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406 Cards in this Set
- Front
- Back
what are the three functions of the foot?
|
(1) to bear weight
(2) mobile adapter at heel strike (pronates) (3) rigid lever at push off phase (supinates) |
|
what are the five types of joints contained within the foot?
|
(1) talocrural
(2) subtalar (3) transtarsal (4) tarsometatarsal (5) metatarsophalangeal |
|
what are the two types of transtarsal joints in the foot?
|
calcaneocuboid, talonavicular
|
|
what two motions of the foot occur in the frontal plane?
|
inversion and eversion
|
|
what two motions of the foot occur in the sagittal plane?
|
dorsiflexion and plantarflexion
|
|
what two motions of the foot occur in the transverse plane?
|
abduction and adduction
|
|
what two motions of the foot occur in the oblique plane of motion (triplanar)?
|
pronation and supination
|
|
pronation is a combination of what three motions at the ankle? (in NWB)
|
(1) eversion
(2) dorsiflexion (3) abduction |
|
supination is a combination of what three motions at the ankle? (in NWB)
|
(1) inversion
(2) plantarflexion (3) adduction |
|
this joint is a syndesmosis joint between the convex medial surface of the distal fibula and the concave fibular notch of the tibia; held together by the anterior and posterior tibiofibular ligaments
|
distal tibiofibular joint
|
|
this joint is also called the ankle mortise, and is formed between the convex talus and the concave tibia
|
talocrural joint
|
|
in dorsiflexion, what directions does the talus roll and slide relative ot the tibia?
|
rolls anterior, slides posterior
|
|
this is the rotation of the ankle joint axis in the transverse plane
|
tibial torsion
|
|
the tibial torsion angle is considered significant when it is greater than --º
|
30º
|
|
what is the normal range of tibial torsion?
|
6-10º
|
|
how much dorsiflexion does someone need to achieve for normal gait?
|
10º
|
|
what is the normal range of ankle dorsiflexion?
|
20-26º
|
|
what is the normal range of ankle plantarflexion?
|
20-50º
|
|
is there more motion at the ankle joint with the knee flexed or extended?
|
flexed
|
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what is the most commonly injured ligament in ankle sprains?
|
anterior talofibular
|
|
what ligament of the lateral ankle is stressed with straight inversion?
|
calcaneofibular
|
|
what ligament of the lateral ankle is stressed with inversion and plantarflexion?
|
anterior talofibular
|
|
what ligament of the lateral ankle is stressed with inversion and dorsiflexion?
|
posterior talofibular
|
|
this joint is formed by the concave posterior facet of the talus resting upon the convex posterior facet of the calcaneus
|
subtalar joint
|
|
about how many degrees from the horizontal does the subtalar joint lie?
|
42º
|
|
about how many degrees from the sagittal plane does the subtalar joint lie?
|
16-23º
|
|
how much eversion is normal in an open kinetic chain at the subtalar joint?
|
10º
|
|
how much inversion is normal in an open kinetic chain at the subtalar joint?
|
20º
|
|
in a closed kinetic chain, what three motions are occurring at the ankle in pronation?
|
(1) plantarflexion
(2) adduction of the talus (3) eversion of the calcaneus |
|
in a closed kinetic chain, what three motions are occurring at the ankle in supination?
|
(1) dorsiflexion
(2) abduction of the talus (3) inversion of the calcaneus |
|
this position is the relationship between the rearfoot (calcaneus) to the lower leg (tibia-fibula); is used as a frame of reference to identify pronation and supination
|
subtalar joint neutral position
|
|
if the subtalar joint neutral is a positive number, is the ankle varus/inverted or valgus/everted?
|
varus/inverted
|
|
if the subtalar joint neutral is a negative number, is the ankle varus/inverted or valgus/everted?
|
valgus/everted
|
|
this position is the position of the forefoot in relation to the rearfoot with the subtalar joint in neutral in the frontal plane (calcaneus to forefoot)
|
forefoot to rearfoot position
|
|
the function of these joints is the pronatory twist of the first ray with rear foot supination (to compensate for motion at the rearfoot)
|
tarsometatarsal joints
|
|
what type of joint is the metatarsophalangeal joint considered?
|
condyloid
|
|
what shapes are the metatarsal and phalanx in the MTP joint?
|
convex metatarsal and concave phalanx
|
|
how many degrees of extension does the first MTP joint need for walking?
|
60º
|
|
what is another name for a foot that is excessively pronated with a low arch, calcaneal eversion, medial bulge, and forefoot abducted?
|
pes planus
|
|
what is another name for a foot that is excessively supinated with a high arch, calcaneal inversion, lateral bulge, and forefoot adduction?
|
pes cavus
|
|
what are four characteristics of an excessively pronated foot?
|
(1) low arch
(2) calcaneal eversion (3) medial bulge (4) forefoot abducted |
|
what are four characteristics of an excessively supinated foot?
|
(1) high arch
(2) calcaneal inversion (3) lateral bulge (4) forefoot adducted |
|
what is one cycle of gait comprised of?
|
2 steps and 1 stride
|
|
in gait, this is considered the distance from the heel strike on one foot to the heel strike on the other
|
step
|
|
in one gait cycle, what percentage is the stance phase?
|
60%
|
|
in one gait cycle, what percentage is the swing phase?
|
40%
|
|
what is the stride frequency in gait?
|
1 stride per second
|
|
this is the number of steps someone takes per minute
|
cadence
|
|
what is the normal cadence of gait?
|
110 steps per minute
|
|
what two bones make up the hindfoot?
|
talus and calcaneus
|
|
what bones make up the midfoot?
|
tarsals
|
|
what bones make up the forefoot?
|
metatarsals and phalanges
|
|
what three ligaments provide stability to the longitudinal arches of the foot?
|
(1) short plantar ligament
(2) long plantar ligament (3) spring ligament |
|
this effect is important at the end of the gait cycle; the toes extend, pulling on the plantar aponeurosis and making the foot rigid, giving it a better ability to push off
|
windlass effect
|
|
at what point in stance, early or late, is pronation seen?
|
early
|
|
at what point in stance, early or late, is supination seen?
|
late
|
|
any muscle that inserts anterior to the talocrural joint axis and acts concentrically does what motion?
|
dorsiflexion
|
|
any muscle that inserts posterior to the talocrural joint axis and acts concentrically does what motion?
|
plantarflexion
|
|
any muscle that inserts anterior to the talocrural joint axis and acts eccentrically CONTROLS what motion?
|
controls plantarflexion
|
|
any muscle that inserts posterior to the talocrural joint axis and acts eccentrically CONTROLS what motion?
|
controls dorsiflexion
|
|
anything that inserts medial to the subtalar joint axis and acts concentrically does what motion?
|
inversion (supination)
|
|
anything that inserts lateral to the subtalar joint axis and acts concentrically does what motion?
|
eversion (pronation)
|
|
anything that inserts medial to the subtalar joint axis and acts eccentrically CONTROLS what motion?
|
pronation
|
|
anything that inserts lateral to the subtalar joint axis and acts eccentrically CONTROLS what motion?
|
supination
|
|
since the anterior tibialis inserts anterior to the talucrural joint and medial to the subtalar joint, what two motions does it do?
|
dorsiflexion and inversion
|
|
since the extensor digitorum longus inserts anterior to the talocrural joint, what motion does it do?
|
straight up dorsiflexion
|
|
since the extensor hallucis longus inserts anterior to the talocrural joint, what motion does it do?
|
dorsiflexion+great toe extension
|
|
since the gastrocnemius inserts posterior to the talocrural joint, what motion does it do?
|
plantarflexion
|
|
since the tibialis posterior, flexor digitorum and flexor hallucis longus tendons insert medial to the subtalar joint and posterior to the talocrural joint, what two motions do they do?
|
plantarflexion and inversion
|
|
since the fibularis longus and brevis insert posterior to the talocrural joint and lateral to the subtalar joint, what two motions do they do?
|
plantarflexion and eversion
|
|
people who are overly pronated lose the stabilization of what muscle of the first ray during walking?
|
fibularis longus
|
|
a loss of the intrinsic muscles of the foot causes what type of deformity?
|
hammer toe
|
|
this is when the forefoot is inverted in relationship to the rearfoot with the subtalar joint in neutral position
|
forefoot varus
|
|
this is when there is less than 10 degrees of dorsiflexion range of motion at the ankle
|
talocrural equinus
|
|
this is when the rearfoot is inverted in relationship to the lower leg with the subtalar joint in the neutral position
|
rearfoot varus
|
|
what are three intrinsic factors that could contribute to someone having a pronated foot?
|
(1) forefoot varus
(2) talocrural equinus (3) rearfoot varus |
|
what are the four extrinsic factors that could contribute to someone having a pronated foot?
|
(1) pathological hip rotation (hip anteversion)
(2) tibial varum (3) tibial torsion (4) leg length discrepancies |
|
what are four intrinsic factors that could contribute to someone having a supinated foot?
|
(1) forefoot valgus
(2) plantar flexed first ray (3) rigid rearfoot varus (4) forefoot varus |
|
this is when the forefoot is everted in relationship to the rearfoot with the subtalar joint in the neutral position
|
forefoot valgus
|
|
this is when someone lacks adequate pronation/eversion at the subtalar joint and it is uncompensated
|
rigid rearfoot varus, forefoot varus
|
|
in the center of progression line of a pronated foot, is everything pushed more medially or laterally?
|
medially
|
|
in the center of progression line of a supinated foot, is everything pushed more medially or laterally?
|
laterally
|
|
what are four extrinsic factors that could cause someone to have a supinated foot?
|
(1) pathological hip rotation
(2) tibial varum (3) tibial torsion (4) leg length discrepancies |
|
this position occurs when the subtalar joint is in neutral and the rearfoot is in a position of inversion compared to the tibia
|
rearfoot varus
|
|
this position occurs when the subtalar joint is in neutral and the rearfoot is in a position of eversion compared to the tibia
|
rearfoot valgus
|
|
this position occurs when the subtalar joint is neutral and the forefoot is in a position of inversion compared to the calcaneus (regardless of the position of the rearfoot)
|
forefoot varus
|
|
this position occurs when the subtalar joint is in neutral and the forefoot is in a position of eversion compared to the calcaneus (regardless of the position of the rearfoot)
|
forefoot valgus
|
|
this is the largest joint in the skeletal system
|
knee
|
|
what are the two joints of the knee?
|
patellofemoral and tibiofemoral joints
|
|
what are the four functions of the knee?
|
(1) shortens limb through the swing phase
(2) provides shock absorption (3) transmits forces through the lower extremity (4) affords large ranges of motion |
|
this is the branch of mechanics that describes the motion of a body without regard to the forces or torques that may produce the motion
|
kinematics
|
|
when there is a convex on a concave body, are the roll and slide the same or in opposite directions?
|
opposite
|
|
when there is a concave on convex body, are the roll and slide the same or in opposite directions?
|
same
|
|
this is the axis about which a body rotates at a given instant
|
instant center/axis of rotation
|
|
this is the path of serial locations of the instant center of rotation; aka evolute
|
path of instant center of rotation (PICR)
|
|
if the knee is moved about a posteriorly displaced ICR, what occurs to the joint?
|
distraction
|
|
if the knee is moved about an anteriorly displaced ICR, what occurs at the joint?
|
compression
|
|
at the knee, this is considered when the distal segment is free to move and the proximal end is fixed
|
open kinetic chain
|
|
at the knee, this is considered when the distal segment is fixed and the proximal segment moves
|
closed kinetic chain
|
|
these are internal reaction forces acting at the contact surfaces when a joint is subjected to external loads
|
joint reaction forces
|
|
at the tibiofemoral joint, what two structures sustain the joint reaction forces?
|
(1) menisci
(2) articular cartilage |
|
at the tibiofemoral joint, the menisci take what percentage of total body weight?
|
about 50%
|
|
at the patellofemoral joint, what two structures sustain the joint reaction forces?
|
(1) articular cartilage
(2) patellar ligament/tendon |
|
what type of joint is the tibiofemoral joint classified as?
|
double condyloid joint
|
|
how many degrees of freedom of movement are allowed at the tibiofemoral joint?
|
2
|
|
what plane does flexion and extension of the knee occur in?
|
sagittal
|
|
what plane does rotation of the knee occur in?
|
transverse
|
|
in the tibiofemoral joint, what surface is convex and what is concave?
|
convex femoral condyles resting on concave menisci on the tibia
|
|
in the frontal plane, the knee is aligned in what type of angle?
|
physiologic valgus
|
|
what is the range of normal physiologic valgus at the knee in adults?
|
165-170º
|
|
this is another name for the hyperextension at the knee that is often common in young children but should disappear by adolescence
|
genu recurvatum
|
|
in the sagittal plane at the knee, what two bones align vertically?
|
tibia and femur
|
|
in the transverse plane at the knee, what structures are aligned?
|
femoral and tibial condyles
|
|
this is the position of maximal joint surface congruity at the knee joint, and is often the position where the majority of joint structures are under maximum tension
|
close packed position
|
|
in the close packed position, how many degrees of flexion/extension can occur?
|
0º
|
|
this is the position of maximal joint laxity at the knee joint, and is the position at which the joint is under the least amount of stress; is also often the position of comfort after injury
|
resting/loose packed
|
|
how much flexion is allowed at the knee joint in the loose packed position?
|
25º
|
|
this mechanism of the knee occurs during the last 30º of extension, and is a mechanical event that occurs both passively and actively; in open chain, the tibia laterally rotates on the femur, and in closed chain the femur medially rotates on the tibia
|
screw home mechanism
|
|
in the screw home mechanism, if the tibia is extending on the femur in an open chain fashion, what motion does the tibia do in order to fully extend?
|
lateral rotation
|
|
in the screw home mechanism, if the femur is extending on the tibia in a closed chain fashion, what motion does the femur do in order to fully extend?
|
medial rotation
|
|
what two things does the screw home mechanism allow the knee to do?
|
(1) permits humans to stand erect without quad muscle contraction
(2) knee can withstand anterior/posterior forces on the extended knee with reduced muscle force |
|
what are three possible factors that contribute to the screw home mechanism?
|
(1) stretch of the ACL
(2) pull of the quadriceps (3) medial condyle curves inwardly |
|
what muscle is responsible for unlocking the knee?
|
popliteus
|
|
what ligaments provide anterior/posterior stability of the knee joint?
|
(1) cruciates (ACL, PCL)
(2) posterior joint capsule (3) collaterals [secondary] (LCL, MCL) |
|
what four muscles provide anterior/posterior stability to the knee joint?
|
(1) quadriceps
(2) hamstrings (3) gastrocnemius (4) popliteus |
|
which ligament of the knee prevents excessive anterior displacement of the tibia on the femur?
|
anterior cruciate ligament (ACL)
|
|
which ligament of the knee prevents excessive posterior displacement of the tibia on the femur?
|
posterior cruciate ligament (PCL)
|
|
which ligaments provide medial/lateral stability of the knee joint?
|
(1) collaterals (MCL, LCL)
(2) joint capsule (3) cruciates [secondary] (ACL, PCL) |
|
what five muscles provide medial/lateral stability to the knee joint?
|
(1) IT band/TFL
(2) gracilis (3) biceps femoris (lateral) (4) semitendinosus (medial) (5) sartorius |
|
which ligament of the knee prevents excessive valgus displacement of the tibia on the femur?
|
MCL
|
|
which ligament of the knee prevents excessive varus displacement of the tibia on the femur?
|
LCL
|
|
at the knee joint, which arthrokinematic movement occurs more often, roll or glide?
|
roll
|
|
what is the typical range of movement of PASSIVE flexion/extension at the knee for an adult up to age 74 years?
|
+5º-->0º-->155º
|
|
what is the typical range of movement of ACTIVE flexion/extension at the knee joint for an adult up to age 74?
|
0-140º
|
|
when the tibia is moving on a fixed femur during knee flexion, in what directions are the roll and glide?
|
posterior roll, posterior glide
|
|
when the tibia is moving on a fixed femur during knee flexion,in what direction do the menisci move?
|
posteriorly (pulled by the semimembranosus and popliteus)
|
|
when the tibia is moving on a fixed femur during knee extension, in what directions are the roll and glide?
|
anterior roll, anterior glide
|
|
when the tibia is moving on a fixed femur during knee extension, in what direction do the menisci move?
|
anteriorly (pulled by the quads)
|
|
in open chain knee flexion, which muscle internally rotates the tibia or externally rotates the femur to unlock the knee?
|
popliteus
|
|
in open chain knee extension, what motion does the tibia do in the last 30º?
|
external rotation
|
|
when the femur is moving on a fixed tibia in knee extension (such as a sit to stand transfer), in what directions are the roll and glide?
|
anterior roll, posterior glide
|
|
when the femur is moving on a fixed tibia in knee extension (such as a sit to stand transfer), in what direction do the menisci move?
|
anterior
|
|
when the femur is moving on a fixed tibia in knee flexion (such as a stand to sit transfer), in what directions are the roll and glide?
|
posterior roll, anterior glide
|
|
when the femur is moving on a fixed tibia in knee flexion (such as a stand to sit transfer), in what direction do the menisci move?
|
posterior
|
|
when the femur is moving on a fixed tibia in knee extension, what motion does the femur do in the last 30º of extension?
|
internal rotation
|
|
when the femur is moving on a fixed tibia in knee flexion, what muscle externally rotates the femur to unlock the knee?
|
popliteus
|
|
in what plane does internal and external rotation of the knee occur?
|
transverse plane
|
|
with the knee flexed to 90º, when the tibia externally rotates, in what direction does the lateral tibial condyle move?
|
posterior
|
|
with the knee flexed to 90º, when the tibia externally rotates, in what direction does the medial tibial condyle move?
|
anterior
|
|
with the knee flexed to 90º, when the tibia externally rotates, in what direction does the lateral meniscus move?
|
anterior
|
|
with the knee flexed to 90º, when the tibia externally rotates, in what direction does the medial meniscus move?
|
posterior
|
|
what ligaments are taut when the tibia externally rotates on the femur?
|
MCL, possibly LCL
|
|
with the knee flexed to 90º, when the tibia internally rotates, in what direction does the lateral tibial condyle move?
|
anterior
|
|
with the knee flexed to 90º, when the tibia internally rotates, in what direction does the medial tibial condyle move?
|
posterior
|
|
with the knee flexed to 90º, when the tibia internally rotates, in what direction does the lateral meniscus move?
|
posterior
|
|
with the knee flexed to 90º, when the tibia internally rotates, in what direction does the medial meniscus move?
|
anterior
|
|
what ligaments are taut when the tibia internally rotates on the femur?
|
LCL, possible ACL/PCL
|
|
with the knee in a fully extended position, how many degrees of rotation are available?
|
0º
|
|
how many degrees of external rotation occurs during end range knee extension?
|
10º
|
|
abduction and adduction of the knee joint occur in what plane?
|
frontal
|
|
what type of joint is the patellofemoral joint classified as?
|
saddle/sellar
|
|
in the patellofemoral joint, which surface is concave and which is convex?
|
concave patella articulating with convex intercondylar groove
|
|
what is excessive deviation of the patella to the medial side called?
|
medial tracking
|
|
what is excessive deviation of the patella to the lateral side called?
|
lateral tracking
|
|
this index is a measure of the ratio between the patellar tendon length to the patellar height, and is measured at 60º of flexion
|
Insall-Salvati index
|
|
what is the normal index of values for the Insall-salvati index?
|
1.1-1.4
|
|
what is excessive deviation of the patella upward called?
|
patella alta
|
|
what is excessive deviation of the patella downward called?
|
patella baja
|
|
when the knee is extension, what direction does the patella slightly tilt in?
|
lateral
|
|
what are the two general functions of the patellofemoral joint?
|
(1) augmentation of knee extension leverage (displacing quad anteriorly, increasing moment arm of knee extensors)
(2) allows a wider distribution of compressive stresses on the femur by increasing the area of contact between the patellar tendon and femur |
|
this is the angle formed between a line connecting the ASIS to the midpoint of the patella and a line connecting the tibial tubercle and the midpoint of the patella; is NOT synonymous with physiologic valgus
|
Q angle
|
|
the line of the resultant force of the quadriceps muscle tends to pull the patella in what two directions relative to the patellar ligament?
|
superiorly and laterally
|
|
what is the normal Q angle for men and women when measured with the knee in extension?
|
Men: <10º
Women: <15º |
|
what is the range of Q angle that is considered abnormal?
|
15-20º
|
|
an enlarged Q angle creates excessive __ forces on the patella that may predispose the patella to pathologic changes
|
lateral
|
|
what are 7 things that can influence the Q angle?
|
(1) knee valgus (as it increases, Q angle increases)
(2) patellar medial or lateral deviation (3) tibial tubercle anomalies (4) femoral anteversion (5) genu recurvatum (6) pronation (7) external tibial torsion |
|
at approximately what degrees of flexion is considered the close packed position of the patellofemoral joint?
|
90º
|
|
what position is considered the loose packed position of the patellofemoral joint?
|
full extension of the tibiofemoral joint
|
|
during flexion from the extended position, the patella moves into what positions?
|
inferiorly, medially and then returns lateral
|
|
during extension from the flexed position, the patella moves into what positions?
|
superiorly, laterally and then returns medially
|
|
during flexion of the knee from 0-30º, the patella glides and tilts in what direction?
|
medially
|
|
during flexion of the knee greater than 30º, the patella glides, tilts, and rotates in what direction?
|
laterally
|
|
when the knee is extended, the patella becomes slightly displaced in what direction?
|
lateral
|
|
what are three things that can be caused when the patella fails to glide, rotate, or tilt appropriately?
|
(1) restriction in knee joint ROM
(2) instability of the patellofemoral joint (3) pain caused by the erosion of joint surfaces |
|
with increasing knee flexion, does the area of contact of the patella increase or decrease?
|
increase
|
|
with increasing knee flexion, does the area of contact of the patella shift distally or proximally?
|
proximally
|
|
in what position of knee flexion/extension does the patella rest above the intercondylar groove against the suprapatellar fat pad?
|
0º extension
|
|
in what position of knee flexion do the odd facet and lateral facet of the patella contact the femur?
|
135º
|
|
in what position of knee flexion does the patella sink into the intercondylar notch and the inferior facet articulate with the infrapatellar fat pad?
|
full knee flexion
|
|
what are the five factors that influence the joint reaction force on the patellofemoral joint?
|
(1) quadriceps muscle force
(2) size of contact area between patella and femur (3) external moment arm of the body segment (4) position of tibia (5) other tissues that dissipate force |
|
for patients with patellofemoral pain syndrome, what type of activities/what range of knee flexion do you want to avoid?
|
open chain activities with knee flexion angles 0-45º, closed chain activities with flexion angles 60-90º
|
|
with increased knee __, body weight shifts farther away from the center of rotation
|
flexion
|
|
in a squat (causing increased knee flexion and the body weight to shift farther away from the center of rotation), what are four consequences?
|
(1) increased external knee flexor moment
(2) increased internal knee extensor moment (3) increased patellofemoral JRF (4) increased patellofemoral joint stress |
|
in the sagittal plane, what are the four actions that occur during gait?
|
(1) heel contact (knee flexed slightly)
(2) knee reaches almost full extension (3) heel off, knee begins to flex again (4) knee then extends again to almost full knee extension just prior to heel strike |
|
at heel contact, how many degrees is the knee flexed?
|
5º
|
|
during heel contact, from an initial position of 5º of flexion, how much farther does the knee flex to before it begins to extend prior to heel off?
|
up to 10-15º
|
|
how much is the knee flexed at toe off during gait?
|
35º
|
|
how much is the knee maximally flexed to at mid-swing during gait?
|
60º
|
|
do children tend to walk in a more flexed or more extended pattern?
|
flexed
|
|
about how many degrees of tibial abduction/adduction occurs in the frontal plane during the gait cycle?
|
5º
|
|
approximately how much rotation occurs at the tibiofemoral joint in the horizontal plane during gait?
|
8-9º
|
|
what motion does the tibia do from heel strike until 20% of the gait cycle?
|
internal rotation
|
|
what motion does the tibia do from 20% of the gait cycle until toe off?
|
external rotation
|
|
what motion does the tibia do from toe off through the swing phase?
|
internal rotation
|
|
what are three deviations that the knee can do during the gait cycle?
|
(1) knee remaining extended (due to weak quads or arthritis)
(2) genu recurvatum (3) varus thrust (ligamentous laxity or general LE weakness) |
|
during running, how far does the knee flex during absorption of stance?
|
45º
|
|
the knee extends during stance to a max of how many degrees of flexion during running at propulsion?
|
25º
|
|
what is the maximum degrees of knee flexion during the swing phase of running?
|
90º
|
|
what is the maximum degrees of knee flexion during the swing phase of sprinting?
|
105º
|
|
the knee extends during stance to a max of how many degrees of flexion during sprinting at propulsion?
|
20º
|
|
during running, what muscle group contracts eccentrically to assist in shock absorption in the acceptance of stance phase?
|
quadriceps
|
|
during running, what muscle group decelerates the limb during the late swing phase?
|
hamstrings
|
|
this alignment of the knee is when the distal segment is toward the midline and the legs form an "O"
|
varum
|
|
is genu varus more commonly seen in males or females?
|
males
|
|
is genu valgus more commonly seen in males or females?
|
females
|
|
genu recurvatum is commonly seen in individuals with what type of posture?
|
swayback
|
|
tibial torsion is considered normal at what degree of external tibial torsion?
|
15º
|
|
tibial torsion is considered abnormal at what degree of external tibial torsion?
|
greater than 30º
|
|
what are three things that can cause osteoarthritis in the knee later in life?
|
(1) injury to the meniscus/ACL
(2) injury changes the PICR of the knee, leading to changes in joint surface contact (3) degenerative changes occurring from wear and tear to the joint over time |
|
this is the restriction unique to each joint that indicates irritation of the entire synovial membrane or joint capsule, as occurs ith an active inflammatory process or degenerative joint changes
|
capsular pattern/proportional limitation
|
|
a limitation of movement or a pattern of pain at a joint that occurs in a predictable pattern
|
capsular pattern/proportional limitation
|
|
limitations in motion at a joint that do not fall into predictable patterns
|
noncapsular patterns
|
|
what is the ratio of female to male incidence of patellofemoral joint dysfunction?
|
2:1
|
|
what are the three most common causes of patellofemoral joint dysfunction?
|
(1) internal rotation of the femur
(2) external rotation of the tibia (3) lateral tracking of the patella |
|
what are four muscle and soft tissue contributions to patellofemoral joint dysfunction?
|
(1) short ITB/TFL
(2) poor performance of hip lateral rotators (3) laxity of medial retinacular fibers (4) poor performance of vastus medialis oblique |
|
what are two bone characteristics that can cause patellofemoral joint dysfunction?
|
(1) shallow intercondylar groove
(2) abnormally sized patella (too small or large) |
|
what are five alignment contributions that could cause patellofemoral joint dysfunction?
|
(1) abnormal patellar positioning
(2) increased Q angle (3) increased genu valgum (4) excessive hip anteversion (5) excessive external tibial torsion |
|
during active sitting knee extension against resistance, which stabilizing structure of the knee is being stressed?
|
ACL resists excessive anterior glide of the tibia
|
|
if a patient had an injury to the ACL, which form of exercise to strengthen the quads could place too much stress on the injured tissue, tibial on femoral extension (Open chain) or femoral on tibial extension (closed chain)?
|
tibial on femoral extension-active quads produces an anterior shear on the tibia, straining the ACL
|
|
which form of exercise, tibial on femoral extension or femoral on tibial extension, might be considered safer for the knee joint if there was an ACL injury?
|
femoral on tibial extension, partial squat from 0-45º
|
|
what are two theories that could help explain why femoral on tibial extension from 0-45º could be safer for an injured ACL?
|
(1) co-contractions of quads and hamstrings decrease the chance for excessive anterior movement of the tibia on the femur
(2) in the weight-bearing position, compression assists in reducing translation between the tibia and femur |
|
what are two alignment faults at the hip that could contribute to excessive knee valgus when someone partially squats?
|
(1) hip medial rotation
(2) hip adduction |
|
what are three alignment faults at the knee that could contribute to excessive knee valgus when someone partially squats?
|
(1) valgus alignment
(2) tibial medial rotation (3) tibial lateral rotation (rotation is dependent on movement of the foot) |
|
what is the alignment fault at the ankle that could contribute to excessive knee valgus when someone partially squats?
|
pronation
|
|
what is the alignment fault at the great toe that could contribute to excessive knee valgus when someone partially squats?
|
hallux valgus
|
|
what are three structural faults that could easily be associated with the faulty movement of excessive valgus at the knee when someone partially squats?
|
(1) hip anteversion
(2) knee valgus alignment (3) tibial torsion |
|
what type of muscle contraction is the quad doing when someone ascends stairs?
|
concentric
|
|
what type of muscle contraction is the quad doing when someone is descending stairs?
|
eccentric
|
|
what type of muscle contraction is the quad doing when someone is performing a sit to stand transfer?
|
concentric
|
|
what type of muscle contraction is the quad doing when someone is performing a stand to sit transfer?
|
eccentric
|
|
what type of contraction is the gluteus maximus doing when someone is ascending stairs?
|
concentric
|
|
what type of contraction is the gluteus maximus doing when someone is descending stairs?
|
eccentric
|
|
what type of contraction is the gluteus maximus doing when someone is doing a sit to stand transfer?
|
concentric
|
|
what type of contraction is the gluteus maximus doing when someone is doing a stand to sit transfer?
|
eccentric
|
|
which hamstrings contribute to medial rotation of the tibia?
|
semimembranosus and semitendinosus
|
|
which hamstrings contribute to lateral rotation of the tibia?
|
biceps femoris
|
|
what are four structures that are stressed at end range knee flexion?
|
(1) patellofemoral joint-compression
(2) PCL-tension (3) ACL (some fibers)-tension (4) menisci-compression and shear |
|
what are five structures that are stressed with repetitive tibiofemoral rotation (tibial lateral rotation on the femur)?
|
(1) MCL
(2) menisci (3) articular cartilage of patella and femur (4) medial rotators of knee (5) possibly LCL but not in all cases |
|
what are 6 structures that are stressed in individuals that chronically hyperextend their knee?
|
(1) ACL
(2) posterior capsule (with arcuate and oblique popliteal ligs) (3) posterior musculature (4) MCL (5) LCL (6) some fibers of the PCL |
|
in what three directions is the acetabulum oriented?
|
(1) laterally
(2) inferiorly (3) anteriorly |
|
what are three functions of the acetabular labrum?
|
(1) aids in stability of the hip joint
(2) deepens acetabular socket (3) increases contact area with femur, decreases contact stress |
|
this angle is the extent to which the acetabulum covers the femoral head within the FRONTAL plane
|
center edge angle
|
|
what is the normal range of hip center edge angle in adults?
|
35-40º
|
|
if there is a decreased center edge angle, what type of instability will someone experience at their hip?
|
lateral instability
|
|
this angle is the extent to which the acetabulum surrounds the femoral head within the HORIZONTAL plane
|
acetabular anteversion angle
|
|
what is the normal acetabular anteversion angle in adults?
|
20º
|
|
if there is a decreased acetabular anteversion angle at the hip, what will someone experience anteriorly and posteriorly at the hip joint?
|
anteriorly-impingement
posteriorly-instability |
|
the lateral trabecular system of the femoral head is due to what type of stress?
|
muscle contraction
|
|
the medial trabecular system of the femoral head is due to what type of stress?
|
body weight/compression
|
|
this axis of the femur that is parallel to the shaft
|
anatomical axis
|
|
axis of the femur that runs from the center of the femoral head to the center of the femoral condyles
|
mechanical axis
|
|
what is the range of angle formed between the mechanical and anatomical axes of the femur?
|
10-15º
|
|
this is the angle within the FRONTAL plane between the femoral neck and the medial side of the femoral shaft
|
angle of inclination
|
|
what is the normal angle of inclination in a newborn?
|
140-150º
|
|
what is the normal angle of inclination in an adult?
|
125º
|
|
this angle is the relative rotation (twist) that exists between the shaft and the neck of the femur in the TRANSVERSE plane
|
angle of declination
|
|
what is the normal angle of declination range in an infant?
|
30-35º
|
|
what is the normal angle of declination range in an adult?
|
15-19º
|
|
what type of joint is the hip joint?
|
ball and socket
|
|
how many degrees of freedom are allowed at the hip joint?
|
3
|
|
what are four factors that contribute to hip joint stability?
|
(1) shape
(2) intracapsular pressure (suction resists distraction) (3) muscles (4) capsule and ligaments |
|
in what area is the capsule of the hip joint thickest?
|
anterosuperiorly
|
|
in what area is the capsule of the hip joint thinnest?
|
posteroinferiorly
|
|
this ligament of the hip joint primarily resists extension and assists in resisting medial rotation, and is located anteriorly
|
iliofemoral ligament
|
|
this ligament of the hip joint resists abduction and is located anteriorly
|
pubofemoral ligament
|
|
this ligament of the hip joint primarily resists medial rotation, and assists in resisting extension and is located posteriorly
|
ischiofemoral
|
|
what three positions is the hip in when it is considered "close packed"?
|
(1) full extension
(2) slight medial rotation (3) slight abduction |
|
this is the mid position of the hip joint
|
central position
|
|
what three positions is the hip in when it is in its central position?
|
(1) 90º flexion
(2) slight abduction (3) slight lateral rotation |
|
what three positions is the hip in when it is considered "loose packed"?
|
(1) 15º flexion
(2) 15º abduction (3) 15º lateral rotation |
|
what are three landmarks that are helpful for determining the hip's center of rotation?
|
(1) medial to the superior edge of the greater trochanter
(2) inferior to the middle 1/3 of the inguinal ligament (3) lateral and inferior to the body's center of mass |
|
this describes the motion of the body without regard to forces or torques that may produce motion
|
kinematics
|
|
this describes the motion of bones relative to the three cardinal planes of the body
|
osteokinematics
|
|
this describes the motion that occurs between articular surfaces of a joint
|
arthrokinematics
|
|
in arthrokinematics, when the surface is convex on concave, are the roll and slide the same or opposite?
|
opposite
|
|
in arthrokinematics, when the surface is concave on convex, are the roll and slide the same or opposite?
|
same
|
|
with the knee flexed, about how many degrees of hip flexion is normal?
|
120º
|
|
with the knee extended, about how many degrees of hip flexion is normal?
|
80º
|
|
what accessory motion is occurring at the hip joint when hip flexion is occurring?
|
spin
|
|
what are three limits to hip flexion with the knee flexed?
|
(1) gluteus maximus
(2) posteroinferior capsule (3) big abdomen or thigh |
|
what is the main limit to hip flexion with the knee extended?
|
hamstrings
|
|
what accessory motion is occurring at the hip joint when the hip is extending?
|
spin
|
|
what are four limits to hip extension with the knee extended?
|
(1) anterior capsule
(2) iliofemoral ligament (3) ischiofemoral ligament [to some degree] (4) iliopsoas |
|
how many degrees of abduction can the hip achieve?
|
40º
|
|
which directions are the roll and glide when the hip is abducting?
|
superior roll, inferior glide
|
|
what are the two limits to abduction of the hip?
|
(1) pubofemoral ligament
(2) adductor muscles |
|
how many degrees of adduction can the hip achieve?
|
25º
|
|
in what plane does abduction and adduction of the hip occur?
|
frontal
|
|
which directions are the roll and glide when the hip is adducting?
|
inferior roll, superior glide
|
|
what are the three limits of hip adduction?
|
(1) TFL/ITB (especially if short)
(2) short glut med and other abductors (3) stiff/short lateral capsule |
|
in what plane does medial and lateral rotation of the hip occur?
|
transverse
|
|
about how many degrees of medial rotation can the hip achieve?
|
30-35º
|
|
which directions are the roll and glide in hip medial rotation?
|
anterior roll, posterior glide
|
|
what are the four limits to hip medial rotation?
|
(1) posterior capsule
(2) ischiofemoral ligament (3) iliofemoral ligament [to some degree] (4) deep lateral rotators |
|
about how many degrees of lateral rotation can the hip achieve?
|
35º
|
|
which directions are the roll and glide in hip lateral rotation?
|
posterior roll, anterior glide
|
|
what is the limit to hip lateral rotation?
|
no TRUE limit, but depending on the leg position, the muscles that medially rotate the leg
|
|
this type of lumbopelvic rhythm occurs when the pelvis and lumbar spine rotate in the same direction, causing hip flexion
|
ipsidirectional
|
|
this type of lumbopelvic rhythm occurs when the pelvis rotates in one direction while the lumbar spine simultaneously rotates in the opposite direction, causing pelvic tilt
|
contradirectional
|
|
in anterior pelvic tilt, what position is the hip in?
|
flexion
|
|
in anterior pelvic tilt, what position is the lumbar spine in?
|
extension
|
|
in posterior pelvic tilt, what position is the hip in?
|
extension
|
|
in posterior pelvic tilt, what position is the lumbar spine in?
|
flexion
|
|
when the hip is abducting, is the spine convex or concave toward the side of the abducting hip?
|
convex
|
|
when the hip is adducting, is the spine convex or concave toward the side of the adducting hip?
|
concave
|
|
when the pelvis is rotating clockwise over the right LE, is the hip medially or laterally rotating?
|
medially
|
|
when the pelvis is rotating counterclockwise over the right LE, is the hip medially or laterally rotating?
|
laterally
|
|
when the hip is in full flexion, is the adductor longus a hip flexor or extensor?
|
extensor
|
|
when the hip is in full extension, is the adductor longus a hip flexor or extensor?
|
flexor
|
|
are more lateral rotators of the hip available with the hip fully flexed or extended?
|
extended
|
|
the moment arm for the medial rotators of the hip increases in what hip position?
|
flexion
|
|
does the moment arm for the lateral rotators of the hip increase or decrease in hip flexion?
|
decrease
|
|
the hip extended position favors which rotators of the hip?
|
lateral
|
|
the hip flexed position favors which rotators of the hip?
|
medial
|
|
do the hip medial and lateral rotators test stronger in the sitting or standing position?
|
sitting (hip flexed to 90º)
|
|
does a flexed or extended knee increase hamstring ability to generate hip extension force?
|
extended
|
|
does a flexed or extended knee increase the rectus femoris' ability to generate hip flexion force?
|
flexed
|
|
does the extension moment of the hip increase or decrease as the hip moves from 90º of hip flexion to 0º?
|
decreases
|
|
the abduction moment of the hip is __% less at 25º of abduction than at 0º of abduction, because the muscle is shortening and there is a greater overlap of actin and myosin
|
60%
|
|
at the hip, these are formed when two or more muscles simultaneously produce forces in different linear directions, although the torque acts in the same rotary direction
|
force couple
|
|
a force couple of what two muscle groups work to anteriorly tilt the pelvis?
|
back extensors and hip flexors
|
|
a force couple of what two muscle groups act to posteriorly tilt the pelvis?
|
abdominals and hip extensors
|
|
what two groups of muscles are short when someone is in a kyphosis-lordosis posture?
|
hip flexors and back extensors
|
|
what two groups of muscles are long when someone is in a kyphosis-lordosis posture?
|
abdominals and maybe hip extensors
|
|
what group of muscles is short when someone is in a swayback posture?
|
hamstrings
|
|
what two groups of muscles are long when a person is in a swayback posture?
|
hip flexors and back extensors
|
|
this describes the effect of forces on the body and how body weight and muscle contractions contribute to joint forces
|
kinetics
|
|
when a person is standing on both lower extremities, there is little muscle activity required and the forces are balanced; what is the total compressive force through each femoral head?
|
60 pounds
|
|
when a person is standing on one lower extremity, greater muscle activity is required and the compressive forces are imbalanced; what is the total compressive force on one hip joint?
|
450 pounds
|
|
what are three ways to decrease hip joint forces?
|
(1) decrease body weight
(2) altering the line of gravity (thereby changing muscle activity) (3) using an assistive device |
|
what is the general equation that describes the balance of muscle force and body weight at the hip?
|
GM (glut med) + D=body weight (BW) + D1
D=moment arm |
|
what are the three subphases of the stance phase of gait?
|
(1) initial contact
(2) midstance (3) terminal stance |
|
what percentage of the gait cycle is the stance phase?
|
60%
|
|
what percentage of the gait cycle is the swing phase?
|
40%
|
|
what percentage of the gait cycle is the initial contact?
|
10%
|
|
what percentage of the gait cycle is midstance?
|
40%
|
|
what percentage of the gait cycle is the terminal stance?
|
10%
|
|
during what part of the stance phase of gait cycle is loading occurring?
|
initial contact
|
|
during what part of the stance phase of gait cycle is unloading occurring?
|
terminal stance
|
|
during initial contact in gait, how much hip flexion is there?
|
30º
|
|
during terminal stance/push-off in gait, how much hip extension is there?
|
10-20º
|
|
during gait, how much abduction and adducting is allowed at the hip?
|
5º
|
|
during gait, how much internal and external rotation are allowed at the hip?
|
5-7º
|
|
this type of gait occurs when there are weak abductors and there is an opposite side hip drop
|
trendelenburg
|
|
this type of gait deviation occurs when there is a weak gluteus medius and the person compensates by shifting the trunk over the weak side to place the center of gravity over the hip joint
|
gluteus medius lurch
|
|
this gait deviation occurs when there is a weak gluteus maximus and the person compensates by shifting the trunk posteriorly to maintain hip extension
|
gluteus maximus lurch
|
|
generally speaking, there are increased ranges of motion and increased magnitudes of forces at the hip in running or walking?
|
running
|
|
in the sagittal plane, what are two parameters that are increased with increased speed during running?
|
(1) pelvic tilt
(2) maximal hip flexion |
|
when does maximal hip extension occur during running?
|
toe off
|
|
what motion does the hip do during running during the 2nd half of the swing phase to prepare for initial contact? (this gets the foot closer to the COG, causing the need for deceleration not to be so strong)
|
extension
|
|
what is the initial goal when coming from sit to stand?
|
positioning the center of gravity over the base of support
|
|
what two things does positioning the center of gravity over the base of support in sit to stand require?
|
(1) leaning trunk forward (hip and lumbar spine flexion)
(2) feet back (flex knees/dorsiflex ankles) |
|
when someone is coming from sit to stand, what movement is occurring at the hip, knee, and lumbar spine to get the person to standing?
|
extension
|
|
what two muscles are primarily used when someone is coming from sit to stand?
|
gluteus maximus and hamstrings
|
|
at the end of the motion of coming from sit to stand, what is the main movement that is occurring?
|
lumbar extension
|
|
when is the peak moment in the hips and the knees (most muscle activity) when coming from sit to stand?
|
at the beginning of rising
|
|
what are three causes of someone initiating sit to stand with excessive hip flexion?
|
(1) stiff ankles/short heel cords
(2) Long legs (3) weak quadriceps |
|
what are four remedies that can be used in someone that initiates with excessive hip flexion in coming from sit to stand?
|
(1) feet back but stay on balls of feet
(2) higher chair (3) scoot farther forward (4) use armrests |
|
what are two things that can cause someone to scoot forward in their chair with excessive lumbar flexion or rotation when coming from sit to stand?
|
(1) stiff hips
(2) habit |
|
what are four remedies that can be used in someone that uses excessive lumbar flexion or rotation when coming from sit to stand?
|
(1) scoot to edge and straddle feet
(2) practice (3) higher chair (4) arm rests |
|
what are three causes of someone straightening with hip adduction and medial rotation when coming from sit to stand?
|
(1) habit
(2) weak quadriceps (3) weak abductors/lateral rotators |
|
what is a remedy for someone that comes up with excessive adduction and medial rotation when coming from sit to stand?
|
teaching them to get up with their knees over their feet (practice optimal alignment)
|
|
what are two causes of someone coming up with excessive lumbar extension in coming from sit to stand?
|
(1) habit
(2) weak gluteals/quadriceps |
|
what are two remedies that can be used in someone who straightens with excessive lumbar extension when coming up from sit to stand?
|
(1) strengthen weak gluteals and quadriceps
(2) extend more at hips and knees instead of their back |
|
what type of lumbopelvic rhythm is seen in normal forward bending?
|
ipsidirectional
|
|
what is the first thing that occurs when someone is preparing to forward bend?
|
hips shift backwards (preparing to move COG forward)
|
|
what is the final range of motion of the hips at the end of a forward bend?
|
70-80º
|
|
what is the final range of motion of the lumbar spine at the end of a forward bend?
|
0-20º
|
|
if someone seems to have a left iliac crest higher than the right when the feet are together but the iliac crests are level when the feet come apart, what could be the cause?
|
the right hip abductors are stiffer than the left hip abductors (when the feet come apart, the right abductors are stretched)
|
|
are you able to correct a structural fault?
|
NO, you need to compensate/modify activities, can't fix the structural fault
|
|
what is the normal angle of inclination in adults?
|
about 125º
|
|
what plane of motion is the angle of inclination in?
|
frontal
|
|
this abnormality is a decreased angle of inclination
|
coxa vara
|
|
in coxa vara, in what two directions does the weight bearing surface of the femur move?
|
superiorly and laterally
|
|
what are two positive biomechanical effects that can occur as a result of coxa vara?
|
(1) increased moment arm for the gluteus medius (decreased muscle force, therefore decreased JRFs)
(2) joint stability may be improved |
|
what are three negative biomechanical effects that can occur as a result of coxa vara?
|
(1) increasing bending moment arm, causing increased shear force across the femoral neck
(2) decreased functional length of hip abductors (3) decreased axial forces through the shaft of the femur (shaft farther away from the head) |
|
what are three things seen in a clinical examination of someone with coxa vara?
|
(1) leg length short (if unilateral)
(2) prominence of greater trochanter (typically in women with a wider pelvis) (3) restricted hip abduction |
|
what are three possible treatments for someone with coxa vara?
|
(1) lift in involved side
(2) support between knees or under waist while in sidelying (3) correct for excessive hip adduction |
|
this structural deformity is an increased angle of inclination
|
coxa valga
|
|
in coxa valga, which way does the weight bearing surface of the femur shift?
|
medially
|
|
what are three positive biomechanical effects that occur as a result of coxa valga?
|
(1) decreased bending moment arm, decreased shear across femoral neck
(2) increased functional length of hip abductor muscles (3) increased axial forces through head of femur |
|
what are two negative biomechanical effects that occur as a result of coxa valga?
|
(1) decreased moment arm for gluteus medius (causing it to work harder, increasing the JRFs)
(2) alightnment may favor dislocation |
|
what are two signs that show up in an examination of someone with coxa valga?
|
(1) leg length (long)
(2) narrow look |
|
what are two treatments for someone that exhibits coxa valga?
|
(1) leg lift on uninvolved side
(2) strengthen hip abductors |
|
this structural deformity is considered excessive femoral rotation in the medial direction
|
femoral anteversion
|
|
a hip is considered anteverted if the angle of declination is greater than what degree?
|
>19º
|
|
what type of sitting is comfortable for someone that is femorally anteverted?
|
W-sitting
|
|
if a person is femorally anteverted, what type of hip rotation will be excessive and what will be limited?
|
excessive medial/internal rotation, limited lateral/external rotation
|
|
this structural fault is when someone has a decreased angle of declination
|
femoral retroversion
|
|
what movement of the hip does someone who is femorally retroverted appear to have excessive amounts of?
|
lateral rotation (in prone)
|
|
what is the angle of declination below which someone is considered to have femoral retroversion?
|
less than 14º
|
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what are four possible accessory joint movement impairments at the hip?
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(1) anterior glide (may have anterior hip pain)
(2) posterior glide (may have posterior hip pain) (3) anterior or posterior glide with medial rotation (4) compression (may have deep hip pain/ache) |
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which muscles have better control over precise hip motion, the ones that insert more proximally or distally?
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proximally
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what are two possible contributing factors to anterior hip joint forces?
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(1) structure-less coverage from the acetabulum
(2) labrum is thinner on the anterior aspect |
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what three positions is someone in when they have a swayback posture?
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(1) posterior pelvic tilt
(2) hip joint extension (3) knee hyperextension |
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what is someone with a swayback posture set up for as far as hip injuries go?
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a labral tear
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