physiologic demand and common injuries[生理需求和常见的伤害](ppt-59)课件

By LaiChiKitJerry LamKitYanWendy TangWingYanTracy YiuOnYeeAnnie SportsPresentationOnTrailwalker Outline OverviewofTrailwalkerPhysiologicdemandandcommoninjuries2Casescenariosassessment treatmentandadviceTrainingguidelinesNutritioninSportsGeneraladviceQ A OverviewofTrailwalker AnannualfundraisingwalkathonorganisedbyOxfamHongKongsince1981 The100 kmMacLehoseTrailTodeveloptheirpotentialandabilitiesofdisadvantagedpeopleinHongKongandpoorpeopleinAsiaandAfrica From1981 80 000raisedincreasetoover 16millionin2000 InterestArouse ExercisePhysiologyofEnduranceSports HighoxygentransportcapacityVO2maxHighfatigueresistanceinworkingmuscleslactatethreshold Tanaka 1995 MusclefibrecompositiontypeI typeIIEnergyutilizationcarbohydrate fat CommonInjuries Medical 59 Musculoskeletal 17 Dermatologic 21 Exercise associatedcollapse EAC Hyponatremia SprainsStrainsFracture BlistersAbrasions Dehydration exhaustion syncope hyperthermia hypothermia RobertsW O 2000 MusculoskeletalInjuries Knee Ankle 31 3 vs28 1 Injuries indescendingorder PFJpainTendinitisoftendonspassingunderextensorrectinaculumMusclecrampAchillestendinitisAnklesprain FallonK E 1996 Casescenario TeamA4long distancerunnerswhohavenoexperienceinTrailwalkerbefore Fitnesslevelforthe4membersisgood However onesuffersfromchronicTAtendinitisandoneclaimsthathassoreheelafter8 hourhikingpractice Hewondersifitistodowithshoe wear Casescenario TeamBMixedteam 2females 2malesofaveragefitness Onefemaleteammembersuffersfromsymptomsofnauseaandvomitinginherlast3Trailwalkerevents possiblysufferingfromhyponatremia Onemaleteammembersuffersfrompatellofermoralpainaftergoingup downhillsfor4hours Heisslightlyoverweight GeneralAssessmentofPhysicalFitness ACSM ChronicAchillesTendinitis Signs symptoms PersistentpainoverTAPainoccursespeciallyinthemorning afterexercise hillwalkingNodulesaroundTAonpalpation ChronicAchillesTendinitis IntrinsicfactorsstiffMTPjointstightnessofcalfandhamstringmuscleflatfoot over pronation Extrinsicfactorssuddenincreasesintrainingexcessivedownhillrunningimproperfootwear SoreHeel Structuresunderlyingsymptomaticarea bone calcaneusplantaraponeurosisplantarfatpadnerve posttibn medcalcanealn medandplantarn whichpassthrotarsaltunnelsmmtendon peronealandtibmmbursa retrocalcanealbursa DifferentialDxofHeelPain Detailedassessmentisessential PlantarFasciitis anoveruseconditionRepetitivestressontheplantarfasciaresultsininflammationatitsattachmenttothecalcaneus PlantarFasciitis Signs symptoms HeelpainPainisworseusuallyat1stfewstepsinmorningPainiscommonatstartofexercise resumingactivityafterrestPainaggravatedbystanding walking running withrunningmostpainful PlantarFasciitis PredisposingfactorsFlatfoot higharchExcessivepronationObesityTightTATrainingerrorImproperfootwearOccupationwithprolongedstanding Assessment TraininghabitAlignmentofwholeLL espTAObservefootarchMusclelengthespcalfTestplantarfasciainastretchedposition toesextwithanklePF WBposition Assessment Shoes Management AcutePRICE US tapping NSAIDChronicstretching transversefrictiontappingremovaloftriggeringfactorsproperfootwearadditionofheelpadorotherorthoticseccentricloadingfootintrinsicmusclestrengthening Exercise inducedHyponatremia PlasmaNalevel 135mmol LBWlossislessthanthatofnormalathletes Medianweightchange Speedyetal 2000 Normal 3 9 Hyponatremia 0 5 Commoninultra enduranceexercisemarathonS SRangesfromasymptomatictolifethreateningconditionsegseizures coma evendeathCommon headache nausea vomiting musclecramps disorientation confusion Na Idiopathic2commonhypothesesLossoflargeamountofsaltsthroughsweatingwithoutreplacementExcessivepurewaterconsumption 10L 4hr Exercise inducedHyponatremia Exercise inducedHyponatremia ManagementNacontainingsportdrinkSaltyfoodsSeekprofessionalsifnecessary Exercise inducedHyponatremia PatellofemoralPain Etiology biomechanicalproblem patellatracking malalignment overuse musculardysfunctionofPFJTrainingerrors PatellofemoralPain S S pain byprolongedsitting durationofactivity esp squatting stairs swelling crepitus AssessmentofPFJpain S E activitypattern trainingtechniques footwear detailsofonset SANDetc O E observationofwholeLLalignment Ant postpelvictilt Q angle genuvalgum varum patellarposition flatfoot pescavus leglengthdiscrepancy AssessmentofPFJpain Palpation bursa tendon ligament jtline patellarfacets retinaculumROM MMT weakVMO poortrackingofpatella patellarglidingmovt ligamentstresstest McMurraytestTestformmtightnesse g hamstring quads hipflexors ITB ManagementofPFJpain Acutephase PRICE Symptomaticreliefe g useofEPT NSAID Avoidstairwalking inclinedslope squattingChronicphase Stretchtightmm StrengtheningexespVMO Taping proprioceptiontraining Balancetraininge g bouncer wobbleboard Hikingpoles jointloading especiallyknee kneeflexionmoment quadseccentricloading shearingforceonTFJ stressonligaments Mulleretal 1999 PreventionofPFJ TFJproblems traumaticinjuriesonuneventerrain Overweight Assessment BMIImplicationlimitsendurance speed loadingonkneesPredisposetoPFJpainManagementWeightcontrolEnduranceexercise diet Overweight Weightreductionguidelines Axe1995 ACSM2001 Reducedietaryfatintaketo 30 oftotalenergyintakeperdayLose1 2lb weekissafeMinof2 5hrofmoderateintensityexperweek Training TrainingGuidelines Overload10 rule PattiF Hard EasysystemSpecificity Minimizeinjury TrainingGuidelines MainlyfocusonaerobictrainingBeginning slowpace progresstocompetitionpaceLongestdistancetotrainshouldnotexceedtotaldistanceCombinationofdistance difficultyofdifferentsections TrainingGuidelines Incorporateappropriateamountofweighttraining back UL2 3sessions wkAperiodofrestatlastcouplesofweekscalledtaperforcarbohydrateloading TrainingSuggestion Initial4wks conditioningthroughtrackrunning TeamA70 80 HRmax 3 5sessions wk 35 40minsTeamB60 70 HRmax 3 4sessions wk 30 35mins Trainingsuggestions Next4wks Walkpractice runningx15 20minsaltdayWalkatleastonedayperweekminimumof4 6hrs about15 25km CheckpointDistance TrainingSuggestion Last4wks atleastonceperwk Sections1 2or9 10 Sections6 7 8 Sections3 4or4 5 nighttraining withbackpackon NUTRITIONINSPORTS Nutritionneeds Dietbeforecompetition Dietbeforecompetition GlycogenLoading 7daysbefore Takein6 10g kgofcomplexCHO andprogressive intrainingintensitydaily1 6hrsbefore Lowfat lowfiber highCHOfoode g bread congee timeforfoodtodayinstomachandsothechanceofgettingstomachekeepbloodglucoselevelstablechoosethefoodthattheathleteslikeWithin1hrbefore Don teat divertsbloodfrommmtostomach Dietduringcompetition EnergyandFluidReplacement 30 60g kgCHOeveryhr150 350mlwaterevery15 20minlittleglucoseconcentration otherwiseeasydehydration highosmolarity 6 glucoseconcentration Maltodextrin surcose glucoseSodium0 5 0 7g Lpreventhyponatremiadon tdrinkwateruntilfeelthirsty AfterExercise Replacement CHO 600g replacementwhen30minafterexerciseandevery2hrsafterexerciseSodiumreplacementhelpswaterreplacemente g soup cheese meat Everypoundweightlossneedsatleast16ozwaterreplacement GeneralAdvice RiskFactors PreventionofEAC AdequatefluidreplacementHigh energysnacksSpareclothes windbreaker Strategiesforsleepdeprivation Eventlastfor 24hr nosleepFigureoutwhichroutemightbedoinginthedark practiceinnighttimeGetinformationonhowyourbodyreactonraceday Blisters Cause heatorfrictionPrevention lubricantsocks syntheticfabrics double layer cushionpadfit sizeshoes Footwear longtrips uneventrails requiretocarryextraweightonbackneedhigher stifferbootwithahardplasticorsteelshanktoavoidtwistingandgivesextrastabilitytofeetandankleappropriateheelcushioningtoreducerepetitiveimpactforceontothejointsLightmaterials References Noakes T D 2000 HyponatremiainDistanceAthletesPullingtheIVonthe DehydrationMyth ThePhysicianandSportsmedicine 28 9 pp1 7SportsMedicine 2001 Sod