Download Biomechanics Kinesiology

KIN 711—Biomechanics Study Guide
Quiz 1 – Biomechanics Review
g=9.81 m/s2
SOH-CAH-TOA
Kinesiology- the study of human movement that encompasses functional anatomy, muscle action
and movement patterns.
Biomechanics- the study of forces and their effects on human movement. Combines engineering
with anatomy and physiology.
Kinematics- study of motion and the relationship between displacement, velocity, and
acceleration. Ex: range of rotational motion that takes place at the knee during gait.
Kinetics- study of motion and the forces that act to produce the motion. Ex: the joint reaction
force between the tibia and femur during stair climbing.
Scalar- Magnitude only, no direction.
Vector- Magnitude and direction.

Physics Review- Practice… (look in green book for instructions)
- Be sure you can convert lbsN, Nlbs
- Resolving vectors (1 vector) (pg 7)
- Composing vectors (2 or more vectors) (pg 9)
- Drawing and solving Free body diagrams (pg 13, 17)
- Pulleys and Cams (pg 20)
Force= mass x acceleration (ma)
Shear forces- co-planer and opposite in direction Injury caused by shear force: blister.
Tensile co-linear forces- act in opposite directions to pull an object apart. Injury caused by
tensile force: ligament tear.  
Compressive Co-linear forces- act in similar directions to push together. Injury caused by
compressive force: compression fracture. 
Levers:
Mechanical advantage (MA)= force arm (FA)/ resistance arm (RA) = df/dr
 First class: FAR
 Second class: ARF
 Third class: AFR
Pulleys:
 Fixed pulley has a MA=1
 Moveable pulley has a MA=2
Quiz 2
Tissue Categories:
1. Muscle
2. Nerve
3. Epithelial
4. Connective tissue (CT)
Function: Connect, Protect, Support
Components: Collagen fibers-made of tropocollagen fibers, ropelike, wavy at
rest
Type I-ligament, tendon, fascia, synovium, skin, bone (thick, supportive)
Type II- cartilage, nucleus pulposus (thinner, less tensile strength, shape)
Elastin fibers- skin, ligamentum flava (flexible)
Fixed cells: fibroblasts, osteoblasts, chondroblasts
Migratory cells: lymphocytes, macrophages
Extracellular matrix (ground substance)
Proteoglycans are made up of many Glycoaminoglycans
(GAG)- provide support and attract/bind water
Properties of CT
Stress- force per unit area (pressure). units: N/sq m, Pascal
Strain- deformation that occurs under loading. Ratio of deformation to original
length (%)
Bending-lengthens on one side and shortens on other side
Torsion- twisting forces
Compression- force that pushes together
Shear- horizontal force
Plastic- a permanent change
Elastic- a temporary change
Fatigue- failure
Viscoelasticity
Time-dependent properties: longer stress is applied greater deformation
Rate-dependent properties: increase speed, decrease deformation
Hysteresis: heat release as cross-links break (represents plastic deformation)
Mechanical Behavior
Stress/strain
stiffness
Young’s Modulus=
Slope=
Changes in collagen affecting curve:
Age: ↓water, ↓elasticity, ↓ strength, ↓ adaptability
Disease (Diabetes)
Immobilization: synovium adhesions,
cartilage atrophy, bone osteoporosis,
ligament atrophy & disorganized fiber
arrangement
Mechanical Properties of CT
Bone: resists compression, tension & shear, somewhat elastic
Collagen type I fibers, osteoblasts/clasts/cytes, ground substance inorganic
materials (Ca, K, Mg)
Cortical bone- compact, mechanical strength, concentric rings
Cancellous bone- spongy
Cartilage: dissipates loads applied to joint, minimize friction
Zone 1- superficial, high water content, horizontal collagen fibers
Zone 2- Transitional, GAG, arch like collagen fibers
Zone 3- Deep, largest layer, perpendicular collagen fibers
Tidemark-division where blood supply is available
Zone 4- Deepest, calcified, has blood supply, vertical collagen fibers
Tendons: Spring like, absorb energy, prone to degenerative changes (lack of blood supply)
Collagen fibers- Type I, dense and run parallel
water, proteoglycans
Ground substance- 60-80%
Cells: Fibroblasts, tenocytes
Tendinitis- acute inflammation
Tendinosis- degenerative change in tendon
Ligaments: resist tension forces, end range joint stabilization, sensory feedback through
mechanoreceptors
Collagen fibers- Type I, less parallel-work in many planes
water, proteoglycans
Ground substance-
Cells: Fibroblasts
Optimal stimulus for regeneration of tendons/ligaments is modified tension along line of function
Joint Types:
symphysis)
1. Synarthrosis [non synovial]- fibrous (skull sutures) & cartilaginous (pubic
2. Diathrosis [synovial]
components: joint capsule, mechanoreceptors, synovial fluid, synovium,
cartilage, ligaments, tendons
Mechanoreceptors:
Type I-thin encapsulated, globular corpuscles
Type II-thick encapsulated, conical corpuscles
Type III-thin encapsulated, fusiform corpuscles
Type IV-free nerve endings
Classification: 1. Uniaxial (1o freedom)-hinge (PIP), pivot/trichoid (proximal
radioulnar)
2. Biaxial (2o freedom)-condyloid (MCP), saddle (thumb CMC),
ellipsoid (radiocarpal)
3. Triaxial (3o freedom)-plane (carpals), spheroidal/ball & socket
(glenohumeral)
Osteokinematics- gross bone movement, relative to 3 cardinal planes (sagittal, frontal,
horizontal)
Arhrokinematcs- accessory movement, conjunct rotation (roll, spin, glide/slide)
Convex-concave rule: convex moving on concave- roll & glide opposite
Concave moving on convex- roll & glide same
Open chain- proximal end stabilized & distal moves
closed chain- distal end fixed & proximal moves
Closed packed- max congruence, capsule
tight, lig. taught
loose packed- lease
congruence, lig. Relaxed
End feel: soft, firm, hard
pathologic
end feel-empty, boggy or end feel is
different from normal/expected
Type I
Type IIa
Type IIb
Slow Oxidative
Fast oxidative
glycolytic
Fast
glycolytic
Color
Red
Red
White
Myoglobin
High
Intermediate
Low
Glycogen
Low
Intermediate
High
Twitch rate
Slow
Fast
Fast
Skeletal muscle fiber types: fusiform
(parallel), penniform (pinnate)
Fatigue rate
Slow
Intermediate
Fast
Type I- prone to weakness, 1st to atrophy,
arthrokinematic, 1 joint
Motor unit size
Small
Intermediate
Large
Respiration
Aerobic
Aerobic
Anaerobic
Type II- prone to tightness, osteokinematic, 2 joint
Cannot change fiber type with training, but
IIa can be more like IIb with high intensity training
IIb can be more like IIa with high endurance training
Active insufficiency: inability of a 2-joint muscle to perform maximum concentric contraction
over both joints
Passive insufficiency: inability of a 2-joint muscle to maximally lengthen over both joints
Exercise:
Isometric-static/fixed angle
advantage- easy to perform, no equipment, can do early in rehab tx
disadvantage- specific to angles, not functional, no power (no speed)
Isotonic-fixed resistance, variable speed
Concentric- tension as muscle shortens
Eccentric-tension as muscle lengthens
Open chain: advantage- isolates muscle
Closed chain: advantage- function, disadvantage-more stress on joint
Isokinetic: fixed speed, variable resistance
advantage- fixed speed, max resistance throughout, multiple joints
disadvantage- expensive equipment, not functional
Isodynamic- resistance from elastic bands
advantage- tension changes, cheap, accessible, varying speeds
disadvantage- max resistance at end range
Force-velocity
Concentric: ↑ velocity ↓force
Eccentric contraction: ↑ velocity ↑force
Length-tension relationship
20% past resting length-max force can be generated
Carry objects at most total tension- needs least
amount of work
Holten Curve
Immobilization- slow twitch mm atrophy first
↓mitochondrial vol, ↓mm cell
synthesis
Aging- peak mm performance 20-30
yrs, >50 mm decline
Lose fast twitch mm,
neuromuscular decline,
Strength
↓mitochondrial vol, stiff CT
Strength/endurance
Endurance
EMG: Rigid platform: can’t move, measures force- stand jump, step
Force transducer- detects a force (pressure) converts into a readable image
Amplifier- magnifies signal received
Filter- removes background noise (electrical signal)
A/D converter- converts analog (wave) to digital (finite points)
Oscilloscope- tool to observe electrical signal, assess amplitude/intensity
Inclinometer- measures incline/angle
Accelerometer-measures acceleration (change in speed/time)
Isokinetic dynamometer: use relative strength to compare to others
Hamstring to quad: At least 70% and no more than 10% difference from side to side
EMG output: (least) eccentric < isometric < concentric (greatest)
(least) mm length: middle < lengthened (passive tension helps) <
shortened (greatest)
With fatigue ↑ EMG output
ANKLE:
4 points of normalcy: (1) vertical tibia (2) calcaneous in line with tibia (3) MT in same plane (4)
MT plane perpendicular to calcaneous
Talocrural joint: Distal tibia+distal fibula (concave), talus (convex)
AROM: PF 50o – DF 20o
Close packed: max DF
Loose packed: 10 PF end feel-firm
10o DF needed for amb, 20o for running
DF glides: Posterior talar glide & traction/distraction
PF glides: Anterior talar glide & traction/distraction
Subtalar joint: talus (concave), calcaneous (convex) AROM: Inv 5o – Ever 5o
Close packed: supination
Loose packed: pronation
end feel-firm or hard
Interosseous ligament is the main calcaneous/talus bond located in sinus tarsi “cruciate lig of the
ankle”
Supination: open chain: calcaneal-inv, add, PF
closed chain: calcaneal-inv, talar DF, abd
(lengthens leg)
Pronation: open chain: calcaneal-eve, abd, DF
closed chain: calcaneal-eve, talar PF, add
(shortens leg)
Rearfoot varus: inv calcaneous (compensate pronate)
Rearfoot valgus: everted calcaneous (compensate supinate)
Forefoot varus: forefoot isn’t perpendicular-medial higher (compensate excessive/longer
pronation)
Forefoot valgus: forefoot isn’t perpendicular-lateral higher (compensate oversupinate)
Pes planus- flat feet (overpronation, flattened medial arch)
Flexible flat feet- no medial arch when standing flat, but present when standing on tip
toes
Rigid flat feet-no medial arch at all times
Predisposition: forefoot varus, tight shoes, weak mm/lig supporting arch, overweight,
excessive pounding on hard surfaces
Common causes: heredity, abnormal walking (forefoot varus), post. tendon tears
Signs/symptoms: foot pain or weakness on medial side, calcaneal eversion, navicular
sticking out, swelling
Treatment- if not painful=no treatment, orthotics, arch support taping, surgery
Pes cavis- rigid supinated feet
Ankle sprains:
Inversion sprain- most common
MOI- foot PF & Add. Grade1 (ATF), 2
(ATF & CF), 3 (ATF, CF, PTF)
Eversion sprain- stronger anatomy-more severe
Predisposition- pronation hypermobility, pes planus
Syndesmosis-often in conjunction with eversion sprains, damage to Interosseous
membrane, ATF, & PTF
MOI- ER & DF
Foot Drop: loss of DF, causes- MS, Stroke, Cerebral Palsy, polio, ALS, injury to nerve root, MD
Tx: AFO, PT depends of underlying cause (Ther Ex, E-stim, surgery), permanent if
neurological condition
Hallux abducto valgus- hallux laterally deviates, causes- genetic, high heels, tight shoes, RA
Tibial torsion: tibia rotated in a transverse plane
Tibial varum: bowed leg in frontal plane
Genu varum: posterior bowing at knee
Functional Use of Muscles—Eccentrically acting to control concentric motion
PHASES
DURING GAIT
TALOCRURAL JOINT
SUBTALAR JOINT
Initial contact
Neutral, Tibialis ant. (ecc)
controls PF
Supination, Post tib (ecc) controls
pronation moment
Loading response
PF, Tibialis ant. (ecc) controls
PF
Supination →Pronation, Post tib (ecc)
controls pronation moment
Mid stance
PF→DF, Soleus (ecc) controls Pronation, Post tib (con) supinates
DF
Terminal stance
DF, Soleus (ecc) controls DF
Supination, Peroneals (ecc) control
supination
Preswing
PF, gastroc & soleus (con) DF
Supination, Peroneals (ecc) control
supination
Navicular drop test- horizontal line on navicular, place STJ in neutral & measure distance to
floor, Pt. march, re-measure
Significant pronation if > 10 mm difference
KINESIOLOGY/BIOMECHANICS TEST 3
KNEE
Lower Extremity Chain Motion:
Pronation: occurs with calcaneal eversion, talar PF and adduction, tibial int. rotation, and knee flexion.
Pronation relatively shortens a limb.
Supination: occurs with calcaneal inversion, talar DF and abduction, tibial ext. rotation, and knee extension.
Supination relatively lengthens a limb. Raises the hip.
Ligaments of the knee:
ACL
PCL
MCL
LCL
Arcuate
Meniscus
Complex
Dashboard Valgus
Varus
Varus force
Compression,
Mechanism Hyperextension,
Deceleration,
(tibia
Stress (more Stess
injures the LCL, Rotation,
of Injury
Cutting
moves
common
Hyperextension
Degeneration
(MOI)
posteriorly than LCL
of the knee
(injury often
70% of the time
relative to
injury)
occurs with
non-contact
femur),
ACL or MCL)
Fall on
Hear a “pop,”
flexed
swelling, positive
knee. Sag
Lachman’s test
test
confirms
Medial ant. Tibia
2 bands:
Superficial
Lateral
Posterior/Lat.l
Medial: “C”
Location
to posterior lateral
Posterior
and deep
knee
corner of knee.
-more stable
and Parts
femur. 2 bands:
medial and components,
Arcuate lig,
-attached to
Ant. Medial and
anterior
medial knee
LCL, lat.
MCL
Post. Lateral
Function
Stability,
Arthrokinematics,
Proprioception
Other Notes
Injury more
common in
females, taut
during extension
lateral
Taut
during
flexion
Gastroc. head,
popliteus tendon
Stability
Stability
Broad
ligament
Thin
ligament
Lateral: “O”
Joint fit,
stability,
distribute
forces
Blood supply
on peripheral
1/3
Patellofemoral Joint: Patella articulation with femoral condyles. Moves inferiorly with flexion and superiorly with
extension.
o Patellofemoral Pain syndrome: presents with pronation, IR, valgus knees (knock knees)
o Function: protects, tib-fem joint, improves MA of quads, decreases friction between quad and
fem. condyles
o Stairs
 Pain going up: tib fem problem
 Pain going down: patellofemoral problem
o Joint loading: load increases with flexion
 Open chain: increased load from 30-0 degrees
 Closed chain: increased load at flexion greater than 90
Q Angle: 18 deg in female, 13 in males. Measure from ASIS to patella and tibial tuberosity to patella.
Subluxation: usually a valgus force, patella usually goes laterally
Axes of the lower leg:
Mechanical: head of femur to head of talus (along tibial shaft)
Anatomical: down femoral shaft
-The angle created by the intersection of these two is physiologic valgus (170-175 degrees)
Genu Valgum: “knock knees” <175
Genu Varum: “bow legs” >175
Concave
Convex
Type of
DOF
End feels Capsular
Surface
Surface
Joint
Pattern
Tibial
Femoral
Modified
2 (Flex/Ext Flex: Soft Lose
Tibiofemoral
condyles
Condyles
Hinge
and ER/IR Ext: Hard Extension
Joint
when knee
over
is flexed)
Flexion
Muscle
Anterior
Compartment
Quadriceps Femoris
Action
Knee Extension
Close/Loose
Packed
Close: Ext.
Loose: Flex.
Posterior Compartment
Medial Compartment
Lateral: Biceps femoris (long & short
head)
Medial: semitendinosus &
semimembranosus
(knee flexion)
Lateral: Knee flexion and external
rotation
Medial: Knee flexion and internal
rotation
Sartorius, Gracilis, Semitendinosus
(attached at pes anserinus)
Knee flexion and internal rotation
Found in the Popliteal Fossa:
 Popliteus: Flexes knee and internally rotates tibia in open chain (externally rotates femur closed chain)
 Gastrocnemius and plantaris: knee flexion
HIP
Hip Joint: made up of the pelvis (ilium, pubic, ischium), acetabulum, and femur
Hip Arthrokinematics & Muscles
Muscles
Open Chain (Convex femoral
Closed Chain (Concave
head on concave acetabulum)
acetabulum on convex femoral
head)
Psoas Major
Spin/glide slightly posterior and
Glides Anterior on fixed femoral
Flexion
Iliacus
inferior
head
Gluteus Max.,
Spin/glide slightly anterior
Glides posterior
Extension
Hamstrings
Gluteus med., gluteus Inferior glide (Anterior when hip Acetabulum glides toward opposite
Abduction
min., TFL
flexed at 90)
side of pelvis
Adductor
Superior glide (Superior when
--------------------------------------Adduction
magnus/brevis/longus, hip flexed at 90)
pectineus, gracilis
Glut. min., TFL, Glut
Posterior glide (Inferior when
Acetabulum spins toward side of
Internal
med.
hip flexed at 90)
rotation
Rotation
Obturators, piriformis, Anterior glide (Superior when
Acetabulum spins opposite the side
External
quad. femoris,
hip flexed at 90)
of rotation
Rotation
gemellus, glut max.
General Hip Joint Info
Capsular
Pattern
Equal limitation
Hip
flexion, abd., IR
Joint
ClosePacked
Maximum
ext., IR,
slight abd.
Loose-packed
DOF
Concave Surface
30 deg.
Flex/abd, slight
ER
3
Acetabulum
Convex
Surface
Femoral
Head
Ligaments:



Iliofemoral Ligament: limits hyperextension
Pubofemoral Ligament: tightens during abduction, extension and ER
Ischiofemoral Ligament: reinforces posterior joint capsule, tight during IR, ext., add.
Angle of Inclination: Angle between femoral shaft and neck, normally 125 deg.
o Coxa varum: less than 125
o Coxa valgum: greater than 125
Angle of torsion: angle between femoral neck and plane of the shaft, normally 8-15 deg.
o Anteversion: greater than 15 (compensates by internally rotating tibia)
o Retroversion: less than 8 (may present with ext. rotated limb)
Neutral Pelvis: ASIS and pubic symphysis should be in a vertical line, PSIS is lower than ASIS in horizontal plane
 Anterior Pelvic Tilt: ASIS in front of pubic symphysis, hip flexors shortened, spine extended
 Posterior Pelvic Tilt: ASIS behind pubic symphysis, spine more flexed, glut max and hams tight
Note: Carry a load on the affected side because the load and muscle work together against body weight.
Clinical Correlations:
1. Developmental Hip Dysplasia
Femoral head not located in acetabulum, usually occurs at birth
Risks: 1st child, female, family history, birth in a breeched position
Symptoms: asymmetric legs, reduced movement at hip, limping, “clicks”
Treatment: closed reduction or spica cast, open reduction and cast, PT
2. Legg-Calve-Perthes Disease
3.
Temporary condition, head of femur loses blood supply
Affects children between 2 and 12 (usually)
Symptoms: Pain (aggravated by activity), limp
Treatment: rest, meds, cast/brace, PT (bone will typically reossify
Hip Replacement
LOWER EXTREMITY CLINICAL CORRELATION
Ligament Sprains and Muscle Strains
 Grade 1: less than 25% of ligament/muscle torn
 Grade 2: 26-75% of ligament/muscle torn
 Grade 3: >75% ligament/muscle torn
Diagnose by performing stability tests for ligaments and strength testing for muscles
Ankle Sprains:
 Lateral Sprain: MOI is inversion (CF torn) with plantar flexion (ATF torn)
o Grade 1: slight stretch of CF and ATF
o Grade 2: partial tear of ATF, stretched CF
o Grade 3: ruptured ATF and CF, other ligaments involved
 High Ankle Sprain: Syndesmoses injury, MOI is dorsiflexion and eversion with tibial rotation
o Takes longer to heal
Shin Splints (catch all term)
 Medial tibial stress syndrome
 Stress fracture
 Compartment syndrome
Tendinitis: occurs most often in the mid-section of a tendon, not at the insertion
Bursitis: often overdiagnosed, trochanteric bursa on lateral hip could be inflamed from falling or tight IT band
Labral Tear: occur more frequently
 Symptoms: anterior groin pain (often long periods of time), click
6 Treatment Areas:
 Modalities
 Manual Therapy
 Exercise
 Home exercise program
 Education
 Assistive Devices
LUMBAR SPINE AND POSTURE
Body Types:
 Endomorphic: obese, fatty tissue
 Mesomorphic: muscular, athletic build
 Ectomorphic: very thin
Characteristics
KyphoticLordotic
Anterior pelvis,
lumbar
extension, hip
flexion
Flat Back
Sway Back
Posterior
pelvis, lumbar
flexion, hip
extension
Posterior pelvis,
lumbar flexion,
hip extension, tspine posterior
Handiness
Pattern
Low shoulder
and high iliac
crest on
dominant side
Scoliosis
Frontal plane
convexity in
spine, named for
convex side,
“C” or “S”
Ideal Plumb line for Posture:
- lobe of ear
- Bodies of cervical vertebrae
- Shoulder joint
- Midway through trunk
- Greater trochanter
- Anterior to midline of knee
- Slightly anterior to lateral malleolus
Function of spinal column: protect spinal cord, mobility, transfers load
Intervertebral Disc:
 Nucleus Pulposus: inner mucoid material, type II collagen, mostly water, resists compression
 Annular Fibrosis: Type I collagen, arranged in lamella (oriented at 65-70 degrees), rotation of
body applies tension to annulus.
 Vertebral end plate: areas where disc is attached to vertebral body, cartilage layer
o Schmorl’s nodes: occur with damage, nucleus pulposus moves into end plate
Lumbar spine facet joints:
L1-L5: oriented more in sagittal plane for greater flex/ext
L5-S1: oriented more in frontal plane for greater rotation and side bending
Angle of Inclination: between horizontal plane and articulation of the sacrum and L5, normally 30-35 deg.
Movements affecting disc injury:
Flexion
Extension
Axial Rotation
Lateral Flexion
Vertebrae rock forward
Vertebrae rocks backward
Fryette’s Law: axial Right: R. facet
Vertebrae
Facets glide upward
Facets glide down
rotation and side
slides down, left
Anterior disc is loaded
Posterior disc is loaded
bending are opposite opens,
IV foramen enlarged
IV foramen narrows
Facets open on side
compression on
(good for foramenal
of rotation
R., vertebra
stenosis)
rotates left
Initiated by abdominals,
Gluts and hamstrings
Muscles
hip flexors
initiate motion
Sacral Motion:
Nutation: flexion of sacrum (forward tilt) accompanied by posterior rotation of the pelvis
Rotation:
Anterior: PSIS high and ASIS low
Posterior: PSIS low and ASIS high
Upslip/Downslip: ASIS/PSIS all up or all down
Inflare/Outflare: ASIS closer to midline and PSIS away from spine (inflare). Outflare is opposite
Ligaments (from student presentation):
 Anterior longitudinal: taut during extension
 Posterior longitudinal: taut during flexion, runs in vertebral canal
 Ligamentum Flavum: constant resistance during flexion
 Interspinous: drawn tight only during extreme flexion
 Supraspinous: from C7 to sacrum, first to rupture in extreme flexion
 Thoracolumbar fascia
 Iliolumbar ligament: stabilizes L5 on sacrum
Clinical Applications:
1. Low Back Pain
60-85% of adults affected
Causes: osteoarthritis, herniation, fractures, overuse, posture…
2.
3.
4.
Herniated Disc
Most common at L4-5 and L5-S1 levels
Cause: nucleus pulposus loses water and is displaced through annular fibrosis
Can press on nerves causing N/T, pain. Symptoms are worse with sitting and bending, better with lumbar
extension
Treatment: bed rest, anti-inflammatories, PT, exercise
Spinal Stenosis: narrowing of spinal or nerve passageway
Cause: aging factors usually- osteoarthritis, disc degeneration, thickened ligaments, spinal tumors
Symptoms: progress over time, cramping, ease by bending forward
Treatment: Pain meds, PT, cortisone injection, surgery
SI Joint Dysfunction
Major source of LBP
Causes: leg length discrepancy, infection, spinal fusion, stress fractures of sacrum
Symptoms: low back and buttock, posterior thigh and knee pain, frequent discomfort sitting/changing
position
Treatment: anti-inflammatory meds, PT, stabilization or fusion
Exam 4
Gait
Determinants of gait:
Pelvic rotation in transverse plane
Lateral pelvic tilt
Lateral shift to weight bearing side
Knee flexion in early stance
Ankle dorsiflexion in stance
Heel rise in terminal stance
Cadence: number of steps per min (100-122 step/min)
Stance time: .6 sec
Swing time: .4 sec
Single support: midstance and terminal stance .4 sec
Double support: initial contact, loading response, preswing
Stride length: distance from heel of same foot to heel of same foot (1 gait cycle)
Step length: one foot to opposite foot
Step width: space between feet , 2-4”
Step angle: amount of abduction, 4-7 deg
Initial
Contact
Loading
Response
MidStance
Terminal
Stance
PreSwing
Initial
Swing
Mid-Swing
Terminal
Swing
Gait
Initial
contact
Loading
Response
Mid Stance
Terminal
Stance
Pre Swing
Initial
Swing
Mid
Swing
Terminal
Swing
% of
cycle
with LR
10%
with IR
10%
20%
20%
10%
13%
14%
13%
hip
20-35 Flex
20 Flex
neutral
20 Ext
0-10 Ext
15 Flex
25
Flex
20 Flex
knee
0-5 Flex
15 Flex
0-5 Flex
0-5 Flex
45 Flex
60 Flex
(max)
25
Flex
5 Flex
ankle
neutral
0-5 PF
5 DF
10 DF
20 PF
5 PF
neutral
neutral
stj
supinated
pronated
pronated>supinating
supinated
supinated/
MTP 70
Ext
supinated
subtalar
muscle
activity
post tib
ecc
post tib
ecc
post tib con
peroneals
ecc
peroneals
ecc
peroneals
ecc
ankle
muscle
activity
pre tibs
ecc
pre tibs
ecc
soleus ecc
soleus
ecc
PF con
pre tibs
con
knee
muscle
activity
quads
ecc,
hams con
quads
ecc
quads con
and
gastroc ecc
hams ecc
and
gastroc
popliteus
con, rect
fem ecc
hams
early,
hams &
quads
late
hip ext
ecc
glut max
con and
med ecc
TFL ecc
rect fem
con,
adductors
ecc, hams
ecc
psoas
con,
adductors
ecc,
hams ecc
hip
muscle
activity
glut med
Cervical Spine
ROM: flexion and extension together create 104 deg of motion
SB: 45 deg to each side
Rot: 90 deg to each side
Arthokinematics
Flexion- facets of superior vertebrae slides superior and anterior
anterior portion of disc is compressed
loose pack position
Extension- facet of superior vertebrae slide inferior and posterior
Posterior portion of disc is compress
Close pack position
Rotation (Right)- R facet moves posterior, contralateral (L) facet moves anterior
R facet moves inferior, L moves superior
R side gaps, left side opens
Sidebend (right)- superior vertebra tilts right and glides inferior, Left facet glides superior
Clinical examples
Spondylosis- degenerative changes causing narrowing of the disc and reduces space for
nerves leading to irritation
Whiplash- high velocity hyperextionsion and hyperflexion, may damge nerves,
ligaments, and tendons
Facet joint impingement- meniscoid cushion for facet jt locked in position
Nerve root irritation- caused by several different mechanisms that put pressure on nerve
(disc degeneration, osteophyte, etc)
Thoracic Outlet Syndrome- obstruction of subclavian artery or vein or brachial plexus
resulting in neurovascular changes (decrease pulse or numbness and tingling)
Kyphosis- posture cause by osteoporosis, weakness, or Scheurman’s disease
Scoliosis- may be function from posture or structural from fix deformity
Exam 5 Review
Shoulder Complex
-Joints: Acromiclavicular joint
Ligaments- Coracolclavicular, coracoacromial
Sternoclavicular
Ligaments- Sternoclavicular, interclavicular, costoclavicular
Scapulothoracic
Glenohumeral
Ligaments- superior, middle, and inferior glenohumeral lig,
coracohumeral, transverse humeral
Motions of shoulder complex (p. 74 of green KIN book)
Shoulder flexion or abduction:
Scapula remains fixed until 30 deg
Scapulohumeral rhythm 2:1
Humerus ER so greater tuberosity clears acromion
Deltiod, supraspinatus elevate humerus, rotator cuff stabilizes head
Trapezuis and serratus anterior control movement of scapula
Motion of glenohumeral
Flexion: 180 deg, anterior rotation with posterior glide
Extension: 60 deg, posterior rotation with anterior glide
Abduction: 180 deg, spin superiorly, glides inferiorly
Adduction: spin inferiorly, glide superiorly
IR: 70 deg, spin anteriorly, glide posteriorly
ER: 90 deg, spin posteriorly, glide anterior
Horz. Abd: 90 deg, spin posterior, glide anteriorly
Horz. Add: 40 deg, spin anterior, glide posterior
Capsular Pattern: ER>ABd>IR
Open pack: 55 deg abduction
Close pack: max abd with ER
Clinical examples
Dislocations—anterior is more common than posterior
Mechanism of anterior dislocation- abduction and ER
Mechanism of posterior dislocation- adduction and IR
Hills-Sachs lesion- bony damage to head of humerus
Bankart lesion- damage to bone of glenoid fossa or labrum
Separation—fall on tip of shoulder that tears ligament
Rotator cuff tear- usually degeneration or overuse at the musculotendinous junction- may treat
conservatively or with surgical repair
SLAP lesion- labral tear involving superior labrum and biceps tendon
Mechanism of injury- fall on out stretched hand (FOOSH), overhead activity
Impingement- impingement of supraspinatus tendon or subdeltoid bursa
Mechanism of injury- overhead movement, narrowed space between head or humerus
and acromion process
Primary classification- hypomobile, middle-aged or older, overhead work
Secondary classification- hypermobile, younger athletes, lack stabilization from muscles
Thoracic Outlet Syndrome—compression of nerves (brachial plexus) and blood vessels
(subclavian artery and vein) in space between first rib and clavical
Symptoms- numbness and tingling, discoloration in hands from lack of blood flow,
temperature change in hand
Elbow Complex
Stabilization
Medial (Ulnar) collateral ligament (anterior, posterior, and oblique band)
Lateral (Radial) collateral ligament
Annular ligament- stabilizes radial head
Carrying Angle: normal is 5-15 degrees,
Cubital valgus-increased angle
Cubital varus- decreased angle
Humeroulnar joint
Flexion: 150 deg, roll anterior, glide anterior (OKC)
Extension: 10deg, roll posterior, glide posterior (OKC)
Capsular Pattern: Flexion=Extension
Close Pack: full extension and supination
Loose Pack: 70-90deg flexion and 10 deg supination
Proximal Radioulnar joint
Supination: 80 deg, head of radius spins anteriorly
Pronation: 80 deg, head of radius spins posteriorly
Capsular patter: equal loss of supination and pronation
Close pack: full pronation or full supination
Loose pack: 70 deg flexion, 35 deg supination
Clinical Examples
Lateral epicondylitis- caused by overuse from repetitive extension motions (extensor carpi
radialis is usually affected)
Elbow dislocation- usually caused by FOOSH or other traumatic injury
Possible injury to arteries and nerves
Panner’s Disease- type of osteochondrosis that usually affects young males—cell death in
growth plate leading to avascular necrosis
Wrist and Hand
Joints: radiocarpal, mid carpal, carpometacarpal, metacarpal, interphalangeal
Stability: triangular fibrocartilage complex, dorsal and volar radioulnar ligament, radial collateral
lig, ulnar collateral lig, volar plates, phalangeal collateral lig
Wrist
Flexion: 80 deg, carpals glide dorsally
Extension: 70 deg, carpals glide volarly
Radial devation: 20 deg, glide dorsally and towards ulna
Ulnar deviation: 30 deg, carpals glide towards radius
Capsular Pattern: equal loss of flexion and extension
Close pack- extension with radial devation
Loose pack- 10 deg flexion with ulnar deviation
Metacarpophalangeal
Flexion: 90 deg, phalanx glides volarly
Extension: 30 deg, phalanx glides dorsally
Abduction: 80 deg, phalanx glides towards side of abduction
Adduction: 0 deg, phalanx glides towards side of adduction
Capsular pattern- equal restriction of flexion and extension
Close pack- full flexion
Loose pack- slight flexion
PIP
Flexion: 120 deg, base of phalanx glides palmarly
Extension: 5 deg, phalanx glides dorsally
Capsular pattern- equal restriction in flexion and extension
Close pack- full extension
Loose pack- slight flex
DIP
Flexion: 90 deg, base of phalanx glides palmarly
Extension: 10 deg, phalanx glides dorsally
Capsular pattern- flexion is limited more than extension
Close pack- max extension
Loose pack- slight flexion
Thumb carpometacarpal (CMC)
Flexion and extension in frontal plane (Parallel to palm)
Abduction and adduction in sagittal plane (perpendicular to palm)
Arthrokinematics
Flexion- metacarpal slides ulnarly (concave)
Extension- metacarpal slides radially (concave)
Abduction- metacarpal slides dorsally (convex)
Adduction- metacarpal slides palmarly (convex)
Capsular pattern- abduction is limited most, then extension
Close pack- full opposition
Loose pack- midabduction and adduction and midflexion and extension
Thumb metacarpophalangeal (MCP)
Flexion and extension in frontal plane (Parallel to palm)
Abduction and adduction in sagittal plane (perpendicular to palm)
Arthrokinematics
Flexion- phalanx glides palmarly
Extension- phalanx glides dorsally
Capsular pattern- flexion limited more than extension
Close pack- max opposition
Loose pack- slight flexion
Thumb interphalangeal (IP)
Flexion- phalanx glides palmarly
Extension- phalanx glides dorsally
Capsular pattern- flexion limited more than extension
Close pack- max ext
Loose pack- slight flexion
Functional position of hand
- slight wrist extension (20 deg)
- slight ulnar deviation (10 deg)
- MCP moderately flexed (45 deg)
- PIP slightly flexed (30 deg)
- DIP slightly flexed
Finger flexion: early phase- flexor digitorum superficialus, flexor digitorum profundus, interossei
Late phase- ext. carpi radialis brevis, ext digitorum (ecc)
Finger Extension: extensor digitorum, interossei ext PIP, oblique retinacular lig is stretched, DIP
ext
Lumberical position- MCP flexion, IP extension
Grip Patterns- Power grips (cylindrical, spherical, hook grip_
Lateral prehension
Two and three point tip
Two and three point pad
Lateral pinch
Innervations of hand
Isolated area
Entrapment
Radial
Dorsal web
Supinator muscle
Clinical signs
Wrist drop
Clinical Examples
Median
Distal tip of 2nd digit
Pronator teres,
carpal tunnel
Loss of thumb
opposition
Ulnar
Distal tip of 5th digit
Cubital tunnel,
Guyon’s tunnel
Loss of thumb
adduction
Carpal tunnel syndrome- compression of median nerve (Carpal tunnel contains tendons of flexor
digitorum profundus and superficialis, Palmaris longus)
causing numbness and tingling, pain, weakness, and atrophy, risk factors are repetitive hand
movements
Scaphoid fracture- FOOSH (wrist hyperextension and radial deviation), tenderness over snuffbox
Colle’s fracture- FOOSH, fracture of distal radius that displaces distally
Swan Neck deformity- PIP hyperextension, DIP Flexion
Boutonniere deformity- extensor digitorum slip avulsion, PIP flexion, DIP extension
Mallet finger- distal avulsion of extensor, caused by hyperflexion while in ext- can’t straighten
DIP
Dupuytrens’ contracture- contracture of palmar fascia causing flexion of PIP
DeQuirvains- tenosynovitis of extensor Palmaris brevis and abductor Palmaris longus from
repetitive ulnar deviation
Biomechanics Lab
Palpations- See Tests and Measures study guide or refer to notes
Passive Accessory Movements (for details refer to textbook)
Shoulder
Lateral Distraction- general ROM and pain
Anterior Glide- promotes Ext, ER, and Horz. ABd
Posterior glide- promotes Flex, IR, and Horz. Add
Inferior glide- promotes ABd, flex, and scaption
Elbow: Joint distraction—increase ROM, decrease pain
Humeroulnar or humeroradial distraction
Wrist
Joint distraction- promotes general mobility
Dorsal glide- promotes wrist flexion
Volar glide- promotes wrist extension
Hip
Inferior glide at 30deg flex- increase ROM, decrease pain
Inferior glide at 90deg flex- use with pt with knee pain
Anterior glide- promotes Ext and ER
Posterior glide- promotes flex and IR
Tibiofemoral
Traction- increase ROM and decrease pain
Anterior glide- promotes knee ext
Posterior glide- promotes knee flex
Patellofemoral
Superior glide- promotes ext
Inferior glide- promotes flex
Medial/lateral glide- general movement
Proximal Tib-fib
Anterior glide- promotes ext
Posterior glide- promotes flex
Talocrual
Traction- increase ROM and decrease pain
Posterior- increase DF
Anterior Promotes PF
Soft Tissue tests
Hip
Piriformis- prone, compare hip IR bilaterally
Hamstring length test- less than 80 deg shows tightness in hamstrings
Ely’s test- heel to buttock, if less then tight quads
Modified Obers- less than 10deg drop below horizontal = tight IT band
Ankle
Navicular drop test- mark navicular, find subtalar neutral and measure distance to floor,
have pt march a few steps and remeasure, if greater than 10 mm distance = pronation