Psoas muscle hypertrophy: mechanical cause for "jogger's trots?"

Long-standing groin pain in sportspeople falls into three primary patterns, a "clinical entity" approach: a prospective study of 207 patients

BACKGROUND

Groin pain remains a major challenge in sports medicine.

AIM

To examine 207 consecutive athletes (196 men, 11 women) with groin pain using a standardised and reliable clinical examination programme that focused on signs that suggest pathology in (1) the adductors, (2) the ilopsoas and (3) the rectus abdominis.

PATIENTS AND METHODS

Most patients were football players (66%) and runners (18%). In this cohort, the clinical pattern consistent with adductor-related dysfunction, was the primary clinical entity in 58% of the patients and in 69% of the football players. Iliopsoas-related dysfunction was the primary clinical entity in 36% of the patients. Rectus abdominis-related dysfunction was found in 20 (10%) patients but it was associated with adductor-related pain in 18 of these patients. Multiple clinical entities were found in 69 (33%) patients; of these, 16 patients had three clinical entities.

CONCLUSIONS

These descriptive data extend previous findings that physical examination for groin pain can be reliable. While underscoring the prevalence of adductor-related physical examination abnormality in football players, the data highlight the prevalence of examination findings localising to the iliopsoas among this cohort. Also, the fact that combinations of clinical entities were present has important implications for treatment. The finding of multiple abnormal clinical entities also raises the possibility that earlier presentation may be prudent; it is tempting to speculate that one clinical entity likely precedes other developing entities. These data argue for the need for a trial where clinical entities are correlated with systematic investigation including MRI and ultrasonography.

Marathon Pancreatitis: Is the Etiology Repetitive Trauma?

Abdominal pain frequently occurs after long-distance running. The cause of the pain may be due to dehydration, diaphragmatic ischemia, muscular spasm, or myonecrosis. However, data regarding the frequency of these purported causes are currently lacking. Pancreatitis can also occur after long-distance running, but few cases have been reported, and the etiology is controversial. We report a case of pancreatitis in a thin, muscular marathon runner. We suggest the etiology in this case may be traumatic as the pancreas may have suffered repetitive injury against the posterior abdominal wall and spine.

Aetiology of running-related gastrointestinal dysfunction. How far is the finishing line?

30 to 65% of long distance runners experience gastrointestinal (GI) symptoms related to exercise. Several hypotheses have been postulated; however, the aetiology and pathophysiology are far from clear. The mechanical effect of running on the viscera must be involved in the development of GI symptoms in this sport. Reduction of splanchnic blood flow due to visceral vasoconstriction is another widely supported theory; nevertheless, it does not explain many of the clinical findings. Examination of the GI tract during exercise is a difficult task, and measurements of both orocaecal and whole-gut transit time have shown equivocal results. GI hormones, and especially prostaglandins, may be of crucial importance for the production of symptoms. Intestinal absorption, secretion and permeability may also be altered during exercise, provoking intestinal dysfunction. Factors such as stress, diet, dehydration, infections and other factors need to be analysed in order to present a global view of the hypotheses regarding the aetiology of this common and often overlooked problem.

Exercise-Induced Gastrointestinal Symptoms

In brief A triathlete and two distance runners sought medical advice for gastrointestinal (GI) symptoms that were brought on by increased training and hard runs. Collectively, their symptoms included heartburn, nausea, abdominal cramping, diarrhea, and bloody diarrhea. One patient had an up-per-GI motility disorder; one had a lower-GI motility disorder; the third had ischemia-related GI bleeding. The first two patients' symptoms improved with pharmacologic therapy and dietary changes, respsectively. The third patient did not require treatment.

Overcoming Runner's Diarrhea

In brief Many people experience bowel dysfunction related to running, ranging from prerace 'nervous diarrhea' to bloody diarrhea after an exhausting run. Potential causes vary. Diagnosis rests on an accurate history and selective investigation to exclude disease. Treatment may include explanation, reassurance, defecation before running, dietary changes, adequate hydration, and, occasionally, antidiarrheals.

Diarrhea and Fecal Incontinence

In brief Two endurance athletes developed diarrhea and fecal incontinence each time they exercised strenuously. Such gastrointestinal difficulties are usually benign, but physicians determined that the disorders were an unusual presentation of lumbar spondylolisthesis in a runner and of jejunal diverticulosis in a cyclist. The runner's diarrhea and incontinence resolved when she avoided activities that precipitated her symptoms, and the cyclist's condition resolved with oral tetracycline.

Effect of exercise and physical fitness on large intestinal function

The effect of exercise on large intestinal function has been determined in 14 healthy but normally sedentary men and women, aged 22-34 yr while on a constant diet. For an initial 3-5-wk period (control) no activity was allowed. Six subjects then undertook a 9-wk training schedule by the end of which they were capable of jogging for 1 h per day, 5 days a week. A further 6 subjects undertook a similar training schedule that lasted for only 7 wk, at the end of which they were jogging for 45 min per day. Finally, 2 subjects were studied continuously while taking light exercise for 6 wk and then jogging for a further 3 wk. Physical fitness was monitored and showed significant changes with maximum aerobic capacity increasing from 2.4 +/- 0.5 to 3.1 +/- 0.4 L/min, maximum heart rate after a step test falling from 152 +/- 8 to 129 +/- 5 beats per minute, and resting pulse rate also falling from 56 +/- 4 to 50 +/- 5 beats per minute. High-density lipoprotein cholesterol also increased significantly. Colonic function was assessed by measurement of stool weight and transit time, using the continuous radiopaque marker technique, fecal pH, nitrogen excretion, and ammonia concentration. No change was observed overall in mean daily fecal weight [124 +/- 39 (control) and 129 +/- 49 g/day (exercise)], transit time [55 +/- 20 (control), 54 +/- 23 h (exercise)], nor in fecal frequency, dry stool weight, pH, ammonia, or total nitrogen excretion. Significant changes did occur in 5 individuals with significant slowing of transit time in 2 and speeding up in 3. Overall transit time increased in 9 subjects and decreased in 5; hence, when diet is constant, exercise has marked effects on physical fitness but no consistent effect on large bowel function.

Gastrointestinal Bleeding in Athletes

In brief: Gastrointestinal (GI) bleeding is a troubling yet intriguing complication of distance running. This clinical overview traces our evolving understanding of the scope and importance of GI bleeding in runners and other athletes, and discusses the diverse causes, sites, and implications of exercise-related GI bleeding. It concludes with practical tips to prevent or mitigate this problem, including gradual conditioning, avoidance of prerace aspirin intake, and when indicated, therapy with antacids, H2 blockers, or iron.

Bilateral pelvic masses in a long-distance cyclist

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Gastrointestinal disturbances in marathon runners

The purpose of this survey was to investigate the prevalence of running-induced gastrointestinal (GI) disturbances in marathon runners. A questionnaire was completed by 471 of the estimated 1,750 competitors in the 1986 Belfast City Marathon. Eighty-three per cent of respondents indicated that they occasionally or frequently suffered one or more GI disturbances during or immediately after running. The urge to have a bowel movement (53%) and diarrhoea (38%) were the most common symptoms, especially among female runners (74% and 68% respectively). Upper GI tract symptoms were experienced more by women than men (p less than 0.05) and more by younger runners than older runners (p less than 0.01). Women also suffered more lower GI tract symptoms than men (p less than 0.05) with younger runners showing a similar trend. Both upper and lower tract symptoms were more common during a "hard" run than an "easy" run (p less than 0.01) and were equally as common both during and after running. Of those runners who suffered GI disturbances, 72% thought that running was the cause and 29% believed their performance to be adversely affected. There was no consensus among sufferers as to the causes of symptoms and a wide variety of "remedies" were suggested. GI disturbances are common amongst long-distance runners and their aetiology is unknown. Medical practitioners should be aware of this when dealing with patients who run.