k & b ii final

secondary causes of inadequate knee flex (pre swing/ initial swing)

• inadequate hip flexion

• inadequate hip ext in term stance

• "no heel off" in term stance

secondary causes of excess flexion/inadequate ext of THIGH

excess knee flexion and excess DF posture

primary causes of excess flexion/inadequate extension of THIGH during stance phases

• hip joint effusion

• hip pain

• joint arthrodesis

• abnormal hip flexor activity

• hip flexion contracture/hypomobility

primary causes of inadequate thigh flex during IC and LR

skeletal deformity & motor control

compensatory cause of inadequate thigh flex during ic and LR

decrease demand on weak hip extensors in LR

secondary cause of excess CL knee flex

intentionally lower shorter reference swing limb to ground for IC

primary causes of excess CL knee flex during swing limb advancement

• knee flexion contracture

• abnormal knee flexor activity

• knee pain

compensatory cause of extensor thrust during mid/term swings

ensure knee ext in term swing in prep for IC when quads are weak

primary causes of inadequate knee extension during mid/term swing

• weak quads

• knee flexion contracture/hypomobility

• abnormal knee flexor activity

• knee pain

• joint effusion

primary cause of excess knee flex during pre swing and initial swing

abnormal hip/knee flexor activity

primary causes of inadequate knee flexion during pre swing/ initial swing

• skeletal deformity

• tibiofemoral and/or patellofemoral pain

• abnormal rec fem/knee extensor activity

secondary causes of inadequate knee flex. (LR)

• abnormal pf activity

• forefoot/flatfoot contact

• pf posture

compensatory cause of inadequate knee flex. (LR)

ACL deficiency

primary causes of inadequate knee flex. (LR)

• weak quads

• abnormal quad acitivity

• impaired proprioception

• tibiofemoral and/or patellofemoral pain

• skeletal deformity

primary causes of varus/valgus thrust

• skeletal deformity

• ligamentum laxity

which of the following is a secondary cause of valgus but not varus

ipsilateral trunk lean

primary causes of knee varus and valgus

• skeletal deformity

• joint instability/ligamentous laxity

• degenerative joint changes

what is valgus

abd of distal tibia relative to femur

what is varus

add of distal tibia relative to femur

what are the primary causes of wobble

impaired proprioception and motor control

what is wobble

repeated alternating flexion and extension

compensatory cause of hyperextension and extensor thrust

increase limb stability with weak quads and pfs

primary causes of hyperextension and extensor thrust

• weak quads

• abnormal quad activity

• impaired proprioception

secondary cause of hyperextension & extensor thrust

pf posture

what are the secondary causes of inadequate knee ext

• excess DF posture

• excess hip flexion posture

primary causes of inadequate knee extension during stance phase

• knee flexion contracture

• abnormal knee flexor activity

• knee pain

• joint effusion

secondary causes of toe drag during ISw

• abnormal rec fem/knee extensor activity which decreases knee flexion on IP leg

• tibiofemoral/patellofemoral pain

• Increased knee flexion on CL leg

secondary causes of no heel off during term stance

• forefoot pain

• inadequate toe extension

• knee hyperextension due to lack of tibial advancement

examples of skeletal deformities for excessive eversion

hindfoot valgus & uncompensated forefoot valgus

weak inverters for excess eversion during stance phase

TA and TP

what are examples of motor system impairments 1. coordination impairments 2. muscle weakness 3. proprioception 4. state of the motor neuron pool

1, 2, 4

secondary causes for inadequate mtp ext

• to avoid forefoot & toe rockers due to pain

• heel off does not occur

primary causes of inadequate mtp extension

• hallus rigidus

• abnormal FHL & FDL activity

primary causes of excess interphalangeal flexion (clawed) during stance

• skeletal deformities

• toe contractures

• abnormal FDL and FHL activity

• weak intrinsic muscles

compensatory cause for excess interphalangeal flexion during stance

increase pf force to control tibial advancement due to weak soleus

compensatory cause of excess eversion

limited ankle df ROM to preserve forward progression

secondary causes for excess eversion during stance

• genu valgus

• compensated forefoot varus

• hip rotational deformities - decreased ER

primary causes of excess eversion

• weak inverters

• skeletal deformities

additional primary cause of excess inversion for ONLY swing phases

flaccid paralysis of pretibialis (TA, EHL, EDL)

secondary causes of excess inversion

• genu varum

• hip rotational deformities

primary causes of excess inversion during stance AND swing

• skeletal deformity such as hindfoot varus and uncompensated forefoot varus

• impaired motor control (TA/TP or soleus)

• equinovarus contracture

secondary cause of early heel off

excess knee flexion

secondary cause of excess df during mid/term stance

excess hip/knee flexion

primary causes of no heel off

• weak pf

• excess ankle df

what mmt grade are the pfs considered weak

less than 4/5

what mmt grade is considered weak for the dfs during IC

less than 3/5

which of the following does not happen during IC

foot slap

primary cause of toe drag

weak dfs

what is toe drag

contact of foot w/ ground during mid swing

what is CL vault

Excess ankle pf with prolonged forefoot weight bearing of the CL stance limb during reference limb swing limb advancement

compensatory causes to CL vault

• voluntary CL pf to lengthen stance limb when there is a longer swing limb

• inadequate knee flexion during IS

• inadequate df in mid swing

primary causes of inadequate df during swing phases

• abnormal pf activity

• weak dfs

• pf contracture

compensatory causes for excess df during mid/term stance

lower CL limb for OIC

primary cause of excess df during mid/term stances

underactive pfs

compensatory causes of inadequate df during mid/term stance

to avoid ankle rocker secondary to weak pfs

primary causes of inadequate df during IC

• weak df

• impaired motor control (abnormal pfs)

• pf contracture

• ankle pain, joint effusion

primary cause of inadequate df during mid/term stance;

• skeletal deformity

• pf spasticity

• pf contracture

compensatory cause of early heel off

voluntary pf to compensate for short reference limb

primary causes of early heel off

• overactive pfs

• PF contracture

• skeletal deformity

what is the primary cause of inadequate pf during LR

abbreviated or absent heel rocker

what is knee flexion always associated with in static posture

ankle DF

what is the primary cause for foot slap

weak dorsiflexors when heel contact at IC occurs

what is the primary causes of BOTH forefoot contact and inadequate dorsiflexion (IC)

• weak dfs

• abnormal pf activity

• pf contracture

• ankle pain/joint effusion

compensatory causes to flatfoot contact

reduce or avoid effects of heel rocker due to weak quads

compensatory causes to forefoot contact

• To accommodate for a shorter limb

• to avoid heel pain

what are the secondary causes of forefoot contact

• knee flexion contracture

• overactive knee flexors

• knee pain

what is the primary cause of flatfoot contact

• weak dfs

• pf contracture

• abnormal pf activity

what are the secondary causes of forefoot contact

• knee flexion contracture

• abnormal knee flexor activity

• knee pain/joint effusion

what is foot slap

rapid PF after heel strike, often audible as forefoot hits ground

what are the 4 major impairment categories for observational analysis

deformity, weakness, impaired motor control, pain

primary causes of medial rotation of thigh

• skeletal deformity: excessive femoral anteversion

• abnormal (overactive) medial rotator muscle activity (add longus/brevis, medial hammie)

• medial rotation contracture

primary causes of lateral rotation of thigh (mid/term stance)

• skeletal deformity: femoral retroversion

• lateral rotation contracture

compensatory cause of medial rotation of thigh

progress COM forward when DF ROM is limited

primary cause of abd of thigh

skeletal deformity

secondary causes of abd of thigh

• pelvic obliquity

• CL pelvic hike

• spinal deformity (scoliosis)

• increase BOS for stability

compensatory cause of abd of thigh

• clear longer swing limb (true leg length discrepancy)

• clear functionally longer swing limb (inadequate hip or knee flexion, inadequate df)

what is add of thigh gait called

scissor gait

primary causes of add in thigh

• skeletal deformity

• add contracture

• abnormal add muscle activity

secondary causes of add in thigh

• pelvic obliquity

• CL pelvic drop

• spinal deformity

primary causes of inadequate flexion of thigh during swing limb advancement

• weak hip flexors

• abnormal hammies

secondary causes of inadequate flexion of thigh during swing limb advancement

• toe drag

• decreased demand on hip extensors in prep for initial contact and loading response

compensatory causes for excess thigh flexion/ inadequate extension during swing

• inadequate knee flexion in IS for toe clearance

• inadequate ankle DF in mid swing for toe clearance

• longer swing limb

• CL knee flexion which shortens stance limb

compensatory cause of lateral rotation of thigh during swing

advance limb using hip add when hip flexors are weak

circumduction

thigh abd w/ flexion followed by add during swing limb advancement

compensatory cause of circumduction

advance limb and clear foot when hip flexion, knee flexion, and/or ankle DF are inadequate

primary causes of CL drop during mid/term stance

• weak hip abd on reference limb

• abnormal add muscle activity of reference limb

• adduction contracture

secondary causes of CL drop during mid/term stance

• skeletal deformity

• pelvic obliquity

compensatory cause of CL drop during mid/term stance

• short CL (leg length discrepancy)

primary causes of excess anterior tilt during mid/term stance

• hip flexion contracture

• abnormal hip flexor activity

• weak hip extensor and/or abdominal muscles

secondary causes of excess anterior tilt mid/term stance

forward trunk lean

primary cause of excess backward rotation during term stance

inability to perform selective activation of trunk, pelvis, hip, and/or pf muscles

secondary cause of excess backward rotation during term stance

CL excess forward rotation

compensatory causes of excess backward rotation during term stance

• trailing limb w/ limited thigh ext in term stance (hip flexion contracture)

• trailing limb when there is no heel off in term stance

primary cause of inadequate backward rotation during term stance

inability to perform selective activation of trunk, pelvis, hip, and/or pf muscles

secondary cause of inadequate backward rotation during term stance

CL inadequate forward rotation

primary causes of ipsilateral drop

• weak CL hip abductors

• abnormal CL adductor muscle activity

• CL add contracture

secondary causes for ipsilateral drop

• skeletal deformity

• pelvic obliquity

compensatory cause for ipsilateral drop

short reference limb

compensatory cause for pelvic hike

for toe clearance when there is

• inadequate knee flexion in pre/initial swing

• inadequate hip flexion and ankle DF in mid swing

primary causes of excess pos tilt

• hamstring tightness/contracture

• abnormal hamstring muscle activity