2) Using PIR corect a hypertonic R quad.
3) Increase L hip adduction with PIR strectch (which muscles?)
4) Perform a grade 4 mobilization to correct a L tibia internal rotation restriction
5) Correct a R calcaneus anterio glide restriction using grade 2 mob.
6) Correct a L navicular superior glide restriction.
7) Use strain/counterstrain to correct a hypertonic R piriformis.
8) Use s/cs to correct a L biceps femoris hypertonicity.
DR FRANGOS’ NMT 4 FINAL EXAM REVIEW
1) iliopsas, find point, football tackle lift both knees for psoas to shorten muscle, one for il
2) pt prone, heel to butt, if not stretching yet lift knee, exert vs force, side lying position OK to, sit on stool and balance pt leg on knee, stabilize pelvis while pt exerts, restretch on rest, repeat
3) incr adduction = stretch abduction ie TFL, glut min & med
(inc abd = stretch adductors ie mag, brev, long, gracilis, pectineus)
4) pt supine leg 90 90 achilles on my heel, thumb on medial tib tubercle, fingers wrap calf tissue and bring to tension. for mobilization toward medial stack thumbs on lateral tib tubercle. grade 4 = holding tension at end range.
5) pt prone and talus on end of table, hand cups heel and forearm lines side of foot, plantar flex with other hand and move in line with foot, grade 2 = fluctuation anywhere in range
6) pt prone, my knee on table their talus on my leg, locate navic and place thumb on inf surface, and supports foot in dorsiflexion, other hand drives with ulnar/pisiform edge on thumb
7) pt prone, locate tender pt in L bi fem, shorten muscle, wait for release
Hip and Knee Osseous Mobilization
DUKE Hip Distraction (Inferior Glide) pt supine 90 90
Tibia Anterior & Posterior Glide sit on foot
Tibia Internal & External Rotation pt supine 90 90
DUKE Knee Distraction pt prone
Fibula Anterior & Posterior Glide (supine)sit on foot, push or pull with both hands
Fibula Anterior Glide (prone) modified duke scoop
Ankle and Foot Osseous Mobilization
Calcaneus Anterior Glide prone
Superior Glide Tarsals pt prone, talus on leg, thumbpad contact knife drive, plantarflex
Inferior Glide Tarsals pt supine, stack midfingers on bone, dorsiflex and pull
Superior Shear Metatarsals pt prone, dorsum of foot on doc thigh, thumbpad & knifeedge
Inferior Shear Metatarsals dorsiflex and stack midfingers grade 3+, free form grade 1-2
Sup/Inf Glides Phalanges grasp sup and inf on both bones & check lig integrity
Med/Lat Glides Phalanges grasp med and lat both bones
Soft Tissue Techniques
Strain/Counterstrain: find point shorten muscle wait, repeat 3x, passive return
Glut Med/Min to shorten abduct, ext
Glut Max to shorten ext
TFL to shorten abduct
Hamstrings to shorten bend knee in supine
Piriformis to shorten ext rot
Iliacus, Psoas, Iliopsoas Tendon to shorten flex hip
Quadriceps to shorten ext leg
Hip Adductors to shorten cross legs
PIR Stretch: stretch muscle pt exert vs resistance, rest & stretch, repeat, passive return
Iliopsoas side lying or prone, ext hip
Quadriceps side lying or prone, bend knee then extend hip
Hamstrings supine, exert to lower heel or bend knee, resist both
TFL side lying drop top leg inferiorly, push up vs resist
Glut med/min side lying drop top leg in front
Hip adductors supine one leg on table other leg on doc knee, rolling stool
Piriformis supine int rot, exert to ext rot