Acromioclavicular (AC) joint injury is a term used to describe an injury to the top of the shoulder, where the front of the shoulder blade (acromion) attaches to the collarbone (clavicle).
Sacroiliac(SI) Joint Dysfunction,Evaluation and Treatment Dr.Md.Monsur Rahman
Dr.MD.Monsur Rahman,PT
MPT-Musculoskeletal Disorders
Maharishi Markandeshwar Institute Of Physiotherapy And Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana - Ambala,133-207 (Haryana)
Deformities observed with Pes cavus includes :
*clawing of the toes
*posterior hind foot deformity (described as an increased calcaneal angle)
*contracture of the plantar fascia
*cock-up deformity of the great toe
Following References were used to prepare this powerpoint presentation which makes the slides accurate and relaible for studying purpose; Therapeutic Exrercise – Carolyn Kisner
Orthopaedic Physical Assessment – Magee
Orthopaedic Medicine – L. Ombregt
Campbell’s Operative Orthopaedics
Slides includes following headings;
DEFINITION
TYPES
ORTHOPAEDIC ASSESSMENT
MEDICAL MANAGGEMENT
PHYSIOTHERAPY MANAGEMENT
SURGICAL MANAGEMENT
Acromioclavicular (AC) joint injury is a term used to describe an injury to the top of the shoulder, where the front of the shoulder blade (acromion) attaches to the collarbone (clavicle).
Sacroiliac(SI) Joint Dysfunction,Evaluation and Treatment Dr.Md.Monsur Rahman
Dr.MD.Monsur Rahman,PT
MPT-Musculoskeletal Disorders
Maharishi Markandeshwar Institute Of Physiotherapy And Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana - Ambala,133-207 (Haryana)
Deformities observed with Pes cavus includes :
*clawing of the toes
*posterior hind foot deformity (described as an increased calcaneal angle)
*contracture of the plantar fascia
*cock-up deformity of the great toe
Following References were used to prepare this powerpoint presentation which makes the slides accurate and relaible for studying purpose; Therapeutic Exrercise – Carolyn Kisner
Orthopaedic Physical Assessment – Magee
Orthopaedic Medicine – L. Ombregt
Campbell’s Operative Orthopaedics
Slides includes following headings;
DEFINITION
TYPES
ORTHOPAEDIC ASSESSMENT
MEDICAL MANAGGEMENT
PHYSIOTHERAPY MANAGEMENT
SURGICAL MANAGEMENT
Introduction:
Patellofemoral pain (PFP) is one of the most common disorders of the knee. The knee is involved in around 10% of all sporting injuries.
Tria and Alica, described Wiberg classification of patella facet shapes, and there is another classification based on Morphology ratio.
The purpose of this case control study is comparison between the different morphologic types of the patella (Wiberg classification and morphology Ratio) in patients with chondromalacia and normal persons.
Patients & Methods:
In this study we evaluated 30 limbs in 30 patients with chondromalacia (20 females, 10 males ). Medial and lateral facets were calculated on patellar knee view. Also patellar articular length and overall patellar length were calculated in knee joint in 30 flexion. The results were compared to values obtained from 30 limbs in 30 healthy volunteers.
Results:
In Wiberg classification, 57% of normal persons had patella type I while 17% of patients with chondromolacia had this type (p=0.01). Also 43% of normal persons had patella type II while 83% of patients had this type (p= 0.01).
In Morphology ratio classification, 40% of normal persons had patella type II while 13% of patients had this type (p=0.02). Also none of normal persons had patella type III while 13% of patients had this type (p=0.03).
Discussion:
A variety of sports commonly lead to chondromoalacia patella due to unusual compressive forces. Therefore young population specially athletes should pay attention to their patella shapes for selecting the sports types.
VIMG's Condition of the Week - Ilio-Tibial Band Syndrome.
Learn more about ilio-tibial band syndrome including ideas for treatment and prevention.
www.markjpitcher.com
www.vailhealth.com
Severe
patellofemoral arthritis secondary to patellofemoral
malalignment
treated by Fulkerson osteotomy plus tricortical
bone graft. A retrospective cohort of 45 knees.
A growing numbers of cities, communities and regions are proving that meeting 100% of our energy demand with renewable energy is viable. As urban areas are responsible for 70-75% of energy related CO2 emissions and 40-50% of global GHG emissions, this is an encouraging trend.
A movement advocating for 100% renewable energy is gaining momentum among local governments, nations, islands, businesses, communities and citizens alike. European local governments like Barcelona are pioneering this development. The Spanish city is aiming to be energy self-sufficient in 40 years.
Cities in other parts of the world like in East Asia have begun ambitious programs to become 100% renewable energy-powered in just 15 years. Further, nations from the global South like Sri Lanka aim at providing electricity for all and to meet the demand for energy services with affordable, reliable, diverse, safe and environmentally acceptable choices and hereby primarily build on renewable sources.
This webinar outlines opportunities, strategies and presents case studies from across the world that show that 100% RE – in close conjunction with energy efficiency & conservation – is technically doable, economically an advantage and socially anyway a better path.
Panelists:
-Anna Leidreiter, World Future Council
-Manuel Valdes Lopez, Deputy Manager of Infrastructures and Urban Coordination, City of Barcelona
-David Thorpe, Moderator and Special Consultant for SustainableCitiesCollective.com
Twig Embody - the wearable 3G/GSM/GNSS personal alarm deviceJane Lindell
TWIG Embody is a wearable 3G/GSM/GNSS personal alarm with
• an all new wearing concept with multiple carrying options,
• a device scalability multiplying device versions for specific customer needs
• software and services integrating the overall personal safety system
TWIG Embody is IP67 waterproof, small and smart, dedicated alarm device with
• selectable mobile network 2G/3G,
• optional GNSS (multi constellation GPS),
• optional ManDown
• optional SRD (short range device) compatibility
Get familiar with the wearable TWIG Embody personal alarm and TWIG Point Software and Services on our new TWIG Embody product pages https://twigcom.com/shop/category/personal-alarms-2
Shoulder Impairment Power Point display that incorporates techniques based off the National Academy of Sports Medicine Corrective Exercise Specialists Certification.
Early Physiotherapy and Management of Deformities.pptxICDDelhi
Dr. Mansoor Alam is a child developmental specialist from ICD, New Delhi. He is a medicine graduate with specialization in Developmental Disability Management. After his graduation, he joined Spastic Society of Northern India, New Delhi to have a Post-Graduation Diploma in Developmental Therapy under RCI. Later, he went to Bobath Centre in London, (United Kingdom) to have specialized training in Bobath Approach to the treatment of Children with Cerebral Palsy, which is popularly known as Neurodevelopment Treatment (NDT). While, he was in Sydney, Australia, he did an advance course on the Use of Botox in Spasticity Management. He is one of the few professionals in India who attended Gait Analysis Course in Australia. To have in-depth knowledge to work with children neurodevelopmental disabilities, he pursued specialized training programs on GMA (General Movements Assessment), Constrained Induced Manual Therapy (CIMT), Early Intervention, Sensory Integration Therapy, Clinical Pathology and Acupuncture.
He joined SSNI as an associate professional in 1993 and worked for 8 continuous years. He became the technical director of “Udaan for the Disabled, New Delhi” to manage the India’s first Multimode Therapy Project in 2001. The MMT Project was the first project in India which conducted studies on the efficacy of Hyperbaric Oxygen Therapy (HBOT) along with other medical therapies including pediatric Therapy in children with neurodevelopmental disabilities ( Cerebral Palsy and Autism).On completion, the MMT Project, he joined Prerna Welfare Society as the Chief Consultant and Executive Director. In 2013, he started an organization named “Institute for Child Development, New Delhi”. Presently, he is the Executive Director of ICD, New Delhi and associated consultant to many organizations.
2011 CMS Physician Quality Reporting System (PQRS): Teaching Doctors of Chiropractic How to Report on Measures Related to Quality Patient Care by Tony Hamm, American Chiropractic Association
Soft Tissue Treatment of Musculoskeletal Disorders Utilizing Functional and Kinetic Treatment with Rehab, Provocation and Motion (FAKTR-PM) by Thomas E. Hyde, DC, DACBSP, CSTI, ICSSD, FRCCSS (Hon).
The Mental Status Examination in Primary Care by the Natural Medicine Physician (DC/ND). Alan B. Korbett, DC, DO, DABCO, DACAN. Adult, Child & Adolescent Psychiatrist. lecturer@aol.com
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Current Concepts in Patellofemoral Pain Syndrome: Treatment and Rehabilitation - Dale J. Buchberger
1. Current Concepts in Patellofemoral Pain Syndrome: Treatment and Rehabilitation Dale J. Buchberger, MS, PT, DC, CSCS, DACBSP Vice-President, American Chiropractic Board of Sports Physicians Chiropractic Consultant, Auburn Doubleday's (Single-A affiliate Washington Nationals) Chiropractic consultant, Syracuse University Athletics Chiropractic consultant, New York Jets Football Strength and Conditioning Coordinator Auburn Stingrays Swim Team NUHS Homecoming Oakbrook, Il USA June 11, 2011
2. Thank you Dr. Winterstein and Shawna McDonough for the invitation to present
42. Straight knee bridge Lift bum Depress abdomen Toes pointed to ceiling, can vary for chosen affect Vary arm position for stability -Can add HS curl later Hold 3-6 seconds
46. Hip Flexion/ Extension Knee to 90 degrees of hip/knee flexion Extend hip/knee 3 points of contact Keep Femur and Tibia parallel to floor during all motion Hip/knee Flexion Hip/knee Extension
47.
48. Bicycle Hip/knee flexion Extend knee BEFORE extending hip Extend hip last in a long lever sweeping motion Maintain 3 points of contact Keep femur and tibia parallel to the floor
49. Circles: Clockwise/counterclockwise Point toe Perform CW/CCW circles as though you are drawing circles with a pen attached to you big toe Perform motions as smooth as possible Maintain 3-points of contact
50. Ball Table Shoulders in center of ball Head resting on ball Knees forward Feet straight ahead Squeeze bum Depress abdomen Hold 3-6 sec
51. Side to side walks Watch shoulder movements Patient will have the tendency to move the contralateral shoulder in the opposite direction of the lead leg. Ex: left leg moves to the left stretching the band and the right shoulder dips down to the right Shoulder should stay parallel to the floor and move in the same direction as the lead leg.
52.
53. Ball squat with band Add the band to ball squat to increase stimulation of hip abductors and reduce dynamic valgus at the knees
58. Thank You! 2006-2007 and 2008-2009 Stingray Sportsmanship award recipient; 2010-2011 High-point trophy winner
59. In Loving Memory of Lyle J. Buchberger Thanks for everything! Love ya dad! May 30, 1928 - January 12, 2009
60.
Editor's Notes
It is nice to be back and to have the opportunity to speak for my alma mater. For those of you that knew me in school; you’re saying’ “What the hell is he doing up there?” I have two explanations: First: I ‘m a late bloomer Second: I was young I needed the money!
I will apologize ahead of time for my bizarre presentation style. Sometimes I speak in random movie lines; it is up to you to decide if it is part of the presentation or a random movie line! On that note; ponder this during the next 90 minutes, Zoolander is to _________ as Space balls is to Star Wars.
The learning objectives for the presentation today include: AS ABOVE
ITBFS hasw been reported as the most common cause of lateral knee pain in runners and has been theorized to result from repetitive friction of the ITB sliding over the lateral femoral condyle. The incidence of ITBFS has been reported to be as high as 22.2% of all LE injuries in runners.
ACL injuries are more common in females than males. This is due to a variety of factors including LE alignment and strength differences which will be discussed shortly. It has been reported that ~70-80% of all ACL injuries in females result from non-contact mechanisms. This finding is significant because prevention may play a key role in lowering this number. Data from the NCAA has found that the majority of ACL injuries for females occurred in women’s basketball and soccer, and for men in football mostly due to contact mechanisms. Due to these findings there has been in a wealth of research in the prevention of ACL injuries, especially in females.
The diagnosis of PFPS encompasses retropatellar and or peripatellar knee pain. It is a diagnosis which is also more common in females than males and for some of the same reasons as ACL injuries which will be discussed shortly. A study by Devereaux and Lachman revealed that ~25% of all individuals with knee pain who were evaluated in a sports injury clinic were given the diagnosis of PFPS.
The ankle is the most frequently injured joint in both sports and daily life. Data from the NCAA Injury Surveillance System showed that ankle ligament sprains were the most common injury over 15 sports, accounting for 15% of all reported injuries. 70-80% of ankle sprains are lateral, or inversion type sprains.
The immediate result of LE injuries are pain and short term disability. Other consequences include long term disability and decreased participation in sports. Injuries have been found to be the leading reason people stop their involvement in sports & physical activity. Therefore, prevention of injury or complete recovery from injury is crucial to keep people active. Physical activity is known to decrease the risk of cardiovascular disease, obesity and diabetes, all of which are associated with higher mortality and morbidity and a significant cost to our health care system. Sports injuries are also a leading cause of the development of OA, especially knee and ankle injuries. Evidence shows that 12-20 years following a knee injury involving the meniscus and/or ACL, more than 50% will have knee OA in comparison with 5% in the uninjured population. The cost to treat LE injury conservatively, or operatively as well as the increased incidence of OA and disease associated with inactivity results in significantly high health care costs.
You can get a better understanding of the kinematic chain with this picture. You can see how weakness of the hip abductors results in the pelvis dropping which causes an increase in femoral adduction in the frontal plane. In regards to ITBFS, this causes the ITB to pulled against the lateral femoral condyle, resulting in injury. Research has shown that ITBFS occurs when the is weakness of the hip abductors and the runner is in a phase of overtraining. Therefore, one of the main components in treatment is to strengthen the hip abductors.
As mentioned previously, there are differences seen in LE alignment and strength in females as compared to males which results in a predisposition to ACL injuries and PFPS. This is not to say that men can’t display similar LE posture as we see here, however it is more commonly seen in females. The wider pelvis that females exhibit result in other changes down the LE such as: AS LISTED ABOVE. It is the external rotation of the tibia which is believed to strain the ACL against the lateral femoral trochlea increasing the chances of injury and it is also associated with increased lateral retropatellar contact pressure, which is a commonly accepted risk factor for PFPS.
Studies have shown that when cutting, landing, squatting and running females exhibit greater hip adduction, hip IR, knee valgus and less knee flexion, as demonstrated in this picture. As we just discussed this alignment places greater stress on the ACL and PF joint. Studies have also suggested that there are greater eccentric demands placed on the hip abductors and ER in females versus males during running. When strength was tested in females with PFPS and ACL injury it was found that they had weakness of their hip abductors, external rotators and in some cases hip extensors. Thus, it makes sense that strengthening these muscle groups should result in less ACL injury and PFPS, and the research has shown just that. A study by Jacobs et al revealed that ↑ hip abductor strength resulted in ↓ knee valgus displacement when landing from a jump. Another study showed that activation of quadriceps and hamstrings is improved when there is an ↑ hip muscle activity. Taken all together, the vast majority of studies which evaluated the relationship of hip strength to injury suggest that LE prevention should include a strengthening program of the hip and knee, specifically hip abductors, ER and extensors.
As with what was found with the ITBFS, ACL injuries and PFPS, studies have shown that lateral ankle sprains; especially chronic ankle sprains are associated with weak hip abductors. The authors cited on this slide state that weakness of the hip may result in chronic loss of stability or compensation throughout the LE kinematic chain which contributes to repeated injury at the ankle. Thus, strengthening the proximal musculature is key to reducing repeated injury at the ankle.
The motion which occurs in the joints of the LE when a person is standing can be explained by the concept of the kinematic chain. When in a weight bearing position, the joints in the leg are linked together into a series of joints so that motion at one of the joints in the series is accompanied by motion at an adjacent joint. For example, as demonstrated by this slide, when a person bends both knees to squat, there must also be motion at both the ankle and hip joints. This concept is useful for assessing joint motion as well as the how injury affects joint movement. A change in the function or structure of one joint in the leg will usually cause a change in the function or structure immediately adjacent to the affected joint or at a more distal joint. This concept will be revisited throughout the rest of the presentation as we discuss how proximal stability at the hip affects both the knee and ankle.
As mentioned previously when discussing the kinematic chain, a squat maneuver can be used to assess how motion in one joint affects another. A squat, or what we refer to as a functional squat is a quick way to assess the flexibility and strength throughout the LE. I will briefly run through the variety of things to look for and what they may indicate when assessing a patient’s ability to perform a functional squat, starting at the feet and going up. The first step is to place the patient in a “start position” in order to have a consistency when assessing or reassessing the move. This position when looking at the patient from the front, is an imaginary straight line drawn from the medial malleous to the lateral edge of the acromion process of the shoulder, with toes out at a 10 degree angle. First, assess the feet for pes planus, or flat feet. This can be structural or functional. Structural pes planus will not be altered by any amount of strengthening, orthotics are a way to provide external support to the arches to temporarily correct this deformity. Functional pes planus often occurs with dynamic knee valgus (everything falls inward). If this can be corrected if the dynamic knee valgus is decreased then hip strengthening will help decrease this occurrence. The next thing to look for is tight heel cords. If the achilles tendon is tight, a few things may happen: either the heels will come off the floor, or if the patient forces the heels down, the lumbar spine will flex and shoulders will come forward, or lastly they will actively contract their ankle dorsiflexors or toe extensors so you will see their toes come off the floor or anterior tibialis tendon stand out. With a normal heel cord, the heels will stay down without any of these compensations occurring.
Next, take a look at the knees. Dynamic knee valgus is the most common thing that will happen and this usually occurs with internal femoral rotation and functional pes planus which indicates weakness of the hip external rotators and hip abductors. Dynamic knee varus and femoral external rotation occurs less often and is usually the result of weakness at the hip so that the patient “pre-positions” themselves consciously to avoid other compensations. You want to correct for this by placing pressure at the lateral knees while they squat and re-assess what happens.
As for the hips and thighs, with normal flexibility and strength of the lower extremity the patient should be able to squat until the thighs are parallel to the ground. If there is weakness of the gluteals a patient won’t be able to get their thighs parallel. As mentioned before an increase in lumbar flexion indicates a tight achilles tendon, but may also be a sign of tight hip flexors and/or weak back extensors and is usually accompanied with forward shoulders. If the back is overly extended with the shoulders back they may have a sway back, or excessive amount of lordosis.
Hip series and clam shells against wall with three (3) points of contact Balance lunge requires adequate psoas/quadriceps flexibility to perform correctly
I’ve tried to make the process simple and efficient. That doesn’t mean you can’t make the process more complicated; that’s easy!