The document discusses osteoarthritis, including its causes such as diabetes, trauma, nutrition, and abnormal force on joints, and how proper hydration and nutrition can help prevent it by keeping tissues hydrated and strong enough to withstand stress. It also examines pathokinematics and how abnormal movement patterns can develop from tightness, weaknesses, or muscular imbalances and lead to injuries if not addressed. References are provided for further reading on related research.

1. LE Pathokinematics: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

2. Osteoarthritis WHAT IS IT

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

12. WristOsteoarthritis CAUSES (not all inclusive):

13. Diabetes – more prone

14. Post traumatic

15. Inflammatory diseases

16. Congenital

17. Hemophilia

18. Nutrition

19. Abnormal force attenuationShear stress

20. Dehydration HydrationHow does H2O help?Walking chemical reaction – Hydrogen needed to create optimal PHOptimal PH means:Tissues heal better/fasterIncreased hydration of TissueIncreased extensibility/flexibility – withstand more force before injuryCartilage more hydrated – less fissures - withstand more force

21. HydrationJournal 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 dehydratedAs little as 1% dehydration results in 10% decrease in performanceCaffeine, diuretic and postulated to increase bone lossRecommended daily dose 420 mg/day, average over 800-1600 mg/dayFor every 10 mg over, add 1 oz of H2OHow do you know if you are hydrated enough?

22. HYDRATION CHART

23. Nutritional ConsiderationsProper nutrition – certified sports nutritionistBasicsWhy?Walking chemical reaction – have to give proper nutrition/hydration to run smoothlyCombined with hydration can have one of the largest impacts on your performanceMuscles that are stronger resist more stressSmall meals over course of the day (5-7) – include all food groups.5-1.0 g/protein per kg BWBUNSupplementation with maturity

24. PathokinematicsDecreased flexibility, balance and strength add to:Pathokinematics:Abnormal movement patternsCan 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 pesplantusIs it an issue - Mature adultIncreased risk or fear of falls - curbsDifficulty with a/d stairsUse of arms with sit/standDecreased endurance with activities (mall/store)

25. In ActionVideo 2: Frontal ViewVideo 1: Floor View

26. Impact on……In the above example:Impact of abnormal force attenuationPesplantus – plantar fascitis, Achilles tendonitis, stress fractures, ankle s/sGenuvalgum/internal rotation – meniscal injuries, ACL/MCL/LCL injuries, IT band friction syndrome, PF syndrome, DJDHip Adduction – piriformis syndrome, SI joint pain, trochanteric bursitis, snapping hip, hip labral tears, DJDLumbar side bending – SI joint pain, low back pain, spondo, facet syndrome, DJD

27. Pathokinematics

28. Causes and TestsTightnessWeaknessesMuscular imbalancesPoor balance

32. ReferencesAhmad, 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. ReferencesMyer 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 InformationTrent Nessler, PT, DPT, MPTArea Vice President – TN, AL, MSChampion Sports Medicine/Physiotherapy AssociatesTrent.nessler@physiocorp.comwww.aclprogram.com