Athletic Training

First step when evaluating scholar-athlete’s injury or illness

Taking a thorough history

What acronym is used for taking history?

OPQRST

What does OPQRST stand for?

O - onset of event

P - provocation or palliation (what makes the problem better or worse)

Q - quality of pain

R - region and radiation

S - severity

T - time (how long)

Olfactory nerve (classification and function)

sensory and smell

Olfactory Assessment

have S-A close eyes and smell something familiar

Optic Nerve (classification and function)

sensory and vision

Optic Nerve Assessment

Have S-A read something like a sign or words on a page

Oculomotor Nerve (classification and function)

motor; eye movement, pupil constriction, and accommodation of muscles of upper eyelid

Oculomotor Nerve Assessment

Have the S-A cover one eye, then shine a light into the eye to see pupil response, also have S-A look up

Trochlear Nerve (classification and movement)

motor; eye movement (downward gaze)

Trochlear Nerve Assessment

Have S-A look down and inward

Trigeminal Nerve (classification and function)

sensory and motor; somatic sensation from face, mouth and muscles of mastication

Trigeminal Nerve Assessment

Have the S-A open and close mouth, touch sides of the face to see if sensation is similar bilaterally

Abducens (classification and function)

motor; eye movement (abduction or lateral movement)

Abducens Nerve Assessment

Have the S-A look from side to side

Facial Nerve (classification and function)

sensory and motor; control muscles of facial expression and taste

Facial Nerve Assessment

Have the S-A smile or raise eyebrows

Vestibulocochlear (classification and function)

sensory; hearing and balance

Vestibulocochlear Nerve Assessment

Have the S-A balance on one leg or rub fingers next to ear and see if S-A can hear the noise from both ears

Glossopharyngeal Nerve (classification and function)

sensory and motor; tongue movement and taste

Glossopharyngeal Nerve Assessment

Have the S-A swallow

Vagus Nerve (classification and function)

sensory and motor; swallowing

Vagus Nerve Assessment

Have the S-A swallow

Accessory Nerve (classification and function)

motor; shoulder and neck movement

Accessory Nerve Assessment

Have the S-A resist shoulder shrug

Hypoglossal Nerve (classification and function)

motor; movement of tongue

Hypoglossal Nerve Assessment

Have the S-A stick his or her tongue out of their mouth

Myotomes

A group of muscles innervated by the motor fibers of a single nerve root

C1/C2

neck flexion/extension

C3

neck lateral flexion

C4

shoulder elevation

C5

shoulder abduction

C6

Elbow Flexion

C7

Elbow extension/wrist flexion/finger extension

C8

finger flexion

T1

Finger Abduction

L2

Hip Flexion

L3

Knee Extension

L4

Ankle Dorsiflexion

L5

Great Toe Extension

S1

Ankle plantarflexion/ankle eversion/hip extension

S2

Knee Flexion

Dermatone

An area of skin supplied by sensory neurons that arise from a spinal nerve ganglion

Origin of Psoas?

ventral surface of the transverse processes of all lumbar vertebrae and sides and bodies of corresponding intervertebral disks

Insertion of Psoas?

Lesser trochanter of femur

Action of Psoas?

Hip flexion

S-A Position for Hip Flexor

• supine

• contralateral knee to chest

• ipsilateral leg supported at joint line by table with leg relaxed hanging off of the table

Clinician Position for Hip Flexor

In line with S-A at foot of the table

Clinician Hand Placement for Hip Flexor

One hand on distal quadriceps and one on table for stability or holding lateral lower leg to resist external rotation

Hip Flexor Stretch Setup

1. Have the S-A sit at the edge of the table

2. Instruct S-A to lie back while hold both knees

3. Instruct S-A to release one leg so it hangs off the table

4. Stabilize the contralateral (other) leg by placing their foot on your shoulder

5. Instruct S-A to hold the leg by wrapping arms around the shin

6. Use arm to stabilize the lateral knee

Psoas Stretch Procedure

1. Apply overpressure at the distal quadriceps until the S-A feels a stretch

2. Hold for 6 seconds at point of stretch

3. Instruct S-A to flex hip toward drawing the knee toward the ceiling

4. Resist S-A’s motion to facilitate and isometric contraction, holding for 6 sec

5. Instruct S-A to relax contraction

6. Repeat for 3 cycles

7. End on a stretch for 6 seconds

Origin of Rectus Femoris?

• AIIS

• above the acetabulum

Insertion of Rectus Femoris

Proximal border of the patella through the patellar tendon to the tibial tuberosity

Action of Rectus Femoris

knee extension and hip flexion

Psoas & Rectus Femoris Stretch Procedure

1. Apply pressure at the distal quadriceps until the S-A feels a stretch

2. Hook your anterior ankle across the S-A’s ipsilateral distal shin and slowly push the knee into a greater flexion until the S-A feels a stretch

3. Hold for six seconds at point of stretch

4. Instruct S-A to flex hip drawing the knee toward the ceiling while simultaneously extending the knee with 30% pressure

5. Resist S-A’s motion, holding for 6 seconds

6. Instruct S-A to relax contraction

7. Repeat for 3 cycles

8. End on a stretch for 6 seconds

Lateral Angle Hip Flexor Stretch Procedure

1. Step your knee over the distal thigh of the S-A and wrap your anterior ankle across S-A’s shin

2. Apply overpressure down and in at the distal quadriceps and distal ITB until S-A feels a stretch

3. Static hold for 20-30 seconds

Origin of Biceps Femoris?

Long head: distal sacrotuberous ligament & posterior ischial tuberosity

Short head: lateral lip of linea aspera, proximal 2/3rds of supracondylar line, lateral intermuscular septum

Insertion of Biceps Femoris?

• lateral head of the fibula

• lateral tibial condyle

• lateral deep fascial

Action of Biceps Femoris

Knee: flexion and lateral rotation

Hip (long head only): extension and lateral rotation

S-A Position for Hamstring

• supine

• knees fully extended

• hips neutral

• feet towards wall

Clinician Position for Hamstring (Biceps Femoris)

Stand at the S-A’s contralateral shoulder facing their feet

Clinician Hand Placement for Hamstring

Stretch Phase: one hand on plantar aspect of foot cupping the metatarsal heads, one hand over the distal quadriceps to maintain knee extension

Contraction Phase: one hand on plantar aspect of food cupping the metatarsal heads, one hand provides tactile feedback on ipsilateral hamstring

Hamstring Stretch Procedure (Bilateral Femoris)

1. Instruct S-A to lift their leg as high as they can

2. Direct the leg medially so that their knee is in line with the contralateral shoulder

3. Provide overpressure until the S-A feels a stretch

4. Ensure that the S-A’s contralateral leg stays in contact with the table

5. Hold stretch for 6 sec

6. Instruct S-A to push their leg back down to the ipsilateral corner of the table with 30% pressure

7. Resist S-A’s downward motion to facilitate contraction, holding for 6 sec

8. Provide tactile cue at the ipsilateral hamstring

9. Instruct S-A to relax

10. Instruct S-A to actively lift leg further into hip flexion

11. Repeat for 3 cycles

12. End on a stretch for 6 seconds

Origin of Semitendionsis?

ischial tuberosity

Origin of Semimembranosus?

ischial tuberosity

Insertion of the Semitendinosis?

proximal, medial surface of tibia

Insertion of the semimembranosus?

posteromedial aspect of medial condyle of tibia

Action of semitendinosis/semimembranosus?

Knee: flexion, medial rotation

Hip: extension, medial rotation

Clinician Position for Hamstring- Semitendinosis/Semimembranosus

stand at the S-A’s ipsilateral shoulder/trunk

Clinician Hand Position for Hamstring- Semitendinosis/Semimembranosus

Stretch Phase: one hand on plantar aspect of foot cupping the metatarsal heads, one hand over distal quadriceps to maintain knee extension

Contraction Phase: one hand on plantar aspect of foot cupping the metatarsal heads, one hand provide tactile feedback on ipsilateral hamstring

Stretch Procedure for Hamstring- Semitendinosis/Semimembranosus

1. Instruct SA to lift leg as high as they can

2. Align knee with ipsilateral shoulder

3. Provide pressure until the SA feels a stretch

4. Ensure the SA’s contralateral leg remains in contact with the table

5. Hold stretch for 6 seconds

6. Instruct SA to push their leg back down to neutral on the table with 30% pressure

7. Resist SA’s downward motion, holding for 6 seconds

8. Provide tactile cues at the ipsilateral hamstrings

9. Instruct SA to relax

10. Instruct SA to lift leg further into hip flexion

11. Repeat for 3 cycles

12. End on a stretch

SA Position for Hamstring-Bent Knee

• supine

• use arms/hands holding at distal hamstrings to maintain flexion

• ipsilateral leg relaxed in flexion

• contralateral hip neutral

• contralateral knee extended

Clinician Position for Hamstring-Bent Knee

stand perpendicular to SA at ipsilateral hip

Clinician Hand Placement for Hamstring-Bent Knee

one hand at ipsilateral plantar aspect cupping the metatarsal heads and one hand cupping ipsilateral calcaneus

Stretch Procedure for Hamstring-Bent Knee

1. Instruct SA to actively flex hip and knee toward the chest

2. Align knee with ipsilateral shoulder

3. Ensure SA’s contralateral leg remains in contact with table

4. Ensure SA’s lumbar spine maintains contact with table

5. When SA feels stretch, instruct them to hold their leg in the position

6. Instruct SA to actively extend knee as far as they can while maintaining hip flexion

7. Provide overpressure by lifting calcaneus upward until the SA feels a stretch

8. Hold the stretch for 6 sec

9. Instruct SA to flex knee with 30% pressure towards glutes

10. Resist SA’s downward motion and hold for 6 sec

11. Provide tactile cue at the ipsilateral hamstrings

12. Instruct SA to relax

13. Instruct SA to extend knee further

14. Repeat for 3 cycles'

15. End on a stretch

Origin for Vastus Medialis?

• distal half of the intertrochanteric line

• medial lip of the linea aspera

• proximal medial supracondylar line

• tendons of the adductor longus and adductor magnus

• medial intermuscular septum

Origin for Vastus Lateralis?

• proximal intertrochanteric line

• anterior and inferior borders of greater trochanter

• lateral lip of gluteal tuberosity

• proximal lateral linea aspera

• lateral intermuscular septum

Origin of Vastus Intermedius?

• anterior and lateral surfaces of the proximal 2/3rds of the femur, distal half of the linea aspera

• lateral intermuscular septum

Insertion for the vastus medialis/lateralis/intermedius?

proximal border of the patella through the patellar tendon to tibial tuberosity

Action for the vastus medialis/lateralis/intermedius?

Knee: extension

Hip: flexion

SA Position for Quadriceps

• prone

• hips neutral

• feet towards wall

Clinician Position for Quadriceps

stand at SA’s ipsilateral trunk/hip

Clinician Hand Placement for Quadriceps

Stretch Phase: one hand stabilizes ipsilateral PSIS and one hand at dorsum of the ipsilateral foot

Contraction Phase: one hand on proximal tibia/patellar tendon and one hand at dorsum of the ipsilateral foot

Stretch Procedure for Quadriceps

1. Instruct SA to flex knee, drawing heel towards glutes

2. Align the knee, ipsilateral hip and ipsilateral shoulder

3. Stabilize hip by providing downward pressure at the PSIS

4. Provide overpressure into knee flexion until SA starts to feel stretch

5. Hold for 6 seconds

6. Transition hand for the PSIS to cupping the patellar tendon

7. Instruct SA to dorsiflex foot and extend knee with 30% pressure

8. Resist SA’s motion at the dorsum of the foot and hold for 6 sec

9. Instruct SA to relax

10. Instruct SA to actively flex knee further

11. Repeat for 3 cycles

12. End on a stretch

Origin of Adductor Magnus?

• inferior pubic ramus

• ischial ramus

• ischial tuberosity

Insertion of Adductor Magnus?

• medial to gluteal tuberosity

• middle of the linea aspera

• medial supracondylar line

• adductor tubercle of the medial femoral condyle

Action of the Adductor Magnus

Hip: adduction, flexion, extension

Origin of Adductor Longus?

Anterior surface of the pubis at the junction of the crest and public symphasis

Insertion of the Adductor Longus?

middle 1/3rd of the medial lip of the linea aspera

Action of the Adductor Longus?

Hip: adduction and flexion

Origin of Adductor Brevis

outer surface of the inferior pubic ramus

Insertion of the Adductor Brevis

• Distal 2/3rds of the pectineal line

• Proximal half of the medial lip of the linea apsera

Action of the Adductor Brevis

Hip: adduction and flexion

Origin of the Pectineus

• superior pubic ramus

• ventral to the pecten

• between the iliopectineal eminence and pubic tubercle

Insertion of the Pectineus?

Pectineal line of the femur

Action of the Pectineus?

Hip: adduction and flexion

Origin of the Gracilis?

• inferior ½ of the pubic symphysis

• medial margin of the inferior pubic ramus

Insertion of the Gracilis?

medial surface of the tibia distal to the condyle, proximal to the insertion of the semitendinosus, lateral to the insertion of the sartorius

Action of the Gracilis?

Hip: adduction

Knee: flexion and medial rotation

SA Position for Adductors

• supine

• knee extension

• hip neutral