Pediatric Neuromechanics and Sports Medicine · 2017. 11. 8. · 3rd Annual MARC Symposium –...

3rd Annual MARC Symposium

November 3-4, 2017

Pediatric Neuromechanics

and Sports Medicine

Samuel Merritt University

Motion Analysis Research Center

400 Hawthorne Avenue, Suite 101

Oakland, CA 95609

www.samuelmerritt.edu/marc

We gratefully acknowledge the generous

sponsorship of the following companies:

Copyright @ 2017 Samuel Merritt University. All rights reserved.

3rd Annual MARC Symposium – November 3 & 4, 2017

Page 1

Table of Contents

WORKSHOPS .................................................................................................................................5

TUTORIALS .................................................................................................................................11

KEYNOTE ADDRESSES .............................................................................................................19

ORAL PRESENTATIONS ............................................................................................................29


Page 2

WELCOME

On behalf of the Organizing Committee of the 3rd Annual MARC Symposium and Samuel

Merritt University, we heartily welcome you to our symposium. This year, the themes are

Pediatric Neuromechanics & Sports Medicine and are very fortunate have three outstanding

Keynote Speakers: Richard Bouché, DPM, Irene Davis, PhD, and Russell Volpe, DPM.

Over the two days of the symposium, we hope that you will take every opportunity to interact

with speakers and other participants to make this a truly enriching experience. It has been our

sincere pleasure to have organized this annual event and we look forward to spending time with

you.

Organizing Committee

Cherri Choate, DPM

California School of Podiatric Medicine, Samuel Merritt University

Timothy Dutra, DPM, MS

California School of Podiatric Medicine, Samuel Merritt University

Kate Hayner, EdD, OTR/L

Director, Department of Occupational Therapy, Samuel Merritt University

Stephen Hill, PhD

Assistant Professor and Laboratory Manager, Motion Analysis Research Center, Samuel Merritt

University

Preeti Nair, PhD, PT

Department of Physical Therapy, Samuel Merritt University

Alejandro Rodriguez

Associate Director of Advertising and Marketing, Samuel Merritt University

Drew Smith, PhD

Professor and Director, Motion Analysis Research Center, Samuel Merritt University

Sasha Solomonov

Associate Director of Social Media and Web Content, Samuel Merritt University


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Page 4

8:15

Time Session Location Moderator(s)

10:00

12:00


3:00

4:30

4:45

MARC Dr. Robert Baker

Gait Retraining: A Biomechanical Approach to Running

InjuriesBechtel Dr. Irene Davis

Break

1:00

2:00

Wine and Cheese Reception (Sponsored by C-Motion, Inc)

Day Wrap-Up - Bechtel Room

3:30

Maximizing opportunities for health sciences

students in faculty-led researchBechtel

Dr. Stephen Hill

Dr. Tim Dutra

Acquired PES Valgus in the Pediatric Patient:

Assessment and a Paradigm for Clinical Decision

Making

Bechtel Dr. Russell Volpe

Welcome

Friday, November 3, 2017

Morning Session

Tutorials (60-hr duration)

Workshops and Tutorials

8:30

Break

10:30

Afternoon Session

Lunch (Sponsored by Qualysis North America)

Workshops (90-min duration)

Provocative Testing for Common Foot, Ankle, and Leg

Disorders in the AthleteDr. Richard BouchéBechtel

Biomechanics of Iliotibial Band Syndrome


Page 5

WORKSHOPS


Page 6

PROVOCATIVE PHYSICAL EXAMINATION MANEUVERS FOR COMMON PATHOLOGIES OF

FOOT, ANKLE & LEG

Richard Bouché

Seattle, WA

Email: [email protected]

PURPOSE:

-Appreciate lack of emphasis & training on clinical evaluation skills- “the lost art of physical examination”

-Identify helpful physical examination maneuvers for common problems affecting the foot, ankle & leg that one would

likely encounter in a busy clinical practice

-Develop skills to perform these maneuvers & appreciate their significance

-Know what diagnostic tests you would get to validate your clinical suspicion(s)

CLINICAL SIGNIFICANCE

-Increased clinical awareness by linking key maneuvers to specific pathologies

-Improved diagnostic skills by performance & discussion of these maneuvers

-Stimulate further study & research

LEARNING OUTCOMES

By the end of this workshop, participants will learn the following:

1. Learning outcome 1.



OUTLINE

Template for each pathology will include the following:

-Problem: common name (include AKAs & eponyms)

-Notes: clinical background information

-Provocative Tests: specific physical examination test(s) that help validate or suggest diagnosis

-Pearls: key insights concerning provocative tests

-Discussion: share what you know


Page 7

FOOT:

CCS of Foot

Os Navicularis Diastasis

Navicular Stress Fx

Midfoot Sprains

Lesser MTPJ Instabilities (Sagittal &/or Transverse

Plane)

Digital Deformities

Posterior Heel Pain- Zone 2 or Insertional Achilles

Tendinopathy

Plantar Heel Pain

Hallux Rigidus

Hallux Abducto Valgus w/ Bunion

Hallux Varus (Adductus)

Cavus Foot

Flatfoot

Supinated vs. Pronated Foot

Inverted Heel

Hallucal Sesamoidopathy

Anterior Tibial Tendinopathy:

-Insertional Tendinopathy

-Partial or Total Rupture

Anterior Tarsal Tunnel

Tarsal Tunnel- Proximal & Distal

SPN (MDCN & IDCN) Neuropathies

5th Metabase Fxs- Zones 1-3

Hallucal Sesamoidopathy

Accessory Bones

Accessory Muscles

Peroneal Tendinopathy- Zones 2 & 3

Stress Fractures

Tarsal Coalition

Deep Flexor Tendinopathies: PT, FDL & FHL

Neuroma (vs. Metatarsalgia vs. MTPJ Instability vs.

Lateral MF

Pain: Anterior Calcaneal Process Fx vs. Sprain vs.

Accessory

Bone vs. Arthropathy vs. Sinus Tarsi Syndrome

vs. Tarsal

Coalition vs. Cuboid Syndrome vs. Zone 2

Peroneal

Tendinopathy vs. Short/Long Plantar Ligament vs.

Lateral

Fascial Band vs. EDB Muscle)

STJ Instability

ANKLE:

Accessory Bones

Achilles Tendinopathy Zone 1 (Non-Insertional)

Achilles Rupture Ankle Fracture

Accessory Bones

Ankle Equinus

Acute/Subacute Ankle Sprain

Ankle Impingement- Anterior

Ankle Impingement-Posterior

Ankle Syndesmosis (high ankle sprain)

Ankle Sprain (growth plate in children & adolescents)

Ankle Subluxation/Dislocation

Basketball Foot (STJ Subluxation/Dislocation)

Chronic Ankle Instability

Chronic Ankle Arthralgia

Peroneal Tendinopathy- Zone 1

Posterior Tibial Tendinopathy (PTTD, Adult Acquired

Flatfoot)

Posterior Ankle Impingement

Snowboarder’s Ankle

SPN Neuropathy

Talar Dome (chondral vs.osteochondral)

Tarsal Tunnel- Proximal

LEG:

Accessory Muscles

CCS Leg

Chronic Muscle Soreness

Claudication Sydromes (PAES, IFAE, SFA)

CPN (Deep & Superficial PN) Neuropathies

Superifical & Deep Vein Thrombosis (SVT & DVT)

Maisonneuve Fracture

Muscle Strain (Tennis Leg)

MTSS (Tibial Fasciitis)

Neoplasm- Bone & Soft Tissue

Stress/Insufficiency Reaction/Fracture

Saphenous Neuropathy

Tibial Neuropathy

Venous Insufficiency

DISCLOSURE STATEMENT

The author report that there are no conflicts of interest to disclose.


Page 8

BIOMECHANICS OF ILIOTIBIAL BAND SYNDROME

Robert L. Baker, PT, PhD, MBA, OCS Clinical Assistant Professor, Samuel Merritt University, MARC


INTRODUCTION

Iliotibial band syndrome (ITBS) continues to evolve in the understanding of kinematic and kinetic influences. The

research has progressed through static measures, anatomical debates, and pathological kinematics.[1,2] Gender issues

have been identified.[3,4] The foot and ankle may have smaller subset contributions.[5] But the hip seems to dominate

as the focus of attention in understanding the neuromuscular factors. This presentation will cover the literature review

and research trends in studying ITBS. Illustrations and animations will be presented. The deep fascia will also be

discussed as an area of study related to ITBS. [6-8]


The clinical significance is a detailed review of kinematic issues related to ITBS for the legs and trunk. Kinetic factors

are discussed with practical biomechanics considerations. The interpretations will bridge theoretical biomechanics

and clinical treatment. Trends in analyzing fascial and movement will be discussed with clinical approach described

and illustrated. Corrective exercises will be illustrated, as related to biomechanical factors.

LEARNING OUTCOMES

By the end of this tutorial, participants will learn the following:

1. Understand the two kinematic issues in the hip and knee related to ITBS, with gender considerations.

2. Appreciate the research trends in pathological kinematics and ITBS.

3. Implement a strategic approach to manual therapy and motor control exercises when treating ITBS.

OUTLINE

I. ITBS theory

A. Epidemiology

B. Static correlates

C. Anatomical discussions

D. Pathophysiology of impingement

E. Kinematic factors

F. Kinetic factors

G. Fascial considerations

II. Research Trends

A. Gaps in kinematic theory: (Trunk-Hip, Gender-Kinematic, Knee)

B. EMG considerations

C. Flexibility factors

D. Muscle strength factors

E. Strain rate

F. Deep fascia influence on pain and activation

G. Foot and ankle factors

III. Treatment guidelines

A. The gluteus medius strengthening and flexibility model

B. Fascial manipulation


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C. Exercise tweaks

ASSESSMENT OF LEARNING

Tutorial evaluations will be used to gather feedback for quality improvement.

REFERENCES

1. Baker RL, Fredericson M. Iliotibial Band Syndrome in Runners: Biomechanical Implications and Exercise

Interventions. Phys Med Rehabil Clin N Am 2016;1:53-77. doi: 10.1016/j.pmr.2015.08.001.

2. Baker RL, Souza RB, Fredericson M. Iliotibial band syndrome: soft tissue and biomechanical factors in evaluation

and treatment. PM R 2011;6:550-61.

3. Noehren B, Davis I, Hamill J. ASB clinical biomechanics award winner 2006 prospective study of the

biomechanical factors associated with iliotibial band syndrome. Clin Biomech (Bristol, Avon) 2007;9:951-

6.

4. Noehren B, Schmitz A, Hempel R, et al. Assessment of strength, flexibility, and running mechanics in men with

iliotibial band syndrome. J Orthop Sports Phys Ther 2014;3:217-22.

5. Messier SP, Edwards DG, Martin DF, et al. Etiology of iliotibial band friction syndrome in distance runners. Med

Sci Sports Exerc 1995;7:951-60.

6. Stecco A, Gilliar W, Hill R, et al. The anatomical and functional relation between gluteus maximus and fascia lata.

J Bodyw Mov Ther 2013;4:512-7. doi: 10.1016/j.jbmt.2013.04.004. Epub 13 May 11.

7. Stecco C, Stern R, Porzionato A, et al. Hyaluronan within fascia in the etiology of myofascial pain. Surg Radiol

Anat 2011;10:891-6. doi: 10.1007/s00276-011-0876-9. Epub 2011 Oct 2.

8. Eng CM, Arnold AS, Lieberman DE, et al. The capacity of the human iliotibial band to store elastic energy during

running. J Biomech 2015;12:3341-8. doi: 10.1016/j.jbiomech.2015.06.017. Epub 15 Jun 27.


Robert L. Baker, PT, PhD, MBA, OCS has no financial disclosures or conflict of interest with the material presented

in this workshop. The illustrations and animations are original productions. Some of the illustrations and animations

were presented at the AAPMR Annual Conference, PMR Journal, and PMR Clinics of North America.


Page 10

8:15


10:00

12:00


3:00

4:30

4:45

MARC Dr. Robert Baker

Gait Retraining: A Biomechanical Approach to Running

InjuriesBechtel Dr. Irene Davis

Break

1:00

2:00

Wine and Cheese Reception (Sponsored by C-Motion, Inc)

Day Wrap-Up - Bechtel Room

3:30

Maximizing opportunities for health sciences

students in faculty-led researchBechtel

Dr. Stephen Hill

Dr. Tim Dutra

Acquired PES Valgus in the Pediatric Patient:

Assessment and a Paradigm for Clinical Decision

Making

Bechtel Dr. Russell Volpe

Welcome

Friday, November 3, 2017

Morning Session

Tutorials (60-hr duration)

Workshops and Tutorials

8:30

Break

10:30

Afternoon Session

Lunch (Sponsored by Qualysis North America)

Workshops (90-min duration)

Provocative Testing for Common Foot, Ankle, and Leg

Disorders in the AthleteDr. Richard BouchéBechtel

Biomechanics of Iliotibial Band Syndrome


Page 11

TUTORIALS


Page 12

GAIT RETRAINING: A BIOMECHANICAL APPROACH TO RUNNING INJURIES

Irene S. Davis, PhD, PT, FACSM, FAPTA, FASB

Spaulding National Running Center, Harvard Medical School


INTRODUCTION

This tutorial will first review established mechanics associated with running injuries. Then it will describe the

components of a program designed to design a new motor skill. Finally, the application of this approach to a patient

population will be presented.


Chronic running injuries are often associated with underlying faulty mechanics that fail to be addressed.

LEARNING OUTCOMES


1. Describe mechanics associated with common running injuries.

2. Describe the components of a motor retraining program.

3. Describe the implementation of a gait retraining program for injured runners.

OUTLINE

1. Can/Should Gait Really be Retrained?

2. Faulty Mechanics

a. Alignment - common malalignments

b. Loading – excessing impact loading

c. Association of faulty alignment and excessive loading with injury

3. Gait Retraining

a. Motor Control Principles

b. Altering Faulty Alignments

c. Altering Excessive loading – FFS vs. Cadence

4. Integrating Gait Retraining in the Clinic

REFERENCES

1. Davis, IS and Futrell, E (2016). Gait Retraining: Altering the Fingerprint of Gait. Physical Medicine and

Rehabilitation Clinics of North America, Feb;27(1):339-55.

2. Willy, RW, Scholz, JP and Davis, IS. (2012). Mirror gait retraining for the treatment of patellofemoral pain in

female runners. Clinical Biomechanics 27(10):1045-51.

3. Cheung, RT and Davis, IS (2011). Landing pattern modification to improve patellofemoral pain in runners: a

case series. Journal of Orthopedic and Sports Physical Therapy, 41(12):914-919.

4. Crowell, HP and Davis, IS (2011). Gait retraining to reduce lower extremity loading in runners. Clinical

Biomechanics, 26(1):78-83.

5. Noehren, BM, Scholz, JP and Davis, IS. (2011). The effect of real-time gait retraining on hip kinematics pain and

function in subjects with patellofemoral pain syndrome. British Journal of Sports Medicine, 45:691-696


No disclosures


Page 13


Page 14

MAXIMIZING OPPORTUNITIES FOR HEALTH SCIENCES STUDENTS IN FACULTY-LED

RESEARCH

Stephen W. Hill PhD1 and Timothy Dutra, DPM2

Podiatry Students2: Brian Kuklok, Jeffrey Tucci, Lance Hopkin, Avery Garner, Isaac Wilhelm, Emily Khuk, Lowell

Tong, Caroline Ko 1Motion Analysis Research Center, Samuel Merritt University; 2California School of Podiatric Medicine

Samuel Merritt University


INTRODUCTION

A thesis project is a key element of many research-focused graduate programs, which serve to train the next generation

of professors and researchers (1). Biomedical research graduate school training focuses on cultivating sophisticated

scientific skills through the production of substantial original published research (2). Engaging healthcare profession

students in research can inspire their interest in evidence-based clinical practice, and enhance their healthcare decision-

making (3). Some differences between these two groups of students include their focus, future plans, and time

available in their curriculum to be involved in the research. The benefits of providing health sciences students the

opportunity to contribute to research include insights from their clinical training perspective, their time and effort,

enthusiasm and ability to learn new information and apply it to the project.


Completing the volume of work involved in research benefits from the assistance provided by students who can

develop the skills and knowledge to perform specific components of a study. Experience with quantitative

measurement of human performance in the laboratory may provide the future clinician with insights relevant for

clinical decision-making. As a member of a research team, the student may gain greater appreciation for

interdisciplinary work, and be prepared to incorporate technology and new knowledge in future clinical practice.

Hopefully some of these aspiring clinicians will be inspired to become at least part-time researchers.

LEARNING OUTCOMES


1. Benefits of providing research opportunities for students training as healthcare professionals.

2. Some ways to maximize research opportunities for these students.

3. Some examples of on-going research in the Motion Analysis Research Center (MARC) at Samuel Merritt

University.

OUTLINE

Introduction:

An overview of some aspects of including students training as healthcare professionals on research teams

Examples:

An overview of some examples of research projects here in the MARC involving these students.

Student presentations:

Pilot studies conducted in the third-year biomechanics rotation at the California School of Podiatric Medicine

ASSESSMENT OF LEARNING (Optional)

Please feel free to ask questions during the tutorial, or follow up via email: [email protected]

REFERENCES

1. Austin A (2002) Preparing the Next Generation of Faculty. The Journal of Higher Education, 73.1 (2002)

94-122.

2. Hall J, O’Connell A, Cook J (2017) Predictors of Student Productivity in Biomedical Graduate School

Applications. PLOS ONE 12(1): e0169121. https://doi.org/10.1371/journal.pone.0169121.


Page 15

3. Weiss J (2009) Broadening Horizons: Engaging Advanced Practice Nursing Students in Faculty Research.

Nurse Educator, Vol. 34, No. 2, pp. 75-79


The authors report that there are no conflicts of interest to disclose.


Page 16

ACQUIRED PES VALGUS IN THE PEDIATRIC PATIENT:

ASSESSMENT AND A PARADIGM FOR CLINICAL DECISION MAKING

Russell G. Volpe,, DPM

New York College of Podiatric Medicine


INTRODUCTION

Acquired pesvalgus in the pediatric patient is a common and complex condition, It has multiple etiologies many of a

multi-factorial biomechanical nature. Compensations for deformities in the cardinal body planes are among the causes

of this frequently encountered clinical entity.

The clinician must acquire an understanding of the impact this condition may have on activity level, function and

quality of life. In addition to understanding the subtle ways in which this deformity may manifest, the clinician must

appreciate what epidemiologic, demographic, structural and radiographic findings best predict risk and progression to

greater disability and dysfunction.

Finally, guidelines for evaluating the patient to determine these risk factors are presented.


Many pediatric patients with this condition present for evaluation when they are asymptomatic or pre-symptomatic

and the clinician must comprehensively evaluate the child for structural and functional deficits resulting from the foot

pathology to determine what recommendations to make to parents and when to initiate treatment.

LEARNING OUTCOMES


1. Understand the potential issues, and functional deficits, for the child with asymptomatic, acquired pes valgus

2. Learn to distinguish non-physiologic from physiologic pes valgus

3. Learn those clinical exam findings, structural risk factors and radiologic findings, which correlate with functional

deficit and likelihood of progressing to symptoms.

4. Introduce a flatfoot clinical paradigm to determine when treatment is indicated

OUTLINE

Clinical significance of pediatric acquired pes plano valgus:

• Consequences

• Functional deficit

Criteria for non-physiologic designation

Functional limitation

• Reduced motor performance in ADL

• Correlation with heel valgus

• Role of gender and BMI

Predictors for progression to symptomatology

• Gender

• Transverse knee alignment

• Transverse tibial alignment

Predictive findings on imaging

• Talonavicular coverage

• Lateral talar-first metatarsal angle

• Lateral talo-calcaneal angle

Flatfoot Clinical Pathway (Proforma)

• History

• Symptom profile


Page 17

• Functional limitations

• Physical findings

o BMI

o Foot/Ankle

▪ Arch height

▪ Heel valgus

▪ Heel inversion on toe rise

▪ RCSP

▪ Navicular height

▪ Sagittal ankle ROM

o Superstructure (leg)

o Dynamic parameters

Decision to treat or not

• Integrate all factors above and make informed recommendations

REFERENCES

1. Pediatric Flexible flatfoot: Clinical Aspects and Algorithmic Approach”: Halabachi, F et al. Iranian Journal of

Pediatrics, Volume 23, No. 3, June, 2013

2. “Health-related Quality of Life in Children with flexible flatfoot: A cross-sectional study”: Kothari, A et. Journal of

Child Orthopedics, Volume 8, 2014

3. “Pediatric Pes Planus: A State of the Art Review”: Carr, J et al. Pediatrics, Volume 137 (3), March, 2016

4. “Diagnosis of Flexible Flatfoot in Children: A Systematic Clinical Approach”: Benedetti M et al., Orthopedics,

Volume 34, No 2, February 2011

5. “The Pediatric flatfoot proforma (p-FFP): improved and abridged following a reproducibility study”: Evans, AM et

al. Journal of Foot and Ankle Research, Volume 2, Number 25, 2009

DISCLOSURE STATEMENT: The authors report that there are no conflicts of interest to disclose.


Page 18

8:15

Time Speaker

8:30 Irene Davis

Time Speaker9:20 Derek Yang

9:45 Gerwyn Hughes

10:10

Time Speaker

10:30 Neeraj Baheti

10:55 Neeraj Baheti

Time Speaker11:20 Richard Bouché

12:05

Time Speaker

12:50 Russell Volpe

Time Speaker

1:35 Stephen Hill

2:00 Stephanie Tine

2:25 Drew Smith

2:50

EMG of lower extremity muscles with iWalk hands free

crutch versus axillary crutches

Bridging the gap: bringing motion analysis technology to

the clinic

Closing Remarks (10-min)

Video Gait Analysis of Common Pediatric Foot and Ankle

Conditions - Before and After Treatment

Theme: TBA (20-min +5-min QA) Moderator:

Title

Maximalist Shoe Study Report

Exercise-Related Leg Pain in the Athlete - What's New?

Lunch (45-min)Afternoon Session (Bechtel Room)

Keynote Address (40-min + 5-min QA)

Title


Break (20-min)Theme: TBA (20-min +5-min QA) Moderator:

Title

The relationship between upper limb anthropometry and

maximum jump height

Inter-rater reliability of 2D motion analysis for running


Title

Title

Using motion analysis with the cutting and pivoting

athlete

Comparing males and females for effect of fatigue on

quadriceps and hamstrings isokinetic strength profile in

post-op ACL reconstruction patients

Title

The Path to Strong, Healthy Feet

Saturday, November 4, 2017Presentations

Morning Session (Bechtel Room)

Welcome Address: Keynote Address (40-min + 5-min QA)


Page 19

KEYNOTE ADDRESSES


Page 20

KEYNOTE SPEAKERS

Dr. Richard Bouché Richard Bouché, DPM, is a SMC podiatrist who specializes in lower

extremity sports medicine and foot & ankle surgery. He has been in

practice in the Seattle area now for 34 years. He is a fellow in the

American College of Foot & Ankle Surgeons and is Board Certified by the

American Board of Foot & Ankle Surgery in 1986 and recertified in 1996.

He presently serves as Special Editor (in Sports Medicine) for the Journal

of Foot & Ankle Surgery and is a 30+ year member of the American

College of Sports Medicine and fellow & past president of the American

Academy of Podiatric Sports Medicine. Dr. Bouché serves on the

residency training committee for the Northwest Podiatric Surgical

Residency Program at Swedish Hospital. He also serves on the SMC

Executive Committee as Chief of Podiatric Medicine & Surgery. He has

special interests in use of extracorporeal shockwave therapy for chronic

tendon problems, exercise-related leg pain, posterior heel pain, lesser

MTPJ instability and sesamoid disorders of the great toe joint. Present

research interests include: new surgical procedures for chronic

sesamoidopathy of great toe joint, plantar plate repair for lesser MTPJ

instability, conservative & surgical treatment for 5th metatarsal base

fractures, chronic muscle soreness (new undescribed leg disorder), running

in active/athletic patients w/ 1st MTPJ fusion.

Dr. Irene Davis Dr Irene Davis is the founding Director of the Spaulding National Running

Center, Department of Physical Medicine and Rehabilitation, Harvard

Medical School. She received her Bachelor's degree in Exercise Science

from the University of Massachusetts, and in Physical Therapy from the

University of Florida. She earned her Master’s degree in Biomechanics

from the University of Virginia, and her PhD in Biomechanics from

Pennsylvania State University. She is a Professor Emeritus in Physical

Therapy at the University of Delaware where she served on the faculty for

over 20 years. Dr. Davis’ research has focused on the relationship between

lower extremity structure, mechanics and injury. Her interest in injury

mechanics extends to the development of interventions to alter these

mechanics through gait retraining. She is interested in the mechanics of

barefoot running and its effect on injury rates and is a barefoot runner

herself. Along with gait analysis, her research encompasses dynamic

imaging and modelling. She has received funding from the Department of

Defense, Army Research Office and National Institutes of Health to

support her research related to stress fractures. Dr. Davis has given nearly

300 lectures both nationally and internationally and authored over 100

publications on the topic of lower extremity mechanics during running.


Page 21

Dr. Russell Volpe

Dr. Russell Volpe is a Professor, and Past Chair, in the Department of

Pediatrics and Orthopedics at the New York College of Podiatric

Medicine/Foot Center of New York, where he has taught since 1985. He

was founding Chair of the Department of Pediatrics from 1993-2006. Also,

he was on the Adjunct faculty of the California School of Podiatric

Medicine at Samuel Merritt University from 2003-2008 and he served as

Medical Consultant to Langer Biomechanics, Inc. from 1992 to 2002. He

is a Diplomate of the American Board of Podiatric Medicine since

1988. Dr. Volpe is co-editor, with Peter Thomson, of Introduction to

Podopediatrics, 2nd edition published in 2001 by Elsevier. Dr. Volpe is a

member of the Vasyli Think Tank which was founded to foster

collaboration and cooperative thought amongst a leading group of health

professionals specializing in the field of lower limb biomechanics. Dr.

Volpe is on the editorial advisory board of Podiatry Today magazine. He

writes articles regularly on the child’s foot and contributes an occasional

blog on topics of interest in podiatric medicine for the magazine. He serves

as a reviewer on Pediatrics topics for the Journal of the American Podiatric

Medical Association.


Page 22

THE PATH TO STRONG, HEALTHY FEET

Irene S. Davis, PhD, PT, FACSM, FAPTA, FASB

Spaulding National Running Center, Harvard Medical School


INTRODUCTION

This presentation will discuss the complex anatomy

and multiple functions of our feet. It will review how

footwear has negatively impacted our feet. Finally,

ways of increasing and maintaining foot strength and

foot health will be presented.


Foot-related pathology is extremely common and

often related to deconditioning of our feet.

LEARNING OUTCOMES

By the end of this tutorial, participants will learn the

following:

1. The complex anatomy and multiple functions of

the foot.

2. How footwear has negatively impacted our feet.

3. A foot strengthening program to improve foot

health.

OUTLINE

1. Evolutionary Perspective of our feet

a. Born to run

b. Foot development

c. Mismatch Theory of Evolution

2. Foot Core Concept

a. Components of Foot Core

b. Assessment of Foot Core

c. Treatment of Foot Core

3. Footwear Matters

a. History of Footwear

b. Characteristics of Footwear

c. Mechanics associated with

Footwear

4. Integrating Foot Core and Footwear for

Strong Healthy Feet

REFERENCES

1. Bowser, BJ, Rose, WC, McGrath, RL, Salerno,

JM, Wallace, JF and Davis, IS (2017). Effect of

footwear on dynamic balance during single leg

jump landings. International Journal of Sports

Science (in press).

2. Davis, IS, Rice, HM and Wearing, SC (2017).

Why forefoot strike running in minimal shoes

might positively change the course of running

injuries. Journal of Sport and Health Sciences (in

press).

3. Chen, TL, Sze, LKY, Davis, IS, Cheung, RT,

(2016). Effects of training in minimalist shoes on

the intrinsic and extrinsic foot muscle volume.

Clinical Biomechanics, Jul;36:8-13.

4. McKeon, PO, Hertel, J, Bramble, D, and Davis I

(2015). The foot core: A new paradigm for

understanding instrinsic foot function. British

Journal of Sports Medicine, 49(5):290.

5. Samaan, CD, Rainbow, MJ, and Davis, IS (2014).

Reduction in ground reaction force variables with

instructed barefoot running. Journal of Sport and

Health Science, 3(2)143-151.


No disclosures


Page 23


Page 24

EXERCISE-RELATED LEG PAIN IN THE ATHLETE - WHAT'S NEW?

Richard Bouché DPM

Seattle, WA


INTRODUCTION

This presentation will provide a brief but

comprehensive overview of exercise-related leg pain

(ERLP) emphasizing problems most likely to be

encountered by the sports medicine health

professional.

When encountering a patient with ERLP, a systematic

evaluation should be performed to determine a

definitive or tentative diagnosis. This is accomplished

by obtaining a complete history, performing a

thorough static & dynamic lower extremity physical

examination (NOT just of foot & ankle) and obtaining

appropriate diagnostic studies to complement the

history and physical examination.

Common causes of ERLP should be considered first,

followed by uncommon & rare causes. Subtle

traumatic or atypical causes should also be considered

especially if the leg problem defies diagnosis. Atypical

causes can simulate sports related leg pain and include:

infections, systemic conditions, upper/lower motor

neuron lesions, neoplasms, rheumatic conditions, pain

dysfunction syndromes, dermatologic conditions,

superficial/deep vein thrombophlebitis, etc. Drug-

induced leg pain should also be considered. Once a

diagnosis has been firmly established, a specific

treatment plan can be initiated. A multidisciplinary

"team" approach to leg problems is most efficient and

highly recommended. If the diagnosis is in doubt

and/or initial treatment is unsuccessful, consultation

should be considered.

PURPOSE

-Present general classification

-Review current thinking on ERLP

-Highlight what you need to know for common

& popular problems you will likely encounter

-Introduce new leg pain diagnosis- “chronic muscle

soreness”

-Discuss differential diagnosis tables and other

handouts (e.g., Drug-Induce Leg Pain)


-Increase awareness of EILP

-Improve ability to differentiate common &

uncommon pathologies based on history & physical

examination

-Know testing procedures that will aid in validation of

your diagnosis

-Be familiar with definitive tx options

-Stimulate further study & research



Page 25


Page 26

VIDEO GAIT ANALYSIS OF SELECT COMMON PEDIATRIC FOOT AND

ANKLE CONDITIONS – BEFORE AND AFTER TREATMENT

Russell G. Volpe, DPM

New York College of Podiatric Medicine


INTRODUCTION

Observational, lower extremity gait analysis is an

important diagnostic assessment tool in clinical

practice. Assessment of gait provides a dynamic

companion to the static examination enabling the

clinician to formulate a complete picture of the child.

Several cases of common pediatric foot and ankle

conditions will be presented with video gait analysis.

Gait findings before and after treatment will be

reviewed. Other concepts related to observational gait

analysis of the child’s foot and lower extremity will be

discussed


The clinician evaluating the lower extremities of

children should be able to identify levels of deformity

and deviations from the normal during gait analysis.

With enhanced skill at identifying deviations from the

normal, a more targeted diagnosis is reached and

treatment facilitated. Subsequent gait analysis allows

for comparison of pre and post-treatment parameters

and serves as an important outcomes measure of

success at normalizing age-appropriate gait.

METHODS

Real-time and slow-motion Dartfish video gait

analysis of select (in-toe gait, low-tone, developmental

delay pes valgus and toe walking) will be presented

highlighting deviations from the normal in each of the

cardinal body planes. Phasic and other changes easily

identified in the observation of gait will be discussed

to illustrate the clinically significant abnormalities

associated with each deformity.

RESULTS

Podopediatric treatments appropriate for each of the

common gait abnormalities will be described and

discussed.

Each patient presented on diagnosis will be

subsequently analyzed in gait after podiatric pedal

treatments have been prescribed and dispensed.

Comparison and outcomes associated with these

treatments will be highlighted and discussed.

DISCUSSION

The importance of skilful analysis of the child’s gait to

identify deviations from the normal will be

emphasized. Comparison of gait video after treatment

will be used to illustrate the effectiveness of optimum

podopediatric interventions and resultant relative

normalization of the post-treatment gait.

REFERENCES

1. “Torsional profile versus gait analysis:

Consistency between the anatomic torsion and the

resulting gait pattern in patients with rotational

malalignment of the lower extremity”: Radler C,

Kranzl, A et al; Gait and Posture 32 (2010) 405-

410

2. “Effect of foot orthoses on the medial longitudinal

arch in children with flexible flatfoot deformity:

A three-dimensional moment analysis”;

Jafarnezhadegro A, Shad M et al; Gait and

Posture 55 (2017) 75-80

3. “An Analysis of Relative Gait Impairment in

Commonly Diagnoses Pediatric Conditions”;

Litrenta, J, Gorton G, et al; Journal of Pediatric

Orthopedics, 2016

4. “Simulated Ankle Equinus Affects Knee

Kinematics During gait”: Drefus, L, Hafer J et al;

HSS Journal, 12: 2016, 39-43

5. “Automated event detection algorithms in

pathologic gait”: Bruening D, Ridge S; Gait and

Posture 39 (2014) 472-477


The author reports that there are no conflicts of interest

to disclose.


Page 27


Page 28

8:15

Time Speaker

8:30 Irene Davis

Time Speaker9:20 Derek Yang

9:45 Gerwyn Hughes

10:10

Time Speaker

10:30 Neeraj Baheti

10:55 Neeraj Baheti

Time Speaker11:20 Richard Bouché

12:05

Time Speaker

12:50 Russell Volpe

Time Speaker

1:35 Stephen Hill

2:00 Stephanie Tine

2:25 Drew Smith

2:50

EMG of lower extremity muscles with iWalk hands free

crutch versus axillary crutches

Bridging the gap: bringing motion analysis technology to

the clinic

Closing Remarks (10-min)

Video Gait Analysis of Common Pediatric Foot and Ankle

Conditions - Before and After Treatment


Title

Maximalist Shoe Study Report

Exercise-Related Leg Pain in the Athlete - What's New?

Lunch (45-min)Afternoon Session (Bechtel Room)


Title


Break (20-min)Theme: TBA (20-min +5-min QA) Moderator:

Title

The relationship between upper limb anthropometry and

maximum jump height

Inter-rater reliability of 2D motion analysis for running


Title

Title

Using motion analysis with the cutting and pivoting

athlete

Comparing males and females for effect of fatigue on

quadriceps and hamstrings isokinetic strength profile in

post-op ACL reconstruction patients

Title

The Path to Strong, Healthy Feet

Saturday, November 4, 2017Presentations

Morning Session (Bechtel Room)

Welcome Address: Keynote Address (40-min + 5-min QA)


Page 29

ORAL PRESENTATIONS


Page 30

INTER-RATER RELIABILITY OF 2D MOTION ANALYSIS

FOR RUNNING GAIT MEASURES

Derek Yang and Vanessa R Yingling

California State University, East Bay, Department of Kinesiology


INTRODUCTION

Gait analysis is a powerful tool in assessing potential

injury risks in runners. In regards to video analysis,

the prevailing means for assessing running gait are

two-dimensional (2D) and three-dimensional (3D)

systems. 3D systems are considered the “gold

standard” and often follow standardized protocols. 2D

systems are practical and cost-effective compared to

their 3D counterpart. As such, 2D systems are found

in more clinics and retail stores compared to 3D

systems.


Most 2D systems require a manual component where

raters must locate bony landmarks to quantify

measurements, which can lead to error across raters

due to misalignment of virtual markers. With the wide

usage of 2D systems, practitioners should be aware of

the inter-rater reliability of 2D systems, which in a

practical sense can represent the error between

practitioners or clinics. Overall, previous research has

found that intra-rater reliability of 2D measures was

high, suggesting that a single rater with enough

experience can provide adequate analysis.

METHODS

Five raters with prior biomechanics and motion

analysis experience were recruited to participate in the

study. Each rater read and signed a document of

informed consent prior to data collection. One

participant was recruited to provide an example video

for the raters. The ratee was asked to run on a

treadmill at their comfortable pace for a 20-minute

run. Markers were placed on the subject’s right: iliac

crest, greater trochanter, lateral femoral condyle,

lateral malleolus, and the fifth metatarsal head. Prior

to testing, the ratee signed and read a document of

informed consent.

The raters were asked to provide angles in the sagittal

plane for tibiofemoral flexion and talocrural dorsi-

flexion; as well as angle measurements for

contralateral pelvic drop, hip adduction, and

tibiofemoral abduction in the frontal plane for five

strides. An example slide was given to raters to

measure gait kinematics.

Inter-rater reliability of 2D kinematics was examined

by using a two-way random intra-class coefficient

(ICC) which assumes a sample of raters. The

coefficient of variance (CV) and standard error of

measures (SEM) were calculated to add an extra level

of validity to the ICC values. All analyses were

completed using Dartfish Pro 9 Motion Analysis Suite

and SPSS Statistics 23 suite.

RESULTS

The inter-rater reliability of tibiofemoral measures in

the sagittal plane demonstrated excellent reliability.

Anterior measures of hip adduction (ICC = 0.506)

displayed a moderate ICC value whereas tibiofemoral

abduction (ICC = 0.620) showed excellent reliability.

Contralateral pelvic drop displayed poor inter-rater

reliability (ICC = 0.174). Talocrural joint measures

showed high ICC values, however also had large CV

values which indicates little or no reliability between

raters Table 1.

Referencing the CV and SEM we can see that there is

a high degree of variability between the measures,

which may contribute to the varied ICC values

between talocrural joint events. Talocrural joint

measures during mid-stance showed a negative ICC

and a high CV which might have occurred due to

systematic error from the setup or recorded video.

Landis and Koch’s (1977) classification scale (poor to

fair < 0.4, moderate 0.41-0.60, excellent 0.61-0.80,

and almost perfect 0.81-1.0) Table 1.

DISCUSSION

The ICC values of the tibiofemoral angles confirm the

excellent ICC reported previously (Damsted et al.,

2015; Maynard, Bakheit, Oldham, & Freeman, 2003).

Tibiofemoral flexion and extension is relatively linear

and easy to assess due to limited planar movement.

Contralateral pelvic drop, displayed the lowest ICC

value (ICC = 0.174) when compared to the other

measures. Previous research observed a high ICC

value (ICC > 0.95) in terms of intra-rater reliability of

frontal plane measures. (Maykut et al., 2015).

However the rater in Maykut et al. (2015) had years of

prior motion analysis experience and experience can

contribute to high ICC values. Examining ICC

between raters can lead to a lower ICC due to higher

variability between raters. An increased number of

raters can lead to varying degrees of experience

between raters. Hip adduction and tibiofemoral

abduction demonstrated moderate (ICC=0.506) and

excellent (ICC=0.620) ICC values respectively, which

aligns with prior research (Maykut et al., 2015).

mailto:[email protected]


Page 31

Tibiofemoral flexion and extension measures showed

excellent to almost perfect ICC values and low CV and

SEM measures, indicating tibiofemoral joint measures

have the least amount of potential error. Previous

studies have found a high inter-rater reliability

(ICC>0.75) when assessing tibiofemoral flexion and

extension (Maynard, Bakheit, Oldham, & Freeman,

2003). It should be noted that tibiofemoral values are

larger compared to talocrural and hip measures.

Therefore, there is an increased acceptance room for

variability when examining larger angles. As stated

by previous research, the degree of clinical acceptance

for each measure has yet to be determined (Damsted

et al., 2015).

Talocrural joint measures displayed the highest degree

of CV, indicating that there was a high degree of

systematic error. Recorded images were not high

quality at the talocrural joint. Low frames per second

capacity on the recording devices and the high speeds

of the runner’s foot contributed to a blurred image.

Raters had trouble finding the fifth metatarsal head

due to the blurred image. A clean image of the ratee’s

foot could contribute to a higher degree of reliability.

A major limitation to this study is the frame rate of the

cameras.

REFERENCES

[1] C. Damsted, R.O. Nielsen, L.H. Larsen,

Reliability of video-based quantification of the knee-

and hip angle at foot strike during running, Int. J.

Sports Phys. Ther. 10 (2015) 147–154.

[2] J.R. Landis, G.G. Koch, The measurement of

observer agreement for categorical data, Biometrics.

33 (1977) 159–174.

[3] J.N. Maykut, J.A. Taylor-Haas, M.V.

Paterno, C.A. DiCesare, K.R. Ford, Concurrent

validity and reliability of 2d kinematic analysis of

frontal plane motion during running, Int. J. Sports

Phys. Ther. 10 (2015) 136–146.

[4] V. Maynard, A.M.O. Bakheit, J. Oldham, J.

Freeman, Intra-rater and inter-rater reliability of gait

measurements with CODA mpx30 motion analysis

system, Gait Posture. 17 (2003) 59–67.


None

Table 1: Inter-Rater Reliability

Average

Angle

(°)

Standard

Deviation Coefficient of V SEM ICC

Contralateral

Pelvic Drop 90.096 1.674 1.858 0.335 0.174

Hip

Adduction 84.480 1.194 1.414 0.239 0.506

Tibiofemoral

Abduction 174.120 2.106 1.210 0.421 0.620

Tibiofemoral Saggital IC 157.380 2.496 1.586 0.499 0.768

Tibiofemoral Saggital MS 128.676 2.385 1.854 0.477 0.850

Tibiofemoral Saggital TO 154.276 3.227 2.092 0.645 0.895

Talocrural IC 90.416 9.458 10.460 1.892 0.535

Talocrural MS 69.412 7.458 10.744 1.492 -0.824

Talocrural TO 111.588 13.091 11.731 2.618 0.855

IC = Initial Contact, MS = Mid-Stance, TO = Toe-Off, SEM = Standard Error of Measure, ICC = Intra-Class

Coefficient


Page 32

THE RELATIONSHIP BETWEEN UPPER LIMB ANTHROPOMETRY

AND MAXIMUM JUMP HEIGHT

Gerwyn Hughes, Kennedy Wischmeyer, Elton Rangel, Jessica Manalang,

Zachary Siebel, Shannon Siegel and Karen Francis

Kinesiology Department, University of San Francisco


INTRODUCTION

Many studies have demonstrated that vertical jump

height increases by around 10% due to an arm swing (1, 2, 3). One theory proposed to explain this is the ‘pull’

theory (2), which states when the arms decelerate at the

end of the arm swing their high velocity relative to the

trunk allows them to pull on the trunk, transferring

kinetic energy from the arms to the rest of the body.

Since kinetic energy is determined by both the mass

and velocity of the upper limbs as they are swung,

athletes with greater arm mass and length may be at an

advantage to those with shorter and lighter arms. To

our knowledge, no study has examined the effect of

upper limb anthropometry on the effectiveness of an

arm swing during jumping. Therefore, the aim of this

study was to examine the relationship between the

change in jump height due to an arm swing and

anthropometry.


Determining the relationship between anthropometry

and the effect of an arm swing when jumping may

have implications for both training and talent

identification of athletes competing in sports which

involve jumping.

METHODS

Following institutional ethical approval, 25

participants (10 males and 15 females) who met the

inclusion criteria (aged between 18-26, healthy, free

from musculoskeletal injuries) volunteered to take part

in the study. Mean descriptive values and standard

deviations (SD) for the sample include age 21.3 ± 4.1

years, stature 167.7 ± 9.4 cm, weight 66.2 ± 10.8 kg

and body mass index (BMI) 23.4 ± 2.4 kg/m2.

Anthropometry for each participant included: Stature

- measured with a fixed stadiometer to the nearest 0.1

cm. Mass - measured with a physician’s scale to the

nearest 0.1 pound, and then converted to kg by

dividing total pounds by 2.2. Humerus length -

measured from the acromion to the lateral epicondyle.

Ulna length - measured from the olecranon to the

styloid process. Hand length - measured from the

lunate to the distal phalanx of the third finger. Arm

span - the distance between the distal phalanges of the

third finger on both hands when raised out in a

horizontal position, i.e. parallel to the ground. Upper

arm girth - measured at maximum circumference.

Biepicondylar breadth of the humerus - distance

between epicondyles of the humerus. All lengths and

breadths were measured in cm. A three-site skinfold

assessment (cm) (males: pectoral, abdomen, thigh;

females: triceps, suprailiac, thigh) was used to

estimate body density and calculate body fat (4). The

components of Heath-Carter somatotype

(endomorphy-relative fatness, mesomorphy-relative

muscularity, and ectomorphy-relative linearity) were

calculated using height, four skinfolds (triceps,

subscapular, supraspinale, and medial calf), flexed

arm circumference (corrected for triceps skinfold),

calf circumference (corrected for calf skinfold),

biepicondylar breadth of the humerus, and bicondylar

breadth of the femur to provide an estimate of

physique-type (5). Skinfold measurements were taken

three times and circumferences and lengths were taken

twice, all on the right side of the body, with the

average used in subsequent analysis.

For the jumping task, participants performed maximal

effort countermovement vertical jumps (CMJ) from a

force platform (Advanced Mechanical Technology,

Inc., Watertown, MA) sampling at 200 Hz. Each

participant performed three CMJ with an arm swing

(AS), and three CMJ without an arm swing (NAS) in

a randomized order, with the maximum jump height of

the three jumps performed in each condition (AS and

NAS) used in subsequent statistical analysis. For NAS,

participants placed their arms on their hips throughout

the jump. Vertical displacement of the center of mass

was calculated from the ground reaction force (GRF)

– time data through initially calculating the

acceleration (a) of the center of mass using the

following equation: a = (GRF - weight) / mass.

Displacement was then calculated through double

integration of the acceleration – time data.

Statistical analysis was carried out using SPSS version

22 (IBM SPSS Inc., Chicago, IL). A Pearson’s Product

Moment correlation was used to determine the

relationship between the absolute difference in jump

height between NAS and AS and each anthropometric

characteristic.

RESULTS

Overall, vertical jump height was significantly higher

in the AS condition (51.2 ± 8.6 cm) than in the NAS

condition (41.1 ± 12.7 cm) (p < 0.05). Average

somatotype for the sample was 4.1 ± 1.7, 4.5 ± 1.2, 1.9

± 0.9 for endomorphy, mesomorphy, and ectomorphy,

respectively. The combined sample of males and

females is generally meso-endomorphic. Analysis

with data partitioned by gender revealed differences


Page 33

only for items related to fat mass, for example, percent

body fat (21.2 ± 5.1% vs 10.4 ± 4.9% for females and

males, respectively). Therefore, data for all other

anthropometric parameters were pooled for further

analysis. The relationships between change in jump

height and anthropometry are positive, and appear

mostly related to frame size (stature, mass, corrected

arm and calf circumferences, biepicondylar breadth,

and ulna length). All significant correlations were

positive and moderate (Table 1). No significant

relationships were found between change in jump

height and humerus length, hand length and arm span.

Table 1. Correlation coefficients of the difference in

jump height between arm swing and no arm swing and

select anthropometric parameters.

Correlation

coefficient

p

value

Height (cm) 0.53 < 0.01

Mass (kg) 0.50 < 0.05

Arm circumference (cm) 0.48 < 0.05

Calf circumference (cm) 0.47 < 0.05

Biepicondylar breadth

(cm)

0.51 < 0.01

Ulna length (cm) 0.45 < 0.05

DISCUSSION

The results show that there is a relationship between

change in vertical jump height due to an arm swing

and select anthropometric variables. The strongest

relationships are with height, weight and

biepicondylar breadth (Table 1). Therefore, the

findings of this study suggest that athletes who are

heavier, taller and have bigger arms (greater

biepicondylar breadth, upper arm girth and ulna

length) experience a moderately increased benefit

from swinging their arms during jumping. However,

none of the significant correlations are more than

moderate in strength. This result suggests that other

factors, such as arm swing technique and velocity of

the arms, may have a greater influence on the

effectiveness of an arm swing for increasing jump

height, rather than just the size (breadth, girth and

length) of the arms alone. Although ulna length was

significantly related to the change in jump height,

humerus length was not. Similarly, to trends in the

literature (1, 2, 3) the difference between vertical jump

height using NAS and AS in the current study was

approximately 10%.

The limitations of the study include the relatively

small sample size and the inclusion criteria were quite

broad which resulted in a sample with a wide range of

jumping experience and ability. In addition, the type

of arm swing was not controlled and was observed to

vary considerably between participants. Future

research should examine the effect of the velocity of

the arms and the type/style of arm swing utilized on

jump height.

REFERENCES

1. Feltner, M. E., Fraschetti, D. J., & Crisp, R. J.

(1999). Upper extremity augmentation of lower

extremity kinetics during countermovement

vertical jumps. Journal of Sports Sciences, 17(6),

449-466.

2. Harman, E. A., Rosenstein, M. T., Frykman, P. N.,

& Rosenstein, R. M. (1990). The effects of arms

and countermovement on vertical jumping.

Medicine and Science in Sports and Exercise,

22(6), 825-33.

3. Shetty, A. B., & Etnyre, B. R. (1989). Contribution

of arm movement to the force components of a

maximum vertical jump. Journal of Orthopaedic

& Sports Physical Therapy, 11(5), 198-201.

4. Siri, W. E. (1961). Body composition from fluid

space and density. In J. Brozek & A Hanschel

(Eds.), Techniques for measuring body

composition (pp. 223-244). Washington D.C.:

National Academy of Science.

5. Duquet, W. & Carter, J.E.L. (2001). Somatotyping.

In: R. Eston & T. Reilly (Eds.), Kinanthropometry

and Exercise Physiology Laboratory Manual:

Tests, procedures and data. Vol. 1. London: E &

F.N. Spon.


No author received any financial benefit for the

research in this study. The authors have no potential

conflicts of interest relevant to the contents of this

abstract.


Page 34

USING MOTION ANALYSIS WITH THE CUTTING AND PIVOTING ATHLETE

Neeraj Baheti & Michelle Cappello


INTRODUCTION

Objectives:

1. Overview of what is a cutting and pivoting athlete

2. Define what data is captured for motion analysis

3. Reference the Sports Research using motion

analysis

4. List injury reduction strategies and Return to Play

criteria


N/A

METHODS

N/A

RESULTS

N/A

DISCUSSION

N/A

REFERENCES

1. Koga et al,2010. Mechanisms for non contact

anterior cruciate ligament injuries. The American

Journal of Sports Medicine 38,2218–2225.

2. Shin et al,2007. Influence of deceleration forces on

ACL strain during single-leg landing: a

simulation study. Journal of Biomechanics

40,1145–1152.

3. Boden BP, Dean GS, Feagin JA Jr, Garrett WE Jr.

Mechanisms of anterior cruciate ligament injury.

Orthopedics. 2000;23(6):573–578.

4. Cochrane JL et al. Characteristics of anterior

cruciate ligament injuries in Australian football. J

Sci Med Sport. 2007;10(2):96–104.

5. Griffin LY et al. Noncontact anterior cruciate

ligament injuries: risk factors and prevention

strategies. J Am Acad Orthop Surg.

2000;8(3):141–150

6. Paterno MV et al. Biomechanical measures during

landing and postural stability predict second

anterior cruciate ligament injury after anterior

cruciate ligament reconstruction and return to

sport. Am J Sport Med. 2010; 38(10):1968-78.

7. Pollard et al. Limited hip and knee flexion during

landing is associated with increased frontal plane

knee motion and moments. Clinical

Biomechanics. 2010;25(2):142-146.

8. Noyes et al. A training program to improve

neuromuscular and performance indices in female

high school soccer players. J Strength Cond Res

27(2): 340–351, 2013

9. Stearns et al. Influence of Relative Hip and Knee

Extensor Muscle Strength on Landing

Biomechanics: Medicine & Science in Sports &

Exercise. 2013;45(5):935-941.

10. Kernozek et al. Gender Differences in Lower

Extremity Landing Mechanics Caused by

Neuromuscular Fatigue. Am J Sports Med.

2008;36(3):554-565.

DISCLOSURE STATEMENT:

No one involved in the planning or presentation of this

activity has any relevant financial relationships with a

commercial interest to disclose.


Page 35


Page 36

COMPARING MALES AND FEMALES FOR EFFECTS OF FATIGUE ON QUADRICEPS AND

HAMSTRINGS ISOKINETIC STRENGTH PROFILE IN POST-OP ACL RECONSTRUCTION

PATIENTS

Baheti ND, Gutierrez SG, He SW, Lam KL, Yamamoto MMK

Sports Medicine Center for Young Athletes, UCSF Benioff Children’s Hospitals


PURPOSE/HYPOTHESIS:

Our purpose was to retrospectively analyze the

isokinetic strength profile of patients who underwent

Anterior Cruciate Ligament Reconstruction (ACLr).

We specifically looked at the peak torque (PTor) and

average power (APow) generated by quadriceps and

hamstrings muscles. Data was collected pre- and post-

fatigue. We hypothesized that there would be a

significant decrease in PTor and APow values on the

involved side compared to the uninvolved side, in both

males and females.

SUBJECTS:

41 subjects (24 females and 17 males, range 11-18

years) who underwent an ACLr (range 6 to 20 months)

participated in this study. Twenty-eight subjects had

undergone a hamstring autograft, seven had bone-

patellar-bone autografts, and two had allografts.

Remaining four subjects underwent hamstrings

autograft with allograft augmentation. Eight of the

subjects had a concomitant meniscus repair. Subjects

who had previously undergone an ACLr, in either leg,

were excluded from this study.

METHODS AND MATERIALS:

All subjects underwent a 5-minute warmup on a

treadmill followed by 3-minutes of dynamic

stretching. Their height and weight was collected

using a digital scale prior to the strength testing on

Biodex System 4 Pro device. Isokinetic strength data

was collected at 300°/second on quadriceps and

hamstrings muscles by performing knee extension and

flexion, respectively. For pre-fatigue data, subjects

underwent 4-6 repetitions of familiarization, followed

immediately by 10 repetitions of data collection.

During data collection, the subjects were instructed to

“push and pull as fast and as hard as possible.” Next,

the subjects completed 6 movements (drop jump test,

step down, triple hopping, lateral shuffle, deceleration,

and cutting). These movements were performed twice,

on both legs, and lasted approximately 20 minutes. To

further fatigue the muscles, the subjects were asked to

perform 20 single-leg squats to an 18-inch tall bench

and 20 standing hamstrings curls with a 5lb weight on

each leg. We then re-tested isokinetic strength, as

described above. This was considered post-fatigue

data. MS Excel and SAS System were utilized for data

analysis.

RESULTS:

ANCOVA was performed, adjusting for pre-values, to

analyze the pre- and post-fatigue data for within group

changes. Among females, a significant difference was

found (p < 0.05) in the change from pre- to post-

fatigue for the involved vs uninvolved side hamstrings

PTor and hamstrings APow production. However, no

significant differences were noted in males. Further,

no fatigue-related differences were found in involved

vs uninvolved side quadriceps PTor and quadriceps

APow production, for females or males.

CONCLUSION/ SIGNIFICANCE:

Females are at a significantly higher risk of a recurrent

ACL tear compared to males and the role of muscle

fatigue as a contributing factor is still under

investigation. Our results suggest that when fatigued,

the hamstrings muscles of females who have

undergone ACLr lose the ability to generate sufficient

PTor and APow, compared to their male counter parts.

While, the potential value of the hamstrings’ muscle

fatigue in predicting an ACL tear in females warrants

further validation, the findings of this study may guide

a physical therapist’s rehabilitation plan for their

patients who have undergone ACRr, specifically

females.

REFERENCES:

1. Noyes et al. J Strength Cond Res 27(2): 340–351,

2013

2. Pollard et al. Clinical Biomechanics.

2010;25(2):142-146.

3. Coats‐Thomas, Margaret S., et al. Journal of

Ortho Research 31.12 (2013): 1890-1896.

4. Kernozek et al. Am J Sports Med.

2008;36(3):554-565.

5. Paterno MV, et al. AMJSM. 2010 Oct;38(10):

1968-78.

6. Hewett TE et al. J Sci Med Sport. 2008 Sep;

11(5):452-9

7. Holcomb WR et al. J Strength Cond Res. 2007

Feb; 21(1):41-7.

8. More RC et al. Am J Sports Med. 1993 Mar-Apr;

21(2):231-7.

DISCLOSURE

The authors state that they have no conflicts of interest

to disclose.


Page 37


Page 38

MAXIMALIST RUNNING SHOE STUDY, PHASE TWO

Stephen Hill, PhD1, Cherri Choate, DPM2, Timothy Dutra, DPM2, Andrew Smith, PhD1

Podiatry Students2: Lawrence Chen, Ivanna Kenwood, Samantha Ralstin, Lowell Tong, 1Motion Analysis Research Center & 2California School of Podiatric Medicine, Samuel Merritt University


INTRODUCTION

Shoe types influence tibial torsion, which is associated

with running injury(1) , vary step rate, stride length,

contact time, and foot-strike pattern (2, 3). Changes of

these variables are associated with changes at more

proximal levels. For example, faster stepping rate

leads to less loading at the patellofemoral joint(4). As

maximalist shoes increase in popularity, the present

study serves to evaluate kinetic and kinematic

differences between maximalist and neutral shoes

during running.

Maximalist shoes are intended to disperse excessive

shock throughout the midsole, to offer a more

contoured and deeper foot bed for foot stability, and to

combine a wider base with a rocker shaped sole that is

enhanced with thickness and height(5). Rocker

bottom shoes can decrease plantar flexion and plantar

pressure in late stance while running. Also, there is an

established relationship with increased knee injury in

runners (6). This combination can further assist

mobilization of individual conditions of certain

diseases such as Achilles tendinopathy(7) and

diabetes(8).


Improving understanding of potential benefits or risks

of particular shoe designs for particular runners

depends on objective measurement during running.

METHODS

Phase One: Six participants were recruited: 3 males,

3 females, ages of 18-35 who run at least 10

miles/week, . body mass 62.8 kg, stdev = 15.1) and

height (mean = 1.71 metre, stdev = 0.138) were

recorded. Foot Posture Index (FPI) was used to screen

each subject. The FPI has been validated as a

reproducible static foot posture measurement. The

subjects received a score on a scale of +12 (pes planus)

to -12 (pes cavus) (9). The foot types are correlated

with: static balance assessment scores, gait joint

dynamic, and plantar pressure data(10). .Brannock

device was used to measure foot size. Subjects were

fitted with a new pair of socks that was used in the

study. Participants walked and ran in both types of

shoes (order randomized). Data were captured with a

9-camera Qualisys 3D motion capture system (100

Hz) tracking 18 retro-reflective spherical markers on

boney landmarks, 4 AMTI tri-axial force plates

measured shoe-floor forces (1000 Hz). Three strides

were analyzed per participant per shoe type.

Figure 1. Overground running; image of shoe types

Phase Two: So far, 3 participants (1 male who was in

Phase One to look for differences between treadmill

versus overground running measures, and 2 females).

Figure 2. Treadmill running

RESULTS

Phase One

Maximalist (430 N/kg/s) significantly greater vertical

foot strike load rate than Neutral (347 N/kg/s), p =

0.03. There was an apparent trend for greater fore-aft

shear transition rate with the neutral cushioning shoe

(37.4 N/kg/s) than with the maximalist shoe (34.9

N/kg/s), p = 0.06. Maximum knee joint compression

force was not significantly different (p = 0.39)

between the maximalist (22.5 N/kg) and neutral (22.6

N/kg) shoes. Peak knee extensor moment of force was

not significantly different (p = 0.32) between

maximalist (2.40 N*m/kg) and neutral shoes (2.45

N*m/kg).


Page 39

Figure 3. Anterior-Posterior shear transition rate

Figure 4. Anterior-Posterior shear transition rate

DISCUSSION

The results of this study demonstrate that although the

additional cushioning of maximalist shoes might have

been expected to decrease abruptness of foot strike

impact, the foot strike loading rate was significantly

higher with the maximalist shoe than the neutral shoe.

This finding suggests that participants relied on

cushioning of maximalist shoes to protect them from

the impact, and were lighter on their feet in the less-

cushioned neutral shoe. This behavior is consistent

with Sinclair (10) who used accelerometers on the

tibia and sacrum, and found that shock attenuation and

peak tibial acceleration were significantly lower in the

minimalist footwear than in the conventional and

maximalist footwear in running.

One of the limitations of the Phase One of the study

was that participants had not reached steady state

running when the data were captured due the length of

the 10-metre walkway. Phase Two of the study uses

the AMTI Force-Sensing Tandem Treadmill to

address this limitation. The beauty of the treadmill is

that the participant can transition from standing to

walking at 5-km/h, then gradually increase speed to a

jog and then maintain steady-state running at 11-km/h,

while staying within the center of the calibrated

volume for motion capture. The treadmill is actually

two treadmills, each with a tri-axial force plate which

can capture left and right foot ground reaction forces,

so the system can calculate lower limb kinematics and

kinetics for 20 strides in less than 30 seconds.

REFERENCES

1. Rose A et al.(2011) Physiotherapy, 97:250-255.

2. McCallion C et al. (2014) J Sports Science

Med.13:280-86.

3. Willy RW (2014) Med and Science in Sports

Exercise, 46(2): 318-323.

4. Lenhart RL (2014) Med Sci Sports Exerc,

46(3):557-64.

5. Twelve facts about maximalist shoes.

http://runnow.eu/2014/shoes-gear/12-facts-

about-maximalist-shoes_2449.

6. Foch, Eric, et. al. Lower extremity joint position

sense in runners with and without a history of

knee overuse injury

7. Sobhani S, Zwerver J, van den Heuvel E, et al.

Rocker shoes reduce Achilles tendon load in

running and walking in patients with chronic

Achilles tendinopathy. J Sci Med Sports. 2015;

18(2):133-8.

8. Perry JE, Ulbrecht JS, Derr JA, Cavanagh PR.

The use of running shoes to reduce plantar

pressures in patients who have diabetes.

9. Redmond AC, Crosbie J, Ouvier RA.

Development and validation for a novel rating

system for scoring standard foot posture: The

Foot Posture Index. CLinical Biomechanics.

2006.;21(1):89:98.

10. Sinclair J (2017) Movement& Sport Sciences,

95:59-64.

ACKNOWLEDGEMENTS

This project is funded ($24,500) by the Samuel Merritt

University Faculty Scholarship Grant Program

(FSGP): PI: Cherri Choate, DPM

The current CSPM Student Team recently submitted

an abstract and poster to the Kaiser Permanente Foot

and Ankle Summit Student Poster Competition May

20-21 2017, who rewarded them with a $1,000

scholarship.


The authors have no conflict of interest to disclose.

http://runnow.eu/2014/shoes-gear/12-facts-about-maximalist-shoes_2449

http://runnow.eu/2014/shoes-gear/12-facts-about-maximalist-shoes_2449


Page 40

EMG OF LOWER EXTREMITY MUSCLES WITH IWALK HANDS FREE CRUTCH VERSUS

AXILLARY CRUTCHES RESEARCH PROJECT

Ivanna Kenwood1 Grace Kim1 Samantha Ralstin1 Stephanie Tine1 11st California School of Podiatric Medicine at Samuel Merritt University


INTRODUCTION

The iWalk Hands Free Crutch is a new alternative to

traditional axillary crutches for patients requiring non-

weight bearing of below the knee injuries. As

podiatric surgeons we wanted to explore whether the

iWalk may be a sufficient replacement to axillary

crutches for off-loading after surgery. Quantitative

surveys of participants who were either given axillary

crutches and the iWalk for 2 weeks each found that 5

out of the 6 participants preferred the iWalk to the

crutch2. Another study by Lim et al looked at 17

participants measuring 3 different test; the 6 min walk

test (6MWT), Stair-climbing-test (SCT) and Timed-

up-and-go test(TUG) with the iWalk versus axillary

crutches. These tests all measure functional outcomes

of mobility. This study found that functional outcome

was better with the iWalk compared to the axillary

crutch. Literature has shown that the iWalk

significantly improves quality of life of our patients,

but there have not been objective studies on how the

iWalk affects gait and muscle function.


This project examined alternative methods to non-

weight bearing of foot injuries and surgeries.

Comparing the iWalk device to axillary crutches is of

great importance to podiatrist, especially those treating

athletes and healthy individuals. Examining the

kinematics, kinetics and EMG data of the iWalk versus

the crutch is important to understand how these

external devices affect the body, muscles and blood

supply.

METHODS

A standard Qualysis PAF package with modified

Helen Hayes lower body marker set. The Qualysis

PAF package is used to measure standard kinematics

and kinetics of lower extremity. EMG electrodes were

placed on rectus femoris, biceps femoris and medial

head of gastrocnemius to record electrical muscle

activity. Two subjects performed 3 different

conditions in a single day. The 3 conditions were

walking, axillary crutches and iWalk. Each condition

was performed 3 times.

RESULTS

DISCUSSION

With adequate training, the phasic muscle bursts were

seen in the rectus femoris, biceps femoris and medial

head of gastrocnemius. This phasic muscle bursting

allows for increased blood flow to the site of injury.

This in theory would lead to less atrophy of

surrounding muscles and allow athletes to maintain

mailto:[email protected]


Page 41

mobility and fitness. Further research needs to be

conducted with a large patient population. Recording

of the EMG data is the most valuable measurement for

evaluating blood flow and muscle activity in the lower

extremity.

REFERENCES

1. Bonnefoy-Mazure, A & Armand, Stéphane.

(2015). Normal gait. 199-214.

2. Dalton A., Maxwell D., Kreder, H. J., Borkhoff C.

M. Prospective Clinical Evaluation Comparing

Standard Axillary Crutches vs. The HANDS

FREE Crutch. Sunnybrook and Women’s

College Health Science Centre, University of

Toronto. 1-12.

3. Kadaba M. P., Ramakrishnan H. K., Wootten M.

E. 1990. Measurement of Lower Extremity

Kinematics During Level Walking. Journal of

Orthopaedic Research 8: 383-392.

4. Lim G.A., MacLeod T.D. Comparison of

Subjective and Physical Function Outcomes

Using Axillary Crutches and a “Hands-Free

Crutch” in Comparison to No Crutch, for

Mobility. California State University,

Sacramento Department of Physical Therapy. 1-

3.


The authors report that they have no conflicts of

interest to disclose.


Page 42

BRIDGING THE GAP: BRINGING MOTION ANALYSIS TECHNOLOGY TO THE CLINIC

Andrew W. Smith

Motion Analysis Research Center, Samuel Merritt University


INTRODUCTION

Throughout the past five decades, the growth of

technology-based biomechanical analysis methods has

been significant, particularly in the past 10 years as

multi-camera motion capture systems have become

more affordable and prevalent. While this growth has

resulted in substantially more sophisticated research

laboratories housed in many universities and colleges,

the cost, in terms of both time and money, has made

most of these technological advances prohibitively

expensive for clinical settings.

In parallel to advances in laboratory-based

technologies has been the worldwide demand for so-

call ‘smart’ devices, beginning in 2007 with the

introduction of the iPhone by Apple. This has led to

literally thousands of apps available to these handheld

devices to monitor heart rate, diet, sleep, exercise,

circadian rhythms, and a whole host of activities of

daily living. With the expansion of smart devices to

watches and even clothing, the potential for quite

sophisticated and affordable technological interactions

between clinician and client are not only possible, but

will almost certainly come to be expected by clients.

The challenges, therefore, are not insignificant:

clinicians will need to continue to educate themselves

on the latest trends in wearable sensors and

technology, particularly those designed for clinical

application, while technology companies will have to

interact with clinicians and scientists to ensure the

validity and reliability of their devices and apps.

Currently, there is no oversight with regards to the

veracity of the data collected, nor are any

considerations made with regard to the ethics of the

collection of mass personal data that the technology

companies hold.

The purpose of this talk is to review the current state

of play in what technologies are available to clinicians,

how useful and trustworthy are these, and how best to

incorporate technology in clinical practice.


Clinical decision-making involves a complex interplay

drawing on the experience and education of the

clinician and having an accurate and valid picture of

the status of the client. If wearable and smart

technologies are to play a role, clinicians need to be

savvy about what the technologies provide to serve the

needs of their clients in an efficacious and ethical

manner.

DISCUSSION

The talk will cover the following topics:

1. Brief history of collaborations between research

laboratories and clinical settings.

2. Overview of wearable and other smart

technologies in human movement analysis.

3. Strategies of implementing new technologies in

clinical settings.

4. Future directions.

REFERENCES

1. Binkley, P.F. (2003). Predicting the potential of

wearable technology, IEEE Eng Med Biol Mag

22(3):23-27

2. Bonato, P. (2005). Advances in wearable

technology and applications in physical medicine

and rehabilitation. J NeuroEng Rehab 2(2):1-4.

3. Patel, S. et al., (2010). A novel approach to monitor

rehabilitation outcomes in stroke survivors using

wearable technology. Proc IEEE 98(3):450-61.

4. Najafi, B., et al. (2010). Assessing postural control

and postural control strategy in diabetes patients

using innovative and wearable technology.


The author reports that there are no conflicts of interest

to disclose.


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List of Authors

Baheti, Neeraj ..................................... 34, 36

Baker, Robert L. .......................................... 8

Bouché, Richard .................................... 6, 24

Cappello, Michelle .................................... 34

Choate, Cherri .......................................... 38

Davis, Irene S. ..................................... 12, 22

Dutra, Timothy .................................... 14, 38

Francis, Karen .......................................... 32

Gutierrez, SG ............................................ 36

He, SW....................................................... 36

Hill, Stephen ........................................ 14, 38

Hughes, Gerwyn ........................................ 32

Kenwood, Ivanna ...................................... 40

Kim, Grace ................................................ 40

Lam, KL..................................................... 36

Manalang, Jessica..................................... 32

Ralstin, Samantha ..................................... 40

Rangel, Elton............................................. 32

Siebel, Zachary ......................................... 32

Siegel, Shannon ......................................... 32

Smith, Andrew ..................................... 38, 42

Tine, Stephanie .......................................... 40

Volpe, Russell G. ................................. 16, 26

Wischmeyer, Kennedy ............................... 32

Yamamoto, MMK ...................................... 36

Yang, Derek............................................... 30

Yingling, Vanessa R. ................................. 30

Pediatric Neuromechanics and Sports Medicine · 2017. 11. 8. · 3rd Annual MARC Symposium –...

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