CPA2 Flashcards
(18 cards)
MET Abduction/Adduction Tibiofemoral SD
- Pt is supine and physician stands on the dysfunctional side
- Physician flexes Pt’s knee and hip to 90 degrees
- The physician places the knee on their thigh
- The physician’s thumbs contact tibial tuberosity below the plateaus
- Engage restrictive barrier.
- Adduction SD = Likes to adduct or go into the varus position
- Abduction SD = likes to abduction or go into the valgus position - Ask the Pt to apply a counterforce against the position where they like to go for 3-5 seconds
- Continue the principles of MET
- Reassess!!!!!!
MET for ER Tibiofemoral SD
- Pt is seated with legs off the table
- Physician is seated facing the dysfunctional leg
- Doc grasps lateral aspect of the patient’s foot and ankle with one hand
- The other hand monitors the medial tibial plateau
- Dorsiflex and IR the distal tibia to the restrictive barrier
- Instruct patient to turn foot into ER for 3-5 seconds against your resistance
Follow the principles of MET
MET for IR Tibiofemoral SD
- Pt is seated with legs off the table
- Physician is seated facing the dysfunctional leg
- Doc grasps MEDIAL aspect of the patient’s foot and ankle with one hand
- The other hand monitors the MEDIAL tibial plateau
- Dorsiflex and IR the distal tibia to the restrictive barrier
- Instruct patient to turn foot into ER for 3-5 seconds against your resistance
Follow the principles of MET
Extended tibiofemoral SD
Patient: Prone
-Physician flexes pt’s knee to restrictive barrier.
Physician places shoulder or hand proximal to ankle of ipsilateral LE. Pt is instructed to extend knee against counter resistance for 3-5 seconds. Repeat 3-5 times or until no new barriers are attained . -Reassess for TART.
Flexed tibiofemoral SD
Patient: Supine with pillow under the knee
-Physician extends pt’s knee to restrictive barrier. Physician places distal hand under the pt’s calcaneus and proximal hand over pt’s knee cap. Pt is instructed to flex knee against counter resistance for 3-5 seconds.
Doc will then push knee down gently and pull lower leg up anteriorly
Repeat 3-5 times or until no new barriers are attained.
-Reassess for TART
Hip Abduction SD (ITB hypertonicity)
- patient is supine
- doc holds up/flexes leg NOT being worked on
- hold the dysfunctional leg in the other hand
- take the bad leg to the restrictive barrier in adduction
- instruct patient to abduct against a counterforce
- Do MET
- ReASSESS
Hip Adduction SD (HYPERTONIC long adductors)
- Pt is supine
- abduct leg to where it rests on the doc’s lateral hip
- doc stabilizes the other leg at the knee with opposite hand
- instruct patient to move their thigh medially into yours while physician applies counterforce
- relax
- engage restrictive barrier by abduction patient’s leg even more
Hip Adduction SD (HYPERTONIC short adductors)
- Pt is supine
- Leg to be tested goes in pirouette position w/ foot contact on other thigh
- doc stabilizes contralateral ASIS with cephalad hand
- pushes down POSTERIOR on patient’s knee with caudad hand
- Then pt pushes their knee toward your hand for 3-5 seconds
- engage next barrier
MET/ART Hip Internal Rotation SD
Just like ROM. Start them where they do not like to go
MET/ART Hip External Rotation SD
Just like ROM. Start them where they do not like to go
Hip Extension SD: Hamstrings
- Pt is supine
doc stabilizes ipsilateral ASIS with cephalad hand - holds up ipsilateral leg with caudad hand
- flex at the hip
- Make sure knee is FULLY extended
- put leg on shoulder
- take them to the restrictive barrier of flexion
- ask them to push down for 3-5 seconds
- follow MET
Hip Extension SD: Gluteus maximus
- Pt is lateral recumbent with leg to be treated flexed toward their chest
- foot goes on doc’s thigh
- doc’s hand grasps PSIS and the bended knee
- take pt into the flexion restricted barrier
- then instruct them to push down into your thigh (10 to 20 lbs of counterforce) against counterforce
- relax
- push their knee closer to chest
Hip flexion SD
- Pt is prone
- bend bad knee
- ceph hand monitors psis
- caudad hand monitors anterior lower thigh by patella
- lift to put them in extension SD barrier
- have them pull knee down to table for 3-5 seconds
- engage next extension barrier
Distal Fibula Anterior Articulatory Treatment
Patient: Supine
Physician: Stand/Sit at the foot of the table
• Stabilize patient’ s foot, wrapping fingers
around calcaneus and engage dorsiflexion
restrictive barrier
DO THIS AS THE:
• Thumb of lateral hand contacts the anterior
aspect of the distal fibula with other thumb on top. Engage the restrictive barrier and PUSH POSTERIOR using articulatory technique until motion improves. Reassess TART
Distal fibula posterior ART
Patient: Prone
Physician: Stand/Sit at the foot of the table
• Stabilize patient’ s foot, wrapping fingers
around calcaneus and engage
plantarflexion restrictive barrier.
DO THIS AS THE:
• Thumb of lateral hand contacts the
posterior aspect of the distal fibula with other thumb on top. Engage the restrictive barrier and using articulatory technique until motion improves. Reassess TART
MET for dorsiflexed talus
Patient: supine
Physician: Stand/Sit at the foot of the table
• Grasp patient’s ankle with one hand at the level of the malleoli. Other hand is placed over the dorsum on the patient’s foot.
• Bring the patient’s foot into the plantar flexion restrictive barrier
Activating Force: Patient is instructed to bring their foot into dorsiflexion against isometric resistance for 3-5sec then isometric relaxation. Engage a new barrier & repeat until no new barriers are met. Reassess TART
MET for plantarflexed talus
Patient: Supine
Physician: Stand/Sit at the foot of the table
• Grasp patient’s ankle with one hand at the level of the malleoli. Other hand is placed
on the plantar surface of the patient’s foot.
• Bring the patient’ s foot into the
dorsiflexion restrictive barrier.
Activating Force: Patient is instructed to bring their foot into plantar flexion against isometric resistance for 3-5sec then isometric relaxation. Engage a new barrier & repeat until no new barrier are met. Reassess TART
Talus Eversion with anteromedial glide
Talus Inversion with posterolateral glide
Articulatory Treatment (with traction)
Patient: Seated with leg hanging off table Physician: Sitting at the foot of the table
• Grasp patient’s heel with one hand and
grasp the talus & dorsum of the foot with the other.
APPLY A TRACTION DOWNWARD
Maintain traction on calcaneus and articulate inversion and eversion with a “figure 8” maneuver
DO THIS UNTIL until no new restrictive barriers are met or quality of ROM normalizes. Reassess TART
