Weight Changes in First 20 Finishers, WHWR, 2008. Comparative scatterplots of Body weight change (%) v. Total performance time (minutes), WHWR2008 and SA Ironman2000/1. Adverse Medical Consequences of Prolonged Exertion Dr Chris Ellis, Kinlochleven Medical Practice.
Weight Changes in First 20 Finishers, WHWR, 2008
Comparative scatterplots of Body weight change (%) v. Total performance time (minutes), WHWR2008 and SA Ironman2000/1.
Adverse Medical Consequences of Prolonged Exertion
Dr Chris Ellis, Kinlochleven Medical Practice.
So, when Persia was dust, all cried, "To Acropolis!Run, Pheidippides, one race more! the meed is thy due!Athens is saved, thank Pan, go shout!" He flung down his shieldRan like fire once more: and the space 'twixt the fennel-fieldAnd Athens was stubble again, a field which a fire runs through,Till in he broke: "Rejoice, we conquer!" Like wine through clay,Joy in his blood bursting his heart, - the bliss!
Robert Browning, 1879.
Pheidippides-First reported running related death, 490 BC
1) To heighten awareness of serious medical problems that may arise.
2) To enable early recognition and treatment.
3) Prevention (of some).
1) Sudden death (usually cardiac).
2) Rapidly but not immediately (within hours to days) life threatening , which may be specifically exercise associated e.g. exercise associated hyponatraemia, rhabdomyolysis, exertional heatstroke, or non-specifically exercise associated, e.g. brain haemorrhage.
3) Limb, but not life-threatening , disorders which are usually musculo-skeletal, eg. compartment syndrome and fractures.
2) Usually (but not exclusively) cardiac.
3) When cardiac, cause usually governed by age:
Under 35 years-Inherited cardiac defect.
Over 35 years-Diseased arteries
Marc-Vivien Foe (Deceased)
Jimmy Fixx (Deceased)
1) EXERCISE ASSOCIATED HYPONATRAEMIA (EAH).
2) RHABDOMYOLYSIS with COMPLICATIONS.
3) EXERTIONAL HEATSTROKE.
David Rogers (Deceased), London Marathon, 2007
Disorder of muscle breakdown with liberation of cell contents into body.
Everyone has this to some degree, but complications are the problem.
Muscle pain. Dark urine. Lack of urine. Lack of well-being. Vomiting.
Affect some people. Kidney failure, death (and others).
Rhabdo is real.
Four cases from WHWR since 2005, two with kidney failure.
Less preventable than EAH. Anti-inflammatories and viral illness are risk factors.
Suspect early to minimise complications. Report dark or reduced urine, inordinate muscle pains.
Non-specific confusion/lack of well-being. Mortality, once established, is high.
Overproduction of heat from muscles with which body can’t deal, probably due to combination of, exercise, inherited disposition and further unknown trigger.
Exercise can cause the core temperature to rise without symptoms or significance.
Suspect disposition if previous problem or severe “heat reaction” to anaesthetic or other drugs. Measure “core” temperature. High suspicion needed. Treat early and aggressively and accept unneccessary treatment. Emergency hospitalisation often needed.
Numerous-too many to mention individually.
Either sudden (e.g. fracture), or overuse (e.g.”shinsplints”, stress fractures, ITBFS).
Tibial stress fracture
Metatarsal stress fracture
Swelling of muscle group within enclosed sinew (fascia), following injury or overuse. May be associated with constricting bandage or plaster cast.
This is an emergency, take off bandage if applicable, if not, needs urgent surgery.
RULE OF THUMB:
Collapse shortly after finishing the race or a stage is usually trivial if the runner finished symptom free.
Collapse while running, or considerably after, is usually serious and needs medical assessment
1) Exercise associated hyponatraemia
3) Exertional heatstroke
4) Compartment syndrome.
5) Causes of collapse, serious or trivial, on the basis of timing.
6) Risk reduction strategies by avoidance of overdrinking and NSAIDs
WHWR website, Medical Guidelines
THANK YOU and QUESTIONS.
This Camelbak’s killing me!
This camelback is killing me!