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Sports Presentation: Topic 3: Running Injuries

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Sports Presentation: Topic 3: Running Injuries By: Siu Yuet Kwan Aggie (109) Sze Ching Yee Anne (112) Tang Hiu Yee Cherry (113) Tang Wing Shan Sandy(116) – PowerPoint PPT presentation

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Title: Sports Presentation: Topic 3: Running Injuries


1
Sports Presentation Topic 3 Running Injuries
  • By Siu Yuet Kwan Aggie (109)
  • Sze Ching Yee Anne (112)
  • Tang Hiu Yee Cherry (113)
  • Tang Wing Shan Sandy(116)

2
Case Summary
  • 10 years old girl
  • Hong Kong junior record of 41 minutes for 10 km
  • Too early intensive training ?predispose to
    potential musculoskeletal injuries
  • From literature review, give evidence on advice,
    support, against the children youth
    participating in distance running.

3
Outline of Presentation
  • 2. Establishing aetiology mechanism of injuries
  • Risk factors
  • Structures involved
  • Load response
  • 1. Establishing the extent of the sports injury
    problem
  • Incidence
  • Common types
  • Sequence of Prevention

4. Assessing their effectiveness by repeating
step 1 (in practical)
3. Introducing preventive measures
4
Incidence
  • Relatively low incidence of sporting injuries in
    children less than 12 or the prebutertal years.
  • Peak incidence of injury at 14 for males, 15 for
    females.
  • Reasons - Inc. participation in sports when age
    ascends, physical immaturity, growth spurt, etc.

5
Definitions (ACSM, 1998)
  • 1-6 years
  • 7-10 years
  • Prebutertal
  • Females 9-15 years
  • Males 12-16 years
  • 11-21 years
  • (International Concesus Conference on Physical
    Activity Guidelines for Adolescence, 1994)
  • Childhood
  • Early
  • Middle
  • Later
  • (Preadolescence)
  • Adolescence
  • Prepubescence
  • Pubescence
  • Postpubescence

6
Children, preadolescents adolescents are not
the miniature of adults !
7
Common Sports Injuries
Common Running Injuries
Common Overuse Injuries
Structures Involved
8
Common Sports Injuries in Children Adolescents
  • Fractures Epiphyseal plate fractures, stress
    fractures
  • Joint Injuries ligamentous sprains, microtrauma
    to articular cartilage
  • Musculotendinous Injuries avulsion fractures
    upon apophysis, muscle strain

9
Common Sports Injuries
Common Running Injuries
Common Overuse Injuries
Structures Involved
10
Common Running Injuries in Children Adolescents
  • 30 50 are overuse injuries (DiFiori J.P.,
    1999)
  • Overuse injuries (Armstrong N et al, 2000)
  • 19.5 medial tibial stress syndrome
  • 18 apophyseal injuries
  • 14.8 non-specific knee pain
  • 7.3 lower back pain
  • Sprains and strains (Armstrong N et al, 2000)
  • 3.4 ankle sprain/strain
  • 2.4 foot sprain/strain
  • Periostitis/stress fracture (van Mechelen W, 1992)

11
Common Sports Injuries
Common Running Injuries
Common Overuse Injuries
Structures Involved
12
Common Overuse Injuries in Running
  • Osgood-Schlatters Disease (tibial tubercle
    apophysitis)
  • Sinding-Larsen-Johansson Syndrome (lower pole of
    patellas apophysitis)
  • Severs Disease (calcaneal apophysitis)
  • Chondromalacia Patellae
  • Stress Fractures
  • Shin Splints/Compartment Syndrome

13
Osgood-Schlatter Disease
14
Common Sports Injuries
Common Running Injuries
Common Overuse Injuries
Structures Involved
15
Different Structures Involved
  • Knee injuries (Ganley MD et al, 2001)
  • Below 10 metaphyseal fractures, patellar
    dislocation
  • 11-12 synovial tears, patellar dislocations,
    osseous bruises
  • 13-16 intra-articular fractures, patellar
    dislocations, ligamentous and meniscal lesions
  • ACL disruptions (Armstrong N et al, 2000)
  • Under 12 80 avulsions of tibial spine
  • ? 12 90 ACL tears

16
Risk Factors For Injury- A Histological
Perspective
17
Risk Factors For Injury- A Histological
Perspective
  • Growing articular cartilage
  • Low resistance to repetitive loading
  • ?Microtrauma to the cartilage or underlying
    growth plate (Micheli, 1983)
  • 2. Less resistance to shear force
  • ?Epiphyeal displacement (Micheli, 1983)
  • ?Loose body Formation (Maffulli, 1990)

18
Risk Factors For Injury- A Histological Aspect
  • 3. Weakness at apophyses
  • ?Traction apophysitis
  • ?Avulsion fracture

19
Risk Factors For Injury- A Histological Aspect
  • Mismatch of growth in bone musculotendinous
    structures
  • ? Rapid longitudinal growth of bone (growth
    spurts)
  • ? The musculotendinous structures tighten
    and loose flexibility
  • ? ?tension in the musculotendonous junction
    (insertion)
  • ? Avulsion fracture

20
Risk Factors For Injury- A Histological Aspect
  • Muscle tendon imbalance
  • ? Stronger at agonists and weaker at
    antagonists
  • ? Bony insertion more susceptible to shear
    force

21
Load Response of Running
22
Running Cycle
23
(No Transcript)
24
Outline of Presentation
  • 2. Establishing aetiology mechanism of injuries
  • Risk factors
  • Structures involved
  • Load response
  • 1. Establishing the extent of the sports injury
    problem
  • Incidence
  • Common types
  • Sequence of Prevention

4. Assessing their effectiveness by repeating
step 1 (in practical)
3. Introducing preventive measures
25
Preventive Measures
26
Preventive Measures
  • About 50 of overuse injuries are preventable
    (ACSM, 1993)
  • Intrinsic Factors
  • pre-participation examination
  • training program
  • flexibility
  • weight training
  • conditioning exercise (including warm-up and
    cool-down)
  • balance diet

27
Preventive Measures (contd)
  • Extrinsic Factors
  • shoe wear
  • education (to coach and parent)
  • running surface
  • environment

28
Pre-participation Examination (ACSM, 1993)
  • To define underlying conditions that require
    special protection or treatment
  • examination includes
  • congenital abnormalities
  • abnormalities caused by previous injury
  • stability and ROM of all major joints (including
    trunk)
  • strength, mm balance, and flexibility of major mm
    groups
  • To screen out any risk factors of running injuries

29
Training Program
  • Gradual progression (Cook, 1990)
  • ?body need time to adapt physiologically
  • van Mechelen (1995)
  • approximately 2-fold increased in the injury
    incidence when sudden increased from low (?15
    km/wk)to high ( ?50 km/wk) running distance.

30
Training Program (contd)
  • Suggestion 10 rule (ACSM, 1993, Cook, 1990,
    Maffulli, 1990)
  • no more than 10 increase per week in
  • amount of training time
  • amount of distance covered
  • running speed
  • specific skill (e.g. stride length)
  • difficulties (e.g. up-hill training)

31
Flexibility
  • ?rapid growth in bone compare with adjacent
    muscles (ACSM, 1993)
  • ? relative mm tightness
  • stretching can increase ROM (Cook, 1990)
  • ? ? stress placed on the tissues around the
    joints during running

32
Conditioning Exercise
  • Warm-up
  • ? mm elasticity and ROM
  • ? circulation to prepare the mm work
  • Cool-down
  • relax the excited mm
  • ? lactate removal rate

33
Conditioning Exercise (contd)
  • van Mechelen (1993) (N167 in control group, 159
    in intervention group)
  • warm-up, cool-down and stretching exercise were
    not effective in reducing the number of running
    injuries (23 injuries in control group, 26 in the
    intervention group)

34
Weight Training
  • Muscle strengthening (esp. eccentric contraction)
  • ?ability to absorb shock
  • ?risk of stress during loading
  • Muscle endurance
  • ?mm fatigue
  • ?overuse injuries
  • Suggestion (ACSM, 1993)
  • Done with knowledgeable instruction and adequate
    supervision
  • lt10 RM

35
Balance Diet
  • High carbohydrate diet (Guten, 1997)
  • ??glycogen storage in muscle
  • ??risk of mm fatigue
  • Calcium (Committee on Sports Medicine and
    Fitness, 2000)
  • ? prevention healing of stress
  • Iron (Committee on Sports Medicine and Fitness,
    2000)
  • ?adequate oxygen transport (haemoglobin)
  • ?muscle aerobic metabolism (Kerbs cycle enzymes)

36
Shoe Wear
  • Function
  • absorb shock (at heel loading and forefoot
    loading)
  • Ability to absorb shock ?40 after run for about
    400km 800km (DiFiori, 1999)
  • to control the medial-lateral translation
  • to limit over-pronation
  • to provide stable base for motion

37
Shoe Wear (contd)
  • Dickinson et al (1985) cited by Cook et al (1990)
  • ?the initial heel spike compare with bare foot
    run
  • ?runner becomes fatigue
  • Daffner (1982) cited by Cook et al (1990)
  • shock absorption ability ?
  • ??risk of stress
  • new pair of shoes ? not comfortable for runner
  • ? unconscious muscular effort
    to protect the ball of foot
  • ? further ? risk of stress

38
Running Surface
  • Hard and uneven surfaces cause more injury than
    soft or level surfaces
  • should be in good condition
  • Blair (1985) cited by Cook et al (1990)
  • no difference in injury incidence between running
    on artificial surface and running on street

39
Environment
  • ?child athletes
  • sweat less,
  • create more heat per body mass,
  • acclimatize slower to extreme environments
  • ? avoid running under hot and humid environment
  • ? enough fluid replacement

40
Education
  • Parent
  • sign of over-training
  • excessive stress
  • Supportive attitude
  • Coach
  • proper training program
  • proper use of equipment
  • recognize and prevent of sport injury
  • first aid

41
Conclusion
  • Children can run but not marathon (Guten, 1997)
  • ?Children/adolescents are tend to have growth
    plate injuries, avulsion fracture and apophysitis
  • ?May affect future growth
  • ?Proper training principle and equipment are
    important
  • ?Adults (e.g. coach and parent) should involve in
    the training program of the child

42
Reference
  • Armstrong N., van Mechelen W. (2000). Paediatric
    Exercise Science and Medicine. New York Oxford
    University Press.
  • Bobbert MF et al. Mechanical Analysis of the
    Landing Phase in Heel-Toe Running. Journal of
    Biomechanics. 199145(3)223-234
  • Campbell SK et al (2000). Musculskeletal
    Development and Adaptation. Physical Therapy for
    Children. 2nd ed. USA W.B. Sannders Company. Ch
    4
  • Committee on sports medicine and fitness.
    Intensive Training and Sports Specialization in
    Young Athletes. Pediatrics. 2000106(1)154-157
  • Cook SD et al. Running Shoes Their Relationship
    to Running Injuries. Sports Medicine. 1990
    10(1)1-8
  • Current Comment from the American College of
    Sports Medicine. The Prevention of Sport Injuries
    of Children and Adolescents. ASCM. 1993 25(supp.
    8) 1-7
  • DiFiori J. P. Overuse Injuries in Children and
    Adolescents. The Physician and Sportsmedicine.
    199927(1).

43
Reference (contd)
  • Ganley T. J., Pill S. G., Flynn J. M., Gregg J.R.
    Pediatric and adolescent sports medicine. Current
    Opinion in Orthopaedics. 200112456-461.
  • Guten GN. (1997). Running Injuries. USA W.B.
    Saunders Company.
  • Maffulli N. The Growing Child in Sport. British
    Medical Bulletin..199248(3)561-568.
  • Maffulli N et al. Intensive Training in Young
    Athletes. British Journal of Sports Medicine.
    1990 24(4)137-239
  • Naughton G., Farpour-Lambert N. J., Carlson J.,
    Bradney M., Praagh E. V. Physiological Issues
    Surrounding the Performance of Adolescent
    Athletes. Sports Medicine. 200030(5)309-325
  • Overbaugh KA et al. The Adolescent Athlete. Part
    II Injury Patterns and Prevention. Journal of
    Pediatric Health Care. 19948(5)203-211

44
Reference (contd)
  • van Mechelen W. Can Running Injuries Be
    Effectively Prevented? Sports Medicine. 1995
    19(3)161-165
  • van Mechelen W et al. Prevention of running
    injuries by warm-up, cool-down, and stretching
    exercise. ACSM. 1993 21(5)711-719
  • van Mechelen W. Running Injuries A Review of the
    Epidemiological Literature. Sports Medicine.
    199214(5)320-335
  • Roitman JL et al. (1998). ACSMs Resource Manual
    for Guidelines for Exercise Testing and
    Prescription, 3rd ed. Baltimore Williams
    Wilkins.

45
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