Week 8 Muscles and Movements of Lower Extremity – Ch 8 Objectives Explain how anatomical structure affects movement capabilities of lower extremity articulations. Identify factors influencing the relative mobility and stability of lower extremity articulations. Explain the ways in which the lower extremity is adapted to its weightbearing function. Identify muscles that are active during specific lower extremity movements. Describe the biomechanical contributions to common injuries of the lower extremity.

Lower Extremity Outline Monday Review epicondylitis and carpal tunnel syndrome Hip Joint Structure (Th Fig 7.1) Hip Joint Muscles and Movements (Th Fig 7.23, 7.24) Knee Joint Structure (Th Fig 8.1) Knee Jt Muscles and Movements Common knee injuries – patellar chondromalacia (a.k.a. runners knee) and anterior cruciate tear Wednesday Ankle Joint Structure (Th F 9.4) Ankle Jt Muscles and Movements (Th Fig 9.5, Kr Fig 6.16) Common ankle and foot injuries - plantar fascitis, pronated feet

Hip Joint Jt Structure - Th Fig 7.1 Uni-articular muscles (Th F 7.24) Flexion - iliopsoas Extension - gluteus maximus Abduction - gluteus medius and minimus Adduction - adductor brevis, longus, & magnus Biarticular muscles Hip flexion, knee flexion - sartorius Hip flexion,knee extension - rectus femoris Hip extension, knee flexion - hamstrings Note passive and active insufficiency of biarticular muscles

Hip: Front View

Loads on the Hip During swing phase of walking: Compression on hip approx. same as body weight (due to muscle tension) Increases with hard-soled shoes Increases with gait increases (both support and swing phase) Body weight, impact forces translated upward thru skeleton from feet and muscle tension contribute to compressive load on hip.

Compressive forces on hip jt Socket while walking may exceed 3 to 4 times body wt, 5-6 times bw while jogging, and 8-9 times bw while stumbling

Muscles of Lower Extremity:

Hip Jt Muscle Vectors:

Thigh muscles in cross-section – which ones do not cause hip joint movement?

Physiological cross-sectional area (PCSA) of hip jt muscles Why are lateral rotators & gluteii muscles so large?

Common Injuries of the Hip Fractures Usually of femoral neck, a serious injury usually occurring in elderly with osteoporosis Contusions Usually in anterior aspect of thigh, during contact sports Strains Usually to hamstring during sprinting or overstriding

Knee Joint Ligaments and cartilage (Th F 8.1) medial and lateral collateral ligaments anterior and posterior cruciate ligaments medial and lateral meniscus Muscles and movements (Kr F 6.4, Adrian F 4.25) Extensors quadriceps femoris (rectus femoris, vastus lateralis, vastus medialis, vastus intermedius) Flexors hamstrings (semitendinosus, semimembranosus, biceps femoris)

Knee Joint Structure: 25% of Alpine skiing injuries are ligament Peripatellar pain (runner’s knee) caused by imbalance of stress on patella

Lower Extremity Misalignment: Q angle is larger in females due to Wider hip structure, increasing potential for PFPS (Patellofemoral pain syndrome)

Quadriceps Tendon and Patella Force Lines Compressive force at PFJ is ½ body wt during normal walking, and over 3 times bw during stair climbing Comp force increases as knee flexion Angle increases

Cruciate Ligaments and Shear Stress

Loads on Knee Forces at tibiofemoral Joint Shear stress is greater during open kinetic chain exercises such as knee extensions and knee flexions Compressive stress is greater during closed kinetic chain exercises such as squats and weight bearing exercises. Forces at Patellofemoral Joint With a squat, reaction force is 7.6 times BW on this joint. Beneficial to rehab of cruciate ligament or patellofemoral surgery

Thigh muscles in cross-section:

PCSA of Muscles Crossing Knee

Common Injuries of the Knee and Lower Leg ACL injuries PCL injuries MCL injuries Prophylactic Knee Bracing Meniscus Injuries Iliotibial Band Friction Syndrome Breaststroker’s Knee Patellofemoral Pain Syndrome Shin Splints

Foot and Ankle joint structure Bones and arches of foot (Th F 9.4) Tibia, fibula, calcaneus, talus, other tarsals, metatarsals, phalanges Longitudinal arch, transverse arch plantar fascia Movements of ankle - talocrural joint (Kr Fig 6.14) Movements of foot - subtalar, intertarsal, intermetatarsal, interphalangeal (Cav Fig 3.15, 3.16, 3.17, 4.4, 4.5)

Bones of Shank and Foot:

Ankle Joint Muscles and Movements Kr Fig 6.16, 6.17, Th Fig 9.5, Th Fig 9.18 Anterior compartment - All dorsiflex Tibialis anterior (also inverts) Extensor digitorum longus (also everts) Posterior compartment - All plantar flex Tibialis posterior (also inverts), gastrocnemius (also flexes knee), & soleus Lateral compartment - All plantar flex & evert Peroneus longus & brevis Foot pronation and supination

Ankle and Foot Muscles:

Percent PCSA of Muscles Crossing Ankle

Subtalar Axis:

Foot Pronation and Tibial Torsion:

Rearfoot Movement During Running:

Plantar Fascium What is the plantar fascium? - attaches to calcaneus posteriorly and to the first row of phalanges anteriorly What is its function? passive intertarsal stabilization

Arches of the Foot:

Plantar Fascium: Plantar fascitis is 4th most common cause of pain among runners (1st – knee pain, 2nd – shin splints, 3rd- achilles tendonitis)

Plantar Fascitis – 4th leading cause of pain in runners What causes plantar fascitis(inflamation of plantar fascium)? anatomic anomalies microtears in fascium and bone spurs inadequate flexibility of plantar flexors inadequate strength of plantar flexors functional pronation (eversion and abduction) overuse overweight poorly designed and poorly fitted shoes running and jumping on hard surfaces sudden increase in stress Treatment remove the cause(s) Therapeutic treatment to promote body’s natural healing NSAIDS Intermittent ice and heat Ultrasound, diathermy, massage

Patellar Chrondomalacia (a. k. a Patellar Chrondomalacia (a.k.a. Runner’s Knee) – leading cause of pain in runners) Primary cause is imbalance in forces on patella Increased Q angle Pronated feet Tissues affected Degrading of articular cartilage of patella & femoral condyles Fluid collection, causing joint stiffness Symptoms Pain around patella with no particular injury causing it Worse going upstairs and downstairs, or after sitting awhile Feels like knee needs to be stretched Prevention/treatment Surgery is seldom beneficial Wet test – walk with wet feet on floor and determine if you have a hypermobile foot. If so, purchase shoes and/or orthotics to decrease degree of foot pronation Exercises to increase strength/endurance of vastus medialis

Runner’s knee, cont’d Wet test: Safe exercise to develop vasti muscles Do not use knee sleeves! Do not bend knee more than 20-30 degrees while doing extensions with resistance!

Websites for Muscles, Movements, & Problems of Lower Extremity MMG - Patient Education Foot and Ankle TOC MMG - Patient Education Knee TOC Problems on lower extremity: Introductory problems, p 263: 7,8,9,10 Additional problems, p 263-264: 1,5,6,8,9