Muscle Length Testing Flashcards
What is the purpose of the technique i.e. what are you measuring and why?
Identify changes in muscle extensibility that may be contribute
to movement impairment and/or symptoms.
Assesses the resistance to passive movement
How do you know whether the measurement is normal?
Normal quality of movement (including resistance).
The ROM (i.e. normal/short/extended length).
The muscular end-feel.
Reproduction or change to symptoms through range.
This can be a comparison to contralateral side where appropriate, or what is considered normal
What principles are used in carrying out (application) the technique?
1) Patient comfortable, explain procedure, informed consent
2) Identify muscle
3) Firmly stabilize one end (usually the origin).
4) Slowly elongate the muscle.
5) Ensure maximal lengthening of the muscle from origin to insertion.
6) Assess the end feel.
7) Adverse affects?
What structures/processes are being assessed?
Soft tissue, muscle & tendons
Precautions / contraindications
Bony limit to movement
Recent fracture
Acute inflammation/ tissue trauma
Acute pain with movement
Non-compliant patient or unable to give consent
Shortened tissues are compensatory
e.g. to neural mechanosensitivity
Do you have any known injuries to this muscle?
Have you recently suffered a fracture in this area?
Do you have any muscle conditions?
How would you document this?
Date, Time, Patient name
Explanation of procedure & gaining informed consent
Muscle being tested
Describe movement quality, RoM, End feel compared to other limb
Any reproduction of symptoms / adverse effects
Sign
Iliospoas normal range
0° hip extension, 10° with overpressure
Rectus femoris normal range
90° knee extension, 125° with overpressure
Tensor Fascia Lata normal range
0° hip abduction (neutral), 15°-20° with overpressure
Adductors normal range
0° hip abduction (neutral), 20°-25° with overpressure in the modified Thomas test position
45° hip abduction in supine position
Hamstrings normal range
80° hip flexion with contralateral leg extended
90° hip flexion with contralateral leg flexed
Quadratus Lumborum end feel
Thoracolumbar curve should be smooth and gradual
Piriformis end feel
Gradual soft end feel
Upper traps end feel
Gradual soft end feel
Levatator scapulae end feel
Gradual soft end feel
Sternocleidomastoid end feel
Gradual soft end feel
Sternal lower fibres pec major normal range
Sternal portion (lower fibres): with shoulder abducted at 150°, arm should be horizontal to table and 15°-20° with overpressure
Sternal mid fibres pac major normal range
Sternal portion (mid-fibres): with shoulder abducted to 90°, arm should be horizontal
to table and 30° with overpressure
Clavicular pec major normal range
Clavicular portion: with shoulder abducted to 60°, arm should hang freely over table
Adductors - Patient position
Supine
Contralateral leg hangs off the side of the plinth
Tested leg extended and placed on the plinth
Adductors - movement
Slowly and progressively produces hip abduction with knee extended
Trick movement: Lateral rotation of the hip
Adductors - measurement
Stationary arm: Contralateral ASIS
Axis: Ipsilateral ASIS.
Moving arm: Middle of thigh towards mid-point of patella
Tensor Fasciae latae and Iliotibial band
(Obers test) - Patient position
Side-lying, with supporting hip and knee flexed to 90 degrees to stabilize pelvis
Tensor Fasciae latae and Iliotibial band
(Obers test) - movement
1) One hand on ipsilateral pelvis to stabilize it and maintain neutral pelvic alignment.
2) Other hand passively abducts hip and extend patient’s hip on upper side in line with trunk, thereby, bringing tensor fasciae latae
over greater trochanter.
3) relax muscles of the lower extremity while allowing uppermost limb to drop into adduction toward table through available ROM.
4) Prevent flexion and internal rotation of hip as the limb drops toward the table
Tensor Fasciae latae and Iliotibial band
(Obers test) - measurement
Positive for tight tensor fasciae latae and
iliotibial band if relaxed hip remains abducted and does not fall below horizontal.
Negative for tight tensor fasciae latae and iliotibial band if the relaxed and extended hip falls below horizontal.
Rectus Femoris and Illiopsoas (Thomas
Test) - patient position
Supine
hip to be measured extended.
Buttock should be toward edge of supporting
surface
knees extend just past the edge
Patient stands at edge of plinth with non-measured thigh to their chest and lie backwards, letting other leg hang off
Rectus Femoris and Illiopsoas (Thomas
Test) - movement
Flex contralateral hip by bringing knee toward chest into full flexion.
The contralateral hip should be flexed only enough to flatten lumbar spine against supporting surface.
Rectus Femoris (Thomas Test) - measurement
Stationary arm: Greater trochanter of femur.
Axis: Lateral epicondyle of femur.
Moving arm: Lateral malleolus
If length of rectus femoris is within normal limits, then the knee remains at 90 degrees of flexion.
Illiopsoas (Thomas Test) - measurement
Stationary arm: Lateral midline of trunk.
Axis Greater trochanter of femur.
Moving arm: Lateral epicondyle of femur
If length of iliopsoas is within normal limits, thigh remains on examining table
Gastrocnemius - Patient position
Supine
Knee extended
Gastrocnemius - movement
Dorsiflex patient’s ankle through full available ROM while maintaining knee in full extension.
Soleus - patient position
Supine, with hip and knee flexed.
Opposite leg straight with knee fully extended
Soleus - movement
dorsiflex patient’s ankle through full available ROM while maintaining hip and knee in 45 degrees of flexion
Gastrocnemius and Soleus - measurement
Stationary arm: Head of fibula.
Axis: Lateral malleolus.
Moving arm: Parallel to fifth metatarsal
Piriformis (FAIR test) - patient position
Upper back flat on plinth, hips twisted
Affected side faces up, the hip flexed to an angle of 60 degrees, and the knee flexed to an angle of 60-90 degrees.
Piriformis (FAIR test) - movement
stabilize the hip
internally rotate and adduct the hip by applying downward pressure to the knee.
Flexion Adduction Internal Rotation (FAIR)
Piriformis (FAIR test) - measurement
look for subjective tightness, and decreased RoM compared to the contralateral side
Hamstrings - Patient position
Supine
Hip & knee extended
Hamstrings - movement
flex patient’s hip through full ROM - keep knee fully extended.
One hand is placed over anterior thigh to ensure knee is maintained in full extension
Hip is flexed until firm muscular resistance to further motion is felt
Hamstrings - measurement
Stationary arm: Lateral midline of trunk.
Axis: Greater trochanter of femur.
Moving arm: Lateral epicondyle of femur
Triceps - patient position
Sitting
Shoulder fully flexed
Elbow extended
Forearm supinated
Triceps - movement
flex elbow through ROM - keep flexion of
shoulder.
This passive movement allows an estimate of ROM available and demonstrates to patient exact motion required
Triceps - measurement
Stationary arm: Lateral midline of humerus toward humeral head.
Axis: Lateral epicondyle of humerus.
Moving arm: Lateral midline of radius toward radial styloid
Pec minor - patient position
Supine
arms at side
shoulders laterally rotated;
forearm supinated (palms up)
lumbar spine should be flat against supporting surface
Pec minor - movement
Relaxes shoulder muscles, allowing the posterior border of the acromion process to move toward plinth.
Over-pressure can be added to the coracoid process
Pec minor - measurement
Palpate posterior acromial border. Using tape measure, measure between posterior border of acromion process and plinth
Or
Use a tape measure to measure the distance between the medial-inferior angle of the
coracoid process and just lateral to the sternocostal junction of the inferior aspect of the fourth rib (1 finger width lateral to the
sternum).
Biceps brachii - patient position
Supine
Shoulder at edge of plinth
Elbow extended
Forearm pronated
Biceps brachii - movement
Maintain elbow extension
Perform passive, or have patient perform active, extension of the shoulder
Biceps brachii - measurement
Stationary arm: Lateral midline of thorax.
Axis: Lateral midline of humerus toward lateral aspect of acromion process.
Moving arm: Lateral epicondyle of humerus
Wrist extensors - patient position
Supine
Shoulder abducted 70 to 90 degrees
Elbow extended
Forearm pronated
Fingers flexed
Wrist extensors - movement
flex patient’s wrist through ROM - keep elbow extension & fingers in flexion
This passive movement allows an estimate of ROM available and demonstrates to patient .
Maintaining elbow in extension and fingers in flexion have patient perform active, flexion of the wrist
Wrist extensors - measurement
Stationary arm: Lateral epicondyle of humerus.
Axis: Lunate.
Moving arm: Dorsal midline of 3rd metacarpa
Pec major - patient position
Supine
Shoulder laterally rotated and abducted to 90
degrees
Elbow fully extended
Forearm supinated
Lumbar spine flat
Pec major - movement
Maintain shoulder lateral rotation and
90 degrees of abduction, extension of elbow and supination of forearm
patient to relax all shoulder muscles, allowing shoulder to move into maximal horizontal abduction.
Ensure that patient maintains flat lumbar spine & no trunk rotation (especially to side of extremity being measured)
Pec major - measurement
Using tape measure, measure between lateral epicondyle of humerus and support surface
Flexor Digitorum superficialis - patient position
Supine
Shoulder abducted 70 to 90 degrees
Elbow extended
Forearm supinated
Fingers extended
Flexor Digitorum superficialis - movement
Extend wrist through ROM - keep elbow and fingers in extension.
This passive movement allows an estimate of ROM available and demonstrates to patient exact motion required.
Maintaining elbow and fingers in full have patient perform active extension of the wrist
Flexor Digitorum superficialis - measurement
Stationary arm: Insertion of biceps muscle.
Axis: Lunate (palmar surface).
Moving arm: Palmar midline of 3rd metacarpal
Latissimus Dorsi - patient position
Crook lying (supine with knees bent) with posterior pelvic tilt (to ensure neutral lumbar
lordosis),
Arms at side with elbows extended;
lumbar spine flat on plinth
Latissimus Dorsi - movement
Flex shoulder through ROM - keeping arms close to head & full elbow extension;
lumbar spine should remain flat
This passive movement allows an estimate of ROM available and demonstrates to patient exact motion required.
Patient performs actively
Latissimus Dorsi - measurement
Using tape measure, measure distance between lateral epicondyle of humerus and plinth
SCM - patient position
Supine, shoulders just beyond end of plinth.
Support patient head
SCM - movement
Extend middle and lower cervical spine, Contralateral side flexion
Ipsilateral rotation.
Upper cervical flexion
SCM - measurement
Compare to other side
Upper fibre traps - patient position
Supine, head slightly over end of plinth.
Support patient head.
Upper fibre traps - Movement
Depress the scapula
Flexes the cervical spine,
Contralateral lateral flexion
Ipsilateral rotation.
Upper traps - measurement
A tape measure is used to measure the distance between mastoid process and acromioclavicular
joint when the upper trapezius muscle is fully lengthened. (second person needed)
Compare to other side
Levitator scapulae - patient position
Supine, head slightly over end of plinth
Support patient head
Levitator scapulae - movement
Depresses the scapula
Flexes the cervical spine,
Contralateral lateral flexion
Contralateral rotation.
Levitator scapulae - Measurement
Compare to other side
Scalenes - patient position
Supine, head slightly over end of plinth
Support patient head
Anterior Scalene - movement
Stabilise 1st rib
Extend the head
Contralateral side flexion until the stretch sensation or resistance is felt,
Ipsilateral rotation
Middle scalene - movement
Stabilise first rib
Contralateral side flexion
Posterior scalene - movement
Stabilise second rib
Contralateral rotation
Ipsilateral side flexion
Anterior scalene - measurement
Tape measure
Mastoid process to the acromioclavicular joint
Middle scalene - measurement
Tape measure
Earlobe to the acromioclavicular joint
Posterior scalene - measurement
Tape measure
Middle of the chin to the acromioclavicular joint
