Endurance Sports Medicine: A Clinical Guide

Contents
Contributors
Part I: Medical Conditions
	1: Taking a Holistic Approach to Treating Endurance Athletes
		Introduction
		Behavioral Health
		Nutrition
		Compression Garments
		Hydrotherapy
		Acupuncture
		Dry Needling
		Iontophoresis
		Ultrasound
		Kinesiology Tape
		Blood Flow Restriction
		Conclusion
		References
	2: Cardiovascular Evaluation and Treatment in the Endurance Athlete
		Introduction
		Pre-Participation Cardiovascular Screening
			History and Physical Examination
			Masters Athletes
			Young Athletes
			Dose
		Exercise-Induced Cardiac Remodeling
			Overview of Exercise Physiology and the Cardiovascular System
			Remodeling of the Cardiac Chambers
			Aortic Adaptation
			Electrical Remodeling
			Demographic Impact on EICR
		Approach to Cardiovascular Symptoms
			Chest Pain
			Syncope
			Palpitations
		Approach to Athletes with Established Cardiovascular Disease
			Atherosclerotic Cardiovascular Disease (ASCVD)
			Atrial Fibrillation
			Hypertension
			COVID-19
		Conclusion
		References
	3: Exercise-Induced Bronchoconstriction and Vocal Cord Dysfunction
		Chapter
		Vocal Cord Dysfunction
		References
	4: Low Ferritin and Anemic Conditions in Endurance Athletes
		Introduction
		Clinical Presentation
		The Function of Iron
		Causes of Iron Deficiency
			Diet and Nutrition
			Iron Absorption
		Diagnostic Testing: Hematologic Markers
			Stages of Iron Deficiency
			Sports Anemia (Dilutional Anemia)
			Sources of Iron Loss in Athletes
		Intravascular Hemolysis
			Gastrointestinal
			Renal
			Metabolic Disturbances
			Genetics and Medications
		Extravascular Hemolysis
			Sweat
			Exercise
			Menses and Hypothalamic Dysfunction
			Dietary Needs and Treatment
			Iron Supplementation and Periodization
		Conclusion
		References
	5: Evaluation and Treatment of Exertional Heat Illness, Rhabdomyolysis, and Hyponatremia
		Exertional Heat Illness
			Introduction
			Epidemiology and Risk Factors
			Pathophysiology
			Diagnosis
			Treatment
			Return to Play
			Prevention
		Exercise-Associated Hyponatremia
			Introduction
			Epidemiology and Risk Factors
			Pathophysiology
			Diagnosis
			Treatment
			Return to Play
			Prevention
		Exertional Rhabdomyolysis
			Introduction
			Epidemiology and Risk Factors
			Pathophysiology
			Diagnosis
			Treatment
				Outpatient Treatment
				Inpatient Treatment
			Return to Play and Prevention
		References
	6: Evaluation and Treatment of Cold- and Altitude-Related Injuries and Illnesses
		Part 1: Cold-Related Injuries and Illnesses
			Hypothermia
			Hypothermia Diagnosis
			Hypothermia Treatment
			Hypothermia Prevention
			Frostbite
			Frostbite Treatment
			Chilblains
			Nonfreezing Cold Injury
			Raynaud’s
			Cold Agglutinin Syndrome
			Cold-Induced Urticaria
			Cold Effect on Chronic Medical Conditions
		Part 2: Altitude Medicine
			High-Altitude Physiology
			High-Altitude Pathophysiology
			High-Altitude Illness Risk Factors
			High-Altitude Illness: Acute Mountain Sickness
				Diagnosis
				Prevention
				Gradual Ascent
				Medication Prophylaxis
				Treatment
			High-Altitude Illness: High-Altitude Cerebral Edema
				Diagnosis
				Prevention
				Treatment
			High-Altitude Illness: High-Altitude Pulmonary Edema
				Diagnosis
				Prevention
				Treatment
			High-Altitude Pathology: High-Altitude De-Acclimation Syndrome
				Diagnosis
				Prevention and Treatment
		References
	7: Pregnancy and Other Considerations for the Female Endurance Athlete
		Introduction
		The Menstrual Cycle and the Endurance Athlete
		Female Athlete Triad/RED-S and Long-Term Health/Contraception Issues
			Pathogenesis
			Investigations
			Management
		Pregnancy and the Endurance Athlete
			Physiological Adaptations to Pregnancy
				Cardiorespiratory Adaptations
				Metabolic Adaptations
				Thermoregulation
			Effects of Endurance Exercise on Maternal and Fetal Health
			Guidelines for Exercise during Pregnancy (See Fig. 7.1 [67])
			Considerations for Pregnant Endurance Athletes
		Postpartum and the Endurance Athlete
			Physiological Adaptations
			Considerations for the Postpartum Endurance Athlete
		Menopause and Exercise in the Masters Athlete
			Bone Health
			Cardiorespiratory Health
			Menopausal Symptoms
		Summary
		References
	8: Considerations for Treating the Pediatric Endurance Athlete
		Introduction
		Recommendations for Youth Participation in Running as a Sport
		Potential Health Concerns Related to Endurance Training
			Apophyseal Injuries
			Tendon Injuries
			Bone Stress Injury (BSI)
			Low Energy Availability in the Youth Runner
			Overtraining Syndrome
		Risk Factors for Running-Related Injuries
			Intrinsic Factors
				Growth-Related
				Age
				Female Gender
				Body Mass Index (BMI)
				Bone Health
				Alignment and Strength
				Prior Injury
			Extrinsic Factors
				Training Characteristics: Volume, Intensity, Terrain, and Footwear
				Biomechanical Factors: Cadence and Footstrike Mechanics
				Sports Specialization
		Injury Screening Tools and Preventative Strategies
		Conclusions
		References
	9: Effects of Exercise and Aging in the Masters-Level Athlete
		Performance Changes
		Cardiopulmonary Changes
		Musculoskeletal Changes
		Metabolic, Psychosocial, and Nutritional Impact
		Conclusions
		References
Part II: Musculoskeletal Conditions
	10: Biologic Advancements in the Treatment of Stress Fractures
		Introduction
		Pathophysiology and Risk Stratification
		Taking a Holistic Approach
		Biologic Healing Enhancement
		Conclusion
		References
	11: Orthobiologic Treatment Options for Injuries in Endurance Athletes
		Introduction
			What Are Orthobiologics?
			Platelet-Rich Plasma
			Advanced Autologous Cellular Therapy
		Bone Marrow Concentrate (BMC)
		Adipose
			Birth-Product Injectables
			Culture-Expanded Mesenchymal Stem Cells
		Orthobiologic Use in Lower Limb Pathologies
			Hamstring Pathology
			A Practical Clinical Perspective
			Technical Pearls for Optimizing Patient Experience and Clinical Outcomes
				Sterility
		Peri- and Post-Procedural Pain Control
			Joint Injections
			Tendon Injections
		Conclusion
		References
	12: Special Considerations for the Periodic Health Evaluation of Endurance Athletes
		Introduction to the PHE
		Start with Why PHE Design Strategy
		Choosing the Elements of the PHE
		Health History and Physical Examination
		Cardiovascular Screening
		Hematologic Screening
		Musculoskeletal Screening and Functional Evaluations
		The Role of Body Composition and Bone Density Measurement in the Endurance Athlete
		Putting it all Together
		References
	13: Chronic Leg Pain in Running Athletes
		Introduction
		Evaluation
		Medial Tibial Stress Syndrome
		Chronic Exertional Compartment Syndrome
		Popliteal Artery Entrapment Syndrome
		Stress Fractures
		Nerve Entrapments
		Conclusion
		References
	14: Hip Injuries and Conditions in the Endurance Athlete
		Introduction
		Anatomy
			Layer I
			Layer II
			Layer III
			Layer IV
		History
		Physical Examination
			Inspection
			Palpation
			Motion, Strength, and Special Testing
		Imaging Evaluation
		Differential Diagnosis Evaluation
		Treatment
		Conclusions
		References
	15: Common Injuries and Conditions in Rowers
		Introduction
		Rowing Stroke
		Back
		Lower Extremity
			Hip Impingement
			Knee
		Ribs and Upper Extremity
			Rib Stress Fracture
			Upper Extremity Deep Vein Thrombosis and Thoracic Outlet Syndrome
		Shoulder Instability and Dislocation
		Forearm Compartment Syndrome
		Intersection Syndrome
		Skin
		References
	16: Common Injuries and Conditions in Crossfit Participation
		Introduction
		Weightlifting
		Endurance
		Gymnastics
		Other
		Conclusion
		References
	17: Blood Flow Restriction and Other Innovations in Musculoskeletal Rehabilitation
		Introduction
		Blood Flow Restriction
			Mechanism
			Clinical Application
			Safety and Side Effects
			Conclusion
		Dry Needling
			Mechanism
			Clinical Application
			Safety and Side Effects
			Conclusion
		Cryotherapy
			Safety and Side Effects
			Conclusion
		Manual Therapy Techniques
			Foam Rolling
				Mechanism
				Clinical Application
				Side Effects and Safety
				Conclusion
			Percussive Massage
				Mechanism
				Clinical Application
				Safety and Side Effects
				Conclusion
			Instrument-Assisted Soft Tissue Mobilization
				Mechanism
				Clinical Application
				Side Effects and Safety
				Conclusion
			Muscle Energy Techniques
				Mechanism
				Clinical Application
				Safety and Side Effects
				Conclusion
			Active Release Technique
				Mechanism
				Clinical Application
				Safety and Side Effects
				Conclusion
		Cupping
			Mechanism
			Clinical Application
			Safety and Side Effects
			Conclusion
		References
Part III: Performance Optimization and Event Coverage
	18: Clinical Aspects of Running Gait Analysis
		Introduction
		Getting Started
		Patient Setup and Video Capture
		Analysis of the Recorded Video
			Sagittal Plane
				Initial Contact
					Foot Inclination Angle
					Horizontal Distance from Foot to COM
					Leg Inclination Angle
					Knee Flexion Angle
				Mid-Stance
					Peak Knee Flexion Angle
					Peak Ankle Dorsiflexion Angle
				Additional Sagittal Measures
					COM Vertical Excursion
					Hip Extension and Pelvic Tilt
					Forward Trunk Lean
			Frontal Plane
				Mid-Stance
					Trunk Side Bend
					Lateral Pelvic Drop
					Knee Center Position
					Base of Gait
					Rearfoot and Forefoot Position
					Other Variables
		Summary
		Appendix 1. Disclosure
		References
	19: Clinical Applications of Bike Fitting
		Introduction
		Anatomy of a Bike
		Pedal Cycle
		Common Clinical Presentations
			Neck Pain
			Back Pain
			Hip Pain
			Hand Numbness
			Perineal Symptoms
			Knee Pain
			Foot Pain and Numbness
		Setup for a Basic Bike Fit
			Helpful Tools and Equipment
			Saddle Positioning
			Foot and Cleat Alignment
			Hand Positioning and Handlebars
		Summary
		References
	20: Clinical Application of Swim Stroke Analysis
		Introduction
		The Four Competitive Strokes
		Freestyle Biomechanics
			Freestyle Upper Extremity Movement
			Freestyle Lower Extremity Movement
			Freestyle Stroke Mechanics
		Backstroke Biomechanics
			Backstroke Upper Extremity Movement
			Backstroke Lower Extremity Movement
			Backstroke Mechanics: General Notes
		Butterfly Biomechanics
			Butterfly Upper Extremity Movement
			Butterfly Lower Extremity Movement
			Butterfly Stroke Mechanics: General Notes
		Breaststroke Biomechanics
			Breaststroke Upper Extremity Movement
			Breaststroke Lower Extremity Movement
			Breaststroke Stroke Mechanics: General Notes
		Common Stroke Technique Errors
		Freestyle Errors
		Injury Prevalence and Incidence
		Performance Considerations
		The Pediatric Swimmer
		The Masters Swimmer
		Common Injuries and Rehabilitation
		Shoulder Injuries
		Shoulder Rehabilitation
		Knee Injuries
		Knee Rehabilitation.
		Spine Injuries
		Spine Rehabilitation
			Cervicothoracic
			Lumbar
		Hip Injuries
		Hip Rehabilitation
		Ankle Injuries
		Ankle Rehabilitation
		Breathing
		Breath Control/Pulmonary Function
		Mobility
		Elastic Therapeutic Taping
		Return to Sport Considerations
		Swimming Injury and Rehabilitation Conclusion
		Return to Swimming Protocol
		Training Considerations
			Equipment
		Coach/Teacher/Trainer Safety Awareness
		Efficacy of Dryland Strength Training
		Efficacy of Swim Training Regimen
		Training Effort and Communication with Coaches
		Injury Prevention
		Video Swim Stroke Analysis
		Feedback
		Injury Screening
		A Proposed Dynamic Warm-Up
		Appendix 1: Part 1—Dynamic Shoulder, Spine, Hip, Knee, and Ankle Warm-Up (all 2 × 15 reps) ([191]; Edelman 2015)
		Appendix 2: Part 2—Strength/Plyometric/Balance/Reaction Time Progression [191]
		Appendix 3: Part 3—Aquatic Swimming-Specific Drills ([191]; Edelman 2015)
		References
	21: High-Intensity Interval Training and Resistance Training for Endurance Athletes
		Physiological and Neuromuscular Determinants of Endurance Performance
		Training Principles and Periodization for Endurance Performance Enhancement
		Effects of HIT on Endurance Performance
		Considerations of HIT Programming
		Effects of Strength Training on Endurance Performance
		Considerations for Strength Training Programming
		References
	22: Mental Skills Training for Endurance Sports
		Introduction
			Motivation
			Goal Setting
			Energy Management
			Self-Talk
			Concentration
			Imagery
			Performance Routines
			Mindfulness
			Balanced Exercise
			Medication Considerations
		Conclusion
		References
	23: Performance-Based Nutrition for Endurance Training
		Introduction
		Carbohydrate
			Pre-Competition: “Loading”
			During Competition: “Fueling”
			Post-Competition: “Repleting”
		Protein
			Pre- and during Exercise Protein
			Post-Exercise Protein
		Fat
		Hydration
		Micronutrients, Electrolytes, and Dietary Supplements/Ergogenic Aids
			Sodium
			Caffeine
			Nitrates
			Iron
			Environmental Considerations
		Conclusion
		References
	24: Coordination of Medical Coverage for Endurance Sporting Events
		Overview
		Coordination
		Weather
		Staffing
		Equipment and Medications
		Communications and Medical Records
		Illness
		Unique Event Considerations
			Event Types
			Remote Settings
		Infection Control: COVID-19 Pandemic Considerations
		Summary
		References
	25: Return to Sport Decision-Making for Endurance Athletes
		Return to Play Versus Return to Sport Versus Return to Performance
			Return to Participation
			Return to Sport
			Return to Performance
		Team Approach and Empowering the Athlete
		Psychological Aspects
			Step 1: Assessment of Health Risk (Tissue Health)
			Step 2. Assessment of Activity Risk (Tissue Stresses)
			Step 3: Assessment of Risk Tolerance (Acceptable Risk)
		References
Index