Movement Analysis Lower Limb Flashcards
What elements do I need to talk about in movement analysis?
JOINT AND MOVEMENT PRODUCED
AXIS AND PLANE OF MOVEMENT
MUSCLES THAT PRODUCE MOVEMENT (Prime movers and synergistic)
TYPE OF MUSCLE WORK (Concentric, eccentric or isometric)
RANGE OF MUSCLE WORK (Outer, Mid range and Inner range)
ESTIMATE JOINT RANGE IN DEGREES
LIMITING FACTORS
FIXATORS
HIP FLEXION
I can see hip joint flexion
Sagittal plane and frontal axis
Produced by prime movers iliopsoas and rectus femoris, and synergists are gracilis, sartorius and pectineus
Into hip flexion, hip flexors work in concentric isotonic contraction (hip extensors passively lengthen)
Full hip flexion = Inner range and full hip extension= outer range for flexors
Slight hip flexion is mid to inner range
Maximum hip flexion = 100-120 degrees , so estimate from video
Limiting factors if full flexion: soft tissue apposition of anterior thigh on abdomen, tension in antagonists (extensors) and active insufficiency of quads where they can’t shorten anymore to develop tension (this would occur if he extended the knee while flexing hip)
Tension in posterior joint capsule
Fixators: Hip abductors and adductors (surround joint to stabilise hip flexion + prevent unwanted movement)
HIP EXTENSION
Hip extension
Sagittal plane and frontal axis
Produced by prime mover gluteus maximus, with synergists being extensor part of adductor magnus, biceps femoris, semitendinosus and semimembranosus
Hip extensors to hip extension is concentric isotonic contraction
Inner range = full hip extension , outer range= full hip flexion Standing is inner to mid range ?
Hip extension gets to 15-20 degrees
Limiting factors: pubofemoral, iliofemoral and ischiofemoral ligaments as closed pack , anterior joint capsule, tension in antagonists.
Fixators: Abdominal muscles, rectus abdominis, erector spinae
HIP ABDUCTION
Abduction at hip joint
Frontal plane about sagittal axis
Prime movers : Gluteus medius and gluteus minimus, synergists are sartorius, tensor fasciae latae and piriformis
Abductors work in concentric isotonic contraction and adductors passively lengthen
Inner range = Full abduction. Outer range= neutral standing. So Mid range is about 15-20 degrees abduction.
Abduction can get to 40-45 degrees
Limiting factors: pubofemoral ligament and medial band of iliofemoral ligament , tension in antagonists, inferior joint capsule
Fixators:
HIP ADDUCTION
Hip joint ADDUCTION
Frontal plane and sagittal axis
In adduction, abductors work in eccentric isotonic contraction to lower leg down
Adductors are - adductor magnus, adductor longus and adductors brevis , pectineus and synergist is gracilis
If against resistance adductors work in concentric isotonic contraction
ADDUCTION to 15-30 degrees
Inner range = Full ADDUCTION and outer range= full abduction so mid range about 10-15 degrees abduction.
Limited by: iliofemoral lateral band as it becomes taut, tension in superior joint capsule, soft tissue apposition (medial thigh to lateral thigh) and tension in iliotibial band
Fixators:
HIP LATERAL ROTATION
Lateral rotation of hip
Transverse plane about longitudinal axis
Produced by: piriformis, sartorius and gluteus maximus with synergists as: quadratus femoris, gemellus inferior and superior and obturator internus and externus
Isotonic concentric contraction
Lateral rotation can get to 45-60 degrees
Muscle range: Inner range is full lateral rotation , outer range is medial rotation. Going into lateral rotation from neutral is outer-mid range
Limited by: Iliofemoral lateral band and tension in medial rotators, tension in anterior joint capsule
Fixators: Hip flexors and hip extensors (gluteus maximus stabilises hip movements)
HIP MEDIAL ROTATION
Hip joint medial rotation
Transverse plane about longitudinal axis
Produced by gluteus medius and minimus (ant fibres), synergists are TFL and adductor longus, brevis and superior part of adductor magnus
Into MR is concentric isotonic contraction
MR can get to 30-40 degrees
Muscle range: inner range is medial rotation and outer range is lateral rotation
Going towards medial rotation is
Limited by: ischiofemoral ligament and posterior joint capsule of hip and tension in lateral rotators
Fixators: Hip flexors and extensors stabilising medial rotation
KNEE FLEXION
Flexion of the tibiofemoral joint
On sagittal plane about frontal axis
Produced by: Biceps femoris, semitendinosus and semimembranosus, synergists are popliteus, plantaris, gastrocnemius and gracilis.
Isotonic concentric contraction into knee flexion of flexors and extensors passively lengthen
Flexion can get to 150 degrees
Inner range is full knee flexion , outer range is full knee extension, so mid range about 50-80 degrees knee flexion
Limited by: soft tissue apposition of hamstrings group and superficial posterior compartment, PCL and patella tendon , tension in antagonists
Fixators:
KNEE EXTENSION
Extension at tibiofemoral joint
Sagittal plane and frontal axis
Produced by rectus femoris, vastus intermedius, vastus medialis and vastus lateralis (no synergists to this action)
Into knee extension from neutral is concentric isotonic contraction of quadriceps
From full knee flexion to neutral standing uses eccentric isotonic work of hamstrings group
Extension can get to 0 degrees
Inner range for quads = full knee extension and outer range= full knee flexion. So mid range is 50-80 degrees knee flexion.
Limited by: Oblique popliteal ligament, MCL, LCL, ACL, PCL and tension in knee flexors (antagonists). Closed pack position
Fixators:
More to mention about knee
POPLITEUS will unlock knee from full extension on the step.
It will laterally rotate the femur on a fixed tibia as the leg is about to step down from step.
At same time the other leg has medial rotation of tibia on the fixed femur
DORSIFLEXION
Dorsiflexion at the TALOCRURAL joint
Sagittal plane about frontal axis
Produced by tibialis anterior, synergists are extensor digitorum longus, extensor hallucis longus and peroneus tertius
Into dorsiflexion is concentric isotonic contraction of dorsiflexors, plantarflexors passively lengthen
Dorsiflexion gets to 20-30 degrees
If only slightly dorsiflexed then mid to inner range.
Inner range = full dorsiflexion and outer range= full plantarflexion Mid range is plantigrade
Limited by: wedging of talus between malleoli, tension in antagonists (plantarflexors and tendocalcaneus), posterior part of deltoid ligament and calcaneofibular ligament, tension in posterior joint capsule.
Fixators: stability from the peroneus longus and brevis
PLANTARFLEXION
Plantarflexion at talocrural joint
Sagittal plane and frontal axis
Produced by: Gastrocnemius and soleus, synergists are plantaris, tibialis posterior, flexor hallucis longus, flexor digitorum longus, peroneus longus and peroneus brevis
Isotonic concentric contraction into plantarflexion
Can get to 50 degrees
Inner range = full plantarflexion. Outer range= full dorsiflexion and mid range is plantigrade
Slight plantarflexion is mid to inner range
Limited by: tension in antagonists (dorsiflexors), anterior part of deltoid ligament and anterior talofibular ligament, tension in anterior joint capsule
Fixators: Peroneus longus and brevis (they wrap around plantar foot stabilising joints)
INVERSION at SUBTALAR joint
Inversion at sub talar joint
Frontal plane and sagittal axis
Inversion produced by: tibialis anterior and tibialis posterior , synergists are flexor hallucis longus and extensor hallucis longus
Isotonic concentric contraction into inversion
Evertors passively lengthen
Inversion can get to 45-60 degrees
Inner range = full inversion. Outer range = full eversion
Limited by: dorsal talonavicular ligament
Fixators: plantar and Dorsi flexors
EVERSION
Eversion at sub talar joint
Frontal plane and sagittal axis
Produced by: Peroneus longus, peroneus brevis and peroneus tertius (in synergy)
Isotonic concentric contraction
15-30 degrees usually
Inner range = full eversion and outer range = full inversion
Limited by: plantar calcaneocuboid ligament and impact of talus on floor of sinus tarsi
Fixators: plantar and Dorsiflexors
Toes
If you can see toes
ABDUCTION by the dorsal interossei
ADDUCTION by the palmar interossei
