Biomechanics is an interdisciplinary subject that seeks to understand the mechanics of living system

- it is mechanics applied to biological system.

Biomechanics helps to understand the relationship between

structure and function, predict changes due to alterations, and
propose methods of artificial interventions.
Biomechanics of trauma, injury and rehabilitation is becoming
increasingly important to the modern society.
 Skeletal System
Types of Bone
(a) Long Bones
(b) Short Bones
(c) Flat Bones
(d) Irregular Bones
(e) Sesamoid(Round) Bones

There are 206 bones in the human skeleton (210 if we

count the two sesamoid bones that lie under the head
of the first metatarsal in each footin mostpeople).

Source: Figure adapted from [Link]

Mechanical Functions: Body
support against external forces.
Example: Gravity
Act as a system of levers to transfer
forces. Example: Muscular forces
Protection for vital organs.
Example: Brain

Biological Functions: Formation of

red blood cells
Calcium storage
□
Bone Function
Support, Movement & Protection
• supports body weight
• protects vital organs, e.g. heart, lungs, brain
• bones and muscles interactwhen limbs move – enables mobility of the human body

□ Blood Cell Formation

• haematopoiesis
• red marrow
□ Mineral Storage
• calcium
• phosphate
• magnesium
• sodium
• potassium
Skeletal Organization
■ Appendicular Skeleton
■ Upper limbs
■ Lower limbs
■ Pectoral (shoulder) girdle
■ Pelvic girdle

■ Axial Skeleton
■ Skull
■ Ossicles of the inner ear
■ Hyoid bone of throat
■ Thoracic cage (Rib cage)
■ Vertebral column

Source: Figure adopted from [Link]

 Anatomical Planes and Directions
Superior

Inferior

Anatomical planes of reference Anatomical directions

 Anatomical Terms
Superior

Anterior and posterior: describe structures at the

front (anterior) and back (posterior) of the body;
e.g. the toes are anterior to the heel.

Superior and inferior: describe a position above

(superior) or below (inferior) another part of the
body; e.g the pelvis is inferior to the abdomen.
Inferior

Proximal and distal: a position that is closer (proximal) or further (distal) from the trunk
of the body; e.g. shoulder is proximal to the arm, footis distal to the knee.
 Anatomical Terms
Superior

• Medial and lateral: a position that is

closer to (medial) or further from (lateral)
the midline of the body; e.g. the thumb is
lateral to the other fingers.
• Ventral and Dorsal: describe structures
towards the front (ventral) and back
(dorsal).

Inferior

• Cranial and Caudal: describe structures towards the top (cranial), and the
bottom of the body (caudal).
 Anatomy of a Femur Epiphysis
Femur – the longest and strongest bone
Fovea
Proximal Capitis Metaphysis
□ Epiphysis:the connectors
Neck Head
■ Connect femur with other bones to form joints
Greater
Trochanter
Shaft
□ Diaphysis:the central shaft Lesser
Diaphysis
Trochanter
■ Composedof hard cortical bone
■ Load transfer
Metaphysis

□ Metaphysis:conical eminences Epiphysis

■ Composed of cancellous bone with

Distal
thin layer of cortex
■ Sites for muscle attachments
 Bone Tissue
• Bone is a hard tissue - a type of specialized connective tissue.

• Bone has a complex internal and external structure.

• Bone possess the remarkable property to repair itself and adapt

its structure according to the mechanical stimulus.

Figure adapted from Wikipedia and [Link]

9
 Cancellous and Compact Bone
Macroscopically, classification of bone tissue is based on porosity
Epiphysis

Trabecular bone

Compact bone Cancellous bone

Diaphysis

• Cortical or Compact Bone - dense solid bone with volume fraction of solid greater than 70%
• Cancellous or Spongy Bone - porous network of interconnected rods or plates with volume
fraction of solid less than 70%

Figure adapted from Wikipedia and [Link]

10
• Hueso Cortical: Solido y alta densidad
• Hueso esponjoso: formados por trabéculas (laminillas que
se orientan en el
sentido del requerimiento
mecánico).
Células en los huesos
• Osteoclastos: se encargan de la reabsorción del hueso
• Osteoblastos: forman el hueso, sintetizando y segregando fibras
colágenas (osteoide) y otros componentes orgánicos.
• Osteocitos: son las células principales del hueso y mantiene su
metabolismo a través del intercambio de nutrientes.
• Crecimiento longitudinal
• Ocurre en la epífisis
(discos cartilaginosos
encontrados cerca de los
extremos de los huesos
largos)
• Crecimiento
circunferencial
• El periostio construye
nuevas capas
concéntricas de hueso, y
el material de desecho
se reabsorbe en la
cavidad medular.
• Perdida de colágeno progresivo e incremento de fragilidad con la
edad.
• La densidad ósea disminuye con el tiempo. Por lo tanto, las
propiedades del hueso van disminuyendo.
• El hueso esponjoso es el mas afectado, las trabéculas se van
desconectando.
• Este fenómeno es mas pronunciado en mujeres que en hombres.
• Aprox. 0,5 – 1,0 % de masa se pierde cada año en mujeres a partir de
los 50, y se incrementa a 6.5% anual en la menopausia.
• El hueso responde dinámicamente a la presencia o ausencia de
fuerzas.
• Modelación es el proceso mediante el cual la masa es incrementada
mediante la formación de hueso nuevo sin preceder una reabsorción.
• Remodelación es el proceso donde la masa se mantiene o disminuye
y precede una reabsorción del hueso dañado.
• La modelación y remodelación esta dirigida por los osteocitos, las
cuales son sensibles a los cambios en deformación que tiene el
hueso.
• Las cargas dinámicas provocan grandes velocidades de deformación lo que
provoca que se mueva fluido a través de la matriz de hueso.
• Entonces los osteocitos desencadenan las acciones de los osteoblastos y
los osteoclastos.
• Aproximadamente 25% del hueso trabecular se remodela cada año.
• Los huesos tienden a ser mas densos y mas mineralizados en personas
activas físicamente que en individuos sedentarios.
• Algunos deportistas como tenistas y beisbolistas sufren hipertrofia.
• Se encontró en algunos estudios que atletas que practican deportes de
impacto como baloncesto y voleibol tienen fémures mas densos que
aquellos que practican natación
Fractura de huesos
• Es una disrupción de la continuidad del hueso.
• Depende de:
• Dirección y magnitud de carga
• Velocidad de carga
• Duración de la carga
• Estado de salud y edad
• La fractura es simple cuando todo el tejido alrededor de la lesión
permanece intacto, y compuesta cuando rompe la piel.
 Fractura de huesos
• Cuando la velocidad de carga es rápida se producen múltiples
fragmentos.
• Avulsiones son fracturas causadas cuando un tendón o ligamento se
rompe en el punto de unión al hueso. Por lo general, se provoca por
saltos explosivos.
Reparación
Ley de Wolff de adaptación
funcional: “la forma del hueso la
determina la ubicación o no-
ubicación de los elementos del
hueso en la dirección de las fuerzas
funcionales.
Incremento o disminución de la
masa de acuerdo a la cantidad de
fuerzas funcionales.”
 FEMUR TIBIA
Resistencia a tensión (MPa) 80-150 95-140
Resistencia a compresión (MPa) 131-224 106-200
Ejemplo
• Un ensayo uni-axial de compresión fue hecho en un cilindro maquinado de hueso cortical de un
fémur humano. Los resultados se muestran en la figura. Estime el Módulo de Elasticidad y la
Esfuerzo Ultimo de esta muestra.

¿Cual sería la carga

última para un fémur
humano de área 800
mm2?
• Los tres tipos de carga mas común en el hueso son axial, flexión y
torsión.
• Recuerde que los esfuerzos de compresión y tensión, generados
desde cargas de flexión, dependen de la distancia desde el eje
neutral, y del momento de inercia.
• Igualmente, los esfuerzos cortantes dependen de la distancia desde el
eje torsional, cuando el hueso se somete a torsión pura, y del
momento polar de inercia.
Ejemplo 2.
• Un fémur de ratón tiene la forma de la figura mostrada obtenido por tomografía
computarizada con la misma resolución en las tres dimensiones. Dada la
configuración mostrada con F = 15 N, determine el esfuerzo normal en el hueso
para la sección a-a’ de la diáfisis.
• Suposiciones:
• Peso del hueso puede ser despreciado
• El hueso se considera homogéneo e isotrópico
• El problema puedes ser tratado en dos dimensiones.
• Imax = 0.2976 mm4 Imin = 0.1382 mm4 A = 0,956 mm2

d F
M
• La fuerzas en la articulación que no actúan a lo largo del eje del
hueso, son a menudo compensadas por las fuerzas musculares que
reducen las fuerzas superficiales en el hueso.
• El desalineamiento de los huesos puede requerir que se incremente
la compensación muscular.
• Movimientos en los cuales las fuerzas externas no actúan a lo largo
del eje del hueso, producen altos esfuerzos.
Ejemplo 3.
• Una fuerza de 4000-N actúa a una distancia de 60-mm desde el eje de la estructura donde se
consideran varias áreas de sección ideales (ver figura). Determine el momento de inercia y el
máximo esfuerzo a flexión en cada sección. Los radios internos y externos para cada sección
están dados como sigue:

SECCION ri (mm) re (mm) Descripción

A 20 25 Estándar
B 15 20 Menor diámetro, igual espesor
C 25 30 Mayor diámetro, igual espesor
D 20 28,3 Engrosamiento del periostio
E 15 25 Engrosamiento del endostio
• Es común considerar el hueso como homogéneo, isotrópico y elástico.
• El hueso es un material anisotrópico, no-homogéneo y sus
propiedades son dependientes del tiempo (viscoelásticas).
• La propiedad viscoelástica le da al hueso la habilidad de regresar a su
forma original una vez removida la carga.
• En las actividades diarias las deformaciones unitarias son pequeñas
entonces puede considerarse el comportamiento elástico
• Se ha demostrado que el modulo de elasticidad no varia mucho con la
velocidad de deformación, por lo tanto se puede considerar elástico.
• En carga con velocidades de deformación muy altas requieren
reconsiderar la suposición de elasticidad.
• La heterogeneidad del hueso se debe a que incluso el hueso cortical
tiene porosidad y no todo el hueso trabecular es el mismo, dado que
las laminillas se orientan de acuerdo al requerimiento mecánico.
• Las propiedades dependen de la dirección.
• Un buen ejemplo es el hueso trabecular de los vertebras.
• En el hueso cortical las variaciones son bastantes debido a la
organización de los ostiones.
• La rigidez del hueso cortical en la dirección longitudinal es
aproximadamente el doble de la rigidez en el sentido transversal.
 Muscle
There are approximately 700different muscles in the human body, divided into three types:

• Skeletal:attached to bones and moves the skeleton, voluntary muscle

• Cardiac: muscle of the heart, involuntary muscle (e.g., in walls of blood vessels, intestine,
and other 'hollow' structures and organs)

• Smooth or visceral: muscle of the viscera

Functions of muscle, responsible for:

• motion
• maintenance of posture
• heat production
 Skeletal Muscles
Skeletal muscles consist of numerous subunits or bundles called fasicles (or fascicles). Fascicles are also
surrounded by connective tissue (called the perimysium) and each fascicle is composed of numerous
muscle fibers (or muscle cells).
Muscle cells, ensheathed by endomysium, consist of many
fibrils (or myofibrils), made up of long protein molecules
called myofilaments, of two types: thick & thin myofilaments.

Skeletal muscles are usually attached to bone by

tendons. The epimysium is a dense connective
tissue (surrounds the muscle tissue) and is also
continuous with the tendons, where it becomes
thicker and collagenous.

Source: Figure adapted from [Link]

Morfología
• Material altamente estructurado y organizado
• Tipos de musculo: estriados y lisos
• Cardiacos y lisos son controlados por el sistema nervioso autónomo
• Musculo esquelético es voluntario
Estriados Lisos

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Morfología (estructuras y subestructuras)

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Morfología (Fibra muscular)
• Fibra muscular es
una célula.
• Membrana llamada
sarcolema
• La fibra esta
compuesta por
miofibrillas que son
paralelas entre si.
• Las miofibrillas
contienen dos tipos
de filamentos de
proteína

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Morfología (miofibrilla)

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Morfología (miofibrilla)
• Sarcómero: unidad básica estructural entre dos líneas Z
• Cada sarcomero es bisecado por una línea M
• La Banda A contiene filamentos de miosina y cada una de
las cuales esta rodeada por seis filamentos delgados de
actina
• La banda I solo contiene filamentos delgados de actina
• En ambas bandas, los filamentos de proteína se mantienen
en su lugar por las sujeciones a la línea Z.
• En el centro de las bandas A esta la zona H que contiene
filamentos de miosina.

09/02/2024 Página 45
Contracción muscular
• Cuando el músculo contrae, los filamentos delgados de actina se
acercan entre si.
• Las líneas Z se mueven hacia las bandas A, las cuales mantienen su
tamaño original, mientras las bandas I se adelgazan y la zona H
desaparece.
• Los filamentos de miosina, llamados “puentes de cruce”, forman
uniones con los filamentos de actina durante la contraccion.

09/02/2024 Página 46
Contracción muscular

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Unidades motoras
• Todas las fibras son inervadas
• El axón de cuada neurona motora se subdivide muchas
veces de tal manera que cada fibra termina en una placa
motora.
• Aunque cada fibra tiene una sola placa motora, la
innervación múltiple ha sido reportada.
• Una unidad motora puede controlar de 100 a 2000 fibras
• Movimientos precisos (ojos y manos) son controlados por
un numero pequeño de fibras.
• Movimientos gruesos, de fuerza (gasctronemius) requieren
una cantidad grande de unidades motoras.
• La mayoría de la unidades motoras en los mamíferos
esta compuesto por células del tipo “tic” que
responden a un estimulo simple desarrollando tensión.
• La tensión en una fibra tic alcanza el pico en menos de
100 ms y decrece inmediatamente (A) (ver figura)
• Cuando se aplican sucesivos impulsos a la fibra ya en
tensión, se adicionan estos impulsos (B)
• Cuando el máximo de tensión es alcanzado, este nivel
es mantenido, se dice que esta en “tétanos”
Tipos de fibras
• Las de tic-rápido (FT) y tic-lento (ST).
• Las FT alcanzan la tensión y se relajan mas rápido
que las ST.
• FT fatigan mas rápido que ST
• Por lo general, la cantidad relativa de fibras varía de
musculo a musculo y de individuo a individuo
• FT están presentes donde se requiere contracción
muscular rápida (saltos y piques)
• ST están presentes en eventos donde requieran
resiliencia (carreras, ciclismo y natación)
 Muscle fibre types
More than 95% of human muscles may be classified into one of three categories according to
their relative speed of contraction and their metabolic properties.
The proportions of each type of muscle fibre vary from muscle to muscle and person to person.

Type I fibres, also called slow twitch or slow oxidative fibres, are red, have a slow contraction velocity,
are fatigue-resistant and have a high capacity to generate ATP by oxidative metabolic processes
Type IIA fibres are called fast twitch or fast oxidative fibres (fast-
oxidative -glycolic fibres) which exhibit fast shortening speeds and a
moderately well-developed capacity for energy transfer from both
aerobic and anaerobic sources.

Type IIB fibres, also called fast twitch or fast glycolytic fibres.
Fibre Type Type I fibres Type II A fibres Type II B fibres
Contraction time Slow Fast Very Fast
Maximum duration of use Hours <30 minutes <1 minute
Fibre colour Red Red White
Size of motor neuron Small Medium Large
Fatigueresistance High Moderate Low
Activity Used for Aerobic Long term anaerobic Short term anaerobic
Force production Low High Very High
Mitochondrial density High High Low
Capillary density High Moderately high Low
Oxidative capacity High Moderately high Low
Glycolytic capacity Low High High
Creatine phosphate, Creatine phosphate,
Major storage fuel Triglycerides
Glycogen Glycogen
Metabolism Oxidative Oxidative glycolytic Glycolytic
Arquitectura de la fibra muscular
• La orientación de las fibras afecta la resistencia de la
contracción muscular y el rango de movimiento.
• Hay dos tipos de arreglos:
• Fibras paralelas
• Fibras pinadas
• Cuando un músculo de fibras
paralelas se contrae, la
contracción del musculo es la
contracción de las fibras.
• En el caso de un músculo pinado,
a medida que las fibras se
contraen, el ángulo aumenta.
• Los velocistas tienen ángulos de
pinación menores que los
maratonistas.
• Los músculos de fibras paralelas
pueden mover segmentos del
cuerpo en rangos mas amplios.
Extensibilidad y Elasticidad
• Extensibilidad: habilidad para
elongarse.
• Elasticidad: habilidad para
retornar a su longitud original
• Comportamiento Elástico
• Componente elástico en
paralelo (PEC): cuando un
musculo se estira pasivamente.
• Componente elástico en serie
(SEC): almacena energía
cuando un musculo tenso se
estira.

09/02/2024 Página 59
Irritabilidad y Habilidad para desarrollar tensión
• Irritabilidad es la habilidad para responder a un estimulo.
• El musculo responde a un estimulo desarrollando tensión
• Contractilidad es la habilidad para acortarse en longitud.
• Tension en un músculo no significa que el musculo se esté acortando.

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Cambio en la longitud del musculo con el
desarrollo de tensión
• La tensión en un músculo genera un torque en la
articulación haciendo que ésta se mueva.
• Cuando el musculo se acorta se denomina contracción
concéntrica y cuando se alarga, excéntrica.
• Los músculos pueden desarrollar tensión sin acortarse –
contracción isométrica
Roles asumidos por los músculos
• Solo desarrollan tensión.
• Cuando un musculo se
contrae para generar un
movimiento se dice que
actúa como agonista (el que
mueve)
• Los que actúan opuestos al
agonista se denominan
antagonistas (el que se
opone)
• Ambos están a lados
opuestos de la articulación.
Roles asumidos por los músculos
• Mientras el músculo agonista esta activo
durante aceleración, los antagonistas se
activan en desaceleración.
• Cuando una persona baja una cuesta el
cuádriceps actúa como antagonista para
controlar la flexión de la rodilla.
• Los músculos también actúan como
estabilizadores, los cuales sostienen una
parte del cuerpo para permitir que otra
musculo desarrolle tensión. Por ejemplo, los
romboides mantienen en su sitio la
escapula.
Roles asumidos por los músculos
• Los músculos también actúan como neutralizadores. Por ejemplo, si
un musculo causa flexión y abducción en una articulación, si se quiere
solo flexión, el musculo neutralizador inhibe la abducción.
Resistencia, Potencia y Resiliencia de Músculos

• Resistencia muscular
• Es medida como una función de la capacidad de generar torque en una
articulación por un grupo de músculos.
• Rara vez ocurre una dislocación en una articulación como producto de la
tensión de un músculo.
Resistencia, Potencia y Resiliencia de Músculos
• El movimiento de un músculo depende de dos factores
• La distancia entre la inserción al hueso y el eje de rotación de la articulación, y
• El ángulo entre la inserción del musculo y el hueso. El mayor torque se
produce cuando el musculo esta orientado a 90 o del hueso, y
anatómicamente está mas alejado de la articulación.
Resistencia, Potencia y Resiliencia de Músculos
• Potencia Muscular
• Se mide como el torque producido por el musculo debido a la velocidad
angular en la articulación.
• Algunos deportes necesitan potencia muscular como son levantamiento de
pesas, salto alto, velocidad 100m.
• Individuos con predominancia de fibras FT pueden generar mas potencia.
Resistencia, Potencia y Resiliencia de Músculos
• Resiliencia Muscular
• Capacidad para ejercer tensión y mantenerla en el tiempo.
• Esta característica no esta muy bien entendida porque el tiempo en el cual se
sostiene una carga es también afectada por la fuerza y la velocidad.
• Este entrenamiento no incrementa el diámetro de la fibra muscular
Resistencia, Potencia y Resiliencia de Músculos
• Fatiga muscular
• Reducción de la capacidad muscular máxima.
• Fatigabilidad es lo opuesto a resiliencia.
• Se cree que es producto de una reducción en la
velocidad de la liberación de calcio.
• Efecto de la temperatura en el musculo
• A temperatura alta, la velocidad del nervio y la función
del musculo se incrementa (procesos para suministrar
oxigeno y remover desechos se incrementan)
• La temperatura optima del musculo es 38,5o
Ejemplo
• Cuanto torque es producido en el codo por el bíceps insertado a un ángulo de 60 º
en el radio cuando la tensión del musculo son 400N? (Asuma que la inserción del
musculo está a 3 cm de la articulación)
• Si la capacidad de generación de tensión es aproximadamente 90 N/cm 2, Cuanta
tensión es desarrollada por el bíceps si tiene un área de 12 cm 2?

60º
There are two types metabolic pathways involved in regenerating ATP
• One uses up chemicals stored within the cell (phosphocreatine and
glucose), without the need for oxygen and is known as anaerobic
• The other one requires oxygen and nutrients to enter
themuscle fibre from the bloodstream and is known as aerobic

• An anaerobic processes can provide quick powerful bursts of energy, however it

can also be exhausted very quickly. For sustained muscular work, an aerobic
metabolic process is used, following an oxygen debt, which will need to be
repaid by aerobic respiration, to remove lactic acid which accumulates in the
muscle.
 Muscle architecture parameters of 21 cadavers

PCSA Peak Optimal Tendon Pennati

Muscle (cm) force fibre slack on
(N) length length Angle
(cm) (cm) (°)
Biceps femoris 11.6 705.2 9.8 32.2 11.6
long head
Rectus femoris 13.9 848.8 7.6 34.6 13.9
Soleus 58.8 3585.9 4.4 28.2 28.3
Tibials anterior 11.0 673.7 6.8 24.1 9.6
Gastrocnemius 21.4 1308.0 5.1 40.1 9.9
medial head
The maximum forc e (𝐹𝑚 𝑎 𝑥 ) for the whole muscle may be
calculated as:

𝐹𝑚𝑎𝑥 = 𝑃𝐶𝐴 ∗ 𝐾
Where PCA is the physiological cross-section area and K is a
constant (20 to 100 N*cm-2).
For pennated muscles, PCA is calculated as:
𝑚 ∗ 𝑐𝑜𝑠𝛼
𝑃𝐶𝐴 =
𝜌∗𝐿
Where m is the mass of the muscle, ρ is its density (1.056
g*cm -2), L is the length of the musc le fibres and α is
pennation angle of the muscle ( Winter, 2009 )
Force-velocity relationship

The force developed by a

specific muscle depends
upon its length and
critically on its velocity of
contraction
 Summary

The literature suggests that the main factors responsible for the force
generation in a muscle depend on such parameters as:
•The number of fibres re cruited and their firing rate and
synchrony;
• The physiological cross-se ction area of the muscle;
•The optimal muscle length (with an optimal pennation angle)
and for some muscles elastic energy can have a significant effect;
•The mechanical properties of the muscle such as the length-
tension relationship, and velocity;
•The fibre length: short fibres produc e more force and long
fibres produc e less force .
MAJOR MUSCLESUSEDIN GAIT
 EMG

An electromyogram (EMG) is a record of the electrical activity of

muscles.

EMG signals have both a magnitude and a frequency response

• Surfac e EMG does not exc eed 5 mV

• Frequency spe ctrum is 0-1000 Hz
Wide spread use of EMG
 Methods of recording EMG

Surface electrodes

Indwelling (intramuscular EMG)

Recording Electromyographic Signal
In general, monopolar signals yield lower-frequency responses and
less selectivity than bipolar recordings. Although monopolar
recordings are frequently used during static contractions and in a
variety of clinical investigations involving needle electrodes
There are different recommended guidelines for locating electrode
placement sites over specific muscles

Skin preparation
Skin impedanc e should be no more than 10 kΩ to obtain a better
electrode–skin contact.
In addition to the recording electrodes, differential amplifiers
require the use of a reference, or ground, electrode that must be
attached to electrically neutral tissue (e.g. a bony landmark).
Surface electrodes
 PROCESSING, ANALYSING AND
PRESENTING
ELECTROMYOGRAMS

• Average Rectified (ARV) EMG

• Root Mean Square (RMS)
• Linear Envelope (LE)
 Average Rectified (ARV) EMG
𝑇
1
𝐴𝑅𝑉 = 2 𝑡 𝑑𝑡
�𝑋
𝑋
𝑇
0

where: X(t) is the EM G signal.

Tis the time over which the ARV is
calculated
 Root Mean Square (RMS)

• The Root M ean Square EM G (RMS) isthe square root of the average
power of the raw EMG calculated over a specific time period, or window
(T)

𝑇
1
𝑅𝑀𝑆 = �𝑋𝑋2 𝑡 𝑑𝑡
𝑇
0
Linear Envelope (LE)

• Rectification
• Lowpass filter 6-8 Hz
 Ligament
Ligament is a fibrous connective tissue, which connects one bone to another bone. It is also
known as articular ligament, fibrous ligament, or true ligament.

Knee Joint
Hip Joint
Función de los ligamentos
• Estabilidad
• Movilidad
Funciones de los ligamentos
• 6 GDL
• Ligamentos restringen el rango de movimiento aun con los músculos relajados.
Funciones de los ligamentos
• Flexión rodilla: 150º
• Rotación tibia relativa a fémur: 35 º
• Varo-valgo: 5º
• Flexión de la rodilla (movimiento acoplado)
• Fémur: rotación sagital
• Tibia: se traslada en el plano frontal y rota en el transversal
Ligamentos Cruzados
Mecanismo 4 barras ligamentos
Ligamentos cruzados
• Durante el movimiento de flexión, los cóndilos femorales ruedan se deslizan
sobre la tibia.
• El área de contacto se mueve hacia atrás y hacia afuera de la tibia en flexión, y
hacia adelante y hacia adentro en extensión.
• Los cóndilos femorales divergen posteriormente y tienen curvatura reducida
• Estos se apoyan en los meniscos en una orientación antero-posterior en
extensión
• En flexión, los cóndilos fuerzan el menisco asumir una curvatura medio-lateral.
Movimiento de los meniscos en extensión y
flexión
Ligamentos cruzados
• Asi los cóndilos siempre están en contacto con los meniscos.
• Los meniscos son los principales disipadores de carga en la rodilla,
haciendo que los cóndilos femorales y tibiales mas bien deslicen que
soporten carga.
• En bajas cargas, prácticamente toda la carga es tomada por los
meniscos.
Ligamentos cruzados
• Los ligamentos cruzados juegan un papel importante en el control de
movimiento.
• Los esfuerzos que desarrollan los ligamentos cruzados varían con el
ángulo de la articulación.
• La configuración trenzada de estos ligamentos y los sitios de inserción
anchos, parece que los dotan para soportar todos los patrones de
carga variantes.
Inserciones de los ligamentos cruzados
Ligamentos cruzados
• El esfuerzo uniforme rara vez es alcanzado.
• Las fibras trenzadas sugieren que el Ligamento Cruzado Anterior (LCA)
se carga tanto en torsión como en tensión.
• El mecanismo “screw home” envuelve una rotación del fémur sobre la
tibia en los últimos 30 grados de extensión.
• Cuando la rodilla experimenta flexión y extensión, algunos ligamentos
están tensos mientras otros están laxos.
Cambios del LCA en flexión
Mecanismo Screw-home
Ligamentos cruzados
• En el LCA, los fascículos anteriores están tensos en flexión, pero relajados
hasta cierto grado en extensión.
• La situación es al contrario para el LCP
• De ahí la ventaja de tener grupos de fibras separadas y variaciones en el
rizado del colágeno.
• La actividad muscular causa que los huesos desarrollen otras orientaciones
que no están presentes cuando no hay gravedad, o en estudios de
cadáveres.
Ligamentos colaterales
• Están ubicados en la parte de afuera de la articulación en la zona
media y lateral
• No están torcionados
• Restringen rotaciones varo y valgo
• Durante la angulación en varo se carga el LCL mientras en LCM se
relaja y viceversa.
• Durante la rotación en el plano trasversal, los ligamentos colaterales
trabajan juntos con los cruzados
Ligamentos Colaterales
• Durante la rotación medial, el LCM toma una angulación similar al ACL
y durante la rotación lateral el LCL toma una angulación similar al PCL
• Durante flexión y extensión, los ligamentos colaterales juegan un
papel secundario. La parte anterior de ellos se tensa mientras la parte
posterior se relaja.
Propiedades Físicas y Mecánicas
• Las propiedades estructurales son derivadas del comportamiento que
envuelve las diferentes partes del ligamento (ligamento, inserción,
• Las propiedades del material corresponden solo al ligamento.
Propiedades Físicas y Mecánicas
• Las propiedades estructurales son derivadas del comportamiento que
envuelve las diferentes partes del ligamento (ligamento, inserción,
• Las propiedades del material corresponden solo al ligamento.
Propiedades Estructurales
• Curva fuerza - deformación
Propiedades estructurales
• Etapa I (punta)
• La variación de la rigidez es no lineal
• La elastina toma la mayor parte de carga
• El rizo del colágeno permanece
• Etapa II (region lineal)
• Los rizos del colágeno van desapareciendo y las fibras se alinean
• Rigidez es lineal
Propiedades estructurales
• Etapa III (región de micro fractura)
• Algunas fibras fallan
• La rigidez empieza a disminuir.
• La carga es tomada por las otras fibras
• Algunas de las fibras no longitudinales se alinean con la carga
• Etapa IV (región de falla)
• El ligamento rompe. Ya sea por avulsión (separación desde el hueso) o rotura
del ligamento.
 Tendon
A tendon (or sinew) is a tough band of dense fibrous connective tissue that usually connects muscle to
bone. It is capable of withstanding tension and transmitting the mechanical forces of muscle contraction to
the skeletal system. Tendonsmay also attach muscles to structures such as the eyeball.

Tendons are similar to ligaments and

fasciae; all are made of collagen.

Tendons and ligaments display

viscoelastic material properties: they
exhibit both elasticand viscous behaviour.

A ligament is a fibrous connective tissue which attaches bone to

bone, and usually serves to hold structures together and keep
them stable.
•Muscles attach either directly to bones or via a tendon. The
tendons and the connective tissues in and around the muscle
belly are elastic structures which help determine the mechanical
characteristics of the whole muscle-tendon unit (MTU) during
contraction and also during passive extension which produces
muscle force to move or stabilise joints.

•The tendon actuator can be defined by specifying its geometry

and force -generating properties.

•The length of tendon at which force begins to develop when

stretched is called the tendon slack length
• Results from previous papers suggest that the tendons of soleus and
gastrocnemius can generate maximum isometric force up to maximum of 10% strain
and after that they lose force generation

• A typical force -length relation curve for tendinoustissue

Morfología e histología
• Un tendón puede estar
restringido a cruzar una
articulación por las
protuberancias del hueso,
o por ligamentos de
tejido especializado.
• Estas restricciones
ayudan a mantener la
orientación del tendón
durante el movimiento.
Morfología e histología
• Estos ligamentos
retinaculares son
importantes en manos y
pies para facilitar el
movimiento.
Morfología e histología
• Organización del tendón
• Unión musculo tendón (unión miotendinosa)
• Tejido denso fibroso (tendón)
• Unión tendón-hueso (unión osteotendinosa)
• Compuesto principalmente por fibras de colágeno tipo I en una matriz
acuosa
• La unidad básica del colágeno es el tropo colágeno (tres cadenas
helicoidales del polipeptidos)
Morfología e histología
• Órgano Golgi-tendon
• Esta entre el tendón y unión
miotendinosa
• Terminales nerviosas
• Cuando el musculo contrae el
tendón se tensiona
• Mecanoreceptores que
monitorean la tensión muscular.
Propiedades Físicas
• La función primaria es transmitir las fuerzas del musculo al hueso
• Las pruebas a tensión son difíciles de obtener dado que el musculo es
liso.
• Para evitar eso se usan mordazas congeladas
Propiedades Físicas
• La alta resistencia del tendón se debe a
su alto contenido de colágeno (aprox.
80% d.w.) y su organización jerárquica.
• La mayoría de fibras de colágeno son
paralelas al eje longitudinal del tendón.
• La organización en paquetes de fibras le
permite cierta flexibilidad en flexión.
• El tamaño de los tendones dependen a
que musculo se conectan.
Propiedades Físicas
• Si un tendón es cargado y descargado forma un ciclo que muestra una histéresis
(perdida de energía)
Propiedades Físicas
• Los tendones muestran un
comportamiento elástico en cargas
fisiológicas.
• Los tendones están sometidos a ciclos
de carga lo que puedo ocasionar falla
por fatiga. También puede fallar por
creep debido a cargas estáticas
constantes.
• Se ha comprobado que los tendones
fallan por creep a cargas de tensión
mas bajas que las cargas dinámicas.
Propiedades Físicas
• El tiempo de ruptura por creep decrece exponencialmente con el incremento de
esfuerzo.
• Muestras de tendón sujetos a 10 MPa, no mostraron falla por creep después de
15 días.
• Se ha demostrado que el sistema tendón-musculo permite almacenar y liberar
energia manteniendo un balance metabólico.
• La eficiencia en la carrera es mas alta en un musculo in vivo, que la eficiencia de
un musculo in vitro en la ausencia de una pre-deformación.
Propiedades Físicas
• Cuando los músculos contraen el tendón se elonga almacenando
energía que luego libera cuando el musculo se relaja.
• Animales con pezuñas desarrollan altas velocidades debido a
músculos con fibras cortas y tendones largos.
• En humanos, durante el impacto y despegue el complejo musculo-
tendón se estira y relaja, almacenando y liberando energía.
Propiedades fisiológicas y función adaptativa
• El tendón es una estructura
metabólicamente activa.
• Algunos pequeños vasos
sanguíneos se introducen en el
tendón y rodean el endótenon
pero no penetran a los paquetes
de fibras.
• Los vasos sanguíneos no
penetran la éntesis, pero si la
rodean.
Propiedades fisiológicas y función adaptativa
• La función de los vasos capilares en el tendón es llevar nutrientes y fibroblastos.
Esta función también la comparten con el liquido sinovial, el cual es
particularmente importante en capas sinoviales.
• Tendinocitos o fibroblastos so laso encargados de mantener el balance
metabólico del tendón
• La biosíntesis del colágeno es la principal función de las células del tendón.
• Los fibroblastos producen sustancia basal, en la cual se sintetizan las moléculas
de tropocolágeno
• El entrecruzamiento del tropocolágeno se lleva a cabo a las 2 semanas.
Propiedades fisiológicas y función adaptativa
• En las siguientes 12 semanas el tejido de colágeno empieza a organizarse y a
formar las fibras de colágeno. Después, estas fibras empiezan a tener la
orientación de la carga.
• La sustancia basal esta compuesta por agua, PGs, y macromoleculas de
glicoproteina y sales inorgánicas.
• La sustancia basal suministra soporte estructural a las fibras de colágeno, sirve
para disipar el calor en el tendón durante su función.
• Los tendones pueden ser capaz de detectar y responder a cambios mecánicos y
bioquímicos.
Propiedades fisiológicas y función adaptativa
• Incluso, puede adaptarse a nuevas condiciones mecánicas si los cambios a los que
se somete no son extremos.
• Si los cambios son rápidos y severos probablemente el tendón no es capaz de
reparase.
• Se ha comprobado que un tendón suturado puede contribuir a una poca
formación de GAGs y numero de fibras de colágeno.
• Investigaciones en cerdos muestran que carreras largas incrementan el área de
los tendones y el contenido de fibras de colágeno.
Propiedades fisiológicas y función adaptativa
• Los tendones por lo general están sometidos a tensión, sin embargo, cuando
pasan por protuberancias de los huesos, se someten a compresión. En estos
casos el tendón puede adaptarse y, en investigaciones hechas en tendones de
cola de rata, el tendón cambia la orientación de las fibras en su centro y su
estructura parece mas un cartílago fibroso.
• En otros estudios se ha comprobado que las cargas compresivas activan la
producción de GAGs.
• Los tendones pueden sanar!
• Laceraciones, rupturas y tendinitis.
Propiedades fisiológicas y función adaptativa
• Proceso de sanado de un tendón:
1. Inflamación
2. Proliferación de sustancia basal y colágeno
3. Remodelación
• Mantener el flujo de sangre en el tendón en laceraciones y rupturas es critico
para que las fibras de colágeno no se dañen.
• Sin embargo, algunas veces el flujo de sangre puede provocar que el retináculo
se adhiera al tendón.
 Rigid Body Model Elements
Anatomic Element Model Element

Bone Rigid links

Joints Standard Joints

Muscle + Tendon Actuators

(responsible for moving or controlling a
mechanism or system)

Ligament Controllers
Springs
(monitors and physically alters the operating
conditions of a given dynamical system)
Joints
Articulations: The site where two or more bones meet.

• Joints are the weakestpart of the skeleton.

Classification:
Functional: Amount of movement allowed
1) Synarthrosis: Immovable joints
2) Amphiarthrosis: Slightly movable joint
3) Diarthrosis: Fully movable joints
 Classification of Joints
Structural: based on material binding the bone

1) Fibrous joint: Bone ends united by collagenic fibers

a) Sutures
b) Syndesmosis
c) Gomphosis

2) Cartilaginous joint: Bones are united by cartilage

a) Synchondrosis
b) Symphysis

3) Synovial joint : Bones are united within a fibrous joint capsule

 Fibrous Joints
Sutures (Synarthrosis) Syndesmosis (Amphiarthrosis)

• A suture is an immovable type of fibrous joint that is only found in the skull (cranial
suture).

• A syndesmosis is a slightly movable fibrous joint in which bones, such as the radius
and ulna, are joined together by connective tissue.
 Gomphosis (Synarthrosis)
A gomphosis is a joint that anchors a tooth inside its socket. Gomphosis lines the upper and lower
jaw in each tooth socket and is also called peg and socket joint.

• Immovable joint
• Ligaments hold tooth in bony socket

Socket

Root of the
Gomphosis tooth

Periodontal
ligament
 Synchondrosis (Synarthrosis)
A synchondrosis is a type of cartilaginous joint where hyaline cartilage completely joins together
two bones. Synchondrosis are immovable joints and are thus also referredto as synarthrosis.
 Symphysis (Amphiarthrosis)
A symphysis is connected by broad flatteneddisks of fibrocartilage as in the articulations between
the bodies of the vertebrae or the inferior articulationof the two hip bones (pubic symphysis).
Synovial Joint (Diarthrosis)
Synovial joints allow free movement of articulating bones within a fluid-filled
synovial cavity. Synovial joints are most common in the skeletal system.

• Most movable type of joint

• Each contains a fluid-filled joint cavity
Synovial Joints with Articular Discs
Some synovial joints containan articular disc:
– Occur in the temporomandibular joint
and at the knee joint

– Occur in joints where articulating bones

have somewhat different shapes

Temporomandibular joint
 References
1) NPTEL Online certification Courses - BIOMECHANICS OF JOINTS AND ORTHOPAEDIC
IMPLANTS
2) Bartel D.L., Davy D.T., Keaveny T. M. Orthopaedics Biomechanics: Mechanics and Design in
Musculoskeletal Systems, 2006, Pearson Prentice Hall, Pearson Education Inc, New Jersey.
3) Nordin M and Frankel V.H. Basic Biomechanics of the Musculoskeletal System, 3rd Edition,
2001, Lippincott Williams & Wilkins, Baltimore, Maryland.
4) Dowson D. and Wright V. An Introduction to the Bio-mechanics of Joints and Joint
Replacement, 1981, Mechanical Engineering Publications Ltd, London.
5) Wikipedia and [Link]
 General Structure of Synovial Joints
Synovial joints allow free movement of articulating bones within a
fluid-filled cavity, known as synovial cavity. Synovial fluid is the viscous
liquid containedinside a synovial joint that functions as a lubricant.

■ Articular cartilage
• Ends of opposing bones are coveredwith hyaline cartilage
• Absorbs compression

■ Joint cavity (synovial cavity)

• Unique to synovial joints
• Cavity is a potential space that holds a small amount of fluid
 General Structure of Synovial Joints
□ Articular capsule – joint cavity is enclosed in a two-layeredcapsule
■ Fibrous capsule – dense irregular connective tissue – strengthens joint
■ Synovial membrane – loose connective tissue
• Lines joint capsule and covers internal joint surfaces
• Functions to make synovial fluid

□ Synovial fluid – a viscous fluid similar to raw egg white

• Contains glycoproteinmolecules secretedby fibroblasts

The articular cartilage and the joints in general are nourished chiefly
by the synovial membrane.
 General Structure of Synovial Joints
□ Reinforcing ligaments
– Often are thickened parts of the fibrous capsule
– Sometimes are extracapsular ligaments – locatedoutside the capsule
– Sometimes are intracapsularligaments – located internal to the capsule

□ Richly supplied with sensory nerves

– Detect pain
– Monitor how much the capsule is being stretched

□ Have a rich blood supply

– Mostsupply the synovial membrane
– Extensive capillary beds produce basis of synovial fluid
– Branches of several major nerves and blood vessels
Synovial Joints

Shoulder joint
 Synovial Joints
Pelvic
Bone

Acetabulum
Femoral (socket)
Head

Femur

Knee joint Hip joint

 Temporomandibular Joints
Articular ■ ComplexJoint
Disk Fossa
■ Articular disc

Ligament
■ Gliding above disc
Condyle ■ Hinge below disc
Muscle
■ Movements:
- depression
- elevation
- protraction
- retraction
The TMJ is a hinge and gliding joint and is one of
the mostconstantly used joint in the human body
Types of Synovial Joints
• Planar Joint
• Hinge Joint
• Pivot Joint
• Saddle Joint
• Ball and Socket Joint
• Condyloid or EllipsoidJoint
Types of Synovial Joints
 Planar
Joint
■ Bone surfaces are slightly curved
■ Side to side movementonly
■ Rotationpreventedby ligaments
■ Examples:
- intercarpal to intertarsal joints
- sternoclavicular joint
- vertebrocostaljoints
 Hinge Joint
■ Convex surface of bone fits in concave surface of 2nd bone
■ Unilaterallike a door hinge
■ Examples:
- knee, elbow, ankle, interphalangeal joints
■ Movements produced:
- flexion
- extension
- hyperextension
 Pivot Joint
■ Rounded surface of bone articulates with the ring formedby the 2nd bone and ligament

■ Monoaxial since it only allows rotationaround the longitudinal axis

■ Examples:
- proximal radioulnar joint
- supination
- pronation
 Condyloid Joint
■ Spherically shaped bone fits into oval depression
■ Biaxial: flex/extend or adduct/abduct is possible
■ Examples:
- Wrist and metacarpophelangeal joints
 Saddle Joint
■ One bone saddle-shaped, other bone fits like a person riding on the saddle

■ Biaxial
- circumduction allows the tip of the thumb to travel in a circle
- oppositionallows thumb to touch tip of other fingers

■ Examples:
- Trapezium of carpus and metacarple of thumb
 Ball-and-socket Joint
• Ball fitting into a cup-like depression
• Multiaxial
- flexion/extension
- abduction/adduction
- rotation
• Examples:
- shoulder joint
- hip joint
 Factors Influencing Joint Stability
□ Shape of the articular surfaces
Shallow poor fitting articular surfaces hinder stability, whereas well
fitting articular surfaces (i.e. hip joint) improve stability

□ Ligaments
Ligaments unite bones and prevent excessive, undesirable motion

□ Muscle Tendon

Muscle tendons are the most important stabilizing factor

Movements of the Synovial Joints
The synovial joints offer a large range of movements

■ Flexion – Extension
■ Horizontal Flexion and Extension
■ Abduction – Adduction
■ Internal Rotation – External Rotation
 Special movements of hands and feet
• Palmar flexion and Dorsal flexion refer to movement of the flexion (palmarflexion) or extension
(dorsiflexion) of the hand at the wrist.

• Pronation and Supination refer to rotation of the forearm or foot so that in the anatomical position
the palm or sole is facing anteriorly (supination) or posteriorly (pronation) rotationof the forearm.

Dorsal flexion

Palmar flexion
 Special movements of hands and feet
• Dorsiflexion and Plantarflexionrefers to flexion(dorsiflexion) or extensionof the footat the ankle.

• Eversion and Inversion refer to movements that tilt the sole of the foot away from (eversion) or
towards (inversion) the midline of the body.
 Joint Disorders
■ Pain and restricted movement and resulting in reduction in productivity and quality of life for
people with damage to their major joints (hip, knee, shoulder, elbow)
Femoral neck
• Osteoarthritis 75% of joint replacements fracture

• Fracture 12%
• Rheumatoid arthritis 4%
• Others 9%
Decreased Intertrochanteric
joint space fracture

Exposed bone

Worn
cartilage

Arthritic hip joint Arthritic knee

21
 Arthroscopy and Arthroplasty
Knee
Joint □ Arthroscopy- examinationof joint
- minimally invasive surgery with instruments
- removal of torn knee cartilage or meniscus
- small incisions only

□ Arthroplasty- replacement of joints (e.g. hip, knee)

- total hip replaces acetablum and femoral head
- uses implants
- partial replacement (hemi-arthroplasty)

Total Hip Arthroplasty

Hip Resurfacing

“Synergy” total hip replacement

(Smith and Nephew)
 References

1) NPTEL Online certification Courses - BIOMECHANICS OF JOINTS AND ORTHOPAEDIC

IMPLANTS
2) Bartel D.L., Davy D.T., Keaveny T. M. Orthopaedics Biomechanics: Mechanics and Design in
Musculoskeletal Systems, 2006, Pearson Prentice Hall, Pearson Education Inc, New Jersey.
3) Nordin M and Frankel V.H. Basic Biomechanics of the Musculoskeletal System, 3rd Edition,
2001, Lippincott Williams & Wilkins, Baltimore, Maryland.
4) Dowson D. and Wright V. An Introduction to the Bio-mechanics of Joints and Joint
Replacement, 1981, Mechanical Engineering Publications Ltd, London.
5) Wikipedia and [Link]
 The Hip Joint
The hip joint forms the primary connection between the bones of the lower limb and the upper limb.
It is a synovial (diarthrodial) joint and the articulation forms a ball-and-socketjoint.

The hip joint consists of: Ball-and-socket joint

• Femoral head (ball)

• Acetabulum (socket)

Femoral Head

Source: [Link]
 Articulating Surfaces of the Hip Joint
Femoral Head Acetabulum
• Spans around two-third of a sphere • Horse-shoe shaped articular surface,
covered by hyaline cartilage
• Covered by hyaline cartilage, except
at fovea of the femur (fovea capitis). • Deep notch with narrow mouth

Ilium

Head of Femur Acetabulum

Acetabulum

Pubis
Ischium
Source: [Link]
 Functions of the Hip Joint
The hip joint is a major load bearing joint
Primary functions of the hip joint are:

■ to support to the body weight in both static (e.g. standing, sitting)

and dynamic (e.g. walking, running) postures.

■ to facilitate transfer of forces and moments (load transfer) from the

upper part of the body (trunk) to the lower extremities.

■ to enable a large range of movement and maintain stability during

these movements.

■ to retainbalance and to maintain the pelvic inclination (tilt) angle

Comparison between a neutral and

Source: [Link] anterior pelvic tilt – effect on height
 Hip Deformities:
■ Femoral neck-shaft angle Varus and Valgus
The angle between longitudinal axes of femoral neck and shaft, is called the caput-collum-diaphyseal
angle or CCD angle, normally measures approx 150° in newborn and 126° in adults (coxa norma).

Coxa vara is a deformity, where the neck-shaft

angle is reduced to less than 120 degrees. This
results in shortening of leg and development
of a limp (asymmetric abnormality of the gait).

Coxa valga is a deformity, where the

neck-shaft angle is increased, usually
greater than 135°.

Source: [Link]
 Hip Deformities: Anteversion and Retroversion
■ Femoral Neck Anteversion:
Angle between an imaginary transverse line oriented
along medial-lateral direction through the knee joint
15 - 20° and an imaginary transverse line oriented through
the center of the femoral head and neck.
Femoral Neck Anteversion: Normal angle 15 - 20°

˂ 10°

˃ 20°
Increased Femoral Neck Anteversion: angle ˃ 20° Femoral Neck Retroversion: angle ˂ 10°
 Muscles of the Hip Joint
Muscles of the hip joint consist of four main groups:

• Adductor: Adductor brevis, Adductor longus,

Adductor magnus, Pectineus, Gracilis

• Iliopsoas: Iliacus and Psoas major

• Gluteal: Gluteus maximus, Gluteus medius,

gluteus minimus, Tensor Fasciae Latae
Posterior View
• Lateral rotator: Obturators externus and internus,
Piriformis, Gemelli superiorand inferior, Quadratus femoris

• Other muscles: Hamstring, Rectus femoris, Sartorius

Anterior View
Source: [Link]
 Movements and Muscles of the Hip Joint
The movements in the hip joint along with the range of motions and the muscles are:
Flexion (140°) and Extension (20°) around the transverse axis (left-right) in sagittal plane

Flexor muscles: Extensor muscles:

iliopsoas (psoas major) gluteus maximus
tensor fasciae latae gluteus medius & minimus
adductor longus adductor magnus
adductor brevis long head of biceps femoris
pectineus semimembranosus
gracilis semitendinosus
piriformis

FLEXION EXTENSION

Source: Mihcin et al. (2021)

 Movements and Muscles of the Hip Joint
External or Lateral (30° with hip extended, 50° with hip flexed) rotationand
Internal or Medial (50°) rotationaround a vertical axis (along the thigh) in transverse plane
Lateral rotator muscles: Medial rotator muscles:
gluteus maximus gluteus medius & minimus
quadratus femoris tensor fasciae latae
obturator internus adductor magnus
gluteus medius & minimus pectineus
iliopsoas (psoas major)
obturator externus
adductor magnus
adductor longus
adductor brevis
adductor minimus
piriformis
sartorius EXTERNAL ROTATION INTERNAL ROTATION

Source: Mihcin et al. (2021)

 Movements and Muscles of the Hip Joint
Abduction (50° with hip extended, 80° with hip flexed) and
Adduction (30° with hip extended, 20° with hip flexed) around a sagittal axis (anterior-posterior)

Abductor muscles: Adductor muscles:

gluteus medius adductor magnus
tensor fasciae latae adductor minimus
gluteus maximus adductor longus
gluteus minimus adductor brevis
piriformis gluteus maximus
obturator internus quadratus femoris
obturator externus
semitendinosus
gracilis
pectineus

ABDUCTION ADDUCTION
Source: Mihcin et al. (2021)
 Ligaments of the Hip Joint
Hip joint is reinforcedby four ligaments:three extracapsular and one intracapsular

Extracapsular ligaments are:

• Iliofemoral ligament
• Pubofemoral ligament
• Ischiofemoralligament

Intracapsular ligament:Ligamentum Teres

(ligament of head of femur)

Source: Schleifenbaum et al. (2016) and Wikipedia

 Iliofemoral Ligament
• Ligament of Bigelow* – Y shaped ligament
• Strongest ligamentof body: resist the trunk from falling
backwards in standing posture.
• The upper (oblique) and lower (vertical) fibers form thick,
strong bands, while the middle fibers are thin and weak.

*American Surgeon Henry Jacob Bigelow described the structure and

function of the Iliofemoral ligament hip joint in great detail.
 Pubofemoral Ligament
• Supports the joint inferomedially
• Triangular shaped.

Anterior view
 Ischiofemoral Ligament
• The ischiofemoral ligament (ischiocapsular or ischiocapsular band) consists
of a triangular band of strong fibers on the posterior side.

• Ligament tends to restrict internal rotationof the hip,

regardless of whether the hip is flexed, extended, or
in neutral position.

Posterior view
 Acetabular Labrum
The acetabular labrum (or cotyloidligament) is a ring of cartilage that surrounds the acetabulum
• Fibrocartilaginous rim on the periphery of acetabulum
• Provides an articulating surface for the acetabulum,
allowing the femoral head to articulate with the pelvis

• Narrows the mouth of acetabulum - helps in holding

the head of femur in position
• Anterior portionis vulnerable during labrum tears

• Transverse acetabular ligament (transverse ligament) is a portion of the

acetabular labrum; however the ligament has no cartilage cells among its fibers.
 Factors affecting Hip stability
□ Shape of the acetabulum: Due to the depth of the acetabulum, it can encompass almost 60 – 70%
of the spherical femoral head. The depth provides a larger articular surface, further improving
the stability of the joint.

□ The iliofemoral, pubofemoral and ischiofemoral ligaments are very strong, and along with the
thickened joint capsule, provide a large degree of stability.

□ The structure of acetabular labrum provides the stability to the joint. It maintains a negative
pressure (acting as "vacuum seal") and enhances hip joint stability.
 Common Problems of the Hip Joint
Intracapsular Fracture
• It may be subcapital (near the head), cervical (in the middle) or basicervical (near trochanters).
• Such a damage is maximum in subcapital and least in basicervical fractures.
• These fractures are common in old age, between 60 and 80 years.

Subcapital Transcervical Basicervical

 Extracapsular Fracture
• Intertrochanteric (between the trochanters)
Trochanteric fractures
• Peritrochanteric (along the trochanters)

• Subtrochanteric (below the trochanters)

• These fractures occur in young adult subjects owing to severe traumaticinjuries.

Intertrochanteric Peritrochanteric Subtrochanteric

 Arthritis: Osteoarthritis
Bone degenerative disease, Osteoarthritis is the most common
form of arthritis in the hip joint.
• In osteoarthritis,the cartilage gradually wears away
• Results in bone-to-bone contact, producing bone spurs,
causes pain and stiffness, restricts movements.

Osteoarthritis
 Rheumatoid Arthritis
In rheumatoidarthritis, inflammation(swelling) of the synovial
membrane that covers the synovial joint, results in pain and stiffness.
Rheumatoid
Synovitis • Rheumatoid arthritis, an autoimmune disorder, occurs when the
Cartilage lining immune system mistakenly attacks the own body's tissues.

• The immune system damages normal tissue (such as cartilage

and ligaments) and softens the bone.

Rheumatoid arthritis
 References

1) NPTEL Online certification Courses - BIOMECHANICS OF JOINTS AND ORTHOPAEDIC IMPLANTS

2) Beverland D. (2010). The transverse acetabular ligament: optimizing version. Orthopedics, 33(9), 631.
3) Mihcin S, Ciklacandir S, Kocak M, Tosun A. (2021) Wearable Motion Capture System Evaluation for
Biomechanical Studies for Hip Joints. ASME. Journal of Biomechanical Engineering, 143(4): 044504.
4) Schleifenbaum S, Prietzel T, Hädrich C, Möbius R. (2016) Tensile properties of the hip joint ligaments are largely
variable and age-dependent - An in-vitro analysis in an age range of 14-93 years. Journal of Biomechanics,
49(14): 3437-3443.
5) Wikipedia and [Link]
6) American Academy of Orthopaedic Surgeons [Link]
 Anatomy of Knee joint
The knee joint is a major load bearing joint in the lower extremity, which forms the connection between the
thigh and the leg. It is the largest joint as well as a synovial (diarthrodial) joint. Knee is a modified hinge joint.

Femur Patella
The knee joint consists of the following joints:
■ Tibiofemoral joint - femur and tibia: between the medial and lateral
condyles of the femur and the corresponding tibial condyles

■ Patellofemoral joint- femur and patella: between the patella and

the patellar surface of the femur
Tibia

Fibula

Source: Wikipedia
 Articulating Surfaces of the Knee Joint
Tibiofemoral Patellofemoral
• Lateral and medial articulation • Intermediate articulation
• Articulations between tibial condyles and their cartilaginous • Articulation between the patella and the femur
menisci and the corresponding femoral condyles
Tibial collateral
Femoral meniscus
condyles

Tibiofemoral Posterior view

Joint
Patellofemoral
Joint

Medial
Knee X-ray Lateral meniscus
meniscus
Fibula
Source: [Link]
 Functions of the Knee Joint
The knee is a weight bearing joint

Primary functions of the knee joint are:

■ to support to the heavy loads, body weight in both static (e.g. standing,
sitting) and dynamic (e.g. walking, running) postures.

■ to facilitate load transfer, forces and moments, from the upper part of the
body to the ankle and foot.

■ to facilitate human locomotion

■ to enable a range of movement and maintain stability during these

movements.
The Patella (Knee Cap)
■ The patella is a ‘sesamoid’ (round) floating bone.

Functions
■ Protectionof the knee joint

■ Provide mechanical advantage:

• It aids in knee extensionby producing anterior

displacement of quadriceps tendon, hence increasing
the moment arm of quadricep muscle force.
• It allows a wider distribution of compressive
stress on femur, by increasing the area of
contact between patellar tendon and femur.
 Menisci
The articular disks of the knee-joint are called menisci. The medial and lateral menisci are C-shaped
fibrocartilage disks, attached at both ends of the intercondylararea of the tibia.

Functions of the Menisci:

• Deepens the articular surface of the tibia, thus increasing
stability of the joint
• Improves congruence of the joint
• Distributes load bearing forces
• Decreases frictionbetween tibia and femur
• Acts as shock absorber

Anterior View
Source: Adapted from [Link]
 Knee Deformities: Varus and Valgus
Varus deformity (genu varum) causes the knees to bend outward, giving a bow-leggedappearance; this
configurationputs additional pressure on the inner (medial) compartment of the knee joint.
The opposite deformity is valgus (genu valgum).
Varus Valgus

Mechanical axis
Axis of femoral
of femur
shaft

Projectionof
mechanical axis
of femur

Axis of tibial
shaft d
d

d = angle of deformity
Normal Varus Valgus
 Muscles of the Knee Joint
Muscles of the knee joint consist of two main groups:

■ Quadriceps: vastus medialis, vastus intermedius,

vastus lateralis, rectus femoris

■ Hamstring:semimembranosus, semitendinosus,
biceps femoris

Other muscles:
Gluteal (gluteus maximus, gluteus medius, gluteus
minimus), Popliteus and Calf (soleus and gastrocnemius)

Quadriceps Hamstring
Anterior View Posterior View

Source: Adapted from [Link]

 Movements and Muscles of the Knee Joint
The knee is a modifiedhinge joint, which permits flexion and extension as well as slight internal and external
rotation.
Flexor muscles: range of motion 120 – 150° Extensor muscles: range of motion 5 – 10°
Semimembranosus Quadriceps
Semitendinosus Sartorius
Biceps femoris
Rectus femoris
Iliopsoas
Gracilis
Sartorius Flexion
Popliteus Extension
Gastrocnemius
Movements and Muscles of the Knee Joint
The knee permits only slight internal and external rotation

External rotator muscles: maximum 30° (for knee flexed at 90°)

Biceps femoris
External Rotation

Internal rotator muscles: maximum 10° (for knee flexed at 90°)

Internal Rotation Semimembranosus
Semitendinosus
Gracilis
Sartorius
Popliteus
Ligaments of the Knee Joint
The major ligaments in the knee joint are:

• Medial collateral ligament

• Lateral collateral ligament
• Anterior cruciate ligament
• Posterior cruciate ligament
• Patellar tendon (ligament)
Medial and Lateral Collateral Ligaments
■ Collateral ligaments - two strap-like ligaments. They act to
stabilize the hinge motionof the knee, preventing
excessive medial or lateral movement.

■ Medial collateral ligament

• Thick, wide and flat ligament;proximally
attaches to the medial epicondyle of the femur,
distally to the medial condyle of the tibia.

■ Lateral collateral ligament

• Thinner, rounder ligament; attaches proximally to
the lateral femoral epicondyle, distally attaches to a
depression on the lateral surface of fibular head.
Patellar Tendon (Ligament)

■ Patellar ligament
• Continuationof the quadriceps tendon, distal to the
patella.
• Attaches to the tibial tuberosity.
Anterior and Posterior Cruciate Ligaments
■ Cruciate Ligaments – these two ligaments connect the
femur and the tibia. In doing so, they cross each other,
hence the term ‘cruciate’.

■ Anterior cruciate ligament:

• Attaches at the anterior intercondylar regionof the
tibia where it blends with the medial meniscus.
• Ascends posteriorly to attach to the femur in the
intercondylar fossa.
• Prevents anterior dislocation of the tibia with
respect to the femur.
Posterior Cruciate Ligament
■ Posterior cruciate ligament

• Attaches at the posterior intercondylar regionof

the tibia and ascends anteriorly to attach at the
anteromedial femoral condyle.
• Prevents posterior dislocationof the tibia with
respect to the femur.
 Factors affecting Knee stability
□ Tissue structure: Stability is provided by the Joint capsule, the menisci and the ligaments.

□ The ligaments of the knee provide the primary stability. Collectively the ligaments help to
maintain optimal knee stability.

□ The ligaments and menisci provide static stability and together with the muscles and
tendons provide dynamic stability.
Common Problems of the Knee Joint
Cruciate ligamenttear
• Anterior cruciate ligament is the most commonly injured ligament of
the knee.
• Posterior cruciate ligament tears make up less than 20% of injuries
to knee ligaments.
 Common Problems of the Knee Joint
■ Patellar tendinitis
• Patellar tendinitis is an inflammationof the patellar ligament
Longitudinal tear
due to overuse and stress on the patellofemoral joint.

Location of pain in
patellar tendinitis
■ Meniscus tears
Stitches • Meniscus tears are among the most common knee injuries.
• Meniscus can tear with forceful twisting or rotation of the knee.
• Athletes, particularly those who play contact sports, are at
high risk of meniscus tears.

Source: Wikipedia
 Knee Arthritis
The most common types of knee arthritis are osteoarthritis and rheumatoid arthritis.
Bone degenerative disease, Osteoarthritis is commonin the knee joint.
• In osteoarthritis,the cartilage gradually wears away.
• Results in bone-to-bone contact, producing bone spurs, causes
pain and stiffness, restricts movements.

Osteoarthritis
 Rheumatoid Arthritis
In rheumatoidarthritis, inflammation(swelling)of the synovial membrane
that covers the synovial joint, results in knee pain and stiffness.

• Rheumatoid arthritis, an autoimmune disorder, occurs when the

immune system mistakenly attacks the own body's tissues.

• The immune system damages normal tissue (such as cartilage and

ligaments) and softens the bone.

Rheumatoid arthritis
 References

1) NPTEL Online certification Courses - BIOMECHANICS OF JOINTS AND ORTHOPAEDIC

IMPLANTS
2) Bartel D.L., Davy D.T., Keaveny T. M. Orthopaedics Biomechanics: Mechanics and Design in
Musculoskeletal Systems, 2006, Pearson Prentice Hall, Pearson Education Inc, New Jersey.
3) Nordin M and Frankel V.H. Basic Biomechanics of the Musculoskeletal System, 3rd Edition,
2001, Lippincott Williams & Wilkins, Baltimore, Maryland.
4) Dowson D. and Wright V. An Introduction to the Bio-mechanics of Joints and Joint
Replacement, 1981, Mechanical Engineering Publications Ltd, London.
5) Wikipedia and [Link]
6) American Academy of Orthopaedic Surgeons [Link]
 The Shoulder Joint
The shoulder joint is an example of a very complex
musculoskeletal structure, consisting of a chain of bones
connecting the upper extremity to the trunk.
Clavicle
Scapula

Humerus
Thoraciccage
(Rib cage)

Front view

Source: [Link] staff (2014). Medical gallery of Blausen Medical 2014 WikiJournal of Medicine 1 (2).
[Link]
The Shoulder Joint: a ball-and-socket joint
 The Shoulder Girdle 4
3

The bony structures of the shoulder girdle 5

6
1. Humerus 3. Clavicle 5. Greater Tuberosity 2

2. Scapula 4. Coracoid Process 6. Lesser Tuberosity

1

Joints consisting the shoulder joint:

a. GlenoHumeral (GH) joint
b. AcromioClavicular (AC) joint
c. SternoClavicular (SC) joint
d. ScapuloThoracic Gliding Plane (STGP)
 The Scapula: Structure

Supraspinous Fossa Spine Infraspinous Fossa

Glenohumeral Joint
Source: Figure adapted from [Link]
 Shoulder Movements Horizontal
Flexion
Normal movements of the shoulder are: Neutral plane
of scapula

Abduction Adduction
■ Abduction and Adduction

■ Flexion and Extension

Abduction Adduction ■ Horizontal Flexionand Extension Horizontal
Extension
■ Internal and External Rotation Horizontal Flexion and Extension

Flexion Extension

Internal External
rotation rotation
Flexion Extension Internal and External Rotation
 Shoulder Muscles: Attachment Sites
Clavicle

Clavicle

Scapula
Scapula
Humerus
Origin
Insertion Humerus

Anterior View Posterior View

Source: Figures adapted from [Link]

 Rotator Cuff
The rotator cuff is a group of tendons and muscles in the shoulder, connecting the upper arm
(humerus) to the shoulder blade (scapula), that enables rotation in the joint.

The bursa is a fluid-filled sac that

Anterior View provides cushion to the joint. Posterior View

Source: Figures adapted from Wikipedia and [Link]

 Rotator Cuff Muscles Supraspinatus

Muscles include:
• Teres minor
• Infraspinatus
• Supraspinatus Infraspinatus
Infraspina
Teres Minor
tus
• Subscapularis Subscapularis
Anterior view Anterior view Posterior view

Posterior view

■ Each muscle inserts at the scapula, and has a tendon that attaches to the humerus.

■ These muscles enable joint rotationand provide rotational stability to the shoulder.

■ Tears in the tendons of these muscles are called rotator cuff tears.
Supraspinatus is the most-commonly-affected muscle.

10
 Shoulder Joint Ligaments
■ Coraco-acromial

■ Coraco-humeral

■ Glenohumeral (joint capsule)

■ Coraco-clavicular – Conoid ligament

– Trapezoid ligament
Function:
• Provide stability to the joint
• Glenohumeral ligament helps to hold the
shoulder in place and prevents dislocation.
Source: Wikimedia Commons
 Common Shoulder Problems
The shoulder joint offers the largest range of motions in the body, but is an unstable joint owing to the
range of movements.
This instability increases potential risk of joint injury, often leading to a
degenerative process, eventually causing pain and reduced mobility; may
also lead to impingement of soft tissue or bony structures, resulting in pain.

Most shoulder problems fall into four major categories:

■ Tendon inflammation(bursitis or tendinitis) or tendon tear
■ Instability
■ Arthritis
■ Fracture (broken bone)
Other much less common causes of shoulder pain are
tumors, infection, and nerve-relatedproblems.
Source: Figure adapted from [Link]
 Common Shoulder Problems
Splitting and tearing of tendons: resulting from acute injury or
degenerative changes in tendons due to age, overuse or a sudden injury.
Rotator cuff and biceps tendon injuries are most common injuries.

Impingement: occurs when the acromionpressurizes the underlying soft Inferior

tissues during abduction. As the arm is lifted, the acromionimpinges on Subluxation

the rotator cuff tendons and bursa. This can lead to bursitis and tendinitis, Dislocation
causing pain and restrictedmovement.

Shoulder instability: occurs when the humeral head is forced out of the
shoulder socket (glenoid cavity). This can happen due to a sudden injury
or from overuse. If the ligaments, tendons, and muscles around the joint
become loose or torn, dislocations can occur.
Repeated subluxations or dislocations may lead to arthritis.
 Common Shoulder Problems
Arthritis: Shoulder pain and stiffness can occur owing to degenerative joint diseases
in synovial joints, like Osteoarthritis and Rheumatoid Arthritis. The glenohumeral
and acromio-clavicular joints are affected, resulting in restricted movement.

Osteoarthritis
Fracture: might occur in the clavicle (collarbone), humerus (upper arm bone), and
scapula (shoulder blade).

FrozenShoulder: is a condition that restricts motions of the glenohumeral joint. It is characterized

by stiffness and pain in the joint, which becomes stuck and its movement is limited.

Source: Wikipedia and [Link]

The Elbow Joint
 The Elbow Joint: Structure and Joints
Joints:
■ Humero-ulnar joint

■ Radio-humeral

■ Radio-ulnar Joint

Anterior view Posterior view

 The Elbow Joint

Lateral view Medial view

 Elbow Joint
Normal range: flexion
0° to 150° Movements Normal range: extension
150° to 0°
■ Flexion and Extension

■ Pronationand Supination

Flexion Extension

Normal range:
Normal range:
75° - 90°
75° - 90°

Supination Neutral Pronation

Source: Figures adapted from [Link]
 Structure and
Humero-Ulnar Articulation:
• Hinge Joint
Articulation
• Movements: Flexionand Extension
• Trochlea (humerus) and Trochlearnotch (Ulna)
• High degree of congruency

~ 40° Space for flexor muscles

Humeral axis

Humerus

Trochlear axis Range of

Olecranon movement
Fossa ~ 150°

Olecranon Ulna
Process
 Structure and Articulation
Radio-Humeral Articulation
Axis of radial
movement Annular
ligament
■ Spherical capitulum (humerus) and concave end-face of radial head
■ Allows
Obliquerotation of the radius at any angle of elbow flexion
cord Ulna

■ Lack of congruency
Interosseous
membrane
■ Movements: Pronation and Supination
Radius
Radius

Pronation
Supination
Source: Figures adapted fromDowson and Wright (1981)
and Wikipedia commons
 Elbow Joint: Movements and Muscles

Main extensor muscles: Triceps brachii Main flexor muscles: Brachialis, Biceps Brachii,
Source: Figures adapted fromDowson and Wright (1981) Brachioradialis
and Wikipedia commons
 Elbow Joint: Movements and Muscles

Ulna

Main supination muscles:

Supinator, Biceps Brachii
Main pronation muscles: Pronator
Quadratus, Pronator Teres Source: Figures adapted from Dowson and Wright (1981)
and Wikipedia commons
 Ligaments of the Elbow Joint
Stability of the elbow joint is provided by the ligaments:
■ Ulnar Collateral Ligament
- stretches from the anterior side of the medial
epicondyle of humerus to the medial edge of
coronoid process of the ulna.
Ulnar Collateral Ligament ■ Radial Collateral Ligament
- stretches from the lateral epicondyle of
humerus to the annular ligament deep to
the common extensor tendon.
■ Annular Ligament
- a strong band of fibers that encircles the head of
the radius, and retains it in contact with the radial
notch of the ulna.

Annular Ligament Source: Wikipedia and [Link]

 Problems of the Elbow Joint
Arthritis: Rheumatoid arthritis is most common at the radio-ulnar joint. It results in pain, stiffness,
and deformities.
Tennis Elbow
Tennis elbow: also known as lateral epicondylitis, is a condition in
which the outer part of the elbow becomes painful and tender.
The pain may also extend into the back of the forearm and grip
strength may be weak.

Golfer's elbow:is a similar condition that affects

the inside of the elbow; causes pain where the
tendons of the forearm muscles attach to the
bony bump on the inside of your elbow. The
pain might spread into your forearm and wrist.

Source: Wikipedia and [Link]

 References

1) NPTEL Online certification Courses - BIOMECHANICS OF JOINTS AND ORTHOPAEDIC

IMPLANTS
2) Bartel D.L., Davy D.T., Keaveny T. M. Orthopaedics Biomechanics: Mechanics and Design in
Musculoskeletal Systems, 2006, Pearson Prentice Hall, Pearson Education Inc, New Jersey.
3) Nordin M and Frankel V.H. Basic Biomechanics of the Musculoskeletal System, 3rd Edition,
2001, Lippincott Williams & Wilkins, Baltimore, Maryland.
4) Dowson D. and Wright V. An Introduction to the Bio-mechanics of Joints and Joint
Replacement, 1981, Mechanical Engineering Publications Ltd, London.
5) [Link]
6) American Academy of Orthopaedic Surgeons [Link]
7) Wikipedia and [Link]
 The Spine
The spine or the backbone is the central support structure of the human Brainstem
body. Spine connects different parts of the musculoskeletal system.
Spinal cord

Vertebra

■ The spinal column consists of:

- vertebrae Nerves Disc
- intervertebral discs Vertebra
- spinal cord
Spinal cord Cauda
equina
(bundle of
nerves)

■ The spinal cord is the main pathway for information connecting the
brain and peripheral nervous system.
 Functions of the Spine
Primary functions of the spine are to:

■ Provide protectionto the spinal cord, nerve roots and

several internal organs of the body.

■ Provide structural support and balance to maintain an

upright posture.

■ Enable sufficient physiologic mobility and flexibility

 Structure of the Vertebral Column
The human spine consists of 33 vertebrae, each one stacked over the other.

• Cervical vertebrae (seven, C1 – C7)

• Thoracic vertebrae (twelve, T1 – T12)
• Lumbar vertebrae (five, L1 – L5)
• Sacrum vertebrae (five fused bones)
• Coccyx (three to four fused coccygeal segments)

A healthy spine has three natural curves that resemble an

S-shape in the sagittal plane. These curves absorb shocks
on the body and protect the spine from injury.

Source: Wikipedia
 Sacrum and Coccyx
■ The sacrum, is a large, flat triangular shaped bone
located between the pelvic bones and positioned
below the last lumbar vertebra (L5). Connection with
the iliac bone forms the sacroiliac joint (either sides).
S1

S2

S3 ■ The pelvic girdle comprises of the sacrum along with

S4 the coccyx and the two sacroiliac joints.
S5

■ The coccyx, commonly known as the tailbone, is the

Co1
Co2
Co3
Co4
final segment of the vertebral column.

■ It comprises of fused coccygeal vertebrae below the sacrum, attached

by a fibrocartilaginous joint (the sacrococcygeal symphysis), which
permits limitedmovement between the sacrum and the coccyx.
 Relationship between Structure and
Function of the Spine
The structure of the spine withstand the combined load of the head, shoulder
and thorax. The upper body weight is transferredto the lower extremity
through the sacrum and the pelvis.

■ Resistance to axial loads on the spine are offeredby:

- the S-shaped (in sagittal plane) curved structure
- increase in size, mass and load carrying capacity of each vertebrae
from C1 to sacrum

■ Elasticity of the spine is accomplished by:

- the curved shape of the structure
- multiple motionsegments (Functional Spinal Units)
 Functional Spinal Unit
The Functional Spinal Unit (FSU), or the motion segment, is
the smallest segment of the spine that exhibits biomechanical
characteristics similar to those of the entire spine.

The FSU consists of:

• two adjacent vertebrae
• intervertebral disc
• two facet joints with ligaments (without muscles)

Spinal Cord

Source: Fatima et al. (2020)

 Facet joint
• Facet joints are a set of synovial joints
that limits the amount of motion of the
vertebrae in six degrees of freedom and
act to transmit loads to the disc.

• Facets are stabilizing structures and carry

almost one-third of the total compressive
load borne by the spine segment. Facet

Source: Kushchayev et al. (2018)

 Vertebra
A vertebra consists of the following bony structures:
Posterior
■ vertebral body (anterior part)

■ vertebral arch (posteriorpart), consists of

• four articulating facets (two superior and two inferior)

Pedicle • two pedicles and lamina

• two transverse process
• one spinous process
Anterior

Source: Fatima et al. (2020)

 Vertebrae
Articulating facets

The vertebral body is a roughly cylindrical

mass of cancellous bone contained within
Cortical bone
a thin shell of cortical bone.
Cancellous bone

Vertebral end-plates
Its superior and inferior surfaces (slightly
concave) are the vertebral end-plates.

Intervertebral disc

Source: Kushchayev et al. (2018)

 Intervertebral Disc
■ The intervertebral disc (IVD) is an fibrocartilage
that lies between two adjacent vertebrae in the
vertebral column. Each disc forms a
fibrocartilaginous joint (a symphysis), allows only a
slight movement of the vertebrae, acts like a
ligament to hold the vertebrae together, functions
as a shock absorbing spacer for the spine.

■ The intervertebral disc consists of two

distinct parts:
• annulus fibrosus Source: Fatima et al. (2020)
• nucleus pulposus
■ The intervertebraldisc displays viscoelastic (elastic + viscous) material properties;
exhibits creep and stress relaxationmechanical behaviour.
■ The annulus fibrosus
Intervertebral
consists of several
Disc
concentric layers of fibrocartilage, with annular
fibres embedded in the ground matrix.

■ The nucleus pulposus contains loose fibres

Annulus fibres
suspended in a gel with the consistency of a jelly
(gelatinous). It has high water content and it
resists axial load.

■ The strong composite of annulus fibrosus ground

matrix and annular fibres encloses the nucleus
pulposus that helps to distribute the pressure
evenly across the disc.

Source: Kushchayev et al. (2018)

 Ligaments of the Spine Anterior longitudinal
ligament (ALL)
• Ligaments are strong fibrous bands of Posterior longitudinal
ligament (PLL)
tissues that hold the vertebrae together
and provide stability to the spine within Ligamentum
its physiologic range of motion. Flavum (LF)

Inter transverse
• Excessive movements, such as hyper- ligament (ITL)
Supra spinous ligament (SSL)
extension or hyper-flexion are Inter spinous ligament (ISL)
restrictedby the ligaments. Capsular
ligament (CL)

• There are seven types of ligaments.

 Movements of
Movements of the spine are:
the Spine Lateral
bending
Rotation
■ Flexion and extension(in sagittal plane)
Flexion
■ Lateral bending – left and right (in coronal plane)
■ Rotation – left and right (in transverse plane)

Extension

Source: Fatima et al. (2020)

Cervical Spine: Structure and Function
The cervical spine is the most superior portion of the
vertebral column that provides mobility and stability to
the head while connecting it to the relatively immobile
thoracic spine. Cervical vertebra
(C3-C7)

The range of motion (RoM) of cervical spine (approx): Occiput

• Flexion: 80° to 90°

• Extension: 70°
• Lateral bending: 20° – 45°
• Rotation:90° both ways

Source: Wikipedia
 Atlanto-Occipital joint: Cervical Spine
The atlas is the first cervical vertebra (C1) and
Atlanto-occipital joint
Dens
articulates with the occiput of the head and the
second cervical vertebra axis (C2).

The movement of nodding the head takes place

predominantly through flexion and extension at
Atlas (C1) the atlanto-occipital joint.

Axis (C2)
 Thoracic Spine: Structure and Function
The main function of the thoracic spine is to
hold the rib cage and protect the heart
and lungs.

There are 12 thoracic vertebrae in humans,

and these bones increase in size and mass
from T1 to T12. The increase in size and
mass ensures more support to the weight of
Thoracic FSU
the body.

The range of motion(RoM) of thoracic spine

is very limited due to joint articulations.

Source: Wikipedia
 Lumbar Spine: Structure and Function
■ The main function is to bear the weight of upper part of body and
transfer the forces and bending moments to the sacrum.

■ The vertebrae are much larger in size to withstand heavy loads

during daily activities.

■ The lumbar spine is more mobile than the thoracic spine and also
carries more weight, making it the most likely regionsusceptible Lumbar FSU
to injury in the spine.

The range of motion (RoM) of the lumbar spine are:

• Combined flexion/extension: 40° to 90°
• Lateral bending: 20° to 45°
• Rotation: 5° to 15°
Source: Wikipedia
 Disc Degenerative Disease (DDD) of the
Spine • Symptoms:back or neck pain and stiffness,
common in cervical or lumbar region.

• Degeneration means a specific injurious change in the

composition, structure and function of the spine.

• Leads to disc dehydration, reduction in disc

height, disruption of outer annulus lamellae,
appearance of cracks and fissures.
Reduced disk height Osteoarthritis

With more severe disc dehydration and reduction of disc height, more load is carried by
the facet joints, compared to healthy spine, eventually leading to facet joint osteoarthritis.

Source: Kushchayev et al. (2018)

 Stages of Disc Degenerative Diseases (DDD)
I II III

• Homogeneous disc structure • Inhomogeneous disc structure • Inhomogeneous disc structure

• Normal disc height • Normal disc height • Normal disc height

IV V

• Inhomogeneous disc structure • Inhomogeneous disc structure

• Reduced disc height • Disc height collapsed

Source: Palepu et al. (2012)

 Treatment
Conservative
• Physiotherapy
• Medicine

Surgery
Fusion Non-fusion
• Fusion
- Surgical procedure that involves fusionof two adjacent
vertebra using interbody cage and pedicle screws

• Non-fusion
- Surgical procedure that involves replacing of IVD with an
artificial intervertebral disc
 References

1) NPTEL Online certification Courses - BIOMECHANICS OF JOINTS AND ORTHOPAEDIC IMPLANTS

2) Fatima, S.G., Ruben, L.L., Marina, C.B., Ruben E.G. (2020), Improvement in determining the risk of
damage to the human lumbar functional spinal unit considering age, height, weight and sex using a
combination of FEM and RSM. Biomechanics and Modeling in Mechanobiology. 19: 351-387.

3) Kushchayev, S.V., Glushko, T, Jarraya, M, Schuleri, K.H., Preul M.C., Brooks M.L., Teytelboym O.M. (2018),
ABCs of the degenerative spine. Insights into Imaging. 9: 253-274.

4) Palepu, V, Kodigudla, M, Goel, V.K. (2012), Biomechanics of Disc Degeneration. Advances in Orthopedics.
[Link]

5) Wikipedia and [Link]