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Joint structure and function, a comprehensive analysis 5th ed p levangie, c norkin (f a davis, 2011)


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Joint Structure
and Function

FIF TH
EDITION

A Comprehensive Analysis



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Joint Structure
and Function
FIF TH
EDITION

A Comprehensive Analysis
Pamela K. Levangie, PT, DSc, FAPTA
Professor and Associate Chairperson
Department of Physical Therapy
MGH Institute of Health Professions
Boston, Massachusetts

Cynthia C. Norkin, PT, EdD
Former Director and Associate Professor
School of Physical Therapy
Ohio University
Athens, Ohio


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F. A. Davis Company
1915 Arch Street
Philadelphia, PA 19103
www.fadavis.com
Copyright © 2011 by F. A. Davis Company
Copyright © 2011 by F. A. Davis Company. All rights reserved. This product is protected by copyright. No part of it may be reproduced,
stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise,
without written permission from the publisher.
Printed in the United States of America
Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1
Acquisitions Editor: Melissa Duffield
Manager of Content Development: George W. Lang
Developmental Editor: Karen Carter
Art and Design Manager: Carolyn O’Brien
As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo
changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted
standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences
from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described
in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances
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Library of Congress Cataloging-in-Publication Data
Joint structure and function : a comprehensive analysis / [edited by ] Pamela K.
Levangie, Cynthia C. Norkin.—5th ed.
p. ; cm.
Rev. ed. of : Joint structure and function / Pamela K. Levangie, Cynthia C. Norkin. 4th ed. c2005.
Includes bibliographical references and index.
ISBN-13: 978-0-8036-2362-0
ISBN-10: 0-8036-2362-3
1. Human mechanics. 2. Joints. I. Levangie, Pamela K. II. Norkin, Cynthia C.
III. Levangie, Pamela K. Joint Structure and function.
[DNLM: 1. Joints—anatomy & histology. 2. Joints—physiology. WE 300]
QP303.N59 2011
612.7’5—dc22
2010033921

Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. A. Davis
Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per
copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license
by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is: 8036–2362/11 0
+ $.25.


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PREFACE TO THE FIFTH EDITION
With the fifth edition of Joint Structure and Function, we
maintain a tradition of excellence in education that began
more than 25 years ago. We continue to respond to the
dynamic environment of publishing, as well as to changes
taking place in media, research technology, and in the education of individuals who assess human function. We include
use of two- and four-color line drawings, enhanced instructor’s tools, and new videos that all support and enhance the
reader’s experience.
Our contributors are chosen for their expertise in the areas
of research, practice, and teaching—grounding their chapters
in best and current evidence and in clinical relevance. Patient
cases (in both “Patient Case” and “Patient Application” boxes)
facilitate an understanding of the continuum between normal
and impaired function, making use of emerging case-based
and problem-based learning educational strategies. “Concept
Cornerstones” and “Continuing Exploration” boxes provide
the reader or the instructor additional flexibility in setting
learning objectives.
What remains unchanged in this edition of Joint Structure and Function is our commitment to maintaining a text

that provides a strong foundation in the principles that underlie an understanding of human structure and function
while also being readable and as concise as possible. We
hope that our years of experience in contributing to the
education of health-care professionals allow us to strike a
unique balance. We cannot fail to recognize the increased
educational demands placed on many entry-level healthcare professionals and hope that the updates to the fifth
edition help students meet that demand. However, Joint
Structure and Function, while growing with its readers, continues to recognize that the new reader requires elementary
and interlinked building blocks that lay a strong but flexible
foundation to best support continued learning and growth
in a complex and changing world.
We very much appreciate our opportunity to contribute
to health care by assisting in the professional development
of the students and practitioners who are our readers.

PAMELA K. LEVANGIE
CYNTHIA C. NORKIN

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ACKNOWLEDGMENTS
The fifth edition of Joint Structure and Function is made
possible only by the continued and combined efforts of
many people and groups. We are, first and foremost,
grateful for the time, effort, and expertise of our esteemed
contributors with whom it has been a pleasure to work.
Our thanks, therefore, to Drs. Sam Ward, Sandra Curwin,
Gary Chleboun, Diane Dalton, Julie Starr, Pam Ritzline,
Paula Ludewig, John Borstad, RobRoy Martin, Lynn
Snyder-Mackler, Michael Lewek, Erin Hartigan, Janice
Eng, and Sandra Olney, as well as to Ms. Noelle Austin
and Mr. Benjamin Kivlan. Additionally, we want to express
our appreciation to the individuals who helped develop the
ancillary materials that support the fifth edition, including
the Instructor’s Resources developed by Ms. Christine
Conroy and the videos developed by Dr. Lee Marinko and
Center City Film & Video. We would also like to acknowledge and thank the individuals who contributed their
comments and suggestions as reviewers (listed on page xi),
as well as those who passed along their unsolicited suggestions through the years, including our students.

We extend our continuing gratitude to F. A. Davis for
their investment in the future of Joint Structure and Function
and its ancillary materials. Particular thanks go to Margaret
Biblis (Publisher), Melissa Duffield (Acquisitions Editor),
Karen Carter (Developmental Editor), Yvonne Gillam
(Developmental Editor), George Lang (Manager of Content
Development), David Orzechowski (Managing Editor),
Robert Butler (Production Manager), Carolyn O’Brien
(Manager of Art and Design), Katherine Margeson (Illustration Coordinator), and Stephanie Rukowicz (Assistant Developmental Editor) who provided great support. As always
we must thank the artists who, through the years, provided
the images that are so valuable to the readers. These include
artists of past editions, Joe Farnum, Timothy Malone, and
Anne Raines. New to the fifth edition is Dartmouth Publishing, Inc., adding both new figures and enhanced color to
the text.
Finally, we acknowledge and thank our colleagues and
families, without whose support this work could not have
been done and to whom we are eternally indebted.

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CONTRIBUTORS
Noelle M. Austin, PT, MS, CHT

Michael Lewek, PT, PhD

CJ Education and Consulting, LLC
Woodbridge, Connecticut
www.cj-education.com
The Orthopaedic Group
Hamden, Connecticut

Assistant Professor
Division of Physical Therapy
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina

Paula M. Ludewig, PT, PhD
John D. Borstad, PT, PhD
Assistant Professor
Physical Therapy Division
Ohio State University
Columbus, Ohio

Associate Professor
Program in Physical Therapy
University of Minnesota
Minneapolis, Minnesota

RobRoy L. Martin, PT, PhD, CSCS
Gary Chleboun, PT, PhD
Professor
School of Physical Therapy
Ohio University
Athens, Ohio

Sandra Curwin, PT, PhD
Associate Professor
School of Physiotherapy
Dalhousie University
Halifax, Nova Scotia, Canada

Diane Dalton, PT, DPT, OCS
Clinical Assistant Professor
Physical Therapy Program
Boston University
Boston, Massachusetts

Janice J. Eng, PT, OT, PhD
Professor
Department of Physical Therapy
University of British Columbia
Vancouver, British Columbia, Canada

Associate Professor
Duquesne University
Pittsburgh, Pennsylvania

Sandra J. Olney, PT, OT, PhD
Professor Emeritus
School of Rehabilitation Therapy
Queens University
Kingston, Ontario, Canada

Pamela Ritzline, PT, EdD
Associate Professor
Department of Physical Therapy
University of Tennessee Health Science Center
Memphis, Tennessee

Lynn Snyder-Mackler, PT, ScD, SCS, ATC,
FAPTA
Alumni Distinguished Professor
Department of Physical Therapy
University of Delaware
Newark, Delaware

Julie Ann Starr, PT, DPT, CCS
Erin Hartigan, PT, PhD, DPT, OCS, ATC
Assistant Professor
Physical Therapy Department
University of New England
Portland, Maine

Clinical Associate Professor
Physical Therapy Program
Boston University
Boston, Massachusetts

Sam Ward, PT, PhD
Benjamin Kivlan, PT, SCS, OCS, CSCS
Doctoral Student
Duquesne University
Pittsburgh, Pennsylvania

Departments of Radiology, Orthopaedic Surgery, and
Bioengineering
University of California San Diego
La Jolla, California

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REVIEWERS
John H. Hollman, PT, PhD

Nancy R. Talbott, PhD, MS, PT

Director and Assistant Professor, Program in Physical
Therapy
Department of Physical Medicine and Rehabilitation
Mayo Clinic College of Medicine
Rochester, Minnesota

Associate Professor
Rehabilitation Sciences
University of Cincinnati
Cincinnati, Ohio

David P. Village, MS, PT, DHSc
Chris Hughes, PT, PhD, OCS, CSCS
Professor
Graduate School of Physical Therapy
Slippery Rock University
Slippery Rock, Pennsylvania

Associate Professor
Department of Physical Therapy
Andrews University
Berrien Springs, Michigan

Krista M. Wolfe, DPT, ATC
Leigh K. Murray, PT, PhD
Assistant Professor
Physical Therapy Department
Walsh University
North Canton, Ohio

Director, Physical Therapy Assistant Program
Allied Health Department
Central Pennsylvania College
Summerdale, Pennsylvania

Linda L. Wright, PhD, PT
William K. Ogard, PT, PhD
Assistant Professor
Physical Therapy Department
University of Alabama at Birmingham
Birmingham, Alabama

Professor, Department of Physical Therapy
Director, Educational Technology
College of Health Professions
Armstrong Atlantic State University
Savannah, Georgia

Suzanne Reese, PT, MS
Associate Professor
Physical Therapist Assistant Program
Tulsa Community College
Tulsa, Oklahoma

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CONTENTS IN
BRIEF
SECTION 1.

Chapter 9.

Joint Structure and Function:
Foundational Concepts
Chapter 1.

Biomechanical Applications
to Joint Structure and
Function

SECTION 4.

Hip Joint

354

Chapter 10. The Hip Complex
RobRoy L. Martin, PT, PhD,
CSCS, and Benjamin Kivlan,
PT, SCS, OCS, CSCS

355

395

138

Chapter 11. The Knee
Erin Hartigan, PT, PhD,
DPT, OCS, ATC; Michael
Lewek, PT, PhD; and Lynn
Snyder-Mackler, PT, ScD,
SCS, ATC, FAPTA

139

Chapter 12. The

3

Joint Structure and Function 64
Sandra Curwin, PT, PhD

Chapter 3.

Muscle Structure and
Function

108

Gary Chleboun, PT, PhD
SECTION 2.

Axial Skeletal Joint Complexes
Chapter 4.

The Vertebral Column

Ankle and Foot
Complex

Diane Dalton, PT, DPT, OCS
Chapter 5.

The Temporomandibular
Joint

SECTION 5.

Integrated Function

482

Chapter 13. Posture
Cynthia C. Norkin, PT, EdD

483
524

230

Chapter 14. Gait
Sandra J. Olney, PT, OT, PhD,
and Janice Eng, PT, OT, PhD

231

Index

212

Pamela D. Ritzline, PT, EdD
SECTION 3.

Upper Extremity Joint
Complexes
Chapter 7.

The Shoulder Complex
Paula M. Ludewig, PT, PhD,
and John D. Borstad, PT, PhD

Chapter 8.

The Elbow Complex

440

RobRoy L. Martin, PT, PhD,
CSCS

The Thorax and Chest Wall 192
Julie Starr, PT, MS, CCS, and Diane
Dalton, PT, DPT, OCS

Chapter 6.

305

Noelle M. Austin, PT, MS, CHT

2

Samuel R. Ward, PT, PhD
Chapter 2.

The Wrist and Hand
Complex

569

271

Cynthia C. Norkin, PT, EdD

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CONTENTS
ADDITIONAL LINEAR
FORCE CONSIDERATIONS

SECTION 1.

Joint Structure and Function:
Foundational Concepts
Chapter 1.

2

23

Tensile Forces

23

Joint Distraction

25

Revisiting Newton’s Law of Inertia

29

3

Shear and Friction Forces

30

INTRODUCTION

4

Considering Vertical and
Horizontal Linear Equilibrium

32

PART 1: KINEMATICS AND
INTRODUCTION TO KINETICS

6

DESCRIPTIONS OF MOTION

6

Biomechanical Applications
to Joint Structure and
Function
Samuel R. Ward, PT, PhD

TORQUE, OR MOMENT
OF FORCE

33

9

Angular Acceleration
and Angular Equilibrium

34

9

Parallel Force Systems

35

Meeting the Three Conditions
for Equilibrium

38

Types of Displacement

6

Location of Displacement in Space

7

Direction of Displacement
Magnitude of Displacement
Rate of Displacement
INTRODUCTION TO FORCES

10
11

Definition of Forces

11

Force Vectors

12

Force of Gravity

14

INTRODUCTION TO STATICS
AND DYNAMICS

18

Newton’s Law of Inertia

18

Newton’s Law of Acceleration

18

TRANSLATORY MOTION
IN LINEAR AND CONCURRENT
FORCE SYSTEMS

PART 2: KINETICS—CONSIDERING
ROTARY AND TRANSLATORY
FORCES AND MOTIONS
33

19

Linear Force Systems

19

Concurrent Force Systems

21

Newton’s Law of Reaction

22

MUSCLE FORCES
Total Muscle Force Vector
TORQUE REVISITED

39
39
41

Changes to Moment Arm
of a Force

42

Angular Acceleration With
Changing Torques

43

Moment Arm and Angle
of Application of a Force

44

LEVER SYSTEMS,
OR CLASSES OF LEVERS

46

Muscles in Third-Class Lever Systems

46

Muscles in Second-Class Lever Systems 47
Muscles in First-Class Lever Systems

48

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Contents

Mechanical Advantage

48

Limitations of Analysis of Forces
by Lever Systems

50

FORCE COMPONENTS
Resolving Forces Into Perpendicular
and Parallel Components
Perpendicular and Parallel
Force Effects

50
51
51

98

Injury

99

Immobilization (Stress Deprivation)

99

Exercise

101

Overuse

102

56

Rotary Effects of Force Components

57

Summary
Study Questions
References

58

Chapter 3.

Summary
Study Questions
References

Joint Structure and Function

61
61
63

64

Sandra Curwin, PT, PhD

INTRODUCTION
Joint Design
MATERIALS FOUND IN HUMAN
JOINTS

Muscle Structure
and Function

103
104
104

108

Gary Chleboun, PT, PhD

INTRODUCTION

109

ELEMENTS OF MUSCLE
STRUCTURE

109

65

Composition of a Muscle Fiber

109

65

The Contractile Unit

110

The Motor Unit

112

Muscle Structure

114

Muscle Architecture: Size,
Arrangement, and Length

115

Muscular Connective Tissue

117

67

Structure of Connective Tissue

67

Specific Connective Tissue Structures

73

GENERAL PROPERTIES OF
CONNECTIVE TISSUE

98

Disease

Translatory Effects of Force
Components
MULTISEGMENT (CLOSEDCHAIN) FORCE ANALYSIS

Chapter 2.

GENERAL CHANGES WITH
DISEASE, INJURY,
IMMOBILIZATION,
EXERCISE, AND OVERUSE

80

Mechanical Behavior

80

Viscoelasticity

84

Time-Dependent and
Rate-Dependent Properties

84

Properties of Specific Tissues

85

COMPLEXITY OF HUMAN
JOINT DESIGN

87

Synarthroses

88

Diarthroses

89

JOINT FUNCTION

94

Kinematic Chains

94

Joint Motion

95

MUSCLE FUNCTION

119

Muscle Tension

119

Classification of Muscles

126

Factors Affecting Muscle Function

128

EFFECTS OF IMMOBILIZATION,
INJURY, AND AGING
132
Immobilization

132

Injury

133

Aging

133

Summary
Study Questions
Refereces

133
134
134


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Contents

SECTION 2.

Axial Skeletal Joint
Complexes
Chapter 4.

The Vertebral Column

138
139
140

GENERAL STRUCTURE
AND FUNCTION

140

Structure

140

Function

150

REGIONAL STRUCTURE
AND FUNCTION

199

Coordination and Integration
of Ventilatory Motions

206

154

Differences Associated
With the Neonate

207

Differences Associated With
the Elderly

207

PATHOLOGICAL CHANGES IN
STRUCTURE AND FUNCTION

208

Chronic Obstructive Pulmonary
Disease (COPD)

208

Structure of the Cervical Region

154

Function of the Cervical Region

159

Structure of the Thoracic Region

162

Summary
Study Questions
References

Function of the Thoracic Region

163

Chapter 6.

Structure of the Lumbar Region

164

The Temporomandibular
Joint

Function of the Lumbar Region

169

Pamela D. Ritzline, PT, EdD

Structure of the Sacral Region

171

INTRODUCTION

213

Function of the Sacral Region

174

JOINT STRUCTURE

214

Articular Structures

214

Accessory Joint Structures

215

Capsule and Ligaments

216

MUSCLES OF THE VERTEBRAL
COLUMN
The Craniocervical/Upper
Thoracic Regions

176
176

Muscles of the Pelvic Floor

Joint Kinematics

217

Muscles

220

Nerves

222

188
188
188

Relationship to the Cervical
Spine and Posture

222

Dentition

223

192

COMMON IMPAIRMENTS
AND PATHOLOGIES

224

Age-Related Changes in the
TM Joint

224

Inflammatory Conditions

225

Capsular Fibrosis

225

186
187

Age-Related Changes

187

The Thorax and Chest Wall
Julie Starr, PT, MS, CCS, and
Diane Dalton, PT, DPT, OCS

INTRODUCTION
GENERAL STRUCTURE
AND FUNCTION
Rib Cage

212

217

EFFECTS OF AGING
Summary
Study Questions
References

210
210
210

JOINT FUNCTION

Lower Thoracic/Lumbopelvic Regions 180

Chapter 5.

Muscles Associated With the
Rib Cage

DEVELOPMENTAL ASPECTS OF
STRUCTURE AND FUNCTION
207

Diane Dalton, PT, DPT, OCS

INTRODUCTION

xvii

193
193
193


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Contents

Osseous Mobility Conditions

225

Articular Disc Displacement

226

Degenerative Conditions

226

Summary
Study Questions
References

227
227
228

SECTION 3.

Upper Extremity Joint
Complexes
Chapter 7.

The Shoulder Complex

230
231

Paula M. Ludewig, PT, PhD,
and John D. Borstad, PT, PhD

INTRODUCTION
COMPONENTS OF THE
SHOULDER COMPLEX

232
232

Sternoclavicular Joint

232

Acromioclavicular Joint

236

Scapulothoracic Joint

240

Glenohumeral Joint

245

INTEGRATED FUNCTION
OF THE SHOULDER COMPLEX

257

Scapulothoracic and Glenohumeral
Contributions

258

Sternoclavicular and
Acromioclavicular Contributions

259

Structural Dysfunction

261

MUSCLES OF ELEVATION

262

Deltoid Muscle Function

262

Supraspinatus Muscle Function

263

Infraspinatus, Teres Minor,
and Subscapularis Muscle Function

263

Upper and Lower Trapezius
and Serratus Anterior Muscle
Function

263

Rhomboid Muscle Function

265

MUSCLES OF DEPRESSION

265

Latissimus Dorsi and Pectoral
Muscle Function

265

Teres Major and Rhomboid
Muscle Function
Summary
Study Questions
References
Chapter 8.

The Elbow Complex

265
266
267
267

271

Cynthia C. Norkin, PT, EdD

INTRODUCTION

272

STRUCTURE: ELBOW JOINT
(HUMEROULNAR AND
HUMERORADIAL
ARTICULATIONS)

272

Articulating Surfaces on
the Humerus

272

Articulating Surfaces on
the Radius and Ulna

272

Articulation

273

Joint Capsule

276

Ligaments

277

Muscles

279

FUNCTION: ELBOW JOINT
(HUMEROULNAR AND
HUMERORADIAL
ARTICULATIONS)

281

Axis of Motion

281

Mobility and Stability

284

Muscle Action

285

STRUCTURE: PROXIMAL
AND DISTAL ARTICULATIONS

288

Proximal (Superior) Radioulnar Joint 288
Distal (Inferior) Radioulnar Joint

288

Articulations

290

Ligaments

290

Muscles

291

FUNCTION: RADIOULNAR
JOINTS

292

Axis of Motion

292

Range of Motion

292


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Contents

Muscle Action

292

Stability

293

Summary
Study Questions
References

295

SECTION 4.

Functional Activities

295

Hip Joint

354

Relationship to the Hand and Wrist

295

Chapter 10. The Hip Complex
RobRoy L. Martin, PT, PhD,
CSCS, and Benjamin Kivlan, PT,
SCS, OCS, CSCS

355

356

MOBILITY AND STABILITY:
ELBOW COMPLEX

EFFECTS OF AGE, GENDER,
AND INJURY

297

349
349
350

Age and Gender

297

Injury

298

INTRODUCTION

301
301
301

STRUCTURE OF THE HIP JOINT 356

Summary
Study Questions
References
Chapter 9.

xix

The Wrist and Hand
Complex

305

Noelle M. Austin, PT, MS, CHT

INTRODUCTION

306

THE WRIST COMPLEX

306

Proximal Articular Surface

356

Distal Articular Surface

358

Articular Congruence

362

Hip Joint Capsule and Ligaments

363

Structural Adaptations to
Weight-Bearing

366

FUNCTION OF THE HIP JOINT

368

Radiocarpal Joint Structure

307

Midcarpal Joint Structure

310

Motion of the Femur on
the Acetabulum

368

Function of the Wrist Complex

312

Motion of the Pelvis on the Femur

369

319

Coordinated Motions of the
Femur, Pelvis, and Lumbar Spine

372

Hip Joint Musculature

374

THE HAND COMPLEX
Carpometacarpal Joints of the Fingers

319

Metacarpophalangeal Joints
of the Fingers

322

Interphalangeal Joints of the Fingers

324

Extrinsic Finger Flexors

326

Extrinsic Finger Extensors

329

Extensor Mechanism

330

Intrinsic Finger Musculature

335

Structure of the Thumb

339

Thumb Musculature

341

PREHENSION

343

Power Grip

344

Precision Handling

346

FUNCTIONAL POSITION
OF THE WRIST AND HAND

348

HIP JOINT FORCES AND
MUSCLE FUNCTION
IN STANCE

379

Bilateral Stance

379

Unilateral Stance

380

HIP JOINT PATHOLOGY

385

Femoroacetabular Impingement

385

Labral Pathology

387

Arthrosis

387

Fracture

388

Summary
Study Questions
References

390
390
391


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Contents

Chapter 11. The Knee
Erin Hartigan, PT, PhD, DPT, OCS,
ATC; Michael Lewek, PT, PhD; and
Lynn Snyder-Mackler, PT, ScD, SCS,
ATC, FAPTA

395

Chapter 12. The

Ankle and Foot
Complex

440

RobRoy L. Martin PT, PhD, CSCS

INTRODUCTION

396

TIBIOFEMORAL JOINT
STRUCTURE

396

Femur

396

Tibia

397

INTRODUCTION

441

DEFINITIONS OF MOTIONS

441

ANKLE JOINT

443

Ankle Joint Structure

443

Ankle Joint Function

447

THE SUBTALAR JOINT

448

Subtalar Joint Structure

448

Subtalar Joint Function

449

Tibiofemoral Alignment and
Weight-Bearing Forces

398

Menisci

399

TRANSVERSE TARSAL JOINT

455

Joint Capsule

401

Transverse Tarsal Joint Structure

455

Ligaments

404

Transverse Tarsal Joint Function

458

Iliotibial Band

411

TARSOMETATARSAL JOINTS

460

Bursae

411

Tarsometatarsal Joint Structure

460

Tarsometatarsal Joint Function

462

METATARSOPHALANGEAL
JOINTS

463

TIBIOFEMORAL JOINT
FUNCTION

412

Joint Kinematics

412

Muscles

417

Stabilizers of the Knee

422

PATELLOFEMORAL JOINT

424

Patellofemoral Articular
Surfaces and Joint Congruence

425

Motions of the Patella

426

Patellofemoral Joint Stress

427

Frontal Plane Patellofemoral
Joint Stability
Weight-Bearing Versus
Non-Weightbearing Exercises
With Patellofemoral Pain
EFFECTS OF INJURY
AND DISEASE

428

463

Metatarsophalangeal Joint
Function

464

INTERPHALANGEAL JOINTS

467

PLANTAR ARCHES

467

Structure of the Arches

467

Function of the Arches

468

Muscular Contribution to the Arches 471
MUSCLES OF THE ANKLE
AND FOOT

432
432

Tibiofemoral Joint Injury

433

Patellofemoral Joint Injury

434

Summary
Study Questions
References

Metatarsophalangeal Joint
Structure

435
435
435

471

Extrinsic Musculature

471

Intrinsic Musculature

474

DEVIATIONS FROM NORMAL
STRUCTURE AND FUNCTION
Summary
Study Questions
Referneces

475
476
477
478


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Contents

SECTION 5.

Integrated Function

482

Chapter 13. Posture
Cynthia C. Norkin, PT, EdD

483

INTRODUCTION

484

STATIC AND DYNAMIC
POSTURES

484

Postural Control

485

Major Goals and Basic
Elements of Control

485

KINETICS AND KINEMATICS
OF POSTURE

489

Inertial and Gravitational Forces

EFFECTS OF AGE, AGE
AND GENDER, PREGNANCY,
OCCUPATION, AND
RECREATION ON POSTURE

xxi

515

Age

515

Age and Gender

516

Pregnancy

518

Occupation and Recreation

518

Summary
Study Questions
References

519
519
520

524

489

Chapter 14. Gait
Sandra J. Olney, PT, OT, PhD,
and Janice Eng, PT, OT, PhD

Ground Reaction Forces

489

INTRODUCTION

525

Coincident Action Lines

490

Gait Analysis

525

External and Internal Moments

490

Major Tasks of Gait

525

491

Phases of the Gait Cycle

525

GAIT TERMINOLOGY

527

OPTIMAL POSTURE
ANALYSIS OF STANDING
POSTURE: VIEWED FROM
THE SIDE
Alignment and Analysis:
Lateral View
Deviations From Optimal
Alignment Viewed From the Side

492
492
497

Optimal Alignment and Analysis:
Anterior and Posterior Views

502

Deviations From Optimal
Alignment

503

ANALYSIS OF SITTING
POSTURES
Muscle Activity

509
509

Interdiscal Pressures and Compressive
Loads on the Spine
511
Seat Interface Pressures

512

Time and Distance Terms

527

Kinematic Terms

528

Kinetic Terms

529

Electromyography

531

CHARACTERISTICS
OF NORMAL GAIT

532

Time and Distance Characteristics

532

Sagittal Plane Joint Angles

532

Frontal Plane Joint Angles

534

Ground Reaction Force
and Center of Pressure

534

Sagittal Plane Moments

535

Frontal Plane Moments

537

Sagittal Plane Powers

540

Frontal Plane Powers

542

ANALYSIS OF LYING
POSTURES

514

Mechanical Energy of Walking

542

Interdiscal Pressures

514

Muscle Activity

545

Surface Interface Pressures

515

Gait Initiation and Termination

550


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Page xxii

Contents

TRUNK AND UPPER
EXTREMITIES

552

Trunk

552

Upper Extremities

553

TREADMILL, STAIR,
AND RUNNING GAITS

553

Treadmill Gait

553

Stair Gait

553

Running Gait

555

Summary

558

EFFECTS OF AGE,
GENDER, ASSISTIVE
DEVICES, AND ORTHOSES

559

Age

559

Gender

560

Assistive Devices

561

Orthoses

561

ABNORMAL GAIT

561

Structural Impairment

562

Functional Impairment

562

Summary
Study Questions
References

564
564
564

Index

569


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Page 1

Joint Structure
and Function

FIF TH
EDITION

A Comprehensive Analysis


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Page 2

Section

1

Joint Structure
and Function:
Foundational
Concepts
Chapter 1
Chapter 2
Chapter 3

2

Biomechanical Applications to Joint Structure
and Function
Joint Structure and Function
Muscle Structure and Function


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