Module 3: LE Part 1 Flashcards by Jon Chicago

forces on feet while walking

1-3 times bodyweight

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forces on feet while running

3-5 times bodyweight

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forces on feet while jumping

5-7 times (some say 7-11 times)

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how to increase joint shock absoprtion

increase surface area of mass of striking object and increase time to bottom out

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joint glide up and down is slowed by

eccentric contraction of posterior tibialis

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amount of energy absorbed before fracture

impact strength

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windlass effect is responsible for

supination of foot and external rotation of contact leg

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involuntary effect that normally raises the longitudinal tarsal arch as foot moves up and over the toes

windlass effect

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windlass effect externally rotates

tibia and femur

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raising the big toe on patient makes

whole limb externally rotate and arch of foot to raise in supination

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functional hallux limitus aka

limited dorsiflexion/limited windlass effect

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dorsiflexion great toe without load normal angle

70-90 degrees

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weight bearing great toe dorsiflexion

35 degrees

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what makes up the midtarsal joint

calcaneocuboid and talonavicular

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what causes plantar fascitis

arch does not raise and joints dont glide, then toes bend and tighten

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80% of plantar fascia originates on

medial tubercle

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pronation occurs as

leg and body move over the foot

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two bones that initiate pronation

talus and calcaneous

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what does the talar head do during pronation

moves medially from a vertical position over head of the calcaneus, to a position horizontal to the head of the calcaneus

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average angle of talar motion is

45 degrees

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pronation of foot causes

medial rotation of tibia and femur, pelvis rocked forward, and spine to lean to that side

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supination begins

as heel raises from the ground

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what starts the windlass effect

leg and body forward motion

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how does the talar head move compared to the calcaneal head

superior and vertical

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primary shock absorber of the body

foot pronation

shock is absorbed by what kind of pronation

rapid

shock is absorbed by eccentric contraction of post tib slowing lowering of longitudinal arch

normal step

secondary shock absorber of the body

knee

popliteus flexes knee its first

15 degrees from full extension

nerve root of popliteus is

can the popliteus effectively bend the knee if heel strike is pronated

no because popliteus is internal rotator and the leg is already internally rotated

action of posterior tibialis

contract in order to decelerate the subtalar joint pronation

if subtalar joint is pronated at heel strike, psoterior tibialis will

exert its contraction force proximally instead of distally (shin splints)

internal rotation increases stress on

anterior horn of meniscus

heel fat pad typically does what with age

decreases

stress fractures occur due to

stress no longer attenuated by the kinetic chain

ability to pronate is compromised by fixations in the

knee or feet or subluxation of the spine

how long does it take for stress fx to heal

6-8 weeks, will feel better in 2 weeks barring activity

painful palpation of sustenaculum tali due to

spring ligament stress due to arch not working

key to medial arch

talus->naviculum->1st cuneiform

pulley for fibularis longus

cuboid

fulcrum for plantar fascia and flexor hallucis longus

1st ray sesamoid

sensations to joint involve

pain and position

Type IV mechanoreceptors

nociception, activate sympathetic nervous system

neuromuscular phenomenon that occurs when joint dysfunction inhibits the muscles that surround the joint

arthrogenic inhibition

how long does it take for plastic deformation to occur if joints out of place

3-6 months

when plastic deformation occurs, what happens

tissues are elongated and no longer activate with inhibition response

the importance of mechanoreceptors with an adjustment

removes stretch in the muscles, tendons, ligaments, and capsules and no loner inhibits activity of muscles stretched around that joint

stance/contact phase of gait cycle takes up

62% of full cycle

swing phase of gait cycle takes up

38% of full cycle

moment heel contacts ground until forefoot makes contact with ground

heel strike

forefoot drops to fully contact plantar surface of foot with ground

midstance

what can cause weakness during muscle testing

nerve, injury, pain, TrP

other than weakness, what indicates a problem

shaking, ratcheting, lack of coordination, recruiting

blood supply to acetabular joint is controlled by

what subluxations are correlated with DJD of hip

L2 and L5

what can mimic short legs

pelvic torque, hyperpronation, anterior talus

what to look for with hip problems

``` L2/L5 subluxation of hip adhesions of hip referral from upper lumbar/lower thoracic piriformis ```

motion related clinical disorder of the hip with a triad of symptoms, clinical signs, and imaging findings.

FAI Syndrome

primary symptom of FAI syndrome

motion or position related pain in the hip or groin

symptoms in addition to pain for FAI Syndrome

clicking, catching, locking, stiffness, restricted ROM, or giving away

most common sign for FAI syndrome for ortho testing

flexion adduction internal rotation (FADIR) is sensitive but not specific

conservative tx for FAI Syndrome

education, watchful waiting, lifestyle and activity modification, NSAIDS, steroid shots

Tx of PT for FAI Syndrome includes

hip stability, NM control, strength, ROM, and movement patterns

injury in the inguinal area that is usually caused by activities, especially when twisting/turning at high speeds

athletic pubalgia

most common patients to get athletic pubalgia

soccer, tennis, hockey

normal hip internal rotation

35-40 degrees

normal hip external rotation

70-90 degrees

hip joint subluxates in what two ways

internal and external rotation

signs/symptoms of femur subluxations

1. ) socket limp with dull ache 2. )early muscle fatigue in involved leg 3. ) limited ROM of hip during passive and active motions in 90+90 positions 4. ) tenderness at anterior greater trochanter (internal rotation) 5. ) tenderness at post greater trochanter (ext rotation)

occurs often with people who run on banked roads or trails

TFL syndromr

Nerve roots of TFL/IT Band

L4/L5

controls blood supply to acetabular socket and controls rectus femoris

L3, L3

function of rectus femoris

flexes the hip and extends the knee (only 2 joint muscle of the quad group)

L5, S1, S2 nerve root

piriformis

L1, L2, L3 nerve roots

psoas

what affects the length of the psoas

rotation of femur which can also affect pelvis, lumbar stability, and curve