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Kinesiology of the Lower Extremity 481 Pop Test • Get out one sheet of paper. • Clear your desk. • No whining. 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.“