Range of Motion
Active ROM= patient actively moves body segment through ROM
Passive ROM= clinician moves body segment through ROM
Resistive ROM= patient resists against clinician through the full ROM
- Flexion
- Extension
- ABDuction and ADDuction
- Lateral and Medial Rotation
Passive ROM= clinician moves body segment through ROM
- Flexion
- Extension
- ABDuction and ADDuction
- Lateral and Medial Rotation
Resistive ROM= patient resists against clinician through the full ROM
- Flexion
- Extension
- ABDuction and ADDuction
- Lateral and Medial Rotation
Goniometry
Hip Flexion: motion occurs in the sagittal plane.
Testing position: subject should be in a supine position with the knees extended
Testing motion: Flex the hip passively
Goniometer alignment:
1. Fulcrum: Greater trochanter
2. Proximal arm: lateral midline of pelvis
3. Distal arm: lateral midline of femur, lateral epicondyle as reference
End feel- soft/firm
Norms: approx 120 degrees (AAOS), 100 degrees (AMA) for adults
AAOS= American Academy of Orhtopedic Surgeons
AMA= American Medical Association
Testing position: subject should be in a supine position with the knees extended
Testing motion: Flex the hip passively
Goniometer alignment:
1. Fulcrum: Greater trochanter
2. Proximal arm: lateral midline of pelvis
3. Distal arm: lateral midline of femur, lateral epicondyle as reference
End feel- soft/firm
Norms: approx 120 degrees (AAOS), 100 degrees (AMA) for adults
AAOS= American Academy of Orhtopedic Surgeons
AMA= American Medical Association
Hip Extension: occurs in the sagittal plane.
Testing position: subject should be in a prone position with both knees extended.
Testing motion: Extend hip passively and maintain knee in extension
Goniometer alignment:
1. Fulcrum: Greater trochanter
2. Proximal arm: lateral midline of pelvis
3. Distal arm: lateral midline of femur, lateral epicondyle as reference
End feel: firm
Norms: approx 20 degrees (AAOS), 30 degrees AMA
Testing position: subject should be in a prone position with both knees extended.
Testing motion: Extend hip passively and maintain knee in extension
Goniometer alignment:
1. Fulcrum: Greater trochanter
2. Proximal arm: lateral midline of pelvis
3. Distal arm: lateral midline of femur, lateral epicondyle as reference
End feel: firm
Norms: approx 20 degrees (AAOS), 30 degrees AMA
Hip Abduction: occurs in the frontal plane
Testing position: subject should be in a supine position
Testing motion: abduct the hip passively by sliding lower extremity laterally
Goniometer alignment:
1. Fulcrum: ASIS
2. Proximal arm: Imaginary horizontal line extending to the other ASIS
3. Distal arm: Anterior midline of femur, use the midline of the patella for reference
End feel: firm
Norms: approx 40 degrees AMA
Testing position: subject should be in a supine position
Testing motion: abduct the hip passively by sliding lower extremity laterally
Goniometer alignment:
1. Fulcrum: ASIS
2. Proximal arm: Imaginary horizontal line extending to the other ASIS
3. Distal arm: Anterior midline of femur, use the midline of the patella for reference
End feel: firm
Norms: approx 40 degrees AMA
Hip Adduction: occurs in the frontal plane
Testing position: subject should be in a supine position Testing motion: adduct the hip passively by sliding lower extremity medially toward the contralateral lower extremity Goniometer alignment: 1. Fulcrum: ASIS 2. Proximal arm: Imaginary horizontal line extending to the other ASIS 3. Distal arm: Anterior midline of femur, use the midline of the patella for reference End feel: firm Norms: approx 20 degrees AMA |
Hip Medial Rotation: occurs in transverse plane
Testing position: hook seated with knees flexed to 90 degrees Testing motion: passively medially rotate the lower leg laterally Goniometer alignment: 1. Fulcrum: Anterior aspect of patella 2. Proximal arm: Perpendicular to the floor or parallel to supporting surface 3. Distal arm: anterior midline of lower leg, use crest of tibia and a point midway between the two malleoli for reference End feel: firm Norms: 45 degrees AAOS, 40 degrees AMA Hip Lateral Rotation: occurs in transverse plane
Testing position: hook seated with knees flexed to 90 degrees Testing motion: passively laterally rotate the lower leg laterally Goniometer alignment: 1. Fulcrum: Anterior aspect of patella 2. Proximal arm: Perpendicular to the floor or parallel to supporting surface 3. Distal arm: anterior midline of lower leg, use crest of tibia and a point midway between the two malleoli for reference End feel: firm Norms: 45 degrees AAOS, 50 degrees AMA |
Goniometry Info: (Norki & White, 2009)
Pictures: http://www.lhup.edu/yingram/jennifer/webpage/hip_goniometry.htm
Pictures: http://www.lhup.edu/yingram/jennifer/webpage/hip_goniometry.htm
Manual Muscle Testing
It is commonly known as "break test". The two testing positions include: gravity resisted and gravity eliminated. To determine a grade, the grading scale is provided below.
Grading Scale (1-5)
Grade 5: Normal- movement occurs through complete test range against gravity and is able to resist against maximum resistance.
Grade 4: Good- movement occurs through complete test range against gravity and is able to resist against moderate resistance.
Grade 3: Fair- movement occurs through complete test range against gravity.
Grade 2: Poor- movement occurs through complete test range in gravity eliminated position.
Grade 1: Trace- slight contraction, no motion
Grade 0: Zero- No evidence of contraction by vision or palpation
Muscles being tested: iliacus, psoas major (hip flexion)
Iliacus
O= iliac crest, superior 2/3 of iliac fossa, anterior sacroiliac and iliolumbar ligaments
I= tendon of psoas major, body of femur
A= hip flexion
N.R= femoral nerve (L2-L3)
Psoas major:
O= sides of vertebral bodies and intervertebral discs of T12-L5 and transverse processes of L1-L5
I= lesser trochanter of femur
A= hip flexion unilaterally, trunk flexion bilaterally
N.R= n/a (L2-L4)
Gravity-resisted:
1. Patient position: Pt should be hook seated, holding onto table edge with hands.
2. Examiner action: Stabilizes pelvis over ipsilateral iliac crest. Instruct pt to flex hip through full available ROM keeping the knee flexed.
3. Patient action: Pt flexes hip through full available ROM while keeping knee flexed.
4. Resistance: Examiner applies resistance over the anterior aspect of distal thigh in direction of hip extension.
Gravity-eliminated:
1. Patient position: Pt should be side lying on the affected side with the hip extended and knee flexed.
2. Examiner action: Stabilize opposite limb in both hands. Instruct pt to flex hip through full available ROM keeping the knee flexed.
3. Patient action: Pt flexes hip through full available ROM while keeping knee flexed on table.
4. No resistance!
Grading Scale (1-5)
Grade 5: Normal- movement occurs through complete test range against gravity and is able to resist against maximum resistance.
Grade 4: Good- movement occurs through complete test range against gravity and is able to resist against moderate resistance.
Grade 3: Fair- movement occurs through complete test range against gravity.
Grade 2: Poor- movement occurs through complete test range in gravity eliminated position.
Grade 1: Trace- slight contraction, no motion
Grade 0: Zero- No evidence of contraction by vision or palpation
Muscles being tested: iliacus, psoas major (hip flexion)
Iliacus
O= iliac crest, superior 2/3 of iliac fossa, anterior sacroiliac and iliolumbar ligaments
I= tendon of psoas major, body of femur
A= hip flexion
N.R= femoral nerve (L2-L3)
Psoas major:
O= sides of vertebral bodies and intervertebral discs of T12-L5 and transverse processes of L1-L5
I= lesser trochanter of femur
A= hip flexion unilaterally, trunk flexion bilaterally
N.R= n/a (L2-L4)
Gravity-resisted:
1. Patient position: Pt should be hook seated, holding onto table edge with hands.
2. Examiner action: Stabilizes pelvis over ipsilateral iliac crest. Instruct pt to flex hip through full available ROM keeping the knee flexed.
3. Patient action: Pt flexes hip through full available ROM while keeping knee flexed.
4. Resistance: Examiner applies resistance over the anterior aspect of distal thigh in direction of hip extension.
Gravity-eliminated:
1. Patient position: Pt should be side lying on the affected side with the hip extended and knee flexed.
2. Examiner action: Stabilize opposite limb in both hands. Instruct pt to flex hip through full available ROM keeping the knee flexed.
3. Patient action: Pt flexes hip through full available ROM while keeping knee flexed on table.
4. No resistance!
(Reese, 2005)
Muscle being tested: Sartorius (Flexion, Abduction, External (lateral) Rotation)
Sartorius (FABER)
O= ASIS, upper aspect of iliac notch
I= proximal aspect of medial surface of tibia
A= hip flexion, ABD, and ER
N.R= femoral nerve (L2-L3)
Gravity-resisted:
1. Patient position: Pt should be hook seated while holding onto table edge with hands.
2. Examiner action: Stabilize pelvis over ipsilateral iliac crest. Palpate sartorius beginning distally to anterosuperior iliac spine. Instruct pt to flex, abduct, and laterally rotate the hip while keeping the knee flexed.
3. Patient action. Pt flexes, abducts, and laterally rotates hip while flexing the knee such as performing a figure 4 position.
4. Resistance: Examiner applies resistance over the anterolateral aspect of thigh in direction of hip extension and adduction while the other hand applies resistance on the medial side of ankle in the direction of hip medial rotation and knee extension.
Gravity-eliminated:
1. Patient position: Pt should be in a supine position with heel of hip being tested on shin of opposite lower leg.
2. Examiner action: Stabilize pelvis over ipsilateral iliac crest. Palpate sartorius beginning distally to anterosuperior iliac spine. Instruct pt to flex, abduct, and laterally rotate the hip while keeping the knee flexed.
3. Patient action: Pt slides heel of hip being tested up shin of opposite leg producing hip flexion, abduction, and lateral rotation in a figure 4 position.
4. No resistance!
Sartorius (FABER)
O= ASIS, upper aspect of iliac notch
I= proximal aspect of medial surface of tibia
A= hip flexion, ABD, and ER
N.R= femoral nerve (L2-L3)
Gravity-resisted:
1. Patient position: Pt should be hook seated while holding onto table edge with hands.
2. Examiner action: Stabilize pelvis over ipsilateral iliac crest. Palpate sartorius beginning distally to anterosuperior iliac spine. Instruct pt to flex, abduct, and laterally rotate the hip while keeping the knee flexed.
3. Patient action. Pt flexes, abducts, and laterally rotates hip while flexing the knee such as performing a figure 4 position.
4. Resistance: Examiner applies resistance over the anterolateral aspect of thigh in direction of hip extension and adduction while the other hand applies resistance on the medial side of ankle in the direction of hip medial rotation and knee extension.
Gravity-eliminated:
1. Patient position: Pt should be in a supine position with heel of hip being tested on shin of opposite lower leg.
2. Examiner action: Stabilize pelvis over ipsilateral iliac crest. Palpate sartorius beginning distally to anterosuperior iliac spine. Instruct pt to flex, abduct, and laterally rotate the hip while keeping the knee flexed.
3. Patient action: Pt slides heel of hip being tested up shin of opposite leg producing hip flexion, abduction, and lateral rotation in a figure 4 position.
4. No resistance!
Muscles being tested: gluteus medius and gluteus minimus (Abduction)
Gluteus Medius
O= outer surface of ilium between anterior and posterior gluteal lines
I= greater trochanter of femur
A= Abduction and IR of hip
N.R= superior gluteal nerve (L4, L5, S1)
Gluteus Minimus (deepest)
O= outer surface of ilium between the anterior and inferior gluteal lines
I= greater trochanter of femur
A= abduction and medial rotation of hip
N.R= superior gluteal nerve
Gravity Resisted:
1. Patient position: Pt should be side lying on unaffected side with pelvis in a neutral positon.
2. Examiner action: Stabilize lateral aspect of pelvis. Palpate gluteus medius, just above greater trochanter with opposite hand. Instruct pt to abduct hip.
3. Patient action: Abducts hip of test limb through full ROM without rotating femur or allowing pelvis to deviate from neutral position.
4 Resistance: Examiner applies resistance at the distal thigh in the direction of hip adduction.
Gravity Eliminated:
1. Patient position: Pt should be supine.
2. Examiner action: Stabilize lateral aspect of ipsilateral pelvis. Palpate gluteus medius above the greater trochanter. Instruct pt. to abduct hip through full ROM.
3. Patient action: Abducts hip on test side through full ROM.
4. No Resistance!
Gluteus Medius
O= outer surface of ilium between anterior and posterior gluteal lines
I= greater trochanter of femur
A= Abduction and IR of hip
N.R= superior gluteal nerve (L4, L5, S1)
Gluteus Minimus (deepest)
O= outer surface of ilium between the anterior and inferior gluteal lines
I= greater trochanter of femur
A= abduction and medial rotation of hip
N.R= superior gluteal nerve
Gravity Resisted:
1. Patient position: Pt should be side lying on unaffected side with pelvis in a neutral positon.
2. Examiner action: Stabilize lateral aspect of pelvis. Palpate gluteus medius, just above greater trochanter with opposite hand. Instruct pt to abduct hip.
3. Patient action: Abducts hip of test limb through full ROM without rotating femur or allowing pelvis to deviate from neutral position.
4 Resistance: Examiner applies resistance at the distal thigh in the direction of hip adduction.
Gravity Eliminated:
1. Patient position: Pt should be supine.
2. Examiner action: Stabilize lateral aspect of ipsilateral pelvis. Palpate gluteus medius above the greater trochanter. Instruct pt. to abduct hip through full ROM.
3. Patient action: Abducts hip on test side through full ROM.
4. No Resistance!
Medial muscles being tested: adductor longus, adductor brevis, adductor magnus, pectineus, and gracilis (Adduction)
Adductor Longus
O= anterior aspect of pubis
I= linea aspera along middle 1/3 of femur
A= adduction and flexion of hip
N.R= obturator nerve (L2-L4)
Adductor Brevis
O= inferior ramus of pubis
I= line from lesser trochanter to linea aspera, upper portion of linea aspera, upper portion of linea aspera
A= hip adduction, flexion, and medial rotation of hip
N.R= Obturator nerve (L2-L4)
Adductor Magnus
O= inferior rami of pubis and ischium, ischial tuberosity
I= line from greater trochanter to the linea aspera, adductor tubercle
A= hip adduction, upper portion assists in hip flexion, lower portion assists in hip extension
N.R= obturator and sciatic nerves (L2-L4)
Pectineus’
O= pectineal line of pubis
I= line from lesser trochanter to linea aspera
A= hip adduction, flexion, and medial rotation
N.R= femoral nerve (L2-L4)
Gracilis
O= body and ramus of pubis
I= proximal aspect of medial surface of tibia
A= hip adduction, flexion, and medial rotation
N.R= Obturator nerve (L2-L4)
Gravity Resisted:
1. Patient position: Pt should be side lying on affected side.
2. Examiner action: Stabilize pelvis with their trunk. Hold non-test limb up and out of the way. Instruct pt to adduct hip through full ROM while palpating adductor muscles.
3. Patient action: Adducts hip of test limb through full ROM.
4. Resistance: Examiner applies resistance on medial aspect of distal thigh.
Gravity Eliminated:
1. Patient position: Pt should by supine with test limb in 0 degrees adduction.
2. Examiner action: Stabilize pelvis with their trunk. Palpate adductors on test limb during active movement.
3. Patient action: Adducts hip on test side through full ROM by sliding foot across table. \
4. No Resistance!
Adductor Longus
O= anterior aspect of pubis
I= linea aspera along middle 1/3 of femur
A= adduction and flexion of hip
N.R= obturator nerve (L2-L4)
Adductor Brevis
O= inferior ramus of pubis
I= line from lesser trochanter to linea aspera, upper portion of linea aspera, upper portion of linea aspera
A= hip adduction, flexion, and medial rotation of hip
N.R= Obturator nerve (L2-L4)
Adductor Magnus
O= inferior rami of pubis and ischium, ischial tuberosity
I= line from greater trochanter to the linea aspera, adductor tubercle
A= hip adduction, upper portion assists in hip flexion, lower portion assists in hip extension
N.R= obturator and sciatic nerves (L2-L4)
Pectineus’
O= pectineal line of pubis
I= line from lesser trochanter to linea aspera
A= hip adduction, flexion, and medial rotation
N.R= femoral nerve (L2-L4)
Gracilis
O= body and ramus of pubis
I= proximal aspect of medial surface of tibia
A= hip adduction, flexion, and medial rotation
N.R= Obturator nerve (L2-L4)
Gravity Resisted:
1. Patient position: Pt should be side lying on affected side.
2. Examiner action: Stabilize pelvis with their trunk. Hold non-test limb up and out of the way. Instruct pt to adduct hip through full ROM while palpating adductor muscles.
3. Patient action: Adducts hip of test limb through full ROM.
4. Resistance: Examiner applies resistance on medial aspect of distal thigh.
Gravity Eliminated:
1. Patient position: Pt should by supine with test limb in 0 degrees adduction.
2. Examiner action: Stabilize pelvis with their trunk. Palpate adductors on test limb during active movement.
3. Patient action: Adducts hip on test side through full ROM by sliding foot across table. \
4. No Resistance!
Muscles being tested: Biceps femoris, semitendinosus, semimembranosus, gluteus maximus (hip extension)
Hamstrings:
Biceps Femoris (most lateral)
O= long head: ischial tuberosity/ short head: lateral lip of linea aspera of femur, lateral intermuscular septum
I= head of fibula- lateral aspect
A= hip extension, knee flexion and ER of knee
N.R= long head: tibial portion of sciatic nerve, short head: peroneal portion of sciatic nerve (L5, S1, S2)
Semimembranosous
O=ischial tuberosity
I= medial condyle of tibia
A= hip extension, knee flexion and ER
N.R= Tibial portion of sciatic nerve (L5, S1, S2)
Semitendinosus (most medial)
O= ischial tuberosity
I= proximal aspect of medial surface of tibia
A= hip extension, knee flexion and ER
N.R= tibial portion of sciatic nerve (L5, S1, S2)
Gluteus Maximus
O= posterior gluteal line of ilium, iliac crest, dorsum of sacrum and coccyx
I= IT tract, gluteal tuberosity of femur
A= hip extension, ER of hip
N.R= Inferior gluteal nerve (L5, S1, S2)
Gravity-Resisted
1. Patient position: Pt should be in a prone position with lower extremities extended.
2. Examiner action: Palpate gluteus maximus and proximal hamstrings. Instruct patient to extend hip through full ROM while keeping the knee extended.
3. Patient action: Pt extends hip through full available ROM, keeping knee extended.
4. Resistance: Examiner applies resistance over posterior aspect of distal thigh in direction of hip flexion.
Gravity-Eliminated:
1. Patient position: Pt should be side lying on the affected side.
2. Examiner action: Palpate gluteus maximus and proximal hamstrings. Instruct patient to extend hip through full ROM while keeping the knee extended.
3. Patient action: Pt extends hip through full available ROM on the table.
4. No resistance!
Hamstrings:
Biceps Femoris (most lateral)
O= long head: ischial tuberosity/ short head: lateral lip of linea aspera of femur, lateral intermuscular septum
I= head of fibula- lateral aspect
A= hip extension, knee flexion and ER of knee
N.R= long head: tibial portion of sciatic nerve, short head: peroneal portion of sciatic nerve (L5, S1, S2)
Semimembranosous
O=ischial tuberosity
I= medial condyle of tibia
A= hip extension, knee flexion and ER
N.R= Tibial portion of sciatic nerve (L5, S1, S2)
Semitendinosus (most medial)
O= ischial tuberosity
I= proximal aspect of medial surface of tibia
A= hip extension, knee flexion and ER
N.R= tibial portion of sciatic nerve (L5, S1, S2)
Gluteus Maximus
O= posterior gluteal line of ilium, iliac crest, dorsum of sacrum and coccyx
I= IT tract, gluteal tuberosity of femur
A= hip extension, ER of hip
N.R= Inferior gluteal nerve (L5, S1, S2)
Gravity-Resisted
1. Patient position: Pt should be in a prone position with lower extremities extended.
2. Examiner action: Palpate gluteus maximus and proximal hamstrings. Instruct patient to extend hip through full ROM while keeping the knee extended.
3. Patient action: Pt extends hip through full available ROM, keeping knee extended.
4. Resistance: Examiner applies resistance over posterior aspect of distal thigh in direction of hip flexion.
Gravity-Eliminated:
1. Patient position: Pt should be side lying on the affected side.
2. Examiner action: Palpate gluteus maximus and proximal hamstrings. Instruct patient to extend hip through full ROM while keeping the knee extended.
3. Patient action: Pt extends hip through full available ROM on the table.
4. No resistance!
Isolating Gluteus Maximus
Option 1: Gravity-resisted
1. Patient position: Pt should be in a prone position with affected hip in full lateral rotation.
2. Examiner action: Stabilize posterosuperior aspect of pelvis. Palpate gluteus maximus. Instruct pt to extend hip through full ROM while maintaining hip in lateral rotation and knee in extension.
3. Patient action: Pt extends hip through full ROM while maintaining hip in lateral rotation and knee in extension.
4. Resistance: Examiner applies resistance over posterior aspect of distal thigh in direction of hip flexion while palpating gluteus maximus.
For grades 3 and below: Gravity-eliminated
Grade 3: Pt moves joint through full ROM without resistance.
Grade 2: Pt moves joint through partial ROM.
Grade 1: No motion, but palpable contraction is present.
Grade 0: No motion or contraction is present.
Option 2: Gravity-resisted
1. Patient position: Pt should be in a prone position, hip in extension, and knee of test limb in 90 degrees of flexion.
2. Examiner action: Stabilize posterosuperior aspect of pelvis. Palpate gluteus maximus. Instruct pt to extend hip through full ROM while keeping knee flexed.
3. Patient action: Pt extends hip through full available ROM while maintaining knee in 90 degrees of flexion.
4. Resistance: Examiner applies resistance over posterior aspect of distal thigh in direction of hip flexion.
Gravity-eliminated= same as gravity-eliminated for hamstrings and gluteus maximus with the knee in flexion.
Option 1: Gravity-resisted
1. Patient position: Pt should be in a prone position with affected hip in full lateral rotation.
2. Examiner action: Stabilize posterosuperior aspect of pelvis. Palpate gluteus maximus. Instruct pt to extend hip through full ROM while maintaining hip in lateral rotation and knee in extension.
3. Patient action: Pt extends hip through full ROM while maintaining hip in lateral rotation and knee in extension.
4. Resistance: Examiner applies resistance over posterior aspect of distal thigh in direction of hip flexion while palpating gluteus maximus.
For grades 3 and below: Gravity-eliminated
Grade 3: Pt moves joint through full ROM without resistance.
Grade 2: Pt moves joint through partial ROM.
Grade 1: No motion, but palpable contraction is present.
Grade 0: No motion or contraction is present.
Option 2: Gravity-resisted
1. Patient position: Pt should be in a prone position, hip in extension, and knee of test limb in 90 degrees of flexion.
2. Examiner action: Stabilize posterosuperior aspect of pelvis. Palpate gluteus maximus. Instruct pt to extend hip through full ROM while keeping knee flexed.
3. Patient action: Pt extends hip through full available ROM while maintaining knee in 90 degrees of flexion.
4. Resistance: Examiner applies resistance over posterior aspect of distal thigh in direction of hip flexion.
Gravity-eliminated= same as gravity-eliminated for hamstrings and gluteus maximus with the knee in flexion.
Muscles being tested: Piriformis, gemellus superior, gemellus inferior, obturator internus, obturator externus, quadratus femoris (lateral rotation)
Piriformis
O= anterior surface of the sacrum, sacrotuberous ligament
I= greater trochanter of the femur
A= lateral rotation of hip, abduction of flexed hip
N.R= sacral nerves 1 and 2
Gemellus Superior
O= ischial spine
I= greater trochanter of femur
A= lateral rotation of hip, abduction of flexed hip
N.R= nerve to the obturator internus (L5, S1, S2)
Gemellus Inferior
O= ischial tuberosty
I= greater trochanter of femur
A= lateral rotation of hip, abduction of flexed hip
N.R= nerve to obturator internus (L4, L5, S1)
Obturator internus
O= obturator membrane and foramen, inner surface of pelvis, inferior rami of pubis and ischium
I= greater trochanter of femur
A= lateral rotation of hip, abduction of flexed hip
N.R= nerve to obturator internus (L5, S1, S2)
Obturator externus
O= rami of pubis and ischium, outer surface of obturator membrane
I= trochanteric fossa of femur
A= lateral rotation of hip
N.R= obturator nerve (L4, L5)
Quadratus femoris
O= ischial tuberosity
I= quadrate tubercle of femur
A= lateral rotation of hip
N.R= nerve to quadrates femoris (L4, L5, S1)
Gravity-Resisted
1. Patient Position: Pt should be hooked seated with a folded towel under knee of test limb. To assist with stabilization, pt should hold onto sides of the table.
2. Examiner action: Passively move pt through lateral rotation, then instruct pt to move through the motion actively.
3. Patient action: Pt actively rotates hip laterally by moving the foot medially.
4. Resistance: Examiner applies resistance in lateral direction on lateral aspect of distal leg. Opposite hand placed on distal thigh to apply counterpressure during resistance.
Gravity Eliminated
1. Patient position: Pt is placed in a supine position.
2. Examiner action: Passively moves pt through lateral rotation. Then stabilizes hip while instructing pt to rotate hip through full ROM.
3. Patient action: Pt rotates hip laterally through full ROM
4. No resistance!
*Common substitution: lateral trunk lean- pt will “cheat” by leaning trunk towards test limb
Piriformis
O= anterior surface of the sacrum, sacrotuberous ligament
I= greater trochanter of the femur
A= lateral rotation of hip, abduction of flexed hip
N.R= sacral nerves 1 and 2
Gemellus Superior
O= ischial spine
I= greater trochanter of femur
A= lateral rotation of hip, abduction of flexed hip
N.R= nerve to the obturator internus (L5, S1, S2)
Gemellus Inferior
O= ischial tuberosty
I= greater trochanter of femur
A= lateral rotation of hip, abduction of flexed hip
N.R= nerve to obturator internus (L4, L5, S1)
Obturator internus
O= obturator membrane and foramen, inner surface of pelvis, inferior rami of pubis and ischium
I= greater trochanter of femur
A= lateral rotation of hip, abduction of flexed hip
N.R= nerve to obturator internus (L5, S1, S2)
Obturator externus
O= rami of pubis and ischium, outer surface of obturator membrane
I= trochanteric fossa of femur
A= lateral rotation of hip
N.R= obturator nerve (L4, L5)
Quadratus femoris
O= ischial tuberosity
I= quadrate tubercle of femur
A= lateral rotation of hip
N.R= nerve to quadrates femoris (L4, L5, S1)
Gravity-Resisted
1. Patient Position: Pt should be hooked seated with a folded towel under knee of test limb. To assist with stabilization, pt should hold onto sides of the table.
2. Examiner action: Passively move pt through lateral rotation, then instruct pt to move through the motion actively.
3. Patient action: Pt actively rotates hip laterally by moving the foot medially.
4. Resistance: Examiner applies resistance in lateral direction on lateral aspect of distal leg. Opposite hand placed on distal thigh to apply counterpressure during resistance.
Gravity Eliminated
1. Patient position: Pt is placed in a supine position.
2. Examiner action: Passively moves pt through lateral rotation. Then stabilizes hip while instructing pt to rotate hip through full ROM.
3. Patient action: Pt rotates hip laterally through full ROM
4. No resistance!
*Common substitution: lateral trunk lean- pt will “cheat” by leaning trunk towards test limb
Muscles being tested: Tensor fasica lata, gluteus minimus, gluteus medius (anterior fibers) (medial rotation)
Gravity-Resisted
1. Patient Position: Pt should be hooked seated with a folded towel under knee of test limb. To assist with stabilization, pt should hold onto sides of the table.
2. Examiner action: Passively move pt through medial rotation, then instruct pt to move through the motion actively.
3. Patient action: Pt actively rotates hip medially by moving the foot laterally, while examiner palpates medial rotators.
4. Resistance: Examiner applies resistance in medial direction on lateral aspect of distal leg. Opposite hand placed on distal thigh to apply counterpressure during resistance.
Gravity Eliminated:
1. Patient position: Pt is placed in a supine position.
2. Examiner action: Passively moves pt through lateral rotation. Next, examiner stabilizes hip while instructing pt to rotate hip through full ROM.
3. Patient action: Pt rotates hip laterally through full ROM
4. No resistance!
*Common substitution pelvic elevation- pt will “cheat” by shifting their weight to non-test side during test
Gravity-Resisted
1. Patient Position: Pt should be hooked seated with a folded towel under knee of test limb. To assist with stabilization, pt should hold onto sides of the table.
2. Examiner action: Passively move pt through medial rotation, then instruct pt to move through the motion actively.
3. Patient action: Pt actively rotates hip medially by moving the foot laterally, while examiner palpates medial rotators.
4. Resistance: Examiner applies resistance in medial direction on lateral aspect of distal leg. Opposite hand placed on distal thigh to apply counterpressure during resistance.
Gravity Eliminated:
1. Patient position: Pt is placed in a supine position.
2. Examiner action: Passively moves pt through lateral rotation. Next, examiner stabilizes hip while instructing pt to rotate hip through full ROM.
3. Patient action: Pt rotates hip laterally through full ROM
4. No resistance!
*Common substitution pelvic elevation- pt will “cheat” by shifting their weight to non-test side during test
JEOPARDY QUESTIONS:
1) Perform correctly RROM for ADDuction.
2) Perform correctly goniometry for hip lateral rotation, estimate the norms,
3) Perform correctly MMT for the hamstrings in a gravity resisted position and gravity eliminated position.
Isolate the gluteus maximus. (State the Origin, Insertion, Action of the muscles)
Bonus points: Nerve roots for biceps femoris (long and short heads), semimembranosus, semitendinosus
4 )Demonstrate MMT for the lateral rotators, what muscles are being tested? (There's 6).
1) Perform correctly RROM for ADDuction.
2) Perform correctly goniometry for hip lateral rotation, estimate the norms,
3) Perform correctly MMT for the hamstrings in a gravity resisted position and gravity eliminated position.
Isolate the gluteus maximus. (State the Origin, Insertion, Action of the muscles)
Bonus points: Nerve roots for biceps femoris (long and short heads), semimembranosus, semitendinosus
4 )Demonstrate MMT for the lateral rotators, what muscles are being tested? (There's 6).