Brandee Waite

Study of injury and illness rates in multiday ultramarathon runners

PURPOSE This study aimed to describe injury and illness rates in runners competing in 7-d, 250-km off-road ultramarathon events. METHODS Three hundred ninety-six runners competing in the RacingThePlanet© 4 Desert Series ultramarathon races from 2005 to 2006 were prospectively followed. Descriptive analyses were used to evaluate overall injury/illness rates, types of injuries/illnesses, and diagnoses for all medical encounters. Multivariate linear regression was used to estimate the risk of number of injuries/illnesses and 95% confidence intervals associated with age, sex, and race completion time. RESULTS Eight-five percent of runners representing a total of 1173 medical encounters required medical care. The overall injury/illness rates were 3.86 per runner and 65 per 1000-h run. Almost 95% were minor in nature, owing to skin-related disorders (74.3%), musculoskeletal injuries (18.2%), and medical illnesses (7.5%). Medical illnesses were more likely on the first day of the race, whereas musculoskeletal and skin injuries were more likely on day 3 or 4. A 10-yr increase in age was associated with 0.5 fewer injuries/illnesses, and females had 0.16 more medical illnesses compared with males. CONCLUSIONS Despite the extreme nature and harsh environments of multiday ultramarathon races, the majority of injuries or illnesses are minor in nature. Future studies are needed to evaluate additional factors contributing to injuries.

Magnetic resonance imaging abnormalities in the shoulder and wrist joints of asymptomatic elite athletes.

To characterize abnormalities on magnetic resonance images (MRI) in the shoulder and wrist joints of asymptomatic elite athletes to better define the range of “normal” findings in this population.

A Prospective Cohort Study of Acute Kidney Injury in Multi-stage Ultramarathon Runners: The Biochemistry in Endurance Runner Study (BIERS)

The purpose of the study was to evaluate the prevalence of acute kidney injury (AKI) during a multi-stage ultramarathon foot race. A prospective observational study was taken during the Gobi 2008; Sahara 2008; and Namibia 2009 RacingThePlanet 7-day, 6-stage, 150-mile foot ultramarathons. Blood was analyzed before, and immediately after stage 1 (25 miles), 3 (75 miles), and 5 (140 miles). Creatinine (Cr), glomerular filtration rate (GFR), and incidence of AKI were calculated and defined by RIFLE criteria. Thirty participants (76% male, mean age 40 + 11 years) were enrolled. There were significant declines in GFR after each stage compared with the pre-race baseline (p < 0.001), with the majority of participants (55–80%) incurring AKI. The majority of study participants encountered significant renal impairment; however, no apparent cumulative effect was observed, with resolution of renal function to near baseline levels between stages.

Injury and Illnesses prevention for ultramarathoners

The popularity of ultramarathon races continue to grow with runners participating in races throughout the world. These events offer challenges unique to an ultramarathon compared to a marathon race. These challenges require the athlete to focus on factors including race distance, race stages, race environment (temperature, humidity, and altitude), appropriate training, nutritional preparation, and equipment. Athletes ill prepared for these challenges will be at risk from injury and illness. The goal of this article is to review preventive strategies for managing commonly encountered musculoskeletal injuries and medical illnesses in ultramarathon runners.

A Prospective Randomized Blister Prevention Trial Assessing Paper Tape in Endurance Distances (Pre-TAPED)

OBJECTIVE Friction foot blisters are a common injury occurring in up to 39% of marathoners, the most common injury in adventure racing, and represent more than 70% of medical visits in multi-stage ultramarathons. The goal of the study was to determine whether paper tape could prevent foot blisters in ultramarathon runners. METHODS This prospective randomized trial was undertaken during RacingThePlanet 155-mile (250-km), 7-day self-supported ultramarathons in China, Australia, Egypt, Chile, and Nepal in 2010 and 2011. Paper tape was applied prerace to one randomly selected foot, with the untreated foot acting as the own control. The study end point was development of a hot spot or blister on any location of either foot. RESULTS One hundred thirty-six participants were enrolled with 90 (66%) having completed data for analysis. There were 36% women, with a mean age of 40 ± 9.4 years (range, 25-40 years) and pack weight of 11 ± 1.8 kg (range, 8-16 kg). All participants developed blisters, with 89% occurring by day 2 and 59% located on the toes. No protective effect was observed by the intervention (47 versus 35; 52% versus 39%; P = .22), with fewer blisters occurring around the tape on the experimental foot than under the tape (23 vs 31; 25.6% versus 34.4%), yet 84% of study participants when queried would choose paper tape for blister prevention in the future. CONCLUSIONS Although paper tape was not found to be significantly protective against blisters, the intervention was well tolerated with high user satisfaction.

Evaluation and treatment of injury and illness in the ultramarathon athlete

Participation in ultramarathon races and knowledge of these athletes continues to increase as the sport becomes more popular. Physicians and athletes need to better understand the impact of the unique aspects of ultramarathon races, such as race environment (temperature, humidity, and altitude), race distance, race stages, nutritional requirements and equipment, on athlete injuries and illness. Proper treatment of injuries and illnesses during an ultramarathon race is important for avoiding long-term medical issues. In this article, the evaluation and treatment of common musculoskeletal injuries and medical illnesses in ultramarathon runners are reviewed.

Examination and Treatment of Pediatric Injuries of the Hip and Pelvis

Injuries to the hip and pelvis are the least common of lower extremity injuries in youth sports, but include many of the more serious conditions. This article describes the bone and soft-tissue conditions of the hip and pelvis that may present to health care providers caring for the pediatric and adolescent sporting population. The article discusses epidemiology, mechanisms, clinical presentation, evaluation, and treatment options.

Exercise-Associated Hyponatremia, Hypernatremia, and Hydration Status in Multistage Ultramarathons

OBJECTIVE Dysnatremia and altered hydration status are potentially serious conditions that have not been well studied in multistage ultramarathons. The purpose of this study was to assess the incidence and prevalence of exercise-associated hyponatremia (EAH) (Na+ <135 mmol·L-1) and hypernatremia (Na+ >145 mmol·L-1) and hydration status during a multistage ultramarathon. METHODS This study involved a prospective observational cohort study of runners competing in a 250-km (155-mile) multistage ultramarathon (in the Jordan, Atacama, or Gobi Desert). Prerace body weight and poststage (stage [S] 1 [42 km], S3 [126 km], and S5 [250 km]) body weight and serum sodium concentration levels were obtained from 128 runners. RESULTS The prevalence of EAH per stage was 1.6% (S1), 4.8% (S3), and 10.1% (S5) with a cumulative incidence of 14.8%. Per-stage prevalence of hypernatremia was 35.2% (S1), 20.2% (S3), and 19.3% (S5) with a cumulative incidence of 52.3%. Runners became more dehydrated (weight change <-3%) throughout the race (S1=22.1%; S3=51.2%; S5=53.5%). Body weight gain correlated with EAH (r=-0.21, P = .02). Nonfinishers of S3 were significantly more likely to have EAH compared with finishers (75% vs 5%, P = .001), but there was no difference in either EAH or hypernatremia between nonfinishers and finishers of S5. CONCLUSIONS The incidence of EAH in multistage ultramarathons was similar to marathons and single-stage ultramarathons, but the cumulative incidence of hypernatremia was 3 times greater than that of EAH. EAH was associated with increased weight gain (overhydration) in early stage nonfinishers and postrace finishers.