ENDURANCE AND SPORTS MEDICINE The Journal of the International Institute for Race Medicine VOLUME 3, NUMBER 2 SUMMER 2019 In this Issue: n Understanding Special Concerns of the Para Athlete n Mental Health Volunteers at the Chicago Marathon n History of the Rock ‘n’ Roll Marathon Series n Highlights of the IIRM-IAAF Boston Conference Endurance and Sports Medicine FOUNDER William O. Roberts, MD IIRM NEWS EXECUTIVE BOARD New and Improved Website Stuart Weiss, MD, Board Chair George Chiampas, DO e are happy to announce a “new and improved” IIRM John Cianca, MD website will be launched on August 21st. The revised site Cathy Fieseler, MD will have easy-to-follow menu options, including simple Mark Harrast, MD W Pierre d’Hemecourt, MD access to member-only resources such as video lectures, Matthias Krüll, MD medical forms and guidelines for endurance events, and the 92- P.Z. Pearce, MD page “IIRM Medical Care Manual.” Over time we will be adding William O. Roberts, MD more video lectures and, as mentioned, in our fundraising Martin Schwellnus, MD Sanjay Sharma, MD campaign (see back cover), we are also hoping to add distance- Ui May Tan, MD learning opportunities for medical professionals and educational Fumihiro Yamasawa, MD information for runners. If you have comments regarding the website and its content, please contact us at membership@ ADVISORY BOARD racemedicine.org. We always welcome your feedback! Douglas J. Casa, PhD, ATC Rob Galloway, MD Timothy Good Run the Marine Corps Marathon! Dave McGillivray Francis G. O’Connor, MD, MPH here are just a few IIRM charity race entries remaining Matthew D. Sedgley, MD for the October 27th Marine Corps Marathon. These are Tbeing offered through a special travel package managed RESEARCH BOARD by Destination Marathons. “Race entry only” options are also Aaron L. Baggish, MD available for runners who are local to the DC area and do Sam Cheuvront, PhD, RD Kourtney Kipps, MD (continued on page9) Anthony Luke, MD Daniel E. Lieberman, PhD Stephen Mears, PhD EXECUTIVE DIRECTOR Chris Troyanos, ATC EDITOR-IN-CHIEF Cathy Fieseler, MD CONTENTS MANAGING EDITOR Barbara Baldwin, MPH Letter from Leadership • 3 Chris Troyanos, ATC JOURNAL COMMITTEE* EDITORIAL ADVISORY BOARD° Para Athletic Injury and Illness Consideration for Race Day Planning • 5 Barbara Baldwin, MPH* David J. Cormier, DO, DPT Nancy Clark, MS, RD° Cathy Fieseler, MD* The Chicago Marathon Medical Psychology Program • 10 Pierre d’Hemecourt, MD*° Daniel E. Lieberman, PhD*° John Ardizzone, PhD Stephen Mears, PhD* Thomas C. Michaud, DC° The Rock ‘n’ Roll Medicine Show • 14 Fred L. Miller, III, PhD* P.Z. Pearce, MD William O. Roberts, MD*° Martin Schwellnus, MD* Rain, Wind and Overuse Injuries: A Recap of the Interprofessional Management of GRAPHIC DESIGN Fritz Partlow Design Endurance Medicine Conference – Boston, April 2019 • 18 Daniel J. Friedman The mission of the International Institute for Race Medicine (IIRM) is to promote the health and safety Participation Requested for CRN Race Day Medical Event Study • 20 of athletes participating in endurance events through education, research, and the development of medical best practices. Follow the IIRM on Social Media Opinions expressed in Endurance and Sports Medicine are not necessarily endorsed by the IIRM. Address editorial, membership, and advertising information to Barbara Baldwin, MPH, IIRM (Satellite Office), 14520 Clopper Road, Boyds, MD 20841, Email: [email protected], TEL: 240-271-1657, racemedicine.org. LETTER FROM LEADERSHIP Dear IIRM Members and Friends: he IIRM has seen much growth in the past year and, with your support, looks forward to continuing this forward momentum. TAs mentioned in the spring 2019 issue of Endurance and Sports Medicine, the IIRM and International Association of Athletics Federations (IAAF) signed a Memorandum of Understanding through which we will jointly develop training courses and educational seminars over the next two years for medical directors of endurance races and other health care professionals who have an interest in endurance medicine. These will be internationally focused, with courses in the U.S., Tokyo, Doha, Valencia, and Singapore (see the back cover for the calendar of events). I was delighted to present at our first IIRM-IAAF jointly held international conference on July 20th in Tokyo. IIRM Executive Board Member Fumihiro Yamasawa, MD, PhD and Yuri Hosokawa, PhD, ATC, IIRM Ambassador (Japan), also presented at the conference. On October 5th, IIRM Member Rebecca Breslow, MD, will help instruct the workshops being held in Doha, State of Qatar, and on November 9th, IIRM Executive Board Member John Cianca, MD, will present at the conference in Valencia, Spain. Through our partnership with the IAAF we have Yuri Hosokawa, PhD, ATC, leads a workshop on managing exercise-associated heat stroke at the been working closely with Dr. Paolo Emilio Adami, the IAAF Health IAAF-IIRM Emergency Race Medicine Workshop and Science Department Medical Manager. In addition to being a in Tokyo. well-respected sports medicine physician and advocate for providing optimal care for participants of athletic events, Dr. Adami has also become a good friend of the IIRM. We feel fortunate to be collaborating with him to provide worldwide education to health care providers. We also have had a partnership with the Association of International Marathons and Distance Races (AIMS) since 2015. They help to promote our organization and we have been involved in three of their World Congresses, where IIRM speakers have presented on topics of endurance medicine. Starting in September, we will be contributing to the AIMS quarterly magazine Distance Running by reprising classic Running & FitNews articles (from the former American Running Association). We hope to also add some of these articles to the IIRM website when we develop a runners’ portal. In regards to the IIRM website, we have been working with our web developers to re-do the look of the site and make it easier to navigate. Our eventual goal is to add more educational content, the runners’ portal included, and increase the number of video presentations from medical conferences. We would also like to develop a distance learning platform. Unfortunately, these endeavors require funding beyond our means. Therefore, we have initiated an online fundraising campaign. Endurance and Sports Medicine • Summer 2019 3 Some of you may have seen the IIRM fundraiser “Saving the Lives of Endurance Race Participants” on our FaceBook page, or you received an email message announcing the fundraising campaign. Individuals can make donations to the fundraiser on the IIRM FaceBook page or by going to racemedicine.org and clicking on the “Donations” icon on our home page (which links to the IIRM fundraising campaign on imATHLETE). We hope you will consider sharing one or both of these donation pages with your fellow runners and/or colleagues. Having multiple IIRM supporters spread the message is key to our fundraising success! In April, I was one of just over 15 individuals who convened at the Consortium for Military and Health Performance (CHAMP) in Bethesda, Maryland, to review recommended medical algorithms for managing emergencies in mass participation running events. I was honored to represent the IIRM as we dissected and revised protocols for up to 13 medical conditions including exercise-associated collapse, cardiac care, chest pain, hyperthermia, hyponatremia, and hypoglycemia. We are still carefully working through these revisions, as they are Francis O’Connor, MD, MPH, leads a discussion on algorithm revisions for managing exercise- extensive and we want to be thorough. The new algorithms will be associated collapse with race medicine experts unveiled at our Marine Corps Marathon endurance medicine conference including COL Anthony Beutler, MD (left) and on October 26th in a lecture presented by IIRM Advisory Board Member LTC Chad Hulsopple, DO. Francis G. O’Connor, MD, MPH, the chairperson of this revision endeavor. It is our goal to then share these algorithms with races around the world in our efforts to standardize medical care provided at endurance events. So, as we push to continue this forward momentum, I must ask for your support. Members are an important part of any association— after all, you are our “base,” our foundation. Please consider renewing your IIRM membership when you receive expiration notices and, if you are involved in the management of endurance events, please share information about the IIRM Event Membership. We have developed a document explaining the benefits of the event membership and how it can be used to educate medical volunteers and event personnel. If you are interested in receiving the IIRM Event Membership outline, please contact us at [email protected]. Finally, we are always looking for feedback regarding our online materials and educational activities. Is there anything you’d like to see us add to the website? Do you have comments regarding our conferences? We gladly welcome your feedback! Please write to us at [email protected]. Best wishes, Chris Troyanos, ATC IIRM Executive Director Endurance and Sports Medicine • Summer 2019 4 Para Athletic Injury and Illness Consideration for Race Day Planning By David J. Cormier, DO, DPT Introduction Illness Epidemiology articipation in sports provides important life Incidence of illness from Rio demonstrated that lessons about teamwork, inclusion, work across all events the average was 10 illnesses Pethic, skill mastery, and