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).
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.
SECTION VI: ORTHOPEDIC TESTS FOR THE KNEE
Anterior and posterior drawer tests for PCL and ACL This tests for the integrity of the knee’s posterior cruciate ligament/PCL. The client should be in the supine position with their hip flexed to 45 degrees and knees flexed to 90 degrees, feet flat on the table for the knee being tested. The therapist places the fingers of both hands behind the knee and their thumbs in front of the knee on the tibial tuberosity. Then the therapist provides a short and sudden draw of the leg anteriorly. An injured PCL is indicated by posterior knee pain during the movement or by more than a few millimeters of movement of the tibia as it is drawn forward. This test can be conducted by pushing the leg posteriorly in the same manner with anterior knee pain indicating an injury to the anterior cruciate ligament/ACL (Cleland et al., 2020).
Healthcare Consideration: Due to the simplicity of the knee’s structure, there is potential for a strong therapist to injury a client’s knee during testing. Clients that report knee pain that is sharp prior to testing should be taken gently through any knee test. Any test that elicits sharp knee pain should be stopped immediately and the client referred to a physician or doctor of physical therapy. Also, manual therapies such as those listed in the beginning of this course will be of limited benefit when it is suspected that there are structural issues with the knee (Cleland et al., 2020).
Page 41
Book Code: MLA1225
EliteLearning.com/Massage-Therapists
Powered by FlippingBook