Objectives: You will be able to give general advise regarding preventive care of runners You will understand how to evaluate and treat common running injuries You will be inspired to exercise for your personal health and as a role model for your patients
15.1 million regular runners (>100 day/yr) 3.65 billion runs (2006) 8.5 million race finishers (2006) Sex: M 53% / F 47% Average age: 44 College graduate: 74% http://www.runningusa.org/cgi/index_largest_races.pl
To prevent arthritis, you should run. True / False
No link between running and arthritis in anatomically normal joints Modifiable risk factors for osteoarthritis Weight Certain sports / Occupations J Rheumatol 1993 Mar;20(3):461-8 JAMA 1986 Mar 7;255(9):1152-4 Menopause 2007 Sept-Oct; 14(5): 830-4
Mechanism of injury Stress = Load x Intensity Load = Distance Intensity = Speed
Limit mileage increase to 10% / week Hold steady every third week Frequency needs individual tailoring
Speedwork Most running at easy pace (65-80% HR max) Minority of time spent running at “quality level” ▪ Marathon pace training: 80-85% HR max ▪ Occas component of marathon program ▪ Tempo training: 85-92% HR max ▪ Use: limit to 10% of total weekly mileage ▪ Interval training: 98-100% HR max ▪ Use: limit to 8% of total weekly mileage
IT Band Syndrome Treatment Reduction in mileage Icing Stretching (B recommendation) Hip abductor strengthening (B recommendation)
Best Stretch www.aafp.org/afp/20050415/1545_f4.jpg
Another Stretch: Iliotibial band and buttock stretch (right side shown). Position yourself as shown above. Twist your trunk to the right and use your left arm to "push" your right leg. You should feel the stretch in your right buttock and the outer part of your right thigh. Hold the stretch for 10 to 20 seconds. Do the exercise 5 to 10 times.
Treatment Activity modification Plus consideration of: ▪ Short course non-weight bearing ▪ Pneumatic splint (tibia) Surgery ▪ Non-union www.anklebrace.info/aircast/leg-brace-big.jpg
Case #6: 36 yr old male training for first half marathon. Avid hiker. Began running eight weeks prior to race. Developed upper L thigh pain with running two weeks prior to race. At mile six of race had increased pain, but kept running. At mile 13 had excruciating pain in L thigh and could not run further. Needed help to walk to finish line.
General risk factors Shoes / Frequency / Distance / Speed Females at high risk Female Athlete Triad
Case #7: 46 yr old female: Ran initial ING Atlanta Marathon 3/25/07 Warm day (T 56-72 over course of race) Slow runner (5:41 marathon) Aid stations ran out of Gatorade Drank water throughout race
At finish, felt lightheaded. Drank Gatorade Continued to feel lightheaded with movement To ER
T 99 BP 110/62 P 88 R 18 Exam unremarkable Orthostatics negative
Na 122 K 3.7 Cr 0.7 Gluc 93 CPK 670 Urine osm 58 Urine Na 9
Prevention Do not force fluids. Drink fluids with glucose & electrolyte replacement
Sudden Death while running 0.8 – 1.2 / 100,000 marathon runners 403,000 marathon finishes in 2007 BMJ 2007;3 35:1275-1277 (22 December) Sports Med 2007 2;37(4-5):448-50. www.marathonguide.com/features/Articles/2007RecapOverview.cfm#TotalFinishers
Average age: 41 Sex: 81% male 21/24 with coronary atherosclerosis Contributing causes: Electrolyte abnormalities (4) Coronary anomalies (2) Heat stroke (1) Competing Risks of Mortality with Marathons: Retrospective Analysis: BMJ 2007;3 35:1275-1277 (22 December)
Prevention is important in keeping runners running Corollary: A runner who isn’t running is likely to be an extremely unpleasant person Consider PFPS and ITBS in running assoc knee pain Plantar fasciitis is the most common etiology of heel pain Consider a stress fracture in a runner presenting with focal pain in the mid-foot / shin / hip Dilutional hyponatremia can be prevented with proper fluid intake Sudden cardiac death while running is rare
Common Problems in Endurance Athletes, Cosca et al, Am Fam Physician 2007; 76: 237-44. Management of Patellofemoral Pain Syndrome, Dixit et al, Am Fam Physician 2007; 75: 194-202. Treatment of Plantar Fasciitis, Young et al, Am Fam Physician 2001; 63:467-74. Common Stress Fractures, Sanderlin et al, Am Fam Physician 2003; 68: 1527-32. Diagnostic & Therapeutic Injection of the Hip & Knee, Cardone, DA, Am Fam Physician 2003;67:2147-52. Running Injuries, Noakes & Granger, Oxford Press, 1996. Daniels’ Running Formula, Human Kinetics, 2005
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