written test #2- lumbar, Hip, Knee Flashcards
(191 cards)
1
Q
Which direction do lumbar intervertebral discs deform and displace when a person performs right lateral flexion?
A
Left
2
Q
If a patient has radiating symptoms that demonstrate motor weakness, the patient is given what type of radiating symptoms diagnosis?
A
Radiculopathy
3
Q
Injury at sub failure load is most likely to occur when there is inadequate recovery (time) between exposures of load. T or F?
A
True
4
Q
Limacon shaped lumbar vertebral discs demonstrate more diffuse nucleus deformation than ovid shaped discs. T or F?
A
False
5
Q
Which of the following spinal motions are limited the greatest due to the orientation of the lumbar facet joints?
A
Rotation
6
Q
What best describes the process of pain centralization?
A
Distal pain that slowly progresses towards the spine
7
Q
Based on categorization of low back pain, what treatment is most ideal for addressing a facet mobility problem?
A
Joint manipulation
8
Q
Lumbar ligaments are densely populated with mechanoreceptors providing feedback regarding position and motion. T or F?
A
True
9
Q
What best describes the reason for the ilopsoas’s attachment to the lumbar spine?
A
Disperse hip flexion forces across the lumbar spine
10
Q
Based on categorization of low back pain, what treatment is the most ideal for addressing a motor control problem?
A
Stabilization exercises
11
Q
What position are the hip abductors capable of generating the greatest force (strongest)?
A
Adducted 10 degrees
12
Q
In a seated position with hips flexed to 90 degrees, the piriform is positioned to efficiently perform which movement?
A
Internal Rotation
13
Q
What combination of positions puts the hip in OPEN packed position?
A
Slight external rotation, hip flexion 30 degrees, abducted 30 degrees
14
Q
What position is the right femur in relative to the pelvis when the pelvis left laterally tilts (left side drops)?
A
Adduction
15
Q
When the pelvis rotates to the left, what direction does the left femur need to move relative to the pelvis to keep the left foot aligned in the sagittal plane?
A
Medial Rotation or Internal rotation
16
Q
Which position will a person adopt posturally, if they have femoral retroversion?
A
Lateral rotation of the leg (toed-out)
17
Q
What position is the femur in relative to the pelvis when the pelvis is tilted anteriorly
A
Flexion
18
Q
In a standing position, posterior rotation of the pelvis is equivalent to closed kinetic chain hip extension. T or F?f
A
True
19
Q
Which of the following is true regarding coxa vara?
A
It is associated with less risk of dislocation
20
Q
Which of the normal variants of the femoral neck increases mobility of the iliofemoral joint, while sacrificing stability- Coxa valga or Coxa vara?
A
Coxa valga
21
Q
Which meniscus demonstrates less mobility, possibly explaining why it more frequently injured?
A
Medial
22
Q
Which area of the meniscus has the best potential to heal due to a better blood supply?
A
Outer 1/3
23
Q
Any movement of the vastus medialis oblique will allow a greater amount of lateral glide of the patella due to the origin of the quadriceps muscles being orientated laterally to their insertion point. T or F
A
True
24
Q
What motions create the “screw home” mechanism of the knee during terminal knee extension? You need to know what a terminal knee extension is to understand this question…
A
The femur internally rotates and the tibia externally rotates
25
Which meniscus is deeper?
Lateral
26
Which directions does the femur move relative to the tibia during knee extension?
Rolls anterior and slides posterior
27
The posterior Cruciate ligament functions to prevent what motions at the knee?
posterior translation of the tibia and anterior translation of the femur
28
The lateral femoral condyle rotates which direction on the tibia during knee flexion?
posterior
29
what position is considered the open packed position of the knee?
30 degrees of flexion
30
Which direction do the menisci move during knee extension?
Anterior
31
What are the 3 common occurrences for patient that reported low back pain compared to those who do not?
Reduced lumbar ROM
Move more slowly
Have reduced proprioception
32
LBP has a high rate of reoccurrence. T or F?
True
33
Treatment of LBP focused on the intervertebral disc should focus on what treatment?
Direction Specific exercise
34
Treatment of LBP focused on the Facet or SI joint should focus on what treatment?
Joint manipulation
35
Treatment of LBP focused on motor control should focus on what treatment?
Stability & motor control exercises
36
Treatment of LBP focused on central sensitization should focus on what treatment?
cognitive behavior therapy
37
IVD deform opposite to _________
Load
38
The nucleus pulposus deforms in the direction opposite to the ________
motion
39
If the spine flexes the nucleus pulposus moves ?
posterior
40
IF the spine extends what direction does the nucleus pulposus move?
Anterior
41
If you laterally flex your spine does the nucleus pulposus move contralateral or ipsilateral?
Contralateral
42
The IVD store energy from rotation and releases that energy to help drive what?
Our gait
43
Put these in order from least force on the IVDs to the most-
Coughing
Lifting 22.5 lbs
Forward bending 40 degrees
Holding 1lbs at arms length
Lying supine
Standing erect
Sitting in an unsupported position
Sitting in a supported position
lying supine- 250 N
Sitting supported- 400 N
Standing erect- 500 N
Sitting unsupported- 700 N
Coughing- 700 N
Forward bending 40 degrees- 1000 N
Lifting 22.5 lbs- 1700 N
Holding 11lbs at arms length- 1900 N
44
What are the lumbar disc shapes?
Ovoid Disc- Circular, thinner spines, more diffuse nucleus deformation
Limacon- bean shaped, thicker spines, more focal deformation
45
3 ways the IVD can cause symptoms are?
Direct injur to annulus fibrosis
Mechanical pressure & Chemical irritation affecting IVFs
Loss of disc height
46
Define radiculitis
Radicular or Radiating pain. Sensory changes due to ectopic discharges from a nerve due to inflammation
47
Define Radiculopathy
compression or a nerve that results in motor weakness
48
Pain originating from the spine that refers distally is called what?
Peripheralization
49
Symptoms moving back towards the midline of the spine is what?
Centralization
50
The bigger the herniation the more likely it will ________ ____________
spontaneously resorb
51
Repeated movement testing is performed and if centralization or a direction preference is identified, they are placed into this category. What treatment category is this?
DIRECTION SPECIFIC EXERCISE
52
What is unique about the lumbar facets superior to inferior?
Primarily lie in a sagittal plane in the upper lumbar and changes to a coronal plane in the lower lumbar
53
Anterior rotation + Anterior translation = What in the spine
Flexion
54
Anterior translation of vertebrae is limited by what?
bony facet joints
55
anterior rotation is limited by ??
Posterior annulus fibrosus & posterior ligament
56
Posterior Rotation + Posterior Translation= what is the spine
Extension
57
Lumbar extension is limited by the approximation of the __________ and __________
articular processes
spinous processes
58
What limits side bending in the lumbar spine
Intertransverse ligament
Capsule of the contralateral facet joint
Approximation of the ipsilateral facet joint
59
In a neutral position- rotation is limited by 2 things. What are they?
Approximation of the facet joint surfaces
limited by tension in the joint capsule, annulus
fibrosus, & PLL.
60
If the vertebral body rotates to the left, what happens that limits the rotation?
joint surfaces of the right facet approximate
joint capsule of the left facet is stretched/under tension
61
What is the open packed position for the lumbar spine?
Flexion & rotation toward the same side
62
What is the closed packed position for the lumbar spine?
extension & rotation toward the same side
63
What is the degrees of ROM seen in rotation for the scarum?
Between 1-8 degrees, avg of 2 to 3 degrees
64
What are the 3 types of SI joint motion?
Symmetrical motion
Asymmetrical motion
Lumbopelvic motion
65
Antagonistic movement of each innominate relative to the sacrum, which includes movement at the symphysis pubis. What motion is this describing?
Asymmetrical motion
66
Movement of both innominates relative to the sacrum. What motion is this describing?
Symmetrical motion
67
Combined movement of the innominates and the spine as a unit around the femoral heads. What motion is this describing?
Lumbopelvic Motion
68
What are the two movements associated with the SI joint and symmetrical motion?
Nutation
Counter-nutation
69
Forces from above and below pass through the body in what direction relative to the sacrum?
Anterior
70
How do the superior and inferior forces act on the sacrum?
Upper body weight tries to tip the sacrum forward
Ground forces tend to rotate the innominate bones backward
71
Extension of the trunk from standing combines extension of the lumbar vertebrae with ________ rotation of the pelvis on the fixed femurs.
posterior
72
Flexion of the trunk from standing combines flexion of the lumbar vertebrae with _______ rotation of the pelvis on the fixed femurs.
forward
73
What factors can limited lumbopelvic flexion?
Hamstring stiffness (limits anterior pelvic rotation)
Excessive lumbar flexion (increased load on discs/ligs)
Weakness in hip flexors (lack of anterior pelvic rotaiton)
74
What factors can limit lumbopelvic extension?
Tension in iliolumbar ligaments
"tightness" in the hip flexors (anterior tilt of the pelvis)
75
What are the two self locking mechanisms of the SI joint?
Form closure
Force closure
76
The sacrum acting as a “keystone”, locks the innominates in place providing bony structural stability. What is this?
Form closure
77
The surrounding ligaments and muscles exert some type of forces through the SIJ providing additional stability. What is this?
Force closure
78
What is the cluster of tests that research shows should be used to confirm a diagnosis of SIJ as the source of a patient's problem is what? What tests are they?
Cluster of Laslett
1. SI Joint Distraction
2. Thigh Thrust
3. Sacral Thrust
4. The Drop Test
5. Gaenslen’s
6. Iliac Compression
79
What 3 criteria are needed to diagnose a patient into a Joint Manipulation Treatment category?
1. If unable to centralize pain through
repeated movements
2. Positive Z-joint clinical features
3. (3>) Cluster of positive SIJ provocation test
80
Most injuries to the spine happen outside of the ____ plane
sagittal
81
What are the "inner core" muscles?
* Multifidus
* Diaphram
* Pelvic floor
* Transverse abdominus
82
What are the "outer core" muscles?
* Rectus abdominus
* Abdominal obliques * Latissimus dorsi
* Gluteus maximus
* Adductors
* Hamstrings
* Quadriceps
* Psoas
* Quadratus lumborum * Spinal erectors (ILS)
83
What are the differences between inner core and outer core musculature?
Inner core- Stabilizers, endurance muscles, low loads, anticipatory control
Outer core- Prime movers, short duration, heavy load, secondary contraction
84
This is the first portion of the core to contract prior to any movement and is reflex driven
Inner core
85
What muscle minimizes posterior shear in the lumbar spine?
Multifidus
86
What muscle has the role of increasing intra-abdominal pressure for strategic in stabilizing the low back?
Transverse Abdominus
87
What are the major extensors of the thoracolumbar spine?
Longissimus & iliocostalis
(also functions to resist any anterior shear forces of the upper vertebrae)
88
What is the direct connection between the bony spine & the deep abdominal muscles while also providing critical support to the spine during lumbar flexion & lifting activities.
Thoracolumbar Fascia
89
What are the requirements with the cluster of laslette to achieve a probability of having SIJ pain of 77%?
3 or more positive SIJ tests whose symptoms do not centralize.
90
What are the primary functions of the iliofemoral joint?
1. Support the weight of the head, arms, and trunk (HAT)
2. Transmit forces between the lower extremity and the trunk
91
What direction does the acetabulum face?
-Anteriorly
* Laterally
* Inferiorly
92
What does the general positioning of the acetabulum prevent?
posterior dislocation
93
The femoral head’s positional orientation faces
medial and superiorly
94
What planes and what degree are the angle of inclination & torsion angle?
AOI- Frontal plane, ~125 degrees
TA- Transverse angle, ~15 degrees
95
What is Coxa Valga?
AOI >125 degrees
96
What is Coxa Vara?
AOI <125 degrees
97
What does Coxa Valga cause for changes in the body?
1. Hip abductor muscles are at a disadvantage through a reduced moment arm.
2. The joint reaction force is displaced laterally in the
acetabulum and is applied over a smaller joint surface. This increases joint stress > risk of DJD
98
What does Coxa Vara cause for changes in the body?
1. Lengthens the moment arm of the hip abductors. Reducing the force required of the hip abductors; increasing fatigue in the antagonist muscles.
2. Increases the compressive forces on the medial aspect of the femoral neck: Increasing risk for stress fractures of the femoral neck
99
What does each femoral neck variations have for pros and cons?
Vara- Increased stability, Decreased mobility, increased risk of femoral neck stress Fx
Valga- Decreased Stability, increased mobility, Greater risk of dislocation
100
In the adult the femoral neck and head face what direction?
Anteriorly
101
What direction does the greater trochanter face?
Posterolateral
102
Angle between the axis through the femoral head and the axis through the femoral condyles is called what?
Femoral Torsion Angle
103
Greater than 15 degrees of medial rotation femoral torsion angle is called?
Anteversion
104
Less than 10 degrees of medial rotation femoral torsion angle is called?
Retroversion
105
What does anteversion cause?
-places the center of the femoral head farther anteriorly in the acetabulum than normal
-Compensation: Medial rotation of the hip positions the femoral head in a more centrated position within the acetabulum providing a better sense of stability.
-Toed-in posture (if not treated with another compensation)
-Patient shows increased medial rotation ROM & a decrease in lateral rotation
106
What does retroversion cause?
-places the center of the femoral head farther posterior in the acetabulum than normal.
-Compensation Lateral rotation of the hip positions the femoral head in a more centrated position in the acetabulum providing better mobility.
-Excessive toeing-out
-Increased lateral rotation ROM of the hip, diminished medial rotation ROM
-increase the risk of slipped capital femoral ephiphysis in adolescents
107
What are the 3 classifications of FAI?
Cam
Pincer
Mixed
108
What provides passive stability to the hip joint?
Labrum and ligaments
109
What provides dynamic stability to the hip?
Muscles crossing the hip
110
What does the labrum do under weight-bearing?
Deforms around the femoral head, stabilizes the head, rate of deformation is inversely proportionate to amount of load
111
Name the 3 ligaments of the hip joint capsule
anterior- iliofemoral lig, pubofemoral lig
Posterior- ischiofemoral lig
112
Why are the ligament of the hip coiled?
Due to rotation of the hip during fetal development
When stretched the fibers clamp onto the femoral neck/head
113
The iliofemoral ligament prevents...
-excessive extension and medial rotation
ROM of the hip joint.
* The superior portion limits adduction ROM.
114
The pubofemoral ligament prevents...
Limits excessive extension and abduction ROM
115
The isciofemoral ligament prevents...
Reinforces the capsule posteriorly.
* The posterior fibers limit:
1. medial rotation of the hip.
2. posterior glide of the femoral head
3. adduction ROM when the hip is flexed.
116
With the hip flexed the joint is pushed....?
posterior and further into the acetabulum
117
What is the OPP for the hip?
-Flexion 30 degrees
-Abduction 30 degrees
-Slight external rotation
118
What is the CPP for the hip?
-Hip extension
-Slight internal rotation
-Slight ADDuction
119
What are the AROM for the hip?
* Flexion 120 ̊
* Extension 20 ̊
* Abduction 45 ̊
* Adduction 30 ̊
* Internal Rotation 30-40 ̊ * External Rotation 45 ̊
120
the ideal loading of a joint in a neutral position that enables optimal loading.
Joint centration
121
Causes the joint to be displaced from the ideal centrated position
Decentration
122
What are the coupled motions for Hip Flexion?
requires the head of the femur to roll anterior and slide posterior and inferior
123
What are the coupled motions for Hip extension?
requires the head of the femur to roll posterior and slide anterior and superior
124
What are the coupled motions for Hip medial rotation?
requires the head of the femur to roll anterior and slide posterior
125
What are the coupled motions for Hip lateral rotation?
requires the head of the femur to roll posterior and slide anterior
126
What are the coupled motions for Hip Abduction?
requires the femoral head rolls superior and slides inferior
127
What are the coupled motions for Hip Adduction?
Requires the femoral head rolls inferior and slides superior.
128
What is the significant detail of open versus closed chain movement in relation to the femur and acetabulum?
Closed kinetic chain the pelvis/acetabulum moves over the femur instead of the femur moving through the pelvis
129
What do the hips do during lumbopelvic extension in a closed kinetic chain?
Hips externally rotate
130
what do the hips do during lumbopelvic flexion in a closed kinetic chain?
Hips internally rotate
131
"Hip drop” (depressed pelvis) causes relative iliofemoral ______ on the ipsilateral side
aBduction
132
"Hip hike” (elevated pelvis) causes relative iliofemoral ______ on the ipsilateral side
adduction
133
When the leg supporting the weight of the body on the lesioned side causes the pelvis to rises ipsilaterally. This presentation is more accurately a dipping of the pelvis towards the contralateral side. (hip drop on the unsupported leg). What is this called?
TRENDELENBURG SIGN
134
External rotation of the pelvis produces relative ___________ rotation of the ipsilateral femur
internal (medial)
135
Internal rotation of the pelvis produces relative _________ rotation of the ipsilateral femur
external (lateral)
136
Impingement typically occurs with excessive motion individually or a lesser degree of combined motions of the _______, ___________, and ____________.
hip flexion, adduction, and medial rotation.
137
Adequate eccentric strength is needed of the psoas to prevent iliacus from pulling the pelvis into an __________
anterior tilt
138
Psoas shares a common midline connection with the quadratus lumborum and works with the QL to _____________________________-
stabilize the spine in the frontal plane
139
Name a posterior muscle that contributes to motion in all 3 planes
Gluteus Maximus
140
The _________ portion of the gluteus maximus contributes to aBduction of the hip
superior
141
The _________ portion of the gluteus maximus contributes to aDduction of the hip
inferior
142
The entire gluteus maximus muscle lies posterior to the axis of medial and lateral rotation, therefore, the muscle is a lateral rotator of the hip joint with the hip ________.
extended.
143
As the hip flexes, the moment arm for lateral rotation decreases, and by the time the hip reaches 90 of flexion, the superior portion of the gluteus maximus actually has a _____________- moment arm.
medial rotation
144
The inferior fibers will maintain what movement irregardless of position?
Lateral/External rotation
145
Clinicians can enhance gluteus maximus recruitment during exercise by combining hip hyperextension with ________ and _____________.
aBduction; Lateral rotation
146
The gluteus medius undoubtedly is an abductor of the hip but, when the hip is flexed, however, virtually the whole muscle contributes to ________ __________ and has little or no capacity to abduct the hip.
medial rotation
147
The Gmed is strongest in 10 degrees of hip ________ when these type of motions are most prevalent during gait.
ADDuction
148
An adductor's primary function is to ___________ ______ _________ during weight shifting from one limb to the other during single leg stance.
stabilize the pelvis
149
What are the lateral rotators of the hip?
Quadratus Femoris
Gemelli
Obturator Internus
Obturator Externus
Piriformis
Gluteus Maximus
150
The piriformis appears to change from a ________ rotator with the hip extended to a _________ rotator with the hip flexed greater than 60 degrees.
lateral; medial
151
There are no muscles at the hip whose primary and consistent action is ______ _____ of the hip. The muscles that _______ _______ the hip depend on hip position and are intimately related to the function of the knee.
medial rotation; medial rotation
152
What part of the knee plays no part in the arthrokinematic movements?
Tibiofibular joint
153
What are the normal ROM for knee flexion and extension?
0-135/155 degrees. Possible hyperextension of up to 15 degrees
154
What is the OPP of the knee?
30 degrees of flexion
155
What is the CPP of the knee?
full extension
156
The _______ femoral condyle is larger than the ______ condyle
medial; lateral
157
The _______ condyle extends farther distally than the _______ femoral condyle when the femur is positioned vertically.
medial; lateral
158
The medial condyle is slightly curved which serves the medial condyle being the __________ ___ _________ and to match the shorter radius
center of rotation
159
Which articular surfaces are largest in the knee joint?
The articular surfaces of the femur are larger than the tibia articular surfaces.
160
Which plateau of the tibia bears more weight?
Medial plateau
161
During Knee flexion:
* The femur rolls _______.
* The femur slides _____ on the tibia
* Contact and compressive loads progressively increase on the ______ tibia as the knee increases flexion
posterior
anterior
posterior
162
During knee extension:
* The femur rolls _______
* The femur slides ______ on the tibia
* Contact and compressive loads progressively increase on the ______ tibia as the knee moves from flexion to extension.
anterior
posterior
anterior
163
What factors cause the lateral femoral condyle to glide posterior during knee flexion?
Medial condyle is the center of rotation, lateral condyle must glide
Lateral rotation of the femur during hip flexion
164
What is the last 20-30 degrees of knee extension called?
Terminal Knee Extension (TKE)
165
What occurs during the "screw home mechanism"
Tibia ER on the femur (Open Kinetic Chain)
Femur IR on the Tibia (Closed Kinetic Chain)
166
–Approximately 5° of __________ with respect to the tibia occurs with knee flexion
femoral abduction
167
What is the function of the patella femoral joint?
Acts as a pulley by lengthening the moment arm of quadriceps
168
The patella glides _____ during knee flexion 5–7 cm. There also is a slight _____ translation of the patella at the beginning of flexion, but by 30° of knee flexion the patella has begun _____ translation that continues to increase at least until 45° of flexion.
inferiorly; medial ; lateral
169
Quadriceps femoris strength as a whole is correlated with the presence or absence of _______ ______ ______.
anterior knee pain
170
The greater the ________ the greater the valgus deformity and increased risk for ________ _______.
Q-angle; patella subluxation
171
Excessive deviation of the patella medially or laterally is known as medial or lateral tracking. Excessive lateral tracking is associated with _______________ __________ and _________ __________.
chondromalacia patellae and patellofemoral pain
172
Patella sitting higher than average is called?
Patella Alta
173
Pattela sitting lower than average is called?
Patella Baja
174
Patella sitting more medial or lateral than normal?
Patella Tracking
175
What are the passive stabilizers of the knee?
Menisci
Ligaments
176
What are the dynamic stabilizers of the knee?
Hamstrings
Quadriceps
IT Band
Adductors
177
primary functions of the menisci is to?
1. Absorb and distribute compressive forces
2. Stabilize the joint
178
What are the depth differences in the menisci?
Medial meniscus is shallow
Lateral meniscus is deeper
179
The medial menisci's accessory attachment is the _______
The lateral menisci's accessory attachment is the _______
MCL
Popliteus muscle tendon
180
Which menisci has less mobility and is more frequently injured?
Medial
181
prevents posterior displacement of the femur on the tibia (anterior displacement of the tibia in relationship to the femur)
ACL
182
prevents anterior displacement of the femur on the tibia (posterior displacement of
the tibia)
PCL
183
prevents valgus movement and rotation
MCL
184
prevents varus movement and rotation
LCL
185
Extensors stronger than flexors throughout the range of motion. Research indicates a 2:1 quadriceps:hamstring ratio _______.
reduces knee symptoms
186
Alignment of the knee is affected by the alignment of the ____, _____, and ____.
hip, ankle, and foot.
187
The knees are closer to the midline, while the feet rest further away from the midline.
Genu Valgum
188
The knees are further from the midline, while the feet are closer to the midline.
Genu Varum
189
Hyperextension of the knee
Genu Recurvatum
190
The greater the_______ the greater the valgus
deformity
Q-angle
191
Male Q-angle= ???
Female Q-angle= ???
10-15 degrees
15-20 degrees
