Impact of injury on ultramarathon performance

Two new bits of research from the same group was recently published in the British Journal of Sports Medicine:

IMPACT OF INJURY PATTERN DURING TRAINING ON ULTRAMARATHON PERFORMANCE
M Khodaee, J Spittler, JC Hill, MD Hoffman
Br J Sports Med 2014;48:619 doi:10.1136/bjsports-2014-093494.160
Abstracts from the IOC World Conference on Prevention of Injury & Illness in Sport, Monaco 2014

Background Little is known about the effect of injuries during training on ultramarathon performance.
Objective Determine effects of injuries during training on race performance.
Design Observational study using a self-administered pre-race survey. Finish times were obtained from race results posted online.
Setting The 2013 Leadville Trail 100 (LT100) and Western States Endurance Run (WSER).
Participants Participants of LT100 and WSER 161 km ultramarathons.
Risk factor assessment Age, gender, educational level, prior completion of a 161 km ultramarathon, shoe type, self-report of foot strike pattern, and injuries or illnesses interfering with training in the past year were considered.
Main outcome measurements The primary outcome measure was whether sustaining an injury or illness resulting in missed training days affected successful completion of an ultramarathon.
Results Out of 1206 LT100 and 408 WSER entrants, 893 and 368 completed the pre-race survey (73.9% and 90.1%, respectively). Most participants were male (82%) with average age of 41 years. 52.3% of LT100 and 72.3% of WSER starters finished the races under the 30 hour cutoff time. Among respondents, 40% had masters or higher degrees and 45% reported using dietary supplements on a regular basis. Respondents reported 1432 (multiple answers per runner) injury episodes causing less than a week of missed training and 641 injury episodes causing a week or longer of missed training in the past year. Pain in Achilles (n=196), lower iliotibial band (n=164), upper hamstring (n=115), and groin pain (n=106) were the most common reported issues interfering with training. Only 45 (2.8%) of respondents reported sustaining a stress fracture during training in the past year. Of these, 27 (60%) involved the metatarsals and 10 (22%) involved the tibia. Using a binary logistic regression model, sustaining an injury during the training, age, gender, educational level, prior completion of a 161 km ultramarathon, shoe type, and self-report of foot strike pattern did not affect finish status (P>.05).
Conclusions Many ultramarathon runners sustain injuries and illnesses interfering with training schedule, but this does not seem to be a predictor of successfully completing the race.

REASONS FOR INABILITY TO COMPLETE ULTRAMARATHONS: A MULTICENTER STUDY
M Khodaee, J Spittler, P Basset, K Vanbaak, JC Hill, I San Millán, MD Hoffman
Br J Sports Med 2014;48:618-619 doi:10.1136/bjsports-2014-093494.159
Abstracts from the IOC World Conference on Prevention of Injury & Illness in Sport, Monaco 2014

Background Despite increased ultramarathon participation in recent years, little is known about causes of race incompletion. This study surveyed runners of three 161–168 km ultramarathons in Europe and North America to explore characteristics and issues that affected race performance.
Objective Determine human and environmental factors related to failure to complete ultramarathons of ∼161 km in the previous year.
Design Observational study using surveys prior to the race.
Setting The 2013 Ultra-Trail du Mont-Blanc® (UTMB®) in Europe; Leadville Trail 100 (LT100) and Western States Endurance Run (WSER) in North America.
Participants Out of 4 110 race entrants, 2 794 (69%) completed the pre-race survey.
Risk factor assessment In this epidemiologic study, we report the incidence of intrinsic and extrinsic factors related to failure to finish of at least one ∼161 km race in the previous year.
Main outcome measurements The main outcome measurements were self-reported reasons for not finishing the race.
Results Among respondents, about 30% had masters or higher degrees. Out of 2,469 UTMB®, 1206 LT 100, and 408 WSER entrants, the majority successfully completed the race (68%, 52% and 72%, respectively). Among participants who responded, 18.3% reported they failed to complete an ultramarathon of ∼161km in the past year. The main reasons for dropping out were inability to make the cut off time (23.1%), nausea and/or vomiting (16.5%), injury during the race (16.5%), and an ongoing injury (13.3%).
Conclusions We conclude that primary performance-limiting issues in 161–168 km ultramarathons include inability to make the cut off time, nausea and/or vomiting, and injury before and during the race.

I have no more information than what is available in the above abstracts as they were conference presentations and we will have to wait for the full publication for more detail. Having said that, nothing jumps out at me as an issue with the methods and analysis.

Clearly, both studies are related as they used the same data set collected at two ultramarathons to answer two different but related research questions. The first study above looked at if injury during the training for an ultramarathon influenced the ability to finish the ultramarathon. They reported that it didn’t. The second study above looked at what factors determined completion of a previous ultramarathon. They reported that the associated factors were: “the main reasons for dropping out were inability to make the cut off time (23.1%), nausea and/or vomiting (16.5%), injury during the race (16.5%), and an ongoing injury (13.3%).“.

Nothing earth shattering in this research, just some good solid background information on the injury issues in ultramarathons. My gut impression from looking at the numbers above it that they do not appear to be any great difference in them and other studies I have read on running injuries in recreational or non-ultramarthon runners. I did review a previous study on muscle damage in ultramarathoners not being as great as in other runners.

As always, I go where the evidence takes me until convinced otherwise.

Khodaee, M., Spittler, J., Hill, J., & Hoffman, M. (2014). IMPACT OF INJURY PATTERN DURING TRAINING ON ULTRAMARATHON PERFORMANCE British Journal of Sports Medicine, 48 (7), 619-619 DOI: 10.1136/bjsports-2014-093494.160

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2 Responses to Impact of injury on ultramarathon performance

  1. Kevin A. Kirby, DPM March 18, 2014 at 3:44 am #

    Just saw Marty Hoffman in my office today. I’m lecturing for his seminar at the Western States 100 Mile run in a few months.

    http://www.wser.org/research-conference/

    I’ll ask Marty for the original papers for you when I see him next week.

    Cheers,

    Kevin

    • Marty Hoffman, MD March 29, 2014 at 7:56 pm #

      Sorry, these are just abstracts from an IOC conference, and the full papers are in preparation.

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