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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
Define an annular tear
Radial, transverse, or concentric tears in the annulus
26
Describe the movements of the lumbar spine.
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
27
What kind of joint is the pubic symphysis?
Amphiarthrosis: slightly moveable, fibrocartilage
28
What is the keystone effect in pelvic statics?
The sacrum forms the keystone of an arch suspended by ligaments. Displacement is resisted by its wedge shape and the sacroiliac ligaments.
29
Describe the self-locking mechanism of the pelvis.
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.
30
How does a sacroiliac joint function in motion?
Transmits force between axial skeleton and lower extremities, acts as a shock absorber for lumber spine and opposite SI joint.
31
Describe sacroiliac nutation and counternutation.
Nutation: anterior sacral tilt, posterior iliac tilt, increases lumbar lordosis Counternutation: posterior sacral tilt, anterior iliac tilt, decreases lumbar lordosis
32
What movements can the pubic symphysis do?
compression, distraction, rotation in sagittal plane with SI joint motion, gliding
33
What is the force couple in anterior pelvic tilt?
Hip flexors and back extensors
34
What is the force couple in posterior pelvic tilt?
Hip extensors and abdominal muscles
35
What are the biomechanical approaches to joint assessment?
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
What is the NMT approach to joint assessment?
Uses both static and dynamic assessment.
37
Provide the definitions of abnormal joint mechanics
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
What are some causes of joint dysfunction?
Mechanical (trauma) Chemical (envionmental toxins, hormonal/inflammatory stressors, reflex interactions) Psychological (mental, emotional, spiritual stress, psychosomatovisceral reflex)
39
Describe the PARTS system for identifying joint dysfunction.
``` 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
What do you look for when inspecting a joint for dysfunction?
Superficial: size, shape, skin features Posture Gait
41
What do you look for when palpating a joint for dysfunction?
Static: feel structures in neutral state Motion: asses passive and active ROM, incl. quantity/quality of movement, joint play, end feel, pain experienced
42
How is global range of motion assessed for joint dysfunction?
goniometry (extremities), inclinometry (spine)
43
What are the segments of the articular range of motion?
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
What types of end-feel may be felt in normal or abnormal conditions?
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
What types of end-feel may be felt ONLY in abnormal conditions?
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
What is a listing?
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
What is the difference between mobilization and manipulation?
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
What are the neurophysiological effects of mobilization?
stimulates mechanoreceptors (inhibits nociception) decreases spasm and guarding stimulates Golgi tendon organs (inhibit muscle tone) stimulates proprioceptors
49
What are the nutritional and mechanical effects of mobilization?
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
What are the indications for mobilization?
``` improve mobility decrease pain decrease spasm decrease restrictions reflexogenic effects proprioceptive effects ```
51
What motions are used for mobilization?
``` Roll Spin Glide Distraction/traction Compression ```
52
What is the rationale for mobilization?
Tissue deformation into plastic range is required to restore motion to hypomobile joint by tissue stretch and breaking adhesions.
53
What are the rules of mobilization?
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
What are the Maitland grades of mobilization?
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
What is involved in a Maitland treatment?
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
What is the Kaltenborn technique?
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
What are contraindications to mobilization?
``` 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
What is the purpose of gait?
Bear weight Provide locomotion Maintain equilibrium
59
What are the principles of gait analysis?
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
What effect does walking speed have on analysis?
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
What is the gait cycle? What are the phases of the gait cycle?
``` 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
What are the sub-phases of stance phase?
Heel-strike Foot-flat Mid-stance: body passes over reference leg Push-off: Heel-off, toe-off
63
What are the sub-phases of swing phase?
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
What happens to the pelvis during the gait cycle?
drops on side of swing leg rotates 4 deg ant (swing), 4 deg post (stance) lateral shift 1-2 inches
65
Describe the width of base support, step length, and stride length.
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
Explain antalgic gait
Stance phase | Stance phase on one leg is shortened because the leg is painful.
67
Explain abnormal heel strike
Stance phase Pain at heel Pt may avoid putting weight on heel altogehter
68
Explain quadriceps weakness
Stance phase | Patient has a hard time keeping leg extended and preventing knee from buckling. May use hand to press thigh back.
69
Explain foot slap
Stance phase | Weakness of foot and ankle dorsiflexors allow foot to fall forcefully to floor, instead of lowering foot smoothly
70
Explain back-knee
Mid-stance | Hyperextension of knee to accommodate fixed plantar flexion deformity of the ankle
71
Explain abnormal pelvic rotation
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
Explain wide-based gait
Swing phase | Impairment of balance and coordination may be compensated by widening of base, resulting in greater energy expenditure.
73
What are the ways visceral pain is experienced as musculoskeletal pain?
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
How can a patient's localization of pain help distinguish somatic pain from referred pain?
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
How do somatic and referred pain differ in provocation and palliation?
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
How does the quality of pain differentiate somatic and visceral pain?
Visceral: poorly localized, dull, ANS symptoms Somatic: sharp or dull, well-localized or diffuse, deep or superficial, no ANS symptoms
77
What are some general considerations for musculoskeletal assessment?
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
What is the circle concept of instability?
Injury to structures on one side of a joint causing instability can simultaneously cause injury to opposite side of joint.
79
What are some principles of physical exam?
``` Test normal side first Active ROM before passive ROM Painful motions last Repeat tests Isometric resistance in neutral first ```
80
Describe myofascial hypomobility
"fascial restriction" | Results from adaptive shortening, hypertonicity of muscles, posttraumatic adhesions, scarring
81
Describe pericapsular hypomobility
Originates from ligaments or joint capsule, multidirectional. May be due to adhesions, scarring, arthritis, fibrosis, tissue adaptation.
82
What are the four classic patterns of contractile lesions upon resistance?
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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