LE various treatments Flashcards
(36 cards)
What is proper treatment position for femorotibial dysfunction BLT?
Pt: Supine, Doc: Ipsi to dysfunction
Hand: Ceph palm over anterior femur, caudad hand over tibial tuberosity
Tech:
- Begin with posterior force
- more pressure caudal hand for ACL, Cephalad for PCL - Add internal/external rotation to obtain BLT (and have pt breath)
Tibia on Femur Supine HVLA
Position: patient supine w knees flexed to 90, doc seated on foot of dysfunctional side
Hand: thenar eminences over anterior tibia and thumbs on plateaus with fingers wrapped around leg
Tech:
- Engage RB and deliver thrust parallel to long axis of femur
- anterior: posterior thrust with thumbs
- posterior: anterior (tug) thrust with fingers
Tibia on Femur Seated HVLA
Position: patient seated w legs off table, pillow under thigh; doc seated in front of patient
Hands: thumbs on anterior tibial plateau with fingers wrapped around
Relaxation method: spring leg up and down 2-3x (may relax thigh and provide running start)
Tech:
- Anterior: deliver posterior thrust with thumbs with simultaneous inferior traction
- Posterior: deliver anterior (tug) with fingers with simultaneous inferior traction
Tibia on Femur Prone HVLA
Position: patient prone, w dysfunctional knee flexed to 90; doc at end of table with dorsiflexion of pts foot on shoulder
Hand: fingers interlaced around tibia just distal to popliteal region
Technique:
- Lead forward to flex knee to 90, plantar flex foot to relax gastrocnemius
- Ant: Thrust (tug) through 4th and 5th finger with both hands parallel to thigh
- Post: deliver superior/cephalad direction thrust w palms on tibial plateaus
Supine Anterior/Posterior Fibular Head
Position: pt supine w pillow under knee; doc standing contra to dysfunction
Hand:
- Cephalad: thenar eminence on anterior aspect of fibular head to push posterior/pull anterior
- Caudad: on ipsi foot at malleoli
Localizing force: IR if anterior, ER if posterior
Activating Force:
- ME: Pt activating force is ER
- HVLA: direct posterior medial thrust at fibular head or anterior lateral pull (posterior)
- ART: rhythmic pressure at barrier
Posterior Fibular Head Technique 1 (supine)
Pos: pt supine ipsi hip and knee flex to 90; doc ipsi
Hand:
- Ceph: 1 MCP on posterior aspect of fib head, flex knee over hand
- Caudad: on ipsi foot
Technique:
- Evert, dorsiflexion, and ER foot
- MET: pt supinate foot
- HVLA: abruptly flex knee to create anterior thrust on fib head
Posterior Fibular Head Technique 2 (Prone)
Pos: pt prone, DF knee flexed to 90; doc contra
Hand:
- Ceph: index finger on posterior fibular head w hypothenar eminence on hamstrings
- Caud: on malleoli of foot
Tech:
- Evert, dorsiflexion, and ER foot
- thrust: further flex knee
Fibula and interosseous BLT
Pos: pt supine; doc ipsi resting elbows on table
Hand:
- ceph: thumb on fib head, palm supporting proximal calf; avoid fibular nerve
- caud: thumb on malleoli, palm supports distal heel
Tech:
- move leg distally puts pressure on proximal fib/proximal puts pressure on malleoli
- extending wrists puts pressure and stretch on interosseous membrane;
- Find position of greatest ease or stretch and await tissue release
Talotibial Dorsiflexion/Plantarflexion HVLA
Pos: pt supine; doc at foot of table
Hand: fingers interlaced on dorsum of foot, thumbs on ball of foot
Tech:
- Caudal traction
- Dorsiflex foot if plantarflexion SD, Plantarflex if dorsiflexion SD
- Thrust: Caudal traction, with thrust into barrier
- Plantarflex: use scooping potion with 4th and 5th finger to disengage talus from tibia
- dosriflexed: place more force on 2nd and 3rd finger
Talotibial Inversion/Eversion HVLA
Pos: Pt supine; doc at foot of table
Hand: One hand on calcaneous, other on dorsum of foot
Tech: HVLA traction (Tug) after positioning
- Inversion: caudal traction with eversion/abduction of ankle
- Eversion: caudal traction with inversion/addiction of ankle
Plantarflexed talus MET
Pos: pt supine, doc at foot of bed
Hand: One hand on heel of foot, other on plantar side with thumb on lateral malleoulus
Technique:
- Dorsiflex foot into restrictive barrier, instruct pt to plantar flex for 3-5s
- Relax for 3-5, repeat 2-3x, or until final barrier
Dorsiflexed Talus MET
Pos: pt supine, doc at foot of bed
Hand: One hand on heel of foot, other on plantar side with thumb on lateral malleoulus
Plantar flex foot, instruct pt to plantar flex
-apply principles of MET
Inverted Talus MET
Pos: pt supine, doc at foot of bed
Hand: One hand on bottom of foot, the other stabilizing the tibia/fib
Tech:
- evert foot to RB, have pt invert
- apply principles of MET
Everted Talus MET
Pos: pt supine, doc at foot of bed
Hand: One hand on bottom of foot, the other stabilizing the tibia/fib
Tech:
- Invert foot to RB, have pt evert
- apply principles of MET
Inverted calcaneous MET
Pos: pt supine, doc at foot of bed
Hand: One hand on heel of foot, the other stabilizing the tibia/fib
Tech:
- evert foot to RB, have pt invert
- apply principles of MET
Everted calcaneous MET
Pos: pt supine, doc at foot of bed
Hand: One hand on heel of foot, the other stabilizing the tibia/fib
Tech:
- Invert foot to RB, have pt evert
- apply principles of MET
Plantar glide navicular, cuboid, cuneiform MET
Pos: pt supine, doc at foot of bed
Hand: Thumbs crossed over area of concern
Tech:
ME: dorsiflex foot to RB, have pt plantar flex (apply principles)
Plantar glide navicular, cuboid, cuneiform HVLA
Pos: pt supine, doc at foot of bed
Hand: One thumb over area of concern at bottom of foot, other hand plantar flex at dorsum of foot
Tech:
-abrupt plantar flexion
Hiss Whip (HVLA)
Pos: pt prone with hip and knee of affected leg off table; doc at foot
Hand: both thumbs over plantar surface of affected foot, fingers on dorsum
Tech:
- Slightly abduct pts lower extremity and flex knee
- Thrust down through thumbs with “whip-like” motion at ankle and knee
Cuneiform and Metatarsal Dysfunction BLT
Pos: pt supine, doc at foot of bed
Hand: Thumbs on dorsum of distal metatarsal, fingers on plantar aspect of foot
Tech:
- Flex/extend, ER/IR, compress/distract as needed
- Once n BLT, await relaxation
Phalanx Dysfunction BLT
Pos: pt supine, doc at foot of bed
Hand: use index finger and thumb of one hand to grasp proximal end of phalanx, use index finger and thumb of other hand to grasp the distal metatarsal
Tech:
- Add compression/traction, rotation, flexion, extension, SB
- Add translation superior/inferior, medial/lateral to balance
- Maintain position until release is felt
Counterstrain steps:
- Structural Exam to find SD
- Find tenderpoint
- Establish pain scale
- Wrap pt around TP while monitoring
- Find 70% ease
- Maintain position for 90s
- Slowly return to neutral
- Reassess
Lateral Trochanter (TFL) location and Tx
Lasted just inferior to Iliac Crest in body of TFL
Pos: pt supine/prone, doc ipsi to TP
FABD (flex, abduct)
IT Band CS Location and Tx
Located in IT band distal to greater trochanter
Pos: pt supine, doc Ipsi
fABD
-maybe some slight IR/ER
