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Untitled - The Chinese University of Hong Kong Study in a Top


									Table of Contents


Welcoming Message by Prof. Kai-Ming Chan                         2

Scientific Program Schedule                                     3-4

Introduction to WASMES                                          5-6

Speakers Profile and Abstracts

    Session 1: Sport Medicine and                              7-11
               Biomedical Engineering Product Research

    Session 2: Presentation of Student Research Projects in   12-27
               Sports Medicine and Rehabilitation Therapy

    Session 3: WASMES Symposium                               28-38

Welcoming Message by Prof. Kai Ming Chan

                       Welcome to Sports Medicine And Rehabilitation Therapy
                       Convention, SMART Convention 2010. The theme of this year
                       is “Running and Hiking”. Besides a series of lectures about
                       running and hiking, you can also witness the latest technology
                       demonstrated by The Sport Performance and Biomechanics
                       Laboratory. It is indeed an exciting and heartening annual event
                       you can never miss!

SMART Convention 2010 is a convention on sports medicine and rehabilitation therapy
in Hong Kong which aims to improve the professional standard of exercise-for-health
services and rehabilitation services after sports and occupational injuries, as well as to
encourage all segments of society to enjoy the benefits of exercise. The SMART
Convention is a once-a-year opportunity for the industry to present products and services
in front of sports physicians, sports scientists, physiotherapists, athletic trainers, allied
health professionals, and professionals from sports and other related industries.

In view of the ever-increasing popularity of running and hiking, Sports Medicine and
Rehabilitation Science specialists, physiotherapists and athletes are invited to give
various lectures. You can also see the latest advances on footwear, sports injury
prevention, sports rehabilitation, performance enhancement and exercise & fitness

I look forward to meeting you all in the SMART Convection 2010 in Hong Kong!

Prof. Kai-Ming Chan
Chairman of Organizing Committee

Scientific Program Schedule

Time          Topic                                       Speakers
10:30-11:15   Session I: Sport Medicine and Moderator:
              Biomedical Engineering Product Prof. Daniel Tik-Pui Fong
10:30-10:45   Intelligent anti-sprain sport shoe          Ms. Vikki Wing-Shan Chu
10:45-11:00   Knee rotational laxity meter                Mr. Mak-Ham Lam
11:00-11:15   An inexpensive       functional      finger Prof. Daniel Tik-Pui Fong
11:15-11:45   Break
11:45-13:15   Session II: Presentation of Student Moderator:
              Research    Projects    in   Sports Prof. Daniel Tik-Pui Fong
              Medicine     and      Rehabilitation
11:45-12:00   Three-year      prospective      injury Mr. Wai-Man Chung
              surveillance study of Hong Kong elite
              able-bodied and disabled foil fencers
12:00-12:15   Pedometer reactivity and rehearsal in Ms. Fiona Chun-Man Ling
12:15-12:30   Association between physical activity Dr. Grace Pui-Sze Hui
              knowledge, physical activity behavior
              and age in Hong Kong Chinese adults
              with Type 2 diabetes
12:30-12:45   A study on muscle fatigue in patients Ms. Rachel Suet-Wai Tsang
              after ACL reconstruction more than 1
              year in involved leg and non-involved
12:45-13:00   Static and dynamic postural control in Ms. Tiffany Ching-Man Choi
              professional dancers
13:00-13:15   Clinical and biomechanical outcome Dr. Alexander Pak-Hin Chan
              following surgery for Achilles tendon
              rupture: comparison of minimally
              invasive repair with open repair
13:15-14:15   Break

14:15-16:00   WASMES Symposium                   Moderator:
                                                 Prof. Kai-Ming Chan
14:15-14:30   Introduction to WASMES             Prof. Kai-Ming Chan
14:30-14:45   New frontiers in sports injury Prof. Martin Schwellnus
              rehabilitation - the role of genetics in
              soft tissue sports injuries
14:45-15:00   Sports    injury prevention  and Prof. Christer Rolf
              management - a multidisciplinary
15:00-15:15   Low back pain and concept of Prof. Jaspal S. Sandhu
              segmental stabilization
15:15-15:30   Osteoporosis and exercise          Dr. Shweta Shenoy Devraj
15:30-15:45   Lower limb weight training can Prof. Gabriel Ng
              effectively build hip and knee strength
              and increase patellofemoral joint
              contact area in people with
              patellofemoral pain
15:45-16:00   Health Track, a novel way of Mr. Goran Andersson
              measuring working capacity and well
16:00-16:30   Expert Panel Discussion            Moderators:
                                                 Prof. Kai-Ming Chan,
              Guests:                            Prof. Tony Parker
              Prof. Martin Schwellnus,
              Prof. Christer Rolf,
              Prof. Jaspal S. Sandhu,
              Dr. Shweta Shenoy Devraj,
              Dr. Chee Keong Chen

Introduction to WASMES
WASMES (World Academy of Sports Medicine & Exercise Science)
  ‐ a NEW dimension of global professional development

World Academy of Sports Medicine & Exercise Science (WASMES) is an international
society which embraces the two professional areas of sports medicine and exercise
science (SM&ES) with selective membership orientation and with aims which are
distinct but complementary to those of existing international organizations.

WASMES aims:

 i. To be recognized internationally as a leading organization in Sports Medicine &
    Exercise Science with recognition for effective advancement of the field in
    research, education and professional development;

 ii. To bring together experts in SM&ES in a collaborative alliance to share ideas and
     resources to enable the development and enhancement of SM&ES to the highest
     international standard;

 iii. To provide a forum to facilitate cooperative and collaborative relationships and
      activities between members of the academy;

 iv. To oversee and stimulate innovative and quality assured programs in SM&ES;

 v. To use the expertise of the academy to provide mentoring for the development of
    young leaders in SM&ES;

 vi. To identify and enhance opportunities for professionals in SM&ES in areas of
     research, education and professional development;

 vii. To liaise with and assist existing international organizations to implement programs
      in SM&ES designed to promote and advance SM&ES in developing countries;

 viii. To provide a forum for the sharing of information in SM&ES via individuals and
       individual organizations;

 ix. To develop leadership in sports & exercise medicine through training, identification
     and recognition of outstanding contributions and opportunities and to take a
     leadership role in regional and international sports medicine activities.

WASMES, launched at the 2010 SMART Convention, is a perfect match for the theme of
excise for health in the coming decades.

The WASMES web will soon be launched with stimulating web-based learning resources,
a global network for communication, a people-to-people touch to enhance exchanges of
expertise and experience in the field of sport medicine and exercise science.

Look out for this NEW venture for ALL!!!

Prof. Kai-Ming Chan

Sport Medicine and Biomedical Engineering Product Research

Intelligent anti-sprain sport shoe
(Presented by Ms. Vikki Wing-Shan Chu)

Vikki W.S. Chu1, Daniel T. P. Fong1, Patrick S. H. Yung1, Kai-Ming Chan1
  Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Faculty of
Medicine, The Chinese University of Hong Kong
  The Hong Kong Jockey Club Sports Medicine and Health Sciences Centre, Faculty of
Medicine, The Chinese University of Hong Kong


Ms. Chu gained her Bachelor of Science degree and Master of Philosophy degree in
Physics in 2000 and 2002 from The Chinese University of Hong Kong. She has also
taken the minor programme of Computer Science at The Chinese University of Hong
Kong. She is currently a research assistant at the Department of Orthopaedics and
Traumatology, The Chinese University of Hong Kong. Her current research interests
include human motion analysis and injury prevention. She is now working on the
project of development of the innovative sprain-free shoe.

Ankle sprain injury is the most common sport-related injury. Among ankle sprain injury,
lateral ankle sprain is the majority. One aetiology of lateral ankle sprain is the slow
reaction time of the peroneal muscles (about 60-90ms), which often fails to react and
pronate the foot to compensate the vigorous supination motion (about 50-70ms).
Therefore, initiate the early onset of the peroneal muscles can help to prevent lateral
ankle sprain. Our research team is working on the design of such an innovative
sprain-free sport shoe. A three-step mechanism is employed, which involves (1) sensing,
(2) identification, and (3) correcting. The first step is to monitor the motion of foot and
ankle at real time by in-shoe motion sensor. The second step is to identify if a supination
motion is hazardous based on the information gained from step 1. The final step is to stop
or delay the hazardous supination motion until the peroneal muscle can be react. A
myoelectric stimulation device is used to deliver electric signals to the peroneal muscles
to correct the spraining motion.

A knee rotational laxity meter to evaluate knee rotational instability
(Presented by Mr. Mak-Ham Lam)

Mak-Ham Lam1, Patrick S. H. Yung1, Daniel T. P. Fong1, Billy K. Y. Law1, Wood-Yee
Chan2, Wei-Hsin Liao 3, Kai-Ming Chan1
  Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Faculty of
Medicine, The Chinese University of Hong Kong
  The Hong Kong Jockey Club Sports Medicine and Health Sciences Centre, Faculty of
Medicine, The Chinese University of Hong Kong
  School of Biomedical Sciences, The Chinese University of Hong Kong
  Department of Mechanical and Automation Engineering, Faculty of Engineering, The
Chinese University of Hong Kong

Mr. Lam received his degree of Bachelor of Education in Sports Science and Physical
Education from The Chinese University of Hong Kong in 2007 and is now a PhD
candidate at the Sports Performance and Biomechanics Laboratory, Department of
Orthopaedics and Traumatology, The Chinese University of Hong Kong. He is also
currently a part-time lecturer of the taught programme of Master of Science in Sports
Medicine and Health Science of The Chinese University of Hong Kong. Mr. Lam is a
Certified Strength and Conditioning Specialist of the National Strength and Conditioning
Association and a Level one Kayak coach of The Hong Kong Canoe Union.
Mr. Lam’s research interests include knee joint biomechanics, anterior cruciate ligament
injury and evaluation of anterior cruciate ligament reconstruction. He was awarded with
the 1st runner up in the Vice-Chancellor’s Cup of Student Innovation (Postgraduate
Individual) of The Chinese University of Hong Kong in 2009 on one of his PhD projects
‘A Knee Rotational Laxity Meter to Evaluate Knee Rotational Stability’.

This study aims to devise a knee rotational laxity meter to quantify and evaluate the knee
rotational instability for clinic use, especially for orthopaedics physicians to examine the
knee rotational instability of patients suffering from anterior cruciate ligament rupture,
and to monitor their rehabilitation progress during follow-up consultations. A rigid ankle
boot will be modified for the simultaneous measurement of knee rotational stress and
displacement. The knee rotational stress will be monitored by a load cell, while the knee
rotational displacement will be measured by electromagnetic tracking sensors. The final
deliverable would be a handy and convenient tool to evaluate knee rotational stability, for
the use in sports medicine clinics, physiotherapy clinics, and also on-field test for sports
team. It would be useful to quantify the progress of rehabilitation after surgical
reconstruction of the ACL. The innovative element of this study is to implement
skin-attached electromagnetic tracking sensors and brings the intra-operative measuring
device from the operation theatre to the clinics, wards and fields. Therefore the whole
procedure could become non-invasive, which is essential for immediate measurement in
clinics. Target user groups will be mainly the orthopaedics surgeons, but also the general
physicians, physiotherapists, sport biomechanics researchers, as well as coaches and team

Funded by Innovation and Technology Commission
Sponsored by One Measurement Group
Collaboration with Sengital Limited
An inexpensive functional finger prosthesis
(Presented by Prof. Daniel Tik-Pui Fong)

Daniel T. P. Fong1, Yvonne Y. W. Chan1, Ying-Ki Fung1, Clara W. Y. Wong1, Leung-Kim
Hung1, Wei-Hsin Liao2
  Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Faculty of
Medicine, The Chinese University of Hong Kong
  The Hong Kong Jockey Club Sports Medicine and Health Sciences Centre, Faculty of
Medicine, The Chinese University of Hong Kong
  Department of Mechanical and Automation Engineering, Faculty of Engineering, The
Chinese University of Hong Kong


Prof. Fong gained his Bachelor in Physics, Master in Exercise Science, and Doctor in
Orthopaedics and Traumatology. In 2009 he was elected Board of Directors and was
awarded Fellow of International Society of Biomechanics in Sports. Locally he is the
founding president of the Hong Kong Society of Sport Biomechanics, and a council
member of the Hong Kong Association of Sports Medicine and Sports Science. Since
2006, he has gained more than HKD 9 million research grant for sport medicine and
biomedical engineering projects. He has published 25 articles in journals, and has
delivered over 100 presentations in local and international conferences.

Hand function is very important to human's daily life. Finger loss leads to weakened hand
function, medical burden, diminished working capability and inferior quality of life. The
"X-finger", the world's first active-function artificial finger, has been invented for patients
to regain the finger function. Such device allows users to perform flexion and extension
actively. However, the device is expensive - each of such artificial finger costs USD
10,000. Therefore, it is often not affordable to most people, especially those low-income
factory workers who lost their fingers due to occupational accidents.

The current project aims to design an inexpensive artificial finger. A ring like detachable
structure is to be designed to attach the prosthesis to the remaining finger bone with the
surrounding muscles and soft tissues. The artificial finger joint is made with a rebounded
type progressive hinge lock which locks for every 15 degrees, starting from full extension
of the whole finger joint. Flexion is done by assistance of another hand. Such design
provides simple passive flexion adjustment and serves as an inexpensive prosthesis for
patient having finger amputation to regain basic hand function.

Presentation of Student Research Projects in Sports Medicine
and Rehabilitation Therapy

Three-year prospective injury surveillance study of Hong Kong elite
able-bodied and disabled foil fencers

(Presented by Mr. Wai-Man Chung)

W.M. Chung1,3, MSc; Simon Yeung1, PhD; Y.L. Wong2, MPhil; F. Lam3, MSc; T.F. Tse3,
BSc; D. Daswani3, BSc; Raymond Lee4, PhD
  Hong Kong Polytechnic University
  University of Alberta
  Queen Elizabeth Hospital
  Roehampton University


Mr. Chung is now the Senior Physiotherapist of Queen
Elizabeth Hospital and Guest Lecturer of the
Department of Rehabilitation Science, Hong Kong
Polytechnic University. He gained his Professional
Diploma in Physiotherapy and Master of Science in
Health Care (Physiotherapy) at the Hong Kong
Polytechnic University. Currently, he is undertaking the
Doctor of Philosophy in the areas of injury prevention and movement study of sports for
physically disabled.

Fencing is a sport that constantly demands fencers to display high agility, fast response
and excellent limbs-trunk coordination. Fencers have to perform repetitive defenses and
attacks throughout each game. The repetitive, asymmetrical and impulsive nature of
fencing renders fencers to sustain a range of upper limb and lower limb injuries (Moyer,
1994; Nystrom, 1990; Roli, 2008). Wheelchair fencing sport, using identical weapons as
the able-bodied counterpart, has been developed after World War II. Each wheelchair
fencer competes in a wheelchair fastened to a frame (Strange, 2008). They are arranged
in a standardized distance to ensure the pace of bouts. Due to the elimination of lower
extremities contribution, wheelchair fencers rely on their arms and trunks to perform all
the necessary techniques. As many wheelchair fencers may have deprived trunk control,
the mechanical loadings on their arms are colossal. Given the above, it is conceivable to
expect high incidence of upper limb injuries among this athlete group. However, there is
no systematic injury surveillance study to investigate the injury patterns of able-bodied
and wheelchair fencers. The aim of this study is to investigate the Injury patterns of Hong
Kong elite able-bodied fencers and disabled foil fencers. The findings from this first
prospective study might help identify common musculoskeletal injuries in the two athlete
groups. It also helps sports clinicians to develop specific injury prevention programs.

A 3-year prospective study on the incidence of injuries among Hong Kong elite
able-bodied and disabled fencers were conducted over the period of Nov 2006 to Oct
2009. Consented fencers were interviewed monthly through face-to-face interview by
team physiotherapists to collect data about training duration, match duration and injuries
(including the types, location and severity of injuries). Only sport-related Injuries (i.e.
during practice session or competition) were analyzed in this study. To facilitate the
comparison of injury data with other studies, the severity of injury was expressed as a
measure of injuries as adopted from the Athletes with Disabilities Injury Registry (Ferrara
and Buckley, 1996). Three categories to describe the severity of injury namely mild
injury (7 days or less of lost participation), moderate injury (8-21 days of missed
participation) and major injury (22 or more days of missed participation) were used in
this study. Causes of injury (traumatic or overuse) and recurrence of incidence
(newly-acquired or recurrent injury) was also recorded to rule out the possible
mechanism and nature of injuries. Incidence of injury (injury per 1000 hrs athlete
exposure) for able-bodied and disabled fencers during training and competition were
compared by independent t-tests.

18 disabled and 12 able-bodied Hong Kong elite foil fencers were recruited in the present
study. 14 disabled and 10 able-bodied fencers successfully completed the 3-year
surveillance injury survey (Table 1). All fencers had at least one missed-participation
injury during the three years study period. 95 and 62 injuries, which accounts for an
overall injury incidence of 3.9 injuries/1000 hours (95% CI: 3.08-4.63) and 2.4
injuries/1000 hours (95% CI: 1.81-3.01), were reported in the disabled and able-bodied
fencers respectively (Table 2). Disabled fencers showed a statistically significant higher
incidence of injury (p<0.05). Although most of the injuries were newly-acquired (77.9%
in disabled; 80.5% in able-bodied fencers) and traumatic (61.1% in disabled; 75.8% in
able-bodied fencers) in nature, the injury patterns between two studied groups varied
greatly. Higher number of upper extremities injuries was found in disabled fencers
(73.8%), Figure 1 & 2. The most prevalent diagnoses among disabled fencers were elbow
strain (32.6%) and shoulder strain (20.0%), Figure 3 & 4. Shoulder injuries led to longer
absence days from practice / competition and especially affected disabled fencers without
active trunk control, Figure 5 & 6. 4 out of 7 of the disabled fencers without active trunk
control were absent from the competition/match for more than 28 days due to
partial-thickness tear of shoulder tendon over their fencing arms. Similar to other studies
(Harmer, 2008; Moyer, 1994; Nystrom, 1990; Roli, 2008), able-bodied elite foil fencers
were more susceptible to sustain lower extremity injuries (69.4%) like hamstrings strain
(22.6%), ankle (14.5%) and knee sprain (11.3%).

                                                               Able-bodied           fencers
                           Disabled fencers (n=14)
 Age                       33 + 9                              28 + 6
 Gender                    Male: 7, Female: 7                  Male: 12; Female: 0
 Years of fencing (yrs)    14.7 + 5.3                          12.9 + 5.2
 BMI (kg/m2)               19.8 + 3.5                          18.6 + 3.1
 Classification status     Category A: 7; Category B: 7        Not applicable
Table 1. Demographic data of able-bodied and disabled fencers (Disabled fencers include
2 lower limb amputee, 6 spinal-cord injury, 2 cerebral palsy, 3 poliomyelitis and 1
congenital limb deficiency athletes; 7 of the athletes were independent walker and 7 of
the athletes were wheelchair-dependent)

                           Total    Exposure Number         of Injury incidence (95%
                           (hr)              injuries          CI) per 1000 player hrs
Able-bodied      fencers
                           25699               62                2.4 (1.81, 3.01)
Disabled fencers (n=14)    24664               95                3.9* (3.08, 4.63)
          *Significantly higher incidence of injuries in disabled fencers as compared to that of
            able-bodied fencers
          Table 2. Total exposure time, number of injuries and injury incidence of the Hong Kong
          elite able-bodied and disabled fencers during the year of 2007-2010.

  Figure 1. Injury severity of various body part      Figure 2. Injury severity of various body
              as recorded in disabled fencers                    parts as captured in able-bodied

Figure 3. Type of injuries in disabled fencers     Figure 4. Types of injuries in able-bodied fencers

Figure 5. Injuries sustained by Class A (with      Figure 6. Injuries sustained by Class B (without
           trunk control) disabled fencers                   trunk control) disabled fencers

Even though the rules of competition, equipments and level of competition are very
similar in able-bodied and disabled fencing, the injury patterns of able-bodied and
disabled fencers varied greatly. Disabled fencers were much vulnerable to the
musculoskeletal injuries of upper limb while the able-bodied counterparts were prone to
lower limb injuries. Highly disabled fencers had higher incidence of shoulder joint
injuries. Poor sitting posture and higher disability level of wheelchair fencers may be
related to higher risk of upper limb injuries.

The results imply that specific injury prevention strategies/programs should be tailored
for both able-bodied fencers and disabled counterparts. Future studies on fencing
biomechanics and investigation of injury mechanism among different fencers are


1. Harmer P. Incidence and characteristics of time-loss injuries in competitive fencing: a
   prospective, 5-year study of national competitions. Clin J Sport Med
2. Moyer J, Konin J. An overview of fencing injuries (Abstract). Am Fencing 1992;
3. Nystrom J, Lindwall O, Ceci R, Harmenberg J, Swedenhag J, Ekblom B.
   Physiological and morphological characteristics of world class fencers. Int J Sports
   Med 1990; 11:136-139.
4. Roi GS, Bianchedi D. The science of fencing. Sports Med 2008, 38(6): 465-81.
5. Strange M. Wheelchair Fencing. Retrieved Jan 10, 2010, from

Pedometer reactivity and rehearsal in children
(Presented by Ms. Fiona Chun-Man Ling)

Fiona C. M. Ling, Alison M. McManus, Richard S. W. Masters
Institute of Human Performance, The University of Hong Kong

Ms. Ling obtained a BSc in Psychology from the University of London and a Master’s
degree in Sport and Exercise Psychology from the University of Queensland before
joining the Institute’s PhD program in 2005. Fiona is under the supervision of Dr Alison
McManus and Prof Rich Masters. Her professional experience as a sport psychologist, an
educator and a children fitness instructor has inspired her to investigate the interplay
between rumination (or rehearsal), cardiovascular risk factors and physical activity in
children. Her aspirations beyond her PhD are two-fold – to further explore the
psychological attributes of sedentary behavior and to promote an active lifestyle in
children through innovative intervention programs.

The main purpose of this study was to investigate whether rehearsal, defined as the tendency to
recurrently ruminate over upsetting aversive experiences, had an effect on pedometry reactivity.
156 Hong Kong Chinese children aged 9-12 years were recruited.            Participants completed the
Rehearsal Scale for Children – Chinese (RSC-C; Ling, Maxwell, Masters and McManus, 2010)
and wore the pedometers for 3 consecutive weeks.           Mean number of steps was significantly
higher in Week 1 than Week 3.      High rehearsers showed a larger decrease in mean number of
steps from Week 1 to Week 3 than low rehearsers.         Future PA intervention studies should adjust
for reactivity in their baseline measurements and should further examine the relationship between
habitual PA and individual propensities for rehearsal.

Association between physical activity knowledge, physical activity
behavior, and age in Hong Kong Chinese adults with Type 2 Diabetes
(Presented by Dr. Grace Pui-Sze Hui)

Grace P. S. Hui
Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong

Dr. Hui is now the Medical Officer (Specialist) at Department of Medicine and Geriatrics
of United Christian Hospital. She obtained the Bachelor of Medicine and Bachelor of
Surgery at The University of Hong Kong. She is Fellow of Hong Kong College of
Physicians as well as Fellow of the Hong Kong Academy of Medicine in the specialty of

Exercise has been a mainstay of the treatment regimen for diabetes mellitus [1-5]. There
have, however, been few attempts to study how much of the information on exercise is
known in patients with diabetes and their physical activity habit in Hong Kong (HK)
Chinese adults.

The purpose of this study was to assess the knowledge of exercise and physical activity
habit, and to assess their correlates in HK Chinese adults with type 2 diabetes.

Two hundred and eleven people were recruited for survey in the diabetes out-patient
clinic of a local regional hospital. The survey consisted of three main parts: 1)
participant’s knowledge about physical activity; 2) physical activity behavior using
International Physical Activity Questionnaire; and 3) sociodemographic and health status
The participants’ characteristics were as follows: age 53.5 + 10.1 years, 60.2% male,
mean length of diagnosis 10.7 + 7.2 years. More than 70% has BMI over 23 kg/m²,
among them 19.9 % of the sample were overweight and another 54.9% were obese
(Figure 1).

For physical activity knowledge, a significant difference among respondents with
different education level was found, F (3, 206) = 2.77, p< 0.05 (Table 1). LSD post-hoc
comparison revealed that the knowledge score for lower educational level (below Form 5)
was significantly lower (p<0.05) than that of the respondents who are university graduate.
Physical activity knowledge is also associate with different physical activity level, F (2,
208) = 7.30,p < 0.05 (Table 1 ). Post-hoc comparison revealed that physical activity
knowledge for the low physical activity group was significantly lower (p<0.05) that for
the moderate and high physical activity group, whereas no difference was found between
the moderate and high physical activity group.

One third of the respondents (29.9%) reported low level of physical activity. Younger
patients were associated with physical inactivity (Figure 2).

The majority of individuals with type 2 diabetes were overweight or obese, one-third of
them did not engage in recommended levels of physical activity. In order to obtain the
beneficial effects of physical activity, more attention should be paid to sedentary
individuals, especially at a younger age, and the positive effects of physical activity on
diabetic management should be the key message.

1. Buse JB, Ginsberg HN, Bakris GL, et al. Primary prevention of cardiovascular
   diseases in people with diabetes mellitus: a scientific statement from the American
   Heart Association and the American Diabetes Association. Circulation 2007;115:114
2. Sigal RJ, Kenny GP, Wasserman DH, et al. Physical activity/exercise and type 2
   diabetes: a consensus statement from the American Diabetes Association. Diabetes
   Care 2006;29:1433-8
3. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee.
   Physical activity and Diabetes. Can J Diabetes 2003;27:s24-s26
4. Albright A, Franz M, Hornsby G, et al. American College of Sports Medicine
   position stand; exercise and type 2 diabetes. Med Sci Sports Exerc 2000;32:1345-60
5. Nathan DM, Buse JB, Davidson MB et al. Management of hyperglycemia in type 2
   diabetes: a consensus algorithm for the initiation and adjustment of therapy. A
     consensus statement from the American Diabetes Association and the European
     Association for the Study of Diabetes. Diabetologia 2006;49:1711-21

                                Body Mass Index

                                                     Underweight <18.5
                                                     Normal      18.5-22.9
                                                     Overweight 23-24.9
                                                     Obese I     25-29.9
                                                     Obese II    >30

Figure 1

Physical activity knowledge score   Mean     SD         F         p
Education level                                         2.77      0.043
 Below Form 5                       12.46    3.80
 High school                        14.00    1.60
 College                            13.67    3.06
 University or above                14.57    2.20
Physical activity level                                 7.30      0.001
 Low                                11.38    4.40
 Moderate                           13.42    3.11
 High                               13.33    2.80
Table 1. Mean, SDs and p values from ANOVA for physical activity knowledge score
(total = 20) among different education level and physical activity level


         52                                                             Age
                     low              moderate             high
                               Physical activity level

Figure 2. Association of physical activity level and age

A study on muscle fatigue in patients after ACL reconstruction more
than 1 year in involved leg and non-involved leg
(Presented by Ms. Rachel Suet-Wai Tsang)

Rachel S.W. Tsang
Department of Physiotherapy, Prince of Wales Hospital, Faculty of Medicine, The
Chinese University of Hong Kong


Ms. Tsang received her B. Sc (2007) in Physiotherapy from the Hong Kong Polytechnic
University and M. Sc. (2010) in Sports Medicine and Health Science from the Chinese
University of Hong Kong. She is currently a physiotherapist in the Department of
Physiotherapy, Prince of Wales Hospital.
People who are suffered from Anterior Curciate Ligament (ACL) injury may need to
undergo ACL reconstruction followed by a period of post-operative rehabilitation of
around 6 months before they could return to sports activities1. However, some studies
showed a significant deficit in quadriceps muscle strength 6 months after surgery. Muscle
activities and muscle fatigue of quadriceps and hamstring were investigated by the
surface EMG in several studies 2-4. However, these studies only include subject after
ACL reconstruction from 3 weeks to 6 months. The long term effect of muscle fatigue
was not been investigated. The aim of this study is to compare the muscle activities and
muscle fatigue on the involved leg and non-involved leg of subjects after ACL
reconstruction more than 1 year by the method of surface Electromyogram (EMG).

Static and dynamic postural control in professional dancers
(Presented by Ms. Tiffany Ching-Man Choi)

Tiffany C.M. Choi
Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Faculty of
Medicine, The Chinese University of Hong Kong


Ms. Choi is a Physiotherapy graduate from HK Polytechnic University with First Class
Honours in 2006. Upon graduation, she joined Prince of Wales Hospital as a
physiotherapist and has been serving patients in different specialties, such as Sports,
Spine, Orthopaedics, Paediatrics, ICU, Stroke, Respiratory, Surgery, Oncology and Burns

To further enhance her skills in clinical practice, Tiffany, after her graduation from the
HK Polytechnic University, soon obtained a diploma in acupuncture from HK Baptist
University and acquired the qualification for being an instructor of Fit Ball and Tai Chi
for Arthritis.
Tiffany is glad to have her first Master degree completed and would like to give special
and heartfelt thanks to Professor Daniel TP Fong and his research team from Sport
Performance and Biomechanics Laboratory CUHK, for their professional advice,
technical support and valuable comments on her thesis.

To compare both static and dynamic postural control of professional dancers with age-
and gender-matched healthy individuals and investigate if a dance training induces
specific adaptations of postural control and motor abilities are transferable among tasks,
under variations in availability of vision and rigidity of support surface.

Two groups; cross-sectional design; simple random sampling; Sport Performance and
Biomechanics Laboratory, the Chinese University of Hong Kong, December 2009 to
April 2010.

Ten young experienced professional dancers and ten age- and gender-matched healthy

Participants were asked to maintain balance on a force platform in four postures in
combinations of variations in availability of vision and rigidity of support surface (eyes
open/rigid; eyes open/foam; eyes closed/rigid; eyes closed/foam) during single leg
standing and after single leg jumping from a wooden box.

The static postural control of the participants was investigated on the basis of mean path
length and average speed of displacement of the center of pressure (COP) of the
participants measured by a force platform in the four above-mentioned postures. Mean
sway latencies (SL), which was the time the participants required to return to a stable
postural state after single leg jumping from a wooden box, were also recorded and
analysed to determine their performance in dynamic postural control.

If a participant failed to complete the static or dynamic tests due to falls, mean time to fall (TTF),
which was the time they stood on the surfaces before falling, was also recorded for analysis.

Two-tailed independent samples t test was used to examine differences in the dependent
variables between the professional dancers and the controls. Repeated measures analysis
of variance (ANOVA) was also used to test the effect and interaction of group and/or
vision and/or surface on the dependent variables.

Based on the displacements of the COP in static balance tests, the results showed that,
postural sway of the dancers was lesser than the controls in all conditions, except in eyes
closed/foam condition, even with the increase in difficulty of the environment (from rigid
to foam surface). However, the differences between the two groups were not significant
(p>0.05). Also, when both groups were further challenged to stand on foam surface with
no vision, all of them fell. In which, professional dancers could stand slightly longer
periods of time than the controls before falling although these differences were not
significant (p>0.05).

When dynamic postural control was investigated, the results showed that, the time the
dancers required to return to a stable postural state in all conditions, except in eyes
closed/foam condition, after jumping was shorter than the controls. However, the
differences between the two groups were not significant (p>0.05). Also, when they were
on foam surface, all of them fell, in which the dancers could bear slightly
non-significantly longer periods of time than the controls before falling (p>0.05).

It is concluded that professional dancers, through a specific training, seems to be able to
perform better through reweighting the remaining sensory information to compensate for
the lack of vision and unstable surface in both static and also dynamic postures. The
specific balance strategies in dancing should be considered to be incorporated into
rehabilitation programs for dancers with balance instability and after injury.

Acute achilles tendon rupture: comparing minimally-invasive surgery
versus conventional open repair using validated outcome measures on
Chinese patients
(Presented by Dr. Alexander Pak-Hin Chan)

Alexander P. H. Chan
Resident, Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole


Dr. Chan is currently Resident and Higher Orthopaedic Trainee serving the New
Territories East Cluster (NTEC) under Hospital Authority. He completed basic surgical
training in NTEC in 2008. He is also a member of the Hong Kong College of
Orthopaedic Surgeons, the Royal College of Surgeons of Edinburgh and the College of
Surgeons of Hong Kong. Dr. Chan pursued a degree in Master of Science in Sports
Medicine & Health Science, The Chinese University of Hong Kong (CUHK), with
special interests in acute Achilles tendon injury. He has established close collaborations
with the Gait Laboratory and allied health departments in Prince of Wales Hospital and
Alice Ho Miu Ling Nethersole Hospital. His research interests include preoperative &
postoperative biomechanical analysis, minimally invasive surgeries and tendon repair. Dr.
Chan has published articles in local and international journals. He has also made
presentations in local and international conferences. He is constantly involved in the
voluntary services organized by the Department of Orthopaedics and Traumatology of
CUHK as well as the Hong Kong Jockey Club Sports Medicine & Health Sciences

Achilles tendon rupture can be a curse to sportsman. Not only does it stop the players
from competitions and games in terms of months for recovery and rehabilitation, but it
can also limit sports performances due to possible disruption of the ankle biomechanics
and residual symptoms of pain and stiffness. The paradigm of treatment has advanced
from conservation with casting to operative repair nowadays. Despite the evolution of
minimally invasive surgical (MIS) repair for Achilles tendon rupture with Achillon
applicator has been introduced for some years, few studies have been conducted to
investigate into the clinical merits of Achillon method over traditional open surgery.
Besides the known fact of smaller surgical incisions, there is still no consensus regarding
the ultimate clinical benefits of MIS over open surgery. Moreover, limited information
can be retrieved on Chinese population from the literature. However, the application of
the disposable Achillon applicator is limited by the additional financial burden to
healthcare providers. This study aims to investigate the correlation between clinical
outcome, gait analysis parameters and biomechanical properties comparing both surgical

A single centre retrospective review on all the consecutive operated patients in Alice Ho
Miu Ling Nethersole Hospital between January 2004 and December 2008 was performed.
All of them were Chinese. An average of one to two patients were admitted each month.
Twenty-two patients (15 male and 7 female; mean age 40.8 years) were identified. 6 MIS
patients versus 9 Open group patients further underwent clinical assessments with
objective functional scoring system by Holz’s scale, gait cycle analysis and
biomechanical evaluation at a mean of 29.9 months after operation. Gait analysis was
conducted in our laboratory with eight-infrared camera motion capture system (VICON,
UK). Cybex II isokinetic dynamometer was utilized to assess the isokinetic peak force of
plantar-flexion and dorsiflexion of both the injured and uninjured side.

No spontaneous re-rupture was reported in both treatment groups. One superficial wound
infection case was noted in the Open group (6.7%, 1/15). All of the patients in both
groups were able to resume sports but with restrictions, except one patient in the MIS
group who could manage sport activities without problems. The mean operative time and
length of hospital stay were shorter in the MIS group: 53 minutes versus 68.80 minutes in
the MIS group and Open group respectively (p= 0.012); 3.43 days versus 6.40 days
respectively (p=0.084). There is statistically significant decrease (p<0.001) in incision
length, 3.53cm versus 9.64cm respectively in the two groups. The Holz’s scores were
similar, 11.83 versus 12.0 respectively (p=0.813). Mean follow-up duration was 3.43
months versus 6.40 months (p=0.084); physiotherapy duration of 3.50 months versus
4.56 months (p= 0.198). The mean percentage stance time of the injured leg was 58.27%
and 56.57% respectively. The loss of peak torque and total work done of the injured side
were similar between the MIS and open group. T-test showed no significance differences.

MIS can achieve smaller incisions, shorter operative time and hospital stay. The results of
this study did not demonstrate any statistically significant difference in objective clinical
outcome scorings, the stance time to strike time ratio and biomechanical properties on the
leg receiving Achilles tendon repair using MIS method and open surgery. However, with
limited population size, a definite conclusion still cannot be drawn. A large-scale
multi-centre prospective study or even randomized controlled trials is suggested.

WASMES Symposium

New frontiers in sports injury rehabilitation – the role of genetics in soft
tissue sports injuries
(Presented by Prof. Martin Schwellnus)

Martin Schwellnus, MP
Professor of Sport and Exercise Medicine, MRC/UCT Research Unit for Exercise Science
and Sports Medicine, Department of Human Biology, Faculty of Health Sciences,
University of Cape Town

Soft tissue injuries in sport are common and extrinsic and intrinsic risk factors for these
injuries can be identified. Most musculoskeletal injuries are in fact injuries to connective
tissue, therefore the structure and function of connective tissue could be an intrinsic risk
factor for soft tissue injuries. Extracellular matrix (ECM) proteins in connective tissue
have an important role in the adaptation to mechanical loading, as well as responses to
injury and healing. Sequence variation in the genes encoding for various ECM proteins
can alter the function of connective tissue and therefore predispose to injury and response
to healing. In the past 8 years, a number of variations in ECM protein genotypes have
been identified that are associated with risk of soft tissue injury. Gene testing to
determine risk of injury and response to healing and rehabilitation of soft tissue injuries
will soon become a reality.

Sports injury prevention and management - a multidisciplinary
(Presented by Prof. Christer Rolf)

Christer G. Rolf
Professor of Sports Medicine, Consultant Orthopaedic Surgeon

It is often suggested that we should approach sport injuries with a “multidisciplinary
approach”. What is that? A sport medical team in a professional club may consist of fitness
coach, masseur, physiotherapist, team doctor and sport scientists. Around the club there are
club owners, managers, coaches, board directors, agents, sales people, pro motors and
myriad of products and equipment linked to players or the club, targeting performance,
fitness or injury prevention and treatment. All included have an agenda, hopefully in line
with each other most of the time. Each club “medic” usually has a local net work of
specialists who can assist with further advice, investigations and surgery on request. Such
net works are often “personal relation based” which is not necessarily equivalent to quality
assured. The treatment for an injury may therefore vary substantially between clubs for a
number of reasons. Then we have the most recent partner in our multidisciplinary team
who we can not ignore, the “web expert”. How are clubs and athletes updated to cutting
edge science and developments in our field? How do they use, if at all, internet? Do they
chat about their injuries on face book? How does our “evidence based readers digest” reach
the end user, and who decides what that evidence base is? Are we really at the front line to
help grass root athletes to keep up to date in their field? How do we challenge popular
media who non-critically report “miracle treatments” for individual famous players? Today
all sporting kids use internet, do we keep up with them to get our message across also
tomorrow? When injured they already come armed with loads of back ground information
to their consultation with us, sometimes with useful information we do not have.
Over last decades international sport medicine/science congresses and meetings repeatedly
highlight “the current concepts” on sport injury management which often refer to “ACL
reconstruction this graft or that graft” or “conservative versus surgical approach”, in
principle we often focus on our own interests from a technical point of view. But are these
the most vital questions asked by the grass root players and athletes today? The internet has
suddenly given everyone open access to expert opinions as defined by Google. It is not
difficult to find out what type of questions that are most frequently asked by our athletes
and team medics. Has anyone bothered to find out? How do we help athletes often without
academic schooling to differentiate among the million hits when searching for advice on
his “knee injury”? I believe it is important for all of us to learn how to interpret this media
constructively and get our message across if we want to maintain our position as experts in
this field using internet as an integral partner in our multidisciplinary team. The career
paths today of our young sport medicine colleges may otherwise turn darker. The multi
disciplinary team must walk hand in hand on this thin line. Who takes responsibility for our
field on the web? Are the current international organisations braced for this huge task?
There is also “a dark side” which seldom is spoken about, which in fact is posing a growing
danger to us all working as experts, medics and scientists with athletes and sport teams, a
danger which may affect future career paths for us all in this field. It is per definition a
conflict of interest to be employed by the same employer as your patients. Your salary and
other benefits are dependent on their performance on the field. Relegation means no job,
promotion is double salary. The manager is the boss, his job is on line as well and conflicts
will arise from time to time. The recent “blood gate affair” in English rugby is an example
when this relationship fell off the track. The manager requested victory, game approaching
final whistle only a drop goal can save the game. The rules allow the team to change a
player if he suffers a bleeding injury. The Team physiotherapist gives a player a blood
capsule, it bursts and the best kicker can enter the field instead of the bleeding player. This
time the opposition interferes, accusing the player of cheating, the blood coming out of his
mouth looking like ketchup. Panic strikes the player and physiotherapist. The doctor is now
approached and requested to cut his lip to create a real injury. She does it. Story ends with
club loosing and severely punished by the rugby board, player banned for two years,
physiotherapist struck of the register and can not work in that capacity again ever, doctor
very close to being struck off. In this example all went wrong because the medics lost their
sense of direction and their basic duties. The Team approach turned against it self. The
pressure to win turned the wind against ethics and normal medical standards. “Stories at the
pub” suggested that this was not a unique event “they were just clumsy to get caught”. Is
that really so or unfounded rumours? And why on earth does a top physiotherapist carry
around blood capsules in his medical kit?
Behind all such stories there are human beings who want to perform, who want to win at
almost any price, the very essence of sport which we all support, some get stuck in the mine
field of short cuts presented as keys to success by unscrupulous business interests. Some
pay the ultimate price for falling for the temptation; some survive cheating over years but
admit their wrong doings at the end of their career. When that happens, their teams official
view usually makes sudden u turns, claiming that they had no idea of this wrong doing in
their own changing room and they easily let go of the person who they employed and have
cheered for his performance. On September 27th, a 31 year old England rugby league
player hanged himself after being banned for using human growth hormone to speed up the
healing of an injury. The club and indeed media wrote nice things about him, he was
described as a troubled but “a larger than life character” and brilliant player. But how did he
get hold of HGH? How can this player without higher education just think of using such
product to enhance healing of an injury? No one else than this player was banned in this
case. Where was the multi disciplinary medical team to help this player through that injury
and then during a period, even though self inflicted, which saw him loosing everything he
had worked for since childhood? What do we know about the “after life” of top athletes in
general? Which part of the multi disciplinary team caters for this knowledge in the
literature? Do we take responsibility for our continuous scientific strive to speed up healing
and enhance rehabilitation back to sport?
Do the athletes care about “evidence based treatment”, or is it just used as a snobbish way
to express our expertise? One of my MSc students asked the Team physiotherapists in
English top level rugby teams if they consider ultrasound treatment to be evidence based
and asked about their knowledge on this issue. All of them answered no to the first question
and therefore had not looked into the literature in this respect. By the same token all of
them answered the question “how often do you use ultrasound treatment in the
management of your players injuries?” with the reply “daily”. Is this a warning sign to
academic medicine?
How do we as sport medicine and sport science experts as a team approach the myriad of
products out there which all claim to prevent injuries and enhance healing and what are our
relationships with industry? Any company selling a product would of course win long term
if their product was evidence based by the criteria we use in science. Are the universities up
to this challenge today? There are long and costly procedures to undertake a controlled
study, referee disclosures of product development are standard, and there is an academic
request for “openness” in a very competitive market. I would argue that most companies
gladly live without our expertise today and instead simply ask a famous athlete to market
the product for them. How many companies around the world use our combined clinical
academic expertise? How many of you are employed by a company to scrutinize the
market and develop new products in this field? Is it all about marketing and quick sales,
using famous athletes as advertisers? I think it is time for a new era of awareness and use of
our academic expertise in the industry working with products related to injury prevention
and treatment. We are sometimes used as consultants for single products, but more seldom
involved as medical experts in company’s equivalent to the pharmaceutical industry. No
doubt the day has come when Universities all over the world has to face lack of funding
and has to reconsider an excess in overhead costs to pay for a huge bureaucracy for any
clinical trial. That should pave the way for closer relationships between academia and
industry in the best interest of our sporting fraternity, creating new type of partnerships in
our multidisciplinary teams.

Low back pain and concept of segmental stabilization
(Presented by Prof. Jaspal S. Sandhu)

Jaspal S. Sandhu
Dean, Faculty of Sports Medicine, Guru Nanak Dev University, Amritsar
Past President, Indian Association of Sports Medicine
Executive Member, Asian Federation of Sports Medicine
Liaison Commission Member, International Federation of Sports Medicine

Universal Problem, More common in sedentary. Not very rare in Sportspersons. Common
Organic Causes of LBA in Sports Persons: Intervertebral Disc Prolapse, Facet Joint
Pathology, Sacroiliac Joint Lesions, Damage to Myofascial Structures, Metabolic Factors.
Nonorganic Causes of LBA: Psychosocial, Iatrogenic, Labels of disability and
subsequent prolonged rest, Forensic, Associated with litigation (Long 1995), Behavioral
(Common in Sportspersons), Perceived disability with mistaken fear of re-injury
(Zusman 1998 and Vlaeyan et al 1995), Anticipation of pain: Pain perceived in
anticipation in the Trapezius area instead of Lumbar area. (Main and Watson 1996).The
Damaging Movements: Bending and tortional forces along with axial loading are most
damaging. Proteoglycan: The proteoglycan is hydrophilic and is 65% of the disc till the
age of 30 and declines to 30% by middle age (Bogduk and Towmey 1987). The even
distribution of pleasure thus decreases with age. Spinal Stability and Low Back Pain:
Spinal Instability; Identifying a specific patho-anatomical cause for LBP is not possible
in a majority of cases in sportspersons (Fritz., 1998),These patients are often described as
having “mechanical” LBP, Researchers and clinicians suggest that segmental instability
of the lumbar spine is a possible mechanism underlying LBP in large number of sports
persons. Definitions of Segmental Instability: No one set definition, Based on earlier in
vitro studies of lumbar spine, the results cited that for segmental instability the following
must occur: Sagittal-plane translation of one vertebra over the other at least 3 mm on
flex/ext radiograph, Sagittal-plane rotation of greater than 9 degrees for L1-L5,Found that
42% of subject without LBP had at least one lumbar segment with 3 mm of saggital-plane
translation, Criteria for diagnosing instability increased to 4 mm of translation and 15
degrees for rotation Physical Signs of Instability: Step Deformity or rotation deformity
on standing which reduces on lying, Transverse band of spasm which reduces on lying,
Localized muscle twitching while shifting weight from one leg to the other, Shaking
during bending forwards, Instability vs. Hypermobility: Hypermobility can lead to
instability (Norris, 1999).The Problem with Instability, the excessive movement may
either be a stretch or compress pain ,sensitive structures leading to inflammation,
excessive range of motion without muscle control but loss of stiffness does not mean the
loss of pathological condition of stiff back but the physiological condition of decreased
resistance against excessive movement. Stabilizing System: Panjabi divided the
stabilizing system into 3 subsystems: passive, active and neural. Passive subsystem
includes Vertebral bodies, zygapophyseal joints, and ligaments, Injury to the passive
system such as intervertebral disk degeneration or disruption of the posterior ligaments of
the spine may increase the size of the neutral zone, increasing the demands on the active
and neural control subsystems to avoid the development of segmental instability. Active
subsystem: Includes Spinal muscles and tendons are Important in neutral zone, where
passive resistance is minimal. Neural subsystem: receives inputs from active and passive
subsystem plays an important role stabilizing the spine in anticipation of an applied load.
The Stabilizing Muscles of the Core has: Two Distinct Groups, Stabilizers and
Mobilizes. Stabilizers are deeply placed, Aponeurotic, Slow twitch nature, selectively
weaken and lengthen.

Osteoporosis and rehabilitation
(Presented by Dr. Shweta Shenoy Devraj)

Shweta Shenoy Devraj, PhD
Reader, Faculty of Sports Medicine, Guru Nanak Dev University
Amritsar and Secretary General, Indian Association of Sports Medicine

Bone is vital connective tissue that makes up the foundation of the human body. When
bone mass drops to a critical level below which the fracture risk is substantially increased
the state is considered pathological and referred to as osteoporosis. Osteoporosis is
currently defined as a systemic disease characterized by low bone mass and micro
architectural deterioration of bone tissue leading to enhanced bone fragility and increased
fracture risk (consensus development conference 1993). This implies that fragility
fractures in osteoporosis can be attributed to the reduced bone quality and low bone mass
both which cause a reduction in bone strength. Further this definition places emphasis on
fractures as critical events that result in the major morbidity and mortality associated with
this condition. Fractures caused by osteoporosis may be prevented by rehabilitation
programs as intervention measures with the active involvement of the patient and a
multidisciplinary approach to address the various concerns faced by the patient. The main
aim of rehabilitation is to improve the quality of life by returning the patient to his
highest level of function. Rehabilitation includes exercise programs to increase strength
and improve balance, nutritional counseling, psychosocial assessment and support, fall
prevention, education and environmental modification. Rehabilitation is also important
post fragility fracture to reduce associated morbidity including pain, disability and
depression as well as prevent subsequent falls. Last but not the least emphasis on the
prevention of osteoporosis by maximizing the peak bone mass achieved by the emphasis
on bone building impact exercise and adequate nutrition in youth is important. A program
of regular physical activity continued throughout life reduces the loss of bone mass that
occurs with age. Thus the main points in the rehabilitation program should include
emphasis on bone building exercise throughout life, early detection of low bone mass,
institution of both pharmacologic as well as non pharmacologic management including
muscle strengthening, postural retraining, fall prevention and environmental

Lower limb weight training can effectively build hip and knee strength
and increase patellofemoral joint contact area in people with
patellofemoral pain
(Presented by Prof. Gabriel Ng)

Gabriel Y.F. Ng1, Joseph K.M. Chiu1&2, Yiu-ming Wong1, Suk-tak Chan3, Patrick S.H.
  Department of Rehabilitation Sciences, The Hong Kong Polytechnic University,
  Department of Physiotherapy, Queen Mary Hospital, 3Massachusetts General Hospital,
Massachusetts, USA, 4Department of Orthopedics and Traumatology, The Chinese
University of Hong Kong

The etiology of patellofemoral pain syndrome (PFPS) is multi-factorial and patellar
mal-alignment is a major contributing factor. However, the relationships between clinical
symptoms and physiological changes in patellar position and knee muscle strength have
not been clearly established.

This study aimed to investigate the effect of lower limb weight training on the knee and
hip muscle strength and patellofemoral joint contact area in subjects with anterior knee

pain and comparing them with able-bodied subjects undergoing the same weight training

21 subjects with and without PFPS were divided into 3 groups of PFPS group (n=9),
normal weight training group (n=6) and no exercise control group (n=6). The subjects
were assessed for hip and knee strength using isokinetic dynamometer and patellofemoral
joint contact area during static quadriceps contraction using magnetic resonance imaging
(MRI). Besides, numeric pain rating score and Kujala knee score were also measured for
subjects in the PFPS group.

After initial assessment, subjects in the PFPS and normal weight training groups were
subject to lower limb weight training program with “leg press” on a leg press machine
and “knee extension exercise” on a weight machine. Each exercise involved 4 sets of 10
repetitions with a 1-minute rest between sessions. The resistance of the exercise was
based on 10 repetition maximum (RM), which was determined in the first training session
and the 10 RM load was adjusted regularly during the period of study.

All the training sessions were conducted by a physical therapist to each subject on an
individual basis. The trainings were conducted 3 times/week for 8 weeks and the
outcomes were reassessed after 8 weeks of weight training.

Subjects with PFPS have increased their patellofemoral joint contact area after weight
training (p<0.001). The isometric strength in hip and knee and isokinetic knee strength in
normal and PFPS subjects increased after the weight training programme (p=0.007-0.05).
The numeric pain rating score and Kujala knee score of subjects with PFPS improved
after training (p<0.001).

The 8-week weight training exercise programme was effective for improving pain,
function and muscle strength in subjects with PFPS. The contact area in the
patellofemoral joint in patients with PFPS has increased after training. The increased
bony contact area could reduce the mechanical stress in the patellofemoral joint and thus
leading to the improvement in pain and knee function in subjects with PFPS.

Health Track, a novel way of measuring working capacity and well
(Presented by Mr. Goran Andersson)

Goran Andersson, Halsosparet AB, Peter Foxdahl, PhD
Uppsala University, Sweden

Physical “fitness” is vital for performance, well being and health. Monitoring fitness
levels has become increasingly important in our “low activity” society, both for
individuals with health risks or undergoing training, and on group level such as sport
teams, school classes, work forces and the population in general. “Aerobic capacity” is
the key physiological factor. Such measure usually requires laboratory equipment and
professional resources to interpret the results. The aim of this presentation is to introduce
and discuss the concept behind Health Track.

Health Track is a novel web based interactive tool to measure aerobic fitness at individual
or group level. The method has been developed and evaluated versus standard laboratory
methods and translated to the applied measures of “working capacity” and “well being”.
Health Track’s basic concept is simplicity, accessibility, high precision and low cost. 1.
The user defines a local suitable walking or running track. 2. Age, gender, body weight
and stature are recorded. 3. Body mass index (BMI) is calculated. 4. A base line
performance test is done on the chosen track. 5. Time used and subjective effort
(subjective scale provided) is documented. 6. Fitness level (aerobic capacity) is
calculated form these data. 7. Data is transferred to a pass word protected secure site in a
comprehensive data base and returned objectively demonstrating the test persons
“physiological age”, “working capacity” and “well being”. 8. The data base allow
comparison of personal or group’s fitness level with age and gender matched individuals
from different professions and sports and/or as monitored changes in relation to an
ongoing training programme.

The figure demonstrates a strong relationship between aerobic fitness measured in
laboratory versus Health Track in 271 sedentary individuals. The concept, data base and
software are developed by Health Track (Halsosparet AB) Sweden Ltd.

In summary, Health Track is a
simple method for monitoring
“working capacity” and “well
being” on individual and group
level, providing a valuable and
user friendly tool to monitor
aerobic fitness. Health Track is
used in Sweden and Denmark
since 2009, and the method is
currently adapted to other
regions around the world.


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