Midterm Flashcards
SUPINE – SACROILIAC JOINT MOBILITY
NORMAL: Anterior to posterior (A-P) shearing motion should occur at the sacroiliac joint.
POSITIVE: Restricted or reduced anterior to posterior (A-P) shearing motion of the sacroiliac joint.
Standing Step test (Gillet’s Test)
Part 1: Dr’s RIGHT thumb on patient’s RIGHT PSIS Dr’s LEFT thumb on patient’s LEFT S2 (2nd sacral tubercle) RIGHT side: The thumbs Approximate. LEFT side: The thumbs Separate.
Part 2:
Dr’s LEFT thumb on patient’s LEFT PSIS
Dr’s RIGHT thumb on patient’s RIGHT S2 (2nd sacral tubercle)
LEFT side: The thumbs approximate.
RIGHT side: Thumbs (distract) move further apart in an oblique direction.
Standing Step test (Gillet’s Test)- “Positive test”
POSITIVE TEST: Normal sacroiliac motion is present when the thumbs either move towards each other (Part 1) or away from each other (Part 2) in an oblique direction. With either part 1 or part 2 if the thumbs move at the same time and in the same direction, this indicates restriction (lack of motion) of the sacroiliac joint. The side on which the thumb does NOT move is the side of the lesion (restriction).
STANDING Flexion test
Dr Contacts:
Dr’s RIGHT thumb on RIGHT PSIS
LEFT thumb on LEFT PSIS.
Procedure: The patient is asked to bend at the waist
NORMAL: Both thumbs MOVE AT THE SAME TIME.
POSITIVE: One thumb MOVES FIRST. The side of first movement is the side of the LESION (restriction).
SEATED Flexion test
Dr Contacts: Dr’s RIGHT thumb on RIGHT PSIS
LEFT thumb on LEFT PSIS.
Procedure: The patient is asked to bend at the waist
NORMAL: Both thumbs MOVE AT THE SAME TIME.
POSITIVE: One thumb MOVES FIRST. The side of first movement is the side of the LESION (restriction).
TESTING GLUTEAL STRENGTH:
Procedure:Stabilize the upper buttock (Iliolumbar) area with the superior hand while pressing straight downward on the thigh with the inferior hand. Grade gluteus maximus muscle strength on a 5/5 scale.
NORMAL: Strong muscle strength (4-5/5) that locks in the contraction without muscle shaking or fading.
POSITIVE: The muscle gives way with resistance and either drops to the table top or shakes or fades with resistance.
GLUTEUS MEDIUS STRENGTH:
Procedure: Stabilize the pelvis with the superior hand to prevent twisting while pressing straight downward on the thigh with the inferior hand. Grade gluteus medius muscle strength on a 5/5 scale.
NORMAL: Strong muscle strength (4-5/5) that locks in the contraction without muscle shaking or fading.
POSITIVE: The muscle gives way with resistance and either drops to the table top or shakes or fades with resistance.
BELT TEST
Part 1. No doctor contact while bends forward (flexes)
Part 2. The doctor stabilizes
NORMAL: The patient fully bends over in both test phases without pain.
POSITIVE: Pain provoked by Part 1 and Part 2 indicates lumbar origin.
Pain with part 1 only indicates sacroiliac origin.
ACTIVE STRAIGHT LEG RAISE TEST (aSLR)
Procedure: Part 1. The patient is instructed alternately lift each leg 8 inches (20 cm) off the table. Palpate the patient’s pelvis for torsion instability or difficulty lifting the leg.
Part 2. Additional information can be ascertained by repeating the test with one of the following:
manual compression of the sacroiliac joint
a sacroiliac belt to compress the sacroiliac joint
active abdominal bracing by the patient
NORMAL: The patient raises each leg alternately without lumbar or pelvic pain and without twisting (rotation) of their pelvis (instability).
POSITIVE: Part 1. If any of the following are present.
- The leg can’t be raised off the table.
- There is heaviness of the legs.
- Decreased strength when downward overpressure is applied to leg.
- There’s significant ipsilateral trunk rotation or twisting (instability).
Part 2. If manual compression, a sacroiliac belt or active abdominal bracing by the patient causes a decrease in symptoms after a positive initial active straight leg raise, there is a loss of neuromuscular control and instability of the pelvis.
HIP EXTENSION TEST – IPSILATERAL PRONE KINETIC TEST
Assessment of Hip Motion
Dr Contacts:
Superior hand: Thumb placed on apex of PSIS.
Inferior hand: Thumb on the sacrum parallel to the other thumb.
Procedure: The patient is asked to lift up their leg, extending the hip.
Palpate for superior (upward) and lateral motion of the PSIS.
Note: this test is usually performed with active hip extension, however, if the patient is too weak to perform active hip extension or if active hip extension causes pain, this test can be performed passively whereby the doctor lifts the leg into hip extension to assess hip joint mobility.
NORMAL: The PSIS does not move before the hip is extended approximately 10o.
Testing in the prone position places the hip in a neutral (0o) position.
Normal hip extension is 10o-30o.
POSITIVE: The PSIS and the sacrum moves superiorly and laterally as the hip is extended.
(PI) PIR Stretch Ipsilateral Hamstrings (Hip Extensors)
(leg on shoulder)
Action:
Fully extend ipsilateral knee with ankle and foot relaxed
Gently stretch hip extensors (hamstrings) by gradually increasing hip flexion while avoiding knee flexion
Deep inhalation and hold breath
Eyes look up (without head movement)
Have patient isometrically contract ipsilateral hip extensors by pushing straight leg into doctor’s HC for 7-10 seconds at 20-75% max contraction.
Rule: “as little force as possible or as much as necessary”
Avoid Valsalva.
Let breath out and eyes release
Relax - wait for muscle resistance to let go (1-3 seconds)
Increase hamstring stretch within comfort zone (should move smoothly).
Repeat PIR stretch 3-5 times total.
(PI) Tighten Iliopsoas (Hip Flexors)
Action: Isometric contraction of ipsilateral hip flexors for 7-10 seconds at 50-75% max contraction. Avoid Valsalva. Repeat 3-5 times
(Pt. foot on Dr’s hip, straight leg on bench, Dr. pushes down on straight leg.)
(AS) PIR Stretch Ipsilateral Psoas (Hip Flexors)
Action:
Contralateral knee to chest; ipsilateral hip extended with the knee relaxed
in extension
Gently stretch hip flexors submaximally into hip extension
Deep inhalation and hold breath
Eyes look up (without head movement)
Have patient isometrically contract hip flexors at end range by pushing up into
doctor’s hand contact for 7-10 seconds at 20-75% maximal contraction.
Rule: “as little force as possible or as much as necessary”
Avoid Valsalva.
Let breath out and eyes release
Relax - wait for muscle resistance to let go (1-3 seconds)
Slowly increase hip flexor stretch within comfort zone (should move smoothly).
Repeat PIR stretch 3-5 times total
(AS) Tighten Hamstrings (Hip Extensors)
Action:
Isometric contraction (50-75% max) of ipsilateral hamstrings for 7-10 seconds.
Avoid Valsalva.
Repeat 3-5 times.
MET FOR LESIONS OF THE PUBIC SYMPHYSIS
PP: Supine, knees flexed at 45o, knees separated, and feet flat and parallel on the table.
DP: Hand contact medial aspects of both of the patient’s knees.
Procedure: The patient gently actively adducts their knees isometrically
The position is held against patient resistance for 7-10 seconds
Repeat 3 times and re-assess
Alternately: Gently pull against the patient, trying to separate their knees
PELVIC BLOCKING; PRONE POSITION
“Right AS Innominate or Left PI Innominate”
Block #1 Right side:
Iliac crest at 45° and place it under the Right ASIS
Block #2 Left side:
Horizontally (90°) under the Left greater trochanter
Adjust both blocks to assure pelvis is level (check PSISs)
After at least 5 minutes, remove the blocks slowly and simultaneously
PELVIC BLOCKING; PRONE POSITION
“Left AS Innominate or Right PI Innominate”
Block #1 Right side:
Iliac crest at 45° and place it under the Left ASIS.
Block #2 Left side:
Horizontally (90°) across the femur under the Right greater trochanter.
PELVIC BLOCKING; SUPINE POSITION
“Right AS Innominate or Left PI Innominate”
Block #1 Right side:
iliac crest at 45° and place it under the Left PSIS
Block #2 Left side:
Horizontally (90°) across the femur under the Right greater trochanter.
PELVIC BLOCKING; SUPINE POSITION
Left AS Innominate or Right PI Innominate
Block #1 Left side:
Iliac crest at 45° and place it under the Right PSIS
Block #2 Right side:
Horizontally (90°) across the femur under the Left greater
trochanter.
PIR-
Tensor Fasciae Latae (TFL)
Patient Position: Side lying with target (involved) muscle up.
Patient’s posterior trunk positioned close to the edge of the table.
Upside leg (target muscle): the hip and knee are extended and the leg is lowered over the edge of the table until the barrier of resistance is palpated.
Downside leg: hip and knee flexed on the table for stability.
PIR-
Piriformis
Patient Position: Supine
Contralateral leg (target muscle): knee flexed. Hip flexed, adducted and internally rotated to the position where the “barrier of resistance” is palpated
Ipsilateral leg: extended and relaxed on the table
PIR-
Iliopsoas
Patient Position: Sitting on the edge of the foot of the table.
Ipsilateral leg: patient pulls their knee-to-chest (flexion) and reclines the upper trunk backwards onto the table, leaving the contralateral leg (target muscle) hanging off the foot of the table.
The doctor places his/her lateral hip against the sole of patient’s foot to help stabilize the leg in flexion.
Contralateral leg (target muscle): allowed to hang over the foot of the table with the thigh resting as close as possible to the table top and the knee passively flexed as much as possible over the edge of the table.
PIR-
Rectus Femoris
Procedure:
Place the superior (cephalad) hand on the patient’s ipsilateral knee to stabilize it.
With the inferior (caudal) hand push on the contralateral tibia to induce knee flexion.
Stretch the rectus femoris (quadriceps) until the “barrier of resistance” can be palpated.
Ask the patient to breathe in and look up with both eyes.
Direct the patient to push their lower leg against your contact hand as you apply isometric resistance to the patient’s knee extension (20-75%).
Quadratus Lumborum
Patient Position: Sidelying with target (involved) muscle up
Patient’s trunk is positioned close to the edge of the table.
Upside leg (target muscle): the knee is straight (extended) and the hip is either flexed or extended (anterior vs. posterior divisions) with the leg lowered over the edge of the table.
Downside leg: hip and knee are flexed on the table for stability.
The patient’s upside arm reaches overhead and grasps the top of the table.
A roll may be placed on the table under the patient’s waist.
Doctor Position: Ipsilateral to dysfunction; standing behind the patient to stretch the posterior division or in front of the patient to stretch the anterior division.
