Module 3: LE Part 1 Flashcards
forces on feet while walking
1-3 times bodyweight
forces on feet while running
3-5 times bodyweight
forces on feet while jumping
5-7 times (some say 7-11 times)
how to increase joint shock absoprtion
increase surface area of mass of striking object and increase time to bottom out
joint glide up and down is slowed by
eccentric contraction of posterior tibialis
amount of energy absorbed before fracture
impact strength
windlass effect is responsible for
supination of foot and external rotation of contact leg
involuntary effect that normally raises the longitudinal tarsal arch as foot moves up and over the toes
windlass effect
windlass effect externally rotates
tibia and femur
raising the big toe on patient makes
whole limb externally rotate and arch of foot to raise in supination
functional hallux limitus aka
limited dorsiflexion/limited windlass effect
dorsiflexion great toe without load normal angle
70-90 degrees
weight bearing great toe dorsiflexion
35 degrees
what makes up the midtarsal joint
calcaneocuboid and talonavicular
what causes plantar fascitis
arch does not raise and joints dont glide, then toes bend and tighten
80% of plantar fascia originates on
medial tubercle
pronation occurs as
leg and body move over the foot
two bones that initiate pronation
talus and calcaneous
what does the talar head do during pronation
moves medially from a vertical position over head of the calcaneus, to a position horizontal to the head of the calcaneus
average angle of talar motion is
45 degrees
pronation of foot causes
medial rotation of tibia and femur, pelvis rocked forward, and spine to lean to that side
supination begins
as heel raises from the ground
what starts the windlass effect
leg and body forward motion
how does the talar head move compared to the calcaneal head
superior and vertical
primary shock absorber of the body
foot pronation
shock is absorbed by what kind of pronation
rapid
shock is absorbed by eccentric contraction of post tib slowing lowering of longitudinal arch
normal step
secondary shock absorber of the body
knee
popliteus flexes knee its first
15 degrees from full extension
nerve root of popliteus is
L5
can the popliteus effectively bend the knee if heel strike is pronated
no because popliteus is internal rotator and the leg is already internally rotated
action of posterior tibialis
contract in order to decelerate the subtalar joint pronation
if subtalar joint is pronated at heel strike, psoterior tibialis will
exert its contraction force proximally instead of distally (shin splints)
internal rotation increases stress on
anterior horn of meniscus
heel fat pad typically does what with age
decreases
stress fractures occur due to
stress no longer attenuated by the kinetic chain
ability to pronate is compromised by fixations in the
knee or feet or subluxation of the spine
how long does it take for stress fx to heal
6-8 weeks, will feel better in 2 weeks barring activity
painful palpation of sustenaculum tali due to
spring ligament stress due to arch not working
key to medial arch
talus->naviculum->1st cuneiform
pulley for fibularis longus
cuboid
fulcrum for plantar fascia and flexor hallucis longus
1st ray sesamoid
sensations to joint involve
pain and position
Type IV mechanoreceptors
nociception, activate sympathetic nervous system
neuromuscular phenomenon that occurs when joint dysfunction inhibits the muscles that surround the joint
arthrogenic inhibition
how long does it take for plastic deformation to occur if joints out of place
3-6 months
when plastic deformation occurs, what happens
tissues are elongated and no longer activate with inhibition response
the importance of mechanoreceptors with an adjustment
removes stretch in the muscles, tendons, ligaments, and capsules and no loner inhibits activity of muscles stretched around that joint
stance/contact phase of gait cycle takes up
62% of full cycle
swing phase of gait cycle takes up
38% of full cycle
moment heel contacts ground until forefoot makes contact with ground
heel strike
forefoot drops to fully contact plantar surface of foot with ground
midstance
what can cause weakness during muscle testing
nerve, injury, pain, TrP
other than weakness, what indicates a problem
shaking, ratcheting, lack of coordination, recruiting
blood supply to acetabular joint is controlled by
L2
what subluxations are correlated with DJD of hip
L2 and L5
what can mimic short legs
pelvic torque, hyperpronation, anterior talus
what to look for with hip problems
L2/L5 subluxation of hip adhesions of hip referral from upper lumbar/lower thoracic piriformis
motion related clinical disorder of the hip with a triad of symptoms, clinical signs, and imaging findings.
FAI Syndrome
primary symptom of FAI syndrome
motion or position related pain in the hip or groin
symptoms in addition to pain for FAI Syndrome
clicking, catching, locking, stiffness, restricted ROM, or giving away
most common sign for FAI syndrome for ortho testing
flexion adduction internal rotation (FADIR) is sensitive but not specific
conservative tx for FAI Syndrome
education, watchful waiting, lifestyle and activity modification, NSAIDS, steroid shots
Tx of PT for FAI Syndrome includes
hip stability, NM control, strength, ROM, and movement patterns
injury in the inguinal area that is usually caused by activities, especially when twisting/turning at high speeds
athletic pubalgia
most common patients to get athletic pubalgia
soccer, tennis, hockey
normal hip internal rotation
35-40 degrees
normal hip external rotation
70-90 degrees
hip joint subluxates in what two ways
internal and external rotation
signs/symptoms of femur subluxations
- ) socket limp with dull ache
- )early muscle fatigue in involved leg
- ) limited ROM of hip during passive and active motions in 90+90 positions
- ) tenderness at anterior greater trochanter (internal rotation)
- ) tenderness at post greater trochanter (ext rotation)
occurs often with people who run on banked roads or trails
TFL syndromr
Nerve roots of TFL/IT Band
L4/L5
controls blood supply to acetabular socket and controls rectus femoris
L3, L3
function of rectus femoris
flexes the hip and extends the knee (only 2 joint muscle of the quad group)
L5, S1, S2 nerve root
piriformis
L1, L2, L3 nerve roots
psoas
what affects the length of the psoas
rotation of femur which can also affect pelvis, lumbar stability, and curve
