We are living in an era in which the financiers of managed health care deny the need for specialization, much less subspecialization, in medicine. What we are told, essentially, is that the expansion of medical science and knowledge is no longer cost-effective. This period in medicine may well be similar to the Dark Ages, when too much knowledge was considered dangerous. This book reflects the belief that only a specialist would be knowledgeable about the syndromes, illnesses, and injuries affecting runners as well as about the quirks and eccentricities involved in caring for the special needs of these patients. To know less would mean that one accepts care that is less than optimum.
Most of the information that is needed to provide treatment to this challenging group of individuals is concentrated in this single volume. The book consists of twenty chapters, each written by a unique set of authors. Information is provided not only on musculoskeletal injuries but also on such diverse topics as the effect of running on the psyche and on mood disorders, medical conditions specific to runners, the construction of running shoes, nutrition, and training regimens. The introduction, by Shorter, sets the tone of the book, with its emphasis on the idea that the avoidance of injury should be the primary goal of the physician and that patients should be advised to follow a logical, physiologically acceptable training regimen. Adherence to this strategy would eliminate many of the injuries seen in runners and would make running the healthy and enjoyable experience that it should be.
An outstanding chapter entitled "The Foot/Shoe Interface," by Pink and Jobe, is a welcome source of basic information about the most important piece of equipment that a runner needs. This chapter will aid the physician in providing intelligent answers to runners' shoe-related questions. An overview entitled "Leg Injuries in Running," by Guten, is a well organized, informative summary of problems related to the lower extremity in runners. This chapter probably should have been the first in the volume in order to set the stage for the remaining diverse chapters. Other chapters succinctly outline the diagnosis and treatment of musculoskeletal problems such as arthritis as well as pain in the ankle, foot, and back.
Problems associated with overtraining, and the morbidity associated with the female triad (anorexia, amenorrhea, and stress fracture), are well presented in the chapter "The Female Athlete Triad in Runners." The effect of running on mood disorders and the psyche is summarized admirably in the chapter by Kiell. Suggestions on how to diagnose and identify individuals who are at risk are included.
The non-orthopaedist will find the chapter on arthroscopy to be clear and concise. The chapter on the role of reconstructive operations involving the hip and the knee provides a conservative, balanced viewpoint on the limits of total joint replacement in patients who participate in running activities.
There are always some disadvantages to a multiauthored text, the main one being repetition. This problem is especially evident in the chapters on the biomechanics of running and the chapter on foot pain, which could have been combined into one definitive section. Neither the chapter on the adolescent runner nor the one on the cardiopulmonary effects of running do justice to the musculoskeletal problems of young patients. The authors of both chapters state that preteen individuals should not run in marathons. However, the belief that running in a marathon has any detrimental effect on the developing musculoskeletal system remains unsubstantiated. At a time when inactivity and obesity is considered to be one of the major health concerns among children, the dangers of running in a marathon, by someone who is disposed to do so at a young age, are probably fewer than those of the opposite extreme that we see so commonly. The number of normal preteen individuals who would voluntarily train for and run in a marathon is probably very small. The greater danger may lie in the overzealous demands of parents who drive their children to extremes in running or in any other organized sport. An important topic that is not addressed concerns the medical problems of the pregnant runner.
As recreational running is one of the most popular activities in the United States, this book should find a place in all medical libraries. Any medical practitioner who wants to communicate with, understand the gestalt of, or offer effective treatment to this group of patients should read this book and keep it as a reference source. Orthopaedists who believe that sports medicine is more than just sports traumatology and that it is part of our orthopaedic knowledge base also will want to have this book on their shelves.
Peter Jokl, M.D.
Department of Orthopaedics and Rehabilitation
Yale University School of Medicine
New Haven, Connecticut