Differences in Training and Health Characteristics Between Trail Ultrarunners and Shorter Distance Runners.

INTRODUCTION: The primary aim of the study was to compare select training and health characteristics between ultramarathon and shorter distance runners participating in a trail race series. METHODS: A questionnaire was sent to all participants who signed up for a trail race series, including distances of 10 km, half marathon, 50 km, 80.5 km (50 mi), and 100 km. There were 59 participants (27 ultramarathoners and 32 half marathon/10-km runners) who completed the questionnaire. We compared the training and health characteristics between groups using t tests and Fisher exact tests. RESULTS: There were no significant differences in reported history of stress fracture (15% vs 9%; P=0.70) or sleep quality scores (4.4 vs 5.5; P=0.15) between the ultramarathon and half marathon/10-km groups. Over half of both groups reported trying to change body weight to improve performance, without significant differences between groups (65% vs 53%; P=0.42). A significantly greater proportion of the ultramarathoners reported an episode of binge eating in the 4 wk preceding the race (38% vs 3%; P=0.001). CONCLUSIONS: Despite differences in training volume, we did not find different injury, sleep, and nutrition data between the ultramarathoners and half marathon/10-km runners, with the exception of more ultramarathoners reporting binging behaviors in the 4 wk leading up to the race. Screening for eating disorder behaviors should be considered in distance runners, particularly ultrarunners.

Wilderness Medical Society Clinical Practice Guidelines for Diabetes Management.

The Wilderness Medical Society convened an expert panel in 2018 to develop a set of evidence-based guidelines for the treatment of type 1 and 2 diabetes, as well as the recognition, prevention, and treatment of complications of diabetes in wilderness athletes. We present a review of the classifications, pathophysiology, and evidence-based guidelines for planning and preventive measures, as well as best practice recommendations for both routine and urgent therapeutic management of diabetes and glycemic complications. These recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks or burdens for each recommendation.

Common Skiing and Snowboarding Injuries.

Participation in skiing, and especially snowboarding, continues to rise. As participation and level of competition in these winter sports increases, the number of injuries increases as well. Upper-extremity injuries are more common in snowboarding, whereas lower-extremity injuries are more common in skiing. Head injuries, particularly concussions, are common in both sports. Special consideration in these sports should be given to environmental conditions, such as high altitude and ultraviolet radiation. The purpose of this review is to discuss the most common musculoskeletal injuries seen in skiing and snowboarding, as well as considerations for initial assessment of these injuries and triage to the appropriate level of care. It is important for sports medicine physicians covering these sports to understand initial assessment and treatment of these injuries. Due to the potential for severe injuries in these sports, it is important to be able to quickly recognize an injury that needs to be assessed and treated urgently or emergently. With the increased participation and number of injuries in these sports, it also is important to consider prevention strategies that may minimize risk of injury.

Iron Status and Homeostasis Across 2 Competitive Seasons in NCAA Division I Collegiate Cross-Country Runners Residing at Low Altitude.

PURPOSE: Inflammatory cytokines including interleukin-6 can upregulate hepcidin and decrease iron absorption. Endurance exercise is associated with transient increases in cytokines, which may alter the risk of iron deficiency (ID). This study examined whether chronic elevations in basal levels of cytokines and hepcidin were associated with ID in highly trained runners. METHODS: Fifty-four collegiate runners (26 males and 28 females) living at ∼1625 m were recruited from an NCAA Division I cross-country team for this prospective cohort study. Over 2 seasons, fasted, preexercise blood draws were performed in the morning 4 times per season and were analyzed for hemoglobin concentration, ferritin, soluble transferrin receptor (sTfR), hepcidin, and 10 cytokines. Stages of ID were defined using ferritin, sTfR, and hemoglobin concentration. During the study, a registered dietician provided all runners with iron supplements using athletic department-created guidelines. RESULTS: Fifty-seven percent of females and 35% of males exhibited stage 2 ID (ferritin <20 ng/mL or sTfR >29.5 nmol/L) at least once. Cytokines, ferritin, and sTfR exhibited changes through the 2 years, but changes in cytokines were not associated with alterations in hepcidin, ferritin, or sTfR. In males and females, lower ferritin was associated with lower hepcidin (both P < .0001). One female exhibited higher hepcidin and lower iron stores compared with other individuals, suggesting a different etiology of ID. CONCLUSION: ID is common in highly trained collegiate runners. In general, the high prevalence of ID in this population is not associated with alterations in basal hepcidin or cytokine levels.

Presence and Perceptions of Menstrual Dysfunction and Associated Quality of Life Measures Among High School Female Athletes.

CONTEXT: Adolescent female athletes are at risk for menstrual dysfunction in the setting of exercise and low energy availability. Education regarding menstrual dysfunction and its associated consequences is important to promote athlete wellbeing. OBJECTIVE: The primary aim was to determine the prevalence and characteristics of female athletes who believed that losing their period was a normal response to high training demands. The secondary aim was to explore the relationship between menstrual dysfunction and patient-reported quality of life measures. DESIGN: Cross-sectional study. SETTING: Preparticipation evaluations for a local high school district. PATIENTS OR OTHER PARTICIPANTS: Female athletes, 13-18 years old (n = 90). MAIN OUTCOME MEASURE(S): Health history, family affluence, and patient-reported quality of life measures. RESULTS: Forty four percent (n = 40) of 90 adolescent athletes answered that losing their period was a normal response to a high level of training, and this group had a lower body mass index, were less likely to report being worried about their current weight, and had a higher family affluence level than those who answered that losing their period was not a normal response to training. The overall prevalence of menstrual dysfunction was 28%. After adjusting for age and body mass index, we found that menstrual dysfunction was significantly associated with higher levels of anxiety, fatigue, and pain interference. CONCLUSIONS: Nearly half of our sample of adolescent female athletes perceived losing their period was a normal response to high training demands. Females with menstrual dysfunction reported higher levels of anxiety, fatigue, and pain interference than those without menstrual dysfunction. Understanding adolescent perceptions of menstrual dysfunction and the characteristics of those with menstrual dysfunction can guide the development of future educational interventions aimed at athletes at risk for the female athlete triad.

Shoulder Conditions: Rotator Cuff Injuries and Bursitis.

Subacromial impingement/pain syndrome is a common cause of shoulder pain that encompasses a spectrum of pathology of the subacromial bursa and rotator cuff tendons. Pathology of the rotator cuff tendons can range from inflammation to fibrotic changes to partial- and full-thickness tears. Biomechanical dysfunction of the rotator cuff and glenohumeral complex contributes to the pathophysiology and progression of subacromial impingement/pain syndrome. The most common risk factor for subacromial pain and rotator cuff tendinopathy is repetitive overhead activity. Rotator cuff conditions typically manifest with an insidious onset of pain but also can be the result of acute injury. Magnetic resonance imaging study and ultrasonography may be useful to evaluate for soft tissue pathology, depending on the level of clinical concern regarding rotator cuff tear. Management of rotator cuff conditions depends on multiple factors, including chronicity, underlying anatomic and biomechanical factors, age, and the presence and degree of tendon tears. Management typically starts with conservative care such as physical therapy, anti-inflammatory drugs, and injection therapies but eventually may include surgical repair.

Shoulder Conditions: Clavicle and Acromioclavicular Joint Conditions.

The clavicle is the most commonly fractured bone, and the most frequently fractured part of the clavicle is the middle third (ie, midshaft). X-ray usually is the first-line imaging modality for clavicle injuries. Conservative management is preferred for patients with uncomplicated and nondisplaced clavicular fractures. Typically, immobilization should last 4 weeks, then range-of-motion exercises should begin after 4 weeks, with full return to activities by 12 weeks. Distal clavicle osteolysis is a relatively uncommon pathologic bone resorption that occurs with repetitive overhead activities. Conservative management includes activity modification, nonsteroidal anti-inflammatory drugs, and injection. Surgical options also are available. Acute acromioclavicular (AC) joint injuries usually are the result of a direct blow to the superolateral shoulder with the humerus in adduction. The Rockwood classification system of AC joint injuries describes types I to VI, classified by the ligaments injured and degree of displacement. Low-grade AC joint injuries (ie, types I to III) typically can be managed nonsurgically, whereas high-grade injuries are managed with surgery. Osteoarthrosis of the AC joint manifests similarly to distal clavicle osteolysis and may be posttraumatic or idiopathic. Osteoarthrosis typically is managed with activity modification, nonsteroidal anti-inflammatory drugs, and injections but also may be managed surgically.

Athletes at High Altitude.

CONTEXT: Athletes at different skill levels perform strenuous physical activity at high altitude for a variety of reasons. Multiple team and endurance events are held at high altitude and may place athletes at increased risk for developing acute high altitude illness (AHAI). Training at high altitude has been a routine part of preparation for some of the high level athletes for a long time. There is a general belief that altitude training improves athletic performance for competitive and recreational athletes. EVIDENCE ACQUISITION: A review of relevant publications between 1980 and 2015 was completed using PubMed and Google Scholar. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 3. RESULTS: AHAI is a relatively uncommon and potentially serious condition among travelers to altitudes above 2500 m. The broad term AHAI includes several syndromes such as acute mountain sickness (AMS), high altitude pulmonary edema (HAPE), and high altitude cerebral edema (HACE). Athletes may be at higher risk for developing AHAI due to faster ascent and more vigorous exertion compared with nonathletes. Evidence regarding the effects of altitude training on athletic performance is weak. The natural live high, train low altitude training strategy may provide the best protocol for enhancing endurance performance in elite and subelite athletes. High altitude sports are generally safe for recreational athletes, but they should be aware of their individual risks. CONCLUSION: Individualized and appropriate acclimatization is an essential component of injury and illness prevention.

An unusual knee mass in a soccer player.

INTRODUCTION: Non-traumatic knee joint effusion and fullness is a relatively common presenting complaint among athletes and non-athletes. Due to its broad differential diagnosis, a comprehensive evaluation beginning with history and physical examination are recommended. Imaging including plain radiography, magnetic resonance imaging (MRI), and in some cases ultrasound are preferred modalities. If inflammatory arthritis is suspected, joint aspiration and analysis may help diagnosis. CASE PRESENTATION: A 37-year-old male soccer player presented with a complaint of left anterior knee pain and fullness for a few months. Physical examination revealed a healthy appearing male with obvious fullness of his left suprapatellar pouch and posterolateral knee. Plain radiographs were unremarkable. MRI demonstrated an effusion infiltrated by multiple, low intensity projections from a fatty mass in the suprapatellar pouch consistent with lipoma arborescens. CONCLUSIONS: Lipoma arborescens is a rare synovial disorder characterized by replacement of subsynovial tissue with mature fat cells, most commonly in the knee joint. MRI is the best diagnostic modality to evaluate and confirm the diagnosis as well as rule out other pathologies. More recent single case-reports and clinical series endorse arthroscopic synovectomy as the treatment of choice.