Pierre de Coubertin's vision for children in France in the 1880s is as applicable in 2012 as it was back then. The French educator and rugby enthusiast, more famous for founding the International Olympic Committee, believed that introducing sport into the curriculum of French schools would ‘create moral and social strength’. While the reasons for including sport as an essential part of the school curriculum may be perceived differently now, its importance remains. In the 130 years since de Coubertin espoused the benefits of sport in schools, evidence has grown for the positive health benefits in addition to the sociological benefits he championed.
It is the other legacy of Pierre de Coubertin that I focus on here. As founder of the modern day Olympics in 1894, Coubertin had a somewhat different vision to that of most modern day Olympic spectators. The goal of his modern Olympics was to encourage participation not winning: ‘L'important c'est de participer’. He saw the Olympic Games as a forum for promoting a peaceful environment through nations coming together with a common purpose in sport. Despite these noble ideas, de Coubertin was not completely inclusive and forward thinking. He believed that female athletes should not be allowed to compete at the Olympic Games as they might provide a distraction for male athletes. The current Olympic charter however promotes equality for all and female athletes have competed at every Olympic Games since 1900, with all sports open to both genders for the first time in 2012 (with the inclusion of women's boxing).
As a team physician for the Australian Olympic Team returning from the London Olympics (Figs 1, 2), I have had time to reflect on the Olympic Games and make observations from this unique setting that may have relevance for clinical paediatric practice. Some of these observations relate to the elite athlete as a patient and how the mindset of an elite athlete can enhance recovery from injury.
Elite athletes have a number of common psychological traits. They tend to be motivated, hardworking and focussed on achieving goals within time frames, usually related to sports competitions. It is this motivation that drives them to be actively engaged in their own rehabilitation from illness or injury. Similarly in clinical practice, the adolescent who sets goals tends to be more likely to self-manage many aspects of their own recovery. Goal setting enables athletes to work backwards, to plan their rehabilitation according to the steps they need to achieve in certain time frames to meet their ultimate goal. Flexible and realistic goal setting can also be useful in special paediatric populations where children may have less control over their own recovery. For instance, in-patient exercise programs for children undergoing bone marrow transplantation are more likely to be embraced by a child who has set himself or herself a sporting goal of getting back on the soccer field in a realistic time frame than the child who has not mapped out their medium-term goals.
A walk around the Olympic Village (Fig. 3) gives you the impression that at least for some sports, athletes are born and not made. Many elite athletes are what we would term ‘outliers’ in terms of standard growth charts. They would not be out of place in the waiting room of the growth clinic. No doubt it is these unique anthropometric characteristics that partly contribute to success in their chosen sport. Short stature is likely to advantage those athletes involved in balance sports such as diving and gymnastics with the average height of gymnasts (men and women) at the London Olympics being 161 cm. To be able to slam dunk in basketball requires not only exceptional calf muscle power but also tall stature (the average height of basketball players at the London Olympics was 192 cm). Ian Thorpe is evidence that foot size can also be important for propulsion in swimming.
The Olympic Games is a unique medical setting. An athlete who you consult as a patient in the morning may be dining with you or watching a sporting event with you in the evening. With the boundaries between work and leisure activity somewhat blurred, it becomes very important to be conscious of maintaining professionalism and the usual principles of privacy and confidentiality. Similarly, team physicians need to ensure that they practise evidence-based medicine in their management of the athlete with illness or injury. Too often in high-profile sports competition, there is the temptation to sample unproven and even potentially harmful treatments in an attempt to shorten recovery times. There is great satisfaction in working as part of a multi-disciplinary team including allied health professionals and sports managers and coaches, but one must remember that the physician's primary goal is the health and well-being of the athlete and medical judgement should not be compromised by pressure from coaches, family members, teammates or even sports fans.
Lessons learnt from the Olympic Games however are not confined to issues of clinical practice. The Olympic Village Dining Hall is an extraordinary place that embodies all the values one associates with the Olympic ideal. Athletes of all shapes and sizes and from every corner of the globe mingle harmoniously. Those from warring nations dine at the same table and Usain Bolt shares the same food as unknown athletes from far-flung countries. Hand sanitisers stationed at every serving counter (Fig. 4) ensure that hand washing rates (even in male wrestlers and weightlifters) are substantially higher than in senior medical officers!
Discovering new sports at the Olympics was a highlight for me. The headquarters medical team, in addition to staffing the medical clinic in the Olympic Village, provided medical coverage for Australian athletes at the venues of combat and collision sports. The thrill of witnessing an ippon or a waza-ari at judo, when just minutes before I had been referring to judokas as judo players and the tatami as a mat, was unexpected. So too was the excitement of BMX racing – a wonderfully entertaining but somewhat dangerous spectacle (Fig. 5) which was all over in 40 s of berms (banked corners) and whoops (bumps in the track). My newfound BMX terminology has greatly improved my credibility with my adolescent patients.
Residing in the Olympic Village for 4 weeks has also taught me never to take sleep for granted. While the long clinic hours were an impediment to prolonged slumber, it was the nocturnal activities of the village that were the primary threat to sleep quality. Overhead helicopters and late night Opening Ceremony rehearsals were the main contributor to insomnia in the first week, while the neighbouring Croatian gold medal winning men's water-polo team was the main impediment to restful nights in the final week. Industrial strength earplugs are an essential travelling companion for any person contemplating sleep in an Olympic Village.
The somewhat artificial environment of the Olympic Village can lead to the false belief (shared by my adolescent children and patients) that money is no longer essential and that the everyday basics come for free. Arriving home comes with the rude awakening that food and coffee costs money and that wearing one's green and gold tracksuit down George Street, Sydney, is not acceptable, even when paired with fancy white Dunlop Volleys.
The London 2012 Olympic Games has reignited the debate over sports funding in Australia and, in particular, whether too much funding in this country goes to elite sports programs at the expense of community sport. This debate formed the basis of the recent Crawford Review. The difficulty with this debate is the lack of good quality data on the health outcomes of major sports events and in particular whether a major international sporting event results in sustained increases in sports participation at a community level. The evidence for this is currently lacking.[2, 3] There is little doubt that watching the Olympic Games promotes a ‘feel good’ factor but whether watching Sally Pearson win a gold medal in the 100-m hurdles or building a new bike path in a neighbouring suburb is the better way of promoting sports participation is difficult to assess. I believe it takes both, and the funding for one should not be at the expense of the other.
Certainly for London, the host city, a number of legacies remain. The east end of London, one of the most economically and socially disadvantaged areas of that city, has inherited a public state-of-the-art medical clinic, which was the polyclinic during the Olympics and Paralympics (Fig. 6). It has also been left with first class transport and sporting infrastructure for the use of those living in this community.
The city of London and the organising committee of the London Olympic and Paralympic Games delivered two wonderful sporting events. There were so many remarkable individual sporting performances but gold medal counts should not be the key indicator of a proud sporting nation. Pierre de Coubertin once declared, ‘A country can truly call itself sporting when the majority of its people feel a personal need for sport.’ With rising rates of inactivity and obesity in Australia, we must ensure that we do not fall short of the mantle of a proud sporting nation.