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Patellar Instability

Introduction Patellar instability remains a problematic entity in the athletic patient population. Most studies agree that adolescent females represent the highest risk group of patients for first-time patellofemoral dislocation. Treatment of patellar instability must be individualized, with care taken to identify both historical and anatomic risk factors. First-time instability that results in a loose chondral or osteochondral body should be addressed with both attention to the…

Patellofemoral Pain in the Female Athlete

Introduction Patellofemoral pain is one of the most common sports-related knee conditions. , Patellofemoral pain is characterized by pain around or behind the patella during activities that load the patellofemoral joint, such as squatting, stair ambulation, running, jumping, and prolonged sitting with knees in a flexed position. Patellofemoral pain is particularly prevalent in younger, active populations, , , with females twice as likely to develop patellofemoral…

Meniscus and Articular Cartilage Injuries

Introduction Meniscal tears and cartilage injuries are common issues in the knee of a female athlete. As female athletes are significantly more likely to suffer anterior cruciate ligament (ACL), tears they are also prone to associated injuries to their meniscus and articular cartilage. The incidence of high-grade chondral injuries ranges from 5% to 10% in patients over 40 years old, , and cartilage lesions may be…

Anterior Cruciate Ligament Injury Prevention

Introduction Anterior cruciate ligament (ACL) injury is of major concern in the field of sports medicine and orthopedics. From 2002 to 2014 the rate of ACL reconstructions has increased by 22%. Those who experience ACL injury experience significant deficits in sports-related movement, including cutting, pivoting, decelerating, jumping, landing, and other functional movements. Concomitant injuries such as meniscal tear, chondral injuries, avulsion fractures, and collateral ligament injuries…

Anterior Cruciate Ligament Injuries in Female Soccer Players

Introduction Since the passing of Title IX in 1972, female participation in sports at every level has increased tremendously and continues to grow. , With that, however, the prevalence of sports-related musculoskeletal injuries has also greatly increased in the female athlete. In particular, anterior cruciate ligament (ACL) injuries have become a critical issue for a variety of reasons, including the severity of the injury itself; time…

Anterior Cruciate Ligament Injuries: Sex-Based Differences

Introduction and Epidemiology In spite of years of research and evolving techniques, rupture of the anterior cruciate ligament (ACL) continues to represent one of the most common traumatic injuries in competitive sports. Female athletes have been noted to be at particular risk for ACL tears, with injury rates as high as two to eight times as those experienced by males, especially in sports requiring quick or…

Anterior Cruciate Ligament Injury in the Female Athlete

Introduction Anterior cruciate ligament (ACL) injuries are one of the most common injuries seen by orthopedic surgeons and sports medicine specialists. Annually in the United States, there are 68.6 isolated ACL tears per 100,000 person-years. Worldwide there are roughly 1.4 million noncontact ACL tears annually. The ACL is subject to injury most commonly in sports that require movements such as cutting, pivoting, and jumping. These are…

Knee Anatomy and Biomechanics

Introduction Important morphologic differences have been found between the female and male knee. In addition to these anatomic differences, there are also significant neuromuscular differences between genders. This chapter outlines these differences, as they specifically pertain to the female athlete and risk for injury. The important characteristics of female knee bones, alignment, and soft tissues (ligament, meniscus) are covered first, followed by neuromechanical differences. The majority…

Caring for and Counseling the Ultramarathoner

Introduction Ultramarathon races represent any foot race longer than 42 km and can occur over single or multiple days. As the popularity of ultramarathon racing continues to grow throughout the world, there are an increasing number of races and participants, with estimates of 70,000 runners participating annually. Most races are continuous single-stage, point-to-point races that occur over a specific time period (i.e., 24–48 hours). Multistage races…

Caring for and Counseling the Peripartum Runner

Introduction Evidence suggests as little as 15 minutes a day of aerobic exercise improves health outcomes and helps prevent and manage common chronic conditions such as hypertension, diabetes, and obesity. Running has only recently been studied in risk factor reduction for these health outcomes, and like general physical activity, relatively low doses (5–10 minutes) of lower intensity speeds (<6 mi/hour) have similar health and longevity benefits…

Caring for and Counseling the Youth Runner

Introduction Running is a popular sport among children and is continually increasing in participation each year. For the 2017–2018 season, the National Federation of High Schools Participation Survey of all 51 state cross-country and track and field associations documented a total of 1,231,321 athletes participated in track and field (680,851 boys and 550,470 girls) and 493,613 participated in cross-country (270,095 boys and 223,518 girls), which represents…

Ankle and Foot Injuries in Runners

Introduction and Epidemiology Injuries of the foot and ankle are common among elite and recreational runners, accounting for nearly one-third of all running injuries. Foot injuries alone account for 10%–20% of all running injuries, and ankle injuries account for 15% of all sports injuries. Achilles tendinopathy, plantar fasciopathy, and ankle sprains are three of the five most commonly sustained foot and ankle injuries in runners. Significant…

Exertional Leg Pain in Runners

Introduction Exertional leg pain (ELP) is defined as pain distal to the knee and proximal to the ankle that is associated with exertion. The incidence of ELP in the general population has not been studied. In runners, the incidence of ELP varies depending on study design and has been reported to be between 12% and 83%. A retrospective study of over 2000 running injuries found an…

Knee Injuries in Runners

Introduction Injuries to the knee are arguably the most common type of injury in runners. Though the differential diagnosis is quite broad (see Table 18.1 ), a more limited set account for the majority of complaints by runners. The purpose of this chapter is to review the assessment and differential diagnosis of knee pain in the runner, with a focus on evidenced-based evaluation and management of common…

Hip, Pelvis, and Thigh Injuries in Runners

Introduction Injuries of the hip, pelvis, and thigh are common in sporting activities, including running. Although less common than injuries in the more distal segments of the lower limbs, injuries to this region represent a large portion of running-related injuries. Reported rates of running-related injuries are variable, as are rates of injuries to the hip, pelvis, and thigh. In a retrospective, case-control study, 10.9% of running-related…

Osteoarthritis and Running

Introduction Osteoarthritis (OA) is the most common joint disorder and a growing health concern in the United States. Approximately 10%–12% of the population, or 30.8 million adults, live with symptomatic OA in any joint. Aggregate annual medical care expenditures for OA are estimated at $185.5 billion ; and the economic burden of OA is projected to increase in the future as half of all patients with…

Bone Health of the Runner: Metabolic Workup and Impact on Fracture Risk

Introduction Bone stress injuries (BSIs) represent an overuse form of injury resulting from the inability of bone to withstand repetitive loading. BSI may impact the runner's ability to continue sport participation in the short term but can also create long-term disability with the potential for recurrent injuries. During running, the skeleton is exposed to mechanical loading, resulting in deformation of bone. The amount of deformation is…

Bone Stress Injuries

Introduction and Epidemiology Bone stress injuries (BSIs) result when bone is unable to withstand repetitive, mechanical loading due to factors that disrupt bone load, bone strength, or bone remodeling. BSIs are a common concern in runners. Studies suggest that BSIs account for 0.7%–20% of all sports medicine clinic injuries. Competitive cross-country and track-and-field athletes have the highest incidence of BSIs compared with other athletes. The 1-year…

Deep Water Running for Prevention and Rehabilitation of Running Injuries

Acknowledgments David Brennan, MEd, for sharing his vast expertise in DWR and use of his sample workouts and RPE scale. Lew Thorne, president and founder of AquaJogger, for his counsel and supplying us with images. Introduction Deep water running (DWR) is a form of cardiovascular exercise that is useful for the injured and noninjured athlete. It is an important cross-training tool for runners, as it closely…

Anti-Gravity Treadmill Training for Prevention and Rehabilitation of Running Injuries

List of Abbreviations ACL Anterior cruciate ligament AlterG® AlterG® Anti-Gravity Treadmill™ BW Body weight F Female KM/HR Kilometers per hour LBPP Lower-body positive pressure M Male M/S Meters per second MPH Miles per hour RPE Rating of perceived exertion V˙ V ˙ O 2 Max Maximum rate of oxygen consumption Introduction Research has documented that a large number of adults run as their primary form of…