Overview of Trailwalker

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Sports Presentation On Trailwalker
By Lai Chi Kit Jerry, Lam Kit Yan Wendy,
Tang Wing Yan Tracy, Yiu On Yee Annie
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Outline

• Overview of Trailwalker
• Physiologic demand and common injuries
• 2 Case scenarios
• assessment, treatment and advice
• Training guidelines
• Nutrition in Sports
• General advice
• Q A

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Overview of Trailwalker

• An annual fundraising walkathon organised by
  Oxfam Hong Kong since 1981.
• The 100-km MacLehose Trail
• To develop their potential and abilities of
  disadvantaged people in Hong Kong and poor people
  in Asia and Africa.
• From 1981, 80,000 raised increase to over 16
  million in 2000.

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Interest Arouse
1985 Five non-military teams join.
1986 1st year opened to public Oxfam Hong Kong co-organise the event.
1989 350 teams (75 Gurkha, 230 civilian) 1st year with more civilian teams than military.
1993 Registration of 600 teams was full in 6 weeks.
1996 Registration was full in a fast 12 hours.
1997 The 700-team quota was full within 3 hours.
1999 Quota increased from 760 teams to 900.
2000 918 teams participated
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Exercise Physiology of Endurance Sports

• High oxygen transport capacity
• VO2max
• High fatigue resistance in working muscles
• lactate threshold (Tanaka, 1995)
• Muscle fibre composition
• type I gt type II
• Energy utilization
• carbohydrate fat

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Common Injuries
Medical (59)
Musculoskeletal (17)
Dermatologic (21)

• Exercise-associated collapse (EAC)
• Hyponatremia

• Blisters
• Abrasions

• Sprains
• Strains
• Fracture

Dehydration, exhaustion, syncope, hyperthermia
hypothermia
(Roberts W.O., 2000)
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Musculoskeletal Injuries

• Knee gt Ankle (31.3 vs 28.1)
• Injuries (in descending order)
• PFJ pain
• Tendinitis of tendons passing under extensor
  rectinaculum
• Muscle cramp
• Achilles tendinitis
• Ankle sprain

(Fallon K.E.,1996)
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Case scenario

• Team A
• 4 long-distance runners who have no experience in
  Trailwalker before. Fitness level for the 4
  members is good. However, one suffers from
  chronic TA tendinitis and one claims that has
  sore heel after 8-hour hiking practice. He
  wonders if it is to do with shoe-wear.

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Case scenario

• Team B
• Mixed team 2 females 2 males of average
  fitness. One female team member suffers from
  symptoms of nausea and vomiting in her last 3
  Trailwalker events, possibly suffering from
  hyponatremia. One male team member suffers from
  patellofermoral pain after going up down hills
  for 4 hours. He is slightly overweight.

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General Assessment of Physical Fitness
Physical Fitness Component Assessment Method(s)
Body composition BMI
Aerobic endurance 12 min run test / 1.5 mile walk test (HR)
Muscular strength Bench press Leg press
Muscular endurance Push up Curl up tests
Flexibility Sit Reach
(ACSM)
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(No Transcript)
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Chronic Achilles Tendinitis

• Signs symptoms
• Persistent pain over TA
• Pain occurs especially in the morning, after
  exercise hill walking
• Nodules around TA on palpation

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Chronic Achilles Tendinitis

• Intrinsic factors
• stiff MTP joints
• tightness of calf and hamstring muscle
• flat foot / over-pronation

• Extrinsic factors
• sudden increases in training
• excessive downhill running
• improper footwear

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Sore Heel

• Structures underlying symptomatic area
• bone calcaneus
• plantar aponeurosis
• plantar fat pad
• nerve post tib n, med calcaneal n, med and
  plantar n, which pass thro tarsal tunnels
• mm tendon peroneal and tib mm
• bursa retrocalcaneal bursa

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Differential Dx of Heel Pain
Detailed assessment is essential !
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Plantar Fasciitis

• an overuse condition
• Repetitive stress on the plantar fascia results
  in inflammation at its attachment to the
  calcaneus

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Plantar Fasciitis

• Signs symptoms
• Heel pain
• Pain is worse usually at 1st few steps in morning
• Pain is common at start of exercise resuming
  activity after rest
• Pain aggravated by standing, walking, running,
  with running most painful

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Plantar Fasciitis

• Predisposing factors
• Flat foot/high arch
• Excessive pronation
• Obesity
• Tight TA
• Training error
• Improper footwear
• Occupation with prolonged standing

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Assessment

• Training habit
• Alignment of whole LL, esp TA
• Observe foot arch
• Muscle length esp calf
• Test plantar fascia in a stretched position (toes
  ext with ankle PF) WB position

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Assessment - Shoes
Shoe design flaws
Achilles tendinitis Inflexible soles Excessive or insufficient cushioning
Plantar fasciitis Too flexible in the middle sole Lack of stability (transverse and longitudinal)
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Management

• Acute
• PRICE, US, tapping, NSAID
• Chronic
• stretching / transverse friction
• tapping
• removal of triggering factors
• proper footwear
• addition of heel pad or other orthotics
• eccentric loading
• foot intrinsic muscle strengthening

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Exercise-induced Hyponatremia
Na

• Plasma Na level lt 135 mmol/L
• BW loss is less than that of normal athletes
• Median weight change (Speedy et al. 2000)
• Normal - 3.9
• Hyponatremia - 0.5
• Common in ultra-endurance exercise
• marathon
• S/S
• Ranges from asymptomatic to life threatening
  conditions eg seizures, coma, even death
• Common headache, nausea, vomiting, muscle
  cramps, disorientation, confusion

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Exercise-induced Hyponatremia

• Idiopathic
• 2 common hypotheses
• Loss of large amount of salts through sweating
  without replacement
• Excessive pure water consumption (10L / 4hr)

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Exercise-induced Hyponatremia

• Management
• Na containing sport drink
• Salty foods
• Seek professionals if necessary

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Exercise-induced Hyponatremia
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Patellofemoral Pain

• Etiology
• biomechanical problem (patella tracking),
• malalignment, overuse muscular
• dysfunction of PFJ
• Training errors

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Patellofemoral Pain

• S/S - pain ?by prolonged sitting,
• ?duration of activity
• (esp. squatting ? stairs)
• - swelling
• - crepitus

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Assessment of PFJ pain

• S/E activity pattern, training techniques,
• footwear, details of onset, SAND etc.
• O/E observation of whole LL alignment (?
  Ant/post pelvic tilt, ?Q-angle, genu
  valgum/varum, patellar position, flat foot, pes
  cavus, leg length discrepancy)

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Assessment of PFJ pain

• Palpation bursa, tendon, ligament, jt line,
  patellar facets retinaculum
• ROM, MMT (? weak VMO ? poor tracking of patella),
  patellar gliding movt, ligament stress test,
  McMurray test
• Test for mm tightness e.g. hamstring, quads, hip
  flexors, ITB

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Management of PFJ pain

• Acute phase
• - PRICE
• - Symptomatic relief e.g. use of EPT
• - NSAID
• - Avoid stair walking, inclined slope
  squatting
• Chronic phase
• - Stretch tight mm
• - Strengthening ex esp VMO
• - Taping
• - ?proprioception training
• - Balance training e.g. bouncer, wobble board

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Hiking poles

• ? joint loading, especially knee
• ? knee flexion moment
• ? quads eccentric loading
• ? shearing force on TFJ
• ? stress on ligaments

(Muller et al, 1999)
Prevention of PFJ / TFJ problems traumatic
injuries on uneven terrain
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Overweight

• Assessment BMI
• Implication
• limits endurance speed
• ? loading on knees
• Predispose to PFJ pain
• Management
• Weight control
• Endurance exercise diet

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Overweight

• Weight reduction guidelines (Axe 1995, ACSM 2001)
• Reduce dietary fat intake to lt 30 of total
  energy intake per day
• Lose 1-2 lb/week is safe
• Min of 2.5hr of moderate intensity ex per week

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Training
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Training Guidelines

• Overload
• 10 rule (Patti F)
• Hard/Easy system
• Specificity

Minimize injury
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Training Guidelines

• Mainly focus on aerobic training
• Beginning slow pace ? progress to competition
  pace
• Longest distance to train should not exceed total
  distance
• Combination of distance difficulty of different
  sections

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Training Guidelines

• Incorporate appropriate amount of weight training
  (back, UL LL) stretching
• general fitness
• avoid injury
• Weight training min 1 set of 8-12 reps
• 2-3 sessions/wk
• A period of rest at last couples of weeks
• called taper
• for carbohydrate loading

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Training Suggestion

• Initial 4 wks(conditioning through track
  running)
• Team A
• 70-80 HRmax 3-5 sessions/wk
• 35-40 mins
• Team B
• 60-70 HRmax 3-4 sessions/wk
• 30-35 mins

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Training suggestions

• Next 4 wks,
• Walk practice running x 15-20 mins alt day
• Walk at least one day per week minimum of 4-6 hrs
  (about 15-25km)

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Checkpoint Distance
From To Distance (km) Difficulty
Start CP1 16.5
CP1 CP2 8.2
CP2 CP3 9.4
CP3 CP4 13.3
CP4 CP5 7.2
CP5 CP6 6.5
CP6 CP7 8.7
CP7 CP8 9.8
CP8 CP9 10.6
CP9 Finish 9.8
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Training Suggestion

• Last 4 wks(at least once per wk)
• Sections 1 2 or 9 10
• ?Sections 6, 7 8
• ?Sections 3 4 or 4 5 (night training)

with backpack on
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NUTRITION IN SPORTS
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Nutrition needs
Sportsmen
More calorie water required
Protein 1.2 1.4 g/kg of BW
Fat 20-25 calorie
Carbohydrate 60-70 calorie
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Diet before competition
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Diet before competition-- Glycogen Loading

• 7 days before.
• Take in 6-10 g/kg of complex CHO, and progressive
  ? in training intensity daily
• 1-6 hrs before.
• Low fat, low fiber, high CHO food e.g. bread,
  congee
• ? time for food to day in stomach and so the
  chance of getting stomache
• keep blood glucose level stable
• choose the food that the athletes like
• Within 1 hr before.
• Dont eat . diverts blood from mm to stomach

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Diet during competition
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Energy and Fluid Replacement

• 30-60g/kg CHO every hr
• 150-350 ml water every 15-20 min
• little glucose concentration (otherwise easy
  dehydration . high osmolarity)
• 6 glucose concentration
• ? Maltodextrin, surcose, glucose
• Sodium
• 0.5-0.7 g/L
• prevent hyponatremia
• dont drink water until feel thirsty

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After Exercise..
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Replacement

• CHO ( 600 g) replacement when
• 30 min after exercise and
• every 2 hrs after exercise
• Sodium replacement helps water replacement
• e.g. soup, cheese, meat.
• Every pound weight loss needs at least 16 oz
  water replacement

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General Advice
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Risk Factors
Heat Illness Hypothermia
Obesity High wind chill factor, altitude, moisture content of air
Low degree of physical fitness malnutrition
Dehydration Excessive alcohol consumption
Lack of heat acclimatization Medications eg antidepressants, tranquilizers
Hx of heat stroke
Sleep deprivation
Medications eg. Diuretics antidepressants
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Prevention of EAC

• Adequate fluid replacement
• High-energy snacks
• Spare clothes, windbreaker

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Strategies for sleep deprivation

• Event last for gt 24hr ? no sleep
• Figure out which route might be doing
  in the dark practice in night time
• Get information on how your body react on race
  day

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Blisters

• Cause
• heat or friction
• Prevention
• lubricant
• socks (synthetic fabrics double-layer)
• cushion pad
• fit-size shoes

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Footwear

• ?long trips, uneven trails require to carry
  extra weight on back
• need higher stiffer boot with a hard plastic or
  steel shank to avoid twisting and gives extra
  stability to feet and ankle
• appropriate heel cushioning to reduce repetitive
  impact force onto the joints
• Light materials

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References

• Noakes, T.D. (2000). Hyponatremia in Distance
  Athletes Pulling the IV on the Dehydration
  Myth. The Physician and Sportsmedicine, 28 (9)
  pp 1-7
• Sports Medicine. (2001). Sodium Needs for
  Athletes. http//sportsmedicine.about.com/library/
  weekly/aa030101a.htm
• Canadian Medical Association Journal. (2000).
  Public Health Ultra-endurance exercise and
  hyponatremia. http//www.cma.ca/cmaj/vol-163/issue
  -4/0439.htm
• Speedy, D.B., et al. (2000). Exercise-Induced
  Hyponatremia in Ultradistance Triathletes Is
  Caused By Inappropriate Fluid Retention. Clinical
  Journal of Sport Medicine, 10 (4) pp 272-278
• Speedy, D.B., et al. (1999). Hyponatremia in
  ultradistance triathletes. Medicine Science in
  Sports Exercise, 31 (6) pp 809-815
• Axe, M.J. Gibney, S. (1995). Nutrition. In
  Baker, C.L. (Ed). The Hughston Clinic Sports
  Medicine Book.

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References

• Tanaka K., Takesshima N., Predication of
  endurance running performance for middle-aged and
  ploder runners. Br. J. Sports. Med.
  199529(1)20-23
• Roberts W.O., A 12-yr profile of medical injury
  and illness for the Twin Cities Marathon. Med.
  Sci. Sports Exerc. 200032(9)1549-1555
• Fallon K.E., Musculoskeletal injuries in the
  ultramarathon the 1990 Westfield Sydney to
  Melbourne run. Br. J. Sports. Med.
  199630319-323
• Muller E., Schwameder H., Roithner R.et al, Knee
  joint forces during downhill walking with hiking
  poles. Journal of Sports Sciences.
  199917969-978
• Deid D.C., Sports Injury Assessment and
  Rehabilitation. New York Churchill Livingstone,
  1992
• Balady G.J., Berra K.A., Golding L.A. et al,
  ACSMs Guidelines For Exercise Testing And
  Prescription 6th Ed. USA Lippincott Williams
  Wilkins, 2000

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Questions Welcome!
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More Water.

• 24 hrs before
• drink lots of water
• 2-3 hrs before
• drink 400-600 g of water
• let water pass out from the body before
  competition