LAB treatment of hip and knee Flashcards
what are the safety rules for HVLA
don’t thrust if more than minimally uncomfortable
dont thrust in neuro symptoms
don’t thrust if there is a rubbery end feel
localize!
what are the goals of HVLA
restore motion and function
reduce muscle hypertonicity and stretching of shortened musculature
increase fluid movement (remove inflammatory mediators)
reduce pain
what are the absolute contraindications to HVLA
lack of patient consent
absence of SD
RA
what is the purpose of strain/counterstrain
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)
what do tenderpoints indicate
how do they form
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
where are counterstrains/tenderpoints
origin, insertion, or belly of a dysfunctional muscle
tendons, ligaments, fascia
how are tenderpoints different than trigger points
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
what are the absolute contraindications for counterstrain
absence of somatic dysfunction
lack of patient consent
what are the relative contraindications for counterstrain
patient who can voluntarily relax severly ill vertebral artery disease osteoporosis pathological conditions to certain body positions
with internal rotation where does the tibia glide
posterolaterally
with external rotation where does the tibia glide
antero-medially
where else should you pay attention to when trying to treat lower extremities
lumbar spine
innominates (hips)
sacrum
what does decreased internal rotation indicate
tight piriformis
hip fracture or other internal derangement
(degenerative joiint disease)
what does a loss of terminal extension possibly indicate
internal derangement (meniscal tear or fracture associated with free floating bony fragment)
what may fibular head restrictions be associated with? tension in what muscle
tension in lateral hamstring muscle (biceps femoris)
what might a persistent fibular head restriction indicate in regards to the knee
injury to the lateral collateral or lateral meniscus
for an externally rotated tibia where do you position the patient
engage barrier by inducing a posterior lateral glid of the proximal tibia and internally rotating the distal tibia
for an internally rotated tibia where do you position the patient
engage the barrier by inducing a anterior medial glide of the proximal tibia and externally rotate the tibia
for a iliacus/psoas tenderpoint how do you position the patient
where is this tenderpoint
1 inch medial to the ASIS
supine, leg flexed to 90 degrees
sidbend and intermally rotate toward TP
where is the piriformis tenderpoint
patient position?
8-9 cm medial and slighly superior to greater trochanter prone flex affected leg to 135 degrees abduct internal/external rotation as needed
what position do you put patient in for the lateral trochanter TP
abduction and slight flexion of thigh
how do you position the patient for a lateral meniscus TP
slight knee flexion
slight abduction of the thigh and external rotation of tibia
for a medial ankle TP where do you position patients foot
inversion
slight dorsi or plantar flexion as needed
for a lateral ankle TP where do you put the patient
eversion of ankle
slight supination of forefoot
