Lower Extremity HVLA and BLT

Question 1

What is a positive squat test? What does this indicate?

Answer 1

Pt’s heels lift off floor and/or pt unable to bend knees past 90 degrees

Must perform further structural and functional eval of joints and tissues of the LE indicated

Question 2

Femorotibial Dysfunction BLT

Answer 2

1. Pt supine, Physician ipsilateral to dysfunction
2. Cephalad palm over the anterior femur, caudad palm over the tibial tuberosity
3. Lean onto the pt’s leg w/ posterior force
4. Approximate the femur and tibia with a compressive force
5. Induce internal or external rotation to obtain BLT

Question 3

Boot Jack Technique

Answer 3

1. Pt supine with knee under physicians axilla, physician ipsilateral
2. Medial hands hold calcaneus w/ thumbs and index finger, fingers of lateral hand wrap around the medial foot
3. Elbow on medial aspect of knee creates a fulcrum w/ proximal pressure
4. Physician leans back inducing further flexion of hip and knee while distracting the calcaneus from the talus
5. Induce slight plantar flexion to obtain BLT

Question 4

Anterior Tibia on Femur - Supine HVLA

Answer 4

1. Pt supine w/ knees flexed to 90 and feet flat on table, physician seated on pts foot on dysfunctional side
2. Thenar eminences over the anterior tibial plateau with fingers wrapped around leg
3. Engage RB by pushing posteriorly on the tibia
4. Deliver thrust posteriorly parallel to the long axis of the femur

Question 5

Anterior Tibia on Femur - Seated HVLA

Answer 5

1. Pt seated w/ legs off table and pillow under thigh, physician in front
2. Thumbs on the anterior tibial plateau w/ fingers wrapped around leg
3. Spring leg up and down to relax thigh
4. Deliver thrust straight toward the floor, simultaneous w/ posterior pressure w/ the thumbs

Question 6

Posterior Tibia on Femur - Prone HVLA

Answer 6

1. Pt prone, dysfxnal knee flexed to 90, physician standing at end of table w/ dorsum of pt’s foot on shoulder
2. Fingers interlaced around tibia just distal to the popliteal region
3. Engage barrier by leaning forward to plantarflex the foot and relax gastroc
4. Thrust w/ both hands parallel to table toward the physician

Question 7

Posterior Tibia on Femur - Seated HVLA

Answer 7

1. Pt seated w/ legs off table, physician seated in front of pt
2. Thumbs on anterior tibial plateau w/ fingers wrapped around leg
3. Slightly flex knee
4. Spring leg up and down to relax thigh
5. Thrust w/ both hands down toward floor and simultaneously anterior

Question 8

Anterior Fibular Head HVLA

Answer 8

1. Pt supine w/ pillow under knee, physician standing ipsilateral or contralateral
2. Cephalad hand: thenar eminence on the anterior aspect of fibular head, Caudad hand: on ipsilateral foot
3. Supinate foot (invert, internally rotate, plantarflex)
4. Pt activating force - towards pronation of foot
5. On final round of MET, direct thrust into table, supinate

Question 9

Posterior Fibular Head supine HVLA

Answer 9

1. Pt supine, physician contralateral to dysfunction
2. Index finger of thrusting hand monitors fibular head w/ MCP
3. Opposite hand flexes hip and knee 90 deg then everts, dorsiflexes, and externally rotatees at the ankle
4. Thrust anterior on fibular head while rapidly flexing the knee

Question 10

Posterior Fibular Head prone HVLA

Answer 10

1. Pt prone w/ knee flexed to 90 deg, physician contralateral to dysfunction
2. MCP of cephalad index finger on posterior aspect of fibular head w/ hypothenar eminence on hamstrings (creates wedge)
3. Externally rotate tib-fib complex
4. Thrust further flexion of knee

Question 11

Tibiotalar Gapping HVLA

Answer 11

1. Pt supine physician at foot of table
2. Hands interlaced on bottom of the foot, thumbs on ball of foot
3. Caudad traction
4. Engage barrier
5. Caudad traction with thrust into barrier

Question 12

Anterior Tibia on Talus HVLA

Answer 12

1. Pt supine
2. One hand cups calcaneus w/ slight traction, other hand on anterior tibia proximal to the ankle
3. Thrust delivered with the hand on the tibia stright into table

Question 13

Calcaneus Inversion/Eversion HVLA

Answer 13

1. Pt supine, physician at foot
2. One hand on calcaneus, other on dorsum of foot
3. Caudad traction with hypereversion/inversion (into barrier) and thrust into barrier

Question 14

Hiss Whip HVLA

Answer 14

1. Pt prone w/ hip and knee of affected leg at edge of table, pt at foot
2. Both thumbs over plantar surface of affected structure w/ fingers on dorsum of foot
3. Slightly abduct pts lower extremity off the table and flex the knee
4. Thrust downward through thumbs with whip-like motion at ankle and knee

Question 15

Plantar Navicular Dysfunction HVLA

Answer 15

1. Pt supine w/ knee flexed, abducted, and externally rotated, physician ipsilateral to dysfunction
2. Cephalad thenar eminence over calcaneus, pinning calcaneus to table
3. Eversion/rotational thrust