Module 1 Flashcards
Foot and Ankle Complex (Bones, Joints Ligaments, Muscles)
52 Bones, 33 Joints, 100 Ligaments, 40 Muscles
Two Major Ankle Joints + Three parts of foot
(True Ankle Joint and Subtalar Joint) + (Hindfoot, Midfoot, and Forefoot)
Heel bone?
Calcaneus
Main arch of midfoot (Heel to toe)
Medial Longitudinal Arch
The foot works as a whole to . . .
Slow down forces by limiting ankle rotation and keeping its system of arches from collapsing
Hindfoot is a . . . .
Shock absorber (Helps displace forces from above) Helps transfer kenetic energy through the midfoot and forefoot
The midfoot . . .
also absorbs shock and helps dissipate forces from side-to-side movement.
Forefoot
ensures that the terrain and the body’s forces interact appropriately.
Two main foot + ankle deviations
- Overpronation
2. Lack of dorsal flexion
Feet + Ankles verbal (7)
- Do you ever experience pain? Specifically where?
- Do you have arthritis?
- Level of physical activity?
- Occupation/Job?
- Does the pain prevent you/limit you from activities you love?
- Do the symptoms coincide with other pains/symptoms of the body?
- What aggravates it and what makes it feel better?
Big Toe Abduction is called
(hallux valgus)
Hammer toe cause
no weight going over the toe. Overpronation
Feet Hands on assessments (3)
- Talus Bone
- The Calf
- Plantar Fascia
inside tendon dimple foot pulls big toe toward shin
extensor hallucis longus
outside foot tendon dimple - pulls lesser toes toward shin
extensor digitorum
Calf muscles? and how they relate to pronation
gastrocnemius + soleus attach to heel (calcaneus) via achilles tendon. Heel roles inward (eversion of the heel) pulling on tendon causes calf muscles to get tight. Limits Dorsi Flexion.
As the foot collapses, all of the muscles of the lower leg . . .
become stressed as they try to hold up the foot
Plantar Fascia
Broad, Dense, Fairly rigid tissue that runs the length of the underside of the foot and helps give arches shape and structure.
What forms the foundation of the human body?
The feet and ankles
Muscles that stabilize the knee originate from the
Lumbo-Pelvic Hip Girdle and feet/ankles.
Patella attached to the upper leg via the . . .
quadriceps tendon
Patella attached to Tibia (shin bone) via . . .
patella ligament.
. . . .allows the patella to glide smoothly over the . . . .
alignment of femur and tibia . . . femoral groove.
The . . . act as shock absorbers between the . . . in the knee What shape are they? What individual names are they?
menisci - femur and tibia - C chaped - lateral meniscus and medial meniscus
. . . . can be found on either side of the knee. They act as . . . to give . . .stability of the knee.
medial and latteral collateral ligaments - guide ropes between the tibia and femur - side to side
the . . .are located inside the knee joint and attach the bones of the upper and lower leg in a . . . They provide . . . as well as minimize . . . across the knee joint. They also restrain excessive . . . movement of the . . . in relation to the . . .
anterior and posterior cruciate ligaments . . .diagonal fashion . . . stability rotational stress . . . forward or backward . . . . tibia . . .femur
Two major knee deviations
- Problems with side-to-side alignment (medial displacement)
- Tracking problems during flexion and extension
S2SA refers to the alignment of the . . .Problems occur when knee moves toward center ( . . . ) or outside of the body without the . . . helping . . . to the knee joint
tibia and femur and the movement/position of these bones in relation to the center line of the body. . . medial displacement . . . muscles and soft tissue structures . . . dissipate forces
Tracking problems during . . . can occur when the patella does not glide smoothly over the bottom of the . . . ( . . . ). Over time this can cause . . . An incorrect position of the kneecap places an abnormal amount of . . . on the . . . . during . . . The . . . of the patella happens when the . . . are not moving together in a . . . as they bend, straighten, move to the side, and/or rotate.
flexion and extension . . . femur (femoral groove) . . . pain and dysfunction . . . pressure . . . underside of the patella . . . flexion or extension . . . displacement . . . femur and tibia . . . synchronized.
Knee verbal assessment (7)
- Pain (if so specifically where)?
- Arthritis?
- Level of activity?
- Occupation or Job?
- Limiting or prevention of activities?
- Pain coincides with other pain/symptom in the body?
- What makes it worst? What makes it better?
Foot Ankle Visual (6)
- Pronation
- Supination
- Foot Ab/Adduction
- Big Toes
- Lesser Toes
- Heel (Achilles tendon)
Knee visual (4)
Anterior View---- 1. (swelling, muscle size, scarring) 2. Side-to-side alignment (1 + 2) 3. Neutral Position of the knee Posterior View 4. Single Leg squat (30 degrees)
Knee hands on assessment (1) and do you have to do.
Patella tracking
Client in supine. Thigh on your leg. One hand on knee feeling for grinding, pops, or clicks. Other hand on ankle moving leg. All gentle.
Knee side-to-side assessment describe (2)
- Draw imaginary line from mid kneecap to middle of ankle/center of upper leg (where quads meet the hips) Make note of intersecting lines. Valgus/Varus knee.
- Single-Legged squat, ask to bend knee 30 degrees. Watch to see if knee moves medially or laterally.
Looking for only excessive motion towards the midline. It’s normal for knee to move towards the midline as a person squats.
How to put the Knee in a neutral position (3)
- Get the foot/ankle in a neutral position. When doing this, the center of the kneecap should align with the second toe.
- Ask clients to feel what happens to the gluteal muscles as they rotate the upper and lower leg out to help supinate the foot.
- —- - Also can help them align knees by coaching them to posteriorly tilt their pelvis. This will externally rotate the femur and tibia, which will help supinate the foot.
Posterior Single Leg Squat
- From behind, ask to squat one leg 30 degrees
- Watch center of buttock or sit bone (ischial tuberosity)
- Center of glutes should sit down just to the side of the heel. Ass crack just to side of the center of the heel - plumb line.
- Look for salsa hips. Knee will generally medially displace when this occurs.
The lumbo-pelvic hip girdle is where the . . . .
lumbar spine, pelvis, and top of the legs come together.
Flexion, extension, side-to-side movement, and rotation of the spine are interpreted by the . . . and converted into movements that can be utilized by the lower limbs for means of . . .
pelvis . . .balancing, propulsion, and creating power.
We have a large gluteus maximus to help . . .
extend the hips forward under the spine.
Our bodies our designed with traits to enable us to have great movement potential and flexibility which . . .
is inevitably paired with a higher probability for pain and dysfunction
Parts of the lumbo-pelvic hip girdle (6)
- femur
- acetabulum (hip socket)
- pelvis
- sacroilliac joint
- sacrum
- lumbar spine
3 fused bones of the pelvis
- ilium
- ischium
- pubis
hip socket is the
acetabulum
sacroilliac joint is
where the pelvis articulates with the spine. Where the sacrum meets the iliac crest of the pelvis.
Sacrum is . . .
triangular shaped of fused bones at the base of the pelvis between the lumbar spine and the coccyx (tail bone)
Lumbar spine is composed of . . . largest . . . in the body and is responsible for helping
five . . . vertebra . . . helping flex, side bend, extend and rotate the spine.
ilium
the broad, upper portion of either hipbone.
pubis
the ventral and anterior of the three principal bones composing either half of the pelvis.
ischial tuberosity
The Sitz Bones or Sit Bones or Sitting Bones: The ischael tuberosity, those two bones at the base of the pelvis that we can feel pressing against the ground or chair when seated. Yes, literally, they are the bones in your butt that you sit on. They could not be more aptly named.
ischium
The ischium forms the lower and back part of the hip bone.
Situated below the ilium and behind the pubis, it is one of these three bones whose fusion creates the coxa. The superior portion of this bone forms approximately one third of the acetabulum.
Two major Lumbo-pelvic hip dysfunctions
- Rotational malalignment of the pelvis. (anterior pelvic tilt) naturally only 10 degrees anterior
- Excessive lumbar lordosis (hyperlordosis)
Lumbo-pelvic hip verbal (8)
- Pain (if so specifically where)?
- Arthritis?
- Level of activity?
- Occupation or Job?
- Limiting or prevention of activities?
- Pain coincides with other pain/symptom in the body?
- What makes it worst? What makes it better?
- Does it ever wake you up at night? Poor sleeping postures can exacerbate the issue. How do they sleep?
Visual Lumbo-pelvic hip (2)
Lateral view—-
- Rot malalignment of pelvis
- Excessive lumbar lordosis
Lumbo-pelvic hip hands-on (2) and how?
Lateral —–
1. Degree of lumbar lordosis (hand wall test - second knuckle) or Supine test - do to show how sleeping supine can worsten ant pelvic rot - don’t do if in pain.
- Neutral position of the pelvis (teach them)
Against Wall ask to posterior rotate pelvis - squeeze glutes - ankle neutral OR Have them step away, hands on front of pelvis - pointer/index rule - index fingers touching and parallel on ASIS
ASIS is . . .
Anterior Superior iliac spine - bony protuberance on front of hips
Hyperkyphosis can cause the . . . to anteriorly rotate because the body is not able to straighten the upper back using the lumbar like a . . . to keep the . . . upright
pelvis - crane - torso
An excessive forward pelvis tilt causes the . . .to shift backwards.
Acetabulum
Thoracic spine and shoulder girdle consist of the . . .
thoracic spine, ribcage, shoulder girdle, and arms
Thoracic spine is responsible for . . . (4)
spinal flexion, extension, side bending, and rotation of the spine.
Ribcage is involved with . . . (2)
Protecting organs and breathing
Shoulder girdle articulates with the . . . . via . . . (5)
thoracic spine - muscles, tendons, ligaments, bones, and nerves.
Thoracic spine contains . . . vertebrae.
12
Thoracic vertebrae are . . . sized and have more . . . capability than vertebrae in the lumbar spine.
medium - rotational
Ribcage is made up of . . . ribs and attach via . . . at the . . . . in the front and . . . . at the back
24 - cartilage - sternum - thoracic spine
bottom two sets of ribs do not . . . known as . . .
attach to sternum - floating ribs
Sternum is a . . . Bone in which the . . . , or collarbone attaches
T-shaped - clavicle
clavicle extends outward from sternum to help form the . . .
shoulder girdle
The shoulder blade or . . . is a broad flat bone that sits flat on the back of the upper ribcage
scapula
the . . . is part of the scapula that extends over the shoulder joint above the . . .
acromion - humerus
the . . . is the bone in the upper arm and articulates with the shoulder joint via the . . . (ring of cartilage on the edge of the . . . which gives the end of the humerus a . . . shaped socket to sit in.
humerus - labrum - scapula - cup-shaped
Thoracic spine and shoulder girdle common deviations (4)
- Excessive thoracic kyphosis (hyperkyphosis)
- Protracted shoulder girdle
- Internally rotated arms
- Elevated scapula
Protracted shoulder girdle occurs when . . .
shoulder blades move away from the spine causing and cause the vertebral border of scap to move forward on ribcage
internally rotated arms occur when . . .
shoulder blades protract causing the humerus to medially rotate
elevated scap caused by
protracted shoulder girdle + internally rotated arms.
Thoracic spine and shoulder girdle verbal (11)
- Pain (if so specifically where)?
- Arthritis?
- Experience numbing or tingling in arms/hands - indication of pressure on nerves due to soft tissue neck/shoulder being irritated
- Diagnosed with carpal tunnel?
- Lose strength in arms/hands?
- Level of activity?
- Occupation or Job?
- Limiting or prevention of activities?
- Pain coincides with other pain/symptom in the body?
- What makes it worst? What makes it better?
- Does pain increase while under stress? Chronic stress can causes shoulders to shrug and upper back to round.
Thoracic spine and shoulder girdle (Visual/handson) (7)
Lateral view—-
1. Degree of thoracic kyphosis (back against wall, correct lumbar position, pull head back to floor while keeping eyes parallel, acromion should be in line of tragus, look for acromion farther forward than tragus.
Posterior view —–
- Elevated Scap (Feel for top border of scap, note any height discrepancies, scaps should be sitting back and down on the ribcage
- Elevated Scap Muscle Tension Check - Feel both upper traps, note tightness, knots, or side differences.
- Protracted scap - border of scap closest to spine (vertebral border) should be flat against ribcage - 1. Visually see if scaps are away from center of body 2. fingers on vertebral border (can you grab it/fingers under - feel if it’s flat.
Ant view——
- Internally rotated arms - ask client straighten thumb - look at direction of the styloid process - should only be turned in 15 degrees - can you see back of hands?
- Neutral position for the Thoracic spine and shoulder girdle - ask client to retract shoulder blades not against wall, no shrugging/arch in lower back, scaps must sit flat to ribcage - arms internally rotated no more than 15 degrees.
- Ask to do same against wall, head back, chin inward 1/3 inch away from wall - no head tilting - eyes parallel - neutral pelvis - ask to pull shoulders and upper back to wall without breaking neutral.
medial displacement of the knee is known as . . . and generally caused by. . .
valgus knee — femur internally rotating
Hyperkyphosis causes shoulders to . . . . head to . . . . and excessive cervical . . . to the keep the eyes . . . .
internally rotate . . . . come forward . . . lordosis . . . level
Hyperkyphosis can compress and restrict . . . . to internal structures such as the . . . . and . . . . restricting . . . . and affecting . . . health and overall . . .
blood supply . . . diaphragm . . . internal organs . . . breathing organ . . . well-being
People with internally rotated shoulders and elevated/protracted scaps have trouble . . .
raising their arms above their head correctly
Average weight of human head is between . . . pounds
9 and 12
every inch forward of its optimal state the weight of the head . . . for the structures to hold up
doubles
All body parts adjust to make sure the head remains . . . This alone can cause the rest of the body to go out of alignment
upright and balanced
Skull is made up of two main components
- Cranium (upper portion protects brain)
2. Mandible (Jaw)
Cranium is comprised of several bones (5) and also forms the . . . .
- occipital
- parietal
- temporal
- frontal
- Nasal bones
. . . eye sockets
Jaw bone is also known as the . . .
mandible
Mandible in connected to the cranium via the
temporomandibular joint (TMJ)
The skull sits on top of the . . . which is the . . . . in the cervical spine.
atlas bone. . . first vertebrae . . . .
How many vetebre are in the cervical spine? They are the . . . and most . . . vertebrae in the spine
7
Smallest and mobile
The cervical spine has a mild . . . to keep the head upright
lordotic curve
Two most common deviations associated with the head and neck.
- A forward position of the head
2. Excessive cervical lordosis (hyperlordosis of the cervical spine)
The more the head moves forward, the more the beck has to . . . . to keep eyes aligned to the horizon
arch
Head and neck verbal
- Pain (if so specifically where)? Headaches?
- Arthritis?
- Level of activity? (biking?)
- Occupation or Job?
- Limiting or prevention of activities?
- Pain coincides with other pain/symptom in the body?
- What makes it worst? What makes it better?
Head and neck - visual and hands on
Lateral view
- Forward Head Position - ask client to sit on edge of chair - cheek bone to collarbone
- Excessive Cervical Lordosis - Neutral against wall - head straight back - check eye socket level - are they looking up? 1/3 away from wall - no head tucking
- Neutral head and neck position - neutral everything - head to 1/3 inch of wall - tuck shin - tragus over acromion
Hip sockets shift backward to keep the body from . . . .
falling forward
Excessive lordotic curve in neck can compress . . . and . . . which can lead to pain in all of the upper body
discs and nerves
malalignment of head and neck causes improper alignment of . . . and can result in increased . . . symptoms and well as grinding/popping when the . . . closes and opens.
jaw - tmj - jaw
visual quick check starts at . . . . and works it’s way . . .
5 check points and specifically where are they?
Head - down
- tragus
- acromion
- greater trochanter of femur (center of hips)
- Gerdy’s tubercle - where it band attaches to tibia (forward a below center of knee joint)
- Tarsal joint of ankle (just forward of ankle bone - big bump)
