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By: Lai Chi Kit Jerry, Lam Kit Yan Wendy, Tang Wing Yan Tracy, Yiu On Yee Annie

Sports Presentation On Trailwalker. By: Lai Chi Kit Jerry, Lam Kit Yan Wendy, Tang Wing Yan Tracy, Yiu On Yee Annie. Outline. Overview of Trailwalker Physiologic demand and common injuries 2 Case scenarios assessment, treatment and advice Training guidelines Nutrition in Sports

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By: Lai Chi Kit Jerry, Lam Kit Yan Wendy, Tang Wing Yan Tracy, Yiu On Yee Annie

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

  2. 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

  3. 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.

  4. Interest Arouse

  5. 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 > type II • Energy utilization • carbohydrate + fat

  6. Common Injuries Medical (59%) Dermatologic (21%) Musculoskeletal (17%) • Exercise-associated collapse (EAC) • Hyponatremia • Blisters • Abrasions • Sprains • Strains • Fracture Dehydration, exhaustion, syncope, hyperthermia & hypothermia (Roberts W.O., 2000)

  7. Musculoskeletal Injuries • Knee > 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)

  8. 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.

  9. 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.

  10. General Assessment of Physical Fitness (ACSM)

  11. Chronic Achilles Tendinitis • Signs & symptoms: • Persistent pain over TA • Pain occurs especially in the morning, after exercise & hill walking • Nodules around TA on palpation

  12. 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 Chronic Achilles Tendinitis

  13. 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

  14. Differential Dx of Heel Pain Detailed assessment is essential !

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

  16. 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

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

  18. 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

  19. Assessment - Shoes

  20. 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

  21. Exercise-induced Hyponatremia Na+ • Plasma Na level < 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

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

  23. Exercise-induced Hyponatremia • Management • Na containing sport drink • Salty foods • Seek professionals if necessary

  24. Prevention methods Before event During event After event  salt intake by 10-25 g  Avoid use of NSAIDs  Na containing sport drinks    Salty foods   Weighing   Exercise-induced Hyponatremia

  25. Patellofemoral Pain • Etiology: • biomechanical problem (patella tracking), malalignment, overuse & muscular dysfunction of PFJ • Training errors

  26. Patellofemoral Pain • S/S: - pain ↑by prolonged sitting, ↑duration of activity (esp. squatting &↓ stairs) - swelling - crepitus

  27. 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)

  28. 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

  29. 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

  30. 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

  31. Overweight • Assessment: BMI • Implication • limits endurance & speed •  loading on knees • Predispose to PFJ pain • Management • Weight control • Endurance exercise + diet

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

  33. Training

  34. Training Guidelines • Overload • 10% rule (Patti F) • Hard/Easy system • Specificity Minimize injury

  35. 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

  36. 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

  37. 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

  38. 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)

  39. Checkpoint Distance

  40. 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

  41. NUTRITION IN SPORTS

  42. Nutrition needs

  43. Diet before competition

  44. 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…. • Don’t eat ‘.’ diverts blood from mm to stomach

  45. Diet during competition

  46. 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 • don’t drink water until feel thirsty

  47. After Exercise…..

  48. 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

  49. General Advice

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