interaction of movement & morphology: better function
TRANSCRIPT
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