Posted by: Duke Raleigh Hospital | July 16, 2018

Hydration: Optimizing Fluids for Best Form and Function

hydration infographic
As the summer temperatures climb and you start training for your fall marathon it’s important to consider an effective fluid plan for longer endurance runs to prevent under and over-hydration.

What to watch for:

Heat Illness
Cause: Under-hydration
Symptoms: Headaches, dizziness, confusion, fatigue, nausea and vomiting.

Hyponatremia (severely low sodium)
Cause: Over-hydration can dilute the amount of sodium (salt) in the blood.
Symptoms: Nausea and vomiting, headache, confusion, feeling tired, irritability, muscle weakness, spasms or cramps, seizures or passing out.

If you experience any of these symptoms of heat illness or hyponatremia, stop running immediately and if symptoms persist seek medical attention.

Fluid losses during activity vary by sweat rate ranging from 400 mL/hour to >2500 mL/hour. Sodium concentration of sweat also varies. Sweating rates fluctuate with the environment and other factors. For example, hot and humid conditions increase sweating and, acclimating level of the participant, their running pace, and level of exertion all affect the sweat rate.

Thirst is an indication that you are under-hydrated. Avoid drinking only when you feel thirsty. Be sure to drink regularly. For longer distance efforts, consider alternating between water and an electrolyte fluid drink or supplements to avoid hyponatremia.

Staying hydrated prior to training efforts should become part of your daily wellness regimen particularly when the heat index is high.

Running partners Jocelyn Wittstein, MD, and Melissa Raddatz, NP, work together at Duke Orthopaedics & Sports Medicine. Dr. Wittstein is Assistant Professor of Orthopaedic surgery at Duke. She specializes in adolescent and adult sports injuries. She has run several marathons and is an age group competitor. She previously coached Team in Training marathon groups in Eastern North Carolina. Melissa enjoys treating athletes and sports enthusiasts of all ages and levels. She ran Division I Cross-Country and Track at William & Mary. She has run a 2:50 marathon and is a five time nominee for New York Road Runners “Runner of the Year.”

Posted by: Duke Raleigh Hospital | June 12, 2018

Orthotics: What are they and do you need them?

Orthotics range from inlays to heel cups to silicone pads to insoles. Runners most commonly use specialized shoe insoles designed to help support feet and prevent instability that can lead to foot, ankle, shin and knee pain, as well as back strain.

While there are differences of opinion on whether specific running shoe design will prevent injury, it has been shown that orthotics reduce the risk of some injuries — specifically stress fractures. Orthotics have also been shown to relieve the pain associated with patellofemoral syndrome, neuromas, high and low arched feet. Talk with your sports medicine practitioner about considering orthotics for symptom treatment if you have any of these issues.

What else should you know?

  • Soft and hard orthotics: depending on your diagnosis there are various types of materials that could be helpful from soft silicone, plastic polymer to hard plastic.
  • Moldable insoles allow you to fit the precise shape of your foot using heat treatment.
  • Over the counter orthotics last an average of 6 months before they begin to lose their structural integrity, while custom orthotics can last up to a few years.
  • Non-prescription orthotics will typically cost less than custom orthotics. Check to see if you your insurance will cover them as part of your health plan before making your purchase.


Running partners Jocelyn Wittstein, MD, and Melissa Raddatz, NP, work together at Duke Orthopaedics & Sports Medicine. Dr. Jocelyn Wittstein is Assistant Professor of Orthopaedic surgery at Duke. She specializes in adolescent and adult sports injuries. She has run several marathons and is an age group competitor. She previously coached Team in Training marathon groups in Eastern North Carolina. Melissa Raddatz, NP enjoys treating athletes and sports enthusiasts of all ages and levels. She ran Division I Cross-Country and Track at William & Mary. She has run a 2:50 marathon and is a five time nominee for New York Road Runners “Runner of the Year.”

Posted by: Duke Raleigh Hospital | May 15, 2018

Iliotibial Band Syndrome

Iliotibial Band Syndrome (ITBS) is one of the most common overuse running injuries. The iliotibial band is a fibrous band that runs longitudinally along the lateral aspect of the thigh from its origin at the iliac crest to the proximal tibia. Iliotibial band syndrome is associated with lateral knee pain that is most intense where the iliotibial band crosses the outside of the knee.

What causes Iliotibial Band Syndrome?

  • Significant increase in running duration, mileage or intensity
  • Weak hip muscles which lead to increased tension on the iliotibial band
  • Bow legged knee alignment
  • Running on the same side of a banked road or running the same direction on a track
  • Footwear with increased heel height and width, causing increased relative supination

Diagnosis of iliotibial band syndrome is by history and physical exam. Occasionally imaging with X-ray or MRI may be needed.

Treatment includes rest, ice, stretching and non-steroidal anti inflammatories as needed. For resistant cases a steroid injection at the distal iliotibial band may be helpful.
Also would add steroid injection at the distal IT band can be helpful in recalcitrant cases.

Running partners Jocelyn Wittstein, MD, and Melissa Raddatz, NP, work together at Duke Orthopaedics & Sports Medicine. Dr. Jocelyn Wittstein is Assistant Professor of Orthopaedic surgery at Duke. She specializes in adolescent and adult sports injuries. She has run several marathons and is an age group competitor. She previously coached Team in Training marathon groups in Eastern North Carolina. Melissa Raddatz, NP enjoys treating athletes and sports enthusiasts of all ages and levels. She ran Division I Cross-Country and Track at William & Mary. She has run a 2:50 marathon and is a five time nominee for New York Road Runners “Runner of the Year.”

Posted by: Duke Raleigh Hospital | April 11, 2018

Stressed about Stressed Fractures?

Stress fracture infographic

Stress fractures are micro cracks in a bone. They originate from repetitive force most commonly in running or repeatedly jumping up and down. They can also occur with normal use of a bone that’s compromised by a condition such as osteoporosis. Athletes in track and field, basketball, dance or gymnastics are more at risk for this injury.

In runners, stress fractures commonly occur in the bones of the feet, legs and pelvis. Symptoms of a stress fracture are increased pain and swelling during activity in a certain bony spot which decreases with rest.

Diagnosis of a stress fracture is usually by physical exam and imaging with X-ray. Occasionally advanced imaging with MRI may be needed. Treatment includes rest and non-weight bearing activities until the bone heals.

What is the best prevention for stress fractures?

  • Avoid dramatic increase in running duration and intensity. Follow the 10% rule: only increase your mileage or duration of physical activity 10% each week.
  • Include a daily Vitamin D and Calcium supplementation in your diet – 400-1,000 iu daily of Vitamin D depending on your age and 1000-1200mg daily of Calcium for a typical healthy athlete.
  • Moderate consumption of caffeine and alcohol.
  • Add strength training in your exercise routine to help prevent osteoporosis. Learn more about the benefits of strength training for runners.
  • Use proper footwear and changing it regularly if worn out, at least every 250 miles.

Running partners Dr. Jocelyn Wittstein and Melissa Raddatz, NP, work together at Duke Orthopaedics & Sports Medicine. Dr. Jocelyn Wittstein is Assistant Professor of Orthopaedic surgery at Duke. She specializes in adolescent and adult sports injuries. She has run several marathons and is an age group competitor. She previously coached Team in Training marathon groups in Eastern North Carolina. Melissa Raddatz, NP enjoys treating athletes and sports enthusiasts of all ages and levels. She ran Division I Cross-Country and Track at William & Mary. She has run a 2:50 marathon and is a five time nominee for New York Road Runners “Runner of the Year.”

Posted by: dukeraleighadmin | March 19, 2018

Importance of Strength Training for Runners

A recent study in the American Journal of Epidemiology found people who do strength-based exercise have a 23 percent lower risk of premature death and a reduced cancer mortality rate. The analysis also showed exercises performed using your own body weight without specific equipment were just as effective as gym-based training. Consider what more you could achieve in longevity and wellness with healthier muscles!

Strength training is an important tool for all ages. In fact, it prevents bone loss (osteoporosis), improves body alignment, and metabolic rate.

When you plan your weekly running program it’s just as important to schedule 2-3 days of strength training.

WHY?
Because regular cardiovascular exercise doesn’t build the skeletal muscles around your bones. If you have arthritis or joint pain, strengthening will allow you to push further in everything else you do with stronger muscles.

Tips to Take Away:

  • No “bulking up” is necessary. Use your own body weight or 3-15 pound weights (depending on your current strength) and higher frequency of repetitions for best results.
  • Incorporate on alternate or “easy” days of aerobic activity to vary your routine and avoid overuse injury.
  • Improvement can be seen in a minimum of 10 minutes for overall exercises.
  • If you are new to strength training you can take a class or work with a trainer to implement appropriate form and target certain muscle groups.

Strength training infographic

Running partners Dr. Jocelyn Wittstein and Melissa Raddatz, NP work together at Duke Orthopaedics & Sports Medicine. Dr. Jocelyn Wittstein is Assistant Professor of Orthopaedic surgery at Duke. She specializes in adolescent and adult sports injuries. She has run several marathons and is an age group competitor. She previously coached Team in Training marathon groups in Eastern North Carolina. Melissa Raddatz, NP enjoys treating athletes and sports enthusiasts of all ages and levels. She ran Division I Cross-Country and Track at William & Mary. She has run a 2:50 marathon and is a five time nominee for New York Road Runners “Runner of the Year.”

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