Download Kinesiology of the Hip

Kinesiology of the Lower
Extremity
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Biomechanics of the Hip Joint
Bones of the Pelvis
• Ilium
– Iliac crest, ASIS, AIIS, PSIS,
PIIS, greater sciatic notch,
acetabulum
• Ischium
– Ischial spine, ischial
tuberosity, lesser sciatic
notch, ramus of ischium,
obturator foramen
• Pubis
– Rami of pubis, pubic
symphysis
• Sacrum
• Coccyx
Gender Difference
• Female
• Male
Femur
• Head and neck
• Greater and lesser trochanters
• Intertrochanteric line, gluteal
tuberosity
• Pectineal line, linea aspera
• Adductor tubercle
• Lateral and medial
epicondyles
• Lateral and medial condyles
• Intercondylar fossa
•
•
•
•
Ligaments of the hip
Pubofemoral (ant.)
Iliofemoral (“Y” ligament) (ant.)
Ischiofemoral (post.)
Ligamentum teres (ligament of the head)
Movements of the hip
•
•
•
•
•
•
Flexion
Extension
Adduction
Abduction
Internal rotation
External rotation
Pelvic Rotation
• Pelvis rotates to accomodate for hip
flexion and extension.
• Anterior rotation= flexion
• Posterior rotation=extension
• In anterior rotation, the upper part of the
pelvis tilts forward. Posterior opposite.
Hip injuries
• Hip is very stable joint. Injuries
typically result from trauma.
• Hip fractures of femoral neck: primarily
in aged or osteoporotic.
• Hamstrings: long tendons. Frequent
site of strain.
• Groin pulls: adductor group strain.
• Varus and valgus
–
–
–
–
Varus (in. prox to dist)
Valgus (out prox to dist)
Knockneed= fem varus, tibial valgus
Bowlegged= fem valgus, tibial varus
Muscles of the anterior hip
• Hip Flexors (primary)
– Iliopsoas group
• Iliacus:
• Psoas major and minor:
– Rectus femoris:
– Sartorius:
– Tensor Fascia Latae:
– Iliopsoas group
• Iliacus: O=ilium
I=lesser trochanter
A=hip flexion, external
rotation
• Psoas major and
minor: O=TP L1-L5,
I=lesser trochanter
A=hip flexion, ext.
rotation
• N: lumbar and femoral
• Rectus femoris:
O=AIIS,
• I=tibial
tuberosity via
patellar tendon,
A= hip flexion,
knee extension
• N: Femoral
– Sartorius:
O=ASIS,
I=Anterior
medial tibia
below condyle
A=hip flexion,
knee flexion,
ext. rot. Hip
– N: femoral
– Tensor Fascia
Latae: O=Ant.
Iliac crest
– I= ¼ way down
iliotibial tract or
band (ITB).
A=hip flexion,
hip abduction
– N: superior
gluteal
Muscles of the posterior hip
• Extensors
– Gluteus maximus:
– Hamstrings
• Semitendinosus
• Semimembranosus
• Biceps femoris
– Gluteus maximus:
O=iliac crest,
sacrum, coccyx.
I=gluteal tuberosity
of femur.
– A=hip extension,
external rotation.
– N: inferior gluteal
Hamstrings
Semitendinosus
O=ischial tuberosity I=ant
medial tibia below condyle.
A=hip extension, knee
flexion.
N: sciatic
Semimembranosus
O=ischial tuberosity I=post
med condyle of tibia A=hip
extension, knee flexion
N: sciatic
Biceps femoris
O=(LH)ischial tuberosity,
(SH) lower ½ linea aspera
and lateral condyloid ridge
I=lateral condyle of tibia and
head of fibula A=hip
extension, knee flexion
N: sciatic
• Deep external rotators (6)
– Obturator internus, gemellus
superior, gemellus inferior,
quadratus femoris, piriformis,
obturator externus:
O=deep areas of the anterior
sacrum, posterior ischium,
obturator foramen. I=top and
back of greater trochanter
A=external rotation
• N: branches from sacral
plexus
Muscles of the medial hip (adductor group)
• Pectineus.
• Adductor brevis
• Adductor longus
• Adductor magnus
• Gracilis
• Pectineus O=pubis
I=pectineal line above
linea aspera
A=adduction, flexion,
external rotation.
• N: femoral
• Adductor brevis
O=ramus of
pubis I=upper ½
linea aspera
A=adduction,
flexion, external
rotation
• N: obturator
• Adductor longus
O=pubis I=Middle
1/3 linea aspera
A=adduction,
flexion, external
rotation
• N: obturator
• Adductor magnus
O=ramus of pubis to
ischial tuberosity
I=entire linea aspera
to the adductor
tubercle
A=adduction,
extension, ext.
rotation.
• N: obturator, sciatic.
• Gracilis
O=ramus of pubis
I=ant med tibia
below condyle
A=adduction of
hip, flexion of
knee
• N: Obturator
Muscles of the lateral hip
• Abductors
– Gluteus medius
– Gluteus minimus
– Gluteus medius
O=lat. Ilium just
below crest
I=greater trochanter
A=abduction of hip
– N: superior gluteal
– Gluteus minimus
O=lat ilium below
medius
– I=greater
trochanter A=hip
abduction
– N: Superior gluteal
Kinesiology of the Knee
The knee joint
• Two side by side hinge joints.
• Flexion, extension, small
amount of rotation
• Articulations of the condyles
of the femur with the
condyles of the tibia.
• Fibula
• Patella
– Sesamoid bone
– Changes angle of insertion of
the quadriceps muscles (knee
extension)
The knee joint
(p. 216)
• Anterior view
– Lateral condyle of
femur, lateral and
medial menisci,
lateral and medial
collateral ligament,
superior tibiofibular
joint, fibula, tibia,
anterior cruciate
ligament, posterior
cruciate ligament.
• Posterior view
– Ligament of
Wrisberg, medial
and lateral
condyles of femur,
posterior and
anterior cruciate
ligaments, lateral
and medial
collateral
ligaments
Ligaments of the Knee
• Collateral
ligaments:
medial and
lateral.
• Cruciate
ligaments:
anterior and
posterior
• Menisci
• Iliotibial tract
Bony landmarks of the knee
• Condyles of femur
• Condyles of tibia
• Tibial tuberosity
Knee Injuries
• Ligament injuries
–
–
–
–
–
Anterior force:PCL
Posterior force: ACL
Forced rotation of knee: ACL or PCL
Lateral force injuries: MCL or LCL
MCL connected to medial meniscus=meniscus
damage
• Overuse injuries
•
•
•
•
•
ITB friction syndrome
Breaststrroker’s Knee
Chondromalacia: tracking of patella
Shin Splints
Runner’s knee: popliteus
Muscles of the knee
• Extension (anterior)
– Quadriceps group
•
•
•
•
Rectus femoris
Vastus medialis
Vastus lateralis
Vastus intermedius
• Flexion
– Gastrocnemius, popliteus
– Hamstrings group
• Biceps femoris
• Semitendinosus
• Semimembranosus
The Quadriceps Group:
powerful knee extensors
•
•
•
•
rectus femoris
vastus lateralis
vastus intermedius
vastus medialis
Rectus Femoris (previously
studied under hip flexors)
• O: AIIS
• I: Tibial tuberosity via
the patellar tendon
• A: knee extension,
and hip flexion
• N: femoral
Vastus lateralis
• O: Entire posterior lateral
femur
• I: Tibial tuberosity via
Patellar Tendon
• A: Knee extension
• N: femoral
Vastus Medialis
• O: Entire linea
aspera and medial
condyloid ridge
(covers posterior
medial femur)
• I: Tibial tuberosity via
Patellar Tendon
• A: Knee extension
• N: femoral
Vastus Intermedius
• O: Upper 2/3
anterior femur
(under rectus
femoris)
• I: Tibial tuberosity
via Patellar Tendon
• A: Knee extension
• N: femoral
Popliteus
• O: post. Lateral
condyle of femur
• I: post. Med.
Condyle of tibia
• A: knee flexion,
“unlocks” knee by
internally rotating
tibia.
• N: tibial
Knee Flexion
• Hamstrings (hip extensors)
– Semitendinosus
– Semimembranosus
– Biceps Femoris
•
•
•
•
Gracilis (adductors)
Sartorius (hip flexors)
Popliteus
Gastrocnemius (covered in next section)
Resistance Exercises for the Knee
•
•
•
•
Squat
Leg Press
Leg curls
Leg extensions
Kinesiology of the Ankle and Foot
Bones of the lower
leg and foot
(p. 293-294)
• Tibia and fibula: lateral and
medial malleoli
• Foot: talus, calcaneous,
cuboid, navicular,
cuneiforms, metatarsal,
phalanges.
• Ligaments:
– (lateral)calcaneofibular,
talofibular
– (medial) deltoid
The structure of the ankle
• Joints
– Tibiotalar, subtalar,
– transverse tarsal,
– tarsometatarsal
• Bones
– Tibia
• Medial malleolus
– Fibula
• Lateral malleolus
– talus, calcaneous,
Injuries of the ankle and foot
•
•
•
•
•
•
•
“ankle” sprains
Achilles tendonitis
Stress fractures: mechanical fatigue
Pes planus: flat foot; rigid cavus:high arch
Plantar fascitis
Varus (inward prox to dist)
Valgus (outward prox to dist)
Movements of the ankle and foot
• Dorsiflexion and plantar flexion
• Eversion and inversion
• Supination (plantar flexion, inversion, and
adduction)
• Pronation (dorsiflexion, eversion, and
abduction)
Muscles of the ankle
• Plantar flexion (posterior)
– Gastrocnemius, soleus, plantaris, flexor hallucis
longus, flexor digitorum longus, tibialis posterior
• Dorsiflexion (anterior)
– Tibialis anterior, extensor digitorum longus, peroneus
tertius, extensor hallucis longus.
• Inversion (medial)
– EHL, tibialis anterior, FDL, tibialis posterior
• Eversion (lateral)
– EDL, peroneus tertius, peroneus longus, peroneus
brevis.
Gastrocnemius
• O: Medial head:
post. Med.
Condyle femur; lat.
Head: post. Lat.
Condyle femur.
• I: calcaneous via
Achilles Tendon
• A: Plantar Flexion
of ankle, knee
flexion
• N: tibial
Soleus
• O: Post. Prox.
Fibula and prox.
2/3 of tibia
• I: Calcaneous via
Achilles Tendon
• A: Plantar
Flexion
• N: tibial
Tibialis Posterior
• O: Post. Upper 1/2
Interosseous
Membrane, Tibia, and
Fibula
• I: Navicular,
cuneiforms, and bases
of MT 2-4 (via medial
gate)
• A:Plantar Flexion of
ankle, Inversion of foot
(sub-talar joint)
• N: tibial
Flexor Digitorum
Longus
• O: Mid 1/3 post. Tibia
• I: Base distal
phalanx, digits 2-5
(via medial gate)
• A: Flexion digits 2-5,
Plantar Flexion of
ankle, inversion of
foot.
• N: tibial
Flexor Hallucis
Longus
• O: Middle 2/3 of the post.
Fibula
• I: Base distal phalanx,
digit 1 (big toe) via the
medial gate.
• A: Flexion digit 1,
Inversion of foot, Plantar
Flexion of ankle.
• N: tibial
Peroneus Longus
• O: Head and upper
2/3 fibula
• I: Medial cuneiform
and MT 1 (via lateral
gate)
• A: Eversion of foot,
Plantar Flexion of
Ankle
• N: peroneal
Peroneus Brevis
• O: Lower 2/3 of the
lat. Surface of the
fibula
• I: Tuberosity of MT 5
(via lateral gate)
• A:Eversion of foot,
Plantar Flexion of
ankle
• N: peroneal
Peroneus Tertius
• O: Distal 1/3 of
the anterior
fibula
• I: Base of MT 5
• A: Eversion of
foot, Dorsiflexion
of ankle
• N: peroneal
Tibialis Anterior
• O: upper 2/3 of lat.
tibia.
• I: medial
cuneiform and MT
1
• A:Dorsiflexion of
ankle and
inversion of foot.
• N: peroneal
Extensor Digitorum
Longus
• O: Lateral condyle of
tibia, head and upper
2/3 of fibula
• I: Tops of middle and
distal phalanges, digits
2-5
• A: Extension digits 2-5,
dorsiflexion of ankle,
eversion of foot.
• N: peroneal
Extensor Hallucis
Longus
• O: Mid. 2/3 of anterior
fibula
• I: Base distal phalanx
digit 1
• A: Dorsiflexion of
ankle, extension of
digit 1, inversion of
foot.
• N: peroneal
The structure of
the foot
• Bones
– Talus, calcaneous,
cuboid, navicular,
cuneiforms,
metatarsals,
phalanges.
• Ligaments
– Deltoid ligament
(medial)
– Talofibular and
calcaneofibular
(medial)
Ankle injuries
• Arches
– Longitudinal arches
– Transverse arch
Innervation of the lower extremity
• Lumbosacral plexus: lumbar plexus and sacral
plexus
– Lumbar plexus:
• femoral, obturator, iliohypogastric, ilioinguinal, genitofemoral,
lateral femoral cutaneous nerves.
• femoral and obturator are largest.
– Sacral plexus
•
•
•
•
Sciatic nerve: common peroneal and tibial nerves
Posterior cutaneous femoral nerve
Pudendal nerve
Sciatic innervates hamstrings.
Exercises of the Lower Extremity
•
•
•
•
•
•
•
•
Leg press
Squat
Toe Raise
Leg curl
Knee extension
Running
Jumping
Other lower body exercises: thigh master,
abductor exercise, etc.
Leg Press
A. Pushing movement
1. Concentric hip extension
1. Gluteus Maximus
2. Hamstrings
2. Concentric knee extension
A. Quadriceps
B. Return movement
1. Eccentric hip flexion
2. Eccentric knee flexion
Squat
• Begins in the standing position: first
movement is eccentric.
• Lowering (squatting) movement
– Eccentric hip flexion
– Eccentric knee flexion
• Raising movement
– Concentric hip extension
– Concentric knee extension
Toe Raise
• Raising up on toes against resistance.
• Raising movement
– Concentric plantar flexion
• Gastrocnemius, Soleus, Tibialis Posterior, FDL,
FHL, Peroneus Longus, Peroneus Brevis.
• Lowering movement
– Eccentric dorsiflexion
Leg curl
• Raising movement
– Concentric knee flexion
• Knee flexors: hamstrings and gastrocnemius
• Lowering movement
– Eccentric knee extension
Knee extensions
• Raising movement
– Concentric knee extension
• Quadriceps group
• Lowering movement
– Eccentric knee flexion
Running
• Running involves concentric activity of virtually
all muscle groups, but the power behind running
(speed) primarily involves the hip extensor,
knee flexor, and plantar flexor groups.
• Generally, as one leg strides forward, the other
leg pushes the body forward.
• Stride leg:
– Concentric hip flexion, Concentric knee extension,
Concentric dorsiflexion
• Pushing leg
– Concentric hip extension, concentric knee flexion,
concentric plantar flexion
Jumping
Jumping involves concentric activity in the push off, and
eccentric activity in the landing.
Push off:
Concentric knee extension
Concentric hip extension
Concentric plantar flexion
Landing
Eccentric dorsiflexion
Eccentric knee flexion
Eccentric hip flexion
Knee joint
• Cruciate ligaments: prevent anterior and
posterior dislocation of tibia.
• Collateral ligaments: prevent lateral and
medial dislocation of knee.
• Medial collateral ligament: most frequently
damaged. Connected to medial meniscus.
• Theories of knee injury
Image credits
"Musculoskeletal Images are from the University of Washington
"Musculoskeletal Atlas: A Musculoskeletal Atlas of the Human Body" by Carol
Teitz, M.D. and Dan Graney, Ph.D."
"Copyright 2003-2004 University of Washington. All rights reserved including
all photographs and images. No re-use, re-distribution or commercial use
without prior written permission of the authors and the University of
Washington.“