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
playback.
You will receive an email containing a link to the recording when it is available.
All microphones and phone lines are muted so we ask that you submit questions by typing them into the
question box located in the lower right corner of your screen and click “send.”
We’ll collect any questions sent throughout the presentation for Ezio and he will answer as many as
possible during the Q&A segment at the end.
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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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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IN VIVO – EXPERIMENTAL ISSUES
PRESSURE
VIDEO
CONTROL &
IMUs
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IN VIVO – EXPERIMENTAL ISSUES
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
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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IN VIVO – FIELD BASED (SCRUM)
CTPE CTS CBS
INTERNATIONAL
ACADEMY
COMMUNITY
ELITE
WOMEN
TECHLEVEL
4–6 reps/team/condition
28 TEAMS
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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IN VIVO – FIELD BASED (SCRUM)
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
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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IN VIVO – FIELD BASED (SCRUM)
0
5
10
15
20
ALL
Fo
rce
[k
N] CTPE
CTS
FoldIn
7+1
5+3
PEAK COMPRESSION ~50%
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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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%
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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0
2
4
6
8
10
ALL
Fo
rce
[k
N] CTPE
CTS
FOLD
7+1
5+3
SUSTAINED COMPR. PUSH
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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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
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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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
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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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
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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South Africa (catastrophic spinal injuries)
IN VIVO – FIELD BASED (SCRUM)
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)
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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
Seminati et al. (2017) ISBS2017; Preatoni et al. (2017) #RSNlive17
# * 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
Seminati et al. (2017) ISBS2017; Preatoni et al. (2017) #RSNlive17
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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
⇧ ⇧⇧
⇧
Seminati et al. (2017) ISBS2017; Preatoni et al. (2017) #RSNlive17
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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
44
HK-BASES webinar | An integrated approach to the analysis of injury mechanisms in sport impacts
CO
NT
AC
T
Dr
Ezio
Pre
ato
ni
|e.p
reato
ni@
bath
.ac.u
k
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?
We have some great webinars coming up:
The National Centre for Sport and Exercise Medicine (NCSEM) –
Delivering an Olympic legacy By Dr Stephen Harris
Date: Wednesday 15th November 2017
Time: 15.00 GMT
Weightlifting exercises and their derivatives – appropriate
application across mesocycles By Dr Paul ComfortDate: Wednesday 13th December 2017
Time: 15.00 GMT
Thanks For Joining Us
Thank you to everyone for joining us today and thanks also to Ezio for the great presentation.
Please take a few moments when your webinar window closes to complete a short survey on
today’s webinar – we appreciate your feedback as it helps us continually improve our
webinars.
Earn your BASES credits with our endorsed CE courses.
We will email everyone a link to the recording of today’s presentation, so you can view it
yourself or pass it along to friends or colleagues.
Thank you again for your participation, enjoy the rest of your day.
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