Mid seft

Hip ROM values (flexion, extension, abduction, adduction, IR, ER)?

Flexion 0 to 120. Extension 0 to 20. Abduction 0 to 45. Adduction 0 to 15/20. IR 0 to 40. ER 0 to 35.

Main hip flexor, and what are its 2 parts?

Iliopsoas = iliacus + psoas major.

Hip flexion G3/4/5: patient position, and where is resistance applied?

Sitting, thighs fully supported on table, legs hanging over the edge. Resistance just proximal to the knee, downward toward the floor.

Why is G3 hip flexion tested sitting with the knee flexed, not supine or with the knee extended? (*)

Knee flexed = no hamstring tension limiting the range and a shorter lever arm. Sitting = thigh lifts against gravity through full range.

Hip flexion G2: position, therapist hold, and the knee rule?

Side lying, tested limb uppermost. Therapist stands behind, cradles the limb with the hand under the knee, other hand keeps trunk alignment at the hip. Knee is allowed to flex to prevent hamstring tension. Order: bring your knee toward your chest.

Hip flexion G1/0: position and where do you palpate?

Supine, hip and knee flexed and supported by the therapist (to loosen the tissue). Palpate just distal to the inguinal ligament, on the medial side of sartorius. Order: try to bring your knee up to your nose.

Substitutions in hip flexion: Sartorius and TFL substitute with what movements?

Sartorius = external rotation + abduction. TFL = internal rotation + abduction.

Main muscles in hip extension?

Gluteus maximus + the 3 hamstrings (biceps femoris, semimembranosus, semitendinosus).

Aggregate hip extensors G3/4/5: position and the two resistance sites?

Prone. Resistance over the posterior thigh just above the knee (less demanding) or over the posterior leg just above the ankle (most demanding), downward toward the floor. Order: lift your leg without bending your knee.

Aggregate hip extensors G2: position and the key order?

Side lying, tested limb uppermost, knee straight and supported by the examiner, lower limb flexed for stability. Opposite hand on the pelvic crest to maintain trunk, pelvic and hip alignment. Order: bring your leg back toward me, keep your knee straight.

Hip extensors G1/0: position, palpation sites, and what does a gluteus maximus contraction look like?

Prone. Palpate the hamstrings deep at the ischial tuberosity and gluteus maximus over the center of the buttocks. Order: try to lift your leg OR squeeze your buttocks together. Gluteus maximus contraction = narrowing of the gluteal crease.

How do you isolate gluteus maximus for G3/4/5?

Prone with the knee flexed to 90 degrees (hamstrings are slack). Resistance over the posterior thigh just above the knee. For G3 the knee may need to be supported at 90 degrees by cradling at the ankle. Order: lift your foot to the ceiling.

Key rule: knee extended vs knee flexed in the extension test?

Knee extended = tests ALL hip extensors. Knee flexed = isolates gluteus maximus.

ROM of isolated gluteus maximus vs aggregate extensors: more, equal, or less? (*)

Less. Hamstrings are shortened and the rectus femoris is stretched with the knee flexed, so extension range is smaller.

Isolated gluteus maximus G2 and G1/0: what changes?

G2: side lying, knee in 90 degrees of flexion supported by the examiner, order: move your leg back, keep your knee flexed. G1/0: identical to the aggregate extensor test.

Hip extension with hip flexion tightness G3/4/5: patient position and resistance direction?

Patient stands with hips flexed, torso prone on the table, arms "hug" the table. The non tested knee is flexed so the test limb rests on the floor at the start. Resistance just above the knee in a downward AND FORWARD direction. Order: lift your foot off the floor.

Who else is the hip flexion tightness extension test used for, and what about grades 2, 1, 0?

Very obese, cardiac and chest patients. Grades 2, 1, 0 are done as in the aggregate or isolated gluteus maximus tests.

Main hip abductors?

Gluteus medius + gluteus minimus.

What is the exception about accessory abductors and hip position?

All accessory abductors (TFL, sartorius, the 4 external rotators) act only from hip flexion, EXCEPT the upper fibers of gluteus maximus, which act from neutral or extension.

Abduction G3/4/5: patient position?

Side lying, tested leg uppermost. Start with the limb slightly extended beyond the midline and the pelvis rotated slightly forward. Lower leg flexed for stability.

Abduction G3 grading: what must NOT happen?

Patient abducts through full available ROM without flexing or rotating the hip, against gravity, no resistance.

Abduction resistance sites?

Lateral thigh just above the knee (less demanding) or lateral leg just above the ankle (most demanding), downward toward the floor.

Abduction G2/1/0: position, therapist hold, palpation?

Supine. Therapist holds under the ankle just above the malleoli only to decrease friction (neither resists nor aids). Palpate gluteus medius just above (proximal to) the greater trochanter. Order: bring your leg out to the side, keep your kneecap pointing to the ceiling.

Substitutions in hip abduction (3 of them)?

Hip hiking = quadratus lumborum. External rotation + flexion = iliopsoas and sartorius. Flexion + internal rotation = TFL.

TFL test (abduction from flexed position) G3/4/5: position and resistance?

Side lying, tested limb flexed to 45 degrees and lying across the lower limb with the foot resting on the table. Resistance over the lateral thigh just above the knee, downward toward the floor.

TFL G2/1/0: position, why, and palpation?

Long sitting, hands behind the body, trunk may lean back up to 45 degrees from vertical. Therapist supports the ankle just above the malleoli to decrease friction. Palpate the proximal anterolateral thigh, below and slightly lateral to the ASIS.

TFL anatomy and main function?

Superficial on the anterolateral thigh, part of the gluteal region muscles (with gluteus maximus, medius, minimus). Runs from the anterior iliac crest to the superior tibia via the iliotibial tract. Main function: extension and lateral rotation of the leg at the knee.

Adduction: main muscles, and which accessory fibers act only from hip flexion?

Main: pectineus, gracilis, adductor longus, brevis, magnus. Accessory acting from hip flexion: obturator externus, quadratus femoris, lower (posterior) fibers of gluteus maximus.

Gluteus maximus upper vs lower fibers?

Upper fibers: abduction (neutral or extended hip). Lower fibers: adduction (flexed hip) + external rotation. G max has no "posterior fibers" like medius/minimus, so it is split into upper and lower.

Adduction G3/4/5: which limb is tested, and what does the non tested limb do?

Tested limb is LOWERMOST, resting on the table. Non tested (uppermost) limb is held in 25 degrees of abduction, supported by the examiner (cradled with the hand on the medial knee). Order: lift your bottom leg up to your top one. G3 = reaches until the lower limb contacts the upper one.

Adduction resistance site and direction?

On the lowermost (tested) limb over the medial surface of the distal femur, just proximal to the knee, downward toward the floor.

Adduction G2/1/0: position, non tested limb, palpation?

Supine. Non tested limb is positioned in some abduction to prevent interference. Therapist supports the ankle just above the malleoli (friction only). Palpate the adductor mass on the inner aspect of the proximal thigh. Order: keep your kneecap pointing to the ceiling.

Substitutions in hip adduction (2 of them)?

Internal rotation + flexion: the patient tries to turn to supine (posterior pelvic tilt + IR). External rotation + extension: the patient tries to turn to prone (anterior pelvic tilt + ER, by hamstring contraction).

External rotation main muscles, and the piriformis exception?

Main: all 6 external rotators (piriformis, 2 obturators, 2 gemelli, quadratus femoris) + lower fibers of gluteus maximus. Piriformis does ER from hip extension (but abducts from hip flexion).

ER G3/4/5: position, hand placement, test order?

Sitting; therapist sits on a low stool or kneels beside the limb. One hand grasps the medial aspect of the ankle above the malleolus and pushes laterally. The other hand is on the lateral distal thigh above the knee and pushes medially (counter directions). Order: turn your leg IN (the foot swings in = hip ER).

IR G3/4/5: hand placement and test order?

Sitting. One hand grasps the lateral aspect of the ankle above the malleolus and pushes medially. The other hand is on the medial distal thigh above the knee and pushes laterally. Order: turn your leg OUT (the foot swings out = hip IR).

Big exception in rotation grading G3/4/5?

Place the limb in the end test position and hold it, rather than perform the movement. G3 = hold end position against gravity with no resistance. G4/5 = hold against moderate/strong or maximum resistance.

ER G2/1/0: position, rule at midline, palpation?

Supine with the tested limb in partial internal rotation. Order: roll your leg out. As the hip rolls past the midline, give minimal resistance to offset gravity's assistance. The ER muscles are NOT palpable except gluteus maximus.

IR main muscles and G2/1/0 position and palpation?

Main: gluteus medius and minimus (anterior fibers) + TFL. G2/1/0: supine with the tested limb in partial external rotation, order: roll your leg in. Palpate gluteus medius just above the greater trochanter and TFL below the ASIS.

What is the knee flexion ROM and knee extension ROM?

Flexion 0 to 135 degrees. Extension 135 to 0 degrees.

Which muscles are tested for knee flexion and for extension?

Flexion = hamstrings (biceps femoris, semitendinosus, semimembranosus). Extension = quadriceps femoris.

Hamstrings grade 3 to 5: patient position?

Prone, leg in neutral rotation (foot in midline), toes hanging over the table edge.

Hamstrings grade 3 to 5: where and at what angle do you resist?

At 45 degrees of knee flexion, hand on the back of the leg just above the ankle, pushing straight down toward knee extension.

What decides which hamstring you test?

The foot (leg rotation) position. Midline = all hamstrings. Turned in = medial hamstrings. Turned out = lateral hamstring.

Medial hamstring test (semitendinosus and semimembranosus): rotation and resistance direction?

Leg in INTERNAL rotation (toes point in). Resistance is oblique, DOWN and OUT.

Lateral hamstring test (biceps femoris): rotation and resistance direction?

Leg in EXTERNAL rotation (toes point out). Resistance is oblique, DOWN and IN.

When do you test the medial and lateral hamstrings separately?

Only if there is deviation or asymmetry in the movement, or the examiner has a doubt. Always test the aggregate first.

What must you observe BEFORE the hamstring test?

Tightness of rectus femoris, shown by limited knee flexion or hip flexion.

Hamstrings grade 2: patient and therapist position?

Patient side

Hamstrings grade 1 and 0: position and palpation?

Prone, knee partly flexed and supported at the ankle. Palpate BOTH hamstring tendons just above the back of the knee. Command: Try to bend your knee.

Name the 3 hamstring substitutions and how to spot them.

Hip flexion (buttock rises, patient rolls toward supine). Sartorius (hip flexes and externally rotates, easier because leg is not lifted vertically). Gastrocnemius (strong dorsiflexion uses the tenodesis effect, so do not allow it).

Knee extension grade 3: patient position and 3 details?

Short sitting with a pad under the distal thigh to keep the femur horizontal. Patient may lean back to relieve hamstring tension. Do NOT allow hyperextension because the knee locks into position.

Knee extension grade 4 and 5: angle, hand placement, and technique?

Knee at about 15 degrees of flexion. Resist on the FRONT of the distal leg just above the ankle, pushing down toward the floor, using a straight arm because quadriceps are very strong.

Knee extension grade 2: patient position?

Side

Knee extension grade 1 and 0: position, palpation, and commands?

Supine. Palpate the quadriceps tendon above the knee or the patellar tendon below it. Commands: push the back of your knee into the table, OR tighten your kneecap (quadriceps setting), OR push your knee into my hand.

What is the substitution in the knee extension grade 2 test?

Hip internal rotators let the knee fall into extension in side

Can the four quadriceps heads be separated by manual muscle testing?

No. None of them can be separated from any other.

Hamstring origin and insertions?

Origin = ischial tuberosity. Semitendinosus inserts at pes anserinus, semimembranosus at the medial tibial condyle, biceps femoris at the head of the fibula.