sierra choi hong kong physiotherapy association aim common injuries, injury prevention and simple...
TRANSCRIPT
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Sierra ChoiHong Kong Physiotherapy Association
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Aim•Common injuries, Injury
prevention and simple self management
•Enjoy this meaningful event
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Oxfam Trail Walker
•Endurance sport•Mind
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Cardiopulmonary Function
Heart rate profile at session 3
0
50
100
150
200
250
0:01
:30
0:09
:30
0:17
:30
0:25
:30
0:33
:30
0:41
:30
0:49
:30
0:57
:30
1:05
:30
1:13
:30
1:21
:30
1:29
:30
1:37
:30
1:45
:30
1:53
:30
2:01
:30
2:09
:30
2:17
:30
2:25
:30
2:33
:30
2:41
:30
2:49
:30
2:57
:30
3:05
:30
3:13
:30
3:21
:30
3:29
:30
3:37
:30
3:45
:30
3:53
:30
4:01
:30
time
hea
rt r
ate
(bea
t/m
in)
Age: 40 Max HR: 220 – 40 = 180
Courtesy of Dr. Simon Yeung, HKPU
4 hours
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Demand
•Musculoskeletal–Lower limb joints for mobility–Spine for stability–Upper limb for holding of pole /
weight
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Preparation
DEMAND FITNESS
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Injury
DEMANDFITNESS
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Injury
• Load exceeds the ability– Trauma– Overuse
• Injury may happen to – Muscles, Ligament, Joints of– Spine, Hip, Knee and Ankle
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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
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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
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Trailwalker’s Injury
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Heat InjuryHeat Injury and
Hypothermia
Heat InjuryHeat Injury and
Hypothermia
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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
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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
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Heat Injury
Heat CrampHeat CrampHeat CrampHeat Cramp
Heat ExhaustionHeat ExhaustionHeat ExhaustionHeat Exhaustion
Heat strokeHeat strokeHeat strokeHeat stroke
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 !!
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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
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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
•Removed from Removed from coldcold
•InsulationInsulation
•Don’t Don’t immediate re-immediate re-warm activelywarm actively
•Monitored Monitored continuously continuously
Management for Hypothermia
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Musculoskeletal Injury
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Musculoskeletal Injury• Load exceeds the ability
– Trauma– Overuse
• Injury may happen to – Muscles, Ligament, Joints of– Spine, Hip, Knee and Ankle
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Overuse injury
• Muscle strain / Cramp• Anterior knee pain• Iliotibial band friction syndrome (I
TB)• Plantar fasciitis (Sole / Heel pain)• Tendonitis (Knee, ankle)
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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
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Muscle cramp
• Management– Replenish of water and electrolyte– Rest– Stretching– GENTLE massage
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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 join
t / distal portion of ITB
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Body Alignment
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Body Alignment
Right knee MRI filmJBJS(Br)1999 81-B: 452-8
HKSI Sports Medicine Education Series IV
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Iliotibial Band Friction Syndrome
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Plantar Fasciitis
• Heel pain• Loading exceeding th
e flexibility of plantar fascia– Overweight– Increase pronation
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Plantar Fasciitis
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• Inflammation of tendon
• Overuse due to Repeated concentric eccentric cycle
Tendonitis
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Traumatic Injury
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•Ligamentous sprain•Muscle tear•Fracture•Dislocation
Traumatic Injury
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Ligamentous and Muscle Injury
• Grade I to III– Grade I – Minor injury, no laxity, function
well preserved– Grade II – Moderate Injury, Laxity (lig.), f
unctional disturbance– Grade III – Complete torn, Laxity or even
dislocation, Great functional disturbance
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Site of common ligament sprain
• Anterior Talofibular Ligament• Anterior Cruciate Ligament• Medial / Lateral Collateral Lig
ament
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Prevention
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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
Acute Mx, Intervention, Rehab
Knowledge, skill, Ability of Medical Team
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
Pre-injury health status
Status of recovery
Flexty, Stabty
Power
Strength
Pre-race condition
Endurance
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How do you prepare yourself
• Reasonable goal• Reasonable training regime• Training log book• Addressing extrinsic factors &
intrinsic factors leading to injury
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Extrinsic factor
• Temperature, Humidity, UV Index, Wind ….
• Trail surface and condition• Lighting• Gear – Clothing, Footwear,
Hiking pole, Flashlight / Headlamp, …
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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
Acute Mx, Intervention, Rehab
Knowledge, skill, Ability of Medical Team
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
Pre-injury health status
Status of recovery
Flexty, Stabty
Power
Strength
Pre-race condition
Endurance
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Intrinsic Factor
• Foundation– Medical background, Body
alignment, Cardiopulmonary function
• Balance / Core control / Stability• Muscle flexibility, strength,
power, endurance
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Body Alignment
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Body Alignment
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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
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Recommendation
• Before the walk and after long rest
• Water break / Check point• Slow and steady• Change of degree of tightness• Support
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Calf stretchCalf stretch
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Hamstring stretchHamstring stretch
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Inner thigh stretchInner thigh stretch
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Quadriceps stretchQuadriceps stretch
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Outer thigh stretchOuter thigh stretch
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Back stretchBack stretch
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Neck and Chest stretchNeck and Chest stretch
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Choice of Shoes
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Function of Shoes
• Maintain foot stability• Shock Absorption• Provide firm lever system for
propulsion
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Foot Type and Stability
Optimum Rigid Floppy
Neutral Cushion Support
Neutral High Arch Flat Feet
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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
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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
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• Application of second skin
• Secure it with tapes
• Avoid creating another pressure area
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