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Posture + walking
Organisation of the Body
| Question | Answer |
|---|---|
| Changes to our skeleton due to bipedalism | Skull - balancing of head on vertebral column Vertebral column - curvatures of the spine Pelvis - larger hip joint, closer to vertebral column Lower limb - increase in length and angle of femur Knee-enlarged and straight Foot-enlarged heel and arches |
| Why do humans walk on two legs | Savannah hypothesis - due to changing from woodland to grasslands Thermoregulation - decreases surface area in contact with the sun Energy efficiency |
| Vertebral adaptations | Secondary lordosis-brings body upright Ligament nuchae-limits flexion and stabilises head Supraspinous ligament-connects spinal processes Ligamentum flavum - allows vertebrae to recover after flexion Anterior/posterior longitudinal ligament |
| Pelvis | A compromise between bipedalism, thermoregulation and childbirth Iliac crest - wider and flared out, leads to reorganisation of gluteal muscles Sacrotuberous ligament -resists downwards force of body movement Ischial tuberosity-posterior for hamstrings |
| Lower limb | Larger hip joint, femoral head/neck Knee is positioned over the ankle to allow a centre of mass Foot has a larger heel, arches, no midtarsal break and a non-opposable, larger big toe Arches for shock absorption and propel the foot forwards |
| Pes Planus | An excessively flat foot where the arches collapse Windlass test can be used to identify pathological pes planus often associated with stiffness and pain E.g. due to weakened string ligament |
| Pes Cavus | An excessively high arched foot which can occur at fore- mid- or hind-foot or if it involves all three 'global' Surgical lengthening of calcaneal tendon can treat this |
| Postural stability of the head - muscles | Sternocleidomastoid - turns the head, innervated by the accessory nerve Rectus capitis anterior, lateralis, posterior major and minor Longus colli and capitis Obliquus capitis superior and inferior Semispinalis colli Spinalis colli |
| Postural stability of the shoulder girdle | The trapezius is a superficial muscle of the back and anchors the scapula to the vertebral column ensuring it can work efficiently and permit its normal range of movement It supports the vertebral column in maintaining an erect posture while standing |
| Effect of damage to the spinal accessory nerve | This innervates the trapezius Damage can result in a depressed pectoral girdle, winged scapula, an inability to raise the arm above the head or weakness during elevation of shoulder |
| Erector Spinae group | Spinalis, Longissimus, Iliocostalis and Multifidus These lie deep to the superficial layer of back muscles Common origin from transverse process of T11-L5 and insert between spinous processes of vertebrae Innervated by posterior rami of spinal nerves |
| Abdominals | Lie in anterior abdominal wall Important role in posture - weakened abdominals can lead to breakdown in normal functioning They flex the trunk and increase intraabdominal pressure for breathing External/internal obliques, Rectus/transverse abdominis |
| Gait cycles | Stance - heel strike, foot flat, midstance, opposite heel strike, pre-swing (foot is on the ground) Swing - Initial swing, Terminal swing and heel strike (foot is off the ground) |
| HS-OHS Gluteus maximus | Powerful extensor of the hip and keeps the trunk upright and maintains centre of gravity Acts to decelerate forward motion of the lower limb Most active during heel strike, foot flat and terminal swing Innervated by inferior gluteal nerve (L5 to S1) |
| What does damage to the gluteal nerve lead to | Extensor lurcher gait Lack of extension on the damaged side leads to the body flying back on the opposite side |
| HS-OHS Quadriceps | Rectus femoris, Vastus lateralis/medialis Act together to keep knee in a stable extended position as the foot contacts the ground Absorb body weight upon impact and provide propulsion Knee extensor and hip flexor Innervated by femoral nerve |
| HS-HO Gluteus medius and minimus | Hip abductors also responsible for stabilisation of the pelvis (contralateral contraction) Both innervated by superior gluteal nerve They stabilise the opposite side of the hip |
| Trendelenburg gait | Paralysis of the gluteus medius causes the pelvis to tilt on the non-weight bearing extremity |
| TO-MS Iliopsoas | Iliacus and psoas major Hip flexor and is the dominant muscle in propelling the lower limb forwards Lumber posture - assist abdominals in supporting lumbar back when moving Iliacus innervated by femoral nerve, psoas major by anterior rami of L1-L3 |
| Hypertrophy of iliopsoas | May compress the femoral nerve and cause knee pain |
| TO-MS and HS-MS Hamstrings | Allows foot to clear the ground and slightly flexes the knee as the foot hits the ground to absorb the impact Combine contractions decelerate the leg, controlling forward momentum and stabilising the pelvis Innervated by sciatic nerve |
| HO-TO Adductors | Pectineus, Adductor brevis/longus/magnus and Gracilis (medial compartment) Adduct the thing and stabilise the pelvis along with the abductors Innervated by obturator nerve except of hamstring component of adductor magnus (tibial nerve) |
| Scissor gait | Marked by excessive medial rotation and adduction of the thigh It can be so extreme that the knee/thigh crosses over to the opposite side Due to spasticity of the muscle e.g. in cerebral palsy |
| Tibialis anterior | Primary dorsiflexor and invertor of the foot Eccentric contraction controls position of the heel as it contacts the ground EDL and EHL assist Innervated by deep fibular nerve Active during heel strike, foot flat, toe off and swing phase |
| Foot drop | Damage to the common or deep fibular nerve can cause foot drop and steppage gate Due to absence of dorsiflexion |
| Triceps surae | Gastrocnemius, plantaris and soleus Provide powerful plantar flexion and working in synchronicity with quadriceps generate the propulsion required during the heel off/toe off phases Innervated by tibial nerve |
| HS-TO Lateral compartment of the leg | Fibularis longus/brevis Function as ankle evertors Offer mediolateral stability by preventing involuntary ankle inversion during foot strike Innervated by superficial fibular nerve |
| Lateral ankle sprains | Strength of the lateral compartment of the leg is associated with functional ankle stability Weakness leads to lateral ankle sprains |
| Screw Home phenomena | Occurs during terminal extension of the knee Tibia rotates 15 degrees on the femur Cruciate and collateral ligaments tighten, all other muscles relax Essential for knee stability while standing upright |
| How does screw home phenomena fit in the gait cycle | Terminal stance-femur medially rotates on locked knee Lateral rotation causes foot to invert and raises arches As knee flexes the tibia medially rotates, foot everts and relaxes to absorb energy on impact In toe off, knee extends again, tibia rotates |
| Windlass mechanism | Foot is an arch like structure that would collapse under vertical and ground reaction forces - plantar fascia helps maintain medial longitudinal arch to prevent this Windlass mechanism involves tightening of this to give a rigid base to propel the foot |
| Plantar fasciitis | An inflammation of the plantar fascia May occur due to weakness of proximal muscles of the leg or excessive pronation |
| Bipedalism - lower back pain | Lower back pain - lordosis increases shearing forces between vertebrae and IV joints, due to sedentary lifestyles and weakening of vertebrae this is increasing Can lead to further complications such as disc herniation, inflammation and bone degradation |
| Bipedalism - Arthritis | Arthritis - genetic evidence suggests knees developed by selection pressures and variants from genetic drift increase risk of developing osteoarthritis in the knee |
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