prac info deck Flashcards
1
Q
what would you be looking for during a PAM
A
resistance, range, reproduction of symptoms, end feel
2
Q
Outcome Measures used in clinical practice commonly measure following treatment
A
Pain – VAS & VAS alternatives
Functional status – specific to region and patient
Impairment Outcomes – ROM, strength
3
Q
FUNCTIONAL MOVEMENTS/TASKS for lower limb
A
dorsiflexion in WB lunge test (knee to wall)
Ability to stand on one leg.
Single leg balance
Tandem balance
Squat
steps
4
Q
f the exact pain has not been reproduced with normal testing repeat the functional
movement with
A
Increased load
Increased speed
5
Q
During functional tests, note when
A
At what point in the movement the symptoms are reproduced
* At what point in the movement the symptoms limit further movement
* Quality/control of the movement
6
Q
preform a knee to wall test (DF in WB lunge
A
Patient standing with foot perpendicular to wall withmiddle of calcaneus & 2 nd toe on a line perpendicular to wall.
* Lunge forward with knee until anterior knee just touches wall with the heel and foot in remaining in position above.
* Ensure heel does not lift.
* Use tape measure to record
7
Q
during passive or active physiological movments (PPM) what are you testing/ feeling for
A
evaluating range
onset of R1 and R2
reproduction of specific symptoms
8
Q
what is the passive clearence test for the hip
A
hip quadrant test
9
Q
preform a hip quadrsnt test
A
pull knee into some flexion, bring knee to ipsilateral shoulder then add more pressure
bring knee to chin
bring knee to contralateral shoulder
bring towards contralateral waist
bring knee to opposite ASIA
10
Q
what is the active clearence test for hip
A
squat
11
Q
what is the passive clearence test for the knee
A
knee flexion with overpressure
knee flexion with PURE knee abduction
knee flexion with PURE knee adduction
knee extension with overpressure
knee extension with PURE knee abduction
knee extension with PURE knee adduction
12
Q
what is the active clearence test for knee
A
squat
13
Q
preform the clearnence test for the knee
A
pt laying down flat
be completely relaxed
push knee into flexion and push even harder
then with knee in flexion and knee in chest move foot distally to bring knee into adduction/ flexion
bring knee into extension stabilse over tibisl tuberosity and increase pressureby increasing extension
in same position move foot distally to bring knee into adduction/ flexion
14
Q
f both active and passive physiological movement testing reproduces the patient’s symptoms or are abnormal in ‘quality,’ then the diagnosis of a what?
A
passive tissue pathology
15
Q
If, however, only active movement testing reproduces the patient’s symptoms, but passive
physiological movement testing is clear then the diagnosis of an
A
active/contractile tissue pathology (musculotendinous)
16
Q
how to preformISOMETRIC MUSCLE TESTING for the HIP flexors
A
Patient position: supine, hip and knee
flexed to 90 degrees
Handling: proximal hand on anterior
knee, distal hand supports under distal
calf
* Procedure: instruct patient to contract as
if moving the knee towards the chest.
Therapist applies extension force
17
Q
how to preformISOMETRIC MUSCLE TESTING for the HIP extensors
A
Patient position: supine (or prone)
* Handling: proximal hand under thigh, distal hand supports distal calf
* Procedure: instruct patient to contract
as if moving thigh/leg towards the plinth.
* Patient holds position whilst therapist applies flexion force
18
Q
how to preform ISOMETRIC MUSCLE TESTING for the HIP abductors
A
Patient position: supine
* Handling: proximal hand on lateral aspect of distal thigh, distal hand supports leg
* Procedure: instruct patient to contract as if moving the leg outwards. Therapist applies adduction force.
* Ensure the hip remains in a neutral position and does not flex
19
Q
how to preform ISOMETRIC MUSCLE TESTING for the HIP adductors
A
Patient position: supine
* Handling: proximal hand on medial
aspect of distal thigh, distal hand
supports the leg
* Procedure: instruct patient to contract
as if moving the leg inwards.
Therapist applies abduction force
20
Q
how to preform ISOMETRIC MUSCLE TESTING for the HIP internal rotation
A
Patient position: in supine with hip and knee flexed to 90 degrees.
* Handling: proximal hand stabilizes knee & thigh position, other hand on lateral aspect of distal tibia to provide resistance
* Procedure: ask patient to contract as if to internally rotate thigh i.e. turn shin/foot towards therapist. Therapist applies external rotation force.
* Alternate positions for testing are sitting
over edge of plinth, or prone
21
Q
how to preform ISOMETRIC MUSCLE TESTING for the HIP external rotation
A
Patient position: in supine with hip and knee flexed to 90 degrees.
* Handling: proximal hand stabilizes knee & thigh position, other hand on medial aspect of distal tibia to provide resistance
* Procedure: ask patient to contract as if to externally rotate thigh i.e. turn shin/foot away from the therapist. Therapist applies internal rotation force.
* Alternate positions: sitting or prone
22
Q
how to preform ISOMETRIC MUSCLE TESTING for the KNEE extension
A
Patient position: Supine, knee over
rolled towel.
* Stabilize femur with one hand, other
applies resistance to tibia.
* Procedure: ask patient to contract as if
straightening the knee whilst therapist
applies flexion force
23
Q
how to preform ISOMETRIC MUSCLE TESTING for the KNEE flexion
A
Patient position: supine, hip flexed ~45 degrees, knee flexed.
* Stabilize femur with one hand, other hand under posterior aspect of distal tibia to provide resistance.
* Procedure: ask patient to contract as if bending knee whilst therapist applies extension force
24
Q
how to preform ISOMETRIC MUSCLE TESTING for the ANKLE dorsiflexion
A
Supine or long sitting rolled towel under
knee, ankle in plantigrade.
* Stabilize tibia with one hand, apply
resistance to dorsum of foot with other.
* Patient holds position whilst therapist
applies plantarflexion force
25
how to preform ISOMETRIC MUSCLE TESTING for the ANKLE planterflexion
Supine or long sitting rolled towel
under knee, ankle in plantigrade.
* Stabilize tibia with one hand, apply
resistance to sole of foot with other.
* Patient holds position whilst therapist
applies dorsiflexion force.
26
how to preform ISOMETRIC MUSCLE TESTING for the ANKLE evertors
Supine or long sitting rolled towel under knee, ankle in plantigrade.
* Stabilize tibia with one hand, apply resistance with other to lateral border of
foot.
* Patient holds position whilst therapist applies inversion force
27
how to preform ISOMETRIC MUSCLE TESTING for the ANKLE Invertors
Supine or long sitting rolled towel under knee, ankle in plantigrade.
* Stabilize tibia with one hand, apply resistance to medial border of foot with the other.
* Patient holds position whilst therapist applies eversion force
28
how to preform ISOMETRIC MUSCLE TESTING for the TOE extensors
Supine or long sitting rolled towel under knee, ankle in plantigrade.
* Stabilize metatarsals with one hand, apply resistance to dorsal side of 1st -5 th toes with other.
* Patient holds position whilst therapist applies flexion force
29
how to preform ISOMETRIC MUSCLE TESTING for the TOE flexors
supine or long sitting rolled towel under knee, ankle in plantigrade.
* Stabilize metatarsals with one hand, apply resistance to underside of 1st -5 th toes with other.
* Patient holds position whilst therapist applies extension force
30
when is it appropriate to do a palpation as an assessment and why
acute injuries and early post-operatively,
presence of swelling is
inhibitory to quadriceps function (and therefore gait), tests of muscle recruitment and
strength may also be performed and have been included here.
31
Brush Swipe Test
Patient supine rolled towel under test knee. Therapist stands beside plinth facing patient.
* With the back of your hand, sweep proximally from the antero-medial aspect of the knee, for about 10cm, for about 5 firm, sweeps.
* Then, also with the back of your hand, swipe downwards/distally from the lower, antero-lateral thigh down to the antero-lateral aspect of the knee and watch for any swelling that bulges at the medial side of the knee
32
PAMs when are they done
PAMs are indicated if there is pain or restriction with passive physiological movement
33
preform AP tibiofemoral joint (PAM)
Patient supine, rolled towel under test knee
* Therapist facing patient.
* Handling: thumbs of both hands placed over
proximal anterior tibia, fingers resting on
adjacent surfaces of tibia & fibula.
* Movement of tibial plateau is performed relative
to femoral condyles in an anterior to posterior
direction.
34
preform PA tibiofemoral joint (PAM)
* Patient supine rolled towel under test knee.
* Therapist facing patient.
* Handling: thumbs of both hands placed over
proximal anterior tibia, fingers resting on
adjacent surfaces of tibia & fibula.
* Movement of tibial plateau is performed relative
to femoral condyles in a posterior to anterior
direction
35
preform TFJ med glide PAM
One hand stabilises distal femur from
medial aspect, one hand performs glide
from lateral aspect of proximal tibia
36
preform TFJ lateral glide PAM
One hand stabilises distal femur from lateral
aspect, one hand performs glide from medial
aspect of proximal tibia
37
preform TFJ internal and external rotation PPM
* Patient supine rolled towel under
test knee.
* Therapist stands beside plinth facing
patient.
* Handling: one hand stabilises distal
femur, other hand grasps distal tibia.
* Internally and externally rotate tibia
on femur.
* Note: This is a passive physiological,
not a passive accessory movement
38
preform PAMs of superior tibiofibular joint AP, PA
Patient crook lying, test leg bent 90° flexion.
* Therapist sits on the plinth facing the patient.
* Handling: Pads of fingers placed behind fibula
head and thenar eminence placed anteriorly,
other hand stabilises tibia/calf muscle bulk.
Care is required to avoid pressure to the
common peroneal nerve
* Glide fibula from anterior to posterior (AP) or
posterior to anterior (PA)direction.
39
Can AP and PA also be a clearing test for the superior tibiofibular joint
yes
40
prefrorm PAM/ clearing test for patellofemoral joint
Patient supine, rolled towel under knee (but can
be performed in varying degrees of knee
flexion.
medial, lateral, cephalad, caudad and medial tilt
Heel of one hand stabilises the patella laterally
whilst other produces a tilt on medial edge of
patella= medial tilt
Ensure you do not compress the patella whilst
gliding as that is likely to result in increased
pain
41
preform FUNCTIONAL MUSCLE TESTING- Inner range quads (IRQ) or Active Straight Leg Raise (ASLR)
* Supine
* Passively extend the knee to full inner range
* Instruct the patient to hold position (knee extension) whilst lifting leg off the bed (flex at
hip)
* (Active) Lag: the difference (in degrees) between normal passive knee extension and
active knee extension on a SLR
* (Passive) Lack: difference between 0 degrees and actual position of passive knee extension i.e. if knee is flexed to 10 degrees, the ‘lack’ is said to be 10 degrees.
* If patient can hold position, assess ability to maintain position against resistance for ~ 10 seconds.
42
when is the functional muscle testing/ training this important for
leg to get out of bed eg TKR
43
when can VMO be used
Assessed in conditions like Patellofemoral Pain
Syndrome (PFPS) or after acute knee injuries.
44
how to preform Examination of quadriceps bulk, activation of VMO and patellar tracking
Patient position in long sitting with knee relaxed
and flexed slightly over rolled towel or pillow.
Progress to other positions relevant to patient
function.
* Correct recruitment sequence (knee extension
initially but can progress to varying degrees of
flexion, followed by functional tasks)
o Vastus medialis oblique contracts at the
same time as Vastus lateralis
45
Faults/substitutions of Examination of quadriceps bulk, activation of VMO and patellar tracking
o VL precedes VMO activation (delayed VMO onset)
o Absence of VMO activation
46
to see for Recruitment/activation patterns what tests to be done
activation of VMO
* Manual Muscle Testing
* Muscle Length Tests
47
preform SPECIAL ORTHOPAEDIC TESTS FOR THE KNEE for MCL/ MCL stress test valgus
In extension - stand on the outside of the patient's leg. Proximal hand stabilises lateral aspect of knee & provides valgus force to joint. Distal hand stabilises medial aspect of leg.
(tests deep MCL, posteromedial capsule, ACL).
* In 30 degrees – Handling as above. Ensure control of hip to prevent the knee rolling when you apply the valgus force
48
what to assess for medial and lateral collateral ligament special test/ stress test
* Assess joint gapping, end feel and
reproduction of pain.
49
preform SPECIAL ORTHOPAEDIC TESTS FOR THE KNEE for LCL/ LCL stress test Varus test
In extension - stand on the inside of
the leg. Proximal hand stabilises
medial aspect of knee & provides
varus force to joint. Distal hand cups
distal leg above the ankle joint
50
preform SPECIAL ORTHOPAEDIC TESTS FOR THE KNEE for PCL/ PCL stress test (sag test)
used before other anterior cruciate
testing to screen for damage to the posterior
cruciate ligament
Patient in crook lying or with feet supported
in 90/90 position. The quadricep muscle
must be relaxed to avoid the tibia being
drawn forward and creating a false negative
test.
* Ask patient to relax lower limbs and then
compare tibial tuberosity levels.
* Positive test: tibial tuberosity of the affected
side will be lower
51
what is a positive Stress tests for the Posterior Cruciate Ligament (PCL) sag test
tibial tuberosity of the affected
side will be lower
52
preform SPECIAL ORTHOPAEDIC TESTS FOR THE KNEE for PCL/ PCL stress test posterior draw
Knee in 90 degrees flexion with patient in crook lying.
* Ensure muscle relaxation, anchor foot, and
push the tibia posteriorly in relation to the femur.
* Compare amount of posterior movement of
the tibia with the unaffected side and assess end feel and reproduction of pain
53
preform SPECIAL ORTHOPAEDIC TESTS FOR THE KNEE for ACL/ ACL stress test (lachmans test)
Anterior drawer test performed in 15-30 degrees of flexion to test the anterior cruciate ligament.
* Knee in 15-30 degrees of flexion via therapist knee under the patient knee. Top hand stabilizes the femur and palpates the joint line. Bottom hand draws the tibia forward.
* Compare amount of anterior tibial movement with unaffected side and assess for end feel and reproduction of pain
54
preform SPECIAL ORTHOPAEDIC TESTS FOR THE KNEE for MENISCAL TESTS- Mc murrys test
* Patient supine.
* Start with the knee fully flexed. One hand supports
the knee and palpates the joint line. The other
hand controls tibia position.
* ‘Scoop’ the tibia in full flexion position through
F/Ab to F/Ad and reverse.
* Apply a valgus/abduction force +/- IR and move
gradually into an extended position.
* Apply a varus/adduction force +/- ER and move
gradually into an extended position
55
what is a positive test for McMurrys
reproduction of pain, click in joint line
or apprehension
56
what does Lachmanns test test for
ACL tear
57
what does McMurrys test for
meniscal tear
58
preform SPECIAL ORTHOPAEDIC TESTS FOR THE KNEE for PATELLOFEMORAL TESTS- Patella Apprehension Test
Supine position, knee flexed to 20-30 degrees by placing rolled towel or therapist knee under patient knee.
* Careful explanation of test technique for patient is essential – in particular, emphasizing the fact that the therapist will protect the joint and support the patella and thus prevent subluxation.
* Glide patella laterally and look for apprehension and mobility
59
what does the Patella Apprehension Test assess
instability emanating from the
patellofemoral joint
60
positive Patella Apprehension Test
Quadriceps guarding and patient apprehension
61
preform SPECIAL ORTHOPAEDIC TESTS FOR THE KNEE for PATELLOFEMORAL TESTS- McConnell test
* Patient sitting on edge of plinth, knee flexed over edge, thigh externally rotated.
* Therapist handling: one hand stabilizes thigh whilst other hand positioned over shin provides resistance to isometric extension.
* Repeat in varying degrees of flexion (120 degrees, 90 degrees, 60 degrees, 30 degrees, 0 degrees)
* If pain reproduced in any of the positions, test is repeated while the clinician passively corrects the patella position by performing a passive
patellofemoral glide
62
positive McConnell Test
Reduction of pain when the passive
patellofemoral glide is applied
63
what does the McConnels test test for
maltracking of the patella relative to the femur
64
Neurological examination tests for
nerve conduction
65
Nerve Palpation and Neurodynamic Tests test for
tests nerve sensitivity (to movement)
66
TIBIAL NERVE paplpation
Ask your subject to lie supine, hold their flexed hip and knee, then extend the
knee. Tibial nerve stands out as a thick cord. If subject DF foot the tibial nerve
may tighten up further
In the popliteal fossa (runs between the semitendinosus and biceps femoris
tendons).
Above the medial Malleoli
Posterior to medial Malleoli - find tip of medial Malleoli and approx. 2cm posteriorly,
the tibial nerve can be palpated
67
PERONEAL NERVE palpation
In the popliteal fossa: (peroneal nerve is smaller than the tibial nerve). Towards the
lateral side of the posterior knee and medial to biceps femoris tendon (palpate
tendon, then slip off medially onto nerve)
Ask your subject to lie supine, hold their flexed hip and knee, then extend the
knee. Get patient to PF foot – peroneal nerve may tighten up further
At the head of fibula: In supine, flex knee a little and feel under the knee inside the
biceps femoris tendon, then in some will be able to follow nerve out to the fibula
head.
68
palpation of Superficial peroneal nerve
foot inverted and PF – terminal branch of
superficial peroneal nerve can be seen and palpated on dorsum of foot. Invert and evert the foot and watch the nerve slide
69
Deep peroneal nerve palpation
palpated indirectly at the anterior tarsal tunnel under the retinaculum, just lateral to tibialis anterior and on lateral side of 1st metatarsal, heading towards web space.
70
SURAL NERVE palpation
continuation of the tibial nerve and descends to the foot between heads of gastrocnemius.
Palpation
1. At Achilles tendon – run a fingernail across the lateral side of the Achilles tendon
about a hand width above the lateral Malleoli with tendon on stretch.
2. Inferior to lateral Malleoli – about a cm inferior to lateral Malleoli.
71
FEMORAL NERVE Palpation
Find the femoral pulse few cm distal to inguinal ligament. Indirect palpation of femoral
nerve
* 4cm distal to inguinal ligament, nerve divides into various motor and sensory branches and can no longer be palpated.
72
aims of a neurological examination are
To confirm/clarify findings
To establish baseline or assess progress
To differentiate lesions of the CNS (spinal cord, cauda equina etc.) from the PNS
73
INDICATIONS TO PERFORM NEUROLOGICAL TESTS LMN
* Spinal pain extending beyond hip/buttock or shoulder.
* Paraesthesia and/or anaesthesia in the limb.
* Weakness and/or clumsiness using the limb.
* Symptoms in the limb thought to be spinal in origin.
74
INDICATIONS TO PERFORM NEUROLOGICAL TESTS UMN
* Bilateral symptoms in arms or legs in a diffuse non-dermatomal distribution.
* Disturbances of gait, balance or co-ordination
* Disturbances (retention or incontinence) of bladder or bowel function (requires urgent medical referral)
* Saddle anaesthesia
75
myotome testing of L2- neurological
supine
The patient holds his flexed hip and knee at 90°
while resistance is applied just above the knee
76
myotome testing of L3
supine
threads one arm under the
patient’s lower thigh to place her hand on the
opposite thigh OR the therapist places his thigh
under the patient’s knee. While the patient holds his leg just short of the fully extended position, resistance is applied against the front of the leg just above the ankle.
77
myotome testing of L4
supine
The patient holds his foot in dorsiflexion and
inversion (“up and in”) while the physiotherapist
applies resistance against the dorsomedial surface of the proximal end of the first metatarsal. (test unilateral or bilateral)
78
myotome testing of L5
supine
The physiotherapist stabilises the patient’s
proximal phalange while resistance is placed
against the nail of the big toe (test unilateral or
bilateral)
79
myotome testing of S1
The patient is asked to evert his foot. The
physiotherapist applies resistance against the
lateral border of the foot. (test unilateral or
bilateral
80
myotome testing of S2
The patient flexes his toes over the pads of the
physiotherapist’s fingers. The physio resists toe
flexion (test unilateral or bilateral)
81
reflex scale
0 = no response; always abnormal
1+ = a slight but definitely present response; may or may not be normal
2+ = a brisk response; normal
3+ = a very brisk response; may or may not be normal
4+ = a tap elicits a repeating reflex (clonus); always abnormal
82
L3,4 patella tendon reflex
supine, hand under leg and wack with stick 2-3 times
83
S1 Achilles tendon reflex
Foot held gently in slight dorsiflexion in physio hand then wack with reflex thing 2-3 times
84
test for lower limb dermotomes L2-S2 locations list
light touch with twisted tissue hard and softly get pt to close their eyes and report which one they feel
L2- anterior medial thigh near inguinal ligament
L3- medial femoral condyle above the knee
L4- medial maleolus
L5- dorsum of foot
S1- lateral heel
S2- mid-point of popliteal fossa
85
how to form clonus CNS reflex
The patient is positioned supine in a comfortable and relaxed position. Apply a sudden dorsiflexion movement to the patient’s ankle and maintain for a brief period noting the any reflex twitches/beats into plantarflexion
86
how to form babinskis CNS reflex
The patient is positioned supine in a comfortable and relaxed position. While gently holding the foot, stroke the outer surface of the sole with a blunt object starting at the heel and moving distally toward the base of the first metatarsal. A normal response if plantar flexion of the toes. The test is positive if the big toe and to a lesser extent the remaining toes dorsiflex.
87
how to conduct Passive Neck Flexion (PNF) & abnormal response
Patient in supine lying, no pillow (if
comfortable. The patient’s head and neck are gently moved into flexion and any symptom
response is noted.
patient’s pain reproduced; patient tries to resist further flexion through activation of the
cervical extensors.
88
how to conduct Straight leg raise (SLR)
Patient - supine close to edge of bed, legs
straight and arms by side (no pillow,
unless neck extension is uncomfortable
and ensure consistency of pillow in
subsequent testing sessions). Ensure
neck, trunk and hips are neutral. Keep the knee extended, flex the hip
COMPARE SIDES
* Therapist – facing the patient, one hand
under the ankle
89
Abnormal response/positive SLR test
Reproduction of LBP, leg symptoms
(between 30 and 70 degrees).
* Less available range compared to
unaffected side.
* Symptoms and range of SLR influenced
by sensitising movements (e.g. Csp
flexion)- get worse w cervical flexion
* Firmer end feel/earlier onset of resistance
than unaffected side – hamstring muscle
activation.
* STUDENTS NOTE
If you have a positive test result with
SLR do not participate in the slump
test
Record findings here:
90
Straight Leg Raise with peripheral nerve bias- tibial, sural, deep peroneal, superfial peroneal
i. Ankle DF + Eversion (DF/EV) – bias the tibial nerve further (i.e. in plantar fasciitis)
ii. Ankle DF + Inversion (DF/IN) – bias the sural nerve (i.e. post inversion ankle
sprains, Achilles tendon problems)
iii. Ankle PF – bias deep peroneal nerve.
iv. Ankle PF + Inversion (PF/IN) – bias superficial peroneal nerve ie post innversion ankle sprains
91
Slump Test method- neurodynamic
Patient: Ask patient to sit up straight with Lx vertical and well back on bed with ankles
uncrossed. Knee crease should be at edge of bed, legs parallel. Place knees together
and legs relaxed. Ask patient to link hands behind back.
Therapist: Sit beside your patient.
Movement:
1. Ask your patient to slump (thoracic flexion). Don’t want the pelvis to rotate
backwards therefore say “stay tall but sag in the middle” while still looking
forward. (Gentle push in the sternum to guide this). Check any symptoms.
2. Now ask patient to bend head down “chin to chest”. Can gently guide with hand
on occiput (do NOT push head down; patient must be able to extend neck if
symptoms provoked). Watch how patient moves head down (i.e. watch if doesn‘t
include upper Cx flexion).
3. Now ask patient to extend one knee - asymptomatic and note range of knee
extension and symptom response. Return asymptomatic knee to starting
position.
4. Now ask the patient to extend the symptomatic side knee. Good to do movement
actively first if symptoms less stable (patient has more control of test). Keep ankle
relaxed. Feel if any transmission of force up to neck/Tx area (with your hand on
upper Tx area – no overpressure). Report any symptoms and note knee
extension range.
5. Release neck flexion “look up to ceiling” (make sure performed slowly and
smoothly so only get Cx movement). Use your other hand to help guide Cx
extension (can do upper, then lower Cx extension). If Cx extension alters the
symptoms – then nervous system implicated.
6. With Cx extension held, ask patient if can now extend knee any further, check
symptoms.
92
Abnormal response of slump test
Implies that the patient's symptoms have been reproduced in whole or part and that
knee extension is limited in range compared to the unaffected side
93
slump test CIs
Acute injury
* Known acute disc herniation.
* Where positions similar to slump provoke long lasting symptoms
problems with interfacing tissue
spinal cord problems
94
prone knee bend- neurodynamic method
Patient: Prone, close to edge of bed.
Therapist: Stand facing patient, about
buttock height. One hand around
ankle, the other on the lumbar spine
stabilising pelvis to monitor when
pelvis movement occurs. Must
stabilise the pelvis first before moving
the leg. Apply your pelvic stabilisation
and check for symptoms (as
symptoms may just be the result of
pressure being applied to the spine).
Movement: Flex the patient’s knee
whilst stabilising pelvis and ask patient
to report any change in symptoms.
Differentiation: can be hard in this
position. Try cervical extension
95
normal respone of prone knee bed test
Heel should be able to touch or come close to touching the buttock and equal on both
sides. Pulling in quadriceps common
96
indication for prone knee bend
femoral nerve
97
femoral nerve slump test indication
femoral nerve
98
femoral nerve slump test method- neurodynamic test
Patient position: side lying, patient holds underneath leg in hip and knee flexion, plus
neck flexed = cuddled up position/slumped position.
Therapist position: Hold top leg with foot (knee at 90ish degrees) resting on hip and hand supporting weight of
leg. Use other hand to stabilise pelvi
99
abnormal response of femoral nerve slump test
Reproduction of the patient’s symptoms, a reduced range of hip extension and
increased resistance through range compared to the unaffected side
100
examples of external physical devices
Motion Limiting Braces
Zimmer Splint
Patella repositioning braces
taping
101
BOX DELOADING TECHNIQUE – to thigh taping
pt to be relaxed on plinth
1) Identify area of tenderness by
palpation; use a pen to mark the
boundaries of tenderness.
2) Apply a strip of tape on the inferior
side of the square, tension it with one
hand while gathering the tissues
towards the centre of the ‘square’
with the other and place it on the skin
3) Apply a second layer of tape as
above, overlapping by half
102
precautions to taping
allergies to tape, latex or bandaids
103
MEDIAL COLLATERAL LIGAMENT TAPING appliaction
pt to be Supported standing with knee slightly flexed (30º) by placing a roll of tape under
patient’s heel
superior anchor and inferior anchor - minimal tension
medial tape applied, then an X created
reapply anchors
104
PATELLOFEMORAL JOINT TAPING pt position
Supine with knee in neutral supported position.
105
application of Medial tilt tape
* Start tape from the middle of the
patella.
* One hand holds the tape while the
thumb of the other hand tilts the
patella medially.
* Lay the tape down over the patella to
finish on the medial side of the knee
106
application of Medial glide tape
Start from the lateral knee.
* Lay the tape down up to the lateral border of the patella and ensure that it is firmly attached.
* One hand holds the tape while the thumb of the other hand glides the patella medially.
* With your fingers, gather up the skin and tissues on the medial side and lay the tape down over the top of the patella to finish on the medial side of the knee. Do not apply compression to the patellofemoral joint.
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FAT PAD DELOADING taping application
pt position is in supine w knee supported by a towel
* Make a ‘V’ to deload the fat pad.
* Place a piece of tape from tibial tuberosity and direct the tape medially and upward.
* Place a piece of tape from tibial tuberosity and direct the tape laterally and upward.
* Draw the fat pad and tissue towards the midline as you apply each of these strips.
* The superior band of tape completes the triangle, including drawing in the tissue toward the centre. This strip can cover the superior border of the patella to create a posterior tilt of the patella to lift the inferior pole off the fat pad
can also be used to deload the patella tendon
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goals for theraputic expercise
* control pain and swelling
* encourage early return of pain free range of motion.
* encourage early return of muscle strength.
* restore normal movement patterns, including gait.
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Patella Dislocation EXERCISE PRESCRIPTION/ dosage
knee extension with towel under leg. ensure VMO is activated first, if need be to help ext rotate
<12 reps x 2-3
sets, 4-5 x day,
everyday
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progression for patella dislocation from ismoetric knee extension
INCREASE ROM IN STAGE 2
knee extension in seat/ edge of the plinth
5-10 reps
X 10 sec hold
3 x day,
everyday
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grade 3 manual therapy techniques what it is and dosage- passive physiological treatments
large amplitude movement performed into resistance or up to the limit of available range
2-3 sets or > of 1 min or > dependent on changes in tissue resistance and/or pain
pain and stiffness
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grade 4 manual therapy techniques what it is and dosage- passive physiological treatments
small amplitude movement performed into resistance or up to limit of available range
2-3 sets or > of 1 min or > dependent on changes in tissue resistance and/or pain
stiffness
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TFJ Extension through Grades application
Patient position: supine
Therapist: standing beside the plinth, facing patient, one leg bent up onto plinth to get close to knee joint
Handling: Both hands grasp around the knee joint, fingers cradling the knee from underneath and thumbs wrapping around the sides to anterior aspect
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Clinical Application: of TF extension as a treatment for what
Osteoarthritis, end range knee extension stiffness+/- pain
NOT joint instability, acute ligament injuries, joint replacements, ACL reconstructions
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TFJ flexion through Grades application
bring hip to 90 degrees
G3- 90-90 degrees
g4- push at end range
116
Clinical Application: of TF flexion as a treatment for what
steoarthritis, end range knee flexion stiffness+/- pain
NOT joint instability, acute ligament injuries, joint replacements, ACL reconstructions
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PASSIVE ACCESSORY TREATMENT TFJ AP
Patient supine rolled towel under test knee.
* Therapist facing patient.
* Handling: thumbs of both hands placed over proximal anterior tibia, fingers resting on adjacent surfaces of tibia & fibula.
* Movement of tibial plateau is performed relative to femoral condyles in an anterior to posterior direction
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clinical application of TF AP as a treatment for what
Flexion stiffness +/- pain
119
PASSIVE ACCESSORY TREATMENT TFJ PA
Patient supine rolled towel under test knee.
* Therapist facing patient.
* Handling: thumbs of both hands placed over proximal anterior tibia, fingers resting on adjacent surfaces of tibia & fibula.
* Movement of tibial plateau is performed relative to femoral condyles in a posterior to anterior direction
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clinical application of TFJ PA as a treatment for what
extension paind and or stiffness
121
PASSIVE ACCESSORY TREATMENT TFJ PA medial glide
Medial glide
One hand stabilises distal femur from
medial aspect, one hand performs glide
from lateral aspect of proximal tibia
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PASSIVE ACCESSORY TREATMENT TFJ PA lateral glide
Lateral glide
One hand stabilises distal femur from lateral
aspect, one hand performs glide from medial
aspect of proximal tibia
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clinical application of TFJ medial and lateral glide as a treatment for what
Medial or lateral knee pain and decreased ROM of flexion or
extension
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what does MWM stand for
mobilistation with movement
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Weightbearing knee flexion MWM
* Patient standing with knee flexed on a stool (holding onto back of chair)
* Therapist stands/squats to side of patient level with knee joint.
* Handling: Glide applied as above, and patient actively lunges into further knee
flexion.
* A seatbelt may also be used for this technique.
* Technique must be pain free throughout movement
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MWM must be PILL
Pain free, Instant, Long Lasting
127
MWM dosage
Dosage: 1 set x 6-10 reps//reassess
May repeat for up to 2 more sets if successful
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PASSIVE ACCESSORY TREATMENT TECHNIQUES FOR THE SUPERIOR TIBIOFIBULAR JOINT PA/AP
AP
Patient crook lying, test leg bent 90°
flexion.
* Therapist sits on the plinth facing the patient.
* Handling: Thumbs/thenar eminence placed over fibula head, other hand stabilises tibia/calf muscle bulk.
* Glide fibula from anterior to posterior direction.
PA- same position
therapist sits on the plinth facing the patient.
* Handling: Pads of fingers placed behind fibula head and thenar eminence placed anteriorly, other hand stabilises tibia/calf muscle bulk.
Care is required to avoid pressure to the common peroneal nerve.
* Glide fibula from posterior to anterior direction
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clinical application of STFJ ap and pa a treatment for what
STFJ pain +/- stiffness eg: post immobilization
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Medial patella tilt in neutral and
relevant flexion angle PAM
place base of thumb on medial boarder, towel under pt
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Medial patella glide PAM
Medial glide and/or tilt of patella with
ITB on stretch
can also be preformed as an MWM
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clinical causes of patella PAMs for when you would use it as a treatment
Patellofemoral maltracking and pain, PFPS
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distraction of a patella what is it and when to use it what grade
grade 4 pull patella up from articular surface
PF stiffness +/- pain e.g., post immobilization, chronic knee
swelling, post TKR
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caudual and cehauld PAMS clinical application
PF stiffness +/- pain e.g., post immobilization, chronic knee
swelling, post TKR
135
clinical reasoning- why would we use PAMs
improve range of motion
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best exercise prescription for PATELLOFEMORAL PAIN SYNDROME and dosage
isometric vastus medialis
3 by 3 second holds 10 times
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best exercise prescription for PATELLA TENDINOPATHY and dosage
in seated position use quads to kick affected leg up with resistance applied by hamstrings of the opposite leg.
do it 5 times for 45 sec at 70% intensity with 2 miniute break in between
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best exercise prescription for GRADE I ACUTE HAMSTRING MUSCLE STRAIN and dosage
standing up i want you to rotate from your hip keeping your leg that ias on the ground and in the air straight while also maintaining your back straight and just bend through your hip to 90 degrees. 3 seconds down 1 second up- helps to improve power
6 rep 2 sets 3 times a day
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best exercise prescription for ACL RECONSTRUCTION and dosage
30 sec 3 sets 3 times a day without agg pain. stingle leg stand
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reflexes in CNS
babinki and clonus ONLY
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reflexes in lower limb
achillies tendon and patella tendon
