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LE Pathokinematics - OA Can It Be Prevented


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LE Pathokinematics - OA Can It Be Prevented

  1. 1. LE Pathokinematics:<br />Osteoarthritis: <br />Can It be Prevented? <br />Trent Nessler, PT, DPT, MPT<br />Area Vice President -Champion Sports Medicine/Physiotherapy Associates<br />CEO - Accelerated Conditioning and Learning<br />USA Cheer National Safety Council<br />
  2. 2. Osteoarthritis <br /><ul><li>WHAT IS IT
  3. 3. Degenerative changes of the articular cartilage
  4. 4. Articular cartilage = Hyaline cartilage and water
  5. 5. Covers surface of weight bearing joints
  6. 6. Prevents bone on bone – oil in piston
  7. 7. Common joints affected
  8. 8. Hip
  9. 9. Knee
  10. 10. Low back
  11. 11. Ankle
  12. 12. Wrist</li></li></ul><li>Osteoarthritis <br /><ul><li>CAUSES (not all inclusive):
  13. 13. Diabetes – more prone
  14. 14. Post traumatic
  15. 15. Inflammatory diseases
  16. 16. Congenital
  17. 17. Hemophilia
  18. 18. Nutrition
  19. 19. Abnormal force </li></ul>attenuation<br /><ul><li>Shear stress
  20. 20. Dehydration </li></li></ul><li>Hydration<br />How does H2O help?<br />Walking chemical reaction – <br />Hydrogen needed to create optimal PH<br />Optimal PH means:<br />Tissues heal better/faster<br />Increased hydration of Tissue<br />Increased extensibility/flexibility – withstand more force before injury<br />Cartilage more hydrated – less fissures - withstand more force<br />
  21. 21. Hydration<br />Journal of Epidemiology (June 2002)<br />Women who drink 5 glasses of water a day reduce potential for heart disease by 41%<br />Men who drink 5 glasses of water a day reduce the potential for heart disease by 56%<br />Nearly 50% of the American population is considered clinically dehydrated<br />As little as 1% dehydration results in 10% decrease in performance<br />Caffeine, diuretic and postulated to increase bone loss<br />Recommended daily dose 420 mg/day, average over 800-1600 mg/day<br />For every 10 mg over, add 1 oz of H2O<br />How do you know if you are hydrated enough?<br />
  22. 22. HYDRATION CHART<br />
  23. 23. Nutritional Considerations<br />Proper nutrition – certified sports nutritionist<br />Basics<br />Why?<br />Walking chemical reaction – have to give proper nutrition/hydration to run smoothly<br />Combined with hydration can have one of the largest impacts on your performance<br />Muscles that are stronger resist more stress<br />Small meals over course of the day (5-7) – include all food groups<br />.5-1.0 g/protein per kg BW<br />BUN<br />Supplementation with maturity<br />
  24. 24. Pathokinematics<br />Decreased flexibility, balance and strength add to:<br />Pathokinematics:<br />Abnormal movement patterns<br />Can be the result of proximal or distal components <br />Where does it start????<br />Typical presentation of kinetic chain:<br />Shoulder depression, positional thoracic scoliosis, lumbar sidebending, trendelenburg at hip, hip adduction, femoral internal rotation, knee genuvalgum, and pesplantus<br />Is it an issue - Mature adult<br />Increased risk or fear of falls - curbs<br />Difficulty with a/d stairs<br />Use of arms with sit/stand<br />Decreased endurance with activities (mall/store)<br />
  25. 25. In Action<br />Video 2: Frontal View<br />Video 1: Floor View<br />
  26. 26. Impact on……<br />In the above example:<br />Impact of abnormal force attenuation<br />Pesplantus – plantar fascitis, Achilles tendonitis, stress fractures, ankle s/s<br />Genuvalgum/internal rotation – meniscal injuries, ACL/MCL/LCL injuries, IT band friction syndrome, PF syndrome, DJD<br />Hip Adduction – piriformis syndrome, SI joint pain, trochanteric bursitis, snapping hip, hip labral tears, DJD<br />Lumbar side bending – SI joint pain, low back pain, spondo, facet syndrome, DJD<br />
  27. 27. Pathokinematics<br />
  28. 28. Causes and Tests<br />Tightness<br />Weaknesses<br />Muscular imbalances<br />Poor balance<br />
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  32. 32. References<br />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.<br />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.<br />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. <br />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. <br />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.<br />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. <br />
  33. 33. References<br />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.<br />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.<br />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.<br />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.<br />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.<br />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. <br />
  34. 34. Contact Information<br />Trent Nessler, PT, DPT, MPT<br />Area Vice President – TN, AL, MS<br />Champion Sports Medicine/Physiotherapy Associates<br /><br /><br />