Movement Analysis & Biomechanical Considerations

Well you are probably wondering where I have been?!  Well to let those of you know who may not already know, a good friend of mine has been kind enough to build me a website.  This is a completely new type of project for me and I am enjoying the templates we have produced so far.  Also with my fast approaching semester one exams on their way I have been in a series of revision and university.

But even more interestingly, just yesterday I was on a course called 'Street Soccer UK' which focused on delivering the most effective conditions for learning to take place in your sessions.  Of course there was lots of street skills involved but more importantly, the session wasn't about making the coach look good.  It wasn't about looking professional with badges all over your tracksuit, nor was it about hiding behind your clipboard and over analysing everything (as we tend to do as coaches).

But even more interesting than that, there was a point in the session that challenged the FUNdamental movements of physical literacy.  In fact they had a good reason to.  They touched briefly on the reptilian brain located in the frontal lobe and how when under pressure or feeling threatened it shuts off from everything around it.  Therefore this defeats all forms of learning and as for FUNdamental movements, they simply won't be learned.  The skills and movements in street soccer are all creative and forever new evolving movement patterns that challenge the FUNdamental movement programme.  So as I talk about this piece I think it's important we don't forget to challenge the science behind movement but also what works best with our athletes.

However excluding all that when we talk about the best biomechanical movement pattern in sport we are talking about the most powerful, precise, attention to detail body dynamics.  Biomechanics will always be a very complex movement no matter what field it's in, from walking to a golf swing; or a boxing punch to a rugby kick.  But all these movements operate on an axis and a plane.

We have three axis and three planes...

An axis is an infinite long line that joints move around.  A joint moves in a 2D manner and a plane is an infinite 2D extremity.  Now we know what they mean I can tell you what they are called.  Firstly we have an anterioposterior axis which operates on the sagital plane and allows movement such as flexion.  Then we have a mediolateral axis that operates on a frontal plane which allows for movements such as abduction.  Finally we have a longitudinal axis that works on a transverse plane allowing movements such as rotation.

Therefore when working with athletes, we use these planes and axis to heighten performance as our centre of gravity is the central point of all these planes.  However when we don't use these axis and planes correctly we can cause lower and upper crossed syndrome as I've spoken about in previous pieces.  In addition Newtons '3 laws of motion' help avoid this from happening and teach us the basic principles to motion.

superiorathleticsnewyork.com

1st Law:  Inertia
This law states that an object isn't going to move unless a force is applied to it and then when a force is applied it won't stop moving until unseen forces intervene.

2nd Law:  Acceleration
Force =  Mass x Acceleration

3rd Law:  Action & Reaction Force
This law say's that for every force we apply to an unmovable object we get an equal reaction (e.g. Sprinting)

Now to bring you back to the course I was on and challenging the science.  Let's take Aaron Lennon.  If you don't know who Aaron Lennon is, he's an exceptionally fast soccer player who plays for Tottenham Hotspurs.  Aaron Lennon is super fast!  However he goes against the best kinomatics of posture (biomechanical anatomical shape).  He runs with his arms flapping down between his hip and chest region,  and the science says this will hinder his speed, yet he is seen as one of the fastest footballers in the professional game.  Therefore it doesn't quite sit right with me to coach a very fast player out of this body movement pattern to increase speed when his body movement pattern allows him to generate speed already.

www.dailymail.co.uk

The other point is that invasion game sports especially are very different to your typical linear and lateral movements as at any moment you may need to change direction, which is a key attribute of Aaron's game.  Therefore to teach him this biomechanical functional way of moving may not be the best approach.  Perhaps a better approach is to incorporate Newton's laws of motion but use the demands of the game to influence his biomechanical movements and still maintain strong kinomatics of posture.  For example; maintaining a low base and centre of gravity to generate power; with a slight anterior tilt on the pelvis with the head down but in line with the spine to send us the direction we aim to go; with slight dorsiflexion and corresponding arm to leg motion; with our arms flapping by our side to use as a shield against invasion from the opposition. 

The Street Soccer UK course has enlightened me to challenge the science and try not to just develop a scientific methodological approach.  But instead, to create the conditions and best environment for people to learn in.  At times it may be useful and vital that we use the science.  Whereas at other times it may be pointless and worth scrapping it if it doesn't work best, as ultimately we all fundamentally move and operate differently.

Anyone who hasn't been on the course and is involved in coaching or a sports field I strongly recommend this course massively as it has much more to offer than just what I related back to you, as this is just what I took from the course as it relates to the learning environment I am in.

Glossary

Anatomical Terminology

Superior - Higher
Inferior - Lower
Proximal - Closer to the body
Distal - Further away from the body
Supra - Above
Infra - Below
Anterior - In front
Posterior - Behind
Medial - Close to the midline
Lateral - Away from the midline
Hypertonic - Short over-active muscle
Hypotonic - Long weak muscle

Flexion - Decrease in an angle at a joint
Extension - Increase in an angle at a joint
Adduction - Movement towards the body
Abduction - Movement away from the body
Plantar Flexion - Ankle extension
Dorsi Flexion - Ankle flexion
Medial rotation - Rotation inwards
Lateral rotation - Rotation outwards
Supination - Lateral rotation of arm
Pronation - Medial rotation of arm
Protraction - Prolonging a body part
Retraction - Drawing back a body part

Maintaining Anatomical Structural Integrity

By now you are probably familiar with the phrase structural integrity as it's a phrase I use a lot and some of you probably aren't familiar with the phrase nor understand what I mean when I use it, so let me explain it in more depth. 

We have learned that there are many joints in the body and by now you should understand the structure, functions and importance of these joints.  However let me touch more on the importance of maintaining the structural integrity of these joints.  What do I mean by structural integrity?  Well our body is a complex and intricate structure as you know by now...  Therefore when I mention structural integrity I am referring our anatomical shape.  During the evolution of the human race our anatomy evolved to adapt to its environment.  Therefore this meant obtaining an upright spine enabling us to walk upright on two legs.  It also meant obtaining the use of our thumbs to use tools, etc...  Therefore we have essentially self designed our anatomical shape through evolving to meet the means of our environment.  That's structural integrity!  The hard job is maintaining it.

Over time, as we get older and grow, our body shapes can change based on our environment or the tasks we undergo on a daily basis, therefore this can prohibit maintaining structural integrity.  In many ways structural integrity is our posture.  We are designed to have curves in our spine, a forward facing head, balanced weight on either side of our hips, forward facing toes, etc...  We are also designed to have a wide range of motion around these joints.  Take into consideration a new born baby, the purest form of nature in the human race.  A new born baby is born with more cartilage than bones, roughly 300-350 parts of cartilage.  By the time they have finished adolescence and are in their mid twenties they have 206 bones that have fused together via cartilage.  This allows the baby to be very flexible as they have no rigid structures preventing this...  However I invite you to imagine this scenario.  By the age of ten, that once new born baby has developed a restriction of motion when bending down to touch their toes, however when that ten year old was five he made it look easy!  Well the reason he could touch his toes at five and not ten is because his refined and under developed muscles have created muscular imbalances that have prevented this action occurring.  Well at such a young age, increasing range of movement at a joint isn't too difficult.  However, how many of you can touch your toes?

This blog isn't to have a go at you, and I say touch your toes because its a basic movement to show flexibility.  However for those of you who can't whats happened is you have most likely developed lower cross syndrome.  Sounds scary right?  Well it's not and in fact with a little more care and therapy on your anatomy it can be cured.  Lower cross syndrome is when you have hypertonic (short and over active) muscles and the opposite muscles being either your antagonist or agonist muscles have switched off making them hypotonic (long and weak).  However this is where it can have a detrimental effect on our anatomy pulling our anatomy out of alignment.  For example it may be having hypertonic hip flexors and hypotonic glutes pulling our pelvis forward, creating an anterior pelvic tilt.  You could also have tight pectorals and traps and weak neck flexors and rhomboids creating a hyper kyphotic curve within the thoracic spine.  Essentially the muscle that is hypertonic means that the opposite muscle slowly becomes hypotonic and therefore our hypertonic muscles pull the body out of alignment.

I touch upon this issue as its more often than not overlooked and in fact if we give our anatomy therapy it will help us maintain structural integrity, and maintain full range of motion around our joints like most of us could when we were younger thus ironing out these muscular imbalances.  How, you might be asking?  Well I touched on it briefly in a previous blog, and its quite simple.  Things such as massage therapy are great as it irons out all those muscular imbalances.  Also yoga is a great healer of the body and allows for a greater range of motion around our joints.  Or something as simple as stretching and not sitting down in one place for too long is an easy and effective activity to do.  I'd also invite you to do this.  Be conscious of your anatomical shape as often as possible and if it needs altering then make those changes instantly.  This will allow you to develop good habits and iron out bad habits through good practice.  A key area to stretch is your hip flexors as most of us sit down at some part of the day, some of us may work in offices and therefore we are sitting down most of the day.  This will create tension in your gluteal muscles when stretching preventing them from becoming hypotonic and restrict tension in your hip flexors preventing them from becoming hypertonic.

MAINTAIN STRUCTURAL INTEGRITY!

The Anatomy of the Elbow, Wrist and Hand

I thought I'd cover these three joints in one piece as they are already similar to the ones we have covered in previous entries, so by now you should be familiar with the type of joints we have.

Lets begin with the elbow joint...

The elbow is made up of three bones.  We have the humerus (upper arm), ulna and radius (bones of lower arm).  The articulation between the distal end of the humerus and the proximal end of the ulna means like the knee it is a synovial hinge joint and aids movements such as flexion and extension.  However unlike the knee it doesn't aid movements such as medial and lateral rotation as those movements occur at the shoulder joint.  Now like all bones it is possible to dislocate the elbow joint and what happens is the humerus shunts forwards and sits on the superior anterior surface of the ulna.  Not pretty right...

meded.ucsd.edu

Well let me run a few bony prominences past you to help you understand the structure further.  The elbow bone is anatomically referred to as the olecranon.  Along with the olecranon we have a medial and lateral epicondyle which are the bony surfaces of the elbow found on either side of the elbow joint.  I presume the term 'funny bone' rings a bell with you.  In case you're confused, it's that really annoying tingling sensation you can feel sometimes when you hit the medial aspect of your elbow against something.  What essentially happens is when you strike the medial epicondyle, the ulnar nerve causes this tingling sensation of the inside of your elbow.  The reason it's so easy to strike your 'funny bone' is because it protrudes posterior to the humerus and makes it easier to strike in comparison to the lateral epicondyle.

The elbow also consists of numerous ligaments similar to the knee.  Firstly we have internal ligaments known as our ulna collateral ligament and radial collateral ligament.  These ligaments connect our ulna and radius to our humerus and maintain lateral and medial stability of the joint.  We also have an external ligament called our annular ligament which wraps around the anterior aspect of the radius and attaches to the ulna, aiding stability in the joint.  This allows movements such as pronation and supination to occur.  These movements occur in our radioulnar joint which is a pivot joint.

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Pronation is palm downward (radius crosses over ulna)
Supination is palm upward

The annular ligament aids the pronation between the joint, allowing the radius to cross over the ulna as shown in the picture (right).  We then have two more joints on the posterior surface of the humerus and ulna called the humeroulnar joint and we also have a joint between the humerus and radius called the humeroradial joint.  These joints prevent our elbow falling into hyper extension.

At the wrist we have two more bony prominences which can be palpated on the medial and lateral aspect.  These are called our styloid processes also referred to as our ulnarstyloid and radialstyloid processes.  We then have our scaphoid process which is the first carpal in our hand and can be palpated when we extend our fingers laterally to the tendon in our thumb.  It's a common injury that can occur in our everyday lives, and usually as a result of falling and landing on the palm of our hands.  This sort of injury can take a while to heal due to the bad blood supply to the bone and often requires surgery.  The movements we get at the wrist are flexion, extension, abduction and adduction. 

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In the hand we have our carpals, metacarpals and phalanges.  In total we have eight carpals all with different names which I won't bore you with.  We then have five metacarpals and three phalanges in each finger except the thumb in which we only have two, like the foot.  The opposable thumb allows us to grip, hold and pick up objects, it is a milestone in the evolution of human beings.  Now the joints...

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Well, between each section I just mentioned we have a joint.  The first joint is our radiocarpal joint which can be palpated between the radius and carpals.  We then have our carpometacarpal joint which is located between the carpals and metacarpals.  The third joint we have in the hand is our metacarpophalangeal joint (a mouthful I know) which is located between the metacarpals and the phalanges.  Finally we have interphalangeal joints, just like the foot.  Therefore using anatomic terminology we can distinguish each one.  The joints between our second and third phalanges are our distal interphalangeal joints.  That means the ones between our first and second are our proximal interphalangeal joints.  Now as we know our thumb only has two phalanges so the joint between these two is simply just our interphalangeal joint.

Like the foot the hand has palmer fascia which helps hold everything in place and stretches across the palms of our hands.  As well as palmer fascia our fingers are made up of numerous medial and lateral collateral ligaments connecting each phalangeal bone to eachother. 

The elbow, wrist and hand are very similar to the other joints I've covered in my previous blogs...  In addition to the hand though I'd like to leave you with this thought.  The hand very much similar to the foot is a tool we use every day of our lives.  For example right now as I type this I am putting strain on the tendons and ligaments of my hand, thus having a knock on effect to the muscles that move the tendons in my hand making them tighter and causing muscular imbalances.  We all put strain on the tendons, ligaments and joints of our hands every day yet we forget to aid these joints with therapy.  Similarly to the foot our hands our always under tension, whether it be pulling, pushing, twisting or typing, etc... Most of us forget to do the basic movements such as stretching them.  In order for our anatomical shape to maintain structural integrity it is vital that we give our bodies therapy and medicine through natural basic activities such as stretching.  Whether you find your therapy through yoga, pilates, massage therapy etc... It's vital we give our bodies down time and therapy time! 

The Anatomy of the Shoulder

I can already hear you screaming a question at me, "I dislocated my shoulder and its never recovered, why!"

Lets see if this helps...

The shoulder consists of three bones,  The clavicle, scapula and humerus.  The shoulder joint is very similar to the hip joint as they are both ball and socket joints.  However the key difference between the two is the fact that the hip is a much larger irregular structure that makes it harder to dislocate the joint in comparison to the shoulder.  By now you must be excellent on learning joint names...  It's simple just merge two bone names to form the joint name (look back over the knee, and foot and ankle entries).

Firstly I should make it clear we have numerous bony prominences protruding around our shoulder joint.  We have our acromial and coracoid process which can both be palpated.  We also have the spine of the scapula which is the only surface of the scapula you can feel along your back.  Right, now that's cleared up we can move on to the joint names.

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We have a joint situated between the superior and lateral surface of the sternum and the medial third of the clavicle.  This is called our sternoclavicular joint.  Also between the last lateral third of our clavicle and the acromion process is our acromioclavicular joint.  Finally we have our main joint of the shoulder which is known as our glenohumeral joint.  This joint is formed between the humeral head (head of the humerus) and the proximal surface of the glenoid fossa.  The glenohumeral joint is a synovial joint (ball and socket).  We have a substance called hyaline cartilage which covers the bony ends of the joint and hyaline membrane that holds the joint in place, aiding stability.

The shoulder joint is all about sacrificing stability for mobility.  Here's why...  The head of our humerus is 2/3 the size of our glenoid fossa which it inserts into, therefore it is only in contact with the glenoid fossa for 1/3 of the time.  This decreases the stability within the joint however increases the mobility.  The shoulder joint however is quite a deep socket joint that increases stabillity.  Labrum (a source of fibrocartilage) adds to stability by increasing the depth round the glenoid fossa, this is called glenoid labrum. 

I briefly touched upon the dislocation of the shoulder earlier telling you its easier to dislocate than the hip, however I never told you why...  The glenoid labrum that surrounds the socket can wear away when a dislocation is present within the joint.  Therefore when the joint is back in place its much easier to pop out.  Sounds gross?  Well that's cause it is!  The glenohumeral joint allows us to perform many movements, such as; rotation, flexion, adduction, abduction, medial and lateral rotation.  However in an individual with worn glenoid labrum these movements become hyper movements and can fall quickly into dislocation again.

We also have a shoulder girdle which is often confused with the glenohumeral joint joint.  The shoulder girdle is made up of the scapula and clavicle and allows us to perform; elevation, depression, protraction and retraction. 

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There are numerous ligaments in the shoulder joint.  These ligament names are very similar to the joint names and are a combination of two or more bone names.  The first ligament we have in the joint is the acromioclavicular ligament which connects the supra lateral third surface of the clavicle and the acromion process.  We then have the coracoacromial ligament which attaches the coracoid process to the clavicle.  This ligament sits on the superior surface of the coracoid and attaches on to the anterior surface of the clavicle.  Finally we have our coracoclavicular ligament which attaches the medial surface of the coracoid to the acromion.  These ligaments are known as our static stabilisers and keep the joint in place.
 

In addition to these stabilisers are another set known as our dynamic stabilisers.  These are what allow movement within the joint.  We can abbreviate these stabilisers as 'SITS'.  These are a group of muscles that all work together to enable rotation of the shoulder, also referred to as our rotator cuff muscles.

S - Supraspinatus
I - Infraspinatus
T - Teres Minor

www.nlm.nih.gov

S - Subscapularis

If you play tennis or badminton or any sport/activity that require many arm over the head motions you will be familiar with rotator cuff problems.  These often occur in the sports above because our dynamic stabilisers become tight and hypertonic (short and over active).  Therefore when the muscles become extremely hypertonic it limits movement around the shoulder and actually causes extreme pain on this area in the picture (right).   Therefore these hypertonic muscles cause muscle impingement which means a task such as putting your hand up in class or stretching to get something out of the cupboard or playing a sport such as badminton becomes difficult.  Therefore our muscles become weak as they are hypertonic and makes it much easier to tear tendons.

Well how do we avoid it?  Unfortunately theres not a lot you can do.  I'd like to invite you to imagine this.  Above the spine of our scapula is a tendon that attaches the clavicle to the supraspinatous which inserts onto the supra surface of the humeral head.  Therefore when we perform these discomforting activities our tendon gets crushed between our clavicle and humeral head.  Doesn't sound nice right?  Its not very pleasant at all... 

Solution? 

Well like I said there's not a lot we can do, however if you are familiar with these problems, such activities such as massage therapy may be a good start or if you can't afford that, then daily stretching exercises of our dynamic stabilisers and our deltoids and pectoral muscles to avoid any upper cross syndrome of our upper appendicular extremities may too be a good place to start.  

The Anatomy of the Foot and Ankle

WATCH THE VIDEO!!!!!!!!!

A fantastic video regarding the anatomy of the foot and ankle if you knew what it all meant!  Right?  Well let me try and break it down for you...  The ankle and foot is made up of numerous bones, joints, ligaments and tendons.  Now you are probably already raring to ask many questions regarding foot pain.  I think we can all say we've experienced some form of pain or problems in our life relating to foot or ankle problems.  Whether it's been a long hard day at work, where you've been on your feet all day, or you've gone for a jog and afterwards your feet are super tight and you can barely move them... What causes these pains?

Lets begin!

www.webmd.com

As mentioned above the foot is made up of many bones, so lets begin there.  The first couple of bones you may be aware of are our tibia and fibula palpated supra to the ankle joint.  We then have our talus which articulates with the tibia and an irregular shape called the calcaneus commonly referred to as our 'heel bone'. These are followed by our tarsals which consists of our navicular, cuboid and cuneiforms.  We then have our metatarsals and phalanges.  Our toes consist of three phalanges except our big toe.  Bones check!

Now on to the complicated bit...  Our foot and ankle have many joints, some of which can be palpated.  Like the knee, the name of the joints consist of two names merged together.  The first noticeable joint can be palpated on the distal end of the tibia, superior to the talus.  This is known as our talocrural joint.  This joint allows for movements such as dorsi and platar flexion of the ankle. Dorsiflexion is flexion at the ankle and plantar flexion is extension at the ankle.  These are followed by our second joint of the foot located on the inferior aspect of the talus, this is anatomically known as our subtalor joint and consists of our talus and calcaneus bones.  This assists movements such as eversion and inversion, which I shall explain later.

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We have a joint between our tarsals and metatarsals, this is called our tarsometatarsal joint.  Also we can palpate another joint on the superiror side of our matatarsals and the inferior side of our phalanges.  This is called our matatarsophalangeal joint.  Finally we have our interphalangeal joints which consists of two joints that can be differentiated between.  There is the proximal phalangeal joint palpated nearer to the ankle and the distal phalangeal joint palpated further from the ankle.  All these joints are supported by ligaments aiding support and movement of the complex structure. 

www.arthroscopy.com

The foot is made up of lots of intricate ligaments.  The first you can see in this diagram, (right) and is called our anterior talo-fibular ligament, abbreviated as ATFL.  This ligament is found on the lateral side of the foot and ankle and prevents movements such as inversion taking place.  We then have a CFL ligament which prevents the ankle falling into hyperinversion of the foot causing serious damage. 

On the medial side of the foot and ankle is our deltoid ligament.  Not to be confused with our deltoid muscle of the shoulder joint... Deltoid is the anatomical word for three.  In this case it means it attaches onto three bones (talus, calcaneus and navicular) and prevents eversion of the ankle.  Eversion is a rare occurence due to the support of the deltoid ligament which attaches onto three bones at one time giving additional support.  However if you have the misfortune to fall victim to this excruciating injury then you'll be left in much discomfort and with a long rehabilitation programme ahead.  Finally there is a posterior talo-fibular ligament (PTFL) which attaches from our fibular to our talus.  This aids the support and structure to the posterior surface of the foot.

Now onto the longitudinal arches of the foot.  These arches give us shape, act as shock absorbers and support the tibia, which is our weight bearing bone of the lower limb.  We have a lateral longitudinal arch, (LLA) a medial longitudinal arch, (MLA) and a transverse lonitudinal arch (TLA).  If you are getting familiar with the terminology now, you will know that the LLA runs from the calcaneus to the little toe, the MLA runs from the calcaneus to the big toe and the TLA is found infra to our tarsals running from the inferior medial aspect to the ineferior lateral surface of the foot.  These arches are held in place by our plantar fascia which is a skin like substance that stretches from our calcaneus to our toes.  Women may be familiar with what I'm about to say next, however men may have experienced this pain too, undergoing different activities in a different environment...  Ladies, ever had a long night out in those high heels and just wished you could take them off sooner rather than later because of the pain.  Well this can be explained...  Essentially what has happened is due to the shape of heels, wearing them over a long period of time has shortened your plantar fascia and this then in turn causes pain.  Next time you are out and have an achy feeling on the sole of your feet, run your thumb along the arches and it will almost feel like bubble wrap.  What can happen over time is you can develop what is medically known as plantar fasciitis which will leave you in constant pain.    

Out of all the muscles, ligaments, tendons and joints we stretch in our anatomy, we seem to forget about the ones that take the full weight of our body.  Seems bizarre when you think about it really!  I'd like to leave you with a simple message and that's this....

STRETCH THOSE FEET AND AVOID A WHOLE LOT OF PAIN!!!

The Anatomy of the Knee

The knee joint, what I refer to as the modern day joint of evolution.  Why?  I'll share with you later, but for now I'd like to introduce you to the complexity of the knee.  By now it's probably not uncommon to you that joints are a detailed manufactured natural construction.  Therefore the complexity of the knee joint won't surprise you if you've read my previous two blogs.

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The knee is consists of three bones, the femur (thigh bone), the tibia (shin bone) and the fibula (located on the lateral aspect of the tibia).  The femur is the proximal bone and connects onto the superior pole of the patella forming the patellofemoral joint.  Then there is the distal bone, in this case the tibia, which latches onto the inferior pole of the patella to form the tibiofemoral joint.

These joints are supported by a diverse list of ligaments.  At the top of the knee we have a lateral and medial groove in which the patella ligament inserts.  What does medial and lateral mean?  Well medial is the inside of the knee, defined as close to the mid-line and lateral is the outside of the knee simply put as away from the mid-line.  So of each bone of the knee we have a ligament.  These are medically known as the lateral and medial femoral condyles attaching the femur and patella whilst contributing to the support of the structure.

We also have the lateral and medial tibial condyles.  These again aid support and connect the tibia bone to the patella.  The knee bone allows movements such as extension, flexion, and slight medial and lateral rotation.  The knee by basic design theoretically should only allow for extension and flexion however the aid of ligaments enables additional movements such as medial and lateral rotation.  

There is also a medial and lateral collateral ligament.  What's the difference?  Well these ligaments connect the femur and tibia bones.  The medial collateral ligament is long and strap like because this is the impact side and therefore the medial aspect of the knee needs to be longer and stronger essentially to aid protection of collisions of the lateral aspect of the knee.  The lateral collateral ligament is short and cord like and provides a smaller amount of support in comparison.

We can refer to ligaments on the medial aspect of the knee as intracapsular ligaments and ligaments on the lateral surface of the knee as extracapsular ligaments.  In addition, we have two more intracapsular ligaments, these are located internally.  The patella bone is a sesamoid bone and provides the knee with protection and increases the efficiency of quadriceps movement, enabling more of a pull action.  I'd like you to hold this thought.  Imagine the removal of the patella bone from the knee joint.  What you would encounter is a web of ligaments, tendons, and menisci all overlapping one another .  Lost you?  Let me break it down for you...

www.webmd.com

Within the internal aspects of our knee structure we have a anterior cruciate ligament and posterior cruciate ligament.  Otherwise put as ACL and PCL.  Our ACL ligament travels along the anterior surface of our tibia diagonally in an upwards direction and connects onto the posterior inferior surface of our femur.  This ligament stops the leg shunting forwards avoiding hyperflexion of the knee.  In comparison to our PCL ligament which runs along the posterior superior surface of our tibia in a diagonal upwards direction and latches on to the anterior inferior surface of our femur.  This ligament also aids support preventing the leg shunting backwards avoiding as you can probably guess, hyperextension of the knee.

There are two key tendons of the knee joint, the easiest tendon of the two to palpate is the infra patellar tendon, medically referred to as the tibial tuberosity.  The other tendon is palpated on the supra surface of the patella attaching the quadriceps muscles to the patella.

Finally we have fibrocartilage also referred to as meniscus which enables many functions of the knee.  These functions can be abbreviated as SLAPS: 

S - Stability (support to the knee)
L - Lubrication (enabling movement)
A - Aids rotation (Additional movements such as medial & lateral rotation)
P - Protection (Hyaline cartilage)
S - Shock absorber (aids running, jumping, lifting etc...)

 

en.wikipedia.org

The menisci can be located medially and laterally on the internal aspects of the knee.  It is a type of cartilage that allows for load distribution and reduces friction during movement.  This allows for a greater mechanical effect and spread the load of the bodies weight.

I referred to the knee joint as a modern day evolving joint.  This is because when we are born, we are born without this joint and without bones in our knees.  These bones only develop through areas of friction and in effect alter the size of the patella.  In effect my knee cap is of a different structural integrity to yours.  The knee is a sesamoid bone which means it's a bone that develops in the tendons of the knee.  To be more specific, through the course of child development as we learn to walk for the first time, we produce enormous amounts of tension on our tendons around are evolving knee cap.  Thus when we fall over we land on our hands and knees producing more tension among these tendons.  When we are encouraged to walk by our parents and loved ones, our patella bone is in the process of evolving within the environment, consisting of many of the above factors that aid the speed of the process. 
  

The Anatomy of the Hip

In this piece I will be boring you with the anatomical facts of the hip...  However, I intend to explain the functions of the hip developing the understanding and importance of the hip joint.  If you are a coach, personal trainer, P.E. teacher, sports performer, etc... or an individual who cares about their health then this piece and last weeks entry on the spine should be of great importance to you.

The hip joint (commonly referred to as the pelvis) is another very complicated joint due to the various bony prominences.  Therefore it makes it hard to distinguish how many bones make up the hip joint.  Fortunately we understand that the pelvis is made up of three bones; the pubis, ischium and illium.  As you can see in the diagram (left) the two round flat surfaces of the hip are called the illium and

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are the largest bones of the pelvis.  Then there is the pubis located on the anterior surface of the hip and the ischium situated at the bottom of the hip.  Now that wasn't too hard was it?  Well now it gets a little bit more complicated.

The hip consists of numerous bony prominences. What's a bony prominence you may ask yourself?  Well if I haven't explained before, a bony prominence is a protruding bony process that can be palpated on the body.  These bony prominences collectively make up a vast majority of the pelvis thus confusing us with lots of medical scientific names.  If I was to begin boring you with the various names of all the bony prominences we could well be here until Christmas, so I won't.  However what I would invite you to do is imagine the hip as a mechanical device such as a lorry.  A lorry carries a mixture of loads to destinations and is made up of lots of specific mechanical parts that all have specific jobs to aid the function of the lorry.  Well essentially the hip joint is the same, it is made up of numerous bony prominences and has the greatest amount of muscle attachments in the body.  These all have specific jobs and aid the support and protection of the pelvis.  Most of all the hip joint provides support to our anatomy.  Through our evolution our anatomy needed the means of support to provide movement.  Therefore as we evolved and adapted to meet the needs of our environment so did our anatomy.  The means of our environment and evolution meant isotonic movements such as bending to pick things from the floor were vital.  Therefore our hip evolved in such a way that allowed us to do this.

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The evolution of the human hip joint and spine has allowed us to stand up right as shown in the (left) diagram.  It's a joint that adapts to meet the means of its environment.  For example Rugby players tend to have large hips because over the course of time it has adapted to meet the means of the environment.  To be specific the hip joint is the articulation between the femoral head and the acetabulum which is a deep socket of the pelvis.  The hip joint has sacrificed mobility for increased stability in our evolution.  This in addition aids us when we load weight on to our hip, thus holding the hip in place so it doesn't fall out of joint.  The acetabulum is surrounded with a layer of labrum.  Labrum is a type of fibrocartilage which wraps around the socket of the hip joint to increase depth of the socket.  During the evolution of the hip joint and the structure of the hip we are able to perform a variety of movements such as; flexion, extension, abduction, adduction, and medial and lateral rotation.

However with these movements can come some issues, for example piriformis syndrome.  Piriformis is a little muscle on the posterior inferior surface of our torso region that originates on our sacrum and attaches onto our femur.  This can also be referred to as lower cross syndrome of the hip which in this case would be when an individual has very tight hip flexors (which most of us do) causing their gluteus maximus muscle to turn off which means our main mobilisers of the hip have turned off.  Therefore the deeper stabilisers of the joint have had to take on the role of mobilisers also.  This in turn makes our piriformis muscle hypertonic, meaning the muscle is over active and essentially goes straight through our sciatic nerve giving us symptoms down the posterior surface of our leg.  This is called piriformis syndrome.  This happens as result to muscle imbalances but in particularly decreased mobiliser activity and increased stabiliser activity.

Athletes tend to develop muscular injuries associated to the hip.  Injuries such as 'groin pain'.  This is a vague diagnosis of an injury that doesn't really tell us much.  The 'groin' is a rough anatomical area, and the pain can occur in any one of four muscle groups.  The only way to define which muscle group is by performing resisted tests and looking at the results.  Theoretically 'groin pain' can occur in our hip flexors, deep rotators, hip abductors, or hamstrings.  This process again occurs due to long weak hypotonic muscles and short over active hypertonic muscles (lower cross syndrome).  Another potential injury that can occur upon our anatomy is hernia.  This is the protrusion of an organ or part of an organ through the fascia that usually contain it.  This again can develop through lower cross syndrome in your abdominal muscles which are hypotonic and then you attempt to load an extensive amount of weight that isn't sufficient for your abdominal muscles to withhold the stomach content, thus causing the muscles to tear.  Squeamish people do not read this!  If your abdomen tears/splits then a bit of your intestines pops out.  Gross right!  This then leaves a lumpy surface that can be palpated on the body and some excruciating pain for your stupidity.  The final issue I come onto related to the hip is iliotibial band syndrome.  This muscle originates on the anterior inferior third of our illium and runs down the lateral surface of our femur and inserts infra to our patella.  Our iliotibial band (ITB) is a thick fascia that tends to get adhesion's if it's having to work too hard, which is the downfall to hypotonic glutes causing medial rotation of our legs due to the lack of stability around the pelvis.  This is a common injury in runners and what is reffered to as 'runners knee'.  This can be because of one of two reasons:

1)  Our ITB begins brushing over the greater trochanter
Or
2)  Our ITB begins brushing over our lateral condyles of the femur.

In conclusion the hip joint is a forever evolving joint that is essential to the support and movement of the anatomy.  It is the link between our upper anatomical muscles and lower anatomical muscles.  Its a surface that is flat yet rigid in structure and vital to our everyday movement, allowing us to walk, run and jump.  Its a fascinating joint that evolves/adapts based on the environment.  It is a joint that protects our fertility organs and arteries and is vital to the creation and evolution of humans.  


  

The Anatomy of the Spine

The spine is a large yet unusual shaped structure that would appear to be very complex...  Well that's because it is!  Our spine offers us movement, support, protection and shape to our being.  It runs from the base of our cranium otherwise known as our occipital bone down to our pelvis.  The spine is made up of five vertebral regions that all consist of tiny vertebrae that form the regions of our spine.  What's a vertebrae you may be asking yourself?  A vertebrae is a bony prominence structure that form the region of our spinal cord.   It consists of a spinous process which protrudes out of the spine and can be palpated on the posterior (back) surface of our torso/body.  The spinous process allows muscles and ligaments to attach onto each vertebra. Each vertebrae also consists of a transverse process align with the other on each side, this too offers the ability for muscles and ligaments to attach to the transverse processes.  Finally the vertebrae also consist of a spinal foramen which transport signals necessary for muscle movements within the spinal cord and a vertebral body that forms the larger part of the structure offering support to each vertebrae.

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The first region of our spine consists of seven vertebrae and is known as the cervical region.  This region allows the following movements;  extension, flexion, side flexion, rotation, protraction and retraction.  Our cervical spine has a distinguished curve in it which is known as a lordotic curve or otherwise simply put as lordosis.  A lordotic curve would appear as a concave shaped curve, similar to the letter 'C'.  Our curves in our spine are formed through child development (womb - crawling - standing).  The cervical region supports the skull as it is the first region that lays directly beneath it.  The first vertebrae of the region C1 (atlas) name stems from the Greek god atlas and the thought that he carried the globe above his shoulders, in this case C1 being the first vertebrae in contact with the occipital bone is supporting the globe (brain) of the head.  The second vertebra of the region C2 name stems from the wide variety of movements within the region.  It is these two vertebrae that connect the skull to the spine allowing for greater motion of the neck.

Then we have our thoracic region which is our largest vertebral column consisting of twelve vertebrae.  However this column only allows for four movements with the absence of protraction and retraction. Within the thoracic spine our ribs attach, giving our heart and lungs protection thus adding support to sustain the cervical spine and skull.  Within this column another curve appears this time more convex, almost like a backwards 'C'.  This is known as a kyphotic curve or sometimes put as kyphosis.  Great, we know what each curve is, but what do they do?  Well imagine the spine completely straight without the curves, we would appear very upright and rigid, this would make it virtually impossible to build support or structure a foundation to your body.  Therefore essentially the curves allow for mobility within the spine and a structure for us to build muscle and support for our anatomy.  However if these curved structures became abnormal and protruded in areas such as the thoracic spine, causing a person to become hunched over in their upper back, this is what is medically referred to as thoracic hyperkyphosis.  These sort of terms exist because of muscle imbalances and bad posture.

The spine of the lower back is called the lumbar spine and this is the strongest of all the vertebral regions offering us the majority of our support.  These vertebrae are thicker than usual as they have to support the two largest regions of the spine and the skull.  Additional support through the attachment of large muscles such as the multifidus, longissimus, and spinalis palpated on the posterior surface of our spinal cord stabilise and aid the spine in rotation.  If these muscles become hypotonic it can have detrimental effects, causing severe pain and misalignment to your lumbar spine.  A final lordotic curve appears in this region increasing the motion available, assisting movements such as, flexion, extension, side flexion and rotation.  However misalignment of this region can cause hyperlordosis, which is due to the muscle imbalances and bad posture causing things such as 'duck butt' when the butt becomes distal.  This spine allows us to bend over flexing at the hip and stretch/reach extending at the hip.  Vital activities in an average persons life.

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Finally we have our sacral spine and coccygeal spine.  In the sacral column are five vertebrae that fuse together to form the sacrum, which is a triangular shaped bone situated below the lumbar region.  This section of the spine is last to develop and only fully develops during early adulthood in which it articulates to the pelvic girdle.  The coccygeal spine is palpated infra to the sacral region and   has four vertebrae.  These vertebrae fuse together to form the coccyx.  This area of the spine is full of many tendons, ligaments, and nerves and can cause much discomfort when damaged.   Ever sat down too fast or too hard and had a burning excruciating pain around your lower back?  This would be inflammation to your coccyx region.  It is commonly referred to as the 'tailbone'.  Research and studies conducted suggest that before the evolution of our existence into human beings, it is believed that we had tails that over the course of time and nature fell off.

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This is an intervertebral disc found between each vertebra and acts as a shock absorber to the forces applied to our spine.  These consist of a nucleus, and a membrane known as annulus fibrosis.  The annulus fibrosis is a spongy outer casing that forms round the nucleus pulposus protecting it from the forces applied to the spine, however sometimes when we apply too much force to one side of the body the nucleus pulposus (liquid like substance) can burst out the other side causing excruciating pain, this is known as herniation.

In summary, anatomically the spine is our most important joint as it occupies our central nervous system (CNS) which consists of the spine and the brain and if damaged can have detrimental effects on the functioning of our musculoskeletal system.  This is vital to everyday activities and movements, movements such as the ones mentioned above.  Discrete skills such as talking and side flexion of the neck can become limited as our spine contains all the nerves that transmit signals throughout our body as a direct pathway via the brain.