Lower Extremity

Question 1

What are the primary muscles of the posterior compartment involved in plantarflexion?

Answer 1

The gastrocnemius and soleus (triceps surae).

Question 2

What are the assisting muscles in plantarflexion?

Answer 2

Tibialis posterior, flexor hallucis longus, flexor digitorum longus, and the peroneals.

Question 3

How do you passively stretch the gastrocnemius and soleus in the prone position?

Answer 3

• Place the foot off the side or edge of the table.
• Slowly dorsiflex the foot.
• Gastrocnemius heads: Add internal rotation of the tibia to target the lateral head or external rotation to target the medial head.
• Soleus: Add knee flexion.

Question 4

How do you passively stretch the gastrocnemius and soleus in the supine or long-seated position?

Answer 4

• Stabilize the leg with one hand and slowly dorsiflex the foot with the other hand.
• Soleus: Add knee flexion and use bolsters as needed.

Question 5

How do you self-stretch the gastrocnemius and soleus in the long-seated position?

Answer 5

• Use a belt or strap around the ball of the foot (not the toes) and slowly pull the strap to dorsiflex the ankle.
• Use a towel pad if shoeless.
• Soleus: Add knee flexion and may use bolsters.

Question 6

Describe the standing position stretch for the gastrocnemius.

Answer 6

• Face a wall with outstretched arms.
• Stagger the legs, with the stretch leg behind.
• Ensure the stretch leg is fully planted and positioned straight with feet pointing directly toward the wall and hips square.
• Lean the whole body toward the wall by bending the elbows and the front knee.

Question 7

How do you modify the standing position stretch to target the soleus?

Answer 7

Add knee flexion to the back/stretch leg while maintaining dorsiflexion.

Question 8

How do you perform isometric strengthening for plantarflexion in a long-seated position with a belt/strap?

Answer 8

• Tie one end of the belt/strap to a secure object and the other end around the ball of the foot (not toes).
• Use a towel pad if shoeless.
• Plantarflex against the resistance of the strap, isolating as necessary.
• The joint angle can be adjusted by changing the strap’s length.

Question 9

How do you perform isometric strengthening for plantarflexion in a long-seated position against the wall?

Answer 9

• Place the foot against the wall and use a towel pad if shoeless.
• Stabilize by placing hands behind or to the side of the torso.
• Plantarflex against the resistance of the wall, isolating as necessary.
• Adjust the joint angle by changing the distance between the wall or by adding towels/bolsters.

Question 10

What is the focus of isotonic strengthening in a long-seated position with a theraband?

Answer 10

• Concentric contraction: Focus on pointing toes (plantarflexion).
• Eccentric contraction: Focus on controlling and releasing plantarflexion.

Question 11

How do you perform isotonic strengthening for plantarflexion using a theraband?

Answer 11

• Tie one end of the theraband to a secure object and the other end around the ball of the foot (not toes).
• Use a towel pad if shoeless.
• Perform plantarflexion against the resistance of the band, isolating as necessary.
• Adjust resistance by changing the tension on the band.

Question 12

How do you perform a passive stretch for the dorsiflexors in a supine or long-seated position?

Answer 12

• The therapist crosses their hands over the ankle joint.
• One hand stabilizes the leg while the other hand slowly takes the ankle into plantarflexion.

Question 13

How do you perform a passive stretch for the dorsiflexors in a seated position?

Answer 13

• Cross the stretch leg over the contralateral leg in a figure 4 position.
• Slowly take the ankle into plantarflexion.

Question 14

How do you perform isometric strengthening for dorsiflexors in a long-seated position using a strap/belt?

Answer 14

• Tie one end of the belt or strap to a secure object and the other end around the top of the foot (not toes).
• Use a towel pad if shoeless.
• Dorsiflex against the resistance of the strap.
• For Tibialis Anterior, add slight inversion of the ankle.
• Change the joint angle by adjusting the strap length or distance from the strap.

Question 15

How do you perform isometric strengthening for dorsiflexors in a long-seated position using the contralateral foot?

Answer 15

• Place the contralateral leg on top of the ipsilateral foot.
• Use a towel pad between the feet if shoeless.
• Dorsiflex against the resistance of the contralateral foot.
• Change the joint angle by repositioning the foot.

Question 16

How do you perform isotonic strengthening for dorsiflexors in a long-seated position?

Answer 16

• Tie one end of the theraband to a secure object and the other end around the top of the foot (not toes).
• Use a towel pad if shoeless.
• Perform concentric contraction by dorsiflexing against the resistance of the band.
• Perform eccentric contraction by controlling and releasing dorsiflexion.
• For Tibialis Anterior, add slight inversion of the ankle.
• Adjust resistance by changing the tension on the band.

Question 17

How do you passively stretch the Tibialis Anterior?

Answer 17

Refer to the dorsiflexors stretch, as the Tibialis Anterior’s prime action is dorsiflexion.

Question 18

Why is the Tibialis Posterior not typically stretched?

Answer 18

The Tibialis Posterior is primarily a plantarflexor and is typically long and weak, so it does not require stretching.

Question 19

How do you perform isometric strengthening for inverters in a long-seated position?

Answer 19

• Tie one end of a belt or strap to a secure object and the other around the mid-foot (not toes).
• Use a towel pad if shoeless.
• Angle the foot so the movement plane is parallel to the strap.
• Invert the foot against the strap’s resistance, isolating the movement if necessary.

Question 20

How do you perform isometric strengthening for inverters in a seated position using a ball?

Answer 20

• Place a ball between the mid-foot.
• Invert the foot into the ball.
• Change the joint angle by using a different-sized ball.

Question 21

How do you perform isotonic strengthening for inverters in a long-seated position?

Answer 21

• Tie one end of the theraband to a secure object and the other end around the mid-foot (not toes).
• Use a towel pad if shoeless.
• Angle the foot so the movement plane is parallel to the theraband.
• Perform concentric contraction by inverting the foot against the resistance of the band.
• Perform eccentric contraction by controlling and releasing the inversion.

Question 22

How do you passively stretch or self-stretch the everters?

Answer 22

• Position A: Supine/Long Seated (Passive)
• Position B: Seated (Self-Stretch)
• Movement: Slowly take the ankle into dorsiflexion and inversion.

Question 23

How do you perform isometric strengthening for the everters in a long-seated position using a wall?

Answer 23

• Sit with the ipsilateral side parallel to a wall.
• Place a towel pad or ball for cushioning between the foot and wall.
• Maintain a neutral ankle and slowly evert into the wall.
• Change the joint angle by moving closer or farther from the wall, like hands on a clock, ensuring accurate joint angles for effectiveness.

Question 24

How do you perform isometric strengthening for the everters in a long-seated position using a strap?

Answer 24

• Tie one end of a belt or strap to a secure object, and the other end around the mid-foot (not toes).
• Use a towel pad if shoeless.
• Angle the foot so the movement plane is parallel to the strap.
• Evert against the resistance of the strap, isolating the movement if necessary.

Question 25

How do you perform isotonic strengthening for the everters in a long-seated position?

Answer 25

• Tie one end of the theraband to a secure object and the other end around the mid-foot (not toes).
• Use a towel pad if shoeless.
• Angle the foot so the movement plane is parallel to the theraband.
• Perform concentric contraction by everting against the resistance of the band.
• Perform eccentric contraction by controlling and releasing the eversion.

Question 26

How do you stretch the intrinsic foot muscles?

Answer 26

Stretch the intrinsic foot muscles using:

• Active Free ROM (AF ROM) or Passive Relaxed ROM (PR ROM) to the toes.
• A therapist can also stretch them passively

Question 27

How do you strengthen the intrinsic foot muscles with a towel?

Answer 27

• Place a towel on the floor.
• Use bare toes to pull the towel towards yourself.
• Increase difficulty by placing a weight on the towel.

Question 28

What are other ways to strengthen the intrinsic foot muscles?

Answer 28

• Use toes to pick up small items like pencils or Lego pieces.
• Walk on various surfaces, starting with the floor, then progressing to grass and sand.

Question 29

What are the knee extensors, and which muscles are involved?

Answer 29

Muscle Group: Quadriceps
Muscles:
• Rectus Femoris
• Vastus Lateralis
• Vastus Medialis
• Vastus Intermedius

Question 30

How do you stretch the quadriceps in a sidelying position?

Answer 30

• Slowly flex the knee toward the buttocks.
• Ensure the knee is in line with the hips and close to the contralateral leg.
• Hold above the ankle (not the foot) to maintain the stretch.
• Modification: Use a belt or strap around the ankle if the individual cannot hold it.

Question 31

How do you stretch the quadriceps in prone/seated positions?

Answer 31

• Slowly flex the knee toward the buttocks.
• Keep the knee aligned with the hips and near the contralateral leg.
• Hold above the ankle joint, not the foot.
• Modification: Use a belt or strap if needed.

Question 32

How do you self-stretch the quadriceps in a standing position?

Answer 32

• Stand and flex the knee, bringing the ankle towards the buttocks.
• Keep the knee in line with the hips and close to the contralateral leg.
• Hold above the ankle joint, not the foot.
• Modification: Use a belt or strap if the ankle cannot be held manually.

Question 33

How is isometric strengthening of the quadriceps performed in a supine/long-seated position?

Answer 33

• Position: Place a bolster under the knee.
• Movement: Push the back of the knee into the bolster, focusing on knee extension.
• Modification: Use additional towels, pillows, or bolsters to strengthen the quadriceps at different joint angles, as available ROM permits.
• Note: This position is not recommended for operations (Ops).

Question 34

How is isometric strengthening of the quadriceps performed in a high-seated position?

Answer 34

• Position: High-seated, cross the contralateral leg over the ipsilateral leg.
• Movement: Resist knee extension with the contralateral leg.
• Modification: Change the joint angle by repositioning the knee or leg.
• Note: This position is recommended for operations (Ops).

Question 35

How is isotonic strengthening of the quadriceps performed in a high-seated position?

Answer 35

• Position: High-seated.
• Equipment: Tie a theraband around the ankle and secure it under the chair or table leg. Use a towel pad between the ankle.

Movement:
• Concentric: Slowly extend the knee.
• Eccentric: Control and release knee extension.

• Modification: An ankle weight can be used instead of the theraband.

Question 36

What are the knee flexors, and which muscles are involved?

Answer 36

Primary Muscles:
• Biceps Femoris
• Semimembranosus
• Semitendinosus
• Sartorius

Assistive Muscles:
• Gracilis
• Gastrocnemius

Question 37

How do you stretch the hamstrings in a long-seated position?

Answer 37

• Position: Long seated, contralateral leg squared off, ipsilateral leg straight in front.

Movement:
• Extend the knee as much as possible.
• Maintain a straight back and lean forward towards the ground, reaching for the feet.
• Biceps Femoris Isolation: Add slight internal rotation of the hip.
• Semimembranosus/Semitendinosus Isolation: Add slight external rotation of the hip.

• Modification: Place a small towel/bolster under the knee for comfort.

Question 38

Sit at the edge of the chair, ipsilateral leg extended in front.

Answer 38

• Extend the knee as much as possible.
• Maintain a straight back and slowly lean forward, reaching for the feet.
• Isolate muscles as necessary with internal/external rotation.

Question 39

How do you perform a Straight Leg Raise to stretch the hamstrings?

Answer 39

• Position: Hooklying, contralateral leg flexed slightly, foot planted for stabilization.

Movement:
• Keep the ipsilateral knee extended as much as possible.
• Flex the hip towards the chest, clasp hands around the thigh to hold the stretch.
• Focus on knee extension, not hip flexion.

• Modification: Use a belt or strap around the foot to enhance the stretch.

Question 40

How do you strengthen the hamstrings in a long-seated position?

Answer 40

• Position: Long seated, bolster under the knee.

• Movement: Push the heel into the table/ground, focusing on knee flexion while maintaining a neutral ankle.

Modification:
• Use a belt or strap for resistance.
• Add towels or bolsters to target different joint angles within available ROM.

Question 41

How do you strengthen the hamstrings in a prone position?

Answer 41

• Position: Prone, strap tied above the ankle and secured to a table leg (behind the individual).
• Movement: Flex the knee towards the buttocks, maintaining tension against the strap.
• Modification: Place a towel pad between the ankle for comfort.

Question 42

How do you strengthen the hamstrings in a seated position?

Answer 42

Position: Seated, ipsilateral leg crossed over the contralateral leg.
Movement: Resist knee extension with the contralateral leg.
Modification: Change the joint angle by repositioning the knee or leg.

Question 43

How do you strengthen the hamstrings isotopically in prone/seated/standing positions?

Answer 43

Movement:
• Concentric: Focus on knee flexion with slight hip extension (as a secondary movement).
• Eccentric: Control and release knee extension.

Setup:
• Tie a theraband above the ankle and secure it to a table leg.
• Use a towel pad between the ankle for comfort.

Prone Position Modifications: Place a pillow under the abdomen for low back support.

Alternative: Use an ankle weight instead of theraband.

Question 44

What are the hip flexor muscles?

Answer 44

Primary Muscles: Iliopsoas, Rectus Femoris, Tensor Fascia Lata (TFL), Sartorius, Pectineus

Question 45

How do you stretch the hip flexors in a sidelying position?

Answer 45

Position: Sidelying with hips stacked, bottom knee bent for stability.

Movement:
• Therapist supports the hips to prevent rolling or lumbar spine rotation.
• Upper leg is guided into hip extension to the first barrier.
• TFL Stretch: Add slight hip adduction (let gravity drop the leg) and slight external rotation.

Question 46

How do you stretch the hip flexors in a prone position?

Answer 46

Position: Prone

Movement:
• Therapist stabilizes the ipsilateral hip to prevent lumbar extension.
• Therapist flexes the ipsilateral knee and extends the hip.

Question 47

How do you perform a Modified Thomas Test stretch for the hip flexors?

Answer 47

Position: Supine, off the edge of a table.

Movement:
• Lean back, bringing both knees to the chest.
• Slowly drop the stretch leg off the table’s edge, ensuring minimal low back arch.
• Therapist can assist by gently pushing down on the stretch leg and supporting the contralateral leg.

Question 48

How do you stretch the hip flexors in a lunge position?

Answer 48

Position: Lunge, with a thick towel pad under the ipsilateral knee.

Movement:
• Lean into the lunge.
• Iliopsoas: Keep the back upright and erect.
• Rectus Femoris: Add knee flexion to the target leg.

Question 49

How do you stretch the TFL in a standing position?

Answer 49

Position: Standing, holding onto a stable object.

Movement:
• Place the stretch leg behind, adduct the leg, and plant the foot fully.
• Side-bend away from the stretch side and shift hips toward the stretch side.
• To increase the stretch, add slight hip external rotation on the stretch side.

Question 50

How do you strengthen the hip flexors isometrically in a supine position?

Answer 50

Position: Supine

Movement:
• Bring the affected hip into flexion.
• Use a hand to resist hip flexion.
• Change the angle by altering the degree of hip flexion.

Question 51

How do you strengthen the hip flexors isometrically in a seated position?

Answer 51

Position: Seated

Movement:
• Use a hand to resist hip flexion.
• Change the angle by altering the degree of hip flexion.
• Increased hip flexion targets the iliopsoas.

Question 52

How do you strengthen the hip flexors isotopically in a standing position?

Answer 52

Position: Standing with a short theraband around both feet.

Movement:
• Lift the affected leg into knee and hip flexion.
• Modification: Use ankle weights instead of a theraband.

Question 53

How do you strengthen the hip flexors isotopically in a supine position?

Answer 53

Position: Supine with a short theraband around both feet.

Movement:
• Flex the affected hip and slowly extend it back eccentrically.
• Ensure no lumbar extension; cue the patient to keep their back flat on the ground or push palms into a wall for core activation.

Question 54

How do you strengthen the hip flexors isotopically in a hooklying position?

Answer 54

Position: Hooklying with an ankle weight.

Movement:
• Flex the hip while keeping the knee straight.
• Avoid going beyond 45 degrees.

Question 55

How do you perform “Hip Hurdles” for isotonic strengthening of the hip flexors?

Answer 55

Position: Long-seated or half-kneeling.

Movement:
• Arrange 2-3 pylons in a semi-circle.
• Lift the affected leg over one pylon, pause, and continue over the next.

Modifications:
• Add ankle weights.
• Increase pylon height.
• In half-kneeling, ensure balance by holding onto a stable object.

Question 56

What are the primary muscles of hip extension?

Answer 56

• Gluteus Maximus
• Hamstrings

Question 57

What are the primary muscles of hip external rotation?

Answer 57

• Gluteus Maximus
• Piriformis
• Deep External Rotators

Question 58

How do you stretch the Gluteus Maximus in a supine position?

Answer 58

Position: Supine (bilateral/unilateral).

Movement:
• Bring knee(s) to the chest; avoid lumbar spine arching.
• Hold under/behind the knees.
• Optional: Use a belt or strap under thighs to assist with hip flexion.

Question 59

How do you stretch the Piriformis in a supine position?

Answer 59

Position: Supine

Movement:
• Flex both hips and knees to 90°/45°.
• Place the ipsilateral ankle on the contralateral thigh in a Figure 4 position.
• Clasp hands under/behind the contralateral knee and bring the legs into hip flexion.
• Optional: Push or maintain external rotation on the ipsilateral hip for a deeper stretch.
• Assist: Use a belt/strap under the contralateral thigh for hip flexion assistance.

Question 60

How do you perform a seated Piriformis self-stretch?

Answer 60

Position: Seated with stretch leg in a Figure 4 position (ipsilateral ankle on contralateral leg).

Movement:
• Keep a straight back and lean forward with the chest.
• Optional: Use one hand to maintain external rotation of the ipsilateral hip.

Question 61

How do you strengthen the hip extensors isometrically in a prone position?

Answer 61

Position: Prone (unilateral).

Movement:
• Flex the knees and contract the glute muscles.
• Think of lifting the leg toward the ceiling (muscle setting).

Optional:
• Use a strap around the legs and table for resistance.
• Place a pillow/bolster to adjust the joint angle.

Question 62

How do you strengthen the hip extensors isometrically in a standing position?

Answer 62

Position: Standing with back to the wall.

Movement:
• Flex the knee and place the bottom of the foot on the wall.
• Press the foot into the wall.
• Optional: Change the joint angle by stepping further away from the wall.

Question 63

How do you perform a modified bridge for isometric strengthening?

Answer 63

Position: Hooklying (supine), knees flexed 90°–100°, feet planted.

Movement:
• Focus on maintaining pressure along the medial arches of the feet.
• Contract the glute max and lift hips off the table while keeping head, neck, and shoulders on the table (muscle setting).

Optional Modifications:
• Use pillows/bolsters under the hips to change the joint angle.
• Use a strap around the hips or mid-thigh for resistance; adjust length to change angle.

Question 64

How do you perform a modified bridge for isotonic strengthening?

Answer 64

Position: Hooklying (supine), knees flexed 90°–100°, feet planted.

Movement:
• Contract the glute max and lift hips off the table while keeping head, neck, and shoulders on the table.
• Hamstrings: Slide feet farther away from the buttocks; a small ball/bolster can be placed between the knees.

Optional Modifications:
• Use a theraband around the table and hips/mid-thigh for resistance.

Question 65

How do you strengthen the hip extensors isotopically in a standing position?

Answer 65

Position: Standing, theraband tied above the ankle and secured to a stable object.

Movement:
• Slowly extend the hip back (concentric).

Optional Modifications:
• Bend the knee and raise the theraband above the knees to isolate the Gluteus Maximus from the Hamstrings.
• Use an ankle weight instead of a theraband.

Question 66

What are the primary muscles involved in hip abduction?

Answer 66

• Gluteus Medius
• Gluteus Minimus
• Tensor Fascia Latae (TFL)

Question 67

How do you stretch the hip abductors in a supine position?

Answer 67

Position: Supine

Movement:
• Flex the knee and hip toward the chest.
• Slowly adduct the leg.
• Turn the head and ipsilateral shoulder away (toward the opposite direction).

Question 68

How do you stretch the hip abductors in a seated position?

Answer 68

Position: Seated.

Movement:
• Cross the stretch leg over the opposite leg.
• Turn shoulders and chest toward the opposite direction.
• Optional: Use the contralateral shoulder/elbow to push the stretch leg further into adduction.

Question 69

How do you strengthen the hip abductors isometrically in a long-seated or hook-lying position?

Answer 69

Position: Long seated or hook-lying.

Movement:
• Sit along a wall with the ipsilateral hip and knee flexed in a 90/45 position.
• Place a towel/bolster between the leg and the wall.
• Contract the glutes and abduct the leg into the wall.

Optional Modifications:
• Add more towels/pillows to change the joint angle.
• Move closer or farther from the wall.
• Use a strap around the thighs to create resistance, adjusting the strap length to alter the angle.

Question 70

How do you strengthen the hip abductors isometrically in a sidelying position?

Answer 70

Position: Sidelying, with the side to be strengthened on top.

Movement:
• Contract the glutes and abduct the leg toward the ceiling (muscle setting).

Optional Modifications:
• Add pillows/bolsters between the ankles/knees.
• Use a belt or strap around the thighs/ankles for resistance.

Question 71

How do you perform a Trendelenburg hold for isometric hip abduction strengthening?

Answer 71

Position: Standing, on a stepping stool or stairs, holding onto support.

Movement:
• Stand on one leg (stance leg is the side to be strengthened).
• Contract the glutes and level the hips bilaterally.
• Avoid compensation in the spine or contralateral hip hiking.
• Notes: This exercise reinforces hip stability during walking.

Question 72

How do you perform clam shells for hip abduction strengthening?

Answer 72

Position: Sidelying, with the side to be strengthened on top.

Movement:
• Flex the hips at 45° and knees at 90°.
• Keep the feet/ankles together.
• Contract the glutes and abduct within 50% of the available range of motion (ROM).

Question 73

How do you strengthen the hip abductors using a theraband in sidelying or standing?

Answer 73

Position: Sidelying or standing.

Movement:
• Tie a theraband to a secure object and loop the opposite end around the ankle or above the knee.
• Contract the glutes and abduct the hip.
• In standing, ensure no spine compensation (e.g., side-bending).

Optional Modifications:
• Use an ankle weight instead of a band.
• Adjust the tension on the band to change resistance.

Question 74

How do you strengthen the hip abductors in a seated position with a theraband?

Answer 74

Position: Seated, unilateral or bilateral.

Movement:
• Tie a theraband around the thighs above the knees.
• Contract the glutes and slowly abduct the hips.