Kines: TMJ, Respiration, Posture, Anthropometric Test Flashcards
What makes up the TMJ
Left and right temporal bones
mandible: only moving bone of the skull
hyoid: ligament and muscle attachment
sphenoid: ligament and muscle attachment
maxilla: upper jaw; muscle attachment
articular disk:
divides each joint into upper and lower joints
attached firmly to mandibular condyle
upper joint: (TMJ)
convex articular eminence of temporal bone
concave superior surface of disk
gliding joint (amphiarthrodial)
lower joint: TMJ
superior/anterior convex articular surface of mandibular condyle
concave inferior surface of the disk
hinge joint (diarthrodial)
functionally: (TMJ)
hinge with a movable socket
motion in all 3 planes
one capsule
articular surfaces (TMJ)
no hyaline cartilage
covered with fibrocartilage with more potential for self-repair
disk is vascular around the edges, avascular in the center
capsule (TMJ)
thin and loose above the disk
thick and strong laterally
encloses the entire mandibular condyle
Open packed (TMJ)
mouth slightly open
Closed pack (TMJ)
Teeth clenched
rest position (TMJ)
rest position–1.5 to 5.0 mm between teeth
TMJ Sagittal plane:
mandibular depression (mouth opening) * measured in mm between central incisors
mandibular elevation (mouth closing) * closed is closed; not measured
TMJ Frontal plane:
lateral deviation–movement of jaw laterally
*10 mm each way is normal
TMJ Transverse plane:
protrusion (jaw forward)
retrusion (jaw backward)
*can be measured
Mandibular elevation prime movers:
masseters
temporalis
medial pterygoids
Lateral deviation prime movers:
Prime: right lateral & medial pterygoids
left masseter and left temporalis
- to R, it’s left lateral and medial pterygoids, right masseter & temporalis
Protrusion/protraction prime movers:
All lateral and medial pterygoids
Retrusion/Retraction prime movers:
Prime:
Temporalis (posterior)
Tongue Motions/Prime Movers (extrinsic muscles)
(CN XII, hypoglossal nerve)
Costovertebral joints:
synovial; nonaxial, amphiarthrodial, gliding joints
Sternocostal joints:
cartilaginous; nonaxial, amphiarthrodial joints
Elevation of the rib cage
rib cage as a whole moves superior and lateral (up and out)
sternum moves anterior
dimensions of thorax increase (along with vertical increase)
creates negative pressure, drawing air in
Depression of the rib cage
rib cage moves down and in, back to rest position
sternum returns to resting position
dimensions of thorax decrease
pressure increases in thorax, pushing air out.
Quiet inspiration:
diaphragm (phrenic nerve, C3, C4, C5 [mostly C4]) external intercostals (T1-T11 intercostal nerves)
Deep inspiration:
more forceful action of diaphragm and external intercostals
accessory muscles: SCM, pec major, all scalenes, levator costarum, serratus posterior superior
Forced inspiration:
even more forceful action of diaphragm and external intercostals
more forceful work of accessory muscles of deep inspiration, plus, levator scapulae, upper traps, rhomboids, pec min
Quiet expiration
mostly passive; external intercostals relax, gravity pulls ribcage down, recoil of thoracic wall and lung tissue
essentially no muscle activity
Forced expiration
internal intercostals (T1-T11 intercostal nerves)
accessory muscles: all four abdominals; quadratus lumborum; serratus posterior inferior
Ideal Posture in (transverse/frontal/sagittal)
transverse: not twisted or rotated in either direction
frontal: neutral, symmetrical, no difference between the sides
sagittal: spine has normal curves
Ideal head/neck
Held erect in position of good balance
Cervical lordosis
Ideal Shoulder posture
Scapulae lay flat against rib cage
~4 inches width between vertebral borders
*not uncommon for dominant hand shoulder to be slightly lower
Ideal spine posture
Normal spinal curves
*cervical lordosis, thoracic kyphosis, lumbar lordosis
Ideal abdomen posture
not protruding
Ideal Pelvis posture
Neutral
Iliac crest level
*not uncommon for dominant hand hip to be slightly higher
Pelvis and thighs in straight line
Ideal hip posture
Body weight evenly distributed through both legs
Ideal knee posture
Patellae face forward
Straight with minimal flexion (not locked)
Ideal ankle/foot posture
Subtalar neutral
Normal medial longitudinal arch
Feet slightly out-toed
Ideal toe posture
straight, not curled downward or extended upward
Sagittal Plumb line: (9)
Sagittal Plumb Line (standing)
Slightly posterior to coronal suture ↓ Through external auditory meatus ↓ Through axis of odontoid process ↓ Midway through tip of shoulder (acromion) ↓ Through bodies of lumbar vertebrae ↓ Slightly posterior to hip joint ↓ Slightly posterior to patella (through axis of knee joint) ↓ Slightly anterior to lateral malleolus ↓ Through calcaneocuboid joint
Postural Pain Syndrome:
pain that results from mechanical stress when a faulty posture is maintained for a prolonged period of time
pain often relieved by activity
no impairments in functional strength or flexibility, however may progress to these impairments if faulty posture continues
Postural Dysfunction:
strength and flexibility impairments
shortening of soft tissues limiting ROM
muscle weakness
may be result of poor prolonged postural habits or adhesions formed during healing after trauma or surgery
predisposes area to injury or overuse syndromes (ex. supraspinatus impingement)
Factors Affecting Posture: INTRINSIC
Structural (fixed deformity) Abnormal muscle tone (we’ll discuss more in neuro) Muscle imbalance or weakness Hyper or hypomobility Impaired sensation, including kinesthesia or proprioception Pain Fatigue Consciousness Attitude
Factors affecting posture: EXTRINSIC
Footwear Seating (office chair, couch, wheelchair, etc.) Work/study station set-up Height/weight, related to situation Environment
Posture: Mobility impairment=
tight muscles
Posture: Impaired muscle performance =
Weak/overstretched muscles
Rounded Back with Forward Head
↑ thoracic kyphosis protracted scapulae (rounded shoulders)
forward head: ↑ flexion of lower cervical and upper thoracic spine, increased extension of upper
cervical spine, and capital extension
Causes: Rounded Back with Forward Head
Causes slouching poor ergonomics poor lumbar spine postures overemphasis on flexion programs
Consequences: Rounded Back with Forward Head
Fatigue of thoracic erector spinae and scapular retractors
Irritation of facet joints in upper cervical spine
Possible impingement on upper cervical spinal nerve roots (What could this lead to?)
Thoracic outlet syndrome (TOS)
Tension headaches (HA)
TMJ dysfunction with protrusion and depression of mandible
Lower cervical disc issues
Describe: Flat Upper Back and Neck Posture (Military Posture)
↓ thoracic and cervical curves (flattening)
depressed scapulae and clavicles
↑ capital flexion
Consequences: Military Posture
Fatigue of scapular retractors and depressors
Restricted scapular movement limiting shoulder flexion and abduction
(Why would these be affected if scapula doesn’t move freely?)
TOS
↑ risk of neck injury due ↓ shock-absorbing function of normal spinal curves
Causes: MIlitary Posture
this is not a common postural fault, usually related to exaggeration of military posture
Lordotic Posture
↑ lumbosacral angle = ↑ lumbar lordosis = ↑ anterior pelvic tilt
Causes of: Lordotic Posture
sustained faulty posture
pregnancy
obesity
weak Hamstrings, abdominals, Glute muscles
Consequences: Lordotic Posture
low back pain
narrowing of posterior disc space and intervertebral foramen → compression of spinal nerve root, dura, or blood vessels
(What could this lead to?)
approximation of articular facets → synovial irritation and joint inflammation → acceleration of degenerative changes
Swayback (Kypholordotic) Posture
relaxed or slouched posture
pelvis shifted anteriorly → hip extension
↑ lumbar lordosis with ↑ thoracic kyphosis with forward head
Causes: Swayback- Kypholordotic
relaxed posture with person using passive structures (ligaments, capsules, bony approximation) at end range to provide stability instead of using muscles to support against gravity attitudinal fatigue poor postural muscle endurance overemphasis on flexion program
Consequences: Swayback-kypholordotic
pain from stress to iliofemoral, anterior longitudinal, and posterior longitudinal ligaments
pain from stress to IT band on elevated hip with asymmetrical single stance posture
narrowing of intervertebral foramen → compression of spinal nerve root, dura, or blood vessels
approximation of articular facets in lower lumbar spine
Flat Low Back Posture
↓ lumbosacral angle = ↓ lumbar lordosis = posterior pelvic tilt
Causes: Flat low back posture
habitual slouching in flexion when sitting or standing
overemphasis on flexion program
Consequences: Flat low back posture
pain due to ↓ shock-absorbing of normal lumbar curve
stress to posterior longitudinal ligament
↑ posterior disc space which allows nucleus pulposus to take in extra fluid which may lead to protrusion with extension
Scoliosis:
lateral curvature and/or rotation in spine
Structural scoliosis:
irreversible lateral curvature with fixed rotation
*rotation is toward convexity of curve
ribs will rotate with vertebrae in thoracic spine causing rib hump on side of convexity (ribs go to side of hump)
*named for side of convexity
Scoliosis causes:
neuromuscular disease (ex. CP) osteopathic disorders (ex. hemivertebrae) idiopathic- most common. Don’t know why
Scoliosis Consequences
muscle fatigue and ligamentous strain on side of convexity
nerve root irritation on side of concavity
rib expansion with difficulty breathing in advanced cases
Nonstructural scoliosis (functional/postural scoliosis)
reversible and can be changed with flexion or lateral flexion or with positional changes
Causes of Nonstructural Scoliosis
LLD
muscle guarding or spasm
habit
