Physical Therapy Notes

Vision

  • The faculty of Physical Therapy, October University for Modern Sciences and Arts, aims to be an outstanding higher education institute.
  • It seeks to be a catalyst for research and community development.
  • The goal is to achieve national and international recognition.

Mission

  • The faculty offers an educational program adopting modern and advanced curricula.
  • It emphasizes scientific research as a means of learning and development.
  • The program uses student-centered teaching methods to suit current generations.
  • The aim is to graduate physiotherapists with skills and competencies to compete in the labor market and serve their community.

Core Values

  • Student Centered: Focus on the student.
  • Accountability: Being responsible and answerable for actions.
  • Credibility: Being trustworthy and reliable.
  • Institutional Loyalty: Commitment to the institution.
  • Inclusiveness: Embracing diversity and ensuring everyone is included.
  • Entrepreneurial Spirit: Having initiative and innovation.
  • Commitment to Quality: Dedication to high standards.

Osteokinematics

  • Movement of the bones.
  • Clear, visible movements of bones.
  • Result from rotation around the joint axis in a specific plane.
    • Flexion and extension.
    • Abduction and adduction.
    • Lateral and medial rotation.

Arthrokinematics

  • Roll.
  • Slide / glide.
  • Spin.

Arthrokinematics: Movement of Joint's Articular Surfaces

  • Roll: Rotary movement where one bone rolls on another.
  • Spin: Rotary movement where one body spins on another.
  • Slide: Translatory movement where one joint surface slides over another.

Movement Definitions and Analogies

  • Roll:
    • Definition: Multiple points along one rotating articular surface contact multiple points on another articular surface.
    • Analogy: A tire rotating on pavement.
  • Slide/Glide:
    • Definition: A single point on one articular surface contacts multiple points on another articular surface.
    • Analogy: A nonrotating tire skidding across an icy pavement.
  • Spin:
    • Definition: A single point on one articular surface rotates on a single point on another articular surface.
    • Analogy: A toy top rotating on one spot on the floor.

Arthrokinematics Value

  • Roll-and-slide arthrokinematics are essential for full-range abduction.
  • The longitudinal diameter of the humeral head's articular surface is almost twice the size of the longitudinal diameter on the glenoid fossa.
  • Abduction arthrokinematics demonstrate how a simultaneous roll and slide allow a larger convex surface to roll over a smaller concave surface without running out of articular surface.

Convex-Concave Relationship / Rule

  • Convex-on-concave movement:
    • The convex surface rolls and slides in opposite directions.
  • Concave-on-convex movement:
    • The concave surface rolls and slides in the same directions.

Specific Joints Demonstrating the Convex-Concave Rule

  • Shoulder joint:
    • Convex-on-concave movement.
    • The convex surface rolls and slides in opposite directions.
  • Knee joint:
    • Concave-on-convex movement.
    • The concave surface rolls and slides in the same directions.

Osteokinematics vs. Arthrokinematics

  • Osteokinematics:
    • Definition: Movement of the bones.
    • Visibility: Clear movements of bones visible from the outside.
    • Description: Result from rotation around a joint axis in a specific plane.
    • Examples: Flexion, extension, abduction, adduction, lateral rotation, and medial rotation.
  • Arthrokinematics:
    • Definition: Movement of the joint’s articular surfaces.
    • Visibility: Not usually visible.
    • Description: Two rotatory (roll & spin) and one translatory motion (slide).
    • Examples: Rolling, spinning, and sliding of joint surfaces.

Open vs. Closed Kinetic Chains

  • Open Kinetic Chain (OKC):
    • The most distal part is free to move.
    • Examples: Shoulder flexion & extension, knee flexion & extension.
  • Closed Kinetic Chain (CKC):
    • The most distal part is fixed.
    • Examples: Pull-ups/chin-ups, squats.

Knee Joint and Kinetic Chains

  • The knee joint can exhibit:
    • Concave-on-convex movement in OKC.
    • Convex-on-concave movement in CKC.
  • Joint motion is typically described in terms of open kinetic chain unless instructed otherwise.

Hip Osteokinematics

  • Femoral-on-pelvic osteokinematics:
    • Describes the rotation of the femur about a relatively fixed pelvis (OKC).
  • Pelvic-on-femoral hip osteokinematics:
    • Describes the rotation of the pelvis over relatively fixed femurs (CKC).

Osteokinematic Movements

  • Movements are:
    • Flexion (anterior pelvic tilt) and extension (posterior pelvic tilt) in the sagittal plane.
    • Abduction and adduction in the frontal plane.
    • Internal and external rotation in the horizontal plane.

Hip Flexion and Extension

  • Sagittal plane:
    • With the knee flexed, the hip flexes to about 120120 degrees.
    • With the knee fully extended, hip flexion is limited to 7070 to 8080 degrees due to hamstring tension.
    • This difference is due to passive insufficiency.
    • Hip typically extends about 2020 degrees beyond the neutral position.
    • With the knee fully flexed during hip extension, tension in the rectus femoris reduces hip extension to about the neutral position.

Hip Abduction and Adduction

  • Frontal Plane:
    • Abduction: Approximately 404540-45 degrees.
    • Adduction: Approximately 2525 degrees.

Hip Internal and External Rotation

  • Horizontal Plane:
    • Internal and external rotation vary among individuals.
    • On average, the hip internally rotates about 3535 degrees.
    • Externally rotates about 4545 degrees.

Pelvic Tilting in the Sagittal Plane

  • Hip flexion can occur through an anterior pelvic tilt.
  • The direction of the tilt (anterior vs. posterior) is based on the direction of the iliac crest's movement around a medial-lateral axis passing through both femoral heads.

Pelvic Rotation in the Frontal Plane

  • Abduction of the support hip occurs by raising the iliac crest on the non-support hip side.
  • Adduction of the support hip occurs by lowering the iliac crest on the non-support hip side.

Pelvic Rotation in the Horizontal Plane

  • Pelvic-on-femoral rotation occurs in the horizontal plane around a longitudinal axis.
  • Internal rotation occurs as the iliac crest on the non-support hip side rotates forward.
  • External rotation occurs as the iliac crest on the non-support hip side rotates backward.

Muscles Controlling Hip Osteokinematics

  • Flexors:
    • Iliopsoas, rectus femoris, sartorius, tensor fasciae latae, adductor longus, pectineus.
  • Extensors:
    • Gluteus maximus, hamstrings, adductor magnus.
  • Abductors:
    • Gluteus medius, gluteus minimus, tensor fasciae latae.
  • Adductors:
    • Adductor magnus, pectineus, gracilis, adductor longus, adductor brevis.
  • Internal Rotators:
    • Gluteus minimus and medius (anterior fibers), tensor fasciae latae, adductor longus & brevis, pectineus.
  • External Rotators:
    • Gluteus maximus, piriformis, quadratus femoris, obturator externus & internus, gemellus superior & inferior.

Hip Joint Arthrokinematics

  • Based on the convex-on-concave rule.
  • Abduction & adduction include roll & glide.
  • During OKC abduction:
    • Inferior glide + superior roll.
  • During OKC adduction:
    • Superior glide + inferior roll.
  • Internal & external rotation include roll & glide.
  • During internal rotation:
    • Posterior glide + anterior roll.
  • During external rotation:
    • Anterior glide + posterior roll.
  • Flexion & extension performed by spinning with minimal anterior & posterior glide.
  • Posterior glide during OKC hip flexion.

Knee Osteokinematics

  • Flexion and extension occur in the sagittal plane around a medial-lateral axis of rotation.
    • 140140° Flexion.
    • 55° to 1010° hyperextension.

Knee Arthrokinematics

  • During knee flexion and extension, the convex femoral condyles move on the concave tibial condyles or vice versa, depending on whether it is an open- or closed-chain.
    • Knee extension – OKC.
    • Squat - CKC.

Femoral Condyle Articular Surface

  • The articular surface of the femoral medial condyle is longer than that of the lateral condyle (causes spinning of the knee).
  • During squat, as extension occurs, the articular surface of the femoral lateral condyle is used up, while some articular surface remains on the medial condyle.

Posterior Gliding of Medial Condyle

  • The medial condyle of the femur must also glide posteriorly to use its entire articular surface.
  • This posterior gliding during the last few degrees of weight-bearing extension (closed-chain action) causes:
    • The femur to spin (rotate medially) on the tibia.
    • Which means the Tibia rotates laterally.
  • Normal motion of the knee demonstrates a combination of rolling, gliding (posteriorly), and spinning (medially) of the femur in the last 2020 degrees of extension of the femur on the tibia (and vice versa for tibia in OKC).

Screw Home Mechanism

  • During non-weight-bearing extension (open-chain action), the tibia rotates laterally on the femur 2020°.
  • These last few degrees of motion lock the knee in extension.
  • With the knee fully extended, an individual can stand for a long time by tension generated passively on the ligaments without using muscles.
  • For knee flexion to occur, the knee must be “unlocked” by medially rotating the tibia on the femur or laterally rotating the femur on the tibia.
  • This small amount of rotation keeps the knee from being a true hinge joint (modified hinge).
  • Because this rotation is not an independent motion, it is not considered a knee motion.

Unlocking of the Knee

  • Function of the popliteus muscle.

Extension of the Knee

  • During tibial-on-femoral extension, the articular surface of the tibia rolls and slides anteriorly on the femoral condyles.
  • During femoral-on-tibial extension (standing up from a deep squat), the femoral condyles simultaneously roll anteriorly and slide posteriorly on the articular surface of the tibia.

Muscles Controlling Knee Osteokinematics

  • Flexors:
    • Hamstrings, sartorius, gracilis, gastrocnemius, plantaris, popliteus.
  • Extensors:
    • Quadriceps femoris.
  • Internal Rotators:
    • Semimembranosus, semitendinosus, sartorius, gracilis, popliteus.
  • External Rotators:
    • Biceps femoris.

Ankle Osteokinematics

  • Movements:
    • Plantar flexion & dorsiflexion.
    • Occurs in the sagittal plane around the frontal axis.
  • The ankle is a uniaxial hinge joint.
    • Articulation between the medial malleolus of the tibia and the lateral malleolus of the fibula with the talus.
  • Allows 3030 to 5050 degrees of plantar flexion and 2020 degrees of dorsiflexion.

Ankle Arthrokinematics

  • During OKC dorsiflexion:
    • The talus rolls forward relative to the leg as it simultaneously slides posteriorly.
  • A therapeutic approach to increase dorsiflexion:
    • Involves posterior-directed translation of the talus and foot relative to the leg.

Ankle Arthrokinematics During Plantar Flexion

  • During OKC plantar flexion:
    • The talus rolls posteriorly as the bone simultaneously slides anteriorly.

Subtalar (Talocalcaneal) Joint

  • Consists of the inferior surface of the talus articulating with the superior surface of the calcaneus.
  • It is a plane synovial joint with 1 degree of freedom.
  • Motions of inversion and eversion occur around an oblique axis.
  • Inversion: Raising the medial border of the foot, turning the forefoot inward.
  • Eversion: Raising the lateral border of the foot.

Transverse Tarsal Joint (Talonavicular and Calcaneocuboid Joints)

  • Movement in the transverse plane is called adduction and abduction.

Pronation & Supination

  • Pronation:
    • Defined as a motion with elements of eversion, abduction, and dorsiflexion.
  • Supination:
    • Defined as a motion with elements of inversion, adduction, and plantar flexion.
  • Occur around an oblique axis.