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OVERUSE INJURIES IN RUNNING
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CONTENTS Overview; Basic biomechanics of running; Epidemiology of running injuries; Causative factors; Dose-response relationship; and Prevention strategies Evaluation strategies
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OVERVIEW Commonest type of sports in Hong Kong Mass entrants in the Tsing Ma Bridge Marathon and 98 New Airport International Marathon and 10 km. run
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BENEFITS OF RUNNING Improve physical fitness level; Positive feeling of good health; Friendship and socialisation; Enjoyment; and Rewards
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1. Establishing the extent of the sports injury problem Incidence Severity Sequence of Prevention 2. Establishing aetiology & mechanism of injuries 4. Assessing their effectiveness by repeating step 1 3. Introducing preventive measures
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EPIDEMIOLOGY OF RUNNING INJURIES Knutzen and Hart (1996) A comprehensive review on running injuries Retrospective studies (16) Prospective studies (5) Annual incidence 48-65% (P); 24-60% (R)
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EPIDEMIOLOGY OF RUNNING INJURIES Retrospective studies Marti et al. (1980) Surveillance study of 4,358 runners in a road race 1,994 injured (46%)
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PROSPECTIVE STUDY Walter et al. (1989) Ontario Cohort study enrolled 1,680 runners at two races prospective survey for 12 months. 1,288 completed the follow-up data 48% were injury.
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SITE OF INJURIES
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Case series studies Clement et al. (1981) Review 1,650 patients between 78-80.
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EPIDEMIOLOGY OF INJURIES Data collection far from comprehensive Subjects selection bias Injuries ill-defined True incidence of injuries yet to be determined (for details, refer to Caine et al., (1996) epidemiology of sports injuries. Human Kinetics. Chapter 22)
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ESTABLISHING AETIOLOGY & MECHANISM OF INJURIES
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RUNNING EVENTS CHARACTERISTICS NEURO-MUSCULAR PREDOMINANCE (SPRINT & HURDLES) CARDIO-RESPIRATORY PREDOMINANCE (MIDDLE & LONG DISTANCE) CAPACITY BASED ON STRENGTH & ENDURANCE (AEROBIC & ANAEROBIC) PHYSIOLOGICAL ADAPTATION TAKING PRECEDENCE OVER TECHNIQUE
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RUNNING CYCLE No double support phase Stance (40%) Float (30%) Swing (30%) Contact, midstance,propulsion forward swing & foot descent
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Jogging: Stance > Swing Distance: Stance = Swing Sprinting: Stance < Swing
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RUNNING BIOMECHANICS INITIAL GROUND REACTION FORCES VERTICAL GROUND REACTION FORCES VERTICAL GROUND REACTION FORCES 2-3 TIMES BODY WEIGHT 2-3 TIMES BODY WEIGHT ANTERIOR /POSTERIOR FORCES - 50% B.W. ANTERIOR /POSTERIOR FORCES - 50% B.W. MEDIAL /LATERAL SHEAR - 10% B.W. MEDIAL /LATERAL SHEAR - 10% B.W. DURATION - 200 - 600 ms. DURATION - 200 - 600 ms. PEAK IMPACT FORCES AT 20-30 ms. PEAK IMPACT FORCES AT 20-30 ms.
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CAUSATIVE FACTORS IN RUNNING INJURIES EXTRINSIC Training error Running Terrain and Surfaces Running shoes
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TRAINING ERROR Clement et al. (1981) Sudden increases in mileage or intensity High intensity without rest High level of competition
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Marti et al. (1980) Increased association of injuries when mileage (>50 km./week) Ontario Cohort study > 40 km/week.
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RUNNING TERRAIN AND SURFACES Clement et al. 1981 Uneven, hardness, road camber Uphill and downhill
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RUNNING SHOES FOOT MUST BE STABLE SHOCK ABSORBPTION – REDUCE THE INITIAL HEEL SPIKE RIGID LEVER FOR THE THRUST OF FORWARD MOTION
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RUNNING SHOES SHOCK ABSORPTION EFFECT FACTS: The Shock absorption effect will easily lost 40% after 400-800 Km. of running (After Cook et al 1985) FACTS: The Shock absorption effect will easily lost 40% after 400-800 Km. of running (After Cook et al 1985)
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CAUSATIVE FACTORS IN RUNNING INJURIES INTRINSIC IMPERFECT MUSCULOSKELTAL ALIGNMENT FLEXIBILITY
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INTRINSIC FACTORS Cowan et al., 1996 Investigate effects of anatomic variation on risk of overuse injuries Prospective study Subjects: 294 army infantry for 12/52 training Risk of injury increase with Valgus knee (RR=1.9) and Q angle >15 degree (RR=5.4)
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INTRODUCING PREVENTIVE MEASURE
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PRINCIPLES OF TRAINING BIOLOGIC ADAPTATIONS TO IMPROVE PERFORMANCE IN SPECIFIC TASKS
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TRAINING PROGRAM Yeung and Yeung 2001 Investigate the characteristics and training profile of marathon finishers and non- finishers Subjects: 113 runners from Standard Chartered Hong Kong Marathon 1998
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Personal and training profile ProfilesFinishers (55) Non- finishers (58) P-value Marathon finished 4.130.420.01 Weekly training51.948.570.00 Longest distance27.515.440.00 Warm-up11.027.650.06 Cool down6.424.780.27 Optimal mileage71.5828.800.00
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TRAINING AND RECOVERY Warm (Cool) down Whirpools and Spas Massage Rest and Sleep Psychological Nutritional
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COOL DOWN Lactate can be removed from blood and muscle more rapidly by light continuous aerobic exercise Optimal rate of removal 30 - 45% VO 2 max 50-65%
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OVER TRAINING Sign of over training Fatigue and poor performance Increase resting heart rate Weight loss Irritability and sleep disturbance Elevated Serum Creatine Phosphokinase (CPK)
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TRAINING TERRAIN TRACK vs ROAD CROSS TRAINING – UPHILL vs DOWNHILL TREADMILL
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FUNCTIONAL ANATOMY OF FOOT Normal Foot arch, flat foot and Pes Cavas Effects of foot arch or weight bearing
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SELECTION OF RUNNING SHOE
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RUNNING SHOES Be Comfortable Protect the wearer from injury Not be a source in injury Facilitate athletic performance Be durable and economical
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SHOE COMPONENTS
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Last Straight / Curve Last Slip Last Board Last Shoe Upper Toe-box Heel Counter Achilles Tendon Pad Sole Outsole Midsole Insole
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PRONATOR Needs stability and arch support Features: Straight last; Supportive heel counter; Extra support on medial side Increased medial wedging on insole Semirigid orthotic
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NEUTRAL Need good fit, adequate arch and shock absorbing Features: Semicurved last; Extra cushioning & Medium heel counter
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SUPINATOR Needs flexibility, maximum shock absorbing Features: Semicurved or curved last; Slip last Maximum cushioning
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ASSESSING THE EFFECTIVENESS OF INTERVENTION
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A systematic review of interventions to prevent lower- limb soft-tissue running injuries Yeung and Yeung, 2001a and 2001b
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Randomised Controlled Trials Twelve studies, with a total of 8,806 subjects met the criteria for inclusion. three main preventive strategies for running injuries: modification of training schedule stretching exercises use of orthotics/support or footwear modification.
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Modification of training schedule InterventionRelative risk Reduction of frequency of training 3/7 vs 5/7 0.19 (0.06-0.66)* Reduction in duration of training 15-30 vs 45per session 0.41 (0.21-0.79)* Reduction in running distance 280 km vs 82 km in 12 weeks 0.70 (0.54-0.91)*
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STRETCHING Stretching outside training session Andrish et al.,1.27 (0.66-2.43) Hartig and Henderson0.57 (0.37-0.89)* Stretching immediately before training session Pope et al.,0.85 (0.43-1.67) Pope et al.,0.83 (0.63-1.09) Van Mechelen et al.,1.19 (0.71-1.99)
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EXTERNAL SUPPORT OR FOOTWEAR MODIFICATION Use of shocking absorbing insoles 0.87 (0.69-1.11) Footwear modification0.83 (0.71-0.98)* Use of Knee brace0.35 (0.13-0.91)*
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Injuries from running can be reduced by modifying training schedules, but now guidelines are available from trials on training load. Wearing a knee brace with a patellar support ring may be effective in preventing anterior knee pain provoked by running
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