Final Exam (Cumulative): LE Kinesiology + Gait Flashcards
What is the angle of inclination at birth, and as an adult?
Birth: 140-150 degrees (coxa valga)
Adult: 125 degrees (angle reduces over time due to walking)
What is femoral torsion? List the angle at birth and as an adult
The angle between the femoral neck and shaft
Birth: 40 degrees (excessive anteversion)
Adult: 15 degrees (normal anteversion)
What are the arthrokinematics during hip flexion, extension, IR, ER, abduction, and adduction?
Flexion: Spin
Extension: Spin
IR: Anterior roll, posterior slide
ER: Posterior roll, anterior slide
Abduction: Superior roll, inferior slide
Adduction: Inferior roll, superior slide
T or F? If you have less than 15 degrees of femoral torsion (anteversion), the patient is considered to have retroverted hip alignment
True
If a patient has 140 degrees angle of inclination at the hip, how is he/she likely to stand? why?
He/she will likely go into hip abduction because it needs to lower the femoral head when walking to promote stability
Which structures influence joint motion and function at the hip?
- Femoral head
- Acetabulum
- Acetabular labrum
- Acetabular ligament
- Acetabular alignment
- Capsule and ligaments
How is the acetabulum and femur aligned?
Anterior/Lateral orientation (20 degrees from lateral orientation)
This causes the femoral head to become slightly exposed (commonly dislocated anterior as a result)
- femoral head is covered anteriorly by anterior capsule and iliopsoas
T or F? In order for a posterior dislocation of the femoral head to happen, a fracture of the posterior acetabulum would need to occur
True
Not enough coverage of the femoral head is called __________. Over coverage of the femoral head is called _____________
Dysplasia, Pincer
List and describe the ligaments of the acetabulofemoral (hip) joint
Iliofemoral: Taut in extension/ER
Pubofemoral: Taut in abd/extension/ER
Ischiofemoral: Taut in IR/Extension
Differentiate between open and close packed position
Open Packed:
- Least amount of joint surface congruency
- Capsule and ligaments are relaxed
- Joint movement is maximized
Close Packed:
- Most amount of joint surface congruency
- Capsule and supporting ligaments are maximally taut
- Joint movement is minimized
Describe the “close packed” position of the hip
Extension, Abduction, Internal Rotation
Describe Femur on Pelvis flexion
Spin
- Slackens anterior capsule and iliofemoral ligament
- Stretches inferior capsule and gluteus maximus
- With knee extended during hip flexion, the hamstrings would limit ROM
Describe Femur on Pelvis Extension
Spin
- Increase tension in all ligaments (especially iliofemoral) and ilipsoas
- With knee flexed, motion is limited due to rectus femoris
Describe Femur on Pelvis Abduction/Adduction
Abduction
- Superior roll, inferior slide
- Stretches pubofemoral ligament and adductors
Adduction
- Inferior roll, superior slide
- Stretches superior ischiofemoral ligament and abductors
Describe Femur on Pelvis IR/ER
Internal Rotation
- Anterior roll, posterior slide
- Stretches external rotators (piriformis/glute max) and ischiofemoral ligament
External Rotation
- Posterior roll, anterior slide
- Stretches iliofemoral ligament and internal rotators (TFL/glute min)
Describe Pelvis on Femur ant./post. tilt
Anterior Tilt
- Slackens most hip ligaments (especially iliofemoral)
- Limited by hip extensors
- Increase lumbar extension (lordosis)
Posterior Tilt
- Taut iliofemoral ligament and rectus femoris
- Decrease lumbar extension
Describe Pelvis on Femur abduction/adduction
Abduction
- “Hip hike” on non weight bearing leg
- Limited by pubofemoral ligament and adductors of weight bearing limb
Adduction
- Lowering of non weight bearing limb
- Limited by IT band, abductors of weight bearing limb
Describe Pelvis on Femur IR/ER
Internal Rotation
- Iliac crest rotates forward on non weight bearing limb
- Lumbar rotation in opposite direction to keep stable trunk
External Rotation
- Iliac crest rotates backward on non weight bearing limb
- Lumbar rotation in opposite direction
Which muscles are used to anteriorly tilt the pelvis (anterior force couple)
Erector spinae, sartorius, iliopsoas (MAYBE????)
Which muscles are used to posteriorly tilt the pelvis (posterior force couple)
Rectus abdominis, hamstrings, glute max
The abdominals prevent the pelvis from tilting ________, which promotes “core stability”
Anterior
T or F? When the spine is in a fixed position, the iliopsoas works on the pelvis. When the lower extremities are in a fixed position, the iliopsoas works on the L-spine
True
List the primary and secondary hip extensor muscles
Primary:
- Glute max
- Biceps femoris
- Semitendinosus
- Semimembranosus
- Adductor magnus
Secondary:
- Glute med
- Adductor magnus (anterior part)
List the primary and secondary hip flexor muscles
Primary:
- Iliopsoas
- Sartorius
- TFL
- Rectus femoris
- Adductor longus
Secondary:
- Adductor brevis
- Gracilis
- Glute min
List the primary and secondary hip internal rotation muscles
Primary:
- None
Secondary:
- Glute min
- Glute med
- TFL
- Adductor longus
- Adductor brevis
- Pectineus
List the primary and secondary hip external rotation muscles
Primary:
- Glute max
- Smaller ER muscles
Secondary:
- Glute med
- Glute min
- Obturator externus
- Sartorius
- Biceps femoris
T or F? Torque potential increases when hip flexion approaches 90 degrees
True
T or F? When internally rotating at the hip, the anterior fibers of glute med/min go from parallel to perpendicular to longitudinal axis of rotation
True
T or F? The moment arm increases 8x when the hip is flexed 90 degrees
True
T or F? Some external rotators become internal rotators and create 50% greater torque when the hip is flexed
True
List the primary and secondary adductor muscles of the hip
Primary:
- Pectineus
- Adductor longus
- Gracilis
- Adductor brevis
- Adductor magnus
Secondary:
- Biceps femoris
- Glute max
- Quadratus femoris
List the primary and secondary abductor muscles of the hip
Primary:
- Glute med (greatest moment arm and CSA)
- Glute min
- TFL
Secondary:
- Piriformis
- Sartorius
T or F? Posterior adductor magnus is a powerful extensor regardless of hip angle
True
T or F? Adductor longus/brevis and pectineus are hip flexors while adductor magnus is an extensor
True
If someone has weak hip abductors while standing on one leg, the _______________ hip will drop, and the patient will likely lean _____________
contralateral, ipsilateral
T or F? Using a cane in the contralateral hand will reduce joint reaction forces by 36%
True
T or F? If someone has right hip abductor weakness, the load should be held on the ipsilateral side to balance out bodyweight
True
T or F? 15% bodyweight load can cause almost 4x body weight compressive force
True
T or F? Most individuals have slight genu valgus (5-10 degrees)
True
Genu valgum causes increased joint stress in the __________ tibiofemoral joint while Genu varum increases joint stress in the ___________ tibiofemoral joint
Lateral, medial
List the norms for knee hyperextension and genu recurvatum
Hyperextension: 5-10 degrees
Genu Recurvatum: >10 degrees
Which motions can occur at the knee?
- Sagittal
- Transverse (knee needs to be slightly flexed)
- Frontal
T or F? Hip IR and ER increases with greater angles of flexion
True
At 90 degrees of knee flexion, ER to IR (of tibia on femur) is __:__
2:1
Describe “screw home rotation”
- Locking knee in full extension (last 30 degrees)
- 10 degrees of ER
- Cannot be performed independently
- External Rotation and extension maximizes contact area and joint stability
- To initiate knee flexion, popliteus “unlocks” the knee
MCL limits _______ stress, LCL limits ________ stress
Valgus, Varus
T or F? The collateral ligaments are taut in full extension
True
Superficial fibers of MCL are most taut in ___ of the knee
ER
Knee extension increases the length of the lateral ligaments by _____ in comparison to full flexion
20%
T or F? The cruciate ligaments of the knee are intracapsular and covered in synovium
True
Describe the ACL
- Runs in a superior, lateral, posterior direction
- Most fibers become taut as knee approaches full extension
- A taut ACL will limit anterior slide (knee extension)
- Most common ligament injured
- 70% of injuries are non contact
- Occurs with landing, cutting, decelerating
Describe the arthrokinematics of the knee joint during flexion/extension
Flexion (open chain): Posterior roll and slide
Flexion (closed chain): Posterior roll, anterior slide
Extension (open chain): Anterior roll and slide
Extension (closed chain): Anterior roll, posterior slide
Describe the PCL
- Runs in a superior, medial, anterior direction
- Most fibers become taut as knee approaches knee flexion (peak tension 90-120)
- Elongates 20% between full extension and 90 degrees (3% per 10 degrees)
- Posterior slide of tibia is limited by PCL during open chain flexion
- Limits anterior slide of femur on tibia in closed chain flexion
- Occurs with falling on a flexed knee, dashboard injury
How is the patellofemoral joint (PFJ) stabilized?
- Quadricep muscle force
- Joint congruency
- Passive restraint from retinaculum and capsule
T or F? Patellofemoral joint (PFJ) osteoarthritis is more common than tibiofemoral joint (TFJ) osteoarthritis
True
Describe the kinematics of the patellofemoral joint (PFJ) during open and closed chain movement
Open Chain:
- Patella slides on the trochlea
- Follows tibia during extension
Closed Chain:
- Trochlea slides relative to the fixed patella/tibia
When is the patellofemoral joint (PFJ) most stable?
Maximum stability:
- Partially flexed (60-90 degrees), bony structure provides the patella with stability
Minimal stability:
- Minimally flexed (20 degrees)
Describe the knee extensors
- Vastus medialis/lateralis produce 80% of the torque
- Rectus femoris produces 20% of the torque
- Collectively generate 66% more force than knee flexors
Describe the quadriceps torque/angle relationship at the knee
Tibial on Femoral Movement:
- Progressively increases from 90 to 0 degrees of knee flexion
- Largest from 45 to 0 degrees of knee flexion
- Smallest from 90 to 45 degrees of knee flexion
Femoral on Tibial Movement:
- Progressively decreases from 90 to 0 degrees of knee flexion
- Largest from 90 to 45 degrees of knee flexion
- Smallest from 45 to 0 degrees
Why is knee extension torque limited at the end range of motion (full extension)?
- Short moment arm
- Muscle shortening (active insufficiency)
Which factors can affect patellar tracking?
- Q angle
- Abnormal trochlear morphology
- VMO
- Retinaculum
- Femur kinematics
- Hip strength
- Foot pronation
Which factors affect the length of the internal moment arm (IMA)?
- Shape and position of patella
- Shape of distal femur (depth of intercondylar groove)
Describe the Q angle
- The angle between the ASIS, Patella, and Tibial tuberosity (13-15 degree average)
- Quadriceps pull the patella in a superior/lateral direction (more lateral pull due to the vastus lateralis being stronger than vastus medialis)
- VMO provides compressive forces from 20 to 0 degrees of knee flexion
List the compressive forces of the patellofemoral joint (PFJ) during walking, straight leg raise, climbing stairs, and squatting
1.3x bodyweight during walking
2.6x bodyweight during straight leg raises
3.3x bodyweight when climbing stairs
7.8x bodyweight during a full squat
(Note: The force occurs during quadricep activation, but the magnitude is influenced by the joint angle)
Which factors affect patellofemoral joint (PFJ) kinematics?
Local factors:
- Q-angle
- Abnormal trochlea of femur
- VMO
- Retinaculum (connective tissue)
Global factors:
- Femur kinematics
- Hip strength
- Foot pronation
- Muscle strength
Which two forces create the “bowstring force” on the patella?
IT band and the lateral patellar retinacular fibers
(Resultant force pulls patella lateral causing decreased contact area and increased joint stress + risk of dislocation)
T or F? A flattened trochlea of the femur will cause trochlear dysplasia
True
T or F? Excessive genu valgum (knee valgus) increases lateral forces which leads to cartilage damage, eventually causing osteoarthritis
True… this can also be caused by an MCL injury
T or F? The knee can be externally rotated even if the femur is internally rotated
True
T or F? External rotation of the knee can be caused by a valgus force and lead to an increased Q angle
True
T or F? Subtalar joint pronation can cause tibial internal rotation
True
List the knee flexors/rotators and their function
Hamstrings
- Semimembranosus: IR
- Semitendinosus: IR
- Biceps Femoris: ER
(All do hip extension, knee flexion)
Sartorius/Gracilis
- Hip flexion
- Knee IR
Pes Anserine Tendons
- Dynamic stability to medial knee
- Resist valgus and ER
Popliteus
- Unlocks the knee
T or F? Knee flexors can accelerate or decelerate the lower leg during swing phase
True
T or F? Knee flexor torque production is at its greatest when the hip is extended with slight knee flexion
True
T or F? The knee flexor (hamstrings) moment arm is greatest at 50-90 degrees of knee flexion
True
T or F? Muscle length plays a more important role in knee flexion torque generation in comparison to leverage
True
What are the two main goals of the foot?
- Foot needs to be flexible to absorb stress
- Also needs to be rigid to withstand large propulsive forces
Which bones make up the talocrural joint (TCJ)?
Fibula, Tibia, Talus
Which bones make up the rearfoot, midfoot, and forefoot?
Rear/hind foot:
- Talus
- Calcaneus
- Subtalar joint
Midfoot:
- Navicular
- Cuboid
- Cuneiforms
(+ transverse tarsal joints, distal intertarsal joints)
Forefoot:
- Metatarsals
- Phalanges
(+ tarsometatarsal joint)
List the planes and axis of dorsiflexion, plantarflexion, eversion, inversion, abduction, adduction
Dorsiflexion/Plantarflexion
- Sagittal plane
- Media/Lateral axis
Eversion/Inversion
- Frontal plane
- Anterior/Posterior axis
Abduction/Adduction
- Transverse plane
- Vertical axis
Which movements make up pronation and supination of the ankle?
Pronation:
- Dorsiflexion
- Abduction
- Eversion
Supination:
- Plantarflexion
- Adduction
- Inversion
T or F? Pronation and supination are triplanar motions
True
Describe the Talocrural joint (TCJ)
- “Mortise” joint
- Convex talus, Concave tibia/fibula
- 90% of forces pass through tibia and talus
- 3mm of articular cartilage
Describe the Talocrural joint osteokinematics
- Oblique axis due to lateral malleolus inferior and posterior to medial
- 1 degree of dorsiflexion with pronation
- 1 degree of plantarflexion with supination
T or F? Ankle rolls while plantarflexed causes soft tissue injuries whereas ankle rolls while dorsiflexed causes a fracture
True
At the subtalar joint, the talus is _________, the calcaneus is __________
Concave, Convex
When dorsiflexing in a closed chain position at the talocrural joint, the roll is _________ and the slide is __________. When dorsiflexing in an open chain position at the talocrural joint, the roll is __________ and the slide is __________
Anterior, Anterior
Anterior, Posterior
Describe the subtalar joint (STJ)
- The joint between the talus and calcaneus
- Can perform dorsiflexion, plantarflexion, abduction, adduction, inversion, and eversion
- Axis goes through from posterior/lateral to anterior/medial
Subtalar joint (STJ) varus consists of ________ and _________, valgus consists of _________ and ________
Inversion, Adduction
Eversion, Abduction
T or F? Subtalar joint (STJ) supination raises the medial arch of the foot while pronation flattens it
True
Describe open and closed chain pronation at the subtalar joint (STJ)
Open Chain:
- Calcaneus abduction, dorsiflexion, eversion
Closed Chain:
- Calcaneus eversion
- Talus plantarflexion and adduction
- Foot abduction and dorsiflexion
- Tibia IR
Describe open and closed chain supination at the subtalar joint (STJ)
Open Chain:
- Calcaneus adduction, inversion, plantarflexion
Closed Chain:
- Calcaneus inversion
- Talus dorsiflexion and abduction
- Foot adduction and inversion
- Tibia ER
Describe the function of the subtalar joint (STJ)
- Shock absorption (pronation) during gait
- Supination in late stance offers rigid lever for push off
List the two transverse (mid) tarsal joints (TTJ) and the bones that make them up
Talonavicular joint (Talus and navicular bones)
Calcaneocuboid joint (Calcaneus and cuboid bones)
What are the functions of the transverse (mid) tarsal joints (TTJ)
- Connect rearfoot to midfoot
- Allows the foot to adapt to a variety of surfaces (standing on rocks, sand, etc.)
Describe the talonavicular joint
- Convex talus, concave navicular
- Provides mobility to the medial column of the foot
- Plantar calcaneonavicular ligament supports head of talus
Describe the calcaneocuboid joint
- Anterior/distal calcaneus and proximal cuboid
- Each surface has a convex and concave curvature (minimal movement)
- Provides lateral foot stability
Ligaments
- Dorsal calcaneocuboid ligament (dorsal lateral stability)
- Bifurcated ligament (dorsal stability)
- Long and short plantar ligament (plantar stability)
T or F? The transverse tarsal joint (TTJ) moves in conjunction with the subtalar joint to produce pronation and supination movements
True
List the axes of rotation at the transverse tarsal joint (TTJ)
- Longitudinal (inversion/eversion)
- Oblique (Abduction/Dorsiflexion and Adduction/Plantarflexion)
Both axes are used to produce pronation/supination
Which position makes the foot more mobile? Which position makes it more rigid?
Mobile
- Pronation
- Talonavicular and calcaneocuboid joint align parallel
Rigid
- Supination
- Talonavicular and calcaneocuboid align perpendicular
T or F? The calcaneocuboid joint basically has the same function/movement as the talocrural joint
True
Which joints connect the rearfoot to midfoot?
Talonavicular and calcaneocuboid
Which structures make up the medial longitudinal arch?
- 1st metatarsal
- Medial cuneiform
- Navicular
- Talus
- Sustentaculum tali
- Calcaneus
Which structures make up the lateral longitudinal arch?
- 5th metatarsal
- Cuboid
- Calcaneus
Which structures make up the transverse arch?
- Medial cuneiform
- Intermediate cuneiform
- Lateral cuneiform
Describe the medial longitudinal arch
- Talonavicular joint is the “keystone”
- Medial instep is concave
- Is the “shock absorber” of the foot and supports the foot when standing
How is the medial longitudinal arch supported?
- Plantar fascia stretches when toe extends, leading to more support
- When standing, the arch distributes the load anterior and posterior from the talonavicular joint
(Note: not much activation is needed from intrinsic or extrinsic muscles)
T of F? If the plantar fascia becomes elongated, then stability will decrease… meaning the lower the arch, the harder it is to stabilize the foot
True
What is the windlass mechanism?
Basically a pulley system
1st MTP joint flexion/extension controls the movement of the plantar fascia
When the 1st MTP extends, plantar fascia is tightened and a higher arch is achieved, allowing for more support and stability
Describe “pes planus” feet
Flat feet with no arch
Caused by: Overstretched fascia and spring ligament or weak posterior tibialis
- During stance, subtalar joint (STJ) pronates/everts causing calcaneal eversion
- Will not be able to dissipate loads properly with flat feet (which will require intrinsic and extrinsic muscles to activate as a compensation)
Describe “pes cavus” feet”
Pes Cavus
- neutral calcaneus
- forefoot is plantarflexed
Severe Pes Cavus
- varus calcaneus
- 1st metatarsal plantarflexion
- claw toes
Which factors influence excessive pronation of the foot?
Hip:
- Internal rotation
- Flexion
- Adduction
Knee:
- Valgus
Tibia:
- Internal rotation
Forefoot and midfoot supination
Which factors influence to excessive supination of the foot?
Hip:
- External rotation
- Extension
- Abduction
Knee:
- Varus
Tibia:
- External rotation
Forefoot and midfoot pronation
List the muscles that dorsiflex/invert, dorsiflex/evert,
plantarflex/invert, and plantarflex/evert
Dorsiflexion/Inversion
- Extensor hallucis longus
- Anterior tib
Dorsiflexion/Eversion
- Extensor digitorum longus
- Fibularis tertius
Plantarflexion/Inversion
- Posterior tib
- Flexor digitorum longus
- Flexor hallucis longus
- Achilles tendon
Plantarflexion/Eversion
- Fibularis brevis
- Fibularis longus
T or F? Anterior tib inverts the subtalar joint and supports the medial arch
True
Which muscles evert the subtalar joint?
Extensor digitorum longus and fibularis tertius
What is the function of the anterior compartment of the ankle?
- Allow for a soft landing
- Keep toes off the ground during swing phase
T or F? Tibialis anterior paralysis will still allow the ankle to dorsiflex, but will evert rather than invert
True
What is the function of the lateral compartment of the ankle?
- Provides the lateral ankle with active stability
- Decelerate the rate of supination at the subtalar joint during mid/late stance of gait
- Assists with plantarflexion and balances the inversion pull of the posterior tibialis during the late stance of gait
What is the function of the posterior compartment of the ankle?
- All of the muscles plantarflex and supinate
- Decelerates dorsiflexion when loading, and concentrically contracts before swing phase
List the functions of the posterior tib
- Greatest supination torque
- Resist/decelerate pronation (slowly lowers medial arch of foot)
- Active supination in late stance
T or F? The plantarflexors generate the most isometric torque of the ankle muscle groups
True (but greatest torque at full dorsiflexion and least at full plantarflexion)
(eversion muscles generate the least isometric torque)
T or F? When plantarflexed, the knee should be extended to prevent over shortening of the gastroc
True
Which muscle is better suited for control of slow and subtle postural sway… gastroc or soleus
Soleus
What is the role of the intrinsic foot muscles?
- Not for dexterity like the hand is
- Provides stability to foot and medial arch during push off (active in late stance)
T or F? Knee flexor torque (hamstrings) is greatest at what angle?
5 degrees of knee flexion
