Movement assignment
rakiyab
2020Kinese-BiomechHipKneeAnklePPT.pptx1
The Lower Extremity – Hip, Knee, & Ankle Regions
Spring 2020
Dr. Terry Conkle
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Pelvic Girdle Structure
Pelvic bones
Illium
Ischium
Pubis
Sacrum
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Pelvic Movements
Neutral
Posterior
Tilt
Anterior
Tilt
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Pelvic Muscles – Right Side (Reverse for Left Side)
Anterior tilt
Hip flexors & lumbosacral spinal extensors.
Posterior tilt
Hip extensors & lumbosacral spinal flexors.
Lateral Tilt to Right
Left lateral lumbosacral flexors, right hip abductors, & left hip adductors.
Rotation to Right
Left lumbosacral rotators, left hip external rotators, & right hip internal rotators.
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Relationship of Pelvis to Trunk & Legs
Link between the trunk and lower extremities.
Must cooperate with motion yet contribute to stability.
Primary movements of pelvis are initiated in the pelvis itself.
Secondary movements are associated with motion of trunk or thighs.
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Primary Pelvic Movements
Pelvis
Anterior tilt
Posterior tilt
Lateral tilt left
Rotation left
Spinal Joints
Hyperextension
Slight flexion
Slight lateral flexion right
Rotation right
Hip Joints
Slight flexion
Complete extension
R: Slight adduction
L: Slight abduction
R: Slight external rotation
L: slight internal rotation
* Don’t forget that rotation and lateral tilt can also occur both right & left!
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Secondary Pelvic Movements
Spine
Flexion
Hyperextension
Lateral flexion left
Rotation left
Pelvis
Posterior tilt
Anterior tilt
Lateral tilt left
Rotation left
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Hip Joint Structure
A ball-and-socket joint.
Articulation of spherical head of femur with deep cup-shaped acetabulum.
Head of femur covered with hyaline cartilage.
Femoral neck is at a 126°- 131° angle w/ femoral shaft.
Femoral neck has slight anteversion (“leaning forward”).
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Hip Joint Structure
Acetabulum is lined with hyaline cartilage.
Acetabular labrum (fibrocartilage) adds depth to joint and cushions femoral head.
Acetabular notch at junction of three pelvic bones.
(Ligamentum) Teres Femoris is deep inside socket
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Ligamentous Reinforcements (Lateral)
Transverse acetabular ligament
A strong flat band.
Bridges the acetabular notch & completes acetabular ring.
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Ligamentous Reinforcements (Medial)
Teres femoris ligament
Ties head of femur to lower part of acetabulum.
Provides reinforcement from within.
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Ligamentous Reinforcements (Anterior)
Iliofemoral ligament
Extraordinarily strong band.
Checks extension & rotation.
Pubofemoral ligament
Prevents excessive abduction.
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Ligamentous Reinforcements (Posterior)
Ischiofemoral ligament
Strong triangular ligament.
Limits rotation & adduction in the flexed position.
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Femoral Movements @ Hip Joint
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Femoral Movements @ Hip Joint
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Hip Joint Muscles
Anterior
Iliopsoas
Pectineus
Rectus femoris
Sartorius
Tensor fasciae latae
Posterior
Biceps femoris
Semimembranosus
Semitendinosus
Gluteus maximus
Six deep outward rotators
Hamstrings
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Hip Joint Muscles
Medial
Adductor brevis
Adductor longus
Adductor magnus
Gracilis
Lateral
Gluteus medius
Gluteus minimus
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Muscular Analysis of Major Movements of the Thigh @ the Hip
Flexion: tensor fasciae latae, pectineus, iliopsoas, rectus femoris, & sartorius.
Extension: Hamstring muscles.
Abduction: Gluteus medius & minimus.
Adduction: adductor longus is primary, adductor magnus & brevis, and gracilis.
Lateral Rotation: Six deep outward rotators, biceps femoris, and gluteus maximus.
Medial Rotation: gluteus medius & minimus.
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Major Injuries to the Thigh / Hip / Pelvis
Contusions
Results from a direct blow.
Pinches muscle between bone and external force.
Blow to Iliac crest - “hip pointer”.
Myositis ossificans may result.
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Major Injuries to the Thigh / Hip / Pelvis
Myositis Ossifican
Calcification following repeated traumas or serious contusions.
Improper treatment of contusions.
Hamstring Strains
Muscular imbalance, fatigue, sudden change in direction or speed.
Occurs at myotendinous junctions.
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Major Injuries to the Thigh / Hip / Pelvis
Hip Fracture
Usually fractures of femoral neck.
Often caused by impact or falls.
Hip replacement often the only option.
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The Lower Extremity – Knee, Ankle, & Foot
Dr. Conkle
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Knee Joint Structure
Hinge joint.
Two condyles of femur articulate with tibial plateaus.
Patella articulates with patellar surface of femur.
Menisci
Circular rims of fibrocartilage.
Lateral –an incomplete circle.
Medial – “C” shaped.
Thick peripheral borders, tapering to a thin inner edge.
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Knee Ligaments
Lateral
Medial
Lateral
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Knee Ligaments
Movements
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Knee Joint Muscles
Anterior
Quadriceps Group
Rectus femoris
Vastus intermedius
Vastus lateralis
Vastus medialis
Posterior
Hamstring Group
Biceps femoris
Semimembranosus
Semitendinosus
Sartorius
Gracilis
Popliteus
Gastrocnemius
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Muscle of The Knee Joint
Vastus intermedius
Beneath Rectus Femoris
Vastus lateralis
Vastus medialis
Function:
Powerful knee extensors.
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Knee Joint Muscles
Biceps femoris
Function:
Flexes knee & external rotation of tibia in non-weight bearing.
Semimembranosus
Semitendinosus
Function:
Flexion and internal rotation in non-weight bearing.
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Muscular Analysis of the Knee
Flexion: Hamstrings, sartorius, gracilis
Extension: Quadriceps
External Rotation: Biceps femoris
Can only occur when knee is flexed & non-weight bearing.
Internal Rotation: Semimembranosus, semitendinosus, popliteus
Can only occur when knee is flexed & non-weight bearing.
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Common Injuries of the Leg, Knee, & Ankle
The Leg: Tibial Stress Injuries
Often called “shin splints”.
An overuse injury.
Repeated microtears where tibialis posterior or anterior attaches to tibia, inflammation.
Sprains in interosseous membrane.
Tenderness & pain on medial surface of tibia.
Rest, softer surface and supporting the arch are best treatment.
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Leg Injuries
The Leg: Fracture
Most common among young people.
Most common to lower 2/3 of the fibula.
May result in instability of the ankle joint.
Severity based on bone displacement:
More displaced = more severe.
The Leg: Shin Contusions
Common, based on exposed nature of tibia.
Usually from a direct blow.
May damage periosteum.
Shin guards are recommended for activities in which leg impacts are common.
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Knee Injuries
The Knee: Collateral Ligament Sprain
Direct blow to either side of knee.
Majority are blows from lateral side causing medial collateral ligament damage.
Depending on amount of force the following structures could be injured:
Medial collateral ligament
Medial meniscus
Anterior cruciate ligament
The Knee: Chondromalacia
Degeneration of cartilage on articulating surface of patella.
Pain, on movement, swelling, grating sensation.
Treatment through evaluation of lower body biomechanics, rehabilitative exercises, limiting activities.
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The Knee
Osgood Schlatter Disease
Due to repeated overuse of knee extensors.
Tearing or avulsion of epiphysis of tibial tuberosity.
Swelling, pain on activity & kneeling.
Treat with rest, ice, rehabilitative exercises.
Often males affected during pubertal growth spurt
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Ankle & Foot Structure
The foot provides for support and propulsion.
Movements within the foot occur primarily at the subtalar and midtarsal joints.
The ankle serves to unite the foot and the leg.
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Ankle Structure (Posterior)
Hinge joint
Articulation of talus with malleoli of tibia & fibula.
Bound together by ligaments.
Tibia
Talus
Sustentaculum
tali
Calcaneous
Fibula
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Ligamentous Reinforcement of Ankle
Lateral side
Anterior talofibular
Calcaneofibular
Posterior talofibular
Medial side
Deltoid
Calcaneotibial
Anterior talotibial
Tibionavicular
Posterior talotibial
Plantar calcaneonavicular
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Foot Structure
An elastic arched structure.
Talus is the keystone.
Comprised of two arches:
Longitudinal
Transverse
Fig 8.15
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Arch Structure of the Foot
3 Cuneiforms
Longitudinal arch:
Heel to heads of five metatarsals.
Supported by the plantar fascia.
Transverse arch:
Side-to-side concavity.
Anterior tarsal bones & metatarsals.
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Subtalar Joint
Joint between underside of talus and upper & anterior aspects of calcaneus.
Plantar calcaneonavicular “spring ligament” helps support talus.
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Ligamentous Reinforcement
Lateral side
Anterior talofibular
Calcaneofibular
Posterior talofibular
Medial side
Deltoid
Calcaneotibial
Anterior talotibial
Tibionavicular
Posterior talotibial
Plantar calcaneonavicular
Deltoid
a. Calcaneotibial
b. Anterior talotibial
Plantar calcaneonavicular
d. Posterior
talotibial
c. Tibionavicular
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Foot Joints
Midtarsal Joint (Chopart’s Joint): Has two articulations:
Calcaneocuboid: Nonaxial – permits only gliding.
Talonavicular: Modified ball-and-socket – permits restricted motion.
Tarsometatarsal Joints: Movements are gliding.
Intermetatarsal Joints: spreading or flattening.
Metatarsophalangeal Joints: Modified condyloid joints.
Interphalangeal Joints: Hinge joints.
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Movement of the Foot @ the Ankle, Tarsal, & Toe Joints
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Muscles of the Ankle & Foot
Location:
22 muscles of the ankle & foot are intrinsic.
11 muscles are extrinsic.
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Muscular Analysis of the Ankle
Dorsiflexion: tibialis anterior, peroneus tertius, extensor digitorum longus, extensor hallucis longus.
Plantar flexion: gastrocnemius, soleus, peroneus.
Possible help from tibialis posterior, peroneus brevis, flexor digitorum longus, flexor hallucis.
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Muscular Analysis of the Tarsal Joints
Dorsiflexion: same as ankle.
Plantar flexion: tibialis posterior, flexor digitorum longus, flexor hallucis longus, peroneus longus.
Supination: tibialis anterior (when foot is dorsiflexed) & tibialis posterior (when foot is plantar flexed).
Pronation: peroneus longus, brevis, & tertius.
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Muscular Analysis of the Toes
Flexion: flexor digitorum longus and flexor hallucis longus.
Extension: extensor digitorum longus and extensor hallucis longus.
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The Ankle: Strain
Due to impact that forces ankle beyond normal range.
Results in tearing at myotendinous junction.
May cause pain, weakness, possible deformity. Potentially very debilitating.
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The Ankle: Sprains
Usually associated with forceful inversion of the foot.
In this case the lateral ligaments stretched or torn, or may rupture.
Results in pain, swelling, disability.
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The Ankle: Fracture
Same causes as ankle sprains.
The majority occur to malleoli.
More serious fractures sometimes dislocate.
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The Foot: Plantar Fasciitis
Pain and tenderness along the sole of the foot.
May be due to inflammation, micro tears, or rupture of the plantar fascia.
Is generally an overuse injury; lack of flexibility may be contributory.
Stretching has been shown to be helpful.
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