Skeletal System and Muscular System Considerations
3/26/2017
Margo Prim Haynes, PT, DPT, MA, PCS, C/NDTPlease do not reproduce without permission 1
Skeletal System and Muscular System Considerations
Margo Prim Haynes, PT, DPT, MA, PCS, C/NDT
Ankle & Foot
Ankle & Foot Function
1. Absorb shock
2. Allow the lower extremity to conform to different surface
inclinations
Skeletal System and Muscular System Considerations
3/26/2017
Margo Prim Haynes, PT, DPT, MA, PCS, C/NDTPlease do not reproduce without permission 2
The foot is divided into 3
general regions:
Hindfoot
Lateral viewRight foot & ankle
Midfoot
Forefoot
Fibula
Tibia
65% of weight is on the hindfoot
tibiafibula
calcaneustalus
cuboidnavicularlateral, middle, &
medial cuneiforms
Metatarsals
Phalanges
26 bones in the foot
Skeletal system considerations
Bones of the foot:
• ossify as late as 4 yrs
• continue to grow thru teen years
Skeletal System and Muscular System Considerations
3/26/2017
Margo Prim Haynes, PT, DPT, MA, PCS, C/NDTPlease do not reproduce without permission 3
Subtalar jointtalus, calcaneus
Talocrural joint(ankle joint)
tibia, fibula, talus
Midtarsal jointcalcaneocuboid,
talonavicular
Tarsometatarsaljoints
Metatarsophalangealjoints
Talocrural joint: ankle jointtibia, fibula, talus
Movement: dorsiflexion, plantarflexion
Subtalar joint: talus, calcaneus
allows the foot to moveindependent of the leg
Movements:Inversion/eversion
Abduction/adduction
STJ helps maintain the arches of the foot: evaluate the foot in “subtalar neutral”.
Skeletal System and Muscular System Considerations
3/26/2017
Margo Prim Haynes, PT, DPT, MA, PCS, C/NDTPlease do not reproduce without permission 4
Midtarsal jointtalonavicular
calcaneocuboid Movement:Pronation
(mainly eversion)Supination
(mainly inversion)
Movement:Pronation (mainly abduction & dorsiflexion)
Supination (mainly adduction & plantarflexion)
Tarsometatarsaljoints
Movements:DorsiflexionPlantarflexionInversionEversion
Metatarsophalangeal Joints
(also called MP joints)Movements:Extension (Dorsiflexion)to 65°
Flexion (Plantarflexion) to40 °
Skeletal System and Muscular System Considerations
3/26/2017
Margo Prim Haynes, PT, DPT, MA, PCS, C/NDTPlease do not reproduce without permission 5
3 Arches in the Foot
Anterior Arch :
between the heads of the 1st and 5th
metatarsals
3 Arches in the Foot
Lateral Arch:
between the head of the 5th metatarsal and lateral tubercle of calcaneous
3 Arches in the Foot
Medial Longitudinal Arch:
between the head of the 1st metatarsal and the posteromedial tubercle of the calcaneus
Skeletal System and Muscular System Considerations
3/26/2017
Margo Prim Haynes, PT, DPT, MA, PCS, C/NDTPlease do not reproduce without permission 6
Ankle Dorsiflexors
Tibialis Anterior
Extensor digitorum longus
Extensor hallucis longus
Muscular system considerations
Ankle Plantarflexors
Gastrocnemius
Soleus
Muscular system considerations
Ankle Evertors
Peroneals
Longus
Brevis
Ankle Invertors
Tibialis Posterior
Flexor digitorum longus
Flexor hallucis longus
Muscular system considerations
Skeletal System and Muscular System Considerations
3/26/2017
Margo Prim Haynes, PT, DPT, MA, PCS, C/NDTPlease do not reproduce without permission 7
Skeletal system considerations
• A hinge joint…little boney stability
• Ligaments & muscles provide stability
• Always impacted above by hip alignment and below by ankle alignment
Anterior viewRight knee
Typical Changes in
Genu Varum & Genu Valgum
Birth: Lower limb positioned in varum
Age 6-months: minimal varus remains
Age 18-months: aligned vertical in frontal plane
Age 30 to 36-months: valgus reaches maximal degree
Age 4 to 6-years: limb is aligned vertical in frontal plane
After age 7-years: typically developing children do not show a change in degree of valgus/varus correction
Quadriceps
(Knee extensors)
rectus femoris
vastus medialis
vastus lateralis
vastus intermedialis
Muscular system considerations
Anterior view right thigh
From: Novartis Interactive Atlas
Frank Netter artist
Rectus femoris:
Skeletal System and Muscular System Considerations
3/26/2017
Margo Prim Haynes, PT, DPT, MA, PCS, C/NDTPlease do not reproduce without permission 8
Muscular system considerations
Hamstrings
Biceps femoris
Semitendinosus
Semi membranosus
Concept:
With a 2 joint muscle, tightness can be expressed at either end depending on
position of both joints
Hip & Pelvis
Skeletal System and Muscular System Considerations
3/26/2017
Margo Prim Haynes, PT, DPT, MA, PCS, C/NDTPlease do not reproduce without permission 9
Hip & Pelvis
1. Weight bearing
2. Movement of the hip joint
allows translation of the trunk unit through space
3. Pelvis is the base for the spine
Built for strength
Ball and socket joint
Acetabulum covers ½ the
head of the femur
Femur is:
longest bone in the body
¼ total height
strongest bone in the
body
Hip Structure:
Angle of Inclination
Angle between the:
•long axis &
•Neck
Typically 126° in
adults
Skeletal System and Muscular System Considerations
3/26/2017
Margo Prim Haynes, PT, DPT, MA, PCS, C/NDTPlease do not reproduce without permission 10
Hip/Pelvic
Musculature
Hip Flexors
Iliopsoas
Tensor facia latae
Rectus femoris
Sartorius
Anterior viewRight lower extremity
Concept: Free segment moves on the fixed segment
Movement of hip flexors:
Pelvis on Femur
or
Femur on pelvis
Hip/Pelvic Musculature
Hip Extensors
Gluteus maximus
Hamstrings
• biceps femoris
• semitendinosus
• semimembranosus
Adductor magnus(posterior head)
Posterior viewLeft lower extremity
Skeletal System and Muscular System Considerations
3/26/2017
Margo Prim Haynes, PT, DPT, MA, PCS, C/NDTPlease do not reproduce without permission 11
Hip/Pelvic Musculature
Hip Abductors
Gluteus medius
Gluteus minimus
Tensor fascia lataePosterior view
right lower extremity
Anterior viewright lower extremity
Concept: Muscle action may change depending on joint position
Gluteus medius
Gluteus minimus
Hip/Pelvic Musculature
Hip Adductors
Adductor brevis
Adductor longus
Adductor magnus
(both heads) Anterior viewright lower extremity
Skeletal System and Muscular System Considerations
3/26/2017
Margo Prim Haynes, PT, DPT, MA, PCS, C/NDTPlease do not reproduce without permission 12
Muscle action may
change depending on joint position
Adductor Longus
Anterior rightPelvis & femur
Posterior right femur
Hip/Pelvic
Musculature
Hip External Rotators
Gluteus maximus
Piriformis
Gemeilus superior
Obturator internus
Gemeilus inferior
Quadratus femoris
SartoriusPosterior view
Left lower extremity
Spine & Trunk
Skeletal System and Muscular System Considerations
3/26/2017
Margo Prim Haynes, PT, DPT, MA, PCS, C/NDTPlease do not reproduce without permission 13
Spine & Trunk
1. Connect the Upper body
Lower body
2. Position the head for interaction
3. Support and position UEs for
purposeful function
Points of transition – Spine
C7
T1
T7, T8 Point of
counter-rotation in the Thoracic spine
Skeletal System and Muscular System Considerations
3/26/2017
Margo Prim Haynes, PT, DPT, MA, PCS, C/NDTPlease do not reproduce without permission 14
“True Ribs”
Ribs 1-7
“False Ribs”
Ribs 8-10
attached to cartilage
Ribs 11, 12
free floating
Diaphragm:
Lowest 4 ribs
Lowest 6 costal cartilages
Role of Trunk Muscles
Rectus
abdominus
External
Obliques
Internal
Obliques
Transverse
abdominusRectus
Abdominus
External Oblique Internal Oblique
Role of Trunk Muscles
Rectus: Brings rib cage and sternum down = flexion in
saggital plane
All Obliques Connect to same band
External and internal obliques: Work in tandem to perform same action
External obliques: Are opposite - side rotators
Internal obliques: Are same-side rotators
Rotation to Left included Right external oblique and
Left internal oblique
Skeletal System and Muscular System Considerations
3/26/2017
Margo Prim Haynes, PT, DPT, MA, PCS, C/NDTPlease do not reproduce without permission 15
Reference
Hansen JT, Lambert DR. Netter’s Clinical Anatomy. 1st ed. 2006. Icon Learning System LLC; 2006.
Netter, F. Interactive Atlas of Clinical Anatomy: The Clear, Easy Way to Put Anatomy into Practice. Icon Learning Systems.