Lower Extremity and torso Flashcards
Rectus abdominis
Attachment:
– costal cartilage of ribs 5-7
– anterior pubis
Action:
– flexion of torso
Supine:
– knees are bent to 80 degrees with legs together.
– hips flexed up 90 degrees
– place one hand under the lower legs for support while the other hand is just superior to the ankles
– do not attempt this muscle test with lower back pain!!
Can also do it where the pt is sitting up, with the legs bent and feet together on the bed, attempt to push them down and they have to resist you pushing them down
Transverse abdominis
Attachment:
– inguinal ligament, iliac crest
– costal cartilages 7-12, linea alba
Action:
– flexion of the torso
Prone:
– lift clients leg off table (your hands superior to their ankles), while the client pulls umbilicus to lumbar spine and pushes legs into table
—– without pulling the umbilicus to the spine, this tests the rectus abdominis
Obliques (external and internal)
External:
- Attachment:
—- lower 8 ribs (5-12)
—- linea alba, pubis, anterior iliac crest
Action:
– bilateral flexion of the trunk, compression of abdominal contents
– unilateral side bending and rotation of trunk to opposite side
Supine:
– both knee and shoulder closest to you as the practitioner
– client lifts shoulder off the table while bringing the ipsilateral leg to bent-knee position.
– place one hand on client’s shoulder and one on knee.
– resist movement of the knee to the shoulder
Internal:
- Attachment:
—- inguinal ligament
—- anterior iliac crest, costal cartilages of ribs 9-12, linea alba
Action:
– bilateral flexion of the trunk and compression of abdominal contents
– unilateral side bending and rotation of the trunk to the same side
Supine:
– clients lift shoulder slightly off table (one opposite you), while bringing the contralateral leg to bent-knee position (knee closest to you)
– place one have on clients shoulder and one on knee
– resist movement of knee to shoulder
Quadratus Lumborum
Attachment-
- Posterior iliac crest and 12th rib, TP’s of L1-L4
Supine and Prone:
- Clients legs straight and together, abducted to opposite side to where examiner standing (prone adduct them to same side)
- Place one hand on opposite hip to stabilise
- Other hand on closest leg superior to ankle
- Resist movement of both legs towards
Rotators of torso (obliques)
Supine:
– clients knees together, feet off the table
– bring legs to the side
– resist at the knees while aiming diagonally to opposite shoulder, which is curled off the table
Can also do it where the pt is sitting up, and rotated and try to push them down and the pt has to resist
Psoas
Innervation:
– anterior rami of L1-L4
Attachment-
- T12-L5 vertebral bodies, Lesser trochanter of the femur
Supine:
- Leg is abducted and flexed 45 degrees and externally rotated
- Stabilise opposite hip
- Place hand superior to ankle and resist adduction and flexing of hip
If necessary, support pt’s leg with your leg
Prone:
- Leg straight, hip externally rotated (foot facing outwards)
- Lower leg extends off the table, and abducted 45 degrees
- Place hand under knee and under foot
- Resist downwards movement
Iliacus
Attachment:
– iliac fossa
– lesser trochanter of femur
Action:
– flexion of the femur at the hip joint
– flexion of the trunk at the hip joint
Supine:
– knee is bent to 90 degrees and hip flexed to 90 degrees, leg slightly abducted
– support lower leg with your hand under the clients ankle and other hand inside the knee
– aim knee to the outside of the ipsilateral ribs
– resist at knee
Prone:
– knee is bent and rotated internally (faber but prone)
– place hand under knee
– resist downward movement
Gluteus Maximus
Attachment-
- Posterior sacrum, ilium and iliotibial tract (band)
Supine:
- Knee bent 90 degrees, leg off side of table
- Hand under clients foot
- Resist downwards movement
Prone:
- Knee bent 90 degrees and lightly lifted off table
- Place hand on hamstring
- Resist upwards movement while other hand supports the lower leg
Dont do prone in case of lower back pain
Gluteus Medius
Attachment:
- Iliac crest to ilium, Greater trochanter of femur
Supine:
- Medial rotation:
– Knee bent 90 degrees
– Hand superior to ankle laterally and medial knee
– Resist outward movement
Prone:
- Leg flexed up 90 degrees
- Quad against the bed
- Resist outward movement of lower leg
Side-lying:
- Leg straight and abducted 30 degrees
- Resist upward movement
Gluteus Minimus
Attachment-
- Posterior ilium, Anterior surface of greater trochanter
Side-lying:
- Leg straight in 15 degrees of hip flexion
- Resist upward motion
Supine and Prone tests same as gluteus medius
Piriformis
Attachment-
- Anterior surface of the sacrum, Greater trochanter
Supine:
- Knee bent 90 degrees
- Resist inwards movement of ankle (lower leg)
Prone:
- Knee bent 90 degrees
- Resist inwards movement
Pectineus (Please, baby, love, my, groin)
Attachment-
- Anterior pubis, Below lesser trochanter of femur
Supine:
- Leg straight, foot turned completely outwards
- Resist adduction
Adductor Brevis (Baby)
Attachment-
- inferior ramus of the pubis
- pectineal line and line aspera
Supine:
- Leg straight, foot turned out 45 degrees
- Resist adduction
Adductor longus (Love)
Attachment-
- Anterior pubis, Below adductor brevis on femur
Supine:
- Leg straight, foot straight up
- Resist adduction
Adductor Magnus (My)
Attachment-
- Anterior:
– inferior ramus of pubis and below adductor longus on femur, Adductor tubercle
- Posterior:
– Ischial tuberosity and ramus of ischium, Adductor tubercle
Supine:
- Anterior head:
– Leg straight, foot turned in 45 degrees
- Resist adduction
Prone:
- Posterior head:
– Leg straight, heel turned in 45 degrees
– Resist extension
Gracilis (Groin)
Attachment-
- Inferior ramus of anterior pubis, Pes anserine
Supine:
- Leg straight, foot turned completely inwards
- Resist adduction
Vastus medialis
Attachment-
- Linea aspera on posterior femur, Tibial tuberosity via patellar ligament
Supine and prone:
- Knee bent, lower leg laterally rotated
- Resist extension
Vastus Lateralis
Attachment-
- Linea aspera on posterior femur, Tibial tuberosity via patellar ligament
Supine and Prone:
- Knee bent, lower leg rotated medially
- Resist extension
Biceps femoris
Attachment-
- Ischial tuberosity, Head of fibula
Supine:
- Knee bent, foot turned out, foot flat on bed
- Support clients heel
- Resist knee flexion
Prone:
- Knee bent, foot rotated out, quad flat on the bed
- Hand behind pt heel
- Resist knee flexion (may have to place hand on hamstring to prevent cramping)
Semitendonosus and semimembranosus
Attachment-
- Semitenbranosus:
– Ischial tuberosity, Pes anserinus
- Semimembranosus:
– Ischial tuberosity, Medial condyle of tibia
Supine:
- Knee bent, foot turned in, foot flat on bed
- Place hand on pt heel
- Resist knee flexion
Prone:
- Knee is bent, foot turned in, quad on bed
- Place hand behind pt heel
- Resist knee flexion
Popliteus
Attachment-
- Lateral condyle of femur, Posterior proximal tibial shaft
Supine:
- Leg straight, foot slightly turned in
- Hand under client’s knee to slightly flex it
- Other hand under heel
- Resist knee flexion
Prone:
- Leg straight, heel turned in
- Place hand on pt heel
- Resist knee flexion (tests first 10-15 degrees of knee flexion)
TFL
Innervation:
– superior gluteal nerve (L4-S1)
Attachment:
– iliac crest
– IT tract to lateral condyle of tibia
Action:
– internal rotation at the hip
– abduction of hip
Supine prone or sidelying
Supine:
– clients leg is straight, slightly abducted and flexed 30 degrees
– turn foot inwards
– place hand superior to ankle
– resist upward and outward movement
Sidelying:
– clients leg is straight in 30 degrees of flexion, abducted 30 degrees
– resist upward movement
Prone:
– leg is straight
– resist abduction of the leg
Obturator internus
Innervation:
– sacral plexus (L5- S2)
Attachment:
– ischium
– greater trochanter
Action:
– external rotation of the hip
Supine and prone
Supine:
– clients knee bent 90 degrees with hip slightly abducted
– hand inside the ankle and one hand outside of knee
– resist upward and inward movement
Prone:
– knee is bent and laterally rotated (knee inwards), with foot angled down to opposite mid calf
– place your hand on opposite side of clients ankle
– resist inward and downward movement
Obturator externus
Attachment:
– ischium
– obturator foramen and greater trochanter
Action:
– external rotation of hip
Supine and prone
Supine:
– clients knee is bent 90 degrees with hip abducted 45 degrees
– one hand on outside of knee the other on inside of ankle
– resist upward and inward movement
Prone:
– knee is bent and laterally rotated (knee inwards)
– foot is angled down to opposite achilles tendon
– resist inward and downward movement
Sartorius
Attachment:
– anterior superior iliac spine
– pes anserine
Action:
– assists flexion, abduction and external rotation of the hip
Supine:
– knee bent, slightly above table
– put one of your hands under the knee to stabilise and the other hand at the heel
– resist movement of heel toward groin
Rectus femoris
Innervation:
– Femoral nerve (L2, L4)
Attachment:
– AIIS
– tibial tuberosity via the patella ligament
Action:
– hip flexion and extension of the knee
Supine:
– leg is straight in 30 degrees of flexion
– clients knee locked out with toes pointing to the ceiling
– resist further hip flexion superior to the ankle
Prone:
– leg is straight with knee locked
– place your hand superior to the ankle
– resist flexion
Vastus intermedius
Attachment:
– anterior and lateral femoral shaft
– patella via the patella ligament to tibial tuberosity
Action:
– extension of the knee
Supine and prone:
– resist extension of the knee with foot straight in both prone and supine
Gastrocnemius
Innervation:
– tibial nerve (S1, S2)
Attachment:
– medial and lateral epicondyles of femur
– calcaneus via achilles tendon
Action:
– plantar flexion of ankle, flexion of knee
Supine:
– clients leg straight
– place hand on ball of foot
– resist plantar flexion
Prone:
– resist plantarflexion
LEG STRAIGHT
Soleus
Innervation:
– tibial nerve (S1-S2)
Attachment:
– posterior tibia and fibula
– calcaneus via achilles tendon
Action:
– plantar flexion of ankle
Supine and prone:
– with clients knee bent, resist plantar flexion
Tibialis posterior
Innervation:
– tibial nerve (L4, L5)
Attachment:
– posterior tibia, fibula and navicular
– tarsals and metatarsals on plantar surface
Action:
– plantar flexion of the ankle, inversion of the foot
Supine:
– clients leg straight with foot turned in.
– place your fingers on the ball of the big toe.
– resist plantar flexion and inversion
Prone:
– leg is straight, foot turned in
– place your hand on the medial ball of the foot
– support the underside of the ankle with the other hand
– resist plantar flexion
Tibialis anterior
Innervation:
– Deep peroneal nerve (L4, L5)
Attachment:
– lateral condyle and lateral shaft of tibia
– interosseous membrane and base of first metatarsal, first medial cuneiform
Action:
– dorsiflexion of ankle, inversion of the foot
Supine:
– clients leg straight, ankle slightly plantarflexed
– resist dorsiflexion superior to the base of the big toe
Peroneus Tertius
Innervation:
– Deep peroneal nerve (L5, S1)
Attachment:
– anterior distal fibula and base of fifth metatarsal
Action:
– eversion of foot wit dorsiflexion
Supine and prone:
– resist eversion of the foot in a dorsiflexed position
Peroneus longus and brevis
Innervation:
– Superficial fibula nerves (L5, S1)
Attachment:
– Longus- head and upper 2/3 of lateral shaft of fibula and base of first metatarsal and first cuneiform
– brevis- lower 2/3 of shaft of fibula and base of 5th metatarsal
Action:
– eversion of the foot with plantar flexion
– supports the foot arches
Supine and prone:
– resist eversion of the foot in a plantar flexed position
Flexor hallucis longus
Innervation:
– tibial nerve (S2, S3)
Attachment:
– posterior fibula
– distal phalanx of big toe (plantar surface) (underneath foot)
Action:
– flexion of big toe, plantar flexion of ankle
Supine:
– place index finger on plantar side of clients slightly extended big toe. Resist flexion
Same prone
Extensor hallucis longus
Innervation:
– deep fibular nerve (L5, S1)
Attachment:
– anterior shaft of fibula
– interosseous membrane
Action:
– extension of big toe
– dorsiflexion of ankle
Supine:
– client curled lateral 4 toes.
– place index finger onto top of big toe, distal phalanx.
– resist extension
Same prone
Extensor digitorum
Innervation:
– Deep fibular nerve (L5, S1)
Attachment:
– lateral condyle of tibia
– middle and distal phalanges of the 4 lateral toes
Action:
– extension of the 4 lateral toes at the MP joints
– assists dorsiflexion of the ankle
Supine:
– place fingers on the dorsal surfaces of the 4 lateral toes, slightly flexed
– resist extension
Flexor digitorum longus
Innervation:
– Tibial nerve (L5, S1, S2)
Attachment:
– posterior tibia and distal phalanges of the 4 lateral toes (plantar surface)
Action:
– flexion of the 4 lateral toes, plantar flexion of the ankle
Supine and prone:
– index finger across lateral toes
– resist flexion
