KINE 4475 final notes

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York University
Kinesiology & Health Science
KINE 4475
Brian Nairn

Pain - sensory experience evoked by stimuli that injure or threaten to destroy tissue, defined introspectively by every man as that which hurts - Definition: o 1. Personal, private sensation of hurt o 2. Harmful stimulus which signals current or impending tissue damage. o 3. Pattern of responses which operate to protect the organism from harm - Functions of Pain:  survival value  prevent pending or further injury  Ensures inactivity/rest  facilitates recovery  Learning  avoid similar situations/objects - Pain injury relationship is generally linear but it’s not always the case (paper-cut), it’s highly variable and can be affected by sex, health anxiety and personality (elderly have lower pain threshold, and women have higher pain sensitivity) - Gate Control Theory Abnormal Gait - when there is variability present in normal gait - in order to walk: o 1.Each leg must be able to support body weight without collapsing o 2.Maintain balance, statically or dynamically, during sing-leg stance o 3.Swinging leg must be able to advance to a position where it can take over supporting role o 4.Sufficient power must be provided to make necessary limb movements and advance trunk  if ¼ is not met, person cannot walk.  Abnormal walking ie walking aids, braces usually increase energy consumption  Can be caused by neural or musculoskeletal disorders - Trendelenburg gait- bending trunk towards side of supporting limb in stance phase  to reduce forces in abductor and hip joint in single-leg stance …best observed from front. Can be unilateral or bilateral o Causes can be painful hip or hip abductor weakness - Abnormal hip joint makes it difficult to stabilize the pelvis using abductors b/c effective length of glute med is reduced b/c greater trochanter of femur moves upward twd pelvic brim o Coax vara <120 degrees, congential dislocation of hip or slipped femoral epiphysis - Wide walking base indicates a problem with balance during single- leg stance. - Unequal leg length, pelvis dips downward (stepping in a hole), lateral bend of trunk - Scoliosis and stroke also factors - Anterior trunk bending is used to move CoG forward, it causes the trunk to flex forward in early stance. If 1 leg is affected the trunk will straighten at time of opposite initial contact, if two legs are affected trunk may stay flexed throughout the gait cycle  best seen in sagittal view - Abnormal gait can also be caused by ineffective knee extensors - Posterior trunk bending is the reverse of anterior trunk bending o Ineffective hip extensors and flexors, knees unable to flex - Functional leg length discrepancy  one or both legs unable to adjust to appropriate length in gait cycle…walking requires the stance phase leg be longer than swing leg otherwise swing leg will collide with the ground. o Results in 4 gait abnormalities  1. Circumduction: swing leg moved laterally  2. Hip hiking : lift pelvis on side of swinging leg  3. Steppage: exaggerated knee and hip flexion (sagittal view)  4. Vaulting (stance phase modification) – go up on toes of stance leg –sagittal view - foot disorders – inversion or weakness of peroneal muscles, eversion of foot - normally knee is fully extended 2x/cycle at initial contact and heel rise, in abnormal gait one or both fail to occur in excessive knee flexion - Cerebral palsy is one of the most important focuses of gait analyses, usually follows brain damage around time of birth, characteristics include abnormal muscle tone and los of selective muscle control o Muscles are not weak but rather nable to contract adequately or at appropriate times in gait cycles - Spastic Hemiplagia, most common neurological cause of abnormal gait, occurs in CP, stroke etc. Loss of function in some or all muscles of one side of the body, arms usually affected more. Most can walk. There are four main groups increasing in severetiy from 1-4. o Group 1 has a single problem, foot drop on affected side o Group 2, foot drop + static or dynamic contracture of calf muscles o Group 3 foot drop + contracted calf + overactivitiy of quad and hamstrings o Group 4 all of the above +reduced range of hip motion b/c over-activity of ilipsoas and adductors - Spastic Diplegia is common manifestation of CP, primarily affects the legs. Spasticity is the prominent element of the condition, tension in spastic msucles during development often leads to bony deformities. - Parkinsons disease caused by degeneration of the bas
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