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

2. Unit 5: Lower Extremity

3. Hip/Pelvis and thigh

4. 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

6. Femur

7. 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

9. 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)

10. Anterior

11. Posterior

12. 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

13. 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

14. 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)

15. Anterior and medial

16. Posterior

17. 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

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

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

20. 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

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

22. 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.

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

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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

32. Knee

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

34. 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

35. 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

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

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

39. posterior

40. anterior

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

42. 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.

43. 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

44. Knee injuries
ACL sprain

45. 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

46. 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

47. 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

48. 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

49. Lower leg/ankle

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

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

52. Ligaments Lateral ligaments Medial Anterior talofibular
Posterior talofibular
Calcaneofibular
Medial
Deltoid

55. 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

56. 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.

58. 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

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

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

61. 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

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

63. 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.

64. 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

65. 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

66. 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

67. 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

68. 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

69. 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

70. Foot

71. 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

73. 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

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

76. 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

77. 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

79. So how does walking work?

80. Gait cycle

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

82. 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)

83. 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!!!

84. 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.