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structure, which, by exercising an ever-
vigilant traction The integrity of the
knee joint,
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so far as its perfect functions are
concerned, is largely dependent on this
upon the capsule of the joint and its
connections
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is almost the sole means by which
excessive
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lateral movement in the knee-joint is prevented
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The ligaments, however strong and
normal, leave a large margin of
undesirable mobility which is
prevented by the ilio-tibial band;
any condition, therefore,
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which interferes with the integrity
of it, or weakens the muscles
which control its action, indirectly
leads to
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weakening of the knee-joint.
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This structure, as shown by the diagram
(Fig. 2) is the very strong specialised
outer portion of the deep fascia of the
thigh Avhich
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at its upper end^ after coming down from the crest of the ileum, receives the insertion of the greater portion of the gluteus maximus and the whole of the tensor fasciae femoris-two very strong muscular arrangements entering the ilio-tibial band obliquely
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-Showing the general arrangement of the ilio-tibialband.
from opposite
points-which by their
combined action
exercise an
immensely strong
traction upon it in a
vertical direction;
below, the band becoming as it
descends more concentrated and thick,
is inserted into the outer side of the
head of the tibia,
having previously sent off expansions
which are attached to the various bony
prominences about the knee
and after reinforcement by expansions from the vasti muscles become indistinguishable from the capsule of the joint.
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The relation of the ilio-tibial band to
the tonicity of the knee-joint is the
same as that of the tendons passing
from the leg to
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and under, the tarsus to the integrity
of the arch of the foot, and it would
be just as rational to attempt to cure
(in the proper sense of the word) flat-
foot by ignoring the treatme
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the condition is peculiar to the individual and normal so far as lie or she is concerned.
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Moreover, it will generally be
found if the looseness of the
knee-joint is only a
peculiarity that other joints
especially the wrists have
the same characteristics.http://www.Cure-JointPain.com
The importance of bearing in
mind that symmetrical
looseness of the knee-joints
may be frequently met with
in perfectly sound subjects is
too obvious to need
comment.http://www.Cure-JointPain.com
Unilateral hyper-mobility should on the other hand clearly suggest either disease or some physical defect.
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In the ideal lower limb the
subject standing fully erect
and being viewed from the
side a line dropped
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vertically through the
middle of the acetabulum
to the foot will cross the
outer edge of the patella
and impinge upon the
metatarso-phalangeal
joints of the fourth and
fifth toes_,
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but in a considerable
number of people mostly
males the normal
extension is in fact hyper-
extension_, in some cases
to such a degree as to
come within a measurable
distance of
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what is clinically called genu recurvatum, without in any way affecting the strength of the individual.
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This peculiarity of hyper-
extension is generally due
to excessive length of the
anterior crucial ligament
which is the main check in
limiting extension of the
knee.http://www.Cure-JointPain.com
Here, again, the deviation
from the ideal condition
may when occurring in
both knees be considered
merely as a peculiarity, but
if unilateral it should not
be so regarded.http://www.Cure-JointPain.com
Again, certain subjects in standing do not apparently place the lower limbs in full extension, slight flexion at the knee when fully erect being with them the normal
condition-if it is symmetrical.
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In the same way deviations from the ideal contour of the lower limbs when viewed from the front constantly occur in perfectly sound
subjects in whom such deviations (e. g. slight inbending or slight bowing-out of the knee).
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When symmetrical may be regarded as mere peculiarities which are sometimes so marked (as, for example, frequently in stable-boys) that it is difficult to say when
the limit beyond the possible normal is reached and the abnormal begins.
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The crucial point of this particular matter then is that deviations from ideal normality either in mobility or shape
provided
that they are symmetrical may be regarded as peculiarities only unless there are obvious indications of disease, as for an example, in the symmetrical
malformation of rickets.
It should however be borne in mind that these deviations from the true normal when symmetrical are prone to be somewhat more
obvious on the right side, excepting in left-handed subjects when the reverse is often the case.
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