Keywords: Runner, Gait Assessment, Gait Analysis, Running Analysis, 2-D, 3-D, high technology, low technology

Transcription

1 Science Meets Practice High Tech vs Low Tech Solutions for Running Assessments Combined Sections Meeting 2018 New Orleans, LA Saturday, February 24 th, am We have no relevant financial disclosures or conflicts of interest to report with respect to this presentation. Course description: Video running gait assessment / analysis is arguably the current examination technique most discussed by physical therapists that treat runners. As technology has improved and expanded, video running gait assessments have continued to evolve. This science meets practice session will cover current research and clinical practice applications of the current research to discuss advantages to both high technology and low technology for gait assessment. Keywords: Runner, Gait Assessment, Gait Analysis, Running Analysis, 2-D, 3-D, high technology, low technology Speakers Kari Brown Budde PT, DPT, SCS Jeffery Taylor-Haas, PT, DPT, OCS Shefali Christopher, PT, DPT, SCS General Outline 11:00 11:05 am Introduction and Overview of the Session Format: Kari Brown Budde 11:05 10:29 am Presentation of 4 short platforms 11:29 11:35 am Moderator led Q&A: Kari Brown Budde 11:35 12:00 pm Moderator led case study integrating platforms: Kari Brown Budde 12:00-12:22 Dialogue #1 High Tech Gait Assessment: Jeffery Taylor-Haas 12:22-12:44 Dialogue #2 Low Tech Gait Assessment: Shefali Christopher 12:44-01:00 Moderator led Q&A/Summary of session: Kari Brown Budde

2 High Tech Solutions for Runners I. Limitations of Two-Dimensional Gait Analysis a. Enhanced reliability is (usually) time-intensive i. The ideal set-up vs. the actual set-up b. Questionable validity i. Triplanar movements 1. Knee Valgus 2. Foot/Ankle Pronation ii. Transverse Plane movements: 1. Hip, Knee, Ankle rotation a. Biomechanical links to Running-Related Injuries (RRI s) iii. Reliance on limited dataset 1. Over reliance on peak values a. Biomechanical links to non-peak data & RRI s 2. Over reliance on very few gait events a. Literature on stride-to-stride variability c. Time-intensive post-runner gait analysis II. Benefits of Three-Dimensional Gait Analysis a. Enhanced reliability & validity i. Transverse plane movements ii. Enhanced publication potential from clinical data iii. Enhanced pre/post intervention data confidence b. Robust dataset i. Entire support phase analysis ii. Temprospatial data c. Time-saver: Very limited post-runner analysis required d. Enhanced marketability in a crowded marketplace III. Other Trends in High-Tech Gait Analysis: a. Wearable Technology i. Potential Advantages: 1. Added data that fills in the gaps of two-dimensional gait analysis a. Tibial Acceleration b. Temporspatial data 2. Accessing data from a non-clinic/laboratory environment ii. Potential Disadvantages: 1. Cart before the horse a rush to market prior to establishing reliability & validity 2. Unclear durability 3. End-User learner curve IV. Summary Comments: a. Clear advantages to using both 3D and 2D gait analysis

3 i. 3D: enhanced validity & reliability; very-limited post-runner analysis ii. 2D: enhanced feedback, less time-intensive set-up b. High potential for wearable technology: i. Potential to assess important force-related variables previously linked to RRI s ii. Potential to acquire data in runner s native environment iii. More research necessary to establish validity, reliability, & durability of wearables prior to wide-spread adoption Low tech solutions for runners 1) Current practice a)what is 2D? (Gallow A., Heiderscheit B., 2016) i) i)video camera that records runners mechanics during running (treadmill or overground) ii) ii)two dimensional views -frontal and sagittal plane iii) iii)could use >1 camera to capture more than one plane at the same time iv) iv)analysis: video analysis software/ playback through monitor with observation of side to side symmetry as well as normative values for biomechanics b) Measurement procedure: Tips for measurement accuracy and reliability: (Areblad et al, 1990) i) fps ii) Knowledge and experience of the examiner: frontal and sagittal plane gait parameters and kinetic parameters (eg. foot inclination angle) ii) Consistent and systematic approach of examiner iv) Tripod, perpendicular to plane of interest v) Avoid trying to quantify subtle motions or interpreting minor changes vi) patient set up: clothing, treadmill, warm up time 2) Advantages of 2D i) comparable values to 3D when looking at frontal plane rearfoot and hip *with strict measurement procedure* (Nakagawa et al, 2012) (Maykut et al, 2015) ii) Cost iii) Training and use iv) User learning curve v) markers? 3) Limitations of 3D analysis i) Cost of equipement ii)training and personnel need (Gallow A., Heiderscheit B. (2016)

4 iii) End-User learner curve iv) Time-intensive marker placement v) Visual feedback to the learner 4) Other trends in low tech gait analysis devices 5 )Summary comments i) Gait analysis should accompany a thorough history and physical exam integrated with gait analysis ii) One can conduct gait analysis with 2D based on all the advantages iv) 2D vs 3D: what is your end goal? ii) Directions for future research References: 1. Gallow A., Heiderscheit B. (2016) Clinical Aspects of Running Gait Analysis. In: Miller T. (eds) Endurance Sports Medicine. Springer, Cham 2. Nakagawa TH, Moriya É, Maciel CD, Serrão AF. Frontal plane biomechanics in males and females with and without patellofemoral pain. Med Sci Sports Exerc. 2012;44(9): Maykut JN, Taylor-Haas JA, Paterno MV, DiCesare CA, Ford KR. Concurrent validity and reliability of 2d kinematic analysis of frontal plane motion during running. Int J Sports Phys Ther. 2015;10(2): Epub 18 Apr Areblad M, Nigg BM, Ekstrand J, Olsson KO, Ekstrom H. Three-dimensional measurement of rearfoot motion during running. J Biomech. 1990;23(9): Videbæk S, Bueno AM, Nielsen RO, Rasmussen S. Incidence of runningrelated injuries per 1000 h of running in different types of runners: a systematic review and metaanalysis. Sports Med. 2015;45(7): Ferber R, Noehren B, Hamill J, Davis IS. Competitive female runners with a history of iliotibial band syndrome demonstrate atypical hip and knee kinematics. J Orthop Sports Phys Ther. 2010;40(2): Wille CM, Lenhart RL, Wang S, Thelen DG, Heiderscheit BC. Ability of sagittal kinematic variables to estimate ground reaction forces and joint kinetics in running. J Orthop Sports Phys Ther. 2014;44(10): Goss DL, Lewek M, Yu B, Ware WB, Teyhen DS, Gross MT. Lower extremity biomechanics and self-reported foot-strike patterns among runners in traditional and minimalist shoes. J Athl Train. 2015;50(6):

5 9. Heiderscheit BC, Chumanov ES, Michalski MP, Wille CM, Ryan MB. Effects of step rate manipulation on joint mechanics during running. Med Sci Sports Exerc. 2011;43(2): Noehren B, Pohl MB, Sanchez Z, Cunningham T, Lattermann C. Proximal and distal kinematics in female runners with patellofemoral pain. Clin Biomech (Bristol, Avon). 2012;27(4):