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Principles and
Mechanisms of
Injury
Theruni Wijewardene
(t.wijewardene@gmail.com)
Lecture Objectives
Identify
Biomechanics
Biomechanics
Biomechanics
Biomechanics: 5 Important
Components
Motion
Force
Momentum
Levers
Balance
Motion
Movement
Velocity
Acceleration
Displacement
Time
Eg.
Force
An
Movement
Direction
Geometrical or anatomical structure
Eg.
Momentum
Product
Levers
In the human body, arms and legs act as
levers, as does equipment such as racquets
and bats
3 parts to a lever:
Resistance
Force
Axis of rotation/fulcrum
Balance
Stability
Alignment of COG over BOS
Balance influenced by:
Width of BOS
Height and motion of the COG
Weight of the person
Extrinsic Factors
New/different
equipment eg shoes
Change in training surface eg hard vs
soft surfaces, non-shock absorbing, too
soft
Sudden change in training load eg
intensity/frequency/duration
Elbow
Meniscus
Ligament
ACL
PCL
LCL
MCL
strain/tear
Rotator Cuff
Injury/Impingement Syndrome
The
Rotator Cuff
Injury/Impingement
Weakness of RC increases demands on the static stabilizers (joint
capsule/labrum/GHJ/ ligaments).
If demands are long term or recurrent, static stabilizers may begin to fail
result in stretching or attenuation of the capsule greater shoulder laxity
greater demands on the already weak rotator cuff muscles.
Humeral head migration may occur with capsule laxity and weak RC RC
impingement and pain.
[Evidence to suggest that impingement may occur initially compromises
blood flow to SS and also relative avascularity at humeral attachment]
Pain may inhibit RC muscle firing, leading to disuse and further weakening
of the dynamic stabilizers with greater demands placed on the static
stabilizers.
Other factors contributing to impingement/RC injuries: faulty postures;
capsular tightness; joint kinematics; structural abnormalities in
coracoacromial arch
RC Injuries
Proper balance between concentrically contracting muscles that
generate force and the eccentrically contracting muscles that
control movement is important. Imbalance between these
opposing muscle groups results in overuse injuries.
During throwing movement where GHJ moves into considerable
abduction and ER, high SS forces required in this position
injury
Role of RC is to synergistically resist distraction of the humeral
head therefore if injury or fatigue is present altering
throwing/movement pattern increases risk of further tissue
damage
Note: Much of the force generated in overhead sports occurs in
the trunk and lower extremity, and require significant stability
and strength
RC Injuries
Often,
RC Injury/Impingement:
Clinical Signs
Mechanism of injury
Pain anterior shoulder and/or mid deltoid region
Pain with shoulder movement
ACJ Sprain
Occurs when an applied force displaces the acromion
process from the distal end of the clavicle
Results from direct or indirect forces
Direct: force applied to the point of the shoulder (ACJ) with
GHJ in adduction
ACJ Injury
ACJ Injuries
Lateral Epincondyalgia:
Mechanism of Injury
Usually
Lateral Epincondyalgia:
Mechanism of Injury
Other causes
new racquet
using a racquet that is
strung too tightly
using a racquet that is
too heavy
hitting wet or heavy balls
or hitting into the wind.
having a grip that is too large.
hitting with a 1-handed backhand versus a 2handed backhand
Knee - Meniscus
Anatomy:
Function:
More
Associated
injury:
Medial VS Lateral
Medial
Anatomy:
Function:
Mechanism of Injury
2
Mechanisms:
Non-contact
Contact
ACL
PCL
Valgus
(partially)
Within 2 hrs
Haemathrosis: 80% chance ACL tear and most likely full
Lateral mensicus
ODonoghues / Unhappy Triad
ACL
Posterior Cruciate
Ligament
Anatomy:
Antero-lateral
Function:
Hyperextension
injury
MCL
Function: superficial MCL provides 57% of the restraining
valgus moment at 5 of knee flexion, and provides 78% of
the moment at 25 of knee flexion due to decreased
contribution from the posterior capsule. MCL strength ~
equal to ACL
After MCL rupture, the ACL may also tear, producing a more
extensive injury.
In one study of MCL injuries, Fetto and Marshall reported the
incidence of ACL tears to be 20% when there is no valgus
laxity on clinical exam, 53% with laxity only in 30 of knee
flexion, and 78% with valgus laxity in full extension.
Therefore, if the knee opens medially in extension, one must
suspect that an ACL injury is likely present
stress
Due
of injury
LCL tender on palpation
Lack of extension pain ++
Postive to varus stress test
Pain worse with incomplete tears vs
complete
Grade III associated with posterloateral
corner instabilities: poplitues; PCL and
posterior capsule
knee pain
Biomechanics of injury:
valgum
External tibial torsion
Increased femoral anteversion
around patella
Pain on knee flexion (eg
sitting/squatting etc); worse with
downstairs/hills
Swelling
McConnels Functional Test: medial glide
of patella during functional test (eg
squat) improves function (eg ROM or
pain)
Hamstrings
Muscles
Hamstring Strains
Hamstrings Strains
Biceps
Inadequate warm up
Lack of literature for best practice guidelines
Warm up increases amount of force and
length a muscle can absorb prior to tearing
Training errors
Poor playing surfaces
Fatigue related to unsuitable structure and
content of training
(player related)
Muscle imbalances
Especially
eccentric
H/S vs Quads
Lack of flexibility
Quads
Increasing age
>25
and HS
Previous HS injury
Lack of neuromuscular control trunk/pelvis
Poor LL proprioception
Fatigue
Injuries late in season or competition
Fatigued muscle absorbs less energy before
failure
Inadequate fitness
Running style
Kicking technique
SIJ dysfunction
Associated
injuries:
markers: swelling;
bruising; heat
Tenderness on palpation: lateral ankle,
distal to lat. Malleolus
Anterior Drawer Test +ve for ATFL in PF
Anterior Drawer Test +ve for CFL in DF
Talar Tilt Test +ve for ATFL
Ankle Rules:
Achilles Tendinopathy
Anatomy:
Injury:
Achilles Tendinopathy:
Contributing Factors
Extrinsic:
Intrinsic
Previous injury
Increased age
Male gender
Increased adiposity/metabolic disorders
Pre-existing tendon abnormalities
Triceps surae inflexibility
Abnormal LL biomechanics
Biomechanical Factors
Biomechanical Factors