LLO2 midterm (mod 1-8)

Step

sequence of events from a specific point in the gaiton one extremity to the same point in the opposite extremity

Step length

distance traveled between the initial contactsof the right and left foo

Step width

distance between the points of contact ofboth feet

Stride

two sequential step

Cadence

number of stepstaken per unit time

Velocity

Velocity—distance covered per unit time

Ground reaction force (GRF)

Contact of the foot with the ground creates forceyielding vertical, anteroposterior (A/P), and mediolateral(M/L) component

Center of pressure (CoP)

Shows the path of the pressure point under the foot duringgai

Efficient gait

minimal side to side motion

max forward motion

body raise and fall aprx 5 cm

path is sunisoidal curve w heigh at midstance and lowest pt at IC

Stance phase

high energy phase, knietic energy is absorbed from the ground and transfered up the kinetic chaing

Swign phase

nonweight bearing phase of gait low energy phase

IC

start 1st rocker, foot makes contact w ground, impact decceleration

Hip flexed, knee flexed, ankle PF

eccentric dorsi flexor, knee extensors prep for deceleration

Loading response

10% end 1st rocker

weight bearing stability, shock absorption, initiation of forward progression

hip flexed, knee flexed, ankle pf,

muscles decelerate in coronal plane and stabliize,

knee extensors pamp up

PR ramp up while dorsiflexors ramp down

Mid stance

2nd rocker

stability of trunk and limb

forward prgression - tallest

hip neutral, knee flexed, ankle dorsiflexed

glute med activation to help w forward propulsion, quads stabilize knee, eccentric pf hold bas so trunk can advance forward

Terminal stance

3rd rocker

stabiity of trunk and limb

forward progressionand propulsiopn

hip extended, knee near full extension, ankle DF

hip flexor prep for concentric contraction, concentric PF

Preswing

contralateral foot contact, end 3rd rocker

propulsion

initialte trajectory for foot and leg

hip- neutral, knee flexed, ankle PF

strong hip flexors and pf drive leg into swing phase

inital swing

limb advancement

foot/limb clearance

leg swings by momentum

hip flexed 30, knee flexed, ankle neutral

strong hip flexion and DF for adequate step length

mid swing

continued limb advancement

continued foot clearance

hip flexed, knee exended, ankle neutral

adductors flex in hip and DF concentrically contract

terminal swing

deccelerate limb advancement

prepare to stablize limb/trunk

hip flexed, knee flexed, ankle “PF”

hip ab/aductors ham and quads and df prepare for IC

Observational gait analysis

poor to moderate reliability, good observation, auditory clues, observe left and right sides seperatley, self selected pace

Knee anatomy

Incongruent surfaces

long levers

stronger muscle pull laterally

Functional KOs types

unloading(OA) and Ligamentous(protect/limit strain)

Funtional KO indications

unstable knee joint

minimize giving way complaints

stance phase

Equation of KO rehab

Properly fitted brace + rehabilitation program = vital adjuncts in treatment of knee instability

Knee sleeve w condylar pads

palumbo(brand)

patellar tracking

chondromalacia patellae

provide medially directed force to patella

What is chondromalacia patellae

Knee condition characterized by softening and damage to the cartilage on the underside of the kneecap. Commonly causes pain and a grinding sensation when moving the knee. Often seen in athletes and individuals with poor knee alignment or overuse. Treatment includes rest, physical therapy, and pain management.

KO with joints

weakness or deformity

mild instability in any plane

extension stop

lever arms

KO w joints and pads

condylar pads to assis w knee control and wont allow orthosis to move down leg.

don by sliding over knee

Swedish knee cage

single axis knee joint with goal to prevent hyperextension

if pt has good ROM, coronal plane and MMT this is good option

O is low profile and simple

hinged to tract knee motion

effective control of genu recurvatum

use hard stops and straps

Unloading concept

OA= bone on bone

orthosis is applied w straps with correct tension to unload the knee

take pressure and shift elsewhere

Ligamentous bracing

ACL, PCL, MCL,LCL, OA

post op, pt wear

procedural

1-2 bands per sig

Positional KO

maintain or increase ROM

KO w locking joint, static and allow multiple locking positions, used for contracture management. pad on patella- corrective force

Knee immobilizers

Foam and velcro

metal stays

prevents knee motion

kinesthetic reminder

knee immobilizers indications

immobilize s/p procedure

prolonged positioning

early mobilization

AROM/IROM

post-op, ROM can set increments

Acute 3-6 weeks

more open/customizable

try to go as close to next joint as possible to increase lever arms

Contracture reducing dynamic force

dynasplint provides low load, prolonged duration stretch using an adjustable tension spring

rental basis

Cancellous bone

Spongy bone found inside bones, composed of trabeculae. It provides structural support, stores bone marrow, and helps in bone metabolism.

Cortical/compact bone

Dense and strong type of bone found on the outer layer of bones. Provides structure, support, and protection to the body.

Epiphysis

The epiphysis is the rounded end of a long bone, which is responsible for the growth and development of the bone. It contains a growth plate, where new bone tissue is formed. crucial for bone growth and plays a vital role in the overall skeletal development of an individual.

Metaphysis

The region of a long bone located between the epiphysis and diaphysis. It is responsible for bone growth and contains the growth plate, which allows for longitudinal bone growth.

Diaphysis

The long, tubular shaft of a bone that provides support and strength is called the diaphysis. It is composed mainly of compact bone and contains the medullary cavity, which houses yellow bone marrow. responsible for transmitting forces generated by muscles and supporting body weight.

periosteum

Outermost layer of bone

Dense connective tissue

Covers and protects bone surface

Contains blood vessels and nerves

Involved in bone growth and repair

medullary cavity

The central hollow space within long bones, filled with bone marrow and surrounded by compact bone tissue. It is responsible for producing and storing red and yellow bone marrow, which play a crucial role in the production of blood cells and storing fat.

Rule of 3rds

divide bone into 3rd

mid 3rd control only Diaphysis

prox/distal 3rd = brace next joint

Complete fractures

transverse

oblique

spiral

comminuted

avulsion

Transverse fracture

perpendic to long axis

oblique fracture

diagonal to long axis of bone- rotatry motion

spiral fracture

progress around the longitudinal axis of bone

comminuted fracture

3 seperarte bone frag- high impact

avulsion

portion of bone that is dislodge by excessive tension of tendon

incomplete fracture

greenstick

fissure

stress fracture

greenstick fracture

immature bone

bone is only broken only one one side, bent on opposite

bowing is often observed

Fissure

fissure fractures usually inovlve onlyu one cortex of the bone w the periosteum remaining intact

stress fracture

repetative stress to bone, no accute event

Femoral head fractures

occur primarily in association w hip dislocations

Pipkin fracture

femoral head fractures

Slipped capital femoral epiphysis

displacement of the head relative to the femoarl shaft

males 10-15

Legg-calve- perthes disease

avasucalr necrosis to femoral head, children 3-12 year old causing osteochondritis of the prox fem epiphysis

femoral shaft fractures

high energy level trauma

possible indicitive of child trauma

Inflammatory response

24-72 hours

hematoma, blood supply interuupted, osteocytes die

acute swelling occurs

macrophages (48hr) arrive at the fracture site to begin the process of removing tissue debri

reparative response

2 day -2 weeks

neovascularization

cells form cartilage, bone or fibrous

callus is formed- starts soft and malluable and grows hard

as callus forms, immobilization should reduce

remodeling

several years- woven bone is dependednt to the mechanical foces applies to it

fracture healing is complete, repopulation of the medullary canal

Cortical bone remodeling

occurs by invasion of an osteoclast whic is then followed by osteoblasts which lay down new lamellar bone(osteon)

Cancellous bone remodeling

occurs on the surface of the trabeculae which causes the trabecule to become thicker

Femoral fracture timelines

immoblisization- 2-4 weeks closed

4-6 weeks(+) open

partial WB= 6-8 weeks

full weight bearing in O until satisfaction w union

tibial fracture timelines

1-3 week closed

4-6 week open

3-6 week for patial weight bearing

full weight bearing until satisfaction w union

Healing goals

begin muscle function asap, early graded function

encourage adjacent joint motion

control fragments through soft tissue compression, contain all soft tissue

avoid avascular disease polycentric joints

capable of accommodating volume change, bivalve construction

contraindications for prefab

massive soft issue injury

bony prominences

gross deformity/ obesity

Pneumatic walker

for foot fracutes= tarsal, met, phalanges

tibial fracture OX

distal and mid 1/3 tib and tib/fib

femoral fx ox

proximal 1/3 tib

dital 1/3 femoral fx

middle 1/3 femoral fx(post op)

HKAFO fraxture OX

prox 1/3 femoral fx post op

Excessive Pronation related to:

pronation neccesary for shock absorption- over 15.5 degree= LE injury

Genu valgum, LLD, pes planus, hip musculature imbalance, soft midsoles in shoes

what does excessive pronation exhibit

calcaneal eversion

lowering and elongation of medial long arch

increased pressure on first MTP

medial knee pain

Excessive supination

ecvessive contacto n lateral aspect of foot

tendency to sprain (inversion)

rigid at IC(no shock absorption)= not noemal gait bc of LR and MS

excessive loading through talocrual and tome of talus

break down of shoe(uneven surface= sprains)

Causes of excessive supination

congenital club foot(not corrected w surgery or fusion of taral and midtarsal bones= ^ chance)

antalgic gait(maybe hallux rigidis)

Internal/ external foot progression angle

toe in/ out- found in mid stance or just after preswing

External= almost always due to hip= stress on medial and plantar surface

internal= stress on lateral soft tissues

Causes of in/external FPA

Tibial rotation, hip rotation, excessive pronation during stance

Plantarflexed ankle at IC

causes= Gastroc spasticity= can only keep ankle in PF(toe walking)

Drop foot- nerve pathology that prevents DF contraction

Hamstring pathology- keeping (gastroc)muscle short eases pain

knee joint pathology

essentially enter gait in LR

Flat foot at stance

reduced step length(bc inadequate push off)(no IC or PS)

absence of intial heel contact= steppage gait

PF at ankle is avoided in term stance and preswing

Causes of flat foot stance

Antalagic gait(pain at max DF w osteocytes in talor dome= shorted step)

ankle sprain

gastroc strain

soleus strain

Inadequate ankle plantarflexion moment at push off

foot flat goes hand in hand

reduced push off, not enough propulsion bc PF group= weak

cut step short

causes of Inadequate Ankle PF moment at push off

inaduqate strength (triceps surae)

acute ankle sprain(pain and swelling)

forefoot pathology

Excessive knee flexion at IC Causes

check alignment if already wearing orthosis

pain, hamstring strain, tight hams or spasm, hip adductor strain, sciatic nerve pathology(herniated disc or piriformis syndrome)

(if die to lumbar or sciatic nerve- ant trunk lean, hip flexion too)

inadequate knee flexion angle during stance

formally flex to 20 degree during stance- controlled by eccentric contraction of quads)

causes= quadricepts pathology (inclusion body myositits- weakness worsen and damage muscles) + knee joint pain

inadequate knee flexion during swing

flexed to 30-60 during walking(40 is av), over 90 during running

less energy efficient (see circumduction and ER to help clear limb)

Causes of inadequate knee flexion during swing

hamstring pathology

strain, spasms, sciatica

Genu varum

laxity of LCL

med meniscus damage

DJD or cartilage damage

body deformity

OA or RA

Genu valgum

laxity of MCL

lateral meniscus damage

cartiaginous deterioration

obesity

Shortened step length causes

pain( hip, knee ankle- shorten stride ot not make symptoms worse)

inadequate push off

inadequate pull off(hip flexors)

Shortened stance time causes

antalgic gait patter

pain- wither acute or chronic- pt wants to avoid load absorption

Asymmetrical arm swing causes

counterbalance hip and pelvis(larger w running)

UE injury

LLD

spine dysfunctions

limited or exagerated motion on one side

Unequal hip height causes

LLD, weak glute med(trendelenburg gait)

Inadequate hip extension at terminal stance causes

contracture of hip flexors(hip would extend as body is propelled forward)

Forward Trunk Angle causes

indicates- low back pathology(herniated disc)

weak or painful hip flexors

weak ankle PF

Circumduction causes

compensation of LLD

hip flexor weakness

hamstring paralysis

functional LLD

ANterior pelvic tilt causes

weak hip extensors

hip flexion contractor

Contralateral pelvic drop

tendelenburg gait

reduced swing phase

ipsilateral glute med weakness

hip hike

voluntary, lack of hip flexion or knee extension

inadequate dorsiflexion

not the same as vaulting(if contralat side is not pf its not vaulting)