SECTION IV: ORTHOPEDIC TESTS FOR THE SPINE AND TRUNK
Functional versus structural scoliosis test This tests for whether the cause of scoliosis is functional/ muscular or structural/skeletal in nature. The client stands with their shirt removed. The therapist stands behind the client and observes the client’s spine and its curvature. The client bends their trunk into lateral flexion on the side of their spine the spine is curving toward, then returns to the neutral position. Then the client flexes their trunk forward. Functional scoliosis is indicated if the spinal curvature corrects itself when the client laterally flexes their trunk or if the curvature reverses when the client flexes their trunk Scoliosis short leg test This tests for uneven leg length that may be causing functional scoliosis. The client should be standing. The therapist is in front of the client noting the position of the bilateral hips and shoulders to see if there is any tilting due to scoliosis. The therapist places a thin book under the foot of the suspected shorter leg, which itself may be indicated Kemp’s test (Lumbar quadrant test) This tests for nerve root compression due to a disc herniation in the lumbar region. The client is standing and hyperextends their back, then laterally flexes their trunk to the affected side before returning to the neutral position. The client may also go into lateral flexion toward the affected side, then rotate their trunk toward the affected Slump test This tests for nerve root compression due to a disc herniation in the lumbar region. The client should be seated on the edge of the therapy table, spine erect, with their feet hanging freely. They will be asked to interlace their fingers behind their back before slumping their entire spine—including their neck—into flexion. Next, the client Quadratus Lumborum (QL) length test This tests for hypertonicity of the QL muscle. The client may be seated or standing. The therapist stands behind the client and notes the position of the bilateral hips at the posterior superior iliac spine (PSIS). The client then laterally flexes their trunk to one side and then the other while the
forward. Structural scoliosis is indicated if the curvature does not correct itself during either action. In either case, the therapist can treat hypertonic muscles on either side of the spine with directional massage, myofascial release, or trigger point therapy, but the client’s long-term relief can only be expected if the client’s scoliosis is functional in nature. It is outside most manual therapists’ scope of practice to attempt structural corrections (Hendrickson, 2020). by either an inferiorly situated hip or shoulder. A positive result is indicated if the curvature disappears after the book is placed under the shorter leg’s foot. Hypertonic muscles of the lower back and hips should be addressed with directional massage, PNF stretches, myofascial release, and/ or trigger point therapy (Hendrickson, 2020). side. A positive result is indicated by tingling, numbness, burning, and/or pain down the leg of the affected side. The therapist should avoid traction of the neck and lower limbs and not attempt to treat the herniated disc directly (Hendrickson, 2020). will extend the knee on the affected side and dorsiflex their ankle. A positive result is indicated by numbness, tingling, burning, and/or pain in the lower back at any time during the test. The therapist should avoid traction of the neck and lower limbs and not attempt to treat the herniated disc directly (Hendrickson, 2020). therapist notes which side has a reduced ROM at the PSIS. A reduced ROM in combination with an elevated hip free of pain indicates a shortened QL. All manual strokes, including cross-fiber friction at the posterior iliac crest, are indicated (Hendrickson, 2020).
SECTION V: ORTHOPEDIC TESTS FOR THE HIPS
Iliopsoas strength test This tests for weakness of the iliopsoas muscles. The client should be lying on the therapy table in the supine position with their knees in full extension; no bolster is placed underneath them. The client is asked to actively raise one of their thighs off the table with a slight lateral rotation while flexing their knee to 30 degrees. The client is asked Iliopsoas length test I This tests for hypertonicity of the iliopsoas muscles. The client should be on the therapy table in the supine position, again, with no bolster. The therapist places the foot of the side being tested on the opposite knee (in a “figure 4” Iliopsoas length test II This tests for hypertonicity of the iliopsoas muscles. The client should be on the therapy table in the supine position near the edge of the table on the side being tested, again with no bolster. The therapist drapes the thigh of the hip being tested off the edge of the table. Hypertonic iliopsoas
to maintain this position. If they cannot, the iliopsoas group is considered weak. Active-resisted exercises may be employed to strengthen the iliopsoas. Trigger points in the deep psoas muscle may also inhibit the strength of this hip flexor group, in which case trigger point therapy and PNF stretches are indicated (Manske & Magee, 2018). position). Hypertonic iliopsoas muscles are indicated if the hip of the side being tested rises above the opposite knee. Non-invasive PNF stretches may help release this hypertonic group (Manske & Magee, 2018).
muscles are indicated if the client’s thigh does not drop below tabletop level. Noninvasive PNF stretches may help release this hypertonic group (Manske & Magee, 2018).
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