Hip and Knee mechanics counterstrain Flashcards
1
Q
what is the hip
A
articulation of the head of the femur with the acetabulum of the innominate
2
Q
the hip joint is what type of socket designed for what?
A
ball and socket designed for stability
this is in contrast to the shoulder joint which is more shallow with less osseous support designed for maximal ROM
3
Q
with external rotation the head of the femur
A
glides anteriorly in the acetabulum
4
Q
with internal rotation the head of the femur
A
glides posteriorly in acetabulum
5
Q
what are the 3 ligaments of the hip
A
Iliofemoral ligament (more anterior) Ischiofemoral ligament (more posterior) Ligamentum teres capitis femoris
6
Q
with dislocation of the hip, what can occur
A
damages the joint capsule, ligaments and blood supply and may result in avascular necrosis of the head of the femur
7
Q
what are the hip flexors
A
psoas major iliacus pectineus rectus femoris sartorius
8
Q
where does the psoas major originate
A
sides of T12-L5 vertebrae and associated intervertebral disks
transverse processes of L1-L5
9
Q
where does the psoas major insert
A
lesser trochanter of femur
10
Q
what is the psoas major innervated by
A
L1, L2, L3
11
Q
what muscle dysfunction is often associated with low back pain and hip problems
what is limited if this muscle is tensed
where is pain referred
A
psoas major
limites hip extension
pain referred to anterior hip or thigh
12
Q
what are the hip extensors
A
gluteus maximus and hamstrings
13
Q
what is the origin of the gluteus maximus
A
posterior gluteal line of ilium iliac crest aponeurosis of erector spinae sacrum and coccyx sacrotuberous ligament fascia covering gluteus medius
14
Q
where does the gluteus maxmus insert
A
iliotibial tract of fascia latae
15
Q
what is the gluteus maximus innervated by
A
L5, S1, S2
16
Q
how does the gluteus maximus become weak
A
May become weak and inhibited with prolonged sitting and sedentary lifestyle and may need to be strengthened with rehabilitative exercises
17
Q
what muscles limit flexion
A
gluteus maximus and hamstring that are tense
18
Q
what are the abdcutors of the hip
A
gluteus medius
gluteus minimus
tensor fascia lata
sartorius muscle
19
Q
dysfunction of what muscle is often is frequently seen with lateral hip and lateral knee pain
A
tensor fascia lata
20
Q
where is the origin of the gluteus medius muscle
A
upper outer ilium
21
Q
where does the gluteus medius insert
A
greater trochanter
22
Q
what is the innervation of the gluteus medius
A
L5 and S1 (superior gluteal nerve)
23
Q
what are the adductors of the hip (5)
A
adductor longus adductor brevis adductor magnus obturator externus gracilis
24
Q
where is the origin of the adductor longus
A
anterior aspect of the pubis
25
where is the insertion of the adductor longus
inserts into middle third of femur
26
what is the innervation of the adductor longus
L2, L3, L4, (obturator nerve)
27
tightness of the adductor longus can result in what?
inferior pubic symphysis shear
this is frequently seen with persistent groin pulls
especially those that are slow to respond to conservative treatment
28
where is the origin of the gluteus minimus
outer surface of ilium and greater sciatic notch
29
where does the gluteus minimus insert
greater trochanter
30
what is the gluteus minimus innervated by
L5 and S1 (superior gluteal n)
31
what are the external rotators
```
obturators
gemelli
quadratus femoris
gluteus maximus
sartorius
piriformis
```
32
where is the origin of the piriformis
originates on anterior surface of sacrum
gluteal surface of the ilium
capsule of sacroiliac joint
sometimes sacroiliac and sacrotuberous ligaments
33
where does the piriformis insert
greater trochanter of femur
34
what is the piriformis innervated by
S1 and S2
35
what does tightness of the piriformis cause
decreases internal rotation and may irritate the sciatic nerve
36
what do decreased hip extension (due to psoas major) and decreased internal rotation (due to piriformis) muscle tension respond to
very well to OMM (muscle energy techniques
37
what is the function of the acetabular labrum
Helps maintain hip stability
| Provides proprioceptive information regarding hip motion
38
what are the signs and symptoms of a torn acetabular labrum
what makes it worse
when do you suspect this injury
sharp, deep pain in the anterior thigh and/or groin.
Worsens when rising from a seated to standing position. May also “click” with motion.
Suspect injury to this with hip injuries that are nonresponsive to conservative treatment
39
how do you diagnose a labrum tear
MRI
if nonresponsive to conservative care may require surgery
40
when looking at a joint where do you also look
joint above and below the injured area for other potential problems
41
what is the first motion lost with intraarticular hip problems (fracture or degenerative joint disease)
internal rotation
42
when examining any body region always compare what to what
compare the injured and uninjured side b/c everyone's normal is different
43
what are the major motions of the knee
flexion and extension
44
what are the minor gliding motions of the tibial plateau
anterior/posterior gliding
medial/lateral gliding
internal rotation with posterolateral gliding
external rotation with anteromedial gliding
45
internal rotation of the tibia is accompanied by what
posterolateral gliding
46
external rotation of the tibia is accompanied by what
anterolateral gliding
47
what is the screw home mechanism of the knee
allows the lower extremity to function as a solid column for weight bearing
48
when the knee is fully extended what happens to the knee
the knee passively locks due to medial rotation of the femoral condyles on the tibial plateau
49
what does the anterior cruciate ligament
prevents anterior translation of the tibia
50
what does the posterior cruciate ligament do
prevents posterior translation of the tibia
injured after hit from the front such as a person in a car accident that drove their tibia into the dashboard
51
how can you injure the medial collateral ligament
injured by valgus force (from lateral side towards medial)
52
how can you injure the lateral collateral ligament
a varus force from the medial side to the lateral
53
what are grade 1 or 2 tears
how do you treat these
partial tears
treated conservatively with OMM and/or rehabilitation
54
what is the grade for a complete tear
how do you treat
grade 3
frequently require surgical repair or reconstruction
55
what are the menisci
crescent shaped plates of fibrocartilage found on the articular surface of the tibia
medial meniscus is larger and more half moon shaped
also medial meniscus is attached to the medial collateral ligament
56
what is the function of the menisci
play role in shock absorption
help provide some stability
provide proprioceptive feedback regarding joint motion
57
what part of the menisci is vascularized and avascularized
outer 1/3 is vascuar (more likely to heal)
inner 1/3 is avascular (less likely to heal)
58
can you still have a meniscal tear without joint locking?
yes but maybe less severe
59
what does joint locking indicate and what is the intervention?
may indicate a very significant meniscal tear and is an indication for an MRI and probable surgery
also a history of subjective instability may indicate a meniscal tear
60
what does lateral joint line tenderness or palpable tissue texture changes indicate?
medial ?
lateral meniscus tear
medial meniscus tear
61
what does tenderness in the popliteal fossa indicate
a possible tear of the posterior horn of either meniscus
***frequently see combinations of ligament and meniscal injuries
62
what is the terrible triad and what is its other name
O'Donoghue's triad
ACL, MCL and medial meniscus
63
what are the knee flexors (5)
```
biceps femoris
semimembranosus
semitendinosus
popliteus
gastrocnemius
```
64
what is the other function of the popliteus (other than knee flexor)
dynamic tensioner of lateral meniscus
65
dysfunction of the flexors of the knee are often associated with what?
posterior knee pain
66
what is the origin of the biceps femoris
originates on the ischial tuberosity and sacrotuberous ligament and femur
67
where is the insertion of the biceps femoris (3)
fibular head
lateral collateral ligament
lateral condyle of tibia
68
what is the innervation of the biceps femoris
L5, S1 and S2 (sciatic nerve)
69
what are the knee extensors
include the rectus femurs
vastus lateralis
vastus medialis
vastus intermedius
70
dysfunction of the knee extensors may be associated with what
anterior knee pain
71
where does the rectus femoris originate
anterior inferior iliac spine (AIIS)
| groove above acetabulum and capsule of hip joint
72
where does the rectus femoris insert
into base of patella and ultimately tibial tuberosity via patellar tendon
73
what innervates the rectus femoris
femoral nerve (L2, L3, L4)
74
what does excessive tension in the knee flexors cause
limit knee extension
75
what does excessive tension in the knee extensors limit
knee flexion
76
what motion does the proximal tibiofibular joint allow
posteromedial and anterolateral of the fibular head
77
when the fibular head glides anteriorly...
the lateral malleolus glides posteriorly
78
when the fibular head glides posteriorly
the lateral malleolus glides anteriorly
79
inversion ankle sprains may result in restriction of what
lateral malleolus and fibular head
80
what do you commonly find with fibular head restrictions
hamstring strains and injuries to the lateral collateral ligament
this is because the lateral collateral ligament and lateral hamstring muscle (biceps femurs) attaches to the fibular head
81
what is wrong if a fibular head restriction persists despite treatment?
injury to the lateral malleolus
82
what is frequently associated with lateral knee pain
somatic dysfunction of the knee is frequently associated with restriction of the tibiofibular joint
83
what nerve runs near the fibular head
the common fibular
84
what dysfunction of the fibula may affect the function of the common fibular nerve. what is the outcome of this?
posterior fibular head
leads to foot drop
85
what is the major artery supplying the lower extremity
femoral artery
located in the femoral triangle
86
what are the boundaries of the femoral triangle
sartorius
adductor longus
inguinal ligament
87
what can reduce arterial supply to the lower extremity ? what is the problem with this?
Any somatic dysfunction affecting the femoral triangle and/or subsequent fascial restriction associated with somatic dysfunction of the lumbar spine, innominates, sacrum and lower extremities can reduce arterial supply to lower extremity
slows healing
88
what is the major venous drainage of the lower extremity
femoral vein which also course through the femoral triangle
89
where is the majority of lymphatic drainage of the lower extremity
majority course through the superficial and deep inguinal nodes in route ultimately to the left lymphatic (thoracic duct)
90
what can impair drainage of the lower extremity
```
tension affecting the various functional diaphragms including:
popliteal
pelvic
respiratory
thoracic inlet
```
the various diaphragms must work in synchrony
91
what is the sympathetic innervation to the lower extremity
cell bodies of PREganglionic neurons located in T10-L3 (NBOME)
92
what happens with sympathetic innervation of the lower limb
Smooth muscle in walls of lymphatic vessels contract when sympathetic nerves are stimulated
Reduces size of lumen, thereby impairing lymphatic drainage
93
what happens if there is somatic dysfunction of the thoracolumbar junction
increases sympathetic tone to the lower extremity
Decreased lymphatic drainage
May lead to increased swelling within the lower extremity, impairing function and recovery
94
where are tender points for hip injuries or trochanteric bursitis
lateral trochanter
95
where are tender points for knee injuries
medial and lateral meniscal tender points
96
what are the principals of counterstrain
how much should pain be reduced and how long do you hold it
Locate a tender point
Establish a pain scale (10 point)
Find a position that reduces the discomfort by at least 70% (preferably 100%). The patient remains passive (relaxed) throughout the technique
Hold the position for 90 seconds
Slowly return the patient to the starting position
Reassess
97
what is the goal of OMM
to improve motion and function, thereby establishing an environment where the body can heal and exist in health
98
when can a patient return to work/play/sports
full painless ROM
strength atleast 90 percent of the uninjured side
able to tolerate work/sport/play without increasing symptoms
