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OVERUSE INJURIES IN RUNNING PowerPoint Presentation
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OVERUSE INJURIES IN RUNNING

OVERUSE INJURIES IN RUNNING

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OVERUSE INJURIES IN RUNNING

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  1. OVERUSE INJURIES IN RUNNING

  2. CONTENTS • Overview; • Basic biomechanics of running; • Epidemiology of running injuries; • Causative factors; • Dose-response relationship; and • Prevention strategies • Evaluation strategies

  3. OVERVIEW • Commonest type of sports in Hong Kong • Mass entrants in the Tsing Ma Bridge Marathon and ‘98 New Airport International Marathon and 10 km. run

  4. BENEFITS OF RUNNING • Improve physical fitness level; • Positive feeling of good health; • Friendship and socialisation; • Enjoyment; and • Rewards

  5. Sequence of Prevention 2. Establishing aetiology & mechanism of injuries • 1. Establishing the extent of the sports injury problem • Incidence • Severity 3. Introducing preventive measures 4. Assessing their effectiveness by repeating step 1

  6. EPIDEMIOLOGY OF RUNNING INJURIES • Knutzen and Hart (1996) • A comprehensive review on running injuries • Retrospective studies (16) • Prospective studies (5) • Annual incidence 48-65% (P); 24-60% (R)

  7. EPIDEMIOLOGY OF RUNNING INJURIES • Retrospective studies • Marti et al. (1980) • Surveillance study of 4,358 runners in a road race • 1,994 injured (46%)

  8. PROSPECTIVE STUDY • Walter et al. (1989) • Ontario Cohort study • enrolled 1,680 runners at two races • prospective survey for 12 months. • 1,288 completed the follow-up data • 48% were injury.

  9. SITE OF INJURIES

  10. Case series studies • Clement et al. (1981) • Review 1,650 patients between 78-80.

  11. EPIDEMIOLOGY OF INJURIES • Data collection far from comprehensive • Subjects selection bias • Injuries ill-defined • True incidence of injuries yet to be determined (for details, refer to Caine et al., (1996) epidemiology of sports injuries. Human Kinetics. Chapter 22)

  12. ESTABLISHING AETIOLOGY & MECHANISM OF INJURIES

  13. RUNNING EVENTS • CHARACTERISTICS • NEURO-MUSCULAR PREDOMINANCE (SPRINT & HURDLES) • CARDIO-RESPIRATORY PREDOMINANCE (MIDDLE & LONG DISTANCE) • CAPACITY BASED ON STRENGTH & ENDURANCE (AEROBIC & ANAEROBIC) • PHYSIOLOGICAL ADAPTATION TAKING PRECEDENCE OVER TECHNIQUE

  14. RUNNING CYCLE • No double support phase • Stance (40%) • Float (30%) • Swing (30%) • Contact, midstance,propulsion • forward swing & foot descent

  15. Jogging: Stance > Swing • Distance: Stance = Swing • Sprinting: • Stance < Swing

  16. RUNNING BIOMECHANICS INITIAL GROUND REACTION FORCES • VERTICAL GROUND REACTION FORCES 2-3 TIMES BODY WEIGHT • ANTERIOR /POSTERIOR FORCES - 50% B.W. • MEDIAL /LATERAL SHEAR - 10% B.W. • DURATION - 200 - 600 ms. • PEAK IMPACT FORCES AT 20-30 ms.

  17. CAUSATIVE FACTORS IN RUNNING INJURIES EXTRINSIC • Training error • Running Terrain and Surfaces • Running shoes

  18. TRAINING ERROR • Clement et al. (1981) • Sudden increases in mileage or intensity • High intensity without rest • High level of competition

  19. Marti et al. (1980) • Increased association of injuries when mileage (>50 km./week) • Ontario Cohort study • > 40 km/week.

  20. RUNNING TERRAIN AND SURFACES • Clement et al. 1981 • Uneven, hardness, road camber • Uphill and downhill

  21. RUNNING SHOES • FOOT MUST BE STABLE • SHOCK ABSORBPTION – REDUCE THE INITIAL HEEL SPIKE • RIGID LEVER FOR THE THRUST OF FORWARD MOTION

  22. RUNNING SHOES SHOCK ABSORPTION EFFECT FACTS: • The Shock absorption effect will easily lost 40% after 400-800 Km. of running (After Cook et al 1985)

  23. CAUSATIVE FACTORS IN RUNNING INJURIES INTRINSIC • IMPERFECT MUSCULOSKELTAL ALIGNMENT • FLEXIBILITY

  24. INTRINSIC FACTORS • Cowan et al., 1996 • Investigate effects of anatomic variation on risk of overuse injuries • Prospective study • Subjects: 294 army infantry for 12/52 training • Risk of injury increase with Valgus knee (RR=1.9) and Q angle >15 degree (RR=5.4)

  25. INTRODUCING PREVENTIVE MEASURE

  26. PRINCIPLES OF TRAINING BIOLOGIC ADAPTATIONS TO IMPROVE PERFORMANCE IN SPECIFIC TASKS

  27. TRAINING PROGRAM • Yeung and Yeung 2001 • Investigate the characteristics and training profile of marathon finishers and non-finishers • Subjects: 113 runners from Standard Chartered Hong Kong Marathon 1998

  28. Personal and training profile

  29. TRAINING AND RECOVERY • Warm (Cool) down • Whirpools and Spas • Massage • Rest and Sleep • Psychological • Nutritional

  30. COOL DOWN • Lactate can be removed from blood and muscle more rapidly by light continuous aerobic exercise • Optimal rate of removal 30 - 45% VO2 max 50-65%

  31. OVER TRAINING • Sign of over training • Fatigue and poor performance • Increase resting heart rate • Weight loss • Irritability and sleep disturbance • Elevated Serum Creatine Phosphokinase (CPK)

  32. TRAINING TERRAIN • TRACK vs ROAD • CROSS TRAINING – UPHILL vs DOWNHILL • TREADMILL

  33. FUNCTIONAL ANATOMY OF FOOT • Normal Foot arch, flat foot and Pes Cavas • Effects of foot arch or weight bearing

  34. SELECTION OF RUNNING SHOE

  35. RUNNING SHOES • Be Comfortable • Protect the wearer from injury • Not be a source in injury • Facilitate athletic performance • Be durable and economical

  36. SHOE COMPONENTS

  37. Last • Straight / Curve Last • Slip Last • Board Last • Shoe Upper • Toe-box • Heel Counter • Achilles Tendon Pad • Sole • Outsole • Midsole • Insole

  38. PRONATOR • Needs stability and arch support • Features: • Straight last; • Supportive heel counter; • Extra support on medial side • Increased medial wedging on insole • Semirigid orthotic

  39. NEUTRAL • Need good fit, adequate arch and shock absorbing • Features: • Semicurved last; • Extra cushioning & • Medium heel counter

  40. SUPINATOR • Needs flexibility, maximum shock absorbing • Features: • Semicurved or curved last; • Slip last • Maximum cushioning