Training patterns associated with injury in New York City Marathon runners.

OBJECTIVE: Training patterns are commonly implicated in running injuries. The purpose of this study was to measure the incidence of injury and illness among marathon runners and the association of injuries with training patterns and workload. METHODS: Runners registered for the New York City Marathon were eligible to enrol and prospectively monitored during the 16 weeks before the marathon, divided into 4-week 'training quarters' (TQ) numbered TQ1-TQ4. Training runs were tracked using Strava, a web and mobile platform for tracking exercise. Runners were surveyed at the end of each TQ on injury and illness, and to verify all training runs were recorded. Acute:chronic workload ratio (ACWR) was calculated by dividing the running distance in the past 7 days by the running distance in the past 28 days and analysed using ratio thresholds of 1.3 and 1.5. RESULTS: A total of 735 runners participated, mean age 41.0 (SD 10.7) and 46.0% female. Runners tracked 49 195 training runs. The incidence of injury during training was 40.0% (294/735), and the incidence of injury during or immediately after the marathon was 16.0% (112/699). The incidence of illness during training was 27.2% (200/735). Those reporting an initial injury during TQ3 averaged less distance/week during TQ2 compared with uninjured runners, 27.7 vs 31.9 miles/week (p=0.018). Runners reporting an initial injury during TQ1 had more days when the ACWR during TQ1 was ≥1.5 compared with uninjured runners (injured IQR (0-3) days vs uninjured (0-1) days, p=0.009). Multivariable logistic regression for training injuries found an association with the number of days when the ACWR was ≥1.5 (OR 1.06, 95% CI (1.02 to 1.10), p=0.002). CONCLUSION: Increases in training volume ≥1.5 ACWR were associated with more injuries among runners training for a marathon. These findings can inform training recommendations and injury prevention programmes for distance runners.

Increased Incidence of Injury Among Runners With COVID-19.

BACKGROUND: Coronavirus disease 2019 (COVID-19) affects multiple organ systems. Whether and how COVID-19 affects the musculoskeletal system remains unknown. We aim to assess the association between COVID-19 and risk of injury. HYPOTHESIS: Runners who report having COVID-19 also report a higher incidence of injury. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 4. METHODS: An electronic survey was distributed from July through September 2020, by New York Road Runners, ASICS North America, race medical directors, and through social media. Inclusion criteria were runners 18 years or older who had participated in ≥1 race (running or triathlon) in 2019. RESULTS: A total of 1947 runners participated and met inclusion criteria. Average age was 45.0 (SD, 12.2) years and 56.5% were women. A total of 123 (6.3%) runners self-reported having COVID-19; 100 (81%) reported their diagnosis was from a laboratory test (polymerase chain reaction or antibody) and 23 reported being diagnosed by a medical professional without confirmatory laboratory testing. Since March 2020, 427 (21.9%) reported an injury that prevented running for at least 1 week, including 38 of 123 (30.9%) who self-reported having COVID-19 and 389 of 1435 (21.3%) who did not report having COVID-19 (P = 0.01). After adjusting for age, sex, the number of races in 2019, and running patterns before March 2020, runners who self-reported a diagnosis of COVID-19 had a higher incidence of injury compared with those who did not (odds ratio, 1.66; 95% CI, 1.11-2.48; P = 0.01). CONCLUSION: Injuries were more often self-reported by runners with laboratory-confirmed or clinically diagnosed COVID-19 compared with those who did not report COVID-19. Given the limitations of the study, any direct role of COVID-19 in the pathophysiology of injuries among runners remains unclear. CLINICAL RELEVANCE: Direct and indirect musculoskeletal sequelae of COVID-19 should be further investigated, including the risk of exercise- and sports-related injury after COVID-19.

Running races during the COVID-19 pandemic: a 2020 survey of the running community.

OBJECTIVES: To survey runners and triathletes about their willingness to resume in-person racing during the COVID-19 pandemic, health concerns related to mass races and changes in running patterns since the start of the pandemic. DESIGN: An electronic survey was distributed from 15 July to 1 September 2020 to runners and triathletes by New York Road Runners, ASICS North America, and race medical directors, and through social media. PARTICIPANTS: Runners and triathletes 18 years of age or older who participated in at least one race in 2019. RESULTS: A total of 2278 surveys were received. Not all participants answered every question; the denominator represents the number of responses to each question. Most participants were from the USA (1620/1940, 83.5%), of which over half were from New York (812/1475, 55.1%). Regarding when respondents would feel comfortable returning to in-person racing, the most frequent response was 'Whenever local laws allow, but only if there are sufficient precautions' (954/2173, 43.9%), followed by 'Not until there is a vaccine' (540/2173, 24.9%). The most common concerns about in-person races were crowded starting corrals (1802/2084, 86.5%), the number of COVID-19 cases in the race location (1585/2084, 76.1%) and the number of participants (1517/2084, 72.8%). Comparing running patterns before the pandemic to Summer 2020, the mean weekly mileage decreased from 25.5 (SD 15.4) miles to 22.7 (16.2) miles (p<0.001). CONCLUSION: Most runners are willing to return to racing when local laws allow, though as of Summer 2020, many desired certain precautions to feel comfortable.

Considerations for Return to Exercise Following Mild-to-Moderate COVID-19 in the Recreational Athlete.

The COVID-19 pandemic has resulted in significant morbidity and mortality around the world. The spectrum of COVID-19 is broad, from clinical disease requiring intensive medical care to less severe symptoms that are treated with supportive care. The majority of COVID-19 cases fall into the mild-to-moderate category, with symptoms lasting less than 6 weeks. Nevertheless, the morbidity from COVID-19 is significant and can affect multiple body systems, most frequently the cardiac, pulmonary, hematologic, musculoskeletal, and gastrointestinal systems. For patients who wish to return to exercise after mild-to-moderate COVID-19, the wide range of disease expression presents a challenge for clinicians seeking to offer counsel. This literature review on return to activity following mild to moderate COVID-19 in the recreational athlete includes evidence-based considerations and recommendations for clinicians in guiding the safest return to activity.

Functional outcomes and patient satisfaction after fasciotomy for chronic exertional compartment syndrome.

BACKGROUND: Patients with chronic exertional compartment syndrome who have failed nonoperative treatment are evaluated with pre-exertion and postexertion compartment pressure testing and may be treated with fasciotomy. Failure rates of up to 20% have been reported and may be related to factors such as age, sex, postexertion compartment pressures, compartment(s) released, and duration of symptoms. HYPOTHESIS: Higher preoperative postexertion compartment pressures are correlated with higher success and patient satisfaction rates after fasciotomy. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: From 1999 to 2008, patients with clinical symptoms of chronic exertional compartment syndrome with failed nonoperative management underwent standardized pre-exertion and postexertion compartment pressure measurements. Patients were then offered continued nonoperative treatment or referral to an orthopaedic surgeon for compartment release. Patients with a minimum 2-year follow-up were given a telephone questionnaire describing their pretreatment and posttreatment conditions including quality and duration of symptoms, analog pain scale, symptomatic and functional responses to treatment, and satisfaction with treatment. Medical records and operative reports were reviewed. RESULTS: The mean follow-up period for the nonoperative treatment group (n = 27) was 5.6 years (range, 2.1-10.6) and for the operative group (n = 73) was 5.2 years (range, 2.0-11.3). The operative group had a higher success rate (81%) compared with the nonoperative group (41%) (P < .001), and the operative group had a higher patient satisfaction rate (81%) compared with the nonoperative group (56%) (P = .011). There was no significant correlation between compartment pressures and patient outcomes. Patients with combined anterior and lateral compartment releases had an increased failure rate compared with isolated anterior release (31% vs. 0%, respectively; P = .035). Surgical patients who were post-college had a lower satisfaction rate (66%) compared with high school (89%) and college patients (94%) (P = .017). CONCLUSION: High school and college patients (age <23 years) and isolated anterior compartment release (compared with anterior/lateral release) were factors associated with improved subjective function and satisfaction after fasciotomy. We recommend the avoidance of lateral release unless symptoms or postexertion compartment pressures are clearly indicative of lateral compartment involvement.

Performance-enhancing drug use in young athletes.

This article explores the issue of performance-enhancing drug use in adolescent athletes. The article describes current substances that are being used by adolescent athletes, explains their positive and negative effects, examines factors contributing to their increased use in adolescent athletes, and discusses approaches to educating adolescents about alternate means of enhancing their athletic performance. It is hoped that this information will be useful toward encouraging young athletes to pursue, safe, healthy, and natural means of performance enhancement, such as practice and strength training, to improve sports performance in a safe, effective manner.

Breakfast habits, nutritional status, body weight, and academic performance in children and adolescents.

Breakfast has been labeled the most important meal of the day, but are there data to support this claim? We summarized the results of 47 studies examining the association of breakfast consumption with nutritional adequacy (nine studies), body weight (16 studies), and academic performance (22 studies) in children and adolescents. Breakfast skipping is highly prevalent in the United States and Europe (10% to 30%), depending on age group, population, and definition. Although the quality of breakfast was variable within and between studies, children who reported eating breakfast on a consistent basis tended to have superior nutritional profiles than their breakfast-skipping peers. Breakfast eaters generally consumed more daily calories yet were less likely to be overweight, although not all studies associated breakfast skipping with overweight. Evidence suggests that breakfast consumption may improve cognitive function related to memory, test grades, and school attendance. Breakfast as part of a healthful diet and lifestyle can positively impact children's health and well-being. Parents should be encouraged to provide breakfast for their children or explore the availability of a school breakfast program. We advocate consumption of a healthful breakfast on a daily basis consisting of a variety of foods, especially high-fiber and nutrient-rich whole grains, fruits, and dairy products.

Patterns in childhood sports injury.

OBJECTIVE: The purpose of this epidemiologic study is twofold: first, to determine the relative frequency of sports-related injuries compared with all musculoskeletal injuries in patients 5 to 21 years of age presenting to the emergency department (ED), and second, to evaluate the sports-specific and anatomic site-specific nature of these injuries. METHODS: Patterns of injury in patients 5 to 21 years of age presenting to four pediatric EDs with musculoskeletal injuries in October 1999 and April 2000 were prospectively studied. Information collected included age, sex, injury type, anatomical injury site, and cause of injury (sports-related or otherwise). Information about patient outcome and disposition was also obtained. RESULTS: There were a total of 1421 injuries in 1275 patients. Musculoskeletal injuries were more common in male patients (790/62%) than in female patients. The mean age of the patients was 12.2 years (95% CI, 12.0-12.4). Sprains, contusions, and fractures were the most common injury types (34, 30, and 25%, respectively). Female patients experienced a greater percentage of sprains (44% vs 36%) and contusions (37% vs 33%) and fewer fractures (22% vs 31%) than male patients. Sports injuries accounted for 41% (521) of all musculoskeletal injuries and were responsible for 8% (495/6173) of all ED visits. Head, forearm, and wrist injuries were most commonly seen in biking, hand injuries in football and basketball, knee injuries in soccer, and ankle and foot injuries in basketball. CONCLUSIONS: Sports injuries in children and adolescents were by far the most common cause of musculoskeletal injuries treated in the ED, accounting for 41% of all musculoskeletal injuries. This represents the highest percentage of sports-related musculoskeletal injuries per ED visit reported in children to date. As children and adolescents participate in sports in record numbers nationwide, sports injury research and prevention will become increasingly more important.

Expectations of pediatric sport participation among pediatricians, patients, and parents.

As the number of pediatric and adolescent athletes involved in competitive sports continues to grow, and as the competitors in youth sports trend toward a "win at all costs" mentality, pediatricians are increasingly being asked to provide sports medicine treatment and counseling for athletic children. This article outlines the demographic changes in the pediatric and adolescent athlete population in the United States and explains how the pediatrician can become a more effective caregiver to the athletic patient.