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Niering M, Klass A, Wolf-Belala N, Seifert J. Prevalence, severity, and predictors of self-reported depression in ultra-distance runners: An online survey based on 265 athletes. Injury 2024; 55:111790. [PMID: 39146612 DOI: 10.1016/j.injury.2024.111790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 07/14/2024] [Accepted: 08/03/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Literature suggests a high prevalence of mental health disorders among athletes practicing elite and extreme sports. One of the most commonly encountered disorders in this group of individuals is depression. OBJECTIVE The aim of this study was to examine the prevalence, severity, and risk factors of symptoms of self-reported depression among ultra-distance runners. METHODS Data was collected using an online survey (February to April 2023) and included 265 (age 48.35 ± 10.52 years) adult ultra-runners. The Beck Depression Inventory-II (BDI-II) was used to measure self-reported depression. Additional variables comprised basic sociodemographic information and information regarding training, ultramarathon experience, and previous injury. Descriptive and interferential statistics were performed using JASP Version 0.16.4. RESULTS We found that 21.9 % (n = 58) of ultra-runners suffered from self-reported depression (i.e., BDI-II score ≥ 14) with an average BDI-II score of 22.7 ± 7.1 (moderately severe symptoms). Female ultra-runners had a higher prevalence (30.8 %) of self-reported depression than males (16.2 %, p = .001). Logistic regression revealed that ultra-runners without previous sports injury (p = .01) and those of increasing age (p = .003) had a significantly lower risk of self-reported depression. Similarly, linear regression showed the absence of injury (p < .001) and increasing age (p = .02) resulted in significantly lower BDI-II scores. Training volume in distance and hours per week as well as ultra-running experience did not show any significant association. CONCLUSIONS Affecting more than one-fifth of our collective, depressive symptoms appear to be highly prevalent among ultra-runners. Our findings underline the importance of screening for clinical depression, especially among injured athletes. However, the previously assumed peculiarities of the sport in the area of high training volume do not appear to be a significant factor.
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Affiliation(s)
- Marc Niering
- Institute of Biomechanics and Neuroscience, Nordic Science, Hannover, Germany
| | - Alexander Klass
- Triagon Academy Munich, School of Sports, Psychology and Education, Ismaning, Germany
| | - Nacera Wolf-Belala
- Institute of Biomechanics and Neuroscience, Nordic Science, Hannover, Germany
| | - Johanna Seifert
- Institute of Biomechanics and Neuroscience, Nordic Science, Hannover, Germany; Department of Psychiatry, Social Psychiatry and Psychotherapy, Medical School Hannover, Hannover, Germany.
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2
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Golubjatnikov M, Walker A. Endurance Sporting Events. Emerg Med Clin North Am 2024; 42:581-596. [PMID: 38925776 DOI: 10.1016/j.emc.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
Endurance sports encompass a broad range of events from marathons and triathlons to ultramarathons, long-distance cycling, skiing, and swimming. As these events have experienced a surge in popularity, we have a greater need to understand the associated medical risks. This article reviews the history of endurance races, reviews the most critical and common causes of cardiovascular, heat, electrolyte, and musculoskeletal injuries/illnesses, and discusses considerations for medical directors/personnel associated with such events.
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Affiliation(s)
- Matt Golubjatnikov
- St Joseph's Medical Center, 1800 N California Street, Stockton, CA 95204, USA
| | - Anne Walker
- St Joseph's Medical Center, 1800 N California Street, Stockton, CA 95204, USA.
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Boshielo PMM, Jansen van Rensburg A, Viljoen C, Botha T, de Villiers CEE, Ramagole D, Seyani L, Janse van Rensburg DCC. Illness is more prevalent than injury in trail runners participating in a mountainous ultra trail race. PHYSICIAN SPORTSMED 2024:1-9. [PMID: 38872606 DOI: 10.1080/00913847.2024.2367401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 06/10/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVES Trail running is a popular off-road sport involving running in natural environments over various terrains, often in remote locations. This study aims to investigate the epidemiology and risk factors of injuries and illnesses, i.e. medical encounters, on race day among trail runners in a high-altitude ultra trail race. METHODS This descriptive cross-sectional study on an ultra trail race (38 km, 65 km and 100 km) in South Africa, included participants 18 years or older. Of the 331 race participants, 285(86.1%) consented to participate in the study. Data collection included demographic details, injuries (body region, specific body area, tissue type, pathology) and illnesses (organ system, symptom cluster, etiology). Risk factor analysis includes sex, age, weight, height, race distance, illness and injury history, training and running experience. Frequency (n, %), prevalence (%) and odds ratios (OR; 95%CI) are reported. RESULTS Eighty-nine (31.2%) individuals reported 131 medical encounters [49 injuries (37.4%); 82 illnesses (62.6%)]. Injuries were sustained by 14.7% of athletes, and 22.5% reported illnesses. For injuries, the lower limb was mainly involved (n = 41; 83.7%). Most injuries affected the foot (n = 18; 36.7%), ankle (n = 10; 20.4%) and knee (n = 7; 14.3%). Tissue types mainly involved skin (n = 21; 42.8%), ligament (n = 7; 14.3%) and muscle (n = 7; 14.3%). Multiple (n = 45; 54.9%) and gastrointestinal (n = 17; 20.7%) organ systems were mainly involved in illnesses. Only 100 km runners reported dehydration (n = 28; 31.5%), and one in every six of these runners (n = 5; 17.9%) did not finish. Runners reporting fatigue (n = 21; 23.6%) had a high (n = 8; 38.1%) did not finish rate. Two in every five participants (n = 36; 40.4%) with a medical encounter, did not finish. No medical encounter-associated risk factors were identified. CONCLUSIONS Illnesses were more common than injuries during the mountainous ultra trail race. Sustaining a medical encounter increased the chance of not completing the race. Further research on the epidemiology of race day medical encounters in trail running is required.
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Affiliation(s)
| | | | - Carel Viljoen
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Science, Amsterdam UMC, Amsterdam, The Netherlands
| | - Tanita Botha
- Department of Statistics, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria, South Africa
| | | | - Dimakatso Ramagole
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Limbikani Seyani
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Dina C Christa Janse van Rensburg
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Chair, Medical Advisory Panel, World Netball, Manchester, UK
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4
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Zhu C, Song Y, Xu Y, Zhu A, Baker JS, Liu W, Gu Y. Toe Box Shape of Running Shoes Affects In-Shoe Foot Displacement and Deformation: A Randomized Crossover Study. Bioengineering (Basel) 2024; 11:457. [PMID: 38790324 PMCID: PMC11118738 DOI: 10.3390/bioengineering11050457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 04/30/2024] [Accepted: 04/30/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Long-distance running is popular but associated with a high risk of injuries, particularly toe-related injuries. Limited research has focused on preventive measures, prompting exploration into the efficacy of raised toe box running shoes. PURPOSE This study aimed to investigate the effect of running shoes with raised toe boxes on preventing toe injuries caused by distance running. METHODS A randomized crossover design involved 25 male marathon runners (height: 1.70 ± 0.02 m, weight: 62.6 + 4.5 kg) wearing both raised toe box (extended by 8 mm along the vertical axis and 3 mm along the sagittal axis) and regular toe box running shoes. Ground reaction force (GRF), in-shoe displacement, and degree of toe deformation (based on the distance change between the toe and the metatarsal head) were collected. RESULTS Wearing raised toe box shoes resulted in a significant reduction in vertical (p = 0.001) and antero-posterior (p = 0.015) ground reaction forces during the loading phase, with a notable increase in vertical ground reaction force during the toe-off phase (p < 0.001). In-shoe displacement showed significant decreased movement in the forefoot medial (p < 0.001) and rearfoot (medial: p < 0.001, lateral: p < 0.001) and significant increased displacement in the midfoot (medial: p = 0.002, lateral: p < 0.001). Impact severity on the hallux significantly decreased (p < 0.001), while impact on the small toes showed no significant reduction (p = 0.067). CONCLUSIONS Raised toe box running shoes offer an effective means of reducing toe injuries caused by long-distance running.
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Affiliation(s)
- Chengyuan Zhu
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
| | - Yang Song
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
- Faculty of Engineering, University of Szeged, 6700 Szeged, Hungary
| | - Yufan Xu
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
| | - Aojie Zhu
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
| | - Julien S. Baker
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
| | - Wei Liu
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
- Faculty of Engineering, University of Szeged, 6700 Szeged, Hungary
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5
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Song Y, Cen X, Sun D, Bíró I, Mao Z, Fang Y, Gu Y. Influence of changes in foot morphology and temperature on bruised toenail injury risk during running. Sci Rep 2024; 14:1826. [PMID: 38246957 PMCID: PMC10800341 DOI: 10.1038/s41598-024-51826-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
Despite runners frequently suffering from dermatologic issues during long distance running, there is no compelling evidence quantitatively investigating their underlying injury mechanism. This study aimed to determine the foot morphology and temperature changes during long distance running and reveal the effect of these alterations on the injury risk of bruised toenail by measuring the subjective-perceived hallux comfort and gap length between the hallux and toebox of the shoe. Ten recreational runners participated in the experimental tests before (baseline), immediately after 5 and 10 km of treadmill running (12 km/h), in which the foot morphology was measured by a 3D foot scanner, the foot temperature was detected by an infrared camera, the perceived comfort was recorded by a visual analogue scale, and the gap length in the sagittal plane was captured by a high-speed camera. Ball width became narrower (106.39 ± 6.55 mm) and arch height (12.20 ± 2.34 mm) was reduced greatly after the 10 km run (p < 0.05). Foot temperature increased significantly after 5 and 10 km of running, and the temperature of dorsal hallux (35.12 ± 1.46 °C), dorsal metatarsal (35.92 ± 1.59 °C), and medial plantar metatarsal (37.26 ± 1.34 °C) regions continued to increase greatly from 5 to 10 km of running (p < 0.05). Regarding hallux comfort, the perceived scores significantly reduced after 5 and 10 km of running (2.10 ± 0.99, p < 0.05). In addition, during one running gait cycle, there was a significant increase in gap length at initial contact (39.56 ± 6.45 mm, p < 0.05) for a 10 km run, followed by a notable decrease upon reaching midstance (29.28 ± 6.81 mm, p < 0.05). It is concluded that the reduced ball width and arch height while increased foot temperature during long-distance running would exacerbate foot-shoe interaction, potentially responsible for bruised toenail injuries.
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Affiliation(s)
- Yang Song
- Research Academy of Medicine Combining Sports, Ningbo No.2 Hospital, Ningbo, China
- Faculty of Sports Science, Ningbo University, Ningbo, China
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Xuanzhen Cen
- Research Academy of Medicine Combining Sports, Ningbo No.2 Hospital, Ningbo, China
- Faculty of Sports Science, Ningbo University, Ningbo, China
- Doctoral School on Safety and Security Sciences, Óbuda University, Budapest, Hungary
| | - Dong Sun
- Research Academy of Medicine Combining Sports, Ningbo No.2 Hospital, Ningbo, China
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - István Bíró
- Doctoral School on Safety and Security Sciences, Óbuda University, Budapest, Hungary
- Faculty of Engineering, University of Szeged, Szeged, Hungary
| | - Zhuqing Mao
- Research Academy of Medicine Combining Sports, Ningbo No.2 Hospital, Ningbo, China.
| | - Yufei Fang
- Research Academy of Medicine Combining Sports, Ningbo No.2 Hospital, Ningbo, China
| | - Yaodong Gu
- Research Academy of Medicine Combining Sports, Ningbo No.2 Hospital, Ningbo, China.
- Faculty of Sports Science, Ningbo University, Ningbo, China.
- Faculty of Engineering, University of Szeged, Szeged, Hungary.
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6
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Abstract
Friction blisters on the feet commonly occur when individuals engage in active pursuits such as running, hiking, and military training. The high prevalence of blisters in active individuals underscores the fact that the pathomechanics of this condition are not fully understood. The traditional blister causation paradigm revolves around heat, moisture, and friction. In reality, foot friction blisters are caused by repetitive shear deformation. The 3 fundamental elements of blister-inducing shear deformation are (1) motion of bone, (2) high friction force, and (3) repetition of the resulting shear events. Rubbing at the skin surface is not a mechanism for friction blister formation. To that end, prevention of the friction blister continues to be an elusive quest for both the patient and the treating clinician. In this article, we aimed to highlight the limitations of the long-held blister-causation paradigm and offer a new explanation.
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Affiliation(s)
- Rebecca Rushton
- Esperance Podiatry and BlisterPod, Esperance, Western Australia, Australia
| | - Douglas Richie
- California School of Podiatric Medicine at Samuel Merritt University, Seal Beach
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Nilssen PK, Connolly CP, Johnson KB, Cho SP, Cohoe BH, Miller TK, Laird RH, Sallis RE, Hiller WDB. Medical Encounters and Treatment Outcomes in Ironman-Distance Triathlon. Med Sci Sports Exerc 2023; 55:1968-1976. [PMID: 37332229 DOI: 10.1249/mss.0000000000003235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
PURPOSE This study aimed to examine the injury and illness characteristics, treatments, and outcomes at elite ultraendurance triathlon events. METHODS We quantified participant demographics, injury types, treatments, and disposition for medical encounters at 27 Ironman-distance triathlon championships from 1989 to 2019. We then calculated the likelihood of concurrent medical complaints in each encounter. RESULTS We analyzed 10,533 medical encounters among 49,530 race participants for a cumulative incidence of 221.9/1000 participants (95% confidence interval [CI] = 217.7-226.2). Younger (<35 yr; 259.3/1000, 95% CI = 251.6-267.2) and older athletes (70+ yr; 254.0/1000, 95% CI = 217.8-294.4) presented to the medical tent at higher rates than middle-age adults (36-69 yr; 180.1/1000, 95% CI = 175.4-185.0). Female athletes also presented at higher rates when compared with males (243.9/1000, 95% CI = 234.9-253.2 vs 198.0/1000, 95% CI = 193.4-202.6). The most common complaints were dehydration (438.7/1000, 95% CI = 426.2-451.6) and nausea (400.4/1000, 95% CI = 388.4-412.6). Intravenous fluid was the most common treatment (483/1000; 95% CI = 469.8-496.4). Of the athletes who received medical care, 116.7/1000 (95% CI = 110.1-123.4) did not finish the race, and 17.1/1000 (95% CI = 14.7-19.8) required hospital transport. Athletes rarely presented with an isolated medical condition unless their injury was dermatologic or musculoskeletal in nature. CONCLUSIONS Ultraendurance triathlon events have high rates of medical encounters among female athletes, as well as both younger and older age categories. Gastrointestinal and exertional-related symptoms are among the most common complaints. Intravenous infusions were the most common treatment after basic medical care. Most athletes entering the medical tent finished the race, and a small percentage were dispatched to the hospital. A more thorough understanding of common medical occurrences, including concurrent presentations and treatments, will allow for improved care and optimal race management.
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Affiliation(s)
- Paal K Nilssen
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
| | | | - Kasey B Johnson
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
| | - Stephanie P Cho
- College of Education, Washington State University, Pullman, WA
| | - Blake H Cohoe
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
| | | | | | | | - W Douglas B Hiller
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
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8
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Zúnica-García S, Moya-Cuenca C, Gracia-Sánchez A, García-Cremades S, Chicharro-Luna E. Influence of blistering lesions on foot functionality in hikers. J Tissue Viability 2023; 32:395-400. [PMID: 37258334 DOI: 10.1016/j.jtv.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/18/2023] [Accepted: 05/16/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Friction blisters are formed by abrasion from frictional forces on the upper layer of the epidermis and can make physical activity an uncomfortable experience. To our knowledge, no previous studies have considered how these injuries affect the functionality of the foot. For this reason, the main aim of this study was to evaluate foot function in hikers, with or without blisters. MATERIAL AND METHODS This case-control study examined 298 hikers who walked the Camino de Santiago long-distance trail (in northern Spain); 207 had one or more blistering foot lesions and 91 had no blisters. Sociodemographic and clinical variables were collected, and the number of blisters and their locations on the foot were recorded. All participants self-completed the Foot Function Index (FFI) questionnaire, in their native language. RESULTS Pain and disability were significantly greater among the hikers with blisters (pain p=<0.001; disability p = 0.015). However, there were no significant differences in the limitation of physical activity between those with blisters (case group) and the control group (p = 0.144). Neither was there any correlation between the number of blisters and pain, disability or limitation of activity. However, the location of the lesion did influence foot functionality. Blisters on the metatarsal heads were more limiting and caused greater pain (right foot p = 0.009; left foot p = 0.017), greater disability (right foot p = 0.005; left foot p = 0.005), greater limitation of activity (on right foot p = 0.012) and more loss of foot functionality (right foot p = 0.002; left foot p = 0.007). CONCLUSION The hikers with blisters experienced reduced foot functionality in terms of pain and disability. The number of blisters was not related to foot functionality. Blisters located on the metatarsal heads caused the greatest increase in pain, disability and limitation of activity.
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Affiliation(s)
- Sara Zúnica-García
- Department of Behavioural and Health Sciences, Nursing Area, Faculty of Medicine, Miguel Hernández University, Spain.
| | - Coral Moya-Cuenca
- Department of Behavioural and Health Sciences, Nursing Area, Faculty of Medicine, Miguel Hernández University, Spain.
| | - Alba Gracia-Sánchez
- Department of Behavioural and Health Sciences, Nursing Area, Faculty of Medicine, Miguel Hernández University, Spain.
| | | | - Esther Chicharro-Luna
- Department of Behavioural and Health Sciences, Nursing Area, Faculty of Medicine, Miguel Hernández University, Spain.
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9
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Kelly CPMG. Is There Evidence for the Development of Sex-Specific Guidelines for Ultramarathon Coaches and Athletes? A Systematic Review. SPORTS MEDICINE - OPEN 2023; 9:6. [PMID: 36695958 PMCID: PMC9877268 DOI: 10.1186/s40798-022-00533-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 11/13/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND There is evidence of sex differences in the physiology of endurance exercise, yet most of the advice and guidelines on training, racing, nutrition, and recovery for ultramarathons are based on research that has largely excluded female athletes. The objective was therefore to review the current knowledge of sex differences in ultramarathon runners and determine if sufficient evidence exists for providing separate guidelines for males and females. METHODS This systematic review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three databases were searched for studies investigating differences in elite and recreational male and female ultramarathon runners. Studies were included if they compared males and females and looked at outcomes relating to the performance or health of ultramarathon runners. The quality of the included studies was determined using the Grading of Recommendations Assessment Development and Evaluation (GRADE) approach. RESULTS The search strategy identified 45 studies that met the inclusion criteria. Most studies were observational in design, with only three papers based on randomised controlled trials. The overall quality of the evidence was low. Sex differences in the predictors of ultramarathon performance; physiological responses to training, racing, and recovery; chronic and acute health issues; and pacing strategies were found. There were areas with contradictory findings, and very few studies examined specific interventions. CONCLUSION The results from this review suggest that the development of sex-specific guidelines for ultramarathon coaches and athletes could have a significant effect on the performance and health of female runners. At present, there is insufficient high-quality evidence on which to formulate these guidelines, and further research is required.
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Affiliation(s)
- Claudia P M G Kelly
- College of Medicine and Health, The University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
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10
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Development of a trail running injury screening instrument: A multiple methods approach. Phys Ther Sport 2022; 56:60-75. [DOI: 10.1016/j.ptsp.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 11/30/2022]
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11
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Viljoen C, Janse van Rensburg DCC, van Mechelen W, Verhagen E, Silva B, Scheer V, Besomi M, Gajardo-Burgos R, Matos S, Schoeman M, Jansen van Rensburg A, van Dyk N, Scheepers S, Botha T. Trail running injury risk factors: a living systematic review. Br J Sports Med 2022; 56:577-587. [PMID: 35022162 DOI: 10.1136/bjsports-2021-104858] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To review and frequently update the available evidence on injury risk factors and epidemiology of injury in trail running. DESIGN Living systematic review. Updated searches will be done every 6 months for a minimum period of 5 years. DATA SOURCES Eight electronic databases were searched from inception to 18 March 2021. ELIGIBILITY CRITERIA Studies that investigated injury risk factors and/or reported the epidemiology of injury in trail running. RESULTS Nineteen eligible studies were included, of which 10 studies investigated injury risk factors among 2 785 participants. Significant intrinsic factors associated with injury are: more running experience, level A runner and higher total propensity to sports accident questionnaire (PAD-22) score. Previous history of cramping and postrace biomarkers of muscle damage is associated with cramping. Younger age and low skin phototypes are associated with sunburn. Significant extrinsic factors associated with injury are neglecting warm-up, no specialised running plan, training on asphalt, double training sessions per day and physical labour occupations. A slower race finishing time is associated with cramping, while more than 3 hours of training per day, shade as the primary mode of sun protection and being single are associated with sunburn. An injury incidence range 0.7-61.2 injuries/1000 hours of running and prevalence range 1.3% to 90% were reported. The lower limb was the most reported region of injury, specifically involving blisters of the foot/toe. CONCLUSION Limited studies investigated injury risk factors in trail running. Our review found eight intrinsic and nine extrinsic injury risk factors. This review highlighted areas for future research that may aid in designing injury risk management strategies for safer trail running participation.PROSPERO registration numberCRD42021240832.
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Affiliation(s)
- Carel Viljoen
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa .,Amsterdam Collaboration for Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam University Medical Centers, location VU University Medical Center, Amsterdam, The Netherlands.,Sport, Exercise Medicine and Lifestyle Institute (SEMLI), University of Pretoria, Pretoria, South Africa
| | - Dina C Christa Janse van Rensburg
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Medical Board Member, World Netball, Manchester, UK
| | - Willem van Mechelen
- Amsterdam Collaboration for Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam University Medical Centers, location VU University Medical Center, Amsterdam, The Netherlands.,School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Queensland, Australia.,Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,School of Public Health, Physiotherapy and Population Sciences, University College Dublin, Dublin, Ireland
| | - Evert Verhagen
- Amsterdam Collaboration for Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam University Medical Centers, location VU University Medical Center, Amsterdam, The Netherlands
| | - Bruno Silva
- School of Sports and Leisure, Department of Sports Science, Tourism and Leisure, Polytechnic Institute of Viana do Castelo, Melgaço, Portugal.,Research Center in Sports Science, Health Science and Human Development (CIDESD), University of Tras-os-Montes e Alto Douro, Vila Real, Portugal
| | - Volker Scheer
- Ultra Sports Science Foundation (USSF), Pierre-Benite, France
| | - Manuela Besomi
- Carrera de Kinesiología, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Rubén Gajardo-Burgos
- Escuela de Kinesiología, Instituto de Aparato Locomotor y Rehabilitación, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Sérgio Matos
- School of Sports and Leisure, Department of Sports Science, Tourism and Leisure, Polytechnic Institute of Viana do Castelo, Melgaço, Portugal.,Department of Sports, Higher Institute of Educational Sciences of the Douro, Penafiel, Portugal
| | - Marlene Schoeman
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | - Nicol van Dyk
- High Performance Unit, Irish Rugby Football Union, Dublin, Ireland
| | - Susan Scheepers
- Department of Library Services, University of Pretoria, Pretoria, South Africa
| | - Tanita Botha
- Department of Statistics, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria, South Africa
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12
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Viljoen CT, Janse van Rensburg DC, Verhagen E, van Mechelen W, Korkie E, Botha T. Epidemiology, Clinical Characteristics, and Risk Factors for Running-Related Injuries among South African Trail Runners. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312620. [PMID: 34886345 PMCID: PMC8656810 DOI: 10.3390/ijerph182312620] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/19/2021] [Accepted: 11/25/2021] [Indexed: 01/25/2023]
Abstract
Trail running involves running on varying natural terrains, often including large elevation gains/losses. Trail running has a high risk of injury, and runners often participate in remote regions where medical support is challenging. The aim of this study was to determine the epidemiology, clinical characteristic, and associated injury risk factors among trail runners. A modified Oslo Sports Trauma Research Center Questionnaire for Health Problems (OSTRC-H) was used biweekly to collect running-related injury (RRI) and training history data prospectively, among 152 participants (males n = 120, females n = 32) over 30 weeks. We report an overall injury rate of 19.6 RRIs per 1000 h and an RRI mean prevalence of 12.3%. The leading anatomical site of RRIs was the lower limb (82.9%), affecting the knee (29.8%), shin/lower leg (18.0%), and the foot/toes (13.7%). A history of previous RRI in the past 12 months (p = 0.0032) and having a chronic disease (p = 0.0188) are independent risk factors for RRIs among trail runners. Two in three trail runners sustain an RRI mainly affecting the knee, shin/lower leg, and foot/toes. A history of previous RRI in the past 12 months and a having chronic disease is independently associated with RRI among trail runners. These results could be used to develop future RRI prevention strategies, combined with clinical knowledge and experience.
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Affiliation(s)
- Carel T. Viljoen
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa;
- Amsterdam Collaboration for Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam University Medical Centers, VU University Medical Center, 1081 HV Amsterdam, The Netherlands; (E.V.); (W.v.M.)
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Pretoria 0186, South Africa;
- Correspondence:
| | - Dina C. Janse van Rensburg
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Pretoria 0186, South Africa;
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
| | - Evert Verhagen
- Amsterdam Collaboration for Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam University Medical Centers, VU University Medical Center, 1081 HV Amsterdam, The Netherlands; (E.V.); (W.v.M.)
| | - Willem van Mechelen
- Amsterdam Collaboration for Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam University Medical Centers, VU University Medical Center, 1081 HV Amsterdam, The Netherlands; (E.V.); (W.v.M.)
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, QLD 4072, Australia
- Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town 7700, South Africa
- School of Public Health, Physiotherapy and Population Sciences, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Elzette Korkie
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa;
| | - Tanita Botha
- Department of Statistics, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria 0028, South Africa;
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Gimigliano F, Resmini G, Moretti A, Aulicino M, Gargiulo F, Gimigliano A, Liguori S, Paoletta M, Iolascon G. Epidemiology of Musculoskeletal Injuries in Adult Athletes: A Scoping Review. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57101118. [PMID: 34684155 PMCID: PMC8539527 DOI: 10.3390/medicina57101118] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/06/2021] [Accepted: 10/14/2021] [Indexed: 02/05/2023]
Abstract
Background and Objectives: Sport-related musculoskeletal injuries (MSK-Is) are a common health issue in athletes that can lead to reduced performance. The aim of this scoping review was to synthetize available evidence on injury incidence rates (IIRs), types, and sites that affect the musculoskeletal (MSK) system of adult athletes. Materials and Methods: We performed a scoping review on the Pubmed database limiting our search to 33 Olympic sports. Results: We identified a total of 1022 papers, and of these 162 were examined in full for the purpose of this review. Archery was the sport with the highest risk of injuries to the upper extremities, marathons for the lower extremities, and triathlon and weightlifting for the body bust. In the majority of the sports examined, muscle/tendon strain and ligament sprain were the most common MSK-Is diagnoses, while athletics, karate, and football were the sports with the highest IIRs, depending on the methods used for their calculations. Conclusions: Our scoping review highlighted the general lack and dishomogeneity in the collection of data on MSK-Is in athletes.
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Affiliation(s)
- Francesca Gimigliano
- Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, 81100 Naples, Italy;
| | - Giuseppina Resmini
- Centre for the Study of Osteoporosis and Metabolic Bone Disease, Section of Orthopaedic and Traumatology, Treviglio-Caravaggio Hospital, 24047 Bergamo, Italy;
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania Luigi Vanvitelli, 81100 Naples, Italy; (M.A.); (F.G.); (S.L.); (M.P.); (G.I.)
- Correspondence: ; Tel.: +39-081-566-5537
| | - Milena Aulicino
- Department of Medical and Surgical Specialties and Dentistry, University of Campania Luigi Vanvitelli, 81100 Naples, Italy; (M.A.); (F.G.); (S.L.); (M.P.); (G.I.)
| | - Fiorinda Gargiulo
- Department of Medical and Surgical Specialties and Dentistry, University of Campania Luigi Vanvitelli, 81100 Naples, Italy; (M.A.); (F.G.); (S.L.); (M.P.); (G.I.)
| | | | - Sara Liguori
- Department of Medical and Surgical Specialties and Dentistry, University of Campania Luigi Vanvitelli, 81100 Naples, Italy; (M.A.); (F.G.); (S.L.); (M.P.); (G.I.)
| | - Marco Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania Luigi Vanvitelli, 81100 Naples, Italy; (M.A.); (F.G.); (S.L.); (M.P.); (G.I.)
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania Luigi Vanvitelli, 81100 Naples, Italy; (M.A.); (F.G.); (S.L.); (M.P.); (G.I.)
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Partyka A, Waśkiewicz Z. The Consequences of Training and Competition to the Musculoskeletal System in Ultramarathon Runners: A Narrative Review. Front Physiol 2021; 12:738665. [PMID: 34630159 PMCID: PMC8497806 DOI: 10.3389/fphys.2021.738665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/26/2021] [Indexed: 12/15/2022] Open
Abstract
Ultramarathons are becoming increasingly popular every year, leading to more and more publications focusing on athletes of these endurance events. This paper summarizes the current state of knowledge on the effects of ultramarathons on the motor system. Various studies have attempted to answer questions about negative and positive effects on the musculoskeletal system, common injuries, optimal strategies, and regeneration. Considering the increasing number of ultramarathon athletes, the discoveries may have practical applications for a multitude of experts in the field of sports medicine, as well as for the athletes themselves. Acute locomotor system changes in runners as assessed by locomotor biomarkers are reversible and may be asymptomatic or painful. Injuries suffered by runners largely allow them to finish the competition and are usually overlooked. Regeneration, including regular massage and the use of supporting techniques, allows for faster convalescence. This publication is meant to be a source of knowledge for people associated with this discipline.
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Affiliation(s)
| | - Zbigniew Waśkiewicz
- Institute of Sport Science, Jerzy Kukuczka Academy of Physical Education, Katowice, Poland.,Department of Sports Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University, Moscow, Russia
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15
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Potential Long-Term Health Problems Associated with Ultra-Endurance Running: A Narrative Review. Sports Med 2021; 52:725-740. [PMID: 34542868 PMCID: PMC8450723 DOI: 10.1007/s40279-021-01561-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2021] [Indexed: 12/14/2022]
Abstract
It is well established that physical activity reduces all-cause mortality and can prolong life. Ultra-endurance running (UER) is an extreme sport that is becoming increasingly popular, and comprises running races above marathon distance, exceeding 6 h, and/or running fixed distances on multiple days. Serious acute adverse events are rare, but there is mounting evidence that UER may lead to long-term health problems. The purpose of this review is to present the current state of knowledge regarding the potential long-term health problems derived from UER, specifically potential maladaptation in key organ systems, including cardiovascular, respiratory, musculoskeletal, renal, immunological, gastrointestinal, neurological, and integumentary systems. Special consideration is given to youth, masters, and female athletes, all of whom may be more susceptible to certain long-term health issues. We present directions for future research into the pathophysiological mechanisms that underpin athlete susceptibility to long-term issues. Although all body systems can be affected by UER, one of the clearest effects of endurance exercise is on the cardiovascular system, including right ventricular dysfunction and potential increased risk of arrhythmias and hypertension. There is also evidence that rare cases of acute renal injury in UER could lead to progressive renal scarring and chronic kidney disease. There are limited data specific to female athletes, who may be at greater risk of certain UER-related health issues due to interactions between energy availability and sex-hormone concentrations. Indeed, failure to consider sex differences in the design of female-specific UER training programs may have a negative impact on athlete longevity. It is hoped that this review will inform risk stratification and stimulate further research about UER and the implications for long-term health.
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Viljoen CT, Sewry N, Schwellnus MP, Janse van Rensburg DC, Swanevelder S, Jordaan E. Independent Risk Factors Predicting Gradual Onset Injury in 2824 Trail Running Race Entrants: SAFER XVIII Study. Wilderness Environ Med 2021; 32:293-301. [PMID: 34266742 DOI: 10.1016/j.wem.2021.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 04/06/2021] [Accepted: 04/06/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Trail running is characterized by elevation changes, with uneven and varying running surfaces. Risk factors that may predict gradual-onset running-related injuries (GORRIs) in short-distance trail running have not been explored. The objective was to determine risk factors that predict GORRIs in trail running race entrants who entered mass community-based trail running events. METHODS In this descriptive cross-sectional study, data were collected prospectively from a prerace medical screening questionnaire over 4 trail run events held annually. Using a Poisson regression model, runner demographics, race distance, running training/racing variables, history of chronic diseases (number of chronic diseases reported as a cumulative "chronic disease composite score"), and allergies were investigated to determine factors predicting self-reported GORRI history in the previous 12 mo. RESULTS This study included 2824 race entrants (80% of entrants). The retrospective annual incidence for GORRIs was 13%. Independent risk factors predicting GORRIs were longer race distance (P<0.0001), increasing chronic disease composite score (P=0.0012), and a history of allergies (P=0.0056). The lower limb (94%) was the main anatomic region of GORRIs, and soft tissue injuries accounted for most (83%) GORRIs. Common specific GORRIs were iliotibial band syndrome (22%), Achilles tendon injury (10%), and hamstring injury (9%). CONCLUSIONS Independent risk factors predicting GORRIs among trail running entrants included longer race distance, a higher chronic disease composite score, and a history of allergies. This study has highlighted trail running race entrants at risk for sustaining GORRIs who could be targeted for future injury prevention interventions.
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Affiliation(s)
- Carel T Viljoen
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; Sport, Exercise Medicine and Lifestyle Institute (SEMLI), University of Pretoria, Pretoria, South Africa; Amsterdam Collaboration for Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam University Medical Centres, VU University Medical Centre, Amsterdam, The Netherlands.
| | - Nicola Sewry
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), University of Pretoria, Pretoria, South Africa; International Olympic Committee (IOC) Research Centre, Pretoria, South Africa
| | - Martin P Schwellnus
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), University of Pretoria, Pretoria, South Africa; International Olympic Committee (IOC) Research Centre, Pretoria, South Africa; Sport and Exercise Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Dina C Janse van Rensburg
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), University of Pretoria, Pretoria, South Africa; Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Sonja Swanevelder
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Esme Jordaan
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa; Statistics and Population Studies Department, University of the Western Cape, Western Cape, South Africa
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Castanier C, Bougault V, Teulier C, Jaffré C, Schiano-Lomoriello S, Vibarel-Rebot N, Villemain A, Rieth N, Le-Scanff C, Buisson C, Collomp K. The Specificities of Elite Female Athletes: A Multidisciplinary Approach. Life (Basel) 2021; 11:622. [PMID: 34206866 PMCID: PMC8303304 DOI: 10.3390/life11070622] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 12/19/2022] Open
Abstract
Female athletes have garnered considerable attention in the last few years as more and more women participate in sports events. However, despite the well-known repercussions of female sex hormones, few studies have investigated the specificities of elite female athletes. In this review, we present the current but still limited data on how normal menstrual phases, altered menstrual phases, and hormonal contraception affect both physical and cognitive performances in these elite athletes. To examine the implicated mechanisms, as well as the potential performances and health risks in this population, we then take a broader multidisciplinary approach and report on the causal/reciprocal relationships between hormonal status and mental and physical health in young (18-40 years) healthy females, both trained and untrained. We thus cover the research on both physiological and psychological variables, as well as on the Athlete Biological Passport used for anti-doping purposes. We consider the fairly frequent discrepancies and summarize the current knowledge in this new field of interest. Last, we conclude with some practical guidelines for eliciting improvements in physical and cognitive performance while minimizing the health risks for female athletes.
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Affiliation(s)
- Carole Castanier
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | | | - Caroline Teulier
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | | | - Sandrine Schiano-Lomoriello
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Nancy Vibarel-Rebot
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Aude Villemain
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Nathalie Rieth
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Christine Le-Scanff
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Corinne Buisson
- Département des Analyses, AFLD, 92290 Chatenay-Malabry, France;
| | - Katia Collomp
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
- Département des Analyses, AFLD, 92290 Chatenay-Malabry, France;
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Scheer V, Krabak BJ. Musculoskeletal Injuries in Ultra-Endurance Running: A Scoping Review. Front Physiol 2021; 12:664071. [PMID: 33868030 PMCID: PMC8044296 DOI: 10.3389/fphys.2021.664071] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/12/2021] [Indexed: 02/05/2023] Open
Abstract
Ultra-endurance running (UER) has seen an important increase in participation over the last few decades. Long hours of UER can lead to excessive stress on the body, resulting in musculoskeletal injuries (MSKI). UER is not a uniform sport and events can differ considerably in distance (over 42.195 km), time (e.g., events over 6 h) and multi-day or multi-stage events on various surfaces (e.g., track, on-road, off-road). The aims of this scoping review were therefore: (1) to examine the current evidence of MSKI, providing a synthesis of the most common MSKI by anatomical region and specific diagnosis; (2) categorize MSKI by type of UER activity (competition: time-limited; multi-stage; continuous UER events and training); (3) describe knowledge gaps in the literature and provide advice on potential further research. Our electronic literature search (PubMed, SPORTDiscus, Web of Science) identified a total of 13 studies (9 in competition, and 4 in training). Anatomical site, diagnosis and rate of injuries differ between competition and training as well as between different UER types. MSKI are observed in 18% of multi-stage events (0.7-1.8 injuries/runner and 7.2 injuries/1000 h). Most MSKI involve the lower leg (35.0%), ankle (16.8%), knee (13.1%) and foot (12.6%), with main diagnosis of medial tibial stress syndrome (30.1%) and patella femoral pain syndrome (PFPS; 7.2%). Single, continuous UER events differ between a 1005 km road race with almost all of the injuries due to overuse, with the main anatomical site of the knee (31%), ankle (28%) and lower leg (14%) and main diagnosis of PFPS (15.6%), compared to a 65 km trail race, with 32.8% of MSKI, mainly on the foot [plantar fasciitis (28.6%)], ankle [sprain (28.6%)] and knee. Timed-UER events (injury rate of 2.1 injuries/athlete) observed most injuries on the ankle (36%) and knee (19%), with the main diagnosis of tendinitis of the foot dorsiflexors (30%). Injuries during training most commonly affect, the back (42%), and knee (40%) and bone stress injuries (22%). Main diagnoses include ankle sprain (18%), iliotibial band injury (16%) and Achilles tendinopathy (11%). Future considerations include examining MSKI in different UER events, environments and surfaces, and on larger study populations. Establishing risk factors, examining sex differences and using a standard reporting system of MSKI in UER are also important.
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Affiliation(s)
- Volker Scheer
- Ultra Sports Science Foundation, Pierre-Bénite, France
| | - Brian J Krabak
- University of Washington and Seattle Children's Sports Medicine, Seattle, WA, United States
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Sewry N, Schwellnus M, Borjesson M, Swanevelder S, Jordaan E. Risk factors for not finishing an ultramarathon: 4-year study in 23996 race starters, SAFER XXI. J Sports Med Phys Fitness 2021; 62:710-715. [PMID: 33871241 DOI: 10.23736/s0022-4707.21.12252-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Limited data support pre-race medical screening to identify risk factors for not finishing an endurance running race. The aim of the study was to determine risk factors associated with not finishing an ultramarathon. METHODS A prospective, cross-sectional study of Two Oceans ultramarathon (56km) race starters who completed a pre-race medical screening questionnaire. Race day environmental conditions were recorded on race day. Univariate analyses of risk factors associated with the did-not-finish (DNF) included race day factors and pre-race medical screening history. RESULTS Risk factors for DNF amongst 23996 starters during the 56km race included older age and being female (p<0.0001). After adjusting for age and sex, the following were significant univariate risk factors: fewer years of running (p<0.0001), less previous race experience (p<0.0001), less training / racing per week (p=0.0002), lower average weekly training distance (p=0.0016), slower race vs. training speed (p<0.0001), lack of allergies (p=0.0100) and average wet-bulb globe temperature (p<0.0001). CONCLUSIONS Females, older age, training-related factors (less training / racing, average weekly training distance, race vs. training speed) and average wet-bulb temperature, were risk factors for not finishing an ultramarathon. The results may not only assist runners and coaches in race preparation, but also have clinical implications for the medical planning prior to races.
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Affiliation(s)
- Nicola Sewry
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,International Olympic Committee (IOC) Research Centre, Johannesburg, South Africa
| | - Martin Schwellnus
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa - .,International Olympic Committee (IOC) Research Centre, Johannesburg, South Africa.,Sport and Exercise Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Mats Borjesson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.,Center for Health and Performance, Goteborg University, Göteborg, Sweden.,Sahlgrenska University Hospital/Östra, Region of Western Sweden, Göteborg, Sweden
| | - Sonja Swanevelder
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Esme Jordaan
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa.,Statistics and Population Studies Department, University of the Western Cape, Bellville, South Africa
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Abstract
Participation in ultramarathons continues to grow, especially among older individuals and among younger runners who may have less running and wilderness experience than many past participants. While ultramarathons tend to have relatively few serious medical issues, adverse medical incidents do occur. These factors make it increasingly important that appropriate safety precautions and medical support are defined and implemented at these events to enhance the safety of participants, spectators, and volunteers. This document establishes the minimum recommended level of medical support that should be available at ultramarathons based on current knowledge and the experience of the authors. It offers a balance that is intended to avoid excessive stress on the local medical system while also precluding undue burden on events to provide medical support beyond that which is practical. We propose a three-level classification system to define the extent of medical services, personnel, systems, supplies, and equipment in place and recommend the level of medical support based on event size, distance/duration, remoteness, and environmental conditions that may be encountered during the event. This document also outlines the recommended education and training of medical providers and discusses other medical and logistical considerations related to the provision of medical support at ultramarathons. We suggest that ultramarathon organizers review and adopt these recommendations to enhance safety and reduce the risk of adverse events to participants.
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21
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Abstract
INTRODUCTION Mountain running races have grown in popularity in the recent years. Nonetheless, there are few studies on injuries and injury rates. Moreover, these studies have focused on long-distance events such as ultramarathons (>42 km). Therefore, the aim of the present study was to examine the severity, type, and body location of musculoskeletal injuries during 20-42 km mountain running races. In addition, the injury rates in this type of races were examined. METHODS Data on injuries were collected during 36 mountain running races over 5 consecutive seasons from 2015 to 2019. The participants reported all musculoskeletal injuries on a standardized injury report form. The results were presented as the number of injuries per 1000 h exposure and per 1000 participants. RESULTS Twenty eight injuries were reported. Most injuries occurred in the ankle (32%) followed by the knee (14%) and foot/toe (11%). The number of injuries represented an overall injury rate of 1.6 injuries per 1000 h running and 5.9 injuries per 1000 runners. The case fatality rate was 0. CONCLUSIONS The incidence of musculoskeletal injuries during 20-42 km mountain running races is low. In addition, the majority of injuries experienced by runners are minor in nature and located in lower extremities, mainly the ankles.
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Viljoen CT, Janse van Rensburg DC, Verhagen E, van Mechelen W, Tomás R, Schoeman M, Scheepers S, Korkie E. Epidemiology of Injury and Illness Among Trail Runners: A Systematic Review. Sports Med 2021; 51:917-943. [PMID: 33538997 DOI: 10.1007/s40279-020-01418-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Trail running is characterised by large elevation gains/losses and uneven varying running surfaces. Limited information is available on injury and illness among trail runners to help guide injury and illness prevention strategies. OBJECTIVE The primary aim of this review was to describe the epidemiology of injury and illness among trail runners. METHODS Eight electronic databases were systematically searched (MEDLINE Ovid, PubMed, Scopus, SportsDiscus, CINAHL, Health Source: Nursing/Academic, Health Source: Consumer Ed., and Cochrane) from inception to November 2020. The search was conducted according to the PRISMA statement and the study was registered on PROSPERO international prospective register of systematic reviews (CRD42019135933). Full-text English and French studies that investigated injury and/or illness among trail runners participating in training/racing were included. The main outcome measurements included: trail running injury (incidence, prevalence, anatomical site, tissue type, pathology-type/specific diagnosis, severity), and illness (incidence, prevalence, symptoms, specific diagnosis, organ system, severity). The methodological quality of the included studies was assessed using an adapted Downs and Black assessment tool. RESULTS Sixteen studies with 8644 participants were included. Thirteen studies investigated race-related injury and/or illness and three studies included training-related injuries. The overall incidence range was 1.6-4285.0 injuries per 1000 h of running and 65.0-6676.6 illnesses per 1000 h of running. The foot was the most common anatomical site of trail running injury followed by the knee, lower leg, thigh, and ankle. Skin lacerations/abrasions were the most common injury diagnoses followed by skin blisters, muscle strains, muscle cramping, and ligament sprains. The most common trail running illnesses reported related to the gastro-intestinal tract (GIT), followed by the metabolic, and cardiovascular systems. Symptoms of nausea and vomiting related to GIT distress and dehydration were commonly reported. CONCLUSION Current trail running literature consists mainly of injury and illness outcomes specifically in relation to single-day race participation events. Limited evidence is available on training-related injury and illness in trail running. Our review showed that injury and illness are common among trail runners, but certain studies included in this review only focused on dermatological injuries (e.g. large number of feet blisters) and GIT symptoms. Specific areas for future research were identified that could improve the management of trail running injury and illness.
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Affiliation(s)
- Carel T Viljoen
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Hillcrest Campus, University of Pretoria, Burnett Street, Hatfield, Pretoria, 0002, South Africa.
- Amsterdam Collaboration for Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Location VU University Medical Center, Amsterdam, The Netherlands.
| | - Dina C Janse van Rensburg
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Hillcrest Campus, University of Pretoria, Burnett Street, Hatfield, Pretoria, 0002, South Africa
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Evert Verhagen
- Amsterdam Collaboration for Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Location VU University Medical Center, Amsterdam, The Netherlands
| | - Willem van Mechelen
- Amsterdam Collaboration for Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Location VU University Medical Center, Amsterdam, The Netherlands
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia
- Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- School of Public Health, Physiotherapy and Population Sciences, University College Dublin, Dublin, Ireland
| | - Rita Tomás
- Portugal Football School, Portuguese Football Federation, Lisbon, Portugal
| | - Marlene Schoeman
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Susan Scheepers
- Department of Library Services, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Elzette Korkie
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Hillcrest Campus, University of Pretoria, Burnett Street, Hatfield, Pretoria, 0002, South Africa
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Viljoen CT, Janse van Rensburg DCC, Jansen van Rensburg A, Booysen E, Chauke S, Coetzee P, Hurlimann A, Jooste M, Nibe Y, Schulenburg C, Korkie E, Ramagole D, Grant C, Cronje T. One in four trail running race entrants sustained an injury in the 12 months training preceding the 2019 SkyRun race. Phys Ther Sport 2020; 47:120-126. [PMID: 33254101 DOI: 10.1016/j.ptsp.2020.11.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To determine the epidemiology and clinical characteristics of RRIs among trail runners who entered the 2019 SkyRun races. DESIGN Descriptive cross-sectional study. SETTING 2019 SkyRun races. PARTICIPANTS Consent for data analysis was given by 305 of 412 (74%) race entrants. MAIN OUTCOME MEASURES Retrospective annual incidence (RRIs/1000 h), point prevalence (%), frequency (%), characteristics (anatomical region, body area, tissue type, pathology type) and injury severity (mean severity score; 95% CI) of RRIs. RESULTS 28.2% of participants reported at least one RRI. The retrospective annual incidence was 49.5 RRIs per 1000h and the point prevalence was 1.3%. Most injuries occurred in the lower limb (87.3%), with the knee (26.5%), ankle (21.6%), and foot (16.7%) reported as the most frequently injured body areas. Muscle/tendon accounted for 44.1% of tissue type injuries. Tendinopathy (27.5%), joint sprain (19.6%), and muscle injury (15.7%) were the most common pathology types reported. The mean injury severity score was 31.6. CONCLUSIONS One in 4 trail runners reported at least one RRI in the 12 months leading up to a race. RRIs mostly affected the lower limb specifically the knee, ankle and foot. Future research should establish injury risk factors to ultimately develop specific injury prevention strategies.
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Affiliation(s)
- Carel T Viljoen
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; Sport, Exercise Medicine and Lifestyle Institute (SEMLI), University of Pretoria, Pretoria, South Africa.
| | - Dina C Christa Janse van Rensburg
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), University of Pretoria, Pretoria, South Africa; Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | - Evan Booysen
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Shihluke Chauke
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Petro Coetzee
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Amy Hurlimann
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Mignette Jooste
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Yoliswa Nibe
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Chene Schulenburg
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Elzette Korkie
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; Sport, Exercise Medicine and Lifestyle Institute (SEMLI), University of Pretoria, Pretoria, South Africa
| | - Dimakatso Ramagole
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Catharina Grant
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Tanita Cronje
- Department of Statistics, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria, South Africa
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24
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Dawadi S, Basyal B, Subedi Y. Morbidity Among Athletes Presenting for Medical Care During 3 Iterations of an Ultratrail Race in the Himalayas. Wilderness Environ Med 2020; 31:437-440. [PMID: 33168403 DOI: 10.1016/j.wem.2020.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 07/08/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Although ultratrail races are increasing in popularity, there is a dearth of data regarding illnesses and medical care at these events. Data about injuries and illnesses for races taking place in the Himalayas, where the nearest medical facility can be hundreds of miles away, are even harder to find. This study aimed to describe the injuries and illnesses befalling the participants of a 7-stage 212 km (132 mi) trail race at high altitude. METHODS Ethical approval was obtained from Nepal Research Health Council. A retrospective study of the record of medical encounters among the 100 participants competing in the Manaslu trail race in Nepal from 2014 to 2016 was performed. Diagnoses were classified into various categories. Informed consent was taken from all participants. RESULTS Acute diarrhea was the most common ailment reported among the participants (18%), followed closely by musculoskeletal problems (17%). Altitude illness made up 6% of care provided. Approximately 35% of the athletes were using acetazolamide as prophylaxis for high altitude illnesses. The 1 case needing evacuation in the 3 iterations was high altitude pulmonary edema. CONCLUSIONS Ultratrail races at high altitude pose a challenge in terms of provision of medical care in a remote setting with limited resources. However, most of the illnesses are minor in nature and easily managed by the race doctor. Knowledge of common illnesses among travelers to the area can help aid in preparation and provision of proper care, especially in remote settings with limited resources.
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Affiliation(s)
- Suvash Dawadi
- CIWEC Hospital and Travel Medicine, Center/Mountain Medicine Society of Nepal, Kathmandu, Nepal.
| | - Bikash Basyal
- Abington Jefferson Health/Mountain Medicine Society of Nepal, Kathmandu, Nepal
| | - Yogesh Subedi
- MedStar Union Memorial Hospital/Mountain Medicine Society of Nepal, Kathmandu, Nepal
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25
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Papagiannaki M, Samoladas E, Maropoulos S, Arabatzi F. Running-Related Injury From an Engineering, Medical and Sport Science Perspective. Front Bioeng Biotechnol 2020; 8:533391. [PMID: 33117776 PMCID: PMC7561420 DOI: 10.3389/fbioe.2020.533391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 08/28/2020] [Indexed: 11/30/2022] Open
Abstract
Etiologic factors associated to running injuries are reviewed, with an emphasis on the transient shock waves experienced during foot strike. In these terms, impact mechanics are analyzed from both, a biomechanical and medical standpoint and evaluated with respect injury etiology, precursors and morbidity. The complex interaction of runner specific characteristics on the employed footwear system are examined, providing insight into footwear selection that could act as a preventive measure against non-acute trauma incidence. In conclusion, and despite the vast literature on running-related injury-risks, only few records could be identified to consider the effect of shoe cushioning and anthropometric data on injury prevalence. Based on this literature, we would stress the importance of such considerations in future studies aspiring to provide insight into running related injury etiology and prevention.
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Affiliation(s)
- Maria Papagiannaki
- Department of Physical Education and Sport Science, Serres, Aristotle University of Thessaloniki, Thessalonik, Greece
| | - Efthimios Samoladas
- Department of Orthopaedics, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stergios Maropoulos
- Department of Mechanical Engineering, University of Western Macedonia, Kozani, Greece
| | - Fotini Arabatzi
- Department of Physical Education and Sport Science, Serres, Aristotle University of Thessaloniki, Thessalonik, Greece
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26
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Schütz U, Ehrhardt M, Göd S, Billich C, Beer M, Trattnig S. A mobile MRI field study of the biochemical cartilage reaction of the knee joint during a 4,486 km transcontinental multistage ultra-marathon using T2* mapping. Sci Rep 2020; 10:8157. [PMID: 32424133 PMCID: PMC7235258 DOI: 10.1038/s41598-020-64994-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 04/21/2020] [Indexed: 02/08/2023] Open
Abstract
Nearly nothing is known about the consequences of ultra-long-distance running on knee cartilage. In this mobile MRI field study, we analysed the biochemical effects of a 4,486 km transcontinental multistage ultra-marathon on femorotibial joint (FTJ) cartilage. Serial MRI data were acquired from 22 subjects (20 male, 18 finisher) using a 1.5 T MR scanner mounted on a 38-ton trailer, travelling with the participants of the TransEurope FootRace (TEFR) day by day over 64 stages. The statistical analyses focused on intrachondral T2* behaviour during the course of the TEFR as the main outcome variable of interest. T2* mapping (sagittal FLASH T2* weighted gradient echo) is a validated and highly accurate method for quantitative compositional cartilage analysis of specific weightbearing areas of the FTJ. T2* mapping is sensitive to changes in the equilibrium of free intrachondral water, which depends on the content and orientation of collagen and the proteoglycan content in the extracellular cartilage matrix. Within the first 1,100 km, a significant running load-induced T2* increase occurred in all joint regions: 44.0% femoral-lateral, 42.9% tibial-lateral, 34.9% femoral-medial, and 25.1% tibial-medial. Osteochondral lesions showed no relevant changes or new occurrence during the TEFR. The reasons for stopping the race were not associated with knee problems. As no further T2* elevation was found in the second half of the TEFR but a decreasing T2* trend (recovery) was observed after the 3,500 km run, we assume that no further softening of the cartilage occurs with ongoing running burden over ultra-long distances extending 4,500 km. Instead, we assume the ability of the FTJ cartilage matrix to reorganize and adapt to the load.
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Affiliation(s)
- Uwe Schütz
- Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Albert-Einstein-Allee 23, D-89081, Ulm, Germany.
| | - Martin Ehrhardt
- Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Albert-Einstein-Allee 23, D-89081, Ulm, Germany
| | - Sabine Göd
- MR Centre of Excellence- High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, BT32, Lazarettgasse 14, 1090, Vienna, Austria
| | - Christian Billich
- Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Albert-Einstein-Allee 23, D-89081, Ulm, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Albert-Einstein-Allee 23, D-89081, Ulm, Germany
| | - Siegfried Trattnig
- MR Centre of Excellence- High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, BT32, Lazarettgasse 14, 1090, Vienna, Austria
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27
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Tiller NB. Pulmonary and Respiratory Muscle Function in Response to Marathon and Ultra-Marathon Running: A Review. Sports Med 2020; 49:1031-1041. [PMID: 31030408 PMCID: PMC6548745 DOI: 10.1007/s40279-019-01105-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The physiological demands of marathon and ultra-marathon running are substantial, affecting multiple body systems. There have been several reviews on the physiological contraindications of participation; nevertheless, the respiratory implications have received relatively little attention. This paper provides an up-to-date review of the literature pertaining to acute pulmonary and respiratory muscle responses to marathon and ultra-marathon running. Pulmonary function was most commonly assessed using spirometry, with infrequent use of techniques including single-breath rebreathe and whole-body plethysmography. All studies observed statistically significant post-race reductions in one-or-more metrics of pulmonary function, with or without evidence of airway obstruction. Nevertheless, an independent analysis revealed that post-race values rarely fell below the lower-limit of normal and are unlikely, therefore, to be clinically significant. This highlights the virtue of healthy baseline parameters prior to competition and, although speculative, there may be more potent clinical manifestations in individuals with below-average baseline function, or those with pre-existing respiratory disorders (e.g., asthma). Respiratory muscle fatigue was most commonly assessed indirectly using maximal static mouth-pressure manoeuvres, and respiratory muscle endurance via maximum voluntary ventilation (MVV12). Objective nerve-stimulation data from one study, and others documenting the time-course of recovery, implicate peripheral neuromuscular factors as the mechanism underpinning such fatigue. Evidence of respiratory muscle fatigue was more prevalent following marathon compared to ultra-marathon, and might be a factor of work rate, and thus exercise ventilation, which is tempered during longer races. Potential implications of respiratory muscle fatigue on health and marathon/ultra-marathon performance have been discussed, and include a diminished postural stability that may increase the risk of injury when running on challenging terrain, and possible respiratory muscle fatigue-induced effects on locomotor limb blood flow. This review provides novel insights that might influence marathon/ultra-marathon preparation strategies, as well as inform medical best-practice of personnel supporting such events.
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Affiliation(s)
- Nicholas B Tiller
- Academy of Sport and Physical Activity, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BP, UK.
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28
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Sewry N, Schwellnus M, Borjesson M, Swanevelder S, Jordaan E. Pre-race screening and stratification predicts adverse events-A 4-year study in 29585 ultra-marathon entrants, SAFER X. Scand J Med Sci Sports 2020; 30:1205-1211. [PMID: 32187395 DOI: 10.1111/sms.13659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/17/2020] [Accepted: 03/10/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Pre-race screening and risk stratification in recreational endurance runners may predict adverse events (AEs) during a race. AIM To determine if pre-race screening and risk stratification predict AEs during a race. METHODS A total of 29 585 participants (Male 71.1%, average age = 42.1 years; Female 28.9%, average age = 40.2 years) at the Two Oceans ultra-marathon races (56 km) completed a pre-race medical screening questionnaire and were risk stratified into four pre-specified groups [very high risk (VHR; existing cardiovascular disease-CVD:3.2%), high risk (HR; risk factors for CVD:10.5%), intermediate risk (IR; existing other chronic disease, medication use or injury:53.3%), and low risk (LR:33.0%)]. Race starters, finishers, and medical encounters (ME) were recorded. Did-not-start (DNS) rate (per 1000 entrants that did-not-start), did-not-finish (DNF) rate (per 1000 starters that did-not-finish), AE rate [per 1000 starters that either DNF or had an ME], and ME rate (per 1000 starters with an ME) were compared across risk categories. RESULTS Adverse events were significantly higher (per 1000 starters; 95%CI) in the VHR (68.9; 52.4-89.9:P = .0407) compared with the LR (51.3; 46.5-56.7). The DNS rate was significantly different between the IR (190.3; 184.0-196.9) and LR (207.4; 199.2-216.0: P = .0011). DNF rates were not different in the VHR (56.4; 41.9-75.9) compared to LR (44.2; 39.7-49.1: P = .1295), and ME rate was also not different between risk categories, however, VHR (12.9; 7.0-23.9) was approaching significance compared to LR (6.9; 5.2-9.1: P = .0662). CONCLUSION Pre-race medical screening and risk stratification may identify athletes at higher risk of AEs. Further studies should be performed in larger cohorts to clarify the role of pre-race medical screening in reducing AEs in endurance runners.
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Affiliation(s)
- Nicola Sewry
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,International Olympic Committee (IOC) Research Centre, Cape Town, South Africa
| | - Martin Schwellnus
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,International Olympic Committee (IOC) Research Centre, Cape Town, South Africa.,Emeritus Professor of Sport and Exercise Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Mats Borjesson
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, Göteborg University, Gothenburg, Sweden.,Center for Health and Performance, Göteborg University, Gothenburg, Sweden.,Sahlgrenska University Hospital/Östra, Göteborg, Sweden
| | - Sonja Swanevelder
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Esme Jordaan
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa.,Statistics and Population Studies Department, University of the Western Cape, Cape Town, South Africa
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Abstract
Exercise is universally recognized for its health benefits and distance running has long been a popular form of exercise and sport. Ultramarathons, defined as races longer than a marathon, have become increasingly popular in recent years. The diverse ultramarathon distances and courses provide additional challenges in race performance and medical coverage for these events. As the sport grows in popularity, more literature has become available regarding ultramarathon-specific illnesses and injuries, nutrition guidelines, psychology, physiologic changes, and equipment. This review focuses on recent findings and trends in ultramarathon running.
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Affiliation(s)
- Jack Spittler
- UCH-A.F. Williams Family Medicine Center at Stapleton, Denver, CO
| | - Lauren Oberle
- University of Colorado-Denver, Anschutz Medical Campus, Denver, CO
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30
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Graham SM, Martindale RJJ, McKinley M, Connaboy C, Andronikos G, Susmarski A. The examination of mental toughness, sleep, mood and injury rates in an Arctic ultra-marathon. Eur J Sport Sci 2020; 21:100-106. [PMID: 32089095 DOI: 10.1080/17461391.2020.1733670] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
There is scarcity of research examining the physiological and psychological effects of ultra-endurance racing on athletes in extreme conditions. The purpose of the current study was to identify common injury patterns and illness, profile mood states and sleep patterns and finally examine the relationships between mental toughness, sleep, mood and injury rates during a 120 mile, three-day Arctic ultra-marathon. Twelve participants (3 females, 9 males) with a mean age of 42 ± 5.35 yrs participated in the study. Mental toughness was measured using the MT18 questionnaire. Injuries were clinically assessed and recorded each day. Temperatures ranged from -20 to -6 degrees Celsius throughout the race. Sleep quantity and mood state were recorded using the BRUMS questionnaire. 10 out of the 12 participants experienced injuries; almost half of the participants had injuries that carried over a number of days. Mean sleep duration over the three days was 4.07 h, with an average of 0.78 injuries per day. Significant changes in mood were recorded across the three days, specifically a reduction in vigour (p = .029) and increase in fatigue (p = .014). Neither sleep quantity nor mental toughness was correlated with injury rate. Interestingly, sleep quantity was not related to changes in mood, as previously shown in ultra-marathons. Mental toughness had a moderate negative correlation (p < 0.01) with depression (-.623), reduced anger (-.616), confusion (-.558), increased vigour (.497) and tension (-.420) during the race. Success in this type of event involves significant psychological and physiological preparation to minimize the effects of sleep deprivation and avoidance of injuries.
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Affiliation(s)
- Scott Murray Graham
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, Scotland.,School of Medicine, University of St. Andrews, St Andrews, Scotland
| | | | - Mairi McKinley
- School of Medicine, University of St. Andrews, St Andrews, Scotland
| | - Chris Connaboy
- Neuromuscular Research Laboratory, Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Georgios Andronikos
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, Scotland
| | - Adam Susmarski
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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31
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Alschuler KN, Krabak BJ, Kratz AL, Jensen MP, Pomeranz D, Burns P, Bautz J, Nordeen C, Irwin C, Lipman GS. Pain Is Inevitable But Suffering Is Optional: Relationship of Pain Coping Strategies to Performance in Multistage Ultramarathon Runners. Wilderness Environ Med 2020; 31:23-30. [PMID: 32044211 DOI: 10.1016/j.wem.2019.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/25/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Ultramarathon runners commonly endure musculoskeletal pain during endurance events. However, the effect of pain coping skills on performance has not been examined. METHODS A prospective observational study during three 250 km (155 mi), 6 stage ultramarathons was conducted. Finish line surveys were completed after each of the four 40 km (25 mi) and one 80 km (50 mi) stages of racing. Variables gathered included pain intensity, pain coping strategy use, pain interference, finishing position (quintile), and successful race completion. RESULTS A total of 204 participants (age 41.4±10.3 y; 73% male) reported average pain intensity of 3.9 (±2.0 SD) and worst pain intensity of 5.3 (±2.3) on a 0 to 10 scale. They used greater adaptive pain coping strategies (3.0±1.3) relative to maladaptive strategies (1.3±1.1). Worst pain and pain interference increased over each stage of the race for all runners (P<0.001), with worst pain being significantly different by finishing status (P=0.02). Although all runners endured increased pain and interference, the nonfinishers (28 [14%]) had significantly greater differences in changes in pain intensity (P<0.01) and pain interference (P<0.001). Maladaptive pain coping strategies were more common in nonfinishers; with each 1-point increase (0-6 scale), there was a 3 times increase in odds of not finishing the race. CONCLUSIONS Although increased pain intensity and pain interference was found in all multistage ultramarathon runners, successful event completion was significantly associated with less maladaptive pain coping. Training in coping with pain may be a beneficial part of ultramarathon preparation.
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Affiliation(s)
- Kevin N Alschuler
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA; Department of Neurology, University of Washington, Seattle, WA.
| | - Brian J Krabak
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA; Department of Orthopedics and Sports Medicine, University of Washington, Seattle, WA
| | - Anna L Kratz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | | | - Patrick Burns
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA
| | - Joshua Bautz
- Department of Emergency Medicine, Naval Medical Center Camp Lejeune, Camp Lejeune, NC
| | - Claire Nordeen
- Department of Emergency Medicine, University of Washington, Seattle, WA
| | - Crystal Irwin
- LA County - University Southern California Emergency Medicine Residency, Keck School of Medicine, Los Angeles, CA
| | - Grant S Lipman
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA
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32
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Scheer V, Hoffman MD. Too much too early? An analysis of worldwide childhood ultramarathon participation and attrition in adulthood. J Sports Med Phys Fitness 2019; 59:1363-1368. [PMID: 31373190 DOI: 10.23736/s0022-4707.19.09495-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Physical inactivity is associated with chronic disease and premature death, but excessive exercise can also lead to injury. Ultramarathon running is popular among adults but has not been assessed in children. To analyze ultramarathon participation in children and to determine if they continue running ultramarathons into adulthood provide some evidence of associated health risks. METHODS Race results databases were used to identify ultramarathon finishers under the age of 19 between 1960-2017. Participation trends across calendar years, age groups and different race distances were analyzed and continued participation into adulthood examined. RESULTS A total of 7775 finishes by 5418 individual children were recorded worldwide with an increase in ultramarathon finishers over time (P<0.0001), with the greatest number among older age groups (>16 years) and the 50 and 100 km race distances. Less than 25% of childhood ultramarathon runners continued running ultramarathons into adulthood and approximately 12% continued beyond 20 years. CONCLUSIONS Childhood participants has been growing exponentially over the last 20 years. While few of those children continue to complete ultramarathons into adulthood, the finding that some have continued well into adulthood suggests there is no obligate serious adverse physical impairment resulting from childhood ultramarathon participation.
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Affiliation(s)
- Volker Scheer
- Ultra Sports Science Foundation, Pierre Benite, France - .,British Forces Germany, RRU Sennelager, Normandy Barracks, BFPO 16, Sennelager, Germany -
| | - Martin D Hoffman
- Ultra Sports Science Foundation, Pierre Benite, France.,Unit of Physical Medicine and Rehabilitation, Department of Veterans Affairs, Northern California Health Care System, Sacramento, CA, USA.,Department of Physical Medicine and Rehabilitation, Davis Medical Center, University of California, Sacramento, CA, USA
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33
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Hoffman MD. Participant Opinions and Expectations about Medical Services at Ultramarathons: Findings from the Ultrarunners Longitudinal TRAcking (ULTRA) Study. Cureus 2019; 11:e5800. [PMID: 31728247 PMCID: PMC6827872 DOI: 10.7759/cureus.5800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background This work explores the opinions and expectations of ultramarathon runners about medical services and their perceived quality during ultramarathons. Methods Focused questions related to medical services at ultramarathons were included in the 2018 survey of Ultrarunners Longitudinal TRAcking (ULTRA) Study enrollees. Results Among the 1,156 respondents, 83.2% agreed that ultramarathons should provide at least a minimum level of medical support with basic first aid and emergency transport services rated as the most important medical services, and individuals with basic first aid training rated as the most important medical providers at ultramarathons. Participant safety was felt to largely be the responsibility of each runner as well as the race and/or medical director. Among 832 respondents having completed an ultramarathon in 2016-2018, their impression of medical services at 4,853 ultramarathons was generally favorable. Of the four percent of times in which medical support was needed, it met expectations 74% of the time. Of the total of 240 different medical issues for which medical support was needed, blister management was the most common, accounting for 26.7% of issues. Conclusions Even though medical services receive minimal utilization during ultramarathons, ultramarathon runners largely believe that these events should provide at least a minimum level of medical support. Ultramarathon runners place a high onus for safety during ultramarathons on themselves, but they also place a high level of responsibility on race and medical directors, so it is prudent for the race and medical directors to consider this information and avoid a mismatch between runner expectations and the medical services actually provided.
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Affiliation(s)
- Martin D Hoffman
- Physical Medicine and Rehabilitation, University of California, Davis, USA
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Warrick A, Currey J, Waite B. Ultramarathon Comprehensive Injury Prevention. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2019. [DOI: 10.1007/s40141-019-00233-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Procter E, Brugger H, Burtscher M. Accidental hypothermia in recreational activities in the mountains: A narrative review. Scand J Med Sci Sports 2018; 28:2464-2472. [PMID: 30203539 DOI: 10.1111/sms.13294] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/03/2018] [Accepted: 09/05/2018] [Indexed: 01/16/2023]
Abstract
The popularity of recreational activities in the mountains worldwide has led to an increase in the total number of persons exposed to cold and extreme environments through recreation. There is little conclusive evidence about the risk of hypothermia for specific activities or populations, nor is it clear which activities are represented in the literature. This is a non-systematic review of accidental hypothermia in different recreational activities in the mountains, with a specific focus on outdoor or winter activities that potentially involve cold exposure. Cases of hypothermia have been reported in the literature in mountaineering, trekking, hiking, skiing, activities performed in the backcountry, ultra-endurance events, and databases from search and rescue services that include various types of recreation. Of these activities, hypothermia as a primary illness occurs most commonly during mountaineering in the highest elevation areas in the world and during recreation practiced in more northern or remote areas. Hypothermia in skiers, snowboarders, and glacier-based activities is most often associated with accidents occurring off-piste or in the backcountry (crevasse, avalanche). Organizers of outdoor events also have a role in reducing the incidence of hypothermia through medical screening and other preparedness measures. More complete collection and reporting of data on mild hypothermia and temperature measurement would improve our understanding of the incidence of hypothermia in outdoor recreation in future.
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Affiliation(s)
- Emily Procter
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bozen/Bolzano, Italy
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
- Austrian Society for Alpine and Mountain Medicine, Innsbruck, Austria
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Abstract
The role of immunohistochemistry (IHC) in endocrine pathology is similar to that in other organ systems in that it can aid in the subclassification of tumors within an organ, confirm site of primary in metastatic disease, provide prognostic information, identify underlying genetic alterations, and predict response to treatment. Although most endocrine tumors do not require IHC to render a diagnosis, there are certain scenarios in which IHC can be extremely helpful. For example, in thyroid, IHC can be used to support tumor dedifferentiation, in the adrenal it can aid in the diagnosis of low-grade adrenocortical carcinomas, and in paragangliomas it can help identify tumors arising as part of an inherited tumor syndrome. This review will focus on the applications of IHC in tumors of the thyroid, parathyroids, adrenals, and paraganglia in adults.
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Sukerkar PA, Fast AM, Riley G. Extreme Sports Injuries to the Pelvis and Lower Extremity. Radiol Clin North Am 2018; 56:1013-1033. [PMID: 30322484 DOI: 10.1016/j.rcl.2018.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Extreme sports are growing in popularity, and physicians are becoming increasingly aware of injuries related to these activities. Imaging plays a key role in diagnosing and determining clinical management of many of these injuries. This article describes general imaging techniques and findings in various injuries specific to multiple extreme sports.
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Affiliation(s)
- Preeti Arun Sukerkar
- Department of Radiology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Angela M Fast
- Department of Radiology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Geoffrey Riley
- Department of Radiology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA.
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How variability in pain and pain coping relate to pain interference during multistage ultramarathons. Pain 2018; 160:257-262. [PMID: 30204649 DOI: 10.1097/j.pain.0000000000001397] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
An important and substantial body of literature has established that maladaptive and adaptive coping strategies significantly impact pain-related outcomes. This literature, however, is based primarily on populations with painful injuries and illnesses. Little is known about coping in individuals who experience pain in other contexts and whether coping impacts outcomes in the same way. In an effort to better understand pain coping in such contexts, this study evaluated pain coping in ultramarathon runners, a population known to experience moderate levels of pain with minimal perceived negative effects. This study reports on pain coping in 204 entrants in 2016 RacingThePlanet multistage ultramarathon events. Participants provided data over 5 consecutive days on pain severity, pain interference, exertion, and coping. Results demonstrated that the study participants were more likely to use adaptive than maladaptive coping responses. However, maladaptive coping, but not adaptive coping, was positively associated with percent time spent thinking about pain and pain-related interference. Taken together, the study supports the idea that this high functioning group of individuals experiencing pain emphasizes the use of adaptive coping strategies over maladaptive strategies, reinforcing the perspective that such a pattern may be the most effective way to cope with pain. Within the group, however, results supported traditional patterns, such that greater use of maladaptive strategies was associated with greater pain-related interference, suggesting that optimizing pain coping may be critical to reducing factors that may interfere with ultramarathon performance.
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Chlíbková D, Ronzhina M, Nikolaidis PT, Rosemann T, Knechtle B. Non-steroidal Anti-inflammatory Drug Consumption in a Multi-Stage and a 24-h Mountain Bike Competition. Front Physiol 2018; 9:1272. [PMID: 30246809 PMCID: PMC6139357 DOI: 10.3389/fphys.2018.01272] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 08/21/2018] [Indexed: 12/04/2022] Open
Abstract
Purpose: Excessive or inappropriate non-steroidal anti-inflammatory drug (NSAID) use during ultra-endurance events could cause potential risk to athletes’ health. Reports on NSAID consumption in mountain bikers or ultra-mountain bikers are scarce. Therefore, the aim of this study was to investigate the prevalence of NSAID consumption immediately before, during and immediately after a mountain bike (MTB) race and to compare NSAID consumption in two different MTB competitions. Methods: This observational study took place at a three-stage MTB race (SMTB) (n = 63) and at a 24-h MTB race (24MTB) (n = 68), both held in the Czechia in 2017. NSAID consumption was evaluated via self-reported electronic questionnaires. Results: Of all finishers (n = 131), fourteen (10%) consumed NSAID at least once during the competition day (immediately before, during or immediately after the race). The number of NSAID consumers was the same in both competitions. Nevertheless, only three athletes (2%), all of them from the 24MTB, consumed NSAID during the race and 5% of all mountain bikers reported consumption after the race. In contrast to the SMTB, the intake reported by the 24MTB participants was quite homogeneous in terms of the timing of NSAID consumption. The NSAID users were older (p = 0.043) than the non-users. Ibuprofen was most commonly used by 79% of all consumers. Conclusion: The prevalence of NSAID use was higher in the older participants and seems to be lower in comparison with results from studies about runners, ultra-runners and triathletes suggesting that it is determined by the discipline (i.e., cycling). On the other hand, the timing of NSAID consumption was probably affected by the competition character (e.g., MTBS or 24MTB). Future studies should focus on a larger sample size of cyclists from various disciplines.
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Affiliation(s)
- Daniela Chlíbková
- Centre of Sports Activities, Brno University of Technology, Brno, Czechia
| | - Marina Ronzhina
- Department of Biomedical Engineering, Brno University of Technology, Brno, Czechia
| | | | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
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Knechtle B, Nikolaidis PT. Physiology and Pathophysiology in Ultra-Marathon Running. Front Physiol 2018; 9:634. [PMID: 29910741 PMCID: PMC5992463 DOI: 10.3389/fphys.2018.00634] [Citation(s) in RCA: 152] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/11/2018] [Indexed: 12/31/2022] Open
Abstract
In this overview, we summarize the findings of the literature with regards to physiology and pathophysiology of ultra-marathon running. The number of ultra-marathon races and the number of official finishers considerably increased in the last decades especially due to the increased number of female and age-group runners. A typical ultra-marathoner is male, married, well-educated, and ~45 years old. Female ultra-marathoners account for ~20% of the total number of finishers. Ultra-marathoners are older and have a larger weekly training volume, but run more slowly during training compared to marathoners. Previous experience (e.g., number of finishes in ultra-marathon races and personal best marathon time) is the most important predictor variable for a successful ultra-marathon performance followed by specific anthropometric (e.g., low body mass index, BMI, and low body fat) and training (e.g., high volume and running speed during training) characteristics. Women are slower than men, but the sex difference in performance decreased in recent years to ~10–20% depending upon the length of the ultra-marathon. The fastest ultra-marathon race times are generally achieved at the age of 35–45 years or older for both women and men, and the age of peak performance increases with increasing race distance or duration. An ultra-marathon leads to an energy deficit resulting in a reduction of both body fat and skeletal muscle mass. An ultra-marathon in combination with other risk factors, such as extreme weather conditions (either heat or cold) or the country where the race is held, can lead to exercise-associated hyponatremia. An ultra-marathon can also lead to changes in biomarkers indicating a pathological process in specific organs or organ systems such as skeletal muscles, heart, liver, kidney, immune and endocrine system. These changes are usually temporary, depending on intensity and duration of the performance, and usually normalize after the race. In longer ultra-marathons, ~50–60% of the participants experience musculoskeletal problems. The most common injuries in ultra-marathoners involve the lower limb, such as the ankle and the knee. An ultra-marathon can lead to an increase in creatine-kinase to values of 100,000–200,000 U/l depending upon the fitness level of the athlete and the length of the race. Furthermore, an ultra-marathon can lead to changes in the heart as shown by changes in cardiac biomarkers, electro- and echocardiography. Ultra-marathoners often suffer from digestive problems and gastrointestinal bleeding after an ultra-marathon is not uncommon. Liver enzymes can also considerably increase during an ultra-marathon. An ultra-marathon often leads to a temporary reduction in renal function. Ultra-marathoners often suffer from upper respiratory infections after an ultra-marathon. Considering the increased number of participants in ultra-marathons, the findings of the present review would have practical applications for a large number of sports scientists and sports medicine practitioners working in this field.
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Affiliation(s)
- Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
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Abstract
Participants in the Ultrarunners Longitudinal TRAcking (ULTRA) Study were asked to answer "yes" or "no" to the question "If you were to learn, with absolute certainty, that ultramarathon running is bad for your health, would you stop your ultramarathon training and participation?" Among the 1349 runners, 74.1% answered "no". Compared with those answering "yes", they were younger (p < 0.0001), less likely to be married (p = 0.019), had less children (p = 0.0095), had a lower health orientation (p < 0.0001) though still high, and higher personal goal achievement (p = 0.0066), psychological coping (p < 0.0001) and life meaning (p = 0.0002) scores on the Motivations of Marathoners Scales. Despite a high health orientation, most ultramarathon runners would not stop running if they learned it was bad for their health as it appears to serve their psychological and personal achievement motivations and their task orientation such that they must perceive enhanced benefits that are worth retaining at the risk of their health.
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Affiliation(s)
- Martin D Hoffman
- a Department of Physical Medicine & Rehabilitation, Department of Veterans Affairs , Northern California Health Care System , Sacramento , CA , USA.,b Ultra Sports Science Foundation , El Dorado Hills , CA , USA.,c Department of Physical Medicine and Rehabilitation , University of California Davis Medical Center , Sacramento , CA , USA
| | - Rhonna Krouse
- d Exercise and Health Science Department , College of Western Idaho , Nampa , ID , USA
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Abstract
Zusammenfassung. In den vergangenen Jahrzehnten hat sich die Zahl der Ultraläufer vervielfacht, und viele Studien haben den Einfluss auf den Bewegungsapparat untersucht. Wir stellen die Erkenntnisse zu Schäden zusammen, die ein Ultramarathon an Gelenken und Muskeln verursachen kann. Die häufigsten Verletzungen bzw. Überlastungsschäden betreffen die untere Extremität, wobei Sprunggelenk und Knie am häufigsten betroffen sind. Bei sehr langen Läufen kommt es zu einer Anpassung mit Verdickung von Sehnen und Knorpel. Ein Ultramarathon kann zu einem ausgeprägten Muskelschaden führen, mit einem Anstieg von myozellulären Metaboliten wie Myoglobin, Laktat-Dehydrogenase und Creatinkinase.
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Affiliation(s)
- Beat Knechtle
- 1 Medbase St. Gallen am Vadianplatz, St. Gallen
- 2 Institut für Hausarztmedizin, Universität Zürich, Zürich
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Laskowski-Jones L, Caudell MJ, Hawkins SC, Jones LJ, Dymond CA, Cushing T, Gupta S, Young DS, Starling JM, Bounds R. Extreme event medicine: considerations for the organisation of out-of-hospital care during obstacle, adventure and endurance competitions. Emerg Med J 2017; 34:680-685. [PMID: 28784607 DOI: 10.1136/emermed-2017-206695] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/28/2017] [Accepted: 06/04/2017] [Indexed: 11/03/2022]
Abstract
Obstacle, adventure and endurance competitions in challenging or remote settings are increasing in popularity. A literature search indicates a dearth of evidence-based research on the organisation of medical care for wilderness competitions. The organisation of medical care for each event is best tailored to specific race components, participant characteristics, geography, risk assessments, legal requirements, and the availability of both local and outside resources. Considering the health risks and logistical complexities inherent in these events, there is a compelling need for guiding principles that bridge the fields of wilderness medicine and sports medicine in providing a framework for the organisation of medical care delivery during wilderness and remote obstacle, adventure and endurance competitions. This narrative review, authored by experts in wilderness and operational medicine, provides such a framework. The primary goal is to assist organisers and medical providers in planning for sporting events in which participants are in situations or locations that exceed the capacity of local emergency medical services resources.
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Affiliation(s)
- Linda Laskowski-Jones
- Department of Emergency Medicine, Christiana Care Health System, Newark, Delaware, USA
| | - Michael J Caudell
- Augusta University Medical College of Georgia, Center of Operational Medicine, Augusta, Georgia, USA
| | - Seth C Hawkins
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Lawrence J Jones
- Appalachian Center for Wilderness Medicine, Morganton, North Carolina, USA
| | - Chelsea A Dymond
- University of Queensland Ochsner Clinical Foundation New Orleans, Los Angeles, California, USA
| | - Tracy Cushing
- University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Sanjey Gupta
- Long Island Jewish Medical Center, Emergency Medicine, New Hyde Park, New York, USA
| | - David S Young
- Rush University Medical Center, Chicago, Illinois, USA
| | - Jennifer M Starling
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Richard Bounds
- Department of Emergency Medicine, Christiana Care Health System, Newark, Delaware, USA
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Krabak BJ, Lipman GS, Waite BL, Rundell SD. Exercise-Associated Hyponatremia, Hypernatremia, and Hydration Status in Multistage Ultramarathons. Wilderness Environ Med 2017; 28:291-298. [PMID: 28781178 DOI: 10.1016/j.wem.2017.05.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 03/29/2017] [Accepted: 05/25/2017] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Brian J Krabak
- Department of Rehabilitation, Orthopedics and Sports Medicine, University of Washington and Seattle Children's Sports Medicine, Seattle, WA (Dr Krabak).
| | - Grant S Lipman
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA (Dr Lipman)
| | - Brandee L Waite
- Department of Physical Medicine and Rehabilitation, University of California, Davis Sports Medicine, Sacramento, CA (Dr Waite)
| | - Sean D Rundell
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA (Dr Rundell)
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Prevention of Friction Blisters in Outdoor Pursuits: A Systematic Review. Wilderness Environ Med 2017; 28:139-149. [DOI: 10.1016/j.wem.2017.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 02/25/2017] [Accepted: 03/13/2017] [Indexed: 11/18/2022]
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Krabak BJ, Parker KM, DiGirolamo A. Exercise-Associated Collapse: Is Hyponatremia in Our Head? PM R 2017; 8:S61-8. [PMID: 26972268 DOI: 10.1016/j.pmrj.2015.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/25/2015] [Accepted: 10/04/2015] [Indexed: 11/18/2022]
Abstract
Exercise-associated hyponatremia (EAH) is one of the most common causes of exercise-associated collapse. The primary pathogenesis of EAH is largely the result of excessive fluid intake but is influenced by other factors, including hormonal abnormalities (ie, inappropriate arginine vasopressin secretion), renal abnormalities, and mobilization of sodium stores. Early recognition of EAH is crucial to appropriate treatment, because symptoms are varied and may be confused with other causes of exercise-associated collapse. Onsite testing of [Na+] will confirm the diagnosis but is not always available. Rapid treatment of EAH will depend upon the type and severity of symptoms. Treatment protocols range from fluid restriction or oral hypertonic fluids for mild symptoms to intravenous hypertonic fluids for more severe symptoms. Preventative strategies should emphasize fluid consumption based on thirst and athlete/coach/staff education regarding proper hydration practices.
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Affiliation(s)
- Brian J Krabak
- Rehabilitation, Orthopedics and Sports Medicine, University of Washington and Seattle Children's Sports Medicine, 3800 Montlake Boulevard NE, Box 354060, Seattle, WA 98105; and University of Washington and Seattle University(∗).
| | - Kelsey M Parker
- University of Washington and Seattle Children's Sports Medicine, Seattle, WA(†)
| | - Anthony DiGirolamo
- University of Washington and Seattle Children's Sports Medicine, Seattle, WA(‡)
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Scheer BV, Reljic D, Murray A, Costa RJS. The enemy of the feet: blisters in ultraendurance runners. J Am Podiatr Med Assoc 2016; 104:473-8. [PMID: 25275735 DOI: 10.7547/0003-0538-104.5.473] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Blisters are the most common dermatologic problem in ultraendurance runners. Their incidence, localization, pain scores, and risk factors in field conditions are poorly understood. METHODS We conducted an observational field-based cohort study during the 5-day multistage 2010 and 2011 Al Andalus Ultimate Trail (219 km). Daily postrace data on blister frequency, localization, severity, and preventive measures from 50 ultramarathon runners were collected through the direct interview technique. RESULTS After 4 days of running (182 km), blisters occurred in 76% of the participants (P < .001 versus stage 1) compared with 34% after day 1, 54% after day 2, and 72% after day 3 (P < .001 versus stage 1). Most of the blisters formed on the toes (65%) (P < .001), followed by blisters on other locations of the foot: the ball of the foot (16%), heel (14%), and sole (5%). Blisters were more painful toward the end of the race, and those on the sole and heel tended to be the most painful, although this did not reach statistical significance. Prophylactic measures studied (type and fabric of socks; application of antiperspirants, talcum powder, or lubricant to feet; and prophylactic taping) did not show any reduction in blister rates. The only predictive marker for reduced blister incidence was previous ultramarathon experience in men (r = -0.44, P < .05). CONCLUSIONS Blisters are extremely common in multistage ultramarathon races. Race experience in male ultramarathon runners is associated with reduced blister rates.
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Affiliation(s)
- Bernd Volker Scheer
- Team Axarsport, Santa Cruz del Comercio, Spain
- Sports Medicine Department, Olympic Training Centre, University of Heidelberg, Heidelberg, Germany
| | - Dejan Reljic
- Sports Medicine Department, Olympic Training Centre, University of Heidelberg, Heidelberg, Germany
| | - Andrew Murray
- Team Axarsport, Santa Cruz del Comercio, Spain
- SportScotland Institute of Sport, Stirling, Scotland
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Abstract
Background: Extreme conditioning programs (ECPs) are fitness training regimens relying on aerobic, plyometric, and resistance training exercises, often with high levels of intensity for a short duration of time. These programs have grown rapidly in popularity in recent years, but science describing the safety profile of these programs is lacking. Hypothesis: The rate of injury in the extreme conditioning program is greater than the injury rate of weightlifting and the majority of injuries occur to the shoulder and back. Study Design: Cross-sectional study. Level of Evidence: Level 4. Methods: This is a retrospective survey of injuries reported by athletes participating in an ECP. An injury survey was sent to 1100 members of Iron Tribe Fitness, a gym franchise with 5 locations across Birmingham, Alabama, that employs exercises consistent with an ECP in this study. An injury was defined as a physical condition resulting from ECP participation that caused the athlete to either seek medical treatment, take time off from exercising, or make modifications to his or her technique to continue. Results: A total of 247 athletes (22%) completed the survey. The majority (57%) of athletes were male (n = 139), and 94% of athletes were white (n = 227). The mean age of athletes was 38.9 years (±8.9 years). Athletes reported participation in the ECP for, on average, 3.6 hours per week (± 1.2 hours). Eighty-five athletes (34%) reported that they had sustained an injury while participating in the ECP. A total of 132 injuries were recorded, yielding an estimated incidence of 2.71 per 1000 hours. The shoulder or upper arm was the most commonly injured body site, accounting for 38 injuries (15% of athletes). Athletes with a previous shoulder injury were 8.1 times as likely to injure their shoulder in the ECP compared with athletes with healthy shoulders. The trunk, back, head, or neck (n = 29, 12%) and the leg or knee (n = 29, 12%) were the second most commonly injured sites. The injury incidence rate among athletes with <6 months of experience in the ECP was 2.5 times greater than that of more experienced athletes (≥6 months of experience). Of the 132 injuries, 23 (17%) required surgical intervention. Squat cleans, ring dips, overhead squats, and push presses were more likely to cause injury. Athletes reported that 35% of injuries were due to overexertion and 20% were due to improper technique. Conclusion: The estimated injury rate among athletes participating in this ECP was similar to the rate of injury in weightlifting and most other recreational activities. The shoulder or upper arm was the most commonly injured area, and previous shoulder injury predisposed to new shoulder injury. New athletes are at considerable risk of injury compared with more experienced athletes. Clinical Relevance: Extreme conditioning programs are growing in popularity, and there is disagreement between science and anecdotal reports from athletes, coaches, and physicians about their relative safety. This study estimates the incidence of injury in extreme conditioning programs, which appears to be similar to other weight-training programs.
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Affiliation(s)
- Kyle T Aune
- American Sports Medicine Institute, Birmingham, Alabama
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50
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Abstract
Ultramarathon runners are a relatively small and unique group of distance runners with somewhat different medical issues than other distance runners. This article outlines some of those differences so that clinicians caring for these runners in the clinic or at competitions might be better prepared.
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