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athletic injuries 2036 > lecture 10: posture and body alignment > Flashcards

lecture 10: posture and body alignment Flashcards

1
Q

postural evalation

A
  • important to assess static posture
  • observe entire body from all angles (improved by use of plum line)
  • significant variability (only obvious asymmetries should be considered)
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2
Q

what are the planes of movement?

A

1: sagittal
2: coronal (frontal plane)
3: transverse

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3
Q

sagittal place

A
  • flexion and extension movements
  • spine, shoulder, hip, knee, ankle (dorsi/plantarflexion)
  • moving forward and backwards
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4
Q

coronal (frontal) plane

A
  • side flexion, abduction, adduction and inversion.eversion
  • spine, shoulder, hip, ankle
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5
Q

transverse plane

A
  • internal and external rotation, pronation/supination
  • shoulders, hips, feet
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6
Q

basic postural observation for sagittal place

A
  • thinking of a straight plum line running down the entire length of the body
  • it should pass:
  • through the ear lobes
  • through the body of the cervical spine
  • though the humeral head
  • through the greater trochanter (PSIS slighter higher than ASIS)
  • anterior to knee, but posterior to patella
  • anterior to the malleolus
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7
Q

classic postural deviation seen in sagittal place

A

1: forward head posture
2: forward rounded shoulders
3: kyphosis
4: lordosis
5: swayback
6: flatback

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8
Q

forward head posture

A
  • ears in front of plumb line
  • chin poke forward (extended upper C-spine and flexed lower C-spine)
  • protracted scapulae
  • usually associated with forward rounded shoulders and possibly kyphosis
  • increased sucocctipital, levator scapulae and trapezius muscle tightness
  • elongated/weak anterior neck flexors
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9
Q

forward rounded shoulders

A
  • humeral head in front of plumb line (glenohumeral internal rotation)
  • tight pectorals
  • elongated/weak Rhomboids, and mid-trapezius muscle
    (restricted scapular upward rotation and posterior tipping, which may affect shoulder movements)
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10
Q

kyphosis

A
  • excessive thoracic curve (tight pectoral major and minor.)
    (weak erector spinae, rhomboids and trapezius)
  • protracted scapulae
  • usually associated with forward head posture
  • increased C-spine extension
    (needed to keep eyes level)
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11
Q

lordosis

A
  • increased curve in lumbar spine
  • increased in anterior pelvic tilt
  • tight hip flexors and lumbar paraspinal muscles
  • elongated (weak) abdominal musculature and hamstrings
  • these people will say their hamstings are tight, but we know that is not actually true
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11
Q

basic postural observation: coronal plane posterior view

A
  • head - straight or tiltied?
    • ears level
  • shoulders equal
  • scapulae equal
  • arms equal distance from body
  • hips equal
    • gluteal fold
  • knee creases equal
  • malleoli equal
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12
Q

swayback

A
  • anterior shift of the entire pelvis
    (results in relative hip extension)
  • thoracic segment shifts posteriorly to balance
    (causes flexion of the thorax)
    (kyphosis because their hips are so far forward that they have to bring their body backwards)
    (sharp curve at lumbar sacral junction)
  • tight hip extensors and lower lumbar extensors
  • weak hip flexors and abdominals (they are clenching their butts)
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12
Q

flatback

A
  • increased posterior pelvic tilt
  • decreased lumbar lordosis
    (tight hip extensors)
    (weak long hip flexors )
    (poor postural sense
  • patien appears stooped forward
  • looks like they are tipping forward when they are walking
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13
Q

basic postural observation: coronal place anterior view

A
  • head straight
    • eyes/ears level
  • shoulders (dominant side may be slightly lower)
    • acromion level
      -equal distance from body to arm
  • hips level
    -ASIS
  • knees level and straight
    • facing forward
  • malleoli equal
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14
Q

genuvalgus

A

when the knees bend in towards eachother

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15
Q

genuvergus

A

when they knees bend away from eachother

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16
Q

scoliosis

A
  • a deformity in which there is one or more lateral curves of the spine
  • C or S curve
  • may occur in the thoracic spine alone, thoracolumbar or lumber spine alone
  • easily measured on x-ray
  • may be non-structural or structural
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17
Q

Scoliosis: why is this relevant to you?

A
  • you may be the 1st point of contact as a coach, educator or therapist
  • you should be able to identify these structural problem ,so they can be evaluated and treated in a timely fashion
  • scoliosis is present in 2 to 4 percent of children between 10-16 years of age range
  • hump is a hallmark sign of curves greater than 10 degrees - send for x-ray!
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18
Q

measuring scoliosis

A
  • the physician chooses the most tilted vertebrae above and below the apex of the curve
  • the angle between intersecting lines drawn perpendicular to the top of the superior vertebrae and the bottom of the inferior vertebrae is the Cobb angle
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19
Q

naming the curve

A
  • curve patterns are designated according to the level of the apex
  • right thoracic curve is convex to the right with apex in the thoracic spine
  • 90% of thoracic curves are to the right.
  • therefore, left thoracic curves should raise a red flag and prompt more extensive evaluation
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20
Q

causes of scoliosis

A

1: chiari malformations
2: spinal cord tumors
3: neuromuscular disorders

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21
Q

types of scoliosis

A

1: non-structual scoliosis
2: structural scoliosis

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22
Q

non-structural scoliosis

A
  • no bony deformity
  • not progressive
  • can be treated
  • disappears on forward or side flexion
  • may be caused by : muscle length tension issue
    • postural problems
    • muscle spasm: tight on concave side, weak on convex side
    • leg length discrepancy
    • hip contracture
  • called non-structural because there is no bony deformity
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23
Q

structural scoliosis

A
  • bony deformity
  • may be progressive
  • hump present on forward flexion (Adam’s forward bend test)
  • vertebral bodies rotate to convexity of the curve
  • may be caused by:
    • genetic problems
    • congenital issues
    • idiopathic
24
Q

adam’s forward bend test

A
  • a rotational deformity known as a rib hump can be easily identified
  • a rib hump is a hallmark sign of a curve greater than 10 degrees. send for x-ray
25
Q

overuse injuires of the lower extremity (LE)

A
  • often multifactorial with many causes cited in the literature
  • primary focus of evaluating overuse injuries of the LE is to identify factors contributing to the condition
    • primary focus needs to be looking at the overall factors and identifying what the person needs
26
Q

contributing factors

A

1: lower chain alignment
- static
- dynamic control (hip and knee)

2: foot-interface with ground
- static - standing
- dynamic - walking/running

27
Q

valgus

A
  • the load bearing axis moves laterally and the patella follows so it goes laterally too
28
Q

varus:

A
  • relative medial migration of the patella
  • load bearing axis moves medially
29
Q

lower chain alignment

A
  • describes the axis formed by the femur and the tibia
  • the greater the Q angle, the greater the lateral pull on the patella
  • Q angle greater than 20 degrees increases the risk of instability of PF joint
  • can be a factor in patellofemoral pain syndrome, OA and ITB friction syndrome (varus)
30
Q

poor multi-plane lumbo-pelvic/pelvo femoral control (core, g.med)
AKA medial collapse mechanism

A
  • hip adduction, femoral internal rotation and knee valgus
  • changes femur under patella
    • decrease joint contact area
    • increased joint stress
31
Q

normal knee motion

A

1: knee flexion-extension
- takes place between the bottom of the femur and the top of the menisci

2: twisting motion:
- takes place between the bottom of the menisci and the tibia.
- when the femur wants to rotate around

32
Q

screw home mechanism

A
  • rotation occurs during last few degrees of extension because the medial femoral condyle is larger than lateral
    • if foot planted - femur rotates medially
    • if femur is fixed - tibia rotates laterally
  • this locks the joint to increase stability
    • ensures stability of knee
    • regulares patellar alignment
  • the popliteus then must contract to externally rotate the femure on the tibia to unlock the knee
33
Q

if the knee is locked, the femur will move in –, but if its in space the tibia moves out –

A

internal rotation

lateral rotation

34
Q

types of arches

A

1: longitudinal
2: transverse

35
Q

longitudinal arches

A
  • medial attached to spring ligament (plantar calcaneonavicular ligament) for support
  • reinforced by tibialis posterior (works to hold the arch up) also lateral longitudinal arch-lower and less flexible
36
Q

foot types

A

1: pes planus
-“flat foot”
- decreased medial longitudinal arch height
- associated with excessive pronation

2: pres cavus
- “ high arch”
- excessive (stiff/high) medial longitudinal arch
- associated with supination

37
Q

transverse arches

A
  • extends across the tarsals bones
  • provides protection to soft tissue and increase the foot’s mobility
38
Q

anatomy of the foot

A

the plantar fascia:
- originates from the medial tubercle on the plantar surface of the calcaneus
- travels toward the toes as a solid band of tissue dividing just prior to the Meta tarsal heads into 5 slips
- supports foot vs downward forces

39
Q

is the anatomy of the foot a muslce?

A

no it is a fascia not a muscle but kinda works like one

40
Q

plantar Fascia

A
  • when the toes are extended, the plantar fascia is functionally shortened as it wraps around each MT head
  • in this way, the plantar fascia functions like a muscle (sort of)
    • ie. it has a dynamic function
41
Q

what is the plantar fascia responsible for?

A
  • transferring the weight from the medial to the lateral side of the foot during the gait cycle as well as arch support/dynamic shock absorption
42
Q

the windlass mechanism

A
  • theres 3 stages

a: the foot is flat on the ground

b: dorsiflexion or extending the toes
- plantar fascia pulled around MT heads - increase arch height and the weight transfers to the lateral side

c: our toes go into dorsiflexion the moment that we start to get the heel lifting off the ground
- tightening up the plantar fascia

43
Q

gait cycle

A
  • stance 60% and swing 40%
  • weight bearing in Closed Kinetic Chain
  • at initial contact and early loading there is double contact
  • at mid-stance and terminal stance, body support by only a single limb
44
Q

pronation (gait cycle)

A
  • pronation is the impact absorption phase of gait
  • we either pronate too much, not enough (supination) or just right.
45
Q

pronation of the foot

A
  • pronation occurs as foot is loaded to allow for shock absorption, ground terrain changes and equilibrium
  • tibia rotates internally with the talus and calcaneus and acts to convert the torque
  • this unlocks the foot to distribute forces
46
Q

what are the 3 movements of pronation of the foot/ankle.. what are their plans?

A

1: eversion (Transverse)
2: dorsiflexion (sagittal)
3: abduction (frontal)

47
Q

what are the 3 movements of supination of the foot/ankle… what are their planes?

A

1: inversion (transverse)
2: adduction (sagittal)
3: plantar flexion (frontal)

48
Q

supination of the ankle

A
  • in supination the mid-tarsal joints are locked
  • foot more stable for toe off
  • allows you to use great amount of force to propel your body
  • achieved with aid of the cuboid pulley
49
Q

what is the order of classic gait

A

1: heel strike
2: Foot Flat
3: midstance
4: Heel off
5: Toe off
6: midswing
7: Heel strike

50
Q

heel strike (apart of gait cycle)

A
  • position: supinated
  • as you accept your weight forward you move from heel strike to foot flat (you are pronating the whole time to absorb shock from your body)
51
Q

heel off (apart of gait cycle)

A
  • need your body to be rigid
  • as soon as you hit foot flat, your foot slowly starts to supinate (still in a pronated position)
  • then supinated in a supinating position to lock bones and push off a rigid lever
52
Q

gait cycle running vs walking

A

Running
- with running there is no simultaneous foot contact with the ground
- at heel strike the foot acts as a shock absorber and adapts to surface
- foot is rigis lever at toe off
- Runners
(80% lateral heel strike )
(sprinters forefoot strike)

53
Q

the role of pronation through the gait cycle

A

foot function: mobile adapter

foot structure: Lowered arches looser joints

Gait phase: just after heel strike to foot flat

54
Q

the role of supination through the gait cycle

A

foot function: rigid lever

foot structure: heightened arches, tighter joints

gait phase: short period at heal strike and foot flat to the off

55
Q

excessive pronation

A
  • over pronation at the subtalar joint causes internal rotation of the tibia and delayed re-supination
  • this affects screw-home mechanism as tibia doesn’t externally rotate
  • as such, the femur must internally rotate more “to get to extension”
    -cause of patellar tracking issues
56
Q

cumulative results of lower limb static and dynamic issues are pain 2 degrees to change in pressure

A

1: at the articulation of the bones
- could be at the joint with the faulty mechanics
- at the joint above or below

2: in the surrounding soft tissues

57
Q

when dealing with issues of the trunk or lower limb,, we must think big picture! you should…

A

assess:
1: posture
2: alignment
3: functional movements
4: question them regarding extrinsic factors!

58
Q
A

athletic injuries 2036 (20 decks)

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