Dedication	6
	Preface	8
	Contents	10
	Contributors	12
	Part I: Medical Conditions	15
	1: Cardiovascular Evaluation and Treatment of the Endurance Athlete	16
	Introduction	16
	Overview of Normal Physiological Adaptations to Endurance Training	16
	Left Ventricular Adaptations to Endurance Exercise	17
	Right Ventricular Adaptations to Endurance Exercise	19
	Atrial Adaptation to Endurance Exercise	19
	Variability of Exercise-Induced Cardiac Remodeling	19
	Clinical Implications of Remodeling	20
	Electrical Remodeling	21
	Evaluation of the Symptomatic Endurance Athlete	22
	Chest Pain	22
	Syncope	24
	Palpitations	26
	Atrial Arrhythmias	27
	Long-Term Effect of Chronic Endurance Training	27
	Sudden Death During Endurance Competition	28
	Conclusion	28
	References	30
	2: Exercise-Induced Bronchoconstriction and Vocal Cord Dysfunction	33
	Vocal Cord Dysfunction	36
	References	39
	3: Evaluation and Treatment of Heat- and Altitude-Related Illness	42
	References	51
	4: Pregnancy and the Endurance Athlete	53
	Introduction	53
	Pregnancy Physiology	53
	Endurance Physiology	55
	Physiological Concerns of Exercise During Pregnancy	55
	Maternal Physiologic Concerns	56
	Fetal Physiological Concerns	56
	Risks/Benefits of Exercise During Pregnancy	57
	Physical Activity in Pregnancy	58
	Exercise Prescriptions	59
	Exercise Prescription During Pregnancy	61
	The Sedentary or Non-exercising Patient	61
	The Regular Exercising Patient	61
	The Elite Athlete	62
	Conclusion	63
	References	63
	5: Gender Differences: Considerations for the Female Endurance Athlete	65
	Historical Perspective	65
	Anatomical and Physiological Differences in the Female Endurance Athlete	66
	VO2max	66
	Other Sex Differences	67
	Medical Conditions in the Female Endurance Athlete	67
	Iron Deficiency Anemia and Iron Depletion	68
	Stress Urinary Incontinence	69
	Overtraining Syndrome	70
	Exercise-Associated Collapse and Hyponatremia	71
	The Female Athlete Triad and the Relative Energy Deficiency in Sport	72
	Energy Availability	73
	Menstrual Dysfunction	75
	Poor Bone Health	75
	Stress Fractures	77
	References	77
	6: Considerations for the Pediatric Endurance Athlete	81
	Background	81
	Is Long-Distance Running Safe?	81
	Endurance Training Physiology	82
	Growth	83
	Training	83
	Cardiac Changes	83
	References	84
	Part II: Musculoskeletal Conditions	86
	7: Treatment of Stress Fractures	87
	Pathophysiology	87
	Risk Factors for Stress Fractures	88
	Intrinsic Factors	88
	Extrinsic Factors	89
	Clinical Presentation	89
	Imaging Evaluation	89
	Radiography	89
	Bone Scintigraphy	90
	Ultrasound	90
	SPECT Scan	91
	Computed Tomography	91
	MRI	91
	Classification/Grading	92
	High-Risk Stress Fractures Versus Low-Risk Stress Fractures	93
	Rib and Upper Extremity Stress Fractures	93
	General Treatment Principles	94
	Management of High-Risk Stress Fractures	94
	Return to Sports Participation	95
	Prevention of Stress Injuries	96
	Summary	96
	References	97
	8: Evaluation and Treatment of Soft Tissue Overuse Injuries	100
	Achilles Tendinosis	100
	Introduction	100
	Terminology	100
	Anatomy	100
	Pathophysiology of Tendinosis	101
	Epidemiology	101
	Etiology	101
	Physical Exam	102
	Imaging	102
	Treatment	103
	Medications	103
	Rehabilitation	103
	Extracorporeal Shock Wave Therapy (ESWT)	104
	Injection Therapies	104
	Topical Treatment	105
	Surgery	105
	Patellar Tendinosis	106
	Introduction	106
	Terminology	106
	Anatomy	106
	Epidemiology	106
	Risk Factors	107
	History and Physical Exam	107
	Workup	107
	Imaging	107
	Treatment	108
	Medication	108
	Rehabilitation	108
	Extracorporeal Shock Wave Therapy (ESWT)	109
	Injections	110
	Greater Trochanteric Pain Syndrome (GTPS) or Gluteal Tendinopathy	111
	Definition	111
	Epidemiology	111
	Anatomy	111
	Risk Factors/History	112
	Physical Examination	112
	Laboratory Studies	114
	Radiographic Workup	114
	Management	115
	Medications	115
	Physical Therapy	115
	Injection Therapy	115
	Extracorporeal Shock Wave Therapy (ESWT)	115
	Surgical Intervention	116
	Newer Considerations	116
	References	116
	9: Chronic Exertional Compartment Syndrome	119
	Introduction	119
	Epidemiology	120
	Anatomy/Physiology	120
	Diagnosis	123
	Differential Diagnosis	125
	Treatment	126
	Two-Incision Technique	127
	Outcomes	128
	Complications	129
	Recovery/Return to Sport	129
	Summary	129
	References	130
	10: Shoulder Injuries and Conditions in Swimmers	132
	Background	132
	Epidemiology	132
	Pathophysiology	133
	Training Factors	133
	Scapular Dyskinesis	133
	Shoulder Instability and Range of Motion Deficits	134
	Muscle Imbalance	135
	Muscle Fatigue	136
	Intrinsic Tendon Degeneration	136
	Diagnosis, Evaluation, and Management	137
	Core Strength, Impaired Posture, and Scapular Dyskinesis	137
	Tight Posterior Capsule	138
	Rotator Cuff Strength	139
	Glenohumeral Instability	139
	Shoulder-Specific Conditions	139
	Subacromial Impingement	139
	Internal Impingement	140
	Multidirectional Instability	141
	Exam/Imaging	141
	Treatment	141
	References	141
	11: Common Injuries and Conditions in Rowers	144
	Introduction	144
	Brief History	144
	Basic Technique and Biomechanics	144
	Mechanisms of Injury and Initial Assessment	145
	Common Injuries and Treatment	146
	Lower Back	146
	Spondylolysis	146
	Spondylolisthesis	146
	Disk Injuries/Herniation	146
	Sacroiliac Joint Dysfunction (SIJD)	147
	Knee	147
	Iliotibial Band Friction Syndrome	147
	Patellofemoral Syndrome	147
	Rib	148
	Rib Stress Fractures	148
	Costochondritis	148
	Wrist and Forearm	148
	Intersection Syndrome (“Oarsmen’s Wrist”)	148
	Tenosynovitis	149
	Exertional Compartment Syndrome	149
	Dermatology and Skin Conditions	149
	Blisters	149
	Abrasions	149
	Conclusion	150
	References	150
	12: Common Injuries and Conditions in Crossfit Participation	152
	Introduction	152
	Weight lifting	153
	Endurance	157
	Gymnastics	158
	Other	160
	Conclusion	162
	References	162
	13: Hip Injuries in the Endurance Athlete	164
	Introduction	164
	Anatomy	164
	Layer I	165
	Layer II	165
	Layer III	168
	Layer IV	170
	History	170
	Physical Examination	172
	Inspection	173
	Palpation	173
	Motion, Strength, and Special Testing	173
	Imaging Evaluation	176
	Differential Diagnosis Evaluation	177
	Treatment	180
	Conclusions	181
	Location of Investigation	183
	Source of Funding	183
	Statement of Originality	183
	Disclosures	183
	References	183
	14: Exercise and Osteoarthritis: The Effect of Running with Aging in the Masters-Level Athlete	187
	Introduction	187
	Pathophysiology of Disease, At-Risk Populations, and the Modifiable Lifestyle Factors	188
	Evaluation of Masters Athlete with Lower Extremity/Knee Pain Associated with Running	190
	Treatment of Masters Athlete: Nonoperative vs. Operative Management	192
	Conclusion (Summary of Evaluation and Treatment, “Barefoot” Running, Role of Diet, and Cross-Training for Healthy Running)	196
	References	198
	Part III: Special Considerations	202
	15: Clinical Aspects of Running Gait Analysis	203
	Introduction	203
	Getting Started	203
	Patient Setup and Video Capture	204
	Analysis of the Recorded Video	205
	Sagittal Plane	205
	Initial Contact	205
	Mid Stance	209
	Additional Sagittal Measures	210
	Frontal Plane	211
	Mid Stance	211
	Other Variables	213
	Summary	214
	Disclosure	214
	References	214
	16: Clinical Considerations of Bike Fitting for the Triathlete	216
	Introduction	216
	Injury Considerations in the Triathlete	217
	Triathlon Bike Anatomy	217
	Clinical Considerations of Cycling Mechanics	217
	Getting Started: Basic Fit Setup and Equipment	219
	The Bike: Fit Window	220
	Seat Tube Angle (STA) (Fig. 16.5)	221
	Seat/Saddle Height (Fig. 16.5)	222
	Cleat Position (Fig. 16.6)	222
	Hip Angle (Fig. 16.7)	223
	Shoulder Angle (Fig. 16.8)	223
	Arm Pad Stack/Drop and Reach (Fig. 16.9)	225
	Armrest Width (Fig. 16.2a)	225
	Crank Length (Fig. 16.1b)	225
	Saddle Position	226
	Helmets/Sunglasses	226
	Other Fit Considerations for Different Triathlon Distances	226
	Summary	227
	References	227
	17: Evaluation and Treatment of the Swimming Athlete	229
	Introduction	229
	The Four Competitive Strokes	229
	Freestyle Biomechanics	230
	Freestyle Upper Extremity Movement	230
	Freestyle Lower Extremity Movement	231
	Freestyle Stroke Mechanics: General Notes	231
	Backstroke Biomechanics	232
	Backstroke Upper Extremity Movement	232
	Backstroke: Lower Extremity Movement	232
	Backstroke Mechanics: General Notes	232
	Butterfly Biomechanics	232
	Butterfly Upper Extremity Movement	233
	Butterfly Lower Extremity Movement	233
	Butterfly Stroke Mechanics: General Notes	233
	Breaststroke Biomechanics	233
	Breaststroke Upper Extremity Movement	234
	Breaststroke Lower Extremity Movement	234
	Breaststroke Stroke Mechanics: General Notes	234
	Common Stroke Technique Error	235
	Freestyle Errors	235
	Common Errors in Freestyle Are Found Below (% Prevalence in Subjects Tested) [21]	235
	Injury Prevalence and Incidence	238
	Performance Considerations	239
	The Pediatric Swimmer	239
	The Masters Swimmer	240
	Common Injuries	241
	Shoulder	241
	Knee	243
	Spine	244
	Hip	244
	Ankle	245
	Swimming Injury Conclusion	246
	Unique Pulmonary Considerations in Swimmers	246
	Thoracic Outlet and Paget-Schroetter Syndrome	246
	Swimming-Induced Pulmonary Edema	246
	Rehabilitation	247
	Breathing	247
	Breath Control/Pulmonary Function	248
	Spine	249
	Cervical	249
	Lumbar	249
	Hip	250
	Knee	251
	Ankle	251
	Shoulder	252
	Mobility	255
	Elastic Therapeutic Taping	256
	Return to Sport Considerations	256
	Return to Swimming Protocol	257
	Training Considerations	262
	Equipment Considerations	262
	Coach/Trainer Resistance Training Expertise	263
	Efficacy of Dryland Strength Training	263
	Efficacy of Swim Training Regimen	263
	Training Effort and Communication with Coaches	265
	Altitude Training	265
	Injury Prevention	266
	Video Analysis	266
	Feedback	267
	A Proposed Injury Screen	267
	A Proposed Dynamic Warm-Up	267
	Appendix A: General Rehab—Neck Pain for Swimmers [86]	268
	Appendix B: General Rehab—Trunk Program (Lumbar and Hip) [119, 121, 122]	269
	Appendix C: General Rehab—Shoulder Program [99, 114, 133]	270
	Appendix D: Part 1—Dynamic Shoulder, Spine, Hip, Knee, and Ankle Warm-Up (All 2 × 15 Reps) [186, 187]	271
	Appendix E: Part 2—Strength/Plyometric/Balance/Reaction Time Progression [186]	273
	Appendix F: Part 3—Aquatic Swimming-Specific Drills [186, 187]	275
	References	276
	18: Mental Skills for Endurance Sports	283
	Introduction	283
	Motivation	284
	Goal Setting	284
	Energy Management	285
	Self-Talk	286
	Concentration	287
	Imagery	288
	Performance Routines	289
	Mindfulness	290
	Balanced Exercise	291
	Conclusion	292
	References	292
	19: Optimizing Nutrition for Endurance Training	295
	Important Nutrition Components and Current Recommendations	295
	The Macro Mixture	296
	Hydration	299
	Common Micronutrient Issues	299
	Summary	301
	References	301
	20: Endurance Medicine: Medical Coverage for Mass Sporting Events	304
	Overview	304
	Anticipated Encounters	304
	Medical Staff and Volunteer Management	305
	Equipment, Supplies, and Logistics	308
	Weather Monitoring and Alerts	309
	Event-Day Communication	311
	Event Security	312
	Conclusion	314
	References	314
	21: Return to Sport Decision-Making for Endurance Athletes	315
	Identification and Correction of Predisposing Factors	315
	Biomechanics and Equipment	315
	Running	315
	Biking	316
	Swimming	316
	Rowing	316
	Training	316
	Nutrition	317
	Restoration of Function	318
	Range of Motion	318
	Strength	318
	Neuromuscular Training	319
	Sport-Specific Training	319
	Returning to Competition	319
	Managing Challenges During Rehabilitation	319
	Maintaining Fitness Level	320
	Dietary Changes	320
	Psychological Challenges	321
	Integrating the Treatment Team	322
	Physical Therapy	323
	Exercise Physiology	323
	Coaching Staff	323
	Nutrition	324
	Sport Psychology	324
	Sports Medicine Physicians and Surgeons	324
	References	325
	Index	328