Endurance Sports Medicine (eBook)

Dedication 6
Preface 8
Contents 10
Contributors 12
Part I: Medical Conditions 15
1: Cardiovascular Evaluation and Treatment of the Endurance Athlete 16
Introduction 16
Overview of Normal Physiological Adaptations to Endurance Training 16
Left Ventricular Adaptations to Endurance Exercise 17
Right Ventricular Adaptations to Endurance Exercise 19
Atrial Adaptation to Endurance Exercise 19
Variability of Exercise-Induced Cardiac Remodeling 19
Clinical Implications of Remodeling 20
Electrical Remodeling 21
Evaluation of the Symptomatic Endurance Athlete 22
Chest Pain 22
Syncope 24
Palpitations 26
Atrial Arrhythmias 27
Long-Term Effect of Chronic Endurance Training 27
Sudden Death During Endurance Competition 28
Conclusion 28
References 30
2: Exercise-Induced Bronchoconstriction and Vocal Cord Dysfunction 33
Vocal Cord Dysfunction 36
References 39
3: Evaluation and Treatment of Heat- and Altitude-Related Illness 42
References 51
4: Pregnancy and the Endurance Athlete 53
Introduction 53
Pregnancy Physiology 53
Endurance Physiology 55
Physiological Concerns of Exercise During Pregnancy 55
Maternal Physiologic Concerns 56
Fetal Physiological Concerns 56
Risks/Benefits of Exercise During Pregnancy 57
Physical Activity in Pregnancy 58
Exercise Prescriptions 59
Exercise Prescription During Pregnancy 61
The Sedentary or Non-exercising Patient 61
The Regular Exercising Patient 61
The Elite Athlete 62
Conclusion 63
References 63
5: Gender Differences: Considerations for the Female Endurance Athlete 65
Historical Perspective 65
Anatomical and Physiological Differences in the Female Endurance Athlete 66
VO2max 66
Other Sex Differences 67
Medical Conditions in the Female Endurance Athlete 67
Iron Deficiency Anemia and Iron Depletion 68
Stress Urinary Incontinence 69
Overtraining Syndrome 70
Exercise-Associated Collapse and Hyponatremia 71
The Female Athlete Triad and the Relative Energy Deficiency in Sport 72
Energy Availability 73
Menstrual Dysfunction 75
Poor Bone Health 75
Stress Fractures 77
References 77
6: Considerations for the Pediatric Endurance Athlete 81
Background 81
Is Long-Distance Running Safe? 81
Endurance Training Physiology 82
Growth 83
Training 83
Cardiac Changes 83
References 84
Part II: Musculoskeletal Conditions 86
7: Treatment of Stress Fractures 87
Pathophysiology 87
Risk Factors for Stress Fractures 88
Intrinsic Factors 88
Extrinsic Factors 89
Clinical Presentation 89
Imaging Evaluation 89
Radiography 89
Bone Scintigraphy 90
Ultrasound 90
SPECT Scan 91
Computed Tomography 91
MRI 91
Classification/Grading 92
High-Risk Stress Fractures Versus Low-Risk Stress Fractures 93
Rib and Upper Extremity Stress Fractures 93
General Treatment Principles 94
Management of High-Risk Stress Fractures 94
Return to Sports Participation 95
Prevention of Stress Injuries 96
Summary 96
References 97
8: Evaluation and Treatment of Soft Tissue Overuse Injuries 100
Achilles Tendinosis 100
Introduction 100
Terminology 100
Anatomy 100
Pathophysiology of Tendinosis 101
Epidemiology 101
Etiology 101
Physical Exam 102
Imaging 102
Treatment 103
Medications 103
Rehabilitation 103
Extracorporeal Shock Wave Therapy (ESWT) 104
Injection Therapies 104
Topical Treatment 105
Surgery 105
Patellar Tendinosis 106
Introduction 106
Terminology 106
Anatomy 106
Epidemiology 106
Risk Factors 107
History and Physical Exam 107
Workup 107
Imaging 107
Treatment 108
Medication 108
Rehabilitation 108
Extracorporeal Shock Wave Therapy (ESWT) 109
Injections 110
Greater Trochanteric Pain Syndrome (GTPS) or Gluteal Tendinopathy 111
Definition 111
Epidemiology 111
Anatomy 111
Risk Factors/History 112
Physical Examination 112
Laboratory Studies 114
Radiographic Workup 114
Management 115
Medications 115
Physical Therapy 115
Injection Therapy 115
Extracorporeal Shock Wave Therapy (ESWT) 115
Surgical Intervention 116
Newer Considerations 116
References 116
9: Chronic Exertional Compartment Syndrome 119
Introduction 119
Epidemiology 120
Anatomy/Physiology 120
Diagnosis 123
Differential Diagnosis 125
Treatment 126
Two-Incision Technique 127
Outcomes 128
Complications 129
Recovery/Return to Sport 129
Summary 129
References 130
10: Shoulder Injuries and Conditions in Swimmers 132
Background 132
Epidemiology 132
Pathophysiology 133
Training Factors 133
Scapular Dyskinesis 133
Shoulder Instability and Range of Motion Deficits 134
Muscle Imbalance 135
Muscle Fatigue 136
Intrinsic Tendon Degeneration 136
Diagnosis, Evaluation, and Management 137
Core Strength, Impaired Posture, and Scapular Dyskinesis 137
Tight Posterior Capsule 138
Rotator Cuff Strength 139
Glenohumeral Instability 139
Shoulder-Specific Conditions 139
Subacromial Impingement 139
Internal Impingement 140
Multidirectional Instability 141
Exam/Imaging 141
Treatment 141
References 141
11: Common Injuries and Conditions in Rowers 144
Introduction 144
Brief History 144
Basic Technique and Biomechanics 144
Mechanisms of Injury and Initial Assessment 145
Common Injuries and Treatment 146
Lower Back 146
Spondylolysis 146
Spondylolisthesis 146
Disk Injuries/Herniation 146
Sacroiliac Joint Dysfunction (SIJD) 147
Knee 147
Iliotibial Band Friction Syndrome 147
Patellofemoral Syndrome 147
Rib 148
Rib Stress Fractures 148
Costochondritis 148
Wrist and Forearm 148
Intersection Syndrome (“Oarsmen’s Wrist”) 148
Tenosynovitis 149
Exertional Compartment Syndrome 149
Dermatology and Skin Conditions 149
Blisters 149
Abrasions 149
Conclusion 150
References 150
12: Common Injuries and Conditions in Crossfit Participation 152
Introduction 152
Weight lifting 153
Endurance 157
Gymnastics 158
Other 160
Conclusion 162
References 162
13: Hip Injuries in the Endurance Athlete 164
Introduction 164
Anatomy 164
Layer I 165
Layer II 165
Layer III 168
Layer IV 170
History 170
Physical Examination 172
Inspection 173
Palpation 173
Motion, Strength, and Special Testing 173
Imaging Evaluation 176
Differential Diagnosis Evaluation 177
Treatment 180
Conclusions 181
Location of Investigation 183
Source of Funding 183
Statement of Originality 183
Disclosures 183
References 183
14: Exercise and Osteoarthritis: The Effect of Running with Aging in the Masters-Level Athlete 187
Introduction 187
Pathophysiology of Disease, At-Risk Populations, and the Modifiable Lifestyle Factors 188
Evaluation of Masters Athlete with Lower Extremity/Knee Pain Associated with Running 190
Treatment of Masters Athlete: Nonoperative vs. Operative Management 192
Conclusion (Summary of Evaluation and Treatment, “Barefoot” Running, Role of Diet, and Cross-Training for Healthy Running) 196
References 198
Part III: Special Considerations 202
15: Clinical Aspects of Running Gait Analysis 203
Introduction 203
Getting Started 203
Patient Setup and Video Capture 204
Analysis of the Recorded Video 205
Sagittal Plane 205
Initial Contact 205
Mid Stance 209
Additional Sagittal Measures 210
Frontal Plane 211
Mid Stance 211
Other Variables 213
Summary 214
Disclosure 214
References 214
16: Clinical Considerations of Bike Fitting for the Triathlete 216
Introduction 216
Injury Considerations in the Triathlete 217
Triathlon Bike Anatomy 217
Clinical Considerations of Cycling Mechanics 217
Getting Started: Basic Fit Setup and Equipment 219
The Bike: Fit Window 220
Seat Tube Angle (STA) (Fig. 16.5) 221
Seat/Saddle Height (Fig. 16.5) 222
Cleat Position (Fig. 16.6) 222
Hip Angle (Fig. 16.7) 223
Shoulder Angle (Fig. 16.8) 223
Arm Pad Stack/Drop and Reach (Fig. 16.9) 225
Armrest Width (Fig. 16.2a) 225
Crank Length (Fig. 16.1b) 225
Saddle Position 226
Helmets/Sunglasses 226
Other Fit Considerations for Different Triathlon Distances 226
Summary 227
References 227
17: Evaluation and Treatment of the Swimming Athlete 229
Introduction 229
The Four Competitive Strokes 229
Freestyle Biomechanics 230
Freestyle Upper Extremity Movement 230
Freestyle Lower Extremity Movement 231
Freestyle Stroke Mechanics: General Notes 231
Backstroke Biomechanics 232
Backstroke Upper Extremity Movement 232
Backstroke: Lower Extremity Movement 232
Backstroke Mechanics: General Notes 232
Butterfly Biomechanics 232
Butterfly Upper Extremity Movement 233
Butterfly Lower Extremity Movement 233
Butterfly Stroke Mechanics: General Notes 233
Breaststroke Biomechanics 233
Breaststroke Upper Extremity Movement 234
Breaststroke Lower Extremity Movement 234
Breaststroke Stroke Mechanics: General Notes 234
Common Stroke Technique Error 235
Freestyle Errors 235
Common Errors in Freestyle Are Found Below (% Prevalence in Subjects Tested) [21] 235
Injury Prevalence and Incidence 238
Performance Considerations 239
The Pediatric Swimmer 239
The Masters Swimmer 240
Common Injuries 241
Shoulder 241
Knee 243
Spine 244
Hip 244
Ankle 245
Swimming Injury Conclusion 246
Unique Pulmonary Considerations in Swimmers 246
Thoracic Outlet and Paget-Schroetter Syndrome 246
Swimming-Induced Pulmonary Edema 246
Rehabilitation 247
Breathing 247
Breath Control/Pulmonary Function 248
Spine 249
Cervical 249
Lumbar 249
Hip 250
Knee 251
Ankle 251
Shoulder 252
Mobility 255
Elastic Therapeutic Taping 256
Return to Sport Considerations 256
Return to Swimming Protocol 257
Training Considerations 262
Equipment Considerations 262
Coach/Trainer Resistance Training Expertise 263
Efficacy of Dryland Strength Training 263
Efficacy of Swim Training Regimen 263
Training Effort and Communication with Coaches 265
Altitude Training 265
Injury Prevention 266
Video Analysis 266
Feedback 267
A Proposed Injury Screen 267
A Proposed Dynamic Warm-Up 267
Appendix A: General Rehab—Neck Pain for Swimmers [86] 268
Appendix B: General Rehab—Trunk Program (Lumbar and Hip) [119, 121, 122] 269
Appendix C: General Rehab—Shoulder Program [99, 114, 133] 270
Appendix D: Part 1—Dynamic Shoulder, Spine, Hip, Knee, and Ankle Warm-Up (All 2 × 15 Reps) [186, 187] 271
Appendix E: Part 2—Strength/Plyometric/Balance/Reaction Time Progression [186] 273
Appendix F: Part 3—Aquatic Swimming-Specific Drills [186, 187] 275
References 276
18: Mental Skills for Endurance Sports 283
Introduction 283
Motivation 284
Goal Setting 284
Energy Management 285
Self-Talk 286
Concentration 287
Imagery 288
Performance Routines 289
Mindfulness 290
Balanced Exercise 291
Conclusion 292
References 292
19: Optimizing Nutrition for Endurance Training 295
Important Nutrition Components and Current Recommendations 295
The Macro Mixture 296
Hydration 299
Common Micronutrient Issues 299
Summary 301
References 301
20: Endurance Medicine: Medical Coverage for Mass Sporting Events 304
Overview 304
Anticipated Encounters 304
Medical Staff and Volunteer Management 305
Equipment, Supplies, and Logistics 308
Weather Monitoring and Alerts 309
Event-Day Communication 311
Event Security 312
Conclusion 314
References 314
21: Return to Sport Decision-Making for Endurance Athletes 315
Identification and Correction of Predisposing Factors 315
Biomechanics and Equipment 315
Running 315
Biking 316
Swimming 316
Rowing 316
Training 316
Nutrition 317
Restoration of Function 318
Range of Motion 318
Strength 318
Neuromuscular Training 319
Sport-Specific Training 319
Returning to Competition 319
Managing Challenges During Rehabilitation 319
Maintaining Fitness Level 320
Dietary Changes 320
Psychological Challenges 321
Integrating the Treatment Team 322
Physical Therapy 323
Exercise Physiology 323
Coaching Staff 323
Nutrition 324
Sport Psychology 324
Sports Medicine Physicians and Surgeons 324
References 325
Index 328