KIN 340 Test 3

Anterior Pelvic Tilt (Rotation)

"Duck butt" Accomplished by hip flexion and lumbar extension.

Tarsal bones

3 Cuneiform Navicular Cuboid

Posterior Pelvic Tilt (Rotation)

Accomplished by hip extension and lumbar flexion

Anterior Cruciate Ligament (ACL)

Anterior ligament of knee Lateral to medial Hyperextension MOI

Menisci

Attached to tibia, deepen tibial fossa, enhance stability, thicker outside, complain of "locking" when injured.

Fibula

Attachment for the knee joint, no articulation with femur or patella.

Movements of the Knee

Extension Flexion Hyperextension of 10 degrees not uncommon. Slight external/internal rotation

Hip Movements

Flexion Extension Abduction Adduction Internal Rotation External Rotation

Hip Joint

Flexion and extension causes movement at the girdle. Pelvic rotation increases as stride length increases. Stable, few dislocations and subluxations. Strong and dense ligamentous capsule

Bursas

Fluid filled sacs 10-18 in knee depending on the individual Functions for shock absorption, lubrication, reduce friction. Some connected to synovial cavity.

Semimembranosus

Hamstring muscle Origin: Ischial tuberosity Insertion: Medial tibial condyle, closer to joint line than semitend. Action: Flexion of knee, extension of hip, internal rotation of the hip. Palpation: Knee flexion and internal rotation Strengthening: leg curls, squats Stretching: touching toes, reaching toward floor

Semitendinosus

Hamstring muscle Origin: Ischial tuberosity Insertion: Pes anserine (medial) Action: flexion of the knee, extension of hip, internal rotation of the hip. Palpation: Posteromedial thigh during knee flexion and internal rotation. Best during extension of the hip, flexion of knee, but together motion is weak. Strengthening: leg curls, squats Stretching: touching toes, reaching toward floor.

Biceps femoris

Hamstring muscle Origin: Ischial tuberosity and linea aspera Insertion: Lateral condyle of tibia, head of fibula Action: Flexes knee, extends hip, external rotation of hip, posterior pelvic tilt. Palpation: Posterior thigh Strengthening: leg curls, squats Stretching: touching toes, reaching toward floor

Knee Joint

Hinge joint with slight rotation to keep femur in place. Tibia bears most of the weight (medial side, 80%) Injuries always opposite the action.

Peroneal Nerve

Innervates anterior and lateral ankle muscles

Common Peroneal Nerve

Innervates fibular division: biceps femoris (short head)

Tibial Nerve

Innervates posterior and medial ankle muscles

Femoral Nerve

Innervates the knee extensors (quads)

Sciatic Nerve

Innervates tibial division: Semitendinosus, semimembranosus, biceps femoris (long head)

Medial Mensicus

Larger C shape Supports more rotation Attached to MCL

Lateral Collateral Ligament (LCL)

Lateral ligament of the knee Varus MOI Inside force

Arches

Longitudinal -Medial -Lateral Transverse Metatarsal

Medial Collateral Ligament (MCL)

Medial ligament of the knee Valgus MOI (large Q angle) OUside force going in, lower contact force

Rectus Femoris

One of the quadriceps. Origin: ASIS, AIIS Insertion: Superior patella, tibial tuberosity Action: flexion of the hip, extension of the knee, anterior rotation of the pelvis Palpation: Anterior thigh during resisted movements Force decreases as shortens, greater force of knee extension when hip is also extended. Strengthening: Squats, leg extension, etc. Stretching: Pull ankle backward in hand when standing

Tensor Fasciae Latae

Origin: ASIS Insertion: Gerdy's tubercle (lateral anterior tibia) Action: Abduction, flexion of hip Palpation: between iliac crest and greater trochanter Helps prevent external rotation of hip joint Strengthening: Side-lying, putting legs to side Stretching: Adduction, cross legs, lean to side

Sartorius

Origin: Anterior superior iliac spine (ASIS) Insertion: Pes anserine (superior medial tibia) Action: Flexion of the hip, flexion of the knee, anterior pelvic rotation Palpation: ASIS Longest muscle in the body Week doing both movements simultaneously Strengthening: lunges, squats, high knees, etc. Stretching: any extension.

Gluteus medius

Origin: Ilium below crest Insertion: greater trochanter Action: Abduction, lateral pelvic rotation to ipsilateral side Anterior fibers - IR, FL, Ant PR Posterior fibers - ER, Ext, Post PR Strengthening: leg raises, side-lying Stretching: cross legs (add)

Gluteus Minimus

Origin: Just below gluteus medius, more in iliac foss than below crest Insertion: Greater trochanter Action: abduction Strengthening: Abduction (leg raises, side lying) Stretching: Crossing leg over (adduction)

Peroneus Brevis

Origin: Lower 2/3 of lateral surface of fibula Insertion: Base of 5th metatarsal Action: Eversion and plantar flexion Strengthening: Any eversion or plantar flexion movement Stretching: extreme inversion and dorsiflexion with knee flexed.

Flexor Digitorum Longus

Origin: Middle 1/3 of posterior tibia Insertion: Distal phalanx of 4 lesser toes Action: Flexion of 4 lesser toes, inversion and plantarflexion of ankle. Strengthening: Towel grabs (cramp easily if underdeveloped) Stretching: Extreme extension of 4 lesser toes, while ankle in eversion and dorsiflexion.

Extensor Hallicus Longus

Origin: Middle 2/3 of anterior fibula Insertion: Distal phalanx of great toe Action: Dorsiflexion of ankle and extension of great toe Strengthening: Extend toe against resistance and ankle dorsiflexion Stretching: Great toe in full flexion and plantar flexion

Flexor Hallicus Longus

Origin: Middle 2/3 of posterior fibula Insertion: Distal phalanx of big toe, plantar surface Action: flexion of big toe, inversion, and plantarflexion of ankle Strengthening: Towel grabs, walk (with toes), cramp easily if underdeveloped Stretching: Extreme extension of big toe, while ankle in eversion and dorsiflexion

Soleus

Origin: Posterior proximal fibula, proximal 2/3 of posterior tibia Insertion: Posteior calcaneus (achilles' tendon) Action: Plantar flexion Strengthening: heel raises with knee bent Stretching: extreme dorsiflexion with knee bent

Tibialis Posterior

Origin: Posterior upper 2/3 of interosseus membrane. Insertion: Navicular, cuneiform, and bases of 2-5 metatarsals Action: Inversion and plantarflexion Strengthening: Heel raises and inversion exercises Stretching: Extreme eversion and dorsiflexion with knee flexed

Gracilis

Origin: Pubic ramus Insertion: Pes anserine Action: Adductions and internal rotation of hip, weak hip flexion Palpation: medial thigh during resisted adduction, medial to semitendinosus Grouped with all other adductors (magnus, brevis, longus) Strengthening: Breast stroke, horseback riding (adduction) Stretching: abduction

Iliopsoas

Origin: Transverse processes of 5 lumbar intervertebral discs of 12th thoracic vertebrae and iliac fossa. Insertion: Lesser trochanter Action: flexion of hip, flexion of lumbar spine Palpation: Difficult (adjacent to rectus abdominus) True groin muscles (hyperextension) Strengthening: Flexion Stretching: Extension

Tibialis Anterior

Origin: Upper 2/3 of lateral tibia Insertion: Medial cuneiform and base of the 1st metatarsal Action: Dorsiflexion and inversion Strengthening: Any inversion or dorsiflexion activity or walking barefoot. Stretching: Extreme eversion and plantar flexion

Peroneus Longus

Origin: head and upper 2/3 of lateral fibula Insertion: Underside of medial cuneiform and 1st metatarsal Action: Eversion and plantar flexion Strengthening: Turning sole of foot out Stretching: Extreme inversion and dorsiflexion with knee flexed.

Adductor Magnus

Origin: ischial tuberosity Insertion: Linea aspera and adductor tubercle Action: adduction, external rotation and extension of hip Palpation: Between gracilis and hamstrings Strengthening: Breast stroke, horseback riding (adduction) Stretching: Abduction

Popliteus

Origin: lateral condyle of the femur Insertion: Posterior, superior tibia Action: "unlocks" the knee, flexion of the knee, internal rotation of flexed knee Strengthening and stretching are not important.

Extensor Digitorum Longus

Origin: lateral condyle of tibia, fibula head, upper 2/3 of anterior fibula. Insertion: Middle and distal 4 lesser toes Action: Extension of foot and dorsiflexion of ankle Strengthening: Lifting toes up against resistance Stretching: 4 lesser toes in full flexion and plantar flexion

Gastrocnemius

Origin: medial femoral condyle, lateral femoral condyle. Insertion: Calcaneus (achilles' tendon) Action: plantar flexion, knee flexion Strengthening: Heel raises with knee straight Stretching: extreme dorsiflexion with knee straight

Gluteus Maximus

Origin: sacroiliac joint (SI), lateral sacrum and coccyx Insertion: Oblique ridge (superior of femur) Action: Extension, Abduction, Adduction Palpation: Butt Worked especially beyond 15 degrees of hip extension. Used in squatting. Strengthening: squatting, "Jane Fonda", etc. Stretching: Hip flexion

Anterior Hip Muscles

Perform Hip Flexion Iliopsoas Rectus femoris (Q) Sartorius

Lateral Hip Muscles

Perform hip abduction Gluteus medius Gluteus minimus External rotators Tensor fasciae latae

Medial Hip Muscles

Perform hip adduction Adductor magnus Gracilis

Posterior Hip Muscles

Perform hip extension Gluteus maximus Biceps femoris (HS) Semitendinosus (HS) Semimembranosus (HS)

Posterior Cruciate Ligament (PCL)

Posterior ligament of the knee

Anterior Ankle Muscles

Produce dorsiflexion

Lateral Ankle Muscles

Produce eversion

Medial Ankle Muscles

Produce inversion

Posterior Ankle Muscles

Produce plantarflexion

Vastus Intermedius

Quadriceps muscle Origin: Anterior femur Insertion: Patella and tibial tubeosity (middle) Action: Knee extension Strengthening: extension of the knee Stretching: knee flexion

Vastus Medialis

Quadriceps muscle Origin: Close to lesser trochanter, anterior medial femur Insertion: Patella and tibial tuberosity (medially) Action: knee extension Strengthening: Last few degrees of extension Stretching: knee flexion

Vastus Lateralis

Quadriceps muscle Origin: greater trochanter, anterior/lateral aspect of the femur Insertion: Patella and tibial tuberosity (laterally) Action: Extension of the knee Strengthening: Extension of the knee Stretching: Knee flexion

Quadriceps

Rectus femoris Vastus medialis Vastus lateralis Vastus intermedius (deep to rectus)

Pes Anserine insertion

Sartorius Semitendinosus Gracilis

Patella

Sesamoid (floating) bone Embedded in quadriceps tendon and patellar tendon Pulley system: decreased mechanical advantage. Keeps tendon off the bone, makes walking easier.

Screw Home Mechanism

Slight rotation of the knee to fully extend due to the shape of medial femoral condyle. As knee approaches full extension, tibia must externally rotation 10 degrees to achieve proper alignment of tibial and femoral condyles. During initial flexion from full extension, knee "unlocks" by internally rotating to a degree from its externally rotated position to achieve flexion.

Lateral Meniscus

Smaller O shape Not attached to LCL

Left Pelvic Rotation

When the left side of the pelvis moves inferiorly.

Right Transverse Pelvic Rotation

When the pelvis moves clockwise (more movement in the pelvic girdle than femur)

Left Transverse Pelvic Rotation

When the pelvis moves counterclockwise (more movement in the pelvic girdle than femur).

Right Pelvic Rotation

When the right side of the pelvis moves inferiorly.