Goals for Today ARE YOU OFF YOUR ROCKER? Discuss the functional - - PDF document

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ARE YOU OFF YOUR ROCKER? Clinical Techniques for Gait Evaluation and Intervention

Patrick O. McKeon, PhD, ATC, CSCS University of Kentucky

Goals for Today

• Discuss the functional demands of the lower extremity

– What are they? – Absorption vs. Propulsion vs. Transition

• Muscles
• Joints
• Timing
• Gait Rockers
• Present evidence for functional assessments of the lower extremity and

how they help us understand gait

• Why do we functionally test the lower extremity as it relates to gait?

– Pre‐participation – Rehabilitation Progression – Return to play decisions

• Put it all together and try them

Lower Extremity Joint Motions

• Hip

– Flexion/Extension, Adduction/Abduction, Internal/External Rotation

• Knee

– Flexion/Extension, Internal/External Rotation

• Ankle (Talocrural and Subtalar Joints)

– Dorsiflexion/Plantarflexion, Inversion/Eversion, Internal/External Rotation

• Foot (Rearfoot, Midfoot, Forefoot)

– Pronation/Supination

Demands of the Lower Extremity

• Absorption

– Flexion – Adduction – Internal Rotation – Pronation

• Propulsion

– Extension – Abduction – External Rotation – Supination

Quatman et al. AJSM 2006

What structures absorb?

• Active

– Muscles – Tendons – How?

• Passive

– Capsuloligamentous – Bone – Articular Cartilage – Fibrocartilage – Nerves – How?

www.aofas.org Hewett et al. AJSM 2005

What propels us?

• Muscles
• Tendons

– How?

Padua et al. AJSM 2009

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Absorption and Propulsion Gait Rockers

Absorption Propulsion Terminal Swing Initial Swing Why do we need lots of absorption during walking? What rocker do we lose when we transition from walking to running? What rocker do we gain when we transition from running to walking?

Perry & Burnfield. Gait Analysis 2nd Edition 2010

Dorsiflexion is a key component…

• Force absorption

– Ankle Rocker

• Optimization of forefoot rocker

– Propulsion

• Functionally linked to hip and knee

flexion

• Fong et al. JAT 2011
• DF restrictions related to knee and

ankle ligament injuries

– Less flexed knee when landing – Anterior reach on SEBT

• Plisky et al. JOSPT 2006
• Drewes et al. JSMS 2009
• Hoch et al. JSMS 2012

Weight‐bearing lunge test Hoch et al. JSMS 2011

What can a hop tell us?

Logerstedt et al. AJSM 2012 Noyes et al. AJSM 1991

Absorption or propulsion issues? What else should we ask?

Docherty et al. J Athl Train 2005 Caffrey et al. JOSPT 2009

Changing demands… Again…what should we ask?

Buchanan et al. J Athl Train 2008 Single‐limb hurdle test Single‐limb hopping test

Absorption + Propulsion = Postural Stability

Gribble and Hertel J Athl Train 2012 Hoch et al. JSMS 2011 and 2012 McKeon et al. MSSE 2008 Star Excursion Balance Test

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Single Limb Balance Test

• Examine errors in ability

to maintain target position

– Hands off hips – Touching down – Hip and trunk movement – Opening eyes – Lifting foot – Stepping or stumbling

Docherty et al. Clin J Sport Med 2006 Trojian et al. BJSM 2006

Considerations for Functional Testing…

• Sensitive dependence on initial conditions (Chaos Theory)

– In what functional conditions do you assess?

• Demands of activity
• Timing of injury, rehab, and RTP
• Fresh vs. fatigued state
• Potential of functional assessment (not just a quick screen)

– How can we use these assessments?

• Objective assessments – need to have a measurable outcome

– Time – Distance – Errors

• Rehabilitation outcomes
• Return to play decisions
• Risk Assessment (Pre‐participation)
• Prophylactic benefit (changes due to prevention program)

Less talking, more doing…

• Let’s explore some of these issues together

– Are you off your rocker? – Star Excursion Balance Test – Single limb hop tests – Single limb balance test

• Let’s talk through some questions…

– Absorption, propulsion, transition

Thank you!!!

Questions??