1. LE Pathokinematics: Osteoarthritis: Can It be Prevented? Trent Nessler, PT, DPT, MPT Area Vice President -Champion Sports Medicine/Physiotherapy Associates CEO - Accelerated Conditioning and Learning USA Cheer National Safety Council

3. Degenerative changes of the articular cartilage

4. Articular cartilage = Hyaline cartilage and water

5. Covers surface of weight bearing joints

6. Prevents bone on bone – oil in piston

7. Common joints affected

8. Hip

9. Knee

10. Low back

11. Ankle

13. Diabetes – more prone

14. Post traumatic

15. Inflammatory diseases

16. Congenital

17. Hemophilia

18. Nutrition

21. 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?

22. HYDRATION CHART

23. 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

24. 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 genuvalgum, and pesplantus 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)

25. In Action Video 2: Frontal View Video 1: Floor View

26. Impact on…… In the above example: Impact of abnormal force attenuation Pesplantus – plantar fascitis, Achilles tendonitis, stress fractures, ankle s/s Genuvalgum/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

27. Pathokinematics

28. Causes and Tests Tightness Weaknesses Muscular imbalances Poor balance

32. References 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. 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. 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. 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. 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. 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.

33. References 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. 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. 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. 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. 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. 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.

34. Contact Information Trent Nessler, PT, DPT, MPT Area Vice President – TN, AL, MS Champion Sports Medicine/Physiotherapy Associates Trent.nessler@physiocorp.com www.aclprogram.com