A Simplified Prediction Model for Lower Extremity Long Bone Stress Injuries in Male Endurance Running Athletes.

OBJECTIVE: Develop a prediction model for lower extremity long bone injuries (LBIs) in male endurance running athletes using dual-energy x-ray absorptiometry (DEXA). DESIGN: Retrospective. SETTING: Sports medicine department in a university athletic setting. PARTICIPANTS: National Collegiate Athletic Association (NCAA) Division 1 white male endurance athletes (n = 27). INDEPENDENT VARIABLES: Backward stepwise elimination was used to achieve a model that predicts LBI, by removing noncontributory variables (P > 0.10), using binary logistic regression. Independent prediction variables analyzed for model were as follows: (1) height (cm), body mass index (BMI) (kg/m), and total mass (kg); and (2) regional and total lean mass, fat mass, and bone density assessed using DEXA. MAIN OUTCOME MEASURES: Dichotomous dependent variable was LBI. RESULTS: Final constructed model predicted 96.3% of athletes with and without LBI. Prediction model were as follows: predict lower extremity long bone stress injury = 23.465 - 0.896 BMI + 1.043 (total upper-body mass) TUB - 34.536 leg bone mineral density (BMD). Predict lower extremity long bone stress injury is the LBI prediction, and TUB (kg) is total fat, muscle, and bone weight in trunk and arms. CONCLUSIONS: These preliminary data suggest that Division 1 white male endurance running athletes are at risk of LBI with higher relative TUB and lower BMI in combination with a lower leg BMD.

Anthropometric Factors Associated With Bone Stress Injuries in Collegiate Distance Runners: New Risk Metrics and Screening Tools?

BACKGROUND: Lower limb bone stress injury (BSI) of the pelvis, femur, and tibia is prevalent in collegiate track and field distance runners. Bone mineral density (BMD), body composition (BComp), and anthropometric parameters before initial collegiate injury have not been compared between runners with BSI and their noninjured counterparts. PURPOSE: To characterize bone health in relation to BComp and anthropometric measurements from total-body dual x-ray absorptiometry (DXA) scans in collegiate male and female distance runners before BSI and develop BMD prediction models. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Distance runners (N = 79) from a single university track and field team were retrospectively enrolled into this study. The runners completed a DXA scan during the fall season (August-November) and participated in sport activities before the scan. Three months after scanning, electronic medical records were reviewed for the occurrence of BSI. An independent-sample t test was used to compare BMD (total and regional [spine, pelvis, and legs]), BComp (% body fat, fat mass, and lean mass), and anthropometric measurements (shoulder width and leg, arm, and trunk length) between runners with versus without BSI (included subgroup analysis by sex). Multiple linear regression with stepwise removal was used to determine variables most predictive of BMD. RESULTS: Of the 79 enrolled participants (42 male, 37 female), 18 runners (22.8%; 11 female, 7 male) sustained a lower limb BSI. Compared with the noninjured group, injured runners had lower total and regional BMD (P < .001 for all) and shorter leg and arm lengths (P < .05 for both), whereas injured male runners had lower fat mass and injured female runners had lower lean mass in the legs (P < .05 for both). Injured runners' age-matched total BMD Z score (-0.1 ± 0.6) was considered clinically normal. BComp and anthropometric measures were predictive of total and regional BMD (P < .05; R 2 = 0.64-0.80; percentage error = 3.8%-4.8%). CONCLUSION: The DXA scans of injured runners prior to incidence indicated lower BMD compared with noninjured runners. Shorter limb lengths, lower fat mass (male), and lower leg lean mass (female) may also be indicative of risk. Certain BComp and anthropometric measures were predictive of BMD.

Cardiovascular screening with electrocardiography and echocardiography in collegiate athletes.

BACKGROUND: Current guidelines for preparticipation screening of competitive athletes in the US include a comprehensive history and physical examination. The objective of this study was to determine the incremental value of electrocardiography and echocardiography added to a screening program consisting of history and physical examination in college athletes. METHODS: Competitive collegiate athletes at a single university underwent prospective collection of medical history, physical examination, 12-lead electrocardiography, and 2-dimensional echocardiography. Electrocardiograms (ECGs) were classified as normal, mildly abnormal, or distinctly abnormal according to previously published criteria. Eligibility for competition was determined using criteria from the 36(th) Bethesda Conference on Eligibility Recommendations for Competitive Athletes with Cardiovascular Abnormalities. RESULTS: In 964 consecutive athletes, ECGs were classified as abnormal in 334 (35%), of which 95 (10%) were distinctly abnormal. Distinct ECG abnormalities were more common in men than women (15% vs 6%, P<.001) as well as black compared with white athletes (18% vs 8%, P<.001). Echocardiographic and electrocardiographic findings initially resulted in exclusion of 9 athletes from competition, including 1 for long QT syndrome and 1 for aortic root dilatation; 7 athletes with Wolff-Parkinson-White patterns were ultimately cleared for participation. (Four received further evaluation and treatment, and 3 were determined to not need treatment.) After multivariable adjustment, black race was a statistically significant predictor of distinctly abnormal ECGs (relative risk 1.82, 95% confidence interval, 1.22-2.73; P=.01). CONCLUSIONS: Distinctly abnormal ECGs were found in 10% of athletes and were most common in black men. Noninvasive screening using both electrocardiography and echocardiography resulted in identification of 9 athletes with important cardiovascular conditions, 2 of whom were excluded from competition. These findings offer a framework for performing preparticipation screening for competitive collegiate athletes.

Cryptogenic stroke associated with patent foramen ovale in a collegiate volleyball athlete: a case report.

Cryptogenic stroke is a form of cerebral vascular accident that has an unknown origin and is rarely associated with patent foramen ovale (PFO) and migraine headaches. This is an uncommon occurrence in young, healthy, active adults, and it is increasingly rare for the episode to occur during an athletic competition. Stroke is easily recognizable with its distinct signs and symptoms, but it is also easily confused with many of its differential diagnoses, such as seizures or head trauma, if the episode occurs during an athletic competition. This case report describes the stroke episode, incidence of migraine headaches, diagnostic testing, and surgical management of a college female volleyball athlete who suffered a cryptogenic stroke associated with PFO during an athletic competition. Diagnostic testing included magnetic resonance imaging with contrast, electroencephalograph, lower extremity Doppler testing, and a transesophageal echocardiograph with agitated saline study. Surgical correction of the PFO included a cardiac catheterization percutaneous procedure based on fluoroscopic and echocardiograph imaging. After release from physicians, the athlete returned to full participation in the sport of volleyball, where she competed for the next 2 years without complications. The patient has reported no symptoms from stroke or PFO closure procedure in 3 years, and migraine headaches have decreased in severity, frequency, and duration.

Elevated Anterior Compartment Pressure in the Leg After Creatine Supplementation: A Controlled Case Report.

OBJECTIVE: To report abnormal changes in lower leg anterior compartment pressure in 1 subject who consumed creatine as a dietary supplement. BACKGROUND: The subject received creatine at a dosage of 0.3 g.kg body mass(-1).d(-1) for 6 days, followed by 0.03 g.kg body mass(-1).d(-1) for 28 days. Thereafter, the subject consumed no supplement for 21 days. Compartment pressure was measured pre-exercise and for 15 minutes postexercise after a treadmill run for 20 minutes at 80% of VO(2) max before supplementation and after 6 and 34 days of supplementation. DIFFERENTIAL DIAGNOSIS: Normally, resting anterior compartment pressure is less than 15 mm Hg, whereas postexercise pressure is below 30 to 35 mm Hg. Creatine supplementation for 6 days dramatically increased pressure at rest (31 mm Hg) and at 1 minute (67 mm Hg), 5 minutes (35 mm Hg), 10 minutes (28 mm Hg), and 15 minutes (26 mm Hg) postexercise. Pressure remained high at rest (35 mm Hg) and at 1 minute (109 mm Hg), 5 minutes (90 mm Hg), 10 minutes (87 mm Hg), and 15 minutes (69 mm Hg) postexercise after 34 days of supplementation. TREATMENT: The subject stopped taking creatine for 21 days. Compartment pressure was measured at rest and after exercise after 7 and 21 days with no supplementation. Anterior compartment pressure decreased after cessation of creatine supplementation. However, pressures were elevated at 7 days postsupplementation at rest (26 mm Hg) and at 1 minute (112 mm Hg), 5 minutes (58 mm Hg), 10 minutes (40 mm Hg), and 15 minutes (30 mm Hg) postexercise. Pressures at 21 days postsupplementation remained high at rest (24 mm Hg) and at 1 minute (64 mm Hg), 5 minutes (42 mm Hg), 10 minutes (27 mm Hg), and 15 minutes (27 mm Hg) postexercise. CONCLUSION: These data indicate that creatine supplementation can substantially increase anterior compartment pressure in the leg.