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Return to Sport Decision-Making for Endurance Athletes

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Endurance Sports Medicine

Abstract

Injury and illness affect all endurance athletes at some point during their careers. The challenge in treating the athlete is not always the diagnosis or initial treatment but instead in returning the athlete to competition. Rarely does an injury or illness involve one body part or system. For example, tendinitis may be most apparent at the site of tendon injury. However, the secondary effects include a reduced aerobic capacity due to the inability to maintain the same training load and an alteration in caloric expenditure for which the athlete’s diet must be adjusted. Neglecting the full extent of an injury can result in a delay in the athlete’s return to racing or adversely affect performance. Guiding an athlete in their successful return to sport often requires a multidisciplinary care team to recognize and address the various consequences of an injury.

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References

  1. Neufer PD. The effect of detraining and reduced training on the physiological adaptations to aerobic exercise training. Sports Med. 1989;8(5):302–20.

    Article  CAS  PubMed  Google Scholar 

  2. Noehren B, Sanchez Z, Cunningham T, McKeon PO. The effect of pain on hip and knee kinematics during running in females with chronic patellofemoral pain. Gait Posture. 2012;36(3):596–9.

    Article  PubMed  Google Scholar 

  3. Souza RB, Powers CM. Differences in hip kinematics, muscle strength, and muscle activation between subjects with and without patellofemoral pain. J Orthop Sports Phys Ther. 2009;39(1):12–9.

    Article  PubMed  Google Scholar 

  4. Dierks TA, Manal KT, Hamill J, Davis I. Lower extremity kinematics in runners with patellofemoral pain during a prolonged run. Med Sci Sports Exerc. 2011;43(4):693–700.

    Article  PubMed  Google Scholar 

  5. Dierks TA, Manal KT, Hamill J, Davis IS. Proximal and distal influences on hip and knee kinematics in runners with patellofemoral pain during a prolonged run. J Orthop Sports Phys Ther. 2008;38(8):448–56.

    Article  PubMed  Google Scholar 

  6. Heiderscheit BC, Chumanov ES, Michalski MP, Wille CM, Ryan MB. Effects of step rate manipulation on joint mechanics during running. Med Sci Sports Exerc. 2011;43(2):296–302.

    Article  PubMed  PubMed Central  Google Scholar 

  7. van Gent RN, Siem D, van Middelkoop M, van Os AG, Bierma-Zeinstra SM, Koes BW. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med. 2007;41(8):469–80. discussion 80.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Hall JP, Barton C, Jones PR, Morrissey D. The biomechanical differences between barefoot and shod distance running: a systematic review and preliminary meta-analysis. Sports Med. 2013;43(12):1335–53.

    Article  PubMed  Google Scholar 

  9. Davis IS. The re-emergence of the minimal running shoe. J Orthop Sports Phys Ther. 2014;44(10):775–84.

    Article  PubMed  Google Scholar 

  10. Milgrom C, Giladi M, Kashtan H, Simkin A, Chisin R, Margulies J, et al. A prospective study of the effect of a shock-absorbing orthotic device on the incidence of stress fractures in military recruits. Foot Ankle. 1985;6(2):101–4.

    Article  CAS  PubMed  Google Scholar 

  11. Silberman MR, Webner D, Collina S, Shiple BJ. Road bicycle fit. Clin J Sport Med. 2005;15(4):271–6.

    Article  PubMed  Google Scholar 

  12. Dahlquist M, Leisz MC, Finkelstein M. The club-level road cyclist: injury, pain, and performance. Clin J Sport Med. 2015;25(2):88–94.

    Article  PubMed  Google Scholar 

  13. Asplund C, St Pierre P. Knee pain and bicycling: fitting concepts for clinicians. Phys Sportsmed. 2004;32(4):23–30.

    Article  PubMed  Google Scholar 

  14. Evershed J, Burkett B, Mellifont R. Musculoskeletal screening to detect asymmetry in swimming. Phys Ther Sport. 2014;15(1):33–8.

    Article  PubMed  Google Scholar 

  15. Roy JS, Moffet H, McFadyen BJ. Upper limb motor strategies in persons with and without shoulder impingement syndrome across different speeds of movement. Clin Biomech (Bristol, Avon). 2008;23(10):1227–36.

    Article  Google Scholar 

  16. Richardson AB, Jobe FW, Collins HR. The shoulder in competitive swimming. Am J Sports Med. 1980;8(3):159–63.

    Article  CAS  PubMed  Google Scholar 

  17. Scovazzo ML, Browne A, Pink M, Jobe FW, Kerrigan J. The painful shoulder during freestyle swimming. An electromyographic cinematographic analysis of twelve muscles. Am J Sports Med. 1991;19(6):577–82.

    Article  CAS  PubMed  Google Scholar 

  18. Stocker D, Pink M, Jobe FW. Comparison of shoulder injury in collegiate- and master’s-level swimmers. Clin J Sport Med. 1995;5(1):4–8.

    Article  CAS  PubMed  Google Scholar 

  19. Yanai T, Hay JG, Miller GF. Shoulder impingement in front-crawl swimming: I. A method to identify impingement. Med Sci Sports Exerc. 2000;32(1):21–9.

    Article  CAS  PubMed  Google Scholar 

  20. Virag B, Hibberd EE, Oyama S, Padua DA, Myers JB. Prevalence of freestyle biomechanical errors in elite competitive swimmers. Sports Health. 2014;6(3):218–24.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Morris FL, Smith RM, Payne WR, Galloway MA, Wark JD. Compressive and shear force generated in the lumbar spine of female rowers. Int J Sports Med. 2000;21(7):518–23.

    Article  CAS  PubMed  Google Scholar 

  22. Smoljanovic T, Bojanic I, Hannafin JA, Hren D, Delimar D, Pecina M. Traumatic and overuse injuries among international elite junior rowers. Am J Sports Med. 2009;37(6):1193–9.

    Article  PubMed  Google Scholar 

  23. Hosea TM, Hannafin JA. Rowing injuries. Sports Health. 2012;4(3):236–45.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Wilson F, Gissane C, Gormley J, Simms C. A 12-month prospective cohort study of injury in international rowers. Br J Sports Med. 2010;44(3):207–14.

    Article  CAS  PubMed  Google Scholar 

  25. Wilson F, Gissane C, McGregor A. Ergometer training volume and previous injury predict back pain in rowing; strategies for injury prevention and rehabilitation. Br J Sports Med. 2014;48(21):1534–7.

    Article  PubMed  Google Scholar 

  26. Jacobs SJ, Berson BL. Injuries to runners: a study of entrants to a 10,000 meter race. Am J Sports Med. 1986;14(2):151–5.

    Article  CAS  PubMed  Google Scholar 

  27. Korpelainen R, Orava S, Karpakka J, Siira P, Hulkko A. Risk factors for recurrent stress fractures in athletes. Am J Sports Med. 2001;29(3):304–10.

    CAS  PubMed  Google Scholar 

  28. Egermann M, Brocai D, Lill CA, Schmitt H. Analysis of injuries in long-distance triathletes. Int J Sports Med. 2003;24(4):271–6.

    Article  CAS  PubMed  Google Scholar 

  29. Nielsen RO, Buist I, Sorensen H, Lind M, Rasmussen S. Training errors and running related injuries: a systematic review. Int J Sports Phys Ther. 2012;7(1):58–75.

    PubMed  PubMed Central  Google Scholar 

  30. Ristolainen L, Kettunen JA, Waller B, Heinonen A, Kujala UM. Training-related risk factors in the etiology of overuse injuries in endurance sports. J Sports Med Phys Fitness. 2014;54(1):78–87.

    CAS  PubMed  Google Scholar 

  31. Wilmore J, Costill DL. Physiology of Sport and Exercise. 3rd ed. Champaign, IL: Human Kinetics; 2004.

    Google Scholar 

  32. Zaryski C, Smith DJ. Training principles and issues for ultra-endurance athletes. Curr Sports Med Rep. 2005;4(3):165–70.

    Article  PubMed  Google Scholar 

  33. McGregor SJ. Periodization. In: Freil J, Vance J, editor. Champaign, Triathlon Science, IL: Human Kinetics; 2013. p. 311–25.

    Google Scholar 

  34. Fleck SJ. Body composition of elite American athletes. Am J Sports Med. 1983;11(6):398–403.

    Article  CAS  PubMed  Google Scholar 

  35. Legaz Arrese A, Gonzalez Badillo JJ, Serrano OE. Differences in skinfold thicknesses and fat distribution among top-class runners. J Sports Med Phys Fitness. 2005;45(4):512–7.

    CAS  PubMed  Google Scholar 

  36. Halson SL, Jeukendrup AE. Does overtraining exist? An analysis of overreaching and overtraining research. Sports Med. 2004;34(14):967–81.

    Article  PubMed  Google Scholar 

  37. Ivkovic A, Franic M, Bojanic I, Pecina M. Overuse injuries in female athletes. Croat Med J. 2007;48(6):767–78.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Cosca DD, Navazio F. Common problems in endurance athletes. Am Fam Physician. 2007;76(2):237–44.

    PubMed  Google Scholar 

  39. Hinton PS. Iron and the endurance athlete. Appl Physiol Nutr Metab. 2014;39(9):1012–8.

    Article  CAS  PubMed  Google Scholar 

  40. Loucks AB, Kiens B, Wright HH. Energy availability in athletes. J Sports Sci. 2011;29 Suppl 1:S7–15.

    Article  PubMed  Google Scholar 

  41. Loucks AB. Low energy availability in the marathon and other endurance sports. Sports Med. 2007;37(4-5):348–52.

    Article  PubMed  Google Scholar 

  42. De Souza MJ, Nattiv A, Joy E, Misra M, Williams NI, Mallinson RJ, et al. 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad: 1st International Conference held in San Francisco, California, May 2012 and 2nd International Conference held in Indianapolis, Indiana, May 2013. Br J Sports Med. 2014;48(4):289.

    Article  PubMed  Google Scholar 

  43. American Dietetic A. Dietitians of C, American College of Sports M, Rodriguez NR, Di Marco NM, Langley S. American College of Sports Medicine position stand. Nutrition and athletic performance. Med Sci Sports Exerc. 2009;41(3):709–31.

    Article  Google Scholar 

  44. Reilly T, Waterhouse J, Edwards B. Jet lag and air travel: implications for performance. Clin Sports Med. 2005;24(2):367–80. xii.

    Article  PubMed  Google Scholar 

  45. Pink MM, Tibone JE. The painful shoulder in the swimming athlete. Orthop Clin North Am. 2000;31(2):247–61.

    Article  CAS  PubMed  Google Scholar 

  46. Mujika I, Padilla S. Detraining: loss of training-induced physiological and performance adaptations. Part I: Short term insufficient training stimulus. Sports Med. 2000;30(2):79–87.

    Article  CAS  PubMed  Google Scholar 

  47. Mujika I, Padilla S. Detraining: loss of training-induced physiological and performance adaptations. Part II: Long term insufficient training stimulus. Sports Med. 2000;30(3):145–54.

    Article  CAS  PubMed  Google Scholar 

  48. Marles A, Legrand R, Blondel N, Mucci P, Betbeder D, Prieur F. Effect of high-intensity interval training and detraining on extra VO2 and on the VO2 slow component. Eur J Appl Physiol. 2007;99(6):633–40.

    Article  CAS  PubMed  Google Scholar 

  49. Hickson RC, Kanakis Jr C, Davis JR, Moore AM, Rich S. Reduced training duration effects on aerobic power, endurance, and cardiac growth. J Appl Physiol Respir Environ Exerc Physiol. 1982;53(1):225–9.

    CAS  PubMed  Google Scholar 

  50. Hickson RC, Foster C, Pollock ML, Galassi TM, Rich S. Reduced training intensities and loss of aerobic power, endurance, and cardiac growth. J Appl Physiol. 1985;58(2):492–9.

    CAS  PubMed  Google Scholar 

  51. Neary JP, Bhambhani YN, McKenzie DC. Effects of different stepwise reduction taper protocols on cycling performance. Can J Appl Physiol. 2003;28(4):576–87.

    Article  PubMed  Google Scholar 

  52. Houmard JA, Kirwan JP, Flynn MG, Mitchell JB. Effects of reduced training on submaximal and maximal running responses. Int J Sports Med. 1989;10(1):30–3.

    Article  CAS  PubMed  Google Scholar 

  53. Houmard JA, Scott BK, Justice CL, Chenier TC. The effects of taper on performance in distance runners. Med Sci Sports Exerc. 1994;26(5):624–31.

    Article  CAS  PubMed  Google Scholar 

  54. Loy SF, Hoffmann JJ, Holland GJ. Benefits and practical use of cross-training in sports. Sports Med. 1995;19(1):1–8.

    Article  CAS  PubMed  Google Scholar 

  55. Tipton KD. Nutrition for acute exercise-induced injuries. Ann Nutr Metab. 2010;57 Suppl 2:43–53.

    Article  CAS  PubMed  Google Scholar 

  56. Biolo G, Agostini F, Simunic B, Sturma M, Torelli L, Preiser JC, et al. Positive energy balance is associated with accelerated muscle atrophy and increased erythrocyte glutathione turnover during 5 wk of bed rest. Am J Clin Nutr. 2008;88(4):950–8.

    CAS  PubMed  Google Scholar 

  57. Frankenfield D. Energy expenditure and protein requirements after traumatic injury. Nutr Clin Pract. 2006;21(5):430–7.

    Article  PubMed  Google Scholar 

  58. Waters RL, Campbell J, Perry J. Energy cost of three-point crutch ambulation in fracture patients. J Orthop Trauma. 1987;1(2):170–3.

    Article  CAS  PubMed  Google Scholar 

  59. Chow O, Barbul A. Immunonutrition: role in wound healing and tissue regeneration. Adv Wound Care (New Rochelle). 2014;3(1):46–53.

    Article  Google Scholar 

  60. Borrelli Jr J, Pape C, Hak D, Hsu J, Lin S, Giannoudis P, et al. Physiological challenges of bone repair. J Orthop Trauma. 2012;26(12):708–11.

    Article  PubMed  Google Scholar 

  61. Vargas R, Lang CH. Alcohol accelerates loss of muscle and impairs recovery of muscle mass resulting from disuse atrophy. Alcohol Clin Exp Res. 2008;32(1):128–37.

    Article  CAS  PubMed  Google Scholar 

  62. Molfino A, Gioia G, Rossi Fanelli F, Muscaritoli M. Beta-hydroxy-beta-methylbutyrate supplementation in health and disease: a systematic review of randomized trials. Amino Acids. 2013;45(6):1273–92.

    Article  CAS  PubMed  Google Scholar 

  63. Sharma RA, Gescher AJ, Steward WP. Curcumin: the story so far. Eur J Cancer. 2005;41(13):1955–68.

    Article  CAS  PubMed  Google Scholar 

  64. Baptista IL, Leal ML, Artioli GG, Aoki MS, Fiamoncini J, Turri AO, et al. Leucine attenuates skeletal muscle wasting via inhibition of ubiquitin ligases. Muscle Nerve. 2010;41(6):800–8.

    Article  CAS  PubMed  Google Scholar 

  65. Hespel P, Op't Eijnde B, Van Leemputte M, Urso B, Greenhaff PL, Labarque V, et al. Oral creatine supplementation facilitates the rehabilitation of disuse atrophy and alters the expression of muscle myogenic factors in humans. J Physiol. 2001;536(Pt 2):625–33.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Winsberg M. The psychology of the injured athlete: endurance corner. 2015. http://www.endurancecorner.com/Mimi_Winsberg/psychology_injuries.

  67. Kübler-Ross EB. On death and dying. New York: Scrobmer; 2014.

    Google Scholar 

  68. McCormick A, Meijen C, Marcora S. Psychological determinants of whole-body endurance performance. Sports Med. 2015;45(7):997–1015.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Wang Y, Morgan WP. The effect of imagery perspectives on the psychophysiological responses to imagined exercise. Behav Brain Res. 1992;52(2):167–74.

    Article  CAS  PubMed  Google Scholar 

  70. Papadelis C, Kourtidou-Papadeli C, Bamidis P, Albani M. Effects of imagery training on cognitive performance and use of physiological measures as an assessment tool of mental effort. Brain Cogn. 2007;64(1):74–85.

    Article  PubMed  Google Scholar 

  71. Taylor J. A conceptual model for integrating athletes’ needs and sport demands in the development of competitive mental preparation strategies. Sport Psychol. 1995;9(3):339–57.

    Article  Google Scholar 

  72. Mujika I, Padilla S. Cardiorespiratory and metabolic characteristics of detraining in humans. Med Sci Sports Exerc. 2001;33(3):413–21.

    Article  CAS  PubMed  Google Scholar 

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Toresdahl, B., deMille, P., Kim, J., Machowsky, J., Silverman, M., Rodeo, S. (2016). Return to Sport Decision-Making for Endurance Athletes. In: Miller, T. (eds) Endurance Sports Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-32982-6_21

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