KIN2 Theory review Flashcards
What happens to the O&I during stretching
O&I are pulled apart
what happens to the O&I during strengthening
O&I are approximated, the insertion goes towards the origin
large sesamoid bone in quadriceps tendon
patella
what way does the patella slide with knee extension
patella slides superiorly
what way does the patella slide with knee flexion
patella slides inferiorly
articulations of the patella
Two condyles of distal femur
Two tibial plateaus on proximal tibia
at what degree of of flexion does the inferior patella begins to articulate with femur
5 degrees of flexion
at what degree does the patella inferior to patellar groove, quadriceps tendon is in contact.
90 degrees
What are some conditions/circumstances where muscle setting is appropriate or indicated?
Fractures: When a client can’t move a joint. (A cast)
During the protection phase
5 periods of stance phase
1) Initial contact (heel strike)
2) Load response (weight accepted or flat foot)
3) Midstance (Single-leg support)
4) Terminal stance (Heel off)
5) Pre swing (Toe off)
3 periods of swing phase
1) Initial swing
2) Mid swing
3) Terminal swing (Deceleration)
Pain in initial contact phase of gait:
heel spur bone bruise heel fat pad bruise Bursitis pain could cause an increase in flexion of the knee with early plantar flexion to relieve the pressure or pain weak knee client extends the knee
Pain in midstance phase of gait:
Greatest force is on the hip in this phase
Experiencing pain- phase shortened as the client hurries through the phase to decrease pain
Weak gluteus medius- positive trendelenburg’s sign
Knee flexes, ankle is locked at 5-8 degrees of dorsiflexion rolling forward on the forefoot. Foot is in contact with the floor, forefoot is pronated, hindfoot is inverted
Pain caused by- arthritis, rigid pes planus, fallen metatarsal (loss of arch), plantar fasciitis, morton’s metatarsalgia.
Pain in toe off stage of gait:
Hallux rigidus
Turf toe
Any pathology involving the great toe
TMJ (joint description)
Synovial condylar, modified ovoid and hinge joint
· Fibrocartilaginous surfaces
· Disc completely divides each joint into two cavities, provides congruent contours and lubrication for the joint, disc is a biconcave articular disc
· Capsule is loose and thin
· Temporal bone (superior), Allows for gliding motion
Movement of TMJ
Gliding, translation or sliding movement occurs in the upper cavity of the TMJ,
· Rotation and hinge movement occurs in the lower cavity
· Rotation – occurs from the beginning to the midrange of movement, It occurs through the two condylar heads, condyle and the articular discs
· Both gliding and rotation is needed for full opening and closing of the mouth
· The TMJ actively displaces only anterior and slightly lateral
· When the mouth is open the condyles of the joint rest on the disc in the articular eminences and any sudden movement (yawn) will displace one or both condyles forward
· The mandible moves forward on opening the disc moves medially and posteriorly until the collateral ligament and later pterygoid stop its movement the disc is then seated on the head of the mandible and both mandible and disc move forward to full opening, if seating does not occur then limited ROM will occur
· The mandible and the disc move together mainly translation occurs in the superior joint space
Muscle of TMJ
The upper lateral pterygoids draw the disc or meniscus anteriorly and prepares for condylar rotation
· medial and lateral pterygoids, temporalis, masseter, supra- and infra- hyoids
ligaments of TMJ
Lateral collateral and capsular ligaments coordinate movement between the disc and condyle
A self-protective and a result of injury to the pelvis, hip, knee, ankle and foot. The stance phase on the affective leg is shorter than that on the non-affected leg, because the client tries to remove weight of the affective side as quickly as possible. The swing phase of the uninvolved leg is decreased. There is a shorter step length on the uninvolved side, decreased walking velocity and decreased cadence.
Antalgic (painful) gait
A gait pattern characterized by staggering and unsteadiness. Lack of coordination and tendency of poor balance. There is usually a wide base of support and movements are exaggerated.
Ataxic gait
A gait pattern in which the feet and toes are lifted through hip and knee flexion to excessive heights; usually secondary to dorsiflexion weakness. The foot will slap at initial contact with the ground secondary to decreased control.
Steppage (drop foot) gait
a staggering gait pattern seen in cerebellar disease
cerebellar gait
.
a gait pattern in which alternate steps of a different length or at a different rate
Double step gait
a gait pattern characterized by high steps, usually involves excessive activity of the gastrocnemius.
Equine gait
a gait pattern in which the legs cross midline upon advancement
Scissor gait
a gait pattern where a patient walks on toes as though pushed. It starts slowly, increases, and may continue until the patient grasps an object in order to stop.
Festinating gait
a gait pattern with stiff movements, toes seeming to catch and drag, legs are held together, hip and knees slightly flexed. Commonly seen in spastic paraplegia
Spastic gait
a gait pattern that denotes gluteus medius weakness; excessive lateral trunk flexion and weight shifting over the stance leg.
Trendelenburg (gluteus medius) gait
The number of steps per time unit
Normally 90-120 steps per minute
Cadence
Contraindications for Stretching?
A bony block limits joint motion
· Recent fracture/ bony union
· Acute inflammatory or infectious process
· Sharp acute pain with joint movement or muscle elongation
· A hematoma
· Joint hypermobility already exists
· Shorted soft tissues enable a patient with paralysis or severe muscle weakness to perform specific functional skills otherwise not possible.
GH JT distraction is increased by
overall mobility
GH JT flexion is increased by
posterior glide
GH JT extension is increased by
anterior glide
GH JT abduction is increased by
inferior glide
GH JT external rot. is increased by
anterior glide
GH JT internal rot. is increased by
posterior glide
GH JT horizontal abduction is increased by
anterior glide
GH JT horizontal adduction is increased by
posterior glide
sternoclavicular jt depression is increased by
superior glide
sternoclavicular jt elevation is increased by
inferior glide
sternoclavicular jt retraction is increased by
posterior glide
sternoclavicular jt protraction is increased by
anterior glide
Acromioclavicular Joint general mobility is increased by
anterior glide
concave scapular on convex rib cage
motion: results in motions occurring at Scapulothoracic and Acromioclavicular joints
Scapulothoracic Articulation
scapular elevation is increased by
depression
scapular protraction/abduction is increased by
abduction/ retraction
scapular upward rotation is increased by
downward rotation
Humeroulnar Joint overall mobility is increased by
distraction
Humeroulnar Joint flexion is increased by
distal glide
Humeroulnar Joint varus (flexion) is increased by
radial glide
Humeroulnar Joint valgus (extension) is increased by
ulnar glide
Humeroradial Joint: overall mobility is increased by
distraction
Humeroradial Joint: extension is increased by
dorsal posterior glide
Humeroradial Joint: flexion is increased by
volar anterior glide
Proximal Radioulnar Joint pronation is increased by
dorsal (posterior) glide
Proximal Radioulnar Joint supination is increased by
volar (anterior) glide
Distal Radioulnar Joint supination is increased by
dorsal (posterior) glide
Distal Radioulnar Joint pronation
volar (anterior) glide
Radiocarpal overall mobility is increased by
distraction
Radiocarpal flexion is increased by
dorsal (posterior) glide
Radiocarpal extension is increased by
volar (anterior) glide
Radiocarpal ulnar deviation is increased by
radial glide
Radiocarpal radial deviation is increased by
ulnar glide
Carpometacarpal overall mobility is increased by
distraction
Carpometacarpal mobility of the arch of the hand is increased by
volar glide
Carpometacarpal of thumb overall mobilty is increased by
distraction
Carpometacarpal of thumb radial adduction (extension)
Ulnar glide
Carpometacarpal of thumb radial abduction is increased by
radial glide
Carpometacarpal of thumb palmar abduction is increased by
dorsal (posterior) glide
Carpometacarpal of thumb palmar adduction is increased by
volar (anterior) glide
MCP/PIP/DIP overall mobility is increased by
distraction
MCP/PIP/DIP flexion is increased by
volar (anterior) glide
MCP/PIP/DIP extension is increased by
dorsal (posterior) glide
MCP/PIP/DIP abduction/adduction is increased by
radial or ulnar glide depending on the finger
Hip joint overall mobility is increased by
distraction
hip joint extension/ external rotation is increased by
anterior glide
Small-amplitude rhythmic oscillations are performed at the beginning of the range (quick vibration)
Oscillation Techniques:
· Grade 1
Large-amplitude rhythmic oscillations are performed within the range, not reaching the limit (slow 2-3/second for 1 to 2 minutes)
Oscillation Techniques:
· Grade 2
Large-amplitude rhythmic oscillations are performed up to the limit of the available motion and are stressed into the tissue resistance (slow 2-3/second for 1 to 2 minutes)
Oscillation Techniques:
· Grade 3
Small-amplitude rhythmic oscillations are performed at the limit of the available motion and stressed into the tissue resistance (quick vibration)
Oscillation Techniques:
· Grade 4
Indication for Oscillation:
Grade 1 and 2 are primarily used for treating joints limited by pain or muscle guarding. These non-stretch motions help move synovial fluid to improve nutrition to the cartilage.
· Grade 3 and 4 are primarily used as stretching maneuvers
Small-amplitude distraction is applied where no stress is placed on the capsule. It equalizes pressure being placed on the joint. (Apply for 7-10 sec with few sec of rest several cycles)
Sustained Techniques:
· Grade 1 (loosen)
Enough distraction or glide is applied to tighten the tissue around the joint (AKA taking up the slack)
Sustained Techniques:
· Grade 2 (tighten)
A distraction or glide is applied with an amplitude large enough to place stretch on the joint capsule and surrounding periarticular structures. (Apply a 6 second minimum hold, release to grade 1 or 2, then repeat in 3-4 second intervals.
Sustained Techniques:
· Grade 3
Indications for Distraction
Grade 1
Grade 1: is used with all gliding motion and may be used to relieve pain.
Indications for Distraction
Grade 2
Grade 2: distraction is used for initial treatment to determine how sensitive the joint is (assessment) and if done intermittently it is used to decrease pain as well as maintain joint play when ROM is not allowed
Indications for Distraction
Grade 3
Grade 3: is used to stretch the joint structures thus increase joint play
palpation for masseter
gloved finger placed between cheek and molars with client’s teeth gently clenched.
o Isolate muscle – clench teeth
palpation for Lateral Pterygoid
gloved finger placed between cheek and molars with the fingernail against the last upper molars, the finger is slid superiorly and posteriorly between the maxilla and the coronoid process into the hollow at the roof of the cheek pouch.
o Isolate muscle – resisted depression (opening)
palpation for Medial Pterygoid
gloved finger placed on the last molar, then slide around to the medial surface of the molar and inferiorly past the gum towards the floor of the mouth. Keeping the finger pad against the inner surface of the mandible the finger is then slid posteriorly to the medial pterygoid
o Isolate muscle – resisted elevation (closing)
palpation for Mylohyoid
gloved finger placed between the lower teeth and tongue. Beginning at the incisors, the finger pad is slid down the inner surface of the mandible to the floor of the mouth, continuing posteriorly to the last molar where mylohyoid ends.
o Isolate muscle – resisted depression (opening)
Tibial motion opened chain (flexion) roll:
posterior and medial rotation slide: posterior
Tibial motion open chain (extension) roll:
anterior and lateral rotation slide: anterior
Femoral motion closed chain (flexion) roll:
posterior and lateral rotation slide: anterior
Femoral motion closed chain (extension) roll:
anterior and medial rotation slide: posterior
close chain for the ankle
Ankle dorsiflexion
open chain for the ankle
Ankle plantarflexion
Open chain for the subtalar (talocalcaneal) joint
the convex posterior portion of calcaneus slides opposite to motion and the concave middle and anterior portions slide in the same direction (like a door knob/tap) can’t find close chain
Open chain for the talonavicular joint
pronation the navicular slides dorsally and laterally and in subination the navicular slides plantarly and medially
TMJ closed pack position
teeth tightly clenched
Use the hand opposite the side on which you are working.
· Place your thumb in the patient’s mouth on the back molars
· the fingers are outside and wrapped around the jaw
· The force is in a downward (caudal) direction
unilateral distraction
After distracting the jaw as above, pull it in an anterior direction with a tipping motion.
· The other hand can be placed over the TMJ to palpate the amount of movement
unilateral distraction with glide
If the patient is supine, stand at the head of the table.
· If the patient is sitting, stand in front of the patient.
· Use both thumbs, placing them on the molars on each side of the mandible
· The fingers are wrapped around the jaw
· The force from the thumbs is equal in a caudal direction
bilateral distraction
Place cotton dental rolls between the back teeth and have the client bite down
· This distracts the condyles from the fossae in the joints
Self-mobilization
What physiological movements make up Supination?
During supination: plantarflexion, inversion, and adduction are the physical movements that make up supination.
What physiological movements make up pronation
During pronation: dorsiflexion, eversion, and abduction are the physical movements that make up pronation.
What are common causes of overuse syndromes?
(As they relate to the leg) Faulty alignment Muscle imbalances Fatigued mm Changes in exercise routine Training errors Improper footwear Predisposing – abnormal pronation of the subtalar joint due to joint mobility, leg length, strength imbalances, genu valgum, mm flexibility
formed by two intersecting lines.
· ASIS to mid patella & Mid patella to tibial tuberosity
· Greater in women (approx. 10-15 degrees
Q angle
lateral shift of the mandible resulting from the movements of the condyles along the lateral inclines of the mandibular fossa during lateral jaw movement.
Bennett Movement (shift)
TMJ resting position
Mouth slightly open lips together, teeth not in contact
Capsular pattern of TMJ
limitation of mouth opening
What muscle is a common source of knee pain but is often overlooked as a cause of knee pain?
sartorius
-other common mms are those that attach at the pes anserine
what would someone with drop foot, & weak dorsiflexion due to get rid of steppage gait
strengthen tibialis anterior
when hip is flexed what direction does the femur roll
anterior
lateral blow to the knee causes what injury
injury to MCL & meniscus
purpose of progressive relaxation exercise
- decrease sns
- reduce pain
- relaxation
- increase body awareness (proprioception)
bones that form the mortise
distal tibia and fibula (med & lat malleolus)
➢ The distance between the two feet
➢ Normally, 5-10 cms (2-4 inches)
Normal base width
➢ Aka gait length
➢ The distance between successive contact points on opposite feet.
➢ Normally, 35-41 cms (14-16 inches)
➢ Should be equal for both legs
Step length
how step length varies with age & sex:
children taking smaller steps than adults
o females take smaller steps than males
o Tends to decrease with age, fatigue, pain and disease
o A taller person also takes larger steps than those who are shorter.
➢ The linear distance in the plane of progression between successive points f foot to
foot contact of the same foot.
➢ Normally, 70-82 cms (27.5 -32.3 inches)
➢ Equals one gait cycle
➢ Decreases with age, pain, disease and fatigue
Stride length
o The side to side movement of the pelvis during walking (also called pelvic list)
o This is necessary to center the weight of the body over the stance leg for balance
o Normally, 2.5-5 cms (increasing if the feet are further apart)
LATERAL PELVIC SHIFT
o Keeps the center of gravity from moving up and down more than 5 cms (2”)
during normal gait
o The high point occurs during midstance and the low point during initial contact.
VERTICAL PELVIC SHIFT
o Necessary to lessen the angle of the femur with the floor, thus lengthening the
femur
o Normally, an 8° total pelvic rotation takes place- 4° forward on the swing leg,
and 4° posteriorly on the stance leg.
o When the pelvis rotates clockwise, the thorax rotates counterclockwise, and vise
vers
PELVIC ROTATION
Is the screw home mechanism open or closed chain for the ankle
Closed chain
Ankle dorsiflexors, hip extensors, knee flexors.
EX: Tibialis anterior, glute max, hamstrings
Stance Phase 1 Initial contact (heel strike)
Knee extensors, hip abductors, ankle plantar flexors
EX: Vasti, glute med, gastrocnemius, soleus
Stance Phase 2 Load response (weight accepted or flat foot)
Ankle plantar flexors (isometric)
EX: gastrocnemius, Soleus
Stance Phase 3 Midstance (Single-leg support)
Ankle plantar flexors (Concentrix)
EX: gastrocnemius, soleus
Stance Phase 4 Terminal stance (Heel off)
Hip flexors
EX: Iliopsoas, rectus femoris
Stance Phase 5 Pre swing (Toe off)
Ankle Dorsiflexors, hip flexors
EX: Tibialis anterior, iliopsoas, rectus femoris
Swing Phase 1 Initial swing
ankle Dorsiflexors
EX: Tibialis anterior
Swing Phase 2 Mid swing
Knee flexors, hip extensors, ankle Dorsiflexors, knee extensors
EX: hamstrings, gluteus maximus, tibialis anterior, vasti.
Swing Phase 3 Terminal swing (Deceleration)