Etymology, Bones and Alignment

Knee Dysfunction

Palpation

Capsule, Ligaments, and Menisci

Bursae & Plicae

Nerves

Joint Actions (Osteokinematics)

Arthrokinematics

Integrated Function

Postural Dysfunction

Knee Joint Anatomy: Tibiofemoral and Patellofemoral Joints

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Knee Joint Anatomy

Knee (Tibiofemoral and Patellofemoral) Joint

This course describes knee joint anatomy including the tibiofemoral and patellofemoral joints. That is knee anatomy includes the tibiofemoral joint which is the approximation of the tibia (shin bone) and femur (thigh bone), and the patellofemoral joint with is the approximation of the patella (knee cap) and the femur. This course includes descriptions of the bones, synovial joints, joint actions, ligaments (e.g. <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> cruciate ligament and <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> cruciate ligament), bursae, relative location, the relationship between the bones of the tibia (shin bone) and femur, and the muscles that cross them. Further, this course discusses palpation and introduces knee joint <a id="specificity" data-tip="1224" target="_blank" href="/glossary-term/specificity" class="glossary">specific</a> exercises, manual techniques, and interventions for dysfunction, pain, <a id="posture" data-tip="1658" target="_blank" href="/glossary-term/posture" class="glossary">posture</a>, and <a id="movement-impairment" data-tip="1575" target="_blank" href="/glossary-term/movement-impairment" class="glossary">movement impairment</a>. The knee joint is included in the common compensation patterns known as functional pes planus (flat feet), pronation distortion syndrome, knee bow out (varus), feet turn out, functional valgus (knee bow in), asymmetrical weight shift (AWS), and <a href="https://brookbushinstitute.com/courses/lower-leg-dysfunction">lower extremity dysfunction (LLD)</a>. Sports medicine professionals (personal trainers, fitness instructors, physical therapists, massage therapists, chiropractors, occupational therapists, athletic trainers, etc.) with advanced knowledge of the knee joint will improve their ability to analyze human movement and develop sophisticated exercise programs and therapeutic (rehabilitation) interventions. Further, this course is essential knowledge for future courses discussing injury prevention and physical rehabilitation/physical therapy (e.g. knee pain, knee injury, knee arthritis, meniscus (cartilage), <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> cruciate ligament injury, <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> cruciate ligament injury, knee <a id="stability" data-tip="1193" target="_blank" href="/glossary-term/stability" class="glossary">instability</a>, knee replacement surgery), the effect the knee joint has on lower extremity alignment (e.g. the relationship between tibial external rotation and hip internal rotation), and tibiofemoral <a id="specificity" data-tip="1224" target="_blank" href="/glossary-term/specificity" class="glossary">specific</a> techniques for enhancing sports performance (e.g. lower body (leg) <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a>, strength, hypertrophy, agility, and <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a>).
<h4>Brookbush Institute&apos;s most recommended techniques for the Knee Joint (see videos below):</h4>
<ul>
 <li>Assess: 
 <ul>
 <li>Overhead Squat Assessment: <a href="https://brookbushinstitute.com/video/overhead-squat-assessment-6-knees-bow-in-breakdown">Knee Bow-In</a></li>
 </ul>
 <a href="https://brookbushinstitute.com/video/overhead-squat-assessment-6-knees-bow-in-breakdown"> </a>
 </li>
 <li>Self-administered Techniques: 
 <ul>
 <li>Release: <a href="https://brookbushinstitute.com/video/rectus-femoris-sa-static-release">Rectus Femoris Static Release</a></li>
 <li>Mobilization: <a href="https://brookbushinstitute.com/video/knee-mobilization">Self-administered Knee Joint Mobilization</a></li>
 <li>Activation: <a href="https://brookbushinstitute.com/video/tibial-internal-rotator-activation">Tibial Internal Rotator Activation</a></li>
 </ul>
 <a href="https://brookbushinstitute.com/video/tibial-internal-rotator-activation"> </a>
 </li>
 <li>Manual Techniques: 
 <ul>
 <li>Release: <a href="https://brookbushinstitute.com/video/vastus-lateralis-manual-release">Vastus Lateralis Static Manual Release</a></li>
 <li>Mobilization: <a href="https://brookbushinstitute.com/video/knee-joint-anterior-posterior-femur-tibia-manual-mobilization">Knee Joint </a><a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> to <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> Manual Mobilization</li>
 <li>Manipulation: <a href="https://brookbushinstitute.com/video/proximal-tibiofibular-joint-manipulation">Proximal Tibiofibular Joint Manipulation</a></li>
 </ul>
 <a href="https://brookbushinstitute.com/video/proximal-tibiofibular-joint-manipulation"> </a>
 </li>
</ul>
<img alt="The knee joint bones, ligaments, and connective tissue" title="A cadaver showing the boney landmarks and ligaments of the knee" src="https://www.datocms-assets.com/25800/1638277388-screen-shot-2016-10-18-at-8-43-35-pm.png">

Course Description: Knee Joint Anatomy: Tibiofemoral and Patellofemoral Joint

Introduction to the Knee (Tibiofemoral and Patellofemoral) Joint

Note it is helpful to learn the palpations below in the order listed:
<ol>
 <li>Patella: The <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> surface of the patella is superficial and can be palpated with your partner in sitting or <a id="supine" data-tip="1562" target="_blank" href="/glossary-term/supine" class="glossary">supine</a>. In <a id="supine" data-tip="1562" target="_blank" href="/glossary-term/supine" class="glossary">supine</a> with the leg extended, the quadriceps tendon is shortened and on slack allowing for movement in the patella. Palpate the edges of the patella and notice its wide <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a> <a id="base-of-support" data-tip="1196" target="_blank" href="/glossary-term/base-of-support" class="glossary">base</a> and more narrow <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> apex. In this position, the patella can be easily moved from side to side. In sitting, you can passively flex and extend the knee while feeling the patella <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> inferiomedially and superolaterally, respectively.</li>
 <li>Femoral Condyles: The term &quot;condyles&quot; is used to refer to the cartilage-covered joint surface, whereas the term epicondyle is used to refer to the rest of the round prominence at the end of the femur. The femoral condyles can be palpated with your partner in <a id="supine" data-tip="1562" target="_blank" href="/glossary-term/supine" class="glossary">supine</a>, or with your partner sitting with legs hanging off the end of a table (knee flexed). Locate the patella. By falling off the patella either medially (<a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> condyle) or laterally (<a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> condyle) you will run into the large, roundish condyles. Explore the smooth surface of the condyles distally as they disappear into the joint line; you can even trace the condyles under the patella to the trochlear groove, by gently shifting the patella <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> or <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a>. Note: The patella will be easier to move with your partner <a id="supine" data-tip="1562" target="_blank" href="/glossary-term/supine" class="glossary">supine</a>.</li>
 <li>Femoral Epicondyles: Now that you know where the condyles are, explore the rest of the bone that makes up the large, roundish &quot;knuckles&quot; at the <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> end of your femur. You should notice that the condyles have a bumpier, rougher surface than the epicondyles. You can trace the epicondyles posteriorly to the hamstring tendons and proximally as they narrow into the femoral shaft under the large <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> of the thigh.</li>
 <li>Adductor Tubercle: If you explore the <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a> portion of the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> epicondyle, you will notice that most of the epicondyle is roundish and follows a predictable path as it slopes toward the more narrow femur. However, you will also notice that the <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a> <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> epicondylar ridge (top of the epicondyle if your partner is <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">prone</a>) comes to a point. You may also notice a tendon inserting into this bony point. That is the adductor tubercle and the tendon belongs to the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> fibers of the <a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">adductor magnus</a>.</li>
 <li>Tibial Plateaus: The tibial plateaus are easiest to palpate with your partner sitting with legs hanging off the end of a table (knee flexed). Although the plateaus themselves cannot be reached, the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> and <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> edges of the tibial plateau can be palpated. Using both hands, wrap your fingers around the back of the upper calf, and place your thumbs on either side of the patella. By falling off the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> edges of the patella, gently pulling the lower leg forward (<a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a>, not flexion), and moving your thumbs down slowly, you should run into the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> edge of the tibial plateau. You should notice a soft space between the condyles (palpated above) and the bony ridge of the tibial plateau. This soft space is occupied by the meniscus. The edge of the tibial plateau can be traced around the knee until it disappears under the gastrocnemius and hamstring tendons.</li>
 <li>Tibial Tuberosity: The attachment site of the patella tendon, the tibial tuberosity is a small but defined protuberance a few centimeters <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> to the bottom edge (apex) of the patella. Palpate the patella and follow the tendon distally until it ends in a distinct bump.</li>
</ol>
<ol></ol>
<img src="https://brookbush.s3.us-east-2.amazonaws.com/wordpress/wp-content/uploads/2016/05/Patella.jpg" alt="An anterior view of the patella attachments" title="Patella attachment on the knee joint from an anterior view">
Patella and attachments. <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> view of the knee.

Knee Joint Palpation

<h3>Non- contractile/ passive tissue</h3>
<ul>
 <li> Open Pack Position: 25-40&#xB0; of flexion</li>
 <li> Close Pack Position: Max extension with maximal tibial external rotation (&quot;knee locked&quot;)</li>
</ul>
<table>
 <tbody>
 <tr>
 <td style="font-weight: bold;">
 <h4>Name</h4>
 </td>
 <td style="font-weight: bold;">
 <h4>Attachments</h4>
 </td>
 <td style="font-weight: bold;">
 <h4>Course</h4>
 </td>
 <td style="font-weight: bold;">
 <h4>Restricted Motions</h4>
 <h4></h4>
 </td>
 </tr>
 <tr>
 <td>
 <h4> Capsule </h4>
 </td>
 <td>
 <ul>
 <li>Femoral Attachment: Proximal to the femoral condyles and intercondylar notch, but <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> to the femoral epicondyles.</li>
 </ul>
 <ul>
 <li>Tibial Attachment: Just <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> to the edge of the tibial plateau with two exceptions. The <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> capsule follows the trochlear notch of the tibia to the tibial tuberosity, and the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> capsule descends on the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> side to meet the insertions of the <a href="https://brookbushinstitute.com/courses/popliteus" target="_blank" rel="noopener">popliteus</a> and the semimembranosus.</li>
 </ul>
 <ul>
 <li>Patellar Attachment: <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> margins of the patella and patellar tendon</li>
 </ul>
 </td>
 <td>
 Generally, the capsule is referred to by region, with each region being reinforced by various ligaments and muscles. The course of the capsule is primarily vertical, but various regions of the capsule have distinct oblique fibers which may resist rotation or <a id="glide" data-tip="1817" target="_blank" href="/glossary-term/glide" class="glossary">shear</a>.
 <ul>
 <li>Posterior:
 <ul>
 <li>Reinforced by: oblique popliteal ligament, arcuate popliteal ligament, <a href="https://brookbushinstitute.com/courses/popliteus" target="_blank" rel="noopener"> popliteus</a>, gastrocnemius, hamstrings (especially semimembranosus tendon)</li>
 </ul>
 </li>
 </ul>
 <ul>
 <li><a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> (aka Extensor Retinaculum):
 <ul>
 <li>Reinforced by: quadriceps <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a>, <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> and <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> patellar retinacular fibers, and patellar tendon.</li>
 </ul>
 </li>
 </ul>
 <ul>
 <li>Lateral:
 <ul>
 <li>Reinforced by: <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> collateral ligament (LCL), <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> patellar retinacular fibers, iliotibial band, <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener"> biceps femoris</a>, <a href="https://brookbushinstitute.com/courses/popliteus" target="_blank" rel="noopener"> popliteus</a> tendon, and the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> head of the gastrocnemius.</li>
 </ul>
 </li>
 </ul>
 <ul>
 <li>Medial:
 <ul>
 <li>Reinforced by: <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> collateral ligament (MCL), <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> patellar retinacular fibers, sartorius, <a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener"> gracilis</a>, semitendinosus and semimembranosus tendon. The <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> 1/3 of the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> capsule consists of thick, well-defined fibers often referred to as the posterior-medial capsule or the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> oblique ligament.</li>
 </ul>
 </li>
 </ul>
 </td>
 <td>Posterior: Hyper-extension (tibial anterior glide / femoral posterior glideAnterior: Hyper-flexion (tibial posterior glide / femoral anterior glideLateral: Excessive varus (tibial medial glide / femoral lateral glide)Medial: Excessive valgus (tibial lateral glide / femoral medial glide)All aspects of the capsule may play a role in limiting rotation.</td>
 </tr>
 <tr>
 <td> Anterior Cruciate Ligament (ACL) </td>
 <td>
 <ul>
 <li>Femoral Attachment: <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">Medial</a> aspect of the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> condyle</li>
 <li>Tibial Attachment: <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> inter-condylar area</li>
 </ul>
 </td>
 <td>
 Consists of 2 bands (anteromedial and posterolateral)
 Courses from the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> trochlea of the femur, down to the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> aspect of the intercondylar eminence with a mild <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> obliquity.
 </td>
 <td>Hyper-extension, anterior translation of the tibia, excessive varus, valgus, rotation</td>
 </tr>
 <tr>
 <td> Posterior Cruciate Ligament (PCL) </td>
 <td>
 <ul>
 <li>Femoral Attachment: Lateral aspect of the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> condyle</li>
 <li>Tibial Attachment: <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> intercondylar area</li>
 </ul>
 </td>
 <td>
 Consists of 2 bands (anterolateral and posteromedial)
 Courses from the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> aspect of the trochlea of the femur to the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> aspect of the intercondylar eminence with a slight <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> obliquity.
 </td>
 <td>Hyper-flexion, excessive varus, posterior translation of the tibia, valgus, rotation</td>
 </tr>
 <tr>
 <td> Medial (Tibial) Collateral Ligament (MCL) </td>
 <td>
 <ul>
 <li>Femoral Attachment: <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">Medial</a> Epicondyle</li>
 <li>Tibial Attachment: Anteromedial surface just <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> to pes anserinus attachment</li>
 </ul>
 </td>
 <td>
 Consists of two separate bands referred to by some texts as superficial and deep, separated by a bursa.
 The superficial band courses anteriorly and distally from its femoral attachment, blending with the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> patellar retinacular fibers and then to the tibia, running more horizontally than the deep band.
 Deep band begins slightly more <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> to the superficial band and attaches to the posterior-medial joint capsule, <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> meniscus, and semimembranosus tendon as it courses inferiorly and slightly <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a>.
 </td>
 <td>Excessive knee valgus (primarily the superficial band), hyper-extension, excessive rotation - especially external rotation of the tibia / internal rotation of the femur (primarily the superficial band)</td>
 </tr>
 <tr>
 <td> Lateral (Fibular) Collateral Ligament (LCL) </td>
 <td>
 <ul>
 <li>Femoral Attachment: <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> epicondyle</li>
 <li>Fibular Attachment: Fibular head</li>
 </ul>
 </td>
 <td>Follows a nearly vertical course inferiorly and slightly posterior blending with the biceps femoris tendon distally.</td>
 <td>Excessive knee varus, hyperextension, excessive tibial external rotation</td>
 </tr>
 <tr>
 <td> Oblique Popliteal Ligament </td>
 <td>
 <ul>
 <li>Femoral Attachment: Superolateral capsule near the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> femoral condyle</li>
 <li>Tibial Attachment: <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> tibial condyle</li>
 </ul>
 </td>
 <td>Posteromedially to the capsule, and semimembranosus tendon</td>
 <td>Knee extension and possibly tibial ER</td>
 </tr>
 <tr>
 <td> Arcuate Popliteal Ligament </td>
 <td>
 <ul>
 <li>Tibial Attachment: <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> intercondylar area</li>
 <li>Fibular Attachment: Fibular head</li>
 </ul>
 </td>
 <td>
 Separates into two bands
 Larger band arches over the popliteal tendon; attaches to the tibia on the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> intercondylar area.
 Smaller band demonstrates inconsistency across individuals; attaches to the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> femoral condyle and the fabella - a sesamoid bone embedded in the gastrocnemius
 </td>
 <td>Knee extension and external rotation</td>
 </tr>
 <tr>
 <td> Posterior Oblique Ligament </td>
 <td>
 <ul>
 <li>Fibular Attachment: <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">Medial</a> epicondyle, near MCL and adductor tubercle</li>
 <li>Tibial Attachment: Posteromedial surface of the tibial condyle</li>
 </ul>
 </td>
 <td>Courses posteriorly, medially, and inferiorly to its tibial attachment, blending with the posterior capsule and posteromedial aspect of the medial meniscus</td>
 <td>Anterior shear, valgus forces, and knee hyper-extension</td>
 </tr>
 <tr>
 <td> Meniscus </td>
 <td>
 <ul>
 <li>Femoral Attachment: <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> surface of the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> condyle via meniscofemoral ligaments (<a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> horn of <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> meniscus)</li>
 <li>Tibial Attachment: Intercondylar region via <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> and <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> horns; outer tibial edge and capsule via coronary (meniscotibial) ligaments</li>
 <li>Patellar Attachment: Via patellomeniscal ligaments (thickenings of the anterior capsule)</li>
 </ul>
 </td>
 <td>
 The knee has a <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> and <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> meniscus which connects anteriorly via the Transverse Ligament
 Medial: Larger and more oval in shape, the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> meniscus extends nearer the edge of the tibial plateau to blend with the deep portion of the MCL (considered part of the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> capsule), quadriceps tendon, and semimembranosus tendon. Laterally blends the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> meniscus blends with the cruciate ligaments.
 Lateral: More circular in shape, the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> meniscus extends laterally to attach to the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> capsule and the <a href="https://brookbushinstitute.com/courses/popliteus" target="_blank" rel="noopener">popliteus</a>. Posteriorly the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> meniscus extends to and is attached to the PCL
 </td>
 <td>
 Primary role is to reduce compressive stress across the joint and help resist rotational forces
 Note: Removal of the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> meniscus has shown to increase peak contact pressures at the knee by 230% (1)
 </td>
 </tr>
 <tr>
 <td> Patellar Tendon </td>
 <td>
 <ul>
 <li>Patellar Attachment: Apex</li>
 <li>Tibial Attachment: Tibial tuberosity</li>
 </ul>
 </td>
 <td>Courses distally from the patella to the tibia.</td>
 <td>May resist superior glide of the patella</td>
 </tr>
 <tr>
 <td> Quadriceps Tendon </td>
 <td>
 <ul>
 <li>Patellar Attachment: <a id="base-of-support" data-tip="1196" target="_blank" href="/glossary-term/base-of-support" class="glossary">Base</a> &amp; sides</li>
 <li>Femoral Attachment: The Quadriceps</li>
 </ul>
 </td>
 <td>Courses distally from the convergence of the quadriceps muscle to the patella</td>
 <td>Excessive inferior, medial, lateral glide of the patella.</td>
 </tr>
 <tr>
 <td> Iliotibial Band </td>
 <td>
 <ul>
 <li><a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">Proximal</a> Attachment: Fascia investing from the <a href="https://brookbushinstitute.com/courses/tensor-fascia-latae-tfl" target="_blank" rel="noopener">tensor fascia latae</a>, <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener"> gluteus maximus</a>, and gluteus medius.</li>
 <li>Tibial Attachment: Anterolateral surface</li>
 <li>Other <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> attachment: <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> intermuscular septum (Gerdy&apos;s tubercle), <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener"> biceps femoris</a>, vastus lateralis</li>
 <li>Patellar Attachment: by way of the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> patellofemoral ligament</li>
 </ul>
 </td>
 <td>Courses distally along the lateral portion of the thigh</td>
 <td>Tibial internal rotation, anterior tibial translation / posterior femoral translation</td>
 </tr>
 </tbody>
</table>
<h2><a href="https://www.datocms-assets.com/25800/1642963815-knee-patella-980x1024.jpeg"><img src="https://www.datocms-assets.com/25800/1642963815-knee-patella-980x1024.jpeg" title="Soft tissues of the knee joint including the patella tendon, knee ligaments, and meniscus" alt="The knee joint with soft tissues structures shown"></a></h2>
Soft tissue structures of the knee. From: http://blog.corewalking.com/wp-content/uploads/2011/11/knee-patella.jpg

Knee Joint Connective Tissues: Capsule, Ligaments, and Menisci

<h4>Bursae</h4>
<ul>
 <li> Subcutaneous prepatellar bursa: Superficial to the patella and deep to the skin; this bursa helps to protect the skin and subdermal tissues from friction and pressure imparted by the rough <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> surface of the patella.</li>
 <li> Suprapatellar bursa (largest): Superficial to the femur and deep to the quadriceps tendon; this bursa aids in reducing friction between the femur during contraction of the quadriceps.</li>
 <li> Deep infrapatellar bursa: Superficial to the tibia and deep to the patellar tendon; this bursa aids in reducing friction between the tibia and tendon during contraction of the quadriceps.</li>
 <li> Subpopliteal bursa: Superficial to the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> femoral condyle and deep to the <a href="https://brookbushinstitute.com/courses/popliteus" target="_blank" rel="noopener">popliteus</a> tendon; this bursa protects the popliteal tendon from friction with the femoral condyle and posterolateral edge of the tibial plateau.</li>
 <li> Semimembranosus bursa: Superficial to the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> condyle of the tibia and deep to the semimembranosus tendon; this bursae protects the tendon of the semimembranosus from the sharp edge of the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> tibial condyle during extension.</li>
 <li> Gastrocnemius bursa: Superficial to the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> femoral condyle and deep to the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> head of the gastrocnemius; this bursa protects the attachment of the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> gastrocnemius from the rough surface of the femoral condyle.</li>
 <li> Pes anserine bursa: Superficial to the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> collateral ligament and deep to the tendon of the pes anserinus (sartorius, <a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener"> gracilis</a>, semitendinosus ); this bursa protects the fibers of the MCL as well as the tendons of the pes anserine group from friction during knee flexion and extension.</li>
 <li> Biceps femoris bursa: Superficial to the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> collateral ligament and deep to the tendon of the <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">biceps femoris</a>; this bursa protects the conjoined tendon of the biceps femoris from friction with the condyle and <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> edge of the tibial plateau.</li>
</ul>
<a href="https://www.datocms-assets.com/25800/1642963892-knee-bursae.jpeg"><img src="https://www.datocms-assets.com/25800/1642963892-knee-bursae.jpeg" title="The suprapatellar, superfiical prepatellar, deep infrapatelar, and superficial intrapatellar bursa of the knee" alt="The bursae of the knee joint"></a>
From: http://medicalfoxx.com/wp-content/uploads/2016/01/knee-bursae.jpg
<h4>Plicae:</h4>
During embryonic development, the synovial membrane may be separated into compartments by synovial septae. The incomplete resorption of these septae results in creases, or folds in the synovial membrane called &quot;plicae&quot;. The 4 most commonly noted plicae are listed in descending order of appearance.
<ul>
 <li> <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">Inferior</a> Plica (infrapatellar, ligementum mucosum) - Located in the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> intercondylar area, <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> to the ACL, this plica passes through the fat pad to attach to the <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">Inferior</a> pole of the patella.</li>
 <li> <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">Superior</a> Plica (suprapatellar) - Located between the suprapatellar bursa and the <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">Superior</a> patella, this plica connects the quadriceps tendon to the synovial pouch.</li>
 <li> <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">Medial</a> Plica (mediopatellar) - This plica is far less common, but when presents are located <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">Medial</a> to the patella, connecting the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">Medial</a> wall of the pouch of the extensor retinaculum to the infrapatellar fat pad.</li>
 <li> <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> Plica - A <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> plica may be present, but is very rare. We could not find reference to attachments or courses.</li>
</ul>
<a href="https://www.datocms-assets.com/25800/1642963948-plicae.jpeg"><img src="https://www.datocms-assets.com/25800/1642963948-plicae.jpeg" title="The lateral, medial, infrapatellar, and suprapatellar plica of the knee joint" alt="The plicae of the knee joint"></a>
Plicae - Netter, Atlas of Human Anatomy

Knee Joint Bursae & Plicae

<ul>
 <li>Sensory Innervation: Primarily supplied through the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> tibial branch of the sciatic <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a> - this branch supplies the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> capsule and associated ligaments, internal structures of the knee, as well as the infrapatellar fat pad. The obturator <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a> carries sensation from the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> and <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> capsule, and the femoral <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a> innervates most of the anteromedial and anterolateral capsule - the common peroneal also supplies branches that are involved in the sensation of the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> capsule (41). The obturator <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a> supplies the skin over the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> aspect of the knee along with some of the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> and <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> capsules. Sensory information from the internal structures of the knee and the knee capsule are received by <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a> roots L3-L5. </li>
</ul>
<table>
 <tbody>
 <tr>
 <td width="322">
 <h4 style="text-align: left;">Muscles Crossing the knee</h4>
 </td>
 <td style="text-align: left;" width="315">
 <h4>Neural Innervation</h4>
 </td>
 <td style="text-align: left;" width="170">
 <h4>Nerve Root&#xA0;</h4>
 </td>
 </tr>
 <tr>
 <td width="322">Sartorius</td>
 <td width="315">Femoral Nerve</td>
 <td width="170">L2 &#x2013; L3</td>
 </tr>
 <tr>
 <td width="322">Quadriceps Femoris (Rectus femoris, Vastus Lateralis, Vastus Medialis, Vastus Intermedius)</td>
 <td width="315">Femoral Nerve</td>
 <td width="170">L2 &#x2013; L4</td>
 </tr>
 <tr>
 <td>Articularis Genu</td>
 <td>Femoral Nerve</td>
 <td></td>
 </tr>
 <tr>
 <td width="322"><a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">Gracilis</a></td>
 <td width="315">Obturator Nerve</td>
 <td width="170">L2 &#x2013; L4</td>
 </tr>
 <tr>
 <td width="322"><a href="https://brookbushinstitute.com/courses/tensor-fascia-latae-tfl" target="_blank" rel="noopener">Tensor Fascia Latae</a></td>
 <td width="315">Superior Gluteal Nerve</td>
 <td width="170">L4 &#x2013; S1</td>
 </tr>
 <tr>
 <td width="322">Semitendinosus</td>
 <td width="315">Tibial Nerve</td>
 <td width="170">L4 &#x2013; S2</td>
 </tr>
 <tr>
 <td width="322">Semimembranosus</td>
 <td width="315">Tibial Nerve</td>
 <td width="170">L4 &#x2013; S2</td>
 </tr>
 <tr>
 <td width="322"><a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">Biceps Femoris (Long Head)</a></td>
 <td width="315">Tibial Nerve</td>
 <td width="170">L5 &#x2013; S3</td>
 </tr>
 <tr>
 <td width="322"><a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">Bicep Femoris (Short Head)</a></td>
 <td width="315">Fibular Nerve</td>
 <td width="170">L5 &#x2013; S2</td>
 </tr>
 <tr>
 <td width="322"><a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">Gluteus Maximus</a> (via ITB)</td>
 <td width="315">Inferior Gluteal Nerve</td>
 <td width="170">L5 - S2</td>
 </tr>
 <tr>
 <td><a href="https://brookbushinstitute.com/courses/popliteus" target="_blank" rel="noopener">Popliteus</a></td>
 <td>Tibial Nerve</td>
 <td>L4 - S2</td>
 </tr>
 <tr>
 <td width="322">Plantaris</td>
 <td width="315">Tibial Nerve</td>
 <td width="170">L4 - S2</td>
 </tr>
 <tr>
 <td width="322">Gastrocnemius</td>
 <td width="315">Tibial Nerve</td>
 <td width="170">S1 - S2</td>
 </tr>
 </tbody>
</table>
<a href="https://www.datocms-assets.com/25800/1642963994-800px-slide2dade.jpeg"><img src="https://www.datocms-assets.com/25800/1642963994-800px-slide2dade.jpeg" title="A cadaver dissection of the knee joint with connective tissue labeled" alt="The knee joint with muscles highlighted in a cadaver"></a>From: https://upload.wikimedia.org/wikipedia/commons/thumb/0/0f/Slide2DADE.JPG/800px-Slide2DADE.JPG[/caption]

Knee Nerves

<h3>Osteokinematics</h3>
<h4>Tibia on Femur</h4>
<ul>
 <li>Flexion
 <ul>
 <li>Flexors: Semimembranosus, Semitendinosus, <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">Biceps femoris</a> (long and short head), Sartorius, <a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">Gracilis</a>, <a href="https://brookbushinstitute.com/courses/popliteus" target="_blank" rel="noopener">Popliteus</a>, Gastrocnemius, Plantaris</li>
 <li>Limited by: Quadriceps femoris, articularis genu, <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> fascia lata, <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> capsule, <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> cruciate ligament, neural restriction (common femoral <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a>)</li>
 <li>Optimal Range of Motion (ROM): 135-150&#xB0; (<a href="https://brookbushinstitute.com/video/knee-flexion-goniometry" target="_blank" rel="noopener">Knee Flexion Goniometry</a>)</li>
 </ul>
 </li>
 <li>Extension
 <ul>
 <li>Extensors: Quadriceps femoris, articularis genu</li>
 <li>Limited by: Semimembranosus, semitendinosus, <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">biceps femoris</a> (long and short head), sartorius, g<a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">racilis</a>, <a href="https://brookbushinstitute.com/courses/popliteus" target="_blank" rel="noopener">popliteus</a>, gastrocnemius, <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> capsule, <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> cruciate ligament, <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> collateral ligament, <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> collateral ligament, oblique popliteal ligament, iliotibial band, <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> fascia lata, <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> crural fascia, popliteal fascia, neural restriction (sciatic nerve: common fibular and tibial nerves)</li>
 <li>Optimal ROM: 0 - 5&#xB0; (<a href="https://brookbushinstitute.com/video/knee-extension-goniometry" target="_blank" rel="noopener">Knee Extension </a><a id="goniometry" data-tip="1523" target="_blank" href="/glossary-term/goniometry" class="glossary">Goniometry</a> <a href="https://brookbushinstitute.com/video/knee-extension-with-hip-flexion-goniometry-hamstring-length-test" target="_blank" rel="noopener">with 90&#xB0; of Hip Flexion</a>)</li>
 </ul>
 </li>
 <li>Tibia Internal Rotation
 <ul>
 <li>Internal Rotaters: Sartorius, <a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">gracilis</a>, <a href="https://brookbushinstitute.com/courses/popliteus" target="_blank" rel="noopener">popliteus</a>, semimembranosus, semitendinosus, Medial Gastrocnemius</li>
 <li>Limited by: <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">Biceps femoris</a> (long and short head), <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> gastrocnemius, <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">Medial</a> collateral ligament, <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> collateral ligament, <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> cruciate ligament, <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> cruciate ligament</li>
 <li>Optimal ROM: 0-15&#xB0; at 90&#xB0; of knee flexion (<a id="goniometry" data-tip="1523" target="_blank" href="/glossary-term/goniometry" class="glossary">Goniometry</a> Unreliable)</li>
 </ul>
 </li>
 <li>Tibia External Rotation
 <ul>
 <li>External Rotators: <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">Biceps femoris</a> (long and short head), <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> gastrocnemius</li>
 <li>Limited by: Sartorius, <a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">gracilis</a>, <a href="https://brookbushinstitute.com/courses/popliteus" target="_blank" rel="noopener">popliteus</a>, semimembranosus, semitendinosus, <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">Medial</a> gastrocnemius, <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">Medial</a> collateral ligament, <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> collateral ligament, oblique popliteal ligament, <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> crutiate ligament, <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> crutiate ligament</li>
 <li>Optimal ROM: 0-20&#xB0; with 90&#xB0; of knee flexion (<a id="goniometry" data-tip="1523" target="_blank" href="/glossary-term/goniometry" class="glossary">Goniometry</a> Unreliable)</li>
 </ul>
 </li>
 <li>Abduction (Valgus)
 <ul>
 <li>Abductors: <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">Biceps femoris</a> (long and short head), <a href="https://brookbushinstitute.com/courses/tensor-fascia-latae-tfl" target="_blank" rel="noopener">tensor fascia lata</a> via ITB, <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> gastrocnemius</li>
 <li>Limited by: Pes anserinus group (sartorius, <a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">gracilis</a>, semitendinosus), semimembranosus, <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> gastrocnemius, <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> collateral ligament, <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> cruciate ligament, <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> cruciate ligament, arcuate popliteal ligament, <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> oblique ligament</li>
 <li>Optimal ROM: 8&#xB0; with full knee extension, 13&#xB0; with 20&#xB0; knee flexion</li>
 </ul>
 </li>
 <li>Adduction (Varus)
 <ul>
 <li>Adductors: Pes anserinus group (sartorius, <a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">gracilis</a>, semitendinosus), semimembranosus, <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> gastrocnemius</li>
 <li>Limited by: <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">Biceps femoris</a> (long and short head), <a href="https://brookbushinstitute.com/courses/tensor-fascia-latae-tfl" target="_blank" rel="noopener">tensor fascia lata</a> via Iliotibial Band, <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> gastrocnemius, <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> collateral ligament, <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> cruciate ligament, <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> cruciate ligament, arcuate popliteal ligament, <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> oblique ligament</li>
 <li>Optimal ROM: 8&#xB0; with full knee extension, 13&#xB0; with 20&#xB0; knee flexion</li>
 </ul>
 </li>
</ul>
<ul>
 <li>Note: Even though fewer muscles produce knee extension, the quadriceps have greater mass and gain a mechanical advantage due to the presence of the patella. Collectively, the knee flexors produce about 60% of the force of the quadriceps.</li>
 <li>
 <h4>See <a id="kinesiology" data-tip="1692" target="_blank" href="/glossary-term/kinesiology" class="glossary">Kinesiology</a> of the Knee for a list of the <a id="prime-mover" data-tip="1663" target="_blank" href="/glossary-term/prime-mover" class="glossary">prime movers</a>, <a id="synergists" data-tip="1650" target="_blank" href="/glossary-term/synergists" class="glossary">synergists</a>, antagonists, neutralizers, stabilizers, and fixators for all joint actions.</h4>
 </li>
</ul>
<img class="size-full wp-image-76410" src="https://brookbush.s3.us-east-2.amazonaws.com/wordpress/wp-content/uploads/2016/05/Knee-Arthrokinematics.jpg" alt="Arthorkinematics of the knee joint" width="567" height="344" title="Illustration of the knee during tibia on femur and femur on tibia extension, with lines of force labeled">
Knee <a id="arthrokinematics" data-tip="1859" target="_blank" href="/glossary-term/arthrokinematics" class="glossary">Arthrokinematics</a> - Donald A. Neumann, &#x201C;Kinesiology of the Musculoskeletal System: Foundations of Rehabilitation &#x2013; 2nd Edition&#x201D; &#xA9; 2012 Mosby, Inc.[/caption]
<ul></ul>

Knee Joint Actions 

<a id="arthrokinematics" data-tip="1701" target="_blank" href="/glossary-term/arthrokinematics" class="glossary">Arthrokinematic motion</a> refers to the motion between joint surfaces - <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a>, <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a>, <a id="spin" data-tip="1603" target="_blank" href="/glossary-term/spin" class="glossary">spin</a>, <a id="compression" data-tip="1595" target="_blank" href="/glossary-term/compression" class="glossary">compression</a>, and distraction/traction. These <a id="arthrokinematics" data-tip="1702" target="_blank" href="/glossary-term/arthrokinematics" class="glossary">arthrokinematic motions</a> accompany <a id="osteokinematic-motion" data-tip="1796" target="_blank" href="/glossary-term/osteokinematic-motion" class="glossary">osteokinematic motions</a> to maintain joint congruence. You could visualize this pairing of motions as joint surfaces attempting to maintain the condyles of the femur center on the tibial plateaus, and maintain the patella within the intertrochlear groove. <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">Optimal</a> <a id="arthrokinematics" data-tip="1701" target="_blank" href="/glossary-term/arthrokinematics" class="glossary">Arthrokinematic motion</a> of the knee joint generally follows &quot;concave (tibia) on <a id="convex" data-tip="1284" target="_blank" href="/glossary-term/convex" class="glossary">convex</a> (femur) rules&quot;, <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> same as <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> when considering the tibia is moving on the femur. While, motion of the femur on the tibia follows &quot;convex on <a id="concave" data-tip="1281" target="_blank" href="/glossary-term/concave" class="glossary">concave</a> rules&quot; - <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> opposite as <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a>. For example, closed chain knee flexion (descending into a squat) involves <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> with <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> of the femoral condyles on the tibial plateaus, and a knee extension would include <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> and <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> of the tibia on the femoral condyles.
As the knee moves through flexion and extension in the sagittal plane, <a id="arthrokinematics" data-tip="1860" target="_blank" href="/glossary-term/arthrokinematics" class="glossary">accessory motion</a> must occur in the transverse and frontal planes. A key component to terminal knee extension is about 10&#xB0; of tibia external rotation (femoral internal rotation). This &quot;locks&quot; the knee, and is commonly referred to as the &quot;screw home mechanism&quot;. This <a id="arthrokinematics" data-tip="1860" target="_blank" href="/glossary-term/arthrokinematics" class="glossary">accessory motion</a> is due primarily to the difference in size between the surfaces of the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> and <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> tibial plateau (1, 3). If we were to examine open chain kinematics (tibia on femur motion) moving into knee extension, the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> tibial plateau would continue to move anteriorly after the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> plateau reached its full excursion - this results in a small amount of external rotation of the tibia and allows the tibial tubercles to lock into the intercondylar notch with all ligaments taut. To unlock the knee, the <a href="https://brookbushinstitute.com/courses/popliteus" target="_blank" rel="noopener">popliteus</a> has been implicated in initiating <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> rotation; however, more recent evidence supports a combination of mechanical factors (for example, in a closed chain, activation of the <a href="https://brookbushinstitute.com/courses/tibialis-anterior" target="_blank" rel="noopener">tibialis anterior</a> will dorsiflex the ankle and flex the knee, providing a better line of pull for all internal rotators of the tibia to impart force).
<h3>Tibiofemoral Joint:</h3>
<h4 style="padding-left: 30px;">Arthrokinematic motion and contributing muscles:</h4>
<ul>
 <li>Compressors: All muscles of the knee may contribute to <a id="compression" data-tip="1595" target="_blank" href="/glossary-term/compression" class="glossary">compression</a>.</li>
 <li>Tibial <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> Glide/Femoral <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> Glide: (Attach from the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> pelvis, and femur to tibial tuberosity; all extensors of the knee): Quadriceps femoris (rectus femoris, vastus lateralis, vastus medialis, vastus intermedius)</li>
 <li>Tibial <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> Glide/Femoral <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> Glide: (Attach from ischial tuberosity and <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> femur to tibia or fibula, all flexors of the knee): Semimembranosus, semitendinosus, <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">biceps femoris</a> (long and short head), sartorius, <a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">gracilis</a>, <a href="https://brookbushinstitute.com/courses/popliteus" target="_blank" rel="noopener">popliteus</a>, gastrocnemius</li>
</ul>
<h4 style="padding-left: 30px;">Glide is also restricted by the joint capsule and ligaments:</h4>
<ul>
 <li>Tibial <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> / Femoral <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> Glide: Restricted by the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> cruciate ligament, <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> collateral ligament, <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> collateral ligament, <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> oblique ligament, arcuate, <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> capsule, iliotibial band</li>
 <li>Tibial <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> / Femoral <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> Glide: Restricted by the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> capsule, <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> and <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> patellar retinacular fibers, patella tendon, <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> cruciate ligament, meniscofemoral ligaments</li>
</ul>
<h4 style="padding-left: 30px;">Roll accompanies the corresponding joint motion:</h4>
<ul>
 <li>Femoral <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">Roll</a> and Extension: Quadriceps femoris (rectus femoris, vastus lateralis, vastus medialis, vastus intermedius)</li>
 <li>Femoral <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">Roll</a> and Flexion: Semimembranosus, semitendinosus, <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">biceps femoris</a> (long and short head), sartorius, <a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">gracilis</a>, <a href="https://brookbushinstitute.com/courses/popliteus" target="_blank" rel="noopener">popliteus</a>, gastrocnemius</li>
</ul>
<h4 style="padding-left: 30px;">Spin accompanies the corresponding joint motion:</h4>
<ul>
 <li>Medial <a id="spin" data-tip="1603" target="_blank" href="/glossary-term/spin" class="glossary">Spin</a> and Internal Tibial Rotation (<a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> of <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">Medial</a> femoral condyle): Semimembranosus, semitendinosus, sartorius, <a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">gracilis</a>, <a href="https://brookbushinstitute.com/courses/popliteus" target="_blank" rel="noopener">popliteus</a>, <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">Medial</a> gastrocnemius</li>
 <li>Lateral <a id="spin" data-tip="1603" target="_blank" href="/glossary-term/spin" class="glossary">Spin</a> and External Tibial Rotation (<a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> of <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> femoral condyle): <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">Biceps femoris</a> and the <a href="https://brookbushinstitute.com/courses/tensor-fascia-latae-tfl" target="_blank" rel="noopener">tensor fasciae latae</a> via the iliotibial band.</li>
</ul>
<h3>Patellofemoral Joint:</h3>
<ul>
 <li>Patellar <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">Superior</a> Glide: Quadriceps femoris (rectus femoris, vastus lateralis, vastus medialis, vastus intermedius)</li>
 <li>Patellar <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">Inferior</a> Glide: No <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> pull inferiorly</li>
 <li>Patellar <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> Glide: Quadriceps femoris (especially vastus lateralis) and <a href="https://brookbushinstitute.com/courses/tensor-fascia-latae-tfl" target="_blank" rel="noopener">tensor fascia latae</a> via the iliotibial band</li>
 <li>Patellar <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">Medial</a> Glide: Vastus medialis obliquus (VMO)</li>
</ul>
<h4 style="padding-left: 30px;">Glide is also restricted by ligaments and connective tissue:</h4>
<ul>
 <li style="font-weight: bold;">Patellar <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">Superior</a> glide: Restricted by <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> &amp; <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> patellar retinacular fibers</li>
 <li style="font-weight: bold;">Patellar <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">Inferior</a> glide: Restricted by quadriceps femoris (rectus femoris, vastus lateralis, vastus medialis, vastus intermedius)</li>
 <li style="font-weight: bold;">Patellar <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> glide: Restricted by <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> patellar retinacular fibers, VMO, steep slope of the intercondylar groove</li>
 <li>Patellar <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">Medial</a> glide: Restricted by <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> patellar retinacular fibers, <a href="https://brookbushinstitute.com/courses/tensor-fascia-latae-tfl" target="_blank" rel="noopener">TFL</a> via the ITB, Quadriceps femoris (especially vastus lateralis)</li>
</ul>
<h4 style="padding-left: 30px;">Glide accompanies the corresponding joint motion:</h4>
<ul>
 <li>Patellar Superiolateral <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">Glide</a> and Extension: Quadriceps femoris (rectus femoris, vastus lateralis, vastus medialis, vastus intermedius)</li>
 <li>Patellar Inferiomedial <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">Glide</a> and Flexion: <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">Glide</a> is created via passive <a id="tension" data-tip="1229" target="_blank" href="/glossary-term/tension" class="glossary">tension</a> within the patellar tendon as the tibia <a id="glide" data-tip="1600" target="_blank" href="/glossary-term/glide" class="glossary">glides</a> posteriorly.<a href="https://upload.wikimedia.org/wikipedia/commons/0/05/Braus_1921_293.png" rel="attachment noopener wp-att-75419" target="_blank"><img src="https://www.datocms-assets.com/25800/1642964085-braus_1921_293-1024x862.png" title="A cross sectional view of the leg muscles from an anterior view" alt="A cross sectional view of the leg muscles"></a> From: https://upload.wikimedia.org/wikipedia/commons/0/05/Braus_1921_293.png</li>
</ul>

Motion of the knee is influenced by muscles, fascia, and the <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a> of nerves that cross multiple joints. Further, the motion of <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a> joints may influence the position of bones, force vectors, moment arms and the dissipation of force.
<ul>
 <li> Joints: (35)
 <ul>
 <li>Low Back - Low back pain most often results in gluteus medius weakness which has been associated with functional valgus and knee pain. (19-21, 23, 27)</li>
 <li>Sacroiliac joint (SIJ) - SIJ pain has been associated with altered lumbopelvic-hip complex <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> recruitment, including <a href="https://brookbushinstitute.com/courses/gluteus-maximus">gluteus&#xA0;maximus</a><a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener"> </a> and gluteus medius weakness and <a href="https://brookbushinstitute.com/courses/biceps-femoris">biceps&#xA0;femoris </a><a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener"> </a> over-activity, which are similar to the altered recruitment patterns noted in a functional valgus (23, 28, 33, 34)</li>
 <li>Hip - Increases in femoral internal rotation, weakness of hip external rotation, inhibition of the <a href="https://brookbushinstitute.com/courses/gluteus-maximus">gluteus&#xA0;maximus</a><a href="https://brookbushinstitute.com/article/gluteus-maximus" target="_blank" rel="noopener"> </a> and gluteus medius are all associated with hip pathology and changes in knee kinematics (19 - 21, 23, 27, 35 - 36)</li>
 <li>Ankle/foot - Decreased dorsiflexion has been correlated with a knee valgus movement pattern, as well as limiting dorsiflexion resulting in an increase in frontal plane excursion of the knee (30, 42).</li>
 </ul>
 </li>
 <li> Muscles: 
 <ul>
 <li>All muscles crossing the knee</li>
 <li>All muscles controlling frontal and transverse plane motion of the entire lower extremity (hip, knee, ankle) (16 - 23, 30)</li>
 <li>All muscles controlling the lumbar spine and trunk that may alter the position of the pelvis and hip (lumbar spine and ankle) (27 - 34)</li>
 </ul>
 </li>
 <li> Fascial Structures: 
 <ul>
 <li>Fascia Latae - The iliotibial band (ITB) invests in the <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a>, <a href="https://brookbushinstitute.com/courses/tensor-fascia-latae-tfl" target="_blank" rel="noopener"> tensor fascia latae </a> (as well as the vastus lateralis ), creating a direct relationship between <a href="https://brookbushinstitute.com/courses/hip-joint" target="_blank" rel="noopener">hip</a> musculature and the knee. (12, 37)</li>
 <li>Crural Fascia - The crural fascia, specifically the fascia of the fibular head, <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> tibia, and ITB, appear to link various passive and contractile structures of the lower leg to the passive and contractile structures of the thigh (12).</li>
 </ul>
 </li>
 <li> Neural Structures: 
 <ul>
 <li>Femoral <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">Nerve</a> - The femoral <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">Nerve</a> is lengthened during knee flexion, and dysfunction of the femoral <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">Nerve</a> commonly results in pain &quot;felt&quot; in the quadriceps.</li>
 <li>Obturator <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">Nerve</a> - The cutaneous branch of the obturator <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">Nerve</a> may have communicating branches with the saphenous <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">Nerve</a>. Abduction of the hip will lengthen the obturator <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">Nerve</a>, and the communicating branches of the obturator <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">Nerve</a> may be lengthened by knee extension.</li>
 <li>Sciatic <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">Nerve</a> - The sciatic <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">Nerve</a> crosses the back of the knee and commonly restricts knee extension with hip flexion, as seen with the Straight Leg Raise <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">Test</a> or the <a href="https://brookbushinstitute.com/video/knee-extension-with-hip-flexion-goniometry-hamstring-length-test" target="_blank" rel="noopener"> Hamstring Length Test</a>.</li>
 </ul>
 </li>
</ul>
<a href="https://www.datocms-assets.com/25800/1642964138-knee-valgus.jpeg"><img src="https://www.datocms-assets.com/25800/1642964138-knee-valgus.jpeg" title="Knee valgus (knee bow in) during squatting, jumping, and running" alt="Three images of functional knee valgus"></a>&#xA0; 3 Images of &quot;Functional Knee Valgus&quot; - Excessive adduction and internal rotation of the hip.

The knee has a propensity toward a <a id="compensation-pattern" data-tip="1696" target="_blank" href="/glossary-term/compensation-pattern" class="glossary">compensation pattern</a> described as a &quot;functional valgus&quot;. This <a id="movement-impairment" data-tip="1575" target="_blank" href="/glossary-term/movement-impairment" class="glossary">movement impairment</a> is a combination of joint actions - excessive femoral internal rotation and adduction, and tibial external rotation and abduction (approximation of <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> femoral condyle and <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> tibial plateau). Clinically, the Brookbush Institute has noted less stiffness and <a id="arthrokinematics" data-tip="1863" target="_blank" href="/glossary-term/arthrokinematics" class="glossary">arthrokinematic</a> dysfunction at the knee than seen at the hip or ankle, but when present is exhibited as excessive tibial external rotation (<a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> <a id="spin" data-tip="1603" target="_blank" href="/glossary-term/spin" class="glossary">spin</a>), the inadequate <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> of the tibia on the femur, and increased <a id="compression" data-tip="1595" target="_blank" href="/glossary-term/compression" class="glossary">compression</a> of the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> compartment. It is also common to note <a id="arthrokinematics" data-tip="1863" target="_blank" href="/glossary-term/arthrokinematics" class="glossary">arthrokinematic</a> <a id="hypermobility" data-tip="1678" target="_blank" href="/glossary-term/hypermobility" class="glossary">hyper-mobility</a> of the knee, as compensation for hip and ankle stiffness. Further, this <a id="compensation-pattern" data-tip="1696" target="_blank" href="/glossary-term/compensation-pattern" class="glossary">compensation pattern</a> often results in the patella adopting a relatively <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> and <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> position in the trochlear groove. The term &quot;relative&quot; has been chosen carefully, as it is believed that it is not the patella that adopts a new position, but rather the femur moving medially under a patella that is relatively fixed by the iliotibial band and <a id="tone" data-tip="1642" target="_blank" href="/glossary-term/tone" class="glossary">tonicity</a> of the quadriceps, especially the rectus femoris.
These changes may result in, or be the result of altered length and activity of one, or many of the muscles crossing the knee joint, and maladaptive changes in length and/or <a id="extensibility-2" data-tip="1308" target="_blank" href="/glossary-term/extensibility-2" class="glossary">extensibility</a> of passive soft tissues (capsule, ligaments, and fascial structures). Although this section will describe dysfunction from the perspective of the knee; the knee could be viewed as a &quot;victim joint&quot;. That is the architecture of the knee seems to predispose it to injury and pain stemming from dysfunction at the hip and/or ankle (a &quot;victim&quot; of &quot;monkey in the middle&quot;). Careful <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a> of the hip and the ankle should be included for every patient/client exhibiting dysfunction of the knee.
It should also be noted that additional compensatory patterns exist and are <a id="relevance" data-tip="1505" target="_blank" href="/glossary-term/relevance" class="glossary">relevant</a> to practice; however, in this article, the focus will be given to this pattern, which is presumed to be &quot;most common.&quot;
<ul>
 <li>Common <a id="osteokinematic-motion" data-tip="1881" target="_blank" href="/glossary-term/osteokinematic-motion" class="glossary">Osteokinematic</a> Dysfunction: Excessive femoral internal rotation and adduction, and tibial external rotation and abduction</li>
 <li>Common <a id="arthrokinematics" data-tip="1863" target="_blank" href="/glossary-term/arthrokinematics" class="glossary">Arthrokinematic</a> Dysfunction:</li>
 <li>Excessive <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> <a id="spin" data-tip="1603" target="_blank" href="/glossary-term/spin" class="glossary">spin</a>, inadequate <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a>, and <a id="compression" data-tip="1595" target="_blank" href="/glossary-term/compression" class="glossary">compression</a> of the <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> compartment</li>
 <li>Relative <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> and <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> of the patella.</li>
</ul>
<h3>Knee Compensatory Pattern Summary (<a href="https://brookbushinstitute.com/courses/lower-leg-dysfunction" target="_blank" rel="noopener">LLD</a> and <a href="https://brookbushinstitute.com/courses/lumbo-pelvic-hip-complex-dysfunction-lphcd" target="_blank" rel="noopener">LPHCD</a>)</h3>
<ul>
 <li>Maladaptive Decrease In Length/Extensibility (Mobilize):
 <ul>
 <li>Posterior Capsule</li>
 <li>Lateral Collateral Ligament</li>
 <li>Anterior Cruciate Ligament</li>
 </ul>
 </li>
 <li>Short/Over-active (<a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">Release</a> and Lengthen)
 <ul>
 <li><a href="https://brookbushinstitute.com/courses/tensor-fascia-latae-tfl" target="_blank" rel="noopener">Tensor Fasciae Latae (TFL)</a></li>
 <li>Vastus Lateralis</li>
 <li>Rectus Femoris</li>
 <li>Lateral Gastrocnemius</li>
 </ul>
 </li>
 <li>Long/Over-active (<a id="synergistic-dominance" data-tip="1649" target="_blank" href="/glossary-term/synergistic-dominance" class="glossary">Synergistically Dominant</a> - <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">Release</a> Only)
 <ul>
 <li><a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">Biceps Femoris</a></li>
 <li>Sartorius</li>
 </ul>
 </li>
 <li>Long/Under-active (Activate and <a id="integration" data-tip="1476" target="_blank" href="/glossary-term/integration" class="glossary">Integrate</a>)</li>
 <li><a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">Gracilis</a></li>
 <li><a href="https://brookbushinstitute.com/courses/popliteus" target="_blank" rel="noopener">Popliteus</a></li>
 <li>Semitendinosus and Semimembranosus</li>
 <li>Vastus Medialis</li>
 <li>Vastus Intermedius and Articularis Genu</li>
 <li><a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">Medial</a> Gastrocnemius</li>
</ul>

Postural Dysfunction and the Knee Joint

<h4>Knee Dysfunction Relative to Predictive Models of Postural Dysfunction:</h4>
<ul>
 <li>In <a title="UBD" href="https://brookbushinstitute.com/courses/upper-body-dysfunction-ubd" target="_blank" rel="noopener">Upper Body Dysfunction (UBD)</a> the knee plays no significant role.</li>
 <li>In <a title="LLD" href="https://brookbushinstitute.com/courses/lower-leg-dysfunction" target="_blank" rel="noopener">Lower Leg Dysfunction (LLD)</a>, dysfunction of the knee is secondary to dysfunction at the foot/ankle complex; however, it is unlikely that a complete resolution from dysfunction and symptoms will occur until the foot/ankle, hip, knee, and potentially the sacroiliac joint has been addressed. <a href="https://brookbushinstitute.com/courses/lower-leg-dysfunction" target="_blank" rel="noopener">LLD</a> may be characterized by a loss of dorsiflexion, excessive pronation (eversion), and a functional knee valgus (excessive femoral internal rotation and adduction, and tibial external rotation and abduction) (6, 7, 9, 16 - 23, 30 - 32, 42); in fact, the predictive <a id="model" data-tip="1469" target="_blank" href="/glossary-term/model" class="glossary">model</a> for <a href="https://brookbushinstitute.com/courses/lower-leg-dysfunction" target="_blank" rel="noopener">LLD</a> could be viewed as an expansion of the research on a &quot;functional knee valgus&quot;. Although research linking knee dysfunction to ankle dysfunction is scarce, a few studies have noted changes in the activity of muscles crossing the ankle and knee, increased frontal plane excursion of the knee in those exhibiting limited dorsiflexion, increased hip internal rotation noted in those who excessively pronate, and a link between Achilles tendinopathy and inhibition of hip abductors (23, 30, 31, 42).</li>
 <li>In <a title="LPHCD" href="https://brookbushinstitute.com/courses/lumbo-pelvic-hip-complex-dysfunction-lphcd" target="_blank" rel="noopener">Lumbo Pelvic Hip Complex Dysfunction (LPHCD), </a>dysfunction of the knee is secondary to dysfunction at the hip. A simplified version of this <a id="model" data-tip="1469" target="_blank" href="/glossary-term/model" class="glossary">model</a> could be described as an <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> pelvic tilt - or, excessive pelvis on femur flexion. This may be the result of low back pain, loss of hip extension, decreased <a id="extensibility-2" data-tip="1308" target="_blank" href="/glossary-term/extensibility-2" class="glossary">extensibility</a> and increased activity of the hip flexors, and/or decreased <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> activity (27-30, 36-37). Although the link between <a href="https://brookbushinstitute.com/courses/lumbo-pelvic-hip-complex-dysfunction-lphcd" target="_blank" rel="noopener">LPHCD</a> and knee dysfunction is not direct, both <a href="https://brookbushinstitute.com/courses/lumbo-pelvic-hip-complex-dysfunction" target="_blank" rel="noopener">LPHCD</a> and knee dysfunction have been correlated with inhibition of the <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> and medius, which may result in excessive femoral internal rotation. Note, that excessive femoral internal rotation is also a component of a functional knee valgus.</li>
</ul>
Note: Much of the knee compensatory pattern noted above is derived from research related to changes in joint motion, <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity, range of motion, and strength in those exhibiting signs of <a href="https://brookbushinstitute.com/courses/lower-leg-dysfunction/" target="_blank" rel="noopener">LLD</a> or <a href="https://brookbushinstitute.com/courses/lumbo-pelvic-hip-complex-dysfunction-lphcd" target="_blank" rel="noopener">LPHCD</a>, just as the predictive <a id="model" data-tip="1471" target="_blank" href="/glossary-term/model" class="glossary">models</a> of dysfunction are influenced by the common patterns noted relative to joint pathology.
<ul>
 <li>In Sacroiliac Joint Dysfunction (SIJD) an asymmetrical weight shift results in two patterns of knee dysfunction. Generally, on the side opposite the sacroiliac joint stiffness (SIJ) the pelvis rotates anteriorly, the sacrum often counter-nutates, and the femur is relatively flexed, adducted, and internally rotated, matching the common pattern seen in a functional knee valgus. In a variation of the commonly seen functional knee valgus, the hip dysfunction on the side of the sacroiliac joint stiffness often contributes to a &quot;functional varus&quot; - excessive external rotation and abduction of the femur. The knees bowing-out is likely the result of <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> hip capsule restriction, <span class="glossaryLink" data-tooltip="An increase in synergistic muscle activity due to a weak or inhibited prime mover.&lt;br /&gt;Example: Inhibition of the glute complex may lead to &lt;a id=" synergistic-dominance" data-tip="1643" target="_blank" href="/glossary-term/synergistic-dominance">synergistic dominance of the biceps femoris during hip extension.&quot; style=&quot;box-sizing: border-box;&quot;&gt;synergistic dominance of the piriformis, <a title="Adductors" href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">adductor magnus</a>, and <a title="Biceps Femoris" href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">biceps femoris</a>. Post-release and lengthening techniques for these over-active structures, the inhibition of the <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> and medius will still require attention.</li>
</ul>
<h3>Signs of changes in Range of Motion, Muscle Activity, and Length:</h3>
<ul>
 <li><a href="https://brookbushinstitute.com/courses/solutions-table-overhead-squat-assessment" target="_blank" rel="noopener">Overhead Squat Assessment</a>
 <ul>
 <li><a href="http://videotree.brookbushinstitute.com/overhead-squat-assessment-6-knees-bow-in-breakdown/" target="_blank" rel="noopener">Knees Bow In</a></li>
 <li><a href="http://videotree.brookbushinstitute.com/overhead-squat-assessment-7-knees-bow-out/" target="_blank" rel="noopener">Knees Bow Out</a></li>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-5-feet-turn-out-breakdown" target="_blank" rel="noopener">Feet Turn Out</a></li>
 <li><a href="http://videotree.brookbushinstitute.com/asymmetrical-weight-shift-overhead-squat-assessment-15-sign-clusters/" target="_blank" rel="noopener">Asymmetrical Weight Shift</a></li>
 </ul>
 </li>
</ul>
<ul>
 <li>Goniometry:
 <ul>
 <li><a href="https://brookbushinstitute.com/video/knee-extension-with-hip-flexion-goniometry-hamstring-length-test" target="_blank" rel="noopener">Knee Extension with Hip Flexion Goniometry</a> &lt;110 - 135&#xB0;</li>
 <li><a href="https://brookbushinstitute.com/video/knee-extension-goniometry" target="_blank" rel="noopener">Knee Extension Goniometry</a> &lt;0 - 10&#xB0;</li>
 <li><a href="http://videotree.brookbushinstitute.com/hip-abduction-goniometry/" target="_blank" rel="noopener">Abduction Goniometry</a> &lt; 35 -45&#xB0;</li>
 <li><a href="http://videotree.brookbushinstitute.com/goniometry-hip-internal-rotation/" target="_blank" rel="noopener">Hip Internal Rotation </a><a id="goniometry" data-tip="1523" target="_blank" href="/glossary-term/goniometry" class="glossary">Goniometry</a> in <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">Prone</a>,<a href="http://videotree.brookbushinstitute.com/goniometric-assessment-hip-internal-rotation-at-90-degree-of-hip-flexion-9090-hip-ir/" target="_blank" rel="noopener">90/90&#xB0;</a></li>
 </ul>
 </li>
</ul>
<ul>
 <li>Muscle Length Tests:
 <ul>
 <li><a href="http://videotree.brookbushinstitute.com/obers-test-tfl-flexibility-assessment/" target="_blank" rel="noopener">Ober&apos;s Test</a></li>
 <li><a href="http://videotree.brookbushinstitute.com/elys-test-rectus-femoris-flexibility-assessment/" target="_blank" rel="noopener">Ely&apos;s Test</a></li>
 <li><a href="https://brookbushinstitute.com/video/knee-extension-with-hip-flexion-goniometry-hamstring-length-test" target="_blank" rel="noopener">Hamstring Length Test</a></li>
 </ul>
 </li>
</ul>
<ul>
 <li>Manual <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> Testing:
 <ul>
 <li><a href="http://videotree.brookbushinstitute.com/gluteus-maximus-manual-muscle-testing-mmt-for-an-active-population/" target="_blank" rel="noopener">Manual </a><a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> Testing (MMT) of the Gluteus Maximus - Weak or With Compensation</li>
 <li><a href="http://videotree.brookbushinstitute.com/gluteus-medius-manual-muscle-testing-mmt-for-an-active-population/" target="_blank" rel="noopener">Manual </a><a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> Testing (MMT) of the Gluteus Medius - Weak or With Compensation</li>
 <li><a href="https://brookbushinstitute.com/video/tibialis-anterior-manual-muscle-testing-mmt-for-an-active-population" target="_blank" rel="noopener">Manual </a><a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> Testing (MMT) of the Tibialis Anterior - Weak or With Compensation</li>
 <li><a href="https://brookbushinstitute.com/video/posterior-tibialis-manual-muscle-testing-mmt-for-an-active-population" target="_blank" rel="noopener">Manual </a><a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> Testing (MMT) of the Tibialis Posterior - Weak or With Compensation</li>
 </ul>
 </li>
</ul>
<ul>
 <li>
 <h3>Clinical Issues:</h3>
 <ul>
 <li>Patellofemoral Pain Syndrome (PFPS)
 <ul>
 <li>Jumper&apos;s Knee</li>
 </ul>
 </li>
 <li>Iliotibial Band Syndrome
 <ul>
 <li>Runner&apos;s Knee</li>
 </ul>
 </li>
 <li>Osteoarthritis</li>
 <li>ACL Tear</li>
 <li>PCL Tear</li>
 <li>Unhappy Triad: Rupture/Strain of the ACL, MCL, <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">Medial</a> Meniscus</li>
 <li>Meniscal Tear</li>
 <li>Dysplasia (abnormal shape or growth)</li>
 <li>Plica Syndrome</li>
 <li>Tendonitis</li>
 <li>Strain</li>
 <li>Trigger-points</li>
 <li>Soreness/inflammation</li>
 </ul>
 </li>
</ul>
<div>
 <dl>
 <dt></dt>
 </dl>
 Knee Pathology <a id="referred-trigger-point-pain" data-tip="1709" target="_blank" href="/glossary-term/referred-trigger-point-pain" class="glossary">Referral Pain</a> Pattern: Osteoarthritis, osteochondritic lesions, damage to the menisci, <a id="effusion" data-tip="1459" target="_blank" href="/glossary-term/effusion" class="glossary">effusion</a>, and other pathology involving the intra-articular surfaces and structures of the knee present with pattern, that is generally fairly concentrated over the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> and <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> aspects of the knee. Often this pain is mistaken for muscular <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> or <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> pain. Note: The <a id="referred-trigger-point-pain" data-tip="1709" target="_blank" href="/glossary-term/referred-trigger-point-pain" class="glossary">Referral Pain</a> pattern for the knee does not follow the path of any one <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a>, group of muscles, or a common compensatory pattern, and in practice, this pattern would be reproducible by knee motion and not reproducible via soft tissue palpation.
 <a href="https://www.datocms-assets.com/25800/1642964644-knee-pain-2.jpeg"><img src="https://www.datocms-assets.com/25800/1642964644-knee-pain-2.jpeg" title="Knee pain referral pattern" alt="Common knee pain referral site"></a>
</div>
<div>Knee Pain Referral Pattern</div>

Knee Dysfunction and Signs of Dysfunction

Videos

<div>
 <iframe src="https://player.vimeo.com/video/97126550" width="640" height="360" frameborder="0" allowfullscreen="allowfullscreen"></iframe>
 <h4>Self-administered Joint Mobilization for the Knee</h4>
 <ol>
 <li>Affix a thick &quot;<a href="https://serioussteel.com/collections/41-individual-bands" target="_blank" rel="noopener">monster band</a>&quot; to a stable object about 18&quot; from the floor (knee height).</li>
 <li>Face the stable object, put the affected leg through the band, and place the band over the <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a> portion of the gastrocnemius (just below the joint line).</li>
 <li>Assume a split stance position, with the affected leg <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> and the unaffected leg <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a>.</li>
 <li>Move far enough from the wall to ensure <a id="tension" data-tip="1229" target="_blank" href="/glossary-term/tension" class="glossary">tension</a> is maintained on the band throughout the entire oscillation.
 <ul>
 <li>It may be helpful to place the unaffected leg on a low step; this aids in preventing the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> leg from adopting a position of terminal knee extension. It is also recommended that set-up allows for the use of the arms against a wall or piece of equipment to aid in stabilization.</li>
 </ul>
 </li>
 <li>Internally rotate the foot of the affected leg so that the 5th metatarsal (pinky toe) is pointing forward.
 <ul>
 <li>Additional Emphasis on Tibial Internal Rotation: Take a step laterally, pinky toe point forward, and continuing to focus on squeezing the <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> at the end of each rep, will place more emphasis on tibial internal rotation and <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> compartment <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> to <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> mobilization.</li>
 </ul>
 </li>
 <li>Gently flex and extend the knee, moving 2 - 4&quot; inches, as if doing a tiny, end-range lunge; contract the quadriceps and <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> at the top of each rep.</li>
 <li>Continue oscillating 2 - 4&quot;, at a tempo of 1 - 2 oscillations per second, for 15 - 30 seconds.</li>
 <li>Reassess</li>
 </ol>
</div>

Self-administered Knee Joint Mobilization

<ol>
 <li>Donald A. Neumann, &ldquo;Kinesiology of the Musculoskeletal System: Foundations of Rehabilitation &ndash; 2nd Edition&rdquo; &copy; 2012 Mosby, Inc.</li>
 <li>David B. Jenkins, Hollinshead&rsquo;s Functional Anatomy of the Limbs and Back: Eighth Edition &copy; 2002 Saunders</li>
 <li>Cynthia C. Norkin, Pamela K. Levangie, Joint Structure and Function: A Comprehensive Analysis: Fifth Edition &copy; 2011 F.A. Davis Company</li>
 <li>Florence Peterson Kendall, Elizabeth Kendall McCreary, Patricia Geise Provance, Mary McIntyre Rodgers, William Anthony Romani, Muscles: Testing and Function with <span class="glossaryLink" data-tooltip="Posture refers to the optimal alignment of bones and joints both statically and dynamically. &ldquo;Good form&rdquo; could be defined as optimal posture during exercise.">Posture and Pain: Fifth Edition &copy; 2005 Lippincott Williams &amp; Wilkins</li>
 <li>Cynthia C. Norkin, D. Joyce White, Measurement of Joint Motion: A Guide to Goniometry &ndash; Third Edition. &copy; 2003 by F.A. Davis Company</li>
 <li>Phillip Page, Clare Frank, Robert Lardner, Assessment and Treatment of Muscle Imbalance: The Janda Approach&copy; 2010 Benchmark Physical Therapy, Inc., Clare C. Frank, and Robert Lardner</li>
 <li>Dr. Mike Clark &amp; Scott Lucette, &ldquo;NASM Essentials of Corrective Exercise Training&rdquo; &copy; 2011 Lippincott Williams &amp; Wilkins</li>
 <li>Leon Chaitow, Muscle Energy Techniques: Third Edition, &copy; Pearson Professional Limited 2007</li>
 <li>Shirley A Sahrmann, Diagnoses and Treatment of Movement Impairment Syndromes, &copy; 2002 Mosby Inc.</li>
 <li>Karel Lewit. Manipulative Therapy: Musuloskeletal Medicine &copy; 2007 Elsevier</li>
 <li>Carolyn Richardson, Paul Hodges, Julie Hides. Therapeutic Exercise for Lumbo Pelvic Stabilization &ndash; A Motor Control Approach for the Treatment and Prevention of Low Back Pain: 2nd Edition (c) Elsevier Limited, 2004</li>
 <li>Tom Myers, Anatomy Trains: Second Edition. &copy; Elsevier Limited 2009</li>
 <li>Andrew Biel, Trail Guide to the Human Body: 4th Edition, &copy; 2010
 <ul>
 <li>Prevelance of Structural Differences</li>
 </ul>
 
 </li>
 <li>Ezoe, M., Naito, M., Inque, T. (2006). The prevalence of acetabular retroversion among various disorders of the hip. The Journal of Bone and Joint Surgery. 88A (2). 372-379</li>
 <li>Karimi-Mobarake, M., Kashefipour, A., Yousfnejad, Z. The prevalence of genu varum and genu valgum in primary school children in Iran 2003-2004. (2005) Journal of Medical Science 5(1). 52-54
 <ul>
 <li>Functional Valgus</li>
 </ul>
 
 </li>
 <li>Hewett, T. E., Myer, G. D., Ford, K. R., Heidt, R. S., Colosimo, A. J., McLean, S. G., &amp; Succop, P. (2005). Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes A prospective study. The American journal of sports medicine, 33(4), 492-501.</li>
 <li>Dos Reis, A. C., Correa, J. C. F., Bley, A. S., Rabelo, N. D. D. A., Fukuda, T. Y., &amp; Lucareli, P. R. G. (2015). Kinematic and Kinetic Analysis of the Single-Leg Triple Hop Test in Women With and Without Patellofemoral Pain. journal of orthopaedic &amp; sports physical therapy, 45(10), 799-807.</li>
 <li>Noehren, B., Scholz, J., Davis, I. (2011) The effects of real-time gait retraining on hip kinematics, pain, and function in subjects with patellofemoral pain syndrome. Br Journal of Sports Medicine. 45:691-696</li>
 <li>Ireland, ML., Wilson, JD., Ballantyne, BT., Davis, IM. (2003). Hip Strength in Females With and Without Patellofemoral Pain. J Orthop Sports Phys Ther 2003. 33: 671-676</li>
 <li>Noehren B, Hamill J, Davis I. Prospective Evidence for a Hip Etiology in Patellofemoral Pain. Medicine &amp; Science in Sports &amp; Exercise. 2013;45(6):1120&ndash;1124.</li>
 <li>Smith, J. A., Popovich, J. M., &amp; Kulig, K. (2014). The influence of hip strength on lower limb, pelvis, and trunk kinematics and coordination patterns during walking and hopping in healthy women. Journal of Orthopaedic &amp; Sports Physical Therapy, (Early Access), 1-23.</li>
 <li>Mauntel, T., Begalle, R., Cram, T., Frank, B., Hirth, C., Blackburn, T., &amp; Padua, D. (2013). The effects of lower extremity muscle activation and passive range of motion on single leg squat performance. Journal Of Strength And Conditioning Research / National Strength &amp; Conditioning Association, 27(7), 1813-1823.</li>
 <li>Padua, D. A., Bell, D. R., &amp; Clark, M. A. (2012). Neuromuscular characteristics of individuals displaying excessive medial knee displacement. Journal of athletic training, 47(5), 525
 <ul>
 <li>Exercise Helps Functional Valgus</li>
 </ul>
 
 </li>
 <li>Bell, D. R., Oates, D. C., Clark, M. A., &amp; Padua, D. A. (2013). Two-and 3-dimensional knee valgus are reduced after an exercise intervention in young adults with demonstrable valgus during squatting. Journal of athletic training,48(4), 442-449.</li>
 <li>Ramskov, D., Barton, C., Nielsen, R. O., &amp; Rasmussen, S. (2015). High Eccentric Hip Abduction Strength Reduces the Risk of Developing Patellofemoral Pain Among Novice Runners Initiating a Self-Structured Running Program: A 1-Year Observational Study. journal of orthopaedic &amp; sports physical therapy, 45(3), 153-161</li>
 <li>Snyder, K. R., Earl, J. E., O&rsquo;Connor, K. M., &amp; Ebersole, K. T. (2009). Resistance training is accompanied by increases in hip strength and changes in lower extremity biomechanics during running. Clinical Biomechanics, 24(1), 26-34
 <ul>
 <li>Low Back Pain (LPHCD)</li>
 </ul>
 
 </li>
 <li>Cooper, N., Scavo, K., Strickland, K., Tipayamongkol, N., Nicholson, J., Bewyer, D., Sluka, K. Prevalence of gluteus medius weakness in people with chronic low back pain compared to healthy controls. J Euro Spine. 26 May 2015
 <ul>
 <li>Loss of Hip Extension</li>
 </ul>
 
 </li>
 <li>Lewis CL, Sahrmann. 2005 Timing of muscle activation during prone hip extension. Abstract. J Orhop Sports Phys Ther 35(1): A56.</li>
 <li>Tateuchi, H., Taniguchi, M., Mori, N., Ichihashi, N. Balance of hip and trunk muscle activity is associated with increased anterior pelvic tilt during prone hip extension (2013) Journal of Electromyography and Kinesiology 22 (3). 391-397
 <ul>
 <li>Regional Interdependence (Other than Functional Valgus)</li>
 </ul>
 
 </li>
 <li>Souza, T. R., Pinto, R. Z., Trede, R. G., Kirkwood, R. N., &amp; Fonseca, S. T. (2010). Temporal couplings between rearfoot&ndash;shank complex and hip joint during walking. Clinical biomechanics, 25(7), 745-748.</li>
 <li>Franettovich, S. M., Honeywill, C. O. N. O. R., Wyndow, N., Crossley, K. M., &amp; Creaby, M. W. (2014). Neuromotor control of gluteal muscles in runners with achilles tendinopathy. Medicine and science in sports and exercise,46(3), 594-599.</li>
 <li>Barker, PJ., Hapuarachchi, K.S., Ross, J.A., Sambaiew, E., Ranger, T.A., and Briggs, C.A. (2013). Anatomy and biomechanics of gluteus maximus and the thoracolumbar fascia at the sacroiliac joint. Wiley Online Library. DOI: 10.1002/ca.22233</li>
 <li>Gibbons, S.G.T. (2004) The anatomy of the deep sacral part of the gluteus maximus and the psoas muscle: A clinical perspective. Proceeds of: The 5th Interdiciplinary World Congress on Low Back Pain. November 7-11, Melbourne, Australia.</li>
 <li>Hungerford, B., Gilleard, W., Hodges, P. (2003) Evidence of altered lumbopelvic muscle recruitment in the presence of sacroiliac <span class="glossaryLink" data-tooltip="Where two or more bones meet.&lt;br /&gt;Etymology: joint (n.) late 13c., &ldquo;a part of a body where two bones meet and move in contact with one another,&rdquo; from Old French joint &ldquo;joint of the body&rdquo; (12c.), from Latin iunctus &ldquo;united, connected, associated,&rdquo; past participle ofiungere &ldquo;join&rdquo; (see &lt;a href=&quot;http://www.etymonline.com/index.php?term=jugular&amp;allowed_in_frame=0&quot;&gt;jugular&lt;/a&gt;). (&lt;a href=&quot;http://www.etymonline.com/index.php?term=joint&quot;&gt;Etymology Online&lt;/a&gt;)">joint pain. Spine 28(14), 1593-1600
 <ul>
 <li>Pathology and Muscle Change</li>
 </ul>
 
 </li>
 <li>Grimaldi, A, Richardson, C, Stanton, W., Durbridge, G, Donnelly, W. and Hides, J. (2009) The association between degenerative hip joint pathology and size of the gluteus medius, gluteus minimus and piriformis muscles. (2009). Manual Therapy 14. 605-610.</li>
 <li>Grimaldi, A., Richardson, C., Durbridge, G., Donnelly, W., Darnell, R., Hides, J. (2009). The association between degenerative hip joint pathology and size of the gluteus maximus and tensor fascia latae muscles. Manual Therapy. 14. 611-617
 <ul>
 <li>Fascia</li>
 </ul>
 </li>
 <li>Stecco, A., Gilliar, W., Hill, R., Fullerton, B., Stecco, Carla. (2013). The anatomical and functional relation between gluteus maximus and fascia lata. Journal of Bodywork &amp; Movement Therapies.17. 512-517</li>
 <li>Jackson BD, Wluka AE, Teichtahl AJ, Morris ME, Cicuttini FM. Reviewing knee osteoarthritis - A Biomechanical Perspective. J Sci Med Sport 7:347, 2004</li>
 <li>Hvid I: The Stability of the Human Patello-femoral Joint. Eng Med 12:55, 1983</li>
 <li>
 <div class="cit">Franco CD1, Buvanendran A, Petersohn JD, Menzies RD, Menzies LP. Innervation of the Anterior Capsule of the Human Knee: Implications for Radiofrequency Ablation. Reg Anesth Pain Med. 2015 Jul-Aug;40(4):363-8</div>
 </li>
 <li>
 <div class="auths">Ito J. (1996). Morphological analysis of the human lower extremity based on the relative muscle weight. Okajimas Folia Anat. Jpn. 73(5): 247-252</div>
 </li>
 <li>Macrum et al. Effect of limiting ankle-dorsiflexion range of motion on lower extremity kinematics and muscle-activation patterns during a squat. Journal of Sport Rehabilitation, 2012, 21, Pg 144-150</li>
</ol>

Bibliography

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 Questions, comments and criticisms welcome and encouraged
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Copyright

A-Band - Refers to the part of the muscle cell that looks darker under a microscope.  This area of the cell is darker due to parallel arrangement of thicker filaments (myosin) and overlap with the thinner filaments (actin).
<ul>
 	<li>As a muscle contracts, the A-band is where actin and myosin interact.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

Accuracy - the proportion of individuals correctly identified by the test results.
<ul>
 	<li>For example, a special test with perfect accuracy would imply a test has 100% specificity, 100% sensitivity, 100% positive predictive value and 100% negative predictive values.</li>
</ul>

Action Potential - A rapid change in voltage, resulting in a wave of excitation, that may result in stimulation of a nerve or muscle cell.
<ul>
 	<li>In order for an action potential to be initiated, the resting membrane voltage must exceed the excitation threshold, which then results in a cascade of depolarization and the "wave of excitation." Any stimulus below that threshold will not result in an action potential, and a stimulus greater than the threshold will not increase a single action potential, but may result in additional action potentials.  In this way, the action potential functions more like an on/off switch (all or none), and less like a dimmer switch.</li>
</ul>

A single-joint movement pattern (most often) designed to load a specific under-active muscle(s), while minimizing the contribution of over-active synergists via specific cues/joint motions.
<ul>
 	<li style="text-align: left;">Activation techniques/exercises are performed with the intent of addressing a muscle exhibiting a reduction in activity (tone) as a result of, or contributing to postural dysfunction.</li>
 	<li style="text-align: left;">Activation techniques/exercises cannot be multi-joint movement patterns due to relative flexibility, altered reciprocal inhibition, and synergistic dominance resulting in compensation patterns.</li>
</ul>
Example, <a href="https://brentbrookbush.com/articles/corrective-exercise-articles/activation/gluteus-medius-activation-progression/" target="_blank">gluteus medius activation</a> involves resisted hip abduction while minimizing the contribution of the TFL via hip extension.

Active stretching is a term used to describe a stretch that involves an active contraction of opposing musculature to lengthen a muscle to its end range. Generally these stretches are held for 2-5 seconds and repeated for 8-15 repetitions.

Adenosine triphosphatase (ATPase): is the enzyme responsible for catalyzing (initiating and accelerating) the decomposition of ATP to ADP.
<ul>
 	<li>This dephosphorylation (breakdown) reaction releases energy for processes like muscular contraction.</li>
</ul>

Adenosine triphosphate (ATP): The molecule that functions as a universal energy-transfer molecule, providing most of the energy associated with muscular contraction and human movement. ATP is composed of an adenine group, a ribose group, and three molecules of inorganic phosphates.
<ul>
 	<li>Energy is provided when hydrolysis results in the cleaving of a phophate group; resulting in adenosine diphosphate, an inorganigic phosphate group, and energy.</li>
</ul>

Algometry - measuring the amount of pressure to result in sensitivity or pain, using an algometer.
<ul>
 	<li>Generally, research uses algometry to establish a minimum pain pressure threshold (PPT), in which a lower PPT implies more sensitivity and pain, and a higher PPT implies less sensitivity and pain. PPT is a common outcome measure in trigger point research.</li>
</ul>
<a href="https://brentbrookbush.com/wp-content/uploads/2019/07/Algometer.jpg"><img class="aligncenter wp-image-140177" src="https://brentbrookbush.com/wp-content/uploads/2019/07/Algometer.jpg" alt="Image of an Algometer" width="500" height="333" /></a>

All-or-none principle - a nerve or muscle cell's response to a stimulus is independent of the strength of the stimulus. If that stimulus exceeds the threshold potential (threshold of an action potential), the nerve or muscle fiber will respond completely; otherwise, there is no response.

Example, when a motor unit in the biceps brachii is stimulated it contracts the same way whether a 10 lb or 50 lb dumbbell is lifted.  It is actually the number of muscle cells and the size of the motor unit that determines force output.

&nbsp;

The transition period between eccentric load and concentric contraction during a repetition of an exercise.  This term is most often used in reference to power/plyometric exercises, in which a shorter amortization phase is believed to be beneficial.  The shorter amortization phase may better use the stored energy from the elastic deformation of connective tissue and enhance synchronization of myotatic (stretch) reflex with maximum voluntary contraction.

Example, the athlete was cued to spend as little time as possible in the bottom of their squat stance (the amortization phase) during a set of box jumps.

Muscles that oppose the prime mover and synergists for a given joint action.

That is, all the muscles that can perform the opposing joint action.

Example: The triceps and anconeus are antagonists during elbow flexion.

An anatomical direction; toward the front

Example, the face is on the anterior aspect of the head

Appendicular Skeleton - referring to the bones the bones of the arms and legs, as well as the bones that support them. This includes the pelvis, clavicle and scapula. There are approximately 126 bones in the appendicular skeleton.
<ul>
 	<li>Etymology - Appendicular, as in appendage, "that which is appended to something as a proper part," 1640s, from <a class="crossreference" href="https://www.etymonline.com/word/append?ref=etymonline_crossreference">append</a> + <a class="crossreference" href="https://www.etymonline.com/word/-age?ref=etymonline_crossreference">-age</a>. - <a href="https://www.etymonline.com/word/appendage" target="_blank" rel="noopener">Etymology Online</a></li>
</ul>
"Appendicular skeleton" is a label referring to a set of bones whose function is distinct from the bones of the "<a href="https://brentbrookbush.com/glossary/axial-skeleton/" target="_blank" rel="noopener">axial skeleton</a>".

A reflexive decrease in muscle activity due to joint dyskinesis.
For example, a reduction in deep cervical flexor activity as a result of cervical spine dyskinesis.

Arthrokinematic Motion - Small amplitude motions between bone surfaces at a joint.  The arthrokinematic motions are roll, glide (slide or translation), spin, compression and distraction (traction). Arthrokinematic motions accompany osteokinematic motions to maintain joint congruence.
<ul>
 	<li>Example, arthrokinematic motion of the talus includes posterior glide on the tibia during ankle dorsiflexion.</li>
</ul>
Synonyms include: arthrokinematics, passive accessory motion, joint play and component motion

&nbsp;

Assessment - is the act of assessing, i.e. determining the importance, size, or value of -

In most cases, the results of an assessment are compared to normative data. If the individual exhibits values that are within normal parameters, it may be assumed that the aspect of health or motion assessed is not contributing to the patient's complaint, symptoms or movement impairment. If the results fall outside of normal parameters, it may indicate that the aspect of health or motion assessed is contributing to, or being affected by the patient/client's complaint, symptoms, or movement impairment. In some cases, the results of an assessment are compared to an "ideal model." In this case, deviations from the ideal are noted as potential issues. For example, deviations noted in the <a title="Introduction to the Overhead Squat Assessment" href="https://brentbrookbush.com/online-courses/articles/assessment/introduction-overhead-squat-assessment/" target="_blank">Overhead Squat Assessment</a> are compared to an "ideal model" of posture and motion.

Assessments used by human movement professionals can be divided into three broad categories:
<ul>
 	<li>"Clear" the Patient/Client for Intervention - These are tests, assessments and evaluations used to determine if a patient/client's issue may improve given the assessing professional's scope, skills, abilities and willingness to treat that individual.
<ul>
 	<li>For example, many of the special tests used in orthopedic medicine assist in determining the level of pathology or likelihood of a particular diagnosis. Certain issues and diagnoses are beyond the scope of the human movement professional, and are better treated by diagnostic professionals in the medical community (physicians, podiatrists, surgeons, etc.). A Calf Squeeze (Thompson) Test is one example, in which a positive sign may indicate a rupture of the Achilles tendon that may be better treated via surgical intervention.</li>
</ul>
</li>
 	<li>Highlight Contraindications - Tests, assessments and evaluations used to stratify risk or preclude a professional from addressing certain tissues, motions or using a particular technique.
<ul>
 	<li>For example, the Vertebral Artery Test (VBI) is often used to determine if high velocity thrust mobilizations (manipulations) are safe for a patient with cervical dysfunction.</li>
</ul>
</li>
 	<li>Refine Exercise/Intervention Selection: Tests, assessments and evaluations used to assist the professional in determining which techniques, modalities and exercises will best address a patient/client's complaints or desired goals.
<ul>
 	<li>Most movement assessments fall into this category. For example, a positive <a href="https://brentbrookbush.com/vimeo_videos/elys-test-rectus-femoris-flexibility-assessment/" target="_blank">Ely's Test</a> may indicate a need to release and/or lengthen the <a href="https://brentbrookbush.com/articles/anatomy-articles/muscular-anatomy/rectus-femoris/" target="_blank">rectus femoris</a>.</li>
</ul>
</li>
</ul>
Note: An assessment, or assessment result, may fall into more than one category. For example, although goniometry is an assessment most often used to Refine Exercise/Intervention Selection, if a range of motion is significantly altered, with an abnormal end-feel, and/or causes the patient or client/pain, the individual may need to be referred to a physician for further testing and Clearance to resume rehab activities.  Further, that same patient may return to the human movement professional with a list of Contraindicated Activities from the physician. - "When in doubt, refer out!"

Axial Skeleton - referring to the bones of the head, neck, trunk and spinal column (does not include pelvis). There are approximately 80 bones in the axial skeleton.
<ul>
 	<li>Etymology - Axial, as in "axis", referring to "imaginary motionless straight line around which a body (such as the Earth) rotates," from Latin axis "axle, pivot, axis of the earth or sky" - <a href="https://www.etymonline.com/word/axis" target="_blank" rel="noopener">Etymology Online</a></li>
</ul>
"Axial skeleton" is a label referring to a set of bones whose function is distinct from the bones of the "<a href="https://brentbrookbush.com/glossary/appendicular-skeleton/" target="_blank" rel="noopener">appendicular skeleton</a>".

Balance - The ability to maintain a body’s center of mass over its base of support. Balance can be static or dynamic.
<ul>
 	<li>For example, maintaining balance is harder on one leg because the center of mass must stay over a much smaller base of support.</li>
</ul>

A ball and socket joint (also called a spheroid joint or spheroidal joint) is a synovial joint in which the rounded or spherical end of one bone fits into a cup-like depression of another bone. The distal bone is capable of motion around an indefinite number of axes, which have one common center. Examples include the hip and shoulder (glenohumeral joint)

Base of support (BoS) - refers to the area beneath an object or person, and the area within the perimeter created by every point of contact that the object or person makes with the supporting surface. This may include the <a href="https://brentbrookbush.com/articles/anatomy-articles/muscular-anatomy/gluteus-maximus/" target="_blank" rel="noopener">glutes</a> of someone sitting on a chair, or the back of someone leaning against a wall.
<ul>
 	<li>For example, during a single leg balance the BoS is the area of the foot in contact with the surface; however, when a person is standing on two feet, the BoS is the area of both feet and the surface between them.</li>
</ul>

Pertaining to both sides

Example, bilateral rows are performed with both arms at the same time.

Case-control Study - a particular form of retrospective study that samples a matched group of people who have, and do not have the outcome being studied. A case-control study is a quasi-experimental design, often used in medicine to aid in determining potential contributing factors (cannot determine causality). In this study type exposure is the dependent variable and outcome is independent.
<ul>
 	<li>Example, in this retrospective case-control, medical records were investigated for trends correlated with cervical pain (1).
<ol>
 	<li>Mäkela, M., Heliövaara, M., Sievers, K., Impivaara, O., Knekt, P., &amp; Aromaa, A. (1991). Prevalence, determinants, and consequences of chronic neck pain in Finland. American journal of epidemiology, 134(11), 1356-1367.</li>
</ol>
</li>
</ul>

An anatomical direction; toward the tail, relative to humans this term is often used to refer to "in the direction of the tale (toward the feet)".

Example, to release the trapezius muscle the therapist used a force directed caudally.

Center of mass (CoM) - an object's mean position of mass; that is, a point that is perfectly surrounded by an equal amount mass in all directions.

Center of gravity (CoG) - point where gravity appears to act. Since the human body is so small compared to the earth, we can assume gravity acts uniformly on the body, and that CoG and CoM are the same.
<ul>
 	<li>Example, the CoM of the human body while lying down or standing straight up is close to our navel. However, it is possible that during a resistance exercise, the combination of the body's weight and the weight of the resistance will place the combined CoM outside the body. For example, during the mid-portion of a <a href="https://brentbrookbush.com/vimeo_videos/back-squat/" target="_blank" rel="noopener">back squat</a> the CoM would be several anterior to the naval.</li>
</ul>

An anatomical direction; toward the head (synonym: cranial)

Example, hip pain was felt with any force directed cephalad.

Cohort Study - a particular form of longitudinal study that samples a cohort (a group of people who share a defining characteristic), performing a cross-section at intervals through-out a period of time. A cohort study is a quasi-experimental design often used in medicine to aid in determining etiology or a cause-and-effect relationship. In this study type exposure is the independent variable and outcome is dependent.
<ul>
 	<li>Example, the study by Cholewicki et al. (1) investigated Yale Varsity Athletes (the cohort) with 2 and 3 year follow up (longitudinal design) and found that trunk muscle response time to off-loading was predictive of future low back injury.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/core/increased-trunk-muscle-latency-may-cause-rather-than-result-from-low-back-pain/" target="_blank" rel="noopener noreferrer">Cholewicki, J., Silfies, S., Shah, R., Greene, H., Reeves, N. Alvi, K., Goldberg, B. (2005). Delayed trunk muscle reflex responses increase the risk of low back injuries. Spine. 30(23), 2614-2620</a></li>
</ol>

Comparable Sign: A combination of pain, stiffness and/or spasm during examination that is comparable to the patients symptoms.
<ul>
 	<li>One common error made during evaluation with special tests is attention given to any discomfort or pain, rather than attempting to identify the pain/discomfort related to the patient's complaint (concordant/comparable sign). Many special tests purposefully test tissue limits and are at least mildly uncomfortable in every individual. Basing your assessment on positive tests that resulted in "concordant/comparable signs" will improve your chances of arriving at the correct diagnosis.</li>
</ul>

An alternative movement pattern that has been adopted to compensate for dysfunction/impairment in the human movement system.
Example: A lack of calf extensibility may limit dorsiflexion, leading to the knees bowing inward (functional valgus) and excessive forward lean of the torso during a squat.

An arthrokinematic motion - the approximation of joint surfaces; that is, a force that directs one bone surface into another resulting in a reduction in intra-articular volume. Although widely thought of as a "destructive force", it is likely best to consider compression as a naturally occurring, stabilizing force. Any arthrokinematic force in excess (spin, glide, roll, traction) may be viewed as potentially deleterious.

For example, during a squat the femoral head is compressed into the acetabulum by muscular forces, bodyweight and any additional external load.

Concave (Concavity) - Having an outline or surface curved like the interior surface of a bowl or sphere - to cave-in or curve inward.
<ul>
 	<li>Example, the internal surfaces of the pelvis is concave, holding some of the bodies viscera.</li>
</ul>

Concordant Sign - The patient's specific pain, symptom or complaint. 
<ul>
 	<li>One common error made during evaluation with special tests is attention given to any discomfort or pain, rather than attempting to identify the pain/discomfort related to the patient's complaint (concordant/comparable sign). Many special tests purposefully test tissue limits and are at least mildly uncomfortable in every individual. Basing your assessment on positive tests that resulted in "concordant/comparable signs" will improve your chances of arriving at the correct diagnosis.</li>
</ul>

Conductivity: Stimulation results in more than a local effect (1).
<ul>
 	<li>For example, in a muscle cell the stimulation of a motor endplate results in a change in cell membrane polarity that rapidly propagates (is conducted) along the entire length of the muscle cell, stimulating all sacromere.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

A condyloid joint (also called condylar, bicondylar, ellipsoid, or ellipsoidal) is an ovoid articular surface, or condyle, that is received into an elliptical cavity.  These joints permit movement in two planes.  Examples include the knee, metacarpophalangeal joints and metatarsophalangeal joints.

Connective Tissue Cell - One of the four basic types of animal tissue, consisting mostly fibers and ground substance.  These cells are specialized to binds organs together, holds them in place, protect them from external forces, and may fill space in the body's cavities.

Example, the body's muscles are enclosed in durable connective tissue sheets known as the "epimysium", "perimysium", and "endomysium," which and in support and transmitting force.
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

Contractility: The ability to shorten (1).
<ul>
 	<li>Contractility: Muscle cells are unique in the amount they can shorten when stimulated; this is this largerly due to the highly organized and unique arrangement of myofilaments (actin and myosin).</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Pertaining to the opposite side

Example, the external oblique muscle performs contralateral rotation; rotation to the opposite side.

Convex (Convexity) - Having an outline or surface curved like the exterior of a circle or sphere - to bulge or curve outward.
<ul>
 	<li>Example, the top of your head is shaped by the convex exterior surface of your skull.</li>
</ul>

Correlational Research - Non-experimental <a href="https://www.questionpro.com/blog/what-is-research/">research</a> method in which the statistical relationship between two variables is investigated.
<ul>
 	<li>In this research by Kwon et al., a correlation was noted between a decrease in extensibility during a hamstring length test (goniometry) and current knee pain (1).</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/correlation-patellofemoral-pain-syndrome-pfps-hamstring-activity/" target="_blank" rel="noopener">Kwon O, Yun M, and Lee W. (2014). Correlation between intrinsic patellofemoral pain syndrome in young adults and lower extremity biomechanics. J. Phys. Ther. Sci. 26: 961-964</a></li>
</ol>

Counter-nutation - posterior rotation of sacrum relative to ilium, and/or anterior rotation of ilium relative to sacrum.
<ul>
 	<li>The pelvic floor muscles are examples of muscle that may counter-nutate the sacrum.</li>
</ul>
[caption id="attachment_126335" align="aligncenter" width="400"]<a href="https://brentbrookbush.com/wp-content/uploads/2018/10/Nutation.png"><img class=" wp-image-126335" src="https://brentbrookbush.com/wp-content/uploads/2018/10/Nutation.png" alt="Nutation and Counter-nutation of the Sacroiliac Joint" width="400" height="967" /></a> Nutation and Counter-nutation of the Sacroiliac Joint[/caption]

&nbsp;

Crossover (Study) Design - A type of longitudinal, repeated measures quasi-experimental design in which each group receives both treatments, but at different times. It is named "crossover" due to the patients "crossing-over" to the other treatment or sham group after a specified period of time.
<ul>
 	<li>This type of study has the advantage of every individual serving as their own control, which may reduce the influence of confounding variables.</li>
 	<li>Unfortunately, the design itself introduces the chances that anyone receiving the experimental variable in the first period will continue to be effected in the second period.</li>
</ul>
In a study by Senna et al., a cross-over design was used to investigate the difference load made on inter-set rest intervals (1).
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/strength-training-research-corner/heavy-vs-light-load-single-joint-exercise-performance-with-different-rest-periods/" target="_blank" rel="noopener">Senna, G.W., Rodrigues, B.M., Sandy, Scudese, Bianco, A, &amp; Dantas, E.H.M. (2017). Heavy vs light load single-joint exercise performance with different intervals. Journal of Human Kinetics, 58, 197-206. </a></li>
</ol>

Cross-sectional Study - a research design that involves gathering data from a population or representative subset at a specific point in time.
<ul>
 	<li>Example, the study by Karimi-Mobarake et al.(1) investigated the prevalence of genu varum and genu valgum among school children 7-11 years old in Iran.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/low-prevalence-of-genu-varum-and-valgum-among-elementary-school-children/" target="_blank" rel="noopener noreferrer">Karimi-Mobarake, M., Kashefipour, A., Yousfnejad, Z. The prevalence of genu varum and genu valgum in primary school children in Iran 2003-2004. (2005) Journal of Medical Science 5(1). 52-54</a></li>
</ol>

Cytokine - A broad and loose category of small proteins that act through receptors, and are especially important to immune function (inflammation).
<ul>
 	<li>Cytokines include substances such as interferon, interleukin, and growth factors, which are secreted by certain cells of the immune system and have an effect on other cells. Their definite distinction from hormones is a topic of continued research.</li>
</ul>
&nbsp;

Dependent variable - in research, this is the variable that is changed by the independent variable, most often this is the "outcome" of the study.
<ul>
 	<li>Example, in the study by Cleland et al. (1), the independent variable is "thoracic manipulation," and the dependent variable is "lower trapezius muscle strength."</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/short-term-effects-lower-thoracic-manipulation-lower-trapezius-muscle-strength/" target="_blank" rel="noopener noreferrer">Cleland J, Selleck B, Stowell T, Brown L, Alberini S, St. Cyr H, Caron T. Short-term Effects of Thoracic Manipulation on Lower Trapezius Muscle Strength.  Journal of Manual &amp; Manipulative Therapy. 2004; 12(2): 82-90</a></li>
</ol>

An anatomical direction; further from the trunk or center of the body

Example, the foot is at the distal end of the leg.

An arthrokinematic motion - a force applied to a body part that may result in the separation of joint surfaces, a reduction in intra-articular pressure, and/or an increase in intra-articlar space.

For example, to hang from one's hands (i.g. in preparation for a pull-up) results in a traction force on the glenohumeral joint (shoulder).

An anatomical term of location; back or upper surface

Example, shoe laces may compress tissues on the dorsal surface of the foot

The "drawing-in" maneuver is a common cue used during exercise and rehabilitation programs. A light contraction of the <a href="https://brentbrookbush.com/articles/muscular-anatomy/transverse-abdominis/" target="_blank" rel="noopener">transverse abominis</a> (and potentially the entire <a href="https://brentbrookbush.com/articles/corrective-exercise-articles/core-subsystems/intrinsic-stabilization-subsystem/" target="_blank" rel="noopener">intrinsic stabilization subsystem</a>) achieved by gently pulling the lower abdominal region away from one's waist band. This should have minimal effect on breathing, and should not be confused with a maximal contraction of the <a href="https://brentbrookbush.com/articles/muscular-anatomy/transverse-abdominis/" target="_blank" rel="noopener">transverse abdominis</a> resulting in a "vacuum pose".
<ul>
 	<li>Research often refers to this maneuver as the "abdominal drawing-in maneuver"; abbreviated ADIM.</li>
</ul>
Development and introduction of this cue into practice is based on the pivotal research and resulting text:
<ol>
 	<li>Carolyn Richardson, Paul Hodges, Julie Hides. Therapeutic Exercise for Lumbo Pelvic Stabilization – A Motor Control Approach for the Treatment and Prevention of Low Back Pain: 2nd Edition (c) Elsevier Limited, 2004</li>
</ol>

Faulty or abnormal movement; an alteration of normal kinematics.

For example, joint stiffness or a reduction in arthrokinematics motion that results in limited osteokinematic range of motion - inadequate inferior glide of the femoral head resulting in limited abduction of the hip.

The seeping into, or abnormal collection of fluid in a body cavity.

For example, knee effusion describes swelling within the knee joint.

Note: the word "effusion" is used differently in medicine than it is used in reference to the movement (seeping out) of liquids and gases, for example in chemistry.

&nbsp;

A trait of body tissues that allows a tissue to return to its resting length or state after deformation or stretch.
Example:  Muscle is elastic tissue; many muscles will return to their resting length after being stretched to 150% of that length without any appreciable change in tissue quality.

Elasticity: Elasticity refers to the ability of a cell to return to its resting length after being stretched/lengthened.
<ul>
 	<li>Note: this term is often confused with extensibility. Elasticity is not the ability to stretch; it is the ability to return to normal length after being stretched. Muscle tissue, connective tissue and even nerve tissue have varying levels of elasticity.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Epithelial cell - One of the four basic cell types, found lining the body's cavities, blood vessels, organs and constitutes most gland tissue.  These cells are specialized to aid with absorption, secretion, or act as a barrier from foreign objects.
<ol>
 	<li>Saladin, K. S., &amp; Miller, L. (1998). Anatomy &amp; physiology. New York (NY): WCB/McGraw-Hill.</li>
</ol>

Equilibrium - a state in which opposing forces or influences are balanced.
<ul>
 	<li>For example, to maintain a neutral trunk while pushing or pulling a weight in one hand, your core musculature must balance the force by creating an equal amount of force in the opposite direction.</li>
</ul>

The study of causation, or origination. The word is commonly used in the medical professions, where it may refer to the study of why things occur, or the reason behind why things act a certain way.

For example, the etiology of low back pain is a complex subject, with multiple contributing factors and various structures implicated.

<div class="gs_citr" tabindex="0">Evidence-based medicine (practice) is the integration of best research evidence with clinical expertise and patient(client) values (2)."</div>
<ul>
 	<li class="gs_citr" tabindex="0">...the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients (clients).  It involves the integration of at least (a) clinical expertise/expert opinion, (b) external scientific evidence, and (c) client/patient/caregiver perspectives to provide high-quality services reflecting the interests, values, needs, and choices of the individuals we serve (1).</li>
</ul>
&nbsp;
<ol>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Sackett, D. L., Rosenberg, W. M., Gray, J. M., Haynes, R. B., &amp; Richardson, W. S. (1996). Evidence based medicine: what it is and what it isn't. Bmj, 312(7023), 71-72.</li>
 	<li class="gs_citr" tabindex="0">Sackett D et al. Evidence-Based Medicine: How to Practice and Teach EBM, 2nd edition. Churchill Livingstone, Edinburgh, 2000, p.1</li>
</ol>

Excitability: The ability of a cell to change in membrane conductance as a response to stimulation.

<ul>
 	<li>For example, muscle cells are specialized to react to a change in membrane potential with contraction, where as nerve cells are specialized to propagate a change in membrane potential along there axons and communicate that message to other tissues via neurotransmitters.
</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Excitation threshold: The level that a depolarization must reach for an action potential to occur.
<ul>
 	<li>The excitation threshold is a contributing factor to the "all-or-none" response of muscle and nerves cells to a stimulus.</li>
</ul>

Exercise Progression - Modification of an exercise with the intent of promoting adaptation by increasing demand. This can be accomplished by increasing reps, load, tempo, range of motion, complexity, and/or challenge to an individual's stability.
<ul>
 	<li>Because load, reps, tempo and complexity are often explicitly noted, the term "exercise progression" is most often used throughout Brookbush Institute (BI) content to refer to an exercise, or series of exercises that make it harder to maintain stability with good form.
<ul>
 	<li>Sample Exercise Progression: <a href="https://brentbrookbush.com/vimeo_videos/kneeling-chop-pattern/" target="_blank" rel="noopener">Kneeling Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/static-standing-chop-pattern/" target="_blank" rel="noopener">Standing Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/single-leg-chop-pattern/" target="_blank" rel="noopener">Single-leg Chop</a></li>
</ul>
</li>
</ul>

Exercise regression - The opposite of progression; that is, modification of an exercise with the intent of reducing demand. This can be accomplished by decreasing reps, load, tempo, range of motion, complexity, and/or challenge to an individual's stability. Generally, regressions are used to modify an exercise to the client's current level of ability, with the intent of improving form, motor learning and retention.
<ul>
 	<li>Because load, reps, tempo and complexity are often explicitly noted, the term "exercise regression" is most often used throughout Brookbush Institute (BI) content to refer to an exercise or series of exercises that make it easier to maintain stability with good form.
<ul>
 	<li>Sample Exercise Regression: <a href="https://brentbrookbush.com/vimeo_videos/single-leg-chop-pattern/" target="_blank" rel="noopener">Single-leg Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/static-standing-chop-pattern/" target="_blank" rel="noopener">Standing Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/kneeling-chop-pattern/" target="_blank" rel="noopener">Kneeling Chop</a></li>
</ul>
</li>
</ul>

Experimental Research - Studies in which the researchers introduce the variable to be studied, with the intent of observing the outcome. This is different than observational research which observes the effect of a variable already present. Many texts also assert that experimental research should include randomization and ideally a control group, as is seen in Randomized Control Trials. Studies in which the variable is introduced by the researchers, but participants are not randomized may be considered Quasi-experimental research.
<ul>
 	<li>In this study by Esformes, the experimental variable was squat depth and the outcome measures observed were various performance measures related to power (1).</li>
</ul>
<ol>
 	<li><a href="https://brookbushinstitute.com/article/back-squat-depth-lower-body-post-activation-potentiation/" target="_blank" rel="noopener">Esformes, J., &amp; Bampouras, T. (2013). Effect of back squat depth on lower-body postactivation potentiation. Journal of Strength and Conditioning Research, 27(11), 2997-3000.</a></li>
</ol>
&nbsp;

Extensibility: The ability of a cell to be stretched or lengthened without damage (1).
<ul>
 	<li>For example, most cells would rupture with even a modest stretch, but muscles can stretch up to 3 times their contracted length.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

False Negative - the proportion of negatives in a group that were assessed incorrectly (assessed as negative when the patient was actually positive)
<ul>
 	<li>Test Results: Although most tests/assessments result in either a positive or negative, the accuracy of a test is dependent on the number  of positives and negatives that are correct. Therefore, when the accuracy of a test is determined, their are 4 possible results, because a positive or negative result could be right (true) or wrong (false).</li>
</ul>

False Positive - the proportion of positives in a group that were assessed incorrectly (assessed as positive when the patient was actually negative)
<ul>
 	<li>Test Results: Although most tests/assessments result in either a positive or negative, the accuracy of a test is dependent on the number  of positives and negatives that are correct. Therefore, when the accuracy of a test is determined, their are 4 possible results, because a positive or negative result could be right (true) or wrong (false).</li>
</ul>

The function of fascia is to transmit force, provide support, and protect tissues. Fascia can effect motion by:
Transmitting force from one or more muscles (example: the thoracolumbar fascia)
Restricting motion in cases of adaptive shortening and/or adhesion to proximal structures (example: iliotibial band in cases of lower-leg dysfunction)
Elastic recoil after stretching can contribute to force production (example: plyometric exercise)

Note: There is evidence that fascia may house more receptors related to human movement than other tissues. In this way fascia may act as a motherboard for the nervous system

The fascial system does not contract or develop trigger points, and its capacity to adapt to stretching and or strengthening exercise is limited, especially when compared to the adaptive capacity of muscle tissue.

Fibromyalgia - A loosely defined diagnosis that is associated with a combination of widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites. Consideration may also be given to the presence of psychosocial stressors and inflammatory disease in the patients history. Newer research suggests that fibromyalgia may be at least in part due to central sensitization of myofascial pain, often associated with trigger points (1 - 4).
<ol>
 	<li>Wolfe, F. (2018). Fibromyalgia Syndrome and Fibromyalgia Syndrome Criteria: Problems in Definition and Validity. Fibromyalgia Syndrome and Widespread Pain: From Construction to Relevant Recognition.</li>
 	<li>Wolfe, F., Smythe, H. A., Yunus, M. B., Bennett, R. M., Bombardier, C., Goldenberg, D. L., ... &amp; Fam, A. G. (1990). The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis &amp; Rheumatism: Official Journal of the American College of Rheumatology, 33(2), 160-172.</li>
 	<li>Alonso-Blanco, C., Fernandez-de-las-Penas, C., Morales-Cabezas, M., Zarco-Moreno, P., Ge, H. Y., &amp; Florez-García, M. (2011). Multiple active myofascial trigger points reproduce the overall spontaneous pain pattern in women with fibromyalgia and are related to widespread mechanical hypersensitivity. The Clinical journal of pain, 27(5), 405-413.</li>
 	<li>Staud, R., Nagel, S., Robinson, M. E., &amp; Price, D. D. (2009). Enhanced central pain processing of fibromyalgia patients is maintained by muscle afferent input: a randomized, double-blind, placebo-controlled study. PAIN®, 145(1-2), 96-104.</li>
</ol>
&nbsp;

Muscles that act to reduce or prevent movement at proximal joints to improve force transmission.
Example: The muscles of the core are important fixators; reducing motion of the spine/trunk to enhance force transmission between the extremities and environment.

An increase in joint stability via compressive forces resulting from muscular contraction and increased tension in fascial structures (1,2).
<ul>
 	<li>This term is most often used in reference to core intrinsic stabilizers, the thoracolumbar fascia and the sacroiliac joint; however, force closure and form closure have been mentioned in the literature referring to other joints.</li>
 	<li>Related term: Form closure</li>
</ul>
<ol>
 	<li>Andry Vleeming, Vert Mooney, Rob Stoeckart. Movement, Stability &amp; Lumbopelvic Pain: <a class="glossaryLink " title="Glossary: Integration" href="https://brentbrookbush.com/glossary/integration/" target="_blank" rel="noopener noreferrer" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Integration&lt;/div&gt;&lt;div class=glossaryItemBody&gt;Making a whole of parts.&lt;br /&gt;&lt;br /&gt;Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.&lt;/div&gt;">Integration</a> of Research and Therapy. (c) 2007 Elsevier Limited</li>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Vleeming, A., Pool-Goudzwaard, A. L., Stoeckart, R., van Wingerden, J. P., &amp; Snijders, C. J. (1995). The Posterior Layer of the Thoracolumbar Fascia| Its Function in Load Transfer From Spine to Legs. Spine, 20(7), 753-758.</li>
</ol>

The relative contribution of joint shape and structure to the stability of a joint (1,2).
<ul>
 	<li>This term is most often used in reference to the "rough" articulating surfaces of the sacroiliac joint and the wedge shape of the sacrum; however, force closure and form closure have been mentioned in the literature referring to other joints.</li>
 	<li>Related term: Force closure</li>
</ul>
<ol>
 	<li>Andry Vleeming, Vert Mooney, Rob Stoeckart. Movement, Stability &amp; Lumbopelvic Pain: <a class="glossaryLink " title="Glossary: Integration" href="https://brentbrookbush.com/glossary/integration/" target="_blank" rel="noopener noreferrer" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Integration&lt;/div&gt;&lt;div class=glossaryItemBody&gt;Making a whole of parts.&lt;br /&gt;&lt;br /&gt;Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.&lt;/div&gt;">Integration</a> of Research and Therapy. (c) 2007 Elsevier Limited</li>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Vleeming, A., Pool-Goudzwaard, A. L., Stoeckart, R., van Wingerden, J. P., &amp; Snijders, C. J. (1995). The Posterior Layer of the Thoracolumbar Fascia| Its Function in Load Transfer From Spine to Legs. Spine, 20(7), 753-758.</li>
</ol>

An arthrokinematic motion - linear motion across a joint surface parallel to the plane of the adjacent joint surface, just as your posterior moves relative to a "slide" in a park.

For example, the glide of facet joint in the spine during spinal flexion and extension, or the posterior glide of the humeral head that must accompany anterior roll to maintain congruence with glenoid fossa during shoulder horizontal adduction.

A plane joint (also called an arthrodial joint, gliding joint or plane articulation) is a synovial joint which allows only gliding movement in the plane of the articular surfaces. The opposed surfaces of the bones are flat or almost flat, with movement generally limited by tight capsules and ligaments. Plane joints are numerous, are most often small, and allow very little motion.  Examples include the carpal joints of the wrist, the tarsal joints of the ankle, and the facet joints of the spine.

"...refers to the measurement of angles, in particular the measurement of angles created at human joints by the bones of the body (1).

&nbsp;
<ol>
 	<li>Cynthia C. Norkin, D. Joyce White. Measurement of Joint Motion: A Guide to Goniometry 3rd Edition. Copyright (C) 2003 by F.A. Davis Company</li>
</ol>

Ground reaction force (GRF) - The force exerted by the ground on the body in contact with it.

For example, when a runner's foot strikes the ground with a force equal to the mass of the individual times their acceleration due to gravity, momentum and muscular exertion, the ground exerts an equal and opposite force on the runner's foot.
<ul>
 	<li>GRF is often measured in research studies using force plates as a means of quantitatively measuring the force generated by an individual.</li>
</ul>

H-Band - Refers to the central zone of a sarcomere that looks lighter under a microscope.  This area of the sarcomere is a lighter portion of the A-band where there is no overlap between the thinner filaments (actin), and the thicker filaments (myosin).
<ul>
 	<li>Example, when a muscle contracts, actin and myosin cross-bridging occurs in the region of the A-band until the H-band is reached where no overlap occurs.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

A hinge joint (also called a ginglymus) is a synovial joint in which the articular surfaces fit one another in a way that only permits motion in one plane. Examples include the elbow, the knee (unless considered a condyloid joint) and the interphalangeal joints.

Holism (holistic) (biological holism) - (from Greek holos "all, whole, entire") is the idea that systems and their properties should be viewed as wholes, not just as a collection of parts.
<ul>
 	<li>Summarized by Aristotle in his "Metaphysics": "The whole is more than the sum of its parts". However, the term "holism" was introduced into language by the South African statesman Jan Smuts as recently as 1926. (Smuts J. C. 1987 [1926]. Holism and evolution. Cape Town: N &amp; S Press.)</li>
</ul>
Example: The Brookbush Institute promotes a holistic approach to human movement science, in which the muscular, fascial, articular and neural systems are not viewed as separable and all proximal segments are considered.

Hormone: Chemical messengers produced by the endocrine system, transported via tissue fluids such as blood, to stimulate cells to "act."
<ul>
 	<li>Example: Growth hormone is secreted by the pituitary gland in the brain; stimulating growth, cell reproduction and cell regeneration in certain types of cells</li>
</ul>
The English physician E. H. Starling discovered in collaboration with the physiologist W. M. Bayliss secretin, the first hormone, in 1902. (1).
<ol>
 	<li>Henriksen, J. H., &amp; de Muckadell, O. S. (2000). Secretin, its discovery, and the introduction of the hormone concept. Scandinavian journal of clinical and laboratory investigation, 60(6), 463-472.</li>
</ol>

A range of motion achieved by the patient/client that is more than normal.
<ul>
 	<li>Note: Both hyper-mobility and hypo-mobility may adversely affect motion and may lead to deleterious effects on joints and soft tissue over time. There is no evidence to suggest that more or less flexibility than normal is beneficial.</li>
</ul>
Example: If an individual can place their forehead on their knees they are likely hypermobile at one, if not several joints

Example 2: 110° of shoulder external rotation would be considered hyper-mobile.

Hyperplasia is an increase in organic tissue size due to an adaptive increase in the number of cells per organ.
<ul>
 	<li>Although muscle hyperplasia has been noted in some animals, human muscle tissue does not seem to have this adaptive ability.</li>
</ul>

A condition of excessive tone of the skeletal muscles; increased resistance of muscle to passive stretching.  May be related to increased neural drive, synergistic dominance, trigger points, reflexive over-activity, and/or muscle length.
Example:  Individuals who exhibit ankle eversion and abduction during an overhead squat assessment likely have hypertonic fibularis (peroneal) muscles.

Muscular hypertrophy is an increase in muscle mass/size due to increase in the volume and cross-sectional area (CSA) of individual muscle cells. The increase in cross-sectional area can be attributed to an an increase in contractile proteins and structural elements (myofibrillar hypertophy), as well as an increase in glycogen storage and elements related to metabolism (sarcoplasmic hypertophy). Hypertrophy is an adaptation of both cardiac and skeletal muscle fibers in response to progressive increases in workload.
<ul>
 	<li>Note: Hypertrophy is not hyperplasia. Hyperplasia is an increase in muscle size due to an adaptive increase in the number of muscle fibers/cells per muscle. This type of adaptation does not occur in human muscle tissue.</li>
</ul>

A range of motion achieved by a patient/client that is less than normal.
<ul>
 	<li>Note: Both hyper-mobility and hypo-mobility may adversely affect motion and may lead to deleterious effects on joints and soft tissue over time. There is no evidence to suggest that more or less flexibility than normal is beneficial.</li>
</ul>
Example: If the end range of shoulder external rotation is reached and measured as 75° during goniometric assessment, the client/patient is exhibiting hypomobility of the glenohumeral joint (shoulder).

Hypothesis - a proposed explanation for a phenomenon; "scientific hypotheses" are generally constructed in a way that is testable or falsifiable.
<ul>
 	<li>Example: The hypothesis, "excessive knee valgus may be correlated with future knee pain and injury," has been the subject of several studies published over the last decade.</li>
</ul>

Diminished tone of skeletal muscles; diminished resistance of muscles to passive stretching.   May be related to inhibition, reciprocal inhibition, arthrokinematics inhibition and/or  increased resting length of muscle.
Example:  If your knees cave (hip adduction) during a squat or leg-press it is likely that your gluteus medius is hypotonic.

I-Band - Refers to the part of the muscle cell that looks lighter under a microscope.  This area of the cell is lighter due to parallel arrangement of thinner filaments (actin), and no overlap with the thicker filaments (myosin).
<ul>
 	<li>As a muscle contracts, the I-bands will decrease in width and move closer to one another.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

Independent variable - in research, this is the variable or phenomenon being manipulated in the study.
<ul>
 	<li>Example, in the study by Ghanbari et al. (1), the independent variable is "knee joint mobilization", the dependent variable is "quadriceps muscle strength."</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/effect-knee-joint-mobilization-quadriceps-muscle-strength/" target="_blank" rel="noopener noreferrer">Ghanbari A. and Kamalgharibi S. (2013). Effect of knee joint mobilization on quadriceps muscle strength. International Journal of Health and Rehabilitation Sciences. 2(4): 186-191</a></li>
</ol>

An anatomical direction; toward the bottom (below)

Example, the mouth is inferior to the eyes

A reduction in neural drive, muscular activity, and or force output due to altered neuromuscular reflex.  Alterations in neuromuscular reflex may occur due to increases in muscle length (hypothesis: increased excitation threshold), altered reciprocal inhibition in response to increased antagonist tone, and or alterations in joint motion (arthrokinematics inhibition).

Making a whole of parts.

Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.

Intermuscular Coordination - Optimal timing and motor unit recruitment of agonists, antagonists, synergists, neutralizers, stabilizers and fixators.

Example: Role of Muscles during Hip Extension
<ul>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Prime Mover" href="https://brentbrookbush.com/glossary/prime-mover/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Prime Mover&lt;/div&gt;The muscle most responsible for a joint action under load -&lt;br /&gt;&lt;br /&gt;That is, the muscle that can produce the most force for a given joint action. Often this term is used synonymously with the term agonist. The prime mover as defined above, may or may not be the most active muscle for a joint action during activities of daily living.&lt;br /&gt;&lt;br /&gt;Example: the gluteus maximus is the most powerful hip extensor and therefore the prime mover; however, the hamstrings are likely the most active hip extensors during low level activities like walking or standing.">Prime Mover</a>:  <a href="https://player.vimeo.com/external/82855344.hd.mp4?s=54c3e7d98fb9d4e0af8d282c85ba9b3e">Gluteus maximus</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Synergists" href="https://brentbrookbush.com/glossary/synergists/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Synergists&lt;/div&gt;Muscles that assist the prime mover in performing a joint action.&lt;br /&gt;&lt;br /&gt;That is, all muscles that can perform a joint action that are not the prime mover, are termed synergists.&lt;br /&gt;Example: The rectus abdominis is the prime mover of spinal flexion. All other muscles that can perform spinal flexion are synergists including – external obliques, internal obliques and psoas.">Synergists</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/biceps-femoris/">Biceps femoris (long head)</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/semitendinosus-and-semimembranosus/">semitendinosus, semimembranosus</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/adductors/">posterior head of adductor magnus</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Antagonist" href="https://brentbrookbush.com/glossary/antagonists/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Antagonist&lt;/div&gt;Muscles that oppose the prime mover and synergists for a given joint action.&lt;br /&gt;&lt;br /&gt;That is, all the muscles that can perform the opposing joint action.&lt;br /&gt;&lt;br /&gt;Example: The triceps and anconeus are antagonists during elbow flexion.">Antagonists</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/psoas/">Psoas</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/iliacus/">iliacus</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/tensor-fascia-latae-tfl/">tensor fascia latae</a> (TFL),<a href="https://brentbrookbush.com/articles/muscular-anatomy/rectus-femoris/"> rectus femoris</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/adductors/">anterior adductors (especially pectineus)</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/sartorius/">sartorius</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Neutralizer" href="https://brentbrookbush.com/glossary/neutralizers/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Neutralizer&lt;/div&gt;Muscles that oppose unwanted joint motions created by the prime mover and/or synergists, and/or muscles that prevent unwanted ancillary motion.&lt;br /&gt;Example: The teres minor and infraspinatus neutralize the internal rotation force created by the pectoralis major during horizontal adduction of the shoulder.">Neutralizers</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-minimus/">Gluteus minimus</a> and <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-medius/">anterior fibers of gluteus medius</a> neutralize external rotation force of <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-maximus/">gluteus maximus</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Stabilizer" href="https://brentbrookbush.com/glossary/stabilizers/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Stabilizer&lt;/div&gt;Muscles whose primary role is to improve arthrokinematics by maintaining optimal alignment of joint surfaces.&lt;br /&gt;&lt;br /&gt;Most often these muscles are the most intrinsic muscles of a joint, have a larger percentage of Type I muscle fibers and are rich in proprioceptors.&lt;br /&gt;Example: The muscles of the rotator cuff act as stabilizers for most shoulder motions.">Stabilizers</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/deep-rotators-of-the-hip/">Deep rotators of hip</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Fixator" href="https://brentbrookbush.com/glossary/fixators/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Fixator&lt;/div&gt;Muscles that act to reduce or prevent movement at proximal joints to improve force transmission.&lt;br /&gt;Example: The muscles of the core are important fixators; reducing motion of the spine/trunk to enhance force transmission between the extremities and environment.">Fixators</a>: <a href="https://brentbrookbush.com/articles/core-subsystems/intrinsic-stabilization-subsystem/">Intrinsic stabilization subsystem</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/rectus-abdominis/">rectus abdominis</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/internal-obliques/">internal</a> and <a href="https://brentbrookbush.com/articles/muscular-anatomy/external-obliques/">external obliques</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/quadratus-lumborum/">quadratus lumborum</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/erector-spinae/">erector spinae</a></li>
</ul>
&nbsp;

Example from: <a href="https://brentbrookbush.com/articles/anatomy-articles/introduction-to-functional-anatomy/kinesiology-of-the-hip/" target="_blank" rel="noopener">Introduction to Functional Anatomy: Kinesiology of the Hip</a>

Intramuscular coordination refers to the coordinated recruitment of motor units within a single muscle. This concept is used to explain increases in maximal strength and power; however, the coordinated and sequential recruitment of motor units is also essential to strength endurance and smooth coordinated motion.  Related terminology may include; motor unit recruitment, preferential recruitment, rate coding, sequence, etc..

Example: It is hypothesized that the "shaking" noted during a novice exercisers attempt at an activity like the <a href="https://brentbrookbush.com/vimeo_videos/ball-crunch-and-progressions/" target="_blank">stability ball crunch</a> may be due to relatively poor intramuscular coordination. Rather than smooth, sequential firing of rectus abdominis motor units, groups of motor units turn on and off in an uncoordinated manner.

Pertaining to the same side

Example, the quadratus lumborum performs ipsilateral flexion; lateral flexion toward the same side as the muscle.

An isoform, or variant, is a member of a set of similar proteins, that originate from the same gene, or gene family.
<ul>
 	<li>Example, the variations in myosin heavy chain proteins (MHC I, MHC IIA, MHC IIB/X) that contribute to the characteristic differences between muscle fiber types.</li>
</ul>

“The Prime Assumption”
Everything crossing a joint will influence joint motion during every joint action.

A concept that has expanded over the past several decades to describe the integration of 4 body systems (muscle, joints, fascia and nerves), as well as, the coordinated function of various body segments (e.g. hip, knee and ankle) to produce motion. Kinetic referring to motion, and chain being an analogy for the interdependent link between systems.

Example, the posterior kinetic chain, refers to the integrated function of nerves, muscles, fascia and joints on the posterior side of the body.

The concept of the kinetic chain was originally adapted from the work of a mechanical engineer named Franz Reuleaux (Kinematics of Machinery (1875)) by Dr. Arthur Steindler in 1955 (Steindler A: Kinesiology of the Human Body. Springfield, IL, Charles C. Thomas Co.. 1955).

Latent Trigger Point - A myofascial trigger point that is not painful at rest, only painful when palpated, and may or may not exhibit a characteristic referral pain pattern when palpated.  Latent trigger points do result in an acute point of sensitivity, in a taut band of muscle, and may restrict range of motion (1).

Note: Based on the clinical experience, the Brookbush Institute suggests that latent trigger points (sometimes refereed to as Tender Points) are more common than active trigger points. Further, they are likely addressed more often than trigger points; being the intended target of many soft-tissue mobility techniques.
<ol>
 	<li>David G. Simons, Janet Travell, Lois S. Simons, Travell &amp; Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition,© 1999 Williams and Wilkens</li>
</ol>

An anatomical direction; further from the midline

Example, the anterior deltoid is lateral to the pectoralis major

Length/Tension Relationship - The amount of force generated by a muscle is dependent on sarcomere length.
<ul>
 	<li>The ability of sarcomere to maximally produce force occurs when sarcomere length results in optimal overlap between actin and myosin. Stretching a sarcomere decreases overlap between actin and myosin filaments and reduces force production (1-3). When length is less than optimal, actin from opposite ends overlap and interfere with cross-bridging, and myosin filament are compressed as they contact the the Z-disk also reducing force (4)</li>
</ul>
<ol>
 	<li>Gordon, A. M., Huxley, A. F., &amp; Julian, F. J. (1966). The variation in isometric tension with sarcomere length in vertebrate muscle fibres. The Journal of physiology, 184(1), 170-192.</li>
 	<li>Edman, K. A. P. (1966). The relation between sarcomere length and active tension in isolated semitendinosus fibres of the frog. The Journal of Physiology, 183(2), 407-417.</li>
 	<li>Lieber, R. L., Loren, G. J., &amp; Friden, J. (1994). In vivo measurement of human wrist extensor muscle sarcomere length changes. Journal of neurophysiology, 71(3), 874-881.</li>
 	<li>Lieber, R. L. (2002). Skeletal muscle structure, function, and plasticity. Lippincott Williams &amp; Wilkins.</li>
</ol>
&nbsp;

Levels of Evidence - Relative to evidence-based practice, levels of evidence are an attempt to describe the strength of the results measured in a clinical trial or research study.  Note: levels of evidence do not supersede the critical evaluation of an experienced professional, and should be viewed as guidelines - a meta-analysis may be poorly constructed (Level IA), and a comparative study (Level III) may employ new technologies and a strong methodology.


The Levels of Evidence used by the Brookbush Institute, as described by Shekelle et al.(1):
<ul>
 	<li class="p1">IA - Evidence from meta-analysis of randomized controlled trials</li>
 	<li class="p1">IB - Evidence from at least one randomized controlled trial</li>
 	<li class="p1">IIA - Evidence from at least one controlled study without randomization</li>
 	<li class="p1">IIB - Evidence from at least one other type of quasi-experimental study</li>
 	<li class="p1">III - Evidence from non-experimental descriptive studies, such as comparative studies, correlation studies, and case-control studies</li>
 	<li class="p1">IV - Evidence from expert committee reports or opinions or clinical experience of respected authorities, or both</li>
</ul>
<ol>
 	<li>Shekelle, P. G., Woolf, S. H., Eccles, M., &amp; Grimshaw, J. (1999). Developing clinical guidelines. Western Journal of Medicine, 170(6), 348.</li>
</ol>

Likelihood Ratios - Likilihood ratios are used for assessing the value of performing a diagnostic test. They use sensitivity and specificity to determine whether a test result usefully changes the practitioner's chance (probability) of reaching the correct assessment. Calculation of likelihood ratios is based on Baye's theorem.
<ul>
 	<li>Positive Likelihood Ratio (LR+) - The ratio of a positive test result in people with the pathology to a positive test result in people without the pathology.</li>
 	<li>Negative Likelihood Ratio (LR-) - The ratio of a negative test result in people with the pathology to a negative test result in people without the pathology.</li>
</ul>

Longitudinal Study - a research design that involves observing the same variables, several times over a period of time.
<ul>
 	<li>Example, the study by Hewett et al. (1) is a type of longitudinal study called a "cohort study." This study investigated whether excessive knee valgus during landing was a predictor of knee injury risk in adolescent females over the course of a season.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/research-review-increased-valgus-during-landing-predicts-acl-injury-in-adolescent-female-athletes/" target="_blank" rel="noopener noreferrer">Hewett, T. E., Myer, G. D., Ford, K. R., Heidt, R. S., Colosimo, A. J., McLean, S. G., &amp; Succop, P. (2005). Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes A prospective study. The American journal of sports medicine, 33(4), 492-501</a></li>
</ol>

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