Practical II

Question 1

Evaluate and treat the hip flexors using muscle energy. Name the muscles

Answer 1

Hip flexors = RIP muscles (rectus femoris, iliacus, psoas major)

Treatment:

1. ) pt prone, flex knee to less than 90 degrees and place hand under knee, place other hand over IT
2. ) extend hip until restrictive barrier
3. ) use ME (pt’s movement = flexing hip)

Question 2

Evaluate and treat the knee flexors using muscle energy. Name the muscles

Answer 2

Knee flexors = hamstrings (aka hip extensors) = BITE ME muscles = BIceps femoris, semiTEndinosus, semiMEmbranosus

Treatment:

1. ) pt supine, flex hip to 90 degrees, slowly extend knee until barrier is felt
2. ) use ME (pt’s movement = bring heel toward table)

Question 3

Evaluate and treat the knee extensors using muscle energy. Name the muscles

Answer 3

Knee extensors = quads = vastus (lateralis, medialis, intermedius) and rectus femoris

Treatment:

1. ) pt prone
2. ) flex knee until restrictive barrier is felt
3. ) use ME (pt’s movement = extension of knee by pushing back on physician’s hand)

Question 4

Evaluate and treat the hip adductors using muscle energy. Name the muscles

Answer 4

Hip adductors = GAAAP muscles = gracilis, adductor (magnus, brevis, longus), pectineus

Treatment:

1. ) pt supine
2. ) abduct the hip without rotation (keep toes upward) until barrier is felt **place other hand on other leg to stabilize - also, use keep leg against your hip for stability
3. ) use ME (pt’s movement = adduction)

Question 5

Evaluate and treat the hip abductors/internal rotators using muscle energy. Name the muscles

Answer 5

Hip abductors/internal rotators = gluteus medius/minimus, tensor fascia lata

Treatment:

1. ) pt supine
2. ) lift non-testing leg into air, abduct the other leg without internally/externally rotating it (toes upward) until barrier is felt
3. ) use ME (pt’s movement = abduction)

Question 6

Evaluate and treat the external hip rotators using muscle energy. Name the muscles

Answer 6

External hip rotators = Gotta Pee GO GO quick muscles = gluteus maximus, piriformis (primary muscle), gemellus superior, obturator externus, gemellus inferior, obturator internus, quadratus femoris

Treatment:

1. ) pt supine
2. ) grasp ankle and internally rotate hip until barrier is felt (look at hips not knee, ankle or foot with evaluation)

Treatment A (for hip or knee pain)

3. ) flex knee and place foot on lateral side of opposite leg (below knee)
4. ) stabilize ipsilateral ASIS and further internally rotate and adduct the hip until barrier is felt
5. ) use ME (pt’s movement = pushing their knee into hand)

Treatment B (no hip or knee pain)

3. ) flex knee and hip to 90 degrees
4. ) externally rotate hip to barrier, flex and adduct hip until restrictive barrier is felt
5. ) use ME (pt’s movement = pushing their lower leg towards physician)

Question 7

Location of ilacus tenderpoint? What position to place pt in to achieve reduction in pain?

Answer 7

Iliacus tenderpoint = 1/3rd from ASIS to midline, use posterior and lateral force
Position = pt supine, flex hips and knees bilaterally to shorten iliacus, cross ankles for abduction and externally rotate hips (place legs on physician’s) - looks like bowl

Question 8

Hip adductor tenderpoint. What position to place pt in to achieve reduction in pain?

Answer 8

Position = slightly flex hip and knee with adduction of hip and slight external rotation

Question 9

Location of piriformis tender point? What position to place pt in to achieve reduction in pain?

Answer 9

Piriformis tenderpoint = midpoint between lower half of lateral aspect of sacrum / ILA and greater trochanter
Position = pt pront, flexion of hip to greater than 90 degrees and abduction (fine tune with int/ext rotation)

Question 10

Location of psoas tender point? What position to place pt in to achieve reduction in pain?

Answer 10

Psoas tenderpoint = pt supine, knees flexed with ankles on physician’s thigh, flex and side bending pelvis toward side of tender point

Question 11

If muscle energy did not address hip flexors to achieve increased ROM, what hip capsule treatment can be performed? Demonstrate. Contraindications?

Answer 11

Treatment of anterior hip capsule d/t restriction may be necessary
** contraindication: pts with hx of hip instability or surgery

Treatment:

1. ) pt prone
2. ) flex pt’s knee and gently extend hip with hand over knee, place other hand over proximal femur
3. ) LV/MA anteriorly (test with one application of force to see if it causes pain) – can fine tune with internal / external rotation and applying lateral and medial forces

Question 12

If muscle energy did not address hip external rotators to achieve increased ROM, what hip capsule treatment can be performed? Demonstrate. Contraindications?

Answer 12

Treatment of posterior hip capsule d/t restriction may be necessary
** contraindication: pts with hx of hip instability or surgery

Treatment:

1. ) pt supine
2. ) flex hip to 90 degrees with knee flexed, cup hands and place on anterior knee
3. ) LV/MA posteriorly (test with one application of force to see if it causes pain) – can fine tune with redirection of posterior force