1Dr. Andy Franklyn-Miller 1

RETURN TO PLAY MOVEMENT ANALYSIS FOR RTP DECISION MAKING

JOIN THE LIVE TWITTER COVERAGE: @AFRANKLYNMILLER

AGILITY VERSUS CHANGE OF DIRECTION

FATIGUE RESISTANCE AND SPEED

MEDICAL CLEARANCE FOR FULL PARTICIPATION IN SPORTS

WITHOUT RESTRICTION OR PAIN

FOR THE MAJORITY OF INJURIES OUTSIDE OF ACL REHABILITATION

THERE IS LITTLE ORIGINAL RTP RESEARCH

LACK OF STANDARDISATION LEADS TO MEDICOLEGAL OR

FINANCIAL IMPLICATION CLUB VS COUNTRY

PLAY VERSUS PERFORMANCE

Return to Play Quick Overview about Return to Play

2 2 @AFRANKLYNMILLER – “Lack of standardisation leads to medico-legal risk in medical clearance of return to play”

Basic Mechanics

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Joint moment

@AFRANKLYNMILLER – “Each joint has an angular velocity , but joints need coordination to produce performance”

T = Fd

Basic Mechanics

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Angular velocity

@AFRANKLYNMILLER – “Each joint has an angular velocity , but joints need coordination to produce performance”

LEVER ARM IS MEASURED FROM THE AXIS OF ROTATION AXIS OF ROTATION

POINT OF APPLICATION OF THE FORCE

RADIUS FROM AXIS OF ROTATION TO POINT OF APPLICATION OF THE FORCE

F APPLIED FORCE

Muscle Contribution

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Multi joint Multi plane

Mh

Ma

ILIOPSOAS GLUTEUS MAXIMUS SEMITENDINOSUS SEMIMEMBRANOSUS BICEPS FEMORIS SARTORIUS RECTUS FEMORIS

GASTROCNEMIUS SOLEUS TIBIALIS POSTERIOR PERONEI TIBIALIS ANTERIOR

Mk

SEMITENDINOSUS SEMIMEMBRANOSUS BICEPS FEMORIS SARTORIUS RECTUS FEMORIS VASTUS MEDIALIS VASTUS LATERALIS VASTUS INTERMEDIUS GASTROCNEMIUS

Mh

Mk

Ma

@AFRANKLYNMILLER – “Multi planar , segmental coordination key in managing return to play, but can you see it?”

Motor Recruitment

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Its not just about the joint moment

@AFRANKLYNMILLER – “Rate of force development and motor recruitment makes it more complex”

Rate of force development

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Motor unit recruitment

@AFRANKLYNMILLER – “Imagine a dimmer switch and the need to turn it to max”

Understanding Groin Pain

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We’re experts in the field of groin pain treatment

3D Biomechanics

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Objective reliability of markers at instant time points

@AFRANKLYNMILLER – “Multi plane, multi joint segmental coordination assessment under load”

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Quantify complex movement

Understand mechanism of injury

Identify joint load

Define greater performance

Determine Variability

Reduce Injury risk

Monitor field based pre and post injury

Return to performance

Side Hurdle Video

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A quick demo of our animation

3600 biomechanics Patients in ACL and Groin

8 Tests per protocol

2 time points, 7 segments and 3 planes

746,592 data points per subjects

268,560,000 datA points since we started

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1 - 2

3 - 4

5 - 6

7 - 8

Movement Patterns

Absolute Strength

Performance

Fatigue

Joint Loading

Intersegmental Coordination

Variability

Coaching

Factor influencing Biomechanics What we don't know

1616 16 @AFRANKLYNMILLER – “How does variability and segmental linkage effect re-injury?”

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Joint Loading Athletic Groin Pain (Part 2): A prospective cohort study on the biomechanical evaluation of change of direction Franklyn-Miller, A BJSM ( In review)

17 17 @AFRANKLYNMILLER – “Movement patterns distinguish joint loading differentiation”

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Movement Patterns Athletic Groin Pain (Part 2): A prospective cohort study on the biomechanical evaluation of change of direction Franklyn-Miller, A British Journal of Sports Medicine (Under review)

18 18 @AFRANKLYNMILLER – “Movement patterns distinguish joint loading differentiation”

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Intersegmental Coordination: Inter-Segmental Coordination Pattern in Patients with Anterior Cruciate Ligament Deficiency during a Single-Step Descent Mohammadreza Nematollahi, PLOS One 2016

19 19 @AFRANKLYNMILLER – “The coordination of multiple joint is vital in controlling COM and COP”

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Absolute Strength Comparison of strength and power measures in identifying a rehabilitation status following anterior cruciate ligament reconstruction – O’Malley, E 2016 JBJS(Br) submitted

20 20 @AFRANKLYNMILLER – “Control of Torque production is greater than absolute strength”

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Variability Foot contact angle variability during a prolonged run with relation to injury history and habitual foot strike pattern M. R. Paquette et al Scandinavian Journal of Medicine and Science in Sports 2016 Early View

21 21 @AFRANKLYNMILLER – “We do not understand whether variability is protective or injurous”

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Fatigue Changes in drop-jump landing biomechanics during prolonged intermittent exercise Schmitz et al SportsHealth.2014Mar;6(2):128-35

22 22 @AFRANKLYNMILLER – “Fatigue effects both reproducibility and segmental coordination”

Sports health. 2014 Mar;6(2):128-35. doi: 10.1177/1941738113503286.

Changes in drop-jump landing biomechanics during prolonged intermittent exercise

Schmitz RJ1, Cone JC2, Tritsch AJ3 Pye ML1, Montgomery MM4, Henson RA5, Shultz SJ1.

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Coaching Through Intrinisic motivation and attention to Learning - Gabriele Wolf Psychon Bul 2016 Online First

23 23 @AFRANKLYNMILLER – “Best method of effecting coaching change in change of direction yet to be understood”

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Performance BiomechanicalfactorsassociatedwithFmetocompleteachangeofdirecFoncuIngmaneuver.Marshall B et al J Strength Cond Res 2014 28(10) 284

24 24 @AFRANKLYNMILLER – “Understanding segmental coordination improves performance in COD”

Existing Agility Tests

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Validated against time only

@AFRANKLYNMILLER – “Change of Direction is a closed skill in predetermined direction”

Concept behind VU

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Reproducibility of performance

@AFRANKLYNMILLER – “The journey from injury to performance controlled biomechanically”

Execution of movement

Reactive Chaos

Controlled condition

Reproducibility under fatigue

RETURN TO TRAIN

RETURN TO

PERFORMANCE

The SSC VU data collection

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Lab and field based data collection

@AFRANKLYNMILLER – “XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX”

28 @AFRANKLYNMILLER – “VU @SSCSantry is new biomechanically driven RTP lab and field test”

SSC VU Test A biomechanically driven RTP field test

LABORATORY

FIELD

GLOBAL CENTRES

SPORTS SURGERY

CLINIC

VU DATABASE

DEIDENTIFIED SERVER INDIVIDUAL

RECREATIONAL CLUB

PROFESSIONAL CLUB

Dr. Chris

Richter

Dr. Eanna

Falvey

Enda

King

Eamon O'Reilly

Mr. Ray

Moran

29 29 @AFRANKLYNMILLER – “A Team dedicated to advancing knowledge and practical rehabilitation”

Presentation thanks to

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Contact Dr. Andy Franklyn-Miller Sports Surgery Clinic, launched in 2007 in Dublin, is a state of the art orthopaedic hospital with orthopaedic surgery, medical imaging and specialise in 3D biomechanical rehabilitation of athletes from across the world.

http://drandyfranklynmiller.com

Twitter.com/afranklynmiller

Northwood Avenue, Santry, Dublin 9

afranklynmiller@me.com