Straight leg test This tests for the cause of lower back pain. The client should be supine on the table with their legs fully extended. Beginning with the client’s leg adducted and medially rotated, the therapist will grasp the client’s heel and, keeping the knee in extension, slowly raises the leg until the client feels pain or discomfort. The leg is slowly lowered until no pain is felt. Hypertonicity of the hamstrings is indicated by pain at any point at the ischial tuberosity, pain in the posterior thigh or the posterior knee, and/or less than 90 degrees of flexion at the hip. Cross-fiber friction at the Supine to sit test This tests for leg length discrepancy. The client should be supine with both legs fully extended. The therapist will make a note of each ankle’s malleolus in relation to each other. The client is then asked to sit up while the therapist takes note of any changes in malleolus position. An anterior hip rotation/pelvic tilt is indicated on the leg side that becomes longer while a posterior hip rotation/pelvic tilt is indicated Thomas test This tests for hypertonicity of the hip flexors. The client should be seated on the edge of a hard surface. The client will lean back and flex one hip at a time, holding themselves at the knee once they’re at the end of their ROM. Hypertonicity of the rectus femoris of the quadriceps group, TFL, sartorius, or iliopsoas is indicated if the client’s knee on the side being tested is above the level of the table. Hypertonicity of the iliopsoas is further indicated by Ely’s test This tests for hypertonicity of the rectus femoris muscle of the quadriceps group. The client should be in the prone position on the therapy table. The therapist passively moves one of the client’s knees into flexion, attempting to touch the client’s heel to their gluteal muscles. A hypertonic rectus femoris muscle is indicated if the hip on the side Hamstring strain test This tests for the location of a hamstring strain. The client will be in a prone position on the table with their knees flexed to approximately 70 degrees. To assess the medial hamstring muscles, the therapist will bring the affected thigh into flexion, then into medial rotation and knee extension while the client resists the movements at both joints. Deep pain indicates an injury of the semimembranosus muscle while superficial pain indicates an injury to the semitendinosus muscle. To assess the lateral hamstrings, the Noble’s test This tests for hypertonicity of the IT band as a cause of pain on the lateral side of the knee. The client should be in the supine position on the table with their affected hip and knee flexed to 90 degrees. The therapist will grasp the ankle and move the knee back and forth through extension and flexion while applying thumb pressure on the lateral epicondyle of the femur. A feeling of crepitus or the client reporting pain at or above the lateral epicondyle is indicative of IT band syndrome. This may be caused by injury to the IT band at or near the lateral epicondyle, or by the hypertonicity of the TFL muscle. As long as inflammation is not present, cross- fiber friction above, at, and below the lateral epicondyle may be helpful. If hypertonicity of the TFL is suspected, directional massage on the TFL itself or PNF stretches for the hip flexors may be applicable (Manske & Magee, 2018).
ischial tuberosity is helpful for the hamstrings, as are PNF stretches and directional massage (Manske & Magee, 2018). A lumbar or sacral dysfunction is indicated if the client is in pain in the lumbar area after 70 degrees of flexion at the hip. A herniated disc is indicated if the client experiences pain down the leg not being raised. A sciatic nerve impingement is indicated by pain down the client’s leg when the leg is lowered while the foot is dorsiflexed. If a herniated disc is the source of dysfunction, the therapist will not attempt to correct the hernia and will not move the client through any ROM at their hips (Manske & Magee, 2018). on the leg side that becomes shorter. Treat hip flexors that may be causing an anterior pelvic tilt with PNF stretches for the longer leg. For the shorter leg, the rectus abdominis and the hamstrings are typically the muscles involved, which can be treated with cross-fiber friction at the respective origins, as well as PNF stretches and directional massage for the hamstrings (Manske & Magee, 2018). a resting anterior tilt to the pelvis (which is often visually assessed during an increase in lumbar lordosis) while hypertonicity of TFL may be indicated by the leg being tested going into abduction when the client leans back. PNF stretches will be the quickest way to release the hypertonicity of the hip flexors in general (Manske & Magee, 2018). being testing goes into flexion during the test, raising the hip off the table. The AIIS and the patellar tendon should be checked for hypertonicity and treated with cross-fiber friction while the muscle belly and the quadriceps in general can be treated with directional massage, PNF stretches, and trigger point therapy (Manske & Magee, 2018). therapist will bring the client’s thigh into lateral rotation and knee extension while the client resists the movements at both joints. Deep pain indicates an injury to the short head of the biceps femoris while superficial pain indicates an injury to the long head of the biceps femoris. Rest is often the easiest treatment option for strains while the application of ice would be suitable for areas that exhibit inflammation (Manske & Magee, 2018).
Self-Assessment Quiz Question #3 Which manual technique might be helpful in quickly releasing the iliopsoas muscles? a. PNF stretches.
b. Cross-fiber friction. c. Directional massage. d. Myofascial release.
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Book Code: MPA0825
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