LowerBody Continued
Terms
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Iliacus: -
ROM Test:
⬢Test 8: Straight leg, hip flexion & external rotation
⬢Test 9: Straight leg, hip flexion, abduction and external rotation
⬢Test 10: Straight leg, hip flexion, adduction and external rotation
Muscle Test:
⬢Lie supine, flex the hip 30º, fully externally rotate the leg
⬢Take tension off of the psoas by having them bend their knee
Tester:
⬢Stand on involved side
⬢Stabilize the opposite ASIS
⬢Action hand on the medial malleolus
⬢Push straight down (force: hip extension)
Palpation:
Ilium
⬢Client flexes hip with femur externally rotated
⬢Get fingers on medial side of ASIS and try to sink down and inside the bowl of ilium
⬢Find medial aspect of ASIS & sink inside the bowl of the ilium, come down & into the ilium straight down, filling as much as the bowl of the ilium as you can
⬢Curl fingers into iliac fossa having client exhale
⬢Confirm through hip flexion
Lesser Trochanter
⬢Find adductor longus, come up pretty high and slide into the triangle just superior and anterior to adductor longus
⬢External rotation of thigh, follow above adductor longus tendon, pressure: down and in -
Psoas Major: Diaphragmatic Fibers -
ROM Test:
•Test 7: Straight leg, abduction and external rotation
•Test 9: Straight leg, hip flexion, abduction and external rotation
Muscle Test:
•Supine, very slight hip flexion, 30º abduction, full external rotation
Tester:
•Stand on involved side
•Stabilizing hand on opposite ASIS
•Action hand on medial malleolus
•Push down and out (extension and abduction through the oblique plane)
Palpation:
•For Diaphragmatic, treat L1 - L2 on the left side & L1 - L3 for the right side
•Can be performed on the patients side to move abdominal contents away
•Palpation is lateral to the bodies and anterior to the transverse processes
•Use umbilicus as a landmark. (Umbilicus is about L3)
•Take tension off of the psoas by having them bend their knee, easier to get into the bodies of vertebras
Left Crus: Xyphoid Process
•Come up to L2, then L1, then underneath the ribs
•Come up and under the rib cage, sink down, pull tissue back, and sink under the edge of the rib cage, palpating with the nail bed of our finger
•Start at the side of the xyphoid process and then slide under the rib cage, work way along the ribs until you get to the 11th rib (first floater), then you’re done
•Palpate from xyphoid process rib cage
•Have patient exhale to relax diaphragm and deflate lungs
Right Crus: Xyphoid Process
•Get upper 2 lumbar, then find rectus abdominis, landmark umbilicus work L3, L2, L1 underneath the ribs
Rib Cage
•Sink down under edge of rib cage, work way along ribs until you get to the 11th rib
•Palpate diaphragm down to angle of ribcage -
Psoas Major: Lumbar Fibers -
ROM Test:
•Test 9: Straight leg, hip flexion, abduction and external rotation
Muscle Test:
•Supine, 45º hip flexion, 30º abduction, full external rotation
•Push down and out
Tester:
•Stand on involved side
•Stabilizing hand on opposite ASIS
•Action hand on medial malleolus
•Push down and out (extension and abduction through the oblique plane)
Palpation:
•If you see Thoracic or Lumbar, treat them as a WHOLE, do L1-T12
•Palpation is lateral to the bodies and anterior to the transverse processes
•Use umbilicus as a landmark. (Umbilicus is about L3)
•Take tension off of the psoas by having them bend their knee, easier to get into the bodies of vertebras
L2 – L5
•Find umbilicus, find rectus abdominis, come lateral, then come down and in at a 45º angle
•Take nice slow movements in as they breathe out, as they breathe out slide in until you feel a hardness
•Get lateral on the bodies of the vertebras and anterior on the transverse processes
•Do palpation, and then slowly come out, move hand, and begin next palpation
•Lies lateral to the abdominal aorta. Feel for pulse and move laterally
•Flex involved hip and have partner exhale.
•Small circles to move abdominal contents to the side
•Active hip flexion to confirm
Lesser Trochanter
•External rotation of thigh, follow above adductor longus tendon, pressure: down and in
•Have them flex adductor longus (pull in), adduct into hand
•After you find adductor longus, have them relax then come superior to adductor longus, slide through and come straight back down towards the table and find the lesser trochanter
•There is a triangle just lateral and anterior to adductor longus, slide into triangle and then down and into the lesser trochanter -
Psoas Major: Thoracic Fibers -
ROM Test:
⬢Test 9: Straight leg, hip flexion, abduction and external rotation
Muscle Test:
⬢Supine, 30º hip flexion, 30º abduction, full external rotation
Tester:
⬢Stand on involved side
⬢Stabilizing hand on opposite ASIS
⬢Action hand on medial malleolus
⬢Push down and out (extension and abduction through the oblique plane)
Palpation:
⬢If you see Thoracic or Lumbar, treat them as a WHOLE
⬢Palpation is lateral to the bodies and anterior to the transverse processes
⬢Use umbilicus as a landmark. (Umbilicus is about L3)
⬢Take tension off of the psoas by having them bend their knee, easier to get into the bodies of vertebras
L1 & T12
⬢Find umbilicus (L3, move up into L2, then L1, and then up and get T12)
⬢Lies lateral to the abdominal aorta. Feel for pulse and move laterally
⬢Flex involved hip and have partner exhale.
⬢Small circles to move abdominal contents to the side
⬢Active hip flexion to confirm
Lesser Trochanter
⬢External rotation of thigh, follow above adductor Longus tendon, pressure: down and in -
Psoas Minor: -
ROM Test:
•Test 10: Straight leg, hip flexion, adduction and external rotation
Muscle Test:
•Supine, flex hip with external rotation of the femur to position of posterior pelvic tilt, adduct thigh across midline
•Get on knees, put hand under back, and then flex the hip until the back becomes flat against the table. That’s when you know they are in a posterior pelvic tilt. That’s the amount of hip flexion that person needs for the test. It’s all dependent upon the person. Then adduct their thigh, and externally rotate the femur.
•Pull down and away from opposite shoulder while maintaining that lumbar position.
Tester:
•Stand on involved side
•Stabilize the opposite ASIS
•Action hand on medial malleolus
•Pull down and across toward you from their opposite shoulder.(extend and abduct thigh through oblique plane to create anterior pelvic rotation)
•Resistance always comes in the plane of your forearm.
Palpation:
•Palpation is lateral to the bodies and anterior to the transverse processes
•Use umbilicus as a landmark. (Umbilicus is about L3)
L1 & L2
•L1 & L2
•Take tension off of the psoas by having them bend their knee, easier to get into the bodies of vertebras
•Same processes as psoas major treating lumbar spine at T12 & L1.
Superior Ramus of Pubis
•Find top of the pubic bone, get superior lateral pubic bone, sink down deep and then up and under the edge of the pubic bone
•Attaches on the posterior most lateral aspect
•Move down, palpate deep to superior ramus
•Top of the pubic bone, sink down and into the posterior aspect -
Adductor Magnus: Oblique Fibers -
ROM Test:
⬢Test 6: Straight leg, external rotation of the femur
Muscle Test: 12A
⬢Supine, full external rotation of the femur
Tester:
⬢Stand at the base of the patient
⬢Stabilize the opposite ankle medially
⬢Action hand on back o the ankle to regulate external rotation
⬢Apply force into abduction away from the midline (pull out)
Palpation:
⬢Leg on bottom moved back, other leg in front at 90º
Ischial Tuberosity & Ramus of Ischium
⬢Patient lying on side with uninvolved hip flexed
⬢Find ischial tuberosity, compress tissue of thigh down, slide down and under the LATERAL aspect of the ramus of the ischium
⬢Slide under LATERAL aspect of ischium using finger tips
⬢Most posterior adductor attachment on the ramus of ischium and ramus of pubis
Linea Aspera (Middle 1/3)
⬢Check to see the position of their leg, so you can tell where you need to go to get to the middle 1/3 of the linea aspera
⬢Have them contract their hamstring, come off the edge of the hamstring, and slide right down and into the linea aspera getting the most posterior middle 1/3 -
Adductor Magnus: Vertical Fibers -
ROM Test:
•Test 1: Straight Leg internal Rotation of the femur
Muscle Test: 12B
•Supine, full internal rotation of the femur
Tester:
•Stand at the base of the patient
•Stabilize the opposite ankle
•Action hand lateral underside of the ankle
•Apply force into hip flexion (lift up)
Palpation:
•Pectineus, Adductor Longus, Adductor Brevis, Gracilis, & Adductor Magnus = Puny Little Boys Go Masticate
•Adductor Longus is the landmark for everything else, it’s the most medial, then it moves the most superior to Pectineus, then lateral and posterior to Brevis, & lateral and posterior to Gracilis, and then Magnus
•Lie on side of weakness
Ischial Tuberosity & Ramus of Ischium
•Patient lying on side with uninvolved hip flexed 90º
•Find ischial tuberosity, compress tissue of thigh down, slide down and under the LATERAL aspect of the ramus of the ischium
•Slide under LATERAL aspect of ischium using finger tips
•Most posterior adductor attachment on the ramus of ischium and ramus of pubis
Adductor Tubercle
•Go to medial femoral condyle and find adductor tubercle, follow up supracondylar ridge about 1 inch
•Find adductor tubercle and palpate 1 inch upwards -
Adductor Longus: -
ROM Test:
•None
Muscle Test: 13
•Supine, elevate both legs 1-2 inches
•Don’t abduct both legs, abduct the leg your not testing
•Adduct & externally rotate the leg you are testing
•Full external rotation of involved femur
Tester:
•Stand at the base of the patient
•Stabilize the opposite ankle
•Action hand lateral underside of the ankle
•Apply force into abduction (pull out)
Palpation:
•Overlap each attachment slightly on linea aspera
•Pectineus, Adductor Longus, Adductor Brevis, Gracilis, & Adductor Magnus = Puny Little Boys Go Masticate
•Adductor Longus is the landmark for everything else, it’s the most medial, then it moves the most superior to Pectineus, then lateral and posterior to Brevis, & lateral and posterior to Gracilis, and then Magnus
•Have a guy re-position himself if needed, on a male client get a skeleton and show them “I am going to be touching here; if there is anything in the way it is ok to touch yourself and move it.â€
Pubic Tubercle
•Patient supine with slight hip flexion and external rotation
•Externally rotate leg, have them pull into your hand, adducting thigh, follow big tendon of adductor longus, compress into it and follow it all the way up until you hit the side of the pubic bone,
•Sink into the bone, and slightly compress tendon into the bone
•Lateral on pubic bone
•Externally rotate leg, find tendon, slide into side of pubic bone into pubic tubercle
•When palpating, compress the tendon, don’t move it
Linea Aspera (lower portion)
•Palpate at the linea aspera along lower portion of muscle belly
•Medial to hamstrings and posterior to quads, feel the division, have them pull heel towards but, feel hamstrings
•Along same line as adductor magnus but more inferior, and more lateral than vastus medialis
•Similar to Vastus Medialis, but more posterior and inferior -
Adductor Brevis: -
ROM Test:
•Test 5: Straight leg, hip flexion, adduction & internal rotation
•Test 10: Straight leg, hip flexion, adduction and external rotation
Muscle Test: 14
•Supine, flex and adduct involved leg across the midline
•Full internal rotation of involved leg
•Repeat test with full external rotation of involved leg
Tester:
•Stand at the base of the patient
•Stabilize the opposite ankle
•Action hand underside of involved ankle
•Apply force into abduction
Palpation:
•Pectineus, Adductor Longus, Adductor Brevis, Gracilis, & Adductor Magnus = Puny Little Boys Go Masticate
•Adductor Longus is the landmark for everything else, it’s the most medial, then it moves the most superior to Pectineus, then lateral and posterior to Brevis, & lateral and posterior to Gracilis, and then Magnus
•Always stay outside of the triangle
Inferior Ramus of Pubis
•Patient lying supine with slight hip flexion and external rotation
•Have client adduct thigh, find big adductor longus tendon and go inferior and lateral (never medial)
•Come to inferior ramus of the pubis
•Palpate just posterior to the adductor longus attachment
Pectineal Line and middle portion of Linea Aspera
•Overlap with Adductor Magnus
•Find adductor longus tendon, go behind it and go inferior to lesser trochanter/upper 1/3 to upper 1/2
•Palpate along the linea aspera, proximal to the adductor longus -
Pectineus: -
ROM Test:
•Test 8: Straight leg, hip flexion & external rotation
•Test 10: Straight leg, hip flexion, adduction and external rotation
Muscle Test: 15
•Lie Supine, flex and adduct the femur 30º
•Full external rotation of the femur
Tester:
•Stand at the base of the patient
•Stabilize the opposite ankle
•Action hand on the medial top of the distal tibia
•Apply force into abduction and extension (push down and out)
Palpation:
•Pectineus, Adductor Longus, Adductor Brevis, Gracilis, & Adductor Magnus = Puny Little Boys Go Masticate
•Adductor Longus is the landmark for everything else, it’s the most medial, then it moves the most superior to Pectineus, then lateral and posterior to Brevis, & lateral and posterior to Gracilis, and then Magnus
•Always stay outside of the triangle
Ramus of Pubis (Superior Border)
•Patient supine with slight hip flexion and external rotation
•Find adductor longus, go superior and lateral to superior ramus of pubis, come in front of adductor longus, find lesser trochanter and come about 2 inches down from lesser trochanter on Pectineal line which is just below the lesser trochanter about 2 inches down
•Have client adduct thigh, find most anterior and superior attachment of the adductor group (above adductor longus)
Pectineal Line of the Femur
•Pectineal line is just below lesser trochanter about 2 inches down & is part of the medial aspect of the linea aspera
•Palpate medial posterior surface of femur from lesser trochanter down approximately 2 inches -
Gracilis: -
ROM Test:
•Test 1: Straight Leg Internal Rotation of the femur
•Test 5: Straight leg, hip flexion, adduction & internal rotation
Muscle Test: 16
•Supine, adduct femur to midline
•Full internal rotation of femur
Tester:
•Stand at base of patient
•Stabilize opposite ankle
•Action hand on medial top of distal tibia
•Apply force into abduction of the involved leg
Palpation:
•Pectineus, Adductor Longus, Adductor Brevis, Gracilis, & Adductor Magnus = Puny Little Boys Go Masticate
•Adductor Longus is the landmark for everything else, it’s the most medial, then it moves the most superior to Pectineus, then lateral and posterior to Brevis, & lateral and posterior to Gracilis, and then Magnus
•Always stay outside of the triangle
Inferior Ramus of Pubis & Ramus of Ischium
•Patient supine with slight hip flexion and external rotation
•Landmark adductor longus & ischial tuberosity, about halfway in between on pubic side
•Have client adduct thigh, follow taut tendon into pubic bone
•Get on adductor longus, sink down and lateral to bone on lateral aspect of the inferior ramus of pubis just behind adductor brevis, on the pubic side of the 40 yard line not the ischium side
Pes Anserine (Upper/Medial Tibia)
•Paint the pes anserine, you will feel a flat spot and a mass of tissue coming in where the Gracilis, Semitendinosus and Sartorius are all blending in
•2 finger widths will paint the whole pes anserine
•Follow tendon into pes anserine attachment on the superior/medial aspect of the tibia -
Vastus Medialis: Upper Fibers -
ROM Test:
⬢Test 18: Hip External rotation with hip and knee flexion
⬢Test 20: Hip flexion, abduction, and external rotation
Muscle Test: 20A
⬢Supine, flex hip 60º, flex knee 110º so that heel is at level of opposite knee
⬢Putting heel at opposite knee = 60º & 110º
⬢Externally rotate the femur
⬢Slightly abduct femur
⬢Internally rotate tibia and plantarflex the foot
Tester:
⬢Stand on same side as leg being tested
⬢Stabilize the lateral side of knee
⬢Action hand cups the heel
⬢Forearm slightly upward
⬢Pull out at the heel applying a force into internal rotation and knee flexion, slight bit of flexion and more rotation
Palpation:
⬢If weak, treat all divisions
Linea Aspera (Upper 1/3)
⬢Prone, palpate lesser trochanter and follow down 1/3 of posterior aspect of femur
⬢Go to ischial tuberosity, then obliquely and find lesser trochanter, have them flex quad and find posterior aspect of quad near the lesser trochanter
Patella (Superior/Medial Border)
⬢Supine, palpate superior, medial patella
Patellar Tendon (Medial Aspect)
⬢Supine, palpate medial patella tendon into tibial tuberosity -
Vastus Medialis: Middle Fibers -
ROM Test:
⬢None
Muscle Test: 20B
⬢Supine, flex hip 30º, flex knee 75º so that heel is at opposite mid shin level
⬢External rotation of femur
⬢Slightly abduct femur
⬢Internally rotate tibia and plantarflex foot
Tester:
⬢Stand on same side as leg being tested
⬢Stabilize lateral side of knee
⬢Action hand cups the heel
⬢Pull out at the heel applying a force into internal rotation
Palpation:
⬢If weak, treat all divisions
Linea Aspera (Middle 1/3 of Posterior aspect of femur)
⬢Prone, palpate middle 1/3 of posterior aspect of femur
Patella (Superior-Medial)
⬢Supine, palpate superior, medial patella
Tibial Tuberosity
⬢Palpate medial patella tendon into tibial tuberosity -
Vastus Medialis: Lower Fibers -
ROM Test:
⬢None
Muscle Test: 20C
⬢Supine, flex hip 10º, flex knee 20º so that heel is at level of opposite ankle
⬢Heel is at ankle
⬢External rotation of femur
⬢Slightly abduct femur
⬢Internally rotate tibia and plantarflex foot
Tester:
⬢Stand on same side as leg being tested
⬢Stabilize lateral side of the knee
⬢Action hand cups the heel
⬢Pull out at the heel applying a force into internal rotation & knee flexion
Palpation:
Linea Aspera
⬢Supine, palpate lower 1/3 of posterior, medial aspect of femur into adductor tubercle
Patella (Superior Medial)
⬢Palpate superior/medial patella
Tibial Tuberosity
⬢Palpate medial patella tendon into tibial tuberosity -
Vastus Lateralis: Upper Fibers -
ROM Test:
•Test 4: Straight leg, hip flexion, abduction and internal rotation
•Test 3: Straight Leg, Hip flexion & Internal Rotation
•Test 17: Hip internal rotation with hip and knee flexion
•Test 24: Hip Internal Rotation
Muscle Test: 21A
•Supine, flex hip 60º, flex knee 110º so that heel is at level of opposite knee
•Full internal rotation of femur
•Slightly adduct femur
•Externally rotate tibia and plantarflex foot
Tester:
•Stand on opposite side of leg being tested
•Stabilize medial side of knee
•Action hand cups the heel
•Pull in at the heel applying a force into external rotation, pull toward you and in
Palpation:
•If weak, treat all divisions
Greater Trochanter
•Supine, palpate anterior inferior border of greater trochanter
•Superior aspect of trochanter, come anterior & inferior, onto the shaft of the femur, once on the femur, work way at a 45º angle down and around to the posterior aspect of the femur through the IT-band, then bend the knee and feel that quad and wrap around to the posterior aspect of the linea aspera
Linea Aspera
•After palpating trochanter, palpate down upper 1/3 of lateral linea aspera posterior to IT-band.
•Work way around posterior aspect of femur all the way down lateral and posterior to IT-Band
•Get in the tunnel between hamstring and quad
•Make sure you aren’t jabbing into back of IT-band and that you are posterior enough, have them tighten quad to make sure you pop off the belly
Patella (Superior/Lateral)
•Palpate superior/lateral patella
•Superior to lateral aspect of patella
Tibial Tuberosity
•Palpate Tendon into tibial tuberosity -
Vastus Lateralis: Middle Fibers -
ROM Test:
⬢None
Muscle Test: 21B
⬢Supine, flex hip 30º, flex knee 75º so that heel is at opposite mid shin level
⬢Full internal rotation of femur
⬢Slightly adduct femur
⬢Externally rotate tibia and plantarflex foot
Tester:
⬢Stand on opposite side o leg being tested
⬢Stabilize medial side of knee
⬢Action hand cups heel
⬢Pull in at the heel applying a force into external rotation and knee flexion
Palpation:
Linea Aspera (Middle 1/3)
⬢Supine, palpate middle 1/3 of lateral linea aspera, below IT-band
Patella (Superior-Lateral)
⬢Palpate superior/lateral patella
Tibial Tuberosity
⬢Palpate lateral patella tendon into tibial tuberosity -
Vastus Lateralis: Lower Fibers -
ROM Test:
⬢None
Muscle Test: 21C
⬢Supine, flex hip 10º, flex knee 20º, so that heel is at level of opposite knee
⬢Full internal rotation of femur
⬢Slightly adduct femur
⬢Externally rotate tibia and plantarflex foot
Tester:
⬢Stand on opposite side of leg being tested
⬢Stabilize the medial side of knee
⬢Action hand cups the heel
⬢Pull in at the heel applying a force into external rotation and knee flexion
Palpation:
Linea Aspera (Lower 1/3)
⬢Supine, palpate lower 1/3 of lateral femur, posterior to IT-band down into lateral condyle
Patella (Superior-Lateral)
⬢Palpate superior, lateral patella
Tibial Tuberosity
⬢Palpate lateral patella tendon into tibial tuberosity -
Vastus Intermedius: Medial Fibers -
ROM Test:
⬢None
Muscle Test: 22B
⬢Supine, flex hip and flex knee to 110º
⬢Internally rotate tibia
Tester:
⬢Stand on side of leg being tested
⬢Stabilize anterior femur
⬢Action hand on anterior tibia
⬢Apply force into knee flexion
Palpation:
Femur
⬢Supine, palpate under belly of medial side of rectus femoris on upper anterior 2/3 of medial femur
⬢Move rectus femoris, same as lateral but about 1 inch more medial and more rectus
⬢Come on anterior upper 2/3 of anterior surface of femur
⬢Have them flex quad, medial aspect of rectus, sink to bone, same for lateral
Patella & Tibial Tuberosity
⬢Palpate superior patella and patella tendon attachment into tibial tuberosity -
Vastus Intermedius: Lateral Fibers -
ROM Test:
⬢None
Muscle Test: 22A
⬢Supine, flex hip and knee 120º
⬢Tibial external rotation
Tester:
⬢Stand on side of leg being tested
⬢Stabilize anterior femur
⬢Action hand on anterior tibia
⬢Apply force into knee flexion (straight down)
Palpation:
Femur
⬢Find trochanter, come on anterior surface just below where you were for Vastus Lateralis, come in at a 45º angle from the side and come right down onto the anterior surface
⬢Supine, palpate under belly of rectus on anterior 2/3 of lateral femur
⬢Lateral aspect below trochanter, inferior, straight down 2/3
Patella & Tibial Tuberosity
⬢Palpate superior patella and patella tendon attachment into tibial tuberosity -
Articularis Genu: -
ROM Test:
•None
Muscle Test: 23
•Supine, 10º of hip and knee flexion
Tester:
•Stand at the side of patient
•Brace under involved knee
•Action hand on anterior aspect of the ankle
•Apply force into hip extension keeping flexion at knee joint
•Push straight down
Palpation:
Supra-Patellar Tendon
•Supine, palpate 1 – 1 ½ inches above patella feel ridge (below quad), at supra-patellar tendon
•Palpate sides of supra-patellar tendon to the top of the patella (at bottom edge of Vastus Intermedius)
•Making a rectangle
Patella (Superior)
•Palpate across superior patella -
Gastrocnemius: Medial Fibers -
ROM Test:
•Test 11: Straight leg, ankle plantar flexion
•Test 19: Knee flexion with hip flexion (add tibial external rotation)None
•Test 12: Straight leg, lower leg, internal rotation
•Test 15: Ankle plantarflexion with adduction and eversion of forefoot (knee flexed)
Muscle Test: 24A
•Supine, flex hip 22.5º, flex knee 45º
•Full Plantarflexion at the ankle
•Full internal rotation of the tibia
•Worry about the 45º at the knee
•Looking for tibia to move upon rotation
Tester:
•Stand at the base of the patient
•Stabilize anterior portion of the knee
•Action hand on the back of the ankle
•Apply force into extension at the knee (pull straight out)
Palpation:
Medial Condyle of Femur
•Prone, palpate into posterior medial condyle of femur
•Go in similar to the hamstring, but instead of tibia, this time it’s the posterior aspect of the femur,
Medial Head of Gastroc
•Have them contract, or flex gastroc, palpate the bottom of the horseshoe line
•Palpate medial head at musculo-tendon junction
Calcaneus (Medial Attachment)
•Hook in and palpate at superior, medial calcaneus
•Pushing the tissue in and getting the superior aspect -
Gastrocnemius: Lateral Fibers -
ROM Test:
⬢Test 11: Straight leg, ankle plantar flexion
⬢Test 19: Knee flexion with hip flexion (add tibial external rotation)None
⬢Test 13: Straight leg, lower leg external rotation
⬢Test 16: Ankle Plantarflexion with abduction & eversion of forefoot (knee flexed)
Muscle Test: 24B
⬢Supine, flex hip 22.5º, flex knee 45º
⬢Full plantarflexion of the foot
⬢Full external rotation of the tibia
Tester:
⬢Stand at the base of the patient
⬢Stabilize the anterior portion of the knee
⬢Action hand on the back of the ankle
⬢Apply force in extension at the knee (pull straight out)
Palpation:
Lateral Condyle of Femur
⬢Prone, palpate into posterior lateral condyle of femur
⬢Kind of like lateral hamstrings, hook into posterior superior lateral condyle of the femur
Lateral Head of Gastroc
⬢Contract gastroc, lateral head is not as low as medial head, palpate lateral head at musculo-tendon junction, between belly of muscle
⬢Lateral gastroc horseshoe line
Calcaneus (Lateral Attachment)
⬢Palpate at superior, lateral calcaneus -
Soleus: -
ROM Test:
⬢Test 11: Straight leg, ankle plantar flexion
Muscle Test: 25
⬢Prone, knee flexed to 90º
⬢Full plantarflexion of the foot with toes curled
⬢Internal Rotation of the Tibia
⬢Repeat Test with External Rotation of the Tibia
⬢Calcaneal evert = medial, Calcaneal invert = lateral
Tester:
⬢Stand on side of leg being tested
⬢Stabilize back of calcaneus
⬢Action hand on ball of foot
⬢Apply force into Dorsiflexion of the ankle (Pushing down and lifting at the heel).
Palpation:
Fibula (Upper 1/3 Posterior/Medial)
⬢Prone, flex knee, palpate the upper 1/3 of the posterior, medial aspect of the fibula.
Tibia (Middle 1/3 Posterior)
⬢Palpate medial head along the middle 1/3 of the posterior tibia
⬢Palpate posterior to anterior on back of tibia by curling lateral
Calcaneus
⬢Palpate at superior calcaneus -
Popliteus: -
ROM Test:
⬢Test 12: Straight leg, lower leg, internal rotation
⬢Test 15: Ankle plantarflexion with adduction and eversion of forefoot (knee flexed)
⬢Test 16: Ankle Plantarflexion with abduction & eversion of forefoot (knee flexed)
Muscle Test: 26
⬢Supine, flex hip 22.5º, flex knee 45º, fully internally rotate tibia
⬢Rotate tibia in, not just the foot
⬢Foot neutral relative to Dorsiflexion and plantarflexion
Tester:
⬢Stand at the base of the patient
⬢Stabilize base of heel
⬢Action hand on medial aspect of the forefoot
⬢Palm on side of foot and come across
⬢Apply force into external rotation of the tibia
Palpation:
Lateral Condyle of Femur
⬢Prone, knee straight, palpate outer portion of lateral condyle of femur
⬢Lateral condyle of femur, posterior to Epicondyle.
Posterior Tibia (Upper Medial 1/3)
⬢Flex knee, palpate upper medial -
Peroneus Longus: -
ROM Test:
⬢Test 13: Straight leg, lower leg external rotation
⬢Test 16: Ankle Plantarflexion with abduction & eversion of forefoot (knee flexed)
Muscle Test: 27A
⬢Supine, flex hip 22.5º, flex knee 45º
⬢Full plantarflexion and abduction of the foot
⬢Do not allow toes to extend
Tester:
⬢Stand at the base of the patient
⬢Stabilize the base of the heel
⬢Action hand on lateral aspect of the forefoot
⬢Apply force into adduction of the foot, maintaining plantarflexion
Palpation:
Fibula (Upper 1/3 Posterior/Lateral)
⬢Prone, flex knee, palpate the upper 1/3 of the posterior, lateral aspect of the fibula
1st Cuneiform (Lateral Base)
⬢Palpate lateral side of base of 1st cuneiform
⬢(feel bony protrusion that divides these bones)
1st Metatarsal (Lateral Base)
⬢Palpate lateral side of base of 1st metatarsal
⬢(feel bony protrusion that divides these bones) -
Peroneus Brevis: -
ROM Test:
⬢Test 13: Straight leg, lower leg external rotation
Muscle Test: 27B
⬢Supine, flex hip 22.5º, flex knee 45º
⬢Neutral foot position relative to Dorsiflexion
⬢Abduction of the foot
⬢Do not allow toes to extend
Tester:
⬢Stand at the base of the patient
⬢Stabilize the base of the heel
⬢Action hand on lateral aspect of the forefoot
⬢Apply force into adduction of the foot
Palpation:
Fibula (Middle 1/3 Posterior-Lateral)
⬢Prone, flex knee, palpate the middle 1/3 of the posterior, lateral aspect of the fibula
5th Metatarsal
⬢Palpate at lateral aspect of the base of the 5th met. -
Peroneus Tertius: -
ROM Test:
⬢Test 14: Straight leg, ankle Dorsiflexion
Muscle Test: 27C
⬢Supine, flex hip 22.5º, flex knee 45º
⬢Full Dorsiflexion & eversion of the forefoot
⬢Full abduction of the foot
⬢Curl toes
Tester:
⬢Stand at the base of the patient
⬢Stabilize the base of the heel
⬢Action hand on the lateral aspect of the forefoot
⬢Apply force into plantarflexion and adduction of the foot
Palpation:
Fibula (Lower Anterior 1/3)
⬢Prone, flex knee, palpate the lower 1/3 of the anterior aspect of the fibula
4th & 5th Metatarsal
⬢Palpate union where 4th and 5th metatarsals meet -
Tibialis Anterior: -
ROM Test:
⬢Test 14: Straight leg, ankle Dorsiflexion
Muscle Test: 29
⬢Supine, flex hip 22.5º, flex knee 45º
⬢Full Dorsiflexion and inversion of the foot
⬢Curl toes
Tester:
⬢Stand at the base of the patient
⬢Stabilize the base of the heel
⬢Action hand on the dorsal aspect of the forefoot
⬢Apply force into plantarflexion and eversion of the forefoot
Palpation:
Fibular Head
⬢Supine, palpate on lateral tibia from anterior fibular head
Tibia (Lateral)
⬢Palpate from anterior fibular head down the upper ½ of the tibia
Medial Cuneiform
⬢Palpate plantar medial cuneiform
1st Metatarsal (Base)
⬢Palpate the base of the 1st metatarsal -
Tibialis Posterior: -
ROM Test:
⬢Test 12: Straight leg, lower leg, internal rotation
⬢Test 15: Ankle plantarflexion with adduction and eversion of forefoot (knee flexed)
Muscle Test: 28
⬢Supine, flex hip 22.5º, flex knee 45º
⬢Full plantarflexion and adduction of the foot
⬢Do not allow toes to extend
Tester:
⬢Stand at the base of the patient
⬢Stabilize the base of the heel
⬢Action hand on medial aspect of the forefoot
⬢Hand cupping heel and blocking laterally
⬢Apply force into abduction of the foot, maintaining plantarflexion, sweep the foot across
⬢Have them drive foot into the table while abducting
⬢Just looking for subtalar joint motion
Palpation:
⬢Attaches to 8 different places in the foot
⬢Deepest muscle, deep to the gastroc and soleus
⬢Compress foot on rearfoot
Fibula (Upper 1/3 Medial/Posterior)
⬢Prone, flex knee, palpate the upper 1/3 of the medial, posterior aspect of the fibula
⬢Get between the bones, sink into the fibula, and then sink across to the tibia
Tibia (Upper 1/3 Lateral/Posterior)
⬢Palpate lateral posterior aspect of the upper 1/3 of the tibia
Medial Malleoli
⬢Posterior aspect of the medial malleoli
Navicular
⬢Palpate the medial and plantar surface of the Navicular, work distal
Cuneiforms
⬢Palpate across the cuneiforms 1,2,3 (medial aspects)
⬢Slide anterior and get metatarsals
Metatarsals
⬢Palpate across the mets. Bases of 4,3 & 2
Cuboid
⬢Palpate the medial aspect of the cuboid