An integrated approach to the analysis of injury ... · About today’s presenter Dr Ezio Preatoni,...

An integrated

approach to the

analysis of injury

mechanisms in

sports impacts

DR EZIO PREATONI

About Today’s Webinar

Today’s webinar is being produced jointly by the British Association of Sport and Exercise Sciences

(BASES) and Human Kinetics.

It is scheduled to last for about an hour and will be recorded and made available for download and

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We’ll collect any questions sent throughout the presentation for Ezio and he will answer as many as

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Join the conversation through Twitter

@HumanKineticsEU @iszio @BASESUK

About today’s presenter

Dr Ezio Preatoni, FHEA is a Lecturer in Biomechanics and Motor Control at the University of Bath,

UK.

Ezio’s research is in the area of movement and coordination dynamics, and injury prevention.

As a member of the Rugby Science group of the University of Bath (RS@Bath) he has been working

in the area of sports collisions and injury prevention, with a specific focus on the Rugby Union scrum

and tackle. These investigations have had a worldwide impact, have driven policy changes and

contributed better health and safety for rugby players.

Ezio has had a number of articles published in journals such as: British Journal of Sports Medicine,

Scandinavian Journal of Medicine and Science in Sports and Sports Biomechanics and Journal of

Sport Sciences.

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HK-BASES webinar | An integrated approach to the analysis of injury mechanisms in sport impacts

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SPORT IMPACTS & INJURY

CC BY-NC-ND 2.0

Peter J Dean

CC BY-NC 2.0

u16panthers

CC BY-NC-ND 2.0

leigh_east_photoman

CC BY-NC-ND 2.0

Sum_of_Marc

CC BY-NC-ND 2.0

Peter J Dean

SUBFAILURE STRESSES

REPETITIVE (μ)TRAUMAS

INJURIES TO LIGAMENTS & RECEPTORS

ALTERED FUNCTION & FEEDBACK

CORRUPTED MUSCLE

PERFORMANCE

DISTORTED STRESSES

ABNORMAL LOADS ON FACET JOINTS

DEGENERATION

(Panjabi, 1996; Quinn & Winkelstein, 1997)

(CATASTROPHIC) TRAUMA

Injury | A transfer of energy to the tissue that exceeds

the ability to maintain structural and/or

functional integrity (McIntosh, 2005)

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TACKLE | “occurs when the ball carrier is held by one

or more opponents and is brought to ground”

(World Rugby, Law 15)

THE RUGBY UNION SCRUM & TACKLE

SCRUM | a means to “restart play quickly, safely and

fairly, after minor infringement or stoppage”

8 players from each team, bound in 3 rows

Contest for the possession of the ball

(World Rugby, Law 20)

high proportion of injuries

most common event

open unpredictable skill

upper body region

high propensity

moderate injury incidence

“controllable” event

~40% of catastrophic inj.

difficult to study!!!technnique injury prev.

(?)

ecol. validity reliability

(?)

high energy impact

unstable equilibrium

may accelerate chronic

degeneration (C-spine)

(Scher, 1990; Panjabi, 1996; Targett ,1998; Quarrie et al., 2002; Brooks et al., 2005; Fuller et al., 2007; Lark & McCarthy, 2007; Fuller et al., 2008; Castinel et al.,2010; Fuller et al.,2010;

McIntosh et al., 2010; Pinsault et al., 2010; Roberts et al., 2014; Taylor et al., 2014; englandrugby.com)

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THE “BIG CHALLENGE”

(CC BY-SA 3.0 by Gruebel Forsey)

www.irb.com/totalrugby

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APPROACHES

CC BY-NC-ND 2.0

(nz)dave

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OUTLINE

① Identify experimental issues in the analysis of injury mechanisms in sport collisions

② Identify potential and limitations of different experimental approaches for the study of the

biomechanical loading generated by sport impacts

③ Describe and discuss the outcomes of an integrated analysis (in situ, in vivo, in vitro, in silico) of

Rugby Union contact events

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RESEARCH AT RS@BATH & ACKNOWLEDGMENTS

20182016201420122010

Prof Keith Stokes

Dr Mike England

Andreas Wallbaum

Pavlos Silvestros

…and many others!

Prof Richie Gill

Dr Tim Holsgrove

Dr Sabina Gheduzzi

Prof Tony Miles

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IN SITU

Advantages

Disadvantages

What needed?

Outcomes?

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IN SITU

Tackle-related injuries were typically associated with:

Highly dynamical occurrences, especially in the frontal direction

Ball carrier and tackler moving at high speed

Head/trunk position

Illegal tackling techniques

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IN SITU SUMMARY

Counts

Type/Context

“Qualitative” description

Movement patterns

(in specific conditions)

Ecological validity

Can capture real injury

Match/training situation

Easily accessible

Reliability

Timing (when injury happens)?

Causality

Quality

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IN VIVO

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IN VIVO – EXPERIMENTAL ISSUES

FORCES

(3D)

KINEMATICS

(3 views)

Preatoni et al. (2012) Proc IMechE Part P:J Sports Eng Tech 226(3/4) 266–273

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PRESSURE

VIDEO

CONTROL &

IMUs

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Cazzola et al. (2013) Proc IMechE Part P:J Sports Eng Tech, 228(2), 147-151

EXISTING CALIBRATIONs NOVEL CALIBRATION TRIALS

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CTPETECH

LEVEL

IN VIVO – FIELD BASED (SCRUM)

Preatoni et al. (2015) Br J Sports Med, 49(8), 520-528; Preatoni et al. (2015) Scand J Med Sci Sports, 26(12), 1398-1407

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CTPE CTS CBSTECH

LEVEL



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CTPE CTS CBS

INTERNATIONAL

ACADEMY

COMMUNITY

ELITE

WOMEN

TECHLEVEL

4–6 reps/team/condition

28 TEAMS


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DISTANCE @SET-UP

0.00

0.10

0.20

0.30

0.40

0.50

0.60

ALL

dis

tan

ce [

m]

CTPE

CTS

CBS

CLOSING SPEED 21% (P<0.05)

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

ALLve

loc

ity [

m/s

]

CTPE

CTS

CBS


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0

5

10

15

20

ALL

Fo

rce

[k

N] CTPE

CTS

FoldIn

7+1

5+3

PEAK COMPRESSION ~50%


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0

5

10

15

20

ALL

Fo

rce

[k

N] CTPE

CTS

FoldIn

7+1

5+3-5

-4

-3

-2

-1

0

ALL

Fo

rce

[k

N] CTPE

CTS

FOLD

7+1

5+3

PEAK DOWNWARD ~20%



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0

2

4

6

8

10

ALL

Fo

rce

[k

N] CTPE

CTS

FOLD

7+1

5+3

SUSTAINED COMPR. PUSH



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CBS

SUSTAINED FORCE ~= (P>0.05)

0

1

2

3

4

5

6

ALL

Fo

rce

[k

N]

CTPE

CTS

CBS

PEAK FORCE 25% (P<0.05)

0

2

4

6

8

10

12

ALL

Fo

rce

[k

N]

CTPE

CTS

CBS



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CBS

AVG PEAK ACC (C7) 18% (P<0.05)

0

1

2

3

4

5

6

7

ALL

ac

ce

lera

tio

n [

g]

CTPE

CTS

CBS



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0

1

2

3

4

5

6

7

8

ALL I E C W U

acce

lera

tio

n [

g]

playing level

CTPE

CTS

CBS



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South Africa (catastrophic spinal injuries)


0123456

Pre law change Post law change

Inci

denc

e/10

00

hour

s

England (all injuries)

www.englandrugby.com – PRISP Annual Report 2015-16

France (catastrophic C-spine injuries)

Reboursiere et al. (2016)

http://www.englandrugby.com/

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IN VIVO – LAB BASED (SCRUM)

KINEMATICS

EMG

Cazzola et al. (2015) Scand J Med Sci Sports, 26, 432-440

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40 kg tackle bag

Full-body MOCAP

Force plates

Pressure pads

Speed ~3.5 m/s

Magnetic clamp

3-step run-up

10 male Rugby Union players

(24.8 ± 6.3 years; 1.85 ± 0.09 m;

99.0 ± 12.6 kg)

2 reps x 2 side x 3 directions

(random order)

90°

45° 45°

0°0°

90°

IMU (head Ԧ𝑎)

IN VIVO – LAB BASED (TACKLE)

Seminati et al. (2017) ISBS2017; Preatoni et al. (2017) #RSNlive17

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IN VIVO – LAB BASED TACKLING

0

2

4

6

0° 45° 90°

Impa

ct F

orce

(kN

)

NON DOM DOM

**

#…decrease from frontal &

diagonal to lateral (-20%)

…highest (5.8 ± 1.0 kN) in

dominant shoulder, frontal

direction

…substantially higher (by 6%)

in dominant than non-dominant

shoulder


# * linear mixed models and magnitude-based inferences were used to assess differences between conditions.

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0

10

20

30

0° 45° 90°

Ang

Vel

Hea

d (r

ad/s

)

NON DOM DOM

0

10

20

0° 45° 90°

Hea

d A

ccel

erat

ion

(g)

NON DOM DOM

RESULTS: HEAD ACCELERATION & ANGULAR VELOCITY

Highest Ԧ𝑎 in frontal (substantially

higher, 10 – 20%), non-dominant

shoulder (13.5 ± 4.9 g).

**

**

*

#

𝜔 substantially decreasing when

tackling from 45° and 90°

Lowest 𝜔 (13.3 ± 5.2 rad/s) for

dominant


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Flexion Bending Rotation

Direction (°) (°) (°)

Non-dominant

shoulder

0° -28 ± 10 14 ± 7 -27 ± 8

45° -24± 10 16 ± 10 -26 ± 7

90° -30 ± 12* 12 ± 12 -26 ± 9

Dominant

shoulder

0° -23 ± 12# -11 ± 13# 22 ± 15

45° -20 ± 8# -12 ± 7# 21 ± 14

90° -28 ± 12*# -8 ± 9# 24 ± 15

Ave neck flexion & bending

@ peak force

greater in non-dominant

Side tackles (from 90°) showed highest neck flexion

RESULTS: NECK KINEMATICS

⇧ ⇧⇧

⇧


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IN VIVO SUMMARY

Movements (kinematics)

Forces (kinetics)

Neuro-muscular activation

⟶ External load

Quantitative

Controllable conditions

Reliability

Only “mimics”

No injuries (ethics)

Time

Expertise & cost

Equipment works “within limits”

Info from real situations

Motion capture lab

Force plates / transducers

Pressure sensors

IMUs / EMG

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IN VITRO

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# ^

# ^ *

High Speed (3.1–3.6 m/s)

Low Speed (2.0–2.5 m/s)

FLE

XE

XT

CO

MP

RE

SS

ION

(N

)T

OR

QU

E (

Nm

)

HEAD-DOWN NEUTRAL HEAD-UP

Ԧ𝐹 substantially decreasing

in neutral and head-up

⇧ ⇧13% 17%

IN VITRO with ATD

Cazzola et al. (2017) ISB2017; Preatoni et al. (2016) #RSNlive17;

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Holsgrove et al. (2015) Spine J, 15(8), 1856-1863

IN VITRO with PORCINE SPECIMEN

Impact force ~6 kN transferred in <1 ms

Damage for 6/8 specimens @C4-C6 level

Principal strain >4% where lordotic behaviour more accentuated (C4-C6)

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IN VITRO – SUMMARY

Individual bodies kinematics

Strain

Viscoelastic properties

Damages (severity and location)

⟶ Internal load

Quantify structures strain

Observe and analysis damage

Replicate injury

Realistic (?)

Specimens

Passive

Experimental protocol complexity

Validation against in vivo

Test rig

High-spec load cells and cameras

Access to specimens

Imaging

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IN SILICO

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Cazzola et al. (2017) PLoS ONE, 12(1), e0169329

RUGBY MODEL

https://simtk.org/projects/csibath

IN SILICO – SCRUM (inverse)

Characterisation of kinematics and cervical load, e.g.:

flattening of lordotic curve @ impact

decreasing pattern of extensor moment from C7-C6 joint to C1-Head

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Cazzola et al. (2017) PLoS ONE, 12(1), e0169329; Silvestros & Cazzola (2017) TGCS2017

EXPERIMENTAL SETUP

IN SILICO – SCRUM (forward)

MSK SIMULATION

NE

CK

FLE

XIO

N (

0 –

30°)

NECK MUSCLE ACTIVATION (25 – 100%)

Muscle activation

Head position

3D load @ bottom of head

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2 kN – dislocation

5 kN – burst fracture

800 N – ligament fracture

25 % 50 % 100 %

CO

MP

RE

SS

ION

C4

C5

C6

NECK MUSCLE ACTIVATIONNECK MUSCLE ACTIVATION

25 % 50 % 100 %

SH

EA

R

C4

C5

C6

Increased muscle activation & neck flexion

C5-C6 shear

C4 shear

Increased muscle activation & neck flexion

C5-C6 compression

C4 compression

4 x exp. forces (where max EMG is ~75%)

IN SILICO – SCRUM (forward)

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IN SILICO – TACKLE (inverse)

PEAK COMPRESSION

(N)

PEAK FLEX/EXT TORQUE

(Nm)

HEAD-DOWN NEUTRAL HEAD-UP

EXPERIMENTAL SETUP MSK MODEL

Cazzola et al. (2017) PLoS ONE, 12(1), e0169329; Cazzola et al. (2017) ISB2017

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IN SILICO – DISCUSSION

Movements (kinematics)

Internal forces (joint and muscles)

Neuro-muscular activation

Injury visualisation

⟶ External/Internal load

Visualise complex movement

Estimate internal loading

Cause-effect relationship

“What if…” scenarios

Search for optimal solutions

Verification and validation not trivial

Computational power

Highly technical

Time consuming

Input from in vivo needed!

Info from in vivo

Modelling software

Imaging (data and software)

Powerful machine

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INTEGRATED APPROACH

Preatoni et al. (2015) ISBS2015; Preatoni et al. (2015) ISB 2015; Preatoni & Cazzola (2017) IOC2017

Any Questions?

We have already received quite a number of questions and we will now try and answer as

many as possible in the time remaining.

Any that remain unanswered will be forwarded to Ezio and he’ll try and email you a reply in

due course.

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What is coming up?

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Time: 15.00 GMT

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An integrated approach to the analysis of injury ... · About today’s presenter Dr Ezio Preatoni,...

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Transcript of An integrated approach to the analysis of injury ... · About today’s presenter Dr Ezio Preatoni,...