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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



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 )


  • 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

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

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


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

  • Various preventive measures can reduce the chance of getting injuries


  • Miss Ng and her coach


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