A very bumpy playing field

As the electronic clock purrs away the milliseconds to the opening of the 2012 London Olympic Games, a new book by a Cambridge University researcher looks at the controversies surrounding the training and performance of athletes over the last 130 years and reveals huge changes in attitudes towards what is fair play and what is cheating, what is natural and what is not.

In A History of British Sports Medicine, the first ever book to examine the topic in depth, Dr. Vanessa Heggie, Research Fellow in the Department of History and Philosophy of Science at Cambridge, focuses on the development of techniques, treatments and drugs to enhance athletic performance and, in parallel, the creation of rules and regulations that attempt to create a controlled environment in which sporting achievement can be tested on a level playing field.

What Heggie is especially intrigued by, and what makes her book more than simply a compendium of advances in sports medicine over the decades, is how changing medical ideas about sport and exercise have shaped our perceptions of what is acceptable and what is unacceptable, resulting in a world in which athletes have to meet standards, and undergo extreme regimes, that simply do not apply to the rest of us.

At the core of Heggie's book is an account of how athletes came to be treated differently to the rest of the population by the doctors and scientists who studied and treated them. As well as enhancement, which can include non-drug-based interventions as basic as training and good diet, the book charts advances in the curing, treating and preventing of diseases and injuries, alongside the drug testing and medical 'policing' of sport.

In the UK sports medicine was added to the UK's Specialty Register as recently as 2005. Yet as early as 1900 there was an institution known as the 'Footballers' Hospital' established in Manchester and treating overseas as well as British athletes and by the early twentieth century nearly every training manual for sports claimed to be scientifically informed or to be using the latest medical understandings of the body.

The athletes now in training for next year's Olympics will arrive with their own entourage of specialists - doctors, dieticians, physiotherapists, masseurs, even psychologists. Only in the arena of sports medicine are bodies so unremittingly honed for specialist tasks and human beings encouraged to undergo regimes that put the body under stress well beyond the parameters regarded as reasonable. The outcome might be bodies that perform with extreme efficiency and consistently break records but it is worth noting Heggie's warning that athletes are not always healthy or long-lived.

Cheating is a word lurking below every topic Heggie turns her mind to. The most arresting topics she tackles are drugs and gender. "The development of increasingly stringent rules governing the use of drugs and the ongoing concerns about gender segregation in the competitive sporting world means that the bodies and lifestyles of athletes are held up to extraordinarily exacting standards," said Heggie.

"You and I can enjoy a beer, take a puff on an asthma inhaler, and swallow a prescription tablet of Viagra, and go to work the next day in no fear of losing our jobs. This has not always been true for the professional athlete, and Viagra is currently under scrutiny by the World Anti-Doping Agency. What other career demands that an individual should choose between losing their job and experiencing sexual dysfunction?"

The earliest Olympic Games rules against doping were introduced ahead of the very first London Olympiad in 1908. Competitors were forbidden to take dope of any sort though, in the absence of practical methods for testing, this was more than a request than a rule. The first successful sports doping test for amphetamines was developed by British scientists, in the 1960s, and tested at the 1966 Football World Cup.

While public attitudes to variations in sexuality have become more tolerant, sport insists that people compete as just one of two genders: male or female. Likewise, sports authorities have a difficult job deciding whether substances or training practices are 'fair' or 'unfair', and whether certain sorts of bodies are 'normal' or 'abnormal'. Heggie concludes that sporting competitions are fundamentally a measure of inequality between people: the creation of a level playing field is a myth and sports cannot be seen as an expression of natural talent.

Sports medicine is not just vital to elite performers; we are all offered advice from many sources about how much exercise we should be doing to stay healthy or whether intervals or resistance training are the best ways to lose weight. Heggie's book also investigates how sports doctors become involved in formulating health politics and giving public health advice, and how their knowledge about the elite sportsman can help them understand the problems of our sedentary lifestyles.

Interestingly, while Heggie is fascinated by the world of sports science and medicine for what these activities tell us about our attitudes towards health, normality and our bodies, she admits to being to being a singularly lacklustre sports person herself.

"This is probably an advantage in many ways as I'm able to look at sport with a measure of impartiality. Given that I've become a historian of sport, it seems funny to remember my absence of enthusiasm for it at school. We played hockey, I was put in goal and was given men's cricket leg pads for protection. They so encumbered me that by the time I had waddled over to the goal, the game, much to my relief, would be half-over," she said.

Marvellous mile stones in the history of British sports medicine:

• At the first London Olympics in 1908, the official caterer at the event was Oxo, which provided its beef extract drink free to athletes. Oxo was described as a tonic food, intended and expected to improve health and vitality.

• In 1922 British scientist Archibald Vivian Hill shared the Nobel Prize in Physiology or Medicine, with Otto Fritz Meyerhof, for their research on the chemistry of muscles during exercise.

• In the 1930s the eccentric coach of the Wolverhampton Wanderers Football Club claimed that he was giving his enervated players extracts of monkey's glands to enliven their performance. While there were some grumblings in the medical and sporting press, there was no suggestion that a footballer taking hormone extracts for personal reasons should be banned for life - which is what would happen today.

• The Sports Council has been one of the biggest funders of British sports medicine research: its first science grant of £2500 was awarded in 1965 to a study of the affects of altitude on runners in preparation for the 1968 Mexico City Olympics; in 1967 the Sports Council funded another study where athletes swallowed radio-transmitting thermometers to record their body temperature, and then ran until they were totally exhausted.

A History of British Sports Medicine by Vanessa Heggie is published by Manchester University Press.