Five Questions with Brian Krabak, M.D.

Dr. Brian Krabak, part of the medical team covering the 4 Deserts Race Series

For our recurring column, we are asking Brian Krabak, M.D. to answer ‘five questions’ about his new book (and more):  “The Long Distance Runner’s Guide to Injury Prevention and Treatment:  How to Avoid Common Problems and Deal with Them When They Happen.” 

Dr. Krabak is a sports medicine physician at the University of Washington Medical Center.  He and his colleagues, Grant Lipman, M.D. and Brandee Waite, M.D., co-edited this new book, which includes many authors known to the readers of CJSM, including Tamara Hew-Butler, who has been featured previously in these blog pages. And though this is a first time appearance in the blog for Dr. Krabak, he has been an author for CJSM before — just one of the many things you’ll learn from this interview.

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1)    CJSM: Congratulations on the new book, “The Long Distance Runner’s Guide to Injury Prevention and Treatment: How to Avoid Common Problems and Deal with Them When They Happen’” which was just published. It was edited by you, Grant Lipman, and Brandee Waite.  How long did this project take to come together and what were the most significant challenges you faced in completing this project?

BK: Thank you. We are very proud of our new book.  The concept for the book started years ago, in a desert far, far away. Seriously, we were in the middle of a desert at an ultramarathon race! The editors met while traveling the world coordinating and providing medical care for long distance running athletes of all ages and abilities.  During these adventures, athletes would frequently ask for advice about issues unique to the long-distance runner. Often, they inquired about how they could learn more about preventing and treating their injury and illnesses.   They wanted a high quality and informative book with the most up-to-date information written for the runner. Though there are some wonderful books on running, we felt there was an opportunity to educate runners.

Unfortunately, it seems the publishing world had a different view. Several publishers declined, noting that such a book “already existed” and would not provide “any value” to the running community. Though frustrating, we continued to move forward with the idea. Eventually, we landed with our publisher who understood the vision and scope of the project. Getting world experts in running medicine to write the various chapters wasn’t too challenging. Keeping them on a tight timeline was a different story. These are quite busy people performing research, lecturing and running. But like competing in a long-distance running race, we kept a steady pace and crossed the finish line.

Dr. Tami Hew-Butler’s got the book….& is talking about it on Twitter

2)   CJSM: We first heard about the book from our friend and frequent CJSM author, Tami Hew-Butler, and we see she has co-authored one of the chapters (on hydration).  What are some of the high points in the content of this book? Any radical reformulations of training, racing, or recovery that might be news to runners out there?

BK: It was a pleasant surprise when Tami posted the book on social media. As you know, she is an outstanding researcher with expertise in the realm of hydration for runners. We are so fortunate to have her as a contributor to the book.

Our book is rich in information that would be beneficial for all runners. Some of the high points from the book are:

• Overall, long distance runners are healthier than the general population and experience lower rates of cancer, heart disease and diabetes¹
• Injury and illness rates in ultramarathons are different than marathons²
• Hyponatremia can be prevent by drinking only when thirsty³
• Long distance runners experience adaptive changes to their hearts secondary to training and receive significant benefit from exercising
• High-intensity training can improve running economy, which can enhance running performance across all distances.

Want to learn even more…..then read the book!

3)   CJSM: Can you let the readers of the blog know a bit about your background, both as a sports medicine clinician and as a runner?

BK:  My sports medicine background includes training as a Physiatrist (Physical Medicine and Rehabilitation) with a sports fellowship at the Mayo Clinic. Such training allowed me to develop an expertise in running medicine while learning how to provide care at various long distance running events. During my time at Johns Hopkins, I was approached by an organization (RacingThePlanet) to provide medical care for ultramarathons around the world. This is where I met my co-editors and as they say, the rest is history.  I am currently at the University of Washington,  where I take care of running athletes of all ages and ability. In addition, I am Medical Director of the Seattle Rock-n-Roll Marathon.

What’s great about this book is that the authors are clinicians, scientists and athletes. I’ve been involved with sports since childhood. But it wasn’t until later in life that I understood my love for long distance running. After completing my first marathon, I decided I needed a different type of challenge. A challenge that pushed the mind, body and soul to a new level. My venture into long-distance running started with adventure racing (running, mountain biking, orienteering, rappelling, etc).  I can still remember my first race, where I ended up running 80 miles due to a change in the course. Over the years, participating in these races has allowed me to understand the challenges experienced by long-distance runners first hand.

4)   CJSM: We see you’ve been intermittently active on Twitter  (@OlympicDrKrabak) – compose a 140 character Tweet singing the praises of your new book.

BK Tweet: #runners unite! Want to understand #injuryprevention? Then read #LongDistanceRunnersGuide @SportsPubBooks.

5)   CJSM: One of the more popular CJSM articles we’ve had in the last few years (with a whopping Altmetric of 303) was written  with Grant Lipman as lead author and you as senior author:  “Paper tape prevents foot blisters: A randomized prevention trial assessing paper tape in endurance distances II (Pre-TAPED 11).”  This study was conducted on runners in an ultramarathon event.  Do you have plans to continue this research in other venues (e.g. shorter distances)?  Do you always wear paper tape when YOU run???

BK: Pre-Taped II⁴  was a very interesting study that addressed an issue we identified in a previous study of multi-day ultramarathon races. Our research showed that multi-day ultramarathon runners experienced injuries and illnesses at a different rate than marathon runners. Specifically, we noted that 74% experience a skin-related disorder (i.e. blister) that was more likely to occur as the race progressed. Since we spent a significant amount of time educating and treating these skin-related disorders, it made sense to see how we could decrease the occurrence of blisters through a simple intervention. Through Dr Lipman ‘s efforts, we were able to perform Pre-TAPED II, which showed a 40% reduction in blisters through the simple use of paper tape. At this time, we plan to continue our research focus on the long-distance runner to answer some other burning questions. And as for me, I must admit I don’t always use paper tape when I run; partially because I haven’t really had significant blister issues. But if you are prone to blisters and have corrected any inflexibility or strength issues, and then consider the simple use of paper tape.

References:

1. Krabak BJ, Waite BW, Lipman GS: Evaluation and Treatment of Injury and Illness in the Ultramarathon Athlete. Phys Med Rehabil Clin N Amer. 2014 Nov; 25(4): 845-863. PMID: 25442162
2. Krabak BJ, Waite BW, Schiff MA: Injury and Illness Rates in Multiday Ultramarathon Runners. Med Sci Sports Exerc. 2011 Dec; 43 (12): 2314-20. PMID: 21552155
3. Krabak BJ, Lipman GS, Waite BL, Rundell SD: Exercise-Associated Hyponatremia, Hypernatremia, and Hydration Status in Multi-Stage Ultramarathons. Wilderness Environ Med. 2017 Aug 3.
4. Lipman GS, Sharp LJ, Christensen M, Phillips C, DiTullio A, Dalton A, Ng P, Shangkuan J, Shea K, Krabak BJ: Paper Tape Prevents Foot Blisters: A Randomized Prevention Trial Assessing Paper Tape in Endurance Distances II (Pre-TAPED II). Clin J Sport Med. 2016 Sep;26(5):362-8