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BIOMECHANICS AND SPORTS MEDICINE

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BIOMECHANICS AND SPORTS MEDICINE By Will Dang, Claudine Dizon, Daniel Hidalgo, and Gina Cuevas KNES 461: Biomechanical Analysis of Human Movement – PowerPoint PPT presentation

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Title: BIOMECHANICS AND SPORTS MEDICINE


1
BIOMECHANICS AND SPORTS MEDICINE
By Will Dang, Claudine Dizon, Daniel Hidalgo,
and Gina Cuevas
KNES 461 Biomechanical Analysis of Human
Movement Sept 8th, 2004 Dr. Guillermo Noffal
2
INTRODUCTION
  • Biomechanics is a major factor in the field of
    sports medicine
  • Whether it is describing the mechanism of a
    sports injury, determining the amount of force
    certain tissue can withstand during a surgical
    procedure, or prescribing a correct
    rehabilitation method,

  • biomechanics plays a major role for sports
    medicine specialists.

3
INTRODUCTION (contd)
  • Because the sports medicine field is so vast, it
    is difficult to encompass all the facets of such
    a major realm of science.
  • Thus, it is the focus of this group to touch on
    certain elements of sports medicine as it
    pertains to biomechanics, i.e. common injuries
    found in the domain of sports medicine

4
WHAT IS BIOMECHANICS?
  • The applications of mechanical principles to
    biological problems.
  • Mechanism Physical process responsible for a
    given action, reaction, or result

5
APPLICATION TO SPORTS MED???
  • Sports Medicine is the branch of medicine
    concerned with physical fitness and with the
    treatment and prevention of injuries and other
    disorders related to sports.
  • Obviously, biomechanics can be linked to almost
    all forms of sports medicine

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7
ACL BIOMECHANICS
  • ACL is primary restraint to anterior translation
    of the tibia
  • ACL is secondary restraint to tibial rotation and
    varus/valgus loading at full extension
  • Average tensile strength for ACL is 2160N

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9
ACL Injury Mechanism
  • Valgus loading and external tibial rotation
    (cutting movements)
  • Hyperextension and internal tibial rotation
    (landing from jumps/rotate)
  • Load exceeds tissue capabilities

10
Arthroscopic ACL Reconstruction Surgery
11
The most common type of tendon graft for an ACL
surgery is the middle one-third of the patella
tendon with a bone block at each end.
12
Holes are then drilled through the tibia and
femur. These holes are located at the attachment
sites of the original ligament.
The graft is then pulled through the holes and
set in place by screws.
13
  • By fastening the graft in this way new blood
    vessels are allowed to grow around the attachment
    sites, thus facilitating the healing process.
  • Because arthroscopy is used in this surgery
    it is typically performed on an outpatient basis.
  • Arthroscopy typically allows athletes to
    recover more quickly so they can return to their
    sport or activity.

14
ACL Rehabilitation Goals
  • Restoration of joint anatomy
  • Providing static and dynamic stability
  • Return to normal activities

15
Accelerated Rehabilitation Phase 1
  • Patient is placed on a CPM machine before they
    awake in the operating room.
  • Next day the brace is put on locked in extension,
    crutches optional
  • Patient remains home for the first 7 days using
    the CPM machine for 23 hours a day.
  • By the end of week patient should have full
    extension and 90 degree flexion

16
Phase 1 Goals
  • Protective reconstruction and avoid falling
  • Ensure wound healing
  • Attain and maintain full knee flexion
  • Promote Quadriceps muscle strength
  • Gain knee flexion to near 90 degrees
  • Decrease knee and leg swelling by avoiding blood
    pooling in leg veins
  • Prescribed exercises will help assist in
    accomplishing goals

17
Phase 1 Goals
  • Protective reconstruction and avoid falling
  • Ensure wound healing
  • Attain and maintain full knee flexion
  • Promote Quadriceps muscle strength
  • Gain knee flexion to near 90 degrees
  • Decrease knee and leg swelling by avoiding blood
    pooling in leg veins
  • Prescribed exercises will help assist in
    accomplishing goals

18
Phase 2 1-5 weeks
  • Patient returns for examination to check status
    of knee
  • Patient is given shorter postoperative brace
  • Patient is encouraged to test knee with full
    weight barring
  • Patient is encouraged to use brace for means of
    support and comfort
  • Prescribed exercises done twice a day
  • Patient should achieve gait independently between
    3-5 weeks post surgery

19
Phase 2 Goals
  • Protect the reconstruction and avoid falling
  • Ensure wound healing
  • Maintain full knee extension
  • Begin quad muscle strengthening
  • Attain knee flexion of 90 degrees or more
  • Decrease knee and leg swelling
  • Normal Gait without crutches or brace

20
Phase 3 3-9 weeks after surgery
  • Swimming may begin at this time (standard
    freestyle kick)
  • phase 1 exercises can be disregarded and strength
    in quadriceps are efficient
  • Resistance using ankle weights may be added
  • Development of single leg strength is emphasized
    at this time
  • Quadriceps strengthening should continue for full
    active knee extension
  • Optional regiment of weight room exercises

21
Goals of Phase 3
  • Protect the reconstruction avoid falling
  • Maintain full knee extension
  • Attain full knee flexion
  • Walk with normal heel to gait with no limp
  • Muscle strength and conditioning improvements

22
Phase 4 Goals
  • Full muscle strength
  • Improve cardiovascular conditioning
  • Sports specific training
  • Straight ahead phase
  • Direction phase
  • Advanced direction change and impact phase
  • Sport specific phase

23
Phase 4
  • Patient is allowed to use stationary bike and or
    swimming
  • Orderly sequenced of drills designed to attain
    the proprioceptive feedback loops
  • Neuromuscular control of operated knee
  • Logical sequence of progressive drills for pre
    sports conditioning is to provide an objective
    criteria for patients safe return to sport

24
FOR MORE INFO...
25
ROTATOR CUFF BIOMECHANICS
  • Primary source of stability to the shoulder
  • Associated with and assist with some shoulder
    motion such as external rotation, internal
    rotation, abduction, adduction, and to some
    degree, extension
  • Principle function, however, is to stabilize the
    GH joint

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28
ROTARY CUFF INJURY
  • Impingements
  • extrinsic structural factors
  • hook acromion
  • hypertrophy of supraspinatus
  • Intrinsic
  • inflammation of the tissue
  • Mechanism
  • overuse in sports requiring overhead movements
  • abductor dominance (wheelchair)

29
ROTARY CUFF INJURY (contd)
  • Rotator Cuff Tear
  • Chain of events
  • Inflammation
  • Microtears
  • Partial or total rupture
  • Movement adaptations
  • Supraspinatus most common
  • Eccentric Actions
  • Acceleration phase
  • Deceleration phase

30
Tensile Failure
  • -Failure with throwing
  • -Throwing motion (5) phases
  • 1.wind-up
  • 2.cocking
  • 3.acceleration
  • 4.deceleration
  • 5.follow-through
  • -Forces generated during these phases result in
    stress around the shoulder joint causing prone to
    acute and chronic inflammatory conditions and
    injuries.

31
KINEMATIC PATTERNS RELATED TO ROTATOR CUFF TEAR
LOCATION
Kinematic Pattern Tear Location
I. Stable fulcrum kinematics Supraspinatus part of infraspinatus
II. Unstable fulcrum kinematics (posterior cuff tear pattern) Supraspinatus all of posterior cuff (infraspinatus teres minor)
III. Captured fulcrum kinematics Supraspinatus major posterior cuff at least 50 subscapularis
IV. Unstable fulcrum kinematics (subscapularis tear pattern) Supraspinatus complete subscapularis
32
  • Rotator Cuff Surgery Options
  • Arthroscopic Rotator Cuff Repair
  • Least invasive of all surgical options
  • Small, 1-centimeter incisions leave less scarring
    and allow quicker healing with less pain
  • Less scar tissue develops so range of motion is
    not restricted and less rehab is needed
  • Surgeon inserts a tiny camera into the incision
    and watches on a television monitor
  • Cause minimal trauma to the tissues that surround
    the shoulder and the rotator cuff (deltoid)
  • Most difficult of the three procedures listed

33
Left Stitches are used to close the large tear.
Right Metallic anchors are set into the humerus
at the site for tendon reattachment.
34
  • Open Rotator Cuff Repair
  • Now only used in the most severe cases
  • Most invasive of the three methods in which a
    6-10 centimeter incision is made
  • Muscle beneath the skin is separated to expose
    the damaged rotator cuff
  • The surgical dissection can potentially cause
    pain and disability, despite a good rotator cuff
    repair
  • Usually leads to more scarring than the less
    invasive procedures
  • Not popular in treating professional athletes
    because of extended post-surgery recovery and
    therapy time that is needed

35
  • Mini-open Rotator Cuff Repair
  • Combination of arthroscopy and a small incision
    (approx. 3-5 centimeters)
  • Currently the most popular rotator cuff repair
    procedure because it is highly successful and
    less invasive than open surgery.
  • Allows more necessary repairs to be done around
    the rotator cuff than the all-arthroscopic
    procedure.

36
  • Surgery is the final option for most but is more
    readily used with professional athletes because
    non-operative therapy can take too long and the
    rotator cuff may never fully heal
  • Other damage to the shoulder that is found during
    surgery is usually repaired at this time (e.g.,
    bone spurs on the underside of the acromion bone
    are common in those suffering from rotator cuff
    tears.)

37
Good throwing technique
  • Requires the athlete to use his body weight and
    the large muscle groups of the legs, back and
    trunk to generate kinetic energy across the
    shoulder in the direction of the thrown object.

Poor mechanics during the wind-up and cocking
phase require the shoulder muscles to generate
more required energy to throw the object, which
then leads to fatigue of the shoulder muscles,
resulting in injuries.
38
Note
  • A great deal of the force generated in overhead
    sports occurs in the trunk and lower extremity,
    and these areas should be targeted in any
    conditioning program for athletes who throw.

39
Example
  •   Wind-up rotator cuff muscles are inactive
    during this initial stage.
  •   Early cocking stage involves external
    shoulder rotation.
  •   Late cocking stage the rotator cuff muscles
    are very active during this stage, especially the
    subscapularis, which contracts and acts as a
    dynamic stabilizer
  •   Acceleration stage begins with internal
    rotation of the humerus and ends with release of
    the baseball. The muscles of the rotator cuff are
    basically inactive.
  •   Follow-through during this phase, the
    rotator cuff muscles are most active. The
    supraspinatus contracts to decelerate internal
    rotation of the limb.

40
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41
Rehabilitation of Rotator Cuff Injuries
  • -Requires reduction of any inflammation.
  • -Soft tissue massage, stretching and
    strengthening.
  • -Specific bungy and free weight exercises in
    functional ranges of motion.

42
WHO USES BIOMECHANICS IN SPORTS MEDICINE???
  • Orthopedic Surgeons
  • Education
  • 4 years of undergrad
  • 4 years of medical school
  • Usually 4 years of residency
  • 1-2 years of fellowship
  • After that is all said and done though, The
    median expected salary for a typical Physician -
    Surgery - Orthopedic in Orange County, CA, is a
    whopping
  • 332,288

43
WHO USES BIOMECHANICS IN SPORTS MEDICINE???
(contd)
  • Physical therapists
  • Dr George Young Interview
  • PT at Alamitos Physical Therapy
  • Graduated with bachelors in biology
  • Taught high school biology and coached tennis and
    softball
  • Worked in the physiology department at USC while
    taking classes
  • Physical therapy masters in 2 years at USC
  • Started his own business

44
Dr. George Young Interview
  • After 8 years with his own practice went back for
    Doctorate
  • Has friends who have succeeded and some that went
    bankrupt with their own practice
  • New grad can start off making 25 an hour
  • Depends on location and demand
  • Downtown New York a new grad can start off
    making 6 figures
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