Muscle length testing Flashcards
Scalenes anterior/medius/posterior
- Anterior – extension, lateral flexion away
and rotation towards the side being tested - Medius – minimal to no extension and
lateral flexion away - Posterior – extension, lateral flexion and
rotation away
Deep neck extensors
- Right hand passively flexes the upper
cervical spine while palpating the deep
occipital muscles with the left hand.
Upper trapezius
- A passive stretch is applied by contralateral
and flexion of the neck with shoulder girdle
depression.
Levator scapulae
- Passive stretch
- Contralateral lateral flexion and rotation with flexion
- Shoulder girdle depression
- Restricted ROM and tenderness
Sternocleidomastoid
- Clinician tucks chin in
- Lateral flexion away
- Rotation towards
- Clavicle stabilised with the other hand
Pectoralis minor
- Patient in supine with arms by their side
- The coracoid is pulled anteriorly & inferiorly if there is a contracture
- The posterior edge of the acromion may rest further from the plinth on the affected
side
Pectoralis major
- Clavicular fibres – shoulder abduction to 90°. Passive overpressure of horizontal ext
will be limited in range & the tendon becomes taut if the muscle is tight - Sternocostal fibres – full shoulder elevation. Restricted ROM & the tendon becomes
taut if the muscle is tight.
Hamstring length test
- Pt supine, spine and pelvis in neutral, one hip
flex to 90°, other leg straight - Passively extend knee until resistance, or loss of
lumbar/pelvis neutral - Benchmark – extend to within 10° of full
extension - Beware neural tissue
- Home stretch – hug knee to chest, extend knee
(no DF), hold 20-30s (3-5 times).
Piriformis
- Passively flex hip to 90°, adducts it and then
adds lateral rotation to the hip - Feeling resistance to the limit of the movement
- There should be around 45° of lateral rotation
- Can be palpated at the point at which an
imaginary line between the iliac crest and
ischial tuberosity crosses a line between the
PSIS & the greater trochanter
MODIFIED THOMAS TEST
Iliopsoas, TFL & Rectus femoris
- Pt perches on the edge of the plinth, holds one knee, rolls backwards onto back,
both legs flexed
- Knee to chest – find neutral position of lumbar spine and pelvis, other leg passively
supported by the physio – knee and hip 90° in the midline
- Physio passively lowers leg – not allowing hip rot, abd/add or tibial rot, knee stays at
90°
- Be aware of femoral head ant translation and of strain on the SIJ
- Tests a lot of structures – need to differentiate
DYSFUNCTION
- Short rectus femoris – knee passively extended and hip goes further
- Short TFL and ITB – thigh abducted and hip goes further
- Short iliopsoas and/or anterior capsule – in unladed position of abduction, if there is
still limited hip extension it can be capsule or muscular – end feel. Capsule – short and
springy. Muscle – more recoil, larger bounce. Contract relax will differentiate.
ILIOPSOAS
3 TP’s
- Distal iliopsoas TP deep along lat wall of
fem triangle, just above dist attachment to
lesser trochanter
- Illiacus TP’s inside brim of pelvis behind
ASIS
- Prox psoas TP – apply digital pressure first
downward beside and then medially
beneath the rectus abdominus muscle
towards psoas – compresses psoas against
lx spine
ITB
OBER TEST
- Bottom leg flexed
- Neutral spine
- Stabilise pelvis
- Top leg knee flexed to 90°
- Abd and ext top leg
- Neutral hip rotation
- Drop leg to table
MODIFIED OBER TEST
- Less strain medially on knee, less tension
on patella, less interference of a tight RF
- Stabilise pelvis and keep lateral trunk in
contact with table
- Neutral hip rotation
- Hip ext in line with trunk
- Allow leg to drop to tabel
ERECTOR SPINAE
- Sitting non-neural slump
- Sit and flex spine by allowing shoulders
to slump towards pelvis - Benchmark: even flexion throughout the
Tx and Lx spine with 20° lumbar flexion
QUADRATUS LUMBORUM
- Pt pushes up sideways as far as possible
without movement of the pelvis -
Mermaid sitting - Limited ROM, lack of curvature in the Lx
sp and/or abnormal tension on palpation
(just above iliac crest and lat to ES)
indicate tightness
QL Palpation of TP’s
- Pt in side lying with a pillow in the waist
- Reach overhead with the arm to elevate
the rib cage - Rest uppermost knee behind the other
knee to pull the pelvis distally - Iliac crest
- 12th rib
- Opposite transverse process of L3
MFR -CROSS HAND TECHNIQUE
- Cross hands to maximise leverage and slowly stretch out the elastic component of
the fascia till you reach a barrier. - Hold 90 – 120 seconds, as this releases, continue your pressure until next barrier is
reached. - Once again hold, as you feel motion, gently release
FRANCINE ST GEORGE METHOD
- Use lateral borders of 3rd and 4th fingers locked at distal IPJ
- Work in direction of muscle fibres
- Where there are adhesions a “nail-type” sensation and erythema
- Perform slowly, working with the patient to avoid too much discomfort
- Care taken in overweight patient’s to avoid bruising
- Not appropriate in older people with thin skin
- Most effective at musc-tend junctions
