Technology in Sport: Medical and Ethical Repercussions

Technological advances can alter the landscape of elite sport performance. The fields of design, engineering, biomechanics, and materials science often combine to provide athletes with equipment, which facilitates the pursuit of the Olympic dream: “citius, altius, fortius” (faster, higher, stronger). More exciting athletic performances often follow these technological advances, and prime-time network coverage ensures that they are brought into living rooms globally. In recent years, the union of sport and technology has resulted in aerodynamic bicycles, efficient clap-skates, and hybrid skis. FINA, the international federation governing swimming, has recently experienced a volatile effect of technology applied to athletic performance: a consequence of the introduction of new swimsuit designs that led to dramatic increases in performance. While the audience may be delighted with the challenge of counting the number of fallen world records, the sport medicine fraternity at the poolside is left to ponder other questions: What are the medical and ethical repercussions of this technological frenzy? In the last decade, aquatic sports have seen a technological explosion in the design of the swimsuits. Full bodysuits were introduced in 1998 by Adidas, debuted by Ian Thorpe (Australia) in his gold medal performances during the World Championships in Perth, and continued to predominate in 2000 at the Sydney Olympic Games. The evolution of swimsuits continued with the worldwide launch in February 2008 of the Speedo LZR Racer. The new swimsuits compress and streamline the swimmer's body, minimizing turbulence, contributing to buoyancy, and facilitating optimal hydrodynamics. By April 2008, 41 world records had been broken, 40 by athletes wearing the new Speedo LZR suit. In the August 2008 Beijing Olympic Games, 23 of the 25 new world records were established by athletes wearing the Speedo LZR. In total, 94% of the Olympic gold medals and 89% of all swimming medals were won by swimmers in the LZR suit. Michael Phelps became the most successful Olympian of all time, winning an Olympic record of 8 gold medals at 1 Olympic Games (and breaking another Olympic record of 14 gold medals in 2 Olympic Games) wearing the LZR suit. The technological swimming saga continued throughout 2008; 108 new world records were established from February 2008 onward. The last quarter of 2008 and early 2009 saw an explosion in the number of swimsuit designs as rival companies quickly developed new models. Like the LZR, all the newer swimsuit designs covered a larger amount of the swimmer's body with a greater percentage of polyurethane- or neoprene-like material. In Rome, in July 2009, at the 13th FINA World Championships, the full-bodied Jaked suit was made of 100% polyurethane. During these world championships, 43 world records were broken throughout the course of the weeklong swimming events. The most recent swimsuit model is engineered to fit the body like a “second skin,” eliminating folds and air pockets. The tailored silhouette of the swimsuit begins at the ankles and extends all the way to the neck. As noted, the proposed performance advantages of the new suits are thought to be multifactorial: They are believed to increase buoyancy, to decrease drag or resistance in the water, to enhance hydrodynamics by streamlining the body shape, and to reduce swimmer fatigue-with resulting increases in swimming performance. It has been suggested that the performance benefit can improve race time by 2%. This difference is huge when the differential between first and eighth places is often a matter of hundredths of a second! Swimmers are quoted as saying that swimming in the new suits makes them feel as if they are “swimming downhill.” The frenzy in the water has been fueled by a basic marketing imperative: profit. New companies have been attracted to the lucrative swimsuit market. And why not? One of these new model swimsuits retails at between €350 and €700 (US $500-US $1000) per suit. Equally attractive from a marketing perspective is that these suits have a very short “performance life.” Due to the fragile nature of the swimsuit material, they are expected to last only for a few events. On one occasion at the Beijing Olympic Games 2008 and once during the 13th FINA World Championships 2009, races had to be delayed as swimsuits had torn while in the call-room just before the race. MEDICAL REPERCUSSIONS As can be imagined, donning one of these new skintight swimsuits is not an easy task. On average, it takes the swimmer 30 to 45 minutes to dress for a race, usually with the aid of a minimum of 1 to 2 assistants. In addition to the physical demands of this process, there are psychological costs to the athlete associated with swimsuit selection and the prevention of tearing. A medical consequence of this new practice seen by the medical staff during the 13th FINA World Championships in Rome in July 2009 was the development of extensive blistering and subsequent ulceration of the fingertips and the dorsum of the distal interphalangeal joints produced by the efforts to don a suit. The prevalence of these lesions among larger national teams averaged up to 50% to 80%, mainly with newly worn swimsuits. Many of these cases were extensive, inflamed, and irritated, requiring medical attention for symptom control. The pain from the raw ulcerations was exacerbated on contact with the chlorinated water (Figure 1).FIGURE 1: Ulcerated bulla on the dorsum of the distal interphalangeal joint, resulting from friction with the swimsuit material while dressing for a race (photo credit M.M.).A second medical issue facing aquatic team physicians in Rome 2009 resulting directly from the challenges of donning the technologically advanced swimsuits was the development of extensive ecchymoses on the lower limbs. The most difficult part of the suit to apply is that which stretches over the lower limbs; because of the tight fit, the underlying skin is pinched in the process. A number of athletes developed purpuric lesions and ecchymoses. The incidence of these in some national teams approached 50% (Figure 2).FIGURE 2: Ecchymoses of the lower limb secondary to swimsuits (photo credit N.C.).ETHICAL REPERCUSSIONS While the swimsuit manufacturers are counting their money, someone has to ask the most important question: Does this new technology affect the integrity of the sport? Although the medical repercussions are not serious and are easily treated, the effect of this new technology on the integrity of swimming as a sport is far greater. Will this new technology mean that swimming will become a sport for the affluent, eliminating those of lesser means? Is the ability of the swimmer overshadowed by the technology of his “artificial keel”? To what extent will custom fit suits confer advantages over those purchased “off the rack”? Is the fundamental appeal of a sport in which competition is between swimmers about to be superseded by competition between design engineers? During the FINA Congress in Rome 2009, the member National Federations voted to change the swimsuit rule to address this issue. From January 1, 2010, all swimsuits will be composed of textile materials only with no zippers or fasteners. The silhouette of the swimsuit for men is to extend, at maximum, from the knees to just below the umbilicus and for women from the knee to the shoulder in 1 or 2 pieces. The voice of the aquatic community was heard as the voting members unanimously ratified this rule change. With these changes in regulation, swimming will return to its former state of excitement with talent, training, nutrition, and sport science playing a larger role than swimsuit technology.

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