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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. Video Show & Case Introduction Epidemiology of Running Injuries

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TOPIC 3

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  1. 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 )

  2. Outline • Video Show & Case Introduction • Epidemiology of Running Injuries • Risk Factors for Adolescent Runners • Preventive Measures • Effectiveness • Q & A

  3. VIDEO SHOW

  4. 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

  5. Overuse Injuries • Repetitive loading23 • foot strike 1,000-1,500 times per mile • 2-3 times of body weight • 20-70% among all injuries40

  6. Types of Injury in Adults8, 31, 32, 39

  7. Types of Injury in Adolescents30, 33, 43

  8. Locations of Injury in Adults11, 21, 22, 39, 42

  9. Locations of Injury in Adolescents26, 28, 33, 43

  10. Risk Factors contributing to overuse injuries In Children and Adolescent

  11. Intrinsic Factors 1. Growth • Repetitive microtrauma damage growth cartilage at 3 sites24 Growth plate Articular cartilage Apophyseal insertion Adopted from Micheli (1983)

  12. 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)

  13. Intrinsic Factors 2. Growth process • Growth of bones > growth of muscles14, 24 •  tightness and inflexibility •  stress at joint surface14, 24

  14. Intrinsic Factors 3. Anatomical malalignment • Femoral neck anteversion  Predispose patellofemoral symptoms14, 19

  15. 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)

  16. Intrinsic Factors 4. Menstrual dysfunction in young female • Intense training may lead to secondary amenorrhea1 •  estrogen secretion and bone mass1 •  risk of stress #1

  17. 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

  18. Extrinsic Factors 1. Training error • Sudden change of training intensity10, 40 • Hill running37 • Excessive training demand by coaches and parents10

  19. Extrinsic Factors 2. Inappropriate equipment / footwear12 • Improper fit of the shoes • Lack of ability to correct malalignment • Decreased ability for shock absorption

  20. Extrinsic Factors 3. Running surface • Hard or uneven surface40 • Slant running surface10 • Change in running surface40

  21. Training Advice • Preparticiaption screening (esp. growth risk factors, psychological factors)13, 14 • Early sport specialization avoided1 • Attention to adolescent growth spurt14, 24

  22. Training Advice • Conditioning and flexibility • General fitness14 • Stretching (for bone growth factors)13

  23. 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

  24. Training Advice • Psychological Health for adolescents • Prevent unrealistic expectation from parents and coaches14 • Enjoyment rather than competition • Respect child’s autonomy

  25. 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

  26. Equipment Advice

  27. Equipment Advice • Brace • External ankle support devices • Knee brace • Taping

  28. 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

  29. 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

  30. Effectiveness of preventive measure • Yeung and Yeung, 2001b • Verhangen et al. (2000) • Quinn et al. (2000) • Cook et al. (1990)

  31. Meta-analysis46 Yeung and Yeung, 2001b • Effectiveness of stretching exercise is unknown • Application of shock absorbing insole is not effective

  32. 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

  33. 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

  34. 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

  35. Conclusion • Early specialized training ( esp. distance running ) are not recommended • Various preventive measures can reduce the chance of getting injuries

  36. Acknowledgements • Miss Ng and her coach

  37. 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.

  38. 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.

  39. 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).

  40. 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.

  41. 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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