Level II Lower quadrant
Terms
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Hip
Arthrokinematics
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Abd- inf glide
Add- sup glide
IR- post glide
ER- ant glide
F/E- distraction
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Hip
Closed Packed, Resting position, capsular pattern
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CP: Ext/IR/ABD
RP: 30 F / 30 abd / lat rot
Capsular pattern: early: Ext / med rot /Flex add
late: Flex / adb / med rot -
Hip
Osteokinematics
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F/E -spin
Adb/Add- cardinal swing
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Key muscles
L1-2
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hip flex
hip Add
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Key muscles
L3
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knee ext
hip add
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Key muscles
L4
- ankle DF and INV
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Key muscles
L5
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great toe ext
hip abd
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Key Muscles
S1
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ankle PF, ankle ev, knee flex
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Key muscles
S2
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hip ext
Lat hamstrings
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Knee
Osteokinematics
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F/E impure swing
IR/ER impure spin
abd/add not physiological
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Knee
Closed packed, resting position, capsular pattern,
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CP ext + ext rot
RP 25-30 flex
Cap pat F>E
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Knee
joint type
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synovial, compound, complex modified ovoid
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Knee
Range of motion
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Flex 130-140 degrees active 160 degrees squat
ext 5-10
Rotation 0-0 degrees, max rot at 90 degrees
IR 0-40 degrees ER 0-30 degrees
Abd and Add 10-13 degrees at 30 degrees
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locking
-extension
-flexion
-contralateral SF
-ipsilateral SF
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ext-vertically towards ceiling
flex-horizontally forward, parallel to floor
contra-pull caudally
ipsilateral-pull cranially
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locking
-rotation
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constant, side to be treated on top
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Pelvic Girdle
SI jt classification
Pubic symphysis jt classification
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synovial jt, complex and variable
symphysis
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structures that limit spinal flex
ant translation
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articular facets
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structures that limit spinal flex
sagittal rotation
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post long lig
supraspinous
interspinous
lig flavum
thoracolumbar facia, erector spinae
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subtalar
arthrokinematics
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Pronation-
ant- lat glide
Post-medial glide
Supination-
ant-medial
Post- lat glide
- Ankle Dorsiflexors (4)
- Tibialis ant. Ext Dig long Peroneus tertius Ext hallucis longus
- Ankle Plantarflexors (8)
- Peroneus longus Peroneus brevis Tib post Plantaris Flex dig long Flex hallucus long Soleus Gastroc
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Arthokinematics innominate
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ant rot- inf (short arm) and post (long arm)
post rot-sup (short arm) and ant (long arm)
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Arthrokinematics sacrum
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Counternutation- sup and ant
Nutation- inf and post
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arthrokinemetics Lumbar spine
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Flex: cranial glide
Ext: caudal glide
SF: ipsi-inf, post
contra-sup and ant
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Combination of movements in SF
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Upper levels SF/rot opposite
L4-L5 variable
L5-S1 SF/rot same direction
- Foot Eversion (4)
- Peroneus longus,brevis,tertius Ext dig long.
- Foot inversion (4)
- Tib ant. post. Ext hallucis longus Flex dig longus Flex hallucis longs
- Hip Abduction (11)
- Psoas maj iliacus Sartorius TFL Glute med, min, max Gem inf, sup Piriformis obt int.
- Hip Adductors (6)
- pectineus Add long, brevis, mag gracilis obt ext
- Hip Extension (7)
- Adductor mag Glute med, max semimembranosis Semitendonosis piriformis biceps fem.
- Hip Flexors (10)
- psoas maj iliacus sartorius pectinius add long, brevis, mag rectus fem TFL Glute min med
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Hip joint type
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simple, synovial, unmodified ovoid, 3DF
- Hip Lateral Rotators (12)
- Psoas maj. Iliacus Sartorius obt ext. int. Glute med, max Gem inf. sup. Quadratus fem Piriformis
- Hip Medial Rotators (7)
- Add long, brevis TFL Glute med min Semimembranosis Semitendonosis
- Hip Range of motion
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flex-90-100 knee ext, 110-120 with knee flexed
Abd-30-57
Add 30-45
IR-30-40
ER-40-60
- how much extension?
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20-35 degrees total
- how much flexion per segment
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8-13 degrees
1-3 mm
- how much lumbar rot?
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3 degrees per segment
L5-5 degrees
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How much SF?
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total 15-30 degrees
10 degrees upper three levels
6 degrees at L4/L5
3 degrees L5/S1
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inferior tibiofibular jt. classification
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syndesmosis-fibrous
pain with splaying
CP-wt bearing in DF
- Knee extensors
- quads TFL
- Knee Flexors (5)
- Sartorius gracilis popliteus plantaris semimembranosis semitendonosis biceps fem gastroc
- Knee Lat rotators
- biceps fem
- knee med rotators
- sartorius gracilis popliteus semimembranosis semitendonosis
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Ligaments limiting pronation
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medial talocalcaneal
medial interosseous
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Ligaments limiting supination
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lat talocalcaneal
cervical ligament
lat interosseous
- Ligaments that limit counternutation
- Long dorsal ligament
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Ligaments that limit nutation
- sacrotuberous and interosseous
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Lumbar capsular pattern
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SF=rot > E
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Lumbar Closed Packed
- ext
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Lumbar jt. stability tests
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compression
traction
torsion (rotational)
translations -ant -post -lateral
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Lumbar specific questions
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effect of sitting
standing vs. sitting vs. walking
cough, sneeze, valsava
bed (hard or soft)
sleeping position
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Mandatory questions
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Bladder, Bowel, genital dysfunction
saddle paresthesia
rectal, scotal, testicular, penile, vaginal pain
groin and medial thigh pain
medication usage, steroids, NSAIDs, anti-coagulants
Weight loss
Special tests <
- muscles of the ant. oblique
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oblique abs
contralateral adductors
- muscles of the lateral system
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Glute med
contralateral adductors
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muscles of the longitudinal systems
- erector spinae, sacrotuberous ligament and biceps femoris
- muscles of the post oblique
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Glute max
Lat dorsi -resist adduction of extended med roted arm
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Muscular Forces in SF
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QL
Psoas
obliques
ipsilateral intertransversarii
iliocostalis lumborum and gravity
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name the four systems
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Post oblique
anterior oblique
lateral
Deep longitudinal
- Pelvic Girdle Osteokinematics
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Sacrum moves congruently with the side of the POST. rotating innominate
L5 appears to rotate and SF congruently with the sacrum
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PG osteo Hip Flex
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innominate-R post rotates relative to sacrum
Right PSIS down
Sacrum-rotates right
Nutated relative to right innominate, Left sacral base nutates
L5-rotates to right
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PG osteo Right Rot
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Intra pelvic torsion
innominate- R inno post rot / L inno ant rot
Sacrum- rot R
L5-R rot,
- PG osteo Right SF trunk
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Intra pelvic torsion
innominate-Left translation
R inno ant rot / L inno post rot
Sacrum-rot L
L5-R sf, rotates L
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PG osteo trunk ext
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innominate-post rotates relative to sacrum
Sacrum-Nutates
L5-ext and post translates on the sacrum
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PG osteo trunk flex
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innominate-post rotates relative to sacrum
Sacrum-Nutates
L5-flexes and ant translates on the sacrum
- repeated loading of the spine in flex can produce
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end plate fractures
internal disruptures of the annulus
radial #
# of pars interarticularis
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specific SI questions
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location
radiation into the limbs
aggravating activities
effect of walking, stair climbing, rolling over in bed, getting in/out of a chair, stepping up onto a curb, cough, sneeze, valsalva,
effect of rest
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Stabilization training progression
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segmental control, functional, CKC, OKC,
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sub talar CP, cap pat, RP
- end range pro/sup, sup>pro, mid position
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Sub talar joint types
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anterior-compound, synovial together work as modified sellar
- Subtalar Osteokinematics
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Pronation-DF, Abd, eversion
Supination- PF, Add, inversion
- talocrural arthrokinematics
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DF-post glide
PF-ant glide
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talocrural DF, CP, RP, Cap Patern
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1 DF - PF, DF
cap pat- PF>DF
CP- DF
RP 10degrees PF
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Talocrural jt. classification
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compound, synovial, modified sellar
- talocrural Osteokinematics
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impure swing
ext rot with DF
int rot with PF