Lower Extremity and torso

Question 1

Rectus abdominis

Answer 1

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

Question 2

Transverse abdominis

Answer 2

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

Question 3

Obliques (external and internal)

Answer 3

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

Question 4

Quadratus Lumborum

Answer 4

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

Question 5

Rotators of torso (obliques)

Answer 5

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

Question 6

Psoas

Answer 6

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

Question 7

Iliacus

Answer 7

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

Question 8

Gluteus Maximus

Answer 8

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

Question 9

Gluteus Medius

Answer 9

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

Question 10

Gluteus Minimus

Answer 10

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

Question 11

Piriformis

Answer 11

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

Question 12

Pectineus (Please, baby, love, my, groin)

Answer 12

Attachment-
- Anterior pubis, Below lesser trochanter of femur

Supine:
- Leg straight, foot turned completely outwards
- Resist adduction

Question 13

Adductor Brevis (Baby)

Answer 13

Attachment-
- inferior ramus of the pubis
- pectineal line and line aspera

Supine:
- Leg straight, foot turned out 45 degrees
- Resist adduction

Question 14

Adductor longus (Love)

Answer 14

Attachment-
- Anterior pubis, Below adductor brevis on femur

Supine:
- Leg straight, foot straight up
- Resist adduction

Question 15

Adductor Magnus (My)

Answer 15

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

Question 16

Gracilis (Groin)

Answer 16

Attachment-
- Inferior ramus of anterior pubis, Pes anserine

Supine:
- Leg straight, foot turned completely inwards
- Resist adduction

Question 17

Vastus medialis

Answer 17

Attachment-
- Linea aspera on posterior femur, Tibial tuberosity via patellar ligament

Supine and prone:
- Knee bent, lower leg laterally rotated
- Resist extension

Question 18

Vastus Lateralis

Answer 18

Attachment-
- Linea aspera on posterior femur, Tibial tuberosity via patellar ligament

Supine and Prone:
- Knee bent, lower leg rotated medially
- Resist extension

Question 19

Biceps femoris

Answer 19

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)

Question 20

Semitendonosus and semimembranosus

Answer 20

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

Question 21

Popliteus

Answer 21

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)

Question 22

TFL

Answer 22

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

Question 23

Obturator internus

Answer 23

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

Question 24

Obturator externus

Answer 24

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

Question 25

Sartorius

Answer 25

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

Question 26

Rectus femoris

Answer 26

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

Question 27

Vastus intermedius

Answer 27

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

Question 28

Gastrocnemius

Answer 28

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

Question 29

Soleus

Answer 29

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

Question 30

Tibialis posterior

Answer 30

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

Question 31

Tibialis anterior

Answer 31

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

Question 32

Peroneus Tertius

Answer 32

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

Question 33

Peroneus longus and brevis

Answer 33

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

Question 34

Flexor hallucis longus

Answer 34

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

Question 35

Extensor hallucis longus

Answer 35

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

Question 36

Extensor digitorum

Answer 36

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

Question 37

Flexor digitorum longus

Answer 37

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