Skeletal Malalignments of the Lower Quarter: Correlated and Compensatory Motions and Postures

Abstract

Pathology of structures within the neuromusculoskeletal system can result from skeletal malalignment, which the authors define as either abnormal joint alignment or deformity within a bone. Pathology can also result from correlated or compensatory motions or postures, which may accompany skeletal malalignment. The purposes of this clinical perspective are to: I) link common lower limb skeletal malalignments to their common correlated and compensatory motions and postures; and 2) document the age-specific normal skeletal postural alignment for joints and bones of the lower limb. The authors have combined literature review with their clinical perspectives and the clinical perspectives of selected colleagues in this paper to compile this information, which should be beneficial to health professionals involved in assessment, treatment, and prevention of lower quarter neuromusculoskeletal dysfunction.

Identifying Relationships Among Lower Extremity Alignment Characteristics

“…14 This would suggest that the identified valgus alignment factor and femoral anteversion were more pronounced in females than in males. As previously described by Riegger-Krugh and Keysor, 13 the relationships among alignment characteristics can be structural or functional in nature, with the position of one segment depending on alignment deviations of an adjacent segment or resulting from compensatory changes toward more efficient dynamic function. As all individuals are known to be different in structure, the positioning of adjacent segments in response to a specific alignment difference would also be unique to that individual, likely explaining the somewhat low correlation values presented in Tables 3 and 4.…”

“…13 These postures were suggested to result from several factors, such as deviations in skeletal alignment (eg, when the position of one segment depends on the position of an adjacent segment) and changes toward efficient dynamic function (eg, when positioning of the limb is altered to improve neuromechanical efficiency). In an effort to account for the potential interactions among lower extremity alignment variables in future studies, our purpose was to measure several lower extremity alignment variables and determine whether distinct relationships among the variables could be identified.…”

Landing Biomechanics in Participants With Different Static Lower Extremity Alignment Profiles

“…The rationale for this approach is based on evidence that static LEA variables are not independent of one another but rather interact along the lower extremity kinetic chain. 21,22 Therefore, the first purpose of our study was to measure static LEA characteristics along the kinetic chain and cluster participants into lower extremity profile groups based on the similarities and differences in their LEA characteristics. Our expectation was that the clusters would be defined by similarities in static alignments of the proximal anatomical structures (pelvis or femur) versus the distal anatomical structures (tibia or foot).…”

Anatomy, Function, and Rehabilitation of the Popliteus Musculotendinous Complex

“…The femoral rotation variability reported by Reischl et al, 58 Tiberio, 64 Heiderscheit et al, 19,20 and Levens et al 34 may partially expose the influences of variable lower extremity postural alignment 49,59 on long-axis tibial and femoral rotation and associated popliteus function. Conceivably, when the tibia is relatively fixed and the femur is in the same relative starting position, subjects with increased external tibial torsion may require increased femoral external rotation to achieve relative knee joint internal rotation during stance phase.…”