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LOWER EXTREM KINES > LOWER EXTREMITY KINES > Flashcards

LOWER EXTREMITY KINES Flashcards

1
Q

Function of collateral ligaments

A

prevent frontal plane movement of the knee (abduction and adduction)

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2
Q

Medial Collateral Ligament

A

restraint against VALGUS stress and thus prevents abduction of the knee

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3
Q

Lateral Collateral Ligament

A

restraint against VARUS stress and thus prevents adduction of the knee

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4
Q

Anterior Cruciate Ligament (ACL)

A

APEX: runs anterior to posterior and externally
- fibers are taut in extension; primary restraint against hyperextension of the knee

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5
Q

Function of ACL

A

Limits ANTERIOR translation of tibia on the femur or POSTERIOR translation of femur on the tibia
- also limits axial rotation of the knee, especially external rotation

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6
Q

Posterior Cruciate Ligament (PCL)

A

PAIN- runs Posterior to Anterior and Internally
- All fibers taut in flexion

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7
Q

Function of PCL

A

Limits posterior translation of the tibia on the femur or anterior translation of the femur on the tibia
- prevents the femoral condyles from sliding off the anterior edge of the tibia

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8
Q

Primary extensors of the knee

A

QUADS
- isometric activation helps to stabilize and protect the knee
- eccentric activation helps to dampen loading and acts as a brake or decelerator of knee flexion during walking, squatting, sitting..ect
- concentric activation accelerates the tibia or femur into extension during walking or standing

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9
Q

Eccentric vs Concentric

A

Stand to sit=eccentric
STAND TO SIT IS EASIER

sit to stand=concentric
SIT TO STAND REQUIRES MORE CONCENTRATION?

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10
Q

The Patella on the quadriceps

A
  • Patella displaces the quads tendon away from the joint axis, thus increasing the moment arm of the quads
  • provides substantial augmentation of extensor torque
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11
Q

Knee flexor-rotator muscles

A
  • with exception of the gastrocnemius, all muscles that cross posterior to the knee joint have the ability to flex and axially rotate the knee
    includes HAMSTRINGS, SARTORIUS, GRACIALIS, AND POPLITEUS
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12
Q

Primary flexors of the knee

A

THE HAMSTRINGS
- medial hamstrings (semitendinosus) internally rotate the knee
- lateral hamstring (biceps femoris) externally rotates the knee

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13
Q

The hamstrings and gait

A
  • active eccentrically to decelerate the advancing tibia at the late swing phase
  • active concentrically to accelerate knee flexion in order to shorten the lower limb during early swing phase
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14
Q

Other knee flexor-rotator muscles

A

sartorius, gracilis (flexors and internal rotators of the knee)
- added effect of providing significant dynamic stability to medial knee

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15
Q

Popliteus

A
  • flexes and internally rotates the knee
  • “key to the knee” provides the necessary internal rotation torque to mechanically unlock the knee
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16
Q

To maximally stretch the quads you would

A

extend hip and flex knee

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17
Q

the quads will

A

flex the hip joint and extend the knee joint!

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18
Q

All of the following are capable of flexing the hip EXCEPT

A

Semitendinosus (a hamstring muscle) WE KNOW HAMSTRING EXTEND THE HIP JOINT

SARTORIUS, RECTUS FEMORIS, AND ILLIACUS CAN FLEX THE HIP

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19
Q

Dropping of the pelvis on the right side during single limb support over the left leg most likely indicates weakness of

A

THE LEFT GLUTEUS MEDIUS

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20
Q

The sartorius muscle can perform all of the following except

A

KNEE EXTENSION
- sartorius can flex hip, flex knee and internally rotate knee

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21
Q

Which of the following muscles can produce movement at both the hip and knee

A

RECTUS FEMORIS

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22
Q

To maximally stretch HAMSTRING you would

A

flex hip, extend knee, anterior pelvic tilt

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23
Q

to maximally stretch hip FLEXORS the pelvis should be

A

Posteriorly tilted

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24
Q

Psoas major

A

hip flexion

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25
Q

semitendinous

A

knee internal rotation

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26
Q

biceps femoris

A

knee external rotation

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27
Q

obturator externus

A

hip external rotation

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28
Q

pectineus

A

hip adduction

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29
Q

the knee joints

A

tibial-femoral joint (medial and lateral articulations)
patello-femoral joint

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30
Q

knee moves in what plane

A

sagittal and horizontal

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31
Q

Function of menisci

A

reduce compressive stress SHOCK ABSORPTION and reduce stress on cartilage
- supports 1/2 load across the knee

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32
Q

How is knee joint stabilized?

A

articular surfaces, quads, retinacular fibers

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33
Q

locking of the knee

A

Locking of the knee in terminal extension requires 10 degrees of external rotation

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34
Q

Before flexion can occur

A

the knee must be unlocked by internally rotating the knee
- driven by the popliteus muscle

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35
Q

internal/external rotation of the knee can only occur

A

AFTER the knee has been unlocked (out of terminal extension)

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36
Q

Ligaments of the hip

A
  • illiofemoral
    -ischiofemoral
  • pubofemoral

limits extremes of all movements of the hip, all three are partially taut in full extension of the hip

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37
Q

The hip joint

A

Articulation between the large spherical head of the femur and deep socket of acetabulum
TRUE BALL AND SOCKET - made for stability (weight-bearing, propelling the body forward)

38
Q

Natural bowing to the femur

A

HELPS WITH LOADING

39
Q

Lumbo-pelvic rhythm

A

ipsi-directional
contra-directional
- related to anterior and posterior pelvic tilt

40
Q

Movements of the hip

A

3 degrees of freedom
- sagittal plane- flexion and extension
- frontal plane- abduction and adduction
- horizional plane- internal and external rotation

41
Q

PRIMARY HIP FLEXORS

A

Iliacus and psoas major (illiopasos)

other hip flexors- sartorius, tensor fascia lata, rectus femoris, pectineus and adductor longus

42
Q

Anterior pelvic tilt force couple

A
  • between hip flexors and back extensors
    (a lot of back pain comes from tight hip flexors)
43
Q

Primary hip adductors

A

Pectineus, adductor longus/brevus, gracilis, and adductor magnus

44
Q

Primary internal rotators of the hip

A

THERE ARE NONE

45
Q

Secondary internal rotators of the hip

A

gluteus medius/minimus, TFL, adductor longus/brevis, pectineus and medial hamstring

46
Q

Primary hip extensors

A

GLUTEUS MAXIMUS
- hamstrings and posterior part of adductor magus also capable hip extensors

47
Q

Posterior pelvic tilt force couple

A

hip extensors and abdominal muscles
- important in controlling forward trunk lean

48
Q

STRETCHING HIP FLEXORS

A

Extend hip and POSTERIORLY TILT PELVIS

49
Q

STRETCHING HIP EXTENSORS

A

Flex the hip and ANTERIORLY TILT PELVIS

50
Q

Primary hip abductors

A

gluteus medius and minimus

main function- control of frontal plane pelvic on femoral stability during gait

51
Q

Weakness in hip abductors results in

A

DROPPING OF THE PELVIS ON THE CONTRALATERAL SIDE DURING SINGLE-LIMB SUPPORT OVER THE WEAK HIP
- referred to as “trendelenburg gait” or “gluteus medius limp”

52
Q

Primary hip external rotators

A

Piriformis, obturator internus/externus, superior/inferior gamellus, quadratus femoris, gluteus maximus and sartorius
- serve additional role of providing substantial stability to the posterior hip joint

53
Q

Movements of the knee joint

A
  1. flexion and extension
  2. internal/external rotation
54
Q

Ankle joints

A
  • talocrural joint (includes tibia, fibula and talus)
  • subtalar joint (articulation between talus and cancaneus)
  • transverse tarsal joint
55
Q

talocrural joint

A
  • total contact area is significantly less than the hip and knee joint
  • main source of stability is provided by lateral and collateral ligaments
56
Q

Movement of talocrural joint

A

plantar/dorsiflexion
- becomes increasingly more stable as dorsiflexion increases to prepare for push-off during gait

57
Q

Movement of the subtalar joint

A

pronation: eversion and abduction

supination: inversion and adduction

58
Q

transverse tarsal joint

A

articulation between talus-navicular and calcaneus-cuboid
- allows the foot to adapt to a variety of surfaces

59
Q

combined actions of the joints

A
  • allows the leg and talus to rotate in all 3 planes relative to a fixed calcaneus
  • allow the foot to repeatedly transform form a flexible and shock absorbent structure to a more rigid level
60
Q

Medial longitudinal arch

A
  • provides the concave in-step at the medial side of the foot
  • primary load bearing and shock absorbing structure in the foot
  • height and general structure are maintained by joint structure, plantar fascia, ligaments and muscles
61
Q

anterior compartment of the leg- “pretibial” dorsiflexors

A

tibialis anterior, extensor digitorum longus, extensor hallicus longus, peroneus tertius

62
Q

dorsiflexors most active as the heel contacts the ground and the foot becomes flat on the foot where they are active

A

CONCENTRICALLY to control the rate of plantar flexion

63
Q

As the lower limb is advancing during swing phase, dorsiflexors are active

A

ECCENTRICALLY to ensure that the foot clears the ground

64
Q

lateral compartment

A

PERONEUS LONGUS/BREVIS
- primary action is eversion and pronation
- also assits in plantar flexion

65
Q

posterior compartment

A

gastrocnemius, soleus and plantaris (superficial group)

tibialis posterior, flexor digitorum longus and flexor hallicus longus (deep group)

Plantar flex and deep group can invert and supinate

66
Q

posterior compartment during gait

A
  • active eccentrically to decelerate dorsiflexion during swing phase of gait
  • active concentrically to accelerate plantar flexion during push off
67
Q

Intrinsic muscles of the foot

A

overall funtion is to provide rigidity to the foot and stabilizing the medial longitudinal arch
- maximally active during late stance phase

68
Q

3 basic approaches for describing gait

A
  1. using the time and distance qualities of the stride
  2. breaking up the gait cycle up into subdivisions according to the variation in reciprocal foot contact by the 2 feet
  3. identifying the functional significance of the phases within the gait cycle
69
Q

Gait cycle is divided into 2 periods

A

stance phase
- the period during which the foot is on the ground
- begins when the heel contacts the ground and ends when the toes are lifted off the ground
- 60% of gait

swing phase
- time when the foot is in the air for limb advancement
- begins when the foot leaves the ground and ends when the heel contacts the ground
- 40% of gait

70
Q

normal values for gait

A
  • speed: 3mph
  • step rate: 110 steps/min
  • step length: 28 in
71
Q

8 steps of gait

A
  1. initial contact
  2. loading response
  3. midstance
  4. terminal stance
  5. pre-swing
  6. initial swing
  7. mid-swing
  8. terminal swing
72
Q

Phase 1: initial contact (heel strike)

A

trunk: erector spinae are active eccentrically/ isometrically to control forward momentum of trunk after heel contact

hip: hamstrings and gluteus max are active eccentrically to control/restrain amount of hip flexion

knee: stabilized by co-contraction of quad and hams

ankle: pre-tibial muscles are active concentrically to position the foot for initial contact

73
Q

Phase 2: loading response (heel strike to foot flat)

A

trunk: erector spinae are active eccentrically/ isometrically to control forward momentum of trunk after heel contact

pelvis: hip abductors active to decelerate contralateral pelvic drop (in prep for single limb support)

hip: hamstrings and gluteus max continue to be active eccentrically to control/restrain amount of hip flexion

knee: sharp eccentric activation of quads to control knee flexion and provide shock absorption

ankle: pre-tibial muscles highly active eccentrically to decelerate planar flexion

74
Q

Phase 3: mid-stance (foot flat to mid stance)

A

pelvis: hip abductors active to decelerate contralateral pelvic drop

hip: hip extensors begin to relax as passive hip extension is acheived through momentum of body weight

knee: quads active early until passive knee extension occurs and quads become silent

ankle: soleus and gastocnemius becomes active eccentrically to control the rate of forward tibial progression

75
Q

Phase 4: Terminal stance (mid-stance to heel off)

A

pelvis: hip abductors continue to be strongly active to stabilize the pelvis

hip: hip flexors are active eccentrically to control/resist hyperextension of hip

knee: little to no activity in quads or hamstrings

ankle: soleus and gastroscnemius active concentrically contributing to heel rise (plantar flexion)

76
Q

Phase 5: Pre-swing (heel off to toe off)

A
  • corresponds with initial contact of oppositre limb

trunk: erector spinar are active eccentrically/ isometrically to control trunk flexion after contralateral heel contact

hip: hip flexors lightly active as hip flexion is assisted by momentum of the body moving forward

knee: knee passively flexes; quads are quiet unless active eccentrically to restrain rapid knee flexion

ankle: plantar flexors active concentrically but gradually reducing

77
Q

Phase 6: Initial swing (toe off to early acceleration)

A

hip: hip flexors are active concentrically but continue to be assisted by passive momentum; increased activity of adductor longus to keep limb in mid-line

knee: passive knee flexion secondary to hip flexion assisted by concentric activity in hams

ankle: pre-tibial dorsiflexors are strongly active concentrically to clear the toes from the floor

78
Q

Phase 7: Mid-swing

A

hip: hip flexors are active concentrically but continues to proceed passively primarily by momentum

knee: passive knee extension created by tibial forward momentum; hamstrings begin to activate eccentrically to decelerate knee extension

ankle: pre-tibial dorsiflexors continue to be strongly active concentrically to clear the toes from the floor

79
Q

Phase 8: Terminal swing (mid swing deceleration)

A

hip: hip extensors become active eccentrically to control further hip flexion and prepare for initial contact

knee: knee extension is decelerated by eccentric activity of hamstrings and quads become active in prep for initial contact

ankle: pre-tibial dorsiflexors continue to be active concentrically

80
Q

Dragging the foot during gait (not being able to clear the foot during swing phase) indicates dysfunction in

A

DORSIFLEXORS

81
Q

During terminal swing when the knee is extending, the hams would be active

A

ECCENTRICALLY

82
Q

During most of the swing phase, the hip flexors are

A

ASSISTED BY FORWARD MOMENTUM

83
Q

In a patient with chronic inversion ankle sprains, it would make sense to strengthen which of the following muscles:

A

Peroneus longus (fibularis longus)

84
Q

Anterior compartment does

A

DORSI FLEXION

85
Q

Posterior compartment does

A

PLANTAR FLEXION

86
Q

Lateral compartment does

A

EVERSION

87
Q

Dysfunction of the tibilais posterior muscle would result in weakness of

A

PLANTAR FLEXION AND INVERSION

88
Q

Soleus

A

Plantarflexion

89
Q

Peroneus longus

A

eversion

90
Q

tibialis anterior

A

dorsiflexion

91
Q

tibialis posterior

A

inversion

LOWER EXTREM KINES (1 decks)

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