(Lab 1.4) LE HVLA and BLT Flashcards
What is a positive squat test?
What does this indicate?
Why perform?
- Pt’s heels lift off floor and/or pt unable to bend knees past 90 degrees
- Must perform further structural and functional eval of joints and tissues of the LE indicated
- tests strength and flexibility of hips, knees, ankles, feet
- If positive= further joint and tissue eval needed
Femorotibial Dysfunction BLT
- Pt supine, Physician ipsilateral to dysfunction
- Cephalad palm over the anterior femur, caudad palm over the tibial tuberosity
- Lean onto the pt’s leg w/ slight posterior force
- More caudal hand pressure for ACL
- more cephalad hand pressure for PCM
- Approximate the femur and tibia with a compressive force
- Induce IR/ER to obtain BLT
Boot Jack Technique
- Pt supine with knee under physicians axilla, physician ipsilateral
- Medial hands hold calcaneus w/ thumbs and index finger, fingers of lateral hand wrap around the medial foot
- Elbow on medial aspect of knee creates a fulcrum w/ proximal pressure
- Physician leans back inducing further flexion of hip and knee while distracting the calcaneus from the talus
- Induce slight plantar flexion to obtain BLT
Anterior Tibia on Femur - Supine HVLA
- Pt supine w/ knees flexed to 90 and feet flat on table, physician seated on pts foot on dysfunctional side
- Thenar eminences over the anterior tibial plateau with fingers wrapped around leg
- Engage RB by pushing posteriorly on the tibia
- Deliver thrust posteriorly parallel to the long axis of the femur
Anterior Tibia on Femur - Seated HVLA
- Pt seated w/ legs off table and pillow under thigh, physician in front
- Thumbs on the anterior tibial plateau w/ fingers wrapped around leg
- Spring leg up and down to relax thigh
- Deliver thrust straight toward the floor, simultaneous w/ posterior pressure w/ the thumbs
Posterior Tibia on Femur - Prone HVLA
- Pt prone, dysfxnal knee flexed to 90, physician standing at end of table w/ dorsum of pt’s foot on shoulder
- Fingers interlaced around tibia just distal to the popliteal region
- Engage barrier by leaning forward to plantarflex the foot and relax gastroc
- Thrust w/ both hands parallel to table toward the physician
Posterior Tibia on Femur - Seated HVLA
- Pt seated w/ legs off table, physician seated in front of pt
- Thumbs on anterior tibial plateau w/ fingers wrapped around leg
- Slightly flex knee
- Spring leg up and down to relax thigh
- Thrust w/ both hands down toward floor and simultaneously anterior
Anterior Fibular Head HVLA
- Pt supine w/ pillow under knee, physician standing ipsilateral or contralateral
- Cephalad hand: thenar eminence on the anterior aspect of fibular head, Caudad hand: on ipsilateral foot
- Supinate foot (invert, internally rotate, plantarflex)
- Pt activating force - towards pronation of foot
- On final round of MET, direct thrust into table, supinate
Posterior Fibular Head supine HVLA
- Pt supine, physician contralateral to dysfunction
- Index finger of thrusting hand monitors fibular head w/ MCP
- Opposite hand flexes hip and knee 90 deg then everts, dorsiflexes, and externally rotatees at the ankle
- Thrust anterior on fibular head while rapidly flexing the knee
Posterior Fibular Head prone HVLA
- Pt prone w/ knee flexed to 90 deg, physician contralateral to dysfunction
- MCP of cephalad index finger on posterior aspect of fibular head w/ hypothenar eminence on hamstrings (creates wedge)
- Externally rotate tib-fib complex
- Thrust further flexion of knee
Tibiotalar Gapping HVLA
- Pt supine physician at foot of table
- Hands interlaced on bottom of the foot, thumbs on ball of foot
- Caudad traction
- Engage barrier
- Caudad traction with thrust into barrier
Anterior Tibia on Talus HVLA
- Pt supine
- One hand cups calcaneus w/ slight traction, other hand on anterior tibia proximal to the ankle
- Thrust delivered with the hand on the tibia stright into table
Calcaneus Inversion/Eversion HVLA
- Pt supine, physician at foot
- One hand on calcaneus, other on dorsum of foot
- Caudad traction with hypereversion/inversion (into barrier) and thrust into barrier
Hiss Whip HVLA
- Pt prone w/ hip and knee of affected leg at edge of table, pt at foot
- Both thumbs over plantar surface of affected structure w/ fingers on dorsum of foot
- Slightly abduct pts lower extremity off the table and flex the knee
- Thrust downward through thumbs with whip-like motion at ankle and knee
Plantar Navicular Dysfunction HVLA
- Pt supine w/ knee flexed, abducted, and externally rotated, physician ipsilateral to dysfunction
- Cephalad thenar eminence over calcaneus, pinning calcaneus to table
- Eversion/rotational thrust
Nerve and muscles for knee flexion
L5, S1
hamstrings, semimem, semitendinosus, biceps femoris, gastrocnemius
Nerve and muscles for ankle dorsiflexion
L4,5 (via deep fibular n)
tibialis anterior
extensor digitorum longus
ext halluces longus
fibularis tertius
Nerve and muscles for ankle plantarflexion
S1,2
gastrocnemius
soleus
flexor digitorum longus
flexor halluces longus
fibularis longus
tibialis posterior
Nerve and muscles for ankle inversion
L4,5
tibialis ant and post
Nerve and muscles for ankle eversion
L5, S1
Fibularis longus/tertius/brevis
Where do you check for LE sensation at the central nerve roots for:
L4
L5
S1
L4- anteromed leg, patella
L5- anterolateral distal leg
S1- big toe
Where would you test sensation of peripheral LE nerve- lateral femoral cutaneous n?
lateral thigh
How is patient positioning different for:
ME, Direct MFR
BLT, Indirect MFR
HVLA
- ME, Direct MFR: balance pt of no more pull, push, twist = position of ease
- BLT, Indirect MFR: feather edge of RB
- HVLA: localize FIRMLY against RB
