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Sports Presentation: Topic 3: Running Injuries

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). Case Summary. 10 years old girl Hong Kong junior record of 41 minutes for 10 km

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Sports Presentation: Topic 3: Running Injuries

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  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. Childhood Early Middle Later (Preadolescence) Adolescence Prepubescence Pubescence Postpubescence 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) Definitions (ACSM, 1998)

  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 patella’s apophysitis) • Sever’s 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. 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

  24. Preventive Measures

  25. 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

  26. Preventive Measures (cont’d) • Extrinsic Factors • shoe wear • education (to coach and parent) • running surface • environment

  27. 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

  28. 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.

  29. Training Program (cont’d) • 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)

  30. 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

  31. Conditioning Exercise • Warm-up: • ↑ mm elasticity and ROM • ↑ circulation to prepare the mm work • Cool-down: • relax the excited mm • ↑ lactate removal rate

  32. Conditioning Exercise (cont’d) • van Mechelen (1993) (N=167 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)

  33. 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 • <10 RM

  34. 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 (Kerb’s cycle enzymes)

  35. 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

  36. Shoe Wear (cont’d) • 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 #

  37. 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

  38. 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

  39. 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

  40. 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

  41. 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. 1991;45(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. 2000;106(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. 1999;27(1).

  42. Reference (cont’d) • Ganley T. J., Pill S. G., Flynn J. M., Gregg J.R. Pediatric and adolescent sports medicine. Current Opinion in Orthopaedics. 2001;12:456-461. • Guten GN. (1997). Running Injuries. USA: W.B. Saunders Company. • Maffulli N. The Growing Child in Sport. British Medical Bulletin..1992;48(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. 2000;30(5):309-325 • Overbaugh KA et al. The Adolescent Athlete. Part II: Injury Patterns and Prevention. Journal of Pediatric Health Care. 1994;8(5):203-211

  43. Reference (cont’d) • 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. 1992;14(5):320-335 • Roitman JL et al. (1998). ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription, 3rd ed. Baltimore: Williams & Wilkins.

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