Koofers

chapters 9 -13 - Flashcards

Flashcard Deck Information

Class:PHED 35343 - Kinesiology
Subject:Physical Education
University:Rowan University
Term:Fall 2014
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What is the action of iliopsoas(hip region) Flexion of the hip 
over-activity of iliopsoas contributes to anteriorly tilted pelvis.
Use thomas test to assess tightness. 
exercise for iliopsoas sit ups- iliopsoas are the primary movers. also use lunge stretch. A
5 structures of lower extremity pelvic girdle
hip joint
knee joint
ankle joint
subtalar joint
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Ball-and-socket joint(for hip joint) head of femur articulates with acetabulum.
(hip joint) head of femur covered with cartilage labrum- in acetabulum adds depth to joint serves as cushion
(hip joint) body structure is strong strong ligaments/muscles
stable joint and good ROM
Motion in pelvis allows greater ROM of lower extremity
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Hip joint motions parallel shoulder joint motions flexion, extension, abduction, adduction, (horizontal as well), internal and external rotation. 
Thomas test in which knee does not flex is positive for rectus femoris vs. iliopsoas. 
Muscles- extension of the knee and flexion of the hip. (along with iliopsoas Rectus femoris
Rectus femoris is a bi-articulate muscle so must train.... to overcome passive and active insufficiency. 
only quadriceps muscle to cross hip joint
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actions of tensor fasciae latae(TFL) Hip abduction, flexion and internal rotation. 
Overactivity of TFL contributes internal rotation especially during hip flexion
- may synergistically dominate the gluteus medius
-both of above can contribute to valgus motions of knee
Action of gluteus maximus Hip extension, 
and external rotation of the hip. 

Posteriorly tilted pelvis... shorten gluteus ( length tension relationship) 
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anteriorly tilted pelvis lengthens glutes
(length tension relationship)
what is gluteus max. important for important for explosive LE movements such as sprinting and jumping. 
Gluteus medius action hip abduction ( open chain) - important to prevent valgus forces on knee. -Especially when jumping and landing. 
important to stabilizing the pelvis when standing/walking/running/ sprinting on one leg (closed chain) 

(hip adductors when landing) 
and external and internal rotation of hip 
3 hamstrings semitendinosus, semmimembranosus, biceps femoris. 
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both semi's are considered? medial hamstring
biceps femoris is considered lateral hamstring
all hamstrings cause... extension of hip and flexion of knee. 
over-activity of hamstrings cause a posteriorly tilt of pelvis. 
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Semi's also cause internal rotation of tibia
bicep femoris cause external rotation of tibia. 
use iliopsoas for sitting and sit-ups
over-activity of iliopsoas causes anterior tilt of pelvis and extension of lumbar spine
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quadriceps muscle, only one to cross hip and knee rectus femoris
when glutes shortens it causes atrophy of glutes
anteriorly tilt limits hip ext. and limites glute development
Closed chain (glute medius) leg is fixed, GM stabilizes pelvis by preventing lateral tilt (frontal plane) to opposite side. 
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Open chaid (glute medius) prevents hip from adducting and putting it in dangerous position for ACL. 
Six deep lateral rotator muscles external rotation of hip 
lateral rotators key point piriformis is near the sciatic nerve. Tightness in piriformis may contribute to sciatic pain and externally rotate hip (over-active)
Semitendinosus muscle action extension of hip, flexion of hip. internal rotation and tibia. 
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Semitendinosus tightness can cause. tight hamstring can cause posterior tilt of pelvis.


same with semimembranosus. 
semitendinosus over-activity over-activity of medial hamstrings can create internal rotation of tibia\


same with semimembranosus. 
Semimembranosus muscle action extension of hip, flexion of knee, internal rotation of tibia.
Bicep femoris action extension of hip, flexion of knee
external rotation of tibia. 
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bicep femoris key point lateral side of the knee, overactivity can cause external rotation of tibia or hip 
Hip adduction ( 4 muscles) adductor Brevis
adductor longus
adductor magnus
gracilis
Key point for adduction. groin pulls are common because we mostly train the LE on the sagittal plane. most sports force muscles across planes. 
Know the effect of posterior tilt and excessive anterior tilt on the gluteus max muscle? Important for explosive LE movements (triple extension) Such as sprinting and jumping. 

Posteriorly tilted pelvis shortens the glutes; causes atrophy of glutes. 

anteriorly tilted pelvis limits hip extension. limiting glute development. 
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Know the actions/role of the glutes medius during open chain and closed chain activities?  closed= leg is fixed, GM stabilizes pelvis by preventing lateral tilt (frontal plane) to opposite side.

open- prevents hip from adducting and putting it in dangerous position for ACL. 
piriforms causes external rotation however when hip is flexed to 90 degrees.... it becomes an internal rotator. 

important to prevent internal rotation and valgus forces of the knee (especially with landing) piriformis syndrome. 
action of vastus lateralis extension of knee- pulls patella laterally


when vastus lateralis over-acts chondromalacia
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actions of vastus medialis- Extension of knee. Pulls patella medially. very active in last 30 degrees of leg extension. 
when weakened the vastus medialis due to excessive quad contractions without moving into extension (riding biek) may allow laterally displacement of patella. 
Rectus femoris action flexion of hip and extension of knee. 

only quadriceps muscle that crosses over the hip. 
Hamstrings-( semitendinosus, semimembranesus. ) extension of hip and flexion of knee. Internal rotation of knee. 
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hamstrings ( biceps femoris) extension of hip. flexion of knee. External rotation of tibia. 
Tibiofemoral joint(knee) Modified hinge joint
two condyles of femur articulate with tibial plateaus/menisci
Note: intercondyloid eminence and notch: ACL tear
Patella articulates with patellar surface of femur.- patellofemoral joint

bony stability is weak. helped by considerable ligaments and cartilage. 
The tibiofemoral structure Menisci are circular rims of cartilage 
Lateral and medial.- Provide shock absorption. Protects bony ends stability of knee. 
outer portion is thicker than outer portion more vascular, supply minimal by 20s 
Medial menisci attached to platear..

where as lateral menisci has greater freedom of movement. 
ACL Prevents anterior displacement of tibia
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PCL Prevents posterior displacement of tibia
Medial collateral resists valgus forces


The medial collateral ligament, or tibial collateral ligament (TCL), is one of the four major ligaments of the knee.
Lateral collateral resists varus forces
Ilio-tibial (IT) band syndrome Inflammation of IT band due to repetitive rubbing against lateral condyle of femur. - Pain on lateral aspect of knee. 
Caused by tightness of IT band - also weakness gluteus medius.

Occurs in exercises in which knee and hip joint repetivily move only in sagittal plane. -also excessive movement of femur into adduction. bikers and runners. 
Prevention; recognizing those at risk, signs/symptoms, stretching of hip abductors and strengthening gluteus medius. 
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Piriformis syndrome Tightness of the piriformis muscle compressing the sciatic nerve contributing to pain down the posterior aspect of the leg. 
lack of stretching into internal rotation. 
extensive hip extension and abduction strengthening exercises. 
Chondromalacia Degeneration of cartilage on surface of patella. Due to patella rubbing on femoral condyle. creates pain, on movement, swelling, grating during knee extension/flexion. 
Cause of chondromalacia patellar tracking problems due to vastus lateralis or weakness. 


what to do to prevent chondromalacia strengthen vastus medialis by training complete extension. - short arch quads (0-30 degree of extension)

Look for structural imbalances for predisposed - genu valgum, tibial torsion, pronated feet. 
be aware of activities that may contribute - cycling, recovering from knee problems. 
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Osgood schlatter disease Repeated overuse of knee extensors creating tendonitis of patellar tendon on tibial turbosity. - especially during growing periods. 
swelling, pain on activity and kneeling 
treatment of osgood disease early recognition
rest and ice
stop exercises that involve knee extension (quads)
cho-pat
Anterior cruciate tears valgus force with rotation while weight bearing
excessive flexion of weight bearing knee (skiing/squats)
Anterior blow to femur with foot fixed (anterior translation of tibia.) 
Prevention for anterior cruciate tears Train hamstrings
train eccentrically
train knee proprioceptors
 increase fitness to minimize fatigue
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Posterior cruciate tears Posterior translation of tibia relative to femur
anterior blow to tibia
   

avoid hyperextension of knee. 
Meniscal tears tends to be damaged more than the lateral 
Due to
medial meniscus has less ability to move in the knee joint
more stresses on knee tend be directed to medial meniscus
major contributing factors to meniscal tears Direct contact
excessive pounding
 unless necessary only 3 distance runs per week, use other CV methods
proper shoe support, proper running surfaces (change shoes every 300-500 miles)
Twisting on a weight bearing knee
excessive flexion on a weight bearing knee. 
Medial collateral ligament strain Direct blow to lateral aspect of knee
repetitive valgus force ( breast strokers knee) incorrect exercises
excessive Q angle ( genu valgum)
pronated feet

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Lateral collateral ligament sprain varus force, genu varum

For both, be aware of structural mechanics (pronated/supinated, feet) contributes backing off when pain begins proper strengthening, proper form
Hamstrings strains Tear in belly of muscle or tendonosus tissue

Caused by muscular imbalance of quads/ hams, fatigue poor flexibility

Hamstring to quadriceps strength ratio is 2;3 GREATER THAN  60%
Hamstrings must brake quads to prevent anterior translation of tibia
weakness to hamstrings (train them functionally)
4 knee rules for proper knee mechanics with exercise, landing, and ADL 1. Knee must be aligned
2. dont go past 90 degrees
3. dont hyper extend
4. dont go past toes. 
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to test if they do 4 rule right ? test for proper squate. 60% of body weight. Then they are ready for pliometics
teach and train proper change of direction and deceleration Maintaining lower center of gravity is key. 
Train hamstrings as much as you train quadriceps traditional leg curls
stability ball hip extensions- knee in extension, more hamstring due to active insufficiency. 
knee in flexion - more gluteus maximus
Hamstring exercises plate sides
single leg squats
roman chair
straight leg dead lift
single leg hip ext. 
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reverse leg curl for knee

glut max?
assess and train the glutues medius hip abduction
cross over step
Talocrural joint(ankle) hinge joint
articulation of talus with distal ends of tibia and fibula - ok bony structure with strong ligament support

subtalar joint- talus and calcaneous- inversion and eversion of heel 
tibiofibular joint joined at both proximal and distal tibiofibular joints
ligaments and a strong, dense interosseus membrane between tibia and fibula shafts provide support
minimal movement possible
 distal joint becomes sprained occasionally in heavy contact sport 

high ankle sprains
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bones (ankle joint) distal malleoli of tibia (medial) and fibula ( lateral)
serve as pulley for posterior tendons to increase mechanical advantage of muscles in performing inversion and eversion actions. 
bones of foot tibia articulates with talus
talus articulates with calcaneus
7 tarsal bones (each foot)
5 metatarsal bones ( each foot)
14 phalanges ( each foot)
Muscles of ankle/foot lower leg- divided into 4 compartments bound by fasciae- facilitates venous return and prevents excessive swelling of muscles during exercise.

anterior compartment dorsiflexion and inversion group
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lateral compartment eversion of foot
posterior compartment superficiall: planter flexes
deep: planter flexes and inverts

action of gastrocnemius(ankle and knee) plantar flexion of ankle
flexion of knee

remember knee needs to be in extension for stretching and strengthening : lateral head externally rotates foot; medially head internally rotates foot
gastrocnemius overactivity and fast twitch muscles key point; more of a fast twitch muscle, essential for explosive movements of sprinting/ jumping; knee must be in extension to stretch and strengthen

Overactivity of lateral head tends to externally rotate foot, medial head tends to internally rotate foot
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actions of soleus planter flexion of ankle

Key point more a slow twitch muscle, involved in walking, knee in flexion to stretch, same insertion as gastroc via the archilles tendon, involved 

overactivity can cause abduction of foot
tibialis anterior actions dorsi flexion of ankle
and inversion of foot
 "anti- pronator
tibialis posterior actions Planter flexion of ankle and inversion of foot

anti- pronator
Peroneal ( Longus, brevis, terseus) eversion of foot
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Anterior (tibialis anterior) compartment syndrom most common - acute caused by trauma to area. Chronic- caused by overuse of tibialis anterior- excessive dorsi flexion 
hill/elevated treadmill walking
tight achillies tendon
excessive pronation- tibialis anterior acts as anti-pronator

too much running to quickly (10% rule) 
reduce risk of anterior compartment syndrom look at structure of LE
increase Q angle ( genu valgum, pronated or everted foot.) 
check shoes support ( cushioning) 300-500 miles change shoes
proper arch support 
wear on shoe ( inside, outside, front, back) 
dont wear cleats for jogging purposes ( wrestlers) 

proper flexibility- especially gastroe/soleus
allowing for adequate rest, ice, message
What are the four inner core muscles Internal obliques
Transverse abdominus
Deep erector spinae
Multifidus
All are stabilization muscles
What are the 4 outer core muscles External obliques 
Rectus abdominus
Quadratus lumborum
Superficial erector spinae
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Motions of spine and their core muscles Flection= rectus abdominus 
Extension= superficial erector spinae
Rotation=  external obliques
Lateral flexion= quadratus lumborum
Neutral spine position The spine is in the safest situation to minimize the stress place in both the facet joints and disks, acts as shock absorption
Anterior longitudinal ligament of spine Limits extension of the spine and protects the annulus fibrosus on the anterior side. Can become hypomoble = loss of normal lordosis
Posterior longitudinal ligament of spine Limits flexion of the spine and protects the annulus fibrosus on the posterior side
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3 components of erector spinae and deep or superficial Iliocostal- superficial outer muscle

Longissimus dorsi- deep inner muscle

The spinalis- deep inner core muscle
Core muscle exercises Pelvic tilt=stretches erector spinae and activates gluts

Back bridge = glut max, rectus and transverse abdominus

Side plank= obliques and rectus and transverse abdominus

Rollout and compress= maybe abs and obliques

Cobra = stretches anterior ligament
Its actions are scapular depression, protraction and downward rotation, often over trained, origin is on the chest pectoralis minor
its actions are scapular retraction, elevation and upward rotation often underactive middle traps
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Serratus anterior its actions are scapular protraction and upper rotation often underactive.
weakness often results in winged scapula. 
latissimus dorsi It is a large fan like. muscle on the posterior trunk actions are shoulder adduction, extension and internal rotation of the humerus often overactive
its action is scapular elevation often overactive levator scapula
anterior deltoids a part of the deltoid muscle in which its actions include shoulder abduction horizontal adduction diagonal adduction shoulder flexion and internal rotation
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major minor rhomboids their actions are shoulder retraction, downward rotation and provides a stable base for the rotator cuff muscles
posterior deltoids or pectoralis major? its actions are shoulder adduction, diagonal adduction, adduction and internal rotation. when over active it can cause altered reciprocal innervation to the teres minor and infraspinatus muscles. 


check if right
middle deltoids its actions are shoulder horizontal abduction and shoulder abduction, middle part of the three part muscle. 
lower traps its actions are scapular retraction, depression and upward rotation. often an under active muscle
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biceps brachii its actions are shoulder flexion, elbow flexion and supination. its long head is often related to glenoid labrum tears. 
upper trapezius its actions are scapular elevation and upward rotation, often overactive, part of the trap group
supraspinatus it is a rotator cuff muscle, its action is shoulder abduction for the first 30 degrees of shoulder abduction. 
Supscapularis it is a rotator cuff muscle and its actions are, depression of the humoral head, internal shoulder rotation and shoulder adduction
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posterior deltoids. Its actions are shoulder abduction, horizontal abduction, diagonal abduction, extension and external rotation, it is one of the three parts of the deltoid, often under trained. 
True the infraspinatus teres minor and subscapularis muscles function to depress the humoral head of the humerus during certain phases of shoulder abduction
true the middle and anterior portions of the deltoid muscles are often undertrained as compared with the posterior deltoid. 

false most people train the middle portion as compared with the upper and lower portions of the trap muscles
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true the movements of the scapula are, elevation, depression, protraction, retraction, upward rotation and downward rotation. 
It is a true elbow flexor, dominate flexor in all forearm positions brachialis
brachioradialis its flexes the elbow mainly from a mid-supinated position, origin is on the lateral supracondylar ridge and epicondyle of the humerus
Tricep brachii all of its heads extend the elbow. its long head is involved in horizontal abduction, diagonal abduction, shoulder adduction and shoulder extension
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supinator it is involved with elbow extension and forearm supination. its origin is on the olecranon and lateral epicondyle of the humerus. 
pronator teres it is involved with forearm pronation and elbow flexion. its origin is on the medial supracondylar ridge and medial epicondyle 

a weaker pronator
pronator quadratus it is involved with forearm pronation, stronger pronator, origin is on the distal portion of the ulna and inserts on the distal portion of the radius. 
Flexor carpi radialis it is involved with weak elbow flexion, wrist flexion, radial deviation. (wrist abduction)
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Flexor carpi ulnaris It is involved with weak elbow flexion, wrist flexion and ulnar deviation ( wrist adduction)
Extensor carpi ulnaris it is involved with weak elbow extension, wrist extension, and ulnar deviation
extensor carpi radialis it is involved with weak elbow extension, wrist extension, and wrist radial deviation. Its longus is also involved with a weak forearm pronation. 
lateral epicondylitis tennis elbow, 
Tennis elbow or lateral epicondylitis is a condition in which the outer part of the elbow becomes sore and tender at the lateral epicondyle.


gripping with extension, supination. 
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medial epicondylitis.

golfers elbow
Golfer's elbow, or medial epicondylitis, is tendinosis of the medial epicondyle on the inside of the elbow.

gripping with flexion, pronation,
two bones that make up the shoulder girdle the scapula and clavicle
Landmarks for clavicle acromial and sternal ends (creates the AC and SC joints)
landmarks for scapula acromion and glenoid fossa
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landmarks for humerus proximal structures, greater and lesser tubercles. bicipital groove-(created between tubercles)

deltoid tubercle. 
muscle involved with scapular elevation

Upper trapezius. (over-active)

muscle involved with depression lower trapezius, pectoralis minor
muscles involved with retraction middle traps, and rhomboids (minor and major) 
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muscles involved with protraction pectoralis minor and serratus anterior. 
muscles involved with upward rotation Middle trapezius. Lower trapezius, 
muscles involved with downward rotation Rhomboids (minor and major) 
what actions are "setting" the scapula motions that move the scapula to midline are stabilizing. 
( retraction, depression, and downward rotation. )
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what muscles are weak/underactive to winged scapular and negative effects serratus anterior (protraction) (underactive) 

weakness leads to winged scapular. and misalignment of humeral head and glenoid fossa. 
what is shoulder impingement? causes? shoulder and upper extremity pain. 
Supraspinatus is compressed b/t acromion & head of humerus
Rotator cuff should cause downward motion of humerus to  impingement.. 
but if not trained properly humerus jams supraspinatus into acromion 
also caused by “lax” shoulder joint
poor shoulder girdle strength

Impingement Zone
b/t 70-120⁰ of abduction
overactive muscle of shoulder area upper traps, pectoralis minor, pectoralis major, latissimus dorsi, 
under active muscles of shoulder area middle traps, lower traps, Rhomboids major and minor, serratus anterior, 
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actions, functions, and names of the 4 rotator cuff muscles.
Supraspinatus---attach to greater tubercle superiorly (Abduct)
Infraspinatus---attach to greater tubercle posteriorly (Ext. Rot.)

Teres Minor--attach to greater tubercle posteriorly (Ext. Rot.)

Subscapularis---attach to lesser tubercle anterior (Int. Rot.)
**all stabilize humeral head, see line of pull; “ITS”  depresses head of humerus

shoulder (arm) abduction. first 30 degrees. supraspinatus. -- abduct. 
Compression of the greater tubercle against the acromion process possibly impingement to supraspinatus and bursa.  Could result in rupture to supraspinatus

shoulder adduction of 30-90 degrees
Shoulder Joint ABD
Deltoid
Rotator Cuff
Scapula Upward Rotation
Middle and Lower Trapezius; Serratus Anterior

60° humerus ABD

30° scapula upward rotationf 

shoulder abduction in 90-170 degrees.

Shoulder Joint ABD

Deltoid

Rotator Cuff

Shoulder Joint ER

Infraspinatus

Teres Minor

Scapula Upward Rotation

Middle and Lower Trapezius; Serratus Anterior

Sternoclavicular Joint

Posterior rotation of clavicle



Inability for scapula to upward rotate past 900 abduction


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list 4 common injuries to the shoulder and their causes
Capsule stretching (instability of shoulder)
Glenoid labrum Tears===Extremes of external rotation and abduction during throwing 
**Rotator cuff strains=-Extreme ROM & muscle forces during external/internal rotation, impingement, loose capsule many times due to excessive throwing & striking activities..
Shoulder impingement---but if not trained properly humerus jams supraspinatus into acromion 
also caused by “lax” shoulder joint
poor shoulder girdle strength


define and describe GIRD it stands for Gleno- humeral internal rotation deficit
a condition resulting in the loss of internal rotation of the glenohumeral joint as compared to the contralateral side
impingement zone
b/t 70-120⁰ of abduction

scapula-humoral rhythm
motion of scapula,  clavicle, & humerus working together; ensure  optimal position of  humeral head in joint,        allowing full safe ROM

Supraspinatus initiates of abduction (30⁰)
middle deltoid continues abduction
Scapula upwardly rotates so humerus, does not get pulled into acromion       (also extend ROM); after 30⁰ abduction
From here 2:1 ratio GH to Shoulder Girdle

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posterior capsule stretch posterior deltoid, rhomboids, and posterior shoulder capsule
anterior capsule stretch Pectoralis major, anterior deltoid
sleep stretch external rotators and posterior capsule
apley stretch internal rotators and capsule of arm over shoulder, external rotators, and posterior capsule of arm behind back. 
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plank leans (side plank) serattus anterior
wall slides rhomboids, middle traps, posterior deltoid, external rotator cuff. 
press ups lower traps, pectoralis minor
alphabet series rhomboids, middle traps, posterior deltoid. 
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setting the scapular rhomboids, middle traps, posterior deltoid, teres minor, and infraspinatus. 
what 3 major structures contribute to gleno-humeral joint stability.
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List View: Terms & Definitions

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 What is the action of iliopsoas(hip region)Flexion of the hip 
 over-activity of iliopsoascontributes to anteriorly tilted pelvis.
Use thomas test to assess tightness. 
 exercise for iliopsoassit ups- iliopsoas are the primary movers. also use lunge stretch. A
 5 structures of lower extremitypelvic girdle
hip joint
knee joint
ankle joint
subtalar joint
 Ball-and-socket joint(for hip joint)head of femur articulates with acetabulum.
 (hip joint) head of femur covered with cartilagelabrum- in acetabulum adds depth to joint serves as cushion
 (hip joint) body structure is strongstrong ligaments/muscles
stable joint and good ROM
 Motion in pelvis allowsgreater ROM of lower extremity
 Hip joint motions parallel shoulder joint motionsflexion, extension, abduction, adduction, (horizontal as well), internal and external rotation. 
 Thomas testin which knee does not flex is positive for rectus femoris vs. iliopsoas. 
 Muscles- extension of the knee and flexion of the hip. (along with iliopsoasRectus femoris
 Rectus femoris is a bi-articulate muscle so must train....to overcome passive and active insufficiency. 
only quadriceps muscle to cross hip joint
 actions of tensor fasciae latae(TFL)Hip abduction, flexion and internal rotation. 
 Overactivity of TFLcontributes internal rotation especially during hip flexion
- may synergistically dominate the gluteus medius
-both of above can contribute to valgus motions of knee
 Action of gluteus maximusHip extension, 
and external rotation of the hip. 

 Posteriorly tilted pelvis...shorten gluteus ( length tension relationship) 
 anteriorly tilted pelvislengthens glutes
(length tension relationship)
 what is gluteus max. important forimportant for explosive LE movements such as sprinting and jumping. 
 Gluteus medius actionhip abduction ( open chain) - important to prevent valgus forces on knee. -Especially when jumping and landing. 
important to stabilizing the pelvis when standing/walking/running/ sprinting on one leg (closed chain) 

(hip adductors when landing) 
and external and internal rotation of hip 
 3 hamstringssemitendinosus, semmimembranosus, biceps femoris. 
 both semi's are considered?medial hamstring
 biceps femoris is consideredlateral hamstring
 all hamstrings cause...extension of hip and flexion of knee. 
 over-activity of hamstringscause a posteriorly tilt of pelvis. 
 Semi's also causeinternal rotation of tibia
 bicep femoris causeexternal rotation of tibia. 
 use iliopsoas forsitting and sit-ups
 over-activity of iliopsoascauses anterior tilt of pelvis and extension of lumbar spine
 quadriceps muscle, only one to cross hip and kneerectus femoris
 when glutes shortens it causesatrophy of glutes
 anteriorly tilt limits hip ext. andlimites glute development
 Closed chain (glute medius)leg is fixed, GM stabilizes pelvis by preventing lateral tilt (frontal plane) to opposite side. 
 Open chaid (glute medius)prevents hip from adducting and putting it in dangerous position for ACL. 
 Six deep lateral rotator musclesexternal rotation of hip 
 lateral rotators key pointpiriformis is near the sciatic nerve. Tightness in piriformis may contribute to sciatic pain and externally rotate hip (over-active)
 Semitendinosus muscle actionextension of hip, flexion of hip. internal rotation and tibia. 
 Semitendinosus tightness can cause.tight hamstring can cause posterior tilt of pelvis.


same with semimembranosus. 
 semitendinosus over-activityover-activity of medial hamstrings can create internal rotation of tibia\


same with semimembranosus. 
 Semimembranosus muscle actionextension of hip, flexion of knee, internal rotation of tibia.
 Bicep femoris actionextension of hip, flexion of knee
external rotation of tibia. 
 bicep femoris key pointlateral side of the knee, overactivity can cause external rotation of tibia or hip 
 Hip adduction ( 4 muscles)adductor Brevis
adductor longus
adductor magnus
gracilis
 Key point for adduction.groin pulls are common because we mostly train the LE on the sagittal plane. most sports force muscles across planes. 
 Know the effect of posterior tilt and excessive anterior tilt on the gluteus max muscle?Important for explosive LE movements (triple extension) Such as sprinting and jumping. 

Posteriorly tilted pelvis shortens the glutes; causes atrophy of glutes. 

anteriorly tilted pelvis limits hip extension. limiting glute development. 
 Know the actions/role of the glutes medius during open chain and closed chain activities? closed= leg is fixed, GM stabilizes pelvis by preventing lateral tilt (frontal plane) to opposite side.

open- prevents hip from adducting and putting it in dangerous position for ACL. 
 piriforms causes external rotation however when hip is flexed to 90 degrees....it becomes an internal rotator. 

important to prevent internal rotation and valgus forces of the knee (especially with landing) piriformis syndrome. 
 action of vastus lateralisextension of knee- pulls patella laterally


 when vastus lateralis over-actschondromalacia
 actions of vastus medialis-Extension of knee. Pulls patella medially. very active in last 30 degrees of leg extension. 
 when weakened the vastus medialisdue to excessive quad contractions without moving into extension (riding biek) may allow laterally displacement of patella. 
 Rectus femoris actionflexion of hip and extension of knee. 

only quadriceps muscle that crosses over the hip. 
 Hamstrings-( semitendinosus, semimembranesus. )extension of hip and flexion of knee. Internal rotation of knee. 
 hamstrings ( biceps femoris)extension of hip. flexion of knee. External rotation of tibia. 
 Tibiofemoral joint(knee)Modified hinge joint
two condyles of femur articulate with tibial plateaus/menisci
Note: intercondyloid eminence and notch: ACL tear
Patella articulates with patellar surface of femur.- patellofemoral joint

bony stability is weak. helped by considerable ligaments and cartilage. 
 The tibiofemoral structureMenisci are circular rims of cartilage 
Lateral and medial.- Provide shock absorption. Protects bony ends stability of knee. 
outer portion is thicker than outer portion more vascular, supply minimal by 20s 
Medial menisci attached to platear..

where as lateral menisci has greater freedom of movement. 
 ACLPrevents anterior displacement of tibia
 PCLPrevents posterior displacement of tibia
 Medial collateralresists valgus forces


The medial collateral ligament, or tibial collateral ligament (TCL), is one of the four major ligaments of the knee.
 Lateral collateralresists varus forces
 Ilio-tibial (IT) band syndromeInflammation of IT band due to repetitive rubbing against lateral condyle of femur. - Pain on lateral aspect of knee. 
Caused by tightness of IT band - also weakness gluteus medius.

Occurs in exercises in which knee and hip joint repetivily move only in sagittal plane. -also excessive movement of femur into adduction. bikers and runners. 
Prevention; recognizing those at risk, signs/symptoms, stretching of hip abductors and strengthening gluteus medius. 
 Piriformis syndromeTightness of the piriformis muscle compressing the sciatic nerve contributing to pain down the posterior aspect of the leg. 
lack of stretching into internal rotation. 
extensive hip extension and abduction strengthening exercises. 
 ChondromalaciaDegeneration of cartilage on surface of patella. Due to patella rubbing on femoral condyle. creates pain, on movement, swelling, grating during knee extension/flexion. 
 Cause of chondromalaciapatellar tracking problems due to vastus lateralis or weakness. 


 what to do to prevent chondromalaciastrengthen vastus medialis by training complete extension. - short arch quads (0-30 degree of extension)

Look for structural imbalances for predisposed - genu valgum, tibial torsion, pronated feet. 
be aware of activities that may contribute - cycling, recovering from knee problems. 
 Osgood schlatter diseaseRepeated overuse of knee extensors creating tendonitis of patellar tendon on tibial turbosity. - especially during growing periods. 
swelling, pain on activity and kneeling 
 treatment of osgood diseaseearly recognition
rest and ice
stop exercises that involve knee extension (quads)
cho-pat
 Anterior cruciate tearsvalgus force with rotation while weight bearing
excessive flexion of weight bearing knee (skiing/squats)
Anterior blow to femur with foot fixed (anterior translation of tibia.) 
 Prevention for anterior cruciate tearsTrain hamstrings
train eccentrically
train knee proprioceptors
 increase fitness to minimize fatigue
 Posterior cruciate tearsPosterior translation of tibia relative to femur
anterior blow to tibia
   

avoid hyperextension of knee. 
 Meniscal tearstends to be damaged more than the lateral 
Due to
medial meniscus has less ability to move in the knee joint
more stresses on knee tend be directed to medial meniscus
 major contributing factors to meniscal tearsDirect contact
excessive pounding
 unless necessary only 3 distance runs per week, use other CV methods
proper shoe support, proper running surfaces (change shoes every 300-500 miles)
Twisting on a weight bearing knee
excessive flexion on a weight bearing knee. 
 Medial collateral ligament strainDirect blow to lateral aspect of knee
repetitive valgus force ( breast strokers knee) incorrect exercises
excessive Q angle ( genu valgum)
pronated feet

 Lateral collateral ligament sprainvarus force, genu varum

For both, be aware of structural mechanics (pronated/supinated, feet) contributes backing off when pain begins proper strengthening, proper form
 Hamstrings strainsTear in belly of muscle or tendonosus tissue

Caused by muscular imbalance of quads/ hams, fatigue poor flexibility

 Hamstring to quadriceps strength ratio is2;3 GREATER THAN  60%
Hamstrings must brake quads to prevent anterior translation of tibia
weakness to hamstrings (train them functionally)
 4 knee rules for proper knee mechanics with exercise, landing, and ADL1. Knee must be aligned
2. dont go past 90 degrees
3. dont hyper extend
4. dont go past toes. 
 to test if they do 4 rule right ?test for proper squate. 60% of body weight. Then they are ready for pliometics
 teach and train proper change of direction and decelerationMaintaining lower center of gravity is key. 
 Train hamstrings as much as you train quadricepstraditional leg curls
stability ball hip extensions- knee in extension, more hamstring due to active insufficiency. 
knee in flexion - more gluteus maximus
 Hamstring exercisesplate sides
single leg squats
roman chair
straight leg dead lift
single leg hip ext. 
 reverse leg curlfor knee

glut max?
 assess and train the glutues mediuship abduction
cross over step
 Talocrural joint(ankle)hinge joint
articulation of talus with distal ends of tibia and fibula - ok bony structure with strong ligament support

subtalar joint- talus and calcaneous- inversion and eversion of heel 
 tibiofibular jointjoined at both proximal and distal tibiofibular joints
ligaments and a strong, dense interosseus membrane between tibia and fibula shafts provide support
minimal movement possible
 distal joint becomes sprained occasionally in heavy contact sport 

high ankle sprains
 bones (ankle joint)distal malleoli of tibia (medial) and fibula ( lateral)
serve as pulley for posterior tendons to increase mechanical advantage of muscles in performing inversion and eversion actions. 
 bones of foottibia articulates with talus
talus articulates with calcaneus
7 tarsal bones (each foot)
5 metatarsal bones ( each foot)
14 phalanges ( each foot)
 Muscles of ankle/footlower leg- divided into 4 compartments bound by fasciae- facilitates venous return and prevents excessive swelling of muscles during exercise.

 anterior compartmentdorsiflexion and inversion group
 lateral compartmenteversion of foot
 posterior compartmentsuperficiall: planter flexes
deep: planter flexes and inverts

 action of gastrocnemius(ankle and knee)plantar flexion of ankle
flexion of knee

remember knee needs to be in extension for stretching and strengthening : lateral head externally rotates foot; medially head internally rotates foot
 gastrocnemius overactivity and fast twitch muscleskey point; more of a fast twitch muscle, essential for explosive movements of sprinting/ jumping; knee must be in extension to stretch and strengthen

Overactivity of lateral head tends to externally rotate foot, medial head tends to internally rotate foot
 actions of soleusplanter flexion of ankle

Key point more a slow twitch muscle, involved in walking, knee in flexion to stretch, same insertion as gastroc via the archilles tendon, involved 

overactivity can cause abduction of foot
 tibialis anterior actionsdorsi flexion of ankle
and inversion of foot
 "anti- pronator
 tibialis posterior actionsPlanter flexion of ankle and inversion of foot

anti- pronator
 Peroneal ( Longus, brevis, terseus)eversion of foot
 Anterior (tibialis anterior) compartment syndrommost common - acute caused by trauma to area. Chronic- caused by overuse of tibialis anterior- excessive dorsi flexion 
hill/elevated treadmill walking
tight achillies tendon
excessive pronation- tibialis anterior acts as anti-pronator

too much running to quickly (10% rule) 
 reduce risk of anterior compartment syndromlook at structure of LE
increase Q angle ( genu valgum, pronated or everted foot.) 
check shoes support ( cushioning) 300-500 miles change shoes
proper arch support 
wear on shoe ( inside, outside, front, back) 
dont wear cleats for jogging purposes ( wrestlers) 

proper flexibility- especially gastroe/soleus
allowing for adequate rest, ice, message
 What are the four inner core musclesInternal obliques
Transverse abdominus
Deep erector spinae
Multifidus
All are stabilization muscles
 What are the 4 outer core musclesExternal obliques 
Rectus abdominus
Quadratus lumborum
Superficial erector spinae
 Motions of spine and their core musclesFlection= rectus abdominus 
Extension= superficial erector spinae
Rotation=  external obliques
Lateral flexion= quadratus lumborum
 Neutral spine positionThe spine is in the safest situation to minimize the stress place in both the facet joints and disks, acts as shock absorption
 Anterior longitudinal ligament of spineLimits extension of the spine and protects the annulus fibrosus on the anterior side. Can become hypomoble = loss of normal lordosis
 Posterior longitudinal ligament of spineLimits flexion of the spine and protects the annulus fibrosus on the posterior side
 3 components of erector spinae and deep or superficialIliocostal- superficial outer muscle

Longissimus dorsi- deep inner muscle

The spinalis- deep inner core muscle
 Core muscle exercisesPelvic tilt=stretches erector spinae and activates gluts

Back bridge = glut max, rectus and transverse abdominus

Side plank= obliques and rectus and transverse abdominus

Rollout and compress= maybe abs and obliques

Cobra = stretches anterior ligament
 Its actions are scapular depression, protraction and downward rotation, often over trained, origin is on the chestpectoralis minor
 its actions are scapular retraction, elevation and upward rotation often underactivemiddle traps
 Serratus anteriorits actions are scapular protraction and upper rotation often underactive.
weakness often results in winged scapula. 
 latissimus dorsiIt is a large fan like. muscle on the posterior trunk actions are shoulder adduction, extension and internal rotation of the humerus often overactive
 its action is scapular elevation often overactivelevator scapula
 anterior deltoidsa part of the deltoid muscle in which its actions include shoulder abduction horizontal adduction diagonal adduction shoulder flexion and internal rotation
 major minor rhomboidstheir actions are shoulder retraction, downward rotation and provides a stable base for the rotator cuff muscles
 posterior deltoids or pectoralis major?its actions are shoulder adduction, diagonal adduction, adduction and internal rotation. when over active it can cause altered reciprocal innervation to the teres minor and infraspinatus muscles. 


check if right
 middle deltoidsits actions are shoulder horizontal abduction and shoulder abduction, middle part of the three part muscle. 
 lower trapsits actions are scapular retraction, depression and upward rotation. often an under active muscle
 biceps brachiiits actions are shoulder flexion, elbow flexion and supination. its long head is often related to glenoid labrum tears. 
 upper trapeziusits actions are scapular elevation and upward rotation, often overactive, part of the trap group
 supraspinatusit is a rotator cuff muscle, its action is shoulder abduction for the first 30 degrees of shoulder abduction. 
 Supscapularisit is a rotator cuff muscle and its actions are, depression of the humoral head, internal shoulder rotation and shoulder adduction
 posterior deltoids.Its actions are shoulder abduction, horizontal abduction, diagonal abduction, extension and external rotation, it is one of the three parts of the deltoid, often under trained. 
 Truethe infraspinatus teres minor and subscapularis muscles function to depress the humoral head of the humerus during certain phases of shoulder abduction
 truethe middle and anterior portions of the deltoid muscles are often undertrained as compared with the posterior deltoid. 

 falsemost people train the middle portion as compared with the upper and lower portions of the trap muscles
 truethe movements of the scapula are, elevation, depression, protraction, retraction, upward rotation and downward rotation. 
 It is a true elbow flexor, dominate flexor in all forearm positionsbrachialis
 brachioradialisits flexes the elbow mainly from a mid-supinated position, origin is on the lateral supracondylar ridge and epicondyle of the humerus
 Tricep brachiiall of its heads extend the elbow. its long head is involved in horizontal abduction, diagonal abduction, shoulder adduction and shoulder extension
 supinatorit is involved with elbow extension and forearm supination. its origin is on the olecranon and lateral epicondyle of the humerus. 
 pronator teresit is involved with forearm pronation and elbow flexion. its origin is on the medial supracondylar ridge and medial epicondyle 

a weaker pronator
 pronator quadratusit is involved with forearm pronation, stronger pronator, origin is on the distal portion of the ulna and inserts on the distal portion of the radius. 
 Flexor carpi radialisit is involved with weak elbow flexion, wrist flexion, radial deviation. (wrist abduction)
 Flexor carpi ulnarisIt is involved with weak elbow flexion, wrist flexion and ulnar deviation ( wrist adduction)
 Extensor carpi ulnarisit is involved with weak elbow extension, wrist extension, and ulnar deviation
 extensor carpi radialisit is involved with weak elbow extension, wrist extension, and wrist radial deviation. Its longus is also involved with a weak forearm pronation. 
 lateral epicondylitistennis elbow, 
Tennis elbow or lateral epicondylitis is a condition in which the outer part of the elbow becomes sore and tender at the lateral epicondyle.


gripping with extension, supination. 
 medial epicondylitis.

golfers elbow
Golfer's elbow, or medial epicondylitis, is tendinosis of the medial epicondyle on the inside of the elbow.

gripping with flexion, pronation,
 two bones that make up the shoulder girdlethe scapula and clavicle
 Landmarks for clavicleacromial and sternal ends (creates the AC and SC joints)
 landmarks for scapulaacromion and glenoid fossa
 landmarks for humerusproximal structures, greater and lesser tubercles. bicipital groove-(created between tubercles)

deltoid tubercle. 
 muscle involved with scapular elevation

Upper trapezius. (over-active)

 muscle involved with depressionlower trapezius, pectoralis minor
 muscles involved with retractionmiddle traps, and rhomboids (minor and major) 
 muscles involved with protractionpectoralis minor and serratus anterior. 
 muscles involved with upward rotationMiddle trapezius. Lower trapezius, 
 muscles involved with downward rotationRhomboids (minor and major) 
 what actions are "setting" the scapulamotions that move the scapula to midline are stabilizing. 
( retraction, depression, and downward rotation. )
 what muscles are weak/underactive to winged scapular and negative effectsserratus anterior (protraction) (underactive) 

weakness leads to winged scapular. and misalignment of humeral head and glenoid fossa. 
 what is shoulder impingement? causes?shoulder and upper extremity pain. 
Supraspinatus is compressed b/t acromion & head of humerus
Rotator cuff should cause downward motion of humerus to  impingement.. 
but if not trained properly humerus jams supraspinatus into acromion 
also caused by “lax” shoulder joint
poor shoulder girdle strength

Impingement Zone
b/t 70-120⁰ of abduction
 overactive muscle of shoulder areaupper traps, pectoralis minor, pectoralis major, latissimus dorsi, 
 under active muscles of shoulder areamiddle traps, lower traps, Rhomboids major and minor, serratus anterior, 
 actions, functions, and names of the 4 rotator cuff muscles.
Supraspinatus---attach to greater tubercle superiorly (Abduct)
Infraspinatus---attach to greater tubercle posteriorly (Ext. Rot.)

Teres Minor--attach to greater tubercle posteriorly (Ext. Rot.)

Subscapularis---attach to lesser tubercle anterior (Int. Rot.)
**all stabilize humeral head, see line of pull; “ITS”  depresses head of humerus

 shoulder (arm) abduction. first 30 degrees.supraspinatus. -- abduct. 
Compression of the greater tubercle against the acromion process possibly impingement to supraspinatus and bursa.  Could result in rupture to supraspinatus

 shoulder adduction of 30-90 degrees
Shoulder Joint ABD
Deltoid
Rotator Cuff
Scapula Upward Rotation
Middle and Lower Trapezius; Serratus Anterior

60° humerus ABD

30° scapula upward rotationf 

 shoulder abduction in 90-170 degrees.

Shoulder Joint ABD

Deltoid

Rotator Cuff

Shoulder Joint ER

Infraspinatus

Teres Minor

Scapula Upward Rotation

Middle and Lower Trapezius; Serratus Anterior

Sternoclavicular Joint

Posterior rotation of clavicle



Inability for scapula to upward rotate past 900 abduction


 list 4 common injuries to the shoulder and their causes
Capsule stretching (instability of shoulder)
Glenoid labrum Tears===Extremes of external rotation and abduction during throwing 
**Rotator cuff strains=-Extreme ROM & muscle forces during external/internal rotation, impingement, loose capsule many times due to excessive throwing & striking activities..
Shoulder impingement---but if not trained properly humerus jams supraspinatus into acromion 
also caused by “lax” shoulder joint
poor shoulder girdle strength


 define and describe GIRDit stands for Gleno- humeral internal rotation deficit
a condition resulting in the loss of internal rotation of the glenohumeral joint as compared to the contralateral side
 impingement zone
b/t 70-120⁰ of abduction

 scapula-humoral rhythm
motion of scapula,  clavicle, & humerus working together; ensure  optimal position of  humeral head in joint,        allowing full safe ROM

Supraspinatus initiates of abduction (30⁰)
middle deltoid continues abduction
Scapula upwardly rotates so humerus, does not get pulled into acromion       (also extend ROM); after 30⁰ abduction
From here 2:1 ratio GH to Shoulder Girdle

 posterior capsule stretchposterior deltoid, rhomboids, and posterior shoulder capsule
 anterior capsule stretchPectoralis major, anterior deltoid
 sleep stretchexternal rotators and posterior capsule
 apley stretchinternal rotators and capsule of arm over shoulder, external rotators, and posterior capsule of arm behind back. 
 plank leans (side plank)serattus anterior
 wall slidesrhomboids, middle traps, posterior deltoid, external rotator cuff. 
 press upslower traps, pectoralis minor
 alphabet seriesrhomboids, middle traps, posterior deltoid. 
 setting the scapularrhomboids, middle traps, posterior deltoid, teres minor, and infraspinatus. 
 what 3 major structures contribute to gleno-humeral joint stability.
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