Hip / Knee ROM & MMT Flashcards
what is the official name of the hip joint?
iliofemoral joint
how many degrees of freedom does the iliofemoral joint have? what motions
3 - frontal, transverse, and sagittal
ab/add, IR/ER, flex/ext
what motion does positioning have a significant effect on when testing the hip?
ER
better to do it sitting than laying down. Sitting locks the pelvis
what directly effects hip flexion?
BMI / Pregnancy
“belly size”
limits sagittal plane motion
mean hip range of flexion is
120°
what is the position of hip flexion ROM
supine with knees extended
hips in neutral ab/add and rotation
what is the testing motion of hip flexion ROM?
lift thigh off table directing patient’s knee toward their head
passive knee flexion is allowed
maintain neutral rotation/abduction
normal end feel of hip flexion?
soft
goniometer positions for hip flexion
axis - greater trochanter
SA - lateral midline of pelvis
MA - femur aimed at lateral epicondyle
how is the pelvis stabilized during hip flexion/extension rom
keep other leg flat on the table to prevent posterior pelvic tilting
what is the mean hip extension ROM
20°
what is the testing position for hip extension
patient is prone
knees extended with hip in neutral ab/add and IR/ER
no pillow under head, can be under abdomen if preferred by patient
testing motion of hip extension ROM
keeping knee in full extension, thigh is raised off of the table
normal end feel of hip extension
firm
goniometer placement during hip extension ROM
axis - greater trochanter
SA - lateral midline of pelvis
MA - midline of lateral femur toward lateral epicondyle
what is the mean ROM for hip abduction
40°
what is the testing position for hip abduction
patient is supine with knee extended, everything in neutral
what is the testing motion for hip abduction
hip is abducted by sliding LE laterally
ensure lack of rotation during abduction
what is the normal end feel for hip abduction
firm
what is the positioning of the goniometer during abduction ROM
axis - over the ASIS of testing side
SA - along line extending from ASIS to ASIS
MA - anterior line of femur toward patella
what is a way someone could cheat during abduction ROM
hip hiking
what is the normative range of hip adduction ROM
20°
what is the testing position for hip adduction
patient is supine with knees extended
hip being tested should be in neutral with opposite hip in abduction (moved out of the way)
what is the testing motion for hip adduction
hip is adducted by sliding the slower extremity medially toward contralateral lower extremity
what is the normal end feel for hip adduction
FIRM
goniometer position for hip adduction
axis - over the ASIS of testing leg
SA - from one ASIS to the other ASIS
MA - anterior femur in line with the patella
what is the normative range of motion for hip IR?
45
what is the testing position for hip IR
patient seated with knees flexed to 90° and leg hanging off of table
what is the testing motion for hip IR
medially rotate hip by moving ankle/leg lateral while stabilizing distal femur.
what is the normal end feel of hip IR
Firm
goniometer alignment for hip IR/ER
axis - over anterior aspect of patella
SA - perpendicular to the floor / supporting surface
MA - anterior midline of the lower leg, pointing midway between the lateral and medial malleoli
what are the two joints of the knee?
tibiofemoral
patellofemoral
what are the degrees of freedom at the knee
flexion / extension
rotation
where is the greatest range of voluntary knee rotation
at 90° flexion
at terminal knee extension __________ happens because _______
involuntary rotation due to asymmetric shape of femoral condyles
what is the locking or screw-home mechanism
at end range of knee extension, motion stops at shorter lateral condyle but continues at the longer medial condyle
this must be undone in order to flex knee
at what age does one expect to see full knee extension? why?
around age 2 because the individuals have not been able to walk or bear weight on the legs
what age do flexion contractures tend to develop?
> 50
can be developmental to assist with balance
how do male and female joints compare? how is this clinically important?
females may tend to have more laxity
hyperextension or ability to hyperextend the knee is a possible factor in increased ACL injury in female athletes
how does BMI affect range of motion at the knee?
less BMI > ROM
what is the mean value for knee flexion? extension?
flex - 140-150
extension - 0
what is the testing position for knee flexion/extension
patient is supine with knees extended
hip in neutral
flex patients knee without hip flexing past 90°
what can be done to test for hyperextension at the knee?
towel roll or support under ankle
end feels for knee flexion/extension
flex - soft
ext - firm
goniometer placement for knee flexion/extension
axis - lateral epicondyle
SA - lateral midline of femur aimed toward greater trochanter
MA - lateral midline of fibula aimed at lateral malleolus
what muscles may contribute to lack of knee ROM
muscle length of rectus femoris and/or hamstrings
what muscles assist in hip flexion
iliacus
psoas major
gravity resisted position for flexion
seated with knees flexed over edge of table (allowed to hold on)
taken through passive ROM
lifted actively to highest point and pressure is applied over anterior aspect of distal thigh
stabilize pelvis at iliac crest
gravity eliminated position for hip flexion
patient is sidelying on the testing side with hip extended and knee flexed
taken through passive ROM
asked to bring their knee to their chest with knee flexed
if the patient’s hip abducts and externally rotates during active hip flexion, they are ________
substituting the sartorius
if the patient’s knee extends as they attempt active knee flexion, they are ______
substituting rectus femoris
if the patient has a weak trunk, what is the best way to test hip flexion?
having them in supine position
what motions does the sartorius do?
flexion, abduction, and lateral rotation
what is the gravity resisted position for the sartorious
seated with knees bent off of table
passively flexed, abducted and laterally rotated (sliding their ankle up the shin) and then actively completed, returning to their highest point
resistance is applied over anterior lateral thigh toward extension and adduction while applying pressure to ankle toward hip IR and knee extension
gravity eliminated position for sartorious
patient is supine with heel of testing LE resting on anterior portion of the opposite ankle w/ legs extended
taken through passive ROM by sliding testing leg up shin of opposite leg
ask patient to reproduce motion
what muscles produce hip extension
glute max
semitendinosus
semimebranosus
biceps femoris
gravity-resisted position for hip extension
prone with LE extended
passively taken through ROM
ask patient to lift leg off of table without bending the knee
resistance applied over posterior aspect of distal femur toward hip flexion
stabilize posteriosuperior aspect of pelvis if needed
gravity eliminated hip extension
side-lying with LE extended
move / hold uppermost limb out of the way
patient is to move leg back toward therapist while keeping the knee straight
what muscles assist in hip abduction
gluteus medius/minimus
what is the gravity resisted test for hip abduction
side lying with testing limb stacked upon other limb
hip in line with trunk in a neutral position
passively abducted, then actively
resistance applied over distal thigh toward adduction
what could be a variation of hip abduction MMT?
a longer lever arm could be used by therapist with resistance at the ankle
what is the gravity eliminated position for hip abduction
supine with knees extended and hips in neutral
patient passively abducted
told to pull their leg out to the side with toes pointing the ceiling
what occurs if the pelvis posteriorly rotates during abduction mmt
tensor fascia lata may be used to substitute for weak hip abductors
what happens if the hip externally rotates during hip abduction mmt
hip flexors may be used instead of hip abductors
what muscle produces hip abduction with flexion
tensor fascia lata
MMT for tensor fascia lata
patient in sidelying with uppermost hip being tested
hip placed in 45° flexion with neutral rotation
testing procedure similar to hip abduction
gravity eliminated for TFL muscle
patient in long sitting position with hips flexed to 45
normal hip abduction
what muscles produce hip adduction
adductor:
magnus
longus
brevis
Pectineus
Gracilis
gravity resisted position for hip adduction
patient in sidelying with lowermost hip being tested
uppermost hip being supported
passively taken through adduction then actively
patient lifts up as high as they can, apply force at distal thigh
gravity eliminated test for hip adduction
supine with nontested hip in full abduction, pelvis in neutral with knees extended
passively adducted, returned to start
actively adduct with knee toward ceiling
if the hip posteriorly / anteriorly rotates, the ____ will be used to compensate for weak adductors
post - hip flexors
ant - hip extensors
what muscles assist in hip internal rotation
tensor fascia lata
gluteus minimus
gluteus medius
gravity resisted hip IR/ER MMT
patient seated with legs hanging off table, towel roll under the knees
patient can hold on to edge of table
hip is passively IR, then actively
resistance is applied over distal leg medially
HIP ER
same position
passively ER then active
resistance applied in a lateral direction instead
gravity eliminated hip IR/ER
patient is supine with legs extended with leg that is tested in full ER
passively IR then returned
patient is asked to roll leg toward the other
opposite for ER
in full IR told to roll externally
muscles that do ER at hip
piriformis
gamellus twins
obturator internus/externus
quadratus femoris
how might a patient cheat during rotation testing
may lean toward testing limb to substitute for lateral hip rotation
may hike the hip or shift weight on other side to substitute medial rotation
muscles that do knee extension
rectus femoris
vastus - medialis, lateralis, intermedius
gravity resisted test for knee extension
seated with legs off of the table with a towel roll under tested leg thigh
allowed to hold onto table
passively then actively extended
resistance applied over anterior leg toward knee flexion
gravity eliminated for knee extension / flexion
sidelying on side of tested limb
knee is flexed with hip extended
passively gone through extension
asked to straighten the knee
flexion
hip and knee extension
passively flexed
asked to bend the knee
muscles that do hip flexion
biceps femoris
semitendinosus
semimembranosus
gravity resisted knee flexion mmt
patient is prone with LE extended
knee passively then actively flexed
resistance applied to posterior distal leg toward extension
how can semimembranosus/tendinosus be isolated?
medial rotation and flexion
how can biceps femoris be isolated
lateral rotation with flexion
