Mid-Term Study Guide Flashcards
Perfect posture - Anterior view
If the client was in perfect postural balance, the plumb line would fall: midway between medial malleoli; midway between knees; pubic symphysis; umbilicus; sternal notch; chin; nose; eyes.
Perfect posture - Lateral view
If the client was in perfect postural balance, the plumb line would fall: just anterior to the lateral malleolus; just anterior to head of fibula; greater trochanter; acromion process; external auditory meatus.
Perfect posture - Posterior view
If the client was in perfect postural balance, the plumb line would fall: midway between medial malleoli; midway between knees; gluteal cleft; in line with vertebrae; midway through external occipital protuberance.
Faulty Posture - Head
Chin up too high.
Head protruding forward.
Head tilted or rotated to one side.
Good Posture - Head
Head erect and well balanced.
Faulty Posture - Shoulders and Arms
Holding the arms stiffly.
Palms of hands face backward.
One shoulder higher than the other.
Both shoulders hiked up.
One or both shoulders drooping forward or sloping.
Shoulders rotated either clockwise or counter-clockwise.
Scapulae pulled back too hard.
Scapulae too far apart.
Winged scapula
Good Posture - Shoulders and Arms
Arms hang relaxed at the sides with palms of the hands facing toward the body.
Elbows are slightly bent, so forearms hang slightly forward.
Shoulders are level
Scapulae lie flat against the rib cage, neither too close together nor too wide apart.
Faulty Posture - Chest
Depressed, or “hollow-chest” position.
Lifted and held up too high, brought about by arching the back.
Ribs more prominent on one side than the other.
Lower ribs flaring out or protruding.
Good Posture - Chest
Chest is slightly up and forward (while the back remains in good alignment).
Chest half-way between exhaling and inhaling.
Faulty Posture - Abdomen
Entire abdomen protrudes.
Lower part of the abdomen protrudes while the upper part is pulled in.
Good Posture - Abdomen
In young children up to about age 10, the abdomen normally protrudes somewhat. In older children and adults, it should be flat.
Faulty Posture - Spine and Pelvis Lateral View
The low back arches forward too much (lordosis).
The normal forward curve of the low back has straightened out (flat back).
Increased backward curve in the upper back (kyphosis or round upper back).
Increased forward curve in the neck.
Lateral curve of the spine (scoliosis); toward one side (C-curve), toward both sides (S-curve).
Good Posture - Spine and Pelvis Lateral View
The front of the pelvis and the thighs are in a straight line.
The buttocks are not prominent in back but instead slope slightly downward.
The spine has four natural curves. In the neck and lower back, the curve is forward, and in the upper back and lowest part of the spine (sacral region), it is backward.
Faulty Posture - Spine and Pelvis Posterior View
One hip is higher than the other (lateral pelvic tilt).
The hips are rotated so that one is farther forward than the other (clockwise or counter-clockwise rotation).
Good Posture - Spine and Pelvis Posterior View
Body weight is even on both feet, and the hips are level.
Faulty Posture - Knees and Legs
Knees touch when feet are apart (genu valgum).
Knees are apart when feet touch (genu varum).
Knee curves slightly backward (hyperextended knee) (genu recurvatum).
Knee bends slightly forward, that is, it is not as straight as it should be (flexed knee).
Patellae face slightly toward each other (medially rotated femurs).
Patellae face slightly outward (laterally rotated femurs).
Good Posture - Knees and Legs
Legs are straight up and down.
Patellae face straight ahead when feet are in good position.
Looking at the knees from the side the knees are straight
Faulty Posture - Feet
Low longitudinal arch or flatfoot.
Low metatarsal arch usually indicated by calluses under the ball of the foot.
Weight borne on the inner side of the foot (pronation).”Ankle rolls in.”
Weight borne on the outer border the foot (supination). “Ankle rolls out.”
Toeing-out while walking or while standing in shoes with heels (“outflared” or “slue-footed”).
Toeing-in while walking or standing (“pigeon-toed”)
Good Posture - Feet
In standing, the longitudinal arch has the shape of a half dome.
Barefoot or in shoes without heels the feet toe-out slightly.
In shoes with heels, feet are parallel.
Faulty Posture - Toes
Toes bend up at the first joint and down at middle and end joints so that the weight rests on the tips of the toes (hammer toes).
Big toe slants inward toward the midline of the foot (hallus valgus).
Good Posture - Toes
Toes should be straight, that is, neither curled downward nor bent upward.
They should extend forward in line with the foot and not be squeezed together or overlap.
Define walking
One foot is always in contact with the ground and within a cycle, there are two periods of single-leg support and two periods of double-leg support.
Define running
There is a period of time during which neither foot is in contact with the ground, a period called “double float.”
How is a normal gait cycle viewed?
From the perspective on one foot OR the other
Step length
the distance from the point of first contact of one foot to the point of first contact of the opposite foot
Stride length
the point of contact of one foot to the next point of contact of the same foot (two step lengths)
Stance phase
when the foot is in contact with the ground and bearing weight
Swing phase
when the foot is not fixed to the ground and is non-weight-bearing
Gait cycle
Stance phase plus swing phase
Gait observation - anterior
observe foot position, lateral pelvic tilt, trunk position
Gait observation - posterior
observe foot and heel positions and motions of knees, pelvis and trunk
Gait observation - lateral
note relative position and ease of motion of ankle, knee, hip, and low back
Initial Contact Abnormalities - If hip extensors are weak
trunk lurches forward with increased lordosis
Initial Contact Abnormalities - If hip adductors are weak
abnormal pelvis and leg rotation
Initial Contact Abnormalities - If knee extensors and flexors are weak
knee will buckle; reflex inhibition, L2-L4 nerve root lesion, internal knee derangement, or polio
Initial Contact Abnormalities - If foot dorsiflexors are weak
foot will drop or slap on heel strike: peroneal neuropathy or L4 nerve root lesion
Initial Contact Abnormalities - If there is pain on the heel
heel spur, bruise, bursitis
Midstance Abnormalities - If hip abductors are weak
Trendelenburg gait (pelvis on non-weight-bearing side drops)
Midstance Abnormalities - If foot plantar flexors are weak
short step on unaffected side; S1-S2 nerve root lesion
Midstance Abnormalities - If there is pain in foot or ankle
OA, pes planus, plantar fasciitis
Terminal stance abnormalities - If hip flexors are weak
compensation by moving the trunk posteriorly to passively swing the leg (glut max gait)
Terminal stance abnormalities - If knee extensors are weak
knee buckles
Pre-swing abnormalities - If hip adductors are weak
leg rotates
Pre-swing abnormalities - If hallux rigidus (great toe stiffness) is present
push off from lateral aspect of foot instead of great toe
Initial swing and mid-swing abnormalities - If foot dorsiflexors are weak
foot drop or steppage gait; L4 nerve root lesion
Terminal Swing abnormalities - If there is an S1-S2 nerve root lesion
the knee will snap out excessively at the end of the swing because the knee flexors that are normally active to slow knee extension are compromised
Antalgic (Painful) Gait
the result of injury
The stance phase on the affected leg is shorter than that on the nonaffected leg.
The swing phase of the uninvolved leg is decreased.
The painful region is often supported by one hand, if it is within reach, and the other arm, acting as a counterbalance, is outstretched.
If a painful hip is causing the problem, the client also shifts the body weight over the painful hip.
ataxic gait
If the client has poor sensation or lacks muscle coordination, there is a tendency toward poor balance and a broad base.
Cerebellar ataxia includes a lurch or stagger, and all movements are exaggerated.
The feet of an individual with sensory ataxia slap the ground, because they cannot be felt.
The client also watches the feet while walking. The resulting gait is irregular, jerky, and weaving.
contracture gait
Caused by prologued immobilization or pathology to the joint has not been properly cared for.
Hip flexion contracture - increased lumbar lordosis, extension of the trunk combined with knee flexion to get the foot on the ground.
knee flexion contracture - excessive ankle dorsiflexion from late swing phase to early stance phase on the uninvolved leg and early heel rise on the involved side in terminal stance.
Plantar flexion contracture at the ankle - knee hyperextension (midstance of affected leg) and forward bending of the trunk with hip flexion (midstance to terminal stance of affected leg). Heel rise on the affected leg also occurs earlier.
Gluteus Maximus Gait
client thrusts the thorax posteriorly at initial contact (heel strike) to maintain hip extension of the stance leg - characteristic backward lurch of the trunk
Gluteus Medius (Trendelenburg) Gait
If the hip abductor muscles (gluteus medius and minimus)
The thorax is thrust laterally to keep the center of gravity over the stance
the contralateral side droops because the ipsilateral hip abductors do not stabilize or prevent the droop
If there is bilateral weakness of the gluteus medius muscles, the gait shows accentuated side-to-side movement, resulting in a wobbling gait or “chorus girl swing.”
Hemiplegic or Hemiparetic Gait
swings the paraplegic leg outward and ahead in a circle (circumduction) or pushes it ahead. the affected upper limb is carried across the trunk for balance. This is sometimes referred to as a neurogenic or flaccid gait.
Steppage or Drop Foot Gait
weak or paralyzed dorsiflexor muscles, resulting in a drop foot. To compensate and avoid dragging the toes against the ground, the client lifts the knee higher than normal. At initial contact, the foot slaps on the ground.
What is the “job” of the cruciate ligaments?
Check motion at the knee
- The cruciate ligaments are named according to their position on what bone?
tibia
- What are three common causes of anterior cruciate injury?
a blow to the lateral knee, forced extension with internal rotation of the tibia, a blow to the posterior tibia
- What are two common causes of posterior cruciate injury?
a blow to the anterior tibia, excessive hyperextension, or in a motor vehicle accident where the tibia is forced posteriorly during the accident
- Describe the signs and symptoms a grade 1 acute cruciate injury.
grade 1 – pain, swelling, and muscle guarding, bruising or redness may be noticeable over the knee, joint is semi-flexed, will be able to continue the activity
- Describe the signs and symptoms a grade 2 acute cruciate injury.
grade 2 – pain, swelling, and muscle guarding, bruising or redness may be noticeable over the knee, joint is semi-flexed, will be able to continue the activity
- Describe the signs and symptoms a grade 3 acute cruciate injury.
grade 3 - pain, swelling, and muscle guarding, bruising or redness may be noticeable over the knee, joint is semi-flexed, a popping feeling in knee at the time of injury, unable to continue activity, hemarthrosis develops, skin over the joint is taut and hard to the touch, pain is sharp, with effusion the pain is dull and achy
- Which movement is limited with a chronic grade 2 or 3 anterior cruciate sprain?
Unable to run forward
- Which movement is limited with a chronic grade 2 or 3 posterior cruciate sprain?
Unable to squat, walk downstairs easily, or run backwards
- In the acute stage of knee injury, active range of motion is limited in extension and flexion due to what?
effusion
- In the acute stage of a knee injury, resisted strength testing should be painless and strong. If pain is present, what does this result indicate?
Accompanying muscular injury
- If swelling of an acute knee injury prevents full knee flexion and effusion tests are positive, what action must the massage therapist take?
The client is referred for immediate medical testing
- In later stages of a knee injury, why might the results of resisted strength testing of quadriceps be reduced?
Disuse atrophy
- What are the functions of menisci?
Provide shock absorption and to add increased gliding potential between the femur and the tibia
- What is a cause of meniscal injury?
a twisting injury while the foot is weight bearing and anchored to the ground
- List signs and symptoms of meniscal trauma.
pain, swelling, and muscle guarding, bruising or redness may be noticeable over the knee, joint is semi-flexed; Acute, more severe trauma – client may feel a tearing sensation in the knee. Local pain effusion at the joint and tenderness along the joint line. A small tear may not show immediate symptoms. Chronic – clicking sound in knee, knee locks in certain positions, quad disuse atrophy, buckling of knee, acute symptoms may occur with activity
- Explain neuropraxia.
Neuropraxia are compression or entrapment injuries which cause a local conduction block in a peripheral nerve, but with no structural damage to the axon or to tissue distal to the lesion.
- What is the result of compression of peripheral nerves from external or internal forces?
It impairs oxygenation and local neural conduction.