WELCOME TO THE. Canadian Federation of Podiatric Medicine 2018 CONFERENCE. #CFPM2018

Transcription

1 WELCOME TO THE Canadian Federation of Podiatric Medicine 2018 CONFERENCE #CFPM2018

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3 Injury Prevention for Lower Extremity Injuries: Top Down and Bottoms Up Impacts Allison Gaudet, Physical Therapist MClScPT, MScPT, BScKin, FCAMPT School of Physical Therapy, MClSc - MT

4 Where we are heading Poor Movement strategies Lower Extremity Injuries Top Down Bottoms Up Exercise strategies Wrap it all up together

5 How to Identify High Risk Athletes

6 KNEE POSITION - ALIGNMENT CORRECT INCORRECT Technique: Essential in order to obtain proper results! Correct vs Incorrect Landing / Jumping Technique **You Need to Learn and Watch for Proper Execution

7 KNEE POSITION: AVOID ANTERIOR KNEE PAIN! CORRECT INCORRECT

8 Movement and Landing Strategies Quadriceps Dominance Trunk Dominance Ligament dominance Leg Dominance 1.Hewett TE, Ford KR, Hoogenboom BJ, Myer GD. Understanding and preventing acl injuries: current biomechanical and epidemiologic considerations - update N Am J Sports Phys Ther. 2010;5(4):

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10 ACL INJURY IN VOLLEYBALL

11 SEAN LIVINGSTON

12 Derek Rose

13 Iman Shumpert

14 Drop-Jump ACL Screening Test (watch the knees come together)

15 Drop jump test - post KNEEFIT program

16 BEFORE & AFTER KNEEFIT COMPARISON

17 High risk of acl injury!!!

18 LOW RISK FOR ACL TEAR

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20 REALITY OF AN ACL TEAR Success Rate: 25% 30% never return to the same level of sport or activity, some reports 75% Edmonton Journal 2012 Re-injury Rates up to 11% = 1/10 Osteo-Arthritis of the knee typically occurs within 5 years of an ACL injury Lost Scholarships, Peer Support Systems, Loss of Self Esteem and Personal Identity Leah Corse - Age 17 Edmonton Journal Leah Corse s knee is messing with her dreams.

21 Torn ACL + Both Players At Risk Previous Torn ACL Over 70% of all ACL injuries are Non-Contact Males account for 75% of all ACL Tears Females are 3-9 X Higher Risk than Males for Non-Contact ACL Injuries in the Same Sport

22 WHY FEMALES? WHAT DID THEY DO WRONG?

23 Females in sport 1972 = 1/ = 1/3 Over 900% females participating in H.S. sports since 1972 = Epidemic # s!

24 AN OUNCE OF PREVENTION IS WORTH A POUND OF CURE 24

25 RESEARCH: Injury Prevention Programs can Decrease Injury Rates: 46-90%!!! for the ACL Bayern Munchen

26 RESEARCH: Injury Prevention Programs can Decrease Injury Rates: 46-90%!!! for the ACL 30-40% Decrease in Overall Injuries Bayern Munchen

27 RESEARCH: Injury Prevention Programs can Decrease Injury Rates: 46-90%!!! for the ACL 30-40% Decrease in Overall Injuries 60% Decrease in Chronic Injuries Bayern Munchen

28 RESEARCH: Injury Prevention Programs can Decrease Injury Rates: 46-90%!!! for the ACL 30-40% Decrease in Overall Injuries 60% Decrease in Chronic Injuries Bayern Munchen Also, Improved SAQ Performance!!

29 Injury Prevention Programming Most Significant Injury Reductions are Ages Age is the Best Time to Begin -> Before They Begin Changing 3 times Per Week Off-Season or Pre-Season (6 Weeks Prior to the Season) 2 Times Per Week In Season Takes About 18 Minutes to Perform the Entire Team KNEEFIT Warm Up Study: 70% Retention of results at 1 Year After a 6 week Program Edmonton Journal 2012

30 KNEEFIT: 4 Part Balanced Program Mix & Match Different Parts B & C! A. Dynamic Warm-Up - 5 Minutes B. Core, Strength & Balance - 7 Min. C. Plyos & Neuromuscular Control - 3 Min. D. Power, Agility, Function - 3 Min.

31 BALANCED PROGRAM FLEXIBILITY - STRENGTH - BALANCE Training Only One Component is Dangerous!

32 Just do it!!! Huge study in (Sweden, 2012) 4500 female soccer players age % Reduction in ACL injuries Just 6 exercises!! (KNEEFIT B & C)

33 THE BIG 6

34 Improvements in Peri-operative care Pre-Operative Surgical Advancements Post-Operative Care IDENTIFICATION OF RISK FACTORS Hewett TE, Ford KR, Hoogenboom BJ, Myer GD. Understanding and preventing acl injuries: current biomechanical and epidemiologic considerations - update N Am J Sports Phys Ther. 2010;5(4):234 51

35 The Numbers 33% Return to the same level of sport 2-7yrs 66% Successful RTS Risk Factors of Re-tear Age Matched counterparts 30-40X increase Wiggins AJ, Grandhi RK, Schneider DK, Stanfield D, Webster KE, Myer GD. Risk of secondary injury in younger athletes after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Am J Sports Med [Internet]. 2016;Published online ahead of print. Available from: Nagelli C V., Hewett TE. Should Return to Sport be Delayed Until 2 Years After Anterior Cruciate Ligament Reconstruction? Biological and Functional Considerations. Sport Med. 2016;1 12.

36 Successful RTS ICF Classification Body Structure and Function Activity Limitation Participation Restriction SUCCESSFUL RTS: FK PROTOCOL - LEFS higher physical function younger athletes psychological readiness reduced fear of re-injury sport locus of control recovery expectations

37 HIPS DON T LIE Bedi A, Warren RF, Wojtys EM, Oh YK, Ashton-Miller JA, Oltean H, et al. Restriction in hip internal Surgery, Sport Traumatol Arthrosc. 2016;24(6): rotation is associated with an increased risk of ACL injury. Knee

38 HIPS DON T LIE Bedi A, Warren RF, Wojtys EM, Oh YK, Ashton-Miller JA, Oltean H, et al. Restriction in hip internal Surgery, Sport Traumatol Arthrosc. 2016;24(6): rotation is associated with an increased risk of ACL injury. Knee

39 Kyritsis P, Bahr R, Landreau P, Miladi R, Witvrouw E. Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. Br J Sports Med [Internet]. 2016;50(15): Available from:

40 RTP SHEETS MEASURE OBJECTIVE Speaking points to HCP Numbers to give credibility to yes or no decision making

41 1. Hewett TE, Myer GD, Zazulak BT. Hamstrings to quadriceps peak torque ratios diverge between sexes with increasing isokinetic angular velocity. J Sci Med Sport. 2008;11(5): Ford KR, Myer GD, Hewett TE. Incremental Increases in Landing Intensity. J Appl Biomech. 2014;27(3): Zwolski C, Schmitt LC, Thomas S, Hewett TE, Paterno M V. The Utility of Limb Symmetry Indices in Return-to-Sport Assessment in Patients With Bilateral Anterior Cruciate Ligament Reconstruction. Am J Sports Med [Internet]. 2016;44(8): Available from: 4. Kyritsis P, Bahr R, Landreau P, Miladi R, Witvrouw E. Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. Br J Sports Med [Internet]. 2016;50(15): Available from: 5. White K, Di Stasi SL, Smith AH, Snyder-Mackler L. Anterior cruciate ligament- specialized postoperative return-to-sports (ACL-SPORTS) training: a randomized control trial. BMC Musculoskelet Disord [Internet]. 2013;14:108. Available from: 6. Gokeler A, Bisschop M, Benjaminse A, Myer GD, Eppinga P, Otten E. Quadriceps function following ACL reconstruction and rehabilitation: Implications for optimisation of current practices. Knee Surgery, Sport Traumatol Arthrosc. 2014;22(5): Ardern CL, Taylor NF, Feller J a., Whitehead TS, Webster KE. Sports participation 2 years after anterior cruciate ligament reconstruction in athletes who had not returned to sport at 1 year: a prospective followup of physical function and psychological factors in 122 athletes. Am J Sports Med [Internet]. 2015;43(4): Available from: Ardern CL, Taylor NF, Feller JA, Webster KE. Return-to-sport outcomes at 2 to 7 years after anterior cruciate ligament reconstruction surgery. Am J Sports Med [Internet]. 2012;40(1):41 8. Available from: 9. Hatton AL, Crossley KM, Clark RA, Whitehead TS, Morris HG, Culvenor AG. Between-leg differences in challenging single-limb balance performance one year following anterior cruciate ligament reconstruction. Gait Posture [Internet]. 2017;52: Schmitt LC, Paterno M V., Ford KR, Myer GD, Hewett TE. Strength asymmetry and landing mechanics at return to sport after anterior cruciate ligament reconstruction. Med Sci Sports Exerc. 2015;47(7): Pappas E, Shiyko MP, Ford KR, Myer GD, Hewett TE. Biomechanical deficit profiles associated with acl injury risk in female athletes. Med Sci Sports Exerc. 2016;48(1): Hewett TE, Ford KR, Hoogenboom BJ, Myer GD. Understanding and preventing acl injuries: current biomechanical and epidemiologic considerations - update N Am J Sports Phys Ther. 2010;5(4): Hall MP, Paik RS, Ware AJ, Mohr KJ, Limpisvasti O. Neuromuscular Evaluation With Single-Leg Squat Test at 6 Months After Anterior Cruciate Ligament Reconstruction. Orthop J Sport Med [Internet]. 2015;3(3): Available from: gi?artid=pmc Hewett TE. Prediction of Future Injury in Sport: Primary and Secondary Anterior Cruciate Ligament Injury Risk and Return to Sport as a Model. J Orthop Sport Phys Ther [Internet]. 2017;47(4): Available from: Hewett TE, Myer GD, Ford KR, Paterno M V., Quatman CE. The 2012 ABJS nicolas andry award: The sequence of prevention: A systematic approach to prevent anterior cruciate ligament injury knee. Clin Orthop Relat Res. 2012;470(10): Barber-Westin SD, Noyes FR. Factors used to determine return to unrestricted sports activities after anterior cruciate ligament reconstruction. Arthrosc - J Arthrosc Relat Surg [Internet]. 2011;27(12): Available from: Pauzenberger L, Syré S, Schurz M. Ligamentization in hamstring tendon grafts after anterior cruciate ligament reconstruction: A systematic review of the literature and a glimpse into the future. Arthrosc - J Arthrosc Relat Surg [Internet]. 2013;29(10): Available from: Nagelli C V., Hewett TE. Should Return to Sport be Delayed Until 2 Years After Anterior Cruciate Ligament Reconstruction? Biological and Functional Considerations. Sport Med. 2016;47(2): Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med [Internet]. 2016;Epud ahead of print. Available from: Grooms DR, Page SJ, Nichols-larsen OTRLDS, Chaudhari AMW, White SE, Onate JA. Neuroplasticity Associated With Anterior Cruciate Ligament Reconstruction. 2017;47(3): Bedi A, Warren RF, Wojtys EM, Oh YK, Ashton-Miller JA, Oltean H, et al. Restriction in hip internal rotation is associated with an increased risk of ACL injury. Knee Surgery, Sport Traumatol Arthrosc. 2016;24(6):

42 THANK YOU Allison