Sierra ChoiHong Kong Physiotherapy Association

Aim•Common injuries, Injury

prevention and simple self management

•Enjoy this meaningful event

Oxfam Trail Walker

•Endurance sport•Mind

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

Demand

•Musculoskeletal–Lower limb joints for mobility–Spine for stability–Upper limb for holding of pole /

weight

Preparation

DEMAND FITNESS

Injury

DEMANDFITNESS

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 InjuryHeat Injury and

Hypothermia

Heat InjuryHeat Injury and

Hypothermia

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

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

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 !!

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

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

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 (I

TB)• 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 join

t / distal portion of ITB

Body Alignment

Body Alignment

Right knee MRI filmJBJS(Br)1999 81-B: 452-8

HKSI Sports Medicine Education Series IV

Iliotibial Band Friction Syndrome

Plantar Fasciitis

• Heel pain• Loading exceeding th

e flexibility of plantar fascia– Overweight– Increase pronation

Plantar Fasciitis

• Inflammation of tendon

• Overuse due to Repeated concentric eccentric cycle

Tendonitis

Traumatic Injury

•Ligamentous sprain•Muscle tear•Fracture•Dislocation

Traumatic Injury

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

Site of common ligament sprain

• Anterior Talofibular Ligament• Anterior Cruciate Ligament• Medial / Lateral Collateral Lig

ament

Prevention

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

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 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

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 stretchCalf stretch

Hamstring stretchHamstring stretch

Inner thigh stretchInner thigh stretch

Quadriceps stretchQuadriceps stretch

Outer thigh stretchOuter thigh stretch

Back stretchBack stretch

Neck and Chest stretchNeck and Chest stretch

Choice of Shoes

Function of Shoes

• Maintain foot stability• Shock Absorption• Provide firm lever system for

propulsion

Foot Type and Stability

Optimum Rigid Floppy

Neutral Cushion Support

Neutral High Arch Flat Feet

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