MT Flashcards
importance of pelvis
middle center of mass
locomotion
stability of masses above/below
base of vertebral column
function of pelvis w/ GI/GU
acts as a bowl supporting most of the systems
pelvis lymphatic/vascular importance
contains all vascular/lymphatic contents for below structures
important areas of pelvis for LE circulation
pelvic diaphragm and inguinal area
pelvis main functions
- biomechanical function/balance
- reproduction
- elimination
- vascular/lymphatics for the region and LE
basic anatomy of the innominate
composed of the ilium, pubis, and ischium
acetabulum structure
composed of 3 different ossifaciton centers (3 areas of innominate)
true vs accessory ligaments
true - bone to bone
accessory - attach at another ligament, tendon, or fascia
ligament functions
- limit movement
- permit motion
- elastic quality
- limit movement as part of reflex response
anterior pelvic ligaments
sacrospinous - sacrum to ischial spine
iliolumbar - from ilia to L5
anterior sacroiliac - covers sacroiliac joint
inguinal L - ASIS to superior pubic rami
posterior pelvic ligaments
sacrotuberous - sacrum to ischial tuberosity
posterior ascroiliac - covers sacroiliac joint
attachment of Gmax/biceps femoris
sacrotuberous L
attachement of coccygeus M
sacrospinous L
iliolumbar L function
stabilization of L5, prevents excessive anterior/rotary motion
origin of IOM and TAM
inguinal L
L preventing anterior displacement of sacrum
anterior sacroiliac L (thicker than PSL for this reason)
L filling irregular space posteriosuperior to sacroiliac joint
interosseous sacroiliac L
attachment points of PSL
3rd/4th sacral segments to PSIS and posteiror iliac crest
attachment points of ASL
3rd sacral segment to lateral pre-auricular sulcus
attachment points of inguinal L
pubic tubercle to ASIS
attachment points of sacrospinous L
ischial spine to lateral sacrum/sacrotuberous L
attachment points of sacrotuberous L
lower sacral tubercles to ischial tuberosity
Ls associated w/ pubic symphysis
superior pubic L (above) and inferior pubic L (below)
innominate w/ heel strike
right heel strike = right innominate rotates posterior due to iliopsoas contraction
innominate w/ toe off
right toe off = right innominate rotates anterior w/ iliopsoas relaxation and gmax/hamstring contraction
major/minor hip flexors
major = iliacus, psoas
minor = rectus femoris, sartorius
hip extensors
Gmax, hamstrings (biceps femoris, semitendonosis, semimembranosis)
hamstring tension effect on innominate
posterior rotation
rectus femoris, iliacus, or adductor tension effect on innominate
anterior rotation
major/minor hip adductors
major = ad magnus/brevis/longus
minor = gracilis, pectineus
hip abductors
Gmed, Gmin, TFL
trendelenburg sign
drop of pelvis when lifting leg opposite to a weak Gmed
+ sign = abductor strenght not adequate
causes of trendelenburg gait
weak abductor (Gmed/Gmin) or superior gluteal N (L5) issues
hip external rotators
piriformis, obturator externus/internus, superior/inferior gemilli, quadratus femoris
only hip rotator connected to sacrum
piriformis
quadratus lumborum effect on Ns
may product Sx of groin pull/hernia by irritating the ilioinguinal and iliohypogastric Ns as they pass anterior to it (L1)
greater and lesser sciatic formaen are created by
sacrospinous L
gravitational line
- auditory meatus
- acromion process
- greater trochanter
- L3 body
- anterior 1/3 of sacrum
- lateral condyle of knee
- lateral malleolus
innominate shear
superior/inferior motion of one innominate
innominate flare
flares out/in as measured by distance of ASIS to midline on both sides
lateralization tests
used to determine which side SD is on
standing flexion test and ASIS compression test
rib articulations w/ spine
articulates w/ superior costal facet of its own vertebra
articulates w/ inferior costal facet of above vertebra
rib tubercle articulation
articulates w/ transverse process of its own vertebra
joints of ribs
costochondral and sternocostal
rib articulation exceptions
1/10/11/12 - articulate only w/ their own vertebra
11/12 - dont have tubercles, dont articulate w/ TPs
atypical/typical ribs
1, 2, 11, 12 (sometimes 10) are atypical
3-9 (sometimes 10) are typical (have all landmarks)
true/false ribs
true = 1-7; cartilage attaches to sternum
false = 8-12;
- 8-10 cartilage attaches to above ribs
- 11-12 are floating
rib at sternal angle (Louis)
rib 2 costal cartilage
Ms of 1st/2nd ribs
i get up at 1 AM 2 P
Anterior scalene/Middle scalene - elevate 1
Posterior scalene - elevates 2
pec minor action and correlation w/ ribs
stabilizes scapula drawing it inferior/anterior; inserts of ribs 3/4/5
serratus anterior action and correlation w/ ribs
protracts scapula, ribs 2-8 insertion
lat action and correlation w/ ribs
extends/adducts/med rotates humerus, lower 4 ribs origin
quadratus lumborum action and correlation w/ ribs
fixes 12th rib in inhalation (insertion)
external intercostals
from spine -> costal cartilage
elevates during forced inspriation
internal intercostals
from rib angle -> sternum
depresses ribs
innermost intercostals
from rib angle -> costal cartilage
depresses ribs
origin of diaphragm
xiphoid process, lower 6 ribs, L1-L3
vessels/nerves b/w ribs
VAN (vein most superior) b/w ribs found in b/w internal and innermost Ms
bucket handle rib motion
ribs
superior/lateral motion, increase transverse diameter (AP axis)
ribs 1-2, 8-10
pump handle rib motion
ribs
superior/anterior motion, increase AP diameter (transverse axis)
ribs 3-7
caliper/pincer rib motion
ribs
downward/posterior in inspiration, upward/anterior in expiration
ribs 11/12
torsional rib movement of rib
due to rotation of thoracic spine
T6 RL -> L 6th rib turns externally, R 6th rib internally; L 6th sharp/flat anteriorly, R 6th accentuated
non-physiologic movement of rib
due to trauma -> ant/post subluxation
inhalation SD
inhalation more free, exhalation restricted
exhalation SD opposite
ribs in inhalation/exhalation SDs
inhalation SD = ribs 1-4 held up (key rib = 4)
exhalation SD = ribs 3-8 held down (key rib = 3)
key ribs
BITE (bottom inhalation, top exhalation)
key rib maintains the group, treat key rib first
ribs 11-12 inhalation SD cause
quadratus lumborum
rib 1 ex SD cause
ant/med scalene Ms
rib 2 ex SD cause
post scalene
ribs 3-5 ex SD cause
pec minor
ribs 6-8 ex SD cause
serratus anterior
ribs 9-10 ex SD cause
lat
ribs 11-12 ex SD cause
quadratus lumborum
major cause of rib dysfunction
thoracic scoliosis/kyphosis
rib asymmetries (excavatum/carinatum)
osteoporosis/osteoarthritis (anteriorly depress ribs)
COPD
M strain
trauma
slumping (depression, desk work, etc)
SI joint after puberty
males: well developed and strong
females: less developed for childbirth
males SI joint degeneration
begin in sacral side in 4th-5th decade of life
SI joint type
diarthrodial joint - contains synovial fluid
is unique b/c 1 side is hyaline cartilage and other is fibrocartilage (sacral hyaline, iliac fibro)
SI ligaments
posterior - thicker, blends w/ STL and thoracolumbar fascia
anterior - blends w/ iliolumbar L
long dorsal SI ligament
stretches w/ pregnancy/aging, connects to PSIS
form/force closure of the sacrum
form - due to how the joints fit together
force - due to gravity/loading forces/Ms/etc
axes of the sacrum
Superior Transverse (respiratory) - parallel and through S2
Middle Transverse (postural) - through S2 parallel to the ground not the vertebrae
Inferior Transverse (pelvic) - through S3 upwards
lumbar/sacrum relationship
lumbar flexion -> sacral extension
lumbar extension -> sacral flexion
sacrum movement relationship w/ base/apex
extension -> base posterior, apex anterior
flexion -> base anterior, apex posterior
Tender vs Trigger points
Tender - in Ms/Ts/Ls/fascia, twitch response not present
Trigger - in Ms, has radiating pain pattern, present in a taut band of tissue, elicits twitch response
Tender vs Trigger points Tx
tender - spontaneous release by positioning (counterstrain)
trigger - spray and stretch
nociceptive model of counterstrain
tissue is strained recruiting nociceptors within that tissue -> reflexive contraction occurs within tissue -> contraction becomes the new neutral
proprioceptive model of counterstrain
muscle is strained (w/o nocicpetor recruitment) -> antagonist M shortens via antagonist gamma neuron system -> antagonist contraction new neutral
seen in whiplash: posterior neck Ms strained, so anterior shorten in new neutral
nociceptive/proprioceptive models similarity
constriction -> decreased circulation causing localized edema and back up of products of metabolism
4 phases of counterstrain
- relaxation
- reset of spindle fibers/nociceptors
- washout
- slow return to neutral
counterstrain vs MET targets
counterstrain - muscle spindle fibers
MET - golgi tendon organs
washout in counterstrain
washing out of waste products
begins 10-15 seconds, peaks at 1 min
time for counterstrain holding
90 seconds for most
120 seconds for ribs
anatomical reasoning for tender point
where motor N pierces investing fascia and enters M
position of comfort
70% of tenderness alleviated
position of optimal comfort
100% of tenderness alleviated
maverick
tender point that does not respond to typical positioning, usually requires opposite position from standard
counterstrain founder
Lawrence Jones 1955/1980 published
sacral Dx
review notes and sacral review ppt
L5 movement w/ sacral torsion
rotates opposite = compensated
rotates same = uncompensated
SB towards the axis
flexed sacrum -> neutral L5 (T1)
extended sacrum -> flexed/extended L5 (T2)
Ms elevating ribs 1/2
woke up at 1am 2P
1 - anterior and middle scalenes
2 - posterior scalenes
pec Ms contraction leads to what rib SD
contraction -> inhalation SD
this is why exhalation dysfunctions contract it
M elevating ribs 3-5
pec minor
M elevating ribs 6-8
serratus anterior
M elevating ribs 9-10
lat
M elevating ribs 11-12
quadratus lumborum
