SPORTS AND ATHLETICS: HOT TOPICS IN SPORTS TRAINING: ADVICE FOR RECREATIONAL AND ELITE RUNNERS FROM PHYSICAL MEDICINE AND REHABILITATION PHYSICIANS

Each year, tens of thousands of America's 30 million adult runners decide to train for a marathon, a distance that taxes the abilities of even the most seasoned athletes. Despite a wealth of available fitness information, recreational and competitive sports participants are sustaining injuries at a higher rate than ever before, according to the Centers for Disease Control and Prevention.

Physical medicine and rehabilitation (PM&R) doctors, also called physiatrists, are experts in therapeutic exercise and rehabilitation, helping athletes of all ages and ability levels train safely and effectively. Many PM&R physicians specialize in sports medicine. They warn that too many people underestimate the physical demands of running 26.2 miles and fail one of the most basic of all training principles: the need to listen to your own body's wisdom. For recreational and elite athletes alike, PM&R physicians help patients learn how to monitor their own progress and pain to avoid serious injury and maximize ability.

The American Academy of Physical Medicine & Rehabilitation (AAPM&R) has developed tips on six hot training topics among runners and other competitive athletes.

· Hydration — More water isn't always better: Most people assume that proper hydration means drinking as much water as possible. Not true, say PM&R physicians. Too much water can trigger a condition called hyponatremia, which means over-hydration. Although it's relatively uncommon, it is difficult to diagnose and can cause reactions ranging from nausea and respiratory failure to seizure, coma and even death. To ensure proper hydration, PM&R physicians recommend that you monitor how much fluid weight you lose during training and then consume 16 ounces of fluids for every pound of weight you lose. Or simply follow a more basic guideline, drink when you're thirsty, not before.

· Training Intensity — Over-training causes injury and poor performance: If it's performance gain you're after, training longer and harder isn't necessarily the best method. Recent studies have shown that over-training often results in injury. Sports medicine experts now stress the importance of building rest or light days into your training schedule to improve your performance. It's also critical that you pay attention to your body's need for rest when you are sick. PM&R experts recommend that you don't run if you have a fever, because your body requires 10 percent more oxygen for every degree that your body temperature rises above normal.

· Overtraining Among Female Athletes — Long-term health risks are increased: Female athletes who over-train risk long-term health complications. Female athletes who exercise intensely and limit their calorie intake frequently develop an irregular menstrual cycle, a condition called amenorrhea that can lead to osteoporosis, infertility and cardiovascular disease. An ongoing study led by PM&R physician Anne Zeni Hoch at the Medical College of Wisconsin in Milwaukee, has shown that female athletes with menstrual irregularity can regain regular cycles simply by making slight reductions in exercise intensity and increases in calorie intake. Surprisingly, while these female athletes gained weight and fat, they also improved their overall health and athletic performance. PM&R physicians caution female athletes not to accept loss of the menstrual period as a necessary consequence of training.

· Pain — Don't train through it: Too many athletes think they should train through the pain, but muscle soreness caused by overuse usually signals the need for rest. Tired muscles are prone to injury, and PM&R physicians warn that once you've sustained an injury to bones, tendons or other tissues, you are in for a long recovery. Physiatrists also urge athletes to monitor their pain and what provokes it. Does your pain flare as you begin, are in the midst of, or have completed exercising? Is your pain localized in one particular spot, causing tenderness or aching, or does it send shooting or radiating pain into other areas? Each characteristic of pain is a clue to its cause. Physiatrists have special expertise in diagnosing and treating pain, evaluating its overall impact and the patterns of physical movement that can trigger problems in interrelated body parts.

· Team Training Programs — Knowing when not to listen can be critical to your success: Remember that you are the best judge of your own progress and preparedness. Despite the value of team training programs springing up across the country, PM&R physicians warn that individual health and fitness isn't generic, and your training program shouldn't be either. If you're training for a marathon or some other race — whether independently or as part of a team — monitor your energy levels on a week-to-week basis. If you frequently feel exhausted, you're probably overdoing it.

· Benefits of Cross-Training — More than just a key to overall fitness and improved performance, new research suggests cross-training can help build stronger bones: Despite the popularity of running as a recreational way to get fit, PM&R physicians say it isn't always the best way to achieve improved overall health. Previous research from the Israeli military has shown that recruits who played ball sports (such as soccer and basketball) that involve jumping activities were less prone to stress fractures than recruits who were runners. Building on this research, a new study by Michael Fredericson, M.D., at Stanford University, using a technique developed by researchers at NASA to evaluate bone geometry, found that, in comparison to runners, elite soccer athletes have more well-rounded, symmetric leg bones that are less likely to break. While further research is needed, the study suggests that stress fractures, one of the most common types of injury among runners, could be reduced by cross-training programs that use multidirectional and higher impact jumping movements. PM&R physicians recommend that runners also do other activities such as swimming, biking, team sports, yoga, pilates or weightlifting.

Consult a PM&R physician if you want more information about treatment and rehabilitation for pain or sports-related injuries. PM&R physicians, also known as physiatrists, are experts at restoring function by treating the whole patient, not just symptoms.