Transcript Trailwalker 2004

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