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…
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…
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…
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…
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…
Increasing running load is the foundation of every progressive training plan. Through this process of stressing the body, and then resting to allow the tissues to remodel and adapt, higher levels of fitness are achieved. At the same time, this process, when done incorrectly, can lead to injury. Runners become injured when the load capacity of a specific structure is exceeded during a running bout or…
Introduction The rapid growth in the participation of running for health and competition has contributed to the exponential demand for running shoe production and development. Over the past 50 years, running shoes have evolved from a minimal design to highly cushioned and supportive to light, partial minimalist shoes. Numerous athletic footwear companies have emerged to respond to the demand for the range of products that fit…
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Introduction The number of runners in the United States has grown exponentially over the last several decades, now with over 35 million people running for exercise or sport. With the rise in the number of individuals running both recreationally and competitively, a corresponding rise in running-related injuries has occurred as well. Many running-related injuries are suggested to result from biomechanical faults in an individual's gait pattern.…
Introduction Musculoskeletal running-related injuries occur when there is an imbalance between tissue tolerance and applied loads experienced by the body. Reasons and risk factors for this imbalance are complex and multifaceted. However, a runner's mechanics significantly influence the extent of loading applied to the musculoskeletal system. This is evidenced by differences in the mechanics of runners with and without injuries or those with a history of…
Introduction Injury, particularly in the context of sport and physical activity, is often viewed through a physical lens, centering on questions such as what is the physical injury, does the injury need to be repaired, or what physical or medical measures can be taken to expedite return to sport. While those factors are inarguably important, it is also the case that injury, recovery, and rehabilitation have…
Introduction The mission of event medical coverage is to ensure a safe event for participants and event staff and to provide medical care when needed during the event. Secondarily, this coverage protects the community where the event is staged from undue stress to the emergency response system. Planning, organization, and execution are the most important factors in fulfilling this mission. The medical director is responsible for…
Introduction Endurance events continue to be a popular athletic and social outlet for runners of all ages and abilities. In 2016, there were a total of 30,400 distance running events, and the estimated number of finishers of sanctioned running events that year was 16,957,100. It is estimated that approximately 25 of every 1000 finishers will seek medical attention during a marathon with fluctuations seen based on…
Introduction Running has become popular among the diverse population of recreational and competitive runners. As such, each runner who presents with injury has a unique set of circumstances that contribute to the problem. Evaluation of the injured runner should therefore include a systematic review of medical and training history, prior treatments, functional ability, pain symptom characteristics, shoewear, and running biomechanics to identify individual features that may…
Establishing evidence-based training recommendations for runners is important to foster healthy training, optimize performance, and promote general well-being. Despite the seemingly innocuous nature of running, a relatively high incidence of running-related injuries (RRIs) has been documented in the literature. The vast majority of RRIs are nontraumatic in nature and primarily involve the soft tissues of the musculoskeletal system. Irrespective of whether one is running for general…
This chapter aimed to review the literature and identify studies that discuss the rate of injury and risk factors related to running-related injuries (RRIs). Only systematic review studies were used in this chapter. The decision to not use individual studies as references in this chapter was to decrease my inclination (bias) about the topic, and systematic review studies are classified with the highest level of evidence…
Acknowledgments The author would like to thank Bill Polian of ESPN and former General Manager/President of Indianapolis Colts, Carolina Panthers, and Buffalo Bills of the NFL; Dave Hammer, ATC, current Head Athletic Trainer Indianapolis Colts; Mark Bartelstein, owner and president of Priority Sports Agency Chicago, IL; Gordon Hayward, former Brownsburg, IN Bulldog, former Butler University Bulldog, former Utah Jazz, current Boston Celtic NBA basketball player; Robert…
Introduction This chapter provides an overview of the rehabilitation principles, appropriate progression of exercise, and return-to-play criteria when dealing with foot and ankle injuries. Rehabilitative protocols and progressions must be based primarily on the physiological responses of the tissues to injury and on an understanding of how various tissues heal. The foot and ankle often are injured during sporting events, recreational activities, and occupational accidents. Injuries…
Introduction Injuries to the foot and ankle are some of the most common injuries in sport. These injuries can significantly affect the performance of an athlete and can often lead to disability and missed playing time. In a series of over 1600 athletic injuries, Garrick and Requa reported that more than 25% of the injuries occurred in the foot and ankle. More recently, Hunt et al. reported…
Introduction In recent years, as orthobiologic interventions for a variety of sports-related foot and ankle conditions have become more readily available, results are beginning to appear in the literature. The notion that we can affect the biology of the musculoskeletal tissues with these treatments and trigger a healing response is generally accepted. What conditions can be affected, how these orthobiologics are delivered, the mechanism of action,…