LE ROM and Flexibility Flashcards Preview

PHTH 550- Orthopaedic Management > LE ROM and Flexibility > Flashcards

Flashcards in LE ROM and Flexibility Deck (23):
1

Knee Flexion ROM

Position: Pt in supine.
Axis: Lat femoral epicondyle
SA: Greater trochanter
MA: Lat Malleolus

AROM: Pt slide heel along plinth through full available ROM.

AROM: Apply OP above the ankle. Assess E/F as you push.

PROM: Support pt leg at ankle and knee.

2

Knee Extension ROM

Position: Pt supine w/ pillow under thigh.
Axis: Lat femoral epicondyle
SA: Greater trochanter
MA: Lat Malleolus

AROM: Pt actively ext knee while keeping thigh on pillow.
OP: Stabilize the thigh and apply pressure at calf.
PROM: Same way as OP.

3

Tibial Rotation

Position: Pt in high sitting. Visual observation, no goniometer measurement.

Internal Rotation:
AROM: Pt bilaterally rotate tibia inwards by pointing toes towards one another.
OP: Stabilize thigh w/ one hand and use a lumbrical grip at malleoli for OP.
PROM: Same as OP, but start in neutral.

External Rotation:
AROM: Bilaterally rotate tibia outwards, point toes as far away from one another as possible.
OP/PROM: As per IR.

4

Patellar Glides

Position: Pt in long sitting or supine w/ quadriceps relaxed.

Medial Glide: Push medially w/ both thumbs.
Lateral Glide: Push laterally using both index fingers.
Glides: Assess for quantity of movement and the E/F at the EOR.
Inferior Glide: Thumb and index finger push patella inferiorly.
Superior Glide: Thumb and index finger of inferior hand to push patella superiorly.
ROM Superior

5

How is Hamstring Flexibility Assessed (Method 1)?

SLR:
Position: Pt in supine.
1. Palpate pt's greater trochanter for axis of goniometer.
2. SA: align w/ pt's trunk parallel to the plinth.
3. MA: lateral epicondyle of femur.
4. Have pt hold goniometer.
5. Support the pt's leg distally and place 1 hand on the proximal thigh to make sure the knee remains in full extension.
6. Slowly bring the pt's let into hip extension maintaining knee extension.
7. One resistance is felt continue until pt feels a strong stretch in posterior thigh- ask where do they feel it?
8. At EOR take a measurement w/ the goniometer. (pt can hold stationary arm).

6

How is Hamstring Flexibility Assessed (Method 2)?

90-90 Test:
Pt in supine.
1. Hip flexed to 90 degrees.
2. Axis of goniometer: Lateral femoral condyle.
3. SA: Align w/ greater trochanter.
4. MA: Aligned w/ lat malleolus.
5. Maintain thigh at 90 degrees, slowly extend the knee.
6. Extend until pt feels a strong stretch in the knee.
7. Take a measure of knee extension w/ the goniometer.

7

How is Rectus Femoris Flexibility assessed in prone?

Assess knee flex using a goniometer.
1. Ensure pt is at the edge of the plinth.
2. Axis: Lateral epicondyle.
3. SA: Greater Trochanter.
4. MA: Lat malleolus.
5. Stabilize pelvis.
6. Gradually flex pt's knee until a strong stretch is felt in the anterior thigh.
7. Take a measure w/ the goniometer of knee flexion.

8

Hip Flexion ROM

Pt in supine.
Axis: Greater Trochanter.
SA: In line w/ trunk parallel to plinth.
MA: Lateral epicondyle.

1. AROM: Pt asked to bring knee towards chest as far as possible. Take measure.
2. AROM w/ OP: Apply OP on posterior thigh.
3. PROM: 1 hand distal tib/fib and 1 hand posterior to knee.
To apply OP 1 hand is shifted to the posterior thigh and 1 hand is at the pelvis preventing anterior tilt.

9

Hip Extension ROM

Pt in prone.
Axis: Greater Trochanter
SA: Trunk parallel w/ the plinth.
MA: Lateral epicondyle, parallel w/ the thigh.

1. AROM: Stabilize pelvis to prevent lumbar spine extension (posterior pelvic tilt). Hand placed on PSIS, downward pressure applied at the pelvis. Pt actively extends hip by bringing thigh off the table.
2. AROM w/ OP: Have to release pelvis to take the goniometer measurement.
3. PROM: Same hand position as OP.

10

Hip Abduction ROM

Pt supine.
Axis: ASIS
SA: Between two ASIS
MA: In line w/ the patella, parallel to the thigh.

2 Hand Positions:
1) Use therapist forearm to support the weight of the lower leg w/ hand on medial knee. Proximal hand stabilize pelvis.
2) Pt provides downward pressure on their own ileum. Therapist can then use 2 hands to provide support at the thigh and distal leg.

1. AROM: Actively move let out to side as far as possible.
2. AROM w/ OP: Must add OP on distal thigh not leg to make sure pressure is not applied to the knee medial ligaments.
3. PROM: Same hand position as OP.

11

Hip Adduction ROM

Pt supine, opposite leg needs to be put into abduction to allow adequate room to move (this may mean putting the leg off the plinth on a chair).

Hand position: 1 hand on ASIS to support the pelvis and other hand on the leg.
1. AROM: Support pt leg and ask them to actively go into adduction. Put down the leg and take measurement using the same placement as for hip abd.
2. AROM w/ OP: Apply at the distal leg.
3. PROM: Therapist move leg through adduction ROM, place leg on table to take goniometer measurement.

12

Hip Internal Rotation ROM- 3 Methods

1) Screening in Prone Bilaterally: Gravity assists movement so not entirely considered AROM.
Flex knees to 90 degrees and have the pt let their feet fall out to the side. Visually assess the symmetry of the movement.

2) Supine No Measure:
Hip and knee to be tested flexed to 90 degrees.
Hand position: Leg supported by therapist's forearm w/ hand on the knee and other hand on proximal thigh. Allows therapist to rotate hip by turning their body.

IR AROM w/ OP: Have pt turn foot outwards. If there is no pain OP can be applied by moving body w/ thigh held tight against chest.
PROM is the same, but the entire movement is done by the therapist.

3) High Sitting w/ Goniometer measure.

Axis: Centre of Patella
SA: Vertically Up and Down
MA: In line w/ tibia

AROM: Have pt move foot out to the side. OP: Apply at the distal leg making sure not to stress the ligaments of the knee.

13

Hip External Rotation ROM- 3 Methods

1) Screening in Prone Unilaterally:
Opposite leg in extension. Allow leg being tested to fall towards the midline. Asses ROM before the pelvis lifts up. 1 hand can be used to stabilize the pelvis. Repeat on opposite side.

2) Supine No Measure:
Hip and knee to be tested flexed to 90 degrees.
Hand position: Leg supported by therapist's forearm w/ hand on the knee and other hand on proximal thigh. Allows therapist to rotate hip by turning their body.

ER AROM w/ OP: Have pt rotate thigh so foot crosses midline. No pain apply OP by turning body w/ thigh held tight against chest.
PROM is the same positioning, except the entire movement is done by the therapist.

3) High Sitting w/ Goniometer measure.

Axis: Centre of Patella
SA: Vertically Up and Down
MA: In line w/ tibia

AROM: Have pt move foot towards midline. OP: Apply at the distal leg making sure not to stress the ligaments of the knee.

14

Thomas Test
What does it test?
How is it performed?

A) Hip Flexor (Iliopsoas Flexibility)
B) Pt in supine.
Limb not being assessed is brought into flexion. Pt is asked to hold onto it. Make sure they are not pulling so much, pull pelvis backwards to remove lumbar lordosis so that only a hand can slide under lower back.

Leg not being held by the pt is assessed.

Normal: Hip remains in neutral w/ thigh on the plinth.
Positive: Thigh comes of the plinth w/ the thigh being pulled into flexion.

15

Modified Thomas Test

Position: Raise plinth to heigh just below ischial tuberosity of the pt. Have the pt lie back onto the plinth. Hold the knee of the limb not being assessed. Assist the pt to lie back onto the plinth. Ensure the pt pulls the knee only so much as to keep the lumbar spine and pelvis in a neutral position so that one hand can still be slid under the lumbar spine.

Iliopsoas Flexibility:
Normal: Thigh should fall to the level of the plinth or slightly below.
Positive: Hip is maintained in flexion and the thigh is elevated. Indicated tightness of iliospoas.

Rectus Femoris Flexibility:
Gentle pressure flex pt knee to 90 degrees w/ out the thigh coming above the level of the plinth.

TFL and ITB:
Observed positioning of the relax leg.
Tight: Movement of the leg into abduction or internal rotation of the hip or external rotation of the tibia. (indentation lateral thigh).

Sartorius:
Leg will be in tailor's position: external rotation, abduction, knee and hip flexion.

16

Modified Thomas Stretch

Increase flexibility using PNF or passive stretch.

Iliopsoas Stretch:
Thigh in neutral position (rotation or abduction/adduction).
Stabilize the pelvis.
Apply downward pressure to move the hip into extension.

TFL and ITB:
Stabilize pelvis in neutral position. Use the hand or leg to move the leg into an adducted position. Hip remains neutral or slightly extended position.

Rectus Femoris Stretch:
Use hand to provide knee flexion. Or therapist uses leg to push on knee and hand to push down on thigh into extension.

Sartorius:
Therapist uses leg to bring hip into internally rotated position and adducted position.

17

Omer's Test
What does it measure?
How is it assessed?

A) ITB Flexibility.

Pt in side lying on the side opposite to the limb being tested.
Bottom knee is flexed to 90 degrees. Leg is supported by the therapist and the pelvis is immobilized.
Therapist move hip through flexion, abduction, extension adduction.

Normal Test: Hip should be adduct to neutral or past neutral.

Test can also be performed w/ knee in extension.

18

Piriformis Test

Pt in side lying on opposite side to the limb being tested. Top leg is flexed to 90 degrees and ankle is supported behind the knee of the other leg.
Test assess for the degree of adduction that is achieved in this position.

Measure the distance between the top knee and the plinth.

False negative are common if the pelvis is not immobilized (knee hits the plinth).

19

Piriformis Stretch

Same relative position as the Piriformis test, except pt is in supine.
Knee bent to 90 degrees and the hip to 45 degrees. Stabilize the pelvis.
Knee is pushed across the midline to stretch the muscle.

20

1. What are the four principles of PNF?
2.What are the four PNF techniques?
3. How can they be used to stretch:
A) Hamstrings
B) Rectus Femoris

* Video demonstrates for the Iliopsoas*

1.PNF Technique Principles
1) Bring target muscle just short of EOR.
2) Contract target muscle for 6s at 20% MVC.
3) Stretch target muscle for 10 to 30 sec.
4) Repeat 2-6 times per muscle group for a total stretch time of 60 s.

2. Hold-relax: Hold here; Don't let me move you, stretch is passive (let me know when you feel a good stretch).

Contract-relax: Isometric contraction through a small ROM. Push gently into my hand and hold at 20% of your maximum, stretch is passive.

Hold-relax agonist contract: Hold here; Don't let me move you, stretch is active (so pt actively moves until a stretch is felt).

Contract-relax agonist contract: Push into my hand (20% as hard as you can); stretch is active (pt actively moves into stretch)

3. A) 90/90 or SLR
B) Modified Thomas Test Position.

21

Ankle Dorsiflexion ROM

Pt in supine or long sitting w/ towel under the knee.

Axis: Lateral Malleolus
SA: In line w/ fibula
MA: Parallel to 5th metatarsal

AROM: Pt actively bring toes toward chest.
OP: Apply OP at metatarsals use thumb to move the arm of the goniometer.
E/F: Stabilize ankle, cup calcaneus and apply OP w/ forearm.
PROM: Same goniometer placement and hand position as OP.

22

Ankle Plantar Flexion ROM

Pt in supine or high sitting w/ towel under knee.

Axis: Lateral Malleolus
SA: In line w/ fibula
MA: Parallel to 5th metatarsal

AROM: Ask pt to point toes down and take measurement.
OP: Apply OP on dorsum of the foot.
PROM: Same position as OP.

23

Ankle Inversion and Eversion ROM- (Combined talocrural and subtalar movements)

Visual Assessment:
AROM Bilateral Scan: Pt in Long sitting or supine w/ knee supported by a towel. Inversion: Ask pt to turn toes in towards each other, making sure there is not rotation at the tibia. Assess bilateral symmetry. Eversion: Ask pt to turn toes out.

OP: Stabilize the tip/fib just above the ankle, place the other hand over the dorsum of the foot.

PROM: Use same hand position as for OP.

PROM w/ OP: Use a lumbricle grip and cup the calcaneus