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140 Cards in this Set
- Front
- Back
Functions of the spine
6 |
Protects spinal chord
provides proximal stability for distal mobility (stable trunk so you can move limbs) allows movement in all directions supports a lot of weight/lifting (e.g. head) provides sites for muscle/ligament attachment acts as a shock absorber |
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How many bones in the spine?
what regions? |
33
7 cervical 12 thoracic 5 lumbar 5 sacral 4 coccygeal (about 5% of people have 8 cervical or 6 lumbar |
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All ribs attach to...
how many of each kind are there |
the thoracic vertebrae
7 true ribs attaching to sternum 5 "false" - 3 vertebrochondral (costal cartilage) and 2 vertebral (floating) |
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A lordotic curve can be found in which regions?
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cervical and lumbar (overemphasized)
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What type of excessive curve tends to occur in the thoracic region
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Kyphotic
|
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Which region of the spine is most mobile?
which articulation |
cervical
between atlas and axis provides most rotation, atlantoaxial |
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What restricts movement in the thoracic region?
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Connection to ribs (which move as rings/units), orientations of facets, and long spinous processes
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The lumbar region has a large range of motion in...
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flexion and extension
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Intervertebral joint is a motion segment with __ joints working together
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2
anterior has interbody joint (intervertebral disc) posterior has apophyseal/zygoappophyseal (intervertebral joint) |
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these structures allow motion, restrict excess motion, and are most resistant to compression
what other properties do they have? |
Vertebral disks
aneural (no neural inervation) avascular viscoelastic |
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What is the central part of a disk?
outer? |
nucleus pulposus (squishy...)
annulus fibrosus (collagen fibers with different perpendicular rotations) |
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When is a disk most susceptible to injury?
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when rotating quickly from one direction to the other (change in tension forces of annulus fibrosus)
Combination of shear force, compression, and flexion |
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In what plane is the lumbar region most limited? Why?
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Transverse, orientation of facets
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Functions of cervical region of spine
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supports skull, shock absorber for brain, protects brainstem and spinal chord
facilitates transfer of weight, provides attachment for muscles and ligaments orient head to receive sensory information from the environment through sight and hearing |
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Passive and active stability of spine provided by
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ligaments, boney congruence, intervertebral discs, joint capsules
muscles and tendons such as multifidus, simispinalis capitus, longis capitus, longis colli (some designed for stability more than prime moving) |
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Anterior longitudinal ligament limits
o/i |
extension (hyperextension)
and forward sliding of vertebrae sacrum; anterior vertebral body and disc to above anterior body and disc; atlas |
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Posterior longitudinal ligament limits?
o/i what else does? |
flexion and lateral flexion
posterior verteral body and disc to posterior body and disc of next vertebra |
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Iliocostalis Cervicis
Origin/insertion Action |
o: angles of 3rd-6th ribs
i: transverse processes of C4-C6 a: bilaterally extends cervical vertebrae, uni - laterally flexes vertebrae and rotates to same side |
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Iliocostalis thoracis
Origin/insertion Action |
Origin: Lower 6 ribs (angles of ribs 7-12, medial to insertion of lumborum)
insertion: ribs 1-6, transverse process of C7 Action: extends vertebral column one - laterally flexes, rotation to same side |
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Iliocostalis Lumborum
Origin/insertion Action |
Origin: medial and lateral sacral crests, spinous processes of L1-L5, T11, T12, iliac crest
insertion: lower 6th or 7th ribs (angle of ribs 6 or 7-12) Action: extension of lower vertebral column alone- lateral flexion and rotation to same side |
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Sternocleidomastoid
Origin Insertion Action |
Origin: sternum and clavicle
Insertion mastoid process Action: Flexes neck, hyperextends head alone- laterally flexes neck, rotates to opposite side |
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Longus Capitis
Origin: Insertion: Action: |
Origin:transverse processes of cervical vertebrae C3-C6
Insertion: occipital bone Action: flexes head, ipsilateral rotation |
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Longus cervicis and longus colli
Origin: Insertion: Action: |
Origin: transverse processes and bodies of lower cervical and upper thoracic vertebrae
Insertion: transverse processes and bodies of upper cervical vertebrae Action: cervical flexion, ipsilateral rotation, lateral flexion |
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Scalenes (anterior, middle, posterior)
Origin: Insertion: Action: |
Origin: transverse processes of cervical vertebrae
Insertion: ribs 1 and 2 Action: cervical flexion contralateral rotation, lateral flexion |
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supraspinous ligament limits
o/i |
flexion and resists forward shear force on spine
spinous process to spinous process of next vertebra |
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Ligamentum flavum limits
o/a |
limits flexion, assists extension, maintains constant tension on disc,
laminae to laminae |
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Interspinous ligament limits
origin insertion |
flexion, shear forces acting on vertebrae
spinous process to transverse process |
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Splenius capitus
Origin: Insertion: Action: |
Origin: Ligamentum nuchae; spinous process of C7, T1-T3
Insertion: Mastoid process, occipital bone Action: head extension, lateral flextion, ipsilateral rotation |
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Splenius cervicis
Origin: Insertion: Action: |
Origin: spinous process of T3-T6
Insertion: Transverse process of C1-C3 Action: neck extension, lateral flexion, ipsilateral rotation |
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Semispinalis capitus
Origin: Insertion: Action: |
Origin: C4-C6 facets; transverse process of C7
Insertion: base of occipital flexion Action: cervical extension, lateral flexion, contralateral rotation |
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Semispinalis cervicis
Origin: Insertion: Action: |
Origin: Transverse process of T1-T6
Insertion: Spinous process of C1-C5 Action: cervical extension, lateral felxion, contralateral rotation |
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Semispinalis ThoracisOrigin:
Insertion: Action: |
Origin: Transverse processes of T6-T10,
Insertion: spinous processes of T1-T4, C6, C7 Action: extension, lateral flexion, contralateral rotation |
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Longissiumus capitis
Origin: Insertion: Action: |
Origin: Transverse process of T1-T5, C4-C7
Insertion: mastoid process Action: head extension, head lateral flexion, ipsilateral rotation |
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Longisimus cervices
Origin: Insertion: Action: |
Origin: Transverse process of T1-T5,
Insertion: transverse process of C4-C6 Action: extension, lateral flexion, ipsilateral rotation |
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Longisimus thoracis
Origin: Insertion: Action: |
Origin: Posterior transverse process of L1-:L5; thoracolumbar fascia
Insertion: transverse process of T1-T12 Action: extension, lateral flexion, ipsilateral rotation (fibers angle out) |
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Erector Spinae Group basic muscles and actions
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lateral layer - iliocostalis (lumborus, thoracis, cervices)
Middle layer - longissimus (capitus, cervicis, thoracis) Medial layer - spinalis (thoracis, cervicis) extension, lateral flexion, rotation (ipsilateral for all except semispinalis) |
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Spinalis cervicis
Origin: Insertion: Action: |
Origin: spinous process of c7
Insertion: spinous process of axis Action: extension, lateral flexion |
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Spinalis thoracis
Origin: Insertion: Action: |
Origin: Spinous processes of L1-L2, T11-T12
Insertion: spinous processes of T1-T8, ligamentum nuchae Action: extension, lateral flexion, ipsilateral rotation |
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Deep Posterior Group
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Intertransversarii
interspinales rotatores multifidus rotation is contralateral when at all |
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Deep Posterior Group: Intertransversarii
Origin: Insertion: Action: |
Origin: transverse process
Insertion: transverse process Action: extension, lateral flexion (not rotation) |
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Deep Posterior Group
Interspinales: Origin: Insertion: Action: |
Origin: spinous process
Insertion:spinous process Action: extension, hyperextension, lateral flexion (according to book) |
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Rotatores
Origin: Insertion: Action: |
Origin:Transverse process
Insertion: laminae of next vertebrae Action: extension, contralateral rotation (lateral flexion according to book) crosses 1-2 intervertebral junctions |
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Deep posterior group: multifidus
Origin: Insertion: Action: |
Origin: Sacrum; iliac spine; transverse processes L5-C4
Insertion: Spinous process of next vertebral side Action: extension, lateral flexion, contralateral rotation Crosses 2-4 intervertebral junctions |
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Trunk Rotators - External Oblique
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From 5th-12th ribs to linea alba, pubic tubercle, anterior iliac crest
Contralateral rotation, lateral flexion to same side, flexion |
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Trunk Rotators - Internal Oblique
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From Lumbar fascia, iliac crest
To last 3 or 4 ribs and ab aponeurosis to linea alba Ipsilateral Rotation, ipsilateral lateral flexion, flexion |
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Trunk Flexors - Rectus Abdominus
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From pubic crest and symphysis to costal cartilage of 5th-7th ribs and xiphoid process
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Trunk Flexors are
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Rectus abdominus
External and internal obliques Illiacus Psoas Major and Minor |
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Trunk Flexors - Iliacus
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– FROM: Inner surface
of ilium and sacrum – TO: lesser trochanter of femur Trunk flexion, thigh flexion |
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Trunk Flexors - Psoas (major and minor):
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– FROM: bodies and transverse processes of lower
thoracic and lumbar vertebrae, and inner surface of ilium and sacrum – TO: lesser trochanter of femur flexion, thigh flexion |
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Trunk lateral flexors - Quadratus Lumborum
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From: iliac crest, transverse processes of lumbar vertebrae
To: transverse processes of lumbar vertabrae and 12th rib Lateral flexion of trunk, or pelvic lateral tilt |
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Functional significance of muscles of respiration
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physiological demand of activity is always going to win. i.e. breathing!
Performance and/or rehabilitation can be greatly enhanced by training respiratory muscles |
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Respiratory muscles - thoracic diaphragm
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• From: xiphoid process
and posterior side of lower six ribs, interdigitating with transverse abdominis • To: lumbarcostal arches (anterior vertebral bodies) ON inhale, central tendon pulls down, creating a pressure gradient, relaxes for exhalation |
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List muscles of respiration
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Thoracic Diaphragm (inhalation)
External intercostal muscles (inhalation) Internal intercostal muscles (forced exhalation) Assist: Scalene (inhalation) Assist: Sternocledomastoid (inhalation) Assist: Pectoralis minor (in) Assist(?): abdominals (forced exhalation) |
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Which muscles are involved in accessory muscle breathing?
What does this breathing pattern impact? |
Trapezius
Sternocleidomastoid Scalenes (also Pectoralis minor) It decreases a person's ability to move his/her head because those muscles are being used for breathing, not movement. |
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Highest loads on the spine are experienced during:
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(starting with highest load)
lifting with trunk flexed lifting with trunk extended standing while carrying load standing with trunk flexed (stooped posture) Seated with trunk flexed (stooped) |
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Disk degeneration
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happens with age
loss of height and loosening of ligaments disc protrusion disc degeneration and osteophyte formation (calcium buildup) See what book says |
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Most common mechanism of disc injury
what happens |
flexion + compression + rotation
Disturb annular fibers, middle bulges (usually posterior and lateral) levels are bulge, herniation, expulsion |
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Spondylolysis
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Repetitive quickly loaded hyperextension creates fatigue fracture of pars articularis (posterior neural arch - lamina)
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Spondylolithesis
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Repetitive quickly loaded hyperextension causes fatigue fracture of BOTH pars articulais (posterior neural arch), displaced vertebral body to anterior side (not held in place in back)
|
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Scoliosis
80-90% is |
right thoracic rotation (R rib hump)
impacts movement patterns and breathing function - diaphragm and organs, left abdominal wall less active than right |
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Sex differences in the sacroiliac joint
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males have thicker/stronger sacroiliac ligaments
Center of mass more posterior in females, less stable joint (not creating strength through pressure) More mobility and higher injury rates in females |
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Pelvic movements in sagittal plane
frontal transverse |
Anterior and posterior tilt
R/L lateral tilt R/L rotation |
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What are pelvic movements for the swing phase of the right leg
|
right lateral tilt and left rotation
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Iliofemoral ligament
From...To... Limits |
Anterior inferior iliac spine TO intertrochanteric line of femur
Supports anterior hip; resists movements of extension, internal rotation, external rotation |
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Ischiofemoral ligament
From...to function - limits... |
Posterior acetabulm TO iliofemoral ligament
Resists adduction and internal rotation |
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Pubofemoral ligament
from...to limits |
Pubic part of acetabulum; superior rami TO intertrochanteric line
Resists abduction and external rotation |
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Sacrotuberous ligament
from...to limits |
Posterior ischium TO sacral tubercles, inferior margin of sacrum & upper coccyx
Prevents the lower part of the sacrum from tilting upward and backward under the weight of the rest of the vertebral column |
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What resists flexion of the thigh at the hip?
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No ligaments do!
Muscles do, depending on how much stretch their under, as well as fascia and bones touching |
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Angle of inclination of the femoral neck greater than 125 degrees in the frontal plane is called...
creates... |
Coxa valga
Less effective abductors (smaller moment arm) Longer limb |
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Angle of inclination of the femoral neck less than 125 degrees in the frontal plane is called...
creates... |
Coxa vara
More effective abductors (greater moment arm) Shorter limb |
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Internal femoral torsion is called
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anteversion
normal is 12-14 deg, ante is less(?) large angle of anteversion common in toddlers, decreases with growth, 2x as likely to persist in females (especially W sitters) |
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external femoral torsion is called
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retroversion
greater than normal of 12-14 degrees |
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Q angle is the angle between
Normal = increased by... |
Quadriceps femoris muscles and patellar tendon
Normal for males - 14degrees, Females- 17 degrees "knock-knees" = genu valgum Femoral anteversion External tibial torsion laterally positioned tibial tuberosity associated with knee injury |
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"downstream" effects of excessive coxa vara and anteversion
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increased Q-angle, patelar problems, mor pronation, increased lumbar curvature, hyperextension
|
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"downstream" effects of excessive coxa valga and retroversion
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Reduced Q-angle, more supination at the subtalar joint
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Strengths of biarticular (2-joint) muscles
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aid in transferring energy/power from proximal to distal segment (in jump, rectus femoris flexes hip and extends knee)
Extension at proximal joint helps maintain favorable contraction velocity at distal joint (length-tension) Optimizes storage/return of elastic energy (gastrocnemius is essentially in isometric contraction during some running/jumping movements) |
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Weaknesses of biarticular muscles
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active insufficiency - 2-joint muscle can not shorten enough to permit full ROM at both joints at the same time (too slack)
Passive insufficienty - the muscle cannot lengthen enough to permit full ROM at both joints at the same time (hamstrings) Body avoids those positions to prevent injury |
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Largest contributors to hip flexion are
others |
Iliacus, psoas major/minor, and rectus femoris
pectinius, sartorius, TFL |
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Hip flexors - iliacus
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Inner surface of ilium, sacrum TO lesser trochanter
Flexion and assists in lateral rotation |
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Hip flexors - Psoas
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Transverse processes, body of L1-L5, T12 TO lesser trochanter
Flexion and assists with lateral rotation |
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Hip Flexors - Rectus Femoris
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Anterior inferior iliac spine TO patella, tibial tuberosity
Flexion and assists abduction |
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Hip extensors - Semitendinosus
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Ischial tuberosity TO medial tibia (pes anserine)
Extension and assists medial rotation |
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Which of the hamstrings cross the hip joint?
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All but the short head of biceps femoris which goes to linea aspera
|
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Hip Extensors - Semimembranosus
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Ischial tuberocity TO medial condyle of tibia
Extension and assists medial rotation |
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Hip extensors - Biceps femoris
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Ischial tuberosity TO lateral condyle of tibia;head of fibula
Extension and assists lateral rotation |
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Role of hamstrings during stance and swing phases of gait
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stance - resist gravity's attempt to flex hip, propel body forward by extending thigh
swing- decelerate hip and knee extension |
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Role of gluteus maximus during gait
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Contralateral swing - resist anterior pelvic rotation (caused by rectus femoris)
|
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Gluteus Maximus
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Posterior ilium, sacrum, coccyx TO gluteal tuberosity, iliotibial band
Hip extensor, lateral rotation |
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Gluteus Medius
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Anterior, lateral ilium, TO lateral surface of greater trochanter
Abduction and medial rotation |
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Gluteus minimus
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Outer, lower illium TO front of greater trochanter
abduction and medial rotation |
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Trendelenburg gait
|
disfunctional abductors (glute med/min), intense lateral tilt - use cane on strong side to partially unweight it
|
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Hip adductors during gait
|
frontal plane control - resist pelvic tilt to swing side
work as a pair with contralateral abductors during swing phase, function also as hip flexors Primary role in stabilizing during stance phase |
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Gracilis
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Inferior rami of pubis TO medial tibia (pes anserine)
Adduction and assits medial rotation |
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Pectineus
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Pectinial line on pubis TO bellow lesser trochanter
flexion and adduction |
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Adductor Brevis
|
inferior rami of pubis TO upper half of posterior femur
Adduction |
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Adductor Longus
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Inferior rami of pubis TO middle third of posterior femur
Adduction, assist medial rotation |
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Adductor Magnus
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Anterior pubis, ischial tuberosity TO linea aspera on posterior femur, adductor tubercle
Adduction, assist in extension and medial rotation |
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External rotators of the hip
Prime movers assistants 6 deep hip rotators |
Prime Movers
• Gluteus maximus • Sartorius • 6 deep hip rotators • Assists – Biceps femoris – Psoas – Iliacus 6 Deep hip rotators • Piriformis • Superior gemellus • Inferior gemellus • Obturator externus • Obturator internus • Quadratus femoris |
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What happens in piriformis "syndrome"?
How can the piriformis be stretched? |
The sciatic nerve is compressed
Flexion, adduction, and external rotation |
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Iliolumbar ligament
|
transverse process of L5 to iliac crest
limits lumbar motion in flexion, rotation |
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Anterior sacroiliac ligament
|
Thin; pelvic surface of sacrum TO pelvic surface of ilium
Maintains relationship between sacrum and ilium |
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IT band "syndrome"
|
IT band is blamed, but not at fault. Could be overcompensating from pelvic instability
Presents on contralateral side Rolling could actually be stimulating trigger points on vastus lateralus |
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What might the diagnosis be for anterior hip pain?
|
Difficult to make because it could be lots of things...
labral tear sports hernia femoral acetabular impingement (doesn't glide... growth spurs) Osteoarthritis Pubic symphysis pain inguinal hernia |
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Possible mechanism for femoral head or neck fracture
|
Shear force from fall on greater trochanter or sometimes before a fall when people turn
huge problem in elderly (osteoporotic) |
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3 joints in knee region
|
tibiofemoral joint
patellofemoral joint superior tibiofibular joint |
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Movements at the tibiofemoral joint
|
condyloid - 2 df + some linear motion (slide, present in all joints)
flexion/extension external/internal rotation |
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Which condyles in the knee joint are convex and which concave?
What does this provide |
Both condyles of femur are convex
Medial plateau of tibia is oval and concave Lateral plateau is circular and convex, creating more mobility |
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Functions of the menisci:
|
• Increase the contact surface
• Shock absorption • Protect bone and cartilage by reducing friction • Enhance lubrication of the joint • Limit motion between tibia – femur |
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Which meniscus is more commonly torn?
|
The medial, c-shaped, less-mobile meniscus
lateral, o-shaped meniscus is more mobile |
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Meniscal movements and causes of translation
|
- posterior with flexion (popliteus, semimembranosus and PCL via posterior meniscofemoral ligament attach on
posterior aspect) - anterior with extension (quadriceps femoris via patella and ACL attach on anterior aspect) - anterior to ipsilateral side with rotation |
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Fibular/lateral collateral ligament
|
Lateral epicondyle of femur TO head of fibula
Resists varus forces, taut in extension |
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Medial/tibial collateral ligament
|
Medial epicondyle of femur to medial condyle of tibia and medial meniscus
Resists valgus forces; taut in extension; resists internal, external rotation |
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What position would you want to put the
knee in assess collateral ligament integrity? |
Slight flexion, so stability isn't due to bony congruence (screw-home)
|
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Varus force
|
Laterally driven, distal segment forced medially, injures lateral collateral ligament
"var is the ball?" |
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Valgus Force
|
Medially driven (from outside)
Distal segment forced laterally Injures medial collateral ligament |
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Posterior cruciate ligament
|
posterior spine of tibia TO inner condyle of femur
Resists posterior tibial movement; resists flexion and rotation |
|
Anterior cruciate ligament
|
Anterior intercondylar area of tibia TO medial surface of lateral condyle
Back of femur to front of tibia Prevents anterior tibial displacement; resists extension, internal rotation, and flexion |
|
Screw home mechanism
|
locking action; external tibial rotation in the last 20 degrees of extension
Caused by differences in sized of condyles perhaps from ACL being taut just prior to extension forcing the rotation? |
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Patellofemoral Compressive
Force in extension and flexion |
Extension: larger contact area and less
patellofemoral compressive force Flexion: smaller contact area and more patellofemoral compressive force |
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Forces in the knee in flexion and extension
|
Flexion:
- Posterior shear forces increase (stresses PCL) - Patellofemoral compressive forces increase Extension: - Anterior shear forces increase (stresses ACL) - Patellofemoral compressive forces decrease |
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What kind of patellar tracking occurs with a Q angle less than 10 degrees?
More than 17? External tibial torsion? Internal tibial torsion? |
Medial tracking (genu varum)
Lateral tracking (genu valgum) Q-angle above or below normal values is associated with increased incidence of patellofemoral pain syndrome External tibial torsion? lateral tracking Internal tibial torsion? medial |
|
What is the type and role of the superior tibiofibular joint
|
plane/gliding joint
relieves the tibia - takes on 10-20% of BW when weight-bearing Motion at ankle is impacted if it's not moving (talocrural joint) Biceps femoris attaches there, on fibula |
|
About how many bursae are in the knee joint region?
|
around 20 fat pads, they provide a protective, gliding surface
|
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Knee flexors
prime movers and assistors |
PM: Biceps femoris, semimenbranosus, semitendinosus
Asst: gastrocnemius, gracilis, popliteus, sartorius (gracilis and sartorius to pes anserinus) |
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Knee extensors
|
PM: rectus femoris, vastus intermedius, vastus lateralis, vastus medialis
|
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Hamstrings are more effective at ___ the knee if hip is flexed
Rectus femoris - more effective knee ____ if hip is extended |
Flexing
Extensor |
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Internal rotators at the knee
|
Popliteus (medial to lateral lip of femoral condyle, unlocks the knee))
Semitendinosus Sartorius Gracilis |
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External rotators at the knee
|
Biceps femoris (on lateral side of midline)
|
|
Knee joint stability influenced by
|
Passive restraint of ligaments
Joint geometry - plateaus,size of condyles Muscle activity Compressive forces (pushing bones together, patella into femur, body weight) |
|
Genu Recurvatum
|
hyperextension of knee, stretched joint capsule and ligaments
Some stand that way because of quad weakness (passive rather than active support) Scary video! |
|
The "unhappy triad"
|
ACL tears, MCL, Medial Meniscus
In addition to ACL injury: Menisci (50%) Articular cartilage (30%) Collateral ligaments (30%) |
|
Mechanisms of ACL injury
|
Usually non-contact
- excessive anterior tibial displacement - internal tibial rotation - valgus force e.g. right foot fixed while body rotates to the right e.g. landing off-balance Plant and change directions |
|
Is ACL reconstruction always necessary? How's it done?
|
Some are fine without ACL if they have good mechanics and strong quads
Autographs from part of Patellar ligament Semitendinosus tendon (most common) Quadriceps tendon high success rates |
|
ACL injuries: gender differences
|
• Women: 4-6x more likely to sustain ACL injury
Theories: • Anatomic – wider pelvis, increased valgus knee (incr. Q angle) – Increased foot pronation – narrower femoral intercondylar notch (‘rubs’ on ACL?) • Hormonal effects on laxity of ligaments – Inconclusive measurements of laxity – Some reports of increased rupture rates during ovulatory phase most support for: • Biomechanical/Neuromuscular control differences – Landing stiffer, less knee flexion (more taut), flatter foot – Greater knee abduction angle at landing – 2.5 times greater knee abduction moment – 20% higher ground reaction force (whereas contact time was 16% shorter) hence, increased motion, force, and moments occurred more quickly. – Muscular timing/patterns/strength (quads vs. hams) • High-risk movement patterns in ‘jumping and cutting’ sports (VB, BB, Soccer) – One-leg landings – Out-of-control baseline landings – Straight-leg landings – Upright torso during cutting |
|
PCL injury
Name and causes |
• “Dashboard injury”
• Falling on bent knee - PCL taut in flexion • Forced knee hyperextension |
|
Meiniscal tears
|
Cutting- bucket handle tear
Forced flexion - peripheral tear Can be traumatic or degenerative Inconsistent pain In athletic population Location of injury matters - lateral part has good blood supply, while inner sections usually need surgical repair |
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Patellofemoral pain
|
Multifactorial:
structural muscular alignment -rotation -Q angle Not the knee's fault |
|
Lateral and medial retinaculum are
|
connective tissue systems that contribute to patellar control and tracking
|
|
The pes anserinus is the common insertion of
|
sartorius, gracilis, and semitendinosus
|
|
"Breast stroker's knee"
|
Bursitis
Maybe from sartorius being overactive Re-educate the gluteus maximus to do its part and let the sartorius take a break |