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Romero-Flores CF, Bustamante-Bello R, Moya Bencomo M, Martinez-Ríos EA, Montesinos L. Optical Marker-Based Motion Capture of the Human Spine: A Scoping Review of Study Design and Outcomes. Ann Biomed Eng 2024; 52:2373-2387. [PMID: 39023832 PMCID: PMC11329589 DOI: 10.1007/s10439-024-03567-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 06/19/2024] [Indexed: 07/20/2024]
Abstract
Biomechanical analysis of the human spine is crucial to understanding injury patterns. Motion capture technology has gained attention due to its non-invasive nature. Nevertheless, traditional motion capture studies consider the spine a single rigid segment, although its alignment changes during movement. Moreover, guidelines that indicate where markers should be placed for a specific exercise do not exist. This study aims to review the methods used to assess spine biomechanics using motion capture systems to determine the marker sets used, the protocols used, the resulting parameters, the analysed activities, and the characteristics of the studied populations. PRISMA guidelines were used to perform a Scoping Review using SCOPUS and Web of Science databases. Fifty-six journal and conference articles from 1997 to 2023 were considered for the analysis. This review showed that Plug-in-Gait is the most used marker set. The lumbar spine is the segment that generates the most interest because of its high mobility and function as a weight supporter. Furthermore, angular position and velocity are the most common outcomes when studying the spine. Walking, standing, and range of movement were the most studied activities compared to sports and work-related activities. Male and female participants were recruited similarly across all included articles. This review presents the motion capture techniques and measurement outcomes of biomechanical studies of the human spine, to help standardize the field. This work also discusses trends in marker sets, study outcomes, studied segments and segmentation approaches.
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Affiliation(s)
- Claudia F Romero-Flores
- Tecnologico de Monterrey, School of Engineering and Sciences, Ave. Eugenio Garza Sada 2501, Monterrey, N.L., México, 64849
| | - Rogelio Bustamante-Bello
- Tecnologico de Monterrey, School of Engineering and Sciences, Ave. Eugenio Garza Sada 2501, Monterrey, N.L., México, 64849
| | - Marcos Moya Bencomo
- Tecnologico de Monterrey, School of Engineering and Sciences, Ave. Eugenio Garza Sada 2501, Monterrey, N.L., México, 64849.
| | - Erick Axel Martinez-Ríos
- Tecnologico de Monterrey, School of Engineering and Sciences, Ave. Eugenio Garza Sada 2501, Monterrey, N.L., México, 64849
| | - Luis Montesinos
- Tecnologico de Monterrey, School of Engineering and Sciences, Ave. Eugenio Garza Sada 2501, Monterrey, N.L., México, 64849
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Legg L, Donahue T, Peel S, Piland S, Thorsen T. Effects of shoe collar height and limb dominance on landing knee biomechanics in female collegiate volleyball players. J Sports Sci 2024; 42:247-254. [PMID: 38456685 DOI: 10.1080/02640414.2024.2327119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/28/2024] [Indexed: 03/09/2024]
Abstract
Volleyball-specific footwear with higher collar heights (a mid-cut shoe) are worn to restrict ankle motion. Reduced ankle dorsiflexion has been associated with increased frontal plane motion and injury risk at the knee. With the high frequency of unilateral landings in volleyball, the purpose of this study was to determine the effect of volleyball-specific shoes and limb dominance on knee landing mechanics in collegiate volleyball players. It was hypothesized that participants would exhibit smaller sagittal plane and greater frontal plane knee joint mechanics in mid-cut and dominant limb and that vertical and posterior directed ground reaction forces would be greater wearing mid-cut, yet similar between limbs. Seventeen female volleyball players performed unilateral landings on each limb in mid-cut and low-top volleyball shoes. For shoe main effects, smaller peak dorsiflexion angle and internal peak plantarflexion moment and greater peak medial ground reaction force were found in the mid-cut but with no impact on knee mechanics. For limb main effects, the internal peak knee abduction moment was greater in the dominant limb. Greater peak lateral ground reaction force was found in the interaction between the non-dominant limb and low-top. Further research is warranted to better understand shoe and limb impact in volleyball players.
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Affiliation(s)
- Lindsey Legg
- Wolfson School of Mechanical, Electrical, and Manufacturing Engineering, Loughborough University, Loughborough, UK
| | - Tyler Donahue
- School of Kinesiology and Nutrition, The University of Southern Mississippi, Hattiesburg, USA
| | - Shelby Peel
- Department of Exercise and Health Sciences, University of Memphis, Memphis, TN, USA
| | - Scott Piland
- School of Kinesiology and Nutrition, The University of Southern Mississippi, Hattiesburg, USA
| | - Tanner Thorsen
- School of Kinesiology and Nutrition, The University of Southern Mississippi, Hattiesburg, USA
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Farhart P, Beakley D, Diwan A, Duffield R, Rodriguez EP, Chamoli U, Watsford M. Intrinsic variables associated with low back pain and lumbar spine injury in fast bowlers in cricket: a systematic review. BMC Sports Sci Med Rehabil 2023; 15:114. [PMID: 37730648 PMCID: PMC10512628 DOI: 10.1186/s13102-023-00732-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 09/12/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Lumbar spine injuries in fast bowlers account for the greatest missed playing time in cricket. A range of extrinsic and intrinsic variables are hypothesised to be associated with low back pain and lumbar spine injury in fast bowlers, and an improved understanding of intrinsic variables is necessary as these may alter load tolerance and injury risk associated with fast bowling. This review critically evaluated studies reporting intrinsic variables associated with low back pain and lumbar spine injury in fast bowlers and identified areas for future investigation. METHODS OVID Medline, EMBASE, SPORTDiscus, CINAHL, Web of Science and SCOPUS databases were last searched on 3 June 2022 to identify studies investigating intrinsic variables associated with low back pain and lumbar spine injury in cricket fast bowlers. Terms relevant to cricket fast bowling, and intrinsic variables associated with lumbar spine injury and low back pain in fast bowlers were searched. 1,503 abstracts were screened, and 118 full-text articles were appraised to determine whether they met inclusion criteria. Two authors independently screened search results and assessed risk of bias using a modified version of the Quality in Prognostic Studies tool. RESULTS Twenty-five studies met the inclusion criteria. Overall, no included studies demonstrated a low risk of bias, two studies were identified as moderate risk, and twenty-three studies were identified as high risk. Conflicting results were reported amongst studies investigating associations of fast bowling kinematics and kinetics, trunk and lumbar anatomical features, anthropometric traits, age, and neuromuscular characteristics with low back pain and lumbar spine injury. CONCLUSION Inconsistencies in results may be related to differences in study design, injury definitions, participant characteristics, measurement parameters, and statistical analyses. Low back pain and lumbar spine injury occurrence in fast bowlers remain high, and this may be due to an absence of low bias studies that have informed recommendations for their prevention. Future research should employ clearly defined injury outcomes, analyse continuous datasets, utilise models that better represent lumbar kinematics and kinetics during fast bowling, and better quantify previous injury, lumbar anatomical features and lumbar maturation. TRIAL REGISTRATION Open Science Framework https://doi.org/10.17605/OSF.IO/ERKZ2 .
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Affiliation(s)
- Patrick Farhart
- School of Sport, Exercise and Rehabilitation, Faculty of Health, Human Performance Research Centre, Moore Park Precinct, University of Technology Sydney, Broadway, NSW, 2007, Australia.
- Spine Labs, Discipline of Surgery, St. George and Sutherland Campus of the Clinical School, Faculty of Medicine, University of New South Wales, Kogarah, NSW, 2217, Australia.
- Cricket New South Wales, 161 Silverwater Road, Sydney Olympic Park, Sydney, NSW, 2127, Australia.
- Delhi Capitals, JSW GMR Cricket Private Limited, Bahadurshah Zafar Marg, New Delhi, 110002, India.
| | - David Beakley
- Deakin University, Burwood Highway, Burwood, VIC, 3125, Australia
| | - Ashish Diwan
- Spine Labs, Discipline of Surgery, St. George and Sutherland Campus of the Clinical School, Faculty of Medicine, University of New South Wales, Kogarah, NSW, 2217, Australia
- Spine Service, Department of Orthopaedic Surgery, St. George Hospital Campus, Kogarah, NSW, 2217, Australia
| | - Rob Duffield
- School of Sport, Exercise and Rehabilitation, Faculty of Health, Human Performance Research Centre, Moore Park Precinct, University of Technology Sydney, Broadway, NSW, 2007, Australia
| | - Elizabeth Pickering Rodriguez
- School of Sport, Exercise and Rehabilitation, Faculty of Health, Human Performance Research Centre, Moore Park Precinct, University of Technology Sydney, Broadway, NSW, 2007, Australia
| | - Uphar Chamoli
- Spine Labs, Discipline of Surgery, St. George and Sutherland Campus of the Clinical School, Faculty of Medicine, University of New South Wales, Kogarah, NSW, 2217, Australia
- School of Biomedical Engineering, Faculty of Engineering and Information Technology, University of Technology Sydney, Broadway, NSW, 2007, Australia
| | - Mark Watsford
- School of Sport, Exercise and Rehabilitation, Faculty of Health, Human Performance Research Centre, Moore Park Precinct, University of Technology Sydney, Broadway, NSW, 2007, Australia
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Skallerud A, Brumbaugh A, Fudalla S, Parker T, Robertson K, Pepin ME. Comparing Lumbar Lordosis in Functional Dance Positions in Collegiate Dancers With and Without Low Back Pain. J Dance Med Sci 2022; 26:191-201. [PMID: 35697483 DOI: 10.12678/1089-313x.091522f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Limited research has explored the relationship between lumbar lordosis and incidence of low back pain in dancers. The purpose of this study was to investigate the relationship between lumbar lordosis in functional dance positions and low back pain (LBP). Thirty full-time undergraduate ballet and modern collegiate dancers (28 female, 2 male) from three university dance programs participated in this study. Functional lumbar lordosis, hip passive range of motion, and core endurance were measured in a single session. Dancers participated in weekly follow-up surveys over a 4-month period to track the presence and severity of LBP. Primary analysis was performed using independent t-tests between groups who did and did not develop pain. Secondary analyses were performed using Pearson's r correlation. Eleven dancers reported no pain during the follow-up period, 16 reported pain, and three did not respond to follow-up surveys. Lumbar lordosis in right developpé á la seconde and right retiré was significantly greater (p < 0.05) in the group who reported pain compared to the group who reported no pain. Increased hold times in the supine bridge position was shown to be fairly correlated (p < 0.05) to reduced lumbar lordosis in first position (Pearson's r = 0.381), left retiré (Pearson's r = 0.396), and right developpé á la seconde (Pearson's r = 0.365). The results of this study suggest a relationship between increased lumbar lordosis in the retiré and developpé á la seconde dance positions and development of LBP. Increased endurance of posterior core musculature and gluteal muscles was inversely related to the magnitude of lumbar lordosis in some dance-specific positions. The measurement of lumbar lordosis during functional dance positions, particularly those requiring single leg stances, may help identify collegiate dancers with increased risk of developing low back pain.
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Zwierzchowska A, Gawel E, Celebanska D, Rosolek B. Musculoskeletal pain as the effect of internal compensatory mechanisms on structural and functional changes in body build and posture in elite Polish sitting volleyball players. BMC Sports Sci Med Rehabil 2022; 14:49. [PMID: 35346336 PMCID: PMC8962485 DOI: 10.1186/s13102-022-00439-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 03/17/2022] [Indexed: 02/04/2023]
Abstract
Background With the dynamic development of professional Paralympic sport, the prevalence of musculoskeletal pain and structural and/or functional disturbances in Para athletes constantly increases. The aim of the study was to evaluate the impact of internal compensatory mechanisms on selected aspects of body structure and function in elite sitting volleyball players. Methods The study included eighteen elite sitting volleyball players (male; n = 12, female; n = 6, age; 36.0 ± 6.1, body mass; 76.6 ± 16.1, body height; 179.3 ± 0.1) from the Polish national team. Retrospective and direct participatory observation methods were used in the study. NMQ-7 was used to assess the current prevalence and location of musculoskeletal pain. The evaluation of spinal curvature and pelvic inclination was performed using a non-invasive Medi Mouse method (Idiag M360) in three different trunk positions. All statistical analyses were performed using Statistica 13.3 software package. Results Lumbar hypolordosis was a predominant sagittal deviation of spinal curvature (n = 15;83%). Low back pain (LBP) and neck pain were the most frequent complaints (50%). Statistically significant differences in the values of thoracic kyphosis angle, pelvic inclination, and spine length (SL) in sagittal standing flexion and extension were found. However, there was no statistically significant difference in sagittal standing flexion for the lumbar lordosis angle with a simultaneous significant change in pelvic inclination (66.9°). Moreover, a tendency to interpenetration of relationships between variables that characterize (a) body structure and (b) function of the spine and musculoskeletal pain were observed. Shoulder pain correlated with SL (R = 0.6; p < 0.05) and body height (R = 0.5; p < 0.05). Pelvic inclination correlated with shoulder pain, LBP (R = 0.5; p < 0.05/R = 0.6; p < 0.01), and body trunk fat mass (R = − 0.6; p < 0.05). Conclusions Trunk fat mass induces internal compensatory mechanisms to maintain optimal pelvic inclination and sagittal spinal balance. Furthermore, the level of pelvic mobility may determine musculoskeletal pain in Para athletes with lower limb impairment.
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Affiliation(s)
- Anna Zwierzchowska
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Mikołowska 72A, 40-065, Katowice, Poland
| | - Eliza Gawel
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Mikołowska 72A, 40-065, Katowice, Poland.
| | - Diana Celebanska
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Mikołowska 72A, 40-065, Katowice, Poland
| | - Barbara Rosolek
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Mikołowska 72A, 40-065, Katowice, Poland
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Vatandoost S, Sheikhhoseini R, Akhbari B, Salavati M, Pourahmadi M, Farhang M, O'Sullivan K. Altered muscle strength and flexibility among a subgroup of women with chronic nonspecific low back pain: Cross-sectional case-control study. Physiother Theory Pract 2022:1-9. [PMID: 35196207 DOI: 10.1080/09593985.2022.2043497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To compare muscle strength and flexibility among a subgroup of women with extension-related chronic nonspecific low back pain (CNLBP) with healthy controls. METHODS In this case-control study, 32 subjects with and without extension-related CNLBP were tested (n = 16 in each group). Gluteal, abdominal, paravertebral, and hamstring strength, along with hip flexor flexibility and hamstring flexibility were compared between groups. Data were analyzed using the Mann-Whitney test (p < .007). RESULTS The CNLBP subgroup displayed significantly lower strength of all muscles analyzed (p < .007), with the exception of gluteus medius. The flexibility of the hip flexors and hamstrings were not significantly reduced among the women with CNLBP (p > .007). DISCUSSION The present study showed that alterations in muscle strength, but not flexibility, partly consistent with those previously hypothesized but not objectively reported, were present among a subgroup of women with extension-related CNLBP. These results may have implications for the selection of therapeutic exercises among this subgroup of people with CNLBP.
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Affiliation(s)
- Sima Vatandoost
- Department of Physical Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Behnam Akhbari
- Department of Physical Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mahyar Salavati
- Department of Physical Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammadreza Pourahmadi
- Department of Physical Therapy, Faculty of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Farhang
- Department of Statistics, Tarbiat Modares University, Tehran, Iran
| | - Kieran O'Sullivan
- School of Allied Health, Ageing Research Center, University of Limerick, Limerick, Ireland.,School of Allied Health, Sports and Human Performance Research Centre, University of Limerick, Limerick, Ireland
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The Impact of Internal Compensatory Mechanisms on Musculoskeletal Pain in Elite Polish Sitting Volleyball Players – A Preliminary Study. J Hum Kinet 2022; 81:277-288. [PMID: 35291641 PMCID: PMC8884867 DOI: 10.2478/hukin-2022-0023] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
The purpose of the study was to evaluate the impact of (1) maximal muscular strength of the upper body and (2) fat mass on musculoskeletal pain and sagittal spinal curvature deviations in elite Polish sitting volleyball players. The study examined twelve players (age = 35.4 ± 6.9 years). The assessments were performed based on objective (anthropometric examinations, Medi Mouse, 1RM test) and subjective (NMQ = 7) measurements. All statistical analyses were performed using the SPSS. The lower back, the upper back and the neck were the most frequent painful areas. Statistical analyses showed a significant relationship between lumbar lordosis (LL) sagittal standing extension (r = 0.62; p = 0.03) and thoracic kyphosis (TK) sagittal standing flexion (r = -0.63; p = 0.28) with the 1RM. Furthermore, correlations between a body adiposity index and TK sagittal standing flexion and extension (r = -0.65; p = 0.05, r = - 0.58; p = 0.0.05) as well as LL sagittal standing flexion (r = 0.61; p = 0.05) were found. The body mass index correlated with wrist pain, whereas a very high relationship was found between pain in the wrists and knee joints. Neck pain positively correlated with TK and LL sagittal standing. Low back pain correlated with LL sagittal standing flexion and TK sagittal standing extension. Fat mass impacts the depth of anteroposterior spinal curvatures, what may cause pain in the neck and the lower back. The 1 RM bench press may influence the prevalence and location of musculoskeletal pain, whereas its values might be predicted by the depth of TK. A lower 1RM in the bench press may impact sagittal spinal curvature deviations. Deepen TK and LL significantly contribute to the prevalence of the neck pain.
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Effect of Compensatory Mechanisms on Postural Disturbances and Musculoskeletal Pain in Elite Sitting Volleyball Players: Preparation of a Compensatory Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910105. [PMID: 34639407 PMCID: PMC8508345 DOI: 10.3390/ijerph181910105] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/16/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022]
Abstract
The aim of the study was to identify the effect of compensatory mechanisms on the prevalence of sagittal spinal curvature deformity and musculoskeletal pain and to assess the interrelationships between those components in sitting volleyball players. Twenty-one elite Polish sitting volleyball players (age = 34.1 ± 7.5, BM = 77.9 ± 16.0) participated in the study in which direct participatory systematic observation and a non-invasive method were used. Both objective (anthropometric, spinal curvature-Idiag M360) and subjective (musculoskeletal ailments-NMQ = 7) measurements were performed. The Statistica 13.3 software package was used for statistical analyses. The neck, lower back (43%), and upper back (38%) were the most frequently reported painful areas. Of all participants, 76% reported sagittal spinal deformities. In the habitual position, the results indicated moderate correlations (r = 0.5, p < 0.05) between the lumbar concavity of the back and low back pain (LBP) and between thoracic convexity and LBP (r = 0.4, p < 0.05). Internal and external compensation have an effect on the prevalence of spinal curvature deformities in the sagittal plane, with thoracic hyperkyphosis (38%) and lumbar hyperlordosis (33%) being the most common. More severe lower and upper back pain were correlated with greater angles of thoracic kyphosis and lumbar lordosis in the habitual position.
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Pimentel R, Potter MN, Carollo JJ, Howell DR, Sweeney EA. Peak sagittal plane spine kinematics in female gymnasts with and without a history of low back pain. Clin Biomech (Bristol, Avon) 2020; 76:105019. [PMID: 32402899 DOI: 10.1016/j.clinbiomech.2020.105019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/16/2020] [Accepted: 04/26/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Female gymnasts have a greater prevalence of back pain compared to other female athletes. There is little evidence that female artistic gymnasts with and without back pain demonstrate different movement patterns during gymnastics skills. The purpose of this study was to determine if there were differences in back movements during back walkovers and back handsprings among female artistic gymnasts. METHODS Female artistic gymnasts (8-18 years old) with and without back pain wore inertial sensors on their torso, arms, and legs while performing back walkovers (N = 14) and back handsprings (N = 15) on the floor and balance beam at their training gymnastics facilities. FINDINGS Gymnasts with back pain had similar spine peak extension, peak flexion, and range of motion during back walkovers and back handsprings compared to gymnasts without back pain. Additionally, no differences in sagittal plane spine kinematics were found between the groups at any specific time point during either the back walkover or back handspring skills. However, a large portion of the data collected was excluded during quality assurance, thus our final sample sizes are small. INTERPRETATION These findings suggest that gymnasts with back pain have similar sagittal plane movements to those without back pain. The relationship between back pain and gymnastics training load/intensity is currently unclear. We suggest future studies to investigate common artistic gymnastics skills and back pain prevalence with more participants, full-body motion analysis with kinetic measurement capabilities, and longitudinally for those demonstrating back pain.
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Affiliation(s)
- Ricky Pimentel
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; North Carolina State University, Raleigh, NC, USA; Center for Gait and Movement Analysis, Children's Hospital Colorado, Aurora, CO, USA
| | - Morgan N Potter
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - James J Carollo
- Center for Gait and Movement Analysis, Children's Hospital Colorado, Aurora, CO, USA; University of Colorado School of Medicine, Department of Physical Medicine and Rehabilitation, Aurora, CO, USA; University of Colorado School of Medicine, Department of Orthopedics, Aurora, CO, USA
| | - David R Howell
- University of Colorado School of Medicine, Department of Orthopedics, Aurora, CO, USA; Children's Hospital Colorado, Sports Medicine Center, Aurora, CO, USA
| | - Emily A Sweeney
- University of Colorado School of Medicine, Department of Orthopedics, Aurora, CO, USA; Children's Hospital Colorado, Sports Medicine Center, Aurora, CO, USA.
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