Osteoarthritis: Can It be Prevented?

Trent Nessler, PT, DPT, MPTArea Vice President -Champion Sports Medicine/Physiotherapy AssociatesCEO - Accelerated Conditioning and LearningUSA Cheer National Safety Council

LE Pathokinematics:

Osteoarthritis • WHAT IS IT• Degenerative changes of the

articular cartilage• Articular cartilage = Hyaline cartilage

and water• Covers surface of weight bearing

joints• Prevents bone on bone – oil in

piston• Common joints affected• Hip• Knee• Low back• Ankle• Wrist

Osteoarthritis • CAUSES (not all inclusive):• Diabetes – more prone• Post traumatic• Inflammatory diseases• Congenital • Hemophilia• Nutrition• Abnormal force attenuation• Shear stress• Dehydration

Hydration

• How does H2O help?– Walking chemical reaction – • Hydrogen needed to create optimal PH• Optimal PH means:

– Tissues heal better/faster– Increased hydration of Tissue• Increased extensibility/flexibility – withstand more

force before injury• Cartilage more hydrated – less fissures - withstand

more force

Hydration• Journal of Epidemiology (June 2002)

– Women who drink 5 glasses of water a day reduce potential for heart disease by 41%

– Men who drink 5 glasses of water a day reduce the potential for heart disease by 56%

– Nearly 50% of the American population is considered clinically dehydrated

• As little as 1% dehydration results in 10% decrease in performance

• Caffeine, diuretic and postulated to increase bone loss– Recommended daily dose 420 mg/day, average over 800-

1600 mg/day– For every 10 mg over, add 1 oz of H2O

• How do you know if you are hydrated enough?

HYDRATION CHART

Nutritional Considerations• Proper nutrition – certified sports

nutritionist• Basics

– Why?• Walking chemical reaction – have to give

proper nutrition/hydration to run smoothly

• Combined with hydration can have one of the largest impacts on your performance

• Muscles that are stronger resist more stress

– Small meals over course of the day (5-7) – include all food groups

– .5-1.0 g/protein per kg BW• BUN

– Supplementation with maturity

Pathokinematics• Decreased flexibility, balance and

strength add to:– Pathokinematics:

• Abnormal movement patterns• Can be the result of proximal or distal

components – Where does it start????

– Typical presentation of kinetic chain:• Shoulder depression, positional

thoracic scoliosis, lumbar sidebending, trendelenburg at hip, hip adduction, femoral internal rotation, knee genu valgum, and pes plantus

• Is it an issue - Mature adult– Increased risk or fear of falls - curbs– Difficulty with a/d stairs– Use of arms with sit/stand– Decreased endurance with

activities (mall/store)

In Action

Video 1: Floor View Video 2: Frontal View

Impact on……

• In the above example:– Impact of abnormal force attenuation• Pes plantus – plantar fascitis, Achilles tendonitis, stress

fractures, ankle s/s• Genu valgum/internal rotation – meniscal injuries,

ACL/MCL/LCL injuries, IT band friction syndrome, PF syndrome, DJD• Hip Adduction – piriformis syndrome, SI joint pain,

trochanteric bursitis, snapping hip, hip labral tears, DJD• Lumbar side bending – SI joint pain, low back pain,

spondo, facet syndrome, DJD

Pathokinematics

Causes and Tests• Tightness• Weaknesses• Muscular imbalances• Poor balance

References1. Ahmad, C.; Clark, M.; Heilman, N.; Schoeb, S.; Gardner, T; Levine, W. “Effect of Gender and

Maturity on Quadriceps to Hamstring Ration and Anterior Cruciate Ligament Laxity”. Am J Sports Med. 34:370-374, 2006.

2. Chappell, J. D., Yu, B., Kirkendall, D. T., and Garrett, W. E.: A comparison of knee kinetics between male and female recreational athletes in stop-jump tasks. Am. J. Sports Med. 30:261-267, 2002.

3. Chappell, J. D., Herman, D. C., Knight, B. S., Kirkendall, D. T., Garrett, W. E., and Yu, B.: Effect of Fatigue on Knee Kinetics and Kinematics in Stop-Jump Tasks. American Journal of Sports Medicine. 33:1022-1029, 2005.

4. Chaudhari, A. M., Hearn, B. K., and Andriacchi, T. P.: Sport-Dependent Variations in Arm Position During Single-Limb Landing Influence Knee Loading: Implications for Anterior Cruciate Ligament Injury. Am J Sports Med. 33:824-830, 2005.

5. Chmielewski, T; Myer, G; Kauffman, D; Tillman, S. “Plyometric Exercise in the Rehabilitation of Athletes: Physiological Reponses and Clinical Application”. JOSPT. 36:308-317, 2006.

6. Mandelbaum, B. R., Silvers, H. J., Watanabe, D. S., Knarr, J. F., Thomas, S. D., Griffin, L. Y., Kirkendall, D. T., and Garrett, W., Jr.: Effectiveness of a Neuromuscular and Proprioceptive Training Program in Preventing Anterior Cruciate Ligament Injuries in Female Athletes: 2-Year Follow-up. Am J Sports Med. 33:1003-1010, 2005.

References7. Myer G; Ford, K; McLean, S; Hewett, T. “The effects of plyometric versus dynamic

stabilization and balance training on lower extremity biomechanics”. Am J sports med. 34:445- 455, 2006.

8. Quatman, C; Ford, K; Myer, G; Hewett, T. “Maturation leads to gender differences in landing force and vertical jump performance”. Am J sports med. 34:806-813, 2006.

9. Sell, T; Ferris, C; Abt, J; Shen Tsai, Y; Myers, J; Fu, F; Lephart, S. “The effect of direction and reaction on the neuromuscular and biomechanical characteristics of the knee during tasks that simulate the noncontact anterior cruciate ligament injury”. Am j sports med. 34:43-54, 2006.

10. Westin, S; Galloway, M; Noyes, F; Corbett, G; Walsh, C. “Assessment of the lower limb neuromuscular control in prepubescent athletes”. Am j sports med. 33:1853-1858, 2006.

11. Westin,S; Noyes, F; Galloway, M. “Jump-land characteristics and muscle strength development in your athletes: A gender comparison of 1140 athletes 9 to 17 years of age”. Am j sports med. 34:375-384, 2006.

12. Withrow, T; Huston, L; Wojtys, E; Miller, J. “ The relationship between quadriceps muscle force, knee flexion, and anterior cruciate ligament strain in an in vitro simulated jump landing”. Am j sports med. 34:269-274, 2006.

Contact Information

Trent Nessler, PT, DPT, MPTArea Vice President – TN, AL, MSChampion Sports Medicine/Physiotherapy AssociatesTrent.nessler@physiocorp.com

www.aclprogram.com