written test #2- lumbar, Hip, Knee Flashcards
Which direction do lumbar intervertebral discs deform and displace when a person performs right lateral flexion?
Left
If a patient has radiating symptoms that demonstrate motor weakness, the patient is given what type of radiating symptoms diagnosis?
Radiculopathy
Injury at sub failure load is most likely to occur when there is inadequate recovery (time) between exposures of load. T or F?
True
Limacon shaped lumbar vertebral discs demonstrate more diffuse nucleus deformation than ovid shaped discs. T or F?
False
Which of the following spinal motions are limited the greatest due to the orientation of the lumbar facet joints?
Rotation
What best describes the process of pain centralization?
Distal pain that slowly progresses towards the spine
Based on categorization of low back pain, what treatment is most ideal for addressing a facet mobility problem?
Joint manipulation
Lumbar ligaments are densely populated with mechanoreceptors providing feedback regarding position and motion. T or F?
True
What best describes the reason for the ilopsoas’s attachment to the lumbar spine?
Disperse hip flexion forces across the lumbar spine
Based on categorization of low back pain, what treatment is the most ideal for addressing a motor control problem?
Stabilization exercises
What position are the hip abductors capable of generating the greatest force (strongest)?
Adducted 10 degrees
In a seated position with hips flexed to 90 degrees, the piriform is positioned to efficiently perform which movement?
Internal Rotation
What combination of positions puts the hip in OPEN packed position?
Slight external rotation, hip flexion 30 degrees, abducted 30 degrees
What position is the right femur in relative to the pelvis when the pelvis left laterally tilts (left side drops)?
Adduction
When the pelvis rotates to the left, what direction does the left femur need to move relative to the pelvis to keep the left foot aligned in the sagittal plane?
Medial Rotation or Internal rotation
Which position will a person adopt posturally, if they have femoral retroversion?
Lateral rotation of the leg (toed-out)
What position is the femur in relative to the pelvis when the pelvis is tilted anteriorly
Flexion
In a standing position, posterior rotation of the pelvis is equivalent to closed kinetic chain hip extension. T or F?f
True
Which of the following is true regarding coxa vara?
It is associated with less risk of dislocation
Which of the normal variants of the femoral neck increases mobility of the iliofemoral joint, while sacrificing stability- Coxa valga or Coxa vara?
Coxa valga
Which meniscus demonstrates less mobility, possibly explaining why it more frequently injured?
Medial
Which area of the meniscus has the best potential to heal due to a better blood supply?
Outer 1/3
Any movement of the vastus medialis oblique will allow a greater amount of lateral glide of the patella due to the origin of the quadriceps muscles being orientated laterally to their insertion point. T or F
True
What motions create the “screw home” mechanism of the knee during terminal knee extension? You need to know what a terminal knee extension is to understand this question…
The femur internally rotates and the tibia externally rotates
Which meniscus is deeper?
Lateral
Which directions does the femur move relative to the tibia during knee extension?
Rolls anterior and slides posterior
The posterior Cruciate ligament functions to prevent what motions at the knee?
posterior translation of the tibia and anterior translation of the femur
The lateral femoral condyle rotates which direction on the tibia during knee flexion?
posterior
what position is considered the open packed position of the knee?
30 degrees of flexion
Which direction do the menisci move during knee extension?
Anterior
What are the 3 common occurrences for patient that reported low back pain compared to those who do not?
Reduced lumbar ROM
Move more slowly
Have reduced proprioception
LBP has a high rate of reoccurrence. T or F?
True
Treatment of LBP focused on the intervertebral disc should focus on what treatment?
Direction Specific exercise
Treatment of LBP focused on the Facet or SI joint should focus on what treatment?
Joint manipulation
Treatment of LBP focused on motor control should focus on what treatment?
Stability & motor control exercises
Treatment of LBP focused on central sensitization should focus on what treatment?
cognitive behavior therapy
IVD deform opposite to _________
Load
The nucleus pulposus deforms in the direction opposite to the ________
motion
If the spine flexes the nucleus pulposus moves ?
posterior
IF the spine extends what direction does the nucleus pulposus move?
Anterior
If you laterally flex your spine does the nucleus pulposus move contralateral or ipsilateral?
Contralateral
The IVD store energy from rotation and releases that energy to help drive what?
Our gait
Put these in order from least force on the IVDs to the most-
Coughing
Lifting 22.5 lbs
Forward bending 40 degrees
Holding 1lbs at arms length
Lying supine
Standing erect
Sitting in an unsupported position
Sitting in a supported position
lying supine- 250 N
Sitting supported- 400 N
Standing erect- 500 N
Sitting unsupported- 700 N
Coughing- 700 N
Forward bending 40 degrees- 1000 N
Lifting 22.5 lbs- 1700 N
Holding 11lbs at arms length- 1900 N
What are the lumbar disc shapes?
Ovoid Disc- Circular, thinner spines, more diffuse nucleus deformation
Limacon- bean shaped, thicker spines, more focal deformation
3 ways the IVD can cause symptoms are?
Direct injur to annulus fibrosis
Mechanical pressure & Chemical irritation affecting IVFs
Loss of disc height
Define radiculitis
Radicular or Radiating pain. Sensory changes due to ectopic discharges from a nerve due to inflammation
Define Radiculopathy
compression or a nerve that results in motor weakness
Pain originating from the spine that refers distally is called what?
Peripheralization
Symptoms moving back towards the midline of the spine is what?
Centralization
The bigger the herniation the more likely it will ________ ____________
spontaneously resorb
Repeated movement testing is performed and if centralization or a direction preference is identified, they are placed into this category. What treatment category is this?
DIRECTION SPECIFIC EXERCISE
What is unique about the lumbar facets superior to inferior?
Primarily lie in a sagittal plane in the upper lumbar and changes to a coronal plane in the lower lumbar
Anterior rotation + Anterior translation = What in the spine
Flexion
Anterior translation of vertebrae is limited by what?
bony facet joints
anterior rotation is limited by ??
Posterior annulus fibrosus & posterior ligament
Posterior Rotation + Posterior Translation= what is the spine
Extension
Lumbar extension is limited by the approximation of the __________ and __________
articular processes
spinous processes
What limits side bending in the lumbar spine
Intertransverse ligament
Capsule of the contralateral facet joint
Approximation of the ipsilateral facet joint
In a neutral position- rotation is limited by 2 things. What are they?
Approximation of the facet joint surfaces
limited by tension in the joint capsule, annulus
fibrosus, & PLL.
If the vertebral body rotates to the left, what happens that limits the rotation?
joint surfaces of the right facet approximate
joint capsule of the left facet is stretched/under tension
What is the open packed position for the lumbar spine?
Flexion & rotation toward the same side
What is the closed packed position for the lumbar spine?
extension & rotation toward the same side
What is the degrees of ROM seen in rotation for the scarum?
Between 1-8 degrees, avg of 2 to 3 degrees
What are the 3 types of SI joint motion?
Symmetrical motion
Asymmetrical motion
Lumbopelvic motion
Antagonistic movement of each innominate relative to the sacrum, which includes movement at the symphysis pubis. What motion is this describing?
Asymmetrical motion
Movement of both innominates relative to the sacrum. What motion is this describing?
Symmetrical motion
Combined movement of the innominates and the spine as a unit around the femoral heads. What motion is this describing?
Lumbopelvic Motion
What are the two movements associated with the SI joint and symmetrical motion?
Nutation
Counter-nutation
Forces from above and below pass through the body in what direction relative to the sacrum?
Anterior
How do the superior and inferior forces act on the sacrum?
Upper body weight tries to tip the sacrum forward
Ground forces tend to rotate the innominate bones backward
Extension of the trunk from standing combines extension of the lumbar vertebrae with ________ rotation of the pelvis on the fixed femurs.
posterior
Flexion of the trunk from standing combines flexion of the lumbar vertebrae with _______ rotation of the pelvis on the fixed femurs.
forward
What factors can limited lumbopelvic flexion?
Hamstring stiffness (limits anterior pelvic rotation)
Excessive lumbar flexion (increased load on discs/ligs)
Weakness in hip flexors (lack of anterior pelvic rotaiton)
What factors can limit lumbopelvic extension?
Tension in iliolumbar ligaments
“tightness” in the hip flexors (anterior tilt of the pelvis)
What are the two self locking mechanisms of the SI joint?
Form closure
Force closure
The sacrum acting as a “keystone”, locks the innominates in place providing bony structural stability. What is this?
Form closure
The surrounding ligaments and muscles exert some type of forces through the SIJ providing additional stability. What is this?
Force closure
What is the cluster of tests that research shows should be used to confirm a diagnosis of SIJ as the source of a patient’s problem is what? What tests are they?
Cluster of Laslett
- SI Joint Distraction
- Thigh Thrust
- Sacral Thrust
- The Drop Test
- Gaenslen’s
- Iliac Compression
What 3 criteria are needed to diagnose a patient into a Joint Manipulation Treatment category?
- If unable to centralize pain through
repeated movements - Positive Z-joint clinical features
- (3>) Cluster of positive SIJ provocation test
Most injuries to the spine happen outside of the ____ plane
sagittal
What are the “inner core” muscles?
- Multifidus
- Diaphram
- Pelvic floor
- Transverse abdominus
What are the “outer core” muscles?
- Rectus abdominus
- Abdominal obliques * Latissimus dorsi
- Gluteus maximus
- Adductors
- Hamstrings
- Quadriceps
- Psoas
- Quadratus lumborum * Spinal erectors (ILS)
What are the differences between inner core and outer core musculature?
Inner core- Stabilizers, endurance muscles, low loads, anticipatory control
Outer core- Prime movers, short duration, heavy load, secondary contraction
This is the first portion of the core to contract prior to any movement and is reflex driven
Inner core
What muscle minimizes posterior shear in the lumbar spine?
Multifidus
What muscle has the role of increasing intra-abdominal pressure for strategic in stabilizing the low back?
Transverse Abdominus
What are the major extensors of the thoracolumbar spine?
Longissimus & iliocostalis
(also functions to resist any anterior shear forces of the upper vertebrae)
What is the direct connection between the bony spine & the deep abdominal muscles while also providing critical support to the spine during lumbar flexion & lifting activities.
Thoracolumbar Fascia
What are the requirements with the cluster of laslette to achieve a probability of having SIJ pain of 77%?
3 or more positive SIJ tests whose symptoms do not centralize.
What are the primary functions of the iliofemoral joint?
- Support the weight of the head, arms, and trunk (HAT)
- Transmit forces between the lower extremity and the trunk
What direction does the acetabulum face?
-Anteriorly
* Laterally
* Inferiorly
What does the general positioning of the acetabulum prevent?
posterior dislocation
The femoral head’s positional orientation faces
medial and superiorly
What planes and what degree are the angle of inclination & torsion angle?
AOI- Frontal plane, ~125 degrees
TA- Transverse angle, ~15 degrees
What is Coxa Valga?
AOI >125 degrees
What is Coxa Vara?
AOI <125 degrees
What does Coxa Valga cause for changes in the body?
- Hip abductor muscles are at a disadvantage through a reduced moment arm.
- The joint reaction force is displaced laterally in the
acetabulum and is applied over a smaller joint surface. This increases joint stress > risk of DJD
What does Coxa Vara cause for changes in the body?
- Lengthens the moment arm of the hip abductors. Reducing the force required of the hip abductors; increasing fatigue in the antagonist muscles.
- Increases the compressive forces on the medial aspect of the femoral neck: Increasing risk for stress fractures of the femoral neck
What does each femoral neck variations have for pros and cons?
Vara- Increased stability, Decreased mobility, increased risk of femoral neck stress Fx
Valga- Decreased Stability, increased mobility, Greater risk of dislocation
In the adult the femoral neck and head face what direction?
Anteriorly
What direction does the greater trochanter face?
Posterolateral
Angle between the axis through the femoral head and the axis through the femoral condyles is called what?
Femoral Torsion Angle
Greater than 15 degrees of medial rotation femoral torsion angle is called?
Anteversion
Less than 10 degrees of medial rotation femoral torsion angle is called?
Retroversion
What does anteversion cause?
-places the center of the femoral head farther anteriorly in the acetabulum than normal
-Compensation: Medial rotation of the hip positions the femoral head in a more centrated position within the acetabulum providing a better sense of stability.
-Toed-in posture (if not treated with another compensation)
-Patient shows increased medial rotation ROM & a decrease in lateral rotation
What does retroversion cause?
-places the center of the femoral head farther posterior in the acetabulum than normal.
-Compensation Lateral rotation of the hip positions the femoral head in a more centrated position in the acetabulum providing better mobility.
-Excessive toeing-out
-Increased lateral rotation ROM of the hip, diminished medial rotation ROM
-increase the risk of slipped capital femoral ephiphysis in adolescents
What are the 3 classifications of FAI?
Cam
Pincer
Mixed
What provides passive stability to the hip joint?
Labrum and ligaments
What provides dynamic stability to the hip?
Muscles crossing the hip
What does the labrum do under weight-bearing?
Deforms around the femoral head, stabilizes the head, rate of deformation is inversely proportionate to amount of load
Name the 3 ligaments of the hip joint capsule
anterior- iliofemoral lig, pubofemoral lig
Posterior- ischiofemoral lig
Why are the ligament of the hip coiled?
Due to rotation of the hip during fetal development
When stretched the fibers clamp onto the femoral neck/head
The iliofemoral ligament prevents…
-excessive extension and medial rotation
ROM of the hip joint.
* The superior portion limits adduction ROM.
The pubofemoral ligament prevents…
Limits excessive extension and abduction ROM
The isciofemoral ligament prevents…
Reinforces the capsule posteriorly.
* The posterior fibers limit:
1. medial rotation of the hip.
2. posterior glide of the femoral head
3. adduction ROM when the hip is flexed.
With the hip flexed the joint is pushed….?
posterior and further into the acetabulum
What is the OPP for the hip?
-Flexion 30 degrees
-Abduction 30 degrees
-Slight external rotation
What is the CPP for the hip?
-Hip extension
-Slight internal rotation
-Slight ADDuction
What are the AROM for the hip?
- Flexion 120 ̊
- Extension 20 ̊
- Abduction 45 ̊
- Adduction 30 ̊
- Internal Rotation 30-40 ̊ * External Rotation 45 ̊
the ideal loading of a joint in a neutral position that enables optimal loading.
Joint centration
Causes the joint to be displaced from the ideal centrated position
Decentration
What are the coupled motions for Hip Flexion?
requires the head of the femur to roll anterior and slide posterior and inferior
What are the coupled motions for Hip extension?
requires the head of the femur to roll posterior and slide anterior and superior
What are the coupled motions for Hip medial rotation?
requires the head of the femur to roll anterior and slide posterior
What are the coupled motions for Hip lateral rotation?
requires the head of the femur to roll posterior and slide anterior
What are the coupled motions for Hip Abduction?
requires the femoral head rolls superior and slides inferior
What are the coupled motions for Hip Adduction?
Requires the femoral head rolls inferior and slides superior.
What is the significant detail of open versus closed chain movement in relation to the femur and acetabulum?
Closed kinetic chain the pelvis/acetabulum moves over the femur instead of the femur moving through the pelvis
What do the hips do during lumbopelvic extension in a closed kinetic chain?
Hips externally rotate
what do the hips do during lumbopelvic flexion in a closed kinetic chain?
Hips internally rotate
“Hip drop” (depressed pelvis) causes relative iliofemoral ______ on the ipsilateral side
aBduction
“Hip hike” (elevated pelvis) causes relative iliofemoral ______ on the ipsilateral side
adduction
When the leg supporting the weight of the body on the lesioned side causes the pelvis to rises ipsilaterally. This presentation is more accurately a dipping of the pelvis towards the contralateral side. (hip drop on the unsupported leg). What is this called?
TRENDELENBURG SIGN
External rotation of the pelvis produces relative ___________ rotation of the ipsilateral femur
internal (medial)
Internal rotation of the pelvis produces relative _________ rotation of the ipsilateral femur
external (lateral)
Impingement typically occurs with excessive motion individually or a lesser degree of combined motions of the _______, ___________, and ____________.
hip flexion, adduction, and medial rotation.
Adequate eccentric strength is needed of the psoas to prevent iliacus from pulling the pelvis into an __________
anterior tilt
Psoas shares a common midline connection with the quadratus lumborum and works with the QL to _____________________________-
stabilize the spine in the frontal plane
Name a posterior muscle that contributes to motion in all 3 planes
Gluteus Maximus
The _________ portion of the gluteus maximus contributes to aBduction of the hip
superior
The _________ portion of the gluteus maximus contributes to aDduction of the hip
inferior
The entire gluteus maximus muscle lies posterior to the axis of medial and lateral rotation, therefore, the muscle is a lateral rotator of the hip joint with the hip ________.
extended.
As the hip flexes, the moment arm for lateral rotation decreases, and by the time the hip reaches 90 of flexion, the superior portion of the gluteus maximus actually has a _____________- moment arm.
medial rotation
The inferior fibers will maintain what movement irregardless of position?
Lateral/External rotation
Clinicians can enhance gluteus maximus recruitment during exercise by combining hip hyperextension with ________ and _____________.
aBduction; Lateral rotation
The gluteus medius undoubtedly is an abductor of the hip but, when the hip is flexed, however, virtually the whole muscle contributes to ________ __________ and has little or no capacity to abduct the hip.
medial rotation
The Gmed is strongest in 10 degrees of hip ________ when these type of motions are most prevalent during gait.
ADDuction
An adductor’s primary function is to ___________ ______ _________ during weight shifting from one limb to the other during single leg stance.
stabilize the pelvis
What are the lateral rotators of the hip?
Quadratus Femoris
Gemelli
Obturator Internus
Obturator Externus
Piriformis
Gluteus Maximus
The piriformis appears to change from a ________ rotator with the hip extended to a _________ rotator with the hip flexed greater than 60 degrees.
lateral; medial
There are no muscles at the hip whose primary and consistent action is ______ _____ of the hip. The muscles that _______ _______ the hip depend on hip position and are intimately related to the function of the knee.
medial rotation; medial rotation
What part of the knee plays no part in the arthrokinematic movements?
Tibiofibular joint
What are the normal ROM for knee flexion and extension?
0-135/155 degrees. Possible hyperextension of up to 15 degrees
What is the OPP of the knee?
30 degrees of flexion
What is the CPP of the knee?
full extension
The _______ femoral condyle is larger than the ______ condyle
medial; lateral
The _______ condyle extends farther distally than the _______ femoral condyle when the femur is positioned vertically.
medial; lateral
The medial condyle is slightly curved which serves the medial condyle being the __________ ___ _________ and to match the shorter radius
center of rotation
Which articular surfaces are largest in the knee joint?
The articular surfaces of the femur are larger than the tibia articular surfaces.
Which plateau of the tibia bears more weight?
Medial plateau
During Knee flexion:
* The femur rolls _______.
* The femur slides _____ on the tibia
* Contact and compressive loads progressively increase on the ______ tibia as the knee increases flexion
posterior
anterior
posterior
During knee extension:
* The femur rolls _______
* The femur slides ______ on the tibia
* Contact and compressive loads progressively increase on the ______ tibia as the knee moves from flexion to extension.
anterior
posterior
anterior
What factors cause the lateral femoral condyle to glide posterior during knee flexion?
Medial condyle is the center of rotation, lateral condyle must glide
Lateral rotation of the femur during hip flexion
What is the last 20-30 degrees of knee extension called?
Terminal Knee Extension (TKE)
What occurs during the “screw home mechanism”
Tibia ER on the femur (Open Kinetic Chain)
Femur IR on the Tibia (Closed Kinetic Chain)
–Approximately 5° of __________ with respect to the tibia occurs with knee flexion
femoral abduction
What is the function of the patella femoral joint?
Acts as a pulley by lengthening the moment arm of quadriceps
The patella glides _____ during knee flexion 5–7 cm. There also is a slight _____ translation of the patella at the beginning of flexion, but by 30° of knee flexion the patella has begun _____ translation that continues to increase at least until 45° of flexion.
inferiorly; medial ; lateral
Quadriceps femoris strength as a whole is correlated with the presence or absence of _______ ______ ______.
anterior knee pain
The greater the ________ the greater the valgus deformity and increased risk for ________ _______.
Q-angle; patella subluxation
Excessive deviation of the patella medially or laterally is known as medial or lateral tracking. Excessive lateral tracking is associated with _______________ __________ and _________ __________.
chondromalacia patellae and patellofemoral pain
Patella sitting higher than average is called?
Patella Alta
Pattela sitting lower than average is called?
Patella Baja
Patella sitting more medial or lateral than normal?
Patella Tracking
What are the passive stabilizers of the knee?
Menisci
Ligaments
What are the dynamic stabilizers of the knee?
Hamstrings
Quadriceps
IT Band
Adductors
primary functions of the menisci is to?
- Absorb and distribute compressive forces
- Stabilize the joint
What are the depth differences in the menisci?
Medial meniscus is shallow
Lateral meniscus is deeper
The medial menisci’s accessory attachment is the _______
The lateral menisci’s accessory attachment is the _______
MCL
Popliteus muscle tendon
Which menisci has less mobility and is more frequently injured?
Medial
prevents posterior displacement of the femur on the tibia (anterior displacement of the tibia in relationship to the femur)
ACL
prevents anterior displacement of the femur on the tibia (posterior displacement of
the tibia)
PCL
prevents valgus movement and rotation
MCL
prevents varus movement and rotation
LCL
Extensors stronger than flexors throughout the range of motion. Research indicates a 2:1 quadriceps:hamstring ratio _______.
reduces knee symptoms
Alignment of the knee is affected by the alignment of the ____, _____, and ____.
hip, ankle, and foot.
The knees are closer to the midline, while the feet rest further away from the midline.
Genu Valgum
The knees are further from the midline, while the feet are closer to the midline.
Genu Varum
Hyperextension of the knee
Genu Recurvatum
The greater the_______ the greater the valgus
deformity
Q-angle
Male Q-angle= ???
Female Q-angle= ???
10-15 degrees
15-20 degrees