Athletics

For Patients

The Principle

Calling something one sport can hide the fact that it asks completely different things of the body.

A marathon and a long jump share a stadium and almost nothing else mechanically.

So the useful question is not what sport someone does, but what their event asks of them.

At the Knee

Distance events ask for a moderate load repeated an enormous number of times. 3.14.4 covers running.

Sprint events ask for very high forces a small number of times, and load the muscles at the back of the thigh most. 3.14.5 covers sprinting.

Jumping events ask for one leg to absorb and then redirect the whole body at takeoff. 3.14.7 covers jumping.

Throwing events ask a fixed foot to absorb a rotating body, which is closer to golf than to running. 3.15.9 covers golf.

Clinical Relevance

Saying which event you compete in tells a clinician more than saying you do athletics.

Distance runners' knee pain is usually about training volume and how fast it changed.

Jumpers' knee pain is usually in the tendon below the kneecap. 6.64 covers it.

No injury rates are given on this page, because no source was available to check them against.

For Medical Students

The Principle

Within a single sport, the mechanical demand can vary more between events than it does between sports.

Grouping by sport therefore conceals the exposure, which is the clinically relevant variable.

The useful axis here is peak load against repetition count.

At the Knee

Distance running: moderate peak forces, very high repetition, and the characteristic problems are patellofemoral pain and iliotibial band syndrome. 3.12.9 covers the pain.

Sprinting: high peak forces, low repetition, and the knee is rarely the failing structure. 3.14.5 covers it.

Jumping events: single leg takeoff with very high extensor mechanism load, producing patellar tendinopathy. 3.14.7 covers jumping.

Hurdling adds repeated extreme hip and knee range with a single leg landing between obstacles.

Throwing events load a blocked front leg in rotation, which is a different mechanism again. 3.15.9 covers the equivalent in golf.

What Changes It

Event and therefore exposure pattern, which is the first question.

Training volume and its rate of change, which dominates in distance events.

Surface and footwear, which alter loading rate. 3.4.10 covers shock absorption.

Growth stage, since adolescent athletes develop apophyseal problems. 2.4.2 covers ossification.

Technique, particularly cadence in distance running. 3.14.4 covers it.

Clinical Relevance

Ask which event, since it changes the differential more than the sport does.

Take a volume and rate of change history in a distance runner.

Expect an extensor mechanism presentation in a jumper and a hamstring presentation in a sprinter.

Describe mechanism rather than rates, as this page does, because no source was available.

MRCS Level

The Principle

Athletics is the natural experiment for the load versus repetition axis, because its events sit at different points on it within one population.

That is why much of the general running literature comes from this sport and generalises to recreational runners imperfectly.

Elite athletes are selected survivors of their own training, which biases every observational finding drawn from them.

At the Knee

Distance running: cumulative load is the operative variable, and the training error pattern, a rapid increase in volume, is the commonest antecedent. 3.14.4 covers it.

The evidence on running and osteoarthritis does not support recreational running as a risk factor, and elite running volumes are a separate question. 6.71 covers the condition.

Jumping events: patellar tendinopathy localises as in basketball, and the single leg takeoff concentrates it. 3.15.5 covers the comparison.

Sprint and hurdle events: hamstring injury dominates and the knee presents with referred or secondary problems. 3.14.5 covers sprinting.

Throwing: a blocked lead leg takes rotation with a fixed foot, loading the knee in a pattern closer to golf than to running. 3.15.9 covers that.

What Changes It

Event, which sets the whole exposure profile.

Training periodisation and the rate of volume change.

Surface, footwear and the recent change in either, which is a classic antecedent.

Skeletal maturity, which determines the failing structure in young athletes.

Selection, since the athletes available to study are those whose knees tolerated the training.

How It Is Measured

Training logs and wearable load monitoring, which give exposure and are self reported in part. 3.16.8 covers wearables.

Laboratory gait and jump analysis, which give mechanics for a small number of trials. 3.16.7 covers capture.

Injury surveillance at championships, which gives rates this page does not quote because no source was retrieved.

Imaging of tendon and bone stress response, which follows presentation.

Survivor bias runs through all of it, and it is rarely acknowledged when elite findings are applied to recreational athletes.

Clinical Relevance

Establish the event before anything else, since it determines the expected pathology.

Take volume, rate of change and any recent change of surface or footwear.

Reassure recreational runners that regular running is not established as a cause of knee arthritis. 6.71 covers the condition.

State the survivor bias when applying elite athletics findings to a recreational patient.

Weigh the athlete's age, physiology, comorbidities, knee demand, psychological state and their own ideas, concerns and expectations, because an athlete's identity is often tied to continuing to train.