Basics of

Biomechanics
 Basics of
Biomechanics
Dr Ajay Bahl
MD (Medicine) MS (Orthopaedics)
DA, DHA, DPMR, FIAMS, FAIMS, FIACM
Professor (Orthopaedics) IMA College
Chairman, IMA Academy of Medical Specialities
Chief of Accident, Trauma and Emergency Services
Maulana Azad Medical College
and associated
Lok Nayak, GB Pant and GNEC Hospitals
New Delhi, India

Dr Sharad Ranga
PhD (AM) DPOE (Mumbai)
Head of Department,
Orthotics and Prosthetics
Pt Deen Dayal Upadhyaya Institute for
the Physically Handicapped
New Delhi, India

Rajnish Sharma
DPO, AMIE (A)
Department of Orthotics and Prosthetics
Pt Deen Dayal Upadhyaya Institute for
the Physically Handicapped
New Delhi, India

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Basics of Biomechanics
© 2010, Ajay Bahl, Sharad Ranga, Rajnish Sharma

All rights reserved. No part of this publication should be reproduced, stored in a

retrieval system, or transmitted in any form or by any means: electronic, mecha-
nical, photocopying, recording, or otherwise, without the prior written permission of
the authors and the publisher.

This book has been published in good faith that the material provided by authors
is original. Every effort is made to ensure accuracy of material, but the publisher,
printer and authors will not be held responsible for any inadvertent error(s). In case
of any dispute, all legal matters to be settled under Delhi jurisdiction only.

First Edition: 2010

ISBN 978-81-8448-754-1
Typeset at JPBMP typesetting unit
Printed at .......................................
 Preface

The purpose of this book is to present the basic facts, the conceptual
ideas and the general principles. It reviews and applies the different
aspects of Human locomotion, anatomy, etc.
The concepts given in this book are useful for the Undergraduate
students of Prosthetics and Orthotics, Physical Therapy, Occupation
Therapy, the activities of daily living, in therapy and orthopaedics,
rehabilitation and adapted physical education for the disabled,
industrial and occupational work. This book will be useful for the
beginners, since the basic concepts have been reflected from the
foundation level. This may also be used as a reference book by the
practitioners in the field of Orthopedics, Rehabilitation, etc.
We are very much thankful to different personalities who have
contributed their time and energy for the successful completion of
this book.

Dr Ajay Bahl
Dr Sharad Ranga
Rajnish Sharma
 Contents

1. Motion ......................................................................................... 1

2. Force .......................................................................................... 12

3. Velocity ..................................................................................... 21

4. Acceleration ............................................................................. 26

5. Friction ...................................................................................... 30

6. Work .......................................................................................... 43

7. Energy ....................................................................................... 49

8. Power ........................................................................................ 56

9. Scalar and Vector Quantities ................................................ 58

10. Torque ...................................................................................... 61

11. Rotation .................................................................................... 66

12. Body Movements .................................................................... 72

13. Normal Human Locomotion ................................................. 81

14. Pathological Gaits or Abnormal Walking ........................... 87

15. ADL ........................................................................................... 90

16. Prosthesis ............................................................................... 100

17. Lower Extremity Prosthesis ................................................. 103

18. Upper Limb Prosthesis ........................................................ 128

19. Spinal Orthotics .................................................................... 144

20. Orthotics ................................................................................. 162

viii Basics of Biomechanics

21. Upper Limb Orthoses .......................................................... 170

22. Lower Limb Orthoses .......................................................... 180

23. Foot Orthosis .......................................................................... 209

Index ........................................................................................ 217

 1 Motion

Motion is the most common natural phenomenon. Movement of

vehicles, flowing of river, rumbling of leaves, flying of birds,
movement of normal individuals, and diseased states like
hemiplegics, paraplegics, etc. are the common examples of motion
in nature.
Some objects like electric motors, fans, machines in factories stay
at their own places but their parts like blade, etc. are seen rotating. In
some machines different parts are moving differently. For example,
when a sewing machine is paddled, the wheel moves round, the
needle moves up and down and the cloth keeps moving forward.
As we observe everyday the sun rises in the east in the morning,
gradually moves across the sky during the day and sets in the West
in evening. At night the moon is seen moving across the sky. Motion
of certain objects is not visible but can be inferred indirectly. For
example, we never see air moving but we detect its motion when it
moves the leaves of tree, small bit of paper or the curtains of our
house.
In fact everything in the universe, right from the electron inside
the atom to the largest galaxy in the universe is in motion.
All motions are relative and there is nothing like absolute motion.
Hence, the motion may be defined as change in position of a body
with respect to the positions of other objects with the passage of
time. The motion is the continuous change in the position of an
object with the passage of time, so in order to study the motion of a
body, the position of a moving body at various instants of time should
be observed. The simplest type of motion which needs to be explained
initially is “motion in a straight line”. The motion by being relative
in nature is explained with reference to a fixed point called origin.
Like in our body the term proximal and distal are explained in terms
of a fixed body part, i.e. head of the body.
2 Basics of Biomechanics

In order to locate the exact position of a body, we should know

its direction and distance from origin. As the body moves its position
changes with the passage of time.
To locate the position of an object, we first choose the origin. ‘O’
and next a reference line ‘OY’ called reference axis. The position of a
moving object at any instant of time can be located by knowing:
A. The distance of the object from origin say OA as r¹ , and
B. θ¹ is the angle which the line joining the origin ‘O’ and point A
(i.e. the line OA) makes with the reference axis OY.
The two positions A and B of the moving object at two different
instants of time are shown in Figure 1.1. The quantities (r1 θ1) and
(r 2 θ2) locate respectively the position A and B of the moving point
object at two different times.

Fig. 1.1: Locating the position of a moving object

UNIFORM MOTION
If a body covers equal distances in equal intervals of time, in the
same direction then its motion is called uniform motion or in other
words, whenever a body is in uniform motion neither its speed nor
its direction of motion changes with the passage of time.

NON UNIFORM MOTION

It is observed that a car starting from the rest, gradually gains its
speed, it moves faster and faster. It covers large distances in each
successive seconds of its motion. If a body covers unequal distances
in equal intervals of time its motion is called non uniform motion.
Falling of an apple from a tree, a cyclist moving on a rough road, an
athlete running on race, people moving through a crowd and a vehicle
starting from the rest are the good examples of non uniform motion.
 Motion 3

GRAPHICAL REPRESENTATIONS OF UNIFORM AND

NON UNIFORM MOTION
The distance time graph of two men ‘X’ and ‘Y’ when ‘X’ is walking
and ‘Y’ is running. They are moving in the same direction as shown
in Figures 1.2 and 1.3. The man ‘X’ covers 10 meters in one second,
another 10 meters in next seconds and so on. Whereas the man ‘Y’ ,
an athlete runs gradually faster and faster (as shown in Figure 1.3).
Therefore, we can see from the Figures 1.2 and 1.3. That the graph of
the Uniform motion is a straight line, whereas the graph of the non
uniform motion is a curved line.

Fig. 1.2: Uniform motion

The distance—Time graph is a straight line

Fig. 1.3: Non Uniform motion

The distance—Time graph is a curved line
4 Basics of Biomechanics

Equation of Motion
First Equation of motion ( V = U + at )
Let us consider velocity of a body under uniform acceleration ‘a’
changes from U to V in interval of time ‘t’.
On a velocity—Time graph, the initial velocity U is represented
by time ‘t’ = O by a point P on the Y—axis and the line QR is drawn
parallel to Y—axis and line PR is drawn parallel to X—axis.
Hence acceleration ‘a’ represented by slope of the line PQ given
by
a = QR / PR
PR = OS = t
RS = OP = u
QR = a PR = at … (1)
Since, QS = RS + QR
v = u + at … (2)

Second Equation of Motion

(S = ut + ½ at²)
In the Figure 1.4, we may see that area enclosed under the curve
of the velocity—Time graph, gives the distance covered by a moving
body. In Figure 1.4, the total distance 's' covered by a uniformly

Fig. 1.4: Graphical representation of

equation of motion
 Motion 5

accelerated body is given by the area of trapezium OS Q P shown

shaded.
S = Area of trapezium OSQP
= Area of rectangle OSRP
+ Area of triangle PRQ
S = OP × OS + ½ PR × QR
Or S = ut + ½ at²

Third Equation of Motion

2 a.s = v2 – u2
In the velocity —Time graph distance covered
S = area of trapezium O S Q P ( Fig. 1.4)
= ½ ( sum of parallel sides ) × altitude
S = ½ (O P + SQ ) × PR
In Figure 1.4
Acceleration, a = slope of line PQ
(v – u)
PR =
a
We get
(v – u)
S = ½ (u + v ) ×
a
Or 2 a. s = v² - u²

v² - u² = 2a.s

Uniform Circular Motion as Accelerated Motion

The motion of a body along a circular path at a constant speed is
called uniform circular motion. The direction of the motion of the
body undergoing such a motion changes from point-to-point even
though it covers equal distances in equal intervals of time. Therefore,
the velocity is not uniform as the direction of motion changes at
every instant of motion. Since the acceleration is the change in velocity
per unit time, a body in uniform circular motion is having an
6 Basics of Biomechanics

accelerated motion. Following illustration will make the above facts

clear.
A boy running on a regular hexagonal track is shown in Figure
1.5. Let us suppose that a boy runs at uniform speed along the straight
portion, AB, BC, CD, DE, EF and FA of the track. At the corners he
quickly turns and changes his direction of motion to keep himself
on the track. He however maintains the same speed.

Fig. 1.5: Boy running on a regular hexagonal track

In completing a full round, he changes his direction of motion

five times. Suppose the track is a 8 sided closed Figure 1.6, i.e. regular
octagon in place of hexagon. In order to keep on the track, he must
change his direction of motion eight times.

Fig. 1.6: Eight changes in the direction of motion

If we keep on increasing the number of sides of the closed track,

then the boy has to change his direction of motion more frequently.
The track shown in Figure 1.7 is 15 sides closed figure.
 Motion 7

Fig. 1.7: More frequent changes in the direction of motion

Running along with this path the boy has to turn 15 times in one
complete round. If the number of sides of the track is increased to an
extremely large number then the shape of the track would almost
become a circle. To run on such circular track, the boy will change
his direction of motion at every instant of time though he maintains
the same speed.
Thus, the motion in a circular path at a uniform speed is an
example of accelerated motion in which the velocity changes
continuously only due to change in the direction of motion.

GALILEO’S STUDY ON THE MOTION OF OBJECTS

Galileo of Italy after making a careful study of motion of objects,
came to the conclusion that a body continues to move with the same
velocity when no unbalanced force is acting on it. On the basis of
everyday experience of motion of objects around us, it is very easy to
understand Galileo's conclusion. When we apply a small push to
the wheelchair, we find that the wheelchair (Fig. 1.8) moves through

Fig. 1.8: Movement of wheelchair

8 Basics of Biomechanics

some distance and then stops. It does not keep moving forever.
Similarly a tricycle on the road continuously needs to be peddled to
keep it in motion.

NEWTON’S LAW OF MOTION

After Galileo, Sir Isaac Newton (1642 - 1727) of England made a
detailed and systematic study of motion of the bodies and formulated
the three basic laws of motion. These laws after his name are called
Newton’s Laws of Motion.

First Law
A body continues in its state of rest or of uniform motion in a straight
line until it is acted upon by an unbalanced external force.

Second Law
The force on an object is directly proportional to the product of the
mass of the object and its acceleration and it acts in the direction of
acceleration produced.

Third Law
To every action there is an equal and opposite reaction. Action and
reaction act on different bodies but they act simultaneously.
These laws are based upon human experience about nature and
are true everywhere in the universe.
The Newton’s first law of motion contains following important
points:
i. Inertia is the basic property of all material bodies in the
universe.
ii. It gives a qualitative definition of the force. It defines the force
is that external influence which is necessary to change the
state of rest or of uniform motion of the body.
iii. It also explains that only an external force can change its state
of rest or of uniform motion in a straight line.
The Newton's second law of motion explains the relationship
between force, mass and acceleration.
If `f’ indicates the force, `m’ stands for the mass and `a’ for
acceleration, then as per second law of motion.
 Motion 9

f ∝ m.a
or f = kma
Where k is constant of proportionality and its value depends
upon the unit chosen for measuring force.
For one unit of force.
f = m. a
Force = mass × acceleration.

Alternatively
The law states that the acceleration of the body is directly
proportional to the unbalanced forces acting on it and is inversely
proportional to its mass. The direction of acceleration is the same as
that of force, i.e.
a ∝ f ( where m is constant)
f
a∝ (where f is constant)
m
Combining the above two equations
f
a∝
m
1
or a∝
m
where k is the constant of proportionality.
Whenever, two bodies interact the force exerted by anyone of
them is called action and that exerted by other is called reaction.

Fig. 1.9: KAFO (Lateral view)

10 Basics of Biomechanics

Fig. 1.10: A patient of PPRP wearing

KAFO (Different views)

Figs 1.11A and B: Patient wearing dorsolumbosacral orthosis

showing three-point pressure points

When a patient with postpolio residual paralysis is wearing a knee

ankle foot orthosis with ischeal weight bearing design the weight of
the upper part of the body is born by the ischeal seat through the
 Motion 11

ischeal tuberosity. The stability achieved during walking with such

orthosis is a good example of equal and opposite forces acting at the
point on ischeal seat (Figs 1.8 to 1.11). However, some of the body
weight is also borne circumferentially on the thigh bands.
The Newton’s third law of motion deals with the interaction
between pair of bodies and is explained as follows:
To every action there is an equal and opposite reaction. Action
and reaction always act on different bodies.
According to this law whenever a body exerts force on a body,
the second body also exerts force on the first body, a force of equal
magnitude but opposite direction. Thus we see that Galileo's
discoveries and those of others contributed to Newton’s laws of
Motion that form the current basis for mechanics and biomechanics.
 2 Force

Force is defined as an external influence which is necessary to change

the speed or direction of motion of a body. The change in speed or
change in the direction of motion of body means the change in the
velocity. Thus, we find that when a body in motion is undergoing a
change in its velocity, then some external force must be acting on it.
To understand clearly what we mean by the term force. Let us
consider the following situations:
1. It is a matter of common experience that if a book is lying on a
table, it continues to be lying on the table at the same position
forever until some body comes and displaces it to some other
position. For moving, one has to lift it, push it or pull it. It shows
that to bring a body into motion from its state of rest, some
external agency or external influence as to act on the body. Thus
to make a body move, i.e. to increase its speed from zero to some
value, an external agency or influence is needed (Fig. 2.1).

Fig. 2.1: Application of force on CP chair

 Force 13

Why does an object after moving some distance on the surface

stops? What does the rough surface do to the motion of the object?
The roughness of the surface provides an external influence called
friction which decreases the speed of the object opposes the motion
of the object.

BALANCED FORCES
When a number of forces acting on a body do not bring about any
change in its state of rest or of uniform motion in a straight line,
the forces are said to be balanced forces. In that case, the body
behaves as if no net force is acting on it.
In the game of tug of war, two teams pull a rope in opposite
directions. They apply forces along the rope in opposite directions,
thus, it is a case of two forces acting on a body in opposite directions
along a straight line (Fig. 2.2).

F1 F2

Fig. 2.2: Application of forces in opposite directions

F1 = F2 yields stability

When the two teams exert equal and opposite forces on the rope.
The rope remains steady and does not move in any direction. It
appears as if no force is acting on the rope. Thus the two forces
acting on the rope in the steady condition are balanced forces.
In the Figure 2.3, a person is shown sitting under the application
of cervical traction, an upward force, which is further neutralized
by the downward acting force resulting from the weight of the person,
muscles and tissues involved in this phenomenon.
Let us consider a heavy box lying on the ground (Figure 2.4).
When we push the box the box does not move because of various
forces acting on the box form a set of balanced forces.
Various forces acting on the box are:
a. W, the weight of the box acting vertically downwards
b. N, the normal reaction exerted by the ground on the box acting
vertically upwards
c. P, the force of push
d. F, the force friction acting in opposite direction to that of the
push.
14 Basics of Biomechanics

Fig. 2.3: The effect of cervical traction balanced

by the weight of the person

Fig. 2.4: Set of balanced forces

These four forces acting on the box are not able to move the box.
This amounts to a situation in which no net force is acting on the
box and as such all these forces form, a set of balanced forces. It has
to be noted that though the balanced forces cannot produce motion
in a body at rest or change the velocity of a moving body, they,
however, can change the shape of a body. This point will be clear
from the following discussion.
 Force 15

Balanced Forces May Change Shape (Figs 2.5 and 2.6)

Two equal and opposite forces acting on a spring along the same
line may result in extension or compression of the spring as shown
in Figures 2.5A and B respectively.

Figs 2.5A and B: A. Extension and

B. Compression of a spring of two balanced forces

Fig. 2.6: Lumbar traction unit depicting the balanced forces

The Resultant Force

In nature, generally, a large number of forces are found to act on a
body simultaneously. These forces collectively produce some effect
on the body. All the forces acting on a body can be replaced by a
single force which will produce the same effect on the body as all
these forces collectively do. Such a force is called the resultant force
or simply the resultant.
16 Basics of Biomechanics

Hence, the resultant of a number of forces acting on a body is

defined as that single force which when acting on the body would
produce the same effect on the body as all these forces collectively
do. The resultant force is also known as net force.

Unbalanced Forces
If a set of forces acting on a body produce a change in its state of rest
or that of uniform motion, then the forces are said to be a set of
unbalanced forces. In this situation all these forces do not
completely balance or cancel out. There is always a net or resultant
force left which acts on the body and brings about a change in its
state of rest or that of uniform motion. The point will become clear
from the following examples:
a. Suppose you are holding a handgrip exerciser in your hand
(Fig. 2.7). The handgrip exerciser is under the action of two forces:
i. The forces of gravity, i.e. the weight of the handgrip exerciser
acting downwards
ii. An upward force exerted by your hand.

Fig. 2.7: Forces acting on a handgrip exerciser

These two forces form a set of balance forces. If you release

the handgrip exerciser, then it falls down to the earth on account
of unbalanced force of gravity.
b. In a tug of war, if the two teams are equally strong, then the two
opposite forces are balanced forces and the rope remains
 Force 17

stationary. If one of the team suddenly releases the rope, then an

unbalanced force acts on the rope and the other team falls
backwards.
c. A cricket ball rolling on the ground comes to rest. On account of
some invisible, unbalanced force, i.e. force of friction between the
ball and the ground. Hence, it can be said that to produce or to
bring about a change in the motion of a body an unbalanced
force must act on the body.

Unbalanced Force:
External, Internal and External Forces
We know that all objects are made up of large number of small
particles. The particles of an object are exerting a large number of
internal forces upon one another all the time. Now consider that a
book is lying on the table and no external force is acting on it. Though
no external force is acting on the body but a large number of internal
forces always exist inside the body. When we observe the body over
any length of time in the above situation, we find that the body does
not undergo any change in its state of rest or that of a uniform motion
in a straight line even when a large number of internal forces are
acting on it. The following conclusions may be derived on the basis
of above:
a. The internal forces acting on a system are always balanced
forces. Under their action, the body behaves as if there is no
net force acting on it, i.e. their resultant is zero. It means that
internal forces always occur in pairs of equal and opposite
forces and they cannot change the velocity of a body.
b. The force which acts on a body from outside, is called an
external force, the force which can bring about a change in
the velocity of a body is necessarily an external force.
It is our everyday experience that all objects when released from
some height, fall towards the earth, fruits fall towards the earth after
they get separated from the trees. If you throw a body upwards, after
reaching some height, it momentarily comes to rest and then falls
back to the ground. In fact all objects fall towards the earth when
they are released from some height.
In Figure 2.8, if we observe the velocity of the falling ball, we find
that the velocity was zero at the top floor and it increases to some
value on reaching the ground. This change in velocity of the ball
18 Basics of Biomechanics

Fig. 2.8: All objects fall towards the ground

indicates that the ball must be under the action of some hidden or
invisible force which is responsible for the change in the velocity of
the ball. What is this force?
The invisible force is the attraction between the ball and the
earth is known as the gravitational force of the earth. In fact the
earth attracts not only the ball but all objects in the universe towards
its center on account of this force.

Universal Character of Gravitation

Newton, in 1687, stated that it is not only the earth that attracts the
other objects, i.e. the gravitational force is not the property of earth
alone, it exists every where in the universe. He stated that all objects
in the universe attract each other along the line joining their centers
and the force of attraction between any two material objects is called
gravitational force. It has to be noted that the force of gravitation acts
even when there is nothing connecting the two objects.

Distinction between Gravitation and Gravity

Gravitation is the term used to express the general phenomenon of
attraction between any two objects in the universe. The attraction
between a table and chair are examples of gravitation.
If out of the two objects involved in attraction, one happens to
the earth or the moon or some other planet, then a special term gravity
is used in place of gravitation. Thus, the gravitational force of earth
is called earth’s gravity and similarly gravitational force of the moon
is called moon’s gravity. Thus we learn that gravitation represents
 Force 19

the general phenomenon of attraction between any two objects in

the universe but gravity is a particular case of gravitation.

THE UNIVERSAL LAW OF GRAVITATION

After discovering that a force of gravitation exists between any
two objects situated anywhere in the universe, Newton further
gave a law which gives the magnitudes of the force in a clear
precise way, i.e. in the form of a mathematical expression. This
law is known as Newton’s Universal Law of Gravitation and is
stated as follows:
The law states that any two bodies in the universe attract each
other with a force whose magnitude is directly proportional to the
product of their masses and inversely proportional to the distance
between them. The direction of the force is along the line joining the
centres of the two masses.
According to this law any two bodies of masses m1 and m2
separated by distanced attract each other with a force of gravitation
F such that—

F  m1 m 2
And also
1
F ∝
d2

m1 m2
F ∝
d2

m1 m2
F=G
d2
Where ‘G’ is a constant of proportionality
It may be noted that if the distance between the two objects is
doubled, the force becomes one-fourth and if the distance is halved,
then the force becomes four times.

UNIVERSAL GRAVITATIONAL CONSTANT

It has been found that the value of the quantity G remains the
same, irrespective of the two objects chosen, i.e. whether the two
20 Basics of Biomechanics

objects chosen are—a stone and the earth or the earth and the sun
or any other two objects taken from anywhere in the universe.
F.d 2
The value of the quantity m m does not also depend upon the
1 2

values of m1, m2, d and f. Such a constant quantity which remains

the same on earth and anywhere in the universe is called a universal
constant. This universal constant quantity is denoted by letter G.

And is called the universal gravitational constant.

We have the relation

G m1 m2
F=
d2
If we put, m1 = m2 = 1 and d = 1 then we have G = F
Thus universal gravitational constant ‘G’ can be defined as that
force of gravitation which is exerted mutually between two bodies
of unit mass separated from each other by a unit distance.
F d2
Since, G = and units of measurements of F is Newton,
m1 m2
distance in meters and mass in kg, therefore the SI Unit of G is
Newton . m 2
is Nm2/kg2.
kg × kg
 3 Velocity

Velocity is speed in a definite direction. It is a vector quantity,

having direction as well as magnitude. Speed and velocity are
measured in the same unit. In the CGS system, it is the centimeter per
second (cm) and in the SI Units it is the meter per second (ms). The
unit kilometer per hour km hr–1 is often used. To completely specify
a velocity as distinguished from a speed, the direction should be
given as 40 km hr–1 North-East or 30 m S–1 vertically upward.
Speed may change only by a change in magnitude. Velocity is a
vector, velocity may change either in magnitude or in direction
(Fig. 3.1).

Fig. 3.1: Direction of particle P 1 and P2

given as tangent at that point

The velocity V2 is different from the velocity V1 because the

directions are different although the magnitudes are the same. For
example, two cars moving at a rate of 60 km/h in different directions
22 Basics of Biomechanics

have the same speed but different velocities. A car may move around
a circular track at constant speed but its velocity is continuously
changing because the direction of motion is changing. Speed is the
time rate of change of position of a particle without regard to the
direction of motion. Velocity is the time rate of change of position of
a particle in a specified direction.
Average velocity in one dimensional motion the particle moves
along a straight line trajectory in any direction. The position of the
particle is defined by its displacement X from an arbitrary point O,
or origin (Fig. 3.2.) suppose that time t, the particle is at position A,
with

X at time T
X1 at time t1

Fig. 3.2: Average velocity of particle moving in a straight line


OA = x At a later time t, it is at B, with OB = x1 (the average)
velocity between A and B is defined by

  
x1  x x
Vav = =
t1  t t
  
Where x = x1  x is the displacement of the particle t = t1 – t is the
elapsed time. Thus the average velocity during a certain time
interval is equal to the average displacement per unit time during
that time interval. The average velocity is a vector. Its direction is
the same as that of the displacement vector.
Instantaneous velocity is the velocity at any instant. To determine
the instantaneous velocity at a point, such as A; we must make the
time interval t as small as possible so that no changes in the state of
 Velocity 23

motion occur during that small interval. When B is brought closer to

A, i.e. finding the limiting value of the fraction appearing in equation
(Fig. 3.1) when the denominator t approaches zero. This is written in
the form.
Instantaneous velocity v = u Lt
When, t O, Vav t O

Lim x dx
xO =
Vav t  O t dt
Thus, we obtain the instantaneous velocity by finding the first
time derivative of the displacement.
If displacements of a particle are equal in a particular direction,
in equal intervals of time, however small the interval may be, it is
said to move with uniform velocity.
If displacement of a particle are unequal in a particular direction,
in equal intervals of time, however small the intervals may be, it is
said to move with variable velocity.
In CGS system, velocity is expressed in centimeter per second
(cms–1).
In SI units, velocity is expressed in meter per second (ms–1).
Body moving with a uniform velocity. Consider a body traveling
in a straight line with a uniform velocity, i.e. it covers equal distances
in equal intervals of time. This the graph between time and
displacement will be straight line as shown in Figure 3.3.

Fig. 3.3: The graph between line and displacement

is a straight line in uniform velocity
24 Basics of Biomechanics

Consider two point A and B on the straight line corresponding

to time t and t1 respectively, so that displacements are x and x1 from
origin O, draw AC and BD perpendiculars to the time axis and AE
perpendicular to BD. Then the distance BE is travelled in the time
AE.
  
BE x1  x x
i.e. uniform velocity = = =
AE t1  t t
= tan ∠BAE = Slope of the straight line AB

x
Thus, the slope is constant at every point on the line and gives
t
the uniform velocity of the body. Thus the slope of the displacement
time graph, which is a straight line—gives the uniform velocity.
And instantaneous velocity
Lt x dx
v = 
t  0 t dt
= slope of the straight line
= constant

Average Velocity
Consider a body traveling in a straight line with a uniformly
increasing speed. A curve of displacement against time for such a
body is shown in Figure 3.4A.
Such a curve is called a displacement time curve.

Figs 3.4A and B: Time displacement curves. Average velocity at any time
interval is given by the slope of the corresponding chord
 Velocity 25

Take two points A and B on the curve at time t and t1 so that the
displacement are x and x1 from origin O. Join AB. Draw AC and BD
perpendicular to the time axis and AE perpendicular to BD. The BE
represents the distance traversed in a time represented by AE
Hence average velocity between A and B
 
BE x x x
= = 1 = = tan ∠BAE = tan ∠AFC
AE t1  t t
Thus the average velocity during anytime interval is given by
the slope of the corresponding chord of the displacement time
graph (B).

Instantaneous Velocity
Now if B is made to approach A the time interval AE diminishes
and BE/AE or tan ∠AFC becomes more and more nearly equal to the
actual velocity at A. At the same time the chord AB becomes more
and more nearly coincident with the geometrical tangent to the curve
at A. This geometrical tangent is the limiting position of the chord
AB and tan ∠AFC (Fig. 3.4B) is the limiting value of BE/AE as B
approaches A. The actual velocity at A, i.e. instantaneous velocity is
represented by tan ∠AFC (Fig. 3.4B) which is called the slope of the
curve at A.
Thus the slope of the tangent to a displacement time curve at
any point represents the instantaneous velocity at the instant
represented by that point.
If curve slopes upward to the right, the slope is positive and
the instantaneous velocity will be positive.
If curve slopes downward to the right, the slope is negative
and the instantaneous velocity will be negative.
 4 Acceleration

A particle has acceleration when its velocity changes with time. The
change in velocity may be a change in their speed or direction or
both, in all the three cases the body has an acceleration. Thus
acceleration is defined as the time rate of change of velocity and
may be either positive or negative. If it is negative, it is sometimes
called retardation.
a. Average acceleration in one dimensional motion, the particle
moves along a straight line (Fig. 4.1):
Let a particle move along X-axis starting from origin O.
Suppose that at time t the particle is at A moving with velocity
v and at time t is at B moving with velocity v1.
The average acceleration between A and B is given by

Fig. 4.1: Average acceleration of a particle moving along a straight line

Where, v” = v1 - v is the change in velocity and t” = t1 – t is the

elapsed time. Thus, the average acceleration during a certain
time interval is the change in velocity per unit time during that
time interval.
The average acceleration aav is a vector since v” is a vector
and is in the same direction as v1 – v or v”.
b. Instantaneous acceleration is at an instant and is defined as the
limiting value of the average acceleration when the time interval
t” becomes very small, that is
v dv
a  Lt aav = Lt =
t–0 t–0 t dt
 Acceleration 27

Thus we obtain the instantaneous acceleration by finding the

first time derivative of the velocity. Its direction is same as that of the
limiting direction of the vector change in velocity.
Uniform acceleration: If a particle moves in such a way, that
changes in the magnitude of velocity are equal in equal intervals
in time, it is said to be moving with a uniform acceleration. Variable
acceleration: If a particle moves in such a way, that its velocity
changes in magnitude are unequal in equal intervals of time, it is
said to be moving with a variable acceleration.
In CGS system, the acceleration is expressed in centimeter per
second per second (cm s–2).
In SI Units the acceleration is expressed in meter per second per
second (ms–2).
A velocity-time graph is a graph drawn with the time intervals
along X-axis and the velocities of the particle at the various instants
along Y-axis (Fig. 4.2). It is useful in calculating the acceleration of
the particle and the distance traveled by the particle in a given
interval of time.
Body moving with uniform acceleration: Consider a body
traveling in a straight line with uniform acceleration. Consider two
points A and B on the graph corresponding to time t and t1
respectively so that velocities are v and v1. Complete the right
angled triangle AEB
BE v1  v v
∴ uniform acceleration  
AE t 1  t t

Fig. 4.2: Time-velocity graph of a body moving with uniform acceleration

28 Basics of Biomechanics

= tan∠BAE = slope of the straight line and instantaneous

acceleration
= slope of the straight line
= constant
Body moving with variable acceleration. When a particle moves
with variable acceleration, the velocity-time graph is a curve as
shown in Figure 4.3B.

Figs 4.3A and B: (A) Average acceleration between two points on a velocity-time
graph is equal to the slope of the curve (B) Instantaneous acceleration at A is slope
of the curve at A

The time being independent variable, is taken along X-axis and

velocity along Y-axis. Consider two points A and B on the curve at
time t and t1. So that the velocities are v and v1 respectively. Joined
the chord AB, draw AC and BD perpendicular to the X-axis and AE
perpendicular to BD. Hence average acceleration between points A
and B.
BE v1  v
= 
AE t1  t
= tan ∠BAE = tan ∠AFC
Thus when a particle moves with a variable acceleration, the
average acceleration between any two points on velocity time graph
is equal to the slope of the chord joining two points.
Instantaneous acceleration: As the point B approaches the point A,
the chord AB becomes more and more nearly coincident with the
geometric tangent to the curve at A. This geometrical tangent is the
limiting position of the chord AB and tan ∠AFC (Fig. 4.3B) is the
limiting value of BE/AE as B approaches A. The instantaneous
 Acceleration 29

acceleration at A is therefore, represented by tan ∠AFC (Fig. 4.3)

which is called the slope of the curve at A.
Thus when a particle moves with variable acceleration the
instantaneous acceleration at any point on velocity time graph is
equal to slope of the tangent to the graph at that point.
Equation of rectilinear motion: When a body or a particle is
moving along a straight line, the relations between the velocity,
acceleration, distance covered and the time are given by simple
equations.

Distance Covered by a Body

Moving with Uniform Velocity
Let a particle move with a uniform velocity u, for a time t, the
distance ‘S’ traveled by the particle is given by
Distance traveled = uniform velocity × time
i.e. S = ut
 5 Friction

Whenever, we try to push a body to make it slide or roll over the

surface of another body, a force is required to act upon it. The
magnitude of this force depends on weight and nature of the body
and also upon the nature of the surface, upon which the body slides.
Thus force of friction or simply friction may be defined as the
opposition or resistance which comes into play when a body tends
to move or actually moves over the surface of another body. This
force always acts in a direction tangential to the surface in contact
and opposite to the direction of the motion of the body. The
tendency of this force is to destroy the relative motion.
This fact seems at first a violation of Newton’s first Law of
Motion, which states that by applying even a small force, a body is
set into motion, further more if the force under which a body moves
be removed, it stops after traveling a certain distance. These
anomalies can be resolved if we taken into consideration the force
called friction, which arises due to relative motion of two bodies.
Friction may also be defined as the forward force required
maintaining the uniform motion of a body over the surface of
another body.

Types of Friction
There are two kinds of friction. Static and Kinetic. Static friction is
the force which resists setting the bodies in relative motion. Kinetic
friction is the force which resists their being maintained in relative
motion. Kinetic friction is also called dynamic friction.
Friction is a self adjusting force which increases with the applied
force as long as the body remains at rest. Once the body starts
moving, the force of friction decreases by a small amount because
there is a decrease in frictional effect from the maximum effect
attaining under static condition. Figure 5.1 shows the drop from the
 Friction 31

highest limiting frictional effect to a frictional effect that is constant

with time, i.e. independent of the velocity of the body and with
magnitude less than the maximum static value. The condition
corresponding to this maximum is termed condition of impending
motion.

The Laws of Friction

Experiments on friction indicate certain general relations, the so
called laws of sliding friction. These experimental laws are not
exactly obeyed but hold more or less approximately over a
considerable range of application.
1. The force of sliding friction is directly proportional to the force
pressing the surface together.
2. The force of sliding friction is independent of the areas of the
surface provided the force pressing the surfaces together is kept
constant.
3. The force of friction may be independent of the relative speeds
of the surfaces for a considerable range of speed.
4. The force required to keep an object moving with constant
velocity when sliding over another body is less than the force
required to set it in motion.
5. The force of friction depends on the nature of the surfaces in
contact.

Fig. 5.1: Friction force drops from the highest limiting effect
to a frictional effect which is constant with time

Limiting Friction
When the applied force on one body is gradually increased to such
magnitude that the body is just on the point of moving on the other,
32 Basics of Biomechanics

the equilibrium is called limiting and the frictional force is called

limiting friction. Thus the maximum value of the force of static
friction exerted when one body is just at the point of sliding upon
the other is called the force of limiting friction.

Cause of Friction
The laws of solid friction were known hundreds of years ago. Efforts
were made to explain the cause or the laws of friction on the basis
of experiments performed from time-to-time.
When one body is placed over the surface of another body of
same or different material there takes place interlocking of the
irregular projections and depressions of the two surfaces. But
experiments reveal that friction at first slightly decreases as the
surfaces are made smooth. But on increasing the smoothness
beyond a certain point, the force starts increasing, when the surfaces
are made extremely smooth, friction increases enormously. This
leads us to the point that perhaps interlocking due to irregularities
is not the cause of friction.
The modern view is based on the atomic theories, which
resulted from the experiments conducted by Bowden and his
collaborators, suggest that the true area of contact between two
surfaces is extremely small, and may be one of the thousands of
the area actually placed together. This is shows in Figure 5.2. This
is because all bodies are irregular on atomic or molecular level.
According to Bowden himself, the finest mirror which is flat to a
millionth of a centimeter, to anyone of the atomic size, would look
like a valley and rolling hills. Two surfaces thus rest on each other’s
projections when placed on the other.

Fig. 5.2: Finer details of contact areas between two bodies

 Friction 33

Since the area of the actual contact is extremely small the

pressures at the points of contact are very high perhaps million
kg/m2 for two steel surface in contact. Due to increase in temperature,
projections merge a little under the pressure, producing welding or
there takes place strong clinging of atoms or molecules, resulting in
a force which opposes motion. This shows that frictional force is
independent of the areas of the surfaces, which explain 2nd law.
The constant ratio of the magnitude of the limiting friction to the
normal reaction acting two surfaces in contact is called the coefficient
of friction and is denoted by μ.
Let the magnitude of force of
Limiting friction = F
The normal reaction = R
Then µ = F/R
The value of coefficient of friction is different for different pairs
of substances. But is always less than unity for any pair of surfaces.
We should distinguish between the coefficient μs the coefficient of
static friction (Fs/R); μk—the coefficient of kinetic friction (FK/R);
µk, where Fs is the magnitude of smallest tangential force to start
motion and Fk is the magnitude of smallest tangential force to
maintain uniform motion. Their relation is μs > μk. The difference
μs – μk is very small. Thus we shall ignore the distinction and speak
of the coefficient of friction.
The resultant of the force of limiting friction and normal reaction
is called the resultant reaction denoted by S in the Figure 5.3. The
angle which this resultant reaction makes with the normal reaction
is called the angle of friction. It is denoted by in Figure 5.3.

Fig. 5.3: Angle of friction the angle the resultant reaction (the resultant of the
force of limiting friction and normal reaction) makes with the normal
34 Basics of Biomechanics

Let A be the point of contact of a body with a surface. Impending

motion body is on the verge of moving right wards. Let R be the
normal reaction of the surface on the body, perpendicular the surface
represented by AB. By the law of limiting friction, the frictional force
will be of magnitude µR acting leftward, where μ is the coefficient of
friction between the body and the surface. This force is represented
by AC. Let AD represent the resultant force S of these two forces.
Resolving the resultant force S into two rectangular components:
R = S cos θ (vertical direction)
and, μ R = S sin θ (horizontal direction)
dividing we have μ R/R = S sin θ/S cos θ
Or μ = tan θ
i.e. coefficient of friction is equal to the tangent of the angle of
friction. Suppose a body of weight w is place on a rough inclined
plane inclination of the plane to the horizontal is gradually
increased till the body just begins to slide down the plane. The
angle which the inclined plane now makes with the horizontal is
called the angle of repose (or sliding) (Fig. 5.4).
The body is in equilibrium under the action of the following
forces:
1. Weight of the body w acting vertically downwards
2. Normal reaction R acting perpendicular to the plane
3. Limiting force of friction μR acting up the inclined plane because
the body is tending to slide downwards.
The weight of the body w can be resolved into two rectangular
components.

Fig. 5.4: Angle of repose—the angle which the inclined plane

makes with the horizontal
 Friction 35

i. W sin λ down the plane

ii. W cos λ perpendicular to the plane if the body is on the point of
sliding when the inclination is λ, it has no acceleration so that
there is no resultant force acting on it in downward direction.
Thus
μ R = W sin λ
and R = W cos λ
Dividing, we have
μR/R = W sin λ /W cos λ
Or μ = tan λ
The coefficient of friction is equal to the tangent of the angle of
repose.
Again μ = tan θ where θ is angle of friction
Hence tan λ = tan θ
Or λ= θ
i.e. angle of repose is equal to the angle of friction for two given
surfaces in contact.
Friction arising from the relative motion of two objects is known
as dynamic friction. It is of three types:
1. Sliding friction is present in a system where a dry surface slides
over another and may be attributed to the fact that when two
metallic surfaces slide over another, their molecules momentarily
get welded and a force is needed to continuously break the
bonds. For non metallic surfaces however, the above reasoning
partly holds and it has been found that the frictional force is
more for these surfaces.
2. Rolling friction arises out of rolling of a body upon a surface.
Its nature is similar to the sliding friction but is much less in
magnitude in comparison with sliding friction.
3. Viscous friction is present in fluid motion and is due to the
cohesive forces present in neighboring molecules which flow
in contact with another. The examples of viscous friction are
parachutes moving with a constant and safe velocity, when
they drop from their aeroplanes. The motion of rain drops in
air. This friction helps the bodies attain a constant velocity,
when the gravitational acceleration is balanced by the viscous
opposition.
36 Basics of Biomechanics

Since friction is a resisting force, work is done when a body is

displaced. If the body remains in motion, there is continuous
dissipation of energy of the body or the system.
As a general rule, work done against friction is measured by
force of limiting friction multiplied by the displacement.
1. A body moving over a horizontal surface. Suppose a body of
mass `m’ moves on a rough horizontal plane (Fig. 5.5).

Fig. 5.5: Frictional resistance offered by

the surface leading to stop motion

Since the body neither moves in upward nor in downward

direction the weight of the body mg is equal to normal reaction R
i.e. R = mg
if μ is the coefficient of dynamic friction, then the frictional resistance
offered by the surface tending to stop the motion of the body is given
by
F = μR
= μ mg
Again if a body moves a distance S along the rough horizontal
plane.
Work done against friction = force × distance = μ mg S
A body moving up an inclined plane. Let a body of mass `m’ move
up an inclined plane when a force P is applied up the plane. The
forces acting on the body are shown in Figure 5.6 are:
i. Weight mg acting vertically downward
ii. Normal reaction R acting perpendicular to the body
iii. A force of dynamic friction F acting down the plane opposite
to the motion
 Friction 37

Fig. 5.6: Forces on a body moving by an inclined plane

iv. Applied force P acting upward. The weight of the body mg.
can be resolved into two rectangular components.

Components
(a) mg cos θ perpendicular to the plane. This balances the normal
reaction R as the body does not move in this direction, i.e.
R = mg cos θ
(a) mg sin θ down the plane
Now the force of dynamic friction
F= μ R
= μ mg cos θ
As F acts in a direction opposite to the direction of motion of
the body.
The total force down the plane = Mg sin θ + μ mg cos θ
The work done W in moving the body through a distance S up
the inclined plane is given by
W = Force × distance
D = (mg sin θ + μ mg cos θ) × S
(sin θ + μ cos θ) mg S
Total force = Mass × acceleration
i.e. ma = mg sin θ + r μ mg cos θ
or a = g sin θ + μ g cos θ
A body moving down the inclined plane: Suppose a mass m is
moving down a rough inclined plane as shown in Figure 5.7. The
forces acting on a body are:
i. Weight mg acting vertically downward
38 Basics of Biomechanics

ii. Normal reaction R acting perpendicular to the plane and

iii. The force of dynamic friction F acting upward, opposite to the
direction of motion.
The weight mg of the body can be resolved into two rectangle
components
a. Mg sin θ down the plane
b. Mg cos θ perpendicular to the plane in a direction opposite to
the normal reaction R.

Fig. 5.7: Forces acting on a body moving down the inclined plane

i.e.
R = mg cos θ,
Now the force of dynamic friction
F = μ mg cos θ
As F acts in a direction opposite to the motion of the body.
The total force on the body down the plane
= mg sin θ-mg cos θ
if the body moves down an inclined plane through a distance S,
then
Work alone = force × distance
= (mg sin θ – μ mg cos θ) × S
= (Sin θ – μ cos θ) mg S
As already explained the opposition or resistance that comes
into play when one body rolls or tends to roll over the surface of
another, is called rolling friction. If Fr is the magnitude of the rolling
friction and R is the normal reaction, then μr = F/R.
 Friction 39

Where μr is the coefficient of rolling friction found to be much

less than μs for the same two bodies, i.e. the rolling friction is much
smaller than the sliding friction. It is for this reason that whatever
possible sliding friction is conveyed into rolling friction by using
wheels and further substituting ball bearing or sleeve bearings.
In sleeve bearing (Fig. 5.8) shaft of a machine slides on the bottom of
the sleeves but in ball bearing, the shaft of a machine or hub rolls around
on steel balls. For example, the hub of a bicycle wheel rolls over steel balls,
and the walls in turn roll over the axle, as shown in Figure 5.8.

Figs 5.8 A and B: (A) In sleeve bearing shaft of machine slide on the bottom of the
sleeves (B) In ball bearing shaft of a machine rolls on steel balls and that in turn
rolls on the wall

When a wheel rolls on a plane surface, the small projections in

the surface of the rim have not got actually to force their way through
the interspaces between the small projections on the plane. Yet the
projections in them engage and disengage into one another during
rolling and this gives rise to the rolling friction.
Rolling friction depends on how much the rolling object presses
in or dents the surface on which it rolls and on how much surface
of the object is flattened. Also, there may be a tendency for the
molecules of each of the two surfaces to stick together. One may
think of the rolling body as always rolling up the slope of the
depressions it made in the surface, but the harder the surface which
it rolls, less is the effect shown in Figure 5.9.
Even if the surface, say read or rail, is made hard, the rolling
body under its own weight may become flat at the point of contact
and area of atomic contact may increase.

Friction is Necessary Evil

Friction, the opposing force which comes into play when there is
relative motion between two bodies in contact, is necessary because
40 Basics of Biomechanics

Fig. 5.9: Rolling friction depends upon how much the undersurface deals and
how much the surface of the rolling object is flattened

life would be impossible in its absence and it is an evil as it is

troublesome in many ways.
It is due to existence of friction that we can walk on the ground,
trains can run on rail tracks. Motion can be transmitted from a motor
to machinery by mean of gears and belts. We have often seen cycles,
cars, buses, etc. skidding on a rainy day, when friction becomes less.
If friction were absent, belts could not run on wheels, we could
not use pens, pencils, and chalks, etc. for writing purposes. Nails
and screws could not be fitted. Brakes could not be applied to
vehicles and vehicles once set into motion could never be stopped.
Such cases are countless.
The presence of friction particularly in the moving parts of
machinery is very irksome, as a large amount of work done on the
machine is used up in overcoming friction which reduces its
efficiency and the machine runs slow. The energy wasted in
overcoming friction appears in the form of heat and causes lot of
damage to the parts of machinery. The parts may melt also if friction
is high. Further there is lot of wear and tear of the parts due to
rubbing against each other.
Thus friction is necessary evil. Sometimes it is quiet necessary
to increase friction between bodies. Following are the instances in
which friction is increased by the suitable methods:
i. While constructing stairs, the steps are mad rough
ii. Resin is applied on belts to avoid slipping of belts over wheels
iii. Tyres of cycles, scooters, buses, etc. have irregular projections
and depressions
iv. Sometimes, when rail tracks become greasy or wet and are
incapable of providing sufficient friction, the engine drivers
 Friction 41

throw some sand on rails through pipes specially provided

for the purpose.
As discussed above it is quiet essential to reduce friction for
efficient running of machines. Following methods are used for
reducing friction.
i. The two surfaces which have to come in contract are polished
to reduce atomic contacts. Polishing saves wear and tear also
ii. Grease or oils are spread in between two surfaces rubbing
against each other so that contact is avoided. Grease is used
in heavy machinery and oils in light machinery. Thin oils are
used in watches.
iii. Friction between two surfaces made from the same material
is greater than between dissimilar materials. Thus as far as
possible, rubbing surfaces should be made of different
materials.
iv. To reduce fluid friction, buses, aeroplane, cars, etc. are stream
lined.
v. Whenever possible, sliding friction is converted into rolling
friction by using ball bearings. Rolling friction is much less
than sliding friction.
Friction is generally necessary to start the movement. Walking
requires adequate friction between the sole of the foot and floor so
that foot will not slip forward and backward and the effect of limb
extension can be imparted to the trunk. The crutches and canes
are stable due to friction between the tip and floor. Many friction
devices are used in exercise equipment to grade resistances in case
of shoulder wheel or stationary exercises.
Friction also exists between the human body normally
lubrication is present as the tendon slides between the synovial
sheath at sites of wear and articulating surfaces of the joints are
bathed in synovial fluid. Many instances of application of friction
can be seen in physical therapy. Set screws or knobs and work
loose and must be tightened as do bolts and nuts. In lowering and
raising the infrared and ultraviolet lamps. One must be certain that
the friction applied by knob and screw is adequate to maintain the
weight of the lamp.
We are able to run, walk on the ground only because of frictional
force at the ground acting on the foot in the direction which we
want to move. The importance of frictional force develops between
the shoe and the ground during walking specially at the heel strike
42 Basics of Biomechanics

and toe off. Studies indicate that the horizontal component of the
foot force at heel strike is 15% of the body weight. Fmax must exceed
this value if the foot is not to slip. The value of normal force at these
points at gait cycle is more than body weight M, the normal force is
more due to momentum of the body weight at heel strike and thrust
of the plantar flexion before the toe off. The increase in normal force
helps to provide adequate stabilization of the foot. The friction
developed in walking in generally less than the maximum frictional
force. But it may reach the Fmax value on the slippery surface where
the coefficient of friction is reduced.
 6 Work

In everyday life when a person applies a mental or a physical effort

he says that he is doing work. A laborer standing with a stack of
bricks in his hands applies physical effort in straining his muscles
continually for holding the bricks against the pull of the earth but
does not do any work. Similarly a student reading a book applies
mental effort but he also does not do any work. Work is said to be
done when force acting on a body produces in it, a displacement
along the line of action of the force. Work is a scalar quantity.
Following two conditions must be satisfied—simultaneously for
work to be done.
1. A force has to act on a body.
2. The point of application of the force should move along the
line of action of the force.
Let us examine, whether work is done in the following two
cases or not.
i. A student holding a book on his palm and
ii. A ball rolling on a frictionless table.
Case (i): The students has been applying a constant force equal
to the weight of the book against the force of the gravity to hold
it, but there is no displacement of the book along the line of the
action of the force, i.e. the essential. Condition No.2 is not
satisfied and hence no work is done.
Case (ii): The ball is getting uniformly displaced in the same
direction on the frictionless surface. There is no force acting on it
because there is no change in the velocity. Hence no work is done
both the conditions must be satisfied simultaneously.
a. When force and displacement act along the same direction: Let a
constant force ‘F’ be applied by a man to push a small wagonr as
shown in Figure 6.1.
44 Basics of Biomechanics

Fig. 6.1: Man applies a force ‘F’ to push a small wagon by a distance `C’

The point of application of force is at p′. The wagon moves over

a distance ‘C’, i.e. point of application of the force moves to position
P’ and such that the distance PP= S. Then the amount of work done
by the force is given by the relation;
Work done = (force applied) × (displacement along the direction
of force).
If ‘w’ stands for the work done, then
W = F. S
From the equation, W = F S it follows that
When F = 1, S = 1, then W is also = 1. Therefore, in general, unit
work is said to be done when a unit force is applied on a body and
its point of application moves through a unit distance along the
line of the force.
The SI unit of force is Newton and that of distance is a meter.
Therefore, from the definition of work, the unit of work is Newton
meter. The SI unit of work is a joule. One joule is defined as the
amount of work done when a force of one Newton acting on a
body moves it through a distance of one meter along the line of the
force. It is denoted by the letter J.
Thus, 1J = 1N.m.
CGS unit of work is an erg. The CGS unit of force is dyne and the
CGS unit of distance is cm. Therefore, one erg is the amount of work
done when force of one dyne acting on a body, moves it through a
distance of one centimeter along the line of force.
Thus,
1 erg = 1 dyne × 1 cm or
erg = dyne × cm
Relation between joule and erg
 Work 45

1 J = 1 N × 1m
1 N = 105 dynes
And 1 m = 102 cm
Therefore,
1J = 107 erg
Depending upon the situation, the work may be done by a force
or against a force. The following considerations will make the point
clear:
i. Let us go back to the situation shown in Figure 6.1. Here the
man pushes the wagon and the wagon moves through some
distance in the direction of the force. In this case, work is said
to be done by the force, because here the direction of the force
and the direction of the displacement are the same. Hence
work is said to be done by a force if the direction of
displacement is the same as the direction of the applied force.
ii. Suppose the wagon is already in motion and the man tries to
stop it by a force applied from the front side. He tends to
destroy the motion of the wagon by applying a force in a
direction opposite to that of the motion of the wagon. Here
the displacement is against the force. Therefore, the work is
said to be done against the force. Hence work is said to be
done against a force if the direction of displacement is
opposite to that of the force. Generally the force of friction
acts opposite to the direction of the motion of the body and
destroys its motion. To stop a fast moving vehicle, the force
of friction is increased by using brakes.
iii. To lift an object, say a piece of stone lying on the earth to some
height above the ground, a force has to be applied in the upward
direction. This applied force has to be equal and opposite to
the force of gravity acting on the stone. If `m’ is the mass of the
stone piece and ‘h’ is the height through which it is raised
then the upward force.
(F) = force of gravity = mg if ‘w’ stand for work done, then
w = F. h = mg. h
Consider a force ‘F’ acting at angle to the direction of
displacement ‘S’ as shown in Figure 6.2.
46 Basics of Biomechanics

Fig. 6.2: Force F acting at angle to the direction of displacement S

OB represents the displacement: A force is a vector quantity and can

be resolved into two parts called components perpendicular to each
other. The two components of the force are the following:
i. OB = F cos θ along the direction
and
ii. OC = F sin θ perpendicular to OB
Work done = (component of the force along the direction of
motion) × (distanced moved)
Symbolically,
W = OA.S
Or W = F cos θ.S
Force is a vector quantity and thus it has both magnitude and
direction. It can be split up into two components mutually
perpendicular to each other. Suppose a force F acting on a body is
represented in magnitude by line segment OA making an angle to
the horizontal direction as shown in Figure 6.3. In order to find the
components of the force F, draw perpendiculars AB and AC on X-
axis and Y-axis respectively as shown in Figure 6.3. OB and OC are
the two components of F in two mutually perpendicular directions.
Let us find their magnitudes in terms of F and trigonometric functions
cos θ and sin θ.
 Work 47

i. The components of ‘F’ along X-axis are OB. To find its

magnitude, refer to Figure 6.3, we can write from right angled
triangle AOB

Fig. 6.3: Resolution of force F along X and Y-axis

Base OB
Cos θ = =
Hypotoneus OA
(i.e. OA represents the magnitude of F)
Hence the components of F along X-axis
OB = Fx and is given as
Fx = F cos θ
ii. The components of the force F along Y-axis is OC
In right angles triangle AOB
Perpendicular AB OC
Sin θ = =
Hypotoneus OA OA
(i.e. OC = AB)
(i.e. OA represents the magnitude of F)
Hence component of F along Y-axis
OC = Fy and is given as
Fy = F sin θ
48 Basics of Biomechanics

Note: That no work is done in the following situations:

1. When a person carries a suitcase in his hand and walks strictly
in the horizontal direction, he does no work against gravity
because gravitational force acts vertically downwards at an
angle of 90° to the direction of displacement of the suitcase.
2. In case of uniform circular motion, the force acts towards the
center and along the radius, whereas at every point of its motion
the body is tending to move in a tangential direction. Thus the
angle between the direction of force and displacement is 90o and
hence no work is done.

Fig. 6.4A: Stone whirled in a circle

Fig. 6.4B: Motion of a satellite

Familiar examples where no work is done are (A) stone whirled

in a circle, and (B) motion of a satellite like the moon (Fig. 6.4) round
the earth.
 7 Energy

We have observed that when work is done on a body by applying

a force, the body either gains speed or suffers a change in position.
A body is said to possess energy if it has the ability to do the work.
For example, a horse possesses energy because it can draw a
cart; a fast moving cricket ball possesses energy because it can uproot
the wickets on hitting them; falling water from a great height (in
dams) possesses energy because it rotates the blades of a turbine; the
spring in a watch when wound possesses energy because it is able to
drive the hands of the watch.
Moreover, when an agent does work, its energy is reduced by
an amount exactly equal to the work done by it. Thus energy is
defined as the capacity of a body to do the work. It is a scalar quantity.
There are many different forms of energy, viz. mechanical energy,
heat energy, sound energy, electrical energy, solar energy, atomic
energy, etc.
The energy of a body is estimated by the amount of work, it is
capable of doing. Therefore, the unit of energy is the same as that
of work since the unit of work is joule; the SI unit of energy is also
joule.
We shall be mainly concerned with mechanical energy which
is of two types, viz. kinetic and potential.
It is a matter of experience that a fast moving stone can break a
window pane (Fig. 7.1). A moving ball on striking another ball can
set it rolling. This fact is commonly observed in the game of marbles
played by children or in the game of billiards. Another game in
which a moving object sets another object already at rest in motion is
that of a carrom. In all these examples work is done by the body
while being in motion.
The ability of a body to do work by virtue of its motion is called
its kinetic energy.
50 Basics of Biomechanics

Fig. 7.1: Kinetic energy possessed by a body on account of motion

The kinetic energy possessed by a body by virtue of its motion, is

given by the amount of work it can perform before coming to rest.
Let ‘m’ be the mass of a body moving with uniform velocity ‘v’.
Suppose the body does work against a retarding force ‘F’ and comes
to rest after covering a distance ‘S’.
The retardation of the body is given by the relation

F
A=– ( F = – ma)
N
The work done by the moving body against the opposing force
is given
By, W = FS
Using equation 7.1
W = (– mas)
W = – mas................. (7.1)
2aS = v2 – u2.................(7.2)
(Final velocity)2 – (Initial velocity)2
Here the final velocity = O
( The body ultimately stops)
and initial velocity =v (given)
 Energy 51

or using the above relation, we

O2 – V2 = 2as
or a.s = – ½ v2 ................... (7.3)
Substituting for a . s from equation (7.3) in equation (7.1) we get
w = m (– a.s)
= m. ½ v2 = ½ mv2
Thus kinetic energy
KE = ½ mv2
Hence the kinetic energy of a moving body is:
1. Directly proportional to the mass of the body
2. Directly proportional to the square of velocity of the body.
It may be inferred from above that doubling the mass of the
body doubles the KE whereas doubling the velocity of the body
makes the energy four times.
A body at rest may also possess the capacity of doing work. For
an example when a piece of stone is raised through a certain height,
work is done against gravity in doing so. This work done is stored in
the stone in the form of energy. If the raised stone is allowed to fall
down, it will perform the same amount of work as was done on it,
during the process of raising it. Thus the stone in the raised position,
acquires the energy known as gravitational potential energy. Thus
the capacity of a body to do the work by virtue of its position is
known as gravitational potential energy.
Another type of potential energy possessed by a body is due to
the change in shape of the body. It is called the elastic potential
energy. When the spring of a watch is wound up, it develops the
ability to do work which keeps the hands of the watch moving.
During the course of winding, work is done against the elasticity
of the spring. This work is stored in the spring as energy due to a
change in its shape. Similarly work is done in compressing a gas
and also in stretching the string of a bow.
As a result of this they develop the potential energy to do the
same amount of work and hence posses potential energy due to
change in shape, known as elastic potential energy. Thus the energy
possessed by a body by virtue of its position or change in shape is
known as potential energy. In Figure 7.2, a Toy Bus can move due to
52 Basics of Biomechanics

Fig. 7.2: Toy bus moves due to potential energy stored

in the compressed spring

the potential energy stored in the compressed spring under strain.

Work is done on the body against the force of gravity mg. So we
have,
Force applied vertically upward
F = mg

Fig. 7.3: Potential energy passes by a body is the product

of the force and distance moved along the force

Vertical distance moved

S= h
PE = work done on the body
where PE potential energy = Force × distance moved along the force
(Fig. 7.3).
 Energy 53

or PE = (mg) × distance
PE = mgh
When a child throws a stone upwards with a certain velocity,
the stone moves upto a certain height and comes momentarily to rest
at the highest point. At the time of throwing, the stone possesed
kinetic energy.
EK = ½ mv2

As the stone moves against gravity, its motion gets retarded and it
gradually attains a zero velocity at the highest point. The kinetic
energy becomes zero, but the stone gains potential energy as it moves
against gravity, to a vertical height ‘h’. The potential energy gained
at the highest point is mgh.
When the stone starts moving towards the ground, it gains
velocity thereby increasing its KE and decreasing its potential energy.
Just before reaching the ground, while of the potential energy
mgh gets converted into kinetic energy. If there is no loss of energy in
any form.
Then KE = PE
½ mv2 = mgh

or v= 2gh

We have described only mechanical energy which exists in two

forms, viz. kinetic and potential, many other different types of
energies have been recognized.
Some of them are:
a. Burning of fuels like diesel or petrol in vehicles provides heat
energy to do work
b. Electric energy is used in homes, industry and even for driving
electric trains
c. When light energy falls on light meter used in photography it
causes its pointer to move across a scale
d. Sound energy causes a thin plate of microphone diaphragm to
vibrate
e. Chemical energy is the source of energy in our food and it
provides us energy to move the various objects.
54 Basics of Biomechanics

f. The energy in the nucleus of an atom is used to produce heat

energy which in turn is used to generate electrical power.
This conversion of energy from one form to the other is known as
transformation of energy. It is usually observed that throughout the
motion, the sum total of the kinetic and potential energies of a body
at any instant of time, remains constant, although energy is being
transformed from potential to kinetic or vice versa. This is a particular
case of a more general law is called the Law of Conservation of
Energy.
This law states that “Energy can neither be created nor be
destroyed. It can simply be transformed from one form to another”.
It may also be stated as “The sum total of all the forms of energy
in the universe remains constant”.
The Law of Conservation of Energy was first stated by a German
Scientist Robert Mayor.
According to this law—Energy can neither be created nor be
destroyed. It may only change from one form to another but the sum
total of all forms of energy remains constant. Sometimes we come
across certain situations in which we start doubting the validity of
the Law of Conservation of Energy. For instance, in the case of body
falling freely from a height, the body strikes the ground and its velocity
reduces to zero. It means that both its kinetic and potential energies
are zero whereas at places above the ground their sum total was not
zero. It appears that the law fails here, but this is not true in fact
when the body hits ground, though its kinetic energy reduces to
zero but we notice that on the ground, heat, sound and sometimes
light are produced. We know that sound, heat and light are different
forms of energy. If we take into account energies of all the forms, it
can be proved that the total energy of the system still remains
constant.
Truly speaking the Law of Conservation of Energy is valid if one
includes all forms of energy available in the universe.
Till the beginning of this century, the scientists believed that
matter and energy are two different entities. It was also believed
that like energy the total mass of the universe is also conserved
and this statement is known as Law of Conservation of Mass.
A German Scientist Einstein however showed that matter and
energy are the two definite aspects of the same thing and they are
 Energy 55

interconvertible. The transformation of mass into energy takes place

according to the famous Einstein’s relation.
E = mc2
The equation is known as mass energy relation. Here ‘E’is the
energy obtained when mass ‘m’is completely converted into energy
and ‘c’ is the velocity of light and is equal to 3 × 108 m/s. The large
magnitude of ‘c’ suggests that a huge amount of energy is obtained
from complete conversion of a small amount of matter. So, while
considering the validity of the Law of Conservation of Energy. We
have not to distinguish between mass and energy. Hence the above
discussion shows that the Law of Conservation of Energy is a
universal law.
 8 Power

In everyday life the word ‘Power’ may have a variety of meanings

but in ‘physics’ it has a precise meaning. Power is defined as:
The rate of doing work or work done per unit time. Thus
symbolically,
P = W/t
where ‘P’, is power, and ‘W’, is work done during the time interval‘t’
Let there be two persons A and B. A is thin and tall and B is a
fat and bulky person. If A and B are of same weight and they climb
up the stairs to the top floor of a building, they do the same amount
of work. If A climbs in 20 seconds and B in 40 seconds then the
power developed by A is double as compared to that developed
by B. Similarly, to carry a pile of bricks to the top of a building, a
laborer might take several minutes, whereas a crane would do the
same job in fraction of a minute. This shows that power developed
by crane is much larger as compared to that of the laborer.
Since;
Power = Work done/time taken,
i.e. Unit of Power = Unit of work/unit of time
The SI unit of work is a joule and that of time is second. Therefore,
the SI unit of power is joule per second which is called watt and is
abbreviated as ‘W’. One Watt is said to be the power of an agent
which performs one joule of work per second.
i.e. 1 Watt = 1 joule/1 second
or
W = J/s
 Power 57

Bigger units of power used in industry are:

1 kilowatt = 1000 Watt
1 kW = 1000W
1 megawatt = 106 W
Smaller unit of power is
1 milliwatt = 10-3 Watt
or 1 mW = 10-3 W
Horse Power is a unit of Power derived from British system of
units, though obsolete now, it is still prevalent in some of the
industries. The power of heavy electrical motors, engines of
vehicles, locomotives and aeroplane is written in Horse Power
abbreviated as HP and
1 HP = 746 Watt.
 9 Scalar and Vector
Quantities

All physically measurable quantities can be divided into two

classes—scalars and vectors.
Scalar quantities are those which are completely designated by
a number and unit and which do not involve any idea of direction,
i.e. scalars are nondirected quantities. Volume is a scalar quantity. It
may be measured in cubic meter, cubic centimeter or some other unit
but it does not involve direction. The statement 3 cubic meters
northeast is meaningless. Mass, density, time, degree of tempera-
ture, number of apples, pressure of gas are scalar quantities.
Any quantity which possesses both magnitude and direction
is called a vector quantity. All vectors are symbolized by arrows, e.g.
velocity, displacement, acceleration, momentum, field strength;
magnetic moments are examples of vector quantities.
The complete specifications of a vector quantity require:
i. A unit depending upon the quantity to be represented.
ii. A numerical value which states how many times that unit is
contained in that quantity.
iii. The statement of direction.
A vector whose magnitude is zero, i.e. | A | = 0 is known
as zero vector. The direction and sense of zero vector are not
defined. The zero vector is denoted by 0–a thick zero.
A vector whose modulus is unity is called a unit vector and
has same direction as that of a given vector. A unit vector
represents direction as its value is always constant. It has no
dimensions. It is denoted by n̂ . Thus,
| A | n̂ = A or n̂ = | A |/A = Vector/its magnitude
iv. Two vectors A and B having
 Scalar and Vector Quantities 59

a. The same magnitude

b. The same or parallel directions regardless of their initial
points and
c. The same sense are said to be equal. Thus in Figure 9.1.
  
AB = CD = EF

Fig. 9.1


v. A vector having the same magnitude as a vector A but in the

opposite direction, is defined as negative of the vector A and

is denoted by A (Fig. 9.2)

Fig. 9.2

vi. A vector which specifies uniquely the position of a point in

space with respect to some arbitrary choosen origin, is defined
as position vector. Consider a point P in a plane and let O be

any point in the same plane for convenience as origin. OP is
called the position vector of P (Fig. 9.3).

Fig. 9.3

vii. Like vectors are parallel vectors having the same sense of
direction while vectors having opposing direction are called
unlike vectors in Figure 9.4, A1, A2 are like vectors.
60 Basics of Biomechanics

Fig. 9.4

But A, A1, Ar are unlike vectors. By sense of directions of a vector

OP we mean whether the direction is from O towards P or from P
towards O.
The process of replacing a single vector by two or more vectors
in definite direction on the same point is called resolution of vectors.
The new vectors are called the components of the original vector.
The most useful type of resolution is that, in which the vector is
replaced by its vector projections or vector components on a set of
mutually perpendicular axes.

Fig. 9.5

Consider any vector A as in Figure 9.5A with the starting point

of the vector as origin O, draw any two axes OX and OY at right
angles to one another. Let the angle between OX and the direction
OP is denoted by θ.
 10 Torque

The one important difference between transitional and rotational

motion is that, for linear acceleration, we need to know only the
magnitude of the force applied, but for angular acceleration, we
must also know the actual point of application of the force and the
way it is directed or, in other words, the moment of the applied force
which is in the terminology used in the context of rotational motion
is reffered as torque (from the Latin word Torque, meaning to twist).
It is measured as the product of the force and the perpendicular
distance of line of action from the axis of rotation. It is represented by
the Greek letter τ. It is a vector quantity, conventionally, the clockwise
torque is taken as negative and that in anticlockwise direction as
positive.
1. Torque acting on a particle. Suppose a particle of mass m is
revolving about an axis ZZ1 in the anticlockwise direction.

Figs 10.1A and B: (A) Force ‘F’ acting on the particle at P (B) The direction of
torque is perpendicular to the plane containing r and F and is given by the right
hand screw rule
62 Basics of Biomechanics

In Figure 10.1A, F is the force acting on the particle and at any

instant the particle is at p, whose position w.r.t. O is at OP = r
where r is the position vector of P. T he moment of the force of torque
on the particle with respect to O is vector product of r and F, i.e.
→ → →
r F
Its magnitude is
τ = rF Sin θ
where θ is the angle between r and F. The direction of Torque is
perpendicular to the plane containing r and F, i.e. directed along z
axis given by right handed screw rule in Figure 10.1B. In other words,
torque is the product of the magnitude of r and F and the cosine of
 
the angle between the vectors r and F .
As a practical illustration, we show the motion of a bolt, it is
perpendicular to both r and F and the magnitude depends on the
angle between these vectors (Fig. 10.2).

Fig. 10.2: Motion of the bolt

i. If θ = 0o as shown in position (1) of the paddle, then   0

ii. If θ = 45o as shown in position (2) of the paddle
 = rF sin 45o = rF/√2 (intermediate)
iii. If θ = 90o as shown in position (3) of the paddle τ = rF
(maximum). This explains why in opening or
closing a door the force is applied by hand is normal
to the door at its outer edge.
 Torque 63

Also the torque depends upon the point of application of the


force, applied at the origin O (i.e position vector r = O) produces
zero torque. That is why we cannot open or close a door by applying
force at the hinges.
Units of torque—It is measured as dyne centimeter in CGS unit
and Newton meter in SI units.
Consider a rigid body rotating about an axis ZZ1; which is fixed
in space so that the possibility of translation of the body as a whole
is ruled out.
Suppose that the rigid body is of arbitrary shape but consists of
a plane section as shown in Figure 10.3, and rotates about a
perpendicular fixed axis at the point O.

Fig. 10.3: Moments on rigid body of plane section rotating

about a perpendicular fixed axis at point O

Imagine the body to be subdivided into many small particles

such as one considered as m1 in the figure at a distance r1 from O.
If F1 is the external force applied at this point, it can be resolved
into a component along the direction of r1 and a component Fm
normal to r1. Since the length of position vector r is fixed, only Fm
1
can produce an acceleration, so that the equation of motion is
Fm = a m1
Where, a = linear acceleration of mass
m1 in the direction of Fm
or Fm = m1 a (in magnitude)
Now, the torque acting on the point mass m1 is given by
64 Basics of Biomechanics

 
1 = r1 × Fm (10.1)
Or

1 = Fmr Sin 90 o
1

 = r1Fm
 = m1 r1 a1
Now the linear acceleration of the point mass m1 is given by
  
a1 =  × r1
a1 = α r1 Sin 90° = αr1
Where α = angular acceleration of the
point mass m1

Hence, τ =m1 r1 (αr1) = m1 r12 

Similarly a particle m2 at a distance r2 from Q will have a torque

τ2 = m1 r12 
For particle m3 at r3 ……………, We have

τ3 = m3 r32  ,

τ4 = m4 r42  , and so on
Total moment on the rigid body shall be sum of the various
individual torques
τ = τ1 + τ2 + τ3………………

= m1 r12  + m2 r22  +

m3 r32  + ………………
= Σmr2 α
If the product Σmr2 is interpreted as rotational inertia of the rigid
body about ZZ1, then we have
τ= α (10.2)
This equation is analogues to the F = ma for translation and
hence called Newton’s 2nd law for rotational motion or it is the
 Torque 65

fundamental equation of rotational motion and is valid for any

rotating body, provided that the torque and the moment of inertia
are both about the same axis.
Since angular acceleration is parallel to the direction of the torque.
Definition of rotational inertia
If α= 1
Then τ = 1
Thus moment of inertia of a rigid body about an axis of rotation
is numerically equal to the external torque required to produce a
unit angular acceleration in the rotational motion of the body about
that axis.
 11 Rotation

Rigid body is a body whose shape and size remains unchanged

under the action of applied forces. In other words, the constituent
particles of such a body bear a fixed relationship to each other.
When a rigid body is in pure translation motion (Fig.11.1A) each
particle of the body has the same linear velocity at any instant and
has the same displacement as any other velocity at any instant and
has the same displacement as any other particle in the body in a
given time. A motion of translation is altered by a single unbalanced
force which may be the resultant of a number of forces acting on
the body.
When a rigid body performs a motion of pure rotation about a
fixed axis, (Fig. 11.1B) the constituent particles of the body, in different
planes trace circular paths about a point on the axis of rotation of
the body. The nearer the particles is to the axis of rotation, the smaller
is the radius of the circle, and farther away the particle is from the
axis, the larger is the radius of the circle. Since these circles are
traced by nearer and farther off particles in the same time, the
particles nearer the axis of rotation have small linear speeds and
particles farther off larger linear speeds. Thus the linear speeds of

Figs 11.1A and B: Pure rotation about a fixed axis. All particles which
lie on a line parallel to axis will have some linear speed
 Rotation 67

particles of the body at any instant, when it is in pure rotation about

a fixed axis are not the same. All particles which lie on a line parallel
to this axis of rotation will have the same linear speed at any instant.
In our daily life we come across many rotational motions such as;
wheel, pulleys, fan blades, drives, hafts, drill and revolving doors.
However, in a most general kind of motion a body may undergo a
combination of translation and rotation at the same time. A top set
into rotation has both translation as well as rotational motions. In
this chapter we wish to concentrate on the kinematics of pure rotation
and will, therefore, assume that axis about which rotation occurs is
fixed in position.
The motion of the individual particles of which a body is
composed of may be regarded as a translation, when the body
rotates, since they all move in circular paths about the point of
support.
Figure 11.2 shows a rigid body rotating with uniform angular
velocity ω about the axis ZZ. Let it be subdivided into a number of
particles of masses m1, m2, m3 ——and at distances r1 r2,r3 -----
respectively from the axis. If v1,v2,v3 be the linear velocities of the
particles respectively. Then kinetic energies of the various particles
are ½ m1 v12 , ½ m2 v22 and so on.

Fig. 11.2: Body rotating with uniform angular velocity ω about the axis ZZ. Body made
of particles of masses m1, m2, m3 …… and at distances r 1, r2, r3 ……respectively
from the axis

Since the kinetic energy is a scalar quantity, its value for the
rigid body is equal to the sum of kinetic energies of various particles
constituting the body. Therefore, kinetic energy of rotation of the
rigid body about the axis of rotation
1 1 1 1
= m1 v12 + m2 v 22 + m3 v 23 …………… + mn v 2n
2 2 2 2
68 Basics of Biomechanics

also linear velocities of various particles constructing the body are

give by.
  
v1 = ω r 1 v2 = ω r 2 v 3 = ω r 3 and so on
In magnitude v1 = r1ω, v2 = r2ω, v3 = r 3 ω
1 1 1
Kinetic energy of rotation = m1 r12 ω2 + m2 r22 ω2 + m3
2 2 2
1 1
r32 ω2 + ….+ m 2n rn2 w2 = Σmr2 ω2
2 2
Since all the constituent particles of a rotating body have the
same angular velocity, ω2 may be taken outside.
1 2 1
Therefore, kinetic energy of rotation = ω (Σmr2) = ω2. I
2 2
The quantity Σmr2 is called the moment of Inertia of the rigid
body about a given axis and has the dimensions (M1L2T0). Thus the
moment of inertia of a body about any axis is the sum of the products
of the masses constituting the rigid body and the squares of their
respective distances from the axis,
Suppose ω= 1
1
Then KE = I
2
or I = 2 KE
Thus, moment of inertia of a rigid body about an axis of rotation
is numerically equal to twice the kinetic energy of rotation of the
body. When rotating with unit angular velocity about that axis,
from the expression I = Σmr2, we learnt that I depends upon the
following two factors:
i. Mass of the body (ii) distribution of mass of the body with
respect to axis of rotation
This means that moment of inertia of a rigid body about a
particular axis is constant.
In CGS units it is measured as gram centimeter2 = gcm2. The SI
unit is kg m2.
Radius of Gyration is defined as the distance from the axis of
rotation at which if whole mass of the body were supposed to be
concentrated, the inertia would be the same as with the actual
distribution of the body into small particles.
 Rotation 69

It is defined as that perpendicular distance of the body from the

axis of rotation, the square of which when multiplied by the total
mass of the body would give its moment of inertia about that axis is
given by I = M K2. It is denoted by the letter K and if M is the total
masses of the body its moment of inertia.
Also I = Σmr2

Or MK2 = ΣMr2 = M( r12 + r22 + r32 … + rn2 )

Where r1, r2, r3 …… are the distances of the particles from axis of
rotation, If n is total number of particles, then

Mn (r12 r22 r32 rn2 )

MK2 =
n
M(r12 r22 r32 rn2 )
=
n
r12  r22  r32   rn2
Or K2 =
n

r12  r22  r32   rn2

Or K=
n
Thus radius of gyration is the square root of mean square
distances of particles from the axis of rotation. The radius of
gyration depends upon:
a. Position and direction of the axis of rotation
b. Distribution of mass of the body with respect to the axis.
The dimensional formula for K is (L) and it is measured in
centimeters or meters.
Torque = I α
And Force = Ma
These relations also show that I in rotational motion is analogous
of mass M in translation motion.
Again the defining equation for angular moment is similar to
that for linear momentum. Thus angular momentum is analogous to
linear momentum, I replacing m and w replacing v.
In translatory motion, mass of body is a measure of the inertia
or opposition to change and greater the mass, greater is the linear
inertia of the body.
70 Basics of Biomechanics

In rotational motion, this role of opposition change in the state of

rotation of a body is played by moment of inertia and may be defined
as an opposition which comes into play when we desire to bring
about a change in the state of rest of a rotating body or state of its
uniform rotation about a given axis.
In other words, it is a measure of inertia in case of rotational
motion and hence called rotational inertia.
Corresponding to the Newton’s three laws of linear motion,
we have three laws of rotatory motion:
Ist Law: A body continues to be in its state of rest or uniform
rotation about a given axis unless an external torque acts on it.
IInd Law: The rate of change of angular momentum of a body
rotating about an axis is directly proportional to the torque applied
and this change takes place in the direction of application of the
torque.
IIIrd Law: If a rigid body exerts a torque on another body in
contact with it, the latter body will exert equal and opposite torque
on the former.
When a body rolls on a horizontal plane without slipping, i.e.
freely, it rotates about a horizontal axis through its center of mass, as
well as its center of mass moves forward along the plane (Fig. 11.3).
Thus, the kinetic energy of a rolling body on a horizontal plane
arises due to (i) motion of rotation and (ii) motion of translation.

Fig. 11.3: Rolling body on a horizontal plane it has both

motion of rotation and motion of translation

Let mass of the body = M

Radius of the body = R
 Rotation 71

Linear velocity of the center of mass v, radius of gyration of the

body about the axis of rotation = k
Moment of inertia of the body about the axis of rotation
I = MK2
And angular velocity of the body about the axis of rotation
w = v/R

1
Also kinetic energy of rolling body = IW
2

1
= mk 2 W 2 ... (11.1)
2
And kinetic energy of translation motion

1
q= Mv2 ... (11.2)
2
The total energy of the rolling body is the sum of 11.1 and 11.2,
i.e. The total kinetic energy of the rolling sphere =

1 1 1
Mk2w2 + Mv2 = Mv2 (K + 1)
2 2 2

1 1
mk 2 w 2  mv 2
2 2

1 v2 1
= mk 2 2  mv 2
2 R 2

1  k2 
= mv 2  2  1 
2 R 

1
= mv 2  k 2  R 2 
2R 2
 12 Body Movements

MOVEMENTS OF THE NECK

Fig. 12.1: Neutral position

Fig. 12.2: Rotation

 Body Movements 73

Fig. 12.3: Extension and flexion

Fig. 12.4: Lateral bending

74 Basics of Biomechanics

MOVEMENTS OF THE SPINE

Fig. 12.5: Flexion

Fig. 12.6: Extension

 Body Movements 75

Fig. 12.7: Lateral bending

Fig. 12.8: Rotation

76 Basics of Biomechanics

MOVEMENTS OF SHOULDER

Fig. 12.9: Neutral

Fig. 12.10: Rotation in neutral

 Body Movements 77

Fig. 12.11: Flexion and extension

Fig. 12.12: Abduction

78 Basics of Biomechanics

Fig. 12.13: Rotation in abduction

Fig. 12.14: Elevation

 Body Movements 79

Fig. 12.15: Abduction and adduction

Fig. 12.16: Flexion and hyperextension

80 Basics of Biomechanics

Fig. 12.17: Neutral

Fig. 12.18: Supination and pronation

 13 Normal Human
Locomotion

An understanding of the normal human locomotion provides us a

basis for the systematic treatment and management of the
pathological gait especially when prosthetics and orthotics are used.
Normal human locomotion can be described as a series of rhythmic
contractions, movements of the extremities and trunk which results
in the forward movement of CG.
Gait cycle consists of the activity of an individual that occurs
between heel strike of one extremity and the subsequent heel strike
on the same side. During a single gait cycle each extremity passes
through two phases, i.e. stance and swing. Stance phase may be
further divided into five parts (Figs 13.1 A and B):
1. Heel strike
2. Foot flat
3. Midstance
4. Heel off
5. Toe off.
Swing phase starts immediately after toe off and ends immediately
before heel strike. Stages of the swing phase are:
1. Acceleration
2. Midswing
3. Deceleration.

Double Support
During this period both the extremities are touching the ground.
Simultaneously this occurs between push off and toe off on one side
and between heel strike and foot flat on other. Period of double
support varies depending upon speed of walking. When speed
increases double support decreases. The absence of double support
is used to distinguish between running and walking.
82 Basics of Biomechanics

Fig. 13.1A: Walking on a horizontal surface

Fig. 13.1B: A single walking cycle on a horizontal surface

The percentage distribution in gait cycle is as follows (Fig. 13.2):

Stance phase is 60% of the total gait cycle, swing phase is 40% of
the total gait cycle, double support is 11% of the total gait cycle,
averagely.
 Normal Human Locomotion 83

The stance phase has the following components:

• Heel strike: It is the first stage of walking cycle in which heel of the
leading extremity strikes the walking surface.
• Foot flat: The foot flat phase comes after the Heel strike in which
the foot is in complete contact with the ground except the toes.
The whole of the body weight is not borne by the foot.
• Midstance: It is the third phase in which the whole of the body
weight is borne by the foot and is also in the complete contact
with the walking surface.
• Heel off: The fourth phase comes after the midstance phase in
which the foot except the heel is touching the ground.
• Toe off: This is the last phase of the gait cycle in which the foot
has just come in the air. It is the beginning of the swing phase.
Likewise the swing phase, i.e. the whole of the foot or its part is
not touching the ground (The foot is in the air). It has the following
components:
• Acceleration: It is the part of the swing phase which starts from
the toe off and ends at the maximum flexion of the hip.
• Mid swing: After the acceleration the limb passes directly beneath
the body. At this point the extremity must be shortened
sufficiently to clear the ground.
• Deceleration: It is the last stage of swing phase which begins from
mid swing and end at heel strike.

Fig. 13.2: Gait cycle

84 Basics of Biomechanics

Comparative Representation of Gait Cycles

Heel strike Foot flat Heel off Knee band Toe off
0% of total 15% of total 15% of total 25% of total 5% of total
gait cycle gait cycle gait cycle gait cycle gait cycle

0 % of total 15% of total 30% of total 55% of total 60% of total

gait cycle gait cycle gait cycle gait cycle gait cycle
completed completed completed completed completed
up to this up to this
phase phase

Swing Phase
Acceleration Mid swing Deceleration
4% of total gait cycle 32% of total gait cycle 4% of total gait cycle
(Largest phase)
64% of the gait cycle in 96% of the gait cycle is 100% of gait cycle is
completed upto this phase completed up to this phase completed

Some of the general characteristics of the normal gait are:

• Vertical displacement of CG: The vertical displacement of the CG
from the midline is 5 cm,
• Lateral shifting of CG: The displacement is also about 5 cm
• Width of walking: It should be 5” to 10”
• Horizontal dip of CG: This is about 5”
• Flexion of knee during stance phase it is about 20° and its purpose
is to reduce the vertical displacement of CG.
• Cadence: It is the number of steps per minute normally it is
70-130 steps depending upon slow and fast walking.
Methods of Studying Normal Human Locomotion
The path through which the CG moves in the course of normal
human locomotion is determined by many factors. The most
important factors are:
• Force of gravity
• The face exerted by muscular contraction
• Inertial effects
• Angular relationship between the segments of the lower extremity
during different phases of walking cycle.
The forces of major importance in analyzing normal human
locomotion are forces exerted by the pull of gravity (Externally
generated forces) and forces exerted by muscular contraction
 Normal Human Locomotion 85

(Internally generated forces). The below shown figure 13.3 helps to

clarify the effects of these two forces on the gait.
Shortly when the heel strikes the floor the forces on the knee tend
to flex the knee joint obviously unless some restraining force acts on
the joint, the knee will buckle. In this instance the quadriceps force is
restraining.

Fig. 13.3: Effect of forces

MEASURING OF THE EXTERNAL FORCES

Kinetics analysis makes it possible to measure the magnitude and
direction of the external forces acting on the limb. Kinematic analysis
makes it possible to determine the location of the joints in space. The
combination of the above two methods of analysis makes feasible
the calculations of the externally generated movement of force at
various joints. For measuring internal forces to date it has not been
practical to quantitatively determine the internally generated forces.
EMG studies (Fig. 13.4) can tell us whether the specific muscle is
active during the gait and when the maximum electricity occurs, but
cannot tell exactly that how force muscle exerted. Such studies do
provide us useful indications of the magnitude of these forces.
However, the electrical activity is directly related to muscle tension.
Analysis of swing function during swing reveals that:
• Hip flexors initiate the action of stance limb and continue to
provide support throughout swing.
• Hip extensions decelerate the swing limb prior to heel strike.
• Hamstring decelerates both hips flexion and knee extension.
• Knee extensions hamper knee flexion to prevent excess heel rise
after toe off.
86 Basics of Biomechanics

Fig. 13.4: EMG study on different muscles

• Knee flexion aid in lifting the toe from the ground.

• Foot dorsiflexors elevates the forefoot during swing to prevent
toe stubbing.
 Pathological Gaits
14 or Abnormal
Walking

Pathological gaits are the gaits other than the normal due to some
disease or abnormality in the anatomical structure of the extremities
(especially lower extremities).

REQUIREMENTS FOR THE GAITS ARE

1. Source of motion
2. Lever
3. Awareness of the quality of motion needed
4. Muscle control
5. Energy.
1. Source of motion: In man the source of motion are muscles, how-
ever, the muscle fibers are so intimately dependent on their
immediate nerve supply that functional classification must
consider the structure as one. As a result, the human source of
motion is motor unit (a functional composite of lower motor
neuron myoneural junction and muscle fibers that neuron
commands.
2. Lever: The purpose of the lever is to translate the motion in to
desired direction. The skeleton and the complex articulation
provide the leverage to define what effect a contracting muscle
will have. Joint anatomy determines the direction in which
motion can occur. Bone length proportionality magnifies the
motor unit action.
3. Awareness of the quality of motion needed: The velocity external
force and direction of motion and its effect on the body are
sensed by the peripheral nerve receptors. This information is
then carried through the tracks of CNS to the centers where it is
interpreted and transformed into appropriate instructions to
the motor system.
88 Basics of Biomechanics

4. Muscle control: Specially the muscle control is the source of desired

motion. Quality of motion is directed by upper motor neuron,
there action response to the feedback from the sensory system.
As much as it is an expression of the patients will.
5. Energy and strength: The patient should have sufficient energy
both to walk and perform the desired task on arriving at his
destination. Availability of adequate energy is dependent on
cardiopulmonary system and provide appropriate amount of
oxygen to the muscles and their supportive tissues.

Results
Source of motion Motor unit (Muscles)
Articulated levers Bones and joints
Awareness of need and action Sensory system
Control of motion CNS
Energy Cardiopulmonary system
Anatomy of the patients, disease or injury indicates the disrupted
components (Fig. 14.1) shows how abnormal forces result in
abnormal gait.
The loss obtained by disease or injury may fall into following
five categories (According to requirement) .
1. Structural insufficiency
2. Motor insufficiency
3. Combined motor unit and peripheral sensory impairment
4. Central control dysfunction (Upper motor neurons)
5. Insufficient energy.
The approach of different phases of gait allows identification of
the different phases without depending upon the normal
performance to provide distinguishing critical events.
Following are different phases of gait:
• Initial contact: Contact response
• Midstance: Terminal stance
• Pursuing for swing period: Initial swing
• Midswing: Terminal swing
• Initial contact and contact response refers to the reaction of limb
segments to being loaded under the circumstance directed by
mode of initial contact with the heel strike, foot normally falls
forward quickly into flat foot posture. If the toes make the contact
first the direction of motion is reversed.
 Pathological Gaits or Abnormal Walking 89

Fig. 14.1: Abnormal forces

• Midstance is the period of stationary foot support. It is the

beginning of the single stance. The normal person first
remains flat on the ground and body advances by progressive
dorsiflexion and extension of the knee. Disability may lead to
either inadequate or excessive motion of the joint with reflection
of the higher segments as well. Also there may not be a flat
foot posture even though there is a period of stability.
• Terminal stance applies to the period of single stance when
the body is forward of the supporting foot normally it is
signified by heel off. In case of disability the person may
maintain heel contact or never have it. A disabled person
may maintain flat foot contact throughout the weight bearing
interval with the heel raising nearly be a part of total limb lift
for swing or the heel may never have contact with the ground.
• Preswing refers to the final movement of the stance, it is
normally characterized by rapid knee flexion and increased
plantar flexion. In case of disability these actions are often lost.
• Initial swing begins with the movements directed towards the
picking up to the foot and advancing of the unloaded leg.
Normally there is a sharp increase in flexion and toe clears
the ground. In case of disability the toes may drag, the knee
flexion may be inadequate. Both these events often induce
substitution.
 15 ADL

DEFINITION
The concept of ADL refers to a group of activities which forms the
integral part of an individual’s independence in routine life. These
activities can be classified as:
1. Self-care activities: Eating, dressing, bathing, combing,
miscellaneous hand activities (e.g. coin handling, phones)
2. Bed activities: Sit in bed, lie in bed, rolling, sit with support
3. Wheelchair activities: Transfer to bed, stool, sofa, bench, chair and
vice versa.
4. Ambulatory activities: With sticks, crutches, wheelchair.
5. Traveling Activities: by car, public transport, air.
6. Communication skills
7. Home management activities
Thus, ADL consist of those tasks which all of us undertake
everyday of our lives, in order to maintain our personal levels of
care. To the disabled person, the ability to perform these tasks, may
mean the difference between being independent or dependent.
One disabled person said:
“ADL are all little things which frustratingly he can’t manage as a
responsible member of the society.”
ADL rehabilitation involves the patient, his family, doctors and
therapist and this teamwork can’t be over emphasized. In addition,
to the personnel, ADL will revolve a round the patient’s natural
environment, his personality, social status, hobbies, work, outdoor
pursuits and interests.
The basis of all modern rehabilitation is functional assessments.
Physiotherapists are concerned with range and Strength of Movement
whereas Occupational therapist use that range and strength for the
performance of essential activities.
 ADL 91

The process of rehabilitation, depending on the clients need may

include medical, psychological, social or vocational services or even
ADL training. It may last just for a few days to several years
depending on the situation.

SCOPE OF ADL IN REHABILITATION

Physical and Mental disabilities do necessitates many change—
1. The loss of independence in the basic activities has a traumatic
effect on the body image and may also affect those person
associated with the patient. Therefore, careful assessment, goal
setting, planning and training program can be geared for
accomplishment of short and long-term goals that aim at self
sufficience for a patient who is either temporarily or permanently
disabled.
2. Dependency in self-care is often the first sign of depression which
later proves to be the major cause of frustrations. So, early
recognition of patient’s needs and ADL training are essential,
especially in acute care setting.
Contrastingly, a chronically disabled person who can be
independent in self-care activities require less custodial care and
thus can be cared for in a more independent unit in a community
setting.
3. Actually, ADL comprise an important area of rehabilitation
particularly for those who are suffering from the more disabling
conditions as for example Multiple Sclerosis, Alzheimer’s disease.
A normal life of work, recreation and family activities may be
impossible for those patients and they therefore, need both physical
and psychological interventions to be able to achieve and maintain
their optimum potential in mobility and personal care.
When considering the individual, his condition and his abilities
and inabilities in ADL, therapist must remember that the ultimate
success of a program of treatment often lies in long, sternous practical
exercise to strengthen weak muscles and improve coordination and
ability which may otherwise cause frustration, anxiety, depression
and lack of motivation. The number and nature of self-care activities
which a person can manage will depend very much on his own
standards and those of his family or community group. The
traditional program of ADL has been an essential part of all
rehabilitation services of any setting, disability and age group.
92 Basics of Biomechanics

IMPORTANT AREAS IN WHICH ADL

PLAY SIGNIFICANT ROLE
1. Knowledge of a person’s level of performance can act as a baseline
from which future progress or deterioration may be measured.
2. They are a guide to any changes which need to be made in a
person’s routine and functional techniques.
3. They may add to both diagnostic and/or prognostic data, in
addition to providing information regarding the patient’s level
of physical impairment.
4. They enable therapist to plan treatment habilitation or
rehabilitation programs.
5. Competence in ADL is affected by self-confidence, intellectual
capacity and motivation, in which physical and psychological
factors are very closely linked.
6. They enable therapist to distinguish between the patient’s
optimum, point at which any condition is most favorable and
his maximum potential and that point of at which he reaches his
highest possible level.
7. Independence contributes to the quality of a person’s life.
8. By planned ‘Salvage Operation’ the therapist can help the patient
to adjust to his new life brought about by disability.
Knowledge guide to diagnostic/prognostic plan treatment
competence enables therefore independent salvage.

AIMS AND OBJECTIVES OF ADL TRAINING

Though the organization of treatment and training program is done
keeping in view the patients needs, his abilities and disabilities;
still there are some general aims of ADL training and these are
discussed under:
1. Establishing and/or maintaining the independence of each and all
basic relevant activities of daily living and developing his potential.
2. Training the patient according to his ability, disability, level of
motivation and home situation. It success is not forthcoming
assisting the patient by using an easier or alternative method,
or supplying an aid or piece of equipment.
3. Assessing the degree of Independence—which will vary for each
patient and helps deciding what kind of help might be needed
by a patient who does not reach full independence and when
and where it will be necessary.
 ADL 93

4. Conditioning the patient physically and psychologically in order

to improve his mobility, dexterity and coordination, and
encouraging positive attitudes towards his own independence.
5. Finding solutions to practical problems. This may include–
i. Avoiding the cause of the problem if possible, i.e. not to
wear a particular garment if it is difficult to put on and/
or take off.
ii. Using alternative methods.
iii. Using an aid, a piece of equipment or an appliance.
iv. Making a specific aid for a patient if no other solution is
available.
6. Educating the patient’s family:
i. To be realistic about the patient’s level of independence.
ii. To help him only when necessary and not because it is
quicker or the patient is demanding, as some children
or elderly people can be.
Finally, therapists must remember that patients often find their
own solutions to difficulties and these should be noted for future
reference (1) Assessing (2) Establishing (3) Finding (4) Training
(5) Educating.

GOALS OF SELF-HELP DEVICES (SHD)

SHD are provided for self-assistance, i.e provided to make the patient
able to do activities without or little external help to be functionally
independent.
Maximum independence in ADL, is the prime goal desired by the
therapist while planning and organizing treatment program for a
patient. Most people don’t want to be dependent upon others for
personal care and their inability to perform a task may make
difference between constantly needing help and managing alone.
Following the assessment of the patient and the organization of
the treatment program aimed at meeting the patients needs, the
therapists will consider whether or not it is worthwhile to attempt to
make a patient independent in a specific activity.
For example—a patient with a progressive illness may have
the neuromuscular potential to feed himself, but in coordination
and weakness in his upper limb may make meal sometimes
frustrating so, he gain no pleasure at all from eating and just struggle
to get his food into his mouth. In order to overcome these problems,
94 Basics of Biomechanics

some special equipment can be given to the patient and these

equipments can be termed as ‘ Self-help devices’.
When assessing and treating the severly disabled patient, the
need for special equipment is likely to arise but aids, appliances or
equipment should only be recommended after comprehensive
assessment and trials of other methods. The therapists must ensure
that recommendations are appropriate to individual needs for disuse
or misuse is usually a result of inadequate assessment and/or
misunderstanding.
1. An AID—It is any small easily handled items prescribed to assist
functional ability, for example—Adapted cutlery or clothing a
dressing stick, typing stick, etc.
2. An appliance—Any device made to fit an individual in order to
connect or prevent deformity and/or increase function. For
example—hand splint, mobile arm supports, calipers, urinary
appliances, prosthesis.
3. Equipment—Any standard article, not usually portable by the
patient, prescribed to assist functional ability any standard item
adopted to fit the needs of the individual patient, for example—
A wheelchair, Special Bed, Hoist, Electric typewriter, telephone,
equipment, possum.
Provision of any item in these 3 categories is complex and must
be preceded by a detailed assessment of a patient needs and his
environment. Other points of note are:
i. The therapist must know the names of suppliers of aids,
appliances and equipment.
ii. She must know where specialist help is available for patients
who may benefit from such items as possum. Mobile arm
supports or a particular make and model of wheelchair.
iii. He should maintain contact with organizations such as the
disabled living foundation, the Royal association for disabled
and others.
iv. He should have sufficient understanding of the design of
commonly used ‘equipment’ to be able to assess immediately
whether it will be suitable for a particular patient and his
environment.
v. Finally, each department should have its own supply of small
aids and relevant appliances. These all are both for assessment
of patient and for loan and for purchase. Such items might
include dressing sticks, stocking/sock/raised toilet seats or
bath seats.
 ADL 95

Therapist must realize that many of the daily problems faced by

the disabled are associated not with their conditions but with the
designed construction of the environment in which we all live. There
own homes may not be suitable architecturally, public buildings,
the homes of friends, roads, pavements may hinder proper function.
It is apparent that it is often necessary to assess and treat the
environment too. There are circumstances in which treatment of
environmental factors would obviate the need to treat a patient.
Many medical conditions are incurable and therapist may not be
able to alter a patient’s situation or solve all his difficulties.
However, a cure is potentially possible for environment. All
therapist as practical, down to earth people, have a responsibility
to the less able, to assist them in campaigning for availability of
information, sign, posting of facilities and educating those who plan
design and build environment.
So these technical aids are an important part of the rehabilitation
program. Aids for the handicapped are generally a last resort, i.e.
when medical treatment has failed to restore full function. For
example parts of body—when other part of body have been unable
to take over the function of an injured one.
Rehabilitation goals can be set-up too high; for example—It might be
advisable for an elderly bilateral above knee amputee to use an
efficient wheelchair rather than depleting his limited energy by
struggling to get out of a chair, walk a few steps and then sit down
again in order to accomplish some task.
A major difficulty today is keeping up with technical progress
in order to apply it for the handicapped. Therefore, technician is
becoming more and more a member of rehabilitation team.
Technical aids have been divided in 5 groups:
1. Transportation aids
2. Aids for daily living
3. Working tools and household equipments
4. Housing problems
5. Therapeutic aids: All these technical aids help the physically
disabled persons to become more self-sufficient, range from
very simple devices to very complicated electronic apparatus;
devices may be temporary or permanent.
Selection of a suitable device and its early use may increase functional
ability sufficiently so that devices may be discarded.
96 Basics of Biomechanics

A self-help aid device must designed for a specific final need to

enable a person to pursue some activity which he either can’t do or
do without spending too much energy or time. The use of aid or
device must give the pleasure and a feeling of achievement with-in
the framework of deformity. It may provide partial or complete
economic independence.
Aids or devices should not be prescribed in unlimited number
nor should they provided until it is that the person wants them. He
will learn to use them in his daily activities.

MAIN GOALS OR FACTORS AFFECTING SELECTION OF AIDS

We must consider the needs of the whole person, the inherent
mechanical characteristics of the aid and device and the value of
training with these.

I. Personal Factors
Physical status: Aids and devices are indicated in many conditions
where there is loss or diminution of strength or decrease in ROM.

Main Goals
1. Stabilization of objects.
2. Compensation for loss of the power as the use of arm slings, etc.
3. Compensation for loss of ROM as with long handles which
makes it possible to do work.
4. Lessening of involuntary motion.
5. Compensation for visual defects with the use of clip boards, etc.

PHYSIOLOGICAL AND PSYCHOLOGICAL

ACCEPTANCE OF DISABILITY AND AIDS
1. The duration of disability often influences the willingness to
accept aids. A person with a congenital and long-standing
disability is generally willing to accept and use the devices, while
a person with a recent acquired disability may refuses to accept
his new body image.
2. The extent of disability may influence, the use of aids.
3. The prognosis of disability is an important factor. When a
disability is ‘progressing’ there may arise a feeling of futility or a
denial of the need for help. In order to minimize the rejection of
 ADL 97

device, we must identify the goals important to each disabled

person and work on those.
4. Social and cultural factors: Cultures have dignified the concept of
strength and beauty. It is difficult for more persons to accept the
idea of being weak, different or conspicuous. Cultural and
sociological pressure affects acceptance of a changes in body
image as well as acceptances of devices.
5. Economical and vocational factors: The cost of an aid and devices
and its repair and maintenance should be in accordance with its
value and the amount of utility it will receive of home and work.
- If a functional aid or device enables a person to earn a living,
the cost is of only secondary importance.
- Generally, aids which make vocational placement possible,
will be acceptable to the person with economic needs and
motivation to support himself and his family.

PRINCIPLES OF MATERIAL DESIGNING

Good designing of ADL devices demand a thorough knowledge of
pathological anatomy and patients requirements.
A Physician may perform an examination and discuss the needs
with the patient and then an orthotist may design the appropriate
appliance.
The PTst and OTst help in identifying problems and orthotic
needs. They teach the patients proper use of the orthosis and evaluate
its adequacy. Many patients discard these orthotic devices because
of improper attention to this important phase of patient education.
A wide variety of material are now available for orthotic
appliances. With space age technology, new ones are constantly
being introduced. These new materials have opened up new
possibilities for: • Better design
• Stronger support
• Increased durability
• Improved cosmetic appearance in orthotics.
However, traditional variety of materials such as steel and leather
are still widely used.
Very obviously, there is no ideal material that will serve all orthotic
problems as each contain completely different clinical situations.
Various characteristics of a good material are:
1. It should be DURABLE.
2. It should be NONTOXIC.
98 Basics of Biomechanics

3. It should be LIGHT.
4. It should be CHEAP.
5. It should be EASILY AVAILABLE.

ROLE OF OT AND PT IN ADL

OT and PT are the branches of rehabilitation and they are concerned
with maximum restoration of function.
- The term rehabilitation refers to a readaptation process following
an injury or a disorder and it includes the repetition of a carefully
designed learning process which enables the patient to
understand his disability and to overcome it.
- Thus, rehabilitation process is a goal oriented process where
individualized sequence of services are designed to assist the
disabled so as to achieve adjustment with the disability.
- It begins with care finding or referred and it continues as gainful
activities which renders the disabled an independence.
- Productive, creative and functional capabilities have to be
expressed in a practical way so that in terms of activities and
assessment it will include—Social, cultural, educational and
domestic aspects; either over a period of a few days or as the state
of a comprehensive progressive treatment program.
* Points which should be considered include-
1. Patient’s age, social circumstances, reactions, dependence,
cooperation and adaptability particularly to his disability.
2. Motivation, altitude and emotions.
3. Experience of doing ordinary everyday task.
4. Residual physical abilities and their exploitation.
5. The physical and psychological factors arising from his condition
and/or disability.
6. The patients actual or potential function with or without aids,
appliances or equipment.
7. General condition of the patient—
i. Acute or chronic stage
ii. Local condition
iii. Degree of deformity and consequent final disabilities.
iv. Extra-articular features and complications.
v. Concurrent illness, physical and psychological problems.
vi. Muscle weakness, muscle wasting and muscle spasm.
vii. Sensory and preprioceptive loss.
 ADL 99

8. The patient may only need an opportunity to try activities in a

suitable environment and it will become obvious to him, his family
and the therapist that he has retained former skills.

Different Approaches of ADL

1. Biomechanical—This approach focuses on the posture, position
and handling of person using the person himself, the therapist
and others. Orthoses, equipment and immediate environment
are also considered.
2. Compensatory—Here, the lack of or reduced ability to perform
an activity or skill is compensated for, by adapting one or more
of following:
- The persons positioning orthoses
- The activity or skill, itself (part or whole)
- The method of technique used
- The equipment used
- The environment.
3. Learning—It uses techniques which promote the understanding
of that which is learned so that—
- As a founder of more complex skill.
- As a stepping stone to allied skills.

ADL Scale—“FIM SCALE”

(Functional Independence Measures)
7 Totally independent
6 Independent with some device
5 Movement with supervision
4 Minimal assistance (<25%)
3 Moderate assistance (25-75%)
2 Maximal assistance (>75%)
1 No movement
 16 Prosthesis

DEFINITION
A prosthesis is an artificial replacement of a missing body segment.
The branch of science which deals with the principles, design,
fabrication and fitting of prosthesis is called ‘Prosthesis’ and the
person specialized in the subject is called ‘Prosthetist’.
• The selection of type of prosthesis must depend on the patients
overall situation, physical and intellectual status and vocational
future.
• Prior to prescription, surgeon must have some knowledge of
principles of prosthetics, the available component parts and
their characteristics.

PRINCIPLES OF PROSTHETICS
1. Patient factors
• Age
• Vascular supply to limb
• Normal sensation of skin
• Muscle strength
- Stump
- Body
• General health condition
• Motivation
• Ability to set realistic goals
• Vocational situations
• Intelligence
• Balance and coordination.
2. Residual limb factors
• Length
• Shape
 Prosthesis 101

• Range of motion
• Skin condition
• Presence of neuromas
• Maturation of residual limb
- Invaginated scars and poorly placed incisions or adherent
incision can affect choice of suspension and thick socket
shape.
- If patient has scarring, neuromas or sensitive areas, specific
provision must be made in socket design, e.g. in diabetic
patient soft padding is necessary inside the socket.
3. Prosthetic factors: If prosthesis is poorly made or improperly
aligned, it will not function satisfactorily. Other prosthetic
factors that affect the final result are:
• Design of socket
• Comfort
• Cosmetic appearance
• Durability
• Type of suspension or knee unit.
Also prior prosthetic use may influence type of prosthesis
prescribed.
- Prosthesis component needs to be matched with good strength
body weight and final goal, e.g. person with good strength
and balance does not require a stance control knee
mechanism for above knee prosthesis. If an amputee wants
to participate in sport, he needs a foot designed for higher
activity level.
- Suspension: There are many methods of suspension ranging
from very basic leather belts to sophisticated suction sockets.
Anticipated volume changes in stump is a key factor to
prescribe a suspension system, e.g. if there is very short below
knee stump, prosthesis is suspended from thigh with
incorporated joint.
4. Activity level: Person using prosthesis only for indoor activities
obviously presents different consideration from someone who
anticipated being active in his job or in competitive sports.
Activity length influences weight bearing, suspension,
components and structural strength of prosthesis.
5. Treatment process: The expertise of surgeons, therapists and other
clinical personnel is significant factor. The methods used for
preamputation, urgent, the surgical technique, the postoperative as
102 Basics of Biomechanics

well as instruction in limb hygiene, prosthesis application and

removal and proper gait training by experienced therapists, all
influences the outcome.
6. Cost: Cost of prosthesis appliance is usually far outweighed by
costs of hospitalization, medical services and therapy. Reducing
number of hospital days is recommended for saving money
rather than compromising the desired prosthesis function and
durability. Facilities may also affect the type of prosthesis
prescribed as well as the proficiency of its use.
- Light weight prosthesis are made from titanium and carbon
fibers as used in endoskeletal prosthesis very expensive
which may increase cost of prosthesis.
Each feature of prosthesis in the prescription should be
considered carefully to provide cost-effective solution to fully
meets the needs of the patient.
7. Energy expenditure: Almost about the same for various prosthesis
when they are properly fitted and aligned. The choice of type
should then be based on other factors such as gait characteristics
that are possible, appearance, cost, weight and convenience for
social activities.

Contraindications
Contraindications for prosthesis of any types includes:
• Severe disability
• Class IV cardiac dysfunction
• Severe neural disorders.
The amputee must be able to maintain balance in erect posture.
Adequate tolerance for exertion must also be present.
The basic requirements for a prosthesis are that it is comfortable
and functional and that the static appearance is cosmetic as well as
its having acceptable appearance during use. For lower limb comfort,
function and appearance during use are generally more important
than cosmetic appearance.
 17 Lower Extremity
Prosthesis

A. There are four types of prosthesis depending on the period

applied:
1. Postsurgical prosthesis within 24 hours of amputation
2. Initial prosthesis within 1 month of amputation
3. Temporary prosthesis within 3 months of amputation
4. Definite prosthesis which is permanent.
1. Postoperative prosthesis: By definition this prosthesis is provided
within 24 hours of amputation. It is prescribed for younger and
healthier patients only.
2. Initial prosthesis: It is sometimes used in place of a postsurgical
fitting and is provided as soon as sutures are removed. Such
devices are used during the acute phase of healing generally from
1–4 weeks after amputation, until the suture line is stable and the
skin tolerates the stresses of
more intimate fitting.
3. Temporary prosthesis (Fig. 17.1):
It is used during the first few
months of the patients rehabi-
litation to ease the transition
into a definite device.
Advantages of this prosthesis are:
i. It helps to classify details of
prosthetic prescription.
ii. It accelerates rehabilitation
by allowing ambulation
before the stump has
completely matured.
iii. These types of prosthesis
may be applied within few Fig. 17.1: Temporary prosthesis
104 Basics of Biomechanics

days following removal of sutures and limited gait training is

started at that point.
4. Definite prosthesis: It is not prescribed, until the patients residual
limb has stabilized to ensure that the fitting of the new prosthesis
will last as long as possible.
B. Classification according to structure: 2 types (Figs 17.2A and B)
1. Exoskeleton prosthesis
2. Endoskeleton prosthesis

A B
Figs 17.2A and B: (A) Exoskeleton prosthesis (B) Endoskeleton prosthesis

I. ENDOSKELETAL PROSTHESIS (INTERNAL SUPPORT)

It consists of internal metal or plastic tube that connects the socket to
the foot and covered with soft foam.

Advantages
• Light weight
• Better cosmesis.

II. EXOSKELETAL PROSTHESIS

It derives their structural strength from external shell of the shank.
It consists of wood or hard plastic material which is always of hard
and durable external shell fixed to the socket and foot. For very
active patients these types of prosthesis are more durable since the
foam covering of the endoskeleton design tear easily and need
replacement at intervals.
 Lower Extremity Prosthesis 105

JAIPUR FOOT—AN EXOSKELETON TYPE OF PROSTHESIS

(FIG. 17.3)
General Description Guidelines of Lower Extremity Prosthesis
1. Check weight bearing areas of
stump, skin condition.
• It should not be prescribed in
edema, neuroma. In diabetic
patients a soft padding is
provided within the socket.
Weight bearing: For lower limb
prosthesis the weight bearing
characteristics of the socket are the
first concern. If the patient has
scarring neuronal or sensitive area
specific provision must be made in
the design of the socket.
2. Suspension: There are many methods
of suspension ranging from very
basic leather belts to suction sockets. Fig. 17.3: Jaipur foot
Anticipated volume changes in the
stump is a key factor to prescribe a suspension system.
3. Activity level: The person using the prosthesis for only indoor
activity obviously present different consideration from some one
who anticipated being active in his job and in competitive sports.
Activity level influences weight bearing, suspension, components
and structural strength of the prosthesis.
4. Prosthesis component: Components need to be matched with
amputee’s activity level, body weight and functional goal, e.g.
person with good strength and balance doesn't require a stance
control knee mechanism for above knee prosthesis. Amputee who
wants to participate in sports need artificial foot designed for
higher activity level.
5. Expenses: Light weight prosthesis are made from titanium or
carbon fibers as used in the endoskeletal prosthesis are very
expensive which may increase the cost of the prosthesis.
Each feature of prosthesis prescription should be considered
carefully to provide the most cost-effective solution that fully meets
the need of the patients.
106 Basics of Biomechanics

PROSTHETICS
Replacement of a body part/parts, i.e. artificial limb. Lower limb
amputations are much more prevalent than upper limb
amputation.

Causes of Need of Prosthesis

1. Congenital (1% cases)
i. Congenital (absence) of a limb
ii. Congenital (deformities) in children which are beyond
repair and are hampering with normal functioning, so
have to be amputated and require a prosthetic fit.
2. Noncongenital
i. Peripheral vascular diseases (64%).
e.g. Arterial Disease: Atherosclerosis of lower aorta and its branches,
especially in elderly where it causes gangrene.
ii. Trauma (8%): In road traffic accidents.
- In severe injuries following failed or partially
successful reconstruction surgery, e.g. reestablish
distal blood supply.
iii. Malignancies: 4%
• Large benign tumors.
• Malignancies irresponsive to chemotherapy.
iv. Metabolic causes: 21%
e.g. Diabetes mellitus
v. Infections:
• Acute: e.g. Gas gangrene
• Chronic: e.g. Osteomyelitis, TB, actinomycosis
(if nonresponsive to treatment).
vi. Nerve injuries: Producing chronic, nonhealing ulcers.

PRINCIPLE LOWER LIMB PROSTHESIS ARE

1. Partial foot prosthesis.
2. Syme’s foot prosthesis.
3. Below knee foot prosthesis.
4. Above knee foot prosthesis.
5. Knee disarticulation.
6. Hip disarticulation.
 Lower Extremity Prosthesis 107

I. PARTIAL FOOT PROSTHESIS

i. Amputation toes
ii. Ray amputation
iii. Transmetatarsal
iv. Tarsometatarsal and transtarsal.

Purpose
1. To restore foot function in walking as much as possible.
2. To simulate shape of joint.
3. Cosmesis.

Factors Affecting Management of

Partial Foot Amputation
1. Condition of soft tissues in weight bearing area and if they can
withstand direct and shear pressure that will occur during
normal activity.
2. Functional consequences of loss of foot joint and of compen-
sation which can be allowed by a prosthesis.

LEVEL OF AMPUTATION AND

PROSTHESIS REQUIRED
1. Amputation of Toes
Purpose of Prosthesis
1. Largely cosmetic
2. To give resistance to hyperextension of the 1st metatarso-
phalangeal joint, if Hallux is also missing.

Prosthetic Options
1. Simple foam or cloth can be used to fill gap in shoe
2. Simple insole with toe fillers made of foam or felt
3. Custom silicone Rubber toes attached to stirrup.

2. Ray Amputation
Amputation of toe with its corresponding metatarsal is called “Ray
amputation”.
108 Basics of Biomechanics

Prosthetic Option
Custom made involves fabrication from pressure insensitive
materials may be used to distribute pressure evenly over the
remainder of the foot.
• In toe amputation standing is not affected as metatarsals head
are intact.
Large stance is less forceful, especially if great toe is absent.

3. Transmetatarsal Amputation
Level of amputation of toes proximal to metatarsal heads.
Disturbs foot appearance more noticeably as more significant
as there is loss of load bearing surface. Patient bears most weight on
heel and decreases the amount of time spent on affected foot during
walking.

Prosthesis
Plastic socket for the remainder of foot.
• Socket is fixed to a rigid plate that extend the full length of inner
sole of shoe.
• Socket protects the amputated ends of metatarsal.
• Plate restores foot length so that the person can spend more time
during stance phase of gait on affected side.

4. Tarsometatarsal Amputation
Disarticulation of foot at tarsometatarsal line and transtarsal
amputation (disarticulation between talus and calcaneum proximal
and navicular and cuboid distally).
• These amputation or disarticulations pose an additional problem
of retaining the small foot segments in shoe during swing phase.
• Foot length is further decreased by an equinus deformity of
amputated limb resulting from unbalanced action of triceps surae.

Prosthesis
To decrease relative movement between stump and prosthetic foot.
Two designs are possible:
i. Above ankle design
ii. Below ankle design
 Lower Extremity Prosthesis 109

Above Ankle Design

Device that encompasses the entire stump end and extends some
distance above ankle.
• The dorsiflexion movement created by forefoot loading is resisted
by counterforces produced on heel and anterior brim of the device
• These are bulky and heavy
• These restrict subtalar movements.

Below Ankle Design

Encloses only the end of stump and terminate around the ankle
joint.
• Resistance to dorsiflexion is produced by accurate fit of socket
on either side of calcaneous.
• Four basic forms:
a. Rigid b. Semirigid
c. Semiflexible d. Flexible
Rigid and Semirigid have a foam lining between walls of socket
and skin surface.
Semiflexible have a combination like urethane elastomer or
silicone base.
For example semiflexible designs are:
1. Slipper type elastomere prosthesis (STEP)
2. Collins orthopedic service partial foot prosthesis
3. Imler partial foot prosthesis or Chicago foot
4. Large silicone partial foot prosthesis.

II. SYME ANKLE DISARTICULATION AND SYME PROSTHESIS

Disarticulation of ankle.

Aims/Characteristics of Satisfactory Prosthesis

i. Transmission of body loads
ii. Light weight
iii. Limb simulation
iv. Lengthening of limb to provide for loss of talus and calcaneous
v. Shock absorption and distribution of force
vi. Provision of rotatory stability about the long axis
vii. Suspension during swing phase
viii. Easy application and removal
110 Basics of Biomechanics

ix. Cosmesis
x. Stability.

Components of Syme Prosthesis

• External keel type foot or foot ankle assembly
• Socket with suspension (optional).
Limited space available between distal portion of residual limb
and floor constraints the foot mechanism. Almost all Syme’s
prosthesis utilizes a nonarticulated foot. Initially thin SACH foot—
External keel type was used but its rigid wooden keel caused large
stress to prosthesis and was not suitable for vigorous activities.
Thicker foot with thinner keel cushion gives decreased shock
absorption.
• A special form of stationary ankle flexible endoskeleton, i.e. SAFE
foot has been used in Syme's prosthesis. It has a flexible Ankle
keel.
• Other available types for Syme level are:
i. Flex foot
ii. Spring lite design.
• Syme amputation provides a long-lasting durable stump with
excellent weight bearing at the end of stump. So mostly end
weight bearing prosthesis are given but sometimes PTB (Patellar
Tendon Bearing) type is given.

Suspension
Bulbous distal ends and flair of Tibia and fibula provide inner
surface for suspension.
• Distal part of socket must be in intimate contact with limbs
bulbous portion.
• If Syme's suspension is proximal to weight bearing then supra-
condylar suspension is required.

Provision for Donning

• It is necessary to allow bulbous distal end to pass the narrow
shank portion of prosthesis.
• So, the plastic prosthesis have windows either medially,
posterior, or posteromedially; or closed double wall prosthesis
 Lower Extremity Prosthesis 111

which have flexible inner walls to allow expansion for entry of

bulbous portion or flexible inner socket is provided.
• For distribution and absorption of stresses during stance phase,
careful moulding is necessary along the tibial crest and supply
of cushioning material around irregular end.
• For decreasing pressure through scar, proximal weight bear is
done through tibial flares.
• For better cosmesis, thinner wall, air cushion types are used
that require no window, straps, buckles and other suspension
devices.

TRANSTIBIAL OR BELOW KNEE AMPUTATION AND

PROSTHESIS
• It is an ideal amputation site.
• It is most proximal level in lower limb at which near normal
function is available. This is because of lesser energy consumption
of this level amputee as patient retains the anatomic knee and its
motor and sensory function.
• Once the patient has completed postoperative phase of treatment
and adequate wound healing is established, goals of
rehabilitation becomes:
– Limbs maturation
– Return to normal activity.
• So initially an intermediate or preparatory prosthesis is worn
followed by definite prosthesis.

Intermediate Prosthesis
Consists of socket. Pylon, foot and a method of suspension.
• Given when edema decreases and patient's residual limb has
atrophies sufficiently to allow independent donning and
removing of prosthesis.

Definite Below Knee Prosthesis

Components are:
i. Foot ankle assembly
ii. Shank
iii. Socket
iv. Suspension component.
112 Basics of Biomechanics

FOOT ANKLE ASSEMBLY

Functions
• To restores general contour of foot and give stability
• Shock absorption at heel contact
• Plantar flexion in early stance
• Simulation of MTP hyperextension
• Muscle simulation
• Cosmesis.

Prosthetic Foot
• Nonarticulated foot
• Articulated foot
- Lighter in weight
- More durable
- More attractive, better cosmesis
- Most commonly used.

Nonarticulated Foot
• Internal keel type
• External keel type.
Mostly used Nonartificial foot is SACH foot (Solid ankle cushion
heel foot).
• Available for multiple shoe styles and heel height, postoperative
uses.
• It is of two types:
- Internal keel type.
- External keel type.

Internal Keel Type (Fig. 17.4)

• Keel is internal and is separated from shoe by foam rubber.
Wooden keel terminates at a point corresponding to metatarso-
phalangeal joint.
The junction of wooden (keel and rubber) allows the foot to
hyperextend at late stance. Posterior cushion is resistant to absorb
shock and simulates plantar flexion in early stance by
 Lower Extremity Prosthesis 113

Fig. 17.4: Internal keel type

compressing. Heel cushion allows a very small amount of

mediolateral and transverse motion. SACH foot is very cosmetic
as the junction between foot and shank can be reduced to a barely
perceptible line.

Advantages
i. Moderate weight
ii. Good durability
iii. No moving components
iv. Minimal maintenance
v. Good shock absorption.

Disadvantages
• Limited range of motion for plantar flexion and dorsiflexion
• Older people have difficulty if there is insufficient compression
of heel at heel strike.

External Keel Type (Fig. 17.5)

• Keel is external
• Keel is not incorporated with rubber foot, instead it is fixed to the
rubber foot
• This is used mostly in Syme prosthesis
• It is used mostly for an exoskeletal prosthesis
• The foot wided keel gives added stability
• This kind of prosthesis is waterproof.
114 Basics of Biomechanics

Fig. 17.5: External keel type

A version of SACH foot is stationary attachment flexible

endoskeleton foot (SAFE foot). It has a rigid ankle block joined to
posterior part of keel at 45° angle (simulating subtalar joint).

Articulated Foot
• These components are manufactured with separate foot and
lower shank regions, joined by a metal bolt or cable.
• Ease of foot motion is controlled by use of a rubber.
• Posteriorly is a Resilient Bumber—to absorb shock and to control
plantar flexion excursion.
• At early stance, slight loading of heel causes foot to plantar flex.
• Anterior to ankle, bolt is firmer rubber, the dorsiflexion stop
which resists dorsiflexion as wearer move forward over the foot.
• Articulated feet are subject to eventual loosening.

Articulated Feet
Single axis feet Multiple axis feet
• Permits plantar flexion and • Move slightly in all planes
dorsiflexion as well as toe to aid wearer in maintain-
break action. No mediolateral ing maximum contact with
or transverse motion walking surface
• These are heavier and less
durable than single axis and
nonarticulated foot

Rotators
• It is a component placed above the prosthetic foot to absorb shock
in transverse plane.
• Used mostly with single axis feet and in very active people.
 Lower Extremity Prosthesis 115

Shank
• Adjacent to foot ankle assembly in below knee prosthesis is shank
• It restores leg length and shape and transmit wearer's body
weight from socket to foot
• Shank
- Exoskeletal
- Endoskeletal.

Exoskeletal Shank (Fig. 17.6)

• Usually made of wood with plastic finishing
• Has a rigid exterior shaped to simulate contour of leg.

Fig. 17.6: Exoskeleton shank

Endoskeletal Shank (Fig. 17.7)

• Made of central aluminium or rigid pylon covered with foam
rubber and sturdy stocking.
• It presents a more life like appearance.
• Pylon has a mechanism to make slight adjustment of angulation
of prosthesis to give more comfort and ease in walking.
116 Basics of Biomechanics

Fig. 17.7: Endoskeleton shank

Socket (Figs 17.8 A to D)

• The amputated limb fits into a receptacle called socket.
• Socket of below knee prosthesis is called patellar tendon bearing
socket.
• It is designed to contact all portion of amputated limb for
maximum distribution of load as well as to assist venous blood
circulation and to provide tactile feedback.
• These are custom moulded of plastic which is shaped over a
model of amputed limb.
• Concavities or reliefs are provided in the socket over areas
contacting sensitive structures. For example bony prominences
Fibular head, tibial crest, tibial condyles, etc. The posterior rim is
made to allow adequate space for medial and lateral hamstrings
when sitting.
• Build ups or convexities over areas contacting pressure tolerant
tissue, e.g. Belly of Gastroneminus, patellar ligament and tibial
and fibular shaft.
• In a superior view the socket resembles triangle with apex
formed by the relief for tibial tubercle and crest and base angle of
which are hamstring relief.
• The anterior wall terminates at the midpatella or above, medial
and lateral walls extends to the femoral epicondyles.
• Posterior wall terminates the across popliteal fossa.
 Lower Extremity Prosthesis 117

• The socket is aligned on the shank in slight flexion to enhance

loading on extension to this resist the tendency of amputation
limb to slide down the socket.

Figs 17.8A to D : A. PTB socket, B. Anterior view of right

PTB socket, C. Posterior view and D. Lateral view

PTB CAN BE OF 3 TYPES

1. Air cushion socket
2. Hard socket
3. Flexible socket with rigid external frames.

Air Cushion Socket

• Has an elastic inner sleeve within a rigid outer shell and cap.
• A sealed chamber between these two has air at atmospheric
pressure.
118 Basics of Biomechanics

• Distal pressure is provided by the tension of sleeve and

compression of air sealed in chamber.

Advantages
• Possibility for higher distal loading
• Maintains distal contact, even when link volume changes
• Lessens skin damage due to skin stretching
• Improved suspension
• Increase range of motion
• Decrease shear on residual limb.

Disadvantages
• Complicated and difficult to fabricate
• Once completed, modifications are very difficult.

Flexible Socket with Rigid External Frames

• Flexible inner socket (of polyethlene) is inserted in a rigid frame
(of thermoplastic).
• Frame covers only primary weight bearing areas while more
sensitive areas like bony prominences and soft tissue are enclosed
in flexible socket.

Advantages
• Decreased weight
• Increased comfort
• Improved heat dissipation
• Inner socket can be changed.

Disadvantages
- More difficult and time consuming
- Less cosmetic.

Socket
• Lined
• Unlined
 Lower Extremity Prosthesis 119

Lined
• Has polyethylene foam liner apart from cushioning the limb, it
also facilitates alteration of socket size as it is removable and
material can be added to the outside of liner.
• Used in diabetics.

Unlined

• Hard socket but a self interface is provided by socks or a sheath

worn with the unlined socket.

Syme’s Socket
As patient with Syme's amputation can usually bear significant
weight through distal end of limb. So, proximal loading provision is
not needed.

Suspension
During swing phase of walking or whenever wearer is not standing
on the prosthesis, e.g. when climbing stairs or jumping, the prosthesis
require some form of suspension.

Cuff Variation
a. Supracondylar cuff
b. Waist belt
c. Sleeve suspension
d. Knee joint and thigh corset.

a. Supracondylar Cuff
• It has a leather strap encircling the thigh immediately above
femoral epicondyles (Fig. 17.9).
• Attachment points on the socket are slightly posterior to sagittal
midline in order to resist hyperextension at knee.
• This kind of suspension is approximate for average length
residual limbs with good knee stability. This is not recommended
for short residual limbs.
120 Basics of Biomechanics

Advantages
• Adjustability
• Ease of application and removal
• Adequate suspension
• Provides moderate control of knee flexion.

Disadvantages
• May pinch soft tissues during knee flexion
• Can't completely eliminate socket positioning
• May restrict circulation.

Fig. 17.9: Medial view and anterior view

Waist Belt
Supracondylar cuff can be augmented by waist belt (Fig. 17.10).
• A belt is situated above iliac crests or between iliac crests and
greater trochanter.
• On the amputated side, an elastic strap extends distally to a
buckle at midthigh.
• Fastened to this Buckle is a strap that attacks to a PTB cuff,
connected to prosthesis.
• It is not which are given to patients with severe scaring or sensitive
skin in regions in contact with belt.
 Lower Extremity Prosthesis 121

Fig. 17.10: Augmentation of supracondylar cuff by a waist belt

Sleeve Suspension
• Made of thin latex rubber or neoprene
• They fit tightly over the proximal aspect of prosthesis and are
rolled up over the patients thigh.

Knee Joint and Thigh Corset (Fig. 17.11)

Fig. 17.11: Knee joint and thigh corset

• Indicated especially for individuals with very sensitive skin on

amputated limb
122 Basics of Biomechanics

• Metal hinges attach distally to medial aspects of socket and

proximally to a leather corset
• Corset height may vary and may reach the ischial tuberosity for
maximum weight relief on amputated limb
• Corset leather increases the area of weight distribution.

ABOVE KNEE OR TRANSFEMORAL

AMPUTATION PROSTHESIS
• Amputation is done at level between femoral epicondyle and
greater trochanter
• They have an increased energy expenditure for walking (it is
important to maintain as much length as possible when doing a
transfemoral amputation)
• The longer the residual limb, the easier it is to sustain a prosthesis
and as well to aligned it
• Those whose residual limbs include the distal part of femur can
wear a knee disarticulation prosthesis
• If the amputation is proximal to trochanter, the patient cannot
retain and control an above knee prosthesis and Hip
disarticulation prosthesis is required.

COMPONENTS OF ABOVE KNEE PROSTHESIS

1. Foot ankle assembly
2. Shank unit
3. Knee unit
4. Socket
5. Suspension.

Foot Ankle Assembly

• Mainly SACH foot is used
• But others, e.g. seatle foot and flex foot are also used (explained
in below knee foot prosthesis).

Shank—Explained in Below Knee Prosthesis

• Both exoskeletal and endoskeletal shank are used
• Endoskeletal shank produces a pleasing appearance especially
in knee area and it is adjustable.
 Lower Extremity Prosthesis 123

Knee Unit
• Enables the user to bend the knee when sitting or kneeling and
in most instance also permit knee flexion during later part of
stance phase and throughout the swing phase of walking.
• Commercial knee units may be described according to
4 features:
- Axis
- Friction mechanism
- Extension aid
- Stabilizer.
Thigh piece can be connected to shank either by (Fig. 17.12):
a. Single axis hinge
b. Polycentric linkage—More complex but give more stability.

Fig. 17.12: Single axis knee and polycentric knee unit

Friction Mechanism
• Leg of above knee prosthetic is a pendulum swinging about the
knee.
• For more active amputee, adjustable friction mechanism is
required to reduce the asymmetry between motions of sound
and prosthetic leg.
• In absence of friction mechanism in individual who walks rapidly
experience high heel rise at the beginning of swing phase and
abrupt and often noisy extension at end of swing phase.
124 Basics of Biomechanics

• The simplest and most popular knee unit provide constant

friction generally by a clamp which can be tightened or loosened
to change the ease of knee motion.
• Another device gives variable friction during different phases of
gait.
• Mostly friction is given as sliding friction, but more complex
fluids like oil or air are used.
• These hydraulic frictions and air frictions vary with velocity of
walking.

Extension Aids
• Many knee units have extension assisting mechanism during
later part of swing phase.
• Simplest type is an extension aid having elastic webbing located
in front of knee axis. The elastic stretches when knee flexes in
early swing and recoil to extension in late swing.
• Internal aid is an elastic strap or coils spring within knee. It acts
as external aid but doesn't extend to the knee on sitting. Acute
flexion brings the spring posterior to knee axis.

Stabilizers
• Most units don't have special stabilizers and knee action is
controlled by hip motion and knee alignment in relation to other
parts of prosthesis.
But, some units have:
- Manual lock
- Friction brake.
Manual lock: In which pin lodges in receptacle and is released only
when wearer manipulates on unlocking lever can then flex the knee.
Friction brake: More complex gives very high friction at early stance
resisting knee flexion. From midstance to heel contact, friction brakes
don't interfere with knee motion.

Socket
• It should be a total contact device as in all other prosthesis to
distribute load over maximum area.
 Lower Extremity Prosthesis 125

• It also assists venous return and prevents edema.

• Flexible socket of thin polyethylene thermoplastic adheres to skin
better than rigid plastic socket. They also dissipate heat more
effectively and afford the wearer sensory outputs from external
objects, e.g. chair.
• Above knee prosthetics sockets are designed to emphasize
loading on pressure tolerant structure, e.g. ischial tuberosity,
gluteal musculature, side of thigh and distal end of amputated
leg (pubic symphysis and perineum should not bear pressure).
• Sockets are of different types in above knee prosthesis.
i. Quadrilateral sockets
ii. Ischial containment sockets.

Quadrilateral Socket
• Quadrilateral in transverse plane. It has 4 walls whose
orientation varies according to patients’ anatomy and
biomechanical requirement. Sockets has a horizontal post shelf
for ischial tuberosity and gluteal musculature. Medial brim at
same level, anterior wall 6-8 cm higher apply posterior force to
limb.
• Height of lateral wall is same as that of anterior wall for
stabilization. There are concave reliefs and convexities at the
contours (Fig. 17.13).

Fig. 17.13: Quadrilateral socket

126 Basics of Biomechanics

Ischial Containment Socket

• Its walls cover the ischial tuberosity and part of ischiopubic
ramus to augment socket stability.
• Mediolateral width of socket is narrower than that of quadrilateral
socket, to increase frontal plane stability and minimize bulk
between legs.
• Anteior wall is lower and lateral wall covers the greater
trochanter.

Fit and Alignment

Slide socket function is required

1. To facilitate contraction of hip extensors
2. To decrease lumbar lordosis.
Socket designing is done best by
a. Giving proper contour relief for functioning muscles
b. Providing stabilizing pressure on skeletal structure
c. Stretching functional muscle to slightly greater than resting length
for maximum power
d. Proper force distribution.

Suspension

• Suction—As suction is the pressure difference inside and

outside the socket it works on the principle of greater pressure
externally.
• The socket brim fits tightly and a one-way air release valve is
located at the bottom of the socket.
• There are 3 means of suspension using suction:
1. Total suction
2. Partial suction
3. No suction.

Total Suction

Achieved without use of any external suspensory unit if limbs fits

snugly.
 Lower Extremity Prosthesis 127

Partial Suction
If socket is slightly loose, patient wears a socks and an external
suspensory aid is needed which can be either a fabric, e.g. Silesian
bandage or a rigid plastic or metal hip joint and pelvic band.

No Suction
Socket has a distal hole but no valve. Pressure is same on both sides.
Amputee wears one or more than one socks and requires a pelvic
band.
 18 Upper Limb
Prosthesis

TYPES
i. Body powered
ii. Externally powered

Body Powered Prosthesis

Operates by a force that comes from mechanical transmission of
muscle effort generated elsewhere in body away from amputation
site.
• Indicates in more distal amputation as greater leverage helps in
operation of the prosthesis.
• Comparatively less costly, lighter weight and high reliability
due to mechanical simplicity.

Externally Powered Prosthesis

Components are used when body power is undesirable and
insufficient.
• External power comes from source outside body, e.g. above elbow
battery, electronic, pneumatic and myoelectric.
Principle Upper Limb Prosthesis
1. Partial hand prosthesis.
2. Wrist disarticulation and transradial or (below elbow prosthesis).
3. Elbow disarticulation (above elbow prosthesis).
4. Shoulder disarticulation prosthesis.

PARTIAL HAND AMPUTATION AND PROSTHESIS

• Because lack of tactile sensation, poor appearance, lack of
ventilation in prosthesis and limited function, most partial hand
amputee prefer to function without prosthesis.
 Upper Limb Prosthesis 129

Indications
i. Aesthetic loss
ii. Protection
iii. Prehension
iv. Cosmetic purpose
1. Aesthetic loss: The disfigurement that hand present makes an
amputee ask for prosthesis for cosmetic purpose although a
rubberized prosthesis decreases sensory input and increases
perspiration.
• These are also made up of PVC plastic.
2. Protection: Another indication for prosthesis is as it protects
hypersensitive or fragile areas. Most necessary during early post-
operative stages while healing is occurring. Preliminary devices
are often fabricated from low temperature plastics that can be
easily reshaped to change of the stump.
3. Prehension: Most congenital deficiencies don’t require any
assistive device as children develop idiosyncratic grasp patterns
naturally.
For improving prehension static devices and dynamic devices
can be used.
1. Static devices: Most commonly used, these are more durable
so are preferred by manual workers. It can be made of:
i. Stainless steel
ii. Laminated plastic over wood
iii. Laminated plastic over light weight aluminium
iv. Thermoplastics.
Prehension devices can be simple to complex depending
upon functional requirement of amputee.
4. Dynamic devices: These articulated devices are powered by
residual motions at wrist or palm.
• These offer wider range of openings, providing grasp for
varied objects.
• Body power transmitted from Biscapular abduction is
generally used to open the device but wrist or other body
motions may also be used.
130 Basics of Biomechanics

Fig. 18.1: Levels of amputation

LEVELS OF AMPUTATION (FIG. 18.1)

• <35 percent very short
• 35-55 percent short
• > 55 percent long below elbow.

WRIST DISARTICULATION AND TRANSRADIAL (BELOW

ELBOW AMPUTATION) BELOW ELBOW PROSTHESIS

Wrist Disarticulation, Below Elbow Prosthesis

• Full forearm length preserves pronation and supination and
gives a long lever arm to operate the terminal device.
• A minor cosmetic drawback is that the active prosthesis will
result in a longer forearm on prosthetic side.
• Maximum functional rehabilitation of upper elbow amputee can
be achieved by an early prosthetic provision.

Immediate and Early Postsurgical Prosthesis

• A immediate prosthesis is applied in surgery at the time of final
closure.
• While an early prosthesis is applied between surgery and suture
removal.
• They are applied by application of separate layers of stockinet
directly over the dressing followed by distal padding and fibre
glass casting tape before applying prosthesis.
 Upper Limb Prosthesis 131

Advantages
i. Edema control
ii. Decreased postoperative pain
iii. Increased prosthetic use
iv. Improved proprioceptive/prosthetic transfer
v. Improved patient psychological adaptation to amputation.

Preparatory/Training Mechanical Prosthesis

Applied at the time sutures have been removed (mostly 10-14 days
after surgery).

Advantages
i. Provides continued edema control
ii. Decrease in pain and anxiety of patient
iii. Helps to condition tissue to accept, the forces exerted by
prosthetic socket.

Definitive Mechanical Prosthesis

• Given after wearing postoperative prosthesis for 1–2 weeks
followed by preparatory prosthesis for 2-4 weeks.

COMPONENTS OF DEFINITIVE BELOW ELBOW PROSTHESIS

1. Socket
2. Terminal device/prehension device
3. Wrist unit
4. Elbow unit
5. Control cable system.

Socket
It is the part of prosthesis covering the stump or residual limb.
• It is a major determinant of functional effectiveness of prosthesis
control.
• The socket design must provide for motion, stability and Comfort
and these are achieved by providing total contact between stump
and prosthesis.
• Socket can have self-suspended or harness suspended system/
design.
132 Basics of Biomechanics

• The longer the residual limb the lower the proximal line of socket
can be.
• For below elbow amputation—2 types of socket designs:
i. Supracondylar Brim–That capture humeral
epicondyles and posterior olecranon, e.g Mirnster type
ii. Sleeve suspension–That uses either atmospheric
pressure or skin traction to maintain suspension.
• For wrist disarticulation—Supracondylar suspension is
used.

Terminal Device or Prehension Device (Fig. 18.2)

• The most distal component of an upper limb prosthesis is known
as terminal device (TD)
• These are functionally divisible into:
i. Passive device
ii. Active/prehensive type.
i. Passive device: Have no moving parts so, require no cables or
batteries for operation.
• Most common, lighter, rehabilitation
• Passive hand-custom sculpted
• Rubber hand serving mostly cosmetic purpose and static
grasp
• Some passive hands may have specialized shapes for
particular activities.
ii. Prehensile type/active device—provide active grasp.

Classification
a. Voluntary opening type b. Voluntary closing type
- Normally held close - Normally held open
by a spring and open by spring and close on
on pulling control cable pulling control
- Less popular as they
provide. Only limited
pinch force.
- Hand like terminal device - Utilization terminal device,
e. g. host type
• These offer graded prehension
- Functional losses in hand type of Terminal device are much
greater than the utilization terminal device because the
 Upper Limb Prosthesis 133

Fig. 18.2: Types of terminal devices

cosmetic glove that covers the hand further impedes motion

and contours often block visual inspection of fingertips.
- Voluntary opening hands are less popular as they provide
only limited pinch force.
- Externally powered hands offer for greater pinch force and
function are therefore preferred to body powered hands.
* Approx 90 percent of hand function consists of palmer
prehension to duplicate function of palmer prehension,
terminal device must open approx. 4 cm.
- Purpose of terminal device is to duplicate pinch, hook and
grasp.

Wrist Unit—Serve 2 Basic Functions

i. To attach terminal device to forearm of prosthesis.
ii. Permit the amputee to preposition the terminal device prior to
operation.
It provides the amputee with device to permit some form of
substitution for active forearm rotation.

Types
i. Friction wrist unit: Permit the amputee supination and
pronation, by manually rotating terminal device by normal
hand.
134 Basics of Biomechanics

- These are made of aluminium or stainless steel in many

sizes.
- They are mostly oval shaped for better cosmetics.
ii. Quick change wrist units: Are designed to facilitate rapid
interchange of different terminal devices, usually a hook hand.
iii. Ball and socket wrist units: Permits universal prepositioning of
terminal device with constant friction.

Elbow Units
Flexible hinges, rigid hinges.
i. Flexible hinges (Fig. 18.3): To facilitate transmission of residual
forearm rotation to terminal device, thereby requirements for
manual prepositioning by amputee.
- Generally made of metal or leather.
- Attached proximally to triceps pad and distally to
prosthetic forearm.
- Generally used in long below elbow amputation.
ii. Rigid Hinges: Used in short and very short below elbow
amputee
- The amputee must manually preposition the terminal
device.
* Hinges can be: Single axis, polycentric
In below elbow amputation very short stump—Prosthetic
socket extremely high trim lines are required. This is called a
step up hinge and provides only 90 percent or less flexion at
elbow.

Fig. 18.3: Flexible elbow hinge

 Upper Limb Prosthesis 135

Fig. 18.4: Control cable system

Control Cable System (Fig. 18.4)

• It works on cable or single control system.
• A stainless steel or nylon control cable is attached proximally to
harness and distally or some form of terminal device which can
be hand type or hook type.
• The amputee used shoulder motion (flexion) on amputated side
to apply tension to control cable.
• This cable tension is transmitted to the thumb of terminal device
and causes opening of terminal device.
• When cable tension is relaxed, the movable finger closes on
stationary finger.

Harness System
This is the suspension system made up of straps by prosthesis is
suspended on stump.
• For below elbow prosthesis, horizontally oriented, “Figure of 8”
harness is used.
• Basic function of harness is to suspend the prosthesis and
transmit the body power to cable system.
• Axilla loop serves as an anchor from which two other straps
originate. It encircles the shoulder girdle on nonamputated side.
• Anterior support strap or inverted “Y” suspensor originates axilla
loop passes over shoulder on the amputated side is attached to
anteroproximal margin of tricep pad of prosthesis.
It resists displacement of socket on residual limb when
prosthesis is subjected to heavy loading.
136 Basics of Biomechanics

Fig. 18.5: Straps are made up of 2.5 cm wide dacron

• Control attachment strap (Fig. 18.5): Joins the axillary loop and
control cable. Its correct positioning is important as too high
attachment does not produce sufficient cable excursion to operate
terminal device.
Too low attachment requires large effort by amputee for
operation of terminal device.

Heavy Duty or Saddle-shoulder Harness (Fig. 18.6)

• Standard harness has axillary loop should always be padded to
avoid excess pressure on axilla and its structure.
• Even after padding when significant tension is applied to anterior
support and control attachment straps, tension drives the loop
vertically upwards into axilla on normal side.
• Over a period of time, it can cause skin irritation and in extreme
cases neuropathic changes from brachial plexus pressure.
• So, when such danger is anticipated, heavy duty or saddle
shoulder harness is used to take loading tension on shoulder of
the amputated fingered sides.

Fig. 18.6: Heavy duty or saddle-shoulder harness

 Upper Limb Prosthesis 137

Bilateral Transradial Harness (Fig. 18.7)

• All these harness require shoulder flexion and scapular
abduction for operation of prosthesis.
• For very short bilateral prosthesis, e.g. Muenster socket.
Harness is used because Muenster Socket is self-suspended
socket that require a harness only to provide terminal device
operation.

Fig. 18.7: Bilateral transradial harness

Advantages and Disadvantages of Mechanical Prosthesis

Advantages
Freedom to perform in a carefree manner in most physical
environment and achieve accuracy and independence in activity of
daily living (ADL).

Disadvantages
Discomfort due to shoulder harness and cosmetic appearance of
hook terminal device.

ELBOW DISARTICULATION AND ABOVE ELBOW

AMPUTATION AND PROSTHESIS
• Amputation should be performed as distally as possible.
• Elbow disarticulation, although provides good suspension and
rotational stability of the prosthesis is not very popular as adult
amputee is limited in cable controls and relatively weak external
hinges. But disarticulation is preferred in juvenile amputees.
• Supracondylar amputation should and take into account that
internal elbow mechanism occupies approx 4-6 cm of length.
138 Basics of Biomechanics

• Amputation through surgical neck of humerus is functionally

equivalent to shoulder disarticulation but is more esthetically
pleasing as shoulder contour and axillary border is preserved
and hence, prosthetic suspension is somewhat easier.
• Deltoid tuberosity is the most proximal level at which shoulder
joint control is effective.

Physical Factors Affecting Prosthesis

1. Length of lever arm.
2. Quality and nature of soft tissue coverage.
3. Shape and muscle tone of residual limb.
4. Flexibility, range of motion, stability of proximal joints.
If the level of amputation is at least 10 cm above the olecranon
tip, all availables, elbow options can be utilized successfully
including external power.
• Elbow disarticulation requires the use of outside, locking joints
located on either side of humeral epicondyle external to socket.
• It is preferred in children as epiphysis is preserved and bony
outgrowth is prevented.
• There should be sufficient tissue to cover a cushion the distal
portion of bone without producing bulbous contours.
• Myoplasty helps to firm the residual limb, help to prevent
redundancy and provides improved EMG, potential for use in
myoelectrically controlled prosthesis.

Levels of Amputation (Fig. 18.8)

< 30 percent - Very short above elbow amputations
30-50 percent - Short above elbow amputations
50-90 percent - Long above elbow amputations
90 percent - Very long above elbow amputations
100 percent - Elbow disarticulation.

Components
1. Terminal device: Same as in below elbow
2. Wrist unit: Same as in below elbow
3. Forearm shell: Cylindrical Hollow shell connecting wrist unit
Elbow unit.
4. Elbow joint/unit: Mechanical substitute should permit amputee
controlled flexion and extension through about 135° and also
 Upper Limb Prosthesis 139

Fig. 18.8: Levels of amputation

locking and unlocking mechanism at numerous points

throughout 135° range of motion (ROM).
These can have—
i. Outside locking hinges: In elbow disarticulation
transcondylar levels of amputation
- It comes into 2 models—
a. Heavy duty model—gives 5 locking position
b. Standard duty model—gives 7 locking position
ii. Inside locking elbow units: In amputation through humerus
approximately 5 cm proximal to elbow joint. As there is
enough space to accommodate inside locking elbow
mechanism.
- Gives parallel position of locking
- It has turntable also to preposition forearm in external
and internal rotation.

Socket
In elbow disarticulation—intimate fitting at and above condyles
provides rotational control and suspension.
Socket has—
i. Soft tissue integral supracondylar wedge
ii. Fenestration covers plate
iii. Flexible bladder variants for less bulbous remnants
iv. Screw in type socket.
Marquardt had developed a socket less design for elbow
disarticulation and very short below elbow amputation
(Fig. 18.9).
140 Basics of Biomechanics

• In this technique, an open mediolateral framework supra-

condylar pads and circumferential straps placed, superior
and inferior to biceps.

Fig. 18.9: Marquardt’s socket less design for elbow disarticulation

Supracondylar Pads (Fig.18.10)

• Provide suspension
• Allows humeral control of rotation.

Fig. 18.10: Supracondylar pads

Control Cable
• Above elbow prosthesis are operated by two distinctly separate
control cable
 Upper Limb Prosthesis 141

• 1st cable—Flexes elbow and operates terminal device

• 2nd cable—Permits amputee to lock and unlock the prosthetic
elbow.

FIRST CABLE OR ELBOW FLEXION/TERMINAL DEVICE

CONTROL CABLE
• This cable housing is split into 2 separate parts
• Proximal part—attached to posterior surface of humeral section
of prosthesis.
• Distal part—Fixed to prosthetic forearm by an ‘elbow flexion’
attachment device.
• Elbow flexion/terminal device control cable originates at control
attachment strap of harness, passes there proximal portion of
split housing, the control cable is exposed anterior to mechanical
elbow axis. The distal portion terminates its attachment at
terminal device.
• Tension applied to cable causes flexion of prosthetic elbow which
is limited to the gap between 2 cable housings.
• The nearer is the attachment of cable/elbow flexion device to
mechanical axis, more is the amount of force required.

SECOND CABLE OR ELBOW LOCK CONTROL CABLE

Originates at anterior suspension strip passing down the
anteromedial surface of humeral section of prosthesis, distal end
attaches to elbow locking mechanism which works on an alternate
principle.
• Pull and relax to lock and pull and relax to unlock.

Operating Sequence of Cables (Fig. 18.11)

1. Tension applied to elbow flexion/terminal device control cables.
2. At the desired angle of elbow flexion rapid application of elbow
lock control cable.
3. With the elbow, reapplication of tension to the 1st cable for
operation to terminal device.

Standard Transhumeral Harness System

• Full operation of terminal device in transhumeral prosthesis
requires more than 10 cm of cable excursion.
142 Basics of Biomechanics

Fig. 18.11: Operating sequence of cables

• Elastic straps forms “figure of 8”.

• Common elements of harness are
i. Axillary loop
ii. Anterior support strap
iii. Lateral support strap
iv. Control attachment strap
v. Elbow lock control strap.
1. Axillary loop: Same as in below elbow prosthesis
2. Anterior support strap: Same as in below elbow prosthesis except
that it attaches to anteromedial part of humeral section of
prosthesis.
Its function are:
i. Suspension of prosthesis against axial loading
ii. Prevention of rotation of prosthesis on the residual limb
during prosthetic usage.
3. Lateral support strap: Originates posteriorly from upper portion of
Axillary loop. The strap is directed horizontally and stitched to
anterior support strap at their intersection.
Its function are:
i. Suspension
ii. Prevent of external rotation of socket on application of
tension on terminal device.
4. Control attachment strap: Same as in below elbow prosthesis.
5. Elbow lock control strap: Originates at upper nonelastic portion of
anterior support strap and is attached at its distal end to allow
lock control cable.
 Upper Limb Prosthesis 143

Fig. 18.12: Harness system for standard above elbow prosthesis

- Across back strap is sometimes used as an adjunct to standard

transhumeral harness.
- In patients engaged in heavy work shoulder harness given.
For bilateral above elbow amputees—Prosthesis has 2 figured
operating harness without axillary loop.

Harness System for Standard above Elbow Prosthesis

Figure 18.12 shows the harness system which issued for standard
above elbow prosthesis.
 19 Spinal Orthotics

DEFINITION
Spinal orthotics is a device fitted externally to include body part in
order to prevent or correct spinal deformity.
Spinal orthotics is therefore an external force system. The force
that can be applied by spinal orthotics on body are:
a. Tension: To decrease bending and straighten a curved element
under constant application.
b. Compression.

FUNCTIONS OF A SPINAL ORTHOTICS

1. To aid in sitting, standing and walking by supporting certain
weakened or paralyzed muscle and unstable joints.
2. To relieve pain and increase speed of recovery of diseases or
injured structure by protecting and immobilizing as well as
providing maximum function and comfort to patient.
3. To prevent progressive deformity of the spine caused by abnormal
stresses and strains.
4. To prevent deformity causing forces like muscle imbalance and
tissue contraction.
5. To correct fixed deformity by means of active corrective
mechanisms added with the brace.

Categories of Spinal Braces

Classified into two general categories:
a. Passive supporting brace
b. Active corrective brace.
a. Passive supporting brace – further divided into:
i. Supporting brace: This brace includes the flexible semi-
rigid cloth corsets, bells and light flexible metal braces,
 Spinal Orthotics 145

e.g. semibraces. For example, soft cervical collar to

maintain postural structure of spine.
a. Supporting brace: This includes corsets of leather,
plastics and rigid metal braces. These are equipped
and moulded pelvic support.
b. Active corrective brace: This brace includes the brace
which produces active corrective forces in one or more
direction.
- Used exclusively in treatment of structural
scoliosis.
- It should be carefully selected and prescribed only
after considering:
- Specific needs of the patient.
- Factors like age, physical condition of the
patient.
Whether brace is permanent or temporary is prescribed by the
physician who must have some functional knowledge of design,
fabrication and relative values of materials. Therefore, it is important
to make sure that the brace is so constructed that it completely fulfils
the function for which it is prescribed.
BASIC COMPONENTS OF SPINAL ORTHOTICS
Pelvic Band
• Location: Midway between the greater trochanter and iliac crest.
• With lateral ends extending upto mid trochanteric line to prevent
lateral shift.
• Dips slightly just lateral to sacrum to increase contact area.

Function
i. Provide support to pelvic strap and ensure sitting comfort
ii. Applies an anteriorly directed force on spine.

Thoracic Band
Location
• Superior border at level of T9 -10 and below inferior angle of
scapulae.
• Lateral ends at lateral midlines of the thoracic cage.
146 Basics of Biomechanics

Function
i. Control motion in lumbar region.
ii. Work posteriorly so as to control extension of spine.
iii. Applies anteriorly directed force.
Thoracic band may also include a subclavicular band.

Lumbosacral/ Thoracolumbosacral Posterior Uprights

Location
a. Inferior bands in both cases at the level of inferior edge of pelvic
band.
b. Superior ends:
• In LSO—upto thoracic band, below inferior angle of scapula.
• In TLSOs—upto superior edge of scapula and lateral aspect
of scapular spine.

Function
Provide extension of the spine through posterior mid support and
anteriorly directed force.

Lateral Uprights
Location
a. Inferior ends at the inferior level of pelvic band.
- Superior ends at superior level of Thoracic band extends
along the lateral midline of spine.
b. May be oblique lateral uprights.

Function
To provide lateral side support and prevent lateral flexion or lateral
shift.

Full Front Abdominal Support

Location
Covers 80 percent of abdominal area, extends upto lateral midlines
of uprights. It is adjustable.
 Spinal Orthotics 147

Function
Posteriorly directed forces causing flexion.

Other Straps
i. Pelvic strap
ii. Waist strap
iii. Thoracic strap
iv. Abdominal strap
v. Shoulder strap.
These straps are used to pull the assembled structure on the
body for adjustment of forces offering resistive forces on the
corresponding bands.

PRINCIPLE OF FUNCTIONING
All the braces function on the 3-point pressure principle. The brace
is designed to support the trunk and spinal column or constructed
on well-known 3-point pressure principles.
Supporting forces are applied from 3 directions:
i. Backward thrust against pelvis in front.
ii. Backward thrust against thorax in front.
iii. Forward thrust over the spine posteriorly, approximately
the sum of the 2 backward forces in front is equal to
forward force in the back (Fig. 19.1).

Fig. 19.1: Principle of functioning of brace

148 Basics of Biomechanics

CLASSIFICATION OF SPINAL ORTHOTICS

On basis of the joints they encompass and function in terms of the
joint motion:
i. Sacroiliac orthosis - SO’s
ii. Lumbosacral orthosis - LSO’s
iii. Thoracolumbosacral orthosis - TLSO’s
iv. Cervical orthosis - CO’s

Lumbosacral Flexion External Control Orthosis

A. Components: i. Thoracic band
ii. Pelvic band
iii. Abdominal support
iv. Pelvic and thoracic straps

Functions
Applies two 3-point force systems.
i. Trunk extension limiting mechanism increase intracavity
pressure and decrease lordosis.
Pressure: Anterior on abdominal support and posterior –
thoracic band and pelvic band (Fig. 19.2).
ii. Limitation of trunk flexion –
Pressure: Anterior on thoracic band and pelvic band and
posterior on abdominal support.

Fig. 19.2: Back brace

 Spinal Orthotics 149

Sacral Orthosis
Flexion, extension and lateral control—Knight’s brace (Fig. 19.3).

Components
i. 2 lumbosacral posterior uprights
ii. Thoracic band
iii. Pelvic band
iv. Abdominal Support
v. Pelvic and thoracic straps

Additional
1. Lateral uprights.

Function
Same as (1) plus limitation of lateral trunk motion.

Fig. 19.3: Knight’s brace

Extension and Lateral Control Orthosis

WILLIAM’S BRACE (FIG. 19.4)

The William’s brace is specified short spinal brace which allows
flexion but limit extension. It utilizes a lever action to gain additional
flattening of the lumbar part. Hence, orthosis enhances flexion
tendency.

Components
i. Pelvic and thoracic bands
ii. Abdominal corset
150 Basics of Biomechanics

iii. 2 oblique lateral uprights

iv. 2 straight lateral uprights.

3-Point Pressure System

a. Posteriorly directed force from abdominal support
b. Anteriorly directed forces from thoracic band and pelvic band

Application
a. Correction of lumbar lordosis
b. Prevention of lateral shift or tilt.

Fig. 19.4: William’s brace

Thoracolumbosacral Flexion Extensions Control Orthosis

TAYLAOR’S BRACE (FIG. 19.5)

Components

i. Two thoracolumbosacral posterior uprights from pelvic band

to T2 level.
ii. Intrascapular band joining uprights
iii. Abdominal support corset
iv. Pelvic band and strap
v. Axillary straps: Extension from superior ends of lateral uprights
anteriorly over the shoulder and posteriorly under through a
loop attached to lateral end of intrascapular band.
Width of the 2 posterior uprights are designed according
to width of the transverse process of lumbar spine.
 Spinal Orthotics 151

Fig. 19.5: Taylaor’s brace

Functions
3-points pressure principle consists of:
i. Flexion limiting mechanism
a. Posteriorly directed forces from the axillary straps and
pelvic straps.
b. Anteriorly directed forces from posterior upright at
thoracolumbar region.
ii. Extension limiting mechanism
a. Anteriorly directed forces from pelvic and intrascapular,
bands.
b. Anterior directed forces from abdominal corset.
Application
i. Used after vertical body compression
ii. Patients with severe round back secondary to spondylitis
iii. Posterior thoracotomy or thoracoplasty patients.

Thoracolumbosacral Flexion Extension Control and Lateral

Control Orthosis
STEINDIER’S BRACE (FIG. 19.6)
Components
i. Double pelvic band
ii. Anterior uprights
152 Basics of Biomechanics

iii. Posterior and lateral uprights

iv. Infraclavicular pressure pads
v. Axillary strap.

Function
i. Limits not only flexion/extension
ii. Also limits axial rotation and lateral tilting tendency.

Fig. 19.6: Steindier’s brace

Anterior Spinal Hyperextension Brace: (ASH Brace) (Fig. 19.7)

ASH brace is useful brace for controlling flexion in the thoraco-
lumbar region through a force system creating hyperextension
tendency.

Components
i. Anterior lateral torso frame
ii. Lateral pads
iii. Manubrial/external pad
iv. Suprapubic pad
v. Posterothoracic lumbar pad.

Function
3-point pressure principle:
a. Anteriorly directed pressure from the thoracolumbar pad
(Posteriorly placed).
 Spinal Orthotics 153

b. Posteriorly directed pressure from the manubrial band and pubic

pad.
Trochanteric pads may be added to prevent lateral bending.

Fig. 19.7: ASH brace

Spinal Corsets
Corsets are made of semirigid cloth called the drill cloth. An effective
spinal corset should meet following requirements:
i. It should grip the pelvis firmly in order to form a stable
foundation.
ii. It should support the spinal column equally throughout the
area covered without undue pressure or any discomfort to the
patient.
iii. It should give adequate support to the abdominal area.
If the corsets are often prescribed to support the abdomen, post-
operative, pre-or postnatally and in conditions like pendulous
abdomen.
Till now all the TLO’s, TLSO’s, etc. described are used for pain
and instability conditions. Now following are the orthotics used for
correcting spinal deformity like scoliosis.

Cervicothoracolumbosacral Orthoses (CTLSO)

MILWAUKEE BRACE
The Milwaukee brace is an orthosis covering perhaps the maximum
range of movements in the spinal region from the pelvic to the
154 Basics of Biomechanics

occipital level (Fig. 19.8). Thus orthosis is a compound structure of

all previous combinations.

Indications
i. Lateral spinal curvatures
ii. Lumbarscoliosis
iii. Thoracolumbar scoliosis
iv. Thoracic scoliosis
v. Lumbar hyperlordosis.

Principle of Production
It is an active corrective brace. It is designed to produce little
restriction of the torso as possible. It is designed to develop and
encourage both active and passive longitudinal forces and active
and passive transverse forces.

Basically an Orthosis has 4 Force System

i. Pelvic girdle (with anterior bar upto the sternal region) opening
from posterior side.
ii. Head support unit having an occipital support and throat
pieces.
iii. Two posterior uprights extending from pelvic girdle to head
support and a lateral thoracic pad.
iv. Various corrective pads such as thoracic and lumbar pads.
This active corrective brace may have following corrective pads:
a. Lumbar pad: Delta-shaped, polyethylene foam lumbar pad to
treat lumbar curves. Delta-shape is necessary to avoid pressure
on lower ribs and iliac crest but applies sufficient pressure on
lumbar sacral (LS).
b. Oval Pad: To correct thoracolumbar curves. Used in conjunction
with lumbar pad and provides corrective forces through the tenth
eleventh rib.

Result
i. It may be used postsurgically to immobilize the spine in an
active corrective brace.
 Spinal Orthotics 155

ii. Adolescent round back and Scheuermann’s kyphosis also

respond to Milwaukee’s brace treatment.
iii. Also effective in treatment of congenital scoliosis, to control
head tilt associated with a cervical thoracic curve.
iv. Can also be used for paralytic scoliosis after modification.
Exercises prescribed when Milwaukee’s Brace is used–
i. Exercises to attain and maintain postural balance
ii. Correction of cause by muscle strengthening
iii. Pelvic tilting, lateral shift and thoracic arching
iv. Breathing exercises
v. Spine extensor exercises – in prone position with hips bent to
90° over the edge. Results in strong contraction of spine
extensors – by eliminating lumbar lordosis.
a. “L” pad: Indicated in treatment of mid and lower thoracic curve.
It should cover and control the inferior tip of the scapula if
provided force through ribs originally at the apex of curve.
b. Costal margin pad: Designed to improve the cosmetic deformity of
the ribs. It is located on the convex end of the thoracic curve to
provide counter force.
c. Axillary sling: Used as a counterforce against the L pad. Helps
the point in balancing the torso and provides longitudinal
unloading. It is withdrawn after the patient develops a lighting
reflex to bring upper torso back on line.
d. Shoulder sling: Used to treat upper thoracic curves, i.e. the apex is
above T6 when the shoulder is not elevated.
e. Trapezium: Upper thoracic curve treatment with high elevated
shoulder.
f. Pectoral pads: Patients with thoracic hyperkyphosis have tight
Pectoral pads.

Boston’s Brace – TLSO Passive Supportive Brace

The unique feature of the Boston brace is the Prefabricated 3 mm
thick propylene rear–opening girdle formed. As the girdle is vacuum
on a positive mould of a normal torso; areas of corrective pressure
and relief are prebuilt on it.
In addition, it has symmetrical scheme of trimlines and pad
placement to balance and correct frontal, sagittal and horizontal
plane deformity.
156 Basics of Biomechanics

20 girdle sizes are available which fits to approximate 95 percent

points.
The Bostons brace is designed to primary treat lumbar and
thoracolumbar curves. In this also a lumbar pad is placed just above
iliac crest and just below ribs thus directing force at L2, 3 and 4.
Anterior counter rotation pads placed below and above lumbar
pad level on the same side. Posterior counter rotation pads placed
on opposite side below and above lumbar pad level.

Fig. 19.8: Milwaukee’s brace

Exercises – Same as Milwaukee’s brace exercises

• Inbrace and out of brace exercise emphasized.
• Since the brace requires compacted fabrication procedures on
point, the metallic hardware required is supplied in the kit form
containing 4 basic units as explained earlier pads and straps are
made to suit individual needs and fitted appropriately during
fabrication.
• Available in 2 sizes of kit I and II.

Adjustment of Corrective Pads

Generally the pads are adjusted to apply firm pressure on the body
when the patient attempts to relax, and it should be relieved when
the patient attempts to correct posture. This effect stimulates the
 Spinal Orthotics 157

patient tendency to actively withdraw from them, thereby tending to

convert deformity actively. Also these pads apply passive restraints
against further deviation, when the patient tends to lean into them.
As the scoliosis is reduced, the pads must be adjusted periodically.

CERVICAL ORTHOSIS
A cervical orthosis is a device applied to the exterior of the body
which influences neck motion by assisting, resisting, blocking or
unloading part of the head joint.

Goals of Cervical Orthosis

i. Bony stabilization with maintenance of alignment
ii. Muscle relaxation
iii. Prevention of deforming skeletal soft tissue contracture
iv. Skeletal distraction to decrease neural compression
v. Immobilisation for soft tissue healing
vi. Motion amplification to facilitate ROM, partial unloading of
the weight of head.

Indications of CO’s
1. Rheumatoid arthritis: Synovitis of atlantoaxial joint decreases a
impaired ligamentous stability
2. Cervical spondylosis: Connective tissues autoimmune
3. DMD: Lack of muscle support
4. Parkinson’s disease: Lack of synergistic neurological control with
neck rigidity and postural deformity.
5. Cerebral palsy: Lack of volitional fine motor control
6. Congenital Cervical anomalies
7. Repetitive postural and occupational stresses
8. Accelerating force trauma: C4 area trauma due to extensor types
injury
9. Decelerative forces: On C5-6 vertebrae are, due to hyperflexion
types of injury.

Classification of CO’s
Bony contact CO’s.
158 Basics of Biomechanics

Skin contact CO’s

a. Soft cervical orthosis
b. Semirigid orthosis
c. Head cervical orthosis (HCO)
- Custom moulded
- Poster type
d. HC thoracic O’s (HCTO)
e. HCTLO’s
f. HCTLSO’s.

Soft Cervical Orthosis (Fig. 19.9)

• Soft cervical orthosis is made from especially designed contoured
form of soft foam cut to different sizes and covered by cotton
stockinette wrap.
• Different length and width can be produced for adjustment of
varying neck circumferences ready to use.
• This device does not restrict motion completely but acts as a
reminder to prevent unwanted motion and has more of
psychological effect on the wearer rather than physical.
• Velcro fasteners use to do the orthosis and adjust length.

Fig. 19.9: Soft cervical orthosis

Semirigid CO’s
In these, mild resistance to flexion and rotational movement is
introduced. Contoured prefabricated plastic wrap with a
semirigid circumferential rubber padding covered from leather
for soft feel.
 Spinal Orthotics 159

Height and circumferential adjustment—Possible through

various sizes (6 lengths and 4 widths). 24 combination are ready to
wear.

Rigid/Hard CO’s (Fig. 19.10)

Almost limit 75-90 percent of movements of flexion, extension, lateral
flexion and side rotation.

Fig. 19.10: Righ/hard cervical orthosis

Head Cervical Orthosis (HCO)

a. Custom moulded type (Fig. 19.11): Polyethylene foam, bivalved
CO’s are useful in restriction of flexion and extension.

Fig. 19.11: Custom moulded type

160 Basics of Biomechanics

b. Poster type, 4 postcervical traction control, victoria type (Fig.

10.12):
- Controls the head through padded mandibular and occipital
rigid supports which are attached to thoracic and chest plates
by 2 rigid uprights anteriorly and posteriorly.
- Cervical traction also possible through adjustment after
wearing.
- 80-85 percent effective in limiting flexion, extension and
lateral flexion, but only 60 percent effective in limiting
rotation.
- Cervical rotation control increased by adding rigid side bar
attachments between chin and occipital pads.

Fig. 19.12: Poster type 4, postcervical traction

control, victoria type orthosis

HCTO – SOMI Cervical Orthosis

Attachments at the sternum, occiput and mandible. Therefore, it is
known as sternal—occiput mandibular immobilization (SOMI).
SOMI is the best orthosis in limiting cervical spine flexion. The SOMI
 Spinal Orthotics 161

is easy to fit in supine point and the occipital piece can be easily
remove from the supine patient.
The new SOMI, Headband is also designed. This is an maxillary
support to be used when the mandible support is removed for eating,
etc.

Advantages of SOMI
1. Easy and safe donning and doffing of the device, enables better
hygiene and soft tissue check
2. Light weight
3. Less encumbrance of the patient
4. Very useful in transferring spinal injury patients. SOMI restricts
flexion. Better in upper and middle cervical spine. HCTO—4
and poster type is much better for all movement resistance.
 20 Orthotics

Orthotics is the study or science which deals in measurement taking,

fabrication and fitting techniques of splints (orthosis).
Orthosis is a device used to support or straighten the weakened
or deformed part in order to maintain anatomical alignment of the
body (the externally applied device).

USERS OF LOWER LIMB ORTHOTICS

Users of Orthotic Devices
Problems at births Diseases Trauma
1. Cerebral palsy 1. Stroke 1. Spinal cord injury C1
2. Spina bifida 2. Multiple sclerosis 2. Fracture
3. Hemophilia 3. Arthritis 3. Head injuries
4. Long bone 4. Polio 4. Muscles,tendon,
malformation rupture, cartilage
5. Osteogenesis 5. Muscular
imperfecta dystrophy
6. Club foot 6. Legg-Calve-Perthes
7. Congenital
dislocation of hip

INDICATIONS OF ORTHOSIS
1. Resting of joint or fracture in a choosen position: The aims of this
may be:
• Protection of joint
• For bracing fractures to prevent stress during healing; to
give traction for fracture healing
• To decrease pain from repeated trauma or due to painful
synovitis.
 Orthotics 163

Usually subdivided into two types: Orthosis used in bed where the
applied forces remain same in direction and those used in
ambulatory patient.

Principles Used
a. 3-point fixation is used to control an area of hinge mobility, three
forces only in one plane are required. In a fracture this hinge is
formed by the periosteum and attached muscles. Usually in
fracture the hinge is on the opposite side to the opening of the
fracture.
b. 3-point fixation applied to an articulated structure limited on
the direction, e.g. by soft tissue hinge in fracture and posterior
capsule in knee joint.

Hydrodynamic Soft Tissue Compression

1. Application of a pneumatic orthosis compresses the area and
forces develop which distract the fracture by pushing trans-
versely around the circumference and realign it.
2. To release compressive stress totally or partially orthosis may
be used to partially or totally relieve the joint or bone from
longitudinal and compressive stresses. Sometimes even
torsional or tensional stresses are removed.
3. Stabilize a joint or joints in a chosen position: It is often used in terms
of correcting a mobile deformity.
Principle: To put the part in a normal position so that the major
mechanical stresses are within the part and the forces required
to maintain this position are minimum, e.g. caliper used for the
knee with paralysis of quadriceps mechanism.
- When the knee fully extends, the load of body in the leg
passes almost entirely though skeletal surfaces and minimal
force required for stabilization. But if dealing with a
contracture at knee flexion then forces needed tend to increase
enormously. Also, longer the orthosis resisting flexion smaller
the force required at each of 3-point fixation.
4. Correction, prevention or support of a deformity: Essential features
of deformity correcting orthosis: force should be applied only
to the point of deformity and does not deform normal tissue.
Forces should be continuously and maximally applied but
consistent with patients’ satisfaction.
164 Basics of Biomechanics

- There are 4 main objectives of proper fit and alignment

- Heel and sole of shoe should properly come in contact with
ground
- Anatomical and mechanical joints should coincide with each
other
- Horizontal orientation of joint axis
- Proper anatomical contours and landmarks.

FUNCTION OF ORTHOSIS
• All orthosis are based on 3-point pressure principle.
• In any case, to correct a deformity, 3-point pressure system of
alignment is very essential. These forces must be placed so that
the extremity cannot escape from desired corrective forces. For
example for the support of knock knee (genu valgum) forces are
applied so that 2 forces act on the lateral side of limb above and
below point of deformity and one or medial side at the knee (i.e.
one at greater trochanter, other at lateral malleolus and an
opposing force on medial condyle femur).
• On the other hand for ‘bow-leg’ forces are to be applied on medial
side of thigh and medial malleolus while opposing forces at
lateral femoral condyle.

Mechanical Principles of Orthosis

1. Motion - Rotatory
- Translatory
2. Force - Resolution into components
- Newton’s 3rd law
Action
Reaction
- Description of force as vector
3. Torque—Torque generated by a device increase as distance
from selected axis to line of action force increases.

Functions
1. Resting a joint or fracture in a suitable position
2. To relieve compresses stress
3. Stabilize a joint
4. Correction and prevention of deformity
 Orthotics 165

5. Exercise muscles and joint.

6. Control joint range of motion and direct during activity.
7. Transmission of forces.
8. Reeducation of phasic muscle activity.
9. Compensation of deformity.
10. Acts as placebo.

PRINCIPLES OF ORTHOSIS
Principles of Orthotic Application
1. Adequate surface area
• Must for comfortable pressure distribution
• Desired function of brace will determine the amount of
surface area needs for comfort
• If joint, is to be mobilized, orthosis should employ the
longest lever practicable with the widest possible pressure
distribution, to give maximum comfort and wearability.
2. Accurate contouring
3. Adaptation to change of position
• Changes of position may cause redistribution of pressure
points to which splint must be adapted, particularly in
case a trunk supports. So, corsets are often more adaptable
and comfortable to points than rigid metal braces.
4. Comfort in orthosis
• Determined by:
- Surface area
- Joint positioning.
• Joint positioning, e.g. mechanical knee joint. If positioned
below anatomical knee joint will have considerable calf
band pressure when the knee is flexed, e.g. in sitting.
• Joint that is too high will loosen the calf band when patient
is sitting but tighten it on standing.
5. Joint design and placement
- Should be as close to anatomical.
6. Minimizing the adverse effects of orthosis. Pain and limb
constriction produced by orthosis are very common. To avoid
this:
• Part to be fitted must be examined closely
• Tender areas of skin over bone should be noted and taken
care of
166 Basics of Biomechanics

• Painful nodules of Rheumatoid arthitis (RA), skin erosion,

bony prominences must be noted and should be avoided,
as pressure over them will be painful.
7. Reshaping of orthosis: Supporting bands around thigh and
calf or in arm may have to be reshaped to accommodate local
lesions.
8. Conservation of time and energy: Brace should conserve time
and energy of the patient.
• Encouraging activity should not increase energy consump-
tion
• For example: Velcro is much easier to use than buckles and
straps and much less damaging to overlying clothing.
9. Durability of orthosis for maintenance, orthosis should be
simple, to decrease visits to the repair shop.
10. Maintenance
• Teach points to clean the leather and oil the joint if
necessary.
• Most braces are periodically immersed in water.
11. Finishing touch
• Marks of bending tools or leather should be avoided as
they are weak points.
• Support should be added to these weak points.
12. Cost control: Patient may be fitted temporarily with adjustable
brace during training period and permanent orthosis only after
returning home.
13. Should not be cumbersome.

Principles of Orthotic Fit and Alignment

• Construction and alignment of an orthosis cannot be based
entirely on disabled limb but functional structure deficiency of
the limbs must also be considered. Special attention must be
given to static and dynamic alignment of hip, knee, ankle and
subtalar joint. If these retention ships are not considered during
fit and alignment procedures, orthosis may not perform up to
the satisfaction of wearer and may tend to increase existing
deformities.

Creations of Deformity can be done in following ways:

• Muscular energy to produce active correction
• Translation of gravitational energy—passive
 Orthotics 167

• Stored energy, in form of elastic bands, spring or torsion device—

passive.

Indications
1. Muscles imbalance as in UMN + LMN lesion
2. Muscular diseases leading to unopposed gravitational force
3. Progressive fibrous disease: Dupuytren’s contracture
4. Scarring as in burns
5. Arthritis
6. Disrupted blood supply as in VIC.

Exercises Muscles and Joints

Upper limb ‘lively splints’ have the most consistent function of
exercising muscles and joints. Energy stored in various flexible
devices (articulation spring and elastic) is assisted by the energy
of muscular action at the limb, to produce motion and strengthen
muscles.
1. Control of joint range and/or direction during activity for
example: orthosis (plantar resist) are used to prevent plantar
flexion if there is foot drop. It thus facilitates heel strike.
2. Transmission of forces: A 1 degree force from shoulder or
hip, or stored energy in form of compressed gas is transmitted
by various linkages to the distal joint for functioning.
3. Reeducation of phasic muscle activity: Though this is a form
of control of joint movement. This might also reeducate function
in muscles.
For example: A patient with high steppage joint springs in
the orthosis can be incorporated so that variable tension is
produced in the limbs preventing (gradually) the high
steppage pattern
4. Provision of coverage - Cosmetic and protective
- Compressive
For example: Shoes which have a protective function and is
normally related to mechanical stresses of pressure and shear.
- In case of intertarsalgia, etc. there are high pressure points.
- There might be thinning of subcutaneous tissue and
callousing of skin causing local pain. To prevent this
foaming of sole and cushioned heel should be used.
- Protective helmet orthosis as in CP and spina bifida.
168 Basics of Biomechanics

10. Compensation for deformity:

For example: Raising the footwear to compensate shortening
of leg done with the help of the following:
- Extension raise made of cork or modern rigid plastic
foam
- O’corner extension—Foot-shaped extension to the leg
with ankle in equines position.
11. Reduction of heat loss—As in old people the lumbosacral
supports that are provided are usually for their heat insulating
effect.
12. Acts as a placebo—May be used as psychological persuader
or an emotional support for the patient.

Principles of Orthotic Application/

Ideal Characteristics of Orthosis
1. Objectives of history taking: Orthosis should be appropriate to
achieve the medical objectives of history/inspection through
accurate actuate highly precise information.
2. Reliability: Frequently breakage or failure of orthosis tends to
increase the complexity of orthosis. The designed choice of
material should be such that no expert maintenance is required
and easy local repair on damages correct the orthosis.
3. Light weight: As far as the deformity or the objective of treatment
allows, the orthosis should be light weight plastics (Light WT,
moldable resistant to chemicals, etc.) or metals (high strength
and stiffness, stable at high temperature, etc.) may be used
according to the aim to be achieved.
4. Manufacturing standards: Manufacturer should maintain high
standard of material product and quality control. This is
managed by means of having a central manufacturing unit
producing standard machinery. Quality control and fuel
modifications with economy consideration should be done.
5. Rapid provision and replacement: There should be fast
transmission of information to and from the workshop and
it should be highly organized modularity (i.e. provision of
standard parts of different shapes and sizes) can be partly or
completely built into and orthosis.
6. Adjustability: An orthosis should be such that it maintains the
original shape unless modified by other external force. Thus is
 Orthotics 169

any material adjustment occurring gradually with usage

makes the orthosis more comfortable, less effective and
replacement is not liked by the patient.
7. Cosmesis: The orthosis must be cosmetically acceptable.
Cosmesis includes both static and dynamic. There should be
not noise or cracking in the braces. Also there should be
cosmetically acceptable to patient.
8. Hygiene: Cleaning of the orthosis should be possible so as to
maintain a hygienic condition over the stein there preventing
stein maceration.
9 Safety: Avoidance of heat retention and skin allergies may occur
in metals like zinc and also with some plastics. Therefore, the
stabilizing side bans, etc. should be designed so that no undue
pressure on artery or nerve occurs. Also there should be
adequate surface area for comfortable pressure distribution.
10. Patient acceptability: It includes the following factors:
a. Comfortable in sitting, standing and walking as well if
knee it is position: below anterior knee it will cause
pressure on calf band while sitting and if placed above
it tighten while standing and loosens when sitting.
b. Ease of toilet.
c. Use of a long lever in orthosis.
d. The wearer should be able to don and doff the orthosis
with ease.
e. Low consumption of time and energy.
f. Reasonable wear on clothes. Touch and close fastening
are better than straps or buckles.
g. The patient should be highly motivated and self-selecting
for adoption and evolution of new designs.
11. Minimizing adverse effects of orthosis
• Part to fitted must be examined closely.
• Tender area of skin and muscle or bone should be marked.
• Painful nodules of RA, skin erosions and bony prominences
must also be noted.
12. Cost control and finishing touch.
 21 Upper Limb
Orthoses

FUNCTIONS
1. Assist residual weakened motor power
2. Substitute appropriate mechanism for total loss of power
3. Protect the part from potential pain and deformity
4. Correct an existing deformity.

HAND AND WRIST ORTHOSES

I. Assistive and substitutive
II. Protective
III. Corrective.

Assistive and Substitutive

Hand function can be aided by:
1. Maintaining a particular position of hand or wrist
2. Substituting motor power from another portion of the hand
or elsewhere
3. Attaching a pocket to the palm to hold utensils.

Categories
A. Positional orthoses
1. Opponens
2. Wrist control
B. Prehension orthoses
C. Utensil holders.

A. Positional Orthoses
1. Opponens: Opponens orthoses assist the patient with residual
motor power by positioning the thumb in opposition to the other
 Upper Limb Orthoses 171

fingers. They are designed to maintain, assist or provide

opposition by stabilizing the thumb and fingers in a functional
position.
a. Basic opponens orthosis (Short opponens)
- Consists of a dorsal and a palmar bars which encircle the
midpalm, with a thumb abduction bar projecting from
the palmar bar (Fig. 21.1). A wrist strap secures the orthosis
to the hand.

Fig. 21.1: Short opponens

Functions
Oppose thumb to index and middle fingers prevent adduction and
webspace contracture, support transverse palmar arch, stabilize,
thumb maintain thumb architecture.
Accessories used
i. Wrist control attachment
ii. Metacarpophalangeal extension stop assembly
iii. Finger extension assist assembly
iv. Thumb abduction extension assist assembly.
2. Wrist control orthoses: Wrist control orthoses assist the wrist with
a weak grasp by preventing flexion or assist slight dorsiflexion
at the wrist, thus creating tension in the finger flexor tendons.

Types
a. Volar wrist flexion control orthoses (Cock-up splint) consists of
a rigid volar forearm section continuous with a plamar section.
172 Basics of Biomechanics

Dorsal straps secure the orthoses to the forearm.

• Forearm section covers volar aspect
• Distal two-third of forearm. Palmar section is dorsiflexion 20°.

Functions
a. Tighten finger flexors by tenodesis effect
- Increase strength of grasp with wrist dorsiflexion
- Prevent palmar flexion
- Prevent stretching weak wrist extensors.
b. Wire wrist extension assist orthoses (Oppenheimer splint)
prefabricated, of spring steelwire and padded steel bands
available in several sizes.

Functions
• Assist wrist extension by means of tension in the steelwire.
• Aiding finger flexion through tenodesis.

B. Prehension Orthoses
For patients with extensive paralysis, they stabilize the thumb while
substituting motor power from other parts of body, or external source,
to provide grasp holding and release. The prehension pattern may
be 3 jaw chuck or lateral grasp.

Types of Orthoses
1. Hand: Finger driven hand orthoses: There is an opening spring
dorsal to metacarpophalangeal joint. Patient flexes fingers to
tense the spring and spring recoils to provide release (extension).
2. Wrist Hand
a. Finger driven: Forearm stabilization provided by adding a
friction wrist joint, radial forearm bar and distal and
proximal cross bars.
b. Wrist drive (Tenodesis orthoses): Incorporates stabilizers for the
thumb, index and middle fingers and the metacar-
pophalangeal joint and forearm assembly to fix wrist joint.
c. Passive prehension orthoses: Based on same design as finger
driven plus a ratchet assembly which consist of a notched
ratchet bar, spring operated lever and push lever.
 Upper Limb Orthoses 173

d. Electrically driven: Finger driven and cable, switch, motor and

battery. Light pressure on the microswitch assembly activates
the motor, tensing the cable leads to prehension.

C. Utensil Holders (Universal splint, ADL splint)

Many persons with hand paralysis use a simple utensil holder
consisting of a pocket in the palmar portion of the orthoses to
accommodate small objects, e.g. spoon, fork, parcel, etc.

PROTECTIVE ORTHOSES
Designed firstly to protect the limb from a potential deformity or
damage. They restrict active function while maintaining desired
position.

Types
Wrist Hand Stabilizers
a. Volar: (Resting splint) rigid material, e.g. low or high temperature
thermoplastic is used. Extends from fingertips to proximal
forearm with contouring for metacarpophalangeal flexion,
transverse palmar arch, thumb abduction and oppens and slight
wrist dorsiflexion.

Functions
• Maintain final position of wrist and hand – 3-point force system
• Prevent flexion contracture of wrist and interphalangeal joints
• Prevent extension of metacarpophalangeal joints.
b. Dorsal: Encompasses the hand and extends along dorsal half of
forearm. It is custom-moulded of polyester laminate or
polypropylene – Easier to maintain for a person with severe
spasticity.

Digital Stabilizers
a. Proximal interphalangeal extension stop (Swan neck splint):
Custom made aluminium or plastic device, shaped to straddle
proximal interphalangeal joint (Fig. 21.2).
174 Basics of Biomechanics

Fig. 21.2: Proximal interphalangeal extension stop (Swan neck splint)

Functions
• Prevent hyperextension of proximal interphalangeal.
• Permit flexion of all joints.
b. Thumb carpometacarpal stabilizer (Thumb post)
Rigid plastic is moulded over 1st and metacarpophalangeal
joints, terminating at interphalangeal joints (Fig. 21.3).

Fig. 21.3: Thumb carpometacarpal stabilizer (Thumb post)

Functions
• Stabilize metacarpophalangeal and carpometacarpal in neutral
position.
• Protect thumb against inadvertant motion.

CORRECTIVE ORTHOSES
Devised to alter joint alignment by stretching articular or musculo-
tendinous contractures or adhesions. They are generally worn for
specified periods during the day.

Type
1. Metacarpophalangeal
a. Flexor orthoses (Knuckle bender): Prefabricated, consists of
padded steel, steelwire and rubber bands (Fig. 21.4). There
 Upper Limb Orthoses 175

Fig. 21.4: Knuckle bender splint

are dorsal finger and handbands with protruded hooks and

a felt-padded palmar rod.

Function
Flexion metacarpophalangeal joints through three point force
system.
b. Extensor orthoses (Reverse knuckle bender).
• Consist of padded steel, steelwire, felt pads and rubber
bands. Has a dorsal hand band, and a palmar finger rod
and a palmar pad.
Function
Extended metacarpophalangeal joint (opposite force system).
c. Adjustable wrist hand orthoses (Swanson postarthroplasty
orthoses).
• Provides numerous options for adjusting the direction
and magnitude of force application.
Function
Facilitate controlled metacarpophalangeal and proximal
interphalangeal, DIP motion, after arthroplasty stabilize joints
selectively.
2. Interphalangeal
a. Fingernail hooks orthoses: Dress hooks affixed to fingernails
by methacrylate (adhesive), looped around a frame, secured
to wrist or forearm.
Function
Position metacarpophalangeal ,proximal interphalangeal, DIP
according to placement of frame provided maximum explosure
of hand, e.g. burns stretch contracted dorsal structure.
176 Basics of Biomechanics

b. Proximal interphalangeal (PIP) joint. Extensor orthosis (Reverse

finger knuckle bender).
• Palmar digit bands have protruding hookers. They are
linked with rubber bands to dorsal digit band.

Function
Extended proximal interphalangeal joint (3 force system).

ELBOW AND SHOULDER ORTHOSES

Functions
1. Protect from pain or potential deformity
2. Correct existing deformity
3. Assist or substitute for motor power.

PROTECTIVE ORTHOSES
Functions
1. Limit active motion to decrease pain and guard weak muscles
and ligaments from untoward stress.
2. Provides optimum environment for newly formed skin.
• Accommodate edema, broad and soft straps so as not to
constrict circulation.
• Nonabsorbent material to thwart bacterial growth.

Major Categories
A. Elbow control orthoses: A pair of elbow hinges join dorsal forearm
and humeral bands hinge
• Single axis
• Polycentric.

Functions
Mediolateral elbow stability
• Forearm rotational stability
• Limit range of motion of flexion/extension of elbow.
B. Shoulder Abduction Stabilizer (Airplane splint).
Consist of chest, axillary and elbow support joined by overlapping
bars that permit accommodation to various limb lengths.
 Upper Limb Orthoses 177

Functions
Support upper arm and shoulder
• Protect shoulder from adduction contracture
• Relieve tension on superior aspect of shoulder—If the support is
directed upwards the shoulder will tend to be external rotate,
stretching internal rotation and relieving tension on deltoid and
rotator cuff (necessary after shoulder surgery).
C. Slings: Usually worn to protect the shoulder form painful motion
after injury to shoulder capsule or its supporting musculature.
They can also support distal weight (e.g. edematous hand).
To minimize pressure broad straps and cuffs should transfer
weight to the trunk.
1. Single strap— Most popular forearm support
Simple proximal
Economical distal cuff – spanning wrist
Easy to don
A diagonal strap passes from distal cuff, crosses anterior
aspects of contralateral shoulder to posterior chest and
terminates at proximal cuff.
Functions: - Support weight of arm or forearm cast
- Elevate hand to decrease edema
- Protect upper limb from inadvertant motion
2. Multiple strap: ……vertical strap over ipsilateral shoulder may
have additional strap to waist belt.
Function: Support ipsilateral shoulder
3. Vertical arm: Permits the elbow to extend. Support consists of
a shoulder saddle and forearm cuff joined anterior and
posterior by Dacron straps.
Function: Support shoulder when elbow is extension.
Abduction Sling (HOOK HEMI – HARNESS)
B/L arm cuffs joined by an adjustable postyolk strap.
Function: Apply diagonal force to support shoulder in slight
abduction.
4. Overhead sling: (Suspension sling) forearm support is
suspended by elastic webbing or a coil spring from an
overhead rod, 12 inch above patient’s head.
178 Basics of Biomechanics

Function: Prevent dependent edema

- Encourage shoulder and elbow movement – horizontal
motion: pendular, vertical motion: pivot elbow at forearm
support.

CORRECTIVE ORTHOSES
Apply gentle force to elongate soft tissues over a long time to reverse
joint malalignment (because of prolonged immobilization).
A. Dorsal elbow orthosis
1. Extensor orthoses – Elbow control orthoses plus turnbuckle or
dorsal tension spring.
An elastic member under tension serves to extend the
elbow.
Functions
— Extend elbow through 3 point force system: dorsally
direction forces from forearm and humeral bands and
volarly directed force from olecranon pads.
— Provide mediolateral elbow and rotational forearm
stability.
2. Flexor orthoses – Serves to flex elbow if screws in the turnbuckle
are gradually brought closes to each other.
Function: Flexion elbow stability.
— Assistive and substitute orthoses.
Functions
— Aid limb transport
— Protect limb from contracture and secondary trauma
upper limb function depends on – effective prehension
and wrist stability, forearm stability/mobility, sufficient
elbow flexion, stable shoulder flexion and rotation.
— Orthoses should be mechanically simple and light
— Power: Insilateral limb, contralateral limb, trunk or lower
limb—body powered—external powered.
Components:
1. Elbow and shoulder locks
2. Suspension system.
1. Elbow and shoulder locks: types
a. Friction lock: Amount of function adjustable by a screw
b. Ratchet lock: Used with active/passive joint flexion pawl,
ratchet wheel with teeth.
 Upper Limb Orthoses 179

c. Alternator lock: External locking elbow unit has cable driven

locking bar, keeper.
2. Suspension systems:
a. Hoop anterior and posterior metal uprights anchored
inferiorly upper part of hoop is strapped to chest with
webbing bound.
b. Shoulder cap: Moulded, plastic cap to allow ipsilateral thorax
to support weight of orthoses and arm. Bulky, causes
sweating.
c. Harness: Bilateral axillary hoops connected at the back by a
cable. Used to suspend orthoses and transmit force of
scapular abduction to operate lock or control cable.

BALANCED FOREARM ORTHOSES

(Mobile arm support ball-bearing feeder linkage feeder).
Usually attached to wheelchair.

Components
1. Wheelchair assembly bracket – bolts orthoses to wheelchair
2. Proximal arm: Usually dropped
3. Distal arm angled or curved
4. Proximal and distal bearings
5. Forearm support: Trough with elbow dial – FLYING SAUCER
6. Rocker assembly: 1st class lever under forearm trough
7. Accessories: Supinator assist vertical stop, horizontal stop.
 22 Lower Limb
Orthoses

ANKLE FOOT ORTHOSES

Functions
1. To limit movement range normal or abnormal weight, complete/
partial
2. To stabilize the foots.
3. To exert a knee control
4. To relieve long or lateral stress.

Indications
1. Neurological conditions causing either flaccid, athetoid or
weakly spastic paralysis
2. Primary disease of the muscles, flaccid paralysis, dystrophy and
myopathy
3. Spastic paralysis as in head injuries, turnovers, neurovascular
incidents, CVAs
4. Valgus or varus
5. Arthritis of ankle.

Conditions in AFO Prescribed

Most of the patients weakness around the ankle and foot are able to
ambulate without an orthosis. However, they may fall, or turn an
ankle and injure themselves, the most common purpose of bracing
is to ensure safe ambulation.
The orthosis will provide.
– Mediolateral stability during stance phase to prevent
unwanted movement in ankle.
– ‘Toe Pick Up’ during swing phase to prevent a stumble caused
by Toe Drag during swing phase.
– Near normal gait.
 Lower Limb Orthoses 181

Types of Ankle Joints

1. Limited motion ankle joint
2. 90° foot drop stop (FDS)
3. Reverse 90° FDS (CDS)
4. Free ankle
5. Fixed ankle.
1. Limited motion ankle joint – when ankle muscles are weak.
2. 90° FDS –
Given for Foot drop (Pes equinus deform) does not allow plantar
flexion but will allow unlimited dorsiflexion.
3. Reverse 90° FDS
prescribed for calcaneal drop
4. Free ankle joint
– When problem is in hip or knee joint.
– No deformity in ankle region.
5. Fixed ankle joint given in fracture cases (tibia/femur) during
weight bearing for quick healing.
AFO [Metal, metal plastic designs, plastic designs].

Plastic Designs

1. Posterior leaf spring

2. Solid ankle
3. AFO flange
4. Patellar tendon bearing AFO
5. Sprial AFO
6. Hemispiral AFO.

Metal and Metal Plastic Designs

These consist of (Fig. 22.1):
• Two metal uprights
• Calf band (attached to proximal end of uprights)
• Foot attachments
– Stirrup/caliper
– Ankle joint/controls
– Varus/valgus correction.
182 Basics of Biomechanics

Fig. 22.1: Metal design of fixed ankle joint

Upright and Calf Bands

• Most orthoses include 2 uprights
• Single upright may be sufficient in cases of relatively mild
dorsiflexion weakness. It may be located medially, laterally or
posteriorly
• Calf band—may be metal or plastic.

Functions
• Add rigidity to orthosis
• Maintain proper alignment of uprights
• Secure orthosis to limb
• Provide a right paint for application of force
[Show is attached to orthosis by means of a stirrup or caliper
(Fig. 22.2)]
• It is a U-shaped steel plated device secured between heel and
sole of the shoe.
• It provides a permanent attachment between uprights and shoe
proper.

Fig. 22.2: Stirrup

 Lower Limb Orthoses 183

Caliper
Caliper (Fig. 22.3) permits easy shoe interchangeability, is of minimal
weight and allows economy of construction.

Drawbacks
Pivot of mechanical joint is at level of shoe heel, considerably distal
to anatomical ankle joint.
Resulting malalignment is an important short coming as ankle
dorsiflexion or plantar flexion, this incongruence produces reduced
relative motion between calf band and patients limb.

Fig. 22.3: Caliper

SHOE INSERT
Stirrup is incorporated in a shoe insert is shaped to the contour of
patients foot that fits into the shoe.

ANKLE JOINTS AND CONTROLS

Most mechanical ankle joints are single-axis joints that control-
medistlat motion by stopping/blocking it.
– Dorsiflexion/plantar flexion by means of STOPS or ASSISTS.

ANKLE STOPS
• Allow for any predetermined range of motion.
184 Basics of Biomechanics

• Plantar flexion stop: Often used when there is dorsiflexion

weakness.
• It restricts plantar flexion but allows unlimited dorsiflexion.
• Dorsiflexion stop: Used for weak plantar flelxion allow plantar
flexion but not dorsiflexion stop.
• Limited motion stop: Used to restrict motion in both directions
often prescribed when there is involvement of many muscles
around ankle joint.
• Knee motion ankle joints: Used when no restraint of ankle motion
is required. Permits full plantar flexion and dorsiflexion provides
only mediolateral control.

ANKLE JOINT ASSISTS (FIG. 22.4)

• Contrary to stops (prevent motion)
• Assists (in form of springs) are utilized to aid motion,
e.g. dorsiflexion assist.

Fig. 22.4: Ankle joint assists

Varus-Valgus Correction (T-straps)

• Leather T-straps provide mediolateral control as ankle varus-
valgus correction straps are attached to the shoe and buckles
around the opposite upright.
 Lower Limb Orthoses 185

• Strap buckled to lateral upright – valgus correction

• Strap buckled to medial upright – varus correction.

PLASTIC DESIGNS
Although plastic AFOs (Fig. 22.5) are formed primary by from single
piece of thermoplastic material, 3 sections can be identified:
• Calf strap
• Calf shell
• Shoe insert.
Most common application of these orthoses is to compensate
for weak dorsiflexion by resisting plantar flexion at heel strike and
during surving phase.
a. Posterior leaf spring
– Most common plastic AFO
– Characterized by narrow calf shell
– Movement of this orthosis at ankle is designed from its
narrower width at junction between calf shell and shoe insert.
It is inadequate for patient weak or absent plantar flexion,
it does not resist dorsiflexion forces.

Fig. 22.5: Plastic AFO

b. Solid ankle
– Similar to posterior leaf spring
– Holds the foot in predetermined position
– Prevents all plantar flexion and dorsiflexion as well as any
valgus/varus deviation of hindfoot and ankle.
186 Basics of Biomechanics

c. AFO flange (padding) (Fig. 22.6)

– Solid ankle AFO is modified to include a polyethylene padded
flange projecting from middle 1/3rd of posterior section.
– For patients requiring maximum resistance to varus or valgus
deviation
– On medial side: Controls foot ankle valgus
Lateral side: Controls foot ankle varus.

Fig. 22.6: AFO flange

d. Patellar Tendon Bearing AFO

(Fig. 22.7)
– Indicated for patients when
reduction of weight trans-
mission from the middle or
distal tibia, ankle or foot is
required.
– PTB brim replaces the calf
band of conventional
double bar orthosis.
– PTB brim supports some
weight on patellar tendon,
popliteal area and tibial
flares (especially medial
flare) load is transmitted to Fig. 22.7: Patellar tendon
shoe by means of upright. bearing AFO
 Lower Limb Orthoses 187

e. Spiral AFO (Fig. 22.8)

It consists of: shoe insert
– Spiral
– Calf band.

Spiral
• Originates at medial distal aspect
• Passes around leg posteriorly continues around and aspect
terminating at medial tibial condyle.
Function: Permits the leg to rotate is transverse plane while
controlling plantar flexion, dorsiflexion, inversion and eversion
(to some extent).

Fig. 22.8: Spiral AFO

f. Hemispiral: Upright makes a half turn around the leg. It offers

greater control for a foot that tends to go into equinus and varus
than does the special design.

KNEE ORTHOSIS
Patients who require support or control of knee, but not the foot and
ankle may benefit from knee orthosis.
188 Basics of Biomechanics

Indications
1. Weakness of muscles controlling knee flexion—paralysis of
quadriceps.
2. Patellar instability—results in patellar subfluxation in children
due to malalignment: Anteversion internal rotation of femur
compensatory exterior rotation of tibia.
3. Abduction/adduction instability (valgus/varus collapse) -
generally seen in rheumatoid arthritis.
4. Hyperextension of knee
5. Anterior/posterior instability—as a result of trauma
6. Rotatory instability.
KO can be used in treatment of Patellofemoral conditions and to
control forces that tend to produce abnormal angulation and
instability of knee.

Treatment Objectives
1. Rest in a choosen position as near to full extension as possible—
usually used in old, frail and polyarthrotic patient. It may be
worn to support an arthritic knee.
2. Stabilization of knee
a. Ligamentous laxity
b. Joint axis change by the loss of meniscus and articular
cartilage or by collapse of osteoporotic bone, e.g. CARS brace.
3. Control of normal and abnormal joint range, e.g. Swedish brace
used in stroke and rheumatoid arthritis patients maintain sitting
cosmesis, stabilization of knee to control hyperextension at the
knee.
4. Retention of heat
5. Comfort of compression: This may be local or circumferential. This
may be quite effective in swollen knee (Orthoses for
patellofemoral arthosis are designed to control tracking of patella
as patient flexes or extends knee).

DYNAMIC PATELLAR ORTHOSIS (FIG. 22.9)

For patellofemoral disorders
It consists of:
• Patella cut out
• 2 Rubber straps (apply dynamic tension)
– Crescent-shaped patellar pad
 Lower Limb Orthoses 189

Fig. 22.9: Dynamic patellar orthosis

– Elastic counterforce strap (designed to maintain position of

pad and prevent axial rotation of device).

Purposes
Prevent lateral subluxation or
dislocation of patella.

SWEDISH KNEE CAGE

ORTHOSIS (FIG. 22.10)
• For angular motion in
frontal and sagittal plane
• For patient genu recurva-
tum providing some
mediolateral stability
• Restricts hyperextension
by means of 2 anterior
straps and 1 posterior
strap held in position by
metal frame. Fig. 22.10: Swedish knee cage
orthosis
190 Basics of Biomechanics

THREE-WAY KNEE STABILIZER (FIG. 22.11)

Same as above but has more pivotable strap attachments [Both the
above allow complete range of motion of knee flexion].

Fig. 22.11: Three-way knee stabilizer

EXTENSION KO
This orthosis consists of two long metal uprights pivoting thigh and
calf cuffs (Fig. 22.12).
Basic purpose is to protect the knee against mediolateral forces.

Fig. 22.12: Extension KO

 Lower Limb Orthoses 191

CARS-UBC ORTHOSIS
Three patients principle: Users an alternate design to provide knee
stabilization, against varus or valgus movements. It consists of 2
plastic cuffs, one on the thigh and one on the leg, connected by a
telescoping rod (Fig. 22.13). The rod is placed on the medial side of the
limb for genu varum and lateral for genu valgum. A third patient of
force applicaton is a pad on lateral side for genu varum and to
medial for genu valgum.

Biomechanics
When the knee is fully extended and bearing wt, this 3-point pressure.
System resist forces that tend to produce varum/valgum. It does not
control axial rotation.

Fig. 22.13: CARS-UBC orthosis

SUPRACONDYLAR KNEE ORTHOSIS (FIG. 22.14)

Patients requiring more control of genu recurvatum as well as firm
mediolateral stabilization may benefit from this.
– Custom made plastic orthosis is laminated over a plastic model
and provids rigid support for knee hindering flexion
– On sitting there is awakward protrusion of supracondylar portion.
Lerman multiligamentous knee control
and Lennox-Hill derotation device (Fig. 22.15).
192 Basics of Biomechanics

Fig. 22.14: Supracondylar knee orthosis

– Both use elastic straps that encircle the leg and thigh and exert
forces designed to provide rotational control.

Fig. 22.15: Lennox-Hill derotation device

KNEE-ANKLE-FOOT ORTHOSIS (KAFO)

External device required to argument fixation of both ankle and knee, is
referred to as KAFO: KAFO extends from thigh to foot and may be
used to control motion and alignment of knee and ankle or provide
support for femur/tibia or both (Fig. 22.16).
 Lower Limb Orthoses 193

Indications
1. Muscle weakness
i. Total lower limb weakness in paraplegia
ii. Weak or absent knee extensors.
2. Lower motor neuron lesions
i. Genu recurvatum in hemiparesis
3. Loss of structural integrity
i. Genu recurvatum
ii. Genu valgum/varum
iii. Hip disorders CDG, Legg-Calvé-Perthes.

Functions
1. To relieve weight partially or totally from the hip.
2. To relieve stress in the leg. Long stress is a direct result of weight
bearing and lateral torsion stress indirect used in—
Treatment of delayed union of fracture in femur or tibia and fibula.
Reduce the interface forces required partially correctable
deformities is sagittal/coronal plane, e.g. a mobile knee lacking
25° extension will require forces applied in the full manner.
to reduce stress.

Fig. 22.16: Knee-ankle-foot orthosis

3. Stabilization of knee
• In sagittal plane — flexion, recurvatum
• In coronal plane — varus/valgus
194 Basics of Biomechanics

4. To limit the most completely or partially at the knee.

- As in subacute stage of septic infections of bone is to limit
extension in a cold knee so as to provide stress face and non-
traumatic atmosphere for healthy tissues.
- In RA or OA where movement limitation occurs due to some
squaring of the condyles.
5. To combine the functinal units of AFO.
6. To exert hip control function in traumatic paraplegia.

DOUBLE UPRIGHT KAFO

It consists of:
1. 2 metal uprights
2. Thigh band
3. Mechanical knee joint
4. Foot attachment (same as AFO)
5. Accessory pad and straps may be made of plastic or leather.
Advantages are: Light weight and more intimate fitting.

Mechanical Knee Joint

(Fig. 22.17)
Since anatomical knee joint is
polycentric (i.e. it has changing
axis of rotation), mechanical
joints that have fixed axis can’t
move in complete motion.
Some shifting of orthosis relative
to time occurs during flexion
extension of knee, but this can be
minimized by proper placement of
mechanical knee joint.

*Types of Mechanical Knee Joint

a. Free-motion knee joint (Fig. Fig. 22.17: Mechanical knee joint
22.18): Allows unrestricted
flexion and extension but ordinarily incorporated a stop that
prevents hyperextension. It is indicated in patients tendency
towards recurvatum.
 Lower Limb Orthoses 195

b. Offset knee joint (Fig. 22.19): If the axis of knee joint is placed
posterior to the uprights the orthotic joint tends to extend
passively when weight is transmitted through the upright. In
this way knee can be stabilized during stance and is free to move
during swing (cannot be used in knee contracture).
c. Centric knee joint lock (Fig. 22.20): Axis of joint is in the center. For
movement patient has to lift the lock up. During flexion part
projects outwards may damage clothing.

Fig. 22.18: Free-motion knee joint Fig. 22.19: Offset knee joint

Fig. 22.20: Centric knee joint lock

196 Basics of Biomechanics

d. Drop lock knee joint (Fig. 22.21): This lock is the most commonly
used knee lock to control flexion. Ordinarily both medial and
lateral joints one provided a lock. However, if weight and activity
level are low, a single lateral joint lock may suffice.
e. UCLA (Fig. 22.22): Uses a quadrilateral socket and set back joints
used to prevent buckling of knee.
f. Spring loaded pull rod (Fig. 22.23): Given to the patient who is
capable of walking a free knee but who may wish to lock joint
occasionally. The sping drives the ring lock down, assisting
gravity in locking the knee.

Fig. 22.22: UCLA

Fig. 22.21: Drop lock knee joint

Fig. 22.23: Spring loaded pull rod

 Lower Limb Orthoses 197

h. Swiss lock (Fig. 22.24): Used in patients where upper extremity is

also paralyzed and patient is unable to carry out locking or
unlocking. It has automatic lock/unlocking.

Fig. 22.24: Swiss lock

i. Pawl lock (Fig. 22.25): Easier to release when a flexion force develop
at knee. A spring loaded pawl fits into a matching recess when
knee extends.

Fig. 22.25: Pawl lock

198 Basics of Biomechanics

Bail: Semicircular level placed unlocks both sides simultaneously

and allows flexion by a manual upward force or when bail is at
range of choice.

Accessory Pads and Straps

Although the locks just described effectively prevent motion in the
orthotic knee, sometimes the assist. Knee may flexion slightly
resulting in an uncomfortable contact behind the orthosis and limb.
To avoid this, accessory pad and a knee cap is added. In case of
genu varum/valgum a medial or lateral strap is added.
* KAFO to help SCI patients.
Components are:
1. Double uprights
2. Offset knee joints pawl locks and bail control
3. Posterior thigh band
4. Anterior leg band is hinged
5. SACH heel
6. Ankle joint adjustable stops.

Supracondylar KAFO (Fig. 22.26)

• Consists of moulded plastic KAFO to hunged or solid supra-
condylar shell is attached.
• Prevents excessive hyper extension of knee.

Fig. 22.26: Supracondylar KAFO

 Lower Limb Orthoses 199

HIP ORTHOSES (HO)

Indications
• Congenital dislocation of hip (CHD)
• Perthes disease
• Aberrant hip movement in cerebral palsy
• Persistent interior rotation of hip internal femoral torsion.
• HO. are used for patients who requires control of selected
motions of hip only.
• In these cases, since there is not orthosis descending to the shoe,
lower bar of hip joint is anchored to thigh cuff.

CONGENITAL DISLOCATION OF HIP

a. von Rosen splint (Fig. 22.27): Consists of a plastic frame that is
easily shaped to conform to the children body. Superior part of
frame passes over the shoulders. Middle part confirms to
posterolateral aspects of trunk. Inferior part comes under the thigh.
A horizontal strap holds the splint in place while two vertical
straps hold the thigh in desired position.

Fig. 22.27: von Rosen splint

b. Pavlik harness (Fig. 22.28): Consists of a chest strap, a shoulder

harness and anterior and posterior straps extend from chest strap
to booties that hold the feet securely.
200 Basics of Biomechanics

Fig. 22.28: Pavlik harness

c. Ilfeld Splint (Fig. 22.29): Consists of two thigh bands connected to

a crossbar by universal joints.
Waistband may be used.

Fig. 22.29: Ilfeld splint

PERTHES DISEASE
(Legg-Calvé-Perthes disease, Juvenile coxa plana)
a. Trilateral orthosis
- Ischial weight bearing plastic brim
- Single medial upright including knee drop lock
- Spring loaded shoe attachment
- Modified pattern bottom.
 Lower Limb Orthoses 201

b. Toronto orthosis (Fig. 22.30): To hold femur in medial rotation.

Fig. 22.30: Toronto orthosis

c. Scottish rite orthosis (Fig. 22.31).

Fig. 22.31: Scottish rite orthosis

SEVERE PARALYTIC DISORDERS AND

ABERRANT HIP MOVEMENTS
a. Standing orthosis (Fig. 22.32): Used to help a child learn standing
balance and achieve a swing through gait in parallel bars.
Consist of 2 uprights, a chest band, a hip part, knee block
unit and shoe platform.
Knee lock and unlock allowing patient.
202 Basics of Biomechanics

Fig. 22.32: Standing orthosis

b. Hip guidance orthosis (HKAFO) (Fig. 22.33): Device is referred to

as HKAFO when hip joint and pelvic are attached to KAFO.

Fig. 22.33: Hip guidance orthosis

 Lower Limb Orthoses 203

Ankle joint—Mechanical and anatomical ankle joint should

coincide at distal tip of medial malleolus (Axis of mechanical joint
at caliper)
Calf Band—To decide this level there are 3 techniques.
i. Maximum calf level, i.e. maximum circumference of calf
muscle
ii. 100 mm below knee joint axis (level of superior border of
calf band) mechanical knee joint
iii. 19 mm below head of fibula.
Knee joint (Mechanical): The anatomical knee joint is polycentric, i.e.
joint axis is constantly changing. But in mechanical knee joint 1
constant patient of axis is taken 19 mm above medial tibial plateau.
Thigh Band: Medial aspect—38 mm below periosteum
Lateral aspect—Just below greater trochanter
Hip Joint: Hip joint axis is 6 mm superior to proximal tip of greater
trochanter.
Pelvic band (Fig. 22.34): Superior border comes at level below ASIS
and greater trochanter/Purpose is to prevent of pelvis.
• May be U/L—(occasionally used) or B/L (commonly used)
• U/L Pelvic Band—encompasses pelvis on involved side below
iliac crest and greater trochanter.
• Extends from just medial to ASIS to PSIS

Fig. 22.34: Pelvic band

• B/L Pelvic Band (Fig. 22.35): Ends lie just anterior to lateral midlines
of pelvis.
• Band then curves post and downwards to contact most
prominent portions of buttocks and continues slightly upward
to overlie sacrum
204 Basics of Biomechanics

Fig. 22.35: B/L pelvic band

Hip Joint (Fig. 22.36)

• Single axis hip joint
• Double axis hip joint
• Single axis hip joint—Permits flexion and extension and includes
an adjustable stop to limit hyperextension. Also restrict
abduction adduction and rotation.
• Double axis hip joint—Used when there is no used to block
abduction and adduction flexion, extension axis may be free or
locked as required while, adduction axis includes adjacent straps
to place limits as these motions are needed.

Fig. 22.36: Hip joint

Hip Knee Ankle Foot Orthosis (HKAFO) (Fig. 22.37)

This type of caliper is given when the hip muscles are weak to prevent
flexion deformity at the hip joint. A pelvic band design a lockable
hip joint is the most means of stability the hip.
 Lower Limb Orthoses 205

In the upper part of the knee joint lower part of the hip is fixed
and in upper part of hip the pelvic belt is fixed. A pelvic band is a
padded rigid metal band covered leather encircles the pelvis
posteriorly (extending between ASIS) and presses on the sacrum. It
is fastened anterior a broad padded leather strap and buckle lateral
metal bands extending from pelvic band hinge upward extensions
of the lateral side bars of long leg calipers at the level of the hips. It is
better to use two long leg calipers a pelvic band. If only one caliper is
used the pelvic band can rotate on the pelvis.
The hinge or hip joint may allow either for flexion of leg
separately or on combination. It is important that the hip appliances
are positioned on the axis of hip-femur parallel and adjacent to the
greater trochanter of femur.

Fig. 22.37: Hip knee ankle foot orthosis

It support to decrease lumber lordosis is required, upward

extension from the pelvic band to a lumbosacral support may be
added. A spinal corset is 3-3½ inches below the axilla can be
used so as to facilitate the use of crutches. The function of a pelvic
band at hip joints is to prevent the development of a flexion to
control adduction and medial rotation at hip in presence of muscle
imbalance around the hip. In addition these appliances increase
the stability of spine.
206 Basics of Biomechanics

Lumbosacroiliac Hip Knee Ankle

Foot Orthosis (LSHKAFO)
This type of caliper is given when the patient has a tendency of
scoliosis especially in lumbar region or the abdominal/spinal
muscles being weak, including weak leg muscles. Along the belt an
extension upto 3-4 inches below axilla is given. HKAFO may be
unilateral or bilateral to the extent of involvement.

PATTERN END CALIPER (FIG. 22.38)

When it is essential for a limb to be relived of all weight bearing, a
pattern ended caliper is required. This type of caliper has a snuggle
fitting top. The steel side bars, without knee joints are adjacent for
length and are prolonged 3″ below heel. The distal ends of the side
bars are welded as steel ring, the pattern from a strap passes to the
back of the shoe to control plantar flexion of ankle. The foot of the
affected leg is thus kept sufficiently clear of the ground to prevent
the child from taking weight on his toes. In add postthigh and calf
bands, a knee pad and an ankle strap are provided.
Normal footwears is worns as the affected side but a
compensating pattern must be added to the other shoe to
accommodate the in length of affected limb.

Fig. 22.38: Pattern end caliper

 Lower Limb Orthoses 207

Fig. 22.39: Compensatory mechanism on a normal shoe

Foot-shoe modification
• Flat foot
• CTEV
• Shortening
• Metatarsal hallux vagus amputation.
AFO (Fig. 22.40)
• Types of ankle joints
• Free 90° FDS reverse stud motion fixed
• Plastic
• Metal and metal plastic.

Fig. 22.40: AFO

208 Basics of Biomechanics

Knee
• KO-Dynamic patellar
• Swedish knee cage
• Extension KO
• Supracondylar
• KAFO-uprights
• Doubling thigh band
• Supracondylar mechanism knee joint.
UCLA, Pawl’s Lock, spring loaded Drop Lock, Swiss Lock,
Centric, Offset Free motion
• Accessory strabs
• HOs-CDH
• von Rosen pavlik harness, Illfeld
• Perthes
• Trilateral, Toronto, Scottish Rite
• Severe reanalysis, Standiping orthosis
• HKAFO.
 23 Foot
Orthosis

FLAT FOOT SHOE

i. Shoe arch support (Fig. 23.1): Ros Parker insole. In this, a wedge
made of firm rubber foam, higher on the medial side than on
the lateral. This is to support the longitudinal arch of the foot.
Also given in painful heel.

Fig. 23.1: Shoe arch support

ii. Shoe crooked elongated heel – (Thomas heel)

Indicated in flat foot
– Genu varum valgum
Genu varum – effective when distance between two
epicondyles of femur is three inches.
Genu valgus – effective when distance between medial.

Flat Foot
In a shoe the width and length of the heel is same. In a flat foot shoe
the heel is elongated upto navicular bone (Fig. 23.2). It is done to
maintain long arch. Thickness in heel is equal on medial and lateral
side. For flat food it is greater a medial side 1/16th’’ – 1/14’’. This is
to shift the body laterally.
210 Basics of Biomechanics

Fig. 23.2: Elongation of the heel upto the navicular bone in case of flat foot

Other Means of Lateral Weight Shift and

Medial Long. Support
i. Cookie insert or insole (Fig. 23.3)
- Navicular pad

Fig. 23.3: Cookie insert

ii. Medial wedging (Fig. 23.4)

- Heel + sold wedging
- Sole wedging
- Heel wedging

Fig. 23.4: Medial wedging

iii. Medial shank filler—Fills the gap blemmed long arch + gap
iv. Valgus corrective strap (T-strap) applied medially in
conjunction to orthosis to prevent the foot and ankle from
assuming valgus attitude. T-strap is now discontinued. Y-strap
(Fig. 23.5) is used.
 Foot Orthosis 211

Fig. 23.5: Y-strap

+ Valgum
‘C’ + ‘E’ heels are prescribed to change the weight bearing line usually
be medially in both varum + valgum, i.e. plumb line from hip it
drops medially some shoe for both.

Mermaid Splint
Night splints given a genu varum + valgum. Extends from 2/3rd of
femur above knee to 2/3rd of tibia below knee genu varum, knee +
calf straps worn on medial side B/L. In genu varum – first thigh +
calf straps tightened then knee strap pulled in of valgum – first knee
strap tightened and then thigh and calf strap pulled in.

Over Corrected Shoe

To the pie shoes a medial raise given (L) worn in (R) and (R) in (L)
corrects varus.
For forefoot add the shape of the shoe itself liads to a straight
medial border.

CONGENITAL TALIPES EQUINOVARUS SHOE (CTEV SHOE)

(FIG. 23.6)
Given after plaster of Pairs serial splinting and surgical correction
is over. Up to 2 yrs. CTEV shoes during day plus serial splinting at
night is done.
212 Basics of Biomechanics

The CTEV shoes have the following modifications –

i. Stiff and straight inner border to prevent forefoot
adduction. An overcorrective shoe may be used.
ii. No heel to prevent equinus.
iii. Lateral sole-heel wedge extending upto metatarsals (outer
raise).

Fig. 23.6: CTEV shoes

HEEL ELEVATION MODIFICATION FOR

SHORTENING OF LEG
Leg shortening or foot problems or a fixed equinus no leg
shortening require heel elevation.
a. Patients no foot problem but only leg shortening. For heel elevation
of >1/2″ cork sheets of varying thickness are stacked, cemented
and attached as a sandwich component. The highest is at the
heel. Elevation should gradually decline at the ball of the foot. A
metatarsal or rocker bar can be installed as an integral part of the
elevation. It will facilitate faster rollover.
b. Fixed equinus: Flaring of the sole or heel is necessary and it is
installed as part of elevation. Lateral flaring (outflaring) is done.

METATARSAL ARCH SUPPORTS – SHOE MODIFICATION

There are 2 metatarsal arches :
Anterior: Made of heads of metatarsals.
Posterior: Made of bases of metatarsals.

Deformities of Metatarsal Arches

i. Pes cavus – Extensor tendons of dorsum are shortened causing
long arches to become high or ‘hollow’ and also causing the
 Foot Orthosis 213

proximal phalanges of each toe to dorsiflexion, while middle

and distal plantar flexion. The dorsiflexion of proximal
interphalangeal joint. It forces metatarsal arch to depression
of tightening of plantarfascia.
Treatment: Metatarsal bar + pad.
ii. Morton’s toe
– Congenital shortening of 2nd metatarsal leading to
additional pressure and resulting in pain in rollover phase
of the stance.
– Anterior metatarsalgia or severe neuralgia affecting 3rd
and 4th toes.
Treatment: Metatarsal pad + bar (Fig. 23.7).

Fig. 23.7: Treatment of Morton’s toe

Fig. 23.8: Morton’s toe extension

Morton’s toe extension (Fig. 23.8) – By raising the level of

1st metatarsal bone and the phalanges of big toe. By
extending 1st toe, the 3 point weight distributing pattern
is restored in weight borne on calcaneus, 1st + 5th
metatarsal heads. Along this a metatarsal pad to support
the heads may be used.
214 Basics of Biomechanics

iii. Hallux valgus – Medial displacement of the 1st metatarsal and

lateral displacement of phalanges. It is a hallux valgus for toe
and metatarsus various for the metatarsal bones.
Shoe modification–A shoe an outflare or a straight inner border.
–Levy’s inlay (wedge-shaped pad made of resilient foam).
iv. Hallux rigidus – A deformity characterized by a rigid 1st MTP
joint pattern a heel strike that is more lateral than normal and
midstance ankle is in slight varus.
Treatment (Figs 23.9A and B): Shoe used long arch, a fitted
metatarsal pad for the 1st metalarsal and a long steel spring
and socker board.
v. Splay foot: A deformity in the metatarsal bones abduct from
each other mediolaterally at their heads; depressing anterior
metatarsal arch.
Shoe modification – Metatarsal corset (Fig. 23.10) and metatarsal
pad.

Figs 23.9A and B: Treatment of hallux rigidus

 Foot Orthosis 215

Fig. 23.10: Metatarsal corset for correction of splay foot

PAINFUL HEEL SHOE MODIFICATION

Usually due to calcaneal spur.
Shoe modification – insert: long arch support + scooped heel
cushion.
Overlay: SACH heel.
Shoes filler after amputation of toes (Fig. 23.11).

Fig. 23.11: Shoe filler after amputation of toes

• Acrial foot is upto Tarsometatarsal level.

• During gait in the rollover phase, all the weight comes on the
toes. After amputation of the toes this gap is to be filled and a
Rocker bar may be given to assist in rollover.
216 Basics of Biomechanics

SPECIFICATIONS OF LOWER LIMB ORTHOSES

1. Foot orthoses (FO)
2. Ankle foot orthoses (AFO)
3. KAFO
4. HKAFO
5. Bilateral HKAFO – Spinal support.

1. Foot Orthoses
It is an external device applied to the body for the purpose of
controlling or at least distributing forces + for improving function.

Indications
1. Foot instability or deformity due to muscle weakness or imba-
lance
– Weak/absent inverter, e.g. calcaneovalgus deformity
– Weak/absent evertors, e.g. secondary to paralysis of
peronei
– Weak/absent toe extensors–inability to dorsiflexion foot—
flexors inability to plantar flexion associated
2. Foot instability or deformity due to structural malalignment
– Often congenital.
3. Foot instability/deformity due to loss of structural integrity
– In arthritis
– Chronic repetitive injury from high levels of sporting
activity.
– Pain on weight bearing: If joint surfaces are severely
damage or degenerate
– Rigid foot deformities, e.g. hallux abductus valgus.
 Index

A B
Accelerated motion 5 Bilateral transradial harness 137
Acceleration 26 Body movements 72
instantaneous acceleration 28 movements of neck 72
uniform acceleration 27 movements of shoulder 76
ADL 90 movements of spine 74
aims 92 Boston’s brace 155
approaches of ADL 99
biomechanical 99 C
compensatory 99 Cervical orthosis 157
learning 99 classification 157
classification 90 rigid/hard CO 159
ambulatory activities 90 semirigid CO 158
bed activities 90 soft cervical orthosis 158
communication skills 90 goals 157
home management activities indications 157
90 Components of definitive below elbow
self-care activities 90 prosthesis 131
traveling activities 90 Congenital dislocation of hip 199
wheelchair activities 90 Control cable system 135
factors affecting selection of aids Corrective orthoses 178
96
personal factors 96 D
goals of self-help devices 93
Definitive mechanical prosthesis 131
objectives 92
Distinction between gravitation and
physiological and psychological
gravity 18
acceptance of disability and
Double upright KAFO 194
aids 96
principles of material designing 97 accessory pads and straps 198
role of OT and PT in ADL 98 mechanical knee joint 194
scope of ADL in rehabilitation 91 types 194
significant role 92 supracondylar KAFO 198
Ankle foot orthoses 180 Dynamic patellar orthosis 188
conditions 180 purposes 189
functions 180 E
indications 180
metal and metal plastic designs Early postsurgical prosthesis 130
181 Elbow disarticulation and above elbow
plastic designs 181 amputation and prosthesis 137
types of ankle joints 181 components 138
Ankle joint assists 184 control cable 140
varus-valgus correction 184 levels of amputation 138
Anterior spinal hyperextension brace physical factors affecting
152 prosthesis 138
components 152 socket 139
function 152 supracondylar pads 140
218 Basics of Biomechanics

Elbow units 134 Graphical representations of uniform

Energy 49 and non-uniform motion 3
types 49
kinetic 49 H
potential 49 Harness system 135
Equation of motion 4 Hip knee ankle foot orthosis 204
Hip orthoses 199
F indications 199
First cable 141 I
Foot ankle assembly 112
articulated foot 114 Ischial containment socket 126
external keel type 113
internal keel type 112
J
advantages 113 Jaipur foot–an exoskeleton type of
disadvantages 113 prosthesis 105
prosthetic foot 112 description guidelines of lower
nonarticulated foot 112 extremity prosthesis 105
rotators 114 activity level 105
shank 115 expenses 105
endoskeletal shank 115 prosthesis component 105
exoskeletal shank 115 suspension 105
socket 116 weight bearing 105
Foot orthosis 209 Juvenile coxa plana 200
congenital talipes equinovarus
shoe 211 K
flat foot shoe 209 Knee orthosis 187
heel elevation modification for indications 188
shortening of leg 212 treatment objectives 188
metatarsal arch supports 212 comfort of compression 188
deformities of metatarsal retention of heat 188
arches 212 stabilization of knee 188
painful heel shoe modification 215 Knee-ankle-foot orthosis 192
specifications of lower limb functions 193
orthoses 216 indications 193
foot orthoses 216
Force 12 L
balanced forces 13
Law of conservation of energy 54
resultant force 15
Legg-Calvé-Perthes disease 200
unbalanced forces 15
Lower extremity prosthesis 103
external 17
Lumbosacroiliac hip knee ankle 206
internal 17
Friction 30 M
causes 32
components 37 Mechanical prosthesis 137
types 30 advantages 137
laws of friction 31 disadvantages 137
limiting friction 31 Milwaukee brace 153
Friction wrist unit 133 indications 154
principle of production 154
G result 154
Morton’s toe 213
Galileo’s discoveries 11 Motion 1
Galileo’s study on the motion of non uniform motion 2
objects 7 uniform motion 2
 Index 219

N requirements 87
awareness of quality of
Newton’s law of motion 8
motion needed 87
first law 8
energy and strength 88
second law 8
third law 8 lever 87
Newton’s third law of motion 11 muscle control 88
Normal human locomotion 81 source of motion 87
comparative representation of gait results 88
cycles 84 Pattern end caliper 206
double support 81 Pavlik harness 199
measuring of the external forces 85 Perthes disease 200
methods of studying normal Plantar flexion 185
human locomotion 84 Power 56
swing phase 84 horse power 57
Preparatory/training mechanical
O prosthesis 131
Orthotics 162 Prosthesis 100
characteristics 168 contraindications 102
adjustability 168 principles 100
cosmesis 169 Prosthetics 106
hygiene 169 above ankle design 109
light weight 168 amputation of toes 107
manufacturing standards 168 below ankle design 109
minimizing adverse effects of causes of need 106
orthosis 169 congenital 106
objectives of history taking 168 noncongenital 106
patient acceptability 169 principal lower limb prosthesis 106
rapid provision and level of amputation and
replacement 168 prosthesis required 107
reliability 168 ray amputation 107
safety 169 tarsometatarsal amputation 108
function 164 transmetatarsal amputation 108
indications 162
PTB types 117
principles 165
air cushion socket 117
P advantages 118
disadvantages 118
Partial hand amputation and cuff variation 119
prosthesis 128 advantages 120
indications 129
disadvantages 120
aesthetic loss 129
supracondylar cuff 119
prehension 129
flexible socket with rigid external
protection 129
frames 118
levels of amputation 130
Pathological gaits 87 advantages 118
phases of gait 88 disadvantages 118
initial contact 88 socket 118
initial contact and contact Syme’s socket 119
response 88 suspension 119
midstance 88 Q
midswing 88
pursuing for swing period 88 Quadrilateral socket 125
220 Basics of Biomechanics

R knee unit 123

shank unit 122
Radius of gyration 69 socket 124
Rotation 66 suspension 126
S Translation motion 69
Transtibial or below knee amputation
Scalar quantities 58 and prosthesis 111
Scottish rite orthosis 201 definite below knee prosthesis 111
Second cable 141 intermediate prosthesis 111
operating sequence 141 Types of terminal devices 133
standard transhumeral harness
system 141 U
Severe paralytic disorders and aberrant Universal character of gravitation 18
hip movements 201 Universal gravitational constant 19
Spinal corsets 153 Universal law of gravitation 19
Spinal orthotics 144 Upper limb orthoses 170
basic components 145 balanced forearm orthoses 179
full front abdominal support components 179
146 corrective orthoses 174
lateral uprights 146 function 175
lumbosacral/thoracolumbo types 174
sacral posterior uprights hand and wrist orthoses 170
146 assistive and substitutive 170
pelvic band 145 categories 170
thoracic band 145 functions 171
classification 148 hand 172
functions 144 types 171, 172
principle of functioning 147 wrist hand 172
Steindier’s brace 151 protective orthoses 173
components 151 functions 173, 174
function 152 types 173
Supracondylar knee orthosis 191 Upper limb prosthesis 128
Swedish knee cage orthosis 189 principles 128
Syme ankle disarticulation and Syme types 128
prosthesis 109 Upright and calf bands 182
aims/characteristics 109 caliper 183
components of Syme drawbacks 183
prosthesis 110 functions 182
provision for donning 110
suspension 110 V
T Vector quantities 58
Velocity 21
Taylor’s brace 150 average velocity 24
application 151 instantaneous velocity 25
components 150 von Rosen splint 199
functions 151
Terminal device 132 W
Toronto orthosis 201 William’s brace 149
Torque 61 components 149
Transfemoral amputation prosthesis Work 43
122 mental work 43
components 122 physical work 43
foot ankle assembly 122 Wrist disarticulation 130