LE various treatments Flashcards
What is proper treatment position for femorotibial dysfunction BLT?
Pt: Supine, Doc: Ipsi to dysfunction
Hand: Ceph palm over anterior femur, caudad hand over tibial tuberosity
Tech:
- Begin with posterior force
- more pressure caudal hand for ACL, Cephalad for PCL - Add internal/external rotation to obtain BLT (and have pt breath)
Tibia on Femur Supine HVLA
Position: patient supine w knees flexed to 90, doc seated on foot of dysfunctional side
Hand: thenar eminences over anterior tibia and thumbs on plateaus with fingers wrapped around leg
Tech:
- Engage RB and deliver thrust parallel to long axis of femur
- anterior: posterior thrust with thumbs
- posterior: anterior (tug) thrust with fingers
Tibia on Femur Seated HVLA
Position: patient seated w legs off table, pillow under thigh; doc seated in front of patient
Hands: thumbs on anterior tibial plateau with fingers wrapped around
Relaxation method: spring leg up and down 2-3x (may relax thigh and provide running start)
Tech:
- Anterior: deliver posterior thrust with thumbs with simultaneous inferior traction
- Posterior: deliver anterior (tug) with fingers with simultaneous inferior traction
Tibia on Femur Prone HVLA
Position: patient prone, w dysfunctional knee flexed to 90; doc at end of table with dorsiflexion of pts foot on shoulder
Hand: fingers interlaced around tibia just distal to popliteal region
Technique:
- Lead forward to flex knee to 90, plantar flex foot to relax gastrocnemius
- Ant: Thrust (tug) through 4th and 5th finger with both hands parallel to thigh
- Post: deliver superior/cephalad direction thrust w palms on tibial plateaus
Supine Anterior/Posterior Fibular Head
Position: pt supine w pillow under knee; doc standing contra to dysfunction
Hand:
- Cephalad: thenar eminence on anterior aspect of fibular head to push posterior/pull anterior
- Caudad: on ipsi foot at malleoli
Localizing force: IR if anterior, ER if posterior
Activating Force:
- ME: Pt activating force is ER
- HVLA: direct posterior medial thrust at fibular head or anterior lateral pull (posterior)
- ART: rhythmic pressure at barrier
Posterior Fibular Head Technique 1 (supine)
Pos: pt supine ipsi hip and knee flex to 90; doc ipsi
Hand:
- Ceph: 1 MCP on posterior aspect of fib head, flex knee over hand
- Caudad: on ipsi foot
Technique:
- Evert, dorsiflexion, and ER foot
- MET: pt supinate foot
- HVLA: abruptly flex knee to create anterior thrust on fib head
Posterior Fibular Head Technique 2 (Prone)
Pos: pt prone, DF knee flexed to 90; doc contra
Hand:
- Ceph: index finger on posterior fibular head w hypothenar eminence on hamstrings
- Caud: on malleoli of foot
Tech:
- Evert, dorsiflexion, and ER foot
- thrust: further flex knee
Fibula and interosseous BLT
Pos: pt supine; doc ipsi resting elbows on table
Hand:
- ceph: thumb on fib head, palm supporting proximal calf; avoid fibular nerve
- caud: thumb on malleoli, palm supports distal heel
Tech:
- move leg distally puts pressure on proximal fib/proximal puts pressure on malleoli
- extending wrists puts pressure and stretch on interosseous membrane;
- Find position of greatest ease or stretch and await tissue release
Talotibial Dorsiflexion/Plantarflexion HVLA
Pos: pt supine; doc at foot of table
Hand: fingers interlaced on dorsum of foot, thumbs on ball of foot
Tech:
- Caudal traction
- Dorsiflex foot if plantarflexion SD, Plantarflex if dorsiflexion SD
- Thrust: Caudal traction, with thrust into barrier
- Plantarflex: use scooping potion with 4th and 5th finger to disengage talus from tibia
- dosriflexed: place more force on 2nd and 3rd finger
Talotibial Inversion/Eversion HVLA
Pos: Pt supine; doc at foot of table
Hand: One hand on calcaneous, other on dorsum of foot
Tech: HVLA traction (Tug) after positioning
- Inversion: caudal traction with eversion/abduction of ankle
- Eversion: caudal traction with inversion/addiction of ankle
Plantarflexed talus MET
Pos: pt supine, doc at foot of bed
Hand: One hand on heel of foot, other on plantar side with thumb on lateral malleoulus
Technique:
- Dorsiflex foot into restrictive barrier, instruct pt to plantar flex for 3-5s
- Relax for 3-5, repeat 2-3x, or until final barrier
Dorsiflexed Talus MET
Pos: pt supine, doc at foot of bed
Hand: One hand on heel of foot, other on plantar side with thumb on lateral malleoulus
Plantar flex foot, instruct pt to plantar flex
-apply principles of MET
Inverted Talus MET
Pos: pt supine, doc at foot of bed
Hand: One hand on bottom of foot, the other stabilizing the tibia/fib
Tech:
- evert foot to RB, have pt invert
- apply principles of MET
Everted Talus MET
Pos: pt supine, doc at foot of bed
Hand: One hand on bottom of foot, the other stabilizing the tibia/fib
Tech:
- Invert foot to RB, have pt evert
- apply principles of MET
Inverted calcaneous MET
Pos: pt supine, doc at foot of bed
Hand: One hand on heel of foot, the other stabilizing the tibia/fib
Tech:
- evert foot to RB, have pt invert
- apply principles of MET
Everted calcaneous MET
Pos: pt supine, doc at foot of bed
Hand: One hand on heel of foot, the other stabilizing the tibia/fib
Tech:
- Invert foot to RB, have pt evert
- apply principles of MET
Plantar glide navicular, cuboid, cuneiform MET
Pos: pt supine, doc at foot of bed
Hand: Thumbs crossed over area of concern
Tech:
ME: dorsiflex foot to RB, have pt plantar flex (apply principles)
Plantar glide navicular, cuboid, cuneiform HVLA
Pos: pt supine, doc at foot of bed
Hand: One thumb over area of concern at bottom of foot, other hand plantar flex at dorsum of foot
Tech:
-abrupt plantar flexion
Hiss Whip (HVLA)
Pos: pt prone with hip and knee of affected leg off table; doc at foot
Hand: both thumbs over plantar surface of affected foot, fingers on dorsum
Tech:
- Slightly abduct pts lower extremity and flex knee
- Thrust down through thumbs with “whip-like” motion at ankle and knee
Cuneiform and Metatarsal Dysfunction BLT
Pos: pt supine, doc at foot of bed
Hand: Thumbs on dorsum of distal metatarsal, fingers on plantar aspect of foot
Tech:
- Flex/extend, ER/IR, compress/distract as needed
- Once n BLT, await relaxation
Phalanx Dysfunction BLT
Pos: pt supine, doc at foot of bed
Hand: use index finger and thumb of one hand to grasp proximal end of phalanx, use index finger and thumb of other hand to grasp the distal metatarsal
Tech:
- Add compression/traction, rotation, flexion, extension, SB
- Add translation superior/inferior, medial/lateral to balance
- Maintain position until release is felt
Counterstrain steps:
- Structural Exam to find SD
- Find tenderpoint
- Establish pain scale
- Wrap pt around TP while monitoring
- Find 70% ease
- Maintain position for 90s
- Slowly return to neutral
- Reassess
Lateral Trochanter (TFL) location and Tx
Lasted just inferior to Iliac Crest in body of TFL
Pos: pt supine/prone, doc ipsi to TP
FABD (flex, abduct)
IT Band CS Location and Tx
Located in IT band distal to greater trochanter
Pos: pt supine, doc Ipsi
fABD
-maybe some slight IR/ER
Lateral Hamstring TP Location and Tx
Located distal aspect of biceps femoris near attachment on fibular head
Pos: pt supine/prone, doc ipsi to TP
F ER ABd knee with compression of calcaneous to plantar flex ankle
Medial Hamstring TP location and Tx
Located at distal aspect of medial hamstrings near posterior/medial surface of tibial condyle (inner leg)
Pos: pt supine or prone, doc ipsi to TP
F IR ADd knee with compression of calcaneous to add plantar flexion
Lateral Meniscus/LCL TP Location and Tx
Located lateral aspect of joint line on posterior surface of knee
Pos: pt supine, doc ipsi and seated near TP
F ER ABd thigh, while tibia is ER/IR ABd until tenderness is reduced to 70%
Medial Meniscus/MCL TP Location and Tx
Located on medial joint line on posterior aspect of knee
Pos: pt supine, doc ipsi and seated
F ABd thigh, ADd and IR tibia
ACL TP Location and Tx
Located on superior aspect of popliteal fossa adjacent to hamstring tendons
Pos: pt supine, doc ipsi
-towel under distal femur, apply posterior force to proximal tibia with hand with other hand on TP
PCL TP Location and Tx
Located slightly below center of popliteal fossa
Pos: pt supine, doc ipsi
-towel under proximal tib, apply posterior force to distal femur with hand while other hand monitors
Popliteus TP Location and Tx
Located in belly of poplitues inferior to popliteal space
Pos: pt prone, doc ipsi
-flex knee, IR tibia
Extension ankle (Gastrocnemius) TP Location and Tx
Location: within one of the heads of gastrocnemius just distal to popliteal margin
Pos: pt prone, doc ipsi
-flex knee, put dorsum of foot on thigh, add compression through calcaneus until 70% reduction
Medial Ankle (Tibialis Anterior): Inversion TP Location and Tx
Located anterior and inferior to the medial malleoli along deltoid lig
Pos: pt lat recum with pillow under leg, doc at foot of table
-apply inversion force to foot and ankle w slight IR
Lateral Ankle Fibularis Longus, Brevis, and Tertius: Eversion TP Location and Tx
Located anterior and inferior to the lateral malleoli along talocalcaneal sulci
Pos: pt lat recum with pillow under leg, doc at foot of table
-apply eversion force to foot and ankle w slight ER
Flexion Calcaneuous (quadratus plantae) TP Location and Tx
Located anterior aspect of plantar surface of calcaneous
Pos: pt prone, doc ipsi to TP
-Flex knee with dorsum of foot on docs thigh; flex while translating calcaneous toward forefoot
Navicular TP Location and Tx
Located medial aspect of plantar surface over navicular bone
Pos: pt supine, doc ipsi to TP
-Flex knee with dorsum of foot on docs thigh; plantar flex subtalar joint while supination forefoot
