The issue: Top-class sport is by nature unhealthy
text Caroline van der Schaaf, photography Ronald van den Heerik
Everyone knows that sport is healthy. Regular exercise reduces the chance of being overweight, lowers blood pressure and reduces the chance of illnesses like cardiovascular disease, type-2 diabetes, osteoporosis, and breast cancer. Psychological ailments, like stress, are also alleviated by exercise. But what about top-class sport? Can that still be considered healthy? When does intense exercise become unhealthy? And why do so many people engage in it anyway?
Top-class sport is by nature unhealthy
“Top-class sport is by nature unhealthy.” Robbart van Linschoten’s opinion is clear. Van Linschoten has been a sports doctor for years, and has served as the club doctor for Feyenoord for the past seven years, so he knows what he is talking about. “Just look at all the injuries that top sportsmen suffer. As a doctor I would never advise anyone to take part in top-class sport.”
What attracted you to the profession of sports doctor? “I became interested when I was 8 years old and was watching the heroic speed skating races between Ard Schenk and Kees Verkerk. In some way or other something about that clicked. I myself started taking part in different sports and when I went to study medicine, it was clear during my first year already that I wanted to become a sports doctor. As a sports doctor I want to contribute to the sport and to that team. Sports medicine has very progressive ideas about exercise therapy and how to treat injuries. This active approach really appeals to me. As does the world in which I work. As a sports doctor you are there on the field, with both feet in the mud, rather than in a starched white jacket in your office during office hours. This is also a profession that is still taking shape. There is a lot of room to be enterprising because the paths are not all trodden. That pioneering aspect really suits me.”
What do you consider to be top-class sport? “Top-class sport means that you engage in sport more or less professionally, with the aim of reaching the highest achievement possible in that sport and winning as many prizes as possible. That means that there are a great many things you have to do, but also a great many things you have to give up. The fact that you have to do a great deal makes it a profession. A very unhealthy profession, because top-class sport is by nature unhealthy.”
That requires some explanation. “It is very simple. Just go through the statistics and keep a tally of the number of injuries that the average top-class sportsman has suffered in his career. No other kind of person has that kind of injury rate, in no other profession. If the labour inspectorate were to hear that there was so much absence due to illness and labour loss at the port or at a bank because of the practice of a profession, alarm bells would be going off all over the place. But in top-class sport that is just the way it is and it is one of the tasks of a sports doctor to guide those kinds of processes properly. Sports medicine is also concerned with protection: with taking preventative measures to prevent people from becoming injured.”
And does that work? “Yes, of course. More and more insight is being gained into this kind of prevention. Another topic that is been an issue in sports for years is young people dying on the sports field. On average 150 people per year die from acute heart failure on the sports field or immediately after a competition. That is something you want to prevent, of course. Sport is in itself healthy, so why do these people die? Research into this topic has been ongoing for a long time. We still have not identified the cause of that fatal arrhythmia, but there is definitely a connection with sport.”
Is it still wise then to engage in sport? “You have to realise that far more people would die of such a heart disorder if they didn’t engage in sport. But it is of course unbelievably tragic when someone is standing on the field full of life one moment, and lying dead on the sidelines five minutes later. This enormous paradox is almost incomprehensible. And it does not even have anything to do with top-class sport, because these heart failures occur also in a casual game of football indoors, at a softball game or during a marathon. But as a doctor I would never advise anyone to take part in top-class sport. I do recommend that everyone exercises. It has been demonstrated that moderate to intense exercise five times a week, 30 minutes a day, has a positive affect on health.”
Is sport addictive? “Yes, it can be. In running for instance you have something called runners’ high. You get addicted to the activity of running because of all kinds of substances that are released. You can also become addicted to the balance between mental labour and wanting to do some physical exertion three times a week, because it clears your head.”
But when does sport become unhealthy? “You cannot say that training four times a week is necessarily unhealthy. It is unhealthy when your target level is ridiculously high and you put it higher every week, then you ultimately hit the limits of what you can physically endure. And you get strain injuries. People exhaust their body to such a degree that certain structures simply break down. Fatigue fractures are a good example of that. Someone runs for so long that at a certain moment the small bones in his feet break. A sudden change in movement can also cause structures to break down. Tears to the cruciate ligament in the knee are a common injury in sports like football, hockey and baseball – sports in which you swivel quickly on your lower leg.”
Can anyone take part in top-class sport, theoretically? “No. Almost no one is suited to top-class sport. There are a lot of contributing factors. You could have an extremely strong heart and big lungs, which allow you to run a marathon very fast, but if your Achilles tendon cannot take it then that becomes your weakest link in the chain. And that is often the case. Ultimately the weakest link determines whether you are suitable for that top-class sport. And in fact every top-class sportsman encounters some point in their career during which they are seriously injured. A few manage to avoid this, but that is less than 2 or 3 percent I would say.”
You sometimes hear stories about cyclists who continue cycling with a skull base fracture. Is that really possible? “Those are urban myths. An athlete does indeed have enormous drive during a competition, however. Sometimes you actually don’t feel the pain of a broken finger or broken wrist because you are so pumped up with adrenaline and so focused that you in fact mentally block out what is happening in the rest of your body.”
So engaging too fanatically in sport is not good, so what would you recommend people do? “You should achieve your minimum exercise level, and if you want to be fitter, then you have to engage in sport for at least a half hour three times a week. That raises your heart rate enough, that’s what it comes down to. It doesn’t matter if you do fitness training, spinning, swimming, running or rowing. It is best to have as varied a sports programme as possible, because then you run the least risk of straining specific structures. If you vary your exercise, then all structures get the chance to be used and also to recover from exertion.”
Friday, May 16th (Week 20).
Every week in 'the issue' an academic from Erasmus University Rotterdam responds to a current topic in the media. 'The issue' is brought to you in cooperation with Erasmus Magazine, the opinion and information magazine of Erasmus University Rotterdam.