Common injuries in track and field athletics – Racing and jumping

Track and field embraces a wide range of activities and has close relatives in cross-country and road racing. Apart from race-walking (20km and 50km) and marathon running, all events are held within the confines of athletic stadia, a fact that itself brings attendant problems. The constantly improving performances in javelin, hammer and discus events may endanger adjacent competitors and spectators unless the programme is carefully planned and recommended safety procedures abided by. This article concentrates on running, hurdling and jumping events while the throws are considered in 8.

The abilities fundamental to track and field participation discussed here are running and jumping. These impose requirements of repetitive locomotion, powerful explosive action and efficient execution of technique to varying degrees. These basic abilities may be performed with appreciable modification as, for example, in the hurdler’s economical and rapid clearance of the barrier. Alternatively they are called upon serially in other events – the long jumper reaches high speeds in the run-up, coordinates powerful muscle action in the take-off and demonstrates skill in aerial movements and landing, all performed to optimal biomechanical specification.

The nature of track and field competition ordains that the trauma associated with physical contact is rarely found among participants. However, preparation for the sport has, over the last two decades, become progressively more rigorous while competition itself has increased in intensity. The season is prolonged providing better opportunities to achieve personal best performances which in turn accentuate individual strain. The majority of injuries occur in training, 60 per cent of the problems of runners being associated with training error (James et al, 1978). The proportion of jumpers’ complaints originating in training and practices is probably greater still. Causal factors and injuries common to running and jumping are considered before those related to specific athletic events.

COMMON CAUSAL FACTORS

The increasingly acknowledged injuries throughout track and field events may be attributed to four major causes apart from fitness- quality of surfaces, excessive training loads, innate musculoskeletal deformities and inadequate footwear.

Surface quality

Unfortunately the majority of long distance racing and training is now performed on hard often uneven roads. These provide inadequate compliance for the athlete’s legs. Continuous running on severely cambered road will cause excessive forces to be exerted on the inside leg resulting in Achilles tendon and possibly ankle and knee joint problems.

Track racing is gradually becoming almost exclusively confined to synthetic surfaces. Although conducive to faster times and better wear the stiffness in these materials has been implicated in joint and tendon injuries (Haberl and Prokop, 1974). Grass provides an altogether gentler surface on which the distance runner especially should frequently train.

Hill training is a basic part of most athlete’s programmes. This again imposes musculo-tendonous strains, particularly on the Achilles tendon in climbing and on thigh muscles in descending.

Jumpers are likewise prone to surface-induced injury. The high jumper must be especially careful to avoid losing balance when forced to take off on a wet synthetic surface. Similarly the broad jumper must be wary when confronted with adverse climatic conditions or uneven approach runs.

Excessive training loads

The heavy training currently indulged in brings various overuse injuries. Stress fractures, shin splints and Achilles bursitis all arise from accumulated impact loading. Jumpers are not excused vulnerability, encountering their own specific exertion injuries such as proximal tibial stress fractures.

Musculoskeletal deformities

Minor deformities which normally go unnoticed often come to light as a result of participation in athletics. Examination of patients with recurrent knee pain may, for example, reveal genu varum or patellar instability. These otherwise occult defects are spotlighted when a strenuous training programme is undertaken.

Footwear

A proportion of injuries are caused by inadequate footwear. Blisters occur when the feet overheat in ill-fitting shoes. Thin soled flat road racing shoes place unnatural strains on the foot in general and the athlete who sacrifices safety for speed often regrets it later. Conversely, thick soled shoes with broad flared heels or a heel roll and wedged mid-sole are found to protect the Achilles tendon in many victims. As first contact is mostly on the outside border of the shoe, for some leg geometries wide shoes may cause unwanted moments about the leg and ankle.

Most present-day track shoes afford little heel protection and have considerable room for design improvements. The sole should be flexible, tough but soft enough to provide cushioning. Excessive training in spikes can cause plantar fasciitis and precipitates recurrent foot strains.

INJURIES COMMON TO THE RUNNING EVENTS Achilles tendon

From the preceding section it is clear that the Achilles tendon with its surrounding tissues is damaged with depressing frequency by competitive athletes. This tendon connects the powerful plantar flexors in the calf to the calcaneus. It is surrounded by a delicate membrane, the paratenon. Deep to its bony insertion is a bursa which can become infected or inflamed. Five basic categories of injury are described:

COMPLETE RUPTURE

This fortunately is a rare occurrence in healthy athletes but causes extreme pain and disability when it happens. Typically, the rupture is of sudden onset during violent contraction of the plantar flexors as in steep uphill running, during the acceleration phase in a sprint start or driving off the long jump board. The patient is unable to walk on tip toe and there is a characteristic ‘step’ in normal heel outline.

Surgical repair is recommended in an active athlete.

PARTIAL RUPTURE

Partial rupture is a recognised clinical entity and is perhaps present in athletes who never seek medical aid.

The rupture at time of occurrence may cause acute pain, otherwise it tends to cause a lack of thrust in running or jumping. Examination may reveal a small lump on the tendon and some wasting of the attached muscles.

ACHILLES TENDINITIS

Here there is an inflammatory reaction deep in the tendon fibres and the athlete experiences discomfort on jogging. X-ray is normal and the only physical sign is tenderness on pinching the affected tendon. The athlete is advised to ease down in training at the first sign of tendon pain. Fortunately most cases resolve with rest and adequate heel protection. Injection of the tendon with steroids is potentially dangerous and may cause complete rupture.

ACHILLES PERITENDINITIS

In this condition there is inflammation in the paratenon and tissues surrounding the tendon. There is pain and swelling in this area. Most cases settle with rest and steroid infiltration around the tendon.

With recurrence of attacks, fibrosis develops between paratenon and tendon proper. Characteristically, there is soft tissue swelling and the athlete complains of morning stiffness. Surgical clearance is then indicated.

BURSITIS

Less commonly, painful bursitis may develop at the Achilles tendon insertion. Steroid and hyaluronidase injections usually clear up this condition successfully.

Chondromalacia patellae

This is a very common condition among sportsmen and adolescent females. The undersurface of the patella degenerates as a consequence of friction between it and the femoral condyle (usually the lateral). The condition causes gradually increasing pain on knee flexion with particular difficulty descending stairs and running.

The underlying cause is attributed to a mechanical defect in the functioning of the extensor muscle group and minor local bony deformities. In the advanced case there is wasting of the vastus medialis with marked crepitus on flexing the knee.

As in virtually all knee conditions quadriceps strengthening exercises are helpful. The natural history of the disease is variable. The adolescent variety tends to resolve with time: the unfortunate athlete may go through a gamut of enforced rest, local steroid injections and an assortment of foot supports in an attempt to find a cure. If symptoms persist and the disease progresses, operative intervention is usually necessary if the athlete is to remain in his sport (Sim and Deten- beck, 1972). Fortunately, only relatively few who fail to respond to an adequate trial of conservative treatment are found to need surgery (Dehaven et al, 1979).

Shin splints

This is a blanket term used to cover a variety of conditions causing pain and disability. These include stress fractures of the tibia and fibula and also musculo-tendonous problems. Shin splints are caused by poor conditioning, unaccustomed over-exertion and training on hard surfaces. Persistent bend running with marked lean, as in indoor racing, is another recognised cause (Rasmussen, 1974).

THE ANTERIOR TIBIAL SYNDROME The tibialis anterior is entirely clothed in a sheath which does not allow this muscle to hypertrophy normally with training. There is impairment of blood supply on exercise producing shin pain. The condition responds well to surgical treatment.

ANTERIOR TIBIAL TENOSYNOVITIS

Here there is a thickening of the sheath surrounding the tendon of tibialis anterior with consequent pain and stiffness. Again, surgical decompression proves rewarding.

MEDIAL TIBIAL SYNDROME

The medial tibial syndrome describes a common cause of athletes’ leg pains. Pain is located at the inner border of the tibia. X-ray and isotope scanning are needed to differentiate this injury from tibial stress fracture as the site and symptoms are similar. The injury occurs almost exclusively in runners on elevating training mileage and arises from increased pressure in the deep flexor muscles due to prolonged exercise. The pathogenesis has been attributed to chronic ischaemia inside the medial fascial compartment (Orava and Puranen, 1979). Most cases heal without any specific treatment with rest and adaptation to training. Fas-ciotomy may be necessary in athletes with chronic exertional ischaemia in the medial fascial compartment failing to respond to conservative treatment.

STRESS FRACTURES OF TIBIA AND FIBULA In this condition a transverse or longitudinal fracture of the cortex of the tibia or fibula occurs. Middle-distance runners moving on to high mileage regimes are especially vulnerable. Fatigue fracture of the fibula shaft arises from excessive repetitive pounding from running on hard surfaces. X-rays are often negative due to the lack of displacement but there is marked bony tenderness on examination. Due to increased local metabolism, the uptake of particular isotopes at the fracture site increases before the radiological signs of the fracture can be seen. Hence isotope scanning can be used for diagnosis.

Rest offers a complete cure. A training pause of four to six weeks is usually sufficient for treatment of leg stress fractures.

Foot pain

There are numerous conditions causing foot pain in runners. Considerable variation exists in foot structure between athletes. Podiatrists believe that a majority of lower limb, and indeed back injuries are due to inherent foot defects. The somewhat enigmatic condition known as Morton’s foot has also been held responsible for many foot problems. Here, there is either a short first or long second metatarsal bone with excessive tendency to pronate the foot. Orthotic appliances are often successful in relieving the symptoms.

Other conditions associated with foot pain include bone spurs, tenosynovitis of the various foot tendons, plantar fasciitis and foot strain with chronic synovitis of the small foot joints. All of these conditions may be traceable to footwear which is either too tight or provides inadequate support. Treatment is directed to developing foot mobility and strength along with adopting appropriate footwear. Bone spurs may require surgical removal if especially troublesome.

Verrucae (warts on the soles of the feet) and tinea pedis (athlete’s foot) can both plague athletes using communal washing facilities. Verrucae respond to liquid nitrogen application and surgical removal under local anaesthetic. Tinea pedes, causing maceration of the skin between the toes, responds to antifungal applications. This condition recurs if treated inadequately.

INJURIES IN SPECIFIC RUNNING AND JUMPING EVENTS Sprinting

MUSCLE INJURIES

Muscle tears are particularly common among sprinters. Localised tears or strains occur where a muscle exerts quick, powerful and often poorly coordinated contraction. Hamstring, thigh adductor and quadriceps muscle tears are precipitated by violent exertion mosdy at the start and towards the finish of the sprints. At the start, the runner may be generating up to 6hp in his desperation to accelerate (Wilkie, 1960). Impaired coordination near the finish produces agonist/ antagonist mismatch and consequent soft tissue injury. Suspect hamstrings may give way in mid-race due to overstretching in attempting to retain a fluent style at full speed. s

Muscles acting on two joints are especially at risk, for example rectus femoris and the hamstrings. Tearing may occur in the belly of these muscles or in the musculo-tendonous junctions. Intramuscular tears promote rapid accumulation of blood within the muscle with consequent severe pain and spasm. Treatment is directed at reduction of this haematoma and its rapid absorption. Several specialised techniques are involved but there is a consensus of opinion that cold and pressure are of most benefit.

Gentle exercise is undertaken as soon as possible with careful graduation to a full course of joint movement. Stretching is crucial to preventing scar tissue formation and development of adhesions. There are adjuvant therapies to this basic routine – massage, ultrasound, short wave diathermy and cryotherapy -all having their proponents either singly or in combination.

Adequate time must be allowed for healing – pain is a warning signal which is perilous to ignore. The athlete should undertake a fitness test prior to resuming full training. Unfortunately, hamstring injuries have a tendency to recur in sprinters and become chronic. Hence attention to stretching exercises before and after activity is advocated in the athlete who has suffered a pulled muscle.

JOINT INJURIES

Sprinting imposes great strain on individual leg joints particularly where the stride is imperfectly balanced and where repetitive bend running is practised. The joint most frequently strained is the knee. Tearing of the medial and lateral collateral ligaments and the cruciate ligaments may occur, albeit uncommonly. Rotational strain arising from poor surfaces or inadequate footwear may cause tearing or rippling of the menisci. Early attention by a specialist in sports medicine is desirable, rather than ‘running through* the pain with the support of bandaging.

The ankle joint together with the shin bones bear the brunt of excessive bend running as in prolonged 200m and relay practices. Over-use of cinder tracks particularly in spiked shoes can lead to synovitis of the small joints of the foot. Foot hygiene with particular attention to toenails is again important.

Distance running

MARCH FRACTURE

The condition owes its name to its initial observation in military recruits. It refers to the development of a stress fracture in the second or third metatarsal bone as a result of prolonged walking or running. Rest is indicated to relieve pain and allow the fracture to heal.

KNEE INJURIES

Injuries specific to the knee in distance runners are diverse. The number of acknowledged conditions is constantly increasing and ranges from simple sprain to rarer entities like tendoperiostitis in the lateral femoral condyle and the iliotibial tract friction syndrome (Orava, 1978).

Patients occasionally complain of knee pain without any localising signs. This may in fact be a secondary injury which occurs as a result of injury elsewhere, for example Achilles tendinitis in the other leg. Knee problems in females may be related to the more acute articulation of the femur because of the broader pelvis. This induces a more lateral sway of the body when running (Klafs and Lyon, 1978). A tendency in young female runners to take the lower leg and foot over to the side when swinging through should be corrected since it results in additional stresses on the medial aspect of the knee joint on ground contact.

SCIATICA

This condition appears to occur with increased frequency in distance runners, possibly as a result of uneven running gait, jumping off kerbs, running downhill or generally transmitting shock through the vertebral column. The symptoms are pain and weakness of the leg, particularly in the hamstrings, which develop on exercise. The pain or numbness in the hamstrings may shift position over time. Some afflicted athletes mistake the condition for a pull in this muscle group. The usual cause of this form of sciatica is intervertebral joint irritation. It generally responds to rest for a few days and anti-inflammatory agents.

Prolapse of the intervertebral disc is a more serious cause of sciatica. It may require operative intervention if it fails to respond to conservative treatment.

HEAT INJURY

Heat stress is an almost constant accompaniment to marathon running and race-walking in hot humid conditions. Body temperature rises and a proportion of cardiac output, subserving the body’s thermoregulatory needs, is shunted to the skin to be cooled making less blood available to the working muscles. Sweating is the primary mechanism for loss of body heat in these conditions, heat being lost when the sweat is evaporated on the skin surface. Marathon runners may lose four to five litres of fluid during a race, amounting to six to ten per cent of bodyweight. Endurance capacity is further adversely affected in that plasma is also lost with reduction in total blood volume, which in turn promotes further temperature increments. The work rate must be retarded to avoid overheating.

Heat distress can be of varying severity. Heat cramps are the result of dehydration with loss of fluid, electrolytes and salt, the muscles employed in the exercise being primarily affected. Heat exhaustion is characterised by body temperature of about 40 °C (104 °F), extreme tiredness, breathlessness, dizziness and tachycardia. These symptoms result from a reduced sweat production. Heat stroke is more serious, characterised by body temperatures of 41 °C (105.8 °F) or higher, cessation of sweating and total confusion or loss of consciousness. As thermo-regulation has priority over control of body water (Astrand and Rodahl, 1977) hypohydration can be driven so far as to threaten life in hot conditions if water is not available. Eventually coma and death ensue if the victim is left untreated. Immediate replacement of body fluid is required and cooling by ice cube application.

Attention is directed towards adequate race and pre-race nutrition and fluid intake. Clothing should be brief, light in colour and loose woven. Early warning symptons preceding heat injury should be heeded including pilo-erection on chest and upper arms, chilling, throbbing head, unsteadiness, nausea and dry skin. Since the body adapts to heat, acchmatisation should be explored where possible. If exposure to heat lasts for several weeks ingestion of salt tablets is advised; 5 to 15g of salt per day depending on diet, climate and degree of exercise is sufficient (Astrand and Rodahl, 1977). Race organisers should pre-arrange with medical personnel for the care of possible cases of heat injury.

FOOT CONTUSIONS

These arise from direct trauma to the heel and forefoot with bruising of the tissues between the bones and skin. Again, inadequate footwear and hard surfaces are implicated. Cross-country runners encountering sections of road in mid-race are liable to bruising of the plantar aspect of the foot if spikes are worn. Use of rippled soles or waffle-sole designs for these road and country courses is advisable.

SPIKING WOUNDS

These predominate in the bustle of middle distance track races and crowded cross-country starts. The areas commonly involved are the heels, instep and the front of the shins. Immediate cleansing and dressing is usually required. The victim would be wise to have an anti-tetanus injection if not previously innoculated.

Hurdling

Hurdling may be described as sprinting with a modified stride for clearing the barrier. Apart from great speed, the high hurdler needs a long stride to permit a three-stride rhythm between clearances. Besides, the taller individual with a high leg length/trunk length ratio has an advantage in that the centre of gravity is raised less to effect hurdle clearance. Females are not handicapped to the same extent in that the effon in clearance is relatively easier because of the lowered hurdle heights. Efficient clearance involves keeping the centre of gravity as low as possible, spending minimal time in the air and landing so as to quickly initiate the running rhythm for further clearances. For this, great flexibility particularly in the hip, groin and back is called for.

The hurdler suffers many of the injuries incurred by the sprinter. Hamstrings are liable to injury if the athlete has to overstretch between barriers to retain the correct stride pattern. This may arise from one poor clearance where momentum is lost or in racing against the wind. Flexibility in the hamstrings is desirable because they are stretched in the lead leg in clearance. Groin strain may occur in the trailing leg action and flexibility here is also essential. A further precaution is for the hurdler to clear a series of phantom barriers during warm-up, emphasising lead and trailing leg motion alternately.

The shin of the leading leg may be bruised in clearance if take-off is too near the barrier. The medial aspect of the knee or the medial malleolus of the trailing leg may be grazed in clearance. Some coaches employ protective pads on the hurdler’s knee and ankle, though this may encourage imperfect technique (Reilly, 1977). If the trailing leg hits the hurdle, the leading leg may land short with the foot abruptly jammed into dorsiflexion. Tearing of the medial belly of the gastrocnemius may result from this sudden dorsiflexion with the knee extended.

Tear of the adductor magnus or gracilis may be caused by imbalanced clearance and overstretching, resulting in landing on the leg with the thigh in forced abduction. Ankle sprain can result from imbalanced landing with the foot in an inverted and inwardly rotated position. Damage is usually to the lateral collateral ligament (O’Donoghue, 1970), though less frequently avulsion of the tip of the lateral malleolus is found (Miller, 1971).

Spiking wounds are mostly self-inflicted in adjusting to errors in stride pattern. Abrasions associated with falling heavily on cinder or tartan are found when the required rhythm and balance are lost. The fatigue of anaerobiosis may be a causal factor, particularly in the low hurdles race, contributing to a variety of injuries associated with errors of coordination. Repetitive bend running in training for the 400m hurdles may lead to strain of the collateral ligaments of the knee.

Good technique is also required of the steeplechaser who, unlike the hurdler, cannot afford to hit the stouter barriers he must cross. Finger and wrist injuries as well as limb abrasions are found in falls after physical contact during clearance. It is sensible to step on the barrier top if the approach run is hampered by other runners as can happen in the early laps. Falls in the water jump can be physically costly, often causing damaged ankles or metatarsal fractures. It is important to accelerate in approaching the jump so as to step easily onto and drive off the barrier top. Good technique involves landing in the water with the lead leg and stepping out of it in the first running stride so that only one foot gets wet . It is wise to practise water-jumping under conditions of fatigue so errors in technique do not creep in over the final laps of competition. Chronic foot injuries may result from repetitive poor landings if training shoes offer insufficient support.

JUMPING

The broad jumps

In the long jump and triple jump the athlete exploits the kinetic energy developed in a fast run-up to achieve some vertical lift in a jump or hop, step and jump for horizontal distance. Since performance is measured from the end of a fixed take-off board, take-off should be as near this point as possible. Efficient aerial technique is important to secure effective landing and avoid falling backwards on contacting the ground. Speed, muscular strength and power are pre-requisites for these events and must be painstakingly developed during the off-season.

Hitting the take-off board consistently requires many hours of repetitive practice. Since stride length can vary with wind conditions and track surface an absolute distance of approach will not work for all conditions. Jumpers generally use check-marks at the beginning and early on in the approach since marks near the board only serve to slow the approach and distract the performer from the explosive effort needed there. Attempts to correct missed strides during the run-up can lead to hamstring tears or injury from later faulty take-off or landing. Problems associated with uneven run-ups are ameliorated with the use of all-weather surfaces.

Contusions involving the soft tissue between the calcaneus and the shin may result from repetitive jumping since the take-off leg is planted heel first in long jumping. The triple jump initial thrust involves a more flat-footed plant. Practitioners in both events may use shortened approach runs in training to avoid the fatigue of repeated full-scale run-ups. Some indoor facilities for top jumpers incorporate declining approaches so speed is gained more quickly. Aerial technique is facilitated with take-off from a springboard which allows more time in the air for skill acquisition.

Groin and lower back injuries may result from imperfect landings in the sandpit. Lower back injuries are especially common in triple jumpers from inefficient absorption of the shock of the landing at each phase (Reilly, 1977). Landing efficiently from the hop must simultaneously incorporate an optimal drive into the step with the same proviso obtaining on landing from the step and thrusting for the jump.

Ankle and knee sprains are possible on uncontrolled landing in the long jump or at any phase of the triple. Meniscus damage in the final triple phase may result from landing heavily if the affected leg undergoes rotational torsion with the knee flexed. Injury can occur to the lower limbs in this phase at club level if the competitor fails to reach the pit. Poor landing facilities can account for severe and unnecessary lower limb injuries. A deep and even pit of fine grain sand is an effective shock absorber and must be well maintained. Female long jumpers tend to incur a greater proportion of overstrain injuries than their male counterparts. It is likely that the male musculoskeletal system is better suited to the explosive effort required. Emphasis should be placed on off-season strength training regimes to improve the quality of the female athlete’s muscle, tendon and bone so that she is better prepared to withstand the stress of the competitive season.

High jump

The high jumper needs great explosive leg strength for vertical propulsion after a controlled run-up. The ability to spring is demanded irrespective of the style employed and typically accounts for about 90 per cent of the height attained. The remainder is due to efficient lay-out crossing the bar, top jumpers using either the straddle or the flop method. In the straddle, approach is at an angle of about 35° and take-off is almost opposite the near upright. The final stride is long with a pronounced heel plant to increase thrust. Take-off demands vigorous ilio-femoral and knee extension, powerful plantar flexion, great hip flexibility to allow a high swing of the lead leg before losing ground contact, and coordinated use of the arms. Clearance is effected by straddling the bar face down and rolling over to land on the side. Wrist and acromio-clavicular sprains have been eliminated with the use of foam landing mats.

The flop gets its name from the ungainly landing on the back or back of the neck after clearing the bar draped crossways and face upwards. The approach is much longer and faster than in the straddle, is curved in its final part and take-off is from the outside rather than the inside leg. Safe landing beds are imperative for floppers. These must be positioned correctly by officials to ensure that the jumper does not slide over the sides or between beds where separate modules are used.

The take-off leg is more vulnerable as it provides the leverage in the jump. Stress from the muscular contractions can lead to muscle or joint injuries. ‘Jumper’s knee’ describes tendinitis of the patellar or quadriceps tendon at the inferior or superior poles of the patella respectively (Roels et al, 1978). The condition occurs also in broad jumpers. An aching type of pain appears insidiously after practice and subsequently at the beginning and termination of a work out. If allowed to go on with intense activity over a prolonged period the jumper may eventually incur a disastrous complete rupture of the tendonous attachment (Blazina et al, 1973). Knee damage is promoted in the flop with forced outward rotation from having to simultaneously twist the take-off leg and rotate the lower body. Lower back pain may also result from poor alignment at takeoff.

The deltoid ligament on the medial aspect of the ankle can be damaged in inexperienced jumpers concentrating on aerial technique too early and planting the take-off foot abnormally abducted and everted. Moulded fibre heel pads have minimised complaints of calcaneal periostitis and contusions of soft tissue in the take-off foot. With insufficient heel support irritation of calcaneal plantar bursa, calcaneal periostitis and bony spurring on the heel present chronically.

Strain of the connective tissue of the iliopsoas muscle is common. Chronic muscle injuries have been reported in this hip flexor, the adductor magnus and longus and biceps femoris (Dickinson, 1971).

Bone injuries include avulsion fracture of the ischial tuberosity in straddlers because of the forceful upward swing of the lead leg. Another complaint is periostitis or epiphysitis at the distal attachment of the iliopsoas on the femur and at the ischial attachment of biceps femoris. Osgood Schlatters disease or epiphysitis of the tibial tubercle is sometimes found related to jumping in youngsters.

Stress fractures of the navicular bone of the foot may occur if the take-off foot is persistently planted parallel to the bar in using the flop technique. This bone forms the final block of the longitudinal foot arch and bears the brunt of the compression and shear forces produced. Strengthening the intrinsic foot muscles, planting the foot tangentially to the run-up and use of an extended heel cap in the take-off shoe have been advocated to avoid this injury (Krahl and Knebel, 1979).

Pole vault

Pole vaulting requires great all-round strength, flexibility, speed, coordination, agility and no small amount of fortitude. The athlete develops great speed in the run-up while carrying the pole pointed ahead, which he plants firmly in the metal or wooden box and drives off the ground in a forward and upward action onto the pole . During flight he rides the pole to which he has imparted kinetic energy, the degree of bend in a flexible pole depending principally on take-off velocity. After a hanging phase behind the arch of the pole, the vaulter rocks back by whipping his feet upwards with bent knees and dropping his shoulders backwards before turning and pushing off at the top of the vault to a flyaway or piked crossing. The release of the pole must be exquisitely timed so that the maximum energy has been taken back from it. Best performances have been found to be characterised by a pronounced bending of the pole, similar rates of pole bending and pole straightening and marked changes in the athlete’s potential energy and kinetic energy of translation as the pole straightens (Hay, 1971).

All top vaulters use fibre glass poles selected to fit their weight, and employ hand holds and hand spreads to suit individual physiques. Metal poles are still used by novices since flexible poles are of little advantage below 3m or so. Technique varies with these different types but the fundamental swinging action can be learnt using a metal pole. Performances at major meetings well exceed the height of a double-decker bus, so that, mindful of the speed and precise timing required, it is easy to appreciate the risk involved in this event.

The approach run may induce muscle pulls if warm-up has been inadequate. Top vaulters tend to use an extensive routine of stretching exercises for muscles involved at the run-up, take-off, ascent and push off the pole. Keeping warm and supple at championships presents a unique problem in that competition may be drawn out for three, four or five hours or more. The muscles pulled in the build-up run tend to be hamstrings, adductors and, less frequently, the soleus and gastrocnemius. Bruising on the side of the leg can occur in inexperienced vaulters if the pole is persistently carried against it.

Breaking a pole during flight from the spectacular bend it gets is a nightmare of all vaulters. When this happens the athlete is usually fired out of control towards the landing beds. One of the dangers is of being impaled on the broken end. In the majority of cases he emerges physically unscathed after his nerve shattering experience.

If the drive at take-off is poor, momentum may be insufficient to carry the vaulter over the landing beds, in which case swinging back on the pole allows him to come down unharmed in a controlled fashion. A poor plant, badly coordinated take-off or a cross-wind may propel him against the uprights with resultant damage on contact. Severe injury can occur when the athlete pulls out without crossing the bar and just fails to contact the landing module on descent.

The back muscles contribute at take-off and need systematic development. In flight, abdominal muscles may be injured from the forceful contraction needed to reach the hanging position. Injury to the shoulder muscles can also occur from their involvement in the ascent. Chronic tendinitis of the rotator cuff muscles is sometimes found.

One of the obvious dangers on landing is of being hit by a dislodged crossbar. Minor or moderately severe sprains of the ankle or the extremities of the spine can occur if the landing is not flat, despite provision of energy absorbing materials. Bruises to the heel on landing may result in chronic soreness in schoolboys using poor landing beds even at moderate heights. Attention at all levels should be given to the security of uprights, the provision of landing mats conforming to competition requirements and the prevailing weather conditions. Storage and proper maintenance of poles will help ensure their integrity and grip for effective and safe performance.

The running and jumping events arguably provide the most glamorous competitions in the world of sport. The urge to emulate their athletic hero often urges ambitious runners and jumpers to step up dramatically their volume of training in the mistaken belief of a linear relationship between quantity of training load and quality of ensuing performance. In effect they pass the thin line separating training from straining and pay a severe penalty in incurring injury. A more cautious approach to increasing training load is advocated as well as the adoption of preventive measures in the conditioning regime. A conservative attitude is supported also when the danger signals of injury are first displayed. A reduction in training load and symptomatic control at this phase proves highly beneficial in the long term.

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