Common Injuries
1. Iliotibial Band Friction Syndrome:
The commonest cause of lateral knee pain. Increased tension or tightness at lliotibial (ITB) causes friction with the thigh bone when bending and extending the knee.
2. Runner's Knee/ Patellofemoral Pain Syndrome:
An overuse syndrome caused by mistracking of patella. It is characterized by pain behind and around the knee cap.
3. Shin Splint or Medial Tibial Stress Syndrome:
It is characterized by pain at the anterior-lateral or posterior-medial shin caused by repetitive stress to the leg muscles. As a result, increased duration and intensity of running further worsen the symptoms.
4. Heel Pain/ Plantar Fasciitis:
An inflammatory pain at plantar fascia. The most common pain site is heel. |
Our Research Findings
 A cross-sectional study on a group of 10-km runners (n=28) in Hong Kong revealed that the better the hip strength, the shorter the time to complete the race. In another study on HKSH Trailwalker teams in 2010, subjects in the training group had significantly less flexible legs, weaker hip strength in the first evaluation, which showed that they were more prone to lower limb pain. But after a six-week training, results showed that the incidence of injuries was lower in the training group (34%) when compared with the non-training group (67%), which proved the success of the Programme in reducing sports injuries. |
How to Prevent Injuries
Cardiovascular Fitness
Training Intensity
A series of 20-to-30-minute sessions of at least 70% training intensity have been found to be an optimal training level. Exercise below 70% of maximum heart rate (MHR) should be continued for at least 60 minutes for any significant aerobic improvement. Longer duration requires lower intensity of effort.
Trailwalker is a unique event requiring a high level of cardiovascular fitness, especially when going up the mountains. Walking training of 8-10 hours should also be included in the training schedule. Periodization of training should be implemented to maintain a high level of cardiovascular fitness before the event and also to prevent overtraining which can lead to musculoskeletal injuries.
Training Frequency
The training frequency is usually 3-4 times a week depending on the intensity and duration of the sessions. If only moderate-intensity exercise (40%-59% VO2R) is performed, the frequency could be high, i.e. 5-7 days per week. If vigorous-intensity exercise (≥60% VO2R) is performed, it could be done at least 3 times a week. Vigorous exercise should only be performed alternately but not in consecutive days to avoid too much stress on the musculoskeletal system. The best approach is to equally arrange the schedule of moderate-intensity and vigorous-intensity exercises. A minimum duration of 20 minutes is recommended to achieve improvement in cardiorespiratory fitness.
Mode of Training
Interval Training
By combining speed work and rest this allows athletes to train at a higher intensity, especially for those training at more than 90% of the VO2max. An exercise-relief ratio of 1:1 can be used. For example, an athlete may run at a high intensity for 2-5 minutes and then walk slowly for 2-5 minutes. This can promote the cardiovascular-respiratory system to deliver oxygen to the muscles. Continuous Training (Slow, long-distance training) Training at 60-70% intensity requires a steady pace. It is safer than higher-intensity exercise. Athletes can train at a specific intensity to simulate the actual competition. This type of training is effective for athletes with high endurance as it stresses the slow-twitch muscle fibers, which produce energy with oxygen. Specific cardiovascular-respiratory training adaptations are therefore greater.
Maintain Good Musculoskeletal Health
1. Good hip abductor and external strength are needed to maintain hip, knee and ankle alignment.
2. Tightness of lower limb muscles is a risk factor for knee pain including hamstrings, quadriceps, tibialis anterior muscles and calf muscles.
3. Choose proper orthotics or shoes according to your foot types. If you have flat feet, you need a supportive insole to aviod over-pronation of your foot while running. If you have a high foot arch, you need a pair of running shoes with more flexible soles to allow better extension of your plantar fascia. |
Video Clips of Therapeutic Exercise
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Exercise and Nutrition by Flavia U, Senior Dietitian & June Chan, Senior Dietitian
During exercise, the body needs various nutrients to generate energy. There are six major classes of nutrients in food, namely, carbohydrate, protein, fat, vitamin, mineral and water. The former three provide energy for exercise whilst the latter three enhance the use of nutrients.
What Does the Body Need during Exercise?
 Whether one can exercise continuously with satisfactory performance depends largely on the amount and type of nutrients one consumes. The exact requirements of various nutrients are conditioned by the intensity of exercise, age, gender, health condition, nutrient reserve, and the way one utilizes nutrients.
There is a sequence of how the body utilizes nutrients. The first six seconds of exercise require explosive force of muscles. During this period in which quick energy is needed, the body mainly derives energy from the ATP-CP energy system. Weight lifting, relying entirely on this system, is a great example of the kind of exercise that needs explosive force.
However, the ATP-CP system can only provide energy in short term. Six to thirty seconds into exercise, the body has to utilize carbohydrates as the fuel to support muscular movement in an anaerobic environment. Aerobic oxidation only begins from 30 seconds to 2 minutes into exercise, during which carbohydrates and fat are broken down. More carbohydrates are needed initially, but a larger amount of fat will be used after 30 minutes.
Whether the body burns carbohydrates or fat depends on both the intensity and duration of exercise. In other words, the more intense the exercise, the higher the proportion of carbohydrates consumed. On the other hand, the longer the duration of exercise, the higher the proportion of fat consumed.
Carbohydrate Storage Enhances Sports Performance
Glycogen, the carbohydrate stored in the muscles and the liver of human body, is the main source of energy during exercise. Glucose is derived from it to provide energy during exercise. Normally, muscle glycogen can sustain 60 to 90 minutes of any medium to high intensity exercise, such as a 15-km long run. After that, glucose will be derived from liver glycogen instead to provide energy, and to be delivered in the form of blood glucose. If the amount of carbohydrates in diet is insufficient, there will be a lack of muscle and liver glycogen. One's endurance and performance during exercise will be greatly affected under such circumstances.
Daily carbohydrate intake for a normal person should amount to 45% to 65% of the total energy consumed, whilst for athletes it should be around 60% to 70%. Prolonged exercise of medium to high intensity may use up all glycogen in the body. A study indicates that increased carbohydrate consumption 3 to 4 days before exercise can help increase the storage of liver glycogen, thus enhancing the usage of energy during exercise. However, there is no extra storage needed for ordinary exercise that takes less than an hour.
The amount of carbohydrates to be stored should be calculated based on body weight. One should consume 7 to 10 grams of carbohydrates every day per each kilogram of body weight. An endurance athlete who weighs 50 kg should consume a total of 350 grams of carbohydrates every day, which is equal to:
- 4 bowls of rice or noodles; and
- 4 servings of fruit; and
- 2 glasses of milk or yoghurt; and
- 1 bottle of sports drink; and
- 2 bowls of cooked vegetables; and
- Appropriate amount of meat
Continuous Supply during Exercise
For prolonged exercise, adequate carbohydrate intake is essential to supplement for the consumption. Not only can the carbohydrates help maintain a stable level of physical fitness, they can also reduce sports injury as muscle fatigue is less likely to happen.
When exercising, the body needs about 35 to 45 grams of carbohydrates every hour, which amounts to 560 to 750 ml of sports drink. This is applicable to medium and high intensity exercises, such as long run, basketball, football, etc. A meal with high glycemic index (GI) food or drinks before exercise will also help increase blood glucose, and energy can thus be obtained by muscles more quickly.
Diet with High Glycemic Index after Exercise
 The storage of carbohydrates has to be replenished when it is used up, especially for athletes who may have competitions one day after another. To regain stamina and energy, one should take 0.7 to 1.5 grams of carbohydrates per kilogram of body mass, which amount to about one and a half bottle of sports drink. It is most efficient to consume carbohydrates within half an hour after exercise. Thereafter, the same amount of carbohydrate should be consumed every 2 hours until 6 hours after exercise.
Fat
Fat is the main energy fuel during endurance exercise. The longer the exercise duration, the more fat will be burnt. When the exercise is aimed at reducing fat, prolonged aerobic exercise of low to medium intensity would be the right choice. The body uses fat as the main energy source when one's heart rate is maintained within 40% to 70% of the maximum heart rate. As the intensity increases, the body will need more carbohydrates. For instance, although both will cover a distance of 6 km, brisk walking at 6 km per hour for 60 minutes will burn more fat than running at 12 km per hour for 30 minutes.
Moreover, studies have shown that athletes or those who exercise regularly have more fat burning enzymes in blood, meaning that their muscles tend to burn more fats compared to others. However, unlike carbohydrates, the amount of fat burnt is not proportional to the amount of fat consumed or stored. Since fat utilization is controlled by hormones, it is not necessary to increase the fat consumption to promote fat utilization during exercise. The optimum amount of fat consumption would be 15% to 30% of the total calories consumed daily.
Protein
Protein can also provide energy, but it is not the main energy source for exercise. In fact, only about 5% of energy used during exercise is from protein. Only when both carbohydrates and fat are used up would the body break down protein as energy. Therefore, an increase in protein intake will not directly enhance sports performance. Yet it is still important to consume enough protein in order to maintain a normal muscle mass.
In general, people's daily need for protein is 0.8 grams per kilogram of body weight. On the other hand, athletes need 1.2 to 1.4 grams per kilogram of body weight whilst bodybuilders need up to 1.8 grams per kilogram of body weight.
Vitamins and Minerals
Vitamins usually function in the body as coenzymes, especially the Vitamin B complex that helps carry nutrients. As a result, carbohydrates can be utilized more efficiently by the body. As for minerals, they are essential to maintaining muscle function, bone health and nutrient transmission.
One's physical functions and sports performance will be affected if the body is deficient in vitamins and minerals. A well-balanced diet should include enough vitamins and minerals and should not require any additional nutrient supplements.
Fluid
A sufficient amount of fluid ensures one's body to function properly and help maintain normal chemical reactions in the body during exercise. Not only can fluid enhance one's performance in endurance sports, but also facilitates efficient utilization of carbohydrates and fat.
The human body loses a huge amount of fluid during exercise. Thirst occurs when 1% of fluid is lost. When more than 2% of fluid is lost, one will feel tired and dry. With 5% of fluid loss, one's physical fitness may even be reduced by 50%. Therefore, fluid is crucial to sports performance.
Basically, healthy individuals are advised to take 1 millilitre of fluid per calorie consumed. Therefore, athletes should consume 2000 to 4000 millilitres of fluid, and an additional amount is required during exercise. For example, one should intake 600 millilitres of fluid an hour before exercise and 150 to 300 millilitres every 15 to 20 minutes during exercise. In hot weather, the amount should be increased accordingly. After exercise, one should replenish 450 to 675 millilitres of fluid for every pound of fluid loss as indicated by body weight.
Under normal circumstances, drinking water should be sufficient for fluid replenishment during exercise. But when doing prolonged and intensive exercise, one can consider replenishing carbohydrates, fluid and electrolytes at the same time with sports drinks. Suitable sports drinks often contain 6 to 8% of carbohydrates, i.e. 6 to 8 grams of carbohydrates in every 100 millilitre fluid, for optimal absorption. |
Proper Shoe Wear by Keith Leung, Prosthetist-Orthotist
How to Choose the Right Hiking Shoes
A breath of fresh air and a glance of green scenery in the countryside during hiking revive our soul. However, mixed with sand and mud, the rugged road there may easily make one get hurt. To prevent accidents, newcomers to hiking should equip themselves with the basic outfit, of which a pair of proper hiking shoes is vitally important.
Before picking the hiking shoes, you should know about your own feet shape, for they may be long and slim, short and round. A pair of tight shoes not only makes you feel uncomfortable, but also causes skin injuries or thickened skin and corns. If the shoes are too roomy, the feet will move about inside, which requires extra effort from the hiker and may give rise to blisters.
To reduce friction against the inside of the shoes, most hikers may wear the hiking shoes with one or even two pairs of thick socks at the same time. Therefore, when choosing the hiking shoes, you should prepare one or two pairs of socks for fitting to make sure the shoe size is neither too small nor too big. Many boutiques specializing in professional footwear for outdoor activities sell or rent thick socks. Request them if you forget to bring socks along. Never make a wild guess with a margin of 1 or 0.5 sizes.
Your feet may move to and fro while walking up a steep and bumpy road. Most hiking shoes are slimmer and longer than normal shoes so as to leave extra space for toes. In most shops specializing in outdoor sports equipment, you can try a few steps on a sloping bench as if you were walking down a slope, just to make sure the toes are not pinched.
There are 3 major types of hiking footwear, i.e. trail running shoes, hiking shoes and mountaineering boots. When choosing shoes, do not value appearance over function.
Trail Running Shoes
Trail runners usually run on concrete roads and muddy paths. A pair of good trail running shoes should therefore provide you with high mobility and strong protection. The low-cut design provides less protection to the ankle joint, yet allows for better joint mobility. Similar to running shoes, the materials should be light in weight and well-ventilated. Though the sole is relatively thin, the shoes are equipped with a hard plate to protect the feet against the gravel. The insole is made of shock-absorbing materials, while the outsole has hook-like grooves (shallower than those of hiking and mountaineering shoes) to enhance the basic grabbing power. Due to its light weight, trail running shoes are less durable. Runners have to change their shoes after running 500-600 kilometres.
Hiking Shoes
With harder materials, thicker soles and deeper grooves, hiking shoes are suitable for walking on a variety of roads, such as concrete roads, muddy paths, rocky roads, etc. The heelpiece and footbed are strengthened to stabilize the feet while walking on the rugged roads. Hikers in need of extra ankle protection can choose the semi-high-cut ones. Some hiking shoes are made of waterproof materials, enabling the hikers to wade across stream or walk in rain or snow. With comprehensive design and stronger protection, hiking shoes can cope with different types of roads.
Mountaineering Boots
Featured with high cut, reinforced footbed, deeper grooves and thicker materials, these boots provide mountaineering hikers and camping lovers with greater protection against craggy range and bad weather.
You may feel uncomfortable when wearing new shoes for the first time. Therefore you are not advised to wear new shoes for hiking and mountaineering purposes, e.g. Trailwalker. You should have adequate practice so as to adapt your feet to the new shoes.
How to Choose the Right Long Run Shoes
A pair of good running shoes is prerequisite to good distance-running performance.
Propulsion power comes from muscle strength, well-trained muscles and posture thus enable efficient transfer of energy to the ground. This energy has to be transformed into speed power, to which the running shoes are the key factor. They are of the same importance to running as wheels to cars. On the other hand, with each forward step exerting pressure 3 times that of body weight to our feet, the running shoes provide protection to the joints in our lower limbs.
Design
There are now 2 major types of running shoes available on the market, namely racing shoes and training shoes. To relieve loading and enhance foot flexibility of the runners, racing shoes are mostly lightweight with thinner soles and shallow grooves, yet prone to friction and lack of support. Made of durable materials, training shoes give better protection to the feet and are better at absorbing shock, making them more suitable for normal runners.
Generally, long run routes are mostly on concrete or asphalt roads which are smooth and flat. Therefore, high-cut heels are not required in running shoes, while the low-cut design can increase the ankle mobility, leading to better performance.
Materials
Well-ventilated materials can slow down the rate at which foot temperature rises and keep the feet dry, providing comfort to runners at a reduced risk of blistering.
Well-built and strapping runners should choose running shoes made with durable materials, with thicker soles and better support, while slim runners should get the lightweight ones with thinner soles.
Length
Suitable running shoes should have a space of 1 to 1.5 cm between the toes and the shoe tip. Try out some running postures, such as pawing and sudden stop, to make sure the shoe length is appropriate.
Width
Foot shape and length-to-width ratio vary from person to person. Some have slender feet while others' may be round-shaped. Squeezing a big foot into a tight shoe may lead to discomfort, skin abrasion, thickened skin and corns. If too much space remains in the shoes, while one's feet can move about inside, the shoes may keep swinging while running, which requires extra effort from the runner and may give rise to blisters.
In general, westerners have longer and slimmer feet than Asians, therefore the running shoes of most western brands are designed with narrower half soles. Recently, running shoes with wider half soles are available for runners with a broad foot shape.
Running Posture
 There are 3 main landings of feet in running, namely forefoot strike, mid-foot strike and heel strike. A forefoot striker should pick running shoes with reinforced forefoot soles. A mid-foot striker should choose those with even shock absorption. And a heel striker should prefer ones with enhanced heel cushioning. Some brands have already marketed a number of running shoes tailored for different running postures.
Foot Shape
Foot shape is classified into normal pronation, underpronation and overpronation. In running, the feet normally pronate slightly to absorb shock. For a high and less flexible arch, there is insufficient inward roll of the foot, causing less effective shock absorption in underpronation. This type of runners needs trainers with better cushioning. If the arch is low (flat foot) and soft, the overpronation causes excessive shock to the feet. Therefore flat-foot runners should choose running shoes with high motion control or stability. |
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