health problems that may require on-going management.
2. Entry into the Health Care System
The PPE may establish a relationship with the health care system, and provide
an opportunity to develop an ongoing health resource for the athlete.

CHAPTER 2. SPORTS AND MEDICINE

3. Discuss Health and Lifestyle Issues
The interview offers an opportunity to discuss and counsel regarding a wide
variety of topics, including nutrition and use of supplements, weight control practices,
alcohol and substance abuse, proper training methods, and sexually transmitted
diseases. Conﬁdentiality must be assured by having a private interview room, either
in a private ofﬁce or in a private examination room as a part of group processing.
C. Personnel Qualiﬁcations

The examination should be carried out by a qualiﬁed physician, which may
include a primary care sports physician, family practice physician, pediatrician,or orthopedic surgeon. Allied health professionals that may support the physician
include the physiotherapist, nurse, and in some cases such specialists asphysiologists and nutritionists.
D. Examination Formats

1. Private Ofﬁce
The primary care physician’s ofﬁce is best for the PPE, especially if the physician isthe athlete’s personal physician. This allows for the use of complete medical records,
knowledge of the athlete’s history, and better physician-athlete rapport.
2. Medical TeamA team approach to the PPE can be valuable if there are cost considerations, theathlete does not have a personal physician, the athlete’s personal physician does not
feel qualiﬁed, or if the institution or team requires an organised system for a large
number of athletes.
The team physician may organise primary care physicians, pediatricians, specialists such as orthopedists, and various para-professionals (physiotherapists, nurses,etc.).
a. Organisation of the Medical Facility (see Table 2-1)
Table 2-1. Medical facility organisation.
Stage

Purpose

Waiting area

Sign-in, registration, including careful instructions
about ﬁlling out required forms

Vitals station

Height, weight, blood pressure, vision

Ofﬁce examination

History review, physical examination
performed by one physician for a given
student-athlete

Specialty ofﬁces

Orthopedic assessment, cardiology evaluation, etc.

Optional stages

Educational and rehabilitation areas

CHAPTER 2. SPORTS AND MEDICINE

b. Facilitating the Examination Process (see Table 2-2)
Table 2-2. Steps to facilitating the examination process.
Provide athletes in advance with information about the detailed nature of theexamination and the appropriate attire to wear to lessen privacy concerns andincrease efﬁciency.
Ensure separate areas for examining male and female athletes
Have a private individual counseling room for discussion of sensitive issues tomaintain conﬁdentiality and facilitate better communication
Enhance familiarity and continuity of care by enlisting the assistance of as many
primary physicians as possible for the athletes being examined
Establish a clear protocol for referral to primary physicians, specialists, rehabilitation, or other medical evaluations for every athlete who is not cleared for participation because of illness or injury. If there is a team physician, he or she should
keep—and follow up on—a list of athletes who are disqualiﬁed or who require
further evaluation before ﬁnal clearance. If the athlete is not cleared for the desired
sport, the evaluating physician should counsel the athlete concerning alternate
permissible activities.

E. Medical History (see Appendix 3, Pre-participation Physical Evaluation)

A complete medical history is the most important part of the PPE, and should beobtained from the athlete and, when appropriate, the athlete’s parents. The physician
must ensure that the athlete and parents understand the questions and provide help if
there is a possibility of illiteracy, or if interpreters are required.
The medical history should include the following speciﬁc information:
1. A history of any signiﬁcant medical diseases including cardiovascular disease,pulmonary disease, diabetes, mononucleosis, hypertension, anemia, hepatitis, ulcers
or sexually transmitted diseases. Any weight changes, especially in the past six
months, should be noted.
2. A history of any medications for acute conditions or chronic disease. The
proper use of this medication should be reviewed with the athlete to ensure that thetherapy is maintained. Unintentional misuse of the medications, especially of nonsteroidal anti-inﬂammatory drugs, should be discussed. Athletes should be awarethat prolonged use of non-prescription medications may cause signiﬁcant bleeding
disorders, liver or kidney injury, or other side effects. Supplement use should bedetermined, and the athlete made aware of their potential untoward use, including
the possibility of their containing banned substances.
3. Medications for exercise-induced bronchospasm or other pulmonary disease
should be discussed with the patient. Athletes with asthma or exercise-induced
bronchospasm should be made aware of the need to obtain a Therapeutic Use
Exemption (TUE) if involved in national or international competition (see also
Chapter 14, Part 2, Asthma and Exercise-Induced Bronchospasm).

CHAPTER 2. SPORTS AND MEDICINE

4. For female athletes, a history of any oral contraceptive use should beobtained and the age of menarche and the menstrual cycle should be discussed. A
history of pregnancy, deliveries, and sexually transmitted disease should be obtained.
Determine if there is a relationship between missed periods and heavy training
activities. Determine if severe menstrual cramps regularly limit routine activities orathletic participation.
5. A history of drug use, including alcohol, recreational drugs, and/or tobacco.
Short- and long-term effects of these drugs should be discussed.
6. Banned substances should be discussed with the athlete to prevent any
inadvertent use. The athlete should be provided with a list of banned substances ora resource where information concerning banned substances can be obtained. (See
Chapter 15, Drugs in Sports/Doping Control.)7. A history of allergies. This should include allergies to medications, foods,
and stings (Hymenoptera, e.g. bees, wasps, yellow jackets; ants). Appropriate
actions and medications for life-threatening emergencies use should be addressed.
Seasonal environmental allergies should also be discussed.
8. A cardiovascular history, particularly for athletes under the age of 30. Any
history of cardiovascular disease, syncope or near syncope, arrhythmias, chest pain,
fatigue, hypertension or pertinent family history should be obtained. Hypertrophic
cardiomyopathy, outﬂow tract obstruction, conduction abnormalities and arrhythmias
or valvular problems including aortic stenosis or mitral valve prolapse should be
diagnosed when possible. A history of Marfan’s syndrome, sickle cell anemia, WolffParkinson-White syndrome or other syndromes should be obtained.
9. A neurological history. Determine if the athlete has ever been unconscious,
had a severe head injury or concussion, or has a history of seizures, cervical spinal
cord neuropraxia with transient quadriplegia, cervical spinal stenosis, congenital
fusions, cervical instability, or cervical or lumbar disc disease.
10. A history of environmental trauma including hyperthermia, hypothermia,
altitude sickness or other. Heat problems may include frequent muscle cramps, heatexhaustion, heat stroke and/or difﬁculty acclimatising to heat.
11. A pulmonary history including any history of asthma, exercise induced
bronchospasm, and seasonal/environmental allergies.
12. A history of skin problems should include any infectious diseases such as
herpes simplex, scabies, pubic lice, molluscum contagiosum, impetigo, and sexuallytransmitted disease.
13. A history of previous injuries. Most athletic injuries are recurrent injuries,
so it’s important to ask, “Were you injured last season?” Inquire about themechanism of injury, treatment obtained, and whether the injury was rehabilitatedadequately. Ask about any fractures, dislocations, or signiﬁcant joint disease. If any
current abnormalities are found on examination, provide the athlete with a plan toobtain a deﬁnitive diagnosis and treatment.

CHAPTER 2. SPORTS AND MEDICINE

14. An ophthalmologic history to determine whether the patient wears glasses,
contact lenses, or protective eye wear. Problems with vision or eyes should be
discussed. Especially important is whether there have been previous eye injuries
including orbital fracture, hyphema, eyelid or globe laceration, or surgery. Depth ofﬁeld is very important in triple jumpers, long jumpers, and relay runners.
15. A history of immunisations. Diphtheria, tetanus, and pertussis (DTP), andpolio are standard children’s vaccines in many countries. Measles, mumps, rubella(MMR), and hemophilus are also frequently given. Everyone should have an updated tetanus immunisation. Hepatitis B immunisation may be considered for sexuallyactive individuals and immunoglobulin for non-immunised individuals exposed to
infections. Requirements for additional immunisations will vary depending upon thetravel destination. As an example, hepatitis A immunisation is highly recommended
for athletes travelling to endemic regions.
16. The use of any protective equipment such as braces, pads, and eye protection
should be ascertained and discussed.
17. A history of current training volume and intensity (if any). E.g. how many
hours training per week, how many kilometres run per week, how many strengthening sessions per week, etc.
F. Physical Examination (see Appendix 3, Preparticipation Physical Evaluation)

The examining physician should start by measuring the athlete’s height andweight; for junior athletes these measurements should be compared to a standard
growth chart. The measurement of body composition can be important in determining
the need for counseling about diet, disordered eating, and weight management (gain,
maintenance, or loss). The IAAF book Too Thin to Win? is an excellent resource
about proper and disordered eating. Counseling about the Female Athlete Triad may
be provided to the athlete. The following components should comprise the remainderof the examination:
1. Visual acuity should be determined using a standard Snellen Eye Chart.
Cases of unusually poor vision (including eye loss) should be discussed with theathlete and his/her parents. Options for visual correction, protective lenses, or eye
wear should be discussed. Anisocoria (unequal size) of the pupils should be noted,
as this could be important following a head injury.
2. The cardiovascular system should be evaluated. Blood pressure should bemeasured and the pulse should be checked for rate and rhythm. A large bloodpressure cuff should be used for athletes with biceps greater than 33 cm in diameter.
3. The heart should be auscultated in both the seated and supine positions.
Functional murmurs can often be differentiated from pathological murmurs suchas hypertrophic cardiomyopathy and aortic stenosis by maneuvers such as deep
inspiration, Valsalva’s maneuvers, rising from a squatting position, and lying on
the left side. Although murmurs are frequent in adolescents, questionable murmurs
should be evaluated to obtain a deﬁnitive diagnosis. Athletes exhibiting signs

CHAPTER 2. SPORTS AND MEDICINE

of mitral or aortic valve stenosis, aortic insufﬁciency, prolapsing mitral valve or
coarctation of the aorta, or any suspicion of post-infectious carditis should be
examined by a cardiologist. (See also Chapter 14, Part 1, Cardiovascular Evaluationof Athletes.)
4. When equipment and personnel are available, an electrocardiogram at rest
may be done during the initial evaluation.
5. The lungs should be auscultated and any abnormalities recorded. The
abdomen should be examined for pain, masses, or organomegaly with particularattention given to the liver and spleen.
6. The skin should be observed and palpated. Particular attention should begiven to any infectious disease or suspicious nevi or lesions.
7. Male athletes should be examined for any undescended testicles, presenceor absence of the testicles in the scrotum, or any masses. Testicular cancer is theleading cause of cancer deaths in men 20–35 years of age. The examiner should
check for inguinal, femoral, or lower abdominal hernias.
8. Whether a genitourinary examination is performed on a female athlete will
depend on the athlete’s age, cultural practices, and whether she has other routine
medical care. Adult and sexually active females should have a Pap and pelvic
examination at least once a year. All women should receive instructions about selfbreast examination.
9. Tanner-Whitehouse staging of pubertal status should be a part of theexamination for all pre-pubertal and pubertal athletes.
10. The musculoskeletal examination should be thorough. The cervical-thoracic
and lumbar spine, hips, and all extremities should be checked for normal range of
motion, strength and endurance. The general habitus should be observed and any
asymmetry, acute or chronic swelling or joint enlargement, surgical scars, or otherabnormalities should be noted. Leg length inequality with a disparity in strength or
ﬂexibility makes an athlete more susceptible to acute strains and overuse syndromes.
The athlete should have full range of motion of the spine. A neurologicalexamination should be performed including Spurling’s axial compression test,
Lhermitte’s sign, deep tendon reﬂexes of the biceps, triceps, brachial radialis, patella
and achilles, and sensory examination of the upper and lower extremities. Special
attention should be given to any indication of peripheral nerve entrapment or nerve root
injury.
A shoulder examination should include tests for full range of motion withemphasis on the rotator cuff, deltoid, and trapezius. The cervical, thoracic, andscapular musculature should be evaluated.
The elbows should be checked for full range of motion and particularly inthrowers, the medial and lateral compartments examined for pain, asymmetries, orneurological entrapment syndromes. For throwers, the hands and wrists should also
be checked.
Knee examination should test for full range of motion and especially forligamentous stability.

CHAPTER 2. SPORTS AND MEDICINE

Ankle and foot examination should include tests for stability, signiﬁcant gait
abnormalities due to pronation, genu valgus or varus, leg length differences, or othermanifestations of malalignment syndromes.
References

1.

Cantu, R., and L. Michel. ACSM’s Guidelines for the Team Physician.
Philadelphia: Lea & Febiger, 1991.
2. Fuller C. M., C. M. McNulty, D. A. Spring, et al. Prospective screening of
5,615 high school athletes for risk of sudden cardiac death. Med. Sci. Sports
Exerc. 29:1131-1138, 1997.
3. International Amateur Athletic Federation. Too Thin to Win? London: IAAF,
1988.
4. Levine, B. D., et al. Position Statement of the International Olympic Committee
Medical Commission. The cardiovascular evaluation of women athletes. Med.
Sci. Sports and Exerc. 37(8):1431-1432, 2005.
5. Maron, B. J., D. P. Zipes, M. J. Ackerman, et al. 36th Bethesda Conference:
Eligibility recommendations for competitive athletes with cardiovascularabnormalities. Journal of the American College of Cardiology 45(8):13121375, 2005.
6. Mellion, M., M. Walsh, and G. Shelton. The Team Physician’s Handbook.
Philadelphia: Hanley and Belfus, 1990.
7. Pelliccia, A., and F. M. DiPaolo. Cardiac remodeling in women athletes
and implications for cardiovascular screening. Med. Sci. Sports and Exerc.
37(8):1436-1439, 2005.
8. Preparticipation Physical Evaluation, Third Edition. A joint publication of
the American Academy of Family Physicians, the American Academy of
Pediatrics, the American Medical Society for Sports Medicine, the American
College of Sports Medicine, the American Orthopaedic Society for Sports
Medicine, and the American Osteopathic Academy of Sports Medicine.
Minneapolis: McGraw-Hill, 2005.
9. Tanaka Y., M. Yoshinaga, R. Anan, Y. Tanaka, et al. Usefulness and costeffectiveness of cardiovascular screening of young adolescents. Med. Sci.
Sports Exerc. 38(1): 2-6, 2006.
10. Wen, D. Y. Preparticipation cardiovascular screening of young athletes.
Phys. Sports Med. 33(12):31-42, 2005.

PART 4

SPORTS RULES AND ATHLETE SAFETY
The rules of athletics are designed primarily to ensure that competition is fairand equitable for all participants. However, IAAF rules concerning the competition
facilities, equipment, and environmental conditions have been put into place inan effort to provide optimal safety and health for the athlete. The health care teamthat is involved in athletics should be familiar with these rules, and be prepared toevaluate the competition venues, equipment, and meeting conduct, and ensure thatrules pertaining to safety and health are enforced. Further, many incidents that occur
during the competition may cause speciﬁc and serious injuries that will require
prompt, appropriate action by the health providers (see Chapter 8, Emergency Care).
Staff, equipment, supplies, and evacuation services must be in place to meet theseemergencies, even though they are uncommon.
A. Administration

1. International Ofﬁcials (Rule 105)
At Olympic Games, World Championships, World Cups, Continental, Area,
and Regional Championships, the IAAF shall appoint a Medical Delegate (Rule113) and a Doping Control Delegate (Rule 114). Their responsibilities are to ensurethat adequate facilities, staff, and equipment are available for medical care andemergency management, and that doping control facilities and staff are suitable tomeet IAAF requirements. For more details, the Medical Delegate and the medicalcare organisation should refer to the IAAF Medical Handbook for Track and Field
and Road Racing: A Practical Guide (2006). The Doping Control personnel shouldrefer to the current edition of the Procedural Regulations for Doping Control.
B. Competition Rules with Medical Implications

1. Shoes (Rule 143.2)
Competitors may compete in bare feet or with footgear on one or both feet.
(Athletes who run barefoot on surfaces to which they are not accustomed may
develop severe blisters. Running barefoot during road or cross-country races
subjects athletes to possible puncture wounds, lacerations, or frost-bite during cold
weather.)
The shoes must not be constructed so as to give an athlete any unfair additional
assistance, including the incorporation of new technology that will give the athlete
any unfair advantage.
The shoe may have up to 11 spikes; spikes must not project more than 9 mm,except in the high jump and javelin throwing where it shall not exceed 12 mm.
The sole may be up to 13 mm thick in the high jump and long jump, and the heel
no more than 19 mm in the high jump.

CHAPTER 2. SPORTS AND MEDICINE

2. Obstruction (Rule 163.2)
Any competing runner or walker who jostles or obstructs another competitor, so
as to impede his or her progress, shall be liable to disqualiﬁcation. (Spike wounds orlower leg lacerations can occur whether there is outright interference or not. These
will require wound care and tetanus prophylaxis.)
3. Assistance to Athletes (Rule 144)
In general, athletes may not be given assistance during competition. However,Rule 144.2 (b) states: “Physiotherapy and/or medical examination/treatment
necessary to enable an athlete to participate or continue participation once on
the competition area may be provided by members of the ofﬁcial medical staff
appointed by the Organising Committee and clearly identiﬁed by arm-bands, vests
or similar distinctive apparel. Accredited team medical personnel approved by the
Medical or Technical Delegate speciﬁcally for the above purpose may be permitted
in medical treatment areas outside the competition area. In neither case shall theintervention delay the competition or an athlete’s trial in the designated order.
Such attendance or assistance by any other person whether during the competition
or immediately before the competition once athletes have left the Call Room is
assistance.”
C. Equipment and Facilities

1. Starting Blocks (Rule 161.1)
Starting blocks must be rigid, and capable of being ﬁxed to the track by pins or
spikes. The foot-plates on the frame may be adjustable, but must allow no movement
during the start. They must be secured by clamps or a locking mechanism. (Thelocking mechanisms should be checked to assure that they will not slip, as a slipping
block may cause a hamstring injury.)
2. Hurdles (Rule 168.2)
The top bar should be made of wood, the edge rounded, and ﬁrmly ﬁxed at theextremities. The bar should be 7 cm wide and between 1.0 and 2.5 cm thick. A force
of at least 3.6 kg and not more than 4.0 kg applied at the centre-top edge is required
to overturn the hurdle. (A damaged, rough cross-bar may cause abrasions; a hurdle
that is too heavy to tip when struck may cause the athlete to fall.)
The hurdles have ﬁve different height settings. In newer hurdles the weights areautomatically adjusted when the height setting is changed; with older hurdles thismust be done manually. If the weights are in the rearmost position with the lowest
height of 76.2 cm, the force against a young competitior may be up to 6–7 kg.
3. Steeplechase (Rule 169)
The hurdles are 0.914 m high for men and 0.762 m high for women, and weigh
80–100 kg. The height and depth of the water jump are now the same for men andwomen. The water jump area should be covered with a synthetic surface, “or matting
or synthetic padding, ﬁxed in place, to allow spikes or shoes to grip satisfactorily.”CHAPTER 2. SPORTS AND MEDICINE

4. Vertical Jumps-Jumping and Landing Areasa. High Jump (Rule 182.10)
The landing area shall measure not less than 5 m x 3 m, but it is recommended
that it should not be less than 6 m x 4 m x 0.7 m in major international
competitions
b. Pole Vault (Rule 183.11)
The landing area shall measure not less than 5 m x 5 m. For major international competition the landing area shall not be smaller than 6 m long(excluding the front pieces) x 6 m wide x 0.8 m high. The front pieces mustbe 2 m long.
The sides of the landing area nearest the box shall be placed 10 to 15 cm
from the box and shall slope away from the box at an angle of approximately
30 degrees.
The stop board’s upper edge shall be rounded with a radius of 5 up to 50 mm.
(Most injuries in the vertical jumps occur when the athlete strikes the groundoutside the landing area, or falls from the landing pad onto the ground. Some older
landing pads that are too small, as well as makeshift pads, have been responsible forsevere injuries, including concussions, skull or cervical fractures, and quadriplegia.)
5. Horizontal Jumps—Takeoff and Landing Areasa. Long Jump (Rule 185.5; 185.6)
The distance from the take-off board and the far end of the landing area
shall be at least 10 m. The board shall be between 1 m and 3 m from thenearer end of the landing area.
b. Triple Jump (Rule 186.3; 186.4)
The distance from the take-off board to the far end of the landing area
shall be at least 21 m. The distance from the take-off board to the nearer
end of the landing area shall be: for men—13 m; for women—11 m forinternational competition. For other competition, the distance shall beappropriate for the level of competition.
(The landing area for both long and triple jumps should be ﬁlled with ﬁne sandand should not contain any materials [rocks, gravel, debris] that could cause injury.)
6. Throwing Events (Rules 187–193)
a. Associated Risks
Most severe and fatal injuries in athletics are associated with the throwing
events. Although the discus and hammer are thrown from protective cages,
an implement may still strike ofﬁcials, athletes, or spectators who venture
imprudently into the ﬁeld in or around the landing area. While landing areas
are usually marked by ﬂags and deﬁned by chalk lines, these do not restrain
errant implements from ﬂying far beyond these boundaries. Everyone must be
cautioned repeatedly to remain alert not only during the competition, but
especially during the warm-up period, as well as during training.

CHAPTER 2. SPORTS AND MEDICINE

b. Cage and Landing Sector
The landing sector for both discuss and hammer has been narrowed
to 34.92°.
For the hammer cage, the height of the netting panels must be at least
7 m at the rear of the cage. Two movable netting panels 2 m wide and 10 mhigh are attached at the front of the cage and adjusted separately for leftand right-handed throwers. The netting shall be of sufﬁcient strength toprevent the implement from passing through the panel. Note that hammer
throwing is now also a women’s event; the women’s hammer weighs 4 kg.
c. Taping of the Hand
Tape on the hand may be used only to cover an open cut or wound. A
physician may be called upon to verify the need for such taping.
7. Long Distance, Road Race, Cross-Country and Race Walking
a. Safety (Rules 230.8; 240.8; 250.8)
Roads used for the competition are closed in both directions, that is,
not open to motorised trafﬁc.
b. Medical (Rules 230.8 c, d; 240.8 b, c)i. A hands-on medical examination during the progress of an event by
designated medical personnel clearly identiﬁed by the Organising
Committee shall not be considered as assistance.
ii. A competitor must retire at once from the race if ordered to do so bya member of the ofﬁcial medical staff appointed by the Organising
Committee. Such staff shall be clearly identiﬁed by armbands, vests,
or similar distinctive apparel.
c. Refreshments
i. Track events (Rule 144.4 )Events of 5000 metres or longer: may provide water and sponges ifweather conditions warrant.
ii. Road Races and Cross-country (Rule 240.9 a–e; 250.8)
Water and suitable refreshments must be at the start and ﬁnish of allraces.
a) Races up to 10 km: drinking/sponging or refreshment stations atapproximately 2–3 km intervals if weather conditions warrant.
b) 10 km or longer: refreshments every 5 km; drinking/sponging
stations (water only) midway between refreshment stations, ormore frequently if weather conditions warrant.
iii. Race Walks (Rule 230.9 a–f)
Water and other suitable refreshments must be available at the startand ﬁnish of all races.
a) All events on the track or road: drinking/sponging stations at
suitable intervals.

CHAPTER 2. SPORTS AND MEDICINEb) Over 20 km: refreshments at 5 km and thereafter every 5 km or
every lap; drinking/sponging stations mid-way between refreshments.
(Drinking and refreshment stations are usually the responsibility of the roadrace/race walk management team. However, it is important to ensure that drinking
water is available at all drinking/sponging stations, and not sponges alone. Sponging
is ineffective in lowering core temperature, although it may produce transient skinsensations of coolness. Drinking ﬂuids is critical.)Current rules do not address the issue of scheduling races to minimise heat
injury, other than to recommend that races be held in April–May or September–
December. This is hardly adequate advice for tropical climates or the Southernhemisphere! Races should be held in the early morning or late afternoon–early
evening, and not the heat of the day. Guidelines issued by the American College ofSports Medicine should be followed as closely as possible (see Appendix 4, ACSM
Position Stand on Heat and Cold Illnesses During Distance Running). The teamphysician, medical committee, or IAAF Medical Delegate may need to become
the athletes’ advocate with the Organising Committee, insisting that distance races,road races, and race walks be held under the safest possible conditions, including
scheduling, adequate drinking stations, and emergency personnel and facilities.