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

5/7/2013 Goals for Today ARE YOU OFF YOUR ROCKER? Discuss the functional demands of the lower extremity • – What are they? – Absorption vs. Propulsion vs. Transition Muscles • Clinical Techniques for Joints • Timing • Gait Rockers • Gait Evaluation and Intervention 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? • Patrick O. McKeon, PhD, ATC, CSCS – Pre ‐ participation – Rehabilitation Progression University of Kentucky – Return to play decisions Put it all together and try them • Lower Extremity Joint Motions Demands of the Lower Extremity Hip • • Absorption • Propulsion – Flexion/Extension, Adduction/Abduction, Internal/External Rotation – Flexion – Extension Knee – Adduction – Abduction • – Flexion/Extension, Internal/External Rotation – Internal Rotation – External Rotation – Pronation – Supination Ankle (Talocrural and Subtalar Joints) • – Dorsiflexion/Plantarflexion, Inversion/Eversion, Internal/External Rotation Foot (Rearfoot, Midfoot, Forefoot) • – Pronation/Supination Quatman et al. AJSM 2006 What structures absorb? What propels us? • Active • Passive • Muscles – Muscles – Capsuloligamentous – Tendons – Bone • Tendons – How? – Articular Cartilage – How? – Fibrocartilage Padua et al. AJSM 2009 – Nerves – How? www.aofas.org Hewett et al. AJSM 2005 1

5/7/2013 Absorption and Propulsion Dorsiflexion is a key component… Gait Rockers Force absorption • Ankle Rocker – Terminal Swing Initial Swing 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 – Absorption Propulsion Anterior reach on SEBT – Plisky et al. JOSPT 2006 • Why do we need lots of absorption during walking? Drewes et al. JSMS 2009 • Hoch et al. JSMS 2012 • What rocker do we lose when we transition from walking to running? Weight ‐ bearing lunge test What rocker do we gain when we transition from running to walking? Hoch et al. JSMS 2011 Perry & Burnfield. Gait Analysis 2 nd Edition 2010 Absorption or propulsion issues? What can a hop tell us? What else should we ask? Docherty et al. J Athl Train 2005 Caffrey et al. JOSPT 2009 Noyes et al. AJSM 1991 Logerstedt et al. AJSM 2012 Changing demands… Absorption + Propulsion = Again…what should we ask? Postural Stability Single ‐ limb hopping test Single ‐ limb hurdle test Star Excursion Balance Test Gribble and Hertel J Athl Train 2012 Hoch et al. JSMS 2011 and 2012 Buchanan et al. J Athl Train 2008 McKeon et al. MSSE 2008 2

5/7/2013 Single Limb Balance Test Considerations for Functional Testing… • Sensitive dependence on initial conditions (Chaos Theory) • Examine errors in ability – In what functional conditions do you assess? to maintain target • Demands of activity position • Timing of injury, rehab, and RTP • Fresh vs. fatigued state – Hands off hips – Touching down • Potential of functional assessment (not just a quick screen) – Hip and trunk movement – How can we use these assessments? • Objective assessments – need to have a measurable outcome – Opening eyes – Time – Lifting foot – Distance – Errors – Stepping or stumbling • Rehabilitation outcomes • Return to play decisions • Risk Assessment (Pre ‐ participation) • Prophylactic benefit (changes due to prevention program) Docherty et al. Clin J Sport Med 2006 Trojian et al. BJSM 2006 Less talking, more doing… • Let’s explore some of these issues together – Are you off your rocker? Thank you!!! – Star Excursion Balance Test – Single limb hop tests – Single limb balance test Questions?? • Let’s talk through some questions… – Absorption, propulsion, transition 3