Bell Ringer Name at least 5 bones in the body Medical terminology and generic terminology

Unit 5: Lower Extremity

Hip/Pelvis and thigh

Anatomy Pelvis formed by 2 innominate bones Function: Sacrum and coccyx Function: Support the spine/trunk and transfer their weight to the lower limbs Attachment for trunk and thigh muscles Protect viscera Hip – articulation of femur and acetabulum Femur- thigh bone

Femur

Ligaments, Joint capsule, and synovial membrane Glenoid labrum- fibrocartilage surrounding the rim of the acetabulum Ligaments Pubofemoral Iliofemoral (Y ligament of Bigelow) Strongest ligament Ischiofemoral Articular capsule- encloses hip joint All help reinforce the hip joint and provide stability

Hip musculature Anterior Posterior Iliacus Psoas muscles (major and minor) Posterior Tensor fascia latae (TFL) Gluteals (maximus, medius, minimus) 6 deep outward rotators (piriformis, gemellus superior, gemellus inferior, obturator internus, obturator externus, quadratus femoris)

Anterior

Posterior

Muscle Action Iliopsoas Flexes the thigh and trunk on femur Gluteus maximus Extends and externally rotates thigh Gluteus minimus and medius Abducts and medially rotates thigh Piriformis Rotates the thigh laterally and assists in extending and abducting thigh Superior gemellus, Inferior gemellus, Obturator internus, Obturator externus, Quadratus femoris Rotates thigh laterally Tensor fascia latae (TFL) Assists in flexion, abduction, and medial rotation of thigh

Bell Ringer Name 3 muscles Be able to identify where they are located and what their action is I am going to call on at least 3 people

Thigh muscular Anterior thigh Posterior thigh Sartorius Quadriceps Rectus femoris Vastus lateralis Vastus medialis Vastus intermedius Posterior thigh Popliteus Hamstrings Biceps femoris Semimembranosus Semitendinosus Medial thigh (groin) Gracilis Pectineus Adductors (magnus, longus, brevis)

Anterior and medial

Posterior

Anterior Muscle Action Sartorius Flexes the thigh and leg and laterally rotates thigh Quadriceps (vastus lateralis, vastus medialis, vastus intermedius, rectus femoris) Extends the leg Rectus also flexes the thigh

Posterior Muscles Actions Hamstrings (semitendinosus, semimembranosus, biceps femoris) Flexes the leg and extends the thigh Popliteus Flexes the leg and rotates tibia medially

Medial Muscles Actions Adductors (magnus, longus, brevis) Adducts and laterally rotates the thigh Pectineus Gracilis Adducts and flexes the thigh

Mini Project-Partners only Come up with an activity to help teach you classmates a way to remember and learn the hip anatomy, muscular, and actions… Examples: Crossword puzzle Word search- but you have to have more than just search for the words Puzzle Diagram Rap/Song Poem Video NO Kahoot – may use Quizlet No more than 2 groups can do an activity- first come, first served

Injuries Hip contusion Hamstring strain Quad strain Groin strain Dislocated hip Snapping hip Hip pointer Stress fracture

Search your mind Group activity Look up the injury assigned to your group. Identify what causes the injury (MOI), some signs and symptoms, and treatment. You need to make a Powerpoint presentation for your injury. Each group will present their injury.

Evaluation of Hip injury History: Observation: Palpation: Special tests:

Injuries Hip contusion MOI: impact to a relaxed thigh Signs and symptoms: Pain Loss of function Bruising Weakness Treatment Light stretch, rest, and ice

Hip injuries Quad strain MOI: sudden, violent, forceful contraction of the hip and knee into flexion Overstretch Signs and symptoms: Pain Swelling Loss of knee flexion Treatment: RICE, pain free ROM, rehab

Hip injuries Hamstring Strain Most common injury to thigh MOI: change from role of knee stabilization to hip extension Signs and symptoms: Bruising Pain Loss of function Varies some with grade of injury Treatment: REST RICE NSAIDS rehab

Hip injuries Groin strain MOI: running, jumping, or twisting with external rotation Signs and symptoms: Pain Weakness Internal hemorrhage Nagging pain Treatment: RICE NSAIDS REST best treatment rehab

Hip injuries Dislocated hip MOI: traumatic force along the axis of the femur Most common: posterior (to acetabulum) with femoral shaft adducted and flexed Signs and symptoms: Palpation reveals that head of femur has moved posterior to acetabulum May result in tearing of capsule and ligaments; fracture; nerve damage Treatment: immobilize and medical attention

Hip injuries Snapping hip Treatment: Commonly seen in dancers, gymasts, hurdlers, and sprinters Due to muscle imbalance IT band snapping over the great trochanter iliofemoral ligaments snapping over femoral head Long head of biceps femoris over ischial tuberosity Treatment: Decrease inflammation and pain with ice, anti-inflammatories, and modalities

Hip injuries Hip pointer Iliac crest contusion Due to fall on the iliac crest Handicapping injury and hard to treat Signs and symptoms: Immediate pain, spasms, and transitory paralysis of soft structures Treatment: RICE Severe- bed rest and refer to doctor for x-ray

Hip injuries Stress fracture Most common in distance runners Due to repetitive forces on the hip while running Signs and symptoms: Rest Refer to doctor – may need xray and/or MRI May cross train when allowed

Knee

Anatomy Bones: Femur Tibia Fibula Patella- “knee cap”

Anatomy Meniscus 2 fibrocartilages: Functions: Medial (C shaped) Lateral (O shaped) Functions: Deepen articular facets of tibia Cushion any stresses Maintain space between femoral condyles and tibial plateaus

Anatomy Ligaments Anterior Cruciate Ligament (ACL) Prevents the femur from moving posteriorly during WB Limits anterior translation of tibia in non-WB Posterior Cruciate Ligament (PCL) Resists internal rotation of the tibia Prevents hyperextension of knee Limits posterior translation of tibia in non-WB

Anatomy Ligaments cont’d Medial collateral ligament (MCL) Prevents valgus force Lateral collateral ligament (LCL) Prevents varus force

Muscles Knee flexion Knee extension External Rotation Internal Rotation Hamstrings Gracilis Sartorius Gastrocnemius Popliteus Soleus Quadriceps Biceps femoris Semitendinosus Semimembranosus

posterior

anterior

Knee injuries MCL sprain ACL sprain Meniscal injuries Patellofemoral pain syndrome Patellar tendinitis IT band syndrome

Search your mind Group activity Look up the injury assigned to your group. Identify what causes the injury (MOI), some signs and symptoms, and treatment. Each group will present their injury.

Knee Injuries MCL Sprain MOI: direct blow from the lateral side in a medial direction (valgus force) or from lateral tibial rotation Signs and symptoms: Instability of the knee joint Pain in medial aspect Swelling (depending on severity) ROM changes Treatment: RICE Crutches or splint Gradual rehab Refer to doctor depending on severity

Knee injuries ACL sprain

Knee injuries Menisical injuries MOI: weight bearing combined with a rotary force while the knee is extended or flexed Signs and symptoms: Swelling Joint line pain Loss of motion Locking, catching, or giving away of joint Treatment: Conservative rehab Refer to doctor  may need surgical intervention

Knee injuries Patellofemoral pain syndrome lateral deviation of the patella as it tracks in the femoral groove Tight hamstrings or gastroc Tight lateral retinaculum Tight IT band Patella alta Vastus medialis weakness Signs and symptoms: dull ache in center of knee, patellar pain and crepitus, swelling Treatment: stretching and strengthening program

Knee injuries Patellar tendinitis AKA jumpers knee MOI: jumping, kicking, running (repetitively) Signs and symptoms: Pain and tenderness at the inferior angle of patella Pain may progress depending on severity (after activity, during activity) Treatment: ice, modalities, ice, rehab

Knee injuries IT band syndrome AKA runner’s or cyclist’s knee MOI: length leg discrepancy, genu varum, pronated feet, muscular tightness Signs and symptoms: pain along the lateral leg and knee Treatment: Correction foot alignments Ice massage Proper warm up and stretching

Lower leg/ankle

Anatomy Tibia Fibula Talus Calcaneus Weight bearing bone of lower leg Heel bone

Articulations Inferior tibiofibular joint Talocrural joint (ankle joint) Subtalar joint

Ligaments Lateral ligaments Medial Anterior talofibular Posterior talofibular Calcaneofibular Medial Deltoid

Muscles (4 compartments) Anterior Tibialis anterior Extensor hallucis longus Extensor digitorum longus Peroneal (fibularis) tertius Lateral Peroneal (fibularis) longus Peroneal (fibularis) brevis Superficial posterior Gastroc Soleus Plantaris Deep posterior Popliteus Flexor hallucis longus Flexor digitorum longus Tibialis posterior

Puppet Muscle Madness Everyone will need their string and draw a muscle from the hat. We will tie the string to one of your toes and “puppet” the movement to grasp an understanding of muscle actions.

Anterior Muscle Action Tibialis anterior Dorisflex and inverts foot Extensor hallicus longus Dorsiflex and inverts foot; extends great toe Extensor digitorum longus Dorsiflex and everts foot; extends the toes Peroneus (fibularis) teritus Dorsiflex and everts foot

Lateral Muscles Actions Peroneus (fibularis) longus Plantar flexes and everts foot Peroneus (fibularis) brevis Plantar flexes and everts the foot

Superficial posterior Muscles Actions Gastrocnemius Flexes the leg and plantarflexes the foot Soleus Plantarflexes the foot Plantaris Flexes the leg; plantarflexes the foot

Deep posterior Muscles Actions Popliteus Flexes and rotates the leg medially Flexor hallicus longus Plantar flexes and inverts the foot; flexes great toe Flexor digitorum longus Plantarflexes and inverts the foot; flexes the toes Tibialis posterior Plantarflexes and inverts the foot

Ankle injuries Lateral ankle sprain Medial ankle sprain Syndesmotic (high) ankle sprain Achilles tendinitis Medial tibial stress syndrome Compartment syndrome

Search your mind Group activity Look up the injury assigned to your group. Identify what causes the injury (MOI), some signs and symptoms, and treatment. Each group will present their injury.

Ankle injuries Lateral ankle sprain Ligaments involved: CF, ATF, PTF MOI: Inversion Signs and symptoms: Painful pop on lateral side of ankle Bruising Instability Swelling Weakness Treatment: RICE/crutches if unable to walk Rehab

Ankle injuries Medial ankle sprain Ligaments involved: deltoid MOI: eversion Signs and symptoms: Painful pop on medial side of ankle Bruising Instability Swelling Weakness Treatment: RICE/crutches if unable to walk Rehab

Ankle injuries Sydesmotic Sprain (high) MOI: forced dorsiflexion Typically happen in conjunction with lateral or medial ankle sprain Signs and symptoms: Severe pain Loss of function Pain with passive ER and dorsiflexion Treatment: Take longer to heal Immobilization RICE rehab

Ankle injuries Achilles tendinitis Inflammation of the Achilles tendon MOI: repetitive weight-bearing activities; duration and intensity of activity is increased too quickly with insufficient recovery time; overuse injury Signs and symptoms: Generalized pain and stiffness in Achilles Uphill running and hill workouts Crepitus in tendon Treatment: Proper shoe ware Decrease activity and proper training Modalities Massage

Ankle injuries Medial tibial stress syndrome (MTSS) Shin splints MOI: repetitive microtrauma due to running and jumping activities Weakness of leg muscles Shoes Training errors (on hard surfaces) Signs and symptoms: pain in medial leg Treatment: stretching, strengthening program, change in shoes and training, ice, modalities

Ankle injuries Compartment syndrome MOI: increased pressure within one of the compartments of the lower leg and causes compression in the muscles and neurovascular structures Signs and symptoms: Deep aching pain Tightness and swelling Pain with passive stretching Reduced circulation and sensory changes Treatment: Ice and elevation, stretching Refer to doctor

Foot

Anatomy Toes (phalanges) First toe- hallux Metatarsals – 5 bones between the phalanges and tarsal bones Tarsal bones Calcaneus (heel bone) Talus Cuboid Navicular Cuneiforms – first, second, and third

Arches of the foot Metatarsal arch Transverse arch Medial longitudinal arch Lateral longitudinal arch Plantar fascia- band of fibrous tissue along the bottom of the foot

Articulations Interphalangeal (IP) joint Metatarsophalangeal (MTP) joint Intermetatarsal joint Tarsometatarsal Joint (Lizfranc) Subtalar joint Midtarsal joint

Muscles and movements Dorsiflexion Plantarflexion Tibialis anterior Extensor digitorum longus Extensor hallicus longus Peroneus teritus Plantarflexion Gastrocnemius Soleus Plantaris Peroneus longus and brevis Tibialis posterior FHL FDL

Muscles and movements Inversion, adduction, and supination “Tom, Dick, and Harry” Tibialis posterior Flexor digitorum longus Flexor hallicus longus Eversion, abduction, and pronation Peroneus longus Peroneus brevis Peroneus tertius EDL

So how does walking work?

Gait cycle

Let’s walk it out… Looking for… Pronation Supination Toe out/in

Foot deformities/injuries Pes planus – flat foot Pes cavus – high arch Plantar fascitis Jones fracture – fx at base of 5th metatarsal Turf toe (great toe hyperextension)

Lower extremity PROJECT TIME Small groups Pick a body part Make a project to demonstrate your knowledge about the body part… Make a model Make a music video Make a diagram or picture If you have another idea, you may ask and I can approve it NO PowerPoints OR papers HAVE FUN WITH IT!!!

REVIEW with plicker We will review all body parts and make sure everyone is knowledgeable about the whole lower extremity. For test…you may pick two body parts and you will be tested on those.