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Practical 2 Flashcards

1
Q

Hip flexor muscles

A

Rectus Femoris, Iliacus, and Psoas Major

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2
Q

Hip flexor diagnosis/treatment

A

–PRONE, knee LESS THAN 90o, stabilize IT, extend hip, asymmetry –ME, pt driving thigh into table

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3
Q

Knee flexor muscles

A

–Biceps Femoris, Semimembranosus, and Semitendinosus

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4
Q

Knee flexor diagnosis/treatment

A
  • -SUPINE, hip flexed to 90o, extend knee, asymmetry

- -ME, pt driving heel into table

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5
Q

Knee extensor muscles

A

Rectus Femoris, Vastus’ Lateralis, Medialis, and Intermedius

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6
Q

Knee extensor diagnosis/treatment

A
  • -PRONE, flex knees, asymmetry

- -ME, pt driving leg into physician hand

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7
Q

Hip adductor muscles

A

Gracilis, Pectineus, Adductors Magnus, Longus, and Brevis

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8
Q

Hip adductor diagnosis/treatment

A
  • -SUPINE, abduct hip (toes pointed upward), asymmetry

- -ME, pt adducting hip

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9
Q

Hip abductor muscles

A

Tensor Fascia Lata, and Gluteus’ Medius and Minimus

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10
Q

Hip abductor diagnosis/treatment

A
  • -SUPINE, adduct hip (toes pointed upward) UNDER lifted leg (non-tested leg), asymmetry
  • -ME, pt abducting hip
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11
Q

External rotator muscles

A

Piriformis

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12
Q

External rotator diagnosis/treatments

A
  • -SUPINE, hold ankle and internally rotate thigh, asymmetry
  • -BELOW 90 degrees: (hip/knee pain), flex knee, foot placed on lateral side of opp. leg, internally rotate/adduct, ME, pt push knee into physician hand
  • -ABOVE 90 degrees: flex knee to 90o, externally rotate hip, flex/adduct hip to barrier, ME, pt pushing thigh into physician hand
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13
Q

Steps of strain/counterstrain

A
  1. Locate tender point
  2. Passively put pt into position into relaxation, where 75-100% improvement, fine tune if needed
  3. Hold for 90 seconds
  4. Slowly, passively return pt to original position
  5. Recheck
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14
Q

Iliacus tender point

A

LOCATE: 1/3 distance between ASIS and midline, deep posterolateral pressure

TREAT: SUPINE, flex knees/hips to 90 degrees cross ankles, strain/counterstrain

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15
Q

Adductor tender point

A

LOCATE: anywhere along medial thigh

TREAT: SUPINE, slight hip flexion/external rotation and hip adduction, strain/counterstrain

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16
Q

Piriformis tender point

A

LOCATE: midpoint of ILA and greater trochanter

TREAT: PRONE, hip flexion GREATER THAN 90 degrees, abduction, fine tune with rotation, strain/counterstrain

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17
Q

Psoas tender point

A

LOCATE: 2/3 distance between ASIS and midline, DIRECTLY posterior

TREAT: SUPINE, flex knees/hips, pt ankles rest on physician thigh, side-bend on side of dysfunction

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18
Q

Anterior hip capsule

A

ASSESS: if ROM not achieved with treatment of HIP FLEXORS –> PRONE, apply pressure to proximal femur

TREAT: PRONE, flex knee and gentle extend hip, test for pain, then apply LV/MA with rotation, reassess

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19
Q

Posterior hip capsule

A

ASSESS: if ROM not achieved with treatment of HIP EXTENSORS –> SUPINE, flex hip to 90o, flex knee, apply posterior force, asymmetry/tightness

TREAT: SUPINE, ASK if pt has Hx of hip/knee injury, test for pain, apply LV/MA with redirection, reassess

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20
Q

Steps to assess innominates

A
  1. Standing flexion test
  2. Muscle imbalances/strain patterns (SUPINE)
  3. Inflares/outflares
  4. Pubic compression/pubic shears
  5. Innominate rotation
  6. Repeat SFT
  7. Upslip (if positive)
  8. Repeat SFT
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21
Q

Innominate inflare assessment

A

SUPINE, ASIS medial positioning on side with positive SFT

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22
Q

Innominate inflare treatment

A

SUPINE, cross ankle of affected side over opp. leg (IF PAIN = POSITIVE FABER TEST = hip or SI joint dysfunction), push leg down to barrier, ME, pt pushes leg into physician hand

23
Q

Innominate outflare assessment

A

SUPINE, ASIS lateral positioning on side with positive SFT

24
Q

Innominate outflare treatment

A

SUPINE, flex hip to 90 degrees, hand on medial aspect of PSIS, adduct leg, ME, apply force through leg into table to stabalize, traction on PSIS

25
Pubic compression assessment
Assumed due to positive standing flexion test
26
Pubic compression treatment
SUPINE, flex knees, pt opposes motion --> hold together (3-5 seconds), then separate (isolytic)
27
Pubic shears assessment
Pubic tubercle positioning on side with positive SFT - -Higher = superior - -Lower = inferior
28
Superior pubic shears treatment
SUPINE, drop leg off table, hold opp. ASIS, have pt contract leg toward OPP. shoulder, ME
29
Inferior pubic shears treatment
SUPINE, leg on shoulder, monitor SI joint, hand cups IT, pt press leg into shoulder, ME
30
Innominate rotations assessment
1. Check whether ASIS on positive SFT side is more superior or inferior to other ASIS 2. Myofascial drag - -More superior ASIS and drags easier to posterolateral/superior ASIS = posterior - -More inferior ASIS and drags easier anteromedial/inferior ASIS = anterior
31
Posterior innominate rotation treatment
ME = same as superior pubic shear, but to SAME SIDE shoulder HVLA = leg level with table, abduction, ask for hip replacement, slight tug, ask for pain, deep breath, pull
32
Anterior innominate rotation treatment
ME = same as inferior pubic shear, but NO IT cupping HVLA = hip flexed 30 degrees, abduction, ask for hip replacement, slight tug, ask for pain, deep breath, pull
33
Upslipped innominates assessment
- -Ischial tuberosity is REQUIRED for diagnosis | - -Need 3/5 landmarks: IT, PSIS, iliac crest, ASIS, pubic tubercles
34
Upslipped innominates treatment (ME)
SUPINE, have pt rest unaffected side foot on physician thigh, slightly abduct and internally rotate affected side leg, have pt push foot into leg, pull affected side leg to new barrier
35
Upslipped innominates treatment (HVLA)
PRONE, have ASSISTANT apply pressure to unaffected side ILA, abduct and internally rotate affected side leg, ask about hip replacement, slight tug, ask for pain, deep breath, pull
36
S1 (sacral tender point)
Found in sulci, treat by caudad and contralateral fascial drag at ILAs
37
S1 (sacral tender point)
Found at medial base (close to lumbosacral junction at spine of sacrum), treated by caudad fascial drag at ILAs
38
S3 (sacral tender point)
Found at medial, central sacrum, treated by either caudad or cephalad fascial drag
39
S4 (sacral tender point)
Found at medial apex (close to sacrococcygeal junction at spine of sacrum), treated by cephalad fascial drag at sacral base
40
S5 (sacral tender point)
Found at ILAs, treated by cephalad and contralateral fascial drag at sacral base
41
Steps to assess sacrum
1. Seated flexion test 2. Pt lies PRONE 3. Sacral sulci 4. Inferior ILA (torsion or unilateral) 5. Sphinx test (flexion/extension or backward/forward) 6. Treat SD 7. No correction --> probably indicates hemipelvis/short leg
42
Fascial drag (sacral confirmatory tests)
``` Caudad = extension/backward torsion Cephalad = flexion/forward torsion ```
43
Tender points (sacral confirmatory tests)
``` S2 = backward sacral torsion S4 = unilateral sacral flexion ```
44
Spring test (sacral confirmatory tests)
Negative (no resistance) = forward/flexion | Positive (resistance) = backward/extension
45
Backward sacral torsion assessment/naming
Deep sacral sulcus and opposite inferior ILA with a positive Sphinx test How to name: if right side = deep side --> left on right backwards sacral torsion (and vice versa)
46
Backward sacral torsion treatment (including revised treatment)
LATERAL RECUMBENT on axis side (deep sulcus side), assess lumbosacral junction, turn pt body backward until motion, extend bottom leg, drop top leg off table, ME, pt HOLD exhale Modifed treatment: top foot rests in popliteal fossa instead of leg off table
47
Forward sacral torsion assessment/naming
Deep sacral sulcus and opposite inferior ILA with a negative Sphinx test How to name: if right side = deep side --> left on left forward sacral torsion (and vice versa)
48
Forward sacral torsion treatments (easy and normal)
EASY: IT spread NORMAL: pt sits, turns toward side of dysfunction, falls forward and hugs around table, assess lumbosacral junction, flex knees and hips until L5 motion felt, push legs down, ME
49
Revised sacral torsion treatments (for pregnant/abdominal pain patients)
Pt sits, turns toward side of dysfunction, falls BACK, assess lumbosacral junction, flex knees and hips until L5 motion, push legs UP, ME
50
Unilateral sacral flexion assessment/naming
Deep sulcus and SAME inferior ILA with negative Sphinx test | How to name: if right sulcus deep/right ILA inferior, right unilateral sacral flexion
51
Unilateral sacral flexion treatment
PRONE, assess lumbosacral joint, abduct and internally rotate leg until motion at L5 felt, pt takes deep breath and holds while physician applies superior force to same side ILA, hold pressure while exhale, repeat to 4th barrier
52
Unilateral sacral extension assessment/naming
Deep sulcus and SAME inferior ILA with positive Sphinx test | How to name: if right sulcus deep/right ILA inferior, right unilateral sacral extension
53
Unilateral sacral extension treatment
PRONE, monitor SI joint at shallow sulcus, abduct and externally rotate leg on shallow sulcus side, ask pt to leave leg in this position, place hypothenar eminence on shallow sulcus with hand grabbing shallow-side ASIS, pt gets into Sphinx position, pt exhales fully, physician applies caudad and anterior pressure into sulcus while pulling ASIS laterally, for 3 seconds with pt HOLDING breath out, then repeat to 4th barrier, MAINTAIN pressure until pt has returned to normal, prone position

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