interaction of movement & morphology: better function

Interaction of Movement & Morphology:

better function follows better movement

Cara L. Lewis, PT, PhD

Associate Professor

College of Health & Rehabilitation Sciences: Sargent College

Morphology Femoroacetabular Impingement

Syndrome (FAI)

Pincer

Cam

Typical

Dysplasia

Morphology Femoroacetabular Impingement

Syndrome (FAI) DysplasiaAcetabular Labral Tear

Hip Pain

Pincer

Cam

Morphology Movement Hip Pain

Modifying movement improves function

Recreational runner

Soccer goalie

Lacrosse player

Modifying movement: Recreational runner

31 yo female

Right anterior hip pain

CorrectedPreferred

Lewis, Khuu & Marinko, 2015

Modifying movement

Preferred Corrected

20 Nm

6 Nm

Hip flexion moment

Modifying movement

Verbal cues to change posture during gait

Preferred: 6/10 Corrected: 2/10

Forward flexedSwayback

Modifying movement

Verbal cues to change posture during gait

Swayback:

Greater peak hip extension

Higher hip flexion moment

Forward flexed:

Less hip extension angle

Lower hip flexion moment

Lewis & Sahrmann, 2015

Modifying movement

flexion

0 20 40 60 80 100

-60

-40

-20

0

20

40

60

80

0 20 40 60 80 100

-60

-40

-20

0

20

40

60

80

Hip

mom

ent (N

m)

flexion

0 20 40 60 80 100-10

0

10

20

30

40

0 20 40 60 80 100-10

0

10

20

30

40

Preferred Corrected

Hip

angle

(degre

es)

Right hip Left hip

Modifying movement

Hip

mom

ent (N

/m)

anterior

-1000

0

1000

2000

0 20 40 60 80 100

Gait Cycle (%)

Join

t F

orc

e (

N)

flexion

0 20 40 60 80 100

-60

-40

-20

0

20

40

60

80

Right hip

Preferred

Corrected

↓ hip flexion moment

↓ anterior hip joint force

immediate ↓ pain

Modifying movement improves function

Return to running Shorten stride to reduce hip extension

Lean forward to reduce hip flexion moment

Push off from the ankle to reduce hip moments and forces

Treadmill running: transition to walk later

Movement modifications, not activity modification

or elimination

Lewis et al, 2015; Lewis & Garibay, 2015

Modifying movement: Lacrosse player

15 yo female athlete

Right hip pain

Right mild dysplasia

Modifying movement

15 yo female athlete

Right hip pain

Right mild dysplasia

Backward rotation of the pelvis

Hip external rotation

Pelvic drop & hip adduction

Knee valgus

Modifying movement

Stress = Force

Area

Modifying movement

12 physical therapy visits over 2

months

Neuromuscular control of trunk,

pelvis and lower extremity

Progressed to functional activities

Return to sport

Modifying movement: Soccer goalie

16 yo female athlete

Bilateral FAIS (L > R)

Cam

Modifying movement

Poor control

Trunk shift & rotation

Hip adduction

Trunk, hip flexion

Modifying movement

Poor control

Trunk shift & rotation

Hip adduction

Trunk, hip flexion

Modifying movement

Poor control

Hip adduction and medial

rotation

Knee valgus

Modifying movement

Physical therapy

to address

control and

strength deficits

returned to

sport

Morphology Strength

Movement matters

Acknowledgements & Disclosures

Shirley Sahrmann

Boston

David Felson

Young-Jo Kim

Sandra Shefelbine

University of Southampton

Maria Stokes

Nadine Booysen

Martin Warner

Human Adaptation Lab

Anne Khuu

Kari Loverro

Funding

Peter Paul Career Development

NIH R21 AR061690

NIH K23 AR063235

NIH R03 AR072808

NIH 1UL1TR001430

Arthritis Research UK