Objective Markers of Rehab Progress

Paul Thawley

Olympic Medical Institute

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REVIEW

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ASSESSMENT

PLAN

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ATHLETE/COACH

MEDICAL

S&CPHYSIOTHERAPY

PHYSIOLOGYNUTRITION

PSYCHOLOGYSOFT TISSUE SPECIALSIST

SITUATION

• World Class rehabilitation centre• Subjective markers of progress

Why Objective?

• Athlete• Coach• Support Staff• Validate what we do• Accountable for what we do

IMPORTANT

• Indicators of progress• Not prescriptive or diagnostic

Sports Science vs Sports Medicine• Test• Plan • Implement• Evaluate

• Diagnose• Plan• Implement • Review

Sports Science AND Sports Medicine• Diagnose• Test• Plan• Implement • Evaluate (Objective)• Review

Where does it fit in to OMI?

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REVIEW

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PHYSIOLOGYNUTRITION

PSYCHOLOGYSOFT TISSUE SPECIALSIST

The Tests

• Lower Extremity Function/Performance• Balance & Proprioception• Upper Extremity Function/Performance• Lumbar – Pelvic Function/Performance

Balance

• Single Leg Balance • Eyes open/closed• Postural Sway (Good v bad? Variability paper…)• 45 s • Kidgell et al., 2007

-200

0

200

400

600Anterior

Medial

Posterior

LateralLeft

Right

Lower Extremity Performance

• 30 cm single leg drop jump• Force Attenuation & Production• EMG Pre-activity? (glute med, TA)• 10-20% Sensitivity

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

Left Right

F[M

ax]/

BW

(N

/BW

)

0.09

0.095

0.1

0.105

0.11

0.115

0.12

Ju

mp

Heig

ht

(m)

Take Off Force

Impact Force

Jump Height

Vertical Jumps

0

0.05

0.1

0.15

0.2

0.25

CMJ SJ L SJ RSJ Ave SJ

Vert

ical

Dis

plac

emen

t (m

)

04/03/2008

17/03/2008

0

0.5

1

1.5

2

2.5

CMJ SJ L SJ RSJ Ave SJ

F [m

ax]/B

W (N

)

04/03/2008

17/03/2008

• Single Leg/Double Leg• Non-injured/Injured• SJ/CMJ (Normative) (quad:ham activation)• 10-20% Sensitivity

Overhead Squat

• Fundamental Movement Competencies• Hip/shoulder & ankle ROM• L-P/scapula & knee control

Overhead Lunge

• Fundamental Movement Competencies• Hip/Shoulder & ankle ROM• L-P/Scapula & knee control• Posterior Sling?

New Areas of Interest

Shoulder

• External rotation EMG Pre-activity (bicep, LFT, infraspinatus)?

• Wall Slide?• EMG & Weight Distribution

Ankle

• Trap Door• EMG pre-activity• TA-GA activity & timing