Stress Fractures Are Annoying and Preventable!

modman

Over the years I have met a ton of endurance athletes, and one thing that they all have in common is their own personal list of annoying injuries. Many people have a war story to go with each injury on that list.

All you have to do is say to an endurance athlete “pulled hammie” and you will watch their whole body scrunch in reaction to how painful that is in real life and how annoying it is to manage the recovery.

Stress fractures not only hurt, but they are traditionally really annoying because it takes so long to heal bones. Hobbling around on crutches, keeping legs elevated, or having an inability to put weight on that region for any athlete is super-duper, big sigh, frustrated kind of annoying.

Taking steps in advance of an endurance event to avoid stress fractures is the “pay attention” advice for the athletes reading this article. This blog series is really focused on the things that happen on the trail and how a support team is going to react to those events, so I will focus on what to do after the injury has occurred.

The chances of a stress fracture for endurance athletes is high, especially for athletes that are pushing their muscles to the very limit. A normal athlete has between a two and 20% chance of having a stress fracture. An endurance athlete will most likely have one at least one in their personal list.

The reason a stress fracture happens is the muscles themselves become too tired to do the work. In order to pick up the impact of the work being performed that the muscles can’t manage, it directs that stress to the bones.

The majority of stress fractures that I have seen on the road really happen in the areas of the feet and the legs.

The athlete will know that they have a fracture because they have a pain that is traditionally getting worse, it will have a lot of swelling, and it may end up with a slight bit of bruising, but it will be first noticeable by pain. You’ll also know it’s a fracture when the pain is reduced as soon as any weight is lifted from the area or it will  immediately start to feel better from rest, and then spurs back as soon as motion or weight is applied to that area.

The hop test- have the athlete hop on the one side where the pain is. A stress fracture will deliver a pinpoint sharp pain.

Your best option is always to STOP-REST-ICE. If you are a trail driver, 100% of the time my advice is to have the athlete pulled off the course, and I will tell you very few athletes want to be pulled from the course. They will endure huge amounts of pain to not leave the course.

My advice to the athlete in a situation like this is to give them as much information as you can about where you think their injury is or where it is heading. Invite them to discontinue what they’re doing if it is causing them pain. In this case if it is a fracture they could actually double the amount of time that they will be unable to perform and be recovering.

Because this type of pain can often look like many other things that are not as critical, like shin splints, you really need to pay attention to the swelling, and how the pain changes when the area has weight taken off of it. When you have pain that is in the muscle tissues, it will start off REALLY screaming. If it is a bone pain, it will get progressively more painful as they move.

There are many athletes that will choose to continue on and bull their way through a stress fracture just to meet those goals. For those crazies, try to wrap the area tightly, give ibuprofen and a sturdy warning. That is all I can offer that will be accepted.

I will leave you with an odd fact, and that is if your athlete was also an athlete as a child, orthopedically they are less likely to get a stress fracture as an adult. And that has to do with the placement of the hip being different in athletic development of children.

Here is that random fact link.

Trail well.

Elevation Burns

chezbeat

When you are trail driving in areas that have high elevation and a lot of sun you’ll want to watch out for elevation burning.

It is also called sun poisoning, but it’s where you see (usually on the arms of an athlete) what looks like sunburn but has teeny white dots in it. Those white dots will be right underneath the skin and may have a little bit of topographical texture to them. Traditionally I see this in higher elevations, but it means that the athlete needs immediate complete sunblock and burn treatment.

I have a tool that I use that is in a tube form called “Rescue Remedy.” It is available at Whole Foods everywhere, or multiple places online. It is a homeopathic treatment that is especially good for burns. If you are taking notes, buy some and keep it in your medic kit at home for burns that happen on the stove. I am not kidding, this stuff is magic!

You want to slather it on that burn as soon as you see it and let it do its job. It will be the difference between blistering and not blistering.

If you have Rescue Remedy, I would apply it immediately and let it soak into that skin as many times as it can. The first application will melt into the skin. You want to apply it until it doesn’t immediately melt anymore and it’s got a white top finish. As soon as that slow sinking white top layer gets melted in (it may take about a minute) then you want to apply sunblock over that.

That should do the trick for the rest of the day, unless they are sweating off their sun block. Be very gentle when touching this area and remind them to not scratch. Scratching will make those white bumps that are actually a kind of blister pop up to the top.

Trail well.

Pulling Athletes Off the Course

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For endurance athletes and teams that are putting themselves in conditions that are personally and medically pushing boundaries, the last thing they will want is to be pulled off the course.

One of the things that I remind all trail drivers when they are servicing endurance athletes is that if it looks painful to you it’s probably not painful enough for that athlete to quit. They are out there to push their limits to places that most people would not consider.

You are there to make sure that they come out alive. And I mean that literally.

For these athletes, before we even set foot on the trail, we come up with a code word or someway in advance to agree when they have lost their mind, or when they are medically unable to continue.

There also has to be an agreement in advance that they will trust you that when you “call it” that they have to stop. And you will have to trust that athlete to know what their personal boundary is and that they can recognize it when they need to pull out. During that agreement time I will usually give a list of items that will make me immediately pull them from the course and those are traditionally the signs of a heart attack, stoke, or medical emergency.

Many times simply resting, or managing water, or a nutrient review will give that athlete enough to continue forward. I never threaten to pull someone from the course, I only invite the idea of rest so they don’t have to get pulled from the course.  I also, during times of complete fatigue, give them a time limit that tells them when I will be managing their health check points. “If you’re still listing sideways  or unable to keep your balance I need you to just sit down and I’ll come get you. I will be watching you in three minute intervals.”

What that simple piece of information does for the athlete is it also lets them know within three minutes if they’re getting better. That sometimes is all the help they need to keep going forward.  It only takes about three minutes for food, hydration, or rest to start working for that athlete.

It also gives you a short enough time for the athlete to work out in their head that we have to go for medical.

Trail well.

 

The Mind is Medicine

stevepb2

I was talking to an athlete and asking him how they get through extreme events when suffering with pain.

What I got back was something I hadn’t expected – the use of imaginary medicine!

The athlete had a mind technique that is really quite good, and I’m going to share it with all of you. They prepare an imaginary stash of mental painkiller that is located in their body and that does not run out. When they feel pain they start to identify if they need their body to send pain killer to that area. And then they just start imagining pain killer from their body being sent to that area.

Sometimes they imagine a few drops, sometimes it’s multiple doses over miles.

“Does that work?” I ask in astonishment. The response I got back was a gigantic smile and a YES head shake.

What I love about this technique is it gives the mind a chance to check in with the body and work together to get through extreme circumstances. It also helps the body know that this pain does not have to stay, it’s been noticed and it should settle down because much more will be required.

Using mind techniques to manage pain has been used for millennia. Using the power of the body and mind connection is a quick tool that every athlete can take with them, wherever they go.

When you are pushing your body to new limits it IS a brain game, and having as many tools as you can to use when you need them is not just a good idea,  it is sometimes the only way to finish.

Plus in this case there’s no prescription refill needed, it never runs out!

If you have other mind tricks to manage pain while on the trail please leave them in the comments section so everyone can pick them up.

Trail well.

Extreme Events

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I have been at a good many extreme events but I do want to give a shout out to the Deadman Peaks Trail Run – if you are planning an event go check it out – I watched that team do a miraculous job on extreme SAG (Supply and Gear) stations!

When you are picking an event one of the things that the athlete is responsible to do is to know who is running that event and to find as many race reports as they can. Extreme events take a ton of training mentally, physically, and sometimes will involve climate training. Even a veteran athlete can crush under courses that they don’t know. 

You should be looking for courses that the leadership team knows very well, an event where dedicated athletes go year after year, and ones that have trained aid workers. 

The reason I give such a huge Kudos to the ENTIRE team at the Deadman Peaks event is that they had thought the whole course through very deeply, right down to a night-before report on where rattlesnakes and cougars were. They had aid stations to manage athletes who were in difficult terrain, climate, and different physical levels. They were also able to manage cuts and scrapes that occurred from difficult terrain. 

The course itself was very difficult and had a lot of elevation changes in it. The team had to manage many different items that were going to come up for those athletes. One of the things that allowed them to be so great at delivering in extreme circumstances was how well they had packed for their athletes. 

Salt pills, electrolytes, pickle juice, chips and every resource imaginable was available, including sunblock! 

They also kept track of the athletes, and these are athletes that had only the aid stations as a way to get off of the course. If they were going to be ill on the course they had to walk it out to get to an aid station.  The aid stations were stacked with multiple people who had a range of skills. 

For those of you who consistently do extreme events you know the value of a great aid station. For those of you who are learning how to support athletes in extreme circumstances I do want to say thank you, because every time you help those athletes move further into their own goals you help someone change their life. You may think you’re just handing them a Coca-Cola but you also are giving them the tools they need to keep going on. 

Congratulations to that event and congratulations to all the finishers. 

Trail Well.

Scratches and Brush Bites

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If your team is moving through a terrain that has a lot of vegetation you will sometimes have to manage brush bites. 

That is when the vegetation itself sticks to or bites the athlete themselves. I see this a lot when an athlete is in a hurry to go to the restroom and gets a little too focused on relieving themselves, ignoring or being oblivious to their real surroundings.

Brush bites can be from anything, they can be poisonous, they can bleed and swell, they can also be a gourmet invitation for every biting fly known to mankind. 

As soon as I see that there is going to be biting brush on a terrain I will remind people of the importance of not letting vegetation touch them. Falling or getting scraped up from the terrain in an area where there are flies can make for a miserable existence when the trail is going slow. 

Your basic first aid will be extremely helpful for brush bites, look to see if anything has punctured or entered the skin and remove it, washing the area, covering it from further exposure. If there’s no cover available for the scrape then a topical ointment with petroleum base may be your only bandage (Neosporin, Vaseline).

Continue to check brush bites for swelling and itching. That will let you know if you’re going to need to use some Benadryl. 

If itching is going to make that athlete crazy you will want to give them a tool to divert their thoughts away from the itching. A simple mind tool where they focus on something else will help make the itch go away.  

So far I have seen no one who has thrown their time or had to quit from a brush bite but it sure has annoyed them. 

Trail well.

Heat Cramps

skeeze switch

When you are managing athletes that are possibly in danger of heat exhaustion you want to really ask about how their muscles feel and look for cramping.

Muscles are SUPER particular about how much hydration and salt they have when they are being exerted. When they are out of whack many athletes will get heat cramps, and those cramps can happen in any of their legs or arms. Being hot and tired for an extended period can induce cramps.

Here’s the phrase I will burn forever into your brain :

“It’s time to switch when you see the twitch.”

The earliest sign of heat cramps is a slight little tremor twitch on a muscle, and sometimes the eyeball will give you that first indication. The “switch” part means that you have to switch what the athlete is taking in for beverages – specifically electrolytes and sugars. Six to 12 ounces of sports drinks at a rest stop may not be enough to combat what the body is consuming; 400-800 ML/hour is the optimum rate of liquid intake for an athlete on the trail.

They don’t need just more liquid- they need fuel. Look to salty broth mixtures with heavy carbohydrates to aide the body’s consumption. Over hydration will exasperate the problem plus lead to rapid nausea, and nothing is more disgusting than a surprise liquid splashing chow-blowing. If they get dizzy and blow, they have too much water and not enough fuel.

A heat cramp later on (from over extension) can be signaled when an athlete lilts, weaves, or changes gait without even knowing it because they are hyper focused on their endurance goal.

Heat cramps also come in the abdomen but we will cover those in a different blog because abdomen cramps can mean a lot of things.  FYI parents – I see abdominal heat cramps a lot more in younger athletes (pre-teen/high school) and it is misdiagnosed on the sports field frequently. “My stomach hurts” is usually a common heat cramp from overexertion in youth.

Most cramps come from muscle tightness, but heat cramps are actually easy to identify. Tension cramps are from a type of tightness, and in the onset a tension cramp will “snap” in and feel like a knot. The biggest way to know if it is heat related or tension related is when rubbing doesn’t actually help and the larger muscle is having spasms. Heat cramps will NOT subside until the body has been cooled and the correct amount of water and salt is replaced into the muscle. That can take more than 30 minutes, so trail drivers will have to pay attention to early onset and keeping athletes regularly cooled down.

Heat cramps are a warning sign that the athlete is approaching heat exhaustion, so it’s a really good idea to use an external cool down method as well as an internal hydration method.

Immediately get out of direct sunlight.
Try to cool the entire body.
Give clear juice like apple.
Give sports drink with electrolytes.
Broth mixtures (with marrow) are also good.

Wrapping athletes in ice soaked towels will help manage core temperature, but the relief won’t come until the muscle has been put back in equilibrium.

If an athlete is going to try to run through heat cramps they absolutely need to be taking in sports liquids with heavy carbs, but if those cramps are more than an hour long they will have to shut down and rest in order to get relief.

To keep them on the trail remember “It’s time to switch when you see the twitch.”

Trail well.