Willis CHAN Sports Specialty Group Hong Kong Physiotherapy Association.

Willis CHANSports Specialty Group

Hong Kong Physiotherapy Association

Aim•Common injuries, Injury

prevention and simple self management

•Enjoy this meaningful event

Oxfam Trail Walker

•Endurance sport•Mind

路段距離 (公里 )

起點至 CP1 16.1

CP1 至 CP2 8.8

CP2 至 CP3 10.1

CP3 至 CP4 12.5

CP4 至 CP5 7.8

CP5 至 CP6 6.1

CP6 至 CP7 8.7

CP7 至 CP8 9.0

CP8 至 CP9 9.6

CP9至終點站 11.3

合共 : 100公里

• What common problems I will facing at OTW

• Why I need to aware on it?

Demand•Musculoskeletal

–Lower limb joints for mobility

–Spine for stability

–Upper limb for holding of pole / weight

Injury

• Load exceeds the ability– Trauma– Overuse

• Injury may happen to – Muscles, Ligament, Joints of– Spine, Hip, Knee and Ankle

Preparation

DEMAND FITNESS

Injury

DEMAND

FITNESS

Inflammation

• Normal body response to ‘problem’• Acute phase - Increased circulation

– Sign and symptoms• Redness, Swelling, Increase temp, Pain

– Management• Control sign and symptoms• R.I.C.E

Inflammation• Sub-acute stage

– Repairmen of the damage– Management

• Controlled activities

• Chronic Stage– Remodeling– Scar formation– Management

• Restoring normal function• Range, Strength, Power, Endurance,

Proprioception

Trailwalker’s Injury

Heat InjuryHeat Injury and

Hypothermia

Heat InjuryHeat Injury and

Hypothermia

• Am I suffering from heat stroke?

MEDICAL Emergency!!

Heat (Metabolism)Heat (Metabolism)ExerciseExerciseShiveringShiveringRadiationRadiation

Heat (Metabolism)Heat (Metabolism)ExerciseExerciseShiveringShiveringRadiationRadiation

Heat Heat GenerationGeneration

Heat Heat GenerationGeneration

BalanceBalance

Heat IndexHeat IndexTemp, wind speed, humidity, radiationTemp, wind speed, humidity, radiation

Heat regulatory system

RadiationRadiationConductionConductionConvectionConvection

EvaporationEvaporation

RadiationRadiationConductionConductionConvectionConvection

EvaporationEvaporation

Heat lossHeat loss

Heat Injury

Heat CrampHeat CrampHeat CrampHeat Cramp

Heat ExhaustionHeat ExhaustionHeat ExhaustionHeat Exhaustion

Heat strokeHeat strokeHeat strokeHeat stroke

DehydrationDehydrationDehydrationDehydration

Electrolyte lossElectrolyte loss

Hot and humid weather without adequate fluid supply

Sweating+++Sweating+++HeadacheHeadacheWeaknessWeaknessVomitVomit↑↑HR, HR, ↓↓awarenessawareness

Redness Hot and dryNo sweating

Strong and rapid pulseCNS damage signs

Unsteady gaitConfusionAggressive

Coma

Heat Injury

Heat CrampHeat CrampHeat CrampHeat Cramp

Heat strokeHeat strokeHeat strokeHeat stroke

Heat ExhaustionHeat ExhaustionHeat ExhaustionHeat Exhaustion

DehydrationDehydrationDehydrationDehydration

Drink / electrolyteDrink / electrolyte Pre-ex, replenish during ex

Rest in Rest in Shaded areaShaded areaLoosen up Loosen up clothingclothingLower tempLower tempWater supplyWater supplyObserveObserveSend to hospSend to hosp

Medical Emergency !!

MildMild •33 – 35ºC33 – 35ºC•Cold Cold extremitiesextremities

•ShiveringShivering

•Rapid pulse Rapid pulse and breathingand breathing

•Urine urgencyUrine urgency

•Slight in-Slight in-coordinationcoordination

ModerateModerate

•31 – 32ºC31 – 32ºC in-in-coordinationcoordination

shiveringshivering

•fatiguefatigue

•Slurred speechSlurred speech

•Drowsiness / Drowsiness / AmnesiaAmnesia

•Poor judgmentPoor judgment

•DehydrationDehydration

Hypothermia

MildMild

•Remove Remove from coldfrom cold

•InsulationInsulation

•Warm, sweet Warm, sweet drinkdrink

•NO AlcoholNO Alcohol

•External External heat over heat over torso areatorso area

ModerateModerate

•Ask for helpAsk for help !!

•Removed from Removed from coldcold

•InsulationInsulation

•Don’t Don’t immediate re-immediate re-warm activelywarm actively

•Monitored Monitored continuously continuously

Management for Hypothermia

Musculoskeletal Injury

Musculoskeletal Injury• Load exceeds the ability

– Trauma– Overuse

• Injury may happen to – Muscles, Ligament, Joints of– Spine, Hip, Knee and Ankle

Overuse injury

• Muscle strain / Cramp• Anterior knee pain• Iliotibial band friction syndrome

(ITB)• Plantar fasciitis (Sole / Heel

pain)• Tendonitis (Knee, ankle)

Muscle Cramp / Strain

• Dehydration / Insufficient electrolytes– More generalized– Water and electrolyte supplementation

• Muscle fatigue– During / after exercise– Accumulation of lactic acid– Training, improve circulation

• Overload - damage– Concentric – muscle shortening– Eccentric – muscle lengthening – Training, aid / support

Muscle cramp

• Management

– Replenish of water and electrolyte– Rest– Stretching– GENTLE massage

Anterior Knee pain /ITB syndrome

• Front knee pain and Side knee pain

• Repeated loading (Overuse)• Related to

– Mal-alignment / Biomechanical fault– Insufficient hip, knee & ankle control – Insufficient flexibility– Increase loading to the patellofemoral

joint / distal portion of ITB

Anterior Knee pain

Body Alignment

Iliotibial Band Friction Syndrome

What should I do?

• Train up your Gluteus muscles and Quadriceps muscles

• Keep stretch and flexibility

• Proper shoes

Plantar Fasciitis

• Heel pain• Loading exceeding

the flexibility of plantar fascia– Overweight– Increase pronation

Plantar Fasciitis

• Inflammation of tendon

• Overuse due to Repeated concentric eccentric cycle

Tendonitis

Traumatic Injury

•Ligamentous sprain•Muscle tear•Fracture•Dislocation

Traumatic Injury

Ligamentous and Muscle Injury

• Grade I to III– Grade I – Minor injury, no laxity,

function well preserved– Grade II – Moderate Injury, Laxity

(lig.), functional disturbance– Grade III – Complete torn, Laxity or

even dislocation, Great functional disturbance

Site of common ligament sprain

• Anterior Talofibular Ligament• Anterior Cruciate Ligament• Medial / Lateral Collateral

Ligament

Prevention

Return to sport

Acute Mx, Intervention, Rehab

Knowledge, skill, Ability of Medical Team

Cardiovascular

Nutrition

Psychological

Athlete E

ducationHealing constrainFlexty, Stabty

Power

Strength, endurance

Skill

Pre-injury health status

Return to sportPerformance



Control of Extrinsic Factors

Strategy, Team management, Support

Cardiovascular

Cardiovascular

Nutrition

Nutrition

Psychological

Psychological

Athlete E

ducationK

nowledge

Healing constrainFlexty, Stabty

Power

Strength, endurance

Skill


Status of recovery

Flexty, Stabty

Power

Strength

Pre-race condition

Endurance

How do you prepare yourself

• Reasonable goal• Reasonable training regime• Training log book• Addressing extrinsic factors &

intrinsic factors leading to injury

Extrinsic factor

• Temperature, Humidity, UV Index, Wind ….

• Trail surface and condition• Lighting• Gear – Clothing, Footwear,

Hiking pole, Flashlight / Headlamp, …

Return to sport



Cardiovascular

Nutrition

Psychological

Athlete E

ducationHealing constrainFlexty, Stabty

Power

Strength, endurance

Skill


Return to sportPerformance



Control of Extrinsic Factors

Strategy, Team management, Support

Cardiovascular

Cardiovascular

Nutrition

Nutrition

Psychological

Psychological

Athlete E

ducationK

nowledge

Healing constrainFlexty, Stabty

Power

Strength, endurance

Skill


Status of recovery

Flexty, Stabty

Power

Strength

Pre-race condition

Endurance

Intrinsic Factor

• Foundation– Medical background, Body

alignment, Cardiopulmonary function

• Balance / Core control / Stability• Muscle flexibility, strength,

power, endurance

Body Alignment

Guidelines for stretching

• Know the muscle direction and location

• Chose a stable position• Slow and steady stretch• Avoid overstretch• Normal breathing• Hold for 15-20 seconds• Repeat 2-4 times

Recommendation

• Before the walk and after long rest

• Water break / Check point• Slow and steady• Change of degree of tightness• Support

Calf stretchCalf stretch

Choice of Shoes

Function of Shoes

• Maintain foot stability• Shock Absorption• Provide firm lever system for

propulsion

Foot Type and Stability

Optimum Rigid Floppy

Neutral Cushion Support

Neutral High Arch Flat Feet

Choice of Shoes

• Trainer for Section 1,2, 8 to 10• Hiking shoes / boot at night

when poor vision may lead to twisting of ankle

• Hiking shoes / boot for rainy day for Section 1 as it’s slippery in San Wan Shan’s trail

Blister Management

• Check whenever feel feet discomfort

• Blister may form in pressure area with repeated rubbing

• Advice– Good fitting shoes– Change socks– Double layers socks– Apply cream– Apply second skin

• Application of second skin

• Secure it with tapes

• Avoid creating another pressure area

Summary

• Prevention is better than cure

• More tired, more injury

• Everyone should overuse, take good care to your own body

Willis CHAN Sports Specialty Group Hong Kong Physiotherapy Association.

Documents

Transcript of Willis CHAN Sports Specialty Group Hong Kong Physiotherapy Association.