It is well established that physical activity reduces all-cause mortality and can prolong life. Ultra-endurance running (UER) is an extreme sport that is becoming increasingly popular, and comprises running races above marathon distance, exceeding 6 h, and/or running fixed distances on multiple days. Serious acute adverse events are rare, but there is mounting evidence that UER may lead to long-term health problems. The purpose of this review is to present the current state of knowledge regarding the potential long-term health problems derived from UER, specifically potential maladaptation in key organ systems, including cardiovascular, respiratory, musculoskeletal, renal, immunological, gastrointestinal, neurological, and integumentary systems. Special consideration is given to youth, masters, and female athletes, all of whom may be more susceptible to certain long-term health issues. We present directions for future research into the pathophysiological mechanisms that underpin athlete susceptibility to long-term issues. Although all body systems can be affected by UER, one of the clearest effects of endurance exercise is on the cardiovascular system, including right ventricular dysfunction and potential increased risk of arrhythmias and hypertension. There is also evidence that rare cases of acute renal injury in UER could lead to progressive renal scarring and chronic kidney disease. There are limited data specific to female athletes, who may be at greater risk of certain UER-related health issues due to interactions between energy availability and sex-hormone concentrations. Indeed, failure to consider sex differences in the design of female-specific UER training programs may have a negative impact on athlete longevity. It is hoped that this review will inform risk stratification and stimulate further research about UER and the implications for long-term health.

/pdf/potential-long-term-health-problems-associated-with-ultra-2d9fe6mazj.pdf

Potential Long-Term Health Problems Associated with Ultra-Endurance Running: A Narrative Review.

Point of care ultrasound is important to the specialty of physical medicine and rehabilitation (PM&R) to aid in the diagnosis and treatment of a variety of neuromusculoskeletal conditions commonly seen in practice. However, across Canada, resident education of sonoanatomy skills is variable. There remain no standards in terms of how ultrasound is taught as part of the residency curriculum as set by the Royal College of Physicians and Surgeons of Canada. As such, residents are often required to find their own educational opportunities. This report describes an alternative approach to learning these skills that was inspired by disruption due to coronavirus disease 2019 in first year residency. This report explores how a PM&R resident was able to develop valuable ultrasound skills from home using not only textbooks and videos, but also new and novel teleguidance technology, namely an ultrasound probe that connects to a clinician's own smart devices to display images.

Education in the time of COVID: At-a-distance training in neuromusculoskeletal ultrasonography

Introduction: Joint overload and sport-related injuries may accelerate the development of osteoarthritis (OA). A systematic review of the literature was performed to establish the risk of athletes to develop premature OA compared with nonathletes. Materials and Methods: This systematic review was conducted according to the PRISMA guidelines. PubMed, Google scholar, Embase, and Web of Science databases were accessed in June 2021. All the published clinical studies investigating OA onset in athletes versus nonathletes were considered. Studies reporting data on secondary and/or post-traumatic OA were excluded. Results: Data from 32 articles (20,288 patients) were retrieved. The mean age was 67.8±10.0 years and the mean body mass index was 25.0±2.5 kg/m2. 74% (6859 patients) of the athletes suffered from premature OA. Of them, 21% were active in soccer, 11% in handball, 11% in ice-hockey, 3% in football, and 0.3% in rugby. 26% of the athletes reported no significant differences in OA progression compared with healthy controls. Of these athletes, 47% were runners, 5% dancers, and 1% triathletes. Conclusion: Certain sports, such as soccer, handball, ice-hockey, and rugby are more likely to be associated with premature knee and hip OA. Conversely, runners and ballet dancers do not evidence significant increase in OA. Moderate and recreational exposure to aerobic sports does not accelerate the development of OA.

Osteoarthritis in Athletes Versus Nonathletes: A Systematic Review

Simple Summary In many equestrian disciplines, circular exercise is utilized to train, exercise, and compete with horses and can vary in gait, as well as diameter. This study aimed to determine if circular exercise diameter impacts animal health. Calves have previously been used as a terminal skeletal model of juvenile horses, allowing for the collection of musculoskeletal samples that are not acceptable from horses. Calves exercised on a small circle (12-m clockwise), large circle (18-m clockwise), treadmill, or served as non-exercised controls. Exercise was performed at a walking speed, starting at 5 min per day and increasing 5 min weekly until reaching 30 min per day during the 7-week study. The response to exercise was monitored in the forelimb bones and joints. The small circular exercise group was found to have bone diameters that differed between the right and left fused third and fourth metacarpi, and between lateral and medial proximal phalanx bones. Cartilage glycosaminoglycan content was greater in the outside leg of the small circle exercise calves than the inside leg, with no differences noted within other treatments. These differences suggest that altering circular exercise diameter can impact bone and joint health, and that larger diameter circles may prevent asymmetric loading between inside and outside legs. Abstract Circular exercise is used in many equestrian disciplines and this study aimed to determine if circle diameter impacts juvenile animal forelimb bone and joint health. On day 0, 24 calves at 9 weeks of age were assigned the following exercise treatments: small circle (12 m clockwise), large circle (18-m clockwise), treadmill, or non-exercised control. Exercise was initiated at 1.1–1.5 m/s for 5 min/d and increased 5 min weekly until reaching 30 min/d. On day 49, synovial fluid was collected from multiple joints, cartilage was collected from the proximal surface of fused third and fourth metacarpi (MC III and IV), and forelimbs underwent computed tomography scans. A statistical analysis (PROC mixed) was performed in SAS 9.4. The inside leg of the small circle treatment had a larger MC III and IV dorsopalmar external diameter than the outside (p = 0.05). The medial proximal phalanx had a greater mediolateral diameter than the lateral proximal phalanx of the small circle treatment (p = 0.01). Fetlock nitric oxide was greater in the large circle and treadmill treatments (p < 0.0001). Cartilage glycosaminoglycan concentration was greater in the outside leg of the small circle exercise treatment than the inside leg (p = 0.03). Even at slow speeds, circular exercise diameter can impact joint and bone health, but faster speeds may have greater alterations.

/pdf/the-impact-of-circular-exercise-diameter-on-bone-and-joint-1mi91h87.pdf

The Impact of Circular Exercise Diameter on Bone and Joint Health of Juvenile Animals

To investigate the response of the infrapatellar fat pad (IFP) to running at different intensities and further explore the underlying mechanisms of these responses under different running-induced loadings. Animals were randomly assigned into the sedentary (SED), low-intensity running (LIR), medium-intensity running (MIR), and high-intensity running (HIR) groups. The rats in the LIR, MIR, and HIR groups were subjected to an 8-week treadmill running protocol. In each group, the IFP was examined at the baseline and at the 8th week to perform histomorphology, immunohistochemistry, and mRNA expression analyses. Compared with LIR and MIR, HIR for 8 weeks led to a substantial increase in the surface cellularity (1.67 ± 1.15), fibrosis (1.29 ± 0.36), and vascularity (33.31 ± 8.43) of the IFP but did not increase IFP inflammation or M1 macrophage polarization. Low-to-medium-intensity running resulted in unchanged or decreased fibrosis, vascularity, and surface cellularity in the IFP compared to those of the SED group. Furthermore, serum leptin and visfatin levels were significantly lower in the LIR and MIR groups than in the SED group or the HIR group (P < 0.05). The effect of running on IFP remodeling was intensity dependent. In contrast to LIR and MIR, HIR increased the fibrosis and vascularity of the IFP. HIR-induced IFP fibrosis was probably due to mechanical stress, rather than pathological proinflammatory M1/M2 polarization.

/pdf/treadmill-running-induces-remodeling-of-the-infrapatellar-49kad1wsq7.pdf

Treadmill running induces remodeling of the infrapatellar fat pad in an intensity-dependent manner.

BACKGROUND Multiple studies demonstrate poor musculoskeletal palpation accuracy of physiatry residents. With the growing use of ultrasound clinically, it could serve as a powerful educational tool. However, there are no published studies examining the efficacy of ultrasound-aided education at the bedside, where much learning takes place during postgraduate training. OBJECTIVE To determine if brief ultrasound-aided teaching improves residents' accuracy and confidence of musculoskeletal palpation. DESIGN Before/After Trial. SETTING Academic Institution. PARTICIPANTS Ten physical medicine and rehabilitation residents were voluntary participants. INTERVENTION Each resident was given a survey to assess confidence in palpating the hook of the hamate and medial calcaneal tubercle. They then attempted to palpate and place a marker over these two structures in a model patient. Marker placement accuracy was verified by ultrasound. Faculty spent less than 1 minute per landmark, sonographically teaching its correct localization. The resident, after moving to a new model patient, was then re-tested on accurate marker placement for both landmarks. A repeat survey to assess confidence was administered. MAIN OUTCOME MEASUREMENTS Preintervention and postintervention accuracy and confidence of correct localization of both landmarks. RESULTS We used McNemar's and Wilcoxon's tests to determine whether the intervention improved the location accuracy and confidence of successful palpation, respectively. Confidence level of correct localization of two landmarks improved on average from 4.3 to 8.15 on a scale of 10 after intervention. Of 20 palpation attempts, 11 correctly placed the marker postintervention after an incorrect placement, 8 made no change, and one changed from correct to incorrect placement. The odds of improvement in accuracy was 11 (95% confidence interval [CI] 1.60-473.47, P < .01). Both tests showed significant improvements after the intervention at the significance level of .05. CONCLUSIONS Brief, ultrasound-aided teaching increases accuracy and confidence of residents' musculoskeletal palpation.

Brief Ultrasound-Aided Teaching to Improve the Accuracy and Confidence of Resident Musculoskeletal Palpation.

Osteoarthritis (OA) is the most common joint disorder and a growing health concern in the United States. There is also significant growth in the popularity of running, with a notable trend of increasing age among marathon participants. The running medicine professional should be aware of the scientific literature at the intersection of running and OA in order to provide evidence-based, patient-centered, and goal-oriented care. Counseling patients about their risk for developing OA secondary to running can be challenging. The current evidence suggests that low-dose running may be protective against the development of OA, but high-dose running may increase the risk of OA. It is important to realize that the evidence still only demonstrates this as an association. There is also emerging evidence to suggest patients with OA may benefit from self-selected running doses, particularly in pain reduction; however, further research is needed in order to provide definitive recommendations for this population.

Osteoarthritis and Running

Whether or not running leads to the development of knee and hip osteoarthritis has been a much-debated topic and is often a question patients pose to their physicians. Recent literature adds to a growing body of evidence suggesting that lower-dose running may be protective against the development of osteoarthritis, whereas higher-dose running may increase one's risk of developing lower-extremity osteoarthritis. However, running dose remains challenging to define, leading to difficulty in providing firm recommendations to patients regarding the degree of running which may be safe. Furthermore, when counseling patients regarding their risk of developing lower-extremity osteoarthritis secondary to running, clinicians must consider many additional factors, such as the numerous health benefits from running and individual risk factors for developing osteoarthritis.

Running Dose and Risk of Developing Lower-Extremity Osteoarthritis.

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Brief Ultrasound-Aided Teaching to Improve the Accuracy and Confidence of Resident Musculoskeletal Palpation.

Osteoarthritis and Running

Running Dose and Risk of Developing Lower-Extremity Osteoarthritis.