the ulna nerve will cause pain of the arm or shoulder. As in the previous case, further nerve impingement should be avoided, so
the therapist should communicate with the client about burning, tingling or numbing sensations.
Assessments for the trunk Functional/structural scoliosis test
under the foot of the suspected shorter leg. A positive result is indicated if the curvature disappears after the book is placed under the shorter leg’s foot. Massage and traction of the lower back muscles and hips of the affected side are indicated. Kemp’s test (Testing for nerve root compression due to disc herniation in the lumbar region.) The client is standing. The client extends their back then returns to the neutral position. Client goes into lateral flexion towards the affected side then rotates the trunk towards the affected side. A positive result is indicated by pain, numbness or tingling down the leg of the affected side. Traction of the neck and lower limbs is contraindicated. Quadratus lumborum (QL) length test (Testing for the length of the QL.) The client is seated. The therapist stands behind the client and notes the position of the hips. Client laterally flexes the trunk to one side then the other while the therapist notes which side has a reduced ROM. A reduced ROM indicates a shortened QL. All massage strokes are indicated. Their bottom leg, the leg not being tested, is flexed to 90 degrees at the hip and knee. The leg being tested is kept straight. The client’s entire leg is abducted with a slight extension to 45 degrees and then the client is asked to slowly lower their leg to the starting position. If the client is unable to lower their leg, this indicated hypertension of the IT Band or TFL. The therapist will massage affected muscles as indicated. Myofacial Release, a light to medium broad application of effleurage along the IT Band from knee to hip may by beneficial. Pace abduction test (Testing for dysfunctions of the piriformis muscle.) The client is in side-lying position. Both legs are flexed to 90 degrees at the hip and knee. With the therapist’s hands on the lateral aspect of the client’s knees, the client is asked to abduct their knees away from each other. Weakness of the piriformis muscles will be indicated if the client is unable to abduct their legs. Pain in the area of the piriformis may indicate a dysfunction or injury of the piriformis muscle. Apply cold therapy to reduce pain. The therapist may use PNF stretches to lengthen the piriformis muscle once pain has subsided. If using deep tissue techniques to treat the piriformis muscle, the therapist should take care not to innervate the sciatic nerve that is deep to the muscle. Piriformis length test (Testing for hypertension of the piriformis muscle.) The client is in prone position on the table. Their legs are straight with knee together, then the client bends at the knees to 90 degree. Each leg is then rotated laterally to test the length of the piriformis. Hypertension will be indicated if there is less than 45 degrees lateral rotation of the affected leg. As in the previous case, the therapist may use PNF stretches to lengthen the piriformis muscle. Gaenlen’s test (Testing for an SI Joint dysfunction.) The client is in a side- lying position on the table. The client flexes the hip and the knee of the unaffected side to their chest. The therapist stands behind the client. The therapist stabilizes the pelvis with one hand, then hyperextends the affected side’s thigh. A positive result is indicated by pain at the SI joint when the affected side’s thigh is moved into hyperextension; the pain may be due to either injured ligaments or hypertensive muscles along the border of the sacrum. Tendons between the sacrum and ilium may be massaged by the therapist within the client’s pain tolerance. The border of the sacrum where gluteus maximus and
(Testing for whether the cause of scoliosis is functional/muscular or structural/skeletal in nature.) With their shirt removed, the client is standing. The therapist stands behind the client and observes client’s spine and its curvature. The client is asked to bend their trunk into lateral flexion on the convex side of their spine, then return to the neutral position. Then the client is asked to flex 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 forward. Structural scoliosis is indicated if the curvature does not correct itself during either action. In either case, the massage therapist can massage hypertensive muscles, but long-term results can only be gained if the client’s scoliosis is functional in nature. It is outside a therapist’s scope-of-practice to attempt structural corrections. Scoliosis short leg test (Testing for uneven leg length that may be causing functional scoliosis.) The client is standing. The therapist is in front of the client noting positions of the bilateral hips and shoulders to see if there is any tilting due to scoliosis. Therapist places a thin book (Testing for shortness or hypertension of the adductors of the femur.) The client is on the table in the supine position. On the adductors side that is being tested, the client places the plantar surface of their foot on the medial portion of the opposite knee. (Client should be in a “Figure-4” position.) From this position, the therapist brings the thigh of the adductors that are being tested into flexion at the hip while applying posterior pressure on the knee of the side being tested. (A hand may be placed on the opposite leg’s inferior Quadricep muscles for stabilization purposes.) Shortened adductors or hypertension of the adductor muscles will be indicated by a limited range of motion on the side being tested. The therapist massages hypertensive muscles as indicated. Iliopsoas strength test Assessments for the hip Thigh adductor length test (Testing for weakness of the iliopsoas muscles.) The client is on the table in the supine position. Knees are in full extension; no bolster is placed under the knees. The client actively brings their leg off the table while flexing their knee to 30 degrees with a slight external rotation. The client is asked to maintain this position. If they cannot, the iliopsoas are considered weak. Active-assisted exercises may be employed to strengthen the iliopsoas. Iliopsoas length test (Testing for the length of the iliopsoas muscles.) The client is on the table in the supine position. The therapist places the foot of the side being tested on the opposite knee (again, a “figure-4” position). Shortened iliopsoas muscles are indicated if the hip of the leg being tested rise above the unaffected knee. Active- resisted stretches may be used by the therapist to lengthen a hypertensive iliopsoas. Hip range of motion test (Testing for complete ROM of the acetabulum/hip joint.) The client is on the table in the supine position. Knees may be bolstered. The client’s thigh is brought into flexion at the hip and circumducted through the joint’s ROM at approximately a 45 degree angle. Limited ROM, pain or crepitus (crackling) at any point through the ROM will indicate a dysfunction in that area. Apply heat therapy to lengthen hypertensive muscles that may be limiting ROM. The therapist should avoid performing ROM and stretches if crepitus is present. Ober’s test (Testing for hypertension of the iliotibial band aka IT Band and tensor fascia latae aka TFL). The client is in side-lying position.
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