Will new Boston qualifying times mean an increase in injuries?

Jodi Broz of Stevenson Ranch, California jumps at the finish line as she finishes the 2018 Boston Marathon. Credit: Winslow Townson-USA TODAY Sports

The Boston Marathon is one of the hallmark road races, requiring participants to qualify with an acceptable time from a prior race. Only the best make it to Boston. Now being best requires a bit more effort as the Boston Athletic Association recently adjusted the qualifying times, requiring participants to be faster than the past few years. Twitter feeds exploded at the news as athletes debated the merits of the new times. However, with the recent setting of a new marathon world record by Eluid Kipchoge, perhaps it’s time for everyone to step up their game.

As runners try to improve their pace in time for their winter and spring races (the typical running season for those in the northern hemisphere), they may increase their chance for injury. Research shows that most running injuries occur due to training errors. When runners increase distance or pace too quickly or change their running environment to incorporate hills or track workouts, they may not give their body time to adjust to the changes. Typical injuries include plantar fasciitis, hamstring strain, and calf muscle pain.

Increasing distance and pace means an increase in energy expenditure. In addition, athletes may buy into the myth that being lighter will make them faster. Therefore, goal oriented endurance athletes are particularly vulnerable to relative energy deficiency in sport (RED-S). Most of the symptoms of RED-S are hidden or explainable, making early detection difficult. It behooves anyone working with athletes to understand the mechanisms of RED-S and screen for signs of energy deficiency. In today’s feature article, I highlight the basic facts about RED-S that every clinician should know. The most glaring of these is that RED-S affects both male and female athletes. Due to their high energy expenditure, para-athletes are also susceptible to low energy availability.

All athletes should be screened for RED-S, no matter if they come to your clinic complaining of shin splints or patellofemoral pain. Screening questions should be part of a complete history and included in every intake packet (see table 1). If the clinician suspects the athlete may suffer from low energy availability, refer them to a sports physician and sports dietician. Early detection is key to a quick and successful recovery.

Table 1: Sample questions for intake history to alert the clinician of possible low energy availability

Menstrual history Have you had a menstrual period?

How old were you when you had your first menstrual period?

When was your most recent menstrual period?

Is your cycle regular?

Are you taking any form of hormones such as birth control pills, estrogen, or progesterone?
Eating historyHow do you feel about your weight?

Are you on a special diet?

Are there certain foods you exclude from your diet?

Are you trying to lose or gain weight?

Has anyone told you that doing so could improve your performance?

Do you have an eating disorder?
Musculoskeletal historyHave you ever suffered a stress fracture?

Have you been told you have low bone density or osteoporosis/osteopenia?

Do you have frequent tendon or muscle injuries?

Does muscle soreness last for more than two days, or do you find it hard to recover from a strenuous workout?
Gastrointestinal historyAre your bowel movements regular?

Do you use laxatives regularly?

Do you feel bloated or suffer from stomach cramps often?

Do you vomit frequently?
General historyDo you get colds or other illnesses often?

Has your growth been along a normal developmental curve?

Do you feel energized for your workouts?

How many hours of sleep do you average per night?

Do you feel rested in the morning?
Cardiovascular historyDo you get dizzy during a workout or when you stand up?

Does your heart ever race or feel like its beating slowly?
Mood historyHow would you describe your mood most of the time?

Are you often irritable?

Do you have trouble concentrating?

Do you frequently feel sad or discouraged?

Have you been diagnosed with depression?


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