Lower Extremity Flashcards
CAM
femoral head shape is round and thickened
Pincer
front rim of acetabulum is elongated
What are two types of femoro-acetabular impingement?
- CAM
- Pincer
Tight psoas leads to what?
- anterior pelvic tilt
- weak glutes
What causes tight hamstrings?
weak glutes
What are some functional hip tests?
- pelvic tilts
- step downs
- pelvic rotation
- bridge with leg extension
What are things to look for in step downs?
- trunk lean
- neutral pelvis
- knee over 2nd toe
What is the hip extension motor pattern?
- ipsi hamstring
- ipsi glut
- contra paraspinal
- ipsi paraspinal
What is tight in lower cross syndrome?
- hip flexors
- paraspinals
- IT band
What is inhibited in lower cross syndrome?
- glutes
- abdominals
What is a stride?
heel strike of right foot to heel strike of right foot
What is a step?
heel strike of right foot to heel strike of left foot
How much does the patella increase extension force?
30%
What areas are prone to mobility loss?
- ankle
- hip
- thoracic spine
- gleno-humeral
- upper cervical spine
What areas are prone to stability loss?
- knee
- lumbar spine
- scapula
- lower cervical spine
What is the patellofemoral joint reaction force at walking level?
0.5 x body weight
What is the patellofemoral joint reaction force with the knee flexed to 90 degrees?
2.5 to 3 x BW
What is the patellofemoral joint reaction force in climbing and descending steps?
3 to 4 x BW
What is the patellofemoral joint reaction force when squatting?
7 to 8 x BW
What is the patellofemoral joint reaction force when jumping?
20 x BW
At what angle in the patellofemoral joint reaction force decreased?
between 0 to 30 degrees
What is the Screw Home Mechanism?
external tibial rotation and anterior glide of the medial tibia during final 20 degrees of knee extension
What does the Screw Home Mechanism do?
- tightens both cruciate LIG
- locks the knee
- tibia in max stability
- allows quads to relax while standing
What is the function of the popliteus?
- unlock knee to begin knee flexion
- externally rotates femur
What is a normal Q angle?
10-15 degrees
What can an increased Q angle lead to?
lateral patellar tracking
What is maltracking of the patella?
medial or lateral deviation of 1/4 - 1/2 the width
What are active patella stabilizers?
- vastus medialis
- vastus lateralis
What are passive stabilizers of the patella?
- femoral groove
- lateral patellofemoral LIG (w/ IT band)
- medial retinaculum
What is the MC type of patellar maltracking?
lateral patellar tracking
What is the MC cause of lateral patellar tracking?
- VMO inhibition due to inflammation
- facilitation of ITB
What is the treatment for lateral tracking?
-train VMO
-terminal arc extension
==>TKE
-stretch ITB
-taping/bracing
What are other causes of lateral tracking?
- pronated ankle
- internal tibial ROT
- inc valgus stress
What is the MC cause of knee pain in teenagers and young adults?
patella-femoral dysfunction
What causes PF dysfunction?
delayed onset of vastus medialis relative to lateral quad
Tightness of what muscles are risk factors for PF dysfunction?
- gastroc
- hamstring
- quad
- ITB
What biomechanics are risk factors for PF dysfunction?
- excessive pronation
- femoral anteversion
- patella alta
What is patellofemoral pain associated with?
reduced hip abduction and rotation strength
What is the treatment for PF dysfunction?
- eval glute medius
- eval stability at foot arch
- eval activation of VM
What does the ACL limit?
- anterior tibial translation
- internal rotation
How do ACL tears occur?
landing from a jump
increased valgus stress
ACL incomplete tear -
ROM
prevent knee extension beyond 40 degrees flexion
ACL incomplete tear - Strengthen
hamstrings
==>isometric
==>half-squat
ACL incomplete tear - stretch
soleus
==>stabilizes knee during gait
What is medial tibial stress syndrome?
tendonitis/periostitis of anterior tibialis, posterior tibialis or medial soleus
Who are most affected by medial tibial stress syndrome?
-female runners
==>especially with female athlete triad
-military recruits
-novice runners
Anatomic risk factors for medial tibial stress syndrome
- leg length difference
- pes planus
- hyperpronation
- femoral neck anteversion
What are some complications/differentials of medial tibial stress syndrome?
- compartment syndrome
- tibial stress fx
Where is the MC location for a tibial stress fx?
distal 1/3 of shaft
What are some provocative tests for medial tibial stress syndrome?
- plantar flexion against resistance
- passive dorsiflexion
- standing on tiptoe
- jumping in place
What are some preventative exercises for medial tibial stress syndrome?
- arch stability
- glute medius stability
What is achilles tendinopathy?
clinical syndrome of overuse tendon injury with pain, swelling and/or functional limitation
What is not considered to be a part of achilles tendinopathy?
inflammation
Who does achilles tendinopathy typically affect?
mid-aged men
Other than exercise, what are other causes of achilles tendinopathy?
- shoes with tight heel
- high heels to sandles or barefoot walking
What is the treatment for achilles tendinopathy?
eccentric calf muscle training
What makes up the Deltoid LIG?
- anterior tibiotalar LIG
- posterior tibiotalar LIG
- tibionavicular LIG
- tibiocalcaneal LIG
What ligaments are found on the lateral aspect of the ankle joint?
- anterior inferior tibiofibular LIG
- anterior talofibular LIG
- calcaneofibular LIG
Acute phase ankle rehab
- PRICE
- pain free ROM
Subacute phase ankle rehab
- Active/Resisted ROM
- adjusting
- gastroc/soleus stretching
- resistance exercise
- proprioception
What are some possible risk factors for plantar fasciitis?
- inc in running distance
- faulty running shoes
- cavus foot (high arch)
- shortened achilles tendon
Site of tenderness in plantar fasciitis
- posterior: heel pad
- medial: medial calcaneal nerve
- no tenderness: DJD in subtalar joint
What are some treatment options for plantar fasciitis?
- strengthen tibialis anterior and posterior
- intrinsic foot muscles
- myofascial release
- adjusting
What is the name of the technique utilized to stabilize the foot arches?
Janda’s short foot exercise
What is the best tool that effects swelling?
- pain free ROM
- compression
- ice
- adjustment
What is the MC mechanism of injury of the deltoid LIG?
inversion via compression forces
