Midterm 1

Question 1

Under gravity, what does the cervical spine, lumbar spine, hip, knee, and ankle want to do ?

Answer 1

Cervical spine - flexion
Lumbar spine - Flexion
Hip - extension
knee - extension
ankle - dorsiflexion

Question 2

What’s common to see in terms of the level of the PSIS and ASIS?

Answer 2

Typical to see ASIS a little lower than PSIS (slight anterior pelvic tilt)

Question 3

Which AC joint is often lower?

Answer 3

The one of the dominant arm

Question 4

What does lifting of the medial border of scapula suggest?

Answer 4

Scapular winging

Question 5

What does lifting of the inferior angle of scapula suggest?

Answer 5

Anterior tilting of scapula

Question 6

Normally the scapula is slightly __________ rotated

Answer 6

Superiorly

Question 7

A neutral scapula is _______ away from the midline

Answer 7

4 finger widths

Question 8

What does it mean if you can see the back of someones hand or their cubital fossa is turning inward when they’re standing normally?

Answer 8

That their shoulder/GH is in internal rotation

Question 9

If foot is lateral to the centre-of-knee line then knee posture is ….

If foot is medial to the centre-of-knee line then knee posture is ….

Answer 9

Genu Valgum (valgus knee)

Genu Varum (Varus knee)

Question 10

What’s it called when someone stands with hyper-extended knees and how can u tell

Answer 10

Genu recurvatum

start line from Greater Troch to Lateral epicond. of femur and then head of fib to lateral mal. (look at the lines to decide)

Question 11

What’s happening at the ankle when…
Knees in hyper extension
Knees in slight flexion

Answer 11

Plantarflexion

Dorsiflexion

Question 12

If it looks like one or both femurs are rotated, what do you do next?

Answer 12

Neutralize the hips so force both patellas to face forward (anterior) and then see how the tibia is rotating relative to the femur
If toes point outward, tibia is externally rotated relative to femur and vice versa

Question 13

Knee flexion is associated with (has to do with tibia)

Knee extension is associated with ?

Answer 13

Flexion –> Internal rotation of tibia (think of sitting criss-cross)

Extension –> external rotation of tibia

Question 14

When you evert the intermalleolar line is?

When you invert, the intermalleolar line is?

Answer 14

More horizontal; the medial malleolus comes down and lateral moves up

Steeper; the medial side comes up more and lateral goes down

Question 15

What are the clues for an over-pronated foot?

Answer 15

curvature of Achilles
Too many toes on lateral side in sight (bc forefoot flattens/spreads out)
there is a lump of the navicular prominent on medial side

Question 16

What 2 factors impact MLA?

Answer 16

Rotation of tibia
Rearfoot position

Question 17

How does tibial rotation impact MLA ?

Answer 17

If the tibia is medially rotated, the talus rotates too and gets pushed down so foot goes into eversion and the MLA is lower
If the tibia is laterally rotated, the talus goes up and out and gives supination so the MLA is higher

Question 18

How does rear-foot position impact MLA?

Answer 18

If the calcaneus sits in an everted position, it puts the talus and navicular down so the MLA is lower
If calcaneus sits in inverted position, this lifts the talus a bit and the MLA is higher

Question 19

What’s pes cavus and pes planus?

Answer 19

pes cavus: foot with high MLA (navicular high)

pes planus: flat foot with low MLA (navicular low)

Question 20

Cervical Extension ROM Test
+
When would you do it?

Answer 20

Tests for Cervical Extension

Can be used If client is in a flexed cervical spine position.

One hand on thoracic spine

Ask person to look back as far as they can without shifting body weight back as well (Sitting same place look at sky)

Full ROM - plane of face nearly parallel with the ground

Question 21

Length Test for LS and UFT
+
When would you do it?

Answer 21

Tests for Limited Lateral Flexion in Cervical Spine (Usually caused by LS and UFT)

Want to perform this test if you see a person that is laterally flexed to one side in the cervical spine

UFT TEST:
Supine position head and neck off edge of table

Start by holding weight of head in your hands underneath occiput

Rotate neck to left side, biasing UFT

Bring a hand and put pressure on top of shoulder in the direction of depression

Because UFT act on shoulder girldle and when they get to their tension point they’ll try to lift that, so trying to keep it down

Lateral flexion to the opposite side and open up UFT

Then do right side and do bilateral comparison

Thinking about as a tester, how much tension you feel at the end, and how much range is available to you

LS Test:

Start with same position (Supine lying)

Rotation to opposite side (so if doing left rotate right)

Depress shoulder

Add lateral flexion

Compare bilateral

Question 22

Cervical Extensor Endurance Test (CEET)

Answer 22

Tests endurance of cervical extensor muscles

Would want to do this if the person is in a flexed cervical position

* Model in prone lying position
* Sternum supported by table, arms at side, but not pressing, head neck falling over the table

To start, ask to extend their neck that is about parallel to the floor, don’t want above that and don’t want opening up through front of throat (Deep curvature)

Adding a 2kg weight can give insight into strength that they can offer from cervical extensors

Average person can hold this for 4 minutes (This is the study)

Question 23

Deep Neck Flexor Endurance Test (DNF)

Answer 23

If there is hyperextension in Upper Cervical Spine you would want to do this test

DNF cause flexion of the head on the neck in a rolling head/chin tucking motion. And flex lower cervical spine by drawing vertebrae forward toward chest. Together they act like a sling that supports cervical lordosis anteriorly and prevent head from poking forward

Limit hyperextension of upper cervical spine

Domenech et al reported average hold position just over 30s and lots of variability between individuals

Question 24

Occiput to Wall Test (OWT) THIS NEEDS EDIT

Answer 24

First measure the TWD
Then Can model bring back of occiput to the wall without hyperextending through the upper cervical spine (so do they have enough mobility to overcome the current TWD)
If they can’t bring occiput all the way to the wall correctly, measure the new TWD to see how much correction they’re capable of

Use this test when you observe forward head posture i guess? so excessive flexion of upper thoracic and lower cervical spine and extension of upper cervical spine
It’s measuring thoracic extension

Want to use this test if there is a lack of extension in the vertebrae below**

Also apply gentle pressure across forehead to see if there is more ROM than the muscles are actively giving you

Question 25

Four Point Kneeling Position (FPK)

Answer 25

Used to examine Spinal extension range

Notice how extension is distributed from middle of thoracic spine down to lumbar spin

When spine cant move well in 1 area, might compensate by moving more in area above or below it
Contract glutes to keep pelvis neutral

Question 26

Lateral Flexion ROM Test

Answer 26

gives us insight into how much joint motion is available and how far lateral flexors on opposite side can lengthen – so it’s kind of a length test for lateral flexors

Important when we notice lateral curvature of thoracic or lumbar spine in observations and when we notice that iliac crests are not levelled (reflects lateral pelvic tilt)

**AKA: If there is pelvic tilt, you would want to use this test to see if they can get out of that position and tilt to the other side

expect about 20* of lateral flexion to each side in lumbar spine and 25* in thoracic

Question 27

Modified Schober’s

Answer 27

Use this test to see ability of extensors of spine to stretch out and allow flexion

Use this test if the individual has a deep lordosis (Hyperextension) because you want to see if they can get out of that position and go into flexion.

Most individuals have 7cm increase

between the PSIS’s and iliac crests is a point where the lumbosacral junction is. Mark 2 points: 10 cm above and 5 cm below (these are the comparator points)

Question 28

Extensor Endurance Test

Answer 28

Get a sense if the extensors of Spine are strong

Use this test if you see the person in a very flexed spine position to see if extensors are strong enough to get them out of it

Average time a person can hold this is about 170s

Question 29

Flexor Endurance Test

Answer 29

Targeting flexors of trunk
* Into anterior abdominal wall
* Flexion through lumbar and thoracic regions

Use this test if person’s posture shows hyperextension in TL spine to get a sense if flexors of spine are strong enough to get them out

Average value is 150s

Question 30

Lateral Flexor Endurance Test

Answer 30

Gain insight on if the lateral flexors are strong

Use this test if you see them laterally flexed to one side, want to see if the other side is weak

Side plank/Side bridge
Healthy adults may last 1-2 min per side

Question 31

What 5 factors affect someone’s posture?

Answer 31

1 - Passive tissue tension and joint ROM
2 - Skeletal architecture
3 - Balance of tension b/w opposing muscles
4 - Neurological factors
5 - Psychosocial factors

Question 32

GH Rotation ROM

Answer 32

External Rotation (85 degrees)
Start with model in supine position
Shoulder abducted 90 degrees
Elbow Flexed 90 degrees
○ Fingers towards the sky
Tester puts support hand at distal end of
humerus
○ Helps maintain abducted shoulder position
○ Pivot point for the humerus to spin around
Second hand will grab distal end of forearm and take shoulder into external rotation, with emphasis on spinning the humerus

End point: no further movement available

Internal Rotation (65 degrees)
Start with model in supine position
Shoulder abducted 90 degrees
Elbow Flexed 90 degrees
○ Fingers towards the sky
Tester puts support hand at distal end of humerus
○ Helps maintain abducted shoulder position
○ Pivot point for the humerus to spin around
Take shoulder into internal rotation

Smaller ROM for most people than external rotation

FOR BOTH:
Watch for scapula, it has tendency to pop off at end of ROM. Don’t want to do this
○ Anterior tilt of scap

Question 33

MMT Lateral Rotators of GH Joint

Answer 33

Which Muscles Are we Looking at:
Infraspinatous, Teres minor, posterior deltoid

These muscles cause have tendency to become weak in many individuals
○ Connect this to observation when person stands with internally rotated shoulder

Check Strength

Start with model in supine lying position with arm right at their side, neutral at the shoulder in terms of ab/adduction

Arm flexed 90 degrees and then tester brings one hand in underneath the elbow
○ Helpful to have heel of palm towards medial side of the elbow

Second hand comes on the back side of distal end of humerus

Using the palm of that hand to apply pressure to the forearm and in that you try to spin the humerus into internal rotation, against model effort to externally rotate

Question 34

Pectoralis Major Length Test

Answer 34

When Pecs are tight, has tendency to draw shoulders forward (Protracted Position)

*Model supine lying position
* Hands behind their head, around level of occiput
* Watch for the fall of the elbow
○ Look at how far off the table the point of the elbow sits
○ Can use tape measure to measure the vertical distance

No normative data, Compare Bilaterally

To do this Standing:
* Go into half squat position/half wall sit
* Bring elbow into 90 degree of flexion
* Bring shoulders up to 90 degrees of abduction
* Try to cross extend through your shoulders
○ Elbows towards the wall
○ Cant change or rotate through the spine or pelvis
Does one get to the wall more easily than the other // does it even get to the wall at all?

Question 35

MMT of LFT

Answer 35

LFT can do Posteriorly tilt and Superiorly rotation

• Start with partner in prone lying position
• Abduct shoulder to 150 degres which brings us into superior rotaion position of scap
• Make sure that GH joint is laterally rotated so thumb is pointing up
  ○ Can increase/make it easier for lower trap to activiate
• Ask person to lift arm off table against resistance and they have to do posterior tilt of scapula to do this
  ○ First job is to coach them on this movement
  ○ Then put a stabilizing hand on pelvis to stop it from popping up
  ○ Main resistance hand will be on back of scap
  § Other people might resist into the arm
  § But we do Scap because that’s what we are trying to target

Question 36

MMT for MFT and Rhomboids

Answer 36

These muscles Share retraction in Common

• Model will retract scap against your resistance that pushes towards protraction
• Model in prone lying position with arm over the edge
  ○ Want to target 90 degree abducted position
  ○ MFT and Rhomboid competition starts to come in
• When in 90 degree abducted position you are in ideal position to emphasize MFT but as shoulder starts to drop from abduction position you might get more rhomboids

Make sure they are not doing cross extension // extension through gh joint

Question 37

Popliteal Angle

Answer 37

Passive test that helps get insight into length and tension of hamstrings
* Model in supine position and start with leg along table
* First thing you do is lift femur up into hip flexed position
* The second hand will now progressively increase the extension of the knee, lifting through Achilles and lifting through posterior aspect of calcaneus until you get to end range of knee extension

When you get to what you think is end point, Then you would measure the popliteal angle (angle between the middle of femur and a line that runs through the center of the leg

Normal popliteal angle is about 140 degrees

Question 38

Modified Thomas Position

Answer 38

Passive test; shows how much tension is coming from hip flexors

• Model starts in standing/leaning position with icial tuberosity sitting right at the edge of the table
• Have them bring one leg up to their chest, and they roll backwards until they are lying fully supine on table
• Other leg is hanging off entirely (no support at all)
• Check if pelvis is in position you want
  ○ When in dangling leg position, mass of leg will have tendency to tilt pelvis anteriorly
  ○ Make correction for this, maybe putting pressure with own hand against asis on the front and push pelvis back a bit or they can use their abdominis region
  ○ Deep lordosis = good change pelvis in anterior tilt
• The hanging leg is of interest
• Measure an angle between the two lines shown
• First line is horizontal line that would extend from greater trochanter of femur and run straigh across
• Second line would go along length of femur, greater trochanter to center of knee
• Normal value is that Femur drops 10 degrees below that horizontal line

Question 39

MMT for Hip Lateral Rotators

Answer 39

Lateral hip rotators have an actual compartment: deep gluteal region
Do this test if someone has too much medial rotation of femur?

Need lateral rotators to limit how much internal rotation hip falls into bc it’s a position we fall into easily
* Model sit at edge of table with thigh fully supported
* Their leg to start would be dangling straight down but we take it into a little lateral rotation – this is start position
* One hand on lateral side of thigh – palm on lateral epicondyle
* Distal hand is near the medial malleolus – use broad hand contact

model try to externally rotate and WE trying to internally rotate femur

Question 40

MMT for Hip Abductors

Answer 40

Superficial gluteal muscles like glute max, med, min and TFL are primary abductors of hip

One of their jobs is to limit how much adduction you can do
An adducted hip position helps drive a valgus knee position

* Model in side lying position on non-target side with hip and knee flexed a little so that they don’t roll forward or back 
* Then ask them to abduct hip to about 30 degrees (make sure femur moving and pelvis is not tilting)
* Stabilizing hand on iliac crest to prevent pelvic tilt and pressure hand on distal end  of femur at lateral femoral condyle 
* Now model tries to abduct against the resistance you apply in the direction of adduction

Question 41

MMT for Ankle Inverters

Answer 41

Ankle inverters tied directly to arch control (medial longitudinal arch)
Inversion = drives supination
do this test If someone has a lot of pronation to see if inverters strong enough to supinate

* Model seated at edge of table 
* Leg dangling off 
* Tester applies pressure in direction of eversion 
* Top hand applies pressure through the heel of the palm against lateral side of leg (above lateral malleolus) 
* The other hand uses palm of hand to apply pressure against the medial side of 1st metatarsal in direction of eversion 
* So tester trying to evert and model trying to invert 
* Stabilizing hand above, pressure hand below

Question 42

MMT for Hip Flexors

Answer 42

Do this test for someone with posterior pelvic tilt
Limitation:
The strength the person can generate can only match what you can do
Evaluate strength from 0-5, and do this only isometrically

• Model in seated position and thigh initially fully supported by table
• Upright position with neutral lumbar spine
• Tester would usually be standing in front of model with 2 hand contact points
  ○ One on contact on iliac crest, stabalizing hand for pelvis so it doesn’t rock back
  ○ Other hand is applying pressure on anterior aspect of thigh just above the knee, and press it down
• Ask model to lift femur off ground just a couple inches and that is the position they will hold when you apply resistance downward

Hold test for about 5 secodns
Compare right and left

Question 43

MMT for Hip Extensors

Answer 43

• Model in prone lying position
• Lift leg off ground about 20 degrees aprox
  ○ With extended knee
• Tester will stabilize pelvis
  ○ Heel of palm hand around level of PSIS
  ○ Resistance hand will come in on posterior side of calcaneus or achilles (depends how far you can reach)
• Extensors are strong muscles so when they do hip extension you are in ideal situation where you can lean body weight into the hand and can step to side closer to the foot so you cana lean more BW down into the hand
• Easy as the hamstring/glute complex, it will easily lift pelvis so you need to make sure pelvis doesn’t lift

5 seconds
Bi lateral comparison
Isometric contraction

Question 44

Weight Bearing Lunge Test

Answer 44

This test helps you gain insight into how much dorsiflexion a person has at their ankle

* Have a person do a lunge a few times in such a way that if you drew a line from the center of their heel that it would come out through their second toe and that line would be perpendicular to the wall that ur lunging toward 
* Then go into lunge position and make sure knee lines up too (not caving medially/laterally) and make sure ASIS's are facing forward too 
* Heel needs to stick to the ground; if heel lifts, you've gone too far 
*  get to a point where the knee JUST touches the wall, everything else lined up perfectly 
	○ Measure the horizontal space b/w big toe and wall 
* You have to repeat test a few times to get this JUST RIGHT 
* Normal Range: 12-15 cm 
* Normal to see diff b/w left and right leg ; a difference of 1.5 cm is normal