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Sports Physiotherapy Presentation. TOPIC 3. Group members: Au Chin Kin, Ken ( 1 ) Chan Hoi Kit, Vincent ( 7 ) Lai Ka Wai ( 62 ) Lee Hing Yin, Patrick ( 74 ) Leung Chak Kei, Jacky ( 78 ). Outline. Video Show & Case Introduction Epidemiology of Running Injuries

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Topic 3

Sports Physiotherapy

Presentation

TOPIC 3

Group members:Au Chin Kin, Ken ( 1 )

Chan Hoi Kit, Vincent ( 7 )

Lai Ka Wai ( 62 )

Lee Hing Yin, Patrick ( 74 )

Leung Chak Kei, Jacky ( 78 )


Outline
Outline

  • Video Show & Case Introduction

  • Epidemiology of Running Injuries

  • Risk Factors for Adolescent Runners

  • Preventive Measures

  • Effectiveness

  • Q & A



Epidemiology of running injuries
Epidemiology of Running Injuries

  • Incidence rate10:

    • 37-56% of runners

    • 2.5-12.1 injuries/1000hrs

  • No significant association

    between age & injury40

    • Koplan et al, 1982

    • Blair et al, 1987

    • Jacobs & Berson, 1986

    • Macera et al, 1989

    • Walter et al, 1989


Overuse injuries
Overuse Injuries

  • Repetitive loading23

    • foot strike 1,000-1,500 times per mile

    • 2-3 times of body weight

  • 20-70% among all injuries40







Intrinsic factors
Intrinsic Factors

1. Growth

  • Repetitive microtrauma damage growth cartilage at 3 sites24

Growth plate

Articular cartilage

Apophyseal insertion

Adopted from Micheli (1983)


Intrinsic factors1
Intrinsic Factors

  • Injuries at :

    • Growth plate

      • Salter type I injury3, 14

    • Articular cartilage

      • Osteocholdritis dissecans3, 24

    • Apophyseal insertion

      • Traction apophysitis3, 14

Salter type I injury

Adopted from Apley (1993)


Intrinsic factors2
Intrinsic Factors

2. Growth process

  • Growth of bones > growth of muscles14, 24

  •  tightness and inflexibility

  •  stress at joint surface14, 24


Intrinsic factors3
Intrinsic Factors

3. Anatomical malalignment

  • Femoral neck anteversion

     Predispose patellofemoral symptoms14, 19


Intrinsic factors4
Intrinsic Factors

  • Anatomical malalignment

    •  Q-angle (in female)

    • Predispose to chondromalacia patellae14

    • Coxa vara and valgus deformity of knee

    • Predispose to traction apophysitis14

Adopted from Magee (1997)


Intrinsic factors5
Intrinsic Factors

4. Menstrual dysfunction in young female

  • Intense training may lead to secondary amenorrhea1

  •  estrogen secretion and bone mass1

  •  risk of stress #1


Intrinsic factors6
Intrinsic Factors

5. Psychological factors

  • Exaggerate personality such as tension28

  • Excressive expectation from adult

  • return to play too soon

  • denial of symptoms of injury28, 38


Extrinsic factors
Extrinsic Factors

1. Training error

  • Sudden change of training intensity10, 40

  • Hill running37

  • Excessive training demand by coaches and parents10


Extrinsic factors1
Extrinsic Factors

2. Inappropriate equipment / footwear12

  • Improper fit of the shoes

  • Lack of ability to correct malalignment

  • Decreased ability for shock absorption


Extrinsic factors2
Extrinsic Factors

3. Running surface

  • Hard or uneven surface40

  • Slant running surface10

  • Change in running surface40


Training advice
Training Advice

  • Preparticiaption screening (esp. growth risk factors, psychological factors)13, 14

  • Early sport specialization avoided1

  • Attention to adolescent growth spurt14, 24


Training advice1
Training Advice

  • Conditioning and flexibility

    • General fitness14

    • Stretching (for bone growth factors)13


Training advice2
Training Advice

  • Nutrition intake (e.g. Fe, Ca)1

  • Monitor body composition, weight, stature, cardiovascular findings, sexual maturation, emotional stress1

  • Risk of heat injury1, 27

  • Careful monitoring of amenorrhea2

  • 10% rule for intensity increment25


Training advice3
Training Advice

  • Psychological Health for adolescents

    • Prevent unrealistic expectation from parents and coaches14

    • Enjoyment rather than competition

    • Respect child’s autonomy


Equipment advice
Equipment Advice

  • Shoes

    • Regular replacement of running shoes

    • Slip, curve last; soft sole; narrow flare for pes cavus feet 23

    • Straight, board last; rigid medial insole; wide flare for pes planus feet23



Equipment advice2
Equipment Advice

  • Brace

    • External ankle support devices

    • Knee brace

  • Taping


Rules and regulation
Rules and Regulation

  • Age limit (Rules from HKAAA)

    • 5000m and 10000m Age 16

      or above

    • 3000m SC Age 14 or above

  • Age limit for local athlete events

    • Watson’s Water HK Age Group Athletic Meet 2002

      • 5000m Age 17 or above

    • Watson’s Water Athletic King Championships 2002

      • Age 20 or below for Junior Group


Rules and regulation1
Rules and Regulation

  • Age limits for local Long Distance Running competition

    • Nike Youth Road Relay 15km---Age 14

    • King of the Road 10km---Age 17

    • Mizuno half-marathon 21.0975km---Age 16

    • Nike 10km---Age 16


Effectiveness of preventive measure
Effectiveness of preventive measure

  • Yeung and Yeung, 2001b

  • Verhangen et al. (2000)

  • Quinn et al. (2000)

  • Cook et al. (1990)


Meta analysis 46
Meta-analysis46

Yeung and Yeung, 2001b

  • Effectiveness of stretching exercise is unknown

  • Application of shock absorbing insole is not effective


Critical review 41
Critical Review41

Verhangen et al. (2000)

  • Braces seem to be more effective in preventing ankle sprains than tape

  • The use of either tape or brace also results in less severe ankle sprains


Meta analysis 34
Meta-analysis34

Quinn et al. (2000)

  • Use of external ankle support devices, e.g. a formal semi-rigid ankle orthoses or Aircast brace to prevent ligamentous injuries


Critical review 12
Critical Review12

Cook et al. (1990)

  • All running shoes lose between 30-50% of their shock absorbency characteristics after as little as 400km of running


Conclusion
Conclusion

  • Early specialized training ( esp. distance running ) are not recommended

  • Various preventive measures can reduce the chance of getting injuries


Acknowledgements
Acknowledgements

  • Miss Ng and her coach


References
References

  • Anderson SJ, Griesemer BA, Johnson MD, et al: Intensive Training and Sports Specialization in Young Athletes. American Academy of Pediatrics 2000;106(1):154-157.

  • Anderson SJ, Griesemer BA, Johnson MD, et al: Medical Concerns in the Female Athlete.American Academy of Pediatrics 2000;106(3):610-613.

  • Apley AG, Solomon L: Apley’s System of Orthopaedics and Fractures. 7th ed. India: Butterworth-Heinemann Ltd, 1993:92-106,515-565.

  • Apple DR: Adolescent runners. Clinics in Sports Medicine 1985;4(4):641-655.

  • Backx FJG: Epidemiology of paediatric sports-related injuries. In: Oded Bar-Or: The Child and Adolescent Athlete (Chapter 11). UK: Oxford Human Kinetics Book, 1996.

  • Boileau RA, Gould D, Weiss MR, et al: Advances in pediatric sport sciences. Champaign, Illinois: Human Kinetics Books, 1984.

  • Books DS, Micheli LJ: Musculoskeletal assessment and training: The young athlete. Clinics in Sports Medicine 1988;7(3):641-677.

  • Brody DM: Running injuries. In: Nicholas JA, Hershman EB, eds. The Lower Extremity and Spine in Sports Med St Louis. Mosby Company, 1986:1534-1579.

  • Burgess-Milliron MJ, Murphy SB: Biomechanical considerations of youth sports injuries. In: Oded Bar-Or: The Child and Adolescent Athlete (Chapter 12). UK: Oxford Human Kinetics Book, 1996.


References1
References

  • Caine DJ, Caine C, Lindner KJ: Epidemiology of sports injuries. Champaign, Illinois: Human Kinetics, 1996.

  • Clement DB, Taunton JE, Smart GW, et al: A survey of overuse running injuries. Phys. Sports Med 1981;9(5):47-50,52-53,56-58.

  • Cook SD, Brinker MR, Roche M: Running shoes: their relationship to running injuries. Sports Medicine 1990;10(1):1-8.

  • Dalton S:Overuse injuries in adolescent athletes.Sports Medicine 1992;13(1):58-70.

  • DiFiori JP: Overuse Injuries in Children and Adolescents.The Physician and Sportsmedicine 1999;27(1).

  • Dixon SJ, Collop AC, Batt ME: Surface effects on ground reaction forces and lower extremity kinematics in running. Medicine and Science in Sports and Exercise 2000;32:1919-1926.

  • Giddings VL, Beaupre GS, Whalen RT, et al: Calcaneal loading during walking and running. Medicine and Science in Sports and Exercise 2000; 32: 627-634.

  • Hamill J, Bates BT: A kinetic evaluation of the effects of in vivo loading on running shoes. The Journal of Orthopaedic and Sports Physical Therapy 1988;10(2):47-53.

  • Hreljac A, Marshall RN, Hume PA: Evaluation of lower extremity overuse injury potential in runners. Medicine and Science in Sports and Exercise 2000;32:1635-1641.


References2
References

  • Magee DJ: Orthopedic Physical Assessment. 3rd ed. USA: W. B. Saunders Company, 1997:460-598.

  • Marti B: Health Effects of Recreational Running in Women: Some Epidemiological and Preventive Aspects. Sports Medicine 1991;11(1):20-51.

  • Marti B, Vader JP, Minder CE, et al: On the epidemiology of running injuries: the 1984 Bern Grand-prix study. Amer J Sports Med 1988;16(3):285-294.

  • McBryde AM, Jackson DW, James CM: Injuries in runners and joggers. In: Schneider RC, ed. Sports Injuries: Mechanism, Prevention, and Treatment. Baltimore: Williams & Wilkins, 1985;395-416.

  • McKenazie DC, Clement DB, Taunton JE: Running shoes: Orthotics and injuries. Sports Med 1985;2(5):334-347.

  • Micheli LJ: Overuse injuries in children's sports: the growth factor. Orthopedic Clinics of North America 1983;14(2):337-60.

  • Micheli LJ, Klein JD: Sports injuries in children and adolescent. British Journal of Sports Medicine 1991;25(1):6-9.

  • Mitchell JR, Anthony JM, Stephen GR, et al: High school cross country running injuries: A longitudinal study. Clinical Journal of Sports Medicine 2000;10:110-16.

  • Nelson MA: Risks in Distance Running for Children. American Academy of Pediatrics 1990;86(5).


References3
References

  • Nudel DB, Hassett I, Gurian A, et al: Young long distance runners. Physiological and psychological characteristics. Clinical Pediatrics 1989;28(11):500-505.

  • O’Neill DB, Micheli LJ: Overuse injuries in the young athlete. Clinics in Sports Medicine 1988;7(3):591-610.

  • Orava S, Saarela J: Exertion injuries to young athletes. American Journal of Sports Medicine 1978;6(2):68-74.

  • Pagliano JW: You don’t have to hurt: a guide to understanding, treating and avoiding the 10 most common running injuries. Runner’s World 1986;21(6):30-32,34,36,38-39.

  • Pagliano JW, Jackson DQ: The ultimate study of running injuries. Runner’s World 1980;15(11):42-50.

  • Paty JF, Swafford D: Adolescent running injuries. Journal of adolescent Health Care 1984;5(2):87-90.

  • Quinn K, Parker P, de Bie R, et al: Interventions for preventing ankle ligament injuries (Cochrane Review). In: The Cochrane Library, Issue 4, 2000. Oxford: Update Software.

  • Sherwood BK, Strong WB: Heat stress in athletes. J Med Association of Georgia 1985;74(7):478-480.

  • Smith NJ: Common problems in pediatric sports medicine. Chicago : Year Book Medical Publishers,1989.

  • Smith WB: Environmental factors in running. Amer J Sports Med 1980;8(2):138-140.


References4
References

  • Stanitski CL: Common injuries in preadolescent and adolescent athletes – recommendations for preventation. Sports Medicine 1989;7:32-41.

  • Temple C: Sports injuries. Hazards of jogging and marathon running. British J Hospital Med 1983;29(3):237-239.

  • Van Mechelen W: Running injuries: A review of the epidemiological literature. Sports Med 1992;14(5):320-325.

  • Verhagen EA, Van Mechelen W, De Vente W: The effect of preventive measures on the incidence of ankle sprains. Clinical Journal of Sport Medicine 2000;10:291-296.

  • Walter SD, Hart LE, McIntosh JM, et al: The Ontario cohort study of running related injuries. Archives Internal Med 1989;149:2561-2564.

  • Watson MD, DiMartino PP: Incidence of injuries in high school track and field athletes and its relation to performance ability. American Journal of Sports Medicine 1987;15(3):251-254.

  • White TL, Malone TR: Effects of running on intervertebral disc height. The Journal of Orthopaedic and Sports Physical Therapy 1990;12(4):139-146.

  • Wmith WB: Environmental factors in running. American Journal of Sports Medicine 1980;8(2):138-140.

  • Yeung EW, Yeung SS: A systematic review of interventions to prevent lower-limb soft-tissue running injuries. British Journal of Sports Medicine 2001b;35:383-389.


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