PIR Flashcards
Hamstring
Pt position; supine with the treatment leg close to the edge of the couch
Procedure:
- Dr lifts up entire leg (straight) and assesses tone and barrier, taking note of the degrees
- Dr maintains position just before the stretch barrier, placing the lower leg on their shoulder
- “Gently push down into my hand and hold that position”
- “Take a big breath in and hold it”
- Resist force for 7-10secs
- “Breathe out, relax, let it go”
- Dr waits until muscle fully relaxes, then flexes the hip further to detect a new barrier
- Steps 3-7 is repeated 3-5 times
Antagonist stimulation: Dr places hands on anterior thigh. “Push up into my hand with your thigh”. Dr oscillates the resistance
Psoas
Pt position: sitting on edge of couch with unaffected hip flexed to their chest. Dr lowers them into a supine position whilst the treatment leg is hanging off the table. The raised foot is supported on the side of Dr’s abdomen
Procedure
- Pt is set up into above position, ensuring neutral spine
- Dr notes the degrees of hip flexion
- Dr pushes down on the affected leg into extension to assess tone and barrier
- Dr maintains position just before the stretch barrier
- “Gently push up into my hand and hold that position”
- “Take a big breath in and hold it”
- Resist force for 7-10secs
- “Breathe out, relax, let it go”
- Dr waits until muscle fully relaxes, then flexes the knee further to detect a new barrier
- Steps 5-9 is repeated 3-5 times
Antagonist contraction: Dr cups under Pts thigh. “Push down into my hand with your thigh”. Dr oscillates the resistance.
Rectus Femoris
Pt position: sitting on edge of couch with unaffected hip flexed to their chest. Dr lowers them into a supine position whilst the treatment leg is hanging off the table. The raised foot is supported on the side of Dr’s abdomen
Procedure:
- Pt is set up into above position, ensuring neutral spine
- Dr notes the degrees of knee flexion
- Dr uses their leg to push knee into more flexion to assess tone and barrier
- Dr maintains position just before the stretch barrier
- “Gently push up into my hand and hold that position”
- “Take a big breath in and hold it”
- Resist force for 7-10secs
- “Breathe out, relax, let it go”
- Dr waits until muscle fully relaxes, then depresses the knee further to detect a new barrier
- Steps 5-9 is repeated 3-5 times
Antagonist contraction: N/A
1 joint hip adductors
Pt position: supine, with treatment knee flexed and hanging off the couch. Towel draped between legs
Procedure:
- Dr stands inside Pts leg, and abducts hip to assess tone and barrier, taking note of the degrees
- Dr maintains position just before the stretch barrier
- “Gently push your leg in and hold that position”
- “Take a big breath in and hold it”
- Resist force for 7-10secs
- “Breathe out, relax, let it go”
- Dr waits until muscle fully relaxes, then abducts the leg further to detect a new barrier
- Steps 3-7 is repeated 3-5 times
Antagonist contraction: Dr hand on lateral thigh. “Push out into my hand”. Dr oscillates the resistance
2 joint hip adductors
Pt position: supine, with treatment leg close to the edge of the couch. Towel draped between legs
Procedure:
- Dr stands inside Pts leg, and abducts hip to assess tone and barrier, taking note of the degrees
- Dr maintains position just before the stretch barrier
- “Gently push your leg in and hold that position”
- “Take a big breath in and hold it”
- Resist force for 7-10secs
- “Breathe out, relax, let it go”
- Dr waits until muscle fully relaxes, then abducts the leg further to detect a new barrier
- Steps 3-7 is repeated 3-5 times
Antagonist contraction: Dr hand on lateral thigh. “Push out into my hand”. Dr oscillates the resistance
Piriformis
Pt position: supine, with treatment leg close to the edge of the couch. Towel draped between legs
Procedure:
- Hip is positioned into flexion (<60°) with knee flexion
- Dr applies axial compression, adduction and internal rotation and assesses for tone and barrier
- Dr maintains position just before the stretch barrier, and places had on lateral knee
- “Gently push your knee into my hand and your foot into my inside elbow and hold that position” (abduction, external rotation)
- “Take a big breath in and hold it”
- Resist force for 7-10secs
- “Breathe out, relax, let it go”
- Dr waits until muscle fully relaxes, then abducts and internally rotates the leg further to detect a new barrier
- Steps 4-8 is repeated 3-5 times
Antagonist contraction: Hand on lateral knee. “Push your knee into my other hand”. Dr oscillates the resistance
Pec Major
Pt position: supine, with treatment arm off the table, but the scapula still on. Pts other hand is on the treatment pec. Arm is abducted 90° for clavicular fibres, and 120° for sternal fibres
Procedure:
- Dr places their forearm on the Pts arm (the one on the pec). Pulls LM SI to take tension
- Dr pushes the treatment arm posteriorly to assess tone and barrier.
- Dr maintains position just before the stretch barrier
- “Gently push your arm up into my fingers and hold that position”
- “Take a big breath in and hold it”
- Resist force for 7-10secs
- “Breathe out, relax, let it go”
- Dr waits until muscle fully relaxes, then extends the arm further to detect a new barrier
- Steps 4-8 is repeated 3-5 times
Antagonist contraction: Dr hand on posterior arm. “Push your forearm down into my hand”. Dr oscillates the resistance
Pec minor
Pt position: supine, with treatment side close to the edge, but the scapula is still on. Pt flexes the arm and shoulder so their hand is on their neck. Pts other hand is on the treatment pec
Procedure:
- Dr places their forearm on the Pts arm (the one on the pec). Pulls LM SI to take tension
- Dr puts other hand on the treatment elbow, and applies axial compression up (causing elevation)
- Dr maintains position just before the stretch barrier
- “Gently push your elbow into my hand and hold that position”
- “Take a big breath in and hold it”
- Resist force for 7-10secs
- “Breathe out, relax, let it go”
- Dr waits until muscle fully relaxes, then compresses the arm further to detect a new barrier
- Steps 4-8 is repeated 3-5 times
Antagonist contraction: Dr puts hand on superioposterior shoulder. “Push your shoulder back and up into my hand”. Dr oscillates the resistance
Gastrocnemius
Pt position: Pt supine, with feet off the edge of the couch
Procedure:
- Dr cups the calcaneus, and applies a traction force to the talocrural joint
- Whilst maintaining this traction, Dr induces dorsiflexion to assess tone and barrier
- Dr maintains position just before the stretch barrier
- “Gently push your foot into my body and hold that position”
- “Take a big breath in and hold it”
- Resist force for 7-10secs
- “Breathe out, relax, let it go”
- Dr waits until muscle fully relaxes, then dorsiflexes the ankle further to detect a new barrier
- Steps 4-8 is repeated 3-5 times
Antagonist contraction: Dr puts hand on dorsum of foot. “Pull up into my hand”. Dr oscillates the resistance
Soleus
Pt position: prone, with feet off the edge of the couch.
Procedure:
- Dr cups Pts heel and applies traction. The other hand is on the outer side of the foot
- Whilst maintaining this traction, Dr induces dorsiflexion to assess tone and barrier
- Dr maintains position just before the stretch barrier
- “Gently push your foot into my hand and hold that position”
- “Take a big breath in and hold it”
- Resist force for 7-10secs
- “Breathe out, relax, let it go”
- Dr waits until muscle fully relaxes, then dorsiflexes the ankle further to detect a new barrier
- Steps 4-8 is repeated 3-5 times
Antagonist contraction: Dr puts hand on dorsum of foot. “Pull up into my hand”. Dr oscillates the resistance
Shoulder internal rotators
Pt position: supine, with arm off the table but the scapula still on. Humerus is parallel to floor
Procedure:
- Dr takes the Pts arm into external rotation using a two finger contact, assessing the tone and barrier. Notes degrees
- Dr maintains position just before the stretch barrier
- “Gently push your wrist into my fingers and hold that position”
- “Take a big breath in and hold it”
- Resist force for 7-10secs
- “Breathe out, relax, let it go”
- Dr waits until muscle fully relaxes, then externally rotates the shoulder further to detect a new barrier
- Steps 3-7 is repeated 3-5 times
Antagonist stimulation: Dr puts hand on posterior side of wrist. “Push into my hand”. Dr oscillates the resistance
Shoulder external rotators
Pt position: supine, with arm off the table but the scapula still on. Humerus is parallel to floor
Procedure:
- Dr takes the Pts arm into internal rotation using a two finger contact, assessing the tone and barrier. Notes degrees
- Dr maintains position just before the stretch barrier
- “Gently push your wrist into my fingers and hold that position”
- “Take a big breath in and hold it”
- Resist force for 7-10secs
- “Breathe out, relax, let it go”
- Dr waits until muscle fully relaxes, then internally rotates the shoulder further to detect a new barrier
- Steps 3-7 is repeated 3-5 times
Antagonist stimulation: Dr puts hand on anterior side of wrist. “Push into my hand”. Dr oscillates the resistance
TFL
Pt position: sidelying, with back on the edge of the couch. The bottom leg is flexed for support
Procedure:
- Dr stabilises the pelvis while bringing the top leg into extension and adduction and assesses tone and barrier. Note degrees
- Dr maintains places hand on the lateral (upside) of the thigh
- “Gently push your thigh into my hand and hold that position”
- “Take a big breath in and hold it”
- Resist force for 7-10secs
- “Breathe out, relax, let it go”
- Dr waits until the thigh fully relaxes, then drops the thigh into more adduction to detect a new barrier
- Steps 3-7 is repeated 3-5 times
Antagonist stimulation: Dr hand on medial side of thigh. “Push into my hand”. Dr oscillates the resistance.
QL
Pt position: sidelying, with back on the edge of the couch. The bottom leg is flexed for support
Procedure:
- Dr begins by facilitating the QL muscle. “Kink up your hip” + “side crunch” + “both at the same time”
- Dr drops top leg into extension and adduction (should be off the table)
- Dr uses cross arm pressure on the ribs and pelvis, assessing for tone and barrier
- “Gently bring your hip and ribs together and hold that position”
- “Take a big breath in and hold it”
- Resist force for 7-10secs
- “Breathe out, relax, let it go”
- Dr waits until the muscle fully relaxes, then cross pressures further to detect a new barrier 9. Steps 4-8 is repeated 3-5 times
Antagonist stimulation: N/A
Lower Erector Spinae
Pt position: Suprone position: upper torso is prone, pelvis and lower limb is sidelying
Procedure:
- Dr can facilitate the ES by getting the patient to stick their bum out
- Dr stabilises with caudal hand on ASIS. Cephalad hand is on low lumbar ES
- “Arch away from hand”
- Hold for 7-10secs
- “Relax, let it go”
- Dr waits until the muscle fully relaxes, then applies pressure further up the spine
- Steps 3-6 is repeated 3-5 times
Antagonist stimulation: N/A
Upper Traps
Pt position: supine
Procedure:
- Primary hand on anterosuperior shoulder, and the secondary hand cupping the head
- Dr positions head into flexion, contralateral lateral flexion, ipsilateral rotation, ensuring chin tuck is maintained
- Dr feels tension with primary contact on shoulder, assessing tone and barrier
- “Gently lift your shoulder up into my hand”
- “Take a big breath in and hold it”
- Resist force for 7-10secs
- “Breathe out, relax, let it go”
- Dr waits until the muscle fully relaxes, then depresses the shoulder further to detect a new barrier
- Steps 4-8 is repeated 3-5 times
Antagonist stimulation: Dr hand grasping the Pts lateral arm. “Pull your hand down towards your toes”
Levator Scapulae
Pt position: supine
Procedure:
- Primary hand cupping the superior scapula, and the secondary hand on C1 TVP
- Dr positions head into flexion, contralateral lateral flexion, and contralateral rotation, ensuring chin tuck is maintained
- Dr feels tension with primary contact on scapulae, assessing tone and barrier
- “Gently lift your shoulder up into my hand”
- “Take a big breath in and hold it”
- Resist force for 7-10secs
- “Breathe out, relax, let it go”
- Dr waits until the muscle fully relaxes, then depresses the shoulder further to detect a new barrier
- Steps 4-8 is repeated 3-5 times
Antagonist stimulation: Dr hand grasping the Pts lateral arm. “Pull your hand down towards your toes”
Sub Occipital
Pt position: supine
Procedure:
- Secondary cupping the occiput, primary on the Pts forehead
- Dr feels tension by applying inferior forehead pressure, assessing tone and barrier
- “Keep your eyes open and look up towards your eyebrows”
- “Take a big breath in and hold it”
- Maintain tension for 7-10secs
- “Breath out, relax, look away”
- Dr waits until the muscle relaxes, and then retracts chin further to detect a new barrier
- Steps 3-7 is repeated 3-5 times
Antagonist stimulation: “Tuck your chin in as I help you sit up”
SCM/Scalene
Pt position: supine, with headrest in extension
Procedure:
- Primary just medial and inferior to SC joint, secondary on inferior mastoid
- Dr positions head into extension, contralateral lateral flexion and ipsilateral rotation
- Dr feels tension with primary contact on inferior SC joint, assessing tone and barrier
- “Keep your eyes open and look towards the opposite wall”
- “Take a deep breath in and hold it”
- Maintain tension for 7-10secs
- “Breath out, relax, look away”
- Dr waits until the muscle relaxes, pushes inferior with primary to detect a new barrier
- Steps 4-8 repeated 3-5 times
Antagonist stimulation: N/A
