the client is unable to lower their leg smoothly, this indicates hypertonicity of the IT band or TFL. Myofascial release along the IT band from knee toward the hip may by beneficial. Piriformis length test Tests for hypertonicity of piriformis. The client should be in the prone position on the table. Their legs should be straight with knees together before the therapist passively flexes the knees to 90 degrees. Holding the client’s ankles, the therapist medially rotates both hips (feet outward) to test the length of piriformis. A hypertonic piriformis is indicated if there is less than 45 degrees lateral rotation of the feet away from the midline. Any signs of sciatica such Posterior sacroiliac joint test This tests for a posterior SI joint dysfunction. The client should be in the side-lying position. Both their hips and knees should be flexed to 90 degrees. Standing behind the client, the therapist places the fingers of one hand on the ASIS and their other palm on the ischial tuberosity of the side being tested. The therapist attempts to passively rotate Anterior sacroiliac joint test This tests for an anterior SI joint dysfunction. The client should be in the supine position on the table. The therapist places crisscrossed hands (fingers facing away from the body) across the client’s ASIS and pushes them laterally away from each other. Deep pain in the inferior abdomen, SI joint motion test/Stork-Gillet test This procedure tests for ROM at the SI joint. The client should be standing with the therapist behind them, a thumb on each side of the client’s PSIS. The client flexes the hip of the side being tested while standing on the unaffected side. Then the other hip will be tested. This should be repeated several times so the therapist has a good sense of the client’s hip movement. An anterior tilt to the pelvis, Gaenslen’s test This tests for an SI joint dysfunction. The client should be in the side-lying position on their unaffected side and will flex their hip and the knee toward their chest. The therapist will stand behind the client and passively extend the affected hip’s thigh as far as possible. A positive result is indicated by pain at the SI joint when the affected side’s thigh is moved 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
Directional massage, PNF stretches, and trigger point therapy are indicated for the TFL muscle itself (Manske & Magee, 2018).
as numbness, tingling, burning, and/or pain in the lower back, gluteal region, and/or down the legs are further confirmations of a hypertonic piriformis. Cross-fiber friction at the edge of the sacrum and the superior-posterior aspect of the greater trochanter may be helpful. PNF stretches are also an effective noninvasive treatment (Manske & Magee, 2018). the hip posteriorly. Pain at the posterior SI joint indicates an SI joint dysfunction. Since a positive result would indicate a dysfunction of the SI joint’s ligaments, manual therapy will be of limited value unless hypertonic muscles such as the psoas or inferior aspect of the erector muscles is the cause (Manske & Magee, 2018). at the anterior SI joint, indicates a dysfunction. As in the previous test, manual techniques will most likely be of limited value in directly addressing any SI joint dysfunction (Manske & Magee, 2018). commonly attributed to hypertonic iliopsoas, may be indicated by a lack of movement of the PSIS on the side of the raised knee or if the PSIS moves superiorly instead of inferiorly during flexion of the hip. PNF stretches and trigger point therapy may relieve the hypertonicity of the iliopsoas (Manske & Magee, 2018). beyond 20 degrees of extension. Note that the pain may be due to either injured ligaments or a hypertonic gluteus maximus at its origin along the superior aspect of the border of the sacrum. Cross-fiber friction between the sacrum and ilium and PNF stretches are indicated for gluteus maximus (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).
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