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Effects of Q-Angle on Lower Extremity Biomechanics And

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Effects of Q-Angle on Lower Extremity Biomechanics And EFFECTS OF Q-ANGLE ON LOWER EXTREMITY BIOMECHANICS AND INJURIES IN FEMALE COLLEGIATE TRACK AND FIELD ATHLETES By MYRANDA HOPE HAM Candidate for Master of Science in Engineering, Biomedical Engineering, Mercer University, May 2020 A Thesis Submitted to the Graduate Faculty of Mercer University School of Engineering in Partial Fulfillment of the Requirements for the Degree MASTER OF SCIENCE IN ENGINEERING MACON, GA 2020 EFFECTS OF Q-ANGLE ON LOWER EXTREMITY BIOMECHANICS AND INJURIES IN FEMALE COLLEGIATE TRACK AND FIELD ATHLETES By MYRANDA HOPE HAM Approved: ______________________________________ Date __________________ Dr. Ha Vo, Advisor ______________________________________ Date __________________ Dr. Edward O’Brien, Committee Member ______________________________________ Date __________________ Dr. Richard Kunz, Committee Member ______________________________________ Date __________________ Dr. Laura Lackey, Dean ACKNOWLEDGEMENTS I would like to first thank Dr. Vo for all his help throughout this project. I would not have been able to complete this study without his guidance. Thank you to Dr. Kunz and Dr. O’Brien for serving as member of my committee. Thank you to Amos Mansfield for approving this study to be conducted with Mercer University student-athletes. Thank you to all the Mercer Women’s Track and Field coaches, including Josh Hayman, Leesa Morales, and Jerod Wims, for being flexible and allowing the athletes to participate in this study around their practice schedule. Thank you to every member of the Mercer Women’s Track and Field team who devoted time to participating in this study. iii TABLE OF CONTENTS ACKNOWLEDGEMENTS ............................................................................................... iii LIST OF FIGURES ........................................................................................................... vi LIST OF TABLES ............................................................................................................. xi ABSTRACT ...................................................................................................................... xii CHAPTERS 1 INTRODUCTION AND BACKGROUND .................................................................... 1 Introduction .................................................................................................................................. 1 Background .................................................................................................................................. 1 Anatomy of the Lower Extremity ............................................................................................ 1 Quadriceps Angle (Q-angle) .................................................................................................. 15 The Gait Cycle ....................................................................................................................... 18 Common Injuries in Running ................................................................................................. 24 2 MATERIALS AND METHODS IRB Requirements ...................................................................................................................... 30 Q-Angle and Limb Length Measurements................................................................................. 30 Gait Analysis Equipment and Procedure ................................................................................... 33 EMG Equipment and Procedure ................................................................................................ 36 Statistical Analysis ..................................................................................................................... 40 iv TABLE OF CONTENTS (Continued) 3 RESULTS AND DISCUSSION .................................................................................... 41 Subject Information and Reported Injuries ................................................................................ 41 Gait Analysis Results ................................................................................................................. 47 EMG Results and Discussion ..................................................................................................... 61 Statistical Analysis ..................................................................................................................... 76 Discussion of Reported Injuries ................................................................................................. 76 Interesting Cases ........................................................................................................................ 78 4 CONCLUSION .............................................................................................................. 82 5 FUTURE STUDIES AND RECOMMENDATIONS ................................................... 83 REFERENCES ................................................................................................................. 85 APPENDICES A IRB APPROVAL .......................................................................................................... 89 B CITI PROGRAM CERTIFICATION ........................................................................... 90 C INFORMED CONSENT FORM .................................................................................. 91 D SUBJECT INFORMATION ......................................................................................... 94 E REPORTED INJURIES ................................................................................................ 96 F GAIT DATA .................................................................................................................. 98 G EMG DATA ................................................................................................................ 113 H ANDERSON-DARLING NORMALITY TESTS ...................................................... 128 I STATISTICAL ANALYSIS ........................................................................................ 139 v LIST OF FIGURES Figure 1.1. Bones of the pelvis ............................................................................................2 Figure 1.2. The ilium and important landmarks ..................................................................2 Figure 1.3. The ischium and important landmarks ..............................................................3 Figure 1.4. The pubis and important landmarks .................................................................3 Figure 1.5. Ligaments of the hip joint..................................................................................4 Figure 1.6. The femur and important landmarks .................................................................4 Figure 1.7. Tendons and ligaments of the knee joint ...........................................................5 Figure 1.8. Ligaments and menisci of the knee joint ...........................................................6 Figure 1.9. The tibia and fibula and important landmarks ...................................................6 Figure 1.10. Ligaments of the ankle ....................................................................................7 Figure 1.11. The tarsal bones ...............................................................................................8 Figure 1.12. Muscles of the gluteal region ..........................................................................9 Figure 1.13. The muscles of the anterior, medial, and posterior compartments of the thigh ............................................................................................................................................11 Figure 1.14. Muscles of the anterior and lateral compartments of the leg.........................12 Figure 1.15. Muscles of the posterior compartment of the leg ..........................................13 Figure 1.16. The muscles of the dorsal aspect of the foot .................................................14 Figure 1.17. Muscles of the plantar aspect of the foot .......................................................15 Figure 1.18. Q-angle and the lines from which it is measured ..........................................16 Figure 1.19. Transition between types of gait....................................................................18 vi LIST OF FIGURES (Continued) Figure 1.20. Walking gait cycle phases .............................................................................19 Figure 1.21. Running gait cycle phases .............................................................................19 Figure 1.22. Pronation and supination and the effects those motions have on tibial rotation ...............................................................................................................................21 Figure 1.23. Knee joint axes for different alignments .......................................................21 Figure 1.24. Joint range of motion for hip, knee, and ankle during the walking, running, and sprinting gait cycles.....................................................................................................23 Figure 1.25. Muscle activation during the running gait cycle ...........................................24 Figure 2.1. Investigator measuring limb length on a subject .............................................31 Figure 2.2. Steps of measuring Q-angle on a subject ........................................................33 Figure 2.3. Marker setup for gait analysis
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