This short article is to introduce the real concept of SEM in Ghana. It is not a new concept or speciality, in fact it has been practised in the USA for about 50 years and in other countries for many years now. These countries are reaping the benefits of SEM on its sports men and women on the world stage. SEM is currently not being practised in Ghana. What is happening in Ghana is that groups of medical doctors without continuing medical education or professional development work in sports. This therefore means that there is no SEM specialist base to help our elite athletes. SEM and current literature is currently a prerequisite for maximum performance of our athletes on the world stage. This is lacking in Ghana and in my view must change. We desperately need positive cultural change and team work behind our athletes so that they can perform maximally on the world stage. In my view NO SEM, NO TEAM WORK = SUBOPTIMAL PERFORMANCE ON THE WORLD STAGE.

DEFINITION

Defining sports and exercise medicine (SEM) is not easy, as it is many things to many people. Personally after looking at various articles on the subject of defining sports and exercise medicine, my definition is that the field of sports and exercise medicine (SEM) is a branch of medicine involved with ?injuries? sustained in sporting activities, including their prevention, diagnosis and treatment.

The injuries in this definition include musculoskeletal, psychological, fatigue, nutritional, biomechanical, ?doping injuries? etc. The prevention and treatment of these injuries demands a huge multidisciplinary input from sports physicians, physiotherapists, nutritionists, podiatrists, sports massage therapists, biomechanists and exercise physiologists among others. So team work is vital in SEM .The purpose of injury prevention and treatment is to maintain optimal health and maximise peak performance. Believe it or not without this input, the end result tends to be less than optimal. This is what has happened to sports in Ghana over the years. We also have to remember that SEM is not only for elite athletes but it embraces every body from the novice to the elite. In effect it will benefit Ghanaians especially as we increasingly embrace western lifestyles which brings with it lack of exercise among other things.

SPECIALITY STATUS IN GHANA

Sports and Exercise Medicine is being established as a speciality in its own right all around the world. There is no reason why it should not be a speciality or gain a speciality status in Ghana. It is not part of orthopaedic surgery or rheumatology. Sports and Exercise (SEM) is diverse and covers many fields of medicine as listed in the SEM syllabus below. Around the world many medical specialities think that they look after SEM. They do not and will not in the future because it is a speciality in its own right and will look after itself. There is a wind of change sweeping the world, the countries which have embraced SEM are reaping the positive rewards financially etc for example U.S.A, U.K and Australia. I believe that SEM should be a speciality within the new postgraduate college in Ghana, it should be taught in medical schools in Ghana, from the undergraduate level. A committee should be set up to look into establishing departments of SEM in our medical schools. In the future a centre of SEM excellence will be an idea worth pursuing as a long term plan for the sub Saharan countries. Our athletes need this behind them. This might seem over ambitious but it is achievable in the long run.

In main stream medicine, SEM?s syllabus will involve the following broad areas as listed below.

• Exercise and muscle physiology
• Injury recognition, management and rehabilitation
• Effects of exercise on human biological systems, such as prevention of disease
• Assessment of physical and functional capacity
• Environmental medicine
• Medical care of sports teams at home and abroad
• Medicolegal issues, ethics, drugs in sport
• Implementation of physical training and pre-participation screening
• Exercise in elderly people
• Exercise in children and adolescents
• Exercise and the female athlete
• Overtraining-underperformance syndrome
• Sports psychology
• Sports radiology

The above areas in medicine should be the core subjects in both undergraduate and postgraduate SEM. In addition postgraduate studies should include Internal medicine, obstetrics and gynaecology, paediatrics and general surgery-6 months rotation in each branch of medicine and one year attached to an accredited sports facility like a sports academy etc. Of course this can?t be done overnight but it is one for the future.

CAREER STRUCTURE

I think that SEM should be fully recognised and then maintain its links with the international federation of sports medicine (FIMS). A speciality of SEM should be established within the new postgraduate college of Ghana to create its own educational and qualification standards (fellowships) to international levels and maintain continuing medical education (CME) and continuing professional development (CPD) and also maintain its links with other SEM colleges around the world. This also means that it should become a part of the medical curriculum in Ghana?s medical schools.

THE PROS AND CONS OF SEM

I have listed the pros and cons of SEM in today?s Ghana. This is listed as below.

Pros

• Exiting developing speciality
• Multidisciplinary environment
• Working with healthy and motivated people
• Positive effect on peak performance of professional athletes i.e. football, track and field athletes etc

Cons

• No speciality status at present
• Recognition of SEM by MEDICAL peers is either non existent or variable
• No SEM Professionals to look after its interests
• Lack of interest from the media and medical establishment
• Absent in medical curriculum
• No strong medical backup for our elite athletes

THE ROLE OF THE SEM DOCTOR

SEM physicians specialise in the non-operative treatment of musculoskeletal injuries as opposed to orthopaedic surgeons for example who are trained in the operative treatment of musculoskeletal injury. By far the greatest number of musculoskeletal injuries i.e. about 95% can be treated by the SEM physician or specialist. Any injury that needs operative treatment is immediately referred to the appropriate speciality. SEM physicians also guides any individual who wants to improve their health and increase their fitness, a process called exercise prescription.

SEM physicians work closely with other practitioners i.e. physiotherapists, podiatrists, nutritionists, massage therapists, exercise physiologists, biomechanists etc. This makes it a subject with a multidisciplinary approach to the individual sports person. SEM physicians also guide patients through their treatment plan and monitor their progress, ensuring they receive the appropriate care before they return to their sporting activity. This broad and inclusive view of SEM led for example to the founding of the American College of Sports Medicine (ACSM) in 1955 by a group of 11 educators, scientists and physicians.

WHAT SEM CAN DO FOR SPORTS IN GHANA

In my view SEM is so important that without a disciplined well qualified SEM personnel behind our athletes, we will continue to perform sub maximally as we continue to see over the years and we don?t need a single more penny than we are doing now to achieve this as a developing country. We just need determination, more focus and team work. In general SEM has benefits for all Ghanaians irrespective of whether they are elite athletes or not.

The benefits are as follows

• Maximises health, i.e. reduces heart attacks and strokes
• Controls body weight
• Improves muscle function
• Reduces anxiety and depression and the consequences of it
• Increases self esteem
• Creates atmosphere of teamwork
• Maximises teamwork and strong medical backup behind our athletes
• Involves quality assurance, audit, research and continuing medical and professional development. This will enable SEM practitioners to appraise itself and continue to improve for the future. This will in the long run benefit everybody in Ghana.

MODEL FOR WORLD CLASS PERFORMANCE OF OUR ATHLETES

This is my world class performance (WCP) model for maximum performance for our athletes. In my view two major factors which have led to our athletes not performing maximally on the world stage are lack of team work and solid organisational factors behind our athletes like poor sports administration. If these two major factors are effectively organised without individual hidden agendas then believe it or not sports will leap forward and we will all reap the benefits of this success.

The team should consist of SEM doctors, a performance director, playing staff, fitness and conditioning staff as well as the managerial/coaching staff. The links between these should never be broken in good and bad times. This then lays down the building blocks for success of sports in this country whatever the type or level of team sports. People with hidden agendas can never keep these links and therefore this model never works with such people handling sports. A performance director can be any well meaning person with genuine interest for the progress of sports in Ghana in mind i.e. lay person, former athlete etc. His job is to make sure that all the team members stick together through regular meetings and effective communication. He must be able to pick up the pieces if anything goes wrong and involve every team member in the model to find solutions to the problem avoiding blame culture which we are currently used to in Ghana.

CAUSES OF BREAKDOWN OF WCP MODEL

The causes of the breakdown of WCP model is listed below and this hold true in Ghana today.

• No SEM speciality
• Lack of respect for our athletes
• Blame culture when things go wrong
• Distrust among our sports personnel
• Indiscipline among our athletes and authorities
• Mishandling of funds
• Lack of motivation
• Lack of interest especially from the media and medical establishment
• Lack of commitment
• No audit and quality assurance
• Lack of desire for change
• Lack of effective communication
• POOR TEAM WORK AND APPROACH

CONCLUSION

I believe that we should establish SEM in Ghana for our people and elite athletes. This is the only way they can maximise their performance on the world stage. Our mission for sports in Ghana should promote and integrate scientific principles and research, education, current literature and practical applications of sports and exercise medicine to maintain and enhance the physical performance, fitness, health and quality of life for our people as well as sports in Ghana.

Sports in Ghana have reached a stage where SEM is needed for our athletes and medical personnel as well as our people. Without this our sports will remain where it is and history will not forgive us if we fail to establish SEM now in Ghana. In my next series of articles I will focus on general sports and exercise medicine which will be of interest to the general reading public, sports personnel and the medical establishment.