When Russian sports will have a decent medical support – Vademecum magazine

The problem of medical support of 40 million Russian physical education and athletes became the mainstream of public and state life this year. People in various audiences – from kitchens and talk shows to meetings of interdepartmental commissions and presidential councils – were carried away by sports and medical themes. The reason for hype, in addition to discussing important but boring intra -industrial tasks, was a series of scandals in a variety of niches of the industry: from the recorded Ministry of Education and Science 211 deaths of schoolchildren in physical education lessons to the disqualification of our Olympians due to doping accusations. The philistine and quite professional complaints about the system of control of the health of athletes have grown up to the critical mass, which is no longer possible to ignore. Need to do something. But what? On the one hand, sports medicine in Russia is supervised by several federal departments at once, specialized committees of both chambers of parliament, social activists, on the other hand, none of these structures assumes the full responsibility for adequate regulation of the segment and the introduction of medical support of the mass and professional sports.

When Russian sports will have decent medical support

Photo: Mediterranean Health Care

The problem of medical support of 40 million Russian physical education and athletes became the mainstream of public and state life this year. People in various audiences – from kitchens and talk shows to meetings of interdepartmental commissions and presidential councils – were carried away by sports and medical themes. The reason for hype, in addition to discussing important but boring intra -industrial tasks, was a series of scandals in a variety of niches of the industry: from the recorded Ministry of Education and Science 211 deaths of schoolchildren in physical education lessons to the disqualification of our Olympians due to doping accusations. The philistine and quite professional complaints about the system of control of the health of athletes have grown up to the critical mass, which is no longer possible to ignore. Need to do something. But what? On the one hand, sports medicine in Russia is supervised by several federal departments at once, specialized committees of both chambers of parliament, social activists, on the other hand, none of these structures assumes the full responsibility for adequate regulation of the segment and the introduction of medical support of the mass and professional sports.

A team without which they cannot live

The failure of domestic sports medicine was once again discussed at a meeting of the Council for the Development of Physical Culture and Sports under the President of the Russian Federation in Krasnodar in May of this year.Kogda_u_rossiyskogo_sporta_poyavitsya_dostoynoe_Meditsinskoe_soprovozhdenie _ – _ zhurnal_vademecum

When Russian sports will have a decent medical support – Vademecum magazine

The problem of medical support of 40 million Russian physical education and athletes became the mainstream of public and state life this year. People in various audiences – from kitchens and talk shows to meetings of interdepartmental commissions and presidential councils – were carried away by sports and medical themes. The reason for hype, in addition to discussing important but boring intra -industrial tasks, was a series of scandals in a variety of niches of the industry: from the recorded Ministry of Education and Science 211 deaths of schoolchildren in physical education lessons to the disqualification of our Olympians due to doping accusations. The philistine and quite professional complaints about the system of control of the health of athletes have grown up to the critical mass, which is no longer possible to ignore. Need to do something. But what? On the one hand, sports medicine in Russia is supervised by several federal departments at once, specialized committees of both chambers of parliament, social activists, on the other hand, none of these structures assumes the full responsibility for adequate regulation of the segment and the introduction of medical support of the mass and professional sports.

When Russian sports will have decent medical support

Photo: Mediterranean Health Care

The problem of medical support of 40 million Russian physical education and athletes became the mainstream of public and state life this year. People in various audiences – from kitchens and talk shows to meetings of interdepartmental commissions and presidential councils – were carried away by sports and medical themes. The reason for hype, in addition to discussing important but boring intra -industrial tasks, was a series of scandals in a variety of niches of the industry: from the recorded Ministry of Education and Science 211 deaths of schoolchildren in physical education lessons to the disqualification of our Olympians due to doping accusations. The philistine and quite professional complaints about the system of control of the health of athletes have grown up to the critical mass, which is no longer possible to ignore. Need to do something. But what? On the one hand, sports medicine in Russia is supervised by several federal departments at once, specialized committees of both chambers of parliament, social activists, on the other hand, none of these structures assumes the full responsibility for adequate regulation of the segment and the introduction of medical support of the mass and professional sports.

Great for a hockey player

A team without which they cannot live

The failure of domestic sports medicine was once again discussed at a meeting of the Council for the Development of Physical Culture and Sports under the President of the Russian Federation in Krasnodar in May of this year.The report “On measures to develop the sports reserve training system” (available at Vademecum), prepared by a working group led by presidential adviser Igor Levitin, analyzed a dozen industry-wide blunders and outright failures.

The document spoke, in particular, about the insufficient coverage of the country by medical and physical education dispensaries, about outdated equipment, about the absence of a professional standard “sports medicine doctor” and a block on children's sports medicine in the system of continuing medical education. “Almost 40% of athletes leave the sport, including due to health problems,” the authors of the report summed up.

Apparently sharing their concern, President Putin, in his closing speech, called on his colleagues to focus on all aspects of the preparation of a sports reserve, and at the same time “to form an intolerant attitude towards doping”: “We understand that the future results of high-performance sports and the solution of the main task is to ensure the health of our citizens”.

The fears voiced at the presidential council were confirmed six months later by a series of high-profile statements and events. In October, at a meeting of the profile committee of the Federation Council, the Minister of Education and Science Olga Vasilyeva cited terrible statistics: in the 2016-2017 academic year in Russia, 211 schoolchildren died in physical education classes.

In November, another scandal thundered – already in the field of high-performance sports. The International Olympic Committee has banned Russian skiers Alexander Legkov and Yevgeny Belov, accused of doping, of the right to compete in the Olympic Games for life and annulled their championship results at the 2014 Games in Sochi. You can appeal, challenge the expertise and discuss the bias of international anti-doping and sports organizations, but these proceedings will concern individual cases. And the systemic problems of domestic sports medicine will not be solved.

In fact, nothing new was said at the May presidential council in Krasnodar. The same theses, perhaps in a calmer tone, have already been voiced. And even recorded in the conceptual government documents. First – in the Strategy for the Development of Physical Culture and Sports in the Russian Federation for the Period until 2020 adopted in 2009, then – in several instructions from the president to the government at once. In particular, these important papers confirmed the urgent need to create a system of medical and physical education dispensaries, develop a standard for medical support for citizens undergoing sports training, and so on and so forth (for more details, see the timeline).

Click on the picture to enlarge

The state bodies responsible for the implementation of these framework and thematic prescriptions already included in the regulatory framework are known: the Ministry of Health, the Ministry of Sports, the Federal Medical and Biological Agency, the Expert Council on Physical Culture and Sports under the Federation Council Committee on Social Policy and the State Duma Committee on Physical Culture, Sports, Tourism and Affairs youth. But for some reason, neither their scattered activities, nor their solidarity efforts had any effect on the situation in the industry.

Now the main efforts of interested federal officials and parliamentarians are concentrated around the problems of professional sports. According to Boris Polyaev, the Ministry of Sports, the Ministry of Health and their subordinate services are agreeing on the “Concept for the preparation of a sports reserve in the Russian Federation until 2025”, the draft of which should be submitted to the government by the end of this year.

This sad statement can be confirmed by the recent report of the Accounts Chamber, devoted to the analysis of the activities of the FTP Development of Physical Culture and Sports for 2016-2020, which says that the FTP does not compete with the strategy on the basis of which it was adopted. Simply put, a funded program of concrete action is at odds with the concept.

“Our regulatory framework is quite adequate, another thing is that in fact there is no one to implement all this. The position of the Ministry of Health, for example, boils down to the following: we have developed the documents, and you execute them. The Ministry of Sports does not have a responsible profile department. FMBA is responsible for its own separate piece – the medical support of the national teams. At meetings in the State Duma and the Federation Council, they say the right things, but all this remains on paper, ”complains the interlocutor of Vademecum in one of the interested federal departments.

Arguments about what is right in this area and what is categorically indigestible should begin with the recognition that the concept of “sports medicine” is absent in the Russian legal field. The nomenclature of the Ministry of Health includes the specialty physiotherapy and sports medicine, but there is no professional standard for such specialists.

The healthcare industry operators surveyed by Vademecum defined sports medicine as a system of medical and nursing control over everyone who is somehow involved in physical education and sports, and divided it into two blocks: professional and mass sports. True, this segmentation is very conditional. “Recently, the boundaries between professional athletes and amateurs have been blurred, because a non-professional can play sports six times a week, and according to all medical classifications, he falls under the definition of a “professional,” says Andrey Korolev, head physician of the ECSTO European Clinic for Sports Traumatology and Orthopedics.

Such a “blurring” of concepts and areas of responsibility for the industry was formed in the early 90s, when the infrastructure of medical support for athletes built in the USSR fell apart and fell apart, the scientific and regulatory bases became obsolete. Although before Perestroika, starting from the 20s of the XX century, physiotherapy exercises and medical supervision accompanying sports at all levels were indeed among the priorities of state social policy.

Obstacle bandage

“Sports medicine was born in 1923, when the People’s Commissar of Health of the RSFSR Nikolai Semashko announced: “No, comrades, there will be no Soviet physical education without medical supervision.” Then the first department appeared, rooms for medical control of athletes, and from the 1950s, the construction of medical and physical education dispensaries (VFD) began. There, the athletes underwent an in-depth examination at various stages of preparation for the competition.About 180 biochemical parameters of the blood were examined in the members of the national team, and in case of diseases and injuries, athletes were restored with an eye to their return to performances at a professional level, ”says the president of the Russian Association for Sports Medicine and Rehabilitation of the Sick and Disabled (RASMIRBI), and at the same time the chief freelance sports medicine specialist of the Ministry of Health Boris Polyaev.

The book “Life in the Medicine of Physical Education and Sports”, authored by well-known specialized specialists Afanasy Chogovadze, Nina Graevskaya and Antonina Zhuravleva, tells: already in 1927, Nikolai Semashko announced that there were 190 specialized medical rooms operating throughout the country – at polyclinics, in educational institutions, sports circles, as well as about 1,162 departments for the improvement of children, in which important attention was paid to physical education. In the 50s, there were already 140 dispensaries in the USSR, and by the 80s their number exceeded 400: “VFDs were created everywhere – in the republics of the Union, in regions, in large cities and districts.”

For comparison: according to the Russian Ministry of Health, in 2016, there were only 90 VFDs and sports training centers, 197 sports medicine rooms and 138 specialized divisions, departments and departments in the country.

In addition to an extensive infrastructure, Soviet sports medicine had a strong scientific base. By the 70s, the Scientific Council on Medical Problems of Physical Education and Sports worked at the Presidium of the USSR Academy of Medical Sciences, and by the 80s, a doctoral dissertation council on sports medicine at the Central Institute for the Improvement of Doctors, the Research Institute of Medical Problems of Physical Education was organized in Kyiv.

In addition, research work in the industry was supervised by the All-Union Scientific Medical Society for Medical Control and Physical Therapy, which had an extensive network of branches in the regions and regularly gathered sports doctors for scientific and practical conferences. Several key competency centers have emerged in the industry.One of them was the Central Research Institute of Resortology and Physiotherapy of the USSR Ministry of Health, where the department of medical control and physiotherapy exercises was created.

The special department of the All -Union Research Institute of Physical Culture (VNIIFK) focused on working with “top” athletes and included four specialized laboratories: medical control in sports, age problems and mass culture, functional diagnosis and clinical biochemistry.

The solution of applied problems in the field of sports medicine was carried out at several levels. The Committee on Physical Culture and Sports and the Ministry of Health then engaged in normative work, and the Federation of Sports Medicine created in 1960, which was recorded in 1960, was responsible for the practical implementation of the ideas recorded by these departments. The Federation, in fact, acted as an industry coordinator: she was negotiating with the Ministry of Health and the Committee, talked with sports federations. And besides this, she was a representative of the USSR in the International Federation of Sports Medicine (FIMS). The Federation, on the other hand, determined the main areas of scientific research, controlled the quality of medical support of physical education and athletes – professionals and lovers of all ages. The federation zone included anti -doping programs and the formation of medical groups for international competitions and the Olympic Games.

In the minutes of the meeting of the Presidium of the Sports Medicine of the USSR of October 25, 1960 (is at the disposal of Vademecum) it was recorded: a medical group of seven people, including doctors, nurses and masseurs, was sent to games from 1960 in Rome. In the capital of the games, a medical center has been opened, where 975 people (more than 30 per day) were served for the entire time of the competition and only 172 people applied for one help, the rest took treatment from three to seven days.

The US medical delegation, as follows from the same protocol, consisted of two doctors, but, as the participants in the meeting admitted, the methods of American colleagues were somewhat surpassed in the equipment and convenience of the Soviet colleagues.“… We did not see anything fundamentally new, but saw an exceptionally convenient form of application. For example, Robertson, who took second place in height jumps, after the first attempt, damaged himself his right thigh. The Americans immediately, at the stadium, made him an injection, then some elastic bandage specifically for the hip, and he took second place. Everything was done instantly. This is important for maintenance, ”the transcript of the performance of one of the doctors serving the Soviet Olympians in Rome has been preserved.

Rebel from WADA

As representatives of the Ministry of Sports told Vademecum, the department is currently working on the execution of the instructions of the president, including the inclusion of sections on medical, biomedical and anti-doping support in the federal standards for sports training. In addition, it is planned to initiate the development of sports medicine doctor's offices in sports organizations.

In the 90s, sports medicine “blown away” as quickly as all other industries of the health industry. The department of sports medicine VNIIFK ceased to exist, relevant laboratories were closed at the Institutes of the Ministry of Health and Academy of Medical Sciences of the USSR, then the Scientific Council for Medical Problems under the Presidium of AMN was liquidated. The Federation of Sports Medicine was also eliminated.

“The material and technical base of dispensaries has already begun to obsolete, and there was simply no money for their re -equipment. The heads of healthcare bodies in the regions believed that first of all it was necessary to allocate funds to combat cancer, strokes and heart attacks, to increase the birth rate, and the financing of sports medicine, if it was carried out, is, according to the residual principle, ”recalls Boris Flyasyev from Rasmirby.

This association, by the way, has grown on the ruins of the All -Union Scientific Medical Society for Medical Control and Physical Education thanks to one of the opinionalists of the industry Athanasius Chogovadze. Rasmirbi managed to restore relations with international organizations, she became a representative of Russia in FIMS and the European Association of Sports Medicine (EFSMA), but could not carry out cardinal reforms in the industry.

In 2011, the Association developed the concept of the development of the sports medicine service, having previously calculated how much funds will be required to restore the material and technical base in the regions. The draft concept was sent for approval to interested departments, but did not receive approval.“18 billion rubles would be enough to bring the industry into perfect order in five years. But we were at a bad time with this application – the Ministry of Health headed for budget austerity and rejected our proposals, ”says Boris Polyaev.

Rasmirbi also failed to promote a professional standard for a sports doctor, although, according to Polyaev, the associations had such developments: “The main problem we encountered is bureaucratic delays: the requirements for professional standards are constantly changing, and they have the right to develop them organizations that won the tender. Won, for example, the Vympel plant and sat down to write the standard for sports medicine, but our association will still have to rewrite the document again.

In the absence of centralized control, the system began to improve on its own, but only in certain, the most budget-intensive segments. For example, in 2009, by Decree of the Government of the Russian Federation No. 812, medical support for national teams was transferred to the FMBA, and leading sports federations and sports clubs formed their own internal medical departments. As a result, a huge audience was left without proper medical support – sports reserve schools and athletes.

Doping scandals and the recognition in 2015 by the World Anti-Doping Agency (WADA) Board of Founders of the Russian Anti-Doping Agency (RUSADA) that they do not comply with the international code became a life-threatening trauma for the industry. The consequences of the dismissal were a ban for Russian experts to participate in the planning of doping tests, sample collection, and research. Until July 2017, doping testing of Russian athletes was carried out by the UK Anti-Doping Agency.

As Vademecum was told in the press service of RUSADA, on June 27 of this year, WADA softened the ban, but left RUSADA experts under the supervision of British colleagues. “We are very pleased that the activities of RUSADA have been partially resumed, and we hope for a full restoration of the agency’s activities,” said Elena Ikonnikova, anti-doping coordinator of the All-Russian Athletics Federation.- True, the Federal State Unitary Enterprise Anti-Doping Center, which was engaged in the analysis of samples of athletes in Russia, still does not have the rights to such activities. Therefore, samples are analyzed in other countries. It makes the whole process more expensive.