Muscles and Movements of Lower Extremity – Ch 8 Objectives
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Transcript of Muscles and Movements of Lower Extremity – Ch 8 Objectives
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Muscles and Movements of Lower Extremity – Ch 8
Objectives• Explain how anatomical structure affects movement
capabilities of lower extremity articulations.• Identify factors influencing the relative mobility and
stability of lower extremity articulations.• Explain the ways in which the lower extremity is
adapted to its weightbearing function.• Identify muscles that are active during specific lower
extremity movements.• Describe the biomechanical contributions to
common injuries of the lower extremity.
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Lower Extremity Outline• Hip Joint Structure (Th Fig 7.1)• Hip Joint Muscles and Movements (Th Fig 7.23, 7.24)• Knee Joint Structure (Th Fig 8.1) • Knee Jt Muscles and Movements• Common knee injuries – patellar chondromalacia (a.k.a.
runners knee) and anterior cruciate tear• Ankle Joint Structure (Th F 9.4)• Ankle Jt Muscles and Movements (Th Fig 9.5, Kr Fig 6.16)• Common ankle and foot injuries - plantar fascitis, pronated feet
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Hip Joint • Jt Structure - Th Fig 7.1
• Uni-articular muscles (Th F 7.24)– Flexion - iliopsoas– Extension - gluteus maximus– Abduction - gluteus medius and minimus– Adduction - adductor brevis, longus, & magnus
• Biarticular muscles– Hip flexion, knee flexion - sartorius– Hip flexion,knee extension - rectus femoris– Hip extension, knee flexion - hamstrings
• Note passive and active insufficiency of biarticular muscles
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Hip: Front View
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Loads on the Hip
• During swing phase of walking:– Compression on hip approx. same as body weight (due
to muscle tension)
• Increases with hard-soled shoes• Increases with gait increases (both support and
swing phase)• Body weight, impact forces translated upward thru
skeleton from feet and muscle tension contribute to compressive load on hip.
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Compressive forces on hip jtSocket while walking may exceed 3 to 4 times body wt, 5-6 times bw while jogging, and 8-9 times bw while stumbling
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Muscles of Lower
Extremity:
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Hip Jt Muscle Vectors:
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Thigh muscles in cross-section – which ones do not cause hip joint movement?
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Physiological cross-
sectional area (PCSA) of
hip jt musclesWhy are lateral rotators& gluteii muscles so large?
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Common Injuries of the Hip
• Fractures– Usually of femoral neck, a serious injury usually
occurring in elderly with osteoporosis
• Contusions– Usually in anterior aspect of thigh, during contact
sports
• Strains– Usually to hamstring during sprinting or overstriding
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Knee Joint • Ligaments and cartilage (Th F 8.1)
– medial and lateral collateral ligaments– anterior and posterior cruciate ligaments– medial and lateral meniscus
• Muscles and movements (Kr F 6.4, Adrian F 4.25)– Extensors
• quadriceps femoris (rectus femoris, vastus lateralis, vastus medialis, vastus intermedius)
– Flexors• hamstrings (semitendinosus, semimembranosus, biceps
femoris)
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Knee Joint Structure:
25% of Alpine skiing injuries are ligament injuries Peripatellar pain (runner’s knee) caused by imbalance of stress on patella
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Lower Extremity Misalignment:
Q angle is larger in females due to Wider hip structure, increasing potential for PFPS (Patellofemoral pain syndrome)
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Quadriceps Tendon and Patella Force LinesCompressive force at PFJ is ½ bodywt during normal walking, and over 3 times bw during stair climbingComp force increases as knee flexionAngle increases
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Cruciate Ligaments and Shear Stress
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Loads on Knee
• Forces at tibiofemoral Joint– Shear stress is greater during open kinetic chain exercises
such as knee extensions and knee flexions– Compressive stress is greater during closed kinetic chain
exercises such as squats and weight bearing exercises.
• Forces at Patellofemoral Joint– With a squat, reaction force is 7.6 times BW on this joint.
• Beneficial to rehab of cruciate ligament or patellofemoral surgery
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Thigh muscles
in cross-
section:
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PCSA of Muscles Crossing Knee
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Common Injuries of the Knee and Lower Leg
• ACL injuries• PCL injuries• MCL injuries• Prophylactic Knee Bracing• Meniscus Injuries• Iliotibial Band Friction Syndrome• Breaststroker’s Knee• Patellofemoral Pain Syndrome• Shin Splints
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Foot and Ankle joint structure
• Bones and arches of foot (Th F 9.4)– Tibia, fibula, calcaneus, talus, other tarsals, metatarsals,
phalanges– Longitudinal arch, transverse arch– plantar fascia
• Movements of ankle - talocrural joint (Kr Fig 6.14)• Movements of foot - subtalar, intertarsal, intermetatarsal,
interphalangeal (Cav Fig 3.15, 3.16, 3.17, 4.4, 4.5)
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Bones of Shank and Foot:
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Ankle Joint Muscles and Movements• Kr Fig 6.16, 6.17, Th Fig 9.5, Th Fig 9.18
• Anterior compartment - All dorsiflex– Tibialis anterior (also inverts) – Extensor digitorum longus (also everts)
• Posterior compartment - All plantar flex– Tibialis posterior (also inverts), gastrocnemius (also
flexes knee), & soleus
• Lateral compartment - All plantar flex & evert– Peroneus longus & brevis
• Foot pronation and supination
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Ankle and Foot Muscles:
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Percent PCSA of Muscles Crossing Ankle
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Subtalar Axis:
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Foot Pronation and Tibial Torsion:
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Rearfoot Movement During Running:
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Plantar Fascium
• What is the plantar fascium? - attaches to calcaneus posteriorly and to the first row of phalanges anteriorly
• What is its function?– passive intertarsal stabilization
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Arches of the Foot:
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Plantar Fascium:Plantar fascitis is 4th most common cause of pain among runners(1st – knee pain, 2nd – shin splints, 3rd- achilles tendonitis)
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Plantar Fascitis – 4th leading cause of pain in runners
• What causes plantar fascitis(inflamation of plantar fascium)?– anatomic anomalies
• microtears in fascium and bone spurs• inadequate flexibility of plantar flexors• inadequate strength of plantar flexors• functional pronation (eversion and abduction)
– overuse• overweight• poorly designed and poorly fitted shoes• running and jumping on hard surfaces• sudden increase in stress
• Treatment– remove the cause(s)– Therapeutic treatment to promote body’s natural healing
• NSAIDS• Intermittent ice and heat• Ultrasound, diathermy, massage
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Patellar Chrondomalacia (a.k.a. Runner’s Knee) – leading cause of pain in runners)
• Primary cause is imbalance in forces on patella– Increased Q angle– Pronated feet
• Tissues affected– Degrading of articular cartilage of patella & femoral condyles– Fluid collection, causing joint stiffness
• Symptoms– Pain around patella with no particular injury causing it– Worse going upstairs and downstairs, or after sitting awhile– Feels like knee needs to be stretched
• Prevention/treatment– Surgery is seldom beneficial– Wet test – walk with wet feet on floor and determine if you have a hypermobile foot. If so, purchase
shoes and/or orthotics to decrease degree of foot pronation– Exercises to increase strength/endurance of vastus medialis
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Runner’s knee, cont’d
Wet test:
Safe exercise to develop vasti musclesDo not use knee sleeves!Do not bend knee more than 20-30 degrees while doing extensions with resistance!
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Websites for Muscles, Movements, & Problems of Lower Extremity
• MMG - Patient Education Foot and Ankle TOC
• MMG - Patient Education Knee TOC
Problems on lower extremity:Introductory problems, p 263: 7,8,9,10Additional problems, p 263-264: 1,5,6,8,9