LAB treatment of hip and knee

Question 1

what are the safety rules for HVLA

Answer 1

don’t thrust if more than minimally uncomfortable
dont thrust in neuro symptoms
don’t thrust if there is a rubbery end feel
localize!

Question 2

what are the goals of HVLA

Answer 2

restore motion and function
reduce muscle hypertonicity and stretching of shortened musculature
increase fluid movement (remove inflammatory mediators)
reduce pain

Question 3

what are the absolute contraindications to HVLA

Answer 3

lack of patient consent
absence of SD
RA

Question 4

what is the purpose of strain/counterstrain

Answer 4

relax intrafusal muscles and reset gamma gain by moving muscle origin and insertion closer together around a tenderpoint thereby reducing afferent activity from the muscle spindle receptor and reducing nociception (pain)

Question 5

what do tenderpoints indicate

how do they form

Answer 5

inappropriate proprioceptive reflex and coorelate with SD

they are formed by a chain reaction started by rapid myofascial tissue lengthening
this causes a reciprocal shortening of antagonist muscle

the body’s protective response to rapid lenghtneing is to contract that tissue . the antagonist muscle must lengthen to accomodate this action and this is interpretated by the body as strain b/c the uncontrolled reflex has occurred

Question 6

where are counterstrains/tenderpoints

Answer 6

origin, insertion, or belly of a dysfunctional muscle

tendons, ligaments, fascia

Question 7

how are tenderpoints different than trigger points

Answer 7

tenderpoints don’t have radiation of pain when palpated
tenderpoints are NOT present in a characteristic pain pattern and DO NOT appear within taut banding tissue
they do NOT elicit a muscle twitch when palpated

Question 8

what are the absolute contraindications for counterstrain

Answer 8

absence of somatic dysfunction

lack of patient consent

Question 9

what are the relative contraindications for counterstrain

Answer 9

patient who can voluntarily relax
severly ill
vertebral artery disease
osteoporosis
pathological conditions to certain body positions

Question 10

with internal rotation where does the tibia glide

Answer 10

posterolaterally

Question 11

with external rotation where does the tibia glide

Answer 11

antero-medially

Question 12

where else should you pay attention to when trying to treat lower extremities

Answer 12

lumbar spine
innominates (hips)
sacrum

Question 13

what does decreased internal rotation indicate

Answer 13

tight piriformis
hip fracture or other internal derangement
(degenerative joiint disease)

Question 14

what does a loss of terminal extension possibly indicate

Answer 14

internal derangement (meniscal tear or fracture associated with free floating bony fragment)

Question 15

what may fibular head restrictions be associated with? tension in what muscle

Answer 15

tension in lateral hamstring muscle (biceps femoris)

Question 16

what might a persistent fibular head restriction indicate in regards to the knee

Answer 16

injury to the lateral collateral or lateral meniscus

Question 17

for an externally rotated tibia where do you position the patient

Answer 17

engage barrier by inducing a posterior lateral glid of the proximal tibia and internally rotating the distal tibia

Question 18

for an internally rotated tibia where do you position the patient

Answer 18

engage the barrier by inducing a anterior medial glide of the proximal tibia and externally rotate the tibia

Question 19

for a iliacus/psoas tenderpoint how do you position the patient

where is this tenderpoint

Answer 19

1 inch medial to the ASIS

supine, leg flexed to 90 degrees
sidbend and intermally rotate toward TP

Question 20

where is the piriformis tenderpoint

patient position?

Answer 20

8-9 cm medial and slighly superior to greater trochanter 
prone 
flex affected leg to 135 degrees 
abduct 
internal/external rotation as needed

Question 21

what position do you put patient in for the lateral trochanter TP

Answer 21

abduction and slight flexion of thigh

Question 22

how do you position the patient for a lateral meniscus TP

Answer 22

slight knee flexion

slight abduction of the thigh and external rotation of tibia

Question 23

for a medial ankle TP where do you position patients foot

Answer 23

inversion

slight dorsi or plantar flexion as needed

Question 24

for a lateral ankle TP where do you put the patient

Answer 24

eversion of ankle

slight supination of forefoot