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Sierra Choi Hong Kong Physiotherapy Association Aim • Common injuries, Injury prevention and simple self management • Enjoy this meaningful event Oxfam Trail Walker • Endurance sport • Mind 0 1:45:30 1:37:30 1:29:30 1:21:30 1:13:30 1:05:30 4 hours time Courtesy of Dr. Simon Yeung, HKPU 4:01:30 3:53:30 3:45:30 3:37:30 3:29:30 3:21:30 3:13:30 3:05:30 2:57:30 2:49:30 2:41:30 2:33:30 2:25:30 2:17:30 2:09:30 2:01:30 Age: 40 1:53:30 250 0:57:30 0:49:30 0:41:30 0:33:30 0:25:30 0:17:30 0:09:30 0:01:30 heart rate (beat/min) Cardiopulmonary Function Heart rate profile at session 3 Max HR: 220 – 40 = 180 200 150 100 50 Demand • Musculoskeletal – Lower limb joints for mobility – Spine for stability – Upper limb for holding of pole / weight Preparation DEMAND FITNESS Injury Injury • Load exceeds the ability – Trauma – Overuse • Injury may happen to – Muscles, Ligament, Joints of – Spine, Hip, Knee and Ankle 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 Injury and Hypothermia Heat regulatory system Heat (Metabolism) Exercise Shivering Radiation Heat Generation Balance Radiation Conduction Convection Evaporation Heat loss Heat Index Temp, wind speed, humidity, radiation Electrolyte loss Heat Injury Heat Cramp Sweating+++ Headache Weakness Vomit ↑HR, ↓awareness Hot and humid weather without adequate fluid supply Dehydration Redness Hot and dry Heat Exhaustion No sweating Strong and rapid pulse CNS damage signs Unsteady gait Heat stroke Confusion Aggressive Coma Heat Injury Drink / electrolyte Heat Cramp Rest in Shaded area Loosen up clothing Lower temp Water supply Observe Send to hosp Pre-ex, replenish during ex Dehydration Heat Exhaustion Heat stroke Medical Emergency !! Hypothermia Mild • 33 – 35ºC • Cold extremities • Shivering Moderate • Rapid pulse and breathing • Urine urgency • fatigue • Slight incoordination • 31 – 32ºC • in-coordination • shivering • Slurred speech • Drowsiness / Amnesia • Poor judgment • Dehydration Management for Hypothermia Mild Moderate •Remove from cold •Removed from cold •Insulation •Insulation •Warm, sweet drink •Don’t immediate re-warm actively •NO Alcohol •Monitored continuously •External heat over torso area 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 Body Alignment Body Alignment Right knee MRI film JBJS(Br)1999 81-B: 452-8 HKSI Sports Medicine Education Series IV Iliotibial Band Friction Syndrome Plantar Fasciitis • Heel pain • Loading exceeding the flexibility of plantar fascia – Overweight – Increase pronation Plantar Fasciitis Tendonitis • Inflammation of tendon • Overuse due to Repeated concentric eccentric cycle Traumatic Injury Traumatic Injury • Ligamentous sprain • Muscle tear • Fracture • Dislocation 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 Performance to sport Strength, endurance Strength Flexty, Stabty Status recovery Healingofconstrain Pre-racehealth condition Pre-injury status Athlete Education Knowledge Endurance Power Psychological Nutrition Cardiovascular Power Skill Acute Control Mx,ofIntervention, Extrinsic Factors Rehab Knowledge, skill,management, Ability of Medical Team Strategy, Team Support 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 Performance to sport Strength, endurance Strength Flexty, Stabty Status recovery Healingofconstrain Pre-racehealth condition Pre-injury status Athlete Education Knowledge Endurance Power Psychological Nutrition Cardiovascular Power Skill Acute Control Mx,ofIntervention, Extrinsic Factors Rehab Knowledge, skill,management, Ability of Medical Team Strategy, Team Support Intrinsic Factor • Foundation – Medical background, Body alignment, Cardiopulmonary function • Balance / Core control / Stability • Muscle flexibility, strength, power, endurance Body Alignment 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 stretch Hamstring stretch Inner thigh stretch Quadriceps stretch Outer thigh stretch Back stretch Neck and Chest stretch Choice of Shoes Function of Shoes • Maintain foot stability • Shock Absorption • Provide firm lever system for propulsion Foot Type and Stability Neutral High Arch Flat Feet Optimum Rigid Floppy Neutral Cushion Support 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