hip and knee Range of Motion (week 4)

Contraindications

•Unstable fracture

•Unexpected increase in pain

•Movement is contraindicated

•End range motion could cause damage the joint

Precautions

•Increase in pain

•Impaired mentation

•Impaired sensation

•Acute injury

Hip flexion

•120 -140 dg is normal

•If possible, keep contralateral leg extended

•Stabilize pelvis so that is remains in neutral

Hip Extension

•18-30 dg is normal

•Knee stays in extension – Rectus femoris

Hip abduction

•40 dg is normal

•Don’t allow lateral rotation or flexion of the femur or lateral trunk flexion

Hip Adduction

•20 dg is normal range

•Both knees are extended

•Contralateral hip is adducted

•Stabilize the pelvis to prevent lateral titling

Medial rotation

•30- 45 dg is normal

•Femur needs to stay in the horizontal plane

Lateral rotation

•32 -50 dg is normal

•Femur needs to stay in the horizontal plane.  Avoid rotation and lateral tilting of the pelvis

Knee Extension

•0 dg hyperextension is normal in adults

•Place a towel roll under the ankle of the patient.  In some patients you will need to put several towels to ensure the back of the calf isn’t resting on the table

Knee Flexion

•130-140 dg is normal range

•Prevent rotation, abduction and adduction of the femur

Steps

•Ascending steps requires between 47-66 dg of hip flexion and 92-105 dg knee flexion.

•Descending steps requires 86-107 dg knee flexion

Sitting in a chair

average seat height requires 112 dg hip flexion and 93 dg knee flexion

•Rising from a chair requires 90-95 dg knee flexion

Putting on a sock

requires 120 dg of flexion, 20 dg abduction, > 20 dg lateral rotation and 117 dg knee flexion

Hip flexors: Thomas test

Muscles involved

•Iliopsoas

•Rectus femoris

•Sartorius

•Tensor fascia latae

•Pectineus

•Adductor longus

•Adductor brevis

Straight Leg raising test

•Muscles involved: semitendinosus, semimembranosus, biceps femoris

•Flexion of the hip between 70-80 dg is considered normal

•precaution with acute lumbar or hip pathology

90/90 Test

•Distal hamstring length Test

•Document flexion of the knee

•Good for showing progression

Tensor fascia lata and iliotibial band: Ober test

•3 step process (Figure 8.43-45)

•IF thigh drops 10 dg below horizontal, test is negative (muscles are normal length)

Rectus femoris :ELY test

•Having at least 90 dg knee flexion is considered normal

•Anterior pelvic rotation/ hip flexion indicates when the muscles is at end length