Clinical Video Analysis for Distance Runners

transcript

UW Neuromuscular Biomechanics

Clinical Video Analysis for

Distance Runners

Bryan Heiderscheit, PT, PhD, FAPTA Professor

Orthopedics and Rehabilitation

Biomedical Engineering

Director, UW Runners’ Clinic

Director of Research, Badger Athletic Performance

Co-director, UW Neuromuscular Biomechanics Lab

Disclosures

I have no financial affiliation or involvement with any commercial organization that has a direct financial interest in any matter included in this presentation.

Equipment

120 fps camera

tripod

treadmill

Stiff deck

Adequate HP

treadmill

sagittal view

frontal view

Video Capture Procedure

Patient selects speed that reflects:

typical running speed

pain provocation

If needed, simulate fatigue by having them run before

0 incline

Run for 5 min before recording

Record:

10s sagittal

10s posterior-frontal

Key Parameters

Focus on loading response (initial contact to mid-stance)

characterize body control during energy absorption

Remainder of stride cycle is also examined

Initial contact Midstance

Loading Response

Step Rate Foot Inclination Angle at Initial Contact

Vertical Displacement of COM

Kinematic Predictors of Kinetics Peak GRFv

Peak Vertical GRF

(R2=0.48)

Wille et al. (2014). J Orthop Sports Phys Ther

Step Rate Heel to COM Distance at Initial Contact

Foot Inclination Angle at Initial Contact

Vertical Displacement of COM

Kinematic Predictors of Kinetics Braking Impulse

Braking Impulse

(R2=0.50)

Step Rate Foot Inclination Angle at Initial Contact

Peak Knee Flexion during Stance

Kinematic Predictors of Kinetics Energy Absorption at Knee

Mechanical Energy Absorbed about the Knee (R2=0.58)

Pseudo-quantitative Approach

Estimate load to body based on posture at landing and midstance

Use physical exam findings to interpret appropriateness of running mechanics

Each parameter is assessed using 3-pt or 5-pt scale

Consideration for the inherent limitations with 2D video analysis

Key parameters demonstrated strong agreement between raters (κ > 0.80)

-2 -1 Appropriate +1 +2

Kotecki et al. (2013) J Orthop Sports Phys Ther

2D Approach to Identify Key Flaws

Overstriding

Bounce

Excessive Compliance

Pipken & Heiderscheit (2016). J Orthop Sports Phys Ther

Wille & Heiderscheit (2014). J Orthop Sports Phys Ther

Joint Center Alignment Midstance

Excessive lateral

Mild lateral

Appropriate (midline)

Mild medial

Excessive medial

Lateral Deviation Appropriate Medial Deviation

Lateral Pelvic Tilt Midstance

Appropriate (3-5° males; 5-7° females)

Mild contralateral

Excessive contralateral

normal mild excessive

Foot-COM Placement at Midstance

Location of the foot with respect to the whole body’s line of gravity (LOG)

As running speed increases, this distance decreases

9:30 min/mile

Appropriate Mild

crossover Excessive crossover

Crossover Changes with Speed

More likely to crossover at higher speeds

Women less likely to crossover Crossover associated

with future injury in women only

Less crossover associated with increased step rate

not the case for foot strike angle

2.5 3 3.5 4 4.5 5

Speed (m/s)

All Subjects Men

Crossover (-)

No Crossover (+)

Bui & Heiderscheit (2016) Proc, Am College Sports Med

Wille & Heiderscheit (2017) J Orthop Sports Phys Ther (abstract)

10 min/mile

5:30 min/mile

Knee Separation at Midstance

Appropriate Narrow with stance

leg deviation Narrow with swing

leg deviation

Narrow Appropriate Wide

Foot Alignment at Midstance

Rearfoot-Shoe Eversion

Toe-out

Out of plane motion can create false positives for

excessive motion

Foot Inclination Angle at Contact

Heel-strike (>10°)

Rearfoot Midfoot Forefoot

Foot Inclination Angle at Contact

heel-strike midfoot forefoot rearfoot

Foot Strike Pattern

Self-reported Video Assessment

Rearfoot 20%

Midfoot 26%

Forefoot 8%

Uncertain 46%

Rearfoot 80%

Midfoot 12%

Forefoot 8%

*asymmetric (n=22, ~6%)

Nelson & Heidercheit (2016) J Orthop Sports Phys Ther (abstract)

Horizontal Distance from Heel to COM at Contact

Knee Flexion Angle at Contact

Excessive decrease

Mild decrease

Appropriate (~20°)

Mild increase

Excessive increase

Tibial Inclination Angle at Contact

Vertical Mild

inclination Excessive inclination

Maximum Knee Flexion Angle

Excessive decrease

Mild decrease

Appropriate (~40°)

Mild increase

Excessive increase

Ankle Dorsiflexion at Midstance

Decrease Appropriate

(knees over toes) Increase

Increased ankle dorsiflexion

COM Vertical Displacement

Maximum Height Minimum Height

Mid-flight Midstance

Appropriate (6-8cm)

Mild Increase

Excessive Increase

Avoid Overstriding

Foot inclination angle

Heel-COM distance

Knee flexion angle

Tibial angle

Avoid Bounce

COM vertical displacement

Maximum Height Minimum Height

Avoid Excessive Compliance

Partially reflected in COM vertical displacement

Evaluate frontal plane collapse

Joint center alignment

Lateral pelvic tilt

Knee separation

Foot-COM placement

LBP GT

Bursitis Anterior

Knee Pain ITBS Achilles MTSS

Plantar Fasciitis

Bone Stress Injury

FRONTAL VIEW (MIDSTANCE)

Lateral Trunk Lean X

Lateral Pelvic Drop X X X

Knee Center Position X X X X

Knee Separation X X X

Foot COM placement X X X X

Rearfoot View X X X X

Forefoot View X X X

SAGITTAL VIEW

Knee Flexion (IC) X X X

Tibial Inclination (IC) X X

Foot Inclination (IC) X X

Knee Flexion (MS) X X X

Ankle Dorsiflexion (MS) X X

COM Vertical Displacement

X X X X X

Putting it all Together

17 y/o with chronic knee pain and tibial stress reactions

9:00 min/mile 168 steps/min

19 y/o with right dorsal foot pain

23y/o with Right Knee Pain

Summary

Designed with the common clinician in mind Minimal overhead

Reimbursable

60min or less

Clinical Video Analysis for Distance Runners

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