RISOM Knee Flexion
Position: Pt supine w/ knee flexed to 90 degrees.
Procedure:
1. Stabilize the proximal segment w/ one hand: at the distal thigh by the knee.
2. Tell the pt, ‘don’t let me move you’ and ‘let me know if there is pain’.
3. Apply gradual resistance at the ankle by pulling out into extension.
RISOM Knee Extension
Position: Pt supine approximately 30 degrees of knee flexion.
Procedure:
- Place arm or knee under its leg to achieve 30 degrees of flexion.
- Stabilize the proximal segment: at the distal thigh by the knee.
- Tell the pt, ‘don’t let me move you’ and ‘let me know if there is pain’.
- Apply gradual resistance at the ankle by pushing downwards into flexion.
What are the three criteria for stopping RISOM?
- Pain
- The pt gives away
- You can’t pull any harder
MMT for Knee Flexion
-Vs Gravity
Position: Pt in Prone.
- Assess AROM having pt flex knee as much as possible.
- Apply OP at EOR (Flexibility of RF is a limiting factor for this test).
- Place knee in 30 degrees of flexion.
- Stabilize thigh by placing hand on the back of the leg.
- Instruction: ‘Don’t let me move you’
- Apply gradual resistance at the ankle (distal leg). Pull into extension.
MMT for Knee Flexion
-No Gravity
Position: Pt in side lying on the opposite side being tested.
- Make sure the leg and thigh are well supported.
- Make sure to provide no assistance or resistance.
- Bring the knee into extension passively.
- Have the pt bring their knee into flexion as far as they can go. (Therapist positioning may interfere/ full ROM).
MMT for Knee Extension
-VS Gravity
Position: Pt in high sitting w/ hands on the plinth behind them to support their upper body.
- Assess AROM against gravity.
- Verify full range w/ OP.
- Place knee just outside of full extension ROM.
- Stabilize at the top of the thigh.
- Provide resistance at the distal leg w/ the instruction ‘don’t let me move you’. Push into flexion.
MMT for Knee Extension
-No Gravity
Position: Pt in side lying on the opposite side of leg being tested.
- Support the thigh and knee. Passively bring pt into knee flexion.
- Without providing any resistance or assistance have the patient actively extend through ROM.
RISOM Hip Flexion
Pt Position: Supine w/ hip flexed 45 degrees and knee slightly flexed.
Hand position: 1 hand on pelvis and 1 hand on posterior thigh.
Instruction: Don’t let me move you.
Apply resistance: Pull into extension.
RISOM Hip Extension
Pt Position: Supine w/ hip slightly flexed and knee extended.
HP: 1 hand on posterior thigh and 1 at the ankle.
Instruction: Don’t let me move you.
Apply resistance: Push into flexion.
RISOM Hip Abduction
Pt Position: Supine w/ hip 0 degrees of abd.
HP: 1 hand lat ankle and 1 hand thigh (med or lat).
Instruction: Don’t let me move you.
Apply resistance: Push leg towards midline.
RISOM Hip Adduction
Pt Position: Supine w/ hip 0 degrees of add.
HP: 1 hand med ankle and 1 hand thigh (med or lat).
Instruction: Don’t let me move you.
Apply resistance: Pull leg away from midline.
RISOM Hip Internal Rotation
Pt Position: Supine w/ hip and knee flexed to 90 degrees, 0 degrees of rotation.
HP: 1 hand at ankle and 1 hand thigh.
Instruction: Don’t let me move you.
Apply resistance: Pull leg out (laterally).
RISOM Hip External Rotation
Pt Position: Supine w/ hip and knee flexed to 90 degrees, 0 degrees of rotation.
HP: 1 hand at ankle and 1 hand thigh.
Instruction: Don’t let me move you.
Apply resistance: Push leg in (medially).
MMT Hip Flexion
- Gravity
- No Gravity
Gravity: (2 positions)
High Sitting: w/ pt supporting weight of body behind them.
1. Pt actively flexes hip. Make sure they go through full ROM (OP).
2. Apply resistance slightly out of range. 1 hand on distal thigh and other hand stabilizes the pelvis.
Supine:
- Pt actively flexes the hip as far as they can go. Make sure full ROM achieved.
- Bring hip to 90 degrees. Apply resistance at the distal knee and provide counter pressure at the pelvis.
No Gravity:
Pt in side lying on the opposite side to the leg being tested.
1. Support the weight of the leg at the knee. Other hand at the pelvis.
2. Passively bring the pt into extension and then have them actively flex the hip.
Assess for how much of the available ROM the pt is able to perform.
MMT Hip Extension
- Gravity
- No Gravity
Gravity:
Pt standing. Plinth raised to a level just below the hips of the pt. Pt support upper body holding on tight to the plinth.
Leg to be tested is placed back and leg not being tested is placed forward slightly bent.
1. Pt actively extends hip. Verify they have gone through the full ROM.
2. Bring them slightly out of EOR.
3. Stabilize the pelvis and apply resistance at the distal thigh. Instruction: Don’t let me move you.
No Gravity:
Pt in side lying on the opposite side to the leg being tested.
1. Support the weight of the leg at the knee.
2. Passively bring the leg into flexion.
3. Pt actively extends hip, assess how much ROM they can achieve.
MMT Hip Abduction
- Gravity
- No Gravity
Gravity:
Pt in side lying on the side opposite to the limb being tested w/ the bottom leg flexed to 90 degrees.
1. Pt actively abducts the hip. Ensure they have gone through the full ROM.
2. Bring them slightly out of the range.
3. One hand at the pelvis. Apply resistance at the distal thigh w/ the instruction don’t let me move you. (Push into adduction).
No Gravity:
Pt in supine.
Fully support the weight of the pt leg. Have them actively abduct the hip. Assess for the portion of the range that they are able to achieve actively.
MMT Hip Abduction Specific Muscles
Gluteus Medius:
Perform as above w/ the hip in external rotation.
External rotation inhibits TFL therefore preferentially testing gluteus medius.
Tensor Fascia Latea:
Perform as above w/ the hip in internal rotation.
Internal rotation inhibits gluteus medium therefore preferentially testing TFL.
MMT Hip Adduction
- Gravity
- No Gravity
Gravity:
Pt in side lying on the same side as the leg being tested.
Top leg should be flexed at the hip and knee so that it is out of the way for hip ROM.
- Pt actively adduct the hip. Make sure they have gone through the full range.
- Bring them slightly out of the full range and apply resistance at the distal thigh (Push into abduction). W/ the instruction Don’t let me move you.
Not gravity:
Pt supine. Opposite limb should be abducted (w/ foot supported on chair off the side of the table).
1. Fully support the weight of the pt’s leg.
2. Ask them to move into adduction. Assess for the portion of the ROM that they are able to achieve.
MMT Hip Internal Rotation
Gravity:
Part 1:
Pt in high sitting no resistance. Assess AROM by having the patient bring their foot out to the side. Apply OP.
If they have full ROM in high sitting:
Part 2:
Pt supine, same hand position as OP for ROM assessment.
Tell the pt you are going to move foot across midline externally rotating the thigh with the instruction don’t let me move you (test strength of IR).
No Gravity:
Pt in supine w/ hip and knee flexed to 90 degrees.
Support the leg at the knee and ankle. Ask the pt to bring their foot out to the side assessing for the amount of ROM they can achieve.
MMT Hip InterExternal Rotation
Gravity:
Part 1:
Pt in high sitting no resistance. Assess AROM by having the patient move foot towards midline. Apply OP to assess EOR.
If they have full ROM in high sitting:
Part 2:
Pt supine, same hand position as OP for ROM assessment.
Tell the pt you are going to move foot away from midline internally rotating the thigh w/ the instruction don’t let me move you (test strength of external rotators).
No Gravity:
Pt in supine. Support leg at knee and ankle. Ask pt to bring foot towards midline assessing for the amount of ROM they can achieve.
MMT for the Sartorius
Pt in supine.
- Pt actively move into the tailor position: Flexion, abduction, external rotation of hip w/ knee flexion. Resistance must be applied to all these movement.
- One hand at the ankle pulling leg into extension and internal rotation.
- One hand at the distal thigh pushing the hip into adduction and extension.
