Pertinent Pearls On Treating Overuse Injuries In Endurance Athletes

By Kirk M. Herring, DPM, MS

Overuse injuries represent the single largest classification of sports-related injuries that require medical attention. All too often, athletes report these injuries to the sports medicine specialist after weeks, if not months, of denial and failed self-treatment. However, with the recent advances in medicine today, injured athletes can recover from injuries that otherwise could end their athletic pursuits. Endurance athletes, especially runners and cyclists, traditionally have a high risk of lower back, hip and lower extremity overuse injury.1-5 During the running boom of the ‘70s and ‘80s, considerable attention and interest were directed to the diagnosis, treatment, classification and causative factors associated with overuse injuries. As the running boom ran its course, interest within the public and general medical community, including podiatry, waned. However, there is a building resurgence of interest. Long-distance running, cycling, swimming and other endurance sports are capturing the attention of the endurance athlete community. Some athletes are attracted to endurance activities as a means to expand their aerobic activities. Some pursue these activities to stay fit and healthy. Others look to endurance activities for cross training to help reduce stress on an aging musculoskeletal system while some have a primal urge to reach new physical limits. Whatever the case, these athletes will, in increasing numbers, develop a wide array of overuse injuries. When these injuries occur, the athletes will turn to the medical community, including podiatrists, for diagnosis and treatment of these injuries, as well as training, biomechanics and equipment recommendations including shoes, pedals, cycling cleats, etc. As was the case with the running boom, podiatry could find itself a key healthcare partner for these athletes. Who are these new-age endurance athletes? Men, women and even youths have become swept up by the challenge to complete a variety of endurance events and adventure races. Most remain close to home and typically focus on local and regional triathlons and duathlons. As athletes gain confidence and experience, they set their sights on larger, more prestigious and even more rigorous events such as an Ironman, Race Across America (RAAM), Badwater or even Primal Quest. Driving this growth are mid-life adults, who are seeking to maintain an active lifestyle in the face of advancing years. However, they often bring to their new athletic pursuits old dominant musculoskeletal injuries hidden during years of relative inactivity. These old and dormant injuries are frequently aggravated by the demands of a rigorous training and/or racing schedule, and frequently intermingle with new overuse injuries. Nicholas DiNubile, MD, has described these injuries collectively as “boomeritis,” an endearing term that clearly defines a generation of aging athletes. Can We Effectively Prevent Overuse Injuries? The exacting etiology of overuse injuries is often shrouded in uncertainty.6 Many have categorized the factors contributing to overuse injuries among endurance athletes with training errors, anatomical/biomechanical factors and equipment failures representing the most frequently cited circumstances associated with overuse injury. The existence of malicious malalignment continues to dominate our suspicions and is frequently described as a cornerstone to overuse injury. However, many more factors play into the development of overuse injuries.7 Contributing factors can be generalized as either intrinsic or extrinsic in nature. One would typically identify these factors via the patient history and physical examination (see “Which Factors May Contribute To Overuse Injuries?” below). The implications for podiatric medicine are to “stay the course” or assume an expanded leadership role in the care of endurance athletes. To accomplish this, podiatric medicine must: pursue randomized investigational/experimental research; reevaluate and revise treatment protocols and recommendations; provide recommendations and preventive measures to the endurance athlete community; strengthen peer education opportunities; promote public awareness; and carefully listen to our patients. Medicine has generally been problem-oriented in its focus on patient care and management. However, we need to help instill preventive behavior within our endurance athletes/patients.

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