Injury Prevention

Injury Prevention

 

Most injuries can be prevented if the underlying biomechanical, anatomical and ergonomic conditions are evaluated before the injury(s).

Common Injury Types

• Low Back Pain
• Ankle Injuries (Lateral Ankle Inversion - Plantarflexion)
• Heel Pain and Plantar Arch Pain
• Metatarsalgia, Intermetatarsal Neuromas, Metatarsal Bursitis
• Achilles Tendinitis
• Shin Splints
• Fractures of the foot, ankle and leg
• Ilio-Tibial Band Syndrome of the lateral thigh
• Knee Injuries (ACL - PCL - Medial Collateral Ligament - Lateral Collateral Ligament)
• Hip & Pelvis (Sciatica - Bursitis)

Unforeseen variables that affect an injury(s).

• Terrain - Uneven floor surfaces such as trail, and grass
• Slippery surfaces
• Leg Shortages
• Joint Motion Preposition (Propensity for Movement in a certain direction)
• Pronation Syndromes
• Supination Syndromes

Accumulative Versus Direct Trauma
Accumulative trauma is the most common type, where the body slowly provides undue stress to tissue over a time period.
Direct trauma is where the injury area(s) are subjected to intense directed force causing the anatomical area to quickly over-exceed its mechanical design and limitations.  A good example of this is a fracture of bone and injury to surrounding tissues.

Soft Tissue versus Bone
Soft Tissue injuries are the most prevalent conditions seen in medicine.   They are usually the result of undue range of motion on a particular joint(s) where the joint motion is excessive and affects surrounding tissues around that joint become affected.   Tendon strain, muscle tears, capsule, ligamentous and nerve trauma can severely affect normal physiology and function leading to pain and loss or restriction of function.   

The underlying causes are usually due to abnormal joint motion (velocity), causing the joint or joints to go through abnormal or excessive range of motion leading to a injury.  This can be augmented by abnormal terrain surfaces that affect joint positioning and range of motion. 

The most vulnerable are of the body which interacts with unpredictable forces is the foot.    The foot is a Tri-Plane appendage of the body which has two primary functions.   The foot works in three body planes simultaneously to fulfill its requirement of shock absorber and stabilizer during gait events.

Heel Contact (heel impact with the floor)

• The foot acts as a Shock Absorber along with the knee as the body interacts with the floor surface.    The physics of body contact with the floor at the heel contact of gait demands equal to slightly excessive reactive forces coming from the ground.  

Midstance to Propulsion (total foot implant (midstance) with ground to heel lift (propulsion))

• When the ball of the foot approximates the floor, a series of complex joint wedge interlocking mechanisms take place which changes the function of the foot into a rigid stabilizer.   This happens in a millisecond period of time.  

Muscle Group Imbalances

• When muscle groups are not symmetrical in strength, it can lead to a predisposition to injury.   The most common of these is Hamstring and Gastrocnemius Equinus.
• Equinus effects the lateral plane and can affect the lumbar spine, knee and foot.

Asymmetrical Body Mass Conditions

Bone Trauma, (Cartilage and Bone)

Ankle Injuries

• Inversion-Plantarflexion injuries represent one of the most common load bearing injuries.  
• The injury is effected by the position of the rearfoot on terrain in addition it is influenced by positional or structural deformities such as rigid plantarflexed 1st Ray of Forefoot Valgus conditions.  
• One of the most important influences is the position of the rearfoot at heel contact on uneven terrain surfaces.   An example would be the foot approximating a rock on the medial foot leading to a inverted force on a already predisposed foot which is unstable in Varus motion already, such as a Valgus Forefoot.    This has also been seen in Hypermobile Varus foot conditions.   These patients generally have a hypermobility associated with ligamentous hyper-elasticity conditions where joints have a larger range of motion as the capsuels and ligaments are looser than normal.  
• In keeping with the Salter Harris Classification, distributes the severity of injury based on anatomical involvement.      
 

Treatment Prevention involves identifying the biomechanical foot type and stabilization of motion and position through a Bio Engineered Device.    Sports such as basketball and tennis, the patient should consider high top athletic shoes to further safeguard the ankle externally.   Ankle Supports with a semi rigid or rigid stirrup are also very good in limiting varus instability.

 

 

 

 

Metatarsal Fractures

• Lesser Metatarsal Fractures are usually due to blunt trauma, but they can also be due to repetitive trauma which can lead to a stress fracture. 
• The most common is the 2nd metatarsal.   Biomechanically, the cause is usually related to a short 1st Metatarsal and or hypermobile 1st Ray deformity.   The 1st Ray in this instance, fails to plantar flex during midstance and there is resultant transfer stress placed on the 2nd metatarsal shaft leading to fracture.
• 5th Metatarsal fractures are usually associated with a rapid varus and adduction force applied to the forefoot where the peroneal brevis is either aggressively pulled at its insertion point into the styloid base of the metatarsal.

 

Joint Implants (Foot - Knee - Hip)

• Joint Implants are made of different materials and have different function which are dependent on the affected joint.
• They are vulnerable to kinetic forces and abnormal motion created from cyclic load conditions from the body interacting with the floor.    These abnormal tri Plane forces can tear down a joint implant and can also lead to transfer joint lesions causing another joint(s) to go through accelerated breakdown leading to more surgery.

Typical Example of a Transfer Joint Lesion or Breakdown:    A 55 year old male goes to physician for pain in the Left Hip.   Radiographs demonstrate Cartilage erosion suggesting Degenerative Osteoarthritis.   Patient asks what the cause is and is shown X Rays to substantiate diagnosis.   Note: The actual cause if due to long standing biomechanical and ergonomic forces which has torn down the joint (Wolf's Law).   The doctor recommends surgery.   Surgery is performed and the patient notices slow but progressive pain in the right knee which began 1-2 years after hip surgery.    He puts up with pain for a few years and goes to the surgeon again.  X rays are taken and the doctor tells him that the right knee is arthritic.   The doctor recommends surgery.  Note:  The right knee pain is due to an artificially created (iatrogenic) leg shortage from the left hip surgery and the body compensates by putting the long right leg into a valgus knock knee position which destabilizes the knee and leads to degenerative arthritis.   So, the patient gets a total knee replacement and life goes on. . .   Four years later he is developing low back pain and tries a variety of remedies with no solution.   He goes back the the surgeon and complains of back pain and gets X Rays demonstrating hypertrophic lipping and joint space narrowing of L5-L4 segments.   All this time he is asking the doctor as to the cause and is shown XRays of proof.   Note:   The lumbar pain is related to both the previous Left Hip Surgery and the Right Knee Surgery.  These are all Transfer Joint Conditions where other anatomical segments are breaking down (Wolf's Law) causing further pain, costs and surgery.   Very few Orthopedic Surgeons understand Biomechanics which is the cause of disease.   We are carpenters and we know how to apply surgical procedures to resolve pain BUT there is a real disconnect in preventing disease and further surgeries.   Billions fo dollars are waisted annually through the practice of multiple Orthopedic procedures.

The Proper Way To Treat Load Bearing Surgeries: 

• Understand the biomechanical cause of the disease through a Static and Dynamic Kinematic Analysis. . .  http://www.digitalorthotics.com/index.php/technology/in-depth

Neurological Influences

• Compression Palsy of the Peroneal Nerve

Metabolic Influences and Endocrine Influences

• Obesity
• Diabetes

The Solution . . .