COMMON ORTHOPEDIC INJURIES IN TRIATHLETES

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1 COMMON ORTHOPEDIC INJURIES IN TRIATHLETES Edward G McFarland MD Jiong Jiong Guo, MD, PhD Gof Tantisricharoenkul MD The Johns Hopkins University Baltimore MD

2 GOALS Review of literature Assessment guidelines Treatment guidelines Questions and specific injuries

3 IMPORTANCE Orthopedic injuries more common than medical ones in triathlons Medical ones tend to be more catastrophic (MI, collapse)

4 INJURIES VARIABLES TWO MAJOR GROUPS Acute Overuse

5 INJURIES VARIABLES THREE SPORTS Swim--shoulder Run---LE injuries Cycle---traumatic injuries

6 INJURIES VARIABLES LOCATION OR TIME OF INJURES Training Competition

7 INJURIES VARIABLES SEVERITY Most difficult to measure Is it a boo-boo or time lost? Makes studies unequal

8 REVIEW OF LITERATURE See attached table Thanks to Dr Al-Saati

9 PRE-TEST The most injuries are seen in the triathlon are seen in the: 1. Swim 2. Bike 3. Run 4. Transitions

10 PRE-TEST The most injuries are seen in the triathlon are seen due to the: 1. Overuse 2. Acute injury 3. Cross training

11 PRE-TEST The most injuries are seen in the triathlon are seen in the: 1. Psyche 2. Back 3. Upper extremity 4. Lower extremity

12 REVIEW OF LITERATURE: SUMMARY Most injuries: Due to running Seen in training Overuse Lower extremity: knee and lower

13 REVIEW OF LITERATURE: SUMMARY Distribution of all conditions to med tent depend upon the level of participation Most injuries are minor but catastrophic injuries always possible

14 EPIDEMIOLOGY STUDY Gosling et al AJSM 2010 Australian study triathlon season All injuries presenting to medical tent

15 EPIDEMIOLOGY STUDY Gosling et al AJSM 2010 Levels studied lower than Iron Man: Fun Run Races Sprint/Olympic distances Combined distances

16 EPIDEMIOLOGY STUDY Gosling et al AJSM 2010 Most injuries in run (39%) or cycle (21%) legs Injuries due to running (54%), cycling (19%), swimming (12%)

17 EPIDEMIOLOGY STUDY Gosling et al AJSM 2010 Most completed the races (54%) 3% required retrieval 2% transferred to hospital 20% referred for further eval/treatment

18 EPIDEMIOLOGY STUDY Gosling et al AJSM 2010 MOST COMMON INJURIES Abrasions 29% Blisters 15% Strains 10%

19 EPIDEMIOLOGY STUDY Gosling et al AJSM 2010 MULTIVARIATE ANALYSIS: Odds Ratios Leg of Race Run 3.27 Cycle 2.79

20 EPIDEMIOLOGY STUDY Gosling et al AJSM 2010 MULTIVARIATE ANALYSIS: Odds Ratios by Etiology Run 5.4 Cycle 3.4

21 EPIDEMIOLOGY STUDY Gosling et al AJSM 2010 INCREASED RISK (p<0.05) Race distance for run and cycle Elite/Junior level for run Race distance for run and cycle NO DIFFERENCE: Male and female

22 EPIDEMIOLOGY STUDY Egermann et al 2003 European Iron Man Competition Retrospective, questionaire 12% fractures 86% in training 76% in cycling Increased risk with age Trunk fx s more common >40 YO

23 EPIDEMIOLOGY STUDY O Toole et al AJSM 1989 Hawaii Iron Man Competition Retrospective, questionaire Only 9% response rate Average age 35 YO Injuries in year prior to event

24 EPIDEMIOLOGY STUDY O Toole et al AJSM 1989 Injuries Hawaii Iron Man Competition 91% reported injury year before Back most common (72%) 80% had more than one injury 63% knee or thigh injury Overuse injuries primarily

25 IRON MAN MAY DIFFER IN INJURY TYPE AND DISTRIBUTION Higher injury rate in Iron Man(17%) versus lower levels Iron man 58-72% injuries dehydration or exhaustion Iron man trauma/orthopedic 13-22% of injuries

26 EPIDEMIOLOGY SUMMARY Wide variety of MS injuries LE most common Run main culprit Severe injuries unusual but do happen Iron man ortho injury rate lower

27 TRIAGE OF MUSCULOSKELETAL INJURY Acute Injury Chronic Injury

28 EVALUATION: THE BASICS What you were taught in medical school Get a history Do the ABC s Observation NV examination

29 EVALUATION: THE BASICS Joint above and below Palpation ROM Provocative maneuvers last

30 EVALUATION: THE BASICS Things do not get black and blue or swell for no reason Suspect fracture or ligament damage God made X-rays for a reason

31 TREATMENT: ACUTE INJURY INITIAL TREATMENT Ice Immobilize Sling or crutches Arrange for radiographs Arrange for follow up

32 TREATMENT: ACUTE INJURY DEFINITIVE TREATMENT Depends upon the injury Depends upon your confidence level Depends upon the standards in your community

33 TREATMENT: CHRONIC INJURY RICE not much of an option in this group Pain is a warning sign: get a diagnosis Treat according to results of the studies

34 TREATMENT: CHRONIC INJURY Ice Relative rest do the other events Maintain function and ROM Judicious use of medication

35 TREATMENT: CHRONIC INJURY Physical therapy Taping Braces Cortisone shots carefully PRP---controversial

36 TREATMENT: SURGERY Difficult decision in this group Risks and benefits carefully considered Cross training an advantage for recovery

37 SPECIFIC INJURIES: MY EXPERIENCE There is a certain natural selection that allow individuals to compete at this level Injury serves Darwinian function

38 SPECIFIC INJURIES: MY EXPERIENCE Lower extremity injuries especially knee most common Always begin with plain films MRI often in this group

39 SPECIFIC INJURIES: MY EXPERIENCE Cross training important NSAIDs Inject shoulders but rarely knees Encourage perspective about skipping a competition

40 SPECIFIC INJURIES: QUESTIONS

Return to same game if sx s resolve within 15 minutes. Return to next game if sx s resolve within one week Return to Competition

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