Lower Extremity Flashcards
What are the primary muscles of the posterior compartment involved in plantarflexion?
The gastrocnemius and soleus (triceps surae).
What are the assisting muscles in plantarflexion?
Tibialis posterior, flexor hallucis longus, flexor digitorum longus, and the peroneals.
How do you passively stretch the gastrocnemius and soleus in the prone position?
• 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.
How do you passively stretch the gastrocnemius and soleus in the supine or long-seated position?
• Stabilize the leg with one hand and slowly dorsiflex the foot with the other hand.
• Soleus: Add knee flexion and use bolsters as needed.
How do you self-stretch the gastrocnemius and soleus in the long-seated position?
• 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.
Describe the standing position stretch for the gastrocnemius.
• 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.
How do you modify the standing position stretch to target the soleus?
Add knee flexion to the back/stretch leg while maintaining dorsiflexion.
How do you perform isometric strengthening for plantarflexion in a long-seated position with a belt/strap?
• 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.
How do you perform isometric strengthening for plantarflexion in a long-seated position against the wall?
• 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.
What is the focus of isotonic strengthening in a long-seated position with a theraband?
• Concentric contraction: Focus on pointing toes (plantarflexion).
• Eccentric contraction: Focus on controlling and releasing plantarflexion.
How do you perform isotonic strengthening for plantarflexion using a theraband?
• 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.
How do you perform a passive stretch for the dorsiflexors in a supine or long-seated position?
• The therapist crosses their hands over the ankle joint.
• One hand stabilizes the leg while the other hand slowly takes the ankle into plantarflexion.
How do you perform a passive stretch for the dorsiflexors in a seated position?
• Cross the stretch leg over the contralateral leg in a figure 4 position.
• Slowly take the ankle into plantarflexion.
How do you perform isometric strengthening for dorsiflexors in a long-seated position using a strap/belt?
• 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.
How do you perform isometric strengthening for dorsiflexors in a long-seated position using the contralateral foot?
• 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.
How do you perform isotonic strengthening for dorsiflexors in a long-seated position?
• 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.
How do you passively stretch the Tibialis Anterior?
Refer to the dorsiflexors stretch, as the Tibialis Anterior’s prime action is dorsiflexion.
Why is the Tibialis Posterior not typically stretched?
The Tibialis Posterior is primarily a plantarflexor and is typically long and weak, so it does not require stretching.
How do you perform isometric strengthening for inverters in a long-seated position?
• 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.
How do you perform isometric strengthening for inverters in a seated position using a ball?
• Place a ball between the mid-foot.
• Invert the foot into the ball.
• Change the joint angle by using a different-sized ball.
How do you perform isotonic strengthening for inverters in a long-seated position?
• 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.
How do you passively stretch or self-stretch the everters?
• Position A: Supine/Long Seated (Passive)
• Position B: Seated (Self-Stretch)
• Movement: Slowly take the ankle into dorsiflexion and inversion.
How do you perform isometric strengthening for the everters in a long-seated position using a wall?
• 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.
How do you perform isometric strengthening for the everters in a long-seated position using a strap?
• 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.
How do you perform isotonic strengthening for the everters in a long-seated position?
• 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.
How do you stretch the intrinsic foot muscles?
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
How do you strengthen the intrinsic foot muscles with a towel?
• Place a towel on the floor.
• Use bare toes to pull the towel towards yourself.
• Increase difficulty by placing a weight on the towel.
What are other ways to strengthen the intrinsic foot muscles?
• 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.
What are the knee extensors, and which muscles are involved?
Muscle Group: Quadriceps
Muscles:
• Rectus Femoris
• Vastus Lateralis
• Vastus Medialis
• Vastus Intermedius
How do you stretch the quadriceps in a sidelying position?
• 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.
How do you stretch the quadriceps in prone/seated positions?
• 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.
How do you self-stretch the quadriceps in a standing position?
• 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.
How is isometric strengthening of the quadriceps performed in a supine/long-seated position?
• 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).
How is isometric strengthening of the quadriceps performed in a high-seated position?
• 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).
How is isotonic strengthening of the quadriceps performed in a high-seated position?
• 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.
What are the knee flexors, and which muscles are involved?
Primary Muscles:
• Biceps Femoris
• Semimembranosus
• Semitendinosus
• Sartorius
Assistive Muscles:
• Gracilis
• Gastrocnemius
How do you stretch the hamstrings in a long-seated position?
• 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.
Sit at the edge of the chair, ipsilateral leg extended in front.
• 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.
How do you perform a Straight Leg Raise to stretch the hamstrings?
• 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.
How do you strengthen the hamstrings in a long-seated position?
• 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.
How do you strengthen the hamstrings in a prone position?
• 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.
How do you strengthen the hamstrings in a seated position?
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.
How do you strengthen the hamstrings isotopically in prone/seated/standing positions?
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.
What are the hip flexor muscles?
Primary Muscles: Iliopsoas, Rectus Femoris, Tensor Fascia Lata (TFL), Sartorius, Pectineus
How do you stretch the hip flexors in a sidelying position?
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.
How do you stretch the hip flexors in a prone position?
Position: Prone
Movement:
• Therapist stabilizes the ipsilateral hip to prevent lumbar extension.
• Therapist flexes the ipsilateral knee and extends the hip.
How do you perform a Modified Thomas Test stretch for the hip flexors?
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.
How do you stretch the hip flexors in a lunge position?
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.
How do you stretch the TFL in a standing position?
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.
How do you strengthen the hip flexors isometrically in a supine position?
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.
How do you strengthen the hip flexors isometrically in a seated position?
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.
How do you strengthen the hip flexors isotopically in a standing position?
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.
How do you strengthen the hip flexors isotopically in a supine position?
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.
How do you strengthen the hip flexors isotopically in a hooklying position?
Position: Hooklying with an ankle weight.
Movement:
• Flex the hip while keeping the knee straight.
• Avoid going beyond 45 degrees.
How do you perform “Hip Hurdles” for isotonic strengthening of the hip flexors?
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.
What are the primary muscles of hip extension?
• Gluteus Maximus
• Hamstrings
What are the primary muscles of hip external rotation?
• Gluteus Maximus
• Piriformis
• Deep External Rotators
How do you stretch the Gluteus Maximus in a supine position?
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.
How do you stretch the Piriformis in a supine position?
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.
How do you perform a seated Piriformis self-stretch?
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.
How do you strengthen the hip extensors isometrically in a prone position?
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.
How do you strengthen the hip extensors isometrically in a standing position?
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.
How do you perform a modified bridge for isometric strengthening?
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.
How do you perform a modified bridge for isotonic strengthening?
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.
How do you strengthen the hip extensors isotopically in a standing position?
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.
What are the primary muscles involved in hip abduction?
• Gluteus Medius
• Gluteus Minimus
• Tensor Fascia Latae (TFL)
How do you stretch the hip abductors in a supine position?
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).
How do you stretch the hip abductors in a seated position?
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.
How do you strengthen the hip abductors isometrically in a long-seated or hook-lying position?
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.
How do you strengthen the hip abductors isometrically in a sidelying position?
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.
How do you perform a Trendelenburg hold for isometric hip abduction strengthening?
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.
How do you perform clam shells for hip abduction strengthening?
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).
How do you strengthen the hip abductors using a theraband in sidelying or standing?
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.
How do you strengthen the hip abductors in a seated position with a theraband?
Position: Seated, unilateral or bilateral.
Movement:
• Tie a theraband around the thighs above the knees.
• Contract the glutes and slowly abduct the hips.
