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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
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  • 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.
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  • 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
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references2
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  • Nelson MA: Risks in Distance Running for Children. American Academy of Pediatrics 1990;86(5).
references3
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references4
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