Ultimate Review Deck Flashcards
How do we rule in SIJ?
Gaeslen’s test
Sacral thrust
Compression
Distraction
Thigh Thrust
How do we rule out SIJ
Gaeslen’s test
FABER
Compression
Distraction
Thigh thrust
What test is this?
which leg is being tested?
Gaeslen’s test
Bottom leg
Which part of the SIJ do we treat first, hypo or hypermobile?
How do we find out which side is hypo and which is hyper
hypomobile
seated or standing flexion test
In this test which side moves more?
The hypomobile side
In the long sitting test which side has a posterior innominate?
Posterior innominate- Longer leg
What are the steps of the active SLR test?
- Lift leg -> causes pain
- Lift leg w/ compression -> No pain? Form Closure
- Lift leg w/ core activation -> No pain? Force Closure
What SIJ problem does this fix?
Can fix general SIJ problems, but mainly for anterior innominate
If you palpate someone’s SIJ and you feel the ASIS lower and the PSIS higher, what is this?
Anterior Innominate
You palpate the SIJ and you feel the ASIS and the PSIS higher, what is this?
Up slip
What is this correcting?
What is the proper positioning for the patient’s leg
Upslip correction
Ext+ IR+ Abd
If a patient is isometrically using their hip flexors, which way are they pulling their innominate
into anterior rotation, fixing a posterior innominate
What is this fixing?
What is the therapist essentially doing?
Posterior innominate
Providing PA glides to one side of the SIJ while that leg is in EXT, the other leg is in hip flexion which is locking out the opposite side SIJ
What is this for?
Whole hip “reset button”
What is this improving?
What is the therapist hand motion?
Improves IR, Adduction
Scoop -> lateral distraction
What is this improving
improve hip flexion
scoop -> posterior-lateral mob
What is this improving
improves hip ext
What is the progression of tests to rule in a labral pathology
FADIR -> Hip Quadrant -> Hip Scour
another option: Fitzgerald (anterior labrum)
How do you test for a stress fracture of the hip or femur?
Patellar-pubic Percussion test
Listen on the pubic symphysis while tapping on each patella
less noise than other side = fx
How do you preform the fitzgerald test?
What is it for?
Passively move hip from FABER into Ext + IR + Adduction
Anterior Labral Tear
What does FADIR test for?
Femoral Acetabular Impingement
What is C- Sign
Indicates possible FAI/Labral pathology
Where will someone point if SIJ is likely the problem
At PSIS (Fortin’s Sign)
How do you preform Hip Quadrant/ Hip Scour
Quadrant - Flexion/Abduction/ER -> Flexion Adduction/IR (Bring hip around the world)
Scour- Add compression
What is craigs test?
For femoral anteversion/retroversion
Palpate greater troch and find angle of leg off of parallel
normal is 10-15 of IR
15+ is Anteversion
<10 is retroversion
Altman’s clinical criteria for hip OA
5 components
Hip Pain
IR Less than 15
Pain with IR
Morning Stiffness up to 60 minutes
Age 50+
Sutlive CPR for Presence of Hip OA
5 components
Squatting increases symptoms
Scour test with adduction causes groin or lateral hip pain
active hip flex -> lateral pain
active hip ext -> pain
Passive hip IR less than 25 degrees
What is this improving?
What is the therapist doing?
Improving hip IR
Holding onto leg, adding PA mob to opposite SIJ
What motions is this helping?
ER/ABD
use when pt has positive FABER, but does not have reproduction of symptoms with treatment
Contraindications for manual therapy
Infection
Febrile state
Acute Circulatory condition
Malignancy
Open Wound
Fracture
Hematoma
Advanced DM
Hypersensitivity
Inappropriate end feel
RA (during exacerbation)
Cellulitis
Constant Severe Pain
Extensive Radiation of pain
3 signs of a positive Neurodynamic test?
Reproduces patient symptoms
Test altered by movement of distant bodypart
Test differences from side to sid e
Contraindication for neurodynamic mobilizations
Recent repaired nerve
Malignancy or any compression of nerve
Active Inflammatory conditions
Demyelinating diseases
Age 2-13
Gradual onset ache in hip
shorter limb
limited abd/ext
antalgic gait
Leg Calve Perthes
8-17
Gradual onset vague pain in hip
Shorter limb, usually obese, Quad atrophy, adductor spasm
Antalgic gait/ trendelenberg sign
Slipped Femoral Capital Epiphysis
Urgent care referral, they can walk into the ER on crutches themselves
30-50 year old
sharp pain/ pain with extreme motion in hip
decreased ROM
limping
Avascular necrosis
40+
Pain w/ weightbearing in hip
obese, joint crepitus
ROM: Limited, capsular pattern
Degenerative joint disease
50+ post menopause female
difficulty climbing stairs, sleeping on side
pain in hip
Gluteus Medius Tendinopathy/tear
How can a patient self-treat limited hip IR?
Rock back onto legs in quadruped with legs in slight IR
How to progress exercises for hip OA
Mobility -> Open chain exercises -> Close chain functional exercises
Valgus force damages:
Hyperext damages:
Dashboard injury damages:
Varus Force damages:
Valgus force damages: MCL
Hyperext damages: ACL
Dashboard injury damages: PCL
Varus Force damages: LCL
Deceleration/acceleration valgus force near extension or hyperextension
hear a pop
knee giving way
loss of end range ext
ACL
What is a segond fracture
(sign of ACL tear) Avulsion of LCL due to too much IR from tear of ACL
Cruciate ligaments limit _______
Collateral ligaments limit ______
IR
ER
What tests are for the ACL?
Lachmans
Anterior Drawer
Pivot Shift
What is the difference between lachmans and anterior drawer
Lachmans is better because of the knee angle being less bent, less guarding from hamstrings
How is the MCL tested?
How is the LCL tested?
Valgus stress at 20-30 degrees knee flexion
Varus stress at 30 degrees of knee flexion
What is the MOI for anteromedial rotary instability
What is the MOI for anterolateral rotary instability
How do you test for anteromedial instability
How do you test for anterolateral instability?
Valgus force with tibial ER motion
Valgus force with tibial IR motion
Anterior Drawer with ER
Anterior Drawer with IR
What is the mechanism of posteromedial rotary instability
What is the mechanism of posterolateral instability
How do you test for posteromedial instability
how do you test for posterolateral instability
traumatic ext + IR
Traumatic ext + ER
Posterior drawer + IR
Posterior Drawer + ER
What kind of injury presents with a varus thrust during gait
Posterolateral corner injury
catching/locking in knee
injury with a twist mechanism
joint line tenderness
pain with forced knee hyperext or passive knee flexion
meniscus
Criteria for Knee OA
Age 50+
Knee Crepitus
Palpable bony enlargement
bony tenderness to palpation
morning stiffness less than 30 minutes
no palpable warmth
Criteria that hip mobs can help knee OA
Pain with ipsilateral hip distraction
ipsilateral knee flexion < 122
ipsilateral hip IR < 17
Pain or paresthesia in ipsilateral groin or hip
ipsilateral anterior thigh pain
Pain with stair climbing, prolonged sitting, squatting
PFPS
What test is often used for PFPS
Step down test
Criteria for lumbopelvic manip to treat PFPS
- Difference between sides of >14 IR in hip
- Ankle DF > 16
- Navicular drop > 3mm
- NO reported stiffness in sitting for 20+ mins
- Squatting reported as most painful activity
Probability of 94% with atleast 3/5
What are the 4 stages of treating patellar tendinopathy
isometric loading
isotonic loading
energy storage
return to sport
Overuse injury common after jumping and running sports
Patellar Tendinopathy (jumpers knee)
whats the biggest risk factor for ankle sprains
BMI
should you use ultrasound on chronic ankle sprains?
no
Ottawa ankle rule
Tenderness at lat mal
Tenderness at med mal
inability to WB 4 steps after and in ER
Ottawa foot rule
Tenderness at Base of 5th met
Tenderness at navicular tubercle
Inability to WB immediately after and in ER
pt complains of burning, worsening with stretching the tissue
pt recently was in an acute injury or had vigorous exertion
compartment syndrome (emergent)
How do PTs manage developing compartment syndrome
elevate extremity to the level of the heart
Where is achilles tendinopathy most common
mid-substance
Loss of arch height
forefoot abduction, rearfoot valgus
limited/painful plantarflexion
abnormal gait w/ decreased pushoff
Posterior tibialis tendon dysfunction
Can we use isolated foot orthoses or ultrasound for plantar fasciitis?
no, evidence says not to use these
What does the evidence say is the best treatment for plantar fasciitis
Manual therapy
stretching (of gastroc/soleus and the plantar fascia)
taping
night splints
How much great toe ext do you need for gait
65-70
How do we treat hallux rigidus
Toe mobilizations
(mob the same way the toe bends)
Wells DVT Criteria
Active cancer within 6 months +1
Paralysis Paresis or recent immobilization +1
Recently bed ridden 3+ days +1
Localized tenderness amongst deep vein distribution +1
Entire lower extremity swollen +1
Calf swelling by 3+ cm compared to other LE +1
Pitting edema 1+
Collateral superficial veins 1+
Alternative diagnosis likely -2
3 or more = 75% chance
What does the foot posture index look at?
How palatable different structures are to indicate if you have pronation or supination
scored -2 to 2
2 is pronated
-2 is supinated
Can you MMT pronation and supination?
NO, dr arnold wants us to focus our tests on specific muscles and NOT motions
What is this mobilization improving?
ER of fibula -> Increase dorsiflexion
What joint is this mobilizing?
What motions are increasing for which direction?
Subtalar inversion/eversion
Mobilize in opposite direction of the motion
Posterior-> anterior force applied here is improving what motion at the talocrural joint
Plantarflexion
anterior -> posterior force applied to the talocrural joint is improving what motion at the talocrural joint
Dorsiflexion
This is improving what motion?
Toe extension
What are the 2 tests for a syndesmotic/high ankle sprain?
Fibular translation test
External rotation test
How do you preform the fibular translation test?
Move distal tib-fib joint back and forth
should recreate symptoms of high ankle sprain
How do you preform the external rotation test?
-knee flexed to 90
-externally rotate ankle
should recreate symptoms of high ankle sprain
What test can you do to see if the ATFL is intact after lateral ankle sprain?
Anterior Drawer test for foot (Pull up on calcaneus)
preform with slight plantarflexion to stay in open packed position
What test can you use to see if the CFL Ligament is intact from a lateral ankle sprain?
Medial Talar Tilt Test
Provide medial force at calcaneus while stabilizing malleoli
+ test is excess laxity
How do you test for ankle impingement?
Forced Dorsiflexion test
Positive test = recreation of symptoms
how do you gain motion at the proximal tibiofibular joint?
Proximal Tibiofibular manip:
-Check knee flexion PROM
-Bring a flat hand in pit of knee
ER tibia
Slow knee flexion to take up slack -> quick knee flexion
How do you mob the distal tib-fib joint?
Provide A->P pressure to distal fib while stabilizing tibia
or turn patient prone and do a P->A mob
What kind of manips can improve dorsiflexion
ER of the tibiofibular joint
Talocrural gapping
Talocrural anterior->posterior mob
This is improving what?
Plantarflexion
What is this improving
Dorsiflexion
How do you improve inversion?
Stabilize talus, Mob calcaneus laterally
How do you improve eversion?
Stabilize talus, mob calcaneus medially
Pt has lateral foot pain and feels like there’s a pebble in their shoe
cuboid displaced inferiorly
Use cuboid whip or cuboid squeeze
How do you preform the more aggressive dorsifleixon talocrural mob
Stabilize tibia, mobilize talus posteriorly
use thigh to increase dorsiflexion
How do you preform “mobilization with movement” for dorsiflexion
mobilize talus back or mobilize tibia forward
What are the 2 parts to thesslays test
closed chain rotation w/ 5 degree knee flex
closed chain rotation w/ 20 degree knee flex
What is the correct position for the lateral patella apprehension test
position patient as shown
High foot posture index score means:
Low score means:
Pronation
Supination
How do you asssess achilles tendon integrety
Thompson test
squeeze calve and see if foot plantarflexes
To increase dorsiflexion in close chain you either need to
_____________
or
______________
Push the talus back as the knee comes over the toes
or
pull the tibia forward with a belt as the knee comes over the toes
what kind of foot is predisposed to tarsal tunnel syndrome
overpronation
Pt has just sprained their ankle 1 day ago and now see’s you in the clinic? Would you recommend they temporarily wear a brace that immobilizing the joint to prevent re-injury
No
You’re doing rehab for an achilles tendinopathy patient and you tell them it’s normal for the eccentric exercise to cause pain, but their pain doesn’t return to normal in 24 hours.. is this normal?
No you loaded them too much. Should always work within a pain level that returns to baseline in 24 hours. it is too early to eccentrically load this patient
Pt has swelling at medial ankle and weakness with pushoff, what can we palpate to help diagnose the patient
posterior tib tendon
What kind of boney abnormality will present as loss of IR in the hip?
Femoral Retroversion
Pt is stiff in AM, better with activity, then worse in evening
OA
Warm-up phenomenon w/ tendons/tendinopathy
Tendon hurts at beginning and end of activity (ex: running)
Neutral + inversion tests =
Neutral + PF tests =
Neutral + DF tests =
CFL
ATFL
PTFL
Manual therapy Criteria for LBP
No symptoms distal to knee
Less than 16 days of pain
Less than 19 FABQ
Atleast 1 hypomobile segment
1 hip with IR over 35
Stabilization Criteria for LBP
Less than 40YO
Post partum
SLR 91+
Catch/abberant movements
Prone instability test
When is the only time we prescribe patients with repeated motions exercises
If they have radiating pain
How many SIJ provocation tests have to be positive to rule in SIJ?
3/5
Important ankle sprain subjective Q: Do they have history of ____________
recurrent ankle sprains
it is the #1 predictor of future ankle sprains
