Sierra Choi Hong Kong Physiotherapy Association

1. Sierra Choi Hong Kong Physiotherapy Association Physiotherapist's Advice in Preparing for OTW 2009

2. Aim • Common injuries, Injury prevention and simple self management • Enjoy this meaningful event

3. Oxfam Trail Walker • Endurance sport • Mind

6. Age: 40 Max HR: 220 – 40 = 180 4 hours Courtesy of Dr. Simon Yeung, HKPU Cardiopulmonary Function

7. Demand • Musculoskeletal • Lower limb joints for mobility • Spine for stability • Upper limb for holding of pole / weight

8. FITNESS DEMAND Preparation

9. FITNESS DEMAND Injury

10. Injury • Load exceeds the ability • Trauma • Overuse • Injury may happen to • Muscles, Ligament, Joints of • Spine, Hip, Knee and Ankle

11. 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

12. 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

13. Trailwalker’s Injury

14. Heat Injuryand Hypothermia

15. Heat regulatory system Heat (Metabolism) Exercise Shivering Radiation Heat Generation Balance Radiation Conduction Convection Evaporation Heat loss Heat Index Temp, wind speed, humidity, radiation

16. Heat Injury Hot and humid weather without adequate fluid supply Electrolyte loss Heat Cramp Dehydration Redness Hot and dry No sweating Strong and rapid pulse CNS damage signs Unsteady gait Confusion Aggressive Coma Sweating+++ Headache Weakness Vomit ↑HR, ↓awareness Heat Exhaustion Heat stroke

17. Heat Injury Pre-ex, replenish during ex Drink / electrolyte Heat Cramp Dehydration Rest in Shaded area Loosen up clothing Lower temp Water supply Observe Send to hosp Heat Exhaustion Heat stroke Medical Emergency !!

18. Hypothermia • Moderate • 31 – 32ºC •  in-coordination •  shivering • fatigue • Slurred speech • Drowsiness / Amnesia • Poor judgment • Dehydration • Mild • 33 – 35ºC • Cold extremities • Shivering • Rapid pulse and breathing • Urine urgency • Slight in-coordination

19. Management for Hypothermia • Mild • Remove from cold • Insulation • Warm, sweet drink • NO Alcohol • External heat over torso area • Moderate • Removed from cold • Insulation • Don’t immediate re-warm actively • Monitored continuously

20. Musculoskeletal Injury

21. Musculoskeletal Injury • Load exceeds the ability • Trauma • Overuse • Injury may happen to • Muscles, Ligament, Joints of • Spine, Hip, Knee and Ankle

22. Overuse injury • Muscle strain / Cramp • Anterior knee pain • Iliotibial band friction syndrome (ITB) • Plantar fasciitis (Sole / Heel pain) • Tendonitis (Knee, ankle)

23. 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

24. Muscle cramp • Management • Replenish of water and electrolyte • Rest • Stretching • GENTLEmassage

25. 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

26. Body Alignment

27. Body Alignment Right knee MRI film JBJS(Br)1999 81-B: 452-8 HKSI Sports Medicine Education Series IV

28. Iliotibial Band Friction Syndrome

29. Plantar Fasciitis • Heel pain • Loading exceeding the flexibility of plantar fascia • Overweight • Increase pronation

30. Plantar Fasciitis

31. Tendonitis • Inflammation of tendon • Overuse due to Repeated concentric eccentric cycle

32. Traumatic Injury

33. Traumatic Injury • Ligamentous sprain • Muscle tear • Fracture • Dislocation

34. 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

35. Anterior Talofibular Ligament Anterior Cruciate Ligament Medial / Lateral Collateral Ligament Site of common ligament sprain

36. Prevention

37. Return to sport Return to sport Performance Power Skill Skill Endurance Power Power Cardiovascular Cardiovascular Cardiovascular Athlete Education Athlete Education Knowledge Nutrition Nutrition Nutrition Psychological Psychological Psychological Strength Strength, endurance Strength, endurance Flex Stab Flex Flex , , , Stab Stab ty ty ty ty ty ty Status of recovery Healing Healing constrain constrain Pre-race condition Pre Pre - - injury injury health status health status Acute Acute Control of Extrinsic Factors Mx Mx , Intervention, Rehab , Intervention, Rehab Knowledge, skill, Ability of Medical Team Knowledge, skill, Ability of Medical Team Strategy, Team management, Support

38. How do you prepare yourself • Reasonable goal • Reasonable training regime • Training log book • Addressing extrinsic factors & intrinsic factors leading to injury

39. Extrinsic factor • Temperature, Humidity, UV Index, Wind …. • Trail surface and condition • Lighting • Gear – Clothing, Footwear, Hiking pole, Flashlight / Headlamp, …

40. Return to sport Return to sport Performance Power Skill Skill Endurance Power Power Cardiovascular Cardiovascular Cardiovascular Athlete Education Athlete Education Knowledge Nutrition Nutrition Nutrition Psychological Psychological Psychological Strength Strength, endurance Strength, endurance Flex Stab Flex Flex , , , Stab Stab ty ty ty ty ty ty Status of recovery Healing Healing constrain constrain Pre-race condition Pre Pre - - injury injury health status health status Acute Acute Control of Extrinsic Factors Mx Mx , Intervention, Rehab , Intervention, Rehab Knowledge, skill, Ability of Medical Team Knowledge, skill, Ability of Medical Team Strategy, Team management, Support

41. Intrinsic Factor • Foundation • Medical background, Body alignment, Cardiopulmonary function • Balance / Core control / Stability • Muscle flexibility, strength, power, endurance

42. Body Alignment

43. Body Alignment

44. 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

45. Recommendation • Before the walk and after long rest • Water break / Check point • Slow and steady • Change of degree of tightness • Support

46. Calf stretch

47. Hamstring stretch

48. Inner thigh stretch

49. Quadriceps stretch

50. Outer thigh stretch