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Biomechanics > Biomechanics Week 6-10 > Flashcards

Biomechanics Week 6-10 Flashcards

1
Q

What are the planes of motion, and what movements occur in each?

A

Coronal (lateral flexion)
Sagittal (flexion & extension)
Transverse (rotation)

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2
Q

What are the axes of motion?

A

X: coronal axis, horizontal from side to side, movement around axis is in sagittal plane
Y: longitudinal axis, vertical, move in transverse plane
Z: sagittal axis, horizontal front to back, movement in coronal plane

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3
Q

What are degrees of freedom?

A

Number of ways in which a body can move. e.g. six for spinal segments

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4
Q

Instantaneous axis of rotation

A

When a body moves in a plane, there is always a single point (fulcrum?) that does not move. The IAR passes through that point and is perpendicular to the plane of rotation.

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5
Q

Motion segment

A

Two adjacent vertebrae plus their associated connective tissue.
The functional unit of the spine, the smallest spinal segment that acts like spine.

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6
Q

Coupled motion

A

A motion around one axis and a motion around a different axis that always happen together.

Ex: When you bend your neck to the left, you combine lateral flexion with right axial rotation of the upper cervical spine, or left axial rotation of the subaxial cervical spine.

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7
Q

Loose and closed packed joint position

A

Loose-packed position: position where CT is relaxed, maximum joint play possible, maximal space between surfaces. Use this position for traction or mobilization. Ex: halfway b/t flexion and extenion for facet joints

Closed-packed position: CT is maximally tightened, no joint play, maximal contact between surfaces. Ex: extension for facets

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8
Q

Regional range of motion

A

In the spine, different regions have different range of motion for different types of motion.
Flexion/extension max in cervical and lumbar, min in thoracic
Axial rotation max in cervical, some in thoracic, min in lumbar
Lateral bending is average across the board

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9
Q

How do C0 and C1 articulate?

A

C0 has condyles that form convex rockers, sit in concave superior articular facets on C1.

Flexion: C0 glides posteriorly (most ROM)
Extension: C0 rolls anteriorly (most ROM)
Lateral flexion: C0 rolls on ipsi side/glides on contra side (minimal)
Rotation: C0 glides posterior on ipsi side and anterior on contra side. Limited by alar lig. (minimal)

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10
Q

How do C1 and C2 articulate?

A

Two facet joints (mostly flat) plus atlas-odontoid joint

Flexion: C1 glides post (minimal)
Extension: C1 glides ant (minimal)
Lateral flexion: C1 glides ipsilaterally (minimal)
Rotation: C1 rotates around dens. Glides posterior on ipsi side, anterior on contra side. (most ROM)

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11
Q

What are some features of the lower cervical spine (C3-C7)?

A

Facets are at 45 deg to transverse plane, parallel to frontal plane, nearly flat.
Limited lateral flexion (due to Joints of Luschka)
45 deg lordosis
Nucleus pulposis slightly posterior

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12
Q

Describe the motions of C3-C7

A

Flexion/Extension dominate. Combo segmental tipping and gliding.
Lateral flexion: coupled motion, limited mobility, mobility decreases rostral to caudal
Rotation: limited

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13
Q

Describe the facets of the typical thoracic spine (T2-T8)

A

Facets are 60 deg to transverse plane, 20 deg to coronal plane.

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14
Q

Describe the atypical thoracic spine (T1, T9-T12)

A

T1 resembles C7
T9-10 have variations on positions of facets and transverse processes
T11-12 look like lumbar

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15
Q

Describe the thoracic curve

A 
45 deg kyphosis
Primary curve (present at birth)
Extends T1-T12, apex at T6-T7 space
Short body height
Central nucleus pulposus
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16
Q

Describe the movements of the thoracic spine

A

Flexion/Extension: avg 6 deg, combo rotation/slight glide
Lateral flexion: coupled to axial rotation (for upper thoracics) and thoracic rotation
Rotation: 8-9 deg upper, less in middle, minimal in lower. Coupled with same-side lateral flexion

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17
Q

Describe rib joint

A

Rib articulates on two vertebral bodies at once and the transverse process, and is held in place by radiate ligament and the costotransverse ligaments.

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18
Q

Describe rib movements.

A

Pump handle: T1-T6 ribs are pulled up and forward on inspiration, increasing A-P diameter of ribcage
Bucket handle: T7-T10 ribs are elevated on inspiration, increasing transverse diameter
Caliper: T8-T12 ribs move laterally with inspiration, increases lateral diameter

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19
Q

Describe the lumbar facets.

A

Mostly parallel to sagittal plane.
Greatest ROM in flexion/extension.
Limited rotational ROM.

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20
Q

Describe features of the lumbar spine, including curve and disc features.

A

35 deg lordosis, L1 to sacrum, apex at L3-L4

Disc is tall (1:3), posterior nucleus pulposus

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21
Q

Explain force transmission through a disc

A

Compression force increases hydrostatic pressure in nucleus pulposus, elevating tension in annulus fibrosus.
Increased annulus tension prevents radial expansion of nucleus, so nucleus pushes up and down instead, supporting the annulus.

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22
Q

What are the kinds of lumbar disc lesions.

A

Bulge, herniation, annular tear

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23
Q

Define a disc bulge

A

A shallow extension of disc tissue beyond edge of vertebral body. Not herniation, but buckling of annular fibers

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24
Q

Define a disc herniation

A

The nucleus pulposus ruptures through the annular fibers, producing a localized displacement of disc beyond edge of vertebral body.
Focal: less than 25% of disc circumference
Broad-based: 25-50% of circumference
Protrusion: broad base
Extrusion: narrow base (like it’s budding off)

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25
Q

Define an annular tear

A

Radial, transverse, or concentric tears in the annulus

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26
Q

Describe the movements of the lumbar spine.

A

Flexion/extension: avg 15 deg, combo sagittal rotation with slight sagittal translation
Lateral flexion: avg 6 deg, coupled with opposite side rotation.
Rotation: limited by sagittal facets. Coupled to lateral flexion, L1-L3 opposite side, L4-L5 same side

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27
Q

What kind of joint is the pubic symphysis?

A

Amphiarthrosis: slightly moveable, fibrocartilage

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28
Q

What is the keystone effect in pelvic statics?

A

The sacrum forms the keystone of an arch suspended by ligaments. Displacement is resisted by its wedge shape and the sacroiliac ligaments.

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29
Q

Describe the self-locking mechanism of the pelvis.

A

Form closure: The anatomy of the SI joints promotes stability. Wedge shape of sacrum, Interlocking groove (sacrum) and ridge (ilium), S-shaped joint surfaces

Force closure: tension in mesenchyme stabilizes SI joints. Posterior myofascial sling formed by lats and glut max compresses SI joints.

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30
Q

How does a sacroiliac joint function in motion?

A

Transmits force between axial skeleton and lower extremities, acts as a shock absorber for lumber spine and opposite SI joint.

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31
Q

Describe sacroiliac nutation and counternutation.

A

Nutation: anterior sacral tilt, posterior iliac tilt, increases lumbar lordosis
Counternutation: posterior sacral tilt, anterior iliac tilt, decreases lumbar lordosis

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32
Q

What movements can the pubic symphysis do?

A

compression, distraction, rotation in sagittal plane with SI joint motion, gliding

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33
Q

What is the force couple in anterior pelvic tilt?

A

Hip flexors and back extensors

34
Q

What is the force couple in posterior pelvic tilt?

A

Hip extensors and abdominal muscles

35
Q

What are the biomechanical approaches to joint assessment?

A

Static model: structural emphasis, “bone out of place”, uses idea that static position determines joint function

Dynamic model: functional emphasis, “loss of motion”, uses idea that a mobile joint is a healthy joint, regardless of structure

36
Q

What is the NMT approach to joint assessment?

A

Uses both static and dynamic assessment.

37
Q

Provide the definitions of abnormal joint mechanics

A

Joint dysfunction: disturbance of function without structural change.

Joint fixation: joint is immobilized at a point within the normal ROM

Joint restriction: limitation of movement, indicates direction

38
Q

What are some causes of joint dysfunction?

A

Mechanical (trauma)
Chemical (envionmental toxins, hormonal/inflammatory stressors, reflex interactions)
Psychological (mental, emotional, spiritual stress, psychosomatovisceral reflex)

39
Q

Describe the PARTS system for identifying joint dysfunction.

A 
Pain on static or motion palpation
Asymmetry of bony landmarks/muscle tone
Range of motion reduced
Tone, texture, and temperature changes in soft tissues 
Special orthopedic tests
40
Q

What do you look for when inspecting a joint for dysfunction?

A

Superficial: size, shape, skin features
Posture
Gait

41
Q

What do you look for when palpating a joint for dysfunction?

A

Static: feel structures in neutral state
Motion: asses passive and active ROM, incl. quantity/quality of movement, joint play, end feel, pain experienced

42
Q

How is global range of motion assessed for joint dysfunction?

A

goniometry (extremities), inclinometry (spine)

43
Q

What are the segments of the articular range of motion?

A

Active ROM: physiological movements
Passive ROM: no conscious assistance/resistance from pt
Physiological barrier: end of active joint movement
Joint play: discrete, small, passive movement of a joint, springing bone in neutral position
End feel: discrete, small, passive movement of a joint, springing bone at limit of PROM
Elastic barrier: elastic resistance felt at end of PROM
Paraphysiological space: area of increased movement beyond elastic barrier available after cavitation
Anatomic limit: absolute limit of joint movement; further mobilization will result in injury

44
Q

What types of end-feel may be felt in normal or abnormal conditions?

A

Capsular: firm, but giving. (norm: ext rot shoulder abnorm: capsular fibrosis)
Ligamentous: like capsular, but firmer. (norm: knee ext abnorm: ligamentous shortening)
Soft tissues approximation: giving/squishy. (norm: elbow flex abnorm: muscle hypertrophy, edema)
Bony: hard, non-giving abrupt stop (norm: elbow ext abnorm: bony exostosis)
Muscular: firm but giving, builds with elongation, less stiff than capsular. (normal: hip flexion)

45
Q

What types of end-feel may be felt ONLY in abnormal conditions?

A

Muscle spasm: guarded, resisted by muscle contraction (soft tissue dz or injury)
Interarticular: bouncy, springy (meniscal tear, joint mice)
Empty: end-feel is not encountered at the normal point (hypermobility/instability)

46
Q

What is a listing?

A

A description of how a joint is dysfunctional.
May be static (malposition) or dynamic (restriction)
Peripheral joints: name position of most moveable bone
Vertebrae: name upper vertebra

47
Q

What is the difference between mobilization and manipulation?

A

Both are passive joint movement.

Mobilization: applies a force light enough that a patient can resist it, from resting position to elastic barrier

Manipulation: uses high-velocity, low-amplitude thrust that is beyond patient’s control, to the end of elastic barrier into paraphysiologic space.

48
Q

What are the neurophysiological effects of mobilization?

A

stimulates mechanoreceptors (inhibits nociception)
decreases spasm and guarding
stimulates Golgi tendon organs (inhibit muscle tone)
stimulates proprioceptors

49
Q

What are the nutritional and mechanical effects of mobilization?

A

Nutritional: stimulates synovial fluid, which nourishes articular cartilage
Mechanical: improves hypomobile joints by loosening adhesions and scarring, maintains extensibility and tensile strength of articular tissues

50
Q

What are the indications for mobilization?

A 
improve mobility
decrease pain
decrease spasm
decrease restrictions
reflexogenic effects
proprioceptive effects
51
Q

What motions are used for mobilization?

A 
Roll
Spin
Glide
Distraction/traction
Compression
52
Q

What is the rationale for mobilization?

A

Tissue deformation into plastic range is required to restore motion to hypomobile joint by tissue stretch and breaking adhesions.

53
Q

What are the rules of mobilization?

A

Joint: lax capsule, loose packed, stabilize proximal bone

Force: apply as close to opposing joint surface as possible, use large contact surface (e.g. palm), one movement at a time, one joint at a time

54
Q

What are the Maitland grades of mobilization?

A

I: small amplitude, top of ROM, manage pain/spasm
II: large amplitude, beg-mid ROM, manage pain/spasm
III: large amplitude, whole ROM, increase ROM/decrease stiffness
IV: small amplitude, end of ROM, increase ROM/decrease stiffness
V: small amplitude, high-velocity thrust, beyond ROM, increase ROM, decrease pain and stiffness

55
Q

What is involved in a Maitland treatment?

A

2-3 oscillations/sec, 3-6 sets of oscillations
For pain: 1-2 min, grades I-II, daily
For tightness: 20-60 sec, grades III-IV, 3-4 per week

56
Q

What is the Kaltenborn technique?

A

Combines traction and mobilization to decrease pain/reduce hypomobility.
Grade I: loosen (reduce compression in joint, no surface separation)
Grade II: take up slack (separates joint surfaces, eliminating joint play)
Grade III: stretch (stretch soft tissue surrounding joint

57
Q

What are contraindications to mobilization?

A 
Malignancy
Fracture/dislocation
Bone disease
Acute inflammation
Acute infection
Acute arthritis
Vertebral artery disease
Ligament instability
Cauda equina lesions
Spinal cord lesions
Multiple nerve root involvement
Significant anticoag/steroid use
Congenital abnormalities
58
Q

What is the purpose of gait?

A

Bear weight
Provide locomotion
Maintain equilibrium

59
Q

What are the principles of gait analysis?

A

Use a pattern–catch all the details
Analyze every joint from feet up to head
Patient should walk at normal speed
If deviations present, follow up with other tests

60
Q

What effect does walking speed have on analysis?

A

Walking slowly: feet spread, less arm swing & trunk rotation, shorter steps, body rocks side to side

Walking fast: feet come close together, eventually crossing midline, arms swing more & trunk rotates more, stride is longer, body translates forward with synchronicity

61
Q

What is the gait cycle? What are the phases of the gait cycle?

A 
Initial contact of one leg to initial contact of same leg.
Stance phase (60%): foot is on ground
Swing phase (40%): leg is swinging forward
62
Q

What are the sub-phases of stance phase?

A

Heel-strike
Foot-flat
Mid-stance: body passes over reference leg
Push-off: Heel-off, toe-off

63
Q

What are the sub-phases of swing phase?

A

Acceleration: from toe leaving floor until leg is directly under body
Mid-swing: reference leg passes below body
Deceleration: from under body to heel-strik

64
Q

What happens to the pelvis during the gait cycle?

A

drops on side of swing leg
rotates 4 deg ant (swing), 4 deg post (stance)
lateral shift 1-2 inches

65
Q

Describe the width of base support, step length, and stride length.

A

Width of base: distance between feet during double stance, usually 2-4 inches
Step length: distance from one foot strike to the next
Stride length: two successive steps (one gait cycle)

66
Q

Explain antalgic gait

A

Stance phase

Stance phase on one leg is shortened because the leg is painful.

67
Q

Explain abnormal heel strike

A

Stance phase
Pain at heel
Pt may avoid putting weight on heel altogehter

68
Q

Explain quadriceps weakness

A

Stance phase

Patient has a hard time keeping leg extended and preventing knee from buckling. May use hand to press thigh back.

69
Q

Explain foot slap

A

Stance phase

Weakness of foot and ankle dorsiflexors allow foot to fall forcefully to floor, instead of lowering foot smoothly

70
Q

Explain back-knee

A

Mid-stance

Hyperextension of knee to accommodate fixed plantar flexion deformity of the ankle

71
Q

Explain abnormal pelvic rotation

A

Swing phase
Weakness of hip flexors on swing-phase leg will not allow sufficient acceleration. Pelvis may be rotated further forward to achieve acceleration.

72
Q

Explain wide-based gait

A

Swing phase

Impairment of balance and coordination may be compensated by widening of base, resulting in greater energy expenditure.

73
Q

What are the ways visceral pain is experienced as musculoskeletal pain?

A

Referred pain: pain perceived at site adjacent to/distant from site of origin
Radiating pain: pain moves from original area outwards to another part of body
Radiculitis: pain along dermatomal distribution due to irritation of nerve root
Radiculopathy: spinal nerve root irritation that leads to pain, numbness, weakness, and possibly atrophy

74
Q

How can a patient’s localization of pain help distinguish somatic pain from referred pain?

A

If patient can point one of two fingers at it, it’s likely an injured somatic structure.
Broad, flat hands rubbing large areas of body often indicates referred pain.

75
Q

How do somatic and referred pain differ in provocation and palliation?

A

Provocation: somatic pain usually relieved by rest, certain positions, some physical factor; visceral pain is not.
Palliation: aggravation of somatic pain usually related to motion, compression, or stretch. Aggravation of visceral pain usually related to stressing involved organ.

76
Q

How does the quality of pain differentiate somatic and visceral pain?

A

Visceral: poorly localized, dull, ANS symptoms
Somatic: sharp or dull, well-localized or diffuse, deep or superficial, no ANS symptoms

77
Q

What are some general considerations for musculoskeletal assessment?

A

Develop a sequence to avoid missing things
Compare findings to normal (opposite) side
Compare contralateral ROM
Understand variations on normal
One task at a time
Consider possible compensatory mechanisms

78
Q

What is the circle concept of instability?

A

Injury to structures on one side of a joint causing instability can simultaneously cause injury to opposite side of joint.

79
Q

What are some principles of physical exam?

A 
Test normal side first
Active ROM before passive ROM
Painful motions last
Repeat tests
Isometric resistance in neutral first
80
Q

Describe myofascial hypomobility

A

“fascial restriction”

Results from adaptive shortening, hypertonicity of muscles, posttraumatic adhesions, scarring

81
Q

Describe pericapsular hypomobility

A

Originates from ligaments or joint capsule, multidirectional.
May be due to adhesions, scarring, arthritis, fibrosis, tissue adaptation.

82
Q

What are the four classic patterns of contractile lesions upon resistance?

A

Strong and pain free: no lesion of muscle or nerve present
Strong and painful: local lesion of muscle or tendon
Weak and painful: severe lesion around joint e.g. fracture
Weak and pain free: muscle or tendon rupture

Biomechanics (4 decks)

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