1st presented at Isokinetic Football Medicine Return to Play Conference 2016 by Dr Andy Franklyn-Miller. The Laboratory to Field based testing of subjects allows the creation of a database of injured and normative subjects with the aim of targeting return to performance of both elite and recreational athletes

1. 1 Dr. Andy Franklyn-Miller 1
RETURN TO PLAYMOVEMENT ANALYSIS FOR RTP DECISION MAKING
JOIN THE LIVE TWITTER COVERAGE: @AFRANKLYNMILLER

2. AGILITY VERSUS
CHANGE OF DIRECTION
FATIGUE RESISTANCE
AND SPEED
MEDICAL CLEARANCE FOR FULL
PARTICIPATION IN SPORTS
WITHOUT RESTRICTION OR PAIN
FOR THE MAJORITY OF INJURIES
OUTSIDE OF ACL REHABILITATION
THERE IS LITTLE ORIGINAL RTP
RESEARCH
LACK OF STANDARDISATION
LEADS TO MEDICOLEGAL OR
FINANCIAL IMPLICATION CLUB VS
COUNTRY
PLAY VERSUS
PERFORMANCE
Return to Play
Quick Overview about Return to Play
2 2@AFRANKLYNMILLER – “Lack of standardisation leads to medico-legal risk in medical clearance of return to play”

3. Basic Mechanics
3 3
Joint moment
@AFRANKLYNMILLER – “Each joint has an angular velocity , but joints need coordination to produce performance”
T = Fd

4. Basic Mechanics
4 4
Angular velocity
@AFRANKLYNMILLER – “Each joint has an angular velocity , but joints need coordination to produce performance”
LEVER ARM IS
MEASURED FROM
THE AXIS OF
ROTATIONAXIS OF ROTATION
POINT OF APPLICATION OF THE FORCE
RADIUS FROM AXIS OF
ROTATION TO POINT OF
APPLICATION OF THE FORCE
F
APPLIED FORCE

5. Muscle Contribution
5 5
Multi joint Multi plane
Mh
Ma
ILIOPSOAS
GLUTEUS MAXIMUS
SEMITENDINOSUS
SEMIMEMBRANOSUS
BICEPS FEMORIS
SARTORIUS
RECTUS FEMORIS
GASTROCNEMIUS
SOLEUS
TIBIALIS POSTERIOR
PERONEI
TIBIALIS ANTERIOR
Mk
SEMITENDINOSUS
SEMIMEMBRANOSUS
BICEPS FEMORIS
SARTORIUS
RECTUS FEMORIS
VASTUS MEDIALIS
VASTUS LATERALIS
VASTUS INTERMEDIUS
GASTROCNEMIUS
Mh
Mk
Ma
@AFRANKLYNMILLER – “Multi planar , segmental coordination key in managing return to play, but can you see it?”

6. Motor Recruitment
6 6
Its not just about the joint moment
@AFRANKLYNMILLER – “Rate of force development and motor recruitment makes it more complex”

7. Rate of force development
7 7
Motor unit recruitment
@AFRANKLYNMILLER – “Imagine a dimmer switch and the need to turn it to max”

8. Understanding Groin Pain
8 8
We’re experts in the field of groin pain treatment

9. 3D Biomechanics
9 9
Objective reliability of markers at instant time points
@AFRANKLYNMILLER – “Multi plane, multi joint segmental coordination assessment under load”
1
2
3
45
6
7
Quantify
complex movement
Understand
mechanism of injury
Identify
joint load
Define
greater performance
Determine
Variability
Reduce
Injury risk
Monitor
field based pre and post injury
Return
to performance

10. Side Hurdle Video
10 10
A quick demo of our animation

11. 3600 biomechanics
Patients in ACL and Groin

12. 8 Tests per protocol

13. 2 time points,
7 segments and 3 planes

14. 746,592 data points
per subjects

15. 268,560,000 datA points
since we started

16. 16
1 - 2
3 - 4
5 - 6
7 - 8
Movement Patterns
Absolute Strength
Performance
Fatigue
Joint Loading
Intersegmental Coordination
Variability
Coaching
Factor influencing Biomechanics
What we don't know
16 16 16@AFRANKLYNMILLER – “How does variability and segmental linkage effect re-injury?”

17. 17
Joint Loading
Athletic Groin Pain (Part 2): A prospective cohort study on the biomechanical evaluation of change of
direction Franklyn-Miller, A BJSM ( In review)
17 17@AFRANKLYNMILLER – “Movement patterns distinguish joint loading differentiation”

18. 18
Movement Patterns
Athletic Groin Pain (Part 2): A prospective cohort study on the biomechanical evaluation of change of
direction Franklyn-Miller, A British Journal of Sports Medicine (Under review)
18 18@AFRANKLYNMILLER – “Movement patterns distinguish joint loading differentiation”

19. 19
Intersegmental Coordination:
Inter-Segmental Coordination Pattern in Patients with Anterior Cruciate Ligament Deficiency during a
Single-Step Descent Mohammadreza Nematollahi, PLOS One 2016
19 19@AFRANKLYNMILLER – “The coordination of multiple joint is vital in controlling COM and COP”

20. 20
Absolute Strength
Comparison of strength and power measures in identifying a rehabilitation status following anterior
cruciate ligament reconstruction – O’Malley, E 2016 JBJS(Br) submitted
20 20@AFRANKLYNMILLER – “Control of Torque production is greater than absolute strength”

21. 21
Variability
Foot contact angle variability during a prolonged run with relation to injury history and habitual foot strike
pattern M. R. Paquette et al Scandinavian Journal of Medicine and Science in Sports 2016 Early View
21 21@AFRANKLYNMILLER – “We do not understand whether variability is protective or injurous”

22. 22
Fatigue
Changes in drop-jump landing biomechanics during prolonged intermittent exercise
Schmitz et al Sports Health. 2014 Mar;6(2):128-35
22 22@AFRANKLYNMILLER – “Fatigue effects both reproducibility and segmental coordination”
Sports health. 2014 Mar;6(2):128-35. doi: 10.1177/1941738113503286.
Changes in drop-jump landing biomechanics during prolonged intermittent exercise
Schmitz RJ1, Cone JC2, Tritsch AJ3 Pye ML1, Montgomery MM4, Henson RA5, Shultz SJ1.

23. 23
Coaching
Through Intrinisic motivation and attention to Learning - Gabriele Wolf Psychon Bul 2016 Online First
23 23@AFRANKLYNMILLER – “Best method of effecting coaching change in change of direction yet to be understood”

24. 24
Performance
Biomechanical factors associated with Fme to complete a change of direcFon cuIng maneuver.
Marshall B et al J Strength Cond Res 2014 28(10) 284
24 24@AFRANKLYNMILLER – “Understanding segmental coordination improves performance in COD”

25. Existing Agility Tests
25 25
Validated against time only
@AFRANKLYNMILLER – “Change of Direction is a closed skill in predetermined direction”

26. Concept behind VU
26 26
Reproducibility of performance
@AFRANKLYNMILLER – “The journey from injury to performance controlled biomechanically”
Execution of movement
Reactive Chaos
Controlled condition
Reproducibility under fatigue
RETURN TO
TRAIN
RETURN TO
PERFORMANCE

27. The SSC VU data collection
27 27
Lab and field based data collection
@AFRANKLYNMILLER – “XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX”

28. 28@AFRANKLYNMILLER – “VU @SSCSantry is new biomechanically driven RTP lab and field test”
SSC VU Test
A biomechanically driven RTP field test
LABORATORY
FIELD
GLOBAL
CENTRES
SPORTS
SURGERY
CLINIC
VU DATABASE
DEIDENTIFIED
SERVER INDIVIDUAL
RECREATIONAL
CLUB
PROFESSIONAL
CLUB

29. Dr. Chris
Richter
Dr. Eanna
Falvey
Enda
King
Eamon
O'Reilly
Mr. Ray
Moran
29 29@AFRANKLYNMILLER – “A Team dedicated to advancing knowledge and practical rehabilitation”
Presentation thanks to

30. 30
Contact
Dr. Andy Franklyn-Miller
Sports Surgery Clinic, launched in 2007 in
Dublin, is a state of the art orthopaedic hospital
with orthopaedic surgery, medical imaging and
specialise in 3D biomechanical rehabilitation of
athletes from across the world.
http://drandyfranklynmiller.com
Twitter.com/afranklynmiller
Northwood Avenue, Santry, Dublin 9
afranklynmiller@me.com