LE Pathokinematics - OA Can It Be Prevented
Transcript of LE Pathokinematics - OA Can It Be Prevented
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 [email protected]
www.aclprogram.com