Data Driven Return to Play: Post‐op ACL · 2018-07-26 · •5. Core Stability •6. Hip Strength...
Transcript of Data Driven Return to Play: Post‐op ACL · 2018-07-26 · •5. Core Stability •6. Hip Strength...
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Data Driven Return to Play: Post‐op ACL
Dave Philbrick AT, ATC, CES, CFSC
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WHEN IT COMES TO MEASURING PERFORMANCE IN SPORTS,NUMBERS DON’T LIE.
TAKE YOUR TRAINING TO THE NEXT LEVEL BY VISITING us.dorsaVi.com
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Current Research
• ACL injuries occur 5 times more often in female soccer, volleyball and basketball players than male athletes in these sports.
• 100,000 ACL reconstructions in U.S. each year– 81% return to sports
– 65% return to their pre‐injury level of play
• 20% of ACL reconstructions have to have another surgery within 2 years
– 10% to the other knee
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Mechanism of Injury: MOI
The most common
cause of ACL injury is…..
ABNORMAL
PRONATION…a
deceleration Injury.
Why are females more prone to serious knee injuries?
• Research to date indicates the reasons are MULTIFACTORIAL.
Uncontrollable Genealogy:
• The female Notch is more narrow and sometimes taller than a male’s notch
• The Female ACL is typically smaller in girth than a male’s and the tissue is more elastic
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Uncontrollable: Pelvic Size / Width
• Females tend to have wider Pelvis‐Femoral‐Length Ratios
• This may put the muscles around the hip at a mechanical disadvantage and/or
• Place the knee in a Genu Valgus position
Uncontrollable: Estrogen and ACL’s
• Do Hormonal levels affect injury rates?
• ACL injury does not remain constant during the menstrual cycle, with a significantly greater risk during the pre‐ovulatory phase than during the postovulatory phase
Wojtys EM, Huston LJ, Lindenfeld TN, et al. Association between the menstrual cycle and anterior cruciate ligament injuries in female athletes. Am J Sports Med. 1998;26:614–9.
Anatomical and other Factors.. We CAN Affect!
• Lower Extremity Malalignments: Core, Hips and Feet
• Muscle Stiffness
• Muscle Strength
• Balance / Proprioception
• Technique Errors –Running, Jumping & Change of Direction.
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Assess and impact
• 1. Foot Assessment and Posture
• 2. Hyper‐mobility • 3. Hip Internal Rotation • 4. Ankle mobility• 5. Core Stability• 6. Hip Strength• 7. Running and Jumping Mechanics
• Typically starts at 3 months post‐op
1. Foot and Posture Assessment
• The knee is stuck in the middle – Between the Hip and the Foot.
• Both joints above and below the knee can affect it.
Joint Primary Need
Ankle Mobility
Knee Stability
Hip Mobility
Lumbar Spine Stability
Thoracic Spine Mobility
Scapulo-Thoracic Stability
Gleno-Humeral Mobility
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1. Foot and Posture Assessment Continued
• There are typically three types of foot structures:
1) The Normal Foot
2) The Flat Foot
3) High Arch Foot.
1. Foot and Posture Assessment
• Flat feet can create valgus strain on the knee.
1. Foot Assessment: High Arch Foot
• The Cavus foot – very rigid
– not allowing adequate Dorsiflexion at the ankle, eversion at the calcaneus and internal rotation at the tibia.
• The Knee will attempt to make up for this loss of “pronation” by producing
extra valgus at the KNEE!
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Other LE enemies of the ACL
• First MTP joint restrictions‐
– May lead to increased toe out and valgus loading
– May facilitate more STJ pronation and tibialrotation
Other enemies of the ACL
• Increased Gastroc/Soleus stiffness
– May lead to increased femoral rotation to make up for lack of DF
2. General Hypermobility
• Females typically demonstrate greater amounts of mobility compared to males.
• This is thought to be secondary to differences in the collagen tissue that makes up the females muscles, tendons and ligaments.
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Hypermobility =
• Slower hamstring recruitment
– Poor deceleration
– Poorjumping/cutting mechanics
3. Restricted Hip Internal Rotation
• Knee: “I got this”
• Athletes find a way to get movement
4. Ankle Mobility
Limited Ankle = Risk of Knee instability
Joint Primary Need
Ankle Mobility
Knee Stability
Hip Mobility
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5. Core Stability
• Stable spine and hips = better movement
6. Gluteus Medius Weakness
• Allows for better frontal plane control
• Hip ADDuction = Knee valgus
7. Poor Running/Jumping Mechanics
• All of the above….Leads to this
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Testing these Controllable factors
• 1. Milestones progression
– Are we jumping gun?
• 2. Did we bridge the gap between PT and Sport
• 3. Translate to sport
Return to Sport
• Grindem et al (2016)
• 106 competitive athletes who recently had ACLR surgery
• 5 key performance criteria
– Quads strength within 10% of the uninjured side
– 4 single leg hop tests; with no more than 10% difference between sides
Return to Sport
• 38% of athletes who RTS despite not passing RTS criteria re‐injured their ACL
• Only 5% of athletes who did meet all 5 RTS criteria re‐injured their ACL
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Common RTP tests used
• Single Leg squat
• Y‐ Balance test
• Vertical Jump
• Fwd/rev Single leg hop
• Med/Lat single leg hop
• 3 hop test
And more…
• T‐Test
• Cross‐over hop
• Cross‐over Triple hop
• 6 Meter Timed Hop
Which Tests are Best??
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REVOLUTIONARY WEARABLE SENSOR
TECHNOLOGY
TAKE HUMAN MOVEMENT AND TURN IT INTO EASILY INTERPRETEDDATA.
• Wireless sensor Tech
• Accelerometers
• Tracks and Measures how athletes move– Real Time
– Wearable
– 200 frames/sec
• Transfers data– Easy to read results
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REVOLUTIONARY WEARABLE SENSOR TECHNOLOGY
DATA
• Quality of motion
• Objective Data
• Shows progress
• Improves confidence of Athlete
• Communication with Parents/Surgeon
• Gives us more reassurance
HOW THE dorsaVi™ PLATFORMWORKS
dorsaVi™ SENSORS SEND INFORMATION WIRELESSLY TO SOFTWAREON YOUR COMPUTER IN REAL‐TIME.
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ASSESS HIGH‐RISK MOVEMENTS WITH HARD DATA, NOT HUNCHES.
dorsaVi™ SENSORS ARE SYNCED WITH HD VIDEOTO PRODUCE REAL‐TIME OBJECTIVE DATA.
RUNNING Athletic Movement Index
• Sportinformation
• ACL injury history
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AHTLETIC MOVEMENT INDEX –CLINICAL APPLICATIONS
• Athletic populations only
• Baseline or RTP test• ACL prevention program as a follow up
ATHLETIC MOVEMENT INDEX™ (AMI™)
• Demographic data• Movement data• Limb Symmetry data• High Intensity
o Sport challenging not sport specifico Fatigue
7 “essential movements”
Core Tests
1. Plank Test (PT)
2. Full Squat Test (FST)
3. Left / Right Side Plank Test (SPT)
Limb Symmetry Testing1. Left / Right Single Leg Squat Test (SLST)
2. Left / Right Single Leg Hop Test (SLHT)
3. Left / Right Single Leg Hop Plant Test (SLPT)
4. Left / Right Ankle Lunge Test (ALT)
ATHLETIC MOVEMENT INDEX™ (AMI™)
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AMI Report – Summary Page
• 336 points possible: 123 per limb for SL tests, 30 per plank (x3)
• LOB, LOPC, Sport, Injuryhx can only detract fromoverall risk, not boost
• Symmetry important, but individual SL performance weighted more
Plank
• Scored based on the amount of time subject is able to maintain a position within 10 degrees of the start.
• POSITION THE ATHLETE IN OPTIMAL PLANK before opening the window
DL Squat
• Looking for shift
• Scoring for each rep:
‐ 3 pts possible per rep
• Lowest possible score = 20
• Trend displayed over all reps
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Single Limb – Squat, Hop, Hop/Plant
• Scored per rep for 10 reps each:
‐ 3 points possible each rep
• Minimum score of 10 each leg
Ankle Lunge Test
<15 degrees = 1 point
16‐35 degrees = 2 points
>35 deg = 3 points
What Are Good Values?
• Speed of frontal plane movement: • SL squat: 10‐20
degrees/second • SL Hop: <100
degrees/second
• SL Hop/Plant: <135 degrees/second
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Running Application
RUNNINGTESTS
Jog
Run
Sprint
Acceleration/Deceleration
Distance Run
Leg Symmetry
Average Ground Reaction Force
(L&R Leg)
Average Initial Peak Acceleration
Average Ground Contact Time
(L&R Leg)
Average Steps Per Minute
Total Distance
Average Speed, Time
Outdoor Assessment for Up to 24 Hours
WHAT’SMEASURED
SAMPLE ViPerform™ RUNNINGANALYTICS
Report Review
*ASI = Absolute Symmetry Index Traffic Lights and Bar Graph
*GRF = Ground Reaction Force
*IPA = Initial Peak Acceleration
Trend = See improvement, or lack thereof, with ASI Comparison to Past Sessions
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Running – Best Practice Recommendations
IPA
Jog/Run < 4g = Good5 – 8g = Okay – watch the higher end8‐10g = Intervene
Sprint <5g = Good6‐8g = Okay – watch at higher
end
9‐10g = Intervene
Accel/Decel <7g = Good
8‐10 = Okay – watch at higher end10+ = Intervene
Reassess and Reprogram
• Failed test = Keep working
• Modify Rehab Program
• Don’t settle for “good enough”
Live Testing
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increased risk of ACL injury. Knee Surg Sports Traumatol Arthrosc. 2014 Sep 11. • Gilchrist J, Mandelbaum BR, et al. A randomized controlled trial to prevent noncontact
anterior cruciate ligament injury in female collegiate soccer players. The American Journal of Sports Medicine;36,8,1476‐1483.
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• Griffin LY, Albohm MJ, Arendt EA, et al. Update on ACL prevention: theoretical and practical guidelines. Am J Sports Med. 2006;34:1512–32.
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Thank you