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166 Cards in this Set
- Front
- Back
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DJD order
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index DIP, great toe MTP, knee, index PIP, thumb MCP (yours), LS joint, cervicals
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if not osteoarthritis, Mr. Mennel, then what?
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joint dysfunction
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Strains become a chronic problem because they heal with
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inelastic scar tissue
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study of forces and their effects
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mechanics
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application of mechanical laws to living things
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biomechanics
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bones from _______, joints from ______
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levers, hinges
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concept of levers/bones and joints/hinges evolved from
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Industrial Rev
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continuous changes in the position of an object
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motion
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human joints have ____ planes of motion
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6 (3 rotation, 3 translation)
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rotation is ______ around an axis
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tilt (cartesian)
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translation is
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glide and slide
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what is most common path of motion?
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curvilinear - rotation and translation together
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planes
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sagittal plane: F/E
coronal plane: R/L flexion Transverse or Horizontal plane: R/L axial rotation |
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what plane is axial rotation
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transverse or horizontal
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geometry of motion
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kinematics
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study of visual appearance of motion without accounting for Force
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kinematics (pretty)
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movement of center of mass includes flight paths, velocities, accelerations, displacements
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kinematics
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relationship between force and changes it makes in body motion
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kinetics = force!
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6 Kinematic forces
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neutral
compression distraction shear lateral bending, torque/counter rotation |
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which kinematic force is a combination of motion?
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lateral bending (rotation, lateral flexion)
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Mass x ? =force
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angular velocity
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MVA at 100,000 deg. per sec is equivalent to ? mph?
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1400mph
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muscle power is determined by cross section, length/tension ratio, _______ and __________ type.
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fatigue, fiber
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shortening, creates acceleration, power generation, begins with flexion
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concentric contraction
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lengthening contraction, deceleration, power absorbed, opens joint
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Eccentric (evolving, lengthening, opening, power absorbing, slowing down - eccentric circles of thought)
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no change in muscle length but stabilizes (no waver)
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Isometric contraction
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strongest of all human contractions but also where injuries occur
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Eccentric (ever widening, lengthening, opening, power absorbing, slowing down eccentric circles of thought are the strongest and therefore an injury is prone to injury)
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what kind of energy enhances force production by 20%
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Elastic plastic (stretch reflex)
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elastic energy is the free lunch - it's free energy with a ratio of muscle to tendon stretch at
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20:1
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Great Index finger race demonstrates
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activation of stretch/elastic plastic reflex
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javelin throwing would be what stretch reflex?
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rotary! torque! elastic winding and unwinding that is typical of NCAA Div I female basketball player injuries
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3 components of a lever
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fulcrum (joint), effort (muscle), resistance (weight)
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joint muscle weight is?
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fulcrum effort resistance
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where is the fulcrum of a 1st class lever
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between the resistance and effort (weight and muscle) Balanced resistance on one end with weight on other
TRAP ON SKULL |
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example 1st class lever
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trapezius on skull
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where is resistance on a 2nd class lever?
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resistance is between the fulcrum and lever, like a wheel barrow (like a pry bar)
GASTROC contraction |
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least efficient lever
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3rd class where there is muscular effort between the weight and fulcrum
BRACHIALIS ON RADIUS |
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allows for fluid, balanced movements such as gait
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Dynamic stabilization
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when walking, muscles that allow dynamic stabilization?
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gluteus medius
ADDuctors (weak glut medius is Trendelenburg gait - compensatory swing) |
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foot splay in a runner is due to
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weak dynamic stabilizers (glut med and adductors)
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what maintains transverse stable hip?
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adductors opposing aBductors
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if the adductors are dominant in hip, what results?
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lateral tilt, pathologic pronation, coxa varus, genu valgus
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knee hyperextension is called
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genu recurvatum
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hyperextension of knee is sign of ______________ tracking patella
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patella
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lateral tracking patella due to knee
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hyperextension
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how does the ankle move as ankle mortise?
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dorsiflexion, plantar flexion
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subtalar biomechanics (think of sailboat on water pictures)
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neutral, dorsi/plantar flex, med/lat tilt, aB/aDDuction,
DEAb PIAd |
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DEAb
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Subtalar motion of Dorsiflexion, Eversion, Abduction
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PIAd
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subtalar motion of Pronation Inversion Adduction
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the ability of a joint to separate or gap
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joint play/gapping
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the small elastic springiness at the end of passive ROM (at the elastic barrier)
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End Feel
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in addition to joint play (gap) and end feel (spring), there is a 3rd motion which includes both joint play and end feel?
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Accessory motion
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total joint movement includes the voluntary _____ plus or minus ?
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ROM +/- joint play /end feel
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Voluntary movement depends on
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joint play (gap) & end feel (spring)
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gted.
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pain!!!
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when specific joint play (gap)/end feel (spring) is restored by manipulation, the pain abates. Test (________) + Impulse (__________)
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diagnosis + treatment is same as Test + Impulse
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Joint play/end feel can only be restored by
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a DYNAMIC THRUST given in correct direction (not by a drug)
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what does normal muscle movement depend on?
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normal joint movement
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what do the repetitive constellation pattern of MFTP's tell you?
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the joint is not free to move so neither are the muscles that move it, hence trigger points
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You can't restore muscles if the __________ does not have restored motion.
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joint (concomitant soft tissue component with all subluxations and why you should stretch)
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Negative cascade can cause joint degeneration, but is started by
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impaired muscle fcn
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how does Mennel define joint dysfunction?
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as the loss of joint play (gap) or end feel (spring)
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How is the degree of joint dysfunction determined upon clinical exam or xray/video flouroscopy?
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by comparing the contralateral joint!
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The Mennel Restriction Theory requires the examiner to do 2 things:
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Test joint play/end feel + treat with Impulse of dynamic thrust in correct direction
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firm but giving end feel, where resistance builds with lengthening like stretching a piece of leather
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CAPSULAR leather
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firmer than capsular end feel, like knee extension
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LIGamentous knee
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what two end feels (spring) are basically the same?
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Capsular and Ligamentous (leather firm but giving resistance builds with length)
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giving, squeezing, painless as in full elbow or knee flexion
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soft tissue approximation end feel
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hard, non-giving abrupt
Elbow extension |
bony end feel
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firm but giving, builds with elongation, not as stiff as capsular
Hip flexion |
Muscular end feel
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guarded with pain flexion or muscle contraction. Cannot be assessed due to swelling or pain
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Muscle spasm end feel
- protective splinting is abnormal |
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a bouncy, springy Tigger like quality
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Inter-articular end feel
-abnormal is meniscal tear or joint mice |
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normal end feel resistance is MISSING, and not met at a normal stopping point. Joint will have odd degree of give or deformation.
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EMPTY end feel
-abnormal is joint injury leading to hypomobility or instability |
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When does the tibia internally rotate faster than the femur?
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with EXCESSIVE SUBTALAR JOINT PRONATION, causing dramatic twisting of knee and surrounding soft tissues
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How to re-supinate the foot
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tighten the Plantar fascia
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failure to re-supinate the foot (get your arch back) causes
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strains the plantar fascia
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longest PROprioreceptive pathway in the body
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the foot!
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how many bones in the foot? arches?
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26 , 4
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regions of foot
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forefoot, midfoot, hindfoot
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role of the foot is as a mobile __________, rigid +++++.
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adapter, lever
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the foot has 4 multiaxial movements
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subtalar/talo-navicular/pronation (DEAb)/supination (PIAd)
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what muscle supports the the medial longitudinal arch?
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tibialis anterior and posterior
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keystone of medial longitudinal arch
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head of TALUS
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keystone of Lateral longitudinal arch (and Dr. Ebbets favorite)
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CUBOID
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keystone of Tarsal Transverse Arch
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think: TARSAL transverse is cuboid + cuneiforms 1/2/3 so Keystone is 2nd cuneiform and Cornerstone is cuboid
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how is the controversial anterior transverse arch supported?
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metatarsal pad, since it is the 5 metatarsal heads of the ball of the foot
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Windlass Effect
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dorsiflexion of great toe leads to elevation of talo/navicular/cuneiform complex (especialy Navicular). Makes foot a rigid lever during heel strike and fixes plantar fascitis in. From Shoes.`
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Describe the CLOSED KINETIC CHAIN of Lower Extremity (7)
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1-pathologic pronation, 2-IR of tibia & femur, 3-lower femur, 4-eccentric psoas & piriformis stretch, 5-post rot of Ilia (PI), 6-nutation of sacrum w ER of L5tp, 7-reactive scoliosis
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first step in closed kinetic chain of LE
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1- pathologic pronation
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2nd step in closed kinetic chain of LE
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2- IR of tibia and femur
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3rd step in closed kinetic chain of LE
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3- lowering of femur
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4th step in closed kinetic chain of LE
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4- eccentric STRETCH of psoas and piriformis
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5th step in closed kinetic chain of LE
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5- posterior rotation of ilia (PI Ilium)
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6th step in closed kinetic chain of LE
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6- nutation of sacrum (if ilia went post, then sacrum nutates) with external rotation of L5 t.p.
stars- facet imbrication at L3-L4 |
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7th final step of closed kinetic chain of LE
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7- reactive scoliosis
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congenital foot condition with loss of arch, DEAb, and calcaneal valgus
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Pes Planus (flat foot)
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flat foot is also called
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pes planus
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foot condition of PIN POINT heel pain, greater in morning. Patient will sleep with foot plantar flexed.
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Plantar Fasciitis
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deformation of the plantar calcaneal navicular ligament (PCN lig) + may come from walking on HARD LEVEL FLOORS
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Plastic DeFLOORmation
deformation |
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Where is the calcaneonavicular ligament and when does it suffer?
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on medial foot plantar surface, suffers from walking on hard level floors
Plastic deFLOORmation |
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pathologic pronation and crush of RETINACULUM - associated foot condition is claw toe
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tarsal tunnel syndrome (Tom Dick & Harry)
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plantar flexed metatarsal head, PIP and DIP with dorsiflexed MTP (the one spiking up to the roof to hit the shoe). TTS shuts off innervation to proximal phalanx.
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Claw Toe (hammer toe) is plantar, dorsi, then plantar flexed with TSS shut-off
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posterior tibialis is the cause, weak feet, do the foot drills to cure
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shin splints
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what controls mid-foot pronation?
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eccentric tibialis posterior contraction
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Why is tibialis posterior responsible for shin spints?
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numerous insertions, Weak T.P. leads to "too fast" eccentric/lengthening which leads to shin splints
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proximal lesion leading to a more distal compression. ART nerve tracts. More common in Upper Extremity.
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Double Crush syndrome (Kim)
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which Achilles tendon is more frequently ruptured and why?
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LEFT - due to right side dominance and people pushing off with their left leg
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Achilles tendon injury affects who and what side?
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men, left (Calliet, '80) because men weigh more and create more force
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where does a rupture of the Achilles occur?
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2-4 cm proximal to calcaneus because of frequent crimping (Bowstring effect) and insufficient blood supply
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Poor biomechanics due to ______________________ expose the kinetic chain to forces such as abnormal shearing, bending or torque.
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structural imbalance
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Bowstring effect
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superior aspect of calcaneus moves lateral to medial to lateral to medial, etc. so Achilles tendon is moving back and forth in the coronal plane
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gait abnormality can be 3:
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structural change to bone length or shape, pathological change of soft tissue to articular structures, neuromuscular control of gait
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two causes of abnormal gait:
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pain and proprioceptive impairment
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pain causing abnormal gait compromises _______ movers and patient uses __________ movers as compensation.
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primary crash, secondary called in
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proprioreceptive impairment causes gait abnormalities by a combination of factors, such as poor ______, _______ weakness/atrophy, _______ injury.
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rehab, muscular, recurrent
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2 phases of gait
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stance & swing
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Stance & ________ are the 2 phases of GAIT
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Swing
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Which is more, stance or swing? How much is it, percentage-wise?
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Stance 65%
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3 phases of Stance
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Double support
Single support Double support again |
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5 components of Stance
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Heel strike
Flat foot MID-stance Terminal stance Push off! |
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Heel strike is
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supination
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Flat foot is
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pronation
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Mid-stance is
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pronated, still, from flat foot
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Terminal stance is
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supinated
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Push off! is
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supination
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H, ff, MID, T, Po!
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He'll flat foot mid-day til pissed off!
S P P S S |
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Stance components: (65%)
He'll flat-foot mid-day til pissed off! |
Heel strike, Flat foot, Mid-stance, Terminal stance, Push off!
S.P.P.S.S. Supinated/Pronated |
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Swing phase
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35% - leg is not in contact with ground
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Along with Pain and Proprioreceptive Impairment, what are more causes of abnormal gait?
DIMPP |
Muscular weakness
Impaired control Deformity (Pain and Proprio) |
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muscular weakness causes abnormal gait by
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not enough strength to lift body so muscle substitution (2nd mover recruit), ie develops from crutches or a limp
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Impaired control of the body causes abnormal gait - what is damaged?
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CNS
can't control timing and intensity MS, Cerebral palsy, brain/sc injury |
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He'll flat-foot Mid-day til pissed off!
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Heel strike S
Flat foot P MID-stance P Terminal stance S Push off! S |
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why is push off of stance (65%) considered supinated?
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Windlass effect of great toe dorsiflexed - rigid lever position
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Normal gait is all the things you imagine (brisk, smooth, purposeful) and?
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Narrow-based, straight/unwavering, arms swing, trunk sways, heels almost touch in passing, thighs don't touch, 180 turns are smooth, stopping is abrupt/unwavering/sure
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Pain and Proprio, Muscle weak, Impaired CNS and __________ cause abnormal gait.
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Deformity
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decreased ROM, tissue spasm, contracture and restriction can all cause abnormal gait due to ?
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deformity
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When is Single support
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2,5,6
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When is pronation during gait?
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2,5,6 (any time there is single support)
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During heel strike, foot is supinated but because it is on the way to pronation, what effect is created?
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Bowstring of Achilles and Internal rotation of tibia (double support)
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During flat foot (pronation/single support), what happens to the swing leg?
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loses ground contact (single support and internal rotation)
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At Mid-stance (MID-day), the foot is in pronation leading to supination. We know the foot is in pronation at mid-stance because
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there's only one foot on the ground/single support and all prior single supports are pronated
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During Terminal stance, we begin ___________ and foot supination so we essentially go from double support to single support.
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toe off = double support to single support/supination
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PUSH OFF! is heel off, and foot supination at
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toe off.
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STEP FLAWS (acronym)
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Spastic/Timid/Extrapyramidal/Paretic/Footdrop/Limp/Apraxia-ataxia/Waddling/Sensory
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Step flaws -diminished height and length
MS, Scissors gait, CP |
Spastic
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sTep flaws - multiple sensory defects
. Visual, neuropathic, vestibular, fear of falling |
Timid
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stEp flaws - festinating (parkinsonism), short stepped, arms hang, glue footed
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Extrapyramidal
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steP flaws - partial or incomplete paralysis,
steppage gait (toe strike), CVA, asymmetrical length and height |
Paretic
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step Flaws - high stepped
peripheral neuropathy, diabetes, pernicious anemia, often irreversible |
Foot drop
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step fLaws - pain limiting factor, cause?
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Limp
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step flAws - wide based
lurching forward, veering, erratic, cerebellar dysfunction |
Apraxia/Ataxia
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step flaWs - hip disease
stiff hip or knees, muscular dystrophy |
Waddling
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step flawS - impairment of visual, vestibular, or nervous system
DJD, weakness, high stepped |
Sensory
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postures in action
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dynamic stabilization
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if one cannot maintain posture, then there is a ___________ breakdown. With this comes decreased performance.
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Technique
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dynamic stabilizers of LE
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Posterior Tibialis
Adductors Glut Medius Abdominal obliques |
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PGAA
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Posterior tibialis
Gluteus medius Abdominal obliques Adductors (dynamic stabilizers) |
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inability to make purposeful movements
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apraxia
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drop of contralateral hip due to weak gluteus medius (a dynamic stabilizer of PGAA) and ipsilateral weakness
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Trendelenburg sign
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primary glut medius fibers
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anterior (hip ABduction and Internal R)
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secondary glut medius fibers
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posterior (hip ABduction and EXTERnal rotation)
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fatigue at limits of speed endurance leads to
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foot splay due to glut medius fatigue (primary anterior Internal rotator fibers crash and posterior secondary external rotators take over)
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controls the velocity of posterior foot pronation for a smooth eccentric contraction
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posterior tibialis
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most commonly affected foot joint of OA
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great toe
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what nerve provides special sensation between the 1st and 2nd toes
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deep peroneal/fibular nerve
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antagonist of posterior tibialis
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peroneus brevis (completes the "stirrup" around the ankle)
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