Week 1 1-A - Principles of LE Movement Flashcards by Michael Obi

UE Vs LE Movement

Is there a difference?

UE = (Open/Closed) kinetic chain
LE = (Open/Closed) kinetic chain
(MOSTLY)

LE – Closed kinetic chain, we don’t walk on our hands.
UE – Open kinetic chain

MMT and things are in open kinetic chain and we don’t function in life like this, so want to look at functional movements.

WB comes into play

Open; Closed

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Principles of LE movement

Lower Kinetic Chain:
(Non Regional/Regional) Interdependence

Definition:
“Regional interdependence refers to the concept that seemingly unrelated impairments in a remote anatomical region may contribute to or be associated with the patient’s primary complaint”
-Wainner 2007 JOSPT

Example in UE?
Poor scapular stability causes GH joint pain
Thoracic spine mobility?

In CKC this becomes more important because the individual links will be influenced by the others.

Regional

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Lower Kinetic Chain

Relationship of the links
– coupled or linked movement

Supination with (internal/external) rotation of the knee.

external

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Lower Kinetic Chain

Relationship of the links
– coupled or linked movement

Pronation with (internal/external) rotation of the knee.

internal

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Lower Kinetic Chain

Examine joint above and below

Proximal and distal influences of movement

Got it

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Knee pain can come from abnormal hip control. It can come from the ground up or vice versa.

Got it

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Have to look at (the whole/half of the) kinetic chain and address the origin of this.

the whole

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How do you find the weak link?

Exam and Observation of Movement
Deficits in:
Strength
NM control
ROM
Hyper/Hypomobility
Muscle length / flexibility

Exam and Observation of Movement
Painful activity? 
* Watch it!
        Stairs 
        Squat / sit to stand
        Run
Movement screen

ID abnormal movement
Helps focus exam

Got it

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Got it

Got it

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Got it

Got it

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How do injuries occur?

Trauma - tissue injury caused by extrinsic agent
(Microtrauma/Macrotrauma)

Tissue overload
Repetitive - activity related/training error
Poorly dissipated/absorbed load
(Microtrauma/Macrotrauma)

Macrotrauma; microtrauma

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Tires on your car – if your car tires are in a good alignment it spreads the load (in one area/evenly), if they are not in alignment it focuses all the load in (one spot/evenly) and it will wear out quickly.

evenly; one spot

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How do injuries occur?

(Increased/Decreased) force concentration

What’s the formula for pressure?

Increase the surface area you will (increase/decrease) the pain. Load will go through a larger area.

Increased; P = F/A; decrease;

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What is this movement pattern called?

Components?

Hip (Adduction/Abduction)
Hip (Internal/External) rotation
Pelvic Drop
Knee valgus - knee (adduction/abduction)
(Pronation/Supination)

People who have dynamic valgus can develop the following condition and are more likely to get hurt:

PFPS (patellofemoral pain syndrome)

ITBS (Iliotibial band syndrome)

TSF (Tibial stress fracture)

MTSS (Medial tibial stress syndrome)

Hip trochanteric bursitis

Dynamic valgus; adduction; Internal; abduction; pronation

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Abnormal Movement Patterns LE

Pattern recognition
ID usual suspects

Got it

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Frontal Plane Abnormal Movements

Pelvic drop (trendelenburg) 
Excessive hip (abduction/adduction)

adduction

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Transverse plane abnormal movements

Dynamic knee valgus 
hip (internal/external) rotation
Tibial (internal/external) rotation
Foot hyper (pronation/supination) (multiplanar)

internal; internal; pronation

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Sagittal Plane Abnormal Movements

Stiff knee gait:

Flexed Knee gait:
Extension (gain/loss) (unable to extend fully)
Arthrofibrosis – post op / trauma
Immobilization

Knee kept in extension:
(Hamstring/Quad) weakness, unstable

Knee hyper extension
Poor (hamstring/quad) control
kinetic chain limitation - limited (DF/PF)

Stiff knee gait – knee flexion contracture could be the cause, LOM in extension, scarring,

Knee hyper extension – weak quads (knee will buckle so they walk like this), kinetic chain limitation – limited DF.

loss; Quad; quad; DF

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As you move into hip extension and you don’t have the movement In your ankle it will put your knee (forward/backwards).

People who don’t have DF can have dynamic (varus/valgus).

backwards; valgus

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Limited DF

Consecuences:

Flexed knee gait
Increased (PF/DF) compression: PAIN

Extended knee
Increased (GRF/Tension) with less joint excursion: PAIN

Knee hyper extension
Abnormal loads (anterior/posterior) knee or PFJ: PAIN

PF; GRF; posterior

Lack of knee extension on the left.

Left pic is absorbing impact (worse/better). Knee does not absorb impact well in (flexion/extension). Guy on the right is landing on heel which is not ideal. More likely to develop an injury on the (left/right) pic.

extension; right

Not enough (DF/PF) so weights behind her.

If you have knee pain that will increase PF joint pain if you have knees way (behind/over) toes.
Squatting low is not a good idea to do if you have knee pain because it will (increase/decrease) load throughout the knee.

DF; over; increase

Good knee alignment

Got it

The position of risk is dynamic (varus/valgus) .

valgus

Want to watch them that they are not in dynamic valgus and want the knees (close/apart).

apart

Dynamic (varus/valgus)

valgus

Greater knee flexion angle will (increase/decrease) PF pain. Want them to step out further to (increase/decrease) knee flexion to (increase/decrease) PF load. Greater impact on the bottom right pic, want them to start with the top right pic to (increase/decrease) load on the patellar.

increase ; decrease; decrease; decrease

Got it

Compensated Trendelenburg – shift to her (right/left) side.

right

Got it

``` Poor _/5 criteria Fair _-_/5 criteria Good _/5 criteria ```

1; 2-3; 4

Got it

What can cause dynamic valgus? Hip Increased femoral (anteversion/retroversion) leg length differences GMax, G Med (Weakness/strength) Poor muscular recruitment or coordination Poor proprioceptive awareness Knee (Valgus/Varus) knee – (medial/lateral) articular cartilage wear / bone loss Foot (Short/Long) Gastroc/soleus (1st/2nd) MTP limited ROM (Hyperpronation/Hypersupination) – uncontrolled flexible flat foot Talo crural joint limitation ROM (DF/PF) PTT (Posterior tibial tendon?) insufficiency

anteversion; weakness; Valgus; lateral; Short; 1st; Hyperpronation; DF;

Why do kinematic differences occur? Why do people move with abnormal movement patterns? Decreased hip (ABD/ADD) strength Iliotibial band syndrome (ITBS)(Fredericson) Achilles tendonitis (Habets) Medial tibial stress syndrome (MTSS) (Becker, Verrelst) TSF (Boling, Ferber)

ABD;

Why do kinematic differences occur? Why do people move with abnormal movement patterns? Normals vs Patellofemoral Pain Syndrome (PFPS) Decreased hip (adduction/abduction) strength Decreased hip (flexion/extension) strength Decreased hip (internal/external) rotation strength

abduction; extension; external

(Correlation/No correlation) b/w muscle strength and amount of valgus or varus movement during testing.

No correlation

Okay coo

Got it

The Effect of a Hip-Strengthening Program on Mechanics During Running and During a Single-Leg Squat Significant gains in strength Hip (ABD/ADD), (IR/ER) SLS kinematics improved reductions in hip (ABD/ADD), (IR/ER) and (ipsilateral/contralateral) pelvic drop No changes were seen in abnormal hip mechanics during running Hip strengthening alone may not be sufficient to change abnormal hip mechanics during running. Activity-specific neuromuscular training may be necessary to alter these aberrant motions. SLS – single leg squat Have to do task specific training!!!!

ABD; ER; ADD; IR; contralateral

Trunk Control Activating core (improves/worsens) dynamic tasks Subjects engaged transverse abdominis (TA) and performed SLS 3D instrumented motion analysis Significantly (more/less) frontal plane deviation compared to non engaged condition in same subjects Movement got better with contracted abdominals so core plays a role in LE movement. Stabilize the core to improve quality of movement in the LE.

improves; less

How Do We Correct Abnormal Movement Patterns? ``` Interventions: Strengthening Stretch or soft tissue work to improve Flexibility / muscle length Joint mobilization Proprioceptive training Core stabilization Movement retraining – motor control ```

Got it

If they have swelling and pain, put them in crutches, putting them in different positions, if they can’t WB put them in the water to offload the joints.

Got it

Give them education on what they should or should not do.

Got it

Pt has to know what they are doing outside of therapy!!

Got it