Brian J. Krabak

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.

Medical Services at Ultra-Endurance Foot Races in Remote Environments: Medical Issues and Consensus Guidelines

An increasing participation in ultra-endurance foot races is cause for greater need to ensure the presence of appropriate medical care at these events. Unique medical challenges result from the extreme physical demands these events place on participants, the often remote settings spanning broad geographical areas, and the potential for extremes in weather conditions and various environmental hazards. Medical issues in these events can adversely affect race performance, and there is the potential for the presentation of life-threatening issues such as exercise-associated hyponatremia, severe altitude illnesses, and major trauma from falls or animal attacks. Organization of a medical support system for ultra-endurance foot races starts with a determination of the level of medical support that is appropriate and feasible for the event. Once that is defined, various legal considerations and organizational issues must be addressed, and medical guidelines and protocols should be developed. While there is no specific or universal standard of medical care for ultra-endurance foot races since a variety of factors determine the level and type of medical services that are appropriate and feasible, the minimum level of services that each event should have in place is a plan for emergency transport of injured or ill participants, pacers, spectators and event personnel to local medical facilities.

Shoulder Injuries in the Skeletally Immature Baseball Pitcher and Recommendations for the Prevention of Injury

Since 1996, when the first article on pitch restriction recommendations was published, the number of research articles involving skeletally immature pitchers has increased. Potential shoulder injuries in this age group are proximal humeral epiphysiolysis, glenohumeral instability, rotator cuff dysfunction, and superior labrum anteroposterior lesions. Fatigue, improper biomechanics, and overuse are the most common reasons for these injuries. In the hopes of preventing injury to young pitchers, numerous organizations, including the USA Baseball Medical & Safety Advisory Committee, The American Sports Medicine Institute, Little League Baseball & Softball, and the Long Term Athlete Development Program for Baseball Canada, have developed recommendations on pitching restrictions that include limits on pitch count, pitches per week, pitches per season, and rest between pitching. Awareness by sports medicine providers, coaches, and parents/guardians of the most up‐to‐date recommendations on injury prevention and return to play guidelines should reduce the incidence of acute and chronic injuries in adolescent baseball pitchers.

Optimal Resistance Training: Comparison of DeLorme with Oxford Techniques

Fish DE, Krabak BJ, Johnson-Greene D, deLateur BJ: Optimal resistance training: Comparison of DeLorme with Oxford techniques. Am J Phys Med Rehabil 2003;82:903–909. ObjectiveProgressive resistive exercises, such as the DeLorme or Oxford techniques, improve strength by adding weights to arrive at the ten-repetition maximum (10RM; DeLorme) or by starting at the 10RM and removing weight (Oxford). The goal of this study was to examine the efficacy of each training method. DesignIn this randomized, prospective, group design, evaluator-blind clinical trial, 50 subjects performed either the Oxford or DeLorme weight-training techniques. Three times a week for 9 wks, subjects completed three sets of ten-repetition knee extensions based on the 10RM measured weekly. Incremental or decremental changes in training weight were utilized in training sessions based on the protocol randomly assigned to each subject. ResultsThe mean 10RM increase was 71.9 kg for the DeLorme group and 67.5 kg for the Oxford group, which was not significantly different. Examination with repeated measures multivariate analysis of variance revealed no significant difference between the two groups for 10RM increase, and no significant sex differences were found. Percentage change scores were not significantly different for 1RM and 10RM for both protocols and sexes. ConclusionBoth protocol groups were able to complete their lifting assignments and progressed similarly in weekly 10RM weight lifted. It can be concluded that both the DeLorme and Oxford protocols improve strength with equivalent efficacy. Further studies involving a larger sample size are needed to address potential sex-specific changes in strength improvement in response to the protocols.

Neurophysiologic influences on hamstring flexibility: a pilot study.

ObjectiveTo examine the potential contribution of neurologic influences on hamstring length during passive range of motion. DesignProspective study. SettingsAcademic sports medicine center. Patients15 subjects undergoing arthroscopic surgery for unilateral knee injuries without previous injury to the contralateral knee. InterventionsSubjects received: 1) spinal anesthesia with bupivacaine, 2) epidural anesthesia with lidocaine, 3) general anesthesia, or 4) femoral nerve block of injured leg only. Main Outcome MeasuresNoninjured leg popliteal angle preoperatively, intraoperatively under anesthesia, and postoperatively after recovery from anesthesia. ResultsThe overall mean popliteal angle was 132.5 ± 3.1° preoperatively, 134.31 ± 11.6° intraoperatively, and 130.7 ± 10.2° postoperatively. Overall, the intraoperative angle was significantly greater than the postoperative angle (p = 0.02). The mean change in popliteal angle was 8.1 ± 2.2° (Group 1), −0.4 ± 1.9° (Group 2), 0.9 ± 1.4° (Group 3), and −2.4 ± 3.8° (Group 4). There was no significant change in pre- to postoperative popliteal angle in relation to postoperative pain. Females had a greater mean popliteal angle (139.84°) compared with males (128.84°) (p = 0.04). Clinical RelevanceUnderstanding the neuromuscular influences on muscle flexibility will assist in the development of new rehabilitative and injury preventative techniques. ConclusionThe present pilot study implicates neural contributions to muscle flexibility. Further studies are needed to delineate the relative contributions of neural and muscular components and to facilitate new techniques in the rehabilitation and prevention of injury.

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.

Functional rehabilitation of lumbar spine injuries in the athlete.

Athletic injuries to the lumbar spine are relatively common, depending upon the specific sport. With proper management, the majority of injuries resolve quickly and allow for rapid return to sport. However, some of these injuries occur because of improper mechanics that adversely affect the core stability of the spine, or conversely these injuries cause instability of the spine through disruption of the spinal support mechanisms. Development of an appropriate treatment plan depends on a thorough understanding of the structures providing core stability and the exercises to correct identifiable deficits. A comprehensive rehabilitation program should include correction of flexibility and strength deficits, with subsequent progression to functional and sports-specific exercises. The purpose of this paper is to review current concepts regarding core stability and rehabilitation in the athlete.

Practical nonoperative management of rotator cuff injuries.

Rotator cuff injury is one of the most common etiologies of shoulder pain affecting people of all activity levels. Many authors think that such an injury represents a spectrum of pathology, ranging from degeneration of the tendon to a complete tear without active inflammation. In addition, secondary maladaptive movements and flexibility and strength deficits involving the shoulder girdle region, spine, and possibly other extremities can contribute to subsequent pain symptoms. Fortunately, many of the patients experiencing rotator cuff pathology can be managed using a nonoperative approach. The purpose of this article is to review the literature-supported nonoperative management of the patient with rotator cuff pathology. Of note, many of the functional rehabilitation principles may apply to the postsurgical patient as well.

The influence of pediatric autonomic dysfunction on recovery after concussion

INTRODUCTION In the United States, the reported incidence of recreation-related or sports-related concussions among children and adults is approximately 3.8 million. Common symptoms include headache, dizziness, and nausea, as well as functional impairments in concentration, memory, and processing. In most cases, there are no abnormalities by neuroimaging and the symptoms resolve within 1 to 2 weeks. Post-concussion management involves physical, cognitive, and emotional rest. Once free of symptoms, a graded increase in exertion is recommended, with return to sport once asymptomatic at all stages. Premature return to athletic participation increases the risk for post-concussive syndrome (PCS). The pediatric athlete deserves unique attention because the child’s brain may be more developmentally vulnerable. Symptom assessment must be age appropriate, and parents and teachers serve as important advocates to monitor a child’s recovery within both school and social realms. Underlying medical conditions may also influence the time to recovery. We present a gymnast whose post-concussive symptoms were compounded by undiagnosed autonomic dysfunction (AD), which once addressed facilitated her recovery and return to sport.

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.