Clinical Video Analysis for Distance Runners
Transcript of Clinical Video Analysis for Distance Runners
UW Neuromuscular Biomechanics
Lab
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
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.
UW Neuromuscular Biomechanics
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Equipment
120 fps camera
tripod
treadmill
Stiff deck
Adequate HP
treadmill
sagittal view
frontal view
UW Neuromuscular Biomechanics
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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
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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
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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
UW Neuromuscular Biomechanics
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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)
Wille et al. (2014). J Orthop Sports Phys Ther
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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)
Wille et al. (2014). J Orthop Sports Phys Ther
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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
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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
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Joint Center Alignment Midstance
Excessive lateral
Mild lateral
Appropriate (midline)
Mild medial
Excessive medial
Lateral Deviation Appropriate Medial Deviation
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Lateral Pelvic Tilt Midstance
Appropriate (3-5° males; 5-7° females)
Mild contralateral
Excessive contralateral
normal mild excessive
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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
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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
-1.5
-1
-0.5
0
0.5
1
1.5
2
2.5 3 3.5 4 4.5 5
ML
Dis
tan
ce (
cm)
Speed (m/s)
All Subjects Men
Women
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
UW Neuromuscular Biomechanics
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Knee Separation at Midstance
Appropriate Narrow with stance
leg deviation Narrow with swing
leg deviation
Narrow Appropriate Wide
Wide
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Foot Alignment at Midstance
Rearfoot-Shoe Eversion
Toe-out
Out of plane motion can create false positives for
excessive motion
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Foot Inclination Angle at Contact
Heel-strike (>10°)
Rearfoot Midfoot Forefoot
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Foot Inclination Angle at Contact
heel-strike midfoot forefoot rearfoot
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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)
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Horizontal Distance from Heel to COM at Contact
UW Neuromuscular Biomechanics
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Knee Flexion Angle at Contact
Excessive decrease
Mild decrease
Appropriate (~20°)
Mild increase
Excessive increase
UW Neuromuscular Biomechanics
Lab
Tibial Inclination Angle at Contact
Vertical Mild
inclination Excessive inclination
UW Neuromuscular Biomechanics
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Maximum Knee Flexion Angle
Excessive decrease
Mild decrease
Appropriate (~40°)
Mild increase
Excessive increase
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Ankle Dorsiflexion at Midstance
Decrease Appropriate
(knees over toes) Increase
Increased ankle dorsiflexion
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COM Vertical Displacement
Maximum Height Minimum Height
Mid-flight Midstance
Appropriate (6-8cm)
Mild Increase
Excessive Increase
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Avoid Overstriding
Foot inclination angle
Heel-COM distance
Knee flexion angle
Tibial angle
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Avoid Bounce
COM vertical displacement
Maximum Height Minimum Height
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Avoid Excessive Compliance
Partially reflected in COM vertical displacement
Evaluate frontal plane collapse
Joint center alignment
Lateral pelvic tilt
Knee separation
Foot-COM placement
UW Neuromuscular Biomechanics
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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
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Putting it all Together
17 y/o with chronic knee pain and tibial stress reactions
9:00 min/mile 168 steps/min
UW Neuromuscular Biomechanics
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19 y/o with right dorsal foot pain
7:00 min/mile 166 steps/min
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23y/o with Right Knee Pain
10:00 min/mile 172 steps/min
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Summary
Designed with the common clinician in mind Minimal overhead
Reimbursable
60min or less