16. Lab: Muscle Imbalance

Question 1

What are the hypertonic/facilitated muscles in lower cross syndrome?

Answer 1

Postural

Erector spinae
Iliopsoas
Hip adductors
tensor fascia lata
Hamstrings
Quads
Q. Lumborum
Piriformis

Question 2

What are the hypotonic/inhibited muscles in lower cross syndrome?

Answer 2

Abdominals

Gluts

Question 3

How do you diagnose Lower cross syndrome? (3)

Answer 3

Lower extremity extension test
Lower extremity abduction test
Abdominal heel slide test

Question 4

What is the correct firing pattern of the lower extremity extension test?

Answer 4

1. Ipsi hamstring (caudal 5th digit)
2. Ipsi glut max (caudal 1st digit)
3. Contra erector spinae (cephalad 1st digit)
4. Ipsi erector spinae (cephalad 2nd digit)

Question 5

What is the correct firing pattern of the lower extremity abduction test?

Answer 5

1. Ipsi glut med (caudal 2nd digit)
2. Ipsi TFL (caudal 5th digit)
3. Ipsi quad lumborum (cephalad 5th digit)
4. Ipsi erector spinae (cephalad 2nd digit)

Question 6

What is a (+) and (-) test for the extension/abduction tests for LCS?

Answer 6

(+) if muscles fire out of order

(-) if they fire in order

Question 7

What is a positive heel slide for abdominals?

Answer 7

If pt cannot maintain/struggles to keep lordosis when they slide

Question 8

Which muscle groups of the leg do you treat with MET for a (+) lower cross syndrome? (4)

Answer 8

Adductors
TFL
Hamstrings
Quads

Question 9

How do you know if you need to treat the psoas for LCS?

Answer 9

Thomas test

If positive, do MET

Question 10

What other major hip stabilizers of (besides psoas) do you treat with MET in LCS?

Answer 10

Quadratus lumborum
-grab hip and resist superior movement

Piriformis
-Externally rotated and flex hip, resist internal rotation

Question 11

Which muscles can you strengthen for LCS? What exercises can you use? (3)

Answer 11

Glut med-clamshell

Glut max-back bridges

Abdominals-heel slide

Question 12

What muscles are hypertonic in Upper Cross Syndrome (UCS)? (6)

Answer 12

Sternocleidomastoid
Scalenes
Pecs
Upper trap
Levator Scap
Lats

Question 13

What muscles are hypotonic in in Upper Cross Syndrome (UCS)? (4)

Answer 13

Longus Coli
Rhomboids
Serratus Anterior
Lower traps

Question 14

What tests can you do to check for UCS?

Answer 14

Cervical flexion test
-(+) if pt has to lift head before flex

Scap stabilization test
-(+) if not stable or drop shoulder

Lower trap recruitment
-(+) if scapula dose not move inferior when raising arm

Question 15

What muscles do you stretch in UCS? (5)

Answer 15

Pec major
Lats
Scalenes
Upper trap
Sternocleidomastoid

Question 16

Which way do you sidebend and rotated head for:

• Anterior scalene
• Middle scalene
• posterior scalene

How do you treat if hypertonic?

Answer 16

• Anterior: rotate neck toward, sidebend away
• Middle: sidebend neck away
• Posterior: rotate neck away, sidebend away

Treat w met if hypertonic

Question 17

How do you stretch the upper traps/Levator scap? How do you treat if Hypertonic?

Answer 17

Flex neck, rotate away, sidebend away

Treat w MET if hypertonic

Question 18

How do you stretch the sternocleidomastoid? How do you treat if Hypertonic?

Answer 18

Extend neck, sidebend away, rotate toward

Treat w MET if hypertonic

Question 19

How do you know if you need to strengthen the longus coli in UCS? How do you treat?

Answer 19

(+) cervical flexion test

Treat w chin tuck
-hold for 5-7s, 2-3x per day

Question 20

How do you know if you need to strengthen the serratus anterior in UCS? How do you treat?

Answer 20

(+) positive scapula stabilization test

Treat w same as test
-hold for 5-7s, repeat 2-3x per day

Question 21

How do you know if you need to strengthen the lower trap in UCS? How do you treat?

Answer 21

(+) lower trap test

Treat by gently flexing arm and retracting shoulder blade
-hold 5-7s, repeat 2-3 x per day