NPTE

MMT grade 5

Full ROM, max resistance

MMT grade 4+

Full ROM, mod/max resistance

MMT grade 4

Full ROM, mod resistance

MMT grade 4-

Full ROM, min/mod resistance

MMT grade 3+

Full ROM, min resistance

MMT grade 3

Full ROM, no resistance

MMT grade 3-

Mod/full ROM, no resistance

MMT grade 2+

MMT grade 2

no gravity, no resistance, full ROM

MMT grade 2-

no gravity, no resistance,

MMT grade 1

Trace

Cervical ROM

-Flex: 45
-Ext: 45
-Lateral flex: 45
-Rotation: 60

Thoracic ROM

-Flex: 80
-Ext: 25
-Lateral flex: 35
-Rotation: 45

Lumbar ROM

-Flex: 60
-Ext: 25
-Lateral flex: 25

Hip ROM

-Flex: 120
-Ext: 30
-Abduction: 45
-Adduction: 30
-IR: 45
-ER: 45

Knee ROM

-Flex: 135
-Ext: 0

Ankle ROM

-DF: 20
-PF: 50
-Eversion: 15
-Inversion: 35

Shoulder ROM

-Flex: 180
-Ext: 60
-Abduction: 180
-Adduction: 40
-ER: 90
-IR: 20

Elbow ROM

-Flex: 150
-Ext: 0

Wrist ROM

-Flex: 80
-Ext: 70
-Radial dev: 20
-Ulnar dev: 30
-Pronation: 80
-Supination: 80

What ROM is needed for normal gait?

-Hip flex: 35
-Hip ext: 10
-Knee flex: 60
-Knee ext: 0
-Ankle DF: 10
-Ankle PF: 20

TMJ capsular pattern

limited mouth opening

GH capsular pattern

ER\>ABD\>IR

Humeroulnar capsular pattern

Flex\>Ext

Radiohumeral capsular pattern

flexion \> extension \> supination \> pronation

Wrist capsular pattern

flexion \= extension

Cervical capsular pattern

lateral flexion \= rotation \> extension

Finger capsular pattern

flexion \> extension

Lumbar capsular pattern

Lat flexion \= rotation \> extension

Hip capsular pattern

flexion \> abduction \> internal rotation

Knee capsular pattern

Flex \> ext

Ankle capsular pattern

PF \> DF

Hip flexion mm

Iliopsoas
Sartorius
Rectus femoris
Pectineus

Hip ext mm

Glute max & med
HS
Biceps femoris

Hip abduction mm

Glute med & min
Piriformis
Obturator internus
TFL

Hip adduction mm

Adductor group
Gracilis

Hip IR mm

TFL
Glute med & min
Pectineus
Adductor longus

Hip ER mm

Glute max
Obturator ext & int
Piriformis
Gemelli
Sartorius

Knee flexion mm

Biceps femoris
HS
Sartorius

Knee ext mm

Rectus femoris
Vastus group

Ankle PF mm

Tibialis post
Gastrocsoleus
Peroneus longus & brevis
Plantaris
Flexor hallicus

Ankle DF mm

Tibialis ant
EHL
EDL
Peroneus tertius

Ankle inversion mm

Tibialis post & ant
FDL

Ankle eversion mm

Peroneus group

Toe flex mm

FDL & FDB
FHL & FHB
FDMB
Quadratus plantae
Lumbricals

Toe ext mm

EDL & EDB
EHL & EHB
Lumbricals

Cervical flex mm

SCM
Longus colli
Scalenes

Cervical ext mm

Splenius cervicis
Semispinalis cervicis
Iliocostalis cervicis
Longissimus cervicis
Multifidus
Trapezius

Cervical rotation/lat flex mm

SCM
Sscalenes
Splenius cervicis
Longissimus cervicis
Iliocostalis cervicis
Levator scapulae
Multifidus

Thoracic/lumbar flex mm

Rectus abdominis
Int & ext oblique

Thoracic/lumbar ext mm

Erector spinae
Quadratus lumborum
Multifidus

Thoracic/lumbar rotation/lat flex mm

Psoas minor
Quadratus lumborum
Ext & int oblique
Multifidus
Longissimus thoracis
Iliocostalis thoracis
Rotatores

Ottawa knee rules

\>55 yrs
TTP at patella
TTP at head of fibula
Inability to flex knee to 90
Inability to WB for 4 steps

Ottawa ankle rules

TTP at lateral malleolus
TTP at medial malleolus
TTP at base of 5th MT
TTP at navicular
Inability to WB for 4 steps

L1/2

Hip flex

L3

Knee flex
Patellar reflex

L4

Ankle DF
Patellar reflex

L5

1st toe ext
Medial HS reflex

S1

Ankle PF/ev
Hip ext
Achilles reflex

S2

Knee ext
Achilles reflex

ACL

prevents anterior & medial rotation of the tibia on the femur

PCL

prevents posterior & medial rotation of the tibia on the femur

MCL

resists valgus & external rotation

LCL

resists varus & external rotation

MOI for ITB syndrome

-Excess foot pronation
-Hip AB weakness
-Internal tibial torsion
-Hip genu varum

Tests for ITB syndrome

Ober's
Noble compression

Interventions for ITB syndrome

Rest
Cryo
ITB stretching
Myofascial release
Hip AB strengthening

Interventions for patellofemoral dysfunction

Quad & glute strengthening
Patellar mobs
Taping

Tests for meniscus tear

McMurray
Thessaly
Apley grind test

Interventions for meniscus tear

Strengthen HS & quad
RICE
Scar tissue mob
Balance training

Tests for PCL tear

Post sag
Post drawer
Reverse Lachman

Phase 1 THA (wk 1-4)

Goals: ⭡ ROM to 0-90, ⭣ edema, 3-4/5 quad MMT
Interventions: ankle pumps, quad/HS/ab/ad setting, gait train, patellar mob

Phase 2 THA (wk 4-8)

Goals: ⭣ edema, ⭡ ROM to 0-110, 4-5/5 LE MMTs, ⭡ balance & NM control
Interventions: patellar mob, LE stretching, CKC strengthening, tibfem mob, CV conditioning, proprioceptive training

Phase 3 THA (wk 8+)

Goals: develop maintenance program, ⭡ CV fitness
Interventions: continue w/ phase 2

ACL MOI

Rotation of knee while foot is planted; a blow that drives the tibia anterior on the femur; hyperextension

ACL injury sxs

-Audible pop
-Instability
-Giving way
-Pain
-Edema
-⭣ knee ext
-Widespread TTP esp at med knee

ACL tests

Lachman
Ant drawer
Apley

Phase 1 ACL (day 1-wk 4)

Pt: pain, hemiarthrosis, ⭣ ROM, ⭣quad activation
Goals: ⭣ edema, control pain, patellar mobility, WB to 75%
Interventions: PROM/AAROM, patellar mobs, quad/HS/add iso, assisted SLR, heel/toe raise, OKC knee ext

Phase 2 ACL (wk 4-10)

Pt: ⭣ pain, full or near full ROM, ⭣ edema, 3+-4/5 MMT, independent ambulation
Goals: 4/5 MMT, dynamic knee control, normalized gait, ⭡ ROM
Interventions: start walk/jog program, high-speed exercises, proprioceptive train

Phase 3 ACL (wk 11-24)

Pt: no instability, no pain or edema, full ROM, symmetric gait
Goals: ⭡ MMT/endurance/power, transition to maintenance program, ⭣ risk of reinjury
Interventions: initiate plyos, progress agility drills, transition to full-speed jog/run & cutting

Manual for DF

Passive DF
Talocrural AP

Manual for PF

-Passive PF
Talocrural PA

Manual for ankle inversion

Passive inversion
STJ medial glide

Manual for ankle eversion

Passive eversion
STJ lateral glide

MOI for syndesmosis sprain

⭡ DF or PF, plant & cut, tib/fib go in opposite direction

Sxs of syndesmosis sprain

⭣ PF, unable to WB, ecchymosis, TTP at anterior ankle

Tests for syndesmosis sprain

Kleiger, squeeze, fibular translation

Week 1-2 interventions for syndesmosis sprain

AROM flex
Ankle ABCs
Ankle 4-way w/ TB
Gait w/ crutches

Week 3-4 interventions for syndesmosis sprain

Standing stretch
Ankle 4-way
Heel raise → single heel raise
Treadmill gait training
NM retraining

MOI for achilles rupture

Sudden forceful contraction of muscle

Sxs for achilles rupture

P! at posterior leg
Edema
Inability to PF
Audible "pop" or "snap"

Test for achilles rupture

Thompson

Post-op management for achilles rupture

Wk 0-4: foot in 15-30 PF, compression dressing
Wk 4: CAM brace to limit DF to 0
Wk 6-8: CAM brace to DF beyond neutral, AROM w/ brace
Wk 12+: functional brace discontinued, brace use or taping encouraged

Phase 1 achilles rupture (wk 4-6)

AROM non-immobilized joints
DF/PF/iv/ev muscle setting
Weight shift in bilateral stance w/ orthosis

Phase 2 achilles rupture (wk 6-12)

Orthosis weaning
GrIII joint mobs
Self-stretch & AROM
Strengthening - OKC of hip, knee, ankle; CKC of heel raise
Balance train w/ functional orthosis
Gait train
CV fitness

Phase 3 achilles rupture (wk 12)

Return to pre-injury
Endurance train
Plyometrics
Treadmill walk on incline

MOI for plantar fasciitis

Obesity
Pes planus or cavus
Pt is \>40 yrs

Sxs of plantar fasciitis

TTP at plantar fascia
Plantar medial heel P!
⭡ P! w/ DF

Tests for plantar fasciitis

Windlass in nonWB & WB

Interventions for plantar fasciitis

Anti-pronation tape immediately
Soft tissue massage
Passive stretch
Foot orthoses
Night splint if ⭡ P! w/ initial steps in morning