Comp 9 Hip/Knee

Question 1

9a: Perform ME treatment for a hip flexion and a hip extension somatic dysfunction

Answer 1

• Describe diagnostic process as: hip flexion is evaluated supine; hip extension evaluated prone with knee flexed to 90 with linkage blocked at ipsilateral ischial tuberosity
• hip flexion dysfunction: note greater ease of motion during hip flexion and restriction of motion during extension. 90 flexion expected with knee in extension and 120-135 with knee fully flexed
• hip extension dysfunction: note greater ease of motion during hip extension and restriction of motion during flexion. 15-30 extension expected
• for hip flexion dysfunction: patient supine or prone.
• -supine: pt with pelvis at edge of table with student standing at edge of table, same side of dysfunction. Stabilize contralateral ASIS and let ipsilateral lower extremity drop off edge of table. Engage restrictive barrier by extending ipsilateral hip into barrier. Instruct pt to provide activating force by pushing lower extremity up towards ceiling (toward hip flexion) for 3-5s against equal resistance force by student. Then pt fully relaxes. Student engages new barrier. Repeat until no new barriers are reached or full range of motion is restored.
• -prone: pt with knee flexed 90. Student on same side as dysfunction and stabilize ipsilateral ischial tuberosity. Grasp ipsilateral thigh proximal to knee and extend hip into barrier. Instruct pt to push leg down towards table (hip flexion) for 3-5s against equal resistance by student. Relax, engage new barrier. Repeat until no new barriers.
• for hip extension: pt supine with student at edge of table on same side. Stabilize contralateral ASIS. Engage restrictive barrier by flexing ipsilateral hip into barrier with knee extended or flexed. Instruct pt to provide activating force by pushing lower extremity toward foot of table (hip extension) for 3-5 s against equal resistance by student. Then pt relaxes. Engage new barrier and repeat until no new barriers.
• Reassess for resolution of dysfunction by assessing hip flexion/extension
• document in plan portion of SOAP note as ME for hip

Question 2

9b: Perform ME for hip internal/external rotation somatic dysfunction

Answer 2

• diagnostic process: hip internal rotation is evaluated supine with hip and knee flexed to 90
• hip internal rotation dysfunction: note greater ease of motion during hip internal rotation and restriction of motion during external rotation. 30-40 internal rotation are expected
• hip external rotation dysfunction: not greater ease of motion during hip external rotation and restriction of motion during internal rotation. 40-60 external rotation expected
• pt supine with student standing at edge of table on same side of dysfunction
• for hip internal rotation dysfunction: engage restrictive barrier by externally rotating ipsilateral hip into barrier. Instruct pt to provide activating force toward internal rotation for 3-5s against equal resistance by student. Then pt fully relax. Engage new barrier. Repeat until no new barrier are met, or full range of motion is restored.
• for hip external rotation dysfunction: engage restrictiver barrier by internally rotating ipsilateral hip into barrier. Instruct pt to provide activating force towards external rotation for 3-5 s against equal resistance by student. Pt relax. Engage new barrier. Repeat until no new barriers
• reassess for hip internal/external rotation, noting resolution of dysfunction
• document in plan portion of SOAP note as ME for hip

Question 3

9c: Perform ME for hip adduction/abduction somatic dysfunction

Answer 3

• diagnostic: hip adduction is evaluated supine with knee fully extended and lifting opposite lower extremity and sweeping ipsilateral leg under the other Abduction can be assessed supine by sweeping leg laterally.
• hip adduction dysfunction: note greater ease of motion during hip adduction and restriction of motion during abduction. 20-30 adduction expected
• hip abduction dysfunction: note greater ease of motion during hip abduction and restriction of motion during adduction. 45-50 abduction expected.
• pt supine with student at foot of table
• for hip adduction dysfunction: engage restrictive barrier by abducting ipsilateral hip into barrier. Instruct pt to provide activating force towards adduction for 3-5s against equal resistance by student. Pt fully relax. Engage new barrier. Repeat until no new barriers are met, or full range of motion is restored.
• for hip abduction dysfunction: engage restrictive barrier by lifting contralateral lower extremity and adducting ipsilateral hip into barrier. Instruct pt to provide activating force towards abduction for 3-5s against equal resistance by student. Pt fully relax. Engage new barrier. Repeat until no new barriers
• reassess for hip abduction/adduction, noting resolution of dysfunction.
• document in plan portion of SOAP note as ME for hip

Question 4

9d: Perform ME treatment for knee flexion/extension somatic dysfunction

Answer 4

• knee flexion somatic dysfunction diagnostic: knee flexion is evaluated prone, noting greater ease of motion during flexion and restriction of during extension. 145-150 flexion expected
• knee extension somatic dysfunction diagnostic: knee extension is evaluated supine or prone, noting greater ease of motion during extension and restriction of motion during flexion. 0 extension expected.
• For knee flexion dysfunction: pt supine with student standing at side of table on same side as dysfunction. Engage restrictive barrier by extending knee into barrier. Instruct pt to provide an activating force towards knee flexion for 3-5s against equal resistance by student. Pt relax. Engage new barrier and repeat until no new barriers.
• for knee extension dysfunction: pt prone with student standing at side of table on same side as dysfunction. Engage restrictive barrier by flexing knee into barrier. Instruct pt to provide activating force towards extension for 3-5s against equal resistance by student. Pt relax. Engage new barrier and repeat until no new barriers
• reassess for knee flexion/extension, noting resolution of dysfunction
• document in plan portion of SOAP note as ME for knee

Question 5

9e: Perform ME treatment for a posterior fibular/anterior head somatic dyfunction

Answer 5

• diagnostic: fibular head is evaluated supine with knee flexed 45 and gliding it anterior and posterior
• posterior fibular head somatic dysfunction: accompanied by foot inversion, adduction, plantarflexion, and tibia internal rotation. Note greater ease of motion during posterior glide and restriction of motion during anterior glide
• anterior fibular head somatic dysfunction: accompanied by foot eversion, abduction, dorsiflexion, and tibia external rotation. Note greater ease of motion during anterior glide and restriction of motion during posterior glide.
• pt supine. Student at side of table, same side as dysfunction with ipsilateral hip and knee flexed to 90
• for posterior head: hold fibular head between thumb and index finger, while other hand contacts foot to engage restrictive barrier by everting, abducting, and dorsiflexing foot and externally rotating tibia. Instruct pt to provide activating force toward inversion, adduction, plantarflexion, and internal rotation for 3-5s against equal resistance by student. Pt relax. Engage new barrier and repeat until no new barriers.
• for anterior head: hold fibular head between thumb and index finger, while other hand contacts foot to engage restrictive barrier by inverting adducting, plantarflexing foot and internally rotating tibia. Instruct pt to provide activating force toward eversion, abduction, dorsiflexion, and external rotation for 3-5s against equal resistance by student. Pt relax. Engage new barrier and repeat until no new barriers
• Reassess for fibular head anterior/posterior glide, noting resolution of dysfunction.
• document in plan portion of SOAP note as ME for knee

Question 6

9f: perform HVLA treatment for posterior fibular head somatic dysfunction

Answer 6

• diagnostic: fibular head is evaluated supine with knee flexed 45 and gliding it anterior and posterior. Dysfunction is accompanied by foot inversion, adduction, plantarflexion, and tibia internal rotation. Note greater ease of motion during posterior glide and restriction of motion to anterior glide
• pt supine with student at side of table, same side as dysfunction with ipsilateral hip and knee flexed to 90
• place index MCP of cephalad hand on posterior aspect of fibular head and other hand on foot/ankle to evert, abduct, dorsiflex, and externally rotate tibia
• engage restrictive barrier by maintaining eversion, abduction dorsiflexion, and external rotation and adding flexion at hip and knee
• after restrictive barrier is engaged, apply HVLA thrust by hyperflexion of knee and anterior thrust on posterior fibular head from cephalad hand
• reassess for fibular head anterior/posterior glide and noting resolution of dysfunction
• document in plan portion of SOAP note as HVLA for knee

Question 7

9g: Perform HVLA treatment for anterior fibular head somatic dysfunction

Answer 7

• diagnostic: fibular head is evaluated supine with knee flexed 45 and gliding it anterior and posterior. Dysfunction is accompanied by foot eversion, abduction, dorsiflexion, and tibia external rotation. Note greater ease of motion during anterior glide and restriction of motion during posterior glide.
• pt supine. Student at side of table, same side as dysfunction, with ipsilateral hip and knee extended (leg flat on table)
• place thenar eminence of cephalad hand over anterolateral aspect of fibular head. Other hand contacts foot/ankle to invert, adduct, plantarflex, and internally rotate tibia
• engage restrictive barrier by maintaining inversion, adduction, plantarflexion, internal rotation and adding posterior force to fibular head
• HVLA thrust is applied by posterior thrust on anterior fibular head from cephala hand
• reassess for fibular head anterior/posterior glide, noting resolution of dysfunction
• document in plan portion of SOAP note as HVLA for knee

Question 8

9h: perform MFR treatment for knee (tibial) internal/external rotation somatic dysfunction

Answer 8

• diagnostic: tibia rotation is a passive, accessory motion and is evaluated supine with hip and knee flexed 45 and rotating tibial plateau internally and externally, noting ease and restriction of motion. 10 range of motion is expected in each direction. For internal rotation tibia dysfunction, note greater ease of motion during internal rotation and restriction of motion during external rotation. For external rotation tibia dysfunction, note greater ease of motion during external rotation and restriction of motion during internal rotation.
• pt supine With ipsilateral hip and knee flexed 90. Student at side of table, same side as dysfunction.
• encompass tibial plateau with both hands, with thumbs on anterior aspect of tibia and fingers on posterior aspect
• engage ease of motion and restrictive barrier by adding slight distraction, then internally and externally rotate tibia, noting freedom/restriction of motion
• for internal rotation dysfunction:
• -direct: direct force is applied toward restrictive barrier by rotating tibial plateau externally and is maintained until tissue relaxation stops re-establishing proper range of motion. (Direct MFR tissue creep)
• -indirect: indirect force is applied toward ease of motion by rotating tibial plateau internally and is maintained until relaxation stops re-establishing proper range of motion. (Indirect MFR tissue creep)
• for external rotation:
• -direct: direct force is applied toward restrictive barrier by rotating tibial plateau internally and is maintained until tissue relaxation stops re-establishing proper range of motion.
• -indirect: indirect force is applied toward ease of motion by rotating tibial plateau externally and is maintained until tissue relaxation stops re-establishing proper range of motion.
• reassess for tibia internal and external rotation noting resolution of dysfunction
• document in plan portion of SOAP note as MFR for tibia

Question 9

9i: perform MFR treatment for a fibular head anterior/posterior somatic dysfunction

Answer 9

• diagnostic: fibular head is evaluated supine with knee flexed 45 and gliding it anterior/posterior noting ease/restriction of motion. Note anterior dysfunction has ease of motion to anterior glide and restriction to posterior glide. Note posterior glide has ease of motion to posterior glide and restriction to anterior glide
• pt supine with ipsilateral hip and knee flexed 45. Student standing at same side of dysfunction
• hold fibular head between thumb and index finger with cephalad hand. Other hand stabilizes distal tib/fib
• for anterior fibular head dysfunction:
• -direct: direct force is applied toward restrictive barrier by applying a posterior force to fibular head and is maintained until tissue relaxation stops re-establishing proper range of motion
• -indirect: indirect force is applied toward ease of motion by applying an anterior force to fibular head and is maintained until tissue relaxation stops re-establishing proper range of motion
• for posterior fibular head dysfunction:
• -direct: direct force is applied toward restrictive barrier by applying anterior force to fibular head and is maintained until tissue relaxation stops re-establishing proper range of motion
• -indirect indirect force is applied toward ease of motion by applying posterior force to fibular head and is maintained until tissue relaxation stops re-establishing proper range of motion
• reassess for fibular head anterior and posterior glide, noting resolution of dysfunction
• document in plan portion of SOAP note as MFR for kneeh