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HIP JOINT: Ilium, ischium, pubic bone
Loose Pack Closed Pack ADL Hip 30 FLEX, 30 ABD, slight ER Full EXT, IR, ABD 120 FLEX, 20 ER, 20 ABD
Angles of the femoral neck to shaft angle in the frontal plane
Anterioposterior angles of the femoral neck to the shaft of the transverse plane Angle is formed by a line through the center of the long axis of the femoral head and neck and a line connecting the posterior end of the medial and lateral femoral condyles
STABILITY Iliofemoral Ligament Pubofemoral Ligament Ischiofemoral Ligament Anterior capsule All twist HyperEXT Superior ADD Inferior ABD, ER
Anterior capsule All twist Hyper EXT All ABD, ER
Posterior Capsule Spiral anteriorly and blend w/iliofemoral ligament, loose in FLEX All HyperEXT, ADD, IR
OSTEO ROM ARTHRO MUSCLES Extra FLEX 0-‐120/140° Posterior
Rotation in sagital plane
1. Iliopsoas 2. rectus femoris 3. pectineus (0-‐40°), 4. TFL
*Hip extended 5. Add longus 6. Add brevis 7. Add magnus
* Sitting – iliopsoas, rectus femoris
Sartorius (ER) cb TFL (IR) Iliopsoas is the main flexor >90°, stabilize lumbar spine, involved w/ sitting form supine w/ SLR, leaning back on chair Tight anterior pelvic tilt Weak posterior pelvic tilt Rectus Femoris – slackness poor hip flexor >90°, ↓ slackness by full flex knee
HypEXT 0-‐15/30° Anterior rotation in sagital plane
1. Glut Max 2. Biceps femoris 3. Semimembranosus 4. Semitendinosus
Glut Max conc control post pelv rot, and ecc control ant pelv rot. Hamstring tightness post pelv tilt during hip ext for lifting and bending, assist in SLR from prone
ABD 0-‐30/ 45° Medial rotation in frontal plane
1. Glut Med 2. Glut Min 3. TFL 4. Piriformis 5. Sartorius 6. Abductor
Weakness Trendelenburg sing standing on one leg, non-‐support side drops, lateral bending of trunk to non-‐support side, compensatory lateral bending of trunk to support weak glut med Cane should be used on strong side long force arm
ADD 0-‐25/ 30° Lateral rotation in frontal plane
1. Add Mag 2. Add Long 3. Add Brev 4. Gracillis 5. * Pectineus, Obt ext,
Quad fem, Glut max
Gracilis assist in EXT, when hip is FLEX, and assist in FLEX, when hips is extended
IR 0-‐30/ 45° Medial rotation in transverse plane
1. Glut Med 2. Glut Min 3. TFL 4. Piriformis (hip flex)
Piriformis When hip is in EXT, greater trochanter is anterior change position of line of action enables ER
ER 0-‐45/ 60° Lateral rotation in transverse plane
1. Glut Max 2. Glut Med 3. Sartorius 4. Obt Int 5. Obt Ext 6. Quad Fem 7. Gemellus Sup 8. Gemellus Inf 9. Piriformis (hip ext)
Piriformis When hip is in FLEX, greater trochanter is posterior change position of line of action enables IR
Femoral Angle Normal 125° Coxa Vara >125° Coxa Valga <125°
Torsion Angle Normal 12-‐15° Head Compensation If head secure Anteversion >20° IR ER lower
limb Move weight bearing surface of femoral head posteriorly
Retroversion <12° ER IR lower limb
Move weight bearing surface of femoral head anteriorly
PELVIS ON FIXED FEMORAL HEAD LUMBAR SPINE WITH PELVIS MOVEMENT Anterior Pelvic Tilt
ASIS ↓ & ant Sacrum ↑ Hip FLEX
M: head and trunk forward C: lumbar spine EXT
Posterior Pelvic Tilt
ASIS ↑ and post Sacrum ↓ Hip EXT
M: head and trunk backward C: lumbar spine FLEX
Lateral Pelvic Tilt w/ support side dropped
Support ≤ Non-‐Support Tilt Support Hip ABD
M: trunk lateral non-‐support/dropped C: Lat FLEX support
Lateral Pelvis Tilt w/ non-‐support side dropped
Support ≥ Non-‐Support Tilt Non-‐support Hip ADD
M: trunk lateral support/dropped C: Lat FLEX non-‐support
Forward Pelvic Rotation
Non-‐Support forward Hip IR, ADD Support/Pivot Hip
M: rotate lumbar and trunk support C: rotate non-‐support
Backward Pelvic Rotation
Non-‐Support backward Hip IR, ABD Support/Pivot Hip ER
M: rotate lumbar and trunk non-‐support C: rotate support
Contralateral Cane ↑ Moment Arm, ↓ torque, ↓ Joint Reaction Force Weight on contralateral ↑ Joint Reaction Force
WEIGHT BEARING STRUCTURES
Tensile strain lateral shaft and superior aspect Compression strain medial shaft and inferior aspect If stronger in compression than tension deform vulnerable to fracture Muscle contraction ↓ strain
o Vastus Lateralis compression force on lateral side ↓ tensile strain o Glut Med compression strain on superior neck main pelvic level during up and down stairs
Zone of weakness mergence of distal neck and greater trochanter FORCES DURING WALKING
Forces @ hip
↑ After heel strike ↓ At Midstance ↑ Peak @Heel Off ↓ @ Toe Off Least @ swing
Other force: 4x’s body weight, using elbow to elevate pelvis to use bed pan Using traps to use bedpan, ↓ 4x’s compared to when using elbow
8/24/2012
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The Kinetics of Single Limb Stance
Weak L Hip Abductors,
Compensated with ipsilateral
trunk lean
Weak L Hip Abductors,
Compensated with ipsilateral
cane
Weak L Hip Abductors,
Compensated with contralateral cane
Functionally strong L Hip Abductors,
What if You Add a Cane?
ABDUCTION MOMENT ADDUCTION MOMENT
Notepack: page 20-21 Text page 382-384
15% of HAT
D3
CANE FORCE
(CF)
COUNTERCLOCKWISE TORQUE CLOCKWISE TORQUE
HAF X D BWF X DCF X D
Example: Abductor MA = 4.39 cmHAT MA = 8.64 cmCane MA = 35 cm
Body Weight = 171 lbs (760.6 N)HAT = 0.6666 x 760.6 N = 507 NWeight of LEFT Limb, (LL) = 760.6 N x 0.1666 = 126.8 NHAT+LL: 507N + 126.8 N = 633.8NCane Force (CF): 15% x 507 N = 76 N
External Torque: (633.8N x 0.0864m) – (76N x 0.35m) = 28 Nm
If Internal Torque= External Torque
then: Y x 0.439m = 28Nm
Y = 635.7N or 142.7 lbs
Calculating the Abductor Muscle Force Required to Stand on 1 Leg with a Level Pelvis + Contralateral
Cane
Notepack: page 20-21 Text page 382-384
0.35M
~50% REDUCTION
8/24/2012
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PELVIC MOTION ACCOMPANYING HIP JOINT MOTION
COMPENSATORY LUMBAR SPINE MOTION
ANTERIOR PELVIC TILT HIP FLEXION LUMBAR EXTENSION
POSTERIOR PELVIC TILT HIP EXTENSION LUMBAR FLEXION
Examples Below: Standing and Weight Bearing Through the LEFT Limb (the right limb is the NON-support limb)
LATERAL PELVIC TILT ( RIGHT PELVIC DROP)
LEFT HIP ADDUCTIONLATERAL FLEX. TOWARDS
SUPPORT SIDE (L)
LATERAL PELVIC TILT ( RIGHT PELVIC HIKE)
LEFT HIP ABDUCTIONLATERAL FLEX TOWARDS NON-SUPPORT SIDE (R)
FORWARD ROTATION OF NON-SUPPORT SIDE
LEFT HIP MEDIAL ROTATION
LUMBAR RIGHT ROTATION
BACKWARD ROTATION OF NON-SUPPORT SIDE
LEFT HIP LATERAL ROTATION
LUMBAR LEFT ROTATION
Pelvis: Hip: Lumbar Spine
Notepack: pages 8-13, Text page 368-373
Structural Adaptations to Weight Bearing
Notepack: pages 14-15, Text page 366
Remember:
The Bone’s trabeculi will form and remodel
and tend to line up along lines of bone
stresses
GRF
Lateral Trabecular System
Medial Trabecular System
Bending Moment Across the Femoral Neck
Notepack: pages 14-15, Text page 366
23
FORCES AT HIP JOINT
• FORCES DURING WALKING
o Forces at the hip increase after heel strike but then decrease at midstance.
o Peak force occurs at heel off but then declines sharply by toe off.
o Forces at the hip are the least during the swing phase.
• OTHER FORCES
o Forces of 4 X BW occur at the hips when a patient lying supine uses their elbows to elevate their pelvis to use a bed pan.
o When a patient uses a trapeze to pull themselves up to use a bed pan, forces at the hip decrease by a factor of 4 compared to forces when the patient uses their elbows to use a bed pan.
KNEE JOINT Loose Pack Closed Pack ADL Knee 10-‐20° Flexion Full Extension 115-‐120° FLEX, good with -‐5/-‐10° EXT
STABILITY FLEX EXT Medial Collateral Lax Taut Lateral Collateral Lax Taut ACL – anteromedial
Taut Lax
ACL – posterolateral
Lax Taut
Antmed max taut @ 90° FLEX Injuries: Antmed FLEX w/ ER or IR, Postlat hyperEXT Limits medial tibial rotation during knee FLEX, becomes tense as it winds around PCL Limits lateral tibial rotation during knee FLEX, tense over lateral femoral condyle
PCL – anteriolateral
Taut Lax
PCL -‐ posteromedial
Lax Taut
Antlat max taut @ 90° FLEX Limits tibial rotation both directions, valgus, varus Tightness of postmed during EXT can lat rot tibia (screw home mech) Injuries: Antlat @ knee FLEX, Postmed @ EXT
OSTEO ROM MUSCLES Extra FLEX 0-‐140° 1. Biceps Femoris
2. Semitendinosus 3. Semimembranosus 4. Gastrocnemius 5. Plantaris 6. Popliteus
Rectus Femoris also flex hip Vastus lateralis forms part of patellar retinaclum w/ IT band Vastus Medialis (distal/oblique) forms medial patellar retinaculum Peak Quadriceps torque @ 50-‐80° FLEX Last 15° of knee EXT, Quads need 60% more force than at 90° or 45° FLEX Removal of patella ↓ force production of Quads by 30%
HypEXT 5-‐10° 1. Vastus Medialis 2. Vastus Latearlis 3. Vastus Medialis
IR 30° (90°flex)
1. Biceps femoris 2. TFL
ER 40° (90°flex)
1. Semitendinosus 2. Semimembranosus 3. Popliteus 4. Gracilis 5. Sartorius
During walking, 9-‐10° , FLEX > 90° ↓ due to soft tissue restriction
ABD/ ADD
11° Most movement @ 30° FLEX, > 30° ↓ due to soft tissue restriction
SCREW HOME MECHANISM -‐ During EXT, tibia translate anteriorly -‐ Last 20-‐30°, anterior tibial translation persist on medial condyle (longer) -‐ Prolonged anterior glide ER tibia relative to femur (open) or IR femur relative to tibia (closed) Screw Home UNLOCKING -‐ ER of femur relative to tibia (closed) or IR of tibia relative to femur (open) -‐ Popliteus unlocks knee (runs posterior medial tibia to lateral femoral epicondyle) by ER femur or IR tibia
HEFLET TEST: used to determine amount of ER of tibia relative to femur during extension Sit w/ hip 90° FLEX, knee FLEX so lower leg hanging free Mark medial and lateral borders of patella and midline of patella and tibial tuberosity EXT knee fully and observe movement of tibial tuberosity relative to midline of patella Normal: tibial tuberosity moves laterally during extension and realigns w/ midline of patella during flexion
FORCES ON TIBIOFEMORAL JOINT Genu Valgum Genu Varum Medial ligaments STRAINED, Lateral ligaments LAX Lateral femoral and tibial condyles compressed erosion of lateral meniscus & articular cartilage Medial knee pain: medial ligament, lateral articular structures
Medial ligaments LAX, Lateral ligaments STRAINED Medial femoral and tibial condyles compressed erosion of medial meniscus and articular cartilage Medial knee pain: medial articular, lateral ligament and capsule
KNEE FLEXION ARTHRO (closed) KNEE EXTENSION ARTHRO (closed) 0-‐25° Anterior Rotation 140-‐115° Posterior Rotation 25-‐140° Ant Rotation
Ant Glide due to ACL 115-‐0° Post Rotation
Post Glide due to PCL Menisci move Posteriorly Loss of menisci limit
Menisci move Anteriorly Ant movement of Post horn block femoral glide preventing hyperextension Loss of menisci limit
FEMUR ON TIBIA (Open)
FLEX Tibia rotate, glide Posteriorly PCL blocks posterior glide Tibia rotate medial relative to femur, Femur rotate lateral relative to tibia
EXT Tibia rotates, glides Anteriorly ACL blocks anterior glide Tibia rotate back laterally, screw home mechanism
FORCES DURING WALKING
Forces @ Knee ↑ @ Heel Strike (hamstring decelerate, ecc control ext, stab) ↑ @ Foot Flat (body weight, ecc control of quad, resist buckling) ↑ Peak @ Heel Off (body weight and contraction of gastroc PF of ankle to
raise heel) ↓ @ initial swing ↑ @ terminal swing (hamstrings ecc decelerate the extending knee)
Role of Menisci
↑ contact surface area ↑ force distribution ↑ stability ↓ unit force pressure on condyles NOT shock absorbers
PATELLOFEMORAL JOINT Q-‐ANGLE
The line representing resultant pull of quadriceps muscles, ASIS mid patella, Mid Patella tibial tuberosity MALES: 12°, FEMALES: 15° >20° is abnormal: Increase lateral pull on patella, Femoral anteversion, External tibial torsion, Lateral displacement of tibial
tuberosity
90-‐135 ° 70-‐90° 20-‐90° 0-‐20° Patella moves laterally and tilts medially into intercondylar groove, full flexion femoral condyle fully covered, medial condyle almost fully exposed
Quad tendon contacts region of intercondylar groove and becomes weight bearing structure ↓ compressive JRF
Patella moves into intercondylar grove
Tibia IR ↓ lateral pull Patella move into intercondylar groove and follows groove until 90°
90-‐130° Post femoral contact Compressive force max @ 90° , large area 130-‐135° Lat facet of patella full contact w/ Post femur, ↑ Force, ↑ SA Odd facet to Med femur, ↑ Force, ↓ SA
45-90° Med & lat facets of patella contact med & lat facets of femur Max surface contact area, but still only 30% Compressive force significant increase, but still low
0° No contact 20° Little inferior pole contact Compressive Force Low, near 0
FORCES ON PATELLOFEMORAL JOINT: flex quad tension ↑ patellar ligament tension ↑ compressive joint reaction force ↑
As quad force ↑, compressive force ↑ o Walking = 0.5 x BW o Stair = 3 – 4 x BW o Squat = 7 – 8 x BW
Normal Force o Tight Rectus patella cranial ↑ inferior patella compression ↑ anterior femoral compression, ↑ PatFem
compression Upward Downward Laterally Medially Rectus Femoris & Vastus Int Patella ligament Vastus Lat, IT band Vast Med
Shifts in location o Factors Affecting Tibial Rotation and Q Angle
IT band tightness Biceps femoris tightness Semimembranosus, semitendinosis weakness
o ↑ Q-‐angle ↑ lateral compression forces ↑ lateral patella facet and lateral femoral condyle wear o Angle
Femoral anteversion Excessive pronation of foot which internally rotates tibia and femur
Changes in length o Patella alta: Ligament 20% longer than patella, females, result from subluxation and dislocation o Patella baja: ligament 20% shorter, occur with ACLR when central patella ligament graft
41
o In genu varum * The strains are opposite those of genu valgum - the
medial ligaments and capsule would be lax and with time shorten and weaken and the medial articular surface compressed with increased erosion.
* The lateral ligaments and capsule would be strained in tension and vulnerable to tearing and elongation.
* Medial knee pain would likely involve articular structures and lateral knee pain involve the lateral ligaments and capsule.
• WALKING
o At heel strike, compression forces at the knee are high because of body weight and contraction of the hamstrings acting to decelerate and control knee extension and stabilize the knee for heel contact with the ground.
o At foot flat, compression forces are high because of body weight and eccentric contraction of the quadricep
controlling the degree of knee flexion to resist buckling of the knee.
8/24/2012
25
Left KneeLeft Knee
“SKYLINE VIEW”
Lateral
VIEW BETWEEN 20-900 OF FLEXION
VIEW BETWEEN 90-1300 OF FLEXION
Path of the sliding patella during active tibia-on-femoral extension: PATELLA MOVES PROXIMALLY
DURING EXTENSION
Arthrokinematics of the PFJ
Regions of Patellar Contact
90 – 600
maximum amount of surface contact
between femur and patella (but
only 30%)
Continued migration of patella contact
points distally towards the inferior
pole
At 1350 --- contact near the superior pole of the patella and the odd facet
Notepack page:s 43-49Text pages 422-429
200
Flexion
900
Flexion1350
Flexion
Full Extension
At full extension the patella rides ABOVE the
groove,
TALOCRURAL/ANKLE JOINT JOINTS
-‐ Distal Tibiofibular Joint: fibrous, superior to ankle joint
o Anterior tibiofibular ligament o Posterior tibiofibular ligament o Interosseus tibiofibular ligament
-‐ Fibulotalar joint: synovial o Anterior talofibular ligament o Posterior talofibular ligament o Calcaneofibular ligament
-‐ Tibiotalar joint o Medial Collateral Ligament
Anterior tibiotalar ligament Posterior tibiotalar ligament Tibionavicular ligament Tibiocalcaneal
-‐ Mortise: inverted “U” shaped curve
ANKLE MOVEMENTS: Up&Out, Down&In
-‐ 3 cardinal planes o Runs anterior posterior from lateral side of trochlea of talus in sagital plane and transverse planes o 10° from medial malleolus superiorly to lateral malleolus inferiorly
-‐ Angulation results in lateral malleolus of the fibula moving a greater distance in an anterior and posterior direction than the medial malleolus of tibia during sagital plane movement
-‐ Angulation also results in o sagittal plane dorsiflexion and plantar flexion being coupled o IR and ER in transverse plane o inversion and eversion in frontal plane
-‐ Results in TRIPLANAR movement -‐ PF: 50°, DF: 20°, IR/ER: 11°
Osteokinematic Arthrokinematic Open Chain (talus tib/fib) Convex Concave
Arthrokinematic Closed Chain (tib/fib talus) Concave Convex
Muscles (Controls eccentrically)
Pronation Dorsiflexion ER/ABD Eversion
Post Rot, Post glide, Ant Roll of talus ER of talus Medial glide of talus
Ant Rot, Glide, Roll of tib/fib IR of tib/fib Minimal lateral glide of tib/fib
Tibialis anterior * EDL, EHL
Supination Plantarflexion IR/ADD Inversion
Ant Rot, Ant glide, Post Roll of talus IR of talus Lateral glide of talus
Post Rot, Glide, Roll of tib/fib ER of tib/ fib Minimal medial glide of tib/fib
Gastrocnemius Soleus Tibialis Posterior * FDL, FHL, PL&B
STABILITY Movement Open Chain Closed Chain DF PF
Dependent on mortise’s ability to widen Tibiofibular joint integrity: fracture of fibula, tear of interosseous membrane, fibrosis, inflammation
Inversion 87% from LCL: calcaneofibular (1st), anterior talofibular (2nd), posterior talofibular (3rd)
Eversion 83% from deltoid ligament
Mainly by compression of articular surfaces
IR Anterior talofibular (LCL), posterior talofibular (MCL) Post talofib (LCL), calcaneofib (LCL), ant tibiotalar (MCL), tibionavicular (MCL)
ER Posterior talofibular (LCL), anterior tibiotalor (MCL) Ant talofib (LCL), Post tibiotalar (MCL), Tibiocalcaneal (MCL) Talar Tilt Medial movement of talus and calcaneous away from fibula
PF: talar tilt limited by anterior talofibular lig Neutral: talar tilt limited by ant/post talofibular lig DF: talar tilt limited by calcaneofibular & posterior talofibular lig
FORCES DURING WALKING
Forces @ Ankle ↑ gradually @ heel strike heel off Max Compression (4-‐5x’s) @ Heel off due to gastroc and soleus ↓ rapidly @ heel off toe off ↓ @ swing phase
With normal standing, compression force on talus is “V” shaped With slight shift of tibia, distribution force is 2 small areas high forces damage
64
• COMPRESSION FORCE DISTRIBUTION ON TALUS WITH WEIGHT BEARING
o With normal standing, compression forces on the trochlea of the talus are distributed in a “V” shaped pattern to decrease the unit forces on the articular cartilage. o With just a slight shift of the tibia, the distribution of compression forces changes and forces are now concentrated in two small areas. o This re-distribution of forces results in high unit forces in these two areas and increases the likelihood of articular cartilage damage.
FOOT: rearfoot/hindfoot (calcaneous, talus, subtalar), midfoot (navicular, cuboid, cuneiform, midtarsal), forefoot (metatarsal, phalange, metatarsophalangeal, interphalangeal joints) JOINTS Joint Type Articulations Movements Ligaments Subtalar Joint
Plane synovial joint
Post/Sup Calcaneous Ant/Mid/Post talus
inversion and Eversion
Medial/Lateral/Posterior talocalcaneal Calcaneofibular Tibiocalcaneal Interosseous calcaneal
Midtarsal Joint: Calcaneocuboid
Plane synovial
Post Cuboid Ant Calcaneous
Inversion and Eversion
Dorsal Calcaneocuboid Calcaneocuboid (bifurcate) Plantar calcaneocuboid (short plantar) Long plantar
Midtarsal Joint: Talonavicular
Ball and socket synovial
Convex Talar head Concave Post Navicular
DF, PF, ER, IR Dorsal talonavicular Tibionavicular Plantar calcaneonavicular (spring)
Tarsometatarsal Plane synovial
Cuneiform and Cuboids 1st-‐5th metatarsals
Flexion and Extension
Dorsal tarsometatarsal Plantar tarsometatarsal Interosseous tarsometatarsal Plantar and dorsal metatarsal ligaments
Metatarsophalangeal Condyloid synovial
Metatarsal head proximal phalanx
Flex, Ext, slight Abd, slight Add, slight circumduction
Medial collateral Lateral collateral Plantar ligament Deep transverse metatarsal ligaments
Interphalangeal Hinge synovial
Proximal phalanx distal phalanx
Flexion and Extension
Medial Collateral Lateral Collateral Plantar ligament
Rays of Forefoot Functional units of foot: 1-‐3: cuneiform metatarsal, 4-‐5: metatarsal 4&5 SUBTALAR JOINT
Eversion Inversion
MIDTARSAL JOINT: triplanar controlled by subtalar -‐ Two axis of motion -‐ Produce 1/3 – ½ as much supination/pronation as subtalar joint
o Longitudinal Axis: inversion, eversion with slight PF, DF, or IR/ER During gait, midtarsal inversion = medial arch of foot rises and eversion = medial arch of foot falls
o Obilque or transverse axis: DF, PF, ER, IR with slight Inversion/Eversion -‐ Hindfoot (subtalar) pronation long and obliq axis becoming parallel mobile/free.
o Heel strike or initial loading allows foot to contour to substrate -‐ Hindfoot (subtalar) supination long and obliq axis becoming corssed restricted
o Heel off and toe off Ray 1 Ray 2 Ray 3 Ray 4 Ray 5 Sup/Pron Twist Gait ↑ hindfoot Pronate: DF (main), Inv, slight adduction Supinate: PF, Ever, slight abduction
Mainly DF, slight inversion Mainly PF, slight eversion
DF PF
Mainly DF, slight eversion Mainly PF, slight inversion
Pronate: DF, Evert, slight abduction Supinate: PF, Inv, slight adduction
SupTwist: Ray1&2 DF, Ray 4&5 PF, forefoot inverts PronTwist: Ray1&2 PF, Ray4&5 DF, forefoot everts
Heel-‐strike toe-‐off ST & MT pron, forefoot sup Heel-‐off toe off ST & MT sup, forefoot pron
Pron: MT is mobile so C by sup, forefoot sup Sup: MT is restricted so can’t pron, forefoot pron
Closed Packed Loose Packed Neutral 5° Pronation Full supination
° Limiting Structures Evert 10 Calcaneofibular
Lateral talocalcaneal Interosseous talocalcaneal Tendon of PL&B Sustentaculum tali Medial talar tubercle
Invert 20 Tibiocalcaneal Medial talocalcaneal Interosseous talocacaneal Tendon of PT, FDL, FHL Lateral process of talus
Osteokinematic Open Chain Closed Chain Muscles Pronation Eversion
(main) Abduction/ER DF
Calcaneal Eversion Calcaneal ABD/ER Calcaneal DF
Calcaneal Eversion Talar ADD/IR Talar PF Tib/Fib IR
PL PB EDL (W)
Supination Inversion (main) Adduction/IR PF
Calcaneal Inversion Calcaneal ADD/IR Calcaneal PF
Calcaneal Inversion Talar ABD/ER Talar DF Tib/Fib ER
PT (ecc pron) Gastr Soleus ATib (W, ecc pron) EHL (W)
Neutral Position at which calcaneous inverts 2x’s # of degrees it everts
FORCES ON FOOT Standing Compression Force
-‐ 60.5% across heel -‐ 7.8% by midfoot -‐ 28.2% by forefoot -‐ 3.6% by toes
Forces at Foot Vertical forces highest at flat foot ↓ w/ slight midstance ↑ @ heel off ↓ rapidly after heel off low @ toe off and swing phase
Greastest load during gait from heel to forefoot transmitted across highest part of longitudinal arch (medial foot) force travels from heel talonavicular naviculocuneiform 1st metatarsal head
Least Loads transmitted along lateral foot forces travels through cuboid 5th metatarsal head
PLANTAR FASCIA
this fascia extends along longitudinal arch of foot form calcaneous to metatarsal heads acts like a tie-‐rod between two trusses When foot loaded, distal and prox ends to plantar fascia move apart which tense up fascia Function:
o shock absorber o distribution of forces o stabilize midfoot esp. during running, climbing types of activities
Plantar fasciits o Inflammation of plantar fascia o May be associated with bone spurs o Overuse o Arch supports may help
GAIT WALKING GENERAL TERMINOLOGY
o Stance time o Stride length: heel strike heel strike of same leg o Stride duration o Step length: heel strike of one leg heel strike of opposite leg o Step duration o Cadence: steps/min, male: 110steps/min, female: 116steps/min o Walking velocity o Width of support base: horizontal distance btwn middle heel of one foot middle heel of opposite foot
80
+ forefoot also compensates by supinating
* Excessive hindfoot supination + midtarsal movement is restricted and unable to
compensate by pronating. + forefoot compensates by pronating excessively
FORCES ON THE FOOT
STANDING
o Compression force distribution * 60.5% across heel * 7.8% by midfoot * 28.2% by forefoot * 3.6% by toes
• WALKING
o Vertical forces are highest at flat foot but then decrease
slight at midstance only to increase again at heel off
o Vertical forces decrease rapidly after heel off and are low at toe off and during the swing phase
84
BIOMECHANICS OF LOCOMOTION
WALKING
GENERAL TERMINOLOGY o Stance time: time of stance phase o Stride length: distance from heel strike of one leg to the
next heel strike of the same leg (heel strike to heel strike distance of the same leg
o Stride duration: time of one stride o Step length: distance from heel strike of one leg to the
successive heel strike of the opposite leg o Step duration: time of one step o Cadence: number of steps per minute
* males: 110 steps per minute * females: 116 steps per minute
o Walking velocity: distance walked per unit time o Width of support base: horizontal distance between
the middle heel of one foot and the middle heel of the opposite foot
PHASES OF GAIT Stance phase
TRADITIONAL TERMS
RANCHO LOS AMIGOS TERMS
HEEL STRIKE INITIAL CONTACT
FOOT FLAT LOADING RESPONSE
MIDSTANCE MIDSTANCE
HEEL OFF TERMINAL STANCE
TOE OFF PRESWING
85
Swing phase
TRADITIONAL TERMS
RANCHO LOS AMIGOS TERMS
ACCELERATION INITIAL SWING
MIDSWING MIDSWING
DECELERATION TERMINAL SWING
Right foot at heel strike (initial contact) and Left foot at toe off, (preswing)
91
• GROUND REACTION FORCES DURING GAIT
STANCE PHASE
SWING PHASE
91
• GROUND REACTION FORCES DURING GAIT
STANCE PHASE
SWING PHASE
GROUND REACTION FORCE – force transmitted up the lower extremity Lies posterior or anterior to hip, knee and ankle applying
flexion or extension moment to that joint The force of ground is trying to move the joint in a
particular direction o If GRF Ant to Hip Flex o If GFR Post to Hip Ext o If GRF Ant to Knee Ext o If GRF Post to Ankle PF
As LE changes position during gait, GRF does too During gait, forces on joint can be from GRF or concentric
muscle contraction By comparing GRF with joint movement, one can
determine if the muscles are producing movement or produced by GRF and controlled by eccentric activity of muscle
* If movement of joint is same as moment applied by GRF at joint, then concentric action is not needed but eccentric by antagonist is * If movement of joint is opposite the moment applied by GRF, concentric action is needed to overcome GRF and move joint
95
THE KNEE
PHASE OF GAIT
ROM MOVEMENT MOMENT MUSCLE CONTRACTION
Heel Strike to Foot Flat
0-5 deg to 15 deg flexion
extension
flexion quads eccentric (prevent knee bucke li ng)
Foot Flat to Midstance
15 deg to 5 deg
extension
extension
flexion
extension
quads
quads
concentric
no activity
Midstance to Heel Off
5 deg to 0 deg
extension extension no activity none
Heel Off to Toe Off
0 deg to 30 deg
flexion
flexion
extension
flexion
quads popliteus
quads
no activity concentric
eccentric
Acceleration to Midswing
30 deg to 60 deg
60 deg to 30 deg
flexion
extension
none
none
hamstrings sartorius graclis
quads
concentric
concentric
Midswing to Deceleration to Heel Strike
30 deg to 5 deg
extension none quads
hamstrings
concentric
eccentric
93
THE HIP (sagittal movements)
PHASE OF GAIT
ROM MOVEMENT MOMENT MUSCLE CONTRACTION CONTRACTION
Heel Strike to Foot Flat
30 deg. to 25 deg.
extension flexion add. mag. glut. max.
concentric concentric
Foot Flat to Midstance
25 deg. to 0 deg.
extension
extension
flexion
extension
glut. max.
glut. max.
concentric
no activity
Midstance to Heel Off
0 deg. to 10-20 deg.
backward extension
extension hip flexors eccentric
Heel Off to Toe Off
10 – 20 deg. to 0 deg
flexion extension iliopsoas add. long. add. mag.
concentric concentric concentric
Acceleration to Midswing
0-20 deg. to 30 deg.
flexion none iliopsoas gracilis sartorius
concentric concentric concentric
Midswing to Deceleration to Heel Strike
30 deg. flexion none glut. max hamstrings
eccentric eccentric
94
OTHER PELVIS, HIP, AND FEMUR MOVEMENTS
PHASE OF GAIT
PELVIS HIP JOINT FEMUR
Heel Strike to Foot Flat
forward internal rotation
adduction
external rotation
neutral to adduction
Foot Flat to Midstance
forward to neutral
internal rotation
adduction
external rotation
adduction
Midstance to Heel Off
neutral to backward
internal to external rotation
adduction
external to internal rotation
adduction
Heel Off to Toe Off
backward external rotation
abduction
internal rotation
abduction
Acceleration to Midswing
backward to neutral
external rotation
abduction
internal rotation
abduction
Midswing to Deceleration to Heel Strike
forward external to internal rotation
abduction to adduction
internal to external rotation
abduction to neutral
96
THE ANKLE
PHASE OF GAIT
ROM MOVEMENT MOMENT MUSCLE CONTRACTION
Heel Strike to Foot Flat
0 deg to 15 deg
plantar flexion plantar flexion ant. tib. ext. dig. long. ext. hal. long.
eccentric
Foot Flat to Midstance
15 deg to 5-10 deg
plantar flexion to dorsiflexion
plantar flexion to dorsiflexion
sole us gastroc. plantar flexors
eccentric
Midstance to Heel Off
5 deg to 0 deg
dorsiflexion to plantar flexion
dorsiflexion sole us gastroc. post. tib. plantar flexors
eccentric to concentric
Heel Off to Toe Off
0 deg to 20 deg
toes
plantar flexion
extension
dorsiflexion
extension
sole us gastroc. post. tib. pero ne us long. and b rev.
FDL, AbH, interossei lumbricles FDB, FHL
concentric to no activity
eccentric
Acceleration to Midswing
20 deg to neutral dorsiflexion none
ant. tib. ext. dig. long. ext. hal. long.
concentric
Midswing to Deceleration to Heel Strike
remains in neutral none none
ant. tib. ext. dig. long. ext. hal. long.
concentric
97
ANKLE AND FOOT MOVEMENTS
PHASE OF GAIT
ANKLE SUBTALAR MIDTARSAL FOREFOOT
Heel Strike to Foot Flat
supination (PF)
pronation (EVERT)
pronation (EVERT)
supination (INVERT)
Foot Flat to Midstance
supination (PF) to pronation (DF)
pronation (EVERT) to neutral
pronation (EVERT) to neutral
supination (INVERT) to neutral
Midstance to Heel Off
pronation (DF) to supination (PF)
neutral to supination (INVERT)
neutral to supination (INVERT)
neutral to pronation (EVERT)
Heel Off to Toe Off
supination (PF)
supination (INVERT)
supination (INVERT)
pronation (EVERT)
Acceleration to Midswing
supination (PF) to neutral
supination (INVERT) to neutral
supination (INVERT) to neutral
pronation (EVERT) to neutral
Midswing to Deceleration
neutral neutral neutral neutral
99
THE HIP
PHASE ROM MOVEMENT MUSCLE CONTRACTION
Weight acceptance to pull-up
60 deg flexion to 30 deg flexion
extension gluteus max. gluteus med.
concentric
Pull-up to forward continuance
30 deg flexion to 5 deg flexion
extension gluteus max. gluteus med.
concentric
Foot clearance to foot placement
5 deg flexion to 60 deg flexion
flexion iliopsoas concentric
THE KNEE
PHASE ROM MOVEMENT MUSCLE CONTRACTION
Weight acceptance to pull-up
80 deg flexion to 35 deg flexion
extension rectus fem. vastus lat. (quads)
concentric
Pull-up to forward continuance
35 deg flexion to 10 deg flexion
extension rectus fem. vastus lat. (quads)
concentric
Foot clearance to foot placement
10 deg flexion to 90 –100 deg
90-100 deg flexion to 85 deg flexion
flexion
extension
hamstrings
rectus fem. vastus lat. (quads)
concentric
concentric
ASCENDING STAIRS
Stance Phase Weight Acceptance Weight Acceptance Pull Up Pull up forward continuance
Swing Phase Foot Clearance Foot Placement
DESCENDING STAIRS
98
ASCENDING STAIRS
• PHASES IN STAIR CLIMBING
o Stance phase * weight acceptance * weight acceptance to pull up * pull up to forward continuance
o Swing phase * foot clearance * foot placement
99
THE HIP
PHASE ROM MOVEMENT MUSCLE CONTRACTION
Weight acceptance to pull-up
60 deg flexion to 30 deg flexion
extension gluteus max. gluteus med.
concentric
Pull-up to forward continuance
30 deg flexion to 5 deg flexion
extension gluteus max. gluteus med.
concentric
Foot clearance to foot placement
5 deg flexion to 60 deg flexion
flexion iliopsoas concentric
THE KNEE
PHASE ROM MOVEMENT MUSCLE CONTRACTION
Weight acceptance to pull-up
80 deg flexion to 35 deg flexion
extension rectus fem. vastus lat. (quads)
concentric
Pull-up to forward continuance
35 deg flexion to 10 deg flexion
extension rectus fem. vastus lat. (quads)
concentric
Foot clearance to foot placement
10 deg flexion to 90 –100 deg
90-100 deg flexion to 85 deg flexion
flexion
extension
hamstrings
rectus fem. vastus lat. (quads)
concentric
concentric
100
THE ANKLE
PHASE ROM MOVEMENT MUSCLE CONTRACTION
Weight acceptance to pull-up
20-25 deg dorsiflexion to 15 deg dorsiflexion
plantar flexion
gastrocnemius soleus acting on tibia
concentric
Pull-up to forward continuance
15 deg dorsiflexion to 10-15 deg plantar flexion
plantar flexion
gastrocnemius soleus acting on tibia and then foot
concentric
Foot clearance to foot placement
10 deg plantar flexion to 20 deg dorsiflexion
dorsiflexion anterior tibialis concentric
DESCENDING STAIRS
100
THE ANKLE
PHASE ROM MOVEMENT MUSCLE CONTRACTION
Weight acceptance to pull-up
20-25 deg dorsiflexion to 15 deg dorsiflexion
plantar flexion
gastrocnemius soleus acting on tibia
concentric
Pull-up to forward continuance
15 deg dorsiflexion to 10-15 deg plantar flexion
plantar flexion
gastrocnemius soleus acting on tibia and then foot
concentric
Foot clearance to foot placement
10 deg plantar flexion to 20 deg dorsiflexion
dorsiflexion anterior tibialis concentric
DESCENDING STAIRS
101
SUPPORT LIMB
JOINT MOVEMENT MUSCLE ACTION
Hip flexion gluteus max. eccentric to control hip flexion
Knee flexion quads eccentric to control knee flexion
Ankle dorsiflexion gastrocnemius soleus plantar flexors
eccentric to control ankle dorsiflexion
Toes extension FDL, FDB, FHL, FHB, AbH, interossei lumbricales
eccentric to control toe extension
NON-SUPPORT LIMB
JOINT MOVEMENT MUSCLE ACTION
Hip extenion gluteus max. concentric to extend flexed hip
Knee extenion quads concentric to extend knee to reach step below
Ankle plantar flexion to dorsiflexion
gastrocnemius soleus plantar flexors
concentric plantar flexion to reach step below then eccentric to control dorsiflexion for full foot loading
Toes Neutral to slight flexion
FDL, FDB, FHL, FHB, AbH, interossei lumbricales
no activity to concentric for toe to step contact
RUNNING
Stance Phase Foot strike Foot strike to midsupport Midsupport to toe off
Swing Phase Forward Swing Deceleration
Running Speed As Speed ↑, stance phase ↓, swing phase ↑ At high speeds, non-‐support is called FLOAT PHASE, where both feet is off the ground
Forces Vertical Forces
o Greater with running than walking o During walking, vertical forces reach 110-‐120% body weight o During running, 200%
Fore and Aft Shear o ↑ 50-‐100% during running as compared to walking
Medial and lateral shear o ↑ 150-‐200% during running as compared to walking
Movements @ Heel strike Walking & Foot Strike Running Calcaneous everts (passive subtalar pronation), midtarsal joint pronates,
midfoot mobile @ Midstance Walking & Midsupport Running Calcaneous inverts and passing through subtalar neutral (midtarsal joint
supinates, midfoot becoming rigid) During running from Foot Strike to Mid support Rapid DF During running from Foot Strike to Midsupport Rapid PF During stance phase of running hip adducts As running speed ↑ magnitude of hip adduction ↑
General Muscle Muscle actions associated w/walking are similar for running, but more overlap of muscle activity, especially btwn hamstring
and quads, as phases of movement are shorter in running In running, muscles are active >70-‐80% of the stance phase (stance phase ↓ w/ running, so muscles are active more) In walking, muscle groups are active <50% of stance phase (stance phase ↑ w/walking, so muscles are active less)
Repetitive Stress on Foot Walking
o 150lb male w/ step length of 2.5ft and walking at 2110 steps/mi shows average vertical force of 80% BW @ heel strike o For a 1 mile walk, the repetitive forces total 253,440lbs (127tons) = 63.5 tons/foot
Running o A 150lb male w/ step length of 3.5ft and rate of 1175 steps/mi shows average vertical forces of 250% BW @ foot strike o For a 1 mile run, the repetitive forces total 440,625lbs (220tons) =110 tons/foot
102
RUNNING
Stance phase o foot strike o foot strike to midsupport o midsupport to toe off
Swing phase o forward swing o deceleration
RUNNING SPEED
o As speed increases, the period of the stance phase decreases and the period of the swing phase increases.
o At high speeds, there is a period of non-support called the FLOAT PHASE in which both feet are off the ground.
FORCES
o Vertical forces * Greater during running than walking. * during walking, vertical forces are 110 - 120% body
weight. * During running the vertical forces reach 200% of body weight.
o Fore and aft shear * Increase of 50 - 100% during running as compared to
walking.
o Medial and lateral shear * Increase of 150 - 200% during running as compared
to walking.