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Quadriceps Muscle Injuries: James Moore

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Quadriceps Muscle Injuries: James Moore
from injury day to return to play

8th MuscleTech Network workshop

Publicado en: Salud y medicina
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Quadriceps Muscle Injuries: James Moore

  1. 1. Quadriceps Muscle Injury:
 From Injury Day to Return to Play VIIIth MuscleTech Network workshop FC Barcelona, 3rd-4th October 2016 James Moore Head of Performance Team GB Intensive Rehabilitation Manager – British Olympic Association
  2. 2. Mechanism Under striding vs. bwd lean vs. Hip extension vs. backswing vs. VGRF Sports Mechanism Sprinting vs. Kicking (high vs. low velocity of limb movement) Location Proximal vs. Mid vs. Distal / Tendon vs. Muscle vs. Fascia Size / Grade 0, 1, 2, 3, 4 Functionality Of the region (architecture) vs. The individual (kinetics) vs. Sport Specific INJURY PROFILE / CLASSIFICATION Marshall 2002
  3. 3. MUSCLE ARCHITECHTURE
  4. 4. MUSCLE ARCHITECHTURE Muscle Fibre Length (cm) Pennation (degrees) PCSA (cm2) Peak Force (N) Psoas 11.69 – 10.4 10.6 – 8.0 7.7 – 14.8 370 – 479.7 Iliacus 10.66 – 10.0 14.3 – 7.0 9.9 – 17.2 430 – 621.9 Sartorius 40.30 – 57.9 1.3 – 0 1.9 – 1.7 105 Rectus Femoris 7.59 – 8.4 13.9 – 5.0 13.9 – 12.8 780 – 848.8 Vast Lateralis 9.94 – 9.9 18.4 -18.4 35.1 – 37.0 2255.4 Vast intermedialis 9.93 – 9.9 4.5 – 4.5 16.7 – 16.8 1024.2 Vast Medialis 9.68 – 9.7 29.6 – 29.6 20.6 – 23.7 1443.7 Ward 2009, Torry 2006, Arnold 2010 • Hip Flexors produced only a small amount of passive joint moment at 200 < 5Nm – only slightly exceed optimal fibre length in this position • Largest contributors were Psoas, Adductor Longus and Iliacus – 1.2 normalised fibre length
  5. 5. MUSCLE PROFILE - ARCHITECHTURE Ward 2009
  6. 6. Muscle stiffness is regulated by: 1. Muscle activation frequency (temporal summation) (Hill 1970) 2. Muscle fibre recruitment (spatial summation)(Moritani 1979) 3. The sarcomere length-tension relationship (Gordan 1966) 4. Sarcomere force-velocity relationship (Hill 1970) 5. Passive sarcomere length-tension relationships (Horowits 1987) 6. Intrafusal and extrafusal (muscle spindle)fibres feedback mechanisms (Lieber 1992) 7. Muscle force and moment regulation by skeletal muscle architecture (Gans 1982, Zajac 1992) MUSCLE STIFFNESS
  7. 7. SPORT MECHANICS
  8. 8. MUSCLE FORCES IN WALKING AND SLOW RUNNING Pandy 2010
  9. 9. MUSCLE CONTRIBUTION IN WALKING & RUNNING Pandy 2010
  10. 10. RUNNING AT 3.4M/S Pandy 2010
  11. 11. MUSCLE ACTIVATION IN RUNNING Riley 2010
  12. 12. MUSCLE CONTRIBUTION TO SAGITTAL PLANE Dorn 2012
  13. 13. MUSCLE RUNNING MECHANICS Dorn 2012
  14. 14. VGRF MUSCLE CONTRIBUTION Dorn 2012
  15. 15. Wiemann 1995 DEMANDS OF THE SPORT
  16. 16. Wiemann 1995 DEMANDS OF THE SPORT
  17. 17. Wiemann 1995 DEMANDS OF THE SPORT
  18. 18. Wiemann 1995 DEMANDS OF THE SPORT
  19. 19. Wiemann 1995 DEMANDS OF THE SPORT
  20. 20. PHYSICS OF KICKING • During kicking – hip has the highest net force with a ballistic impact • 15% of kinetic energy is absorbed by the ball • Thigh is moving at up to 5000 /sec • Remaining force dissipated through the body • Traction / eccentric load on the groin Barfield 1998
  21. 21. MAXIMAL EFFORT KICKING IN SOCCER Charnock 2009 Adductor longus was active throughout the swing phase Maximum activation and eccentric load occurred at peak hip extension
  22. 22. ATHLETE PROFILE
  23. 23. MOVEMENT PROFILE OF THE ATHLETE
  24. 24. SPECIFIC PROFILE
  25. 25. LACTATE PROFILE
  26. 26. REHAB SELECTION
  27. 27. Effective DDx & Classification 1st 48 hours is critical – do not be afraid to off-load with crutches Athlete Profile Sport Profile Athlete specific clinical outcome measures Need to pass clinical measures at each stage – stretch, force, palpation Capacity Assessment within the rehab KEY DECISIONS
  28. 28. EARLY STAGE - Isometric CKC, Hip focus OKC, Knee focus CKC, Ankle focus Prescription – 6 second isometric, 5 reps, 4-8 sets
  29. 29. INTERMEDIATE STAGE - ECCENTRIC Proximal vs. Distal focus Prescription – 5 sets of 5, on 402 tempo
  30. 30. Repeated bike sprint efforts (>140rpm) 30s duration – GH production (Stokes 2010) Single leg strength endurance challenge 1 Leg Hack Squat vs. Step Ups Speed frequency loading in Quadriceps Velocity & Volume Drop Jump capacity Return to running
  31. 31. ADVANCED STAGE – FUNCTIONAL RTR Prescription – 10 reps, 10 second x3 = 1 set
  32. 32. Decline Bench Dynamic Flexion Gravity Wt of limb Contralateral Ms Activation & Force
  33. 33. Standing Open Chain Flexion • External light resistance • Velocity
  34. 34. Reactive Open Chain Flexion Very light resistance Recoil with good alignment
  35. 35. Single leg loading - Step ups Vickers 2001
  36. 36. 60cm LANDING 44% 34% 22% Pruyn 2014
  37. 37. MONITOR PROGRESSION 0 200 400 600 800 Mon Tue Wed Thu Fri Sat S&C Bike Training Load
  38. 38. PHILOSOPHY CASE STUDY
  39. 39. OUR PHILOSOPHY
  40. 40. Diagnosis is key Design based on architecture Design based on sport demand Design based on athlete profile Use outcome measures that equate to running Use outcome measures that equate to kicking Add in variability SUMMARY
  41. 41. Background - • 2006 - CWG Gold – Bilateral Achilles repair. • 2007 - WC Gold, 2008 OG Gold • 2009 – WC 5th, Pars fracture and HHT • 2010 – 80% complete rupture – direct & indirect heads of RF, 10cm retraction • Mechanism – High speed running in PPT, on foot contact • Focus – hypertrophy of Iliacus & Psoas • 2011 – recurrent myofascial tears distal MTU with tendonopathic changes and Myositis Ossificans • Focus – regaining tendon E absorption – L-T & F-V relationship. ATHLETE CASE STUDY
  42. 42. THE RESULT
  43. 43. Rio medal haul 27 – 23 – 17 • Total medallists - 145 THANK YOU

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