Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Footwear

Normal daily activities make considerable demands upon the feet, which are required constantly to support the entire body weight. These demands are far greater during sporting activities, and in most sports shoes are by far the most important item of clothing or equipment. Use the correct shoe for the purpose. A number of factors have to be considered when choosing sports shoes, including the proposed training program, the surface involved, the anatomy of the foot, previous injuries, and the requirements of the particular sport. Soccer players who are improving their fitness by running on asphalt, for example, should not wear cleated boots or shoes.

Shoe construction

The sole of the shoe determines the amount of shock absorption that the shoe provides, and thus a sports shoe should be constructed of layers with different properties. The out sole should insulate from cold and be water-repellent and hardwearing, as it is this surface that determines the durability of the shoe, and reduces the amount of friction against the playing surface.
The heel counter of a sports shoe should be made of a firm material, cover the whole of the heel area, and fit well around the heel. A well-fitting heel counter should give improved lateral stability, with restriction of the movements of the joints below the ankle. The construction of the shoe varies with the different sports.

Equipment design and standards

Rapid technical developments in the field of sports equipment have meant both advantages and disadvantages for athletes. Performance is improving at the expense of an increase in the risk of injury. Modern alpine skis and boots, for example, have contributed both to improved performance and to a changed pattern of injuries. The design of the ski boot is such that most injuries now occur not in the area immediately above the ankle but mainly at mid-shin level and especially at the knee joint. Technical developments have also contributed to better results in athletics, for instance in pole-vaulting, where a change in design and material has resulted in a change in the technique of vaulting and the achievement of greater heights.

When new equipment is being designed, medical opinion concerning its requirements should be sought at an early stage. This enables the designer to avoid errors that could lead to an unforeseen increase in the number of injuries. If there are obvious elements of risk, then safeguards should be incorporated into the equipment from the outset. A change in one type of equipment can affect the functioning of another: for example, the shape of a ski-boot sole markedly affects the functioning of the ski binding, and the openings in the face guard used by both goalkeepers and players in ice hockey should be adjusted with the design of ice-hockey sticks in mind.

 Protective equipment

Any protective device should prevent—or at least reduce—both long-term and short-term injuries to the part of the body for which it is designed. This is usually achieved by relieving the relevant part of the body of the full force of the impact and redistributing it over as large an area as possible. Protective equipment should not hamper the athlete’s activity or technique, although the human ability to adapt is considerable. There may be restrictions in movement when, for example, a guard is first being used, but the athlete’s adaptability will soon overcome any problems.

In many fields of sport there is no standard design or specification for protective equipment, so it is left to the individual athlete to evaluate its effectiveness. Poorly designed guards give a false sense of security which may have disastrous consequences.

Athletes and spectators alike often have preconceived ideas of what athletes should wear. If this attitude can be changed by enlightened and objective information, the use and range of protective clothing could be increased with a corresponding reduction in the number of injuries suffered.

Helmets

Safety helmets are used by boxers, American football players, lacrosse and ice hockey players, cyclists, riders, alpine skiers, and racing drivers. Different sports have specific safety and design requirements relating to helmets, but the principles are generally similar for those used in ice hockey, cycling, riding, and American football. Considerably higher safety standards have to be met by the helmets used in alpine skiing and motor racing, because of the potentially much greater speeds of impact in these sports.

The head must be protected from contact with other players, the ground and surrounding objects, and from blows from sticks, pucks, or balls. Safety helmets are usually made of a hard outer shell separated from the skull by a softer lining.When the helmet is subjected to a violent impact the energy is transferred to the softer lining. In some helmets, e.g. ice hockey helmets, the outer shell is semisoft, and can be partially deformed without coming into direct contact with the skull. The force of the impact is moderated by the change of shape and the remaining energy is both distributed over a larger area because of the soft lining of the helmet and further moderated when the lining is compressed.

For a protective helmet to fulfill its task properly, it must be fastened securely so that it does not fall off or fall down in front to block the player’s vision.

Bicycle helmets

There are about a thousand fatal bicycle accidents in the USA each year; half of these deaths occur in children and adolescents, and most of the victims do not wear helmets. Some studies have indicated that bicycle helmets can reduce the risk of head injuries by 85%.

Face Guards

Face guards are used by players of American football and youth hockey, by goalkeepers in ice hockey, and by fencers, cricketers, and alpine skiers. Facial injuries can occur as a result of a blow from a stick, puck, or ball, or through collision with surrounding objects or other players. It is essential that face guards are designed with due regard for the shape and size of the equipment used in the sport concerned. Standards have been laid down for the design of face guards for ice hockey and American football players.A visor, made of Plexiglass (Perspex), covers the upper half of the face and serves mainly to protect against injuries to eyes, nose, and temple bones. A mask made of steel wire covers the whole or part of the face, and protects against eye injuries, fractures of facial bones, cuts and gashes to the face, and dental damage. Protective eye frames or glasses are essential for squash and other racket sports. Ski goggles are valuable protectors against snow, sun, and wind.

Gum shields

Dental injuries are serious and expensive and can present a great problem, particularly in contact sports such as rugby, boxing, ice hockey, and American football. As the loss of a tooth can influence the development of the jawbone and maxillary bone, a dental injury must be considered more serious in a young, growing athlete than in an adult. In boxing it is compulsory to use gum shields (mouth guards), which may be designed in one of two ways. An intraoralgum shield is made from a cast of the upper teeth and is worn inside the mouth, while an shield is worn in front of the mouth. The surest protection against dental injuries is probably using both types of protection in combination.Standards for extraoral gum shields have been established.

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