Chapter 8 Plumbline and Gait (page 18) Flashcards
Bad posture is often simply a bad habit, due to _______________, or as the __________________.
Misuse of the capacities of the body
Sequelae of some sort of trauma
While joint integrity is maintained primarily by _______________, ultimately muscular activity
plays a key part in the maintenance of ____________, and maintains _____________.
Ligamentous structure
Good posture
Kinetic Work
Muscles that are excessive in length are usually ______, and allow ___________ of opposing muscles. Muscles that are too short are usually ______, and maintain opposing muscles in a ______________.
Weak
Adaptive shortening
Strong
Lengthened position
The word “tight” has two meanings. It may be used interchangeably with the word ______, or it may be used to mean ______.
Short
**Taut **(Short or lengthened muscle)
Normally, the body is kept in the correct posture by the balancing action of opposing muscle groups and by the efficient working of the nervous system which controls this type of muscular activity; such activity is an anti-gravity reaction and is called ____________.
Postural Tone
________ is the force by which all bodies are attracted to the earth; if unopposed, the body would f all to the ground.
Gravity
The Centre of Gravity is a point at the exact centre of the __________; in ideal posture, it lies ________________, and moves upwards, downwards and sideways during activities.
Mass of the body
Approximately 1 inch anterior to S2
The body is always trying to right itself within the _____________.
Gravitational field (Gravity Line)
_____________ is a mechanism whereby the correct posture of the body is maintained at rest or during activity.
Postural Reflex
_________ of postural deformity involves muscular hypertonicity, but no bony changes – can be corrected (prevention).
1st degree
_________ is termed as a structural deformity involving extensive bony changes and correctible only with surgery (symptomatic relief).
3rd degree postural deformity
___________ postural deformity involves muscular, fascial, and some bony changes - can help prevent further changes (maintenance).
2nd degree
During the growing years, self-consciousness about early increases in height or developing breasts can affect posture, even into adulthood. This is an illustration of ____________ cause of postural inefficiency.
Psychological
__________ is the most common direct organic cause of bad posture; with this condition, other
structures cannot take the burden and may give way leading to sprains, avulsions, dislocations.
Muscle Weakness
Defective eyesight, constitutional weakness, respiratory or cardiac weakness are examples of __________ causes of postural inefficiency.
Heredity (Hereditary)
Cramped, crouched or flexed positions for prolonged periods result in alteration of the vertebral curvatures and stretching or torsion of certain muscle groups. This is an illustration of ______________ as causes of postural inefficiency.
Occupations or Bad Habits
Absence of back rests, incorrect desk or keyboard height, chair too high without foot support or standing too long are examples of ________________.
Detrimental Work Conditions
_________________________ will overdevelop certain muscles at the expense of others.
Repeated carrying of heavy loads
Posture may appear to be _____, yet the individual may be very flexible and the position of the body may change readily.
Faulty
“IDEAL” POSTURE
- body: __________________
- hip and knee joints: _________
- abdomen: _____________
- arms hang from shoulders, with elbows and fingers: __________
- head: _______________
Well-balanced, weight equal on both feet
Extended but not hyperextended
Retracted and lax
Slightly flexed
Erect and relaxed
“IDEAL” POSTURE:
Back shows anatomical curves from caudad to cephalad:
__________ (sacral)
__________ (lumbar spine)
__________ (thoracic spine)
__________ (cervical spine)
**Kyphotic
Lordotic
Kyphotic
Lordotic **
Ideal Posture can never be said to be established until _________________ of which the person is not aware
It has become a habit
The ___________ refers to setting the vertical in a specific position for the view. When standing, that point is _________ – the point that moves the least in reference to the line, the most stable point in the person’s posture.
Fixed Point
Nearest the floor
Post erior View:
- Head in _____________, neither _____________
- Cervicle spine is _______
- Shoulders are ______, not _______________
- Scapulae are ______ (should not be _______ and medial borders about _______ apart)
Neutral position (midline), Tilted nor rotated
Straight
Level, Elevated or depressed
Level (“winged” 3-4 inches apart)
Posterior View
- Thoracic and lumbar spines are _______
- Waist angles are ______
- Arms are _________ from body and ____________
- PSIS are _______
Straight
Level
Equidistant, Equally Rotated
Level
Posterior View
- Gluteal folds are _______
- Greater trochanters are ______
- Lower extremities are __________
- Feet should have ________________
Level
Level
Straight
Normal Alignment
Lateral View Plumbline points
_________ to lateral malleolus
________ to axis of knee joint
__________ to axis of hip joint
___________ vertebral bodies of lumbar vertebrae
___________ to apex of coronal suture
Earlobe in line with _________ and _________ of iliac crest
- *- slightly anterior
- slightly anterior
- slightly posterior
- passes through
- slightly posterior
- acromion process, high point of iliac crest**
- *Anterior View**
- Head is _______ on shoulders
- Posture of jaw is _________
- Tip of nose is in line with ______________
- Shoulders are _____ and trapezius is equal on both sides with _______________
- The dominant arm is usually lower causing the slope on that side to be __________ and the shoulder ___________
Straight/Level
Normal
Sternal notch and xiphoid process
Level, Respect to muscle bulk and slope
Slightly greater, slightly lower
- *Anterior View**
- Clavicles & acromioclavicular joints are __________
- ________________ of the sternum and ribs
- “Carrying angle” of each elbow is about _____ degrees
- Both palms face the _______
Level and equal
Normal alignment
5-15
Body
- *Anterior View**
- High points of iliac crest are ___________
- Patella apex points ________
- Head of fibula are _______
- Malleoli are ______
- Arches of feet are ________
- Feet angle out (usually ___ degrees)
The same height
Straight down
Level
Level
Normal
**10 **
Any tilting of the pelvis involves simultaneous movements of the ________ and __________. These movements may be caused by, or may cause, _____________.
Low back
Hip joints
Muscle imbalances
Note four (4) examples of skeletal postures.
- *a. Ideal posture
b. Kyphosis-lordosis-scoliosis posture
c. Flat-back posture
d. Sway-back posture**
POSTERIOR TILT: The pelvis tilts ________, causing the hip joints to _____ and the lumbar spine to ________.
Backward
Extend
Flatten
____________: Apparent leg length difference. This will cause to lengthen same side leg.
Anterior Tilt
ANTERIOR TILT: The pelvis tilts forward ____________ between the pelvis and the anterior thigh, resulting in flexion of the hip joint; the low back _________, therefore ________________ lumbar lordosis.
Decreasing the angle
Arches forward
Increasing
What are the possible causes of a Lateral Tilt?
Handedness pattern
Carrying body weight more to the “high” side
True leg length difference
SI dysfunction
LATERAL TILT: One hip is _____________ and correction occurs __________________.
Higher than the other hip
Above throughout the spine
For a left-handed person, the handedness pattern is:
- The left shoulder is ______ than the right; the pelvis deviates slightly towards the _______
- The left hip appears slightly ______ than the right
- The ____ gluteus medius is usually weaker
Lower
Left
Higher
Left
The Stance Phase consists of: (in order)
Heel strike
Foot flat
Midstance (a.k.a. single leg stance)
Heel off
Toe off
The Swing Phase consists of:
(in order)
Initial swing (acceleration)
Midswing
Terminal swing (deceleration)
The gait cycle is divided into 2 major phases:
- The stance phase consists of _____ of the gait cycle
- The swing phase consists of _____ of the gait cycle
60%
40%
The phases start with ________ and end with the next ________.
Heel strike
Heel strike
This is the brief time in walking when both feet are making contact on the floor at the same time.
Double stance
What is the most weight-bearing phase during gait?
Midstance of the same leg (Stepping leg)
Most hip pathologies present themselves during what phase?
Midstance of the same leg (Stepping leg)
Double stance _________ when the pace increases and jogging or running starts.
Decreases/ Disappears
- *Heel strike to foot flat** (Muscles active)
- ________ will fire eccentrically to absorb shock at the knee
- _____________, fires eccentrically to lower fore-foot, to the ground, for foot flat
Quadriceps
Anterior compartment of the leg
- *Foot flat to mid-stance** (Muscle active)
- ________ will fire concentrically, to (__________ only during resisted, i.e. uphill or stair climbing)
- At mid-stance, _____________ will fire isometrically to steady pelvis
Hamstrings
Gluteus Maximus
Hip Abductors (Gluteus Medius)
- *Heel off to push/toe off** (Muscles active)
- _____________________ fire concentrically, to propel the body forward
Plantarflexors and long toe flexors
- *Acceleration/ initial swing** (Muscle active)
- ________ fire concentrically, ______________ start to fire concentrically later in this stage to shorten length of the leg through mid swing
Hip flexors
Hamstrings and dorsiflexors
- *Mid-swing** (Muscle active)
- ____________ fire concentrically to start to extend knee once leg is passed mid-point of mid-swing
Quadriceps
Deceleration/ terminal swing (Muscles active)
- _________ fire eccentrically to slow extension of the knee and slow the leg back down to
ground speed
- Foot is in _____ due to active contraction of the __________ in preparation for the next phase
Hamstrings
Dorsiflexion
Anterior compartment
This abnormal gait pattern is due to pain during the stance phase and thus remains on the painful side for as little time as possible (short stance phase).
Antalgic Gait
An ataxic gait marked by unsteadiness and staggering making one have the appearance of being drunk.
Cerebellar Gait
The individual has difficulty initiating the first step, once initiated, the steps are small and shuffling.
Glue-footed gait
___________ - This type of gait marked by excessive hip abduction in the swing phase (seen in some upper motor lesions).
Scissor gait
This is described as unsteady, staggering gait.
Ataxic gait
The patient abducts the paralyzed limb, swings it around and brings it forward so the foot comes to the ground in front.
Hemiplegic gait
This gait is characterized by weakness or paralysis of abductor causes the hip to drop on the affected side during the swing phase.
Trendelenburg gait
aka gluteus medius gait
This is usually caused by paralysis or weakened anterior compartment (tibialis anterior etc.)
Foot drop gait
This type of gait is marked by short steps may become successively more rapid.
Parkinson’s gait
Gait with high steps (maybe seen with foot drop), if the dorsiflexors are paralyzed then the client must lift the leg up to clear the floor during swing phase.
Equine gait
Steppage or Footdrop Gait
The patient has ____________, resulting in a foot drop. To compensate and to avoid dragging the toes against the ground, the patient lifts the knee higher than normal; this results in a ___________.
Weak or paralyzed dorsiflexor muscles
High steppage gait
Scissors Gait
The result of spastic paralysis of the _________, causes the knees to be drawn together so that the legs can only be swung forward by swinging the hips forward with great effort. This is seen in ________ and may be referred to as a ___________.
Hip adductor muscles
Spastic paraplegics
Neurogenic or spastic gait
Antalgic Gait
The stance phase on the affected leg is _______ than on the non-affected leg as the patient attempts to “get off” the affected leg as quickly as possible.
Shorter
Arthrogenic Gait
This is due to ____________. If the knee or hip is fused, or if the knee has recently been removed from a cylinder cast, the pelvis must be elevated by exaggerated plantarflexion of the other ankle & circumduction of the stiff leg to provide ________. This compensates for the __________________.
Stiffness, laxity, or deformity
Toe clearance
Lack of flexion in the hip or knee
Short Leg Gait
If one leg is shorter than the other, or if there is a deformity in one of the bones of the leg, the patient will demonstrate ____________ and the pelvis will ____________, creating a limp. The weightbearing period may be the same for both legs. It is also termed __________.
A lateral shift to the affected side
**Tilt down on the affected side **
Painless osteogenic gait
Ataxic Gait
If the patient has poor sensation or lack of muscle coordination, there is a tendency toward _____________. The patient also watches the feet while walking. The gait is described as _____________________.
Poor balance and a broad base
Irregular, jerky and weaving
Ataxic Gait
With _____________, the gait is a lurch or stagger and all movements are exaggerated. With ___________, the feet slap the ground because they cannot be felt.
Cerebellar Ataxia
Sensory Ataxia
Gluteus Maximus Gait
If the gluteus maximus muscle is weak, the patient will thrust the thorax posteriorly at (gait phase) __________ to maintain hip extension of the stance leg. The resulting gait has a _______.
Initial Contact
Lurch
Trendelenburg Gait
If the gluteus medius muscle is weak, the patient will exhibit an ______________, thrusting the thorax laterally to keep the center of gravity over the ______ leg.
An execesive lateral list
Stance
Psoatic Limp
It may be due to ___________ of the _______ muscle. The limp shows classically as _________ of the hip. The patient will exaggerate movement of the pelvis and trunk to help move the thigh into ______.
Weakness or reflex inhibition
Psoas Major
Lateral rotation, flexion and adduction
Flexion
Stiff Knee or Hip Gait
Characterized by __________ of the other foot occurs and the affected leg swings forward ________. Because loss of flexibility in the hip or knee or both, gait length is different for both legs. When the stiff limb is weight bearing, the gait length will be ________.
Excessive plantarflexion
Through an arc
Smaller
