Holistic Sports Medicine Aids Endurance Athletes

PM&R physicians prepared to address endurance athletes’ unique medical needs

HONOLULU— Physical medicine and rehabilitation (PM&R) physicians working in sports medicine can help ultraendurance athletes achieve their athletic goals while maintaining physical well being through a multidisciplinary, multilayer approach, according to Brian Krabak, M.D.

“We provide resources for holistic care that include performance counseling, injury rehabilitation and prevention, performance improvement and medical treatment. These allow our patients to attain their goals – whether it is to run a 5K or a 150 miles through the desert,” says Dr. Krabak, an assistant professor of physical medicine and rehabilitation and assistant professor of orthopedic surgery at Johns Hopkins Sports Medicine in Baltimore.

Dr. Krabak will speak on Nov. 9 at the American Academy of Physical Medicine and Rehabilitation’s 67th Annual Assembly as part of a panel on treating multisport and endurance athletes.

The increasing numbers of athletes competing in endurance sports has provided PM&R physicians with a wealth of treatment experience about sports-related injuries and other related medical conditions. “We now better understand the potential causes of various sports-related illnesses and overuse injuries and know how to optimize performance, whether through stretching and strengthening or nutrition intake and supplementation,” Dr. Krabak explains.

Since the ultramarathons and Ironman-like competitions began in the late ‘70s, PM&R physicians have focused on the unique aspects of sports medicine that ultraendurance athletes require. PM&R training provides physiatrists with an approach to treating and training athletes functionally because of their expertise in the musculoskeletal system.

Dr. Krabak says that participation in marathons and ultraendurance competitions is greatly increasing, and that many of these events now sell out a year in advance.

Endurance Athletes Face Nutritional, Physical and Medical Challenges
“There are multiple layers of monitoring and treatment that a PM&R physician should consider when working with an endurance athlete,” explains Dr. Krabak. “These concerns include nutritional balance and physical conditioning to prevent athletic-related medical conditions.”

Optimal hydration requires a balance of fluids – water and sports drinks – to protect athletes from over hydrating and lowering the body’s sodium and electrolytes, a condition called hyponatremia. Endurance athletes should consume nutrients that help optimize performance and keep them from “bonking” or running out of fuel and not being able to continue competition. PM&R physicians also are qualified to advise athletes on over-the-counter supplement safety.

Rehabilitation physicians treat many musculoskeletal injuries. “Focused, dedicated athletes tend to ignore injuries until whole systems break down,” says Dr. Krabak. “Some athletes ramp up too high without allowing themselves days of rest, which puts a lot of pressure on the tendons and ligaments that often lead to subsequent injuries. Tendonitis in the knee can lead to using the hip more until the hip develops bursitis. This downward spiral will eventually lead to a decrease in performance. We can help with rehabilitation and prevention techniques.”

Endurance illnesses are another challenge for the extreme athlete. The conditions under which these grueling events take place often have related medical problems. Extreme heat or cold and high altitudes can all play a role in exercise-associated collapse.

As previously mentioned, hyponatremia, or low sodium, is an endurance illness. Another exercise-related medical condition is hyperthermia, which is associated with dehydration and increased internal body temperature elevation. Hypothermia, or low body temperature, often occurs when endurance athletes train or compete in cold climates. Altitude sickness often affects athletes who are performing at altitudes higher than their normal training altitude, leading to headaches and dizziness. Extreme athletes are at risk for brain swelling and fluid in the lungs. All of these environmental illnesses can be affected by environmental factors (air temperature, humidity, wind) and the athlete’s fitness (ability to sweat, hydration and acclimation to the environment).

PM&R is not a simplistic approach, says Dr. Krabak. “We offer a holistic approach to sports medicine that involves physical and mental components and teamwork with coaches and families.”

The American Academy of Physical Medicine and Rehabilitation is the national medical specialty society of more than 7,500 physical medicine and rehabilitation (PM&R) physicians, also called physiatrists. Physical medicine and rehabilitation physicians focus on restoring function. They care for patients with acute and chronic pain and musculoskeletal problems like back and neck pain, tendinitis, pinched nerves, and fibromyalgia. They also treat people who have experienced catastrophic events resulting in paraplegia, quadriplegia, or traumatic brain injury and individuals who have strokes, orthopaedic injuries, or neurological disorders such as multiple sclerosis, polio, or ALS.

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Editor’s Note: Dr. Krabak has no financial interests, arrangements or affiliations to disclose that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation.

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