Evaluation and Treatment of Injury and Illness in the Ultramarathon Athlete

Krabak, Brian J.; Waite, Brandee; Lipman, Grant S.

doi:10.1016/j.pmr.2014.06.006

Cited by 17 publications

(33 citation statements)

References 60 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Fortunately, severe complications from EAH often are quite rare and represent less than 1% of all cases of EAH [2,4]. These studies suggest the overall incidence of EAH will vary by the sporting event and appears to be multifactorial depending on the length of the endurance event, experience of the athlete, and environmental conditions [5,6]. Risk factors for the development of EAH are listed in Table 1.…”

Section: Epidemiologymentioning

confidence: 99%

“…Overconsumption of sustained fluids (water, sports drinks, or other hypotonic fluids) in excess of total body fluid losses (sweat, respiratory, and renal water excretion) is the main etiology of both asymptomatic and symptomatic EAH [2,6,11]. In Noakes study of endurance athletes, the mean serum [Na+] level was 136.1 ± 6.4 mmol/L for athletes who were overhydrated; 140.5 ± 3.7 mmol/L who were defined as euhydrated and; 141.1 ± 3.7 mmol/L for those defined as dehydrated [11].…”

Section: Pathophysiology Of Eahmentioning

confidence: 99%

“…When assessing an athlete with EAC or altered sensorium, it is important to keep a broad differential to prevent delayed diagnoses, misdiagnoses, or delayed treatment. The following diagnoses shoulder be strongly considered when assessing an athlete with EAC: transient postural hypotension, heat‐related illness, dehydration, electrolyte abnormalities (ie, EAH), hypoglycemia, primary seizure disorder, cardiovascular compromise, and respiratory compromise [6,39]. With vigilance by well‐trained medical personnel, and appropriate studies, a correct diagnoses is highly achievable and life threatening complications preventable.…”

Section: Differential Diagnosismentioning

confidence: 99%

“…Treatment should begin with a 100‐mL bolus of 3% hypertonic saline given in less than 60 seconds, although other comparable solutions may be used alternatively. This can be given up to 3 times total at 10‐minute intervals [2,6,40,41]. The goal of administration is to prevent and/or reverse cerebral edema by acutely increasing serum [Na+] levels by 2‐5 mmol/L [2,40].…”

Section: Differential Diagnosismentioning

confidence: 99%

“…Medical staff should be knowledgeable of EAH as symptoms can easily be mistaken for other common exercise diagnoses, such as heat illness, altitude sickness, and dehydration, as noted previously [6,40]. Because EAH can be confused for diagnoses that would have an opposite treatment approach, serum sodium analysis should be available onsite and should be obtained as soon as possible.…”

Section: Differential Diagnosismentioning

confidence: 99%

See 4 more Smart Citations

Exercise‐Associated Collapse: Is Hyponatremia in Our Head?

Krabak

Parker

DiGirolamo

2016

PM&R

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: Epidemiologymentioning

confidence: 99%

Section: Pathophysiology Of Eahmentioning

confidence: 99%

Section: Differential Diagnosismentioning

confidence: 99%

Section: Differential Diagnosismentioning

confidence: 99%

Section: Differential Diagnosismentioning

confidence: 99%

See 3 more Smart Citations

Exercise‐Associated Collapse: Is Hyponatremia in Our Head?

Krabak

Parker

DiGirolamo

2016

PM&R

Self Cite

View full text Add to dashboard Cite

show abstract

Years of running, chronic diseases, and allergies are associated with gradual onset Achilles tendon injuries in 61,252 running race entrants: SAFER XXXIX study

Young,

Wood,

Schwellnus

et al. 2024

PM&R

View full text Add to dashboard Cite

BackgroundGradual‐onset Achilles tendon injuries (GoATIs) in runners are common. Data show that chronic diseases are associated with GoATI.ObjectiveTo determine risk factors associated with a history of GoATIs among long‐distance runners (21.1 and 56 km) entering a mass community‐based running event.MethodsOnline pre‐race medical screening questionnaire data from 76,654 consenting Two Ocean Marathon race entrants (71.8% entrants) were collected prospectively over 4 years (2012–2015); this cross‐sectional study is a retrospective analysis of these data. A total of 617 entrants (0.8%) reported a GoATI in the last 12 months; 60,635 entrants reported no history of any running injury (controls). Categories of factors associated with GoATI were explored (univariate and multiple regression analyses): demographics (age group, sex, race, distance), training/racing history, and history of allergy, history of chronic disease, and Composite Chronic Disease Score. Prevalence and prevalence ratios (PRs; 95% CI) are reported.ResultsFactors associated with a higher prevalence of a history of GoATI (univariate analysis vs. controls) were older age (>31 years) (p < .001), male sex (PR = 1.76; p < .001), and longer race distance (56 km vs. 21.1 km) (PR = 2.06; p < .001). Independent factors associated with a history of GoATI (multiple regression) were increased years of recreational running (PR = 1.17 for every 5‐year increase, p < .001), higher Composite Chronic Disease Score (PR = 2.07 for every 2‐unit increase, p < .001), and allergy history (PR = 1.98 p < .001).ConclusionNovel independent factors associated with a history of GoATI in distance runners were increased years of recreational running, chronic disease history, and allergy history. Runners at risk for GoATI could be targeted for injury prevention interventions. Future studies should focus on establishing a causal relationship.

show abstract

Pulmonary and Respiratory Muscle Function in Response to Marathon and Ultra-Marathon Running: A Review

Tiller

2019

Sports Med

View full text Add to dashboard Cite

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 (MVV 12 ). 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.

show abstract

Evaluation and Treatment of Injury and Illness in the Ultramarathon Athlete

Cited by 17 publications

References 60 publications

Exercise‐Associated Collapse: Is Hyponatremia in Our Head?

Exercise‐Associated Collapse: Is Hyponatremia in Our Head?

Years of running, chronic diseases, and allergies are associated with gradual onset Achilles tendon injuries in 61,252 running race entrants: SAFER XXXIX study

Pulmonary and Respiratory Muscle Function in Response to Marathon and Ultra-Marathon Running: A Review

Contact Info

Product

Resources

About