Significant effusion in the joints of the lower extremity after running an ultramarathon in extreme conditions

Introduction: The “Brocken challenge” ultramarathon takes place in the cold of February over 80 km with 1,900 m of elevation change. The purpose of this study was to evaluate the effects of an ultramarathon under extreme conditions on the lower extremities. Methods: Out of the 182 starters, 44 athle...

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Published in:	Journal of Human Sport and Exercise
Main Authors:	Steinmetz, Gino, Höller, Sebastian, Hubert, Jan, Hawellek, Thelonius, Schilling, Arndt Friedrich, Saul, Dominik
Other Authors:	Georg-August University Goettingen
Format:	Article in Journal/Newspaper
Language:	English
Published:	Universidad de Alicante 2020
Subjects:	Marathon Physiology Swelling Effusion Sonography Brocken Arctic
Online Access:	https://www.jhse.ua.es/article/view/2020-v15-n4-significant-effusion-joints-lower-extremity-running-ultramarathon-extreme-conditions https://doi.org/10.14198/jhse.2020.154.08

id	ftunialicanteojs:oai:oai.revistes.ua.es:article/14779
record_format	openpolar
institution	Open Polar
collection	Scientific Journals - University of Alicante
op_collection_id	ftunialicanteojs
language	English
topic	Marathon Physiology Swelling Effusion Sonography
spellingShingle	Marathon Physiology Swelling Effusion Sonography Steinmetz, Gino Höller, Sebastian Hubert, Jan Hawellek, Thelonius Schilling, Arndt Friedrich Saul, Dominik Significant effusion in the joints of the lower extremity after running an ultramarathon in extreme conditions
topic_facet	Marathon Physiology Swelling Effusion Sonography
description	Introduction: The “Brocken challenge” ultramarathon takes place in the cold of February over 80 km with 1,900 m of elevation change. The purpose of this study was to evaluate the effects of an ultramarathon under extreme conditions on the lower extremities. Methods: Out of the 182 starters, 44 athletes were included into the study (n = 44). We examined these athletes using a questionnaire, by measuring circumferences of their lower extremities and by standardized sonographic measurement of joint effusion of knee and ankle joints before and after the run. Results: After the run, the right leg and both feet significantly increased in circumference. Knee joints on both sides and the left ankle joint showed significantly more effusion after the run (right knee: 84%, right ankle: 43%; left knee: 80%, left ankle: 48%). Heavier and less trained athletes showed significantly more effusion in sonographic assessment of the knee and ankle. Neither swelling, nor effusion had a measurable influence on finishing time. Conclusions: Running an ultramarathon in the cold overloads the fluid draining capacity in the muscles and joints of the legs especially in heavier and less trained athletes without measurable immediate effect on performance.
author2	Georg-August University Goettingen
format	Article in Journal/Newspaper
author	Steinmetz, Gino Höller, Sebastian Hubert, Jan Hawellek, Thelonius Schilling, Arndt Friedrich Saul, Dominik
author_facet	Steinmetz, Gino Höller, Sebastian Hubert, Jan Hawellek, Thelonius Schilling, Arndt Friedrich Saul, Dominik
author_sort	Steinmetz, Gino
title	Significant effusion in the joints of the lower extremity after running an ultramarathon in extreme conditions
title_short	Significant effusion in the joints of the lower extremity after running an ultramarathon in extreme conditions
title_full	Significant effusion in the joints of the lower extremity after running an ultramarathon in extreme conditions
title_fullStr	Significant effusion in the joints of the lower extremity after running an ultramarathon in extreme conditions
title_full_unstemmed	Significant effusion in the joints of the lower extremity after running an ultramarathon in extreme conditions
title_sort	significant effusion in the joints of the lower extremity after running an ultramarathon in extreme conditions
publisher	Universidad de Alicante
publishDate	2020
url	https://www.jhse.ua.es/article/view/2020-v15-n4-significant-effusion-joints-lower-extremity-running-ultramarathon-extreme-conditions https://doi.org/10.14198/jhse.2020.154.08
long_lat	ENVELOPE(-36.067,-36.067,-54.483,-54.483)
geographic	Brocken
geographic_facet	Brocken
genre	Arctic
genre_facet	Arctic
op_source	Journal of Human Sport and Exercise; Vol. 15, Núm. 4; 802-815 1988-5202
op_relation	https://www.jhse.ua.es/article/view/2020-v15-n4-significant-effusion-joints-lower-extremity-running-ultramarathon-extreme-conditions/remote Aumüller, G. (2007). Anatomie: 208 Tabellen [mit CD-ROM zum Präp-Kurs]. Duale Reihe. Stuttgart: Thieme. Bergeron, M. F. (2014). Heat stress and thermal strain challenges in running. The Journal of orthopaedic and sports physical therapy, 44(10), 831-838. https://doi.org/10.2519/jospt.2014.5500 Bracher, A., Knechtle, B., Gnädinger, M., Bürge, J., Rüst, C. A., Knechtle, P., & Rosemann, T. (2012). Fluid intake and changes in limb volumes in male ultra-marathoners: Does fluid overload lead to peripheral oedema? European journal of applied physiology, 112(3), 991-1003. https://doi.org/10.1007/s00421-011-2056-3 Carmona, G., Roca, E., Guerrero, M., Cussó, R., Irurtia, A., Nescolarde, L., et al. (2015). Sarcomere Disruptions of Slow Fiber Resulting From Mountain Ultramarathon. International journal of sports physiology and performance, 10(8), 1041-1047. https://doi.org/10.1123/ijspp.2014-0267 Case, S., Evans, D., Tibbets, G., & Miller, D. (1995). Dietary intakes of participants in the IditaSport Human Powered Ultra-marathon. Alaska medicine, 37(1), 20-24. Cejka, C., Knechtle, B., Knechtle, P., Rüst, C. A., & Rosemann, T. (2012). An increased fluid intake leads to feet swelling in 100-km ultra-marathoners - an observational field study. Journal of the International Society of Sports Nutrition, 9(1), 11. https://doi.org/10.1186/1550-2783-9-11 Chávez-López, M. A., Hernández-Díaz, C., Moya, C., Pineda, C., Ventura-Ríos, L., Möller, I., et al. (2013). Inter- and intra-observer agreement of high-resolution ultrasonography and power Doppler in assessment of joint inflammation and bone erosions in patients with rheumatoid arthritis. Rheumatology international, 33(1), 173-177. https://doi.org/10.1007/s00296-011-2297-9 Christodoulou, A. G., Givissis, P., Antonarakos, P. D., Petsatodis, G. E., Hatzokos, I., & Pournaras, J. D. (2010). Knee joint effusion following ipsilateral hip surgery. Journal of orthopaedic surgery (Hong Kong), 18(3), 309-311. https://doi.org/10.1177/230949901001800310 Costa, R. J. S., Snipe, R., Camões-Costa, V., Scheer, V., & Murray, A. (2016). The Impact of Gastrointestinal Symptoms and Dermatological Injuries on Nutritional Intake and Hydration Status During Ultramarathon Events. Sports medicine - open, 2, 16. https://doi.org/10.1186/s40798-015-0041-9 Del Coso, J., González, C., Abian-Vicen, J., Salinero Martín, J. J., Soriano, L., Areces, F., et al. (2014). Relationship between physiological parameters and performance during a half-ironman triathlon in the heat. Journal of sports sciences, 32(18), 1680-1687. https://doi.org/10.1080/02640414.2014.915425 Frey, W., Wassmer, P., Frey-Rindova, P., Braun, D., Schwarz, F., Arnold, M., et al. (1994). Muskelschmerzen und biochemische Veränderungen nach einem Ultramarathon in der Kälte--Beeinflussung durch Diclofenac [Muscle aches and biochemical changes following a ultra-marathon in the cold--modification by diclofenac]. Schweizerische Zeitschrift fur Medizin und Traumatologie = Revue suisse pour medecine et traumatologie. (2), 30-36. Gaulrapp, H. Funktionelle sonografische Diagnostik bei fibularer Kapselbandläsion: Gaulrapp H. Functional sonography in lateral ankle joint sprains. Unpublished manuscript, OUP 2014, 3: 100-104. Hartung, W., Kellner, H., Strunk, J., Sattler, H., Schmidt, W. A., Ehrenstein, B., et al. (2012). Development and evaluation of a novel ultrasound score for large joints in rheumatoid arthritis: One year of experience in daily clinical practice. Arthritis care & research, 64(5), 675-682. https://doi.org/10.1002/acr.21574 Hoffman, M. D., Ong, J. C., & Wang, G. (2010). Historical analysis of participation in 161 km ultramarathons in North America. The International journal of the history of sport, 27(11), 1877-1891. https://doi.org/10.1080/09523367.2010.494385 Hoffman, M. D., & Wegelin, J. A. (2009). The Western States 100-Mile Endurance Run: Participation and performance trends. Medicine and science in sports and exercise, 41(12), 2191-2198. https://doi.org/10.1249/MSS.0b013e3181a8d553 Hung, A., Sayre, E. C., Guermazi, A., Esdaile, J. M., Kopec, J. A., Thorne, A., et al. (2016). Association of Body Mass Index With Incidence and Progression of Knee Effusion on Magnetic Resonance Imaging and on Knee Examination. Arthritis care & research, 68(4), 511-516. https://doi.org/10.1002/acr.22714 Ishikawa, M., Dousset, E., Avela, J., Kyröläinen, H., Kallio, J., Linnamo, V., et al. (2006). Changes in the soleus muscle architecture after exhausting stretch-shortening cycle exercise in humans. European journal of applied physiology, 97(3), 298-306. https://doi.org/10.1007/s00421-006-0180-2 Jacobson, J. A., Ruangchaijatuporn, T., Khoury, V., & Magerkurth, O. (2017). Ultrasound of the Knee: Common Pathology Excluding Extensor Mechanism. Seminars in musculoskeletal radiology, 21(2), 102-112. https://doi.org/10.1055/s-0037-1599204 Kane, D., Balint, P. V., & Sturrock, R. D. (2003). Ultrasonography is superior to clinical examination in the detection and localization of knee joint effusion in rheumatoid arthritis. The Journal of rheumatology, 30(5), 966-971. Kingston, A.-R., Toms, A. P., Ghosh-Ray, S., & Johnston-Downing, S. (2009). Does running cause metatarsophalangeal joint effusions? A comparison of synovial fluid volumes on MRI in athletes before and after running. Skeletal radiology, 38(5), 499-504. https://doi.org/10.1007/s00256-008-0641-2 Knechtle, B., Knechtle, P., & Lepers, R. (2011). Participation and performance trends in ultra-triathlons from 1985 to 2009. Scandinavian journal of medicine & science in sports, 21(6), e82-90. https://doi.org/10.1111/j.1600-0838.2010.01160.x Knechtle, B., Wirth, A., Knechtle, P., Zimmermann, K., & Kohler, G. (2009). Personal best marathon performance is associated with performance in a 24-h run and not anthropometry or training volume. British journal of sports medicine, 43(11), 836-839. https://doi.org/10.1136/bjsm.2007.045716 Krampla, W., Mayrhofer, R., Malcher, J., Kristen, K. H., Urban, M., & Hruby, W. (2001). MR imaging of the knee in marathon runners before and after competition. Skeletal radiology, 30(2), 72-76. https://doi.org/10.1007/s002560000296 Kursunoglu-Brahme, S., Schwaighofer, B., Gundry, C., Ho, C., & Resnick, D. (1990). Jogging causes acute changes in the knee joint: An MR study in normal volunteers. AJR. American journal of roentgenology, 154(6), 1233-1235. https://doi.org/10.2214/ajr.154.6.2110734 Lohman, M., Kivisaari, A., Vehmas, T., Kallio, P., Malmivaara, A., & Kivisaari, L. (2001). MRI abnormalities of foot and ankle in asymptomatic, physically active individuals. Skeletal radiology, 30(2), 61-66. https://doi.org/10.1007/s002560000316 Magrini, D., Khodaee, M., San-Millán, I., Hew-Butler, T., & Provance, A. J. (2017). Serum creatine kinase elevations in ultramarathon runners at high altitude. The Physician and sportsmedicine, 45(2), 129-133. https://doi.org/10.1080/00913847.2017.1280371 Millet, G. Y., Banfi, J. C., Kerherve, H., Morin, J. B., Vincent, L., Estrade, C., et al. (2011). Physiological and biological factors associated with a 24 h treadmill ultra-marathon performance. Scandinavian journal of medicine & science in sports, 21(1), 54-61. https://doi.org/10.1111/j.1600-0838.2009.01001.x Millet, G. P., & Millet, G. Y. (2012). Ultramarathon is an outstanding model for the study of adaptive responses to extreme load and stress. BMC medicine, 10, 77. https://doi.org/10.1186/1741-7015-10-77 Parise, C. A., & Hoffman, M. D. (2011). 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op_rights	Copyright (c) 2018 Journal of Human Sport and Exercise https://creativecommons.org/licenses/by-nc-nd/4.0
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spelling	ftunialicanteojs:oai:oai.revistes.ua.es:article/14779 2023-05-15T14:28:32+02:00 Significant effusion in the joints of the lower extremity after running an ultramarathon in extreme conditions Steinmetz, Gino Höller, Sebastian Hubert, Jan Hawellek, Thelonius Schilling, Arndt Friedrich Saul, Dominik Georg-August University Goettingen 2020-12-01 https://www.jhse.ua.es/article/view/2020-v15-n4-significant-effusion-joints-lower-extremity-running-ultramarathon-extreme-conditions https://doi.org/10.14198/jhse.2020.154.08 eng eng Universidad de Alicante https://www.jhse.ua.es/article/view/2020-v15-n4-significant-effusion-joints-lower-extremity-running-ultramarathon-extreme-conditions/remote Aumüller, G. (2007). Anatomie: 208 Tabellen [mit CD-ROM zum Präp-Kurs]. Duale Reihe. Stuttgart: Thieme. Bergeron, M. F. (2014). Heat stress and thermal strain challenges in running. The Journal of orthopaedic and sports physical therapy, 44(10), 831-838. https://doi.org/10.2519/jospt.2014.5500 Bracher, A., Knechtle, B., Gnädinger, M., Bürge, J., Rüst, C. A., Knechtle, P., & Rosemann, T. (2012). Fluid intake and changes in limb volumes in male ultra-marathoners: Does fluid overload lead to peripheral oedema? European journal of applied physiology, 112(3), 991-1003. https://doi.org/10.1007/s00421-011-2056-3 Carmona, G., Roca, E., Guerrero, M., Cussó, R., Irurtia, A., Nescolarde, L., et al. (2015). Sarcomere Disruptions of Slow Fiber Resulting From Mountain Ultramarathon. International journal of sports physiology and performance, 10(8), 1041-1047. https://doi.org/10.1123/ijspp.2014-0267 Case, S., Evans, D., Tibbets, G., & Miller, D. (1995). Dietary intakes of participants in the IditaSport Human Powered Ultra-marathon. Alaska medicine, 37(1), 20-24. Cejka, C., Knechtle, B., Knechtle, P., Rüst, C. A., & Rosemann, T. (2012). An increased fluid intake leads to feet swelling in 100-km ultra-marathoners - an observational field study. Journal of the International Society of Sports Nutrition, 9(1), 11. https://doi.org/10.1186/1550-2783-9-11 Chávez-López, M. A., Hernández-Díaz, C., Moya, C., Pineda, C., Ventura-Ríos, L., Möller, I., et al. (2013). Inter- and intra-observer agreement of high-resolution ultrasonography and power Doppler in assessment of joint inflammation and bone erosions in patients with rheumatoid arthritis. Rheumatology international, 33(1), 173-177. https://doi.org/10.1007/s00296-011-2297-9 Christodoulou, A. G., Givissis, P., Antonarakos, P. D., Petsatodis, G. E., Hatzokos, I., & Pournaras, J. D. (2010). Knee joint effusion following ipsilateral hip surgery. Journal of orthopaedic surgery (Hong Kong), 18(3), 309-311. https://doi.org/10.1177/230949901001800310 Costa, R. J. S., Snipe, R., Camões-Costa, V., Scheer, V., & Murray, A. (2016). The Impact of Gastrointestinal Symptoms and Dermatological Injuries on Nutritional Intake and Hydration Status During Ultramarathon Events. Sports medicine - open, 2, 16. https://doi.org/10.1186/s40798-015-0041-9 Del Coso, J., González, C., Abian-Vicen, J., Salinero Martín, J. J., Soriano, L., Areces, F., et al. (2014). Relationship between physiological parameters and performance during a half-ironman triathlon in the heat. Journal of sports sciences, 32(18), 1680-1687. https://doi.org/10.1080/02640414.2014.915425 Frey, W., Wassmer, P., Frey-Rindova, P., Braun, D., Schwarz, F., Arnold, M., et al. (1994). Muskelschmerzen und biochemische Veränderungen nach einem Ultramarathon in der Kälte--Beeinflussung durch Diclofenac [Muscle aches and biochemical changes following a ultra-marathon in the cold--modification by diclofenac]. Schweizerische Zeitschrift fur Medizin und Traumatologie = Revue suisse pour medecine et traumatologie. (2), 30-36. Gaulrapp, H. Funktionelle sonografische Diagnostik bei fibularer Kapselbandläsion: Gaulrapp H. Functional sonography in lateral ankle joint sprains. Unpublished manuscript, OUP 2014, 3: 100-104. Hartung, W., Kellner, H., Strunk, J., Sattler, H., Schmidt, W. A., Ehrenstein, B., et al. (2012). Development and evaluation of a novel ultrasound score for large joints in rheumatoid arthritis: One year of experience in daily clinical practice. Arthritis care & research, 64(5), 675-682. https://doi.org/10.1002/acr.21574 Hoffman, M. D., Ong, J. C., & Wang, G. (2010). Historical analysis of participation in 161 km ultramarathons in North America. The International journal of the history of sport, 27(11), 1877-1891. https://doi.org/10.1080/09523367.2010.494385 Hoffman, M. D., & Wegelin, J. A. (2009). The Western States 100-Mile Endurance Run: Participation and performance trends. Medicine and science in sports and exercise, 41(12), 2191-2198. https://doi.org/10.1249/MSS.0b013e3181a8d553 Hung, A., Sayre, E. C., Guermazi, A., Esdaile, J. M., Kopec, J. A., Thorne, A., et al. (2016). Association of Body Mass Index With Incidence and Progression of Knee Effusion on Magnetic Resonance Imaging and on Knee Examination. Arthritis care & research, 68(4), 511-516. https://doi.org/10.1002/acr.22714 Ishikawa, M., Dousset, E., Avela, J., Kyröläinen, H., Kallio, J., Linnamo, V., et al. (2006). Changes in the soleus muscle architecture after exhausting stretch-shortening cycle exercise in humans. European journal of applied physiology, 97(3), 298-306. https://doi.org/10.1007/s00421-006-0180-2 Jacobson, J. A., Ruangchaijatuporn, T., Khoury, V., & Magerkurth, O. (2017). Ultrasound of the Knee: Common Pathology Excluding Extensor Mechanism. Seminars in musculoskeletal radiology, 21(2), 102-112. https://doi.org/10.1055/s-0037-1599204 Kane, D., Balint, P. V., & Sturrock, R. D. (2003). Ultrasonography is superior to clinical examination in the detection and localization of knee joint effusion in rheumatoid arthritis. The Journal of rheumatology, 30(5), 966-971. Kingston, A.-R., Toms, A. P., Ghosh-Ray, S., & Johnston-Downing, S. (2009). Does running cause metatarsophalangeal joint effusions? A comparison of synovial fluid volumes on MRI in athletes before and after running. Skeletal radiology, 38(5), 499-504. https://doi.org/10.1007/s00256-008-0641-2 Knechtle, B., Knechtle, P., & Lepers, R. (2011). Participation and performance trends in ultra-triathlons from 1985 to 2009. Scandinavian journal of medicine & science in sports, 21(6), e82-90. https://doi.org/10.1111/j.1600-0838.2010.01160.x Knechtle, B., Wirth, A., Knechtle, P., Zimmermann, K., & Kohler, G. (2009). Personal best marathon performance is associated with performance in a 24-h run and not anthropometry or training volume. British journal of sports medicine, 43(11), 836-839. https://doi.org/10.1136/bjsm.2007.045716 Krampla, W., Mayrhofer, R., Malcher, J., Kristen, K. H., Urban, M., & Hruby, W. (2001). MR imaging of the knee in marathon runners before and after competition. Skeletal radiology, 30(2), 72-76. https://doi.org/10.1007/s002560000296 Kursunoglu-Brahme, S., Schwaighofer, B., Gundry, C., Ho, C., & Resnick, D. (1990). Jogging causes acute changes in the knee joint: An MR study in normal volunteers. AJR. American journal of roentgenology, 154(6), 1233-1235. https://doi.org/10.2214/ajr.154.6.2110734 Lohman, M., Kivisaari, A., Vehmas, T., Kallio, P., Malmivaara, A., & Kivisaari, L. (2001). MRI abnormalities of foot and ankle in asymptomatic, physically active individuals. Skeletal radiology, 30(2), 61-66. https://doi.org/10.1007/s002560000316 Magrini, D., Khodaee, M., San-Millán, I., Hew-Butler, T., & Provance, A. J. (2017). Serum creatine kinase elevations in ultramarathon runners at high altitude. 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Ultraschall in der Medizin (Stuttgart, Germany : 1980), 33(7), E173-8. https://doi.org/10.1055/s-0031-1281973 Copyright (c) 2018 Journal of Human Sport and Exercise https://creativecommons.org/licenses/by-nc-nd/4.0 CC-BY-NC-ND Journal of Human Sport and Exercise; Vol. 15, Núm. 4; 802-815 1988-5202 Marathon Physiology Swelling Effusion Sonography info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion 2020 ftunialicanteojs https://doi.org/10.14198/jhse.2020.154.08 https://doi.org/10.2519/jospt.2014.5500 https://doi.org/10.1123/ijspp.2014-0267 https://doi.org/10.1007/s00296-011-2297-9 https://doi.org/10.1080/02640414.2014.915425 https://doi.org/10.1007/s00421-006-0 2022-08-26T12:31:39Z Introduction: The “Brocken challenge” ultramarathon takes place in the cold of February over 80 km with 1,900 m of elevation change. The purpose of this study was to evaluate the effects of an ultramarathon under extreme conditions on the lower extremities. Methods: Out of the 182 starters, 44 athletes were included into the study (n = 44). We examined these athletes using a questionnaire, by measuring circumferences of their lower extremities and by standardized sonographic measurement of joint effusion of knee and ankle joints before and after the run. Results: After the run, the right leg and both feet significantly increased in circumference. Knee joints on both sides and the left ankle joint showed significantly more effusion after the run (right knee: 84%, right ankle: 43%; left knee: 80%, left ankle: 48%). Heavier and less trained athletes showed significantly more effusion in sonographic assessment of the knee and ankle. Neither swelling, nor effusion had a measurable influence on finishing time. Conclusions: Running an ultramarathon in the cold overloads the fluid draining capacity in the muscles and joints of the legs especially in heavier and less trained athletes without measurable immediate effect on performance. Article in Journal/Newspaper Arctic Scientific Journals - University of Alicante Brocken ENVELOPE(-36.067,-36.067,-54.483,-54.483) Journal of Human Sport and Exercise 15 4

Significant effusion in the joints of the lower extremity after running an ultramarathon in extreme conditions

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