Kinesiology_Fall_2013.docx

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Exercise Science and Sport Studies
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01:377:303
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Sara Campbell

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Kinesiology 01:377:303 Emil Manfredonia 908-331-1654 [email protected] EXAM 1 - September 19 CHAPTER 1: Intro to Kines Kinesiology: the study of human movement from the point of view of the physical sciences • professions involved: PT, OT, Orthopedics, and ATC • foundations in biomechanics, musculoskeletal anatomy, and neuromuscular physiology Outline for a Kinesiology Analysis 1. Description of the motor skill performance: in terms of four elements that together help the analyst focus on the nature of the skill 1. primary purpose of the skill: ID purpose of the movement to evaluate its effectiveness 1. in statement should include references to speed, accuracy, form or distance 2. ex purpose of 50 m backstroke is to cover the course in the shortest amount of time 2. movement phases: break the skill into phase with each phase having a beginning and end 1. some skills have beginnings and ends that are more discrete (ex winding up and throwing baseball) 2. the beginnings and endings are less obvious in continuous/cyclic skills (ex walking) 2. classification of the skill: permits organization of skills into groupings which facilitates the ability to recognize similar skills as well as the anatomical and mechanical requirements for a particular group of skills **see chart** 1. some skills combine multiple phases that cross categories (ex tennis serve) 2. Simultaneous-sequential nature of the motion: 1. simultaneous: all body segments move as one such as lifting, pushing, and pulling; movements directed towards a straight line used in push or pull movements that overcome forces or for accuracy b. sequential: use of segments in an orderly sequence so that subsequent segments are accelerated at the appropriate time to create the highest possible speed **require max speed at impact or release; use of body segments in an orderly sequence to max forces; throwing final segment moves along a curved path used in throwing and striking movements c. motions occur anywhere on the continuum or as a combination of the two basic forms; break down simultaneous-sequential motion into phases for analysis: 1. preparatory phase- simultaneous motion of the joints of the lower extremity, into a semi-squat position 2. execution (force) phase- simultaneous extension of the segments in a forward-upward direction 3. flight (unsupported) phase- sequential motion of the lower body to “whip” the legs forward 4. landing phase- simultaneous flexion of the lower extremity to take up the shock of the landing forces 1. Anatomical analysis: review of how the body accomplishes a task (not an examination of the results) *includes an examination of the following: 1. joint and segment actions 2. muscle participation and contraction 3. NM considerations (parkinson's example) 4. anatomical principles for safe and effective performance answers the following questions: • which joints are involved and what are their movements in the motor skill? (table 1.2) • are any of the joints used to the limit of their range of motion? • which muscles are responsible for the joint actions and what is the nature of their contraction? (table 1.2) • which neuromuscular mechanisms are likely to help or hinder the action and what is the nature of their involvement? • which anatomical principles contribute to maximal efficiency and accuracy in the performance of the motor skill? • which principles are directly related to the avoidance of an injury? a set of anatomical principles govern the safe and effective performance of a motor skill by taking into account the structure and fx of the body, tolerance of internal and external stress, and the efficiency of movement patterns III. Mechanical analysis: involves identification of laws and principles that help explain the most appropriate form for the execution of the activity and identify the reasons for success or failure. 1. underlying objective- to explain mechanical factors that contribute most to the performance first ID purpose of the motion; underlying objectives may be: 1. balance: regain stability or attain mobility 2. locomotion: travel from point to point, a prescribed distance, or a prescribed pattern 3. projection: for max height, max range, max accuracy, or optimum speed and accuracy 4. manipulation: of objects, to reproduce a pattern, or of resistance 5. maximum effort: max speed, power or force 2. Nature of the forces causing or impeding motion- must be aware of the kind of motion being performed (classification and simultaneous-sequential nature) and the forces that are acting to cause, modify, or prevent that motion 1. includes external forces such as the environment and internal forces such as weight of the performer, strength, and flexibility 2. Mechanical principles that apply- ID the mechanical principles related to the execution of the skill to establish causes of error in performance of the skill; deals with safety, efficiency, and effectiveness 1. critical elements: elements of the motion that contribute most to safety, efficiency, and effectiveness; dependent on the purpose of the motor skill. 1. example: if the purpose is throwing a ball for a max distance then the initial critical element is the velocity at which the ball is released 2. *critical elements identified help determine the mechanical principles which apply to a given motor skill 2. principles consider speed power and forces 2. Violation of principles- given the purpose of a motor skill ID which of the principles, if violated, have the greatest potential for limiting performance; examines the following: 1. which application(s) of mechanical principles is (are) violated? 2. what are the errors? 3. what are the sources of error? III. Prescription for improvements of performance- indicate how the performance should be changed so that the principles are no longer violated. CHAPTER 2: The Musculoskeletal System Anatomical position: used as a frame of reference, standing with the body erect, feet are shoulder width apart, arms are supinated and extended, shoulders are externally rotated, hips are neutral, spine is in a normal cervical-lumbar lordosis thoracic kyphosis Skeletal System • 206 bones in the body 177 of which are movable • axial skeleton includes the skull, spinal column, sternum, and ribs • appendicular skeleton includes the bones of the upper and lower extremities • pelvis- “link” btwn the axial and appendicular skeleton 1. Types of Bones 1. long bones- long cylindrical shaft with broad knobby ends, thick walls composed of compact bone and a central medullary cavity  includes humerus, femur, clavicle, radius, ulna, tibia, fibula, and metatarsals & phalanges of the lower extremity 2. short bones- relatively small solid bones  includes carpals and tarsals (wrist and ankle bones) 3. flat bones-flat platelike bones  includes sternum, ribs, scapulae, and pelvic bones 4. irregular bones: bones of the spinal column  includes vertebrae, sacrum, and coccyx II. Skeletal Changes 1. osteogenesis: process of bones development beginning with the formation of chondrocytes  chondrocytes-lay down a matrix upon which osteoblasts form bone  osteoclasts- resorb bone  osteoblasts-reform bone 2. types of bone formed  compact (cortical) bone-dense outer layer of bone  cancellous (trabecular) bone-spongy bone which allows a high strength to weight ration 3. epiphysis: part of the bone separated from the main bone by a layer of cartilage (pic*); does not ossify until the late teens to mid twenties  growth plate where cartilage calcifies and is converted into bone  separated from the main bone by a layer of cartilage  its presence indicates that a bone has not completed growth  table 2.1 1. inferior rami of pubis & ischium: ages 7-8 2. scapula, lateral epicondyle, and olecranon: ages 15-17 2. ultrasound contraindications  what is ultrasound? deep form of heat used on soft tissues, muscles, tendons, and ligaments. uses continuous or cyclic pulsing waves 1. continous waves- used to promote blood flow and healing 2. pulsing waves-used to mechanically break up hardened tissue/muscle  places to avoid when using ultrasound 1. over a growth plate in teens and young adults (can disrupt plate and hinder growth) 2. over metal implants-plates, screws, knee or hip replacements 3. over metastatic cancer 4. over a pacemaker or the heart 5. over an open wound III. mechanical axis of a bone/segment: a straight line that connects the midpoint of a joint at one end with the midpoint of a joint at the other end, or in the case of a terminal segment with the midpoint of its distal end IV. articulations *structure dictates fx 1. diarthrosis: a joint in which there is a separation or articular cavity *joints which tend to move characteristics:  presence of articular cavity  joint is encased within a capsule  joint is lined with synovial membrane which secretes synovial fluid (serves as nutrients and for protection/cushioning)  hyaline or fibrocartilage cover joint surfaces  carpals, elbow, AA joint, MCP, thumb, shoulder, hip why do you need protection at the end of each bone that forms a joint? at the end of a bone under the cartilage are periosteum and nerve endings which need to be protected, why bone to bone contact is painful when articular cartilage is gone is bc nerves are being hit ex. micro fracture surgery- when articular cartilage is gone surgeon drills bone to create bleeding, bleeding creates clots which turns into a fibrocartilage material (not as strong as hyaline) classifications: 1. irregular (arthrodial, plane)- joint surfaces are irregularly shaped, non axial joints that only permit gliding 2. hinge joint (ginglymus)- one surface is spool like and the other is concave, uniaxial joint that permits gliding movement in one plane about a single axis, mvmts permitted include flexion and extension 3. pivot joint (trochoid, screw)- characterized by a peg like pivot (ex as in atlas and axis) or at the ends of two long bones which fit with one another, uniaxial joint that permits mvmt in one plane about a single axis, mvmt permitted is rotation 4. condyloid (ovoid, ellipsoidal)-characterized by a convex surface which fits onto a concave surface, biaxial joint which permits mvmt in two planes, mvmts permitted include flexion-extension, abduction-adduction (lateral flexion), and circumduction (when previous mvmts are performed sequentially) 5. saddle joint (sellar, reciprocal reception)-characterized by concave and convex surfaces (similar to condyloid) with ends of the convex surface that are tipped upward, biaxial joint which permits mvmt in two planes, mvmts permitted include flexion- extension, abduction-adduction (lateral flexion), and circumduction, more movable than condyloid 6. ball and socket joint (spheroidal, enarthrodial)-spherical end of one bone fits into the cup like end of another bone, triaxial joint which permits mvmt about three axi, mvmts permitted include flexion-extension, abduction-adduction (lateral flexion), circumduction, horizontal abduction-horizontal adduction, and rotation B. Synarthrosis- a joint in which there is no separation or articular cavity characteristics:  no articular cavity, capsule, synovial membrane, or synovial fluid  includes joints btwn the vertebrae, skull sutures, radius/ulna, and tibia/fibula  includes three types: cartilaginous, fibrous, and ligamentous classifications: 1. cartilaginous-only permit mvmt of the bending a twisting nature, includes articulations btwn the bodies of the vertebrae 2. fibrous- no mvmt is permitted, includes skull sutures 3. ligamentous- two bodies held together by one or more ligaments and permits limited mvmt, includes coracoacromial union, and midunion of the radius/ ulna and tibia/fibula ex. cranial sacral therapy (CST)- six to eight times a minute the head changes shape because of cerebrospinal fluid flow V. Joint stability- resistance to displacement 1. shape of bony structures  may refer to the kind of joint (non, uni, bi, triaxial) but more likely to refer to specific characteristics of that joint.  ex. shoulder versus hip which is more stable? both are ball and socket joints but the hip is more stable because it has a deeper socket 2. ligamentous arrangements: vertebrae  ligaments: strong, flexible, and elastic fibrous tissues that attach to the ends of bones which form a movable joint  fx to help maintain bones in correct position with relationship to one another and to keep movement within normal limits 3. muscular arrangements: shoulder  stabilize joints especially those joints whose bony structures provide little stability  rotator cuff muscles of the shoulder: 1. subscapularis 2. supraspinatus 3. infraspinatus 4. teres minor 2. fascia and skin: ITB  facia- consists of fibrous CT which forms sheaths btwn muscles and muscle cells, vary in thickness/toughness and are similar to ligaments in composition  iliotibial band-runs down the outside of the thigh from the hip to the shin, attaches to the knee to help stabilize and move the joint (common overuse injury in runners results in inflammation of ITB) ex. myofascial release- procedure releasing connectedness between fascia of muscles to allow more movement (especially if muscles haven't been used in a while) E. atmospheric pressure  key role in stabilizing hip and shoulder joint (glenohumeral)  pressure forms a vacuum within joint that holds the head of the bone in its socket VI. Factors limiting ROM  inflammation/pain  shape of the bone  obstruction (ex chipped bone)  lack of flexibility  body comp- muscle mass or adipose  scar tissue (from burn or injury)  swelling VII. Methods of measuring ROM 1. goniometry- the measurement of angles, particularly those of range of motion of a joint 2. film 3. videotaping VIII. Planes of the Body 1. sagittal-divides the body into right and left halves along the bilateral axis permits flexion and extension mvmt B. frontal (coronal)- divides the body into anterior and posterior along the anterior- posterior axis permits abduction and adduction movement C. transverse (horizontal)-divides the body into superior and inferior along the longitudinal axis permits rotation D. special plane: diagonal/PNF- proprioceptive neuromuscular facilitation, most movements occur diagonally (as a combination of multiple planes) IX. Other locations of the Body 1. cranial/superior-towards the head 2. caudal/inferior-towards the tail 3. medial- towards the midline of the body 4. lateral- away from the midline of the body 5. dorsal/posterior- backside of the body 6. ventral/anterior-front side of the body 7. palmar/dorsal of wrist- underside of palm/ top side of hand 8. plantar/dorsal of foot- sole of foot/top side of foot X. Movements of the body 1. flexion-decreasing the angle at a joint 2. extension-increasing the angle at a joint 3. abduction- away from the body 4. adduction-towards the body 5. internal rotation 6. external rotation 7. pronation 8. supination 9. radial deviation- using wrist as a frame of reference movement towards the thumb 10. ulnar deviation- using the wrist as a frame of reference movement towards the ulna/pinkey 11. side bending- cervical and lumbar side bending/ lateral flexion 12. opposition- movement of the thumb CHAPTER 3: Properties of the Musculoskeletal System Properties of Muscular Tissue 1. extensibility- allows a muscle to stretch 2. elasticity- allows a muscle to return to resting length after being stretched 3. contractility- allows a muscle to shorten and produce tension at its ends 1. The Muscle Fiber o the muscle fiber is made up of myofibrils o myofibrils contain the proteins actin and myosin which allow a muscle contraction to occur II. Slow and Fast Twitch Fibers Slow Twitch Fast Twitch • small • large • red • pale • rich blood supply • low blood supply • highly efficient • fast to fatigue • slow fatigue • short periods of activity • suitable for long endurance • sprints • postural and endurance events • weight lifting III. Muscle Attachments- what is the nature of the bony landmark in which a tendon is attached? o bone surfaces are rough and often large for ligament attachment IV. Types of Contraction- contraction occurs whenever muscle fibers generate tension 1. concentric- shortening of a muscle during contraction 2. eccentric- lengthening of a muscle during contraction (usually returning to resting length after shortening) 3. isometric- contraction without a change in the length of the muscle 4. isotonic- contraction where the tension is constant throughout 5. isokinetic- contraction where the speed is constant throughout which builds more muscle concentric or eccentric contraction? eccentric, but a combination of both builds even more which type of contraction is safest post injury? isometric because the length of the muscle or angle of the joint does not change potentially problematic because you do not work the full ROM therefore need to work muscle at multiple angles which is time consuming, also patients have a tendency to hold their breath during an isometric contraction (especially upper extremity muscles) which can lead to an inc in bp what type of functional activity requires both concentric and eccentric contractions? which is more difficult to control? II. Length tension relationship- maximum tension is achieved within a muscle when the muscle is slightly greater than its resting length 1. there is an optimum length at which a muscle can exert maximum tension when stimulated (actin and myosin are in optimum positions) 2. this length is slightly greater than the resting length of the muscle 3. muscle length less than or greater than this length will result in a weaker tension/contraction III. Force-velocity relationship 1. as the speed of a muscular contraction increased, the force it is able to exert decreases 2. fore any given load there is an optimum velocity 3. as the velocity of concentric contraction increases, the force that can be exerted decreases. 4. when the velocity drops to zero, the contraction is isometric 5. in eccentric contraction tension increases with increase speed of lengthening IV. Roles of Muscles 1. prime mover- muscle that is directly responsible for producing a movement 1. examples: bicep (supinator, elbow flexor) brachialis (elbow flexor) 2. synergists- muscles that work together to create a desired movement 1. ex. for shoulder flexion pec major, anterior deltoid, coracobrachialis, and long head of biceps work together 2. stabilizers- help to stabilize a bone statically during the movement of possibly another bone figure 3.9* teres major and rhomboids example If the scapula were not stabilized, the teres major would increase the upward rotation of the scapula as it adducts the humerus. The scapula is stabilized by the scapular adductors and downward rotators. This permits the teres major to concentrate its force on the adduction of the humerus. d. neutralizers- muscle that acts to prevent an undesired action of one of the movers 1. if a muscle both flexes and adducts but only flexion is desired an abductor contracts to prevent adduction of the mover figure 3.10* traps and rhomboids example The traps adduct the scapula and rotate it upward. The rhomboids adduct the scapula and rotate it downward. When the contract together they adduct/retract the scapula without rotation. subacromial/subdeltoid space- space above acromioclavicular joint and humoral head where the rotator cuff, bursa, joint head capsule, bicep, and ligaments are if you don't have stabilization of the shoulder joint or have poor posture compression of this space will result fix by strengthening scapula stabilizers problem with over working rhomboids - imbalance and shoulder problems exercise: patient lies stomach side on table, moves arm up and down with thumbs up to isolate mid traps and thumbs down to isolate rhomboids e. antagonists-opposite of prime movers, break system 1. ex swing phase of gait- hip flexors (concentric) are the primary movers, hamstrings and glutes (eccentric) contract as antagonists to slow hip flexor down and control walking V. Co-contraction- when a prime mover and antagonist work together *often associated with movements that require stabilization and in open chain activities 1. closed chain activity- movement where the extremity is fixed to a flat immobile surface and cannot move 1. upper extremity: push ups and their derivatives (pull-up, chin-up, dip) 1. concentrate on the co-contraction of the biceps triceps, pecs, delts, lats, abdominals, and lower back 2. lower extremity: squat, leg press, stairs, lunges, deadlifts 1. concentrate on the co-contraction of the quads, hamstrings, hip flexors, soleus, and gastrocnemius 2. open chain activity- movement where the extremity is free to move 1. upper extremity: bicep curl, lying triceps extension, bench press 2. lower extremity: leg extension, leg curl, hamstring curl 3. *in a practical setting is more functional and time conserving because larger/multiple muscle groups are working at one time knee bend versus squat example knee bend increases the patellar force which stresses the knee and eliminates working the lower back, glutes, and hamstring VI. Action of Biarticular Muscles 1. biarticular muscles-muscles that pass over and act on two joints hamstrings-(semitendinosus, semimembranosus, and biceps femoris) knee flexion and hip extension rectus femoris-knee extension and hip flexion sartorius- knee and hip flexion gastrocnemius- knee flexion, plantar flexes ankle biceps brachii- triceps- Firgure 3.11* b. concurrent movement- simultaneous extension or flexion of the hip and knee, no loss of tension or length (when one end loses tension the other one gains it) 1. ex. soccer- in simultaneous extension of the hip and knee the rectus femoris loss of tension at the distal or knee end is balanced by a gain in tension in the proximal or hip end b. countercurrent movement- mover shortens at both ends and antagonist lengthens at both ends biarticular muscle shortens rapidly at both joints and its antagonist lengthens correspondingly gaining tension at both ends some tension is lost because of extremes at both end 1. ex. hurdles- when the hip is flexed and the is extended simultaneously there is a rapid loss of tension in the rectus femoris and corresponding gain of tension in the hamstrings VII. Musculoskeletal Anatomy Review *see pictures CHAPTER 4: The Neuromuscular Basis of Human Motion 1. The Motor Unit- functional unit of the neuromuscular system, includes a single motor neuron and all the muscle fibers it integrates which allows a muscle to contract o large ration of muscle fibers per motor neuron is found in motor units that require a lot of power or speed (1: 1,000) ex. kicking a soccer ball or football using quad or gastrocnemius o small ratio of muscle fibers per motor neuron is found in motor units that requires precision/accuracy (1:10 or 1:1) ex. fingers or eye muscles II. Gradations in the strength of muscle contractions o lifting a pen versus lifting a gallon of milk (more strength and gross motor) o two factors determine the gradation of a muscle contraction 1. amount of motor units 2. frequency of firing of motor units o all or nothing response to individual motor units o the more motor units that contract the greater will be the total strength o orderly sequence to the recruitment of motor units 1. smaller slow-twitch are the first with lower thresholds (takes less to activate) 2. larger fast-twitch are next with higher thresholds (take more stimulus to activate) III. Proprioception- knowing where the body is in space o muscles, tendons, joints, ligaments, labyrinth of inner ear o different classifications 1. muscles: spindles, GTO 2. joint and skin: ruffini endings and pacinian corpuscles 3. labyrinth and neck receptors IV. muscle proprioception: spindles o detect changes in length (tonic response) and rate of change of length (phasic response) o located mostly in the muscle belly o more prominent in fine motor responses versus postural (posture) o muscle talling and quick stretch- ways to get a muscle to respond by activating the muscle spindle ex patient with a hard time moving a muscle use these techniques Figure 4.13 baseball-the phasic type of stretch is long and rapid to activate the muscle spindle for a forceful arm throw movement golf put- the tonic type of stretch is short and slow with a pause to activate the muscle spindle for precision movement V. Muscle proprioception: Golgi tendon organ (figure 4.8*) o detects changes in tension and contraction o has the opposite effect as the muscle spindle o when the GTO is stimulated the muscle relaxes o located at the MT joints (musculotendinous) o has a higher threshold for activation then the muscle spindle because if activated too early or the muscle will never be activated ex when someone jumps from a high location the gto is activated and the person collapses to prevent the tearing of muscles and ligaments from bone where is the location of the muscle spindle versus gto? muscle spindle is located in the muscle belly, gto is located in series at the musculotendinous junction VI. Joint and skin proprioceptors o important for the awareness of a body in space so you are not prone to injury and to succeed in a motor skill o ruffini endings and pacinian corpuscles VII. Reflex movement-specific pattern of response that occurs without direction from the cerebellum 1. exteroceptive reflexes- when we hear a loud sound, we jump (reaction to stimulation from the outside environment) 1. extensor thrust reflex- facilitates contraction of the extensor muscles in the legs or arms when weight is shifted to the balls of the foot (figure 4.11*) 2. flexor reflex- quickly withdrawing a body part in response to pain stepping on a nail example 3. crossed extensor reflex- contract to support the additional weight thrust upon it in response to flexor reflex to stabilize body on one foot b. proprioceptive reflexes- interoceptors* respond to stimulation within the skeletal muscle, tendons, joints, and labyrinth of the inner ear 1. stretch reflex-the stretched muscle stimulates the muscle spindle causing the muscle to contract and relaxation of antagonist 1. phasic response (short latency)-contraction is of brief duration resulting in a forceful response (throwing baseball figure 4.13) 2. tonic response (long latency)- slow stretched for s sustained muscle contraction and precision (golf putt figure 4.13) IX. Tendon reflex-purpose is describing how you could shut down the activity of the muscle spindle 1. hold 10-30 seconds overrides the muscle spindle reflex which can permit more flexibility and ROM 2. when a muscle is stretched (lengthened) sensory organs in the tendon send signals to the spinal cord which causes a reflex contraction (shortening) of the muscle. This reflex restricts initial efforts at stretching at stretching, however if the stretch is maintained 10-30 seconds the stretch reflex will subside and permit gains X. CNS: Levels of control 1. cerebral cortex-initiation of voluntary movement, motor area 2. basal ganglia/thalamus-homeostasis, coordination, control 3. cerebellum-sensory integration, assists in producing smooth precise movement 4. brain stem, pons, medulla- has facilitatory and inhibitory centers effecting muscle sensitivity 5. spinal cord-integration center for CNS and PNS ataxia-uncoordinated movement, example of strong man who couldn't transfer himself between two chairs XI. Pyramidal and Extrapyramidal tracts- descending motor tracts of the spinal cord 1. pyramidal or corticospinal tracts- fibers cross, controls muscles required for precision, develops later on, one synapse very fast (needs to be able to adjust quickly), cortex, spinal cord 2. extrapyramidal- function of stabilization, control of posture, general gross movement patterns, not as fast, activation of large muscle groups XII. Kinesthesis: the awareness of the body in space and rate/amount of joint movement o input from sensory receptors of the capsules and ligaments including the ruffini endings, pacinian corpuscles and GTO o signals from these receptors are transmitted to the spinal cord and brain so that we become aware of our body positions XIV. Reciprocal Inhibition & Coactivation o use of RI for stretching o use of contact o hold-relax for stretching o reciprocal inhibition- when motor neurons transmit impulses to muscles causing them to contract the motor neurons that control their antagonists are inhibited 1. antagonists remain relaxed and prime movers can contract without opposition o coactivation- of antagonists with contraction of prime movers, occurs when there is uncertainty about the movement task 1. practice increases familiarity of a movement and coactivation dec with favor of reciprocal inhibition (efficiency of the movement also inc) XV. Proprioceptive Neuromuscular Facilitation (PNF) a strengthening technique used in therapeutic exercise that is based on human anatomy and neurophysiology used to increase strength, flexibility, and ROM physiology o PNF exercises are based on the stretch reflex which is caused by stimulation of the golgi tendon and muscle spindles o this stimulation results in impulses being sent to the brain which leads to the contraction and relaxation of muscle o when a body part is injured there is a delay in the stimulation of the muscle spindles and golgi tendons resulting in weakness of the muscle o PNF exercises help to re-educate the motor units which are lost due to the injury. these also overflow. How PNF stretching works • recall that during an isometric stretch, when the muscle performing an isometric contraction is relaxed, it retains its ability to be stretched beyond its initial maximum length • PNF takes advantage of this increased ROM by immediately subjecting the contracted muscle to a passive stretch • The isometric contraction of the stretched muscle accomplishes several things: 1. it helps to train the stretch receptors of the muscle spindle to immediately accommodate a greater muscle length 2. the intense muscle contraction and the fact that is it maintained for a period of time serves to fatigue many of the fast-twitch fibers of the contracting muscles  this makes it harder for the fatigued muscle fibers to contract in resistance to a subsequent stretch 2. the tension generated by the contraction activates the golgi tendon organ which inhibits contraction of the muscle via the lengthening reaction • PNF stretching techniques take advantage of the sudden “vulnerability” of the muscle and its increased ROM by using the period of time immediately following the isometric contraction to train the stretch receptors to get used to this new increased range of muscle length The hold-relax (aka contract-relax) • after assuming an initial passive stretch the muscle being stretched is isometrically contracted for 7-15 seconds after which the muscle is briefly relaxed after 2-3 seconds and then immediately subjected to a passive stretch o passive stretch stretches muscle even further than the initial passive stretch • final passive stretch is held for *10-15 seconds • the muscle is then relaxed for 20 seconds before performing another PNF technique Four types of PNF strengthening 1. rhythmic initiation- includes progression from passive to active-resistive then followed by active movement o used when a patient cannot start a range of motion and to teach the patient the movement o ex sit to stand 2. repeated contraction- patient moves limb isotonically through resistance until fatigue is present 3. slow reversal- isotonic contraction of agonist and immediate contraction of antagonist o helps to develop AROM as well as coordination between agonist and antagonist o helps to increase strength of a specific ROM 4. rhythmic stabilization- isometric contraction of agonist followed by isometric contraction of antagonist o increases the holding power of a specific ROM When Performing PNF exercise remember the following principles: 1. patient must be taught the pattern 2. have the patient watch the moving limb moved passively 3. the athletic trainer must give proper verbal cues 4. manual contact with appropriate pressure is important 5. contraction of the muscle group is facilitated by hand placement 6. apply maximal resistance throughout ROM 7. resistance will change 8. rotation of movement will change throughout ROM 9. distal movement should occur first and before halfway through the movement 10. use maximal contraction to promote overflow of strength D1 & D2 PNF patterns UPPER EXTREMITY: LOWER EXTREMITY: D1 Flexion: (self feeding) D1 Flexion: (soccer kick) scapular elevation, abduction, and upward rotation pelvic protraction shoulder flexion, adduction, external rotation hip flexion, adduction, and external rotation forearm supination ankle and foot dorsiflexion with inversion wrist and finger flexion to the radial side with the thumb toe extension adducting D1 Extension: (toe-off) D1 Extension: (swimmers stretch) pelvic retraction scapular depression, adduction, and downward rotation hip extension, abduction, and internal shoulder extension, abduction, and internal rotation rotation forearm pronation ankle and foot plantar flexion with eversion wrist and finger extension to the radial side with thumb toe flexion extension D2 Flexion: (draw sword) D2 Flexion: (slow plow) scapular elevation, adduction, and upward rotation pelvic elevation shoulder flexion, abduction, and external rotation hip flexion, abduction, and internal rotation forearm supination ankle and foot dorsiflexion with eversion wrist and finger extension to the radial side with thumb toe extension extension D2 Extension: (turn out) D2 Extension: (sheath sword) pelvic depression scapular depression, abduction, and downward rotation hip extension, adduction, and external shoulder extension, adduction, and internal rotation rotation forearm pronation ankle and foot plantar flexion with inversion wrist and finger flexion to the ulnar side with thumb toe flexion opposition EXAM II CHAPTER 5: The Upper Extremity: Shoulder Region 1. Joints: o sternoclavicular (SC) joint: articulation between clavicle and sternum  clavicle helps transfer forces from the upper extremity to the thorax  diarthrodial joint with two joint cavities, an articular disc and various ligaments which hold it in place o acromioclavicular (AC) joint: articulation between the acromion process and lateral end of clavicle  clavicle goes laterally and anteriorly to meet with acromion, spine of scapula goes laterally ending in acromion process of AC joint o glenohumeral (GH) joint: articulation between the glenoid fossa of scapula and head of humerus  humeral head is much larger in size compared with glenoid fossa  humeral head sits superiorly and anteriorly in glenoid fossa o scapulothoracic (ST false joint): articulation between ribs/ thoracic area and scapula (bony structure against bony structure, no capsule or ligamentous attachments) • Subacromial (subdeltoid space) o includes:  bursa- fluid filled sac that allows movement while reducing friction  supraspinatus  long head of biceps  labrum (triangles on pic)- help deepen socket and provide stability  capsule  various ligaments o long head of biceps- assists in shoulder flexion, goes from the intertubercular groove and attaches to the supraglenoid tubercle of scapula o floor is the top part of the humerus o roof is the AC joint III. Biceps Brachii contradictions o slap lesion- top half of the labrum is torn *if tear labrum may also tear long head of biceps because they are in the same region  type I slap lesion repair: tear does not include long head of biceps  type II: tear includes long head of the biceps (in early stages must avoid forward flexion could worsen tear of biceps) o Transverse humeral ligament (Yergason's test)  keeps long head of biceps in intrabecular grove  when long head moves out of groove pain will occur when raise arm above your head  can result in a tear or tendonitis  elbow at 90 degrees and forearm pronated provide resistance as patient supinates forearm with external rotation, if they have pain or you can feel tendon go out of place while palpating positive for torn transverse humeral ligament IV. shoulder joint stabilization o humeral head is anteriorly and superiorly placed in glenoid fossa o if external rotators and supraspinatus are compromised the will slide up and forward o if supraspinatus and subscapularis do their job the external rotators will keep humeral head down and back inside glenoid fossa o supraspinatus, infraspinatus and teres minor stabilize GH joint their fibers run down and in which pull humeral head down so doesn’t hit AC joint IV. Frozen shoulder o axillary recess- allows 180 degree of rom in arm extension  when you raise your arm upward humeral head rotates downward (arthrokinematics) and the humeral shaft rotates upward (osteokinematics)  without axillary recess humeral head could not translate downward, would hit a hard stop part of the capsule o adhesive capsulitis (frozen shoulder)- axillary recess becomes stuck together and humeral head cannot translate downward  instead when raise extend arm up, humeral head goes upward and gets jammed into AC joint instead and compresses subdeltoid space  reversed scapulohumeral rhythm  fix frozen shoulder by unfreezing axillary recess, if cant fix may have to undergo manipulation under anesthesia (MUA) o dynasplint- contraption for improving ROM and stretching soft tissues o puts shoulder in loose packed position 30 degrees adduction and internal rotation then starts gradually working external rotation o always start with lower range of motion then gradually increase ROM IV. degrees of freedom o one (two)- knee (hinge) joint: flexion and extension o two (four)- wrist (condyloid): flexion, extension, radial deviation, ulnar deviation o three (six)- hip or shoulder (ball and socket): flexion, extension, abduction, adduction, external rotation, internal rotation IV. movements of the joint surfaces or accessory motions- without these would not be able to move at a joint o rolling/rocking o sliding/gliding o spinning IV. kinematics: the science of the motion of bodies in space o osteokinematics: shaft of bone, stationary or movable bone o arthrokinematics: joint surface 1. concave moving on convex rule of kinematics  concave surface moves on a stationary convex surface, the arthrokinematics and the osteokinematics move in the same direction  ex. open chain knee extension- concave tibial plateau (arthrokinematics) moves superiorly on the stationary convex femur, the tibial shaft (osteokinematics) also moves superiorly 2. convex moving on concave rule or kinematics  convex surface moven on a stationary concave surface, the arthrokinematics and osteokinematics move in the opposite direction  ex. shoulder adduction- convex humeral head (arthrokinematics) moves inferiorly on stationary concave glenoid fossa, the shaft of the humerus moves superiorly (osteokinematics) 1. closed packed and open packed positions o closed packed- maximum surface area contact at a joint, ligamentous attachments are far apart and tense, capsule is taught, and the joint is compressed  ex. shoulder adducted and externally rotated= max tautness of the capsule, congruency of the GH joint, AC joint in most compact position (baseball, tennis, volleyball)  shoulder splint with pillow- arm is adducted and flexed with neutral rotation, *scaption position prevents compression of joint and frozen shoulder which a regular sling would cause o open packed position- all other positions Joint Closed Packed Position: Open Packed Position: SC Joint elevation and protraction arm by side AC Joint full shoulder elevation arm by side GH Joint 90 degrees of abduction and 55 degrees abduction, 30 degrees horizontal adduction, external rotation and 0 degrees rotation II. Scapulohumeral rhythm- for every two degrees of movement of the humerus the scapula rotates one degree, allows increased range of motion at the GH joint, puts length tension relationship of the muscles at most proper position o describes timing of the movement of joints involved in shoulder elevation o shoulder elevation involves  humeral movement at the GH joint  scapular movement at the ST joint o scapular setting phase: *2:1 ratio first 30 degrees of shoulder elevation, the movement is largely glenohumeral, scapulothoracic movement is small and inconsistent (a lot of movement is a problem) o after the first 30 degrees of shoulder elevation the ratio of movement is 1:1  the glenohumeral and scapulothoracic joints move simultaneously o you can observe scapulothoracic rhythm by palpating the scapulas position as a person elevates their shoulder  helpful scapular landmarks for palpation include the base of the spine and inferior angle o scapulohumeral rhythm serves two purposes: 1. it preserves the length tension relationship of the glenohumeral muscles  the muscles do not shorten as much as they would without the scapular upward rotation  and so they can sustain their force production through a larger portion of the ROM 2. it prevents impingement between the glenoid fossa and humeral head  subacromial impingement can occur unless relative movement between the humerus and scapula is limited  simultaneous movement of the humerus and scapula during shoulder elevation limits relative arthrokinematic movement between two bones 1. Sternoclavicular joint 1. what is the importance of the SC joint?  only joint which connects the upper extremity to the thorax o movements: elevation, depression, protraction, retraction, rotation o when you raise your arm overhead what does the SC joint do? (* convex moving on concave)  the convex sternal end of clavicle moves inferiorly (arthrokinematics) on the stationary concave surface of the manubrium, the clavicle moves upward (osteokinematics)  if you move forward the sternal end (arthro) moves posteriorly and clavicle moves anteriorly (osteo) in the same dir of the humerus  if you move backward the sternal end moves anteriorly (arthro) and the clavicle moves posteriorly (osteo) in the same dir of the humerus • Acromioclavicular joint o movements: external rotation with abduction and forward flexion o what moves more the AC or SC joint?  SC moves slightly more but they are about the same • glenohumeral joint (shoulder joint) o favors mobility over stability so we can manipulate objects more easily • scapula o what are the movements of the scapula? (pic*)  elevation, depression  protraction, retraction  upward rotation, downward rotation  forward tilt  convex moving on concave rule- convex humeral head goes anteriorly (arthro) on glenoid fossa, humeral shaft goes posteriorly (osteo)  pec minor attaches to the coracoid process which promotes the tilt  results in compression of the subdeltoid space o scaption- scapular plane of the shoulder, plane in between flexion and abduction, most desirable position/ alignment of the shoulder joint, allows optimum length tension relationship of muscles (no strain) o winging scapula- long thoracic nerve palsy which goes from serratus anterior, caused by compromised serratus ant  wall test- put hands on wall without bending elbows push and see if scapula wings o how does posture affect the upper girdle/upper quarter positioning and movements of the scapula?  if have an increased thoracic kyphosis and forward head shoulder blades will protract forward and will not be able to get full 180 degree ROM in arm elevation, minimizes subacromial space, will hit humeral head against the AC joint and cause pain II. Functions of muscles o pec minor: inspiration, chest posture  coracoid process and ribs 3-5, tightness results in a forward tilted scapula o serratus anterior: works with the lower trap for humeral elevation o trapezius: upper, mid, lower o scapular stabilizers: serratus anterior, rhomboids, external rotators (stabilize shoulder blade and help offset power of internal rotators) o subscapularis: depresses the humeral head during abduction and flexion  attached to humeral head when you raise your arm up it pulls it down so you can rotate, along with axillary recess o supraspinatus: prevents downward dislocation of GH joint o subscapularis/ infraspinatus/teres minor: decrease head of humerus and prevent impingement (fibers run down and in depres head into glenoid fossa)  fibers run down and in pull the humeral head down and in • Supraspinatus tendon region *critical zone o no blood supply to the area so if tendon is torn its ability to heal is compromised o which way will you move your shoulder to expose supraspinatus tendon? extension- humeral head goes back and the joint surface goes forward (convex concave rule) o PT can perform deep friction massage to bring blood flow to the area where there is no blood flow to help promote healing o ultrasound can be used to dilate blood vessels to bring blood to the area and promote healing o Rotator cuff strain: supraspinatus- why is it difficult to heal?  critical zone* there is no blood supply to this area necessary for healing  a superficial tear may be repaired with deep friction massage or ultrasound but can't heal full rupture of tendon • Common shoulder pathology: impingement o can lead to bursitis, tendonitis of the long head of the biceps and rotator cuff, degenerative joint disease (arthritis) of the AC joint, rotator cuff tear or strain o may take time to develop, at first you may feel minor pain in your shoulder tendons these tough strands of fibrous tissue connect muscle to bone o as the tendon becomes irritated your body sends more blood to the area, this causes inflammation which can narrow the space even more, this inflammation is called tendonitis o if the shoulder is not rested may trigger another problem the bursa normally a flat membrane fills with fluid this is called bursitis and causes more swelling and compression within the shoulder joint o both tendonitis and bursitis decrease the space within your shoulder joint, you may feel a painful pinching when you use your shoulder o if don't allow time to heal impingement pain can increase or can cause a tear of the tendon in the critical zone, a big enough tear cannot heal naturally and will need surgery o if chronic condition bursa will become hardened and cannot decrease once inflamed, the tendon is scared down and will become less elastic and less strong o compression hits the AC joint and can result in a bone spur o humeral head goes up first before translating downward which is causing the impingement • Variations in acromial space 1. type I: normal, acromion process is not hooking down into subacromial space 2. type II: some hooking, can be born with poor mechanics or as a result of impingement 3. type III: severe hooking o subacromial decompression: surgery where the bone spur is removed • Why should you have your thumbs up when you raise your arm above 90 degrees? o having your thumbs up when going above 90 degrees is important because it clears the supraspinatus tendon out of the way of the head of the humerus and prevents it from being compresses, also prevents the humerus from hitting the acromion process o empty cans test- do empty can motion in scapular plane if there is pain could have tendonitis of the supraspinatus tendon **doing empty cans for exercise is bad, damages rotator cuff • Dislocations of the shoulder (*picture) 1. subcoracoid dislocation - most common 2. subglenoid dislocation- humeral head moves out of glenoid fossa inferiorly 3. posterior dislocation- humeral head out of glenoid fossa posteriorly 1. Multi-positional instability (young athletes) o young athletes who participate in multiple repetitive sports are at risk for injury o ex young pitcher-can get impingement of supraspinatus from repetitive throwing position  have to back off or won't get better and joint will become hypermobile  try to stabilize joint with co-contraction exercises (push up) or rhythmic stabilization exercises (balancing and moving ball on wall), PNF patterns • what happens in reversed scapulohumeral rhythm? (*pic) o humeral head can't translate downward so goes upward into AC joint o can be due to RC tear or frozen shoulder • Painful arc in the shoulder o 0-45/60 degrees - painless o 45/60- 120 degrees- glenohumeral painful arc due to impingement of RC o 120-170- painless because gravity pulls down on humerus o 170-180- acromioclavicular painful arc- max compression of the AC joint, pain can indicate arthritis EXAM II what is the only joint that connects the upper extremity to the axial skeleton? what is the common position of shoulder dislocation? what muscle depresses the humeral head during abduction and flexion? what muscle of the RC is hard to heal because of lack of blood supply? supraspinatus (critical zone) the subacromial space will be normal in what type of posture? lumbar lordosis thoracic kyphosis what are the concave convex rule for open chain shoulder movements? what are the true and false joints of the shoulder? what is the loose packed position of the GH joint? what are the structures in the subacromial space? what is not in the subacromial space? what is the ratio of scapulohumeral rhythm? 2:1 what happens during the first 30 degrees of shoulder elevation? soleus and gastroc and bending the knee when the pelvis tilts forward first what happens to the lumbar spine and the hips? penguin versus pigeon toes in anteversion what is the neck shaft angle, coxa vara, coxa valga and does how it relate to leg length? trendelenburg gait reverse and regular hip and trunk hip precautions screw home mechanism unhappy triad in patellofemoral syndrome what muscle are you going to exercise more to keep the kneecap tracking medially (when tracks laterally)? VMO patella movements during knee flexion and extension Q-angle what it does to the knee pes anserine ACL PLC MCL LCL what they do attachments active insificiency of the biceps what happens to the caprals when you RD UD position of wrist for max grip strength joint center for RD UD concave convex rule of the elbow during flexion where does wrist extension mostly occur which carpal bone when palpating is prominent during passive flexion of the wrist thumb movements passive insufficiency of the hip (knee straight flexed) median nerve involvement in CTS pronator quadratus and teres what they do and where they are manual muscle testing grades best position to improve grip strength listers tubercle joint center for shoulder internal and external rotation ankle is most commonly sprained in what two directions supination of the subtalar joint position of the ankle in subtalar neutral what other tendon is strained when the ATFL is sprained arches in relation of the heel (supination and valgus) over pronated foot what tendon is strained closed packed position of the ankle unweighted or weighted (T/F) ACL and hamstring versus PCL and quad patella is attached to the IT band via what connective tissue (lateral retinaculum *pic) manual muscle testing pictures what two muscles downward rotate the scapula types of acromion processes and what would be more or less likely to cause a shoulder impingement nerve injury for serratus ant problem FOOSH injury and direction of distal radius is colles and smith fracture JOINT CLOSED PACKED POSITION CLOSED PACKED POSITION sternoclavicular elevation and protraction of the arm by side shoulder acromioclavicular full shoulder elevation arm by side glenohumeral joint 90 degrees of shoulder abduction 55 degrees abduction, 30 degrees horizontal and external rotation adduction, 0 degrees rotation humeroulnar elbow extension and forearm 70 degrees elbow flexion and 10 degrees supination forearm supination humeroradial 90 degrees of elbow flexion and 70 degrees elbow flexion and forearm mid-pronation supination proximal radioulnar full pronation 70 degrees elbow flexion and 35 degrees joint forearm supination distal radioulnar joint full supination 10 degrees of supination knee joint full knee extension 30 degrees flexion ankle joints weightbearing dorsiflexion 30 degrees plantar flexion CONCAVE ON CONVEX KINEMATICS- arthro and osteo move in the same direction 1. Upper Extremity • humeroulnar joint during elbow flexion- trochlear notch of ulna moves anteriorly on trochlea of humerus, ulnar shaft moves anteriorly (reverse for extension-moves posterior) • humeroradial joint during elbow flexion- radial head moves anteriorly on capitulum of humerus, radial shaft moves anteriorly (reverse for extension- moves posterior) • humeroradial joint during forearm pronation- radial head rotates medially and posteriorly on capitulum, radial shaft also rotates medially and posteriorly • humeroradial joint during forearm supination- radial head rotates laterally and anteriorly on capitulum, radial shaft also rotates laterally and anteriorly • proximal radioulnar joint during forearm supination- radial head moves anteriorly on the ulna • proximal radioulnar joint during forearm pronation- radial head moves posteriorly on the ulna • distal radioulnar joint during forearm supination- radius glides posteriorly on the ulna • distal radioulnar joint during forearm pronation- radius glides anteriorly on the ulna II. Lower Extremity • open chain knee extension- tibial plateau moves superiorly on femoral condyle, tibial shaft also moves superiorly • closed chain hip flexion- acetabulum moves on the femoral head CONVEX ON CONCAVE KINEMATICS- arthro and osteo move in opposite directions 1. Upper Extremity • shoulder adduction- humeral head moves inferiorly on glenoid fossa, humeral shaft moves superiorly • forward tilting scap- humeral head moves anteriorly on glenoid fossa, humeral shaft moves posteriorly • sc joint in arm elevation- sternal end of clavicle moves inferiorly on manubrium of sternum, clavicle moves superiorly (same if extend or flex shoulder) • radiocarpal joint during ulnar deviation- proximal carpal row (scaphoid, lunate and triquetrum) glide laterally on the distal radius and ulna, the metacarpals (fingers) go medially (the distal carpal row also moves medially) • radiocarpal joint during radial deviation- the proximal carpal row (scaphoid, lunate, and triquetrum) glide medially on the distal radius and ulna, the metacarpals go laterally (the distal carpal row also moves laterally) II. Lower Extremity • closed chain knee flexion (squat)- femoral condyles move anteriorly on the tibial plateau, femoral shaft moves posteriorly • open chain hip flexion- femoral head moves inferiorly on the acetabulum, the femoral shaft moves superiorly • talocrural dorsiflexion- talus moves posterior on malleoli, foot goes anterior • talocrural plantarflexion- talus moves anteriorly on malleoli, foot goes posterior JOINT MOVEMENT JOINT CENTER MOVEABLE ARM STATIONARY ARM shoulder flexion (supine) and lateral and slightly distal shaft of humerus to parallel to the thorax or extension (prone) to acromion process lateral epicondyle perpendicular to the floor shoulder abduction and adduction anterior to acromion anterior shaft of parallel to the thorax or (prone) process humerus perpendicular to the floor shoulder internal and external olecranon process ulnar shaft to ulnar parallel to moveable rotation (supine) *make sure styloid process arm or perpendicular to patient doesn’t compensate w/ the floor shoulder popping up elbow flexion and extension lateral epicondyle radial shaft to humeral shaft to (supine) radial styloid acromion process process forearm pronation and supination 3rd metacarpal aligned with a long parallel to held object or phalangeal joint with object held in hand perpendicular to object hand in a fist and forearm such as a pencil & parallel to the floor in neutral position wrist flexion and extension (arm distal to ulnar styloid aligned to 5th aligned with ulnar shaft supine) process metacarpal wrist radial and ulnar deviation lunate aligned with 3rd aligned with mid metacarpal forearm fingers, MCP, PIP, DIP flexion in alignment with the PIP distal phalangeal proximal phalangeal DIP or knuckle shaft shaft thumb flexion and extension at the palmar/ anterior CMC 1st metacarpal radial shaft CMC joint joint at the base of the shaft thumb thumb abduction and adduction at lateral/ dorsal CMC joint lateral 1st lateral 2nd metacarpal CMC joint metacarpal shaft shaft 1st MCP flexion and extension dorsal MCP joint dorsal midline of dorsal midline of the (important for precision grips) proximal phalanx metacarpal hip abduction and adduction ASIS femoral shaft perpendicular to the (supine) towards patella movable arm (across to opposite ASIS) hip flexion (supine) and extension greater trochanter femoral shaft to in line with trunk or (prone)- bend the knee to reduce lateral femoral parallel to the floor the passive insufficiency of the condyle hamstrings during hip flexion* hip internal rotation and external mid patella tibial shaft to sinus parallel or perpendicular rotation (sitting with knee bent) tarsus to the floor knee flexion and extension distal lateral femoral fibula to lateral femur to greater (supine) condyle/joint line malleolus trochanter ankle inversion and eversion sinus tarsus in line with 2nd in line with tibial shaft metatarsal ankle dorsiflexion and just distal to lateral in line or parallel to fibula shaft to proximal plantarflexion- flex knee to reduce malleolus the 5th metatarsal fibula head the passive insufficiency of the gastroc limiting dorsiflexion hallux flexion and extension metatarsal phalangeal metatarsal phalangeal joint STRUCTURES iliac crest- lines up with L4 L5 posterior superior iliac spine- lines with S2 lateral and medial retinaculum of the knee- help stabilize patella quadriceps femoris tendon to patella tendon medial meniscus- larger c shaped, allows you to ER tibia when extend the knee during the screw home mechanism (helps during heel strike so the knee doesn't buckle) tiba in screw home- ER in extension IR in knee flexion (sagittal and transverse plane) patella- sesamoid bone increases the mechanical advantage of the quadriceps Primary Movements of the Pelvis- contralateral Pelvis Spinal Joints Hip Joint forward tilt hyperextension slight flexion backward tilt slight flexion complete extension lateral tilt to the left slight lateral flexion to the R: slight adduction right L: slight abduction lateral tilt to the right slight lateral flexion to the left R: slight abduction L: slight adduction rotation to the left (without moving head or feet) rotation to right R: slight outward rotation L: slight inward rotation rotation to the right (without moving the head or rotation to the left R: slight inward rotation feet) L: slight outward rotation Secondary Movements of the Pelvis & Primary Movements of the Spine- ipsilateral Spine Pelvis flexion backward tilt hyperextension forward tilt lateral flexion to the left lateral tilt to the left lateral flexion to the right lateral tilt to the right rotation to the left rotation to the left MUSCLES hamstrings- semitendinosus, semimembranosus, biceps femoris, flexes the knee and extends the hip, cross the knee and hip joint, help the functioning of the ACL, attaches to the ischial tuberosity and crosses the knee joint so when tight causes a posterior pelvic tilt and bending of the knee passive insufficient when a person simultaneously flexes the hip and extends the knee, pulls on knee and limits hip flexion, remove passive insufficiency by bending the knee biceps femoris- lateral, long head crosses the hip joint semimembranosus- medial semitendinosus- medial quadriceps: vastus lateralis, vastus medialis obliquus, vastus intermedialis, rectus femoris, help the functioning of the PCL , extend the knee and flex the hip popliteus: unlocks the knee, rotates the knee inward and helps flex the knee vastus medialis obliquus: externally rotates the knee, locks it into a fully extended position piriformis- tightness or spasm causes piriformis syndrome and compression of the sciatic nerve onto the superior gemellus muscle, fx in external rotation so stretch with internal rotation pes anserine- sartorius, gracilis, semitendinosus sartorius- crosses the hip joint contributes to hip flexion, assists in lateral rotation of hip, origin is ASIS inserts on medial tibia rectus femoris- crosses the hip joint contributes to hip flexion iliopsoas- attaches to lesser trochanter and lumbar spine, flexes the hip, tightness of this muscle extends the lumbar spine and rotates it laterally, together the iliacus and psoas cross the hip joint gluteus medius- hip abduction and internal rotation, major hip stabilizer during mid stance of gait, ilium to greater trochanter gluteus minimus- hip abduction and internal rotation, ilium gluteus maximus- extends hip, lateral rotator when whip is extended (because of the angular nature of its fibers), lower portion assists in resisted adduction, upper portion abducts against strong resistance adductors (longus and brevis): flex and adducts the hip tensor fasciae- abducts, medially rotates and flexes the thigh hip flexors- iliopsoas (psoas major and minor, iliacus), rectus femoris, sartorius, tensor fasciae, pectineus, adductor longus, adductor brevis, gracilis hip extensors- gluteus maximus, hamstrings hip external/ lateral rotators- superior/inferior gemellus, internus/externus obturator, piriformis, quadratus femoris hip internal/ medial rotators- gluteus medius and minimus articularis genu- on top of the femur goes through the suprapatellar bursa and attaches to the superior portion of the patella, important muscle for getting the patella to move, if someone is immobilized bc of an injury this muscle will shorten and prevents knee flexion be patella will not be able to translate downard peroneus longus- eversion will be injured in an inversion and plantar flexion ankle sprain tibialis anterior- dorsiflexion, inversion soleus- can isolate this muscle for stretching and strengthening by bending the knee (eliminates the passive insufficiency of the gastroc) tibialis posterior- medial, tendon supports the arch and prevents over pronation midstance, injured with overpronated stretching biceps- flexes elbow and shoulder and supinates simultaneously, active in all movements when supinated, not active when pronated unless resistance is applied, not active during slow supination, crosses the elbow and the shoulder, active insufficient when flexed shoulder and elbow flexed and forearm supinated brachialis- flexes elbow under all conditions brachioradialis- active in quick movements, active with resisted elbow flexion pronator teres- pronator and elbow flexor against resistance triceps- crosses the shoulder and the elbow, extends both, make active insufficient by extending elbow and shoulder supinator- supinates forearm, wraps around the radial head pectoralis minor- inspiration and chest posture, coracoid process and ribs 3-5, tightness will cause a forward tilting scapula serratus anterior- works with the lower trapezius for humeral elevation, long thoracic nerve palsy supplying this muscle or general muscle weakness can cause winging of the scapula supraspinatus- prevents downward dislocation, abducts shoulder levator scapulae- downward rotates the scapula (levator scap stretch) subscap/infraspinatus/teres minor- depress the humeral head in the glenoid fossa and prevent impingement, fibers rundown and in scapular stabilizers- serratus anterior, rhomboids, external rotators (infraspinatus, teres minor) external rotators of shoulder- insert on the posterior part of the humerus, help offset the power of the internal rotators, infraspinatus and teres minor internal rotators- subscapularis, pec major, teres major, trap, deltoid EXAM III what are the angle of the facet joints in the cervical, thoracic, and lumbar spine? which SP lines up with the vertebrae which line up with the TP in the thoracic spine? what happens to the neural foramen when you flex or extend the lumbar and cervical spine? PLL of the lumbar spine what are the two muscles that contribute to stability of the lumbar spine? where does most of cervical rotation occur? what happens during retraction of the cervical spine? where does the SP of the cervical spine go when you turn your head? what happens when you flex or extend with the nucleus populsus? tilting and nodding in terms of the upper cervical spine: where does the occipital condyle go? (when tilt to the right) know shape of the TMJ disc and articular surfaces of the TMJ know where rotation and translation take place in the TMJ what is the 4:1:1 ratio in TMJ? what are the positions to avoid with spondylolisthesis? and spinal stenosis where does the lumbar spine go when you have a over pronated foot? what is the joint center for cervical flexion and extension? what is the position of the upper neck when stretching the upper trap? what is the ligament involved with RA and down syndrome in the upper cervical spine? what is an uncinate process know the dermatomes right levator scap stretch TMJ definitions: orthostatic position, freeway space, centric relation, centric occlusion neutral occlusion, retro profile, anterior inclined profile (three faces on picture) L3 myotome L5 myotome when rotate trunk to the right what obliques are functioning? what are the primary respiratory muscles? what are the point of references when measuring thoracic and lumbar flexion and extension? (two points that don’t move) what is the complete way to stretch the upper trap? what is the order of the anatomy of the lumbar vertebrae from front to back? know the MMT pictures (four questions) what happens to the condyles when you open your mouth? TMJ what is the functions of the buccinator? what is the function of the temporalis? what is the function of the masseter? what is the function of the pterygoids? what are the micro and macro traumas in TMJ? what are the parafunction of TMJ? what is the importance of the ligamentum flavum? what happens during diaphragmatic breathing? (what moves and what does not move) ROM in lumbar and thoracic flexion with the tape measure what are the normal movements of TMJ? depression, protrusion, and lateral deviation how do you stretch the sternocleidomastoid muscle? Goniometry of the Cervical, Thoracic, and Lumbar Spine & TMJ Movement Joint center/axis stationary arm moveable arm normal angle CS: flexion and external auditory meatus perpendicular or align with the 45 degrees extension parallel to the floorbase of the nose CS: lateral flexion C7 spinous process along SP of the dorsal midline 45 degrees or sidebending thoracic SP or of the head perpendicular to the floor CS: rotation center of the cranium aspect align parallel to an align to the 60 degrees of the head imaginary line btwn distal tip of the the two acromion nose processes LS and TS: flexion use of tape measure, *C7 and S1 do not normal: flexion is and extension measure the distance btwn move 10 cm; extension C7 and S1 then have the is ¼ of the flexion patient flex or extend and value, (2.5 cm) measure the difference btwn the starting and ending distance normal angle:
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