Pelvic stress fractures in long distance runners

We describe five cases of radiographically proven stress fracture of the pubic ramus in serious runners, three of whom were elite female marathoners. In a further two cases in which radiography failed to support the clinical diagnosis, there was bone scintigraphic evidence of stress fracture. Another five cases had the identical clinical presentation, but the diagnosis was not confirmed radiologically and bone scanning was not performed. Most patients experienced persistent groin discomfort during any activity for the first 4 weeks after injury, but all recovered completely after 8 to 12 weeks of rest, in particular, avoidance of running. In common with other studies, we found that the injury occurred in competitive runners, especially females, and was likely to develop during competitive races or intensive training sessions. We suggest that a diagnosis of pelvic stress fracture or stress fracture syndrome can be made with confidence, even in the absence of radiographic evidence, if the following three features are present in a long distance runner presenting with groin pain: First, activity causes such severe discomfort in the groin that running is impossible. Second, the athlete develops discomfort in the groin when standing unsupported on the leg corresponding to the injured side (positive standing test). In some cases the pain is so severe that standing on one leg is impossible. Third, deep palpation reveals extreme, exquisite nauseating tenderness localized to the pubic ramus and not to the overlying soft tissues. The diagnosis can be confirmed by bone scintigraphy where such facilities exist.     

Continuous glucose monitoring in diabetic long distance runners

Marathon running is growing in popularity, and many diabetic patients are participating in various marathon races all over the world each year. This study aimed to investigate the prevalence and extent of glycemic excursions (hypo- and hyperglycemic) during a marathon run in patients with well-controlled diabetes mellitus using a continuous glucose monitoring system (CGMS). Five subjects with type 1 and one patient with type 2 diabetes mellitus were monitored with the Medtronic MiniMed CGMS during the 2002 Vienna City Marathon (n = 3) or the "Fernw?rme run" (n = 3) long distance runs of 42.19/15.8 km. All six patients finished their course. The CGSM system was well tolerated in all patients over an average duration of 34 +/- 4.0 hours and it did not limit the patients' activities. The mean running time for the Vienna city marathon was 257 +/- 8 min (247 to 274 min) and for the Fernw?rme run 134 +/- 118 min (113 to 150 min). A total of 1470 blood glucose measurements (mean 245 readings per subject) were performed. During and after the marathons frequent hypo- and hyperglycemic episodes with and without clinical symptoms were measured. Our data confirm that the CGMS may help to identify asymptomatic hypoglycemia or hyperglycemia during and after a long distance run. The system may also be helpful to improve our understanding about the individual changes of glucose during and after a marathon and may protect hypoglycemic or hyperglycemic periods in future races.     

Illness behaviour in elite middle and long distance runners

OBJECTIVES: To examine the illness attitudes and beliefs known to be associated with abnormal illness behaviour (where symptoms are present in excess of objective signs and pathology) in elite middle and long distance runners, in comparison with non-athlete controls. METHODS: A total of 150 athletes were surveyed using the illness behaviour questionnaire as an instrument to explore the psychological attributes associated with abnormal illness behaviour. Subjects also completed the general health questionnaire as a measure of psychiatric morbidity. A control group of 150 subjects, matched for age, sex, and social class, were surveyed using the same instruments. RESULTS: A multivariate analysis of illness behaviour questionnaire responses showed that the athletes' group differed significantly from the control group (Hotelling's T: Exact F = 2.68; p = 0.01). In particular, athletes were more somatically focused (difference between means -0.27; 95% confidence interval -0.50 to -0.03) and more likely to deny the impact of stresses in their life (difference between means 0.78; 95% confidence interval 0.31 to 1.25). Athletes were also higher scorers on the Whiteley Index of Hypochondriasis (difference between means 0.76; 95% confidence interval 0.04 to 1.48). There were no differences in the levels of psychiatric morbidity between the two groups. CONCLUSIONS: The illness attitudes and beliefs of athletes differ from those of a well matched control population. The origin of these psychological attributes is not clear but those who treat athletes need to be aware of them.     

The use of laboratory test results with long distance runners

Appropriate tests can be used to accurately estimate: an individual's potential for success in long distance running; his current level of conditioning; his appropriate training and racing paces; and his ideal bodyweight. The proposed tests include the study of VO2max, running efficiency, maximal steady-state, and body composition. Based on a review of the literature it was determined that VO2max, running efficiency, and body composition provide the information about long distance running potential, including specific paces for various events. Maximal steady-state running pace (pace that elicits 2 mmol/L lactate) identifies appropriate running paces for various events. Relative maximal steady-state oxygen consumption (% VO2max) identifies the current level of conditioning. A comparison of maximal steady-state, running efficiency, and body composition by assessing current status with optimums, provide guidelines for appropriate changes.     

The self selected speed of running in recreational long distance runners.

The aim of this study was to test the hypothesis that the self selected speed in running (vss) is dependent upon the same factors that determine maximal speed in endurance events (e. g. the anaerobic threshold). Experiments were carried out on 8 recreational long distance runners (42.1 +/- 8.6 years of age, 70.1 +/- 10.6 kg of body mass, 1.74 +/- 0.06 m of body height) while they were participating in a 14 day relay race. During the "race" the subjects were not requested to perform maximally but only to cover their running turn (1 hour per day) at their preferred pace. The relationships between heart rate (HR), perceived exertion (RPE), blood lactate concentration ([La]b) and speed (v) were determined in each subject, before the race, during an incremental running test. From these relationships the speed corresponding to a 4 mM concentration of lactate in blood (v4mM) was calculated and found to be 14.3 +/- 1.8 km x h(-1) (n = 8). At this speed the RPE and HR values were 13.6 +/- 1.4 and 156.4 +/- 12.8 bpm, respectively. The average values of speed (vss, 13.4 +/- 0.6 km x h(-1)), RPE (13.5 +/- 1.4) and HR (154.4 +/- 7.6 bpm) measured during the race (n = 47) were not significantly different from those measured at the lactate threshold (v4mM, RPE4mM and v4mM). However, vss and the average HR during the race showed significantly lower variances than v4mM and HR4mM suggesting that, besides the need of avoiding lactate accumulation in blood, other factors must be involved in the choice of speed in running.     

The angiotensin converting enzyme I/D polymorphism in long distance runners

AIM: There is an assumption that ACE I/D polymorphism represents one of the possible genetic factors that might be associated with sports excellence. Recent studies have identified an increased frequency of I allele in elite endurance athletes, long distance runners, rowers and mountaineers. The aim of this study was to test the hypothesis that the ACE I/D polymorphism is associated with enhanced endurance performance. METHODS: We examined this hypothesis by determining ACE I/D allele frequency in 215 marathon runners, 222 half-marathon runners and 18 inline skaters classified by performance (marathon competition results). ACE genotype and allele frequencies were compared with 252 healthy controls. RESULTS: ACE genotype frequency in the whole cohort did not differ from that in the sedentary controls (P < 0.56). However, there was an increase of the I/I genotype incidence amongst successful marathon runners scoring on places from 1st to 150th (P < 0.01). These findings were confirmed in the group of inline skaters, similarly demonstrating an increase of the I/I genotype (P < 0.01). There was no association found between half marathon runners and the ACE genotype (P < 0.59). CONCLUSIONS: An excess of the I allele in long distance runners confirms the association between the ACE I/D polymorphism and endurance sports performance.     

Biofeedback and relaxation techniques improves running economy in sub-elite long distance runners.

PURPOSE: The purpose of this investigation was to determine whether a psychophysiological intervention of biofeedback and relaxation could decrease the submaximal oxygen consumption (VO2submax) during treadmill running and improve running economy for a group of trained long distance runners. METHODS: Before and after a 6-wk control phase, seven long distance runners were tested for running economy, peak oxygen consumption (VO2peak), peak running velocity, and stretch-shortening cycle efficiency. These runners then participated in a 6-wk training program in which they learned and practiced relaxation techniques and ran on the treadmill at a velocity eliciting 70% of peak running velocity for 10 min while biofeedback of heart rate (HR), ventilation (VE), and VO2 was presented to them. RESULTS: Data indicated that participants were able to lower their VO2, HR, and VE at lactate threshold by 7.3%, 2.5%, and 9.2%, respectively, using relaxation techniques (P<0.05). Post-tests of lactate threshold, VO2peak, peak running velocity, and stretch-shortening cycle efficiency showed that these changes did not occur as a result of a training effect. CONCLUSION: It was concluded that the improvements in running economy occurred as a result of the psychophysiological intervention.     

Abdominal pain in long distance runners: case report and analysis of the literature

Abdominal pain is a common complaint among participants in endurance sports. It may be severe, recurrent, and resistant to treatment. There is no direct evidence of the cause of this phenomenon. This report is of a long distance runner who had severe pain in the upper right abdominal quadrant during strenuous exertion. The symptom had been present for several years and did not respond to conservative treatment. Laparoscopy showed congenital supernumerary ligaments binding the gallbladder to the abdominal wall. The complaint resolved after cholecystectomy and resection of adhesions. There was evidence of chronic cholecystitis on histopathological examination. Two years after the operation, he remains free of symptoms. The differential diagnosis of abdominal pain in athletes is discussed.     

Soundmyogram analysis during sustained maximal voluntary contraction in sprinters and long distance runners.

The aim of this study was to describe the influence of the different fiber type composition of the vastus lateralis muscle on the soundmyogram (SMG) time and frequency domain characteristics. The SMG was recorded from the vastus lateralis belly during exhausting maximal voluntary contraction (MVC) of the leg extensors in 7 sprinters (SPR) and 7 long distance runners (LDR). Seven sedentary males (SED) were investigated in the same experimental conditions. In the SPR the effort time was shorter and the MVC was greater while the SMG root mean square and the SMG frequency content, at the onset of contraction, were higher than in the SED and LDR, respectively. Throughout exertion the SMG RMS showed clear reduction for SPR and SED only and the SMG power spectra presented a compression towards the lower frequencies. The reported phenomena were less pronounced in the LDR than in SPR and SED. These results can be explained when the differences in the % of fast twitch fibers area, belonging to stronger and more fatiguing F motor units, in the three groups of subjects are considered and suggest that SMG characteristics reflect the muscle fiber typing.     

Effect of music on short-term maximal performance: sprinters vs. long distance runners

Sport Sciences for Health - We aimed to examine the effect of listening to music during a warm-up on the subsequent Wingate test performance, rating of perceived exertion (RPE) and mood in...     

Blood lipids in young distance runners

PURPOSE: The purpose of this study was to examine the age-and sex-associated variation in blood lipids among young athletes. METHODS: A mixed-longitudinal design was used to examine the development of blood lipids in competitive young distance runners followed from 1982 to 1985. Serial data included 99 annual measurements for 27 male subjects and 84 annual measurements for 27 female subjects aged 9-18 yr. Total cholesterol (TC), high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C), and triglycerides (TG) were determined by standard procedures. RESULTS: In general, cross-sectional age group means showed that TC and LDL-C remained stable and HDL-C declined with age, especially in male subjects. TG increased with age. Age-related trends were statistically significant for HDL-C and TG in boys only (P < 0.05). TC and LDL-C were slightly greater in boys at all ages except 11, 15, and 17 yr (P > 0.05). HDL-C was similar between the sexes until 13 yr when values became greater in girls (3.2-13.8 mg.dL(-1)) (P < 0.05 in 17+ yr). No clear pattern of sex differences emerged for TG. Compared with the general population, blood lipids of young distance runners showed the following trends: 1) TC was above reference medians, 2) LDL-C tended to approximate or to be slightly above reference medians, 3) TG fluctuated about the reference medians, and 4) HDL-C was higher in distance runners compared to the reference medians before age 14 yr, but in the older age groups, especially male subjects, HDL-C either approximated or fell slightly below the reference medians. There was considerable variability in blood lipid levels among the runners. In 21 male and 18 female subjects with serial data for 3-5 yr, HDL-C declined 22.4 and 18.3 mg.dL(-1) (P < 0.05), whereas TG increased 18.0 and 14.0 mg.dL(-1)(P < 0.05 in female subjects only) in male and female subjects, respectively. Tracking coefficients over intervals of 3-5 yr were moderate to high (0.48-0.90), except for TG in male subjects (0.08). CONCLUSIONS: The results indicate that the development of blood lipids in young distance runners is similar to youth in the general population. In contrast to observations in adult endurance athletes, young distance runners did not possess a superior blood lipid profile except for HDL-C in the younger age groups.     

Iliotibial band syndrome in distance runners

Iliotibial band syndrome was diagnosed in 48 of 1030 runners treated for lower extremity musculoskeletal complaints. Most athletes had been running 20 to 40 miles a week for one year or longer and had significantly changed their distance, speed, terrain, surface, and/or shoes before the onset of symptoms. Symptoms often persisted for 2 to 6 months. All runners were treated conservatively with rest, stretching, reduced distance, anti-inflammatory medications, local cortisone injections and/or orthoses.     

Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review

The purpose of this study was to present a systematic overview of published reports on the incidence and associated potential risk factors of lower extremity running injuries in long distance runners. An electronic database search was conducted using the PubMed-Medline database. Two observers independently assessed the quality of the studies and a best evidence synthesis was used to summarise the results. The incidence of lower extremity running injuries ranged from 19.4% to 79.3%. The predominant site of these injuries was the knee. There was strong evidence that a long training distance per week in male runners and a history of previous injuries were risk factors for injuries, and that an increase in training distance per week was a protective factor for knee injuries.     

Reduced training maintains performance in distance runners

This investigation examined endurance runners during a 3-week reduction in training volume and frequency. Ten well-conditioned runners were monitored for 4 weeks while training at their normal weekly training distance (mean +/- SE) (81 +/- 5 km/week, 6 days/week). This period was designated as baseline training (BT). Sixty km/week were run at approximately 75% VO2max, and the remainder (21 km/week) at approximately 95% VO2max in the form of intervals and races. The runners then reduced weekly training volume (RT) by 70% of BT to 24 +/- 2 km/week and frequency by 17% to 5 days/week for 3 weeks. During RT 17 km/week was performed at approximately 75% VO2max and the remainder (7 km/week) at approximately 95% VO2max (intervals and races). The runners were tested weekly and performed 5-km races on a 200-m indoor track during Bt and after 2 and 3 weeks of RT. Maximal heart rate (HR) increased (P less than 0.05) by approximately 4 beats/min at RT week 3, which may have been associated with a decrease in estimated plasma volume (P less than 0.01) of 5.62 +/- 0.43%. Time to exhaustion during the VO2max tests increased (P less than 0.05) by 9.5% at RT week 3. No significant (P greater than 0.05) changes occurred with RT in body weight, % body fat, overall 5 km race times, VO2max, muscular power (vertical leap and Margaria power test), and citrate synthase activity (at 2 weeks of RT). No alterations in venous lactate, energy expenditure, and HR were observed during submaximal running at two speeds (approximately 65% and 85% VO2max) with RT.(ABSTRACT TRUNCATED AT 250 WORDS)     

Variability of competitive performance of distance runners

PURPOSE: The typical variation in an athlete's performance from race to race sets a benchmark for assessing the utility of performance tests and the magnitude of factors affecting medal prospects. We report here the typical variation in competitive performance of endurance runners. METHODS: Repeated-measures analysis of log-transformed official race times provided the typical within-athlete variation in performance as coefficients of variation (CV). The types of race were cross-country runs (4 races over 9 wk), summer road runs (5 races over 4 wk), winter road runs (4 races over 9 wk), half marathons (3 races over 13 wk and 2 races over 22 wk), and marathons (2 races over 22 wk). RESULTS: Typical variation of times for the fastest quartile of male runners was 1.2-1.9% in the cross-country and road runs, 2.7% and 4.2% in half marathons, and 2.6% in marathons. Times for the slower half of runners in most events were more variable than those of the faster half (ratio of slower/faster CV, 1.0-2.3). Times of younger adult runners were more variable than times of older runners (ratio of younger/older CV, 1.1-1.8). Times of male runners were generally more variable than those of female runners (ratio of male/female CV, 0.9-1.7). CONCLUSION: Tests of endurance power suitable for assessing the smallest worthwhile changes in running performance for top runners need CV < or = 2.5% and < or = 1.5% for tests simulating half or full marathons and shorter running races, respectively. Most of the differences in variability of race times between types of race, ability groups, age groups, and sexes probably arise from differences in competitive experience and attitude toward competing.     

Training intensity of elite male distance runners

To quantify training intensity in 13 nationally ranked male distance runners, training heart rates, environmental factors, and motivational factors were recorded throughout a 6-8 wk period of normal training. Variation in motivational and environmental factors such as intended effort, terrain, and running with companions altered training session mean heart rates by up to 4.min-1 (standard deviation). Heart rates and blood lactate concentrations, recorded in a series of steady-state treadmill runs, were used to convert training session mean heart rates to mean training speeds (TS) and to derive a measure of the anaerobic threshold (AT, the treadmill speed at a blood lactate concentration of 4 mmol.l-1). TS (15.6 +/- 1.4 km.h-1, mean +/- SD) was considerably lower than AT (20.2 +/- 1.1 km.h-1) in all subjects (P less than 0.001). Relative TS (TS expressed as a fraction of AT) differed significantly (P less than 0.001) between subjects and correlated significantly with the distance of the event for which the subject was training (r = 0.59, P less than 0.05). Relative TS may therefore be determined by the subject's or coach's perception of the appropriate intensity for the event. If the AT is the optimum training intensity, these subjects have considerable scope for improvement.     

Fecal bile acid concentration in distance runners.

Fecal bile acid concentration, fecal characteristics, bowel habits and habitual food intake were measured in male distance runners (n = 14) and sedentary men (n = 14). Fecal bile acid concentration was significantly (p less than 0.05) lower and stool weight, frequency of defecation and daily intake of fibre, carbohydrate, and protein were significantly (p less than 0.01) higher in the runners. After adjustment for differences in dietary fibre intake, fecal bile acid concentration was no longer significantly different between the distance runners and the sedentary men, but frequency of defecation remained significantly (p less than 0.05) higher in the runners. This study has identified lower fecal bile acid concentration in distance runners, which was probably due mainly to dilution of colon contents by higher consumption of dietary fibre. These findings may be relevant to the reduced incidence of colon cancer in physically active subjects.