Singapore Airlines: Business, Marketing and Operations

Singapore Airlines: Business, Marketing and Operations This paper study is based on Singapore Airlines (SIA), in this case study the project has discuss about the SIAs Business, Marketing and operational strategy, what are the changes is the SIAs facing in future, how this airline company has changed its strategy and how this airline from a small country-state with a population of about three million people, on an island no larger than the Isle of Man, earn a reputation for being the most constant money-making airline in the world, in spite of the various world-wide recessions. The paper study also discuss about, how the Singapore Airline retained employees and the customers. QUESTION 1: Evaluate SIAs Business, Marketing and Operational Strategies and assess their effectiveness in relation to the competition? Over the last decade Singapore Airline has grown from a local airline into one of the worlds leading passenger and cargo carriers. In an attempt to survive, many of the organization which is working in the same business tried to observe and investigate the approaches or strategy which are using by Singapore Airlines (SIA, 2007). Finally it became clear and understandable that SIA are more competitive because of its business and operations strategy. The long term growth of a business design to provide and maintain shareholder value is called the business strategy. So, this part of the paper contains the business, market and operation strategy of Singapore Airlines. As we all know the SIAs has developed a status for being an industry innovator as well as doing things in a different way than its competitors who are in the same industry line, for example, As the study says SIA was the first airline to introduce free drinks, a choice of meals and free headsets back in the 1970s. Not only this, the Singapore airlines are the first who start a two year programme to install Kris World, that is a new in-flight entertainment scheme, for passengers in all three classes of its Megatop B747s. KrisWorld provides around 22 channels of video entertainment, around twelve digital audio channels, around ten Nintendo video games (Nintendo was best known for console industry and famous for home video game), and always alert the destination information and provides a telephone at each seat. By using this innovative ideas and creativity techniques the SIAs has done wonder in this airline business and earn a reputation for being the most consistent money-making airli ne in the world. Not only this, SIAs has done many changes in the history of airline and they provide numerous innovative ideas and doing things differently than its competitors. SIAs is the one who spend lot of millions in order to install KrisWorld movies; by doing this they had given an amazing entertainment to their customers while traveling and this lead to make them a different from their competitors and by adding this KrisWorld they are the first one to do so and this types of strategy help them a lot in becoming a number one in these business. SIA is the first in the market for discoverer and performer of the mostly innovative live teletext news service (KrisNews) and also for an interactive in-flight shopping service for its aircrafts. These creative and innovative developments by SIA, eventually won numerous awards for the best air lines. SIA was the first airline which bought a collection of finest chefs from all over the world to serve best in-flight cooking for its passengers as well as it was the first airline which tried to accomplish the wants of individual passengers by launch the special meal service with lighter and better options plus the unique in-flight meal service which is specially introduced for young flyers and enabled them to choose their desired meals up to 24 hours before the flight departure. Besides that, SIA started to update its menus monthly and even weekly to create an impression among its frequent travelers and also to keep track of flyers tastes. These were the main line of attack for SIA to compete among its competitors in the market and also to shore up its business strategy1. The main success of SIAs is Singapores Changi airport, Changi is situated in eastern end of the Singapore. Changi airport is one of the world busiest airport QUESTION 2: Using change management models evaluate how the company has changed; in strategic terms. QUESTION 3: What challenges is SIA facing in the future. What should SIAs business and operations strategies be for the future and why? Provide justification for your recommendations. As we know that SIAs is the one of the leading airport in the world but due to the large number of competitors in the world. SIAs have to maintain their top ranking in the future by maintaining their operations and business strategy and by developing more innovative ideas. The challenges which a SIA facing in future is mainly due to their competitors, as we all know in airline business the profit is very less and its mainly because of growing airline industry, passengers have many choices to select the low fare flight, so they must provide the better facility in a lower price that may affect their capital turnover. Recession is also the one of the factor for affecting then in future. Like in recession, there is a reduction in number of fliers. In future there is my advance airplanes/crew because of the competition and so the availability of the best crew is very important. There are more challenges that airline industry is facing like escalating costs and stiff competitions. As this part of the paper contains that which type of business as well as operations strategies should SIAs makes for their future and which makes them different from there competitors. Before going to this we must know about the operations strategy, operations strategy is the total guide of decision made the management which leads to the long-term growth for any type of operations, it is the long term process. Basically operations strategy is the method or tools that help us producing goods and services to the consumers. Operations basically deal with the producing or delivering of goods. This paper study discuss the competitive strategies of Porter, In 1980s Porter has argued that there is two types of competitive advantages which can be shared with either a broad or narrow competitive scope to create four well known business strategies: 2 Cost leadership, Differentiation, Focused low-cost, and Focused differentiation The Porters four competitive strategies are shown in table below:- Competitive Advantage Lower Cost Differentiation Cost leadership Differentiation à ¯Ã†â€™Ã… ¸ broad target Low cost focused Focused differentiation à ¯Ã†â€™Ã… ¸ narrow target Cost leadership technique or strategy is normally used by the companies for generally generating the profit even though the low price of the product or the services offered. In this strategy company mainly focused on the decreasing of price and retaining their old customer and generating the new one, so by applying this rule to the airline business SIAs have to take some initiative for lowing there prices in spite of that providing the full facility to their passengers. By doing this the SIA is always be a head from its competitor in present as well in future because doing this the high, medium and even low class passenger get attractive towards it and SIAs will make even more profit than earlier. Differentiation strategy, in this strategy a companys offers a service that consumers perceived it as a different and ready to pay a high amount or cost for that. So, SAI have to innovate some new facilities like new entertainment programs while travelling and some advance technology features with some extra cost, and it must be different as well as a new thing for passengers so that they are ready to pay a high amount for it. Or do offering the old facilities but offered it in that manner that passengers are ready to pay a high amount. This type of innovation or creativity make them different from there competitor and good for future also. Focus Differentiation strategy focus on a narrow sector and within that sector, they are attempting to achieve either a price advantage or differentiation. The principle is that the sector which is focusing must be better served by entirely focusing on it. So, SIAs must use this strategy for be a top in their business by focusing in a small small sector and offered better services to the passengers and then they will definitely be a head in the airline business. Reflection on Career Goals: Becoming an Ophthalmologist Reflection on Career Goals: Becoming an Ophthalmologist 1. Please provide evidence of activities and achievements which demonstrate your commitment to a career in this specialty and/or which have led to the development of skills relevant to a career in this specialty.(250 words) My inspiration for becoming an ophthalmologist stemmed from working in DARUL-HIKMAT DARUL-SHIFA, a charity eye hospital in Pakistan, which I have attended biannually since first year in medical school. There I observed how a small procedure brings a remarkable improvement in the quality of a patients life. Out of my own interest, I undertook 2 ophthalmology electives. I was privileged to observe practice on an incredible elective at MOORFIELDS EYE HOSPITAL. It was a great experience and further motivated me to become ophthalmologist. I achieved Distinction in Ophthalmology during my MBBS. As a Foundation year doctor, I regularly attended eye clinics and theatres in my free time. I did a week of a TASTER SESSION and managed to arrange a SPECIAL MODULE in ophthalmology during my GP rotation. I have made several international presentations and have published in peer reviewed journals. I have excellent hand to eye coordination and dexterity. I am competent in Objective Subjective Refraction. The combination of medicine and surgery, along with the variety of cerebral and fine motor skills necessary has drawn me to the specialty. It is the only specialty that has satisfied me to practice medicine at the highest level. Sight is the most valued of senses for many people, and to be in a position to improve and restore sight, as well as prevent eye disease, gives me great pleasure. I am a dedicated, hardworking, and energetic person. In addition, I have passed RCO exams and my experience in ENT, neurosurgery, diabetics and oncology make me a great candidate. 2. Please provide details of outstanding achievements outside the field of medicine. (250 words) I have regularly arranged clinical courses for the junior doctors and GP since 2008. The courses consist of â€Å"ECG interpretation day† â€Å"Pain Management Course† â€Å"Eye ENT day†. This involves a great deal of organizational and managerial skills. This has also given me experience of developing a successful business plans and dealing with the finances, which will be very beneficial for me, in the future, to set up new services in the NHS. Following additional demand, I have setup a company with a name of AR MEDICS to organise courses more widely. We won the first prize of  £5000 in South Asian Federation (SAF) Quiz competition, 2004. As Sports Coordinator at Medical College, I reformed the Sports Society and wrote its new rules and regulations. For the first time in its 25 year history, I arranged sports fixtures with other universities and introduced new sports. This improved college sports reputation remarkably. I was the captain of the basketball team and was awarded â€Å"Colours†. I learned to cope under pressure and improved my leadership decision-making skills. I enjoy hiking mountaineering. I have hiked up to the base camp of Nanga Parbat- the worlds 7th highest peak- and won first prize. 3. Clinical Audit: What experience of clinical audit do you have? Please state clearly where and when this was undertaken and indicate specifically your role. (250 words) â€Å"Evaluation of Glaucoma Management Services† M Amjad, R Job, S Walker. 01/02/2009 at Leighton Hospital. I initiated the study and formulated the pro-forma and collected data, which was presented in the Divisional Audit Meeting. I made recommendations to improve the system. I then re-audited to complete the cycle of the audit.. My material was later presented as poster at the Royal College of GP Annual Congress Nov 2009. A pilot Glaucoma care pathway was initiated from my recommendations., and Glaucoma Medisoft was installed to document and print clinic letters instantly. Improved documentation was made available for the GP ‘Management of Eyelid CA M. Amjad, S Raja. 01/09/2008 at Blackpool Victoria Hospital. Once again, I initiated the literature research, formulated a pro-forma, collected data, and analysed it. I presented this in the departmental audit meeting. â€Å"An Audit of Ophthalmology Emergencies presenting in AE† M Amjad, W Khan. 30/03/2007 at Blackpool Victoria Hospital. I researched the literature, formulated a pro-forma, collected, and analysed data. My conclusions were presented in the Divisional Audit meeting. â€Å"Management of Corneal Abrasion in AE† M Amjad, W Khan. 01/04/2007 at Blackpool Victoria Hospital. Again, I researched literature, formulated the pro-forma, collected, and analysed data, all for a presentation in the Divisional Audit meeting. Guidelines from Kings College Hospital have now been taken up inn the AE department. Management of Gastro-oesophageal CA six years audit† M Amjad, MU Javed. 01/03/2007 at Blackpool Victoria Hospital. I researched literature, formulated a pro-forma, collected, and analysed data. A presentation was made at the North West Regional Meeting for Upper-GI Carcinoma. â€Å"Major Limb Amputation, Environmental Study† M. Amjad, MU Javed, G Riding. 01/06/2007 at Blackpool Victoria Hospital. I designed pro-forma, reviewed literature, collected and analysed data for a presentation in the Divisional Audit Meeting. 2. Managing Teams: Please provide evidence of leadership skills, managing and/or working in teams. You may give examples from both inside and outside medicine. (250 words) I was elected as a Sports Coordinator at Medical College in my final year, which was a great honour and position of responsibility. In order to make this successful, I needed a good team and representatives from each year, whom I appointed. Working through the team and using my leadership skills, I was able to make significant changes. I reformed the Sports Society and devised its rules and regulations. For the first time since its foundation, I arranged fixtures with other universities and introduced new sports. I took on board ideas from team members and organized sponsors and a concert to generate funds. Our efforts improved the colleges sports reputation. This was because of the good management, delegation of responsibilities to team members and proper use of the recourses generated. I also captained the basketball team and was awarded â€Å"Colours.† This experience not only improved my team working and leadership skills, but also improved my ability to perform under pressure and make clear decisions. 5.Teaching Experience: What experience do you have of delivering teaching? (250 words) I have attended the â€Å"How to Teach Course†, in order to learn new teaching skills and develope a methodology. I have been regularly organizing and coordinating a full day study course for junior trainee doctors and GPs on â€Å"ECG interpretation† â€Å"Pain Management† ‘Eye and ENT day since 2008. The feedbacks has been excellent and the courses are very popular. I regularly delivered formal lectures to foundation and AE doctors on the use of slit lamp and management of acute eye problems. The feedback has always been good and higher than that given to my peers. I organized formal teaching and mock OSCE for final year Manchester medical students. In addition, I regularly present and attend the weekly regional teaching to keep up-to-date with advances within the specialty. My written feedbacks from the sessions have been very encouraging. I enjoy teaching and endeavour to continue it. 6. Research: Please provide evidence of research whether past or in progress. If you have undertaken or are undertaking a research project, please give details and indicate your involvement. (250 words) I worked as a junior Research Fellow Gastroenterology under Prof M Umer in Holy Family Hospital. I was involved in two projects, both presented as poster and also published â€Å" CHRONIC HEPATITIS-C RESPONSE TO ANTI-VIRAL COMBINATION THERAPY† A prospective study of 200 patients. The objective was to study the response of chronic hepatitis-C patients to combination antiviral therapy. I reviewed the literature, collected and analyzed data using SPSS. The results showed that combination therapy with interferon and ribavirin for CAH-C helps to treat the disease as well as to improve the symptoms of the patients. â€Å"SYMPTOMATOLOGY OF CHRONIC HEPATITIS-C† A case control study involving 1000 patients. The purpose was to study the common symptoms in patients with Chronic Hepatitis-C. I formulated the pro-forma, collected data and analyzed using SPSS. This was my first experience in research. Moreover, it was presented internationally. It gave me a lot of confidence and motivation. I learned the skills needed to search the literature, design a research project and to statistically analyze the results. It also improved my communication and presentation skills. Recently I was involved in two small studies and presented them as poster in RCO annual congresses. They are â€Å" The Impact of GDX in the management of new glaucoma referrals† and â€Å"Post-operative ocular complications after acoustic neuroma surgery† 7. Additional Achievements: Please note any prizes, awards and other distinctions (include specialty and qualifying distinction) which you may have. Please indicate undergraduate or postgraduate award, the awarding body and date awarded. (250 words) Grade A+ in MBBS Examinations, Rawalpindi Medical College, Jun 2005 Distinction in Ophthalmology (MBBS Exams), Rawalpindi Medical College, Apr 2004 Distinction in Forensic Medicines Toxicology (MBBS Exams), Rawalpindi Medical College, Jan 2001 Awarded Gold Medals for best in academics, Education Board, Jan 2000 Won Merit Scholarship for 5 years, Education Board, Jan 1999 8. Presentations: In this section please provide details of your most relevant presentations at local level (state whether departmental, hospital or trust). Please give a statement about your personal contribution to the work. (250 words) I have initiated these projects and presented the using PowerPoint at different meetings. Morbidity and mortality meeting. Presented in divisional meeting. 2009 â€Å"Negative dysphotopsia: Long-term study and possible explanation for transient symptoms.† Oral presentation in Journal Club, Leighton Hospital 2008. â€Å"Management of Eyelid CA† M. Amjad, S Raja Presented in departmental audit meeting in Sept 2008 â€Å"Major Limb Amputation, Environmental Study† M. Amjad, MU Javed, G Riding Presented in departmental audit meeting in Jun 2007 â€Å"An Audit of Ophthalmology Emergencies presenting in AE† M Amjad, W Khan Presented in departmental audit meeting in Apr 2007 â€Å"Management of Corneal Abrasion in [emailprotected] Amjad, W Khan Presented in trust annual review meeting in Mar 2007 â€Å"Management of Gastro-oesophageal CA six years audit† M Amjad, MU Javed Feb 2007 9. Presentations: In this section please provide details of your most relevant presentations at regional and/or national level. Please give a statement about your personal contribution to the work. (250 words) I have initiated, written and presented the following work. â€Å"Patient with previously undiagnosed Autoimmune Hypophysistis (AH) presenting with bilateral recurrent cystoid macular oedema secondary to Intermediate uveitis.† M. Amjad, A Sachdev, V Kotamarhi Submitted for Poster presentation at Royal College Ophthlmology Annual Congress, 2010. â€Å"Post operative complications affecting eyes after acoustic neuroma surgery.† A. Garrick, M. Amjad, I Marsh, C Noonan. Submitted for Poster presentation at Royal College Ophthalmology Annual Congress, 2010. â€Å"Restructuring and Innovating the Glaucoma Services. Role of Primary and Tertiary Care.† M. Amjad, R Job, A Asghar, S Walker. Poster presentation at Royal College of GP Annual National Conference, Glasgow, 2009. â€Å"The impact of GDX in the management of new glaucoma referral.† M. Amjad, R Job, S Walker Poster presentation at North of England Ophthalmology Society, Allensford UK, June 2009. â€Å"Patients perspective of new Intra-vitreal Anti-VEGF treatment† V. Kotamarthi, M. Amjad Poster presentation at Royal College Ophthalmology Annual Congress, Birmingham 2009. â€Å"Chiari malformation with the symptom of photopsiae as the only ocular symptom and no ocular signs.† M. Amjad, V. Kotamarthi Poster presentation at The 10th Congress of International Ocular Inflammation Society, Prague. May 2009 â€Å"Value of Ultrasound in detecting pathology in vitreous haemorrhage.† T. El-kashab, M. Amjad Oral presentation The 10th Congress of International Ocular Inflammation Society, Prague. May 2009 â€Å"A Case of Idiopathic Sclerochoroidal Calcification associated with Primary Open Angle Glaucoma.† M. Amjad, T. El-kashab, R Job, A Needham Poster presentation at The 10th Congress of International Ocular Inflammation Society, Prague. May 2009 Communication and interpersonal skills: Please give a recent example that demonstrates that you possess these skills. (150 words max) A 59 year old gentleman was referred over the weekend with a six month history of left temporal ache. All the examinations and bloods were normal, except for a disc swelling on his left side. I informed my consultant and devised a plan. Then, I liaised with the ENT and on call radiologist to review the patient. I kept the patient and his partner informed about all the progress throughout this time. After arranging an urgent scan, which showed a mass compressing his orbit, I arranged for the admission and booked theatre for removal of the mass compressing orbit. As the focal point of communication between concerned groups, I enabled us to work as a large team, efficiently and effectively, to save the patients eye from future complications. My ability to communicate and delegate facilitated the effective success of a multi-disciplinary team approach to patient care. Initiative: Please give a recent example that demonstrates initiative. (150 words max) In October 2008, I attended a busy eye camp in Pakistan. During my stay, I was astonished to find that operations are cancelled on-table by the surgeons due to high IOP. Only high risk patients were having their IOP checked due to high patient turnover. This resulted in a huge waste of resources. After discussion with the management, I took the initiative to provide a solution to this problem. After research and discussions with senior doctors visiting the camp, I proposed to use a puff tonometer to check IOP of all patients undergoing surgery. This method doesnt require extraordinary skill to use, hence it is effective in a busy camp. This proposal was accepted by the supervisors. It had been a great success with surgical cancellations dropping by more than 95%. I received a letter of thanks. Making such a difference in patient care makes me proud. PAPER 2 Describe how you realised that you wanted to become an Ophthalmologist? [Edit] My inspiration for becoming an ophthalmologist stemmed from working in DARUL-HIKMAT DARUL-SHIFA, a charity eye hospital in Pakistan, which I have attended biannually since my first year in medical school. There I observed how a small procedure brings a remarkable improvement in the quality of a patients life. Out of interest, I undertook 2 ophthalmology electives and I was privileged in observing practice on an incredible elective at MOORFIELDS EYE HOSPITAL. It was a great experience and further motivated me to become ophthalmologist. Achieving a Distinction in Ophthalmology during my MBBS, I joined Rawalians Research Forum during my final year in medical school, where I published two research papers. Since then I have been actively involved in audits and clinical studies. I have presented 14 papers in international and national conferences. In addition, I have several published articles in many journals. Most notably during the Haematology, I was involved in ‘randomized control trials. As a Foundation year doctor, I regularly attended eye clinics and theatres in my free time. I did a week of a TASTER SESSION and managed to arrange a SPECIAL MODULE in ophthalmology during GP rotation. I have excellent hand to eye coordination and dexterity. I am competent in Objective Subjective Refraction. In my recent job I have done 53 Phacoemulsifications,6 Squint Surgeries, 23 IV injections, and 64 argon YAG laser procedures. The combination of medicine and surgery, the variety of cerebral and fine motor skills necessary has drawn me to the specialty. It is the only specialty that has satisfied me at the highest level. Sight for many is the most valued of senses and to be in a position to improve and restore eyesight, and prevent eye disease gives me great pleasure. I am dedicated, hardworking, and energetic person. In addition, I have passed RCO exams and my experience in ENT, neurosurgery, diabetics and oncology will make me a great candidate. What do you think are the main issues in solving global blindness by 2020? [Edit] Approximately 314 million people worldwide live with low vision and blindness. 90% of these blind people live in low-income countries. 80% of blindness is avoidable. Without effective, major intervention, the number of blind people worldwide has been projected to increase to 76 million by 2020. The major causes of blindness in the world are cataract (50%), refractive errors (15-30%), Trachoma, Onchocerciasis, Glaucoma, Diabetic Retinopathy, Age Related macular degeneration. According to WHO, restorations of sight and blindness prevention strategies are among the most cost-effective and gratifying interventions in health care. In 1999, WHO launched VISION 2020 The Right to Sight. It is a joint programme of the World Health Organization (WHO) and the International Agency for the Prevention of Blindness (IAPB) with an international membership of NGOs, professional associations, eye care institutions and corporations. It aims for control of avoidable blindness by 2020; to achieve the aim the following issues need to be addressed. HR development: adequate and purposeful training of all eye care personnel is a key factor. Apart from ophthalmologists, the ophthalmic nurse, ophthalmic medical assistants and especially refractionsists should be recruited and trained appropriately. Infrastructure Equipments development: facilities should be equipped according to the tasks. Local entrerpreaunership should be encouraged to participate to reduce cost and enhance sustainability. Awareness Education of local community: community participation is vital and this can be achieved by creating awareness in the public about the diseases and the facilities available to treat and prevent them. Funding: regular and new funding sources should be explored. Outside medicine, what personal attributes make you a good candidate for a career in Ophthalmology? [Edit] I possess combination of qualities through which I have not only achieved over and above the required competencies mentioned in the RCOphth curriculum for ST1 and F2 but also a good working relationship with the colleagues to prove as a good and successful ophthalmologist. I maintain good rapport with patients. During my foundation training, I had experience of caring for terminally ill patients, breaking bad news and discussing the patients care and resuscitation status with their family, which I was able to do in an empathetic and sensitive manner. I am actively involved in audits, and publications to maintain good medical practice alongside the tough demands of clinical work. This requires refinement of my time management and organizational skills. I believe in sharing the skills and experiences, which I do by not only involving myself in teaching but also in charity and voluntary work. I possess qualities of a good team leader and an effective team player, which I have gained thr ough my clinical and non-clinical experiences. I prioritize work and this helps me in coping when working under pressure. I am making most of the opportunities to gain experience and refine my personal skills and will do my best to become a good ophthalmologist. Injuries in Sports and Exercise | Case Studies Injuries in Sports and Exercise | Case Studies PDG. Understanding Injury in Sport and Exercise Settings Self-Selected Case Studies Introduction In this case study we shall consider three athletes who are superficially similar and have presented with injuries as a result of their sport. The athletes will be referred to as Mr.A, Mr. B and Mr. C. Each is in their twenties and are club standard runners. Mr.A fell during a training run and sustained an inversion injury to his left ankle. Mr. B presented with a pre-patella bursitis of his right knee and Mr. C could not compete because of severe metatarsalgia. Mechanism and pathophysiology of injury If we consider the aetiology and mechanisms of each injury we can see that although they are largely sports related and, to a degree sports specific, each is fundamentally different in terms of presentation, cause, treatment and outcome. Let us consider Mr. A. who fell during training. He was a modest club runner who ran sporadically for personal enjoyment. He sustained an acute inversion injury which resulted in a partial tear of the lateral malleolar ligament. This ligament effectively joins the Tibia to the talus and calcareous and is largely responsible for the lateral stability of the joint. (Clemente C D 1975). There was immediate pain and subcutaneous swelling and, although he could weight bear immediately after the injury, Mr.A could only walk with great pain. Lateral distortion of the joint was extremely painful. The fundamental aetiology of the injury was a sudden inversion stress to the ankle which was greater than the ligament could withstand and this resulted in rupture of some of the collagen fibres of the lateral ligament together with the underlying joint capsule. This allowed substantial bleeding to track into the surrounding tissues which, together with both extravasation of synovial fluid and accum ulation of tissue oedema, led to the clinically apparent swelling over the lateral malleolus. Mr. B, by contrast, was a fiercely competitive sub-elite runner who noticed his injury developing more slowly over a period of about ten days. He was preparing for a race and had increased his running schedule both in intensity and distance covered. Initially he was aware of a discomfort in the anterior aspect of his knee which felt superficial. This was apparent at the end of his training sessions and persisted for a few hours while travelling home. As the training sessions intensified, the pain grew more persistent until it occurred throughout his running session. Although it was a nuisance, it was not severe. By the end of ten days it had become very severe to the point that there was demonstrable swelling over the lower pole of the patella which was tender to the touch and constantly painful. The mechanism of this injury is typical of the overuse injury seen with overtraining. It is believed to arise initially from micro tears within the body of the patella ligament which become inflamed and the constant stresses involved with training do not let the injury heal sufficiently and the inflammation becomes accumulative to the point that histology would show inflammatory changes occurring throughout the ligament and this, in turn, causes friction on the surrounding structures. (Hewett T E et al. 1999) This is manifest as a constant progressively painful swelling localised in the region of the patella ligament and is aggravated by movement of the knee joint. It is tender to the touch and limits exercise. Mr. C was a club runner of modest ability, but with an over optimistic appreciation of his own ability, who trained with the elite runners at the club. He frequently complained of minor injuries that were blamed for his particular lack of performance in races. On this occasion he presented with pains in his forefoot over the metatarsal heads which was very specific and occurred when the toes were flexed but not when they were extended (an unphysiological finding). He could run, but complained bitterly of forefoot pain after the race and could be seen hobbling off the track and around the changing rooms after the race. Examination of his foot was completely unremarkable and no consistent physical abnormality could be found. It was noticeable that Mr. C vociferously blamed this problem for his inability to perform well. No physical diagnosis was made but the aetiology of his complaint was thought to be a psychosomatic manifestation of his anxiety relating to his inability to beat the b etter runners at the club. This equated to a mechanism of cognitive distortion and denial together with a compensatory conversion symptom complex to rationalise his poor performance. (Patel D R et al. 2000) In short we see three competitive runners with common presentations of injury, but three very different mechanisms of pathophysiology and aetiology. Each will require a different approach to treatment and will follow a very different illness trajectory. Psychology of sports injury There are a number of different theoretical concepts (with differing degrees of security of evidence base) that can be usefully employed in describing sporting motivation and are therefore relevant to the incidence of sporting injury. (Wigfield A et al. 2000) The literature on these subjects is very extensive and beyond the scope of this essay to consider in any degree of detail. Reversal theory (Apter M J 2001) is commonly utilised in this regard and can describe relationships between the personality characteristics and motivational stimuli. Paratelic dominant athletes commonly enter the paratelic motivational state and are typically arousal seekers and engage in high risk and highly competitive sports (viz Mr. B )(Cogan N A et al. 1998) Mr.A, by contrast is the typical telic dominant athlete who tend to be arousal avoiders, who plan and consider their training carefully and prefer low intensity experiences. (Kerr J H et al. 1999) Let us start this consideration of the psychology of sports injury with an assessment of Mr. C who presents with a primarily psychological complaint Mr. C has an overtly psychosomatic presentation. This can be conveniently described in terms of reversal theory (Apter M J 2001). and the paratelic concept (Murgatroyd S et al. 1978). There are aspects of the metamotivational states described in the theory which are relevant to Mr. C’s perception of his motives for continued participation in running even when he was clearly failing to achieve his set targets. If appears that Mr. C has developed a variation of a paratelic protective framework with somatic constructs. He needs the high arousal gratification of the paratelic dominant athlete by lining up on the starting line with the elite athletes, but has developed his idiosyncratic phenomenological frame as a coping mechanism which allows him a sensation of safety from his perception of failure with a series of somatic excuses for his failure to perform. (Kerr J H 2001) One psychological technique that has been demonstrated to work in this type of case is a form of cognitive behaviour therapy which allows a realisation of the implications of an action to be re-evaluated by the client. (Fowler D et al. 1995) This was combined with a strategy of the setting of â€Å"step-by-step† short term goals. This effectively allowed the client to consider his need to unrealistically compare himself with the elite athletes and to allow him to achieve progressive attainable targets, thereby recognising and capitalising on achievement rather than ruminating on poor past performance comparisons with other (better) athletes. (Pain M et al. 2004). The idea is that by setting and achieving some short term goals, the client can focus on the present, make small progressive steps, and recognise new achievements, instead of ruminating on past performance level. (Hall H K et al. 2001). Complicity by the clinician in agreeing that his symptoms may actually be physical can be completely counterproductive in this type of case (see on) Injury management The object of management of any injury is clearly to maximise the degree of recovery possible and to limit and residual disability that may occur as a result of the injury. In broad terms we can consider the immediate (first aid) treatment and the subsequent longer term management as separate issues. (Hergenroeder A C 2003) In the case of Mr.A’s acute injury the essential elements of treatment (once the diagnosis has been confidently made) should be to prevent further tissue damage and bleeding by immobilisation of the joint (splinting), prompt cooling to reduce the tissue reaction to the injury, analgesia to relieve the pain (but with the caveat that pain relief should not be an indication to stress the joint) and pressure to minimise blood and tissue fluid accumulation. The longer term considerations should be that weight bearing should be kept to a minimum for about 7-10 days. Mobilisation should then begin in a graded fashion over about four to six weeks. Running on flat surfaces could realistically begin (possibly with an ankle support) after that time. Mobilisation (both active and passive) is necessary to ensure that the fibroblastic activity of the ligament repair mechanism does not restrict movement of the joint to the degree that the long term restriction of movement becomes a problem. (Orchard J 2003) Mr.A would be well advised to avoid running on uneven surfaces for a period of many months and to undertake a course of physiotherapy involving modalities such as wobble board training to improve his proprioceptive capabilities. (Lephart S M et al. 1997) Because of the injury, Mr.A should always regard himself as more prone to get a recurrence if he were to have another fall. Mr. B should be treated in a distinctly different way. There is no â€Å"acute† first aid treatment as such, as the critical factor here is to recognise that the injury is the result of overuse of a joint. Rest, or in some cases simply a reduction in the training schedule, is often all that is needed to allow the condition to resolve. (Krivickas L S 1997) There is some evidence to suggest that the use of NSAIAs may help to reduce the inflammatory reaction and thereby increase the speed of recovery but their use must be undertaken with caution because of the propensity of runners to consider that the analgesic properties of the NSAIA group can be equated with evidence of suppression of the pathophysiology of the lesion, and therefore they can start to increase their training schedule thinking that the inflammation has settled because the knee is pain free. (Nickander R et al. 2005) Some clinicians would recommend the use of steroid injections in the paratendon tissues. It has to be noted that this is contentious because of the risk of tendon damage if the steroid is injected into the wrong area. Mr. C requires no immediate physical treatment. Indeed on an intuitive basis, physical treatment could be considered counterproductive as it could be viewed as reinforcing his aberrant adaptive and compensatory mechanisms by colluding in the physical nature of his pathology. By entrenching his position, the clinician could be actually aggravating the problem. Once confidently diagnosed, Mr. C should be promptly referred to a competent sports psychologist for treatment along the lines that we have outlined above. Lecture to club The first serious examination of sports injuries as a specific entity was carried out by William Haddon in 1962 (Haddon W et al. 1962). The growth in interest since then has been exponential. In terms of general observation about sports related injuries we can observe that it is generally accepted that one of the common predictive factors for an injury is a history of previous injury. (Watson A W 2001) ( Lee A J et al. 2001) Various studies have reported increased odds ranging from 1.6 to 9.4. (Chalmers D J 2002). In order to accommodate this information it is clearly important to know the other risk factors involved The practical problem is that in order to assemble a coherent evidence base on this issue it is vital to have well designed and robust trials to consider. In short, there are very few of these. (Parkkari J et al. 2001). A critical analysis of the literature on the subject reveals that there is a surprising paucity of evidence for any significant preventative measure for sports injury. Part of the reason for this is that if there is anecdotal evidence that a procedure reduces the risk of injury then it is likely that a substantial proportion of participants will already be using it. This makes double blind trials almost impossible. Van Mechelen ran a trial of the prophylactic value of warming up and down only to find that over 90% of participants were using the technique already. (van Mechelen et al. 1993) It is clearly of dubious ethical possibility, quite apart from a practical possibility to get a control group of athletes not to warm up just to see if they are more likely to get injured. The management of sports injuries is therefore largely a combination of intuition based on anatomical and physiological principles, guided by experience and validated by what scientific evidence base there is on the subject. The three case studies presented above have all occurred in similar status club runners for completely different reasons. This therefore exemplifies the need to undertake a holistic assessment of each case in order to be in a position to make a confident and accurate diagnosis. One should note that there are occasions when the injury or the pathology is blindingly obvious, but it is more common to have to undertake further investigations in order to firmly establish the diagnosis. Mr.A might require X-Rays to exclude a chip fracture of his lateral malleolus. Mr. B might require some blood tests to exclude a connective tissue disorder and Mr. C may need further assessment in order to be confident that there is no genuine physical pathology. References Apter M J. (2001). Motivational styles in everyday life: a guide to reversal theory.  Washington: American Psychological Association, 2001. Chalmers D J (2002). Injury prevention in sport: not yet part of the game? Inj. Prev., Dec 2002 ; 8 : 22 25. Clemente C D. (19750. Anatomy: A Regional Atlas of the Human Body.  Philadelphia, PA: Lea Febiger; 1975 (Figure 180). Cogan N A, Brown R I F. (1998). Metamotivational dominance, states and injuries in risk and safe sports. Pers Individ Dif 1998 ;10 :789–800. Fowler D, P A Garety, L Kuipers (1995). Cognitive Behaviour Therapy for Psychosis: Theory and Practice. London : Wiley 1995 Haddon W, Ellison A E, Carroll R E. (1962). Skiing injuries: epidemiologic study.  Public Health Rep 1962 ; 77 : 973–85. Hall H K, Kerr A W. 92001). Goal-setting in sport and physical education: tracing empirical development and establishing conceptual direction. In: Roberts GC, ed. Advances in motivation in sport and exercise. Campaign, IL: Human Kinetics, 2001 : 183–233. Hergenroeder A C (2003) Prevention and treatment of sports injuries. Clin Sports Med 2003 Hewett T E , T N Lindenfeld, J V Riccobene, F R Noyes (1999). The effect of neuromuscular training on the incidence of Knee injuries in Female athletes. The American Journal of Sports Medicine, 1999 Kerr J H, Svebak S. (1999). Motivational aspects of preference for and participation in risk and safe sports. Pers Individ Dif 1999 ; 27 : 503–18 Kerr J H. (2001). Counselling athletes: applying reversal theory. London: Routledge, 2001. Krivickas L S (1997) Anatomical factors associated with overuse sports injuries  Sports Med, 1997 Vol 5, no 3 Lee A J, Garraway W M, Arneil D W. (2001). Influence of preseason training, fitness, and existing injury on subsequent rugby injury. Br J Sports Med 2001 ; 35 : 412–17 Lephart S M, D M Pincivero, J L Giraldo, F H Fu (1997) The role of proprioception in the management and rehabilitation of athletic injuries,  American Journal of Sports Medicine, 1997 Vol 3 Pg 55-59 Murgatroyd S, Rushton C, Apter M J. (1978). The development of the telic dominance scale. J Pers Assess 1978 ;42 : 519–28. Nickander R, FG McMahon, AS Ridolfo (2005). Anti-inflammatory agents,  Annual Review of Pharmacology and Toxicology Vol. 19 : 469-490 Orchard J, T M Best (2002) The management of muscle strain injuries: an early return versus the risks of recurrance. Clin J Sport Med, 2002 vol 3 pg 26-30 Pain M and J H Kerr (2004). Extreme risk taker who wants to continue taking part in high risk sports after serious injury. Br. J. Sports Med., Jun 2004 ; 38 : 337 339. Parkkari J, Kujala U M, Kannus P. (2001). Is it possible to prevent sports injuries? Review of controlled clinical trials and recommendations for future work.  Sports Med 2001 ; 31 : 985–95. Patel D R , E F Luckstead (2000). Sport participation, risk taking and health risk behaviours. Adolesc Med, 2000 Vol 312 pg 22-30 Stevenson M R , Peter Hamer, Caroline F Finch, Bruce Elliot, and Marcie-jo Kresnow (2000). Sport, age, and sex specific incidence of sports injuries in Western Australia. Br. J. Sports Med., Jun 2000 ; 34 : 188 194. van Mechelen W, Hlobil H, Kemper H C G, et al. (1993). Prevention of running injuries by warm-up, cool-down, and stretching exercises. Am J Sports Med 1993 ; 21 : 711–19 Watson A W. (2001). Sports injuries related to flexibility, posture, acceleration, clinical defects, and previous injury, in high-level players of contact sports. Int J Sports Med 2001 ; 22 : 222–5 Wigfield A, JS Eccles (2000). Expectancy -value theory of achievement motivation. Contemporary Educational Psychology, 2000 ############################################################## PDG