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Joachim MR, Kuik ML, Krabak BJ, Kraus EM, Rauh MJ, Heiderscheit BC. Risk Factors for Running-Related Injury in High School and Collegiate Cross-country Runners: A Systematic Review. J Orthop Sports Phys Ther 2024; 54:1-13. [PMID: 37970801 DOI: 10.2519/jospt.2023.11550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVE: To summarize and describe risk factors for running-related injuries (RRIs) among high school and collegiate cross-country runners. DESIGN: Descriptive systematic review. LITERATURE SEARCH: Four databases (Scopus, SPORTDiscus, CINAHL, Cochrane) were searched from inception to August 2023. STUDY SELECTION CRITERIA: Studies assessing RRI risk factors in high school or collegiate runners using a prospective design with at least 1 season of follow-up were included. DATA SYNTHESIS: Results across each study for a given risk factor were summarized and described. The NOS and GRADE frameworks were used to evaluate quality of each study and certainty of evidence for each risk factor. RESULTS: Twenty-four studies were included. Overall, study quality and certainty of evidence were low to moderate. Females or runners with prior RRI or increased RED-S (relative energy deficiency in sport) risk factors were most at risk for RRI, as were runners with a quadriceps angle of >20° and lower step rates. Runners with weaker thigh muscle groups had increased risk of anterior knee pain. Certainty of evidence regarding training, sleep, and specialization was low, but suggests that changes in training volume, poorer sleep, and increased specialization may increase RRI risk. CONCLUSION: The strongest predictors of RRI in high school and collegiate cross-country runners were sex and RRI history, which are nonmodifiable. There was moderate certainty that increased RED-S risk factors increased RRI risk, particularly bone stress injuries. There was limited evidence that changes in training and sleep quality influenced RRI risk, but these are modifiable factors that should be studied further in this population. J Orthop Sports Phys Ther 2024;54(2):1-13. Epub 16 November 2023. doi:10.2519/jospt.2023.11550.
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Tenforde AS, DeLuca S, Wu AC, Ackerman KE, Lewis M, Rauh MJ, Heiderscheit B, Krabak BJ, Kraus E, Roberts W, Troy KL, Barrack MT. Prevalence and factors associated with bone stress injury in middle school runners. PM R 2022; 14:1056-1067. [PMID: 34251763 DOI: 10.1002/pmrj.12673] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 06/22/2021] [Accepted: 07/02/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Bone stress injury (BSI) in youth runners is clinically important during times of skeletal growth and is not well studied. OBJECTIVE To evaluate the prevalence, anatomical distribution, and factors associated with running-related BSI in boy and girl middle school runners. DESIGN Retrospective cross-sectional study. SETTING Online survey distributed to middle school runners. METHODS Survey evaluated BSI history, age, grade, height, weight, eating behaviors, menstrual function, exercise training, and other health characteristics. MAIN OUTCOME MEASUREMENTS Prevalence and characteristics associated with history of BSI, stratified by cortical-rich (eg, tibia) and trabecular-rich (pelvis and femoral neck) locations. PARTICIPANTS 2107 runners (n = 1250 boys, n = 857 girls), age 13.2 ± 0.9 years. RESULTS One hundred five (4.7%) runners reported a history of 132 BSIs, with higher prevalence in girls than boys (6.7% vs 3.8%, p = .004). The most common location was the tibia (n = 51). Most trabecular-rich BSIs (n = 16, 94% total) were sustained by girls (pelvis: n = 6; femoral neck: n = 6; sacrum: n = 4). In girls, consuming <3 daily meals (odds ratio [OR] = 18.5, 95% confidence interval [CI] = 7.3, 47.4), eating disorder (9.8, 95% CI = 2.0, 47.0), family history of osteoporosis (OR = 6.9, 95% CI = 2.6, 18.0), and age (OR = 1.6, 95% CI = 1.0, 2.6) were associated with BSI. In boys, family history of osteoporosis (OR = 3.2, 95% CI = 1.2, 8.4), prior non-BSI fracture (OR = 3.2, 95% CI = 1.6, 6.7), and running mileage (OR = 1.1, 95% CI = 1.0, 1.1) were associated with BSI. Participating in soccer or basketball ≥2 years was associated with lower odds of BSI for both sexes. CONCLUSION Whereas family history of osteoporosis and prior fracture (non-BSI) were most strongly related to BSI in the youth runners, behaviors contributing to an energy deficit, such as eating disorder and consuming <3 meals daily, also emerged as independent factors associated with BSI. Although cross-sectional design limits determining causality, our findings suggest promoting optimal skeletal health through nutrition and participation in other sports including soccer and basketball may address factors associated with BSI in this population.
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Affiliation(s)
- Adam S Tenforde
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Stephanie DeLuca
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander C Wu
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Kathryn E Ackerman
- Harvard Medical School, Boston, Massachusetts, USA
- Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Margo Lewis
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Mitchell J Rauh
- Doctor of Physical Therapy Program, San Diego State University, San Diego, California, USA
| | - Bryan Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, Wisconsin, USA
| | - Brian J Krabak
- Rehabilitation, Orthopedics and Sports Medicine, University of Washington, Seattle, Washington, USA
| | - Emily Kraus
- Stanford Children's Orthopedic and Sports Medicine Center, Stanford University, Stanford, California, USA
| | - William Roberts
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Karen L Troy
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, Massachusetts, USA
| | - Michelle T Barrack
- Department of Family and Consumer Sciences, California State University, Long Beach, California, USA
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Wu AC, Rauh MJ, DeLuca S, Lewis M, Ackerman KE, Barrack MT, Heiderscheit B, Krabak BJ, Roberts WO, Tenforde AS. Running-related injuries in middle school cross-country runners: Prevalence and characteristics of common injuries. PM R 2022; 14:793-801. [PMID: 34053194 DOI: 10.1002/pmrj.12649] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 05/11/2021] [Accepted: 05/21/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Understanding the prevalence and factors associated with running-related injuries in middle school runners may guide injury prevention. OBJECTIVE To determine the prevalence of running-related injuries and describe factors related to a history of injury. DESIGN Retrospective cross-sectional study. SETTING Survey distributed online to middle school runners. METHODS Participants completed a web-based survey regarding prior running-related injuries, training, sleep, diet, and sport participation. MAIN OUTCOME MEASUREMENTS Prevalence and characteristics differentiating girls and boys with and without running-related injury history adjusted for age. PARTICIPANTS Youth runners (total: 2113, average age, 13.2 years; boys: n = 1255, girls: n = 858). RESULTS Running-related injuries were more prevalent in girls (56% vs. 50%, p = .01). Ankle sprain was the most common injury (girls: 22.5%, boys: 21.6%), followed by patellofemoral pain (20.4% vs. 7.8%) and shin splints (13.6% vs. 5.9%); both were more prevalent in girls (p < .001). Boys more frequently reported plantar fasciitis (5.6% vs. 3.3%, p = .01), iliotibial band syndrome (4.1% vs. 1.4%, p = .001) and Osgood-Schlatter disease (3.8% vs. 1.2%, p = .001). Runners with history of running-related injuries were older, ran greater average weekly mileage, ran faster, had fewer average hours of sleep on weekends, skipped more meals, missed breakfast, and consumed less milk (all p < .05). Girls with history of running-related injuries reported higher dietary restraint scores, later age of menarche, more menstrual cycle disturbances, and higher likelihood of following vegetarian diets and an eating disorder diagnosis (all p < .05). Runners with no history of running-related injuries were more likely to have participated in ≥2 years of soccer or basketball (p < .001). CONCLUSIONS Most middle school runners reported a history of running-related injuries and certain injuries differing by gender. Modifiable factors with the greatest association with running-related injuries included training volume, dietary restraint, skipping meals, and less sleep. Sport sampling, including participation in ball sports, may reduce running-related injury risk in this population.
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Affiliation(s)
- Alexander C Wu
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Mitchell J Rauh
- Doctor of Physical Therapy Program, San Diego State University, San Diego, California, USA
| | - Stephanie DeLuca
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Margo Lewis
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Kathryn E Ackerman
- Sports Medicine, Boston Children's Hospital; Neuroendocrine Unit, Massachusetts General Hospital; and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Bryan Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, Wisconsin, USA
| | - Brian J Krabak
- Rehabilitation, Orthopedics and Sports Medicine, University of Washington, Seattle, Washington, USA
| | - William O Roberts
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Adam S Tenforde
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
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Lipman GS, Burns P, Phillips C, Jensen J, Little C, Jurkiewicz C, Jarrett B, Walker A, Mansfield N, Krabak BJ. Effect of Sodium Supplements and Climate on Dysnatremia During Ultramarathon Running. Clin J Sport Med 2021; 31:e327-e334. [PMID: 32097177 DOI: 10.1097/jsm.0000000000000832] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 01/19/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Analyze the effect of sodium supplementation, hydration, and climate on dysnatremia in ultramarathon runners. DESIGN Prospective observational study. SETTING The 2017 80 km (50 mile) stage of the 250 km (150 mile) 6-stage RacingThePlanet ultramarathon in 2017 Chilean, Patagonian, and 2018 Namibian, Mongolian, and Chilean deserts. PARTICIPANTS All race entrants who could understand English were invited to participate, with 266 runners enrolled, mean age of 43 years (± 9), 61 (36%) females, average weight 74 kg (± 12.5), and average race time 14.5 (± 4.1) hours. Post-race sodium collected on 174 (74%) and 164 (62%) participants with both the blood sample and post-race questionnaire. INTERVENTION Weight change and finish line serum sodium levels were gathered. MAIN OUTCOME MEASURES Incidence of exercise-associated hyponatremia (EAH; <135 mmol·L-1) and hypernatremia (>145 mmol·L-1) by sodium ingestion and climate. RESULTS Eleven (6.3%) runners developed EAH, and 30 (17.2%) developed hypernatremia. Those with EAH were 14 kg heavier at baseline, had significantly less training distances, and averaged 5 to 6 hours longer to cover 50 miles (80 km) than the other participants. Neither rate nor total ingested supplemental sodium was correlated with dysnatremia, without significant differences in drinking behaviors or type of supplement compared with normonatremic runners. Hypernatremic runners were more often dehydrated [8 (28%), -4.7 kg (± 9.8)] than EAH [4 (14%), -1.1 kg (± 3.8)] (P < 0.01), and EAH runners were more frequently overhydrated (6, 67%) than hypernatremia (1, 11%) (P < 0.01). In the 98 (56%) runners from hot races, there was EAH OR = 3.5 [95% confidence interval (CI), 0.9-25.9] and hypernatremia OR = 8.8 (95% CI, 2.9-39.5) compared with cold races. CONCLUSIONS This was the first study to show that hot race climates are an independent risk factor for EAH and hypernatremia. Sodium supplementation did not prevent EAH nor cause hypernatremia. Longer training distances, lower body mass, and avoidance of overhydration were shown to be the most important factors to prevent EAH and avoidance of dehydration to prevent hypernatremia.
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Affiliation(s)
- Grant S Lipman
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Patrick Burns
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Caleb Phillips
- Department of Computational Science, University of Colorado, Boulder, Colorado
| | - Jacob Jensen
- Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Colin Little
- Department of Emergency Medicine, Oregon Health and Sciences University, Portland, Oregon
| | - Carrie Jurkiewicz
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Bryan Jarrett
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; and
| | - Anne Walker
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Nicky Mansfield
- Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Brian J Krabak
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle, Washington
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McSweeney SC, Grävare Silbernagel K, Gruber AH, Heiderscheit BC, Krabak BJ, Rauh MJ, Tenforde AS, Wearing SC, Zech A, Hollander K. Adolescent Running Biomechanics - Implications for Injury Prevention and Rehabilitation. Front Sports Act Living 2021; 3:689846. [PMID: 34514384 PMCID: PMC8432296 DOI: 10.3389/fspor.2021.689846] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/23/2021] [Indexed: 12/28/2022] Open
Abstract
Global participation in running continues to increase, especially amongst adolescents. Consequently, the number of running-related injuries (RRI) in adolescents is rising. Emerging evidence now suggests that overuse type injuries involving growing bone (e.g., bone stress injuries) and soft tissues (e.g., tendinopathies) predominate in adolescents that participate in running-related sports. Associations between running biomechanics and overuse injuries have been widely studied in adults, however, relatively little research has comparatively targeted running biomechanics in adolescents. Moreover, available literature on injury prevention and rehabilitation for adolescent runners is limited, and there is a tendency to generalize adult literature to adolescent populations despite pertinent considerations regarding growth-related changes unique to these athletes. This perspective article provides commentary and expert opinion surrounding the state of knowledge and future directions for research in adolescent running biomechanics, injury prevention and supplemental training.
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Affiliation(s)
- Simon C McSweeney
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | | | - Allison H Gruber
- Department of Kinesiology, School of Public Health - Bloomington, Indiana University, Bloomington, IN, United States
| | - Bryan C Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI, United States
| | - Brian J Krabak
- Department of Rehabilitation, Orthopedics and Sports Medicine, University of Washington and Seattle Childrens Hospital, Seattle, WA, United States
| | - Mitchell J Rauh
- Doctor of Physical Therapy Program, San Diego State University, San Diego, CA, United States
| | - Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Scott C Wearing
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Astrid Zech
- Department of Human Movement Science and Exercise Physiology, Institute of Sport Science, Friedrich Schiller University Jena, Jena, Germany
| | - Karsten Hollander
- Institute of Interdisciplinary Exercise Science and Sports Medicine, Faculty of Medicine, MSH Medical School Hamburg, Hamburg, Germany
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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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Krabak BJ, Roberts WO, Tenforde AS, Ackerman KE, Adami PE, Baggish AL, Barrack M, Cianca J, Davis I, D'Hemecourt P, Fredericson M, Goldman JT, Harrast MA, Heiderscheit BC, Hollander K, Kraus E, Luke A, Miller E, Moyer M, Rauh MJ, Toresdahl BG, Wasfy MM. Youth running consensus statement: minimising risk of injury and illness in youth runners. Br J Sports Med 2020; 55:305-318. [PMID: 33122252 DOI: 10.1136/bjsports-2020-102518] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2020] [Indexed: 01/25/2023]
Abstract
Despite the worldwide popularity of running as a sport for children, relatively little is known about its impact on injury and illness. Available studies have focused on adolescent athletes, but these findings may not be applicable to preadolescent and pubescent athletes. To date, there are no evidence or consensus-based guidelines identifying risk factors for injury and illness in youth runners, and current recommendations regarding suitable running distances for youth runners at different ages are opinion based. The International Committee Consensus Work Group convened to evaluate the current science, identify knowledge gaps, categorise risk factors for injury/illness and provide recommendations regarding training, nutrition and participation for youth runners.
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Affiliation(s)
- Brian J Krabak
- Rehabilitation, Orthopedics and Sports Medicine, Univesrity of Washington, Seattle, Washington, USA
| | - William O Roberts
- Family Medicine and Community Health, University of Minnesota, St Paul, Minnesota, USA
| | - Adam S Tenforde
- Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | | | - Paolo Emilio Adami
- Health and Science, IAAF Health & Science Department, International Association of Athletics Federations (IAAF), Monaco
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michelle Barrack
- Family and Consumer Sciences, California State University, Long Beach, Long Beach, California, USA
| | - John Cianca
- Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - Irene Davis
- Physical Medicine and Rehabilitation, National Running Center, Cambridge, Massachusetts, USA
| | | | | | - Joshua T Goldman
- Sports Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Mark A Harrast
- Rehabilitation, Orthopedics and Sports Medicine, Univesrity of Washington, Seattle, Washington, USA
| | - Bryan C Heiderscheit
- Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Emily Kraus
- Orthopaedic Surgery, Stanford Hospital and Clinics, Stanford, California, USA
| | - Anthony Luke
- Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Emily Miller
- Sports Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Melissa Moyer
- Sports Physical Therapy, Sanford Health, Sioux Falls, South Dakota, USA
| | - Mitchell J Rauh
- School of Exercise and Nutritional Sciences, Doctor of Physical Therapy Program, San Diego State University, San Diego, California, USA
| | - Brett G Toresdahl
- Primary Care Sports Medicine, Hospital for Special Surgery, New York, New York, USA
| | - Meagan M Wasfy
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
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Zhang P, Joseph J, Rojas J, McFarland EG, Krabak BJ. Bone Injury In A Gymnast. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000670252.43675.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Tenforde AS, Roberts WO, Krabak BJ, Davis IS, Fredericson M, Luke AC, Ackerman KE. Recommendations to Optimize Health in Youth Runners. Strength Cond J 2020. [DOI: 10.1519/ssc.0000000000000504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Krabak BJ, Tenforde AS, Davis IS, Fredericson M, Harrast MA, d'Hemecourt P, Luke AC, Roberts WO. Youth Distance Running: Strategies for Training and Injury Reduction. Curr Sports Med Rep 2019; 18:53-59. [PMID: 30730342 DOI: 10.1249/jsr.0000000000000564] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Running is a popular sport for children in the United States. However, review of available literature on health effects and safety recommendations for youth running has not been previously conducted. Unique factors for injury include periods of growth during puberty and potential for growth plate injury. Youth runners may benefit from activities that incorporate high-impact loading and multidirectional movement for optimal bone maturation, exercises to strengthen tendons and muscles, and strategies aimed at improving running biomechanics to reduce risk of injury. In addition, addressing lifestyle factors, including nutrition and sleep is essential for a runner's general health. Similar to other sports, sports specialization should not be encouraged in youth runners. Reducing running-related injury in growing children and assessing readiness for running should be based on a combination of physical, emotional, psychological, social, and cognitive factors. Youth runners require individualized training and competition to safely participate in the sport.
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Affiliation(s)
- Brian J Krabak
- Rehabilitation, Orthopedics, and Sports Medicine, University of Washington and Seattle Children's Sports Medicine, Seattle, WA
| | - Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, MA
| | - Irene S Davis
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA.,Spaulding National Running Center, Cambridge, MA
| | - Michael Fredericson
- Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, CA
| | - Mark A Harrast
- Rehabilitation, Orthopedics, and Sports Medicine, University of Washington, Seattle, WA
| | | | - Anthony C Luke
- UCSF Primary Care Sports Medicine, UCSF Department of Orthopaedics, UCSF Department of Family and Community Medicine, San Francisco, CA
| | - William O Roberts
- Department of Family Medicine, University of Minnesota Medical School, Minneapolis, MN
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Little CE, Lipman GS, Migliaccio D, Young DS, Krabak BJ. Accuracy of Estimated Creatinine in Multistage Ultramarathon Runners. Wilderness Environ Med 2019; 30:129-133. [PMID: 30872022 DOI: 10.1016/j.wem.2018.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 11/30/2018] [Accepted: 12/12/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Ultramarathon running is increasing in popularity worldwide, as is the growing body of research on these athletes. Multiple studies have examined acute kidney injury through estimated baseline creatinine (Cr) and glomerular filtration rate (GFR). Values are estimated through an age-based formula of GFR and the modification of diet in renal disease (MDRD) equation. However, the accuracy of this practice in a cohort of healthy athletes is unknown. METHODS A prospective analysis of the first 40-km (25-mi) stage of 6-stage 250-km (155-mi) multistage ultramarathons in the Sahara, Namibia, Atacama, and Gobi Deserts. Runners had prerace measured baseline Cr compared to estimated values through age-based estimated GFR and back calculation of Cr through the MDRD equation. RESULTS Forty-eight participants (27% female, age 39±10 y) had Cr values analyzed. The mean measured Cr was 0.99±0.17, which was 11% higher than an estimated Cr of 0.88±0.14 (P<0.01). Estimated age-based GFR was 95.9±5.8 mL⋅min-1 compared to GFR based on measured Cr and MDRD of 86.1±14.6 (P<0.001). CONCLUSIONS Estimated values of GFR and Cr by standard age-based values and MDRD equation were significantly inaccurate, which would overinflate the incidence of acute kidney injury. Future studies should devise a new model for estimation of baseline Cr that is validated in this population.
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Affiliation(s)
- Colin E Little
- University of Utah Division of Emergency Medicine, Salt Lake City, UT.
| | | | - Daniel Migliaccio
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - David S Young
- Department of Emergency Medicine, University of Colorado, Denver, CO
| | - Brian J Krabak
- Department of Sports Medicine, University of Washington, Seattle, WA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Lipman GS, Shea K, Christensen M, Phillips C, Burns P, Higbee R, Koskenoja V, Eifling K, Krabak BJ. Ibuprofen versus placebo effect on acute kidney injury in ultramarathons: a randomised controlled trial. Emerg Med J 2017; 34:637-642. [PMID: 28679502 DOI: 10.1136/emermed-2016-206353] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 05/30/2017] [Accepted: 06/01/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND Despite concerns that non-steroidal anti-inflammatory drugs (NSAIDs) contribute to acute kidney injury (AKI), up to 75% of ultramarathon runners ingest these during competition. The effect of NSAID on AKI incidence in ultramarathon runners is unclear. METHODS Multisite randomised double-blind placebo-controlled trial in the Gobi, Atacama, Ecuador and Sri Lankan deserts to determine whether ibuprofen (400 mg every 4 hours) would be non-inferior to placebo during a 50-mile (80 km) foot race. The primary outcome was incidence of AKI defined as severity categories of 'risk' of injury of 1.5× baseline creatinine (Cr) or 'injury' as 2× Cr, combined to calculate total incidence at the finish line. Non-inferiority margin for difference in AKI rates was defined as 15%. RESULTS Eighty-nine participants (47% ibuprofen and 53% placebo) were enrolled with similar demographics between groups. The overall incidence of AKI was 44%. Intent-to-treat analysis found 22 (52%) ibuprofen versus 16 (34%) placebo users developed AKI (18% difference, 95% CI -4% to 41%; OR 2.1, 95% CI 0.9 to 5.1) with a number needed to harm of 5.5. Greater severity of AKI was seen with ibuprofen compared with placebo (risk=38% vs 26%; 95% CI -9% to 34%; injury=14% vs 9%; 95% CI -10% to 21%). Slower finishers were less likely to encounter AKI (OR 0.67, 95% CI 0.47 to 0.98) and greater weight loss (-1.3%) increased AKI (OR 1.24, 95% CI 1.00 to 1.63). CONCLUSION There were increased rates of AKI in those who took ibuprofen, and although not statistically inferior to placebo by a small margin, there was a number needed to harm of 5.5 people to cause 1 case of AKI. Consideration should therefore be taken before ingesting NSAID during endurance running as it could exacerbate renal injury. TRIAL REGISTRATION NUMBER NCT02272725.
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Affiliation(s)
- Grant S Lipman
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Kate Shea
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Mark Christensen
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Caleb Phillips
- Department of Computational Sciences, University of Colorado at Boulder, Boulder, Colorado, USA
| | - Patrick Burns
- Emergency Medicine Residency, University of Washington, Seattle, USA
| | - Rebecca Higbee
- Stanford-Kaiser Emergency Medicine Residency, Stanford, USA
| | - Viktoria Koskenoja
- Harvard Affiliated Emergency Medicine Residency, Harvard Medical School, Boston, USA
| | - Kurt Eifling
- Washington University in St. Louis Emergency Medicine Residency, St. Louis, USA
| | - Brian J Krabak
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Davenport KL, Air M, Grierson MJ, Krabak BJ. Examination of Static and Dynamic Core Strength and Rates of Reported Dance Related Injury in Collegiate Dancers: A Cross-Sectional Study. J Dance Med Sci 2016. [DOI: 10.12678/1089-313x.20.4.151] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
The popularity of running among young athletes has significantly increased over the past few decades. As the number of children who participate in running increases, so do the potential number of injuries to this group. Proper care of these athletes includes a thorough understanding of the unique physiology of the skeletally immature athlete and common injuries in this age group. Treatment should focus on athlete education, modification of training schedule, and correction of biomechanical deficits contributing to injury. Early identification and correction of these factors will allow a safe return to running sports.
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Affiliation(s)
- Brian J Krabak
- Rehabilitation, Orthopedics and Sports Medicine, University of Washington, 3800 Montlake Boulevard Northeast, Box 354060, Seattle, WA 98105, USA; Orthopedics and Sports Medicine, Seattle Children's Sports Medicine, 4800 Sandpoint Way NE, Seattle WA 98105, USA.
| | - Brian Snitily
- Rehabilitation, Orthopedics and Sports Medicine, University of Washington, 3800 Montlake Boulevard Northeast, Box 354060, Seattle, WA 98105, USA
| | - Carlo J E Milani
- Rehabilitation, Orthopedics and Sports Medicine, University of Washington, 3800 Montlake Boulevard Northeast, Box 354060, Seattle, WA 98105, USA
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Khodaee M, Edelman GT, Spittler J, Wilber R, Krabak BJ, Solomon D, Riewald S, Kendig A, Borgelt LM, Riederer M, Puzovic V, Rodeo S. Medical Care for Swimmers. Sports Med Open 2016; 2:27. [PMID: 27512647 PMCID: PMC4960281 DOI: 10.1186/s40798-016-0051-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/07/2016] [Indexed: 12/25/2022]
Abstract
Swimming is one of the most popular sports worldwide. Competitive swimming is one of the most watched sports during the Olympic Games. Swimming has unique medical challenges as a result of a variety of environmental and chemical exposures. Musculoskeletal overuse injuries, overtraining, respiratory problems, and dermatologic conditions are among the most common problems swimmers encounter. Although not unique to swimming, overtraining is a serious condition which can have significant negative impact on swimmers' health and performance. This review article is an attempt to discuss various issues that a medical team should consider when caring for swimmers.
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Affiliation(s)
- Morteza Khodaee
- Department of Family Medicine, University of Colorado School of Medicine, Denver, CO USA
| | - George T Edelman
- Edelman Spine & Orthopaedic Physical Therapy, Dover, DE USA ; Department of Physical Therapy, University of Delaware, Newark, DE USA
| | - Jack Spittler
- Department of Family Medicine, University of Colorado School of Medicine, Denver, CO USA
| | - Randall Wilber
- United State Olympic Committee, Colorado Springs, CO USA
| | - Brian J Krabak
- Rehabilitation, Orthopedics and Sports Medicine, University of Washington and Seattle Children's Sports Medicine, Seattle, WA USA
| | | | - Scott Riewald
- Winter Sports, United States Olympic Committee, Colorado Springs, CO USA
| | - Alicia Kendig
- United State Olympic Committee, Colorado Springs, CO USA
| | - Laura M Borgelt
- Department of Clinical Pharmacy and Family Medicine, University of Colorado Skaggs School of Pharmacy and School of Medicine, Aurora, CO USA
| | - Mark Riederer
- Department of Pediatrics and Orthopaedic Surgery, University of Michigan, Ann Arbor, MI USA
| | - Vladimir Puzovic
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Scott Rodeo
- Sports Medicine and Shoulder Service, Orthopaedic Surgery, The Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY USA ; Tissue Engineering, Regeneration, and Repair Program, The Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY USA
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Lipman GS, Ellis MA, Lewis EJ, Waite BL, Lissoway J, Chan GK, Krabak BJ. A Prospective Randomized Blister Prevention Trial Assessing Paper Tape in Endurance Distances (Pre-TAPED). Wilderness Environ Med 2014; 25:457-61. [DOI: 10.1016/j.wem.2014.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 06/06/2014] [Accepted: 06/12/2014] [Indexed: 11/26/2022]
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Lipman GS, Krabak BJ, Waite BL, Logan SB, Menon A, Chan GK. A prospective cohort study of acute kidney injury in multi-stage ultramarathon runners: the Biochemistry in Endurance Runner Study (BIERS). Res Sports Med 2014; 22:185-92. [PMID: 24650338 DOI: 10.1080/15438627.2014.881824] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The purpose of the study was to evaluate the prevalence of acute kidney injury (AKI) during a multi-stage ultramarathon foot race. A prospective observational study was taken during the Gobi 2008; Sahara 2008; and Namibia 2009 RacingThePlanet 7-day, 6-stage, 150-mile foot ultramarathons. Blood was analyzed before, and immediately after stage 1 (25 miles), 3 (75 miles), and 5 (140 miles). Creatinine (Cr), glomerular filtration rate (GFR), and incidence of AKI were calculated and defined by RIFLE criteria. Thirty participants (76% male, mean age 40 + 11 years) were enrolled. There were significant declines in GFR after each stage compared with the pre-race baseline (p < 0.001), with the majority of participants (55-80%) incurring AKI. The majority of study participants encountered significant renal impairment; however, no apparent cumulative effect was observed, with resolution of renal function to near baseline levels between stages.
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Affiliation(s)
- Grant S Lipman
- a Stanford University School of Medicine, Surgery , Stanford , CA , USA
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Kaufman EA, Lipman GS, Sharp LJ, Krabak BJ. Two cases of paradoxical hypothermia in a Sahara desert multi-stage ultramarathon. Emerg Care J 2014. [DOI: 10.4081/ecj.2014.4279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Abstract
Anterior cruciate ligament (ACL) injury is a common sports injury which can have severe negative consequences. Neuromuscular factors that increase risk, such as knee landing kinematics, may be ameliorated through training. Effective ACL injury prevention programs exist, although the ideal program is yet to be determined. It is recommended that athletes engaged in high-risk sports participate in an ACL injury prevention program to reduce the risk of sustaining this injury.
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Affiliation(s)
- Judith R Peterson
- Department of Neurosciences, Sanford School of Medicine, University of South Dakota, 1400 West 22nd Street, Sioux Falls, SD 57105, USA; Yankton Medical Clinic, 1104 West 8th Street, Yankton, SD 57078, USA.
| | - Brian J Krabak
- Rehabilitation, Orthopedics, and Sports Medicine, University of Washington Sports Medicine, 3800 Montlake Boulevard Northeast, Box 354060, Seattle, WA 98195, USA; Seattle Children's Sports Medicine, 4800 Sand Point Way Northeast, Seattle, WA 98145, USA
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Abstract
Participation in ultramarathon races and knowledge of these athletes continues to increase as the sport becomes more popular. Physicians and athletes need to better understand the impact of the unique aspects of ultramarathon races, such as race environment (temperature, humidity, and altitude), race distance, race stages, nutritional requirements and equipment, on athlete injuries and illness. Proper treatment of injuries and illnesses during an ultramarathon race is important for avoiding long-term medical issues. In this article, the evaluation and treatment of common musculoskeletal injuries and medical illnesses in ultramarathon runners are reviewed.
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Affiliation(s)
- Brian J Krabak
- Rehabilitation, Orthopedics, and Sports Medicine, University of Washington Sports Medicine, 3800 Montlake Boulevard Northeast, Box 354060, Seattle, WA 98195, USA; Seattle Children's Sports Medicine, 4800 Sand Point Way Northeast, Seattle, WA 98145, USA.
| | - Brandee Waite
- Physical Medicine and Rehabilitation, Sports Medicine, University of California Davis, 4860 Y Street, Suite 3850, Sacramento, CA 95817, USA
| | - Grant Lipman
- Division of Emergency Medicine, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Dr Alway Bldg M121 MC 5119, Stanford, CA 94305, USA
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26
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Simpson S, Krabak BJ. Interspinous ligament calcification in a collegiate gymnast. PM R 2014; 6:742-5. [PMID: 24508047 DOI: 10.1016/j.pmrj.2014.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 12/19/2013] [Accepted: 01/09/2014] [Indexed: 11/25/2022]
Abstract
A 21-year-old collegiate gymnast presented with midline pain at the thoracolumbar junction upon back extension and a "gritty" sensation at that level. Ultrasound revealed an area of hyperechogenicity, representing a calcification, within the interspinous ligament at the area of maximal tenderness at the T12-L1 level. Under ultrasound guidance, multiple fenestrations were made into the calcification and a mixture of lidocaine and triamcinolone was injected. The patient experienced immediate improvement in her symptoms, and resolution occurred during the subsequent 6 weeks; she was able to make a gradual return to gymnastics. Interspinous ligament calcification in a young athlete has not been previously reported.
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Affiliation(s)
- Scott Simpson
- Rehabilitation Medicine, University of Washington, Seattle, WA(∗)
| | - Brian J Krabak
- Rehabilitation, Orthopedics and Sports Medicine, University of Washington and Seattle Children's Sports Medicine, Seattle, WA(†).
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Abstract
The popularity of ultramarathon races continue to grow with runners participating in races throughout the world. These events offer challenges unique to an ultramarathon compared to a marathon race. These challenges require the athlete to focus on factors including race distance, race stages, race environment (temperature, humidity, and altitude), appropriate training, nutritional preparation, and equipment. Athletes ill prepared for these challenges will be at risk from injury and illness. The goal of this article is to review preventive strategies for managing commonly encountered musculoskeletal injuries and medical illnesses in ultramarathon runners.
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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 98105, USA.
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Air ME, Grierson MJ, Davenport KL, Krabak BJ. Dissecting the Doctor-Dancer Relationship: Health Care Decision Making Among American Collegiate Dancers. PM R 2013; 6:241-9. [DOI: 10.1016/j.pmrj.2013.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 08/26/2013] [Accepted: 09/03/2013] [Indexed: 10/26/2022]
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Krabak BJ, Hancock KJ, Drake S. Comparison of Dry-Land Training Programs Between Age Groups of Swimmers. PM R 2013; 5:303-9. [DOI: 10.1016/j.pmrj.2012.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 11/05/2012] [Accepted: 11/11/2012] [Indexed: 11/26/2022]
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Zaremski JL, Krabak BJ. Shoulder Injuries in the Skeletally Immature Baseball Pitcher and Recommendations for the Prevention of Injury. PM R 2012; 4:509-16. [DOI: 10.1016/j.pmrj.2012.04.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 04/12/2012] [Accepted: 04/13/2012] [Indexed: 10/28/2022]
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Affiliation(s)
- Brian J Krabak
- Department of Rehabilitation, Orthopedic and Sports Medicine, University of Washington, Seattle, WA, USA.
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Putnam AR, Bandolin SN, Krabak BJ. Impact of Ankle Bracing on Skill Performance in Recreational Soccer Players. PM R 2012; 4:574-9. [DOI: 10.1016/j.pmrj.2012.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 03/27/2012] [Accepted: 04/02/2012] [Indexed: 12/26/2022]
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Abstract
PURPOSE This study aimed to describe injury and illness rates in runners competing in 7-d, 250-km off-road ultramarathon events. METHODS Three hundred ninety-six runners competing in the RacingThePlanet© 4 Desert Series ultramarathon races from 2005 to 2006 were prospectively followed. Descriptive analyses were used to evaluate overall injury/illness rates, types of injuries/illnesses, and diagnoses for all medical encounters. Multivariate linear regression was used to estimate the risk of number of injuries/illnesses and 95% confidence intervals associated with age, sex, and race completion time. RESULTS Eight-five percent of runners representing a total of 1173 medical encounters required medical care. The overall injury/illness rates were 3.86 per runner and 65 per 1000-h run. Almost 95% were minor in nature, owing to skin-related disorders (74.3%), musculoskeletal injuries (18.2%), and medical illnesses (7.5%). Medical illnesses were more likely on the first day of the race, whereas musculoskeletal and skin injuries were more likely on day 3 or 4. A 10-yr increase in age was associated with 0.5 fewer injuries/illnesses, and females had 0.16 more medical illnesses compared with males. CONCLUSIONS Despite the extreme nature and harsh environments of multiday ultramarathon races, the majority of injuries or illnesses are minor in nature. Future studies are needed to evaluate additional factors contributing to injuries.
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Affiliation(s)
- Brian J Krabak
- Department of Rehabilitation, Orthopedics and Sports Medicine, University of Washington, Seattle, WA, USA.
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Abstract
Cervical pain is a common complaint in both the well-conditioned athlete and the weekend warrior. Some injuries are mild in nature, responding to conservative treatment, including rest, medication, physical therapy, and time. However, more serious injuries, especially those involving the cervical spine, can have devastating consequences. Having a comprehensive understanding of the evaluation and management of cervical pain and cervical spine emergencies is crucial for physicians providing coverage for organized athletic events or for those who serve as team physicians. This article reviews the common causes of cervical spine pain in the competitive athlete.
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Affiliation(s)
- Brian J Krabak
- Rehabilitation, Orthopaedics and Sports Medicine, University of Washington and Seattle Children's Sports Medicine, Seattle, WA, USA.
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Krabak BJ, Waite B, Schiff M. Study Of Injury And Illness Rates In Multi-day Ultra-marathon Running Athletes. Med Sci Sports Exerc 2011. [DOI: 10.1249/01.mss.0000400980.13901.c7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Singh V, Green JR, Krabak BJ. Chronic knee synovitis in an adolescent dancer. PM R 2010; 2:573-5. [PMID: 20630445 DOI: 10.1016/j.pmrj.2010.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Revised: 12/08/2009] [Accepted: 01/19/2010] [Indexed: 11/25/2022]
Affiliation(s)
- Virtaj Singh
- Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
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Singh V, Krabak BJ. Posterior Knee Pain In A Dancer. Med Sci Sports Exerc 2009. [DOI: 10.1249/01.mss.0000353958.62062.ee] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Injuries to the hip and pelvis are the least common of lower extremity injuries in youth sports, but include many of the more serious conditions. This article describes the bone and soft-tissue conditions of the hip and pelvis that may present to health care providers caring for the pediatric and adolescent sporting population. The article discusses epidemiology, mechanisms, clinical presentation, evaluation, and treatment options.
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Affiliation(s)
- Brandee L Waite
- Department of Physical Medicine and Rehabilitation, University of California Davis School of Medicine, Sacramento, CA 95817, USA.
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Krabak BJ. Preface. Phys Med Rehabil Clin N Am 2008. [DOI: 10.1016/j.pmr.2008.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abbasi A, Abdel-Moty E, Abdi S, Adin DR, Ahn SH, Akuthota V, Ante WA, Antony AK, Aprill CN, Are M, Auerbach JD, Barolat G, Bartholomeeusen K, Bartoli LM, Bermas BL, Bhagia SM, Bhargava AS, Bhat AL, Birnbaum K, Bogduk N, Bonaiuti D, Bonaldi G, Borg-Stein J, Botwin KP, Brigham CD, Bronov O, Brown LA, Brown MD, Bryce TN, Burtony AW, Carrino JA, Chen B, Chen YC, Chin C, Chin KR, Chou LH, Chow DW, Chen YC, Cinotti G, Cohen SP, Cooke P, Cucuzzella AR, Daniels RJ, David KS, Day G, Day M, Delamarter RB, DePalma MJ, Derby R, Dillingham TR, Dolinskas CA, Drezner JA, Edrich T, El-Abd O, Ellen MI, Elliott DM, Everett CR, Fayyazi AH, Feler CA, Fernandez J, Ferrari R, Fischgrund JS, Fishbain DA, Fitzgerald CM, Floman Y, Fox EJ, Furman MB, Gallagher RM, Garfin SR, Garvey TA, Gatchel RJ, Gerner P, Gerszten PC, Gilchrist RV, Gotlin RS, Grady MS, Guyer RD, Haig AJ, Hanks S, Hannibal M, Harb M, Harney DF, Harrast MA, Hasan SA, Haspeslagh SRS, Heavner J, Hellinger J, Hellinger S, Helper S, Herkowitz HN, Hosalkar HS, Hsu K, Hubbard RD, Huston CW, Isaac VW, Isaac Z, Kang JD, Kantha BS, Kaplan FS, Karppinen J, Kawaguchi Y, Hynes CK, Kim BJ, Kim CW, Kim DH, Kim DH, Knaub MA, Krabak BJ, Krames ES, Kristiansson PO, Kouri JP, Lackman RD, Lagattuta FP, Lane JM, Le HN, Lee KE, Lee SH, Lenrow DA, Lento PH, Lieberman IH, Lin JT, Lipetz JS, Liss D, Liss H, Lobel SM, López-Acevedo CE, Lord SM, Lu WW, Luk KD, Lutz GE, Maigne JY, Malanga GA, Marley J, Materson R, Mattern CJ, Mayer EA, Mayer TG, McCabe F, McLaughlin C, McPhee IB, Mehta S, Melfi RS, Metkus T, Michaels M, Micheo WF, Minkoff ER, Moley PJ, Monticone M, Moonis G, Moore MR, Moskowitz MH, Mostoufi SA, Nadler SF, Negrini S, Niederwanger M, O'Neill CW, Ohnmeiss DD, Ostelo RW, Ostrowski J, Park AL, Parmar V, Patel RK, Perry A, Phillips FM, Pignolo RJ, Plastaras CT, Postacchini F, Postacchini R, Pradhan BB, Prager JP, Prather H, Prawak AS, Press JM, Qiu G, Racz GB, Ragnarsson KT, Rao RD, Reeves RS, Rigolosi L, Rosomoff HL, Rosomoff RS, Rothman SM, Russell AS, Rydevik B, Sakalkale D, Savarese R, Sawchuk TC, Schofferman J, Schuster J, Schwartz ED, Shah RV, Sheth P, Simeone FA, Simotas AC, Singh G, Singh R, Skaggs CD, Slezak J, Slipman CW, Smeal WL, Solomon JL, Sommer HM, Sorosky B, Southern D, Sowa GA, Stojanovic MP, Sullivan WJ, Talu GK, Tarquinio A, Tasca P, Thomas SA, Thongtrangan I, Tirado CF, Tobey JE, Togawa D, Torbert JT, Trevisan C, Triano JJ, Tyburski MD, Uddin MN, Vaccaro A, Vad VB, Wiele CVD, van Kleef M, Van Zundert J, Vlassakov K, Weigele JB, Welch WC, Wen C, Windsor RE, Winklestein BA, Won DS, Wood K, Yerramalli CS, Yeung AT, Yeung CA, Yin W, Zaman FM, Zucherman JF. List of Contributors. Interventional Spine 2008:ix-xv. [DOI: 10.1016/b978-0-7216-2872-1.50002-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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de Lateur BJ, Magyar-Russell G, Bresnick MG, Bernier FA, Ober MS, Krabak BJ, Ware L, Hayes MP, Fauerbach JA. Augmented Exercise in the Treatment of Deconditioning From Major Burn Injury. Arch Phys Med Rehabil 2007; 88:S18-23. [DOI: 10.1016/j.apmr.2007.09.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Affiliation(s)
- William Moore
- Physical Medicine and Rehabilitation, Johns Hopkins Sports Medicine, Baltimore, Maryland, USA.
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Abstract
OBJECTIVES To characterize graduating physical medicine and rehabilitation (PM&R) residents physicians' perceptions of their current musculoskeletal (MSK) training, to identify barriers perceived by resident physicians to improving MSK education experiences, and to compare the views of resident physicians with those of PM&R residency program directors. DESIGN Fourth-year PM&R residents graduating in 2004 whose program directors attended the 2004 Association of Academic Physiatrists annual meeting were asked to complete an MSK education survey developed by the authors. Data were compared with a previous MSK education survey that had been completed by PM&R residency program directors. RESULTS Ninety-three of 156 (61%) fourth-year PM&R residents responded after multiple contacts. According to residents, the most frequently used MSK education formats during residency were MSK lecture series, MSK journal clubs, and MSK workshops. Potential barriers to improved MSK education during residency included staff, money, and time. If given unlimited resources, most residents would greatly increase the use of visiting lecturers, MSK workshops, and MSK lecture series. CONCLUSION Graduating PM&R residents as well as residency program directors indicated a strong interest in expanding resident MSK education through the use of visiting lecturers. Differences were noted with respect to the use of hands-on learning (i.e., MSK workshops [residents]) vs. passive learning (i.e., CD ROMS/DVDs and videos [program directors]). Both groups described how limited resources including staff, money, and time are barriers to resident MSK education.
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Affiliation(s)
- Brian J Krabak
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Sports Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
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Krabak BJ, Cosgarea A, Tucker A, McFarland E. Recurrent Concusions - Football. Med Sci Sports Exerc 2007. [DOI: 10.1249/01.mss.0000273354.66017.1e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Moore WV, Krabak BJ, McFarland E, Martire J. Lateral Knee Pain - Running and Cycling. Med Sci Sports Exerc 2006. [DOI: 10.1249/00005768-200605001-01465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Waite B, Krabak BJ. Knee Pain - Martial Arts. Med Sci Sports Exerc 2005. [DOI: 10.1249/00005768-200505001-02197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lin SK, Selhi HS, Krabak BJ, McFarland EG. Shoulder Instability - Collegiate Diver. Med Sci Sports Exerc 2005. [DOI: 10.1249/00005768-200505001-00312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
OBJECTIVE To characterize current musculoskeletal (MSK) education experiences in physical medicine and rehabilitation residency programs and to identify perceived barriers to providing more extensive MSK education experiences. In addition, to establish utilization patterns for the PASSOR Physical Examination Core Competencies List. DESIGN Between March and November 2003, all 81 physical medicine and rehabilitation residency program directors were asked to complete an MSK education survey developed by the authors. RESULTS A total of 69 of 81 program directors (86%) responded after multiple contacts. The most frequently utilized MSK education formats were MSK lecture series, MSK departmental conferences, and physical examination workshops. Potential barriers to expanded MSK education included money, time, and staff number. Given unlimited resources, most residency programs would greatly increase utilization of visiting lecturers, CD-ROMs/DVDs, objective structured clinical examinations, and physical examination videos. Of the 30 program directors who recalled receiving the Core Competencies List, only 40% (12 of 30) have formally integrated the list into their residency training. Barriers to implementation included logistical challenges and lack of direction regarding implementation. CONCLUSIONS Residency program directors indicate a strong interest in expanding resident MSK education through the use of CD-ROMs/DVDs, physical examination videos, objective structured clinical examinations, and visiting lecturer programs. CD-ROMs/DVDs and videos represent particularly attractive educational formats for supplementing resident MSK education due to the advantages of central production, nominal costs, widespread distribution, multimedia capabilities, and accessibility. These educational formats should be considered for targeted educational initiatives to enhance resident MSK education, regardless of residency program size or resources.
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Affiliation(s)
- Jay Smith
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA
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