Medical Issues on Triathletes - Essay Example

MSc Sports Medicine/Science Introduction Triathletes who participate in Ironman distance racing events will tend to encounter a number of infirmity and injuries. Research studies have been carried out both in medical labs and during actual triathlon events for many years to investigate the potential medical problems that many triathletes face. The risk and percentage of triathletes seeking medical assistance has increase over the years as the triathlon events become longer and more difficult to complete. Only a fraction of triathletes seek aid on race day itself and many more determined triathletes get sick in the days following the treacherous events. Many of the enduring triathletes prefer to be resilient to pain and tend to carry their impacted and sometimes senseless (without knowledge) injuries throughout each race till to the finish line. Medical cover is to be arranged at the finish of an Ironman event taking place at Lanzarote in early October. In order to achieve adequate medical support and care, health issues that are common to triathletes must be outlined. Ironman at Lanzarote is considered to be one of the most arduous, all-terrain event for any fittest and able-bodied triathlete. The Ironman event is expected to include three major sub-events consisting of 3.8km swim, 180km bike race, and 42.2km run to the finish line. Any appropriate medical cover can only be provided by priori understanding of different types of illnesses or injuries based on previous therapeutic experiences and gathering of medical information from past records seen in other Ironman races. 2. Medical Issues of Triathletes Most triathletes naturally undergo rigorous cross physical training and are less likely to develop any kind of muscle imbalances. An issue with many young, amateur and firt-time triathletes is that they usually underestimate their fitness level and skill such that they may be good in one event but that does not automatically translate into adaptation for another. All bodily injuries can be classified as either internal or external fatalities. The latter injuries may be knee injuries, wrist fractures, sore toes and blisters, cold shoulder and other injuries from improperly adjusted bicycles [16]. Only a small amount of competitors experience this sought of external injuries. One of the more common medical problems is the triathlete sustains a bad sunburn a few days before the actual race. A serious and unattended sunburn (such as a second degree burn with blisters) can have a damaging effect on how the body is able to adjust the coherent body temperature and sweat loss during exercise. This naturally decrease the ability to control body temperature and sweating can have a negative impact on the triathlete's race outcome. Most injuries that befall triathletes are overuse injuries such as tendonitis or muscle strains, as opposed to acute ones (like when fall of a bike and bruise something). While overuse injuries are fairly common among triathletes, they are relatively easy to prevent and treat, if they are careful. The most effective way to prevent overuse injuries is to prevent and reverse the muscle imbalances that contribute to most of them and allowing the body to have sufficient time to properly recover from any stress developed during training. Through the nature of the postures and repetitive motions involved, triathletes tend to develop particular imbalances that are associated with particular injuries. To correct imbalances, they need to stretch muscles that tend to become shortened through training and strengthen muscles that tend to become weakened. Triathletes should frequently stretch their calves, hamstrings, hip flexors, lower back, neck, and chest, and should regularly performing functional exercises that strengthen the hips, butt, abdomen, upper back, and shoulders [3, 7, 16, 20]. Tendons and muscles need to have adequate time to recover fully from increases in training to especially prevent chronic injuries. Poor technique is also associated with a majority of overuse injuries. Swimmers who deviate from the recommended arm cycle technique tend to develop swimmer's shoulder. Cyclists who position their seat too high or low tend to develop low back and knee problems. Runners whose feet overpronate tend to develop plantar fasciitis, Achilles tendinitis, and runner's knee [23]. It is always advisable to have knowledgeable team coaches inspect their technique in each of the three triathlon disciplines and point out flaws before each race. Modifying technique takes time and discipline, but it does work in a long run. Each individual event of the Ironman presents a unique set of injuries and medical problems from race day. With the lengthy races normally beginning with a large mass start, injuries from close-contact events such as swimming are common. The usual close-contact injuries from the swim tend to be corneal abrasions, i.e. a scratch on the surface of the eye, after a possible pair of goggles being knocked off and other occurring injuries to the head such as bruises and even mild concussions as a result of collision between other group swimmers racing side by side in the pack. The bike portion of the Ironman race inflicts the majority of traumatic injuries. Broken clavicles (collarbones), shoulder injuries and road rash are some of the more popular injuries, all caused from falls mainly due to crash-skidding from overspeeding (due to loss of control of bike) and crashes with other cyclists (due to little knowledge of nearby traffic especially around tight corners and blind-spots). The risk of collision also can happen while overtaking another cyclist with the other triathlete not being aware that there is a cyclist behind trying to make a pass. The most common injury complaints from the run are muscle cramps and blisters [19]. While there are a lot of theories on the causes of muscle cramps in athletes, there haven't been any good studies that can prove or disprove that muscle cramps are a result of dehydration or electrolyte imbalances [30]. The cause of exercise-induced muscle cramps is probably multifactorial. There are case reports of athletes known to have high sodium sweat rates that resolve their muscle cramps after drinking a sodium electrolyte drink [27]. Another current theory for exercise-induced cramps is that the cramping is due to muscle fatigue and acts as a protective mechanism designed to prevent further damage to the muscles [16]. Blisters can develop due to increased friction and pressure upon the skin, and the discomfort can impair running performance. Majority of triathletes encounter internal sickness during an Ironman which can be categorized as heat sickness and dehydration leading to hyponatremia (low sodium levels in blood) [25, 28]. More than a third of all triathletes sought some form of medical attention relating to these problems. These illnesses normally become apparent during the run or just after crossing the finish line. They generate a constellation of symptoms relating to post endurance syndrome such as headache, dizziness, decreased body temperature, nausea, diarrhea, vomiting, cramping and inability to drink fluids [10]. Dehydration or over-hydration, in extreme cases, which increases the risk for potentially fatal heat stroke, while drinking too much fluid can lead to a rare condition known as hyponatremia. This condition assumes the levels of sodium drops in the athlete's blood to dangerously low levels, putting them at risk for coma, seizure and even death. Temporary heart damage may also be caused by extreme endurance of Ironman activities such and long-distance marathon and cycling [22]. Such hyponatremia conditions have been experimentally studied during previous Ironman events in Hawaii [28]. Random blood samples have been taken from triathletes and tested for serum sodium levels. The results are shown in the Table A below [21, 25]: % of Triathletes Sodium level Athlete status Possible symptoms 15 Lightly low Normal (aid not required) Fatigue, somnolence, body weakness, lethargy, vomiting, nausea, seizures, coma, death 25 Moderately low Light medical attention 60 Extremely low Admitted to medical tents Table A: Percentage of triathletes per sodium level and degree of treatment required The seriousness of symptoms depends on the shortage of sodium chloride (NaC1). The occurance of hyponatremia can also worsen if the athlete tends to take only fluid replacements and consuming of food stuffs with low salts. Hence, replacing sodium will have to taken separately to balance the salt and water content in the body. At the end of the last event, the triathletes are transiently suppressed and are thus vulnerable to a whole variety of infections particularly harmful viruses [12] such as viral upper respiratory tract infections. Generally, endurance triatletes experience a higher incidence of viral infections because high intensity exercise before a race has a short-term (about 2 to 24 hours) depressive effect of the body's immune system. Combining this virus problem with the great number of people from all over the world who are gathered together in such an event as Ironman, the risk of infection would be expected to be much greater. 3. Medical Provisions for all Triatheletes Most of the triathletes that end up in the medical tents arrive from after the finish line. Once across the finish line, they finally stop running, and many triathletes suffer from exercise-associated collapse [29]. This collapse isn't usually due to dehydration, but a sudden drop in systemic blood pressure. During the run, the muscles of the legs act as secondary pumps, helping to return blood back to the heart. After the triathlete stops, there is a slight delay until the body's cardiovascular system can compensate for the sudden lack of pumping action from the leg muscles. The cure for this condition isn't necessarily IV fluids, but simply laying the triathlete down with the legs slightly elevated above the level of the heart and gradual oral hydration. Medical support is big operation in any Ironman event. Some of the compulsory provisions include several medical tents, a medical station at the bike-run transition, and up to approximately 10 medical vans along the entire race course. Each medical van are staffed with a driver, nurse and either a physician or paramedic. Every attempt has to be made to staff vans with at least one volunteer experienced at Ironman and those with emergency medicine experience. Rotational shift duty is to be organized for volunteers who choose to operate the tents as part of the Ironman medical team. The busiest time to man the tents is between 4-10pm or from 8pm to closing of event past midnight. A limited number of physical therapists, athletic trainers and massage therapists are required at both the bike-run transition and the medical tents. Volunteers will have to be part of massage therapist since Ironman does not officially have a team of professional masseurs. There is also a need for support teams for the physically challenged athletes. The volunteers must meet with the triathletes prior to the race and provide any assistance these athletes need during the race. About 5-10 large medical tents (depending on mass field size) have to be set-up at the finish line to cater for incoming triathletes. The Ironman at Lanzarote needs to employ many capable physicians who can handle various medical problems such as those discussed above. They would require the assistance from nurses, medical personnel (or medics) and even non-medically trained volunteers available from Red-Cross or from local nearby hospitals, etc. The volunteers are to act as supports and ushers for triathletes who especially manage to complete the Ironman event. The triathletes should be escorted to the individual medical tents or their own readily available team buses. Those triathletes that require medical attention are to be ushered or carried by stretches (for over-exhausted triathletes) and the nurses or volunteers are to handle record-keeping at each tent. Nurses at the medical tents are also required to ask and check with participants whether they felt dehydrated, too hot or cold, nauseous, breathless or dizzy, or whether they were experiencing cramps in their abdomen, hands or feet and whether they had any abrasions or blisters. At bigger races, such as Ironman in Hawaii [1], the medical staff is expected to exceed over 200 volunteer doctors, nurses, lab techs and other medical providers such as physician assistants. This number doesn't include the numerous volunteer massage therapists that also donate their time to these events. The medical tent can get quite busy, with 10 to 20% of competitors receiving medical treatment throughout the day. It's a long day - starting well before the race, and usually ending sometime well after midnight, once all the triathletes have finished. Adequate medical facilities and consumable supplies have to be arranged before-hand. Lots of cold water is to be made available especially to treat muscle soreness and inflammation. Ice should also be easily obtainable for use with any acute injury, such as a sprained ankle or pulled muscle, as soon as possible after the final event. According to previous medical advice [13, 25], application of ice is most effective in the first 24 to 48 hours following an injury. By timely icing, the severity of any injury can be reduce dramatically. It is also valuable for treating chronic inflammations, such as Achilles tendonitis, plantar fasciitis, shin splints and other tendon injuries. The medics should have sufficient antibiotics to clean and eliminate any bacteria in the body. Massage therapist and masseurs are to be arranged to provide professional massages for triathletes for triathletes experiencing stomach, leg cramps, etc. Teams with their own medical group and supplies are welcome to take up spaces in the medical tents, if required. 4. Conclusion There are other forms of sickness considered as non-Ironman afflicted injuries such as dietary problems. In some of these not-so genuine cases, medical assistance at Ironman will not be provided. The triathlete will have be responsible for paying for any medical treatment out of their own pockets unless they have valid proof to claim of food-poisoning triggered only from Ironman catering services. For extreme cases of medical treatment, i.e. those triathletes that cannot be medically treated in the tents such as difficulty in breathing due to respiratory problems or broken/fracture of bones/skull occurred during Ironman races, contractual liaising will have to be pre-arranged with nearby local hospitals. The more serious and life-threatening tritahletes will be immediately transported either via the medical vans or vans from the local hospitals for specialized treatment, surgery and care. Special assistance is also to be arranged for more senior triathletes (those above the age of 60 years) and physically challenged athletes. Based on the availability of medical volunteers, at least one volunteer is advised to accompany these less-able athletes throughout the entire race course. Red-cross services are to provide 24/7 telephony support and have an established helpline to cater for worried friends and relatives of triathletes. A similar online or helpline should also be set-up by the Ironman committee at the official Lazarote website. The Ironman committee should always be generous in sponsoring as many volunteers as possible to help and assist full-time committed staffs and part of their motto should be to provide full and consistent welfare and support to all triathletes who take part in the Ironman races. Any shortage in such medical and other supports would greatly affect the reputation of Ironman and the seriousness of seeing a decline of Ironman participation in the subsequent Ironman years. REFERENCES [1] B. Babbitt and J. Lampley (2004). 25 years of the Ironman Triathlon World Championship. Client Distribution Services. [2] B. J. Hosch (1994). Committed To Tri: An Empirical Investigation Of Triathletes And Commitment. MA in Interdisciplinary Studies. University of Texas at Dallas. [3] Collins, Kathryn, M. Wagner, K. Peterson and M. Storey (1989). Overuse injuries in triathletes. American Journal of Sports Medicine, pp. 675-680. [4] D. C. Hilliard (1988). Finishers, competitors, and pros: A description and speculative interpretation of the triathlon scene. Play and Culture, pp. 300-313. [5] D. C. Neiman (1995). Fitness and Sports Medicine: A Health-Related Approach. 3rd ed. Palo Alto, CA: Bull Publishing, pp. 371-376. [6] E. M. Peters (1997). Exercise, immunology and upper respiratory tract infections. Int J Sport Med pp. 69-77. [7] E. M. Wojtys, D. Hovda and G. Landry (1999). Concussion in sports. Am J Sports Med, pp. 676-687. [8] G. J. Bell and B. L. Howe (1987). Mood state profiles and motivations of triathletes.Journal of Sport Behavior, pp. 66-77. [9] H. S. Becker (1960).Notes on the concept of commitment. American Journal of Sociology 66:32-40. [10] H. W. B. Douglas, M. O'Toole, E. Fortress, R. Laird, P. Imbert and D. Sisk(1987).Medical and physiological considerations in triathlons.American Journal of Sports Medicine, pp. 164- 67. [11] Icon Health Publications (2004). Hyponatremia: A Medical Dictionary, Bibliography and Annotated Research Guide to Internet References. Lightning Source Inc. [12] J. A. Robert (1986). Viral illnesses and sports performance. Sport Med, pp. 296-303. [13] J. Horacio, M. D. Adrogue, E. Donald and M. D. Wesson (1994). Salt and Water (Blackwell's Basic of Medicine). Blackwell Science, Inc. [14] J. R. Berning and S. N. Steen (1998). Nutrition for Sport and Exercise. Gaithersburg, MD: Aspen, pp. 236-239. [15] K. B. Batts, J. E. Glorioso Jr and M. S. Williams (1998). The medical demands of the special athlete. Clin J Sport Med, pp. 22-25. [16] K. B. Fields (1997). Medical Problems in Athletes. Blackwell Science Inc. [17] K. D. Brownell, J. Rodin and J. H. Wilmore (1992). Eating, Body Weight and Performance in Athletes: Disorders of Modern Society. Lippincott Williams & Wilkins. [18] K. D. Thom (2002). Becoming an Ironman: First Encounters with the Ultimate Endurance Event. Consotium Book Sales and Dist. [19] K. M. Herring (1990). Friction blisters and sock fiber composition-A double blind study. Journal of Am Podiatr Med Assoc., pp. 63-71. [20] K. M. Walsh (2005). General Medical Conditions in the Athlete. Elsevier Science Health Science. [21] L. E. Armstrong, W. C. Curtis, R. W. Hubbard, R. P. Francesconi, R. Moore and E. W. Askew (1993). Symptomatic hyponatremia during prolonged exercise in heat. Medical and Science in Sport and Exercise, pp. 543-549. [22] L. S. Arthur and H. Blackburn (1977). The relationship of physical activity to coronary heart disease and life expectancy. Paul Milvy (ed.) The Marathon:Physiological, Medical Epidemiological and Psychological Studies. New York: New York Academy of Sciences. pp. 561-78. [23] O'Toole, L. Mary, W. Douglas, B. Hiller, R. A. Smith and D. Sisk(1989). Overuse injuries in ultraendurance triathletes. American Journal of Sports Medicine, pp. 514-518. [24] R. E. Heidrich (1990). Race for Life: From Cancer to the Ironman. Heidrich and Assoc. [25] S. I. Barr, D. L. Costill and W. J. Fink (1991). Fluid replacement during prolonged exercise: effects of water, saline or no fluid. Medical and Science in Sport and Exercise, pp. 811-817. [26] T. Noakes (1993). Fluid replacement during exercise [Review]. Exercise and Sport Sciences Reviews, pp. 297-330. [27] W. A. Latzka (1999). Water and electrolyte requirements for exercise. Clinical, Sports, and Medicine, pp. 513-524. [28] W. D. Hiller (1989). Dehydration and hyponatremia during triathlons [Review]. Medical and Science in Sport and Exercise, pp. 219-21. [29] W. M. Kohrt, J. S. O'Connor and J. S. Skinner(1989). Longitudinal assessment of responses by triathletes to swimming, cycling and running. Medicine and Science in Sports and Exercise, pp. 569-575. [30] W. Robert and M. D. Schrier (1986). Renal and Electrolyte Disorders. Third Edition. Little Brown and Company. Read More