(2) Lecture 10: Body Alignment 101 Flashcards

1
Q

Postural Evaluation

A
  • assess STATIC posture
  • observe ENTIRE body from all angles
  • significant variability = only obvious asymmetries should be considered
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2
Q

Sagittal plane movements

A

Flexion and extension

spine, shoulder, hip, knee, ankle

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3
Q

Coronal/Frontal plane movements

A

Side flexion, abduction, adduction and inversion/eversion

spine, shoulder, hip and ankle

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4
Q

Transverse plane movements

A

Internal and external rotation, pronation/supination

shoulders, hips, feet

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5
Q

Basic Postural Observation

Sagittal Plane

A
  • think of straight/plumb line running down entire length of body

line should pass
- thru ear lobes
- thru body of cervical spine
- thru humeral head
- thru greater trochanter (PSIS slightly higher than ASIS b/c of lordosis)
- anterior to knee but posterior to patella
- anterior to malleolus of ankle

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6
Q

Classic Postural Deviations in Sagittal Plane

A
  • forward head posture
  • forward rounded shoulders
  • kyphosis
  • lordosis
  • swayback
  • flatback
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7
Q

Forward head posture

A

Seen in sagittal plane

  • ears in front of plumb line
  • chin pokes forward
  • extended upper C-spine + flexed lower C-spine
  • protracted scapulae
  • usually has forward rounded shoulders + possible kyphosis
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8
Q

Forward rounded shoulders

A

Seen in sagittal plane

  • humeral head in front of plumb line (GH internal rotation)
  • tight pec minor
  • elongated/weak rhomboids + mid-trap
  • restricted scapular upward rotation + posterior tipping

Shoulder problem but caused all over

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9
Q

Kyphosis

A

Seen in sagittal plane

  • excessive THORACIC curve
  • tight pec major + minor (on front)
  • weak erector spinae, rhomboids and traps
  • protracted scapulae
  • associated w/ fwd head posture
  • increased C- spine extension to keep eyes level
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10
Q

Lordosis

A

Seen in sagittal plane

  • more than 40 degrees of tilt
  • increased curve in LUMBAR spine
  • increase in anterior pelvic tilt
  • tight hip flexors + lumbar muscles
  • elongated/weak ab muscles + hams (functionally shortened but not actually)
  • shorter ROM
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11
Q

Is a lordosis bad?

A

NO, we need lordosis to give spine curves a spring

Excessive lordosis is bad

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12
Q

Swayback

A

Seen in sagittal plane

  • anterior shift of entire pelvis = hip extension
  • thoracic segment shifts posteriorly = flexion of thorax + kyphosis
  • tight hip extensors + lower lumbar extensors
  • weak hip + ab flexors
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13
Q

Flatback

A

Seen in sagittal plane

  • increased posterior pelvic tilt
  • decreased lumbar lordosis
  • tight hip extensors
  • weak/long hip flexors
  • poor postural sense
  • patient appears STOOPED FWD
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14
Q

Basic Postural Observation

Coronal Plane Posterior View

A
  • head/ears level
  • shoulders equal
  • scapulae equal
  • arms equal distance from body
  • hips equal (gluteal fold equal)
  • knee creases equal
  • malleoli equal
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15
Q

Basic Postural Observation

Coronal Plane Anterior View

A
  • head straight
  • eyes/ears level
  • shoulders (dominant side may be slightly lower)
    – acromion level
    – equal distance from body to arm
  • hips level (ASIS)
  • knees level and straight – facing fwd
  • malleoli equal
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16
Q

Scoliosis

A

Seen in coronal plane

Deformity in which there is one or more lateral curves of spine more than 10 degrees
- C or S curve
- may occur in thoracic, thoracolumbar or lumbar spine
- easily seen on X-ray
- rib hump is a hallmark sign of structural curve
- May be non-structural or structural

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17
Q

Structural vs non-structural scoliosis

A

Non-structural: easier for rehab (can be reversed)

Structural: can’t be reversed (goal - slow down)

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18
Q

Measuring Scoliosis

A
  • physician chooses most tilted vertebrae above and below apex of curve
  • angle btwn intersecting lines drawn perp is COBB ANGLE
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19
Q

Right thoracic curve

A

CONVEX to the right with apex in the thoracic spine
- curve is pointing to the right

90% of thoracic curves are to the right

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20
Q

Left thoracic curve

A
  • less common
  • should raise a RED FLAG

Causes
- chiari malfunctions
- spinal cord tumours
- neuromuscular disorders

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21
Q

Types of scoliolis

A

Non-structural scoliolosis and structural scoliosis

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22
Q

Non-structural scoliosis

A
  • NO bony deformity
  • not progressive
  • can be TREATED clinically
  • disappears on forward or side flexion

May be caused by
- postural problems (muscle spasm - tight on concave side + weak on convex)
- leg length discrepancy
- hip contracture (hip is tight)

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23
Q

Structural scoliosis

A
  • bony deformity
  • may be progressive
  • hump present on fwd flexion (Adam’s Forward Bend Test)
  • vertebral bodies rotate to convexity of curve

May be caused by
- genetic problems
- congenital issues
- idiopathic (unknown cause)

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24
Q

Adam’s Forward Bend Test

A

A rib hump (rotational deformity) is a hallmark sign of a curve greater than 10 degrees

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25
Q

Contributing factors of lower extremity overuse injuries

A
  1. Lower Chain Alignment
    - static
    - dynamic control (hip and knee)
  2. Foot - interface w/ ground
    - static: standing
    - dynamic: walking/running
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26
Q

Lower Chain Alignment

A
  • valgus
  • neutral
  • varus
27
Q

Valgus

A
  • knees go in together and feet apart
  • more force/compression on outside part of lower leg
  • lower chain alignment

force on outside of load bearing axis

28
Q

Neutral lower chain alignment

A

axis goes through middle of knee

29
Q

Varus

A
  • knees move apart and feet together
  • more force/compression on inside of lower leg
  • lower chain alignment

force on inside of load bearing axis

30
Q

Q-Angle

A
  • describes the axis formed by femur and tibia
  • greater Q angle = greater lateral pull on patella
  • Q angle > 20 degrees increase risk of instability of patellofemoral (PF) jt
  • can be a factor in PF pain syndrome, OA and ITB friction syndrome (varus)
31
Q

Medial Collapse Mechanism

A

Poor multi-plane lumbo-pelvic/pelvo-femoral control
- typically caused by weak glut medius

problems caused:
- hip adduction
- femoral internal rotation
- knee valgus

Changes femur under patella
- DECREASE in jt. contact area
- INCREASED jt. stress

32
Q

Normal knee motion

A

Knee flexion-extension
- happens btwn bottom of femur and top of menisci

Twisting motion
- happens btwn bottom of menisci and tibia

33
Q

Screw Home Mechanism

A

Rotation happens during last few degrees of extension b/c medial femoral condyle is larger than lateral
- planted foot = femur medially rotates
- fixed femur = tibia laterally rotates

Locks joint to increase stability (passive)
- regulates patellar alignment

POPLITEUS then contracts to externally rotate femur on the tiba to UNLOCK the knee (active movement)

34
Q

Foot arches

A
  • longitudinal arch
  • transverse arch
35
Q

Longitudinal arch

A

Medial longitudinal arch attached to spring ligament (plantar calcaneoclavicular lig) for support
- reinforced by tibialis posterior

Lateral longitudinal arch - lower and less flexible

36
Q

Foot types

A

Pes Planus
Pes Cavus

37
Q

Pes Planus

A

Flat Foot

  • decreased medial longitudinal arch height
  • associated with excessive PRONATION
38
Q

Pes Cavus

A

High arch

  • excessive (stiff/high) medial longitudinal arch
  • associated with SUPINATION
39
Q

Transverse arch

A
  • extends across TARSAL bones
  • provides protection to soft tissue and increases the foot’s mobility
40
Q

Plantar Fascia

A
  • attaches on metatarsal heads
  • starts from medial tubercle on plantar surface of calcaneus
  • travels towards toes as a solid band of tissue dividing just before metatarsal heads into 5 slips
  • ARCH SUPPORT + DYNAMIC SHOCK ABSORPTION
  • responsible for transferring weight from medial to lateral side of foot during gait cycle
41
Q

Plantar fascia during extension

A

When toes are extended, plantar fascia is functionally shortened as it wraps around metatarsal heads

Plantar fascia functions sort of like a muscle - has a DYNAMIC function

42
Q

Windlass Mechanism

A

Windlass: apparatus for moving heavy weights

Dorsiflexing toes w./ flat foot: plantar fascia pulled around MT heads = increase in arch height and weight transfers to lateral side

Heel lift/toes dorsiflex: tightening up plantar fascia

43
Q

Gait cycle

A

Classic gait terms:
heel strike - foot flat - midstance - heel off - toe off - midswing - heel strike

New gait terms
initial contact - loading response - mid stance - terminal stance - preswing - initial swing - mid-swing - terminal swing

44
Q

Look at pictures of gait cycle

A
45
Q

Walking Gait Cycle

A
  • 60% stance and 40% swing
  • weight bearing in Closed Kinetic Chain
  • initial contact + early loading = double contact
  • at mid-stance and terminal stance, body support by only a SINGLE limb
46
Q

When in gait cycle, is the body supported by a single limb?

A

Mid-stance and terminal stance

47
Q

When in gait cycle, is the body supported by both limbs?

A

Initial contact and early loading

48
Q

What is pronation?

A

impact ABSORPTION phase of gait

  • we either pronate too much, not enough (supinate) or just right
49
Q

When does pronation occur?

A

Pronation occurs as foot is LOADED to allow for shock absorption, ground terrain changes and equilibrium

Tibia rotates internally w/ talus and calcaneus and acts to convert torque
- affects screwhome mechanism (unlocks foot to distribute forces)

50
Q

Movements of pronation

A
  1. Eversion (transverse)
  2. Dorsiflexion (sagittal)
  3. Abduction (frontal)
51
Q

Movements of supination

A
  1. Inversion (transverse)
  2. Adduction (frontal)
  3. Plantar flexion (sagittal)
52
Q

Supination

A
  • mid-tarsal jts. are locked
  • foot is more stable for toe-off
  • allows you to use great amount of force to propel body
  • achieved with aid of CUBOID pulley
53
Q

Supination during movement

A
  • supination is needed to pull bones tight = makes foot a rigid lever and allows you to PUSH OFF

peroneus longus allows us to turn foot from a mobile adapter to a rigid lever

54
Q

What are supination and pronation paired with?

A

Supination + external rotation
Pronation + internal rotation

55
Q

Heel strike

A

Motion is pronation
Position is supination

To push off, you need rigid lever = re-supinate through pronated position

56
Q

Foot flat

A

As you transition from heel strike to foot flat, you need to move into pronation (floppy foot)
- convert torque and be a SHOCK absorber

57
Q

Stance phase

A

In pronated position but need to move into supination (rigid) by heel-off to propel yourself and push off

58
Q

Flat feet and gait control

A

Ppl with flat feet have trouble getting to neutral phase between midstance and propulsion
- trouble trying to push off with a floppy/pronated foot

59
Q

What kind of foot is floppy? Rigid?

A

Pronated foot = floppy
Supinated foot = rigid lever

60
Q

Gait Cycle Running

A

with running, there is NO simultaneous foot contact w/ the ground

  • at heel strike, foot acts as a shock absorber and adapts to surface
  • foot is rigid lever at toe off

Runners
- 80% lateral heel strike
- sprinters forefoot strike

61
Q

Role of Pronation in Gait Cycle

A

Foot function: MOBILE ADAPTER

Foot structure: lowered arches looser jts

Gait phase: just after heel strike to foot flat (weight acceptance/shock absorber)

62
Q

Role of Supination in Gait Cycle

A

Foot function: RIGID LEVER

Foot structure: heightened arches, tighter jts (locks jts)

Gait phase: short period at heel strike and foot flat to toe off (push off)

63
Q

Excessive Pronation

A
  • over pronation at SUBTALAR jt = internal rotation of tibia and delayed re-supination
  • affects screw-home mechanism b/c tibia doesn’t externally rotate
  • femur MUST internally rorate more to get to extension
  • cause of patellar tracking issues
64
Q

Primary result of lower limb static + dynamic issues

A

Change in pressure distribution:
1. At the articulation of the bones
- could be at the jt. with faulty mechanics
- at the jt. above or below problem

  1. In surrounding soft tissues

Pain is secondary