Hip/Knee ROM, MMT, Flexibility

______ degrees of error is normal between sessions/testers

5

always compare _________________, testing the __________________ side first

bilaterally, unaffected

true/false: you have to document any change from the norm

true

will passive or active range of motion yield greater results?

PROM

how would you document lacking 25 degrees of extension from neutral and full hip flexion?

25-120

how would you document 15 degrees of knee hyperextension and 135 degrees of knee flexion?

15-0-135

HIP FLEXION ROM

testing position:

axis:

fulcrum:

stationary arm:

moveable arm:

normal values:

end feel:

testing position: supine

axis: medial-lateral

fulcrum: greater trochanter

stationary arm: lateral midline of pelvis

moveable arm: lateral epicondyle

normal values: 0-120

end feel: soft or firm

HIP EXTENSION ROM

testing position:

axis:

fulcrum:

stationary arm:

moveable arm:

normal values:

end feel:

testing position: prone or side lying

axis: medial-lateral

fulcrum: greater trochanter

stationary arm: lateral midline of pelvis

moveable arm: lateral epicondyle

normal values: 0-30

end feel: firm

HIP ABDUCTION ROM

testing position:

axis:

fulcrum:

stationary arm:

moveable arm:

normal values:

end feel:

testing position: supine

axis: anterior-posterior

fulcrum: ASIS

stationary arm: imaginary line ASIS-ASIS

moveable arm: anterior midline of femur

normal values: 0-50

end feel: firm

how to remember hip abduction and adduction normal values

abduction is 0-50, adduction is 0-25 (half of 50, have to ADD adduction to itself to get abduction)

should you support under calf or ankle for hip abduction?

calf (keep leg against body)

HIP ADDUCTION ROM

testing position:

axis:

fulcrum:

stationary arm:

moveable arm:

normal values:

end feel:

testing position: supine

axis: anterior-posterior

fulcrum: ASIS

stationary arm: imaginary line ASIS-ASIS

moveable arm: anterior midline of femur

normal values: 0-25

end feel: firm

which ROM tests do you need a towel roll for? why?

hip internal/external rotation, need to keep hip at 90 degrees of flexion

HIP INTERNAL ROTATION ROM

testing position:

axis:

fulcrum:

stationary arm:

moveable arm:

normal values:

end feel:

testing position: sitting

axis: vertical

fulcrum: anterior patella

stationary arm: perpendicular to floor

moveable arm: tibial crest

normal values: 0-45

end feel: firm

HIP EXTERNAL ROTATION ROM

testing position:

axis:

fulcrum:

stationary arm:

moveable arm:

normal values:

end feel:

testing position: sitting

axis: vertical

fulcrum: anterior patella

stationary arm: perpendicular to floor

moveable arm: tibial crest

normal values: 0-50

end feel: firm

true/false: for hip IR/ER ROM, you can ask the patient to actively flex their other knee out of the way

true

true/false: for hip IR/ER ROM, you can use your leg to hold the patient's leg at end range

true

KNEE FLEXION ROM

testing position:

axis:

fulcrum:

stationary arm:

moveable arm:

normal values:

end feel:

testing position: supine

axis: medial/lateral

fulcrum: lateral epicondyle

stationary arm: greater trochanter

moveable arm: lateral midline of fibula

normal values: 0-140

end feel: soft

KNEE EXTENSION ROM

testing position:

axis:

fulcrum:

stationary arm:

moveable arm:

normal values:

end feel:

testing position: supine, towel under heel

axis: medial-lateral

fulcrum: lateral epicondyle

stationary arm: greater trochanter

moveable arm: lateral midline of fibula

normal values: 0

end feel: firm

for MMT's, you are strongest at _______-range

mid

muscles tested for hip flexion MMT

psoas major, iliacus

substitutions for hip flexion MMT (3)

sartorius (ER, abduction), TFL (IR, adduction), trunk flexion/extension

where should your stabilizing hand be for hip flexion MMT? why?

on patient's back, cues them to sit up

muscle tested for hip flexion/abduction/external rotation MMT

sartorius

substitutions for hip flexion/abduction/external rotation (2)

iliopsoas (no ER/abduction), rectus femoris (no ER/abduction)

muscles tested with hip extension MMT (2/4)

gluteus maximus, hamstrings (biceps femoris, semitendinosus, semimembranosus)

substitutions for hip extension MMT (2)

pelvis rotation, knee flexion (uses hamstrings instead of glut max)

in the hip extension test to isolate glut max, do you stabilize the ipsilateral or contralateral glute?

contralateral (opposite)

what muscles are tested for hip abduction MMT?

gluteus medius, gluteus minimus

substitutions for hip abduction MMT (3)

hip hike, sartorius (ER, flexion), TFL (if test begins in hip flexion)

true/false: you can internally rotate the testing leg for hip abduction MMT to avoid the patient using the TFL

true

if resistance is moved to the knee from the ankle for hip abduction MMT, what is the highest grade the patient can get?

4

muscles tested with hip adduction MMT

adductor magnus, adductor longus, adductor brevis, pectineus, gracilis

substitutions for hip adduction MMT

hip flexors (patient will try to turn to supine from side lying)

muscles tested for hip external rotation MMT (7)

obturator internus/externus, gemelli superior/inferior, piriformis, quadratus femoris, glut max (posterior)

for hip external rotation MMT, where is the stabilizing hand?

external thigh

for hip internal rotation MMT, where is the stabilizing hand?

internal thigh

muscles tested with hip internal rotation MMT

gluteus medius, gluteus minimus, TFL

muscle tested with hip abduction from flexed position

TFL

where do you provide stabilization for knee flexion MMT?

pelvis (NOT posterior thigh)

muscles tested with knee flexion MMT

hamstrings (biceps femoris, semitendinosus, semimembranosus)

to test the semimembranosus and semitendinosus w/MMT, _______________ rotate the leg

internally

to test the biceps femoris w/MMT, _________________ rotate the leg

externally

substitutions for knee flexion MMT (2)

hip flexion (patient will start to roll supine), gastroc (if patient strongly dorsiflexes)

muscles tested with knee extension MMT

quadriceps (rectus femoris, vastus lateralis, vastus medialis, vastus intermedius)

substitutions for knee extension MMT (1)

in side lying (grade 2), patient may use hip internal rotators

normal values for Thomas test

10 (degrees) hip extension, 80 (degrees) knee flexion

normal end feel for thomas test

firm

in Thomas test, have to keep back/pelvis ______________

flat

negative/normal values for straight leg raise test

68-80 degrees (of hip flexion)

normal value for popliteal angle test

31 degrees

in the popliteal angle test, must keep hip flexed to _______ degrees

90

normal end feel for popliteal angle test and why

firm, tension in hamstrings

what does the ober test, test?

length of TFL and IT band

negative/normal ober tests

leg below horizontal

simple directions for ober test

forward, up, back, down

why use the modified ober test?

reduce strain on medial knee, reduce influence of tight rectus femoris

how is the modified ober test different from the ober test?

straight knee

what does the ely test, test?

length of rectus femoris

normal/negative value for ely test

90 degrees knee flexion