Week 1 1-A - Principles of LE Movement Flashcards
UE Vs LE Movement
Is there a difference?
UE = (Open/Closed) kinetic chain
LE = (Open/Closed) kinetic chain
(MOSTLY)
LE – Closed kinetic chain, we don’t walk on our hands.
UE – Open kinetic chain
MMT and things are in open kinetic chain and we don’t function in life like this, so want to look at functional movements.
WB comes into play
Open; Closed
Principles of LE movement
Lower Kinetic Chain:
(Non Regional/Regional) Interdependence
Definition:
“Regional interdependence refers to the concept that seemingly unrelated impairments in a remote anatomical region may contribute to or be associated with the patient’s primary complaint”
-Wainner 2007 JOSPT
Example in UE?
Poor scapular stability causes GH joint pain
Thoracic spine mobility?
In CKC this becomes more important because the individual links will be influenced by the others.
Regional
Lower Kinetic Chain
Relationship of the links
– coupled or linked movement
Supination with (internal/external) rotation of the knee.
external
Lower Kinetic Chain
Relationship of the links
– coupled or linked movement
Pronation with (internal/external) rotation of the knee.
internal
Lower Kinetic Chain
Examine joint above and below
Proximal and distal influences of movement
Got it
Knee pain can come from abnormal hip control. It can come from the ground up or vice versa.
Got it
Have to look at (the whole/half of the) kinetic chain and address the origin of this.
the whole
How do you find the weak link?
Exam and Observation of Movement Deficits in: Strength NM control ROM Hyper/Hypomobility Muscle length / flexibility
Exam and Observation of Movement
Painful activity?
* Watch it!
Stairs
Squat / sit to stand
Run
Movement screen
ID abnormal movement
Helps focus exam
Got it
Got it
Got it
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How do injuries occur?
Trauma - tissue injury caused by extrinsic agent
(Microtrauma/Macrotrauma)
Tissue overload
Repetitive - activity related/training error
Poorly dissipated/absorbed load
(Microtrauma/Macrotrauma)
Macrotrauma; microtrauma
Tires on your car – if your car tires are in a good alignment it spreads the load (in one area/evenly), if they are not in alignment it focuses all the load in (one spot/evenly) and it will wear out quickly.
evenly; one spot
How do injuries occur?
(Increased/Decreased) force concentration
What’s the formula for pressure?
Increase the surface area you will (increase/decrease) the pain. Load will go through a larger area.
Increased; P = F/A; decrease;
What is this movement pattern called?
Components?
Hip (Adduction/Abduction) Hip (Internal/External) rotation Pelvic Drop Knee valgus - knee (adduction/abduction) (Pronation/Supination)
People who have dynamic valgus can develop the following condition and are more likely to get hurt:
PFPS (patellofemoral pain syndrome)
ITBS (Iliotibial band syndrome)
TSF (Tibial stress fracture)
MTSS (Medial tibial stress syndrome)
Hip trochanteric bursitis
Dynamic valgus; adduction; Internal; abduction; pronation
Abnormal Movement Patterns LE
Pattern recognition
ID usual suspects
Got it
Frontal Plane Abnormal Movements
Pelvic drop (trendelenburg) Excessive hip (abduction/adduction)
adduction
Transverse plane abnormal movements
Dynamic knee valgus hip (internal/external) rotation Tibial (internal/external) rotation Foot hyper (pronation/supination) (multiplanar)
internal; internal; pronation
Sagittal Plane Abnormal Movements
Stiff knee gait:
Flexed Knee gait:
Extension (gain/loss) (unable to extend fully)
Arthrofibrosis – post op / trauma
Immobilization
Knee kept in extension:
(Hamstring/Quad) weakness, unstable
Knee hyper extension
Poor (hamstring/quad) control
kinetic chain limitation - limited (DF/PF)
Stiff knee gait – knee flexion contracture could be the cause, LOM in extension, scarring,
Knee hyper extension – weak quads (knee will buckle so they walk like this), kinetic chain limitation – limited DF.
loss; Quad; quad; DF
As you move into hip extension and you don’t have the movement In your ankle it will put your knee (forward/backwards).
People who don’t have DF can have dynamic (varus/valgus).
backwards; valgus
Limited DF
Consecuences:
Flexed knee gait
Increased (PF/DF) compression: PAIN
Extended knee
Increased (GRF/Tension) with less joint excursion: PAIN
Knee hyper extension Abnormal loads (anterior/posterior) knee or PFJ: PAIN
PF; GRF; posterior
Lack of knee extension on the left.
Left pic is absorbing impact (worse/better). Knee does not absorb impact well in (flexion/extension). Guy on the right is landing on heel which is not ideal. More likely to develop an injury on the (left/right) pic.
extension; right
Not enough (DF/PF) so weights behind her.
If you have knee pain that will increase PF joint pain if you have knees way (behind/over) toes.
Squatting low is not a good idea to do if you have knee pain because it will (increase/decrease) load throughout the knee.
DF; over; increase
Good knee alignment
Got it
The position of risk is dynamic (varus/valgus) .
valgus
Want to watch them that they are not in dynamic valgus and want the knees (close/apart).
apart
Dynamic (varus/valgus)
valgus
Greater knee flexion angle will (increase/decrease) PF pain. Want them to step out further to (increase/decrease) knee flexion to (increase/decrease) PF load.
Greater impact on the bottom right pic, want them to start with the top right pic to (increase/decrease) load on the patellar.
increase ; decrease; decrease; decrease
Got it
Got it
Compensated Trendelenburg – shift to her (right/left) side.
right
Got it
Got it
Got it
Got it
Poor _/5 criteria Fair _-_/5 criteria Good _/5 criteria
1; 2-3; 4
Got it
Got it
What can cause dynamic valgus?
Hip
Increased femoral (anteversion/retroversion)
leg length differences
GMax, G Med (Weakness/strength)
Poor muscular recruitment or coordination
Poor proprioceptive awareness
Knee
(Valgus/Varus) knee – (medial/lateral) articular cartilage wear / bone loss
Foot
(Short/Long) Gastroc/soleus
(1st/2nd) MTP limited ROM
(Hyperpronation/Hypersupination) – uncontrolled flexible flat foot
Talo crural joint limitation ROM (DF/PF)
PTT (Posterior tibial tendon?) insufficiency
anteversion; weakness; Valgus; lateral; Short; 1st; Hyperpronation; DF;
Why do kinematic differences occur? Why do people move with abnormal movement patterns?
Decreased hip (ABD/ADD) strength
Iliotibial band syndrome (ITBS)(Fredericson)
Achilles tendonitis (Habets)
Medial tibial stress syndrome (MTSS) (Becker, Verrelst)
TSF (Boling, Ferber)
ABD;
Why do kinematic differences occur? Why do people move with abnormal movement patterns?
Normals vs Patellofemoral Pain Syndrome (PFPS)
Decreased hip (adduction/abduction) strength
Decreased hip (flexion/extension) strength
Decreased hip (internal/external) rotation strength
abduction; extension; external
(Correlation/No correlation) b/w muscle strength and amount of valgus or varus movement during testing.
No correlation
Okay coo
Got it
The Effect of a Hip-Strengthening Program on Mechanics During Running and During a Single-Leg Squat
Significant gains in strength
Hip (ABD/ADD), (IR/ER)
SLS kinematics improved
reductions in hip (ABD/ADD), (IR/ER) and (ipsilateral/contralateral) pelvic drop
No changes were seen in abnormal hip mechanics during running
Hip strengthening alone may not be sufficient to change abnormal hip mechanics during running.
Activity-specific neuromuscular training may be necessary to alter these aberrant motions.
SLS – single leg squat
Have to do task specific training!!!!
ABD; ER; ADD; IR; contralateral
Trunk Control
Activating core (improves/worsens) dynamic tasks
Subjects engaged transverse abdominis (TA) and performed SLS
3D instrumented motion analysis
Significantly (more/less) frontal plane deviation compared to non engaged condition in same subjects
Movement got better with contracted abdominals so core plays a role in LE movement. Stabilize the core to improve quality of movement in the LE.
improves; less
How Do We Correct Abnormal Movement Patterns?
Interventions: Strengthening Stretch or soft tissue work to improve Flexibility / muscle length Joint mobilization Proprioceptive training Core stabilization Movement retraining – motor control
Got it
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If they have swelling and pain, put them in crutches, putting them in different positions, if they can’t WB put them in the water to offload the joints.
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Give them education on what they should or should not do.
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Pt has to know what they are doing outside of therapy!!
Got it
