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in Cyriax's 15 movement functional test for the hip, what are the first 7 movements?
- SUPINE
- flexion
- er (along longitudinal axis - leg straight, stabilize other hip)
- ir (ditto)
- abd (w slight IR so you won't get ER)
- add (move other leg out of the way)
- PRONE
- ext w knee flexed
- ir w knee flexed
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if the pt performs the first 7 movements in Cyriax's hip test in AROM w/o pain, what do you do? what if there is pain or restriction?
- apply overpressure at the end of each mvmnt
- if pain - repeat as PROM
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dermatomes in the tush
- sup med: L2 L3
- inf med: S1 S2
- sup lat: L1
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in Cyriax's mvmnt test for the hip, what are the 8 resisted movements?
and how do you apply the resistance?
- done in middle of range / resting position:
- flexion
- ext
- add
- abd
- ER (w/o ab/adduction!)
- IR
- knee flex
- knee ext
the resistance is isometric - so the leg never moves really from resting pos. - brace her w your knee or a towel under her, and have her push against your hands
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resting pos for the hip (maximal joint laxity)
- 30 degrees flex
- 30 degrees abd
- slight ER
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closed packed position for hip
- max extension
- max IR
- max abd
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hip flex ROM
110-120 degrees
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hip ext ROM
10-15 degrees
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hip abd ROM
30-50 degrees
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mobility testing - caudal distraction for hip ... how??
- pt is supine
- hip is in resting pos
- fixate pt w hands or w strap around pelvis
- grasp femoral condyles or malleoli
- shift yr wt backwards w lunge stance, or pull thru yr arms
- if it's hypomobile, implies overall loss of mobility
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mobility testing for hip, lateral... how??
- pt is supine
- hip is in resting pos.
- strap around ASIS to stabilize pt on table (or another person's hands on the ASISes)
- yr hands: yr ulnar border in the groin, or use a strap around you and around the pt's thight
- shift wt back to move leg laterally
- don't let leg do abd or ER (whole femur should move in parallel) - use your hands or bring upper body forward to prevent this
- if hypomobile, implies overall loss of movement
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mobility test "femur ventral glide" aka anterior glide ... how to do this w pt PRONE??
- wedge under ant pelvis
- ASISes on table
- yr hands: over proximal post femur, distal to IT, primary contact is 5th metacarpal (not whole hand!) so yr hand is cupped w the other hand pressing on it to add wt
- push down to table w extended arm for a post --> ant glide
- implication for hypomobility: loss of extension
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mobility test "femur ventral glide" aka anterior glide ... how to do this w pt standing??
- pt is prone w one leg on the floor, ASISes on the table, and you're holding the other leg
- (this is good for a pt who can't get into 0 degrees of ext)
- hold pt just distal to knee, and use webspace or 5th metacarpal or heel of hand to press, distal to ITs
- (femur must move as a parallel unit! so as you push with your pushing hand, lower w your holding hand)
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3 directions, 4 types of MOBILITY testing w distraction for hip
- 1. caudal (pt is supine, PT pulls on thigh or ankle)
- 2. lateral ( pt is supine, PT pulls lat on thigh at groin)
- 3. ventral (pt is prone, PT pushes ant just distal to IT and a bit medial)
- 4. ventral (pt is standing on one leg, prone on table, PT is supporting other leg and pressing down where thigh meets tush)
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The Continuum the 6 stages of pain and ROM
- painful movement, limited >50%
- pain decreased
- pain decreased, range increased to >50%
- pain decreased, range increased
- pain and range same but resistance is now the limiting factor
full range w/o pain
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according to The Continuum, what do you do for a joint w painful movement that's limited >50 %?
- consider it predominantly painful, acute
- treat for pain, starting w Grade 1 motions to affect type I and II receptors
- start in resting pos (least noxious) w small amplitude, pain free movements, ossilating 1-2/sec for ~15 sec
(remember, for these to give pain relief, direction doesn't matter)
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according to The Continuum, what do you do for a joint w "pain decreased"
- 1) increase repetitions
- 2) increase amplitude (to Grade II, but not into painful range)
- 3) increase time of tx
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according to The Continuum, what do you do for a joint w "pain decreased, range increased to >50%"
- it's still considered acute and needs to be treated for pain
- do physiologic movement (instead of just staying in joint, add movement of limb)
- large amplitude, but short of pain
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in evaluation a joint, specifically w The Continuum, what does a hard end feel tell you to do?
treat the joint or movement as painful/acute
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according to The Continuum, what do you do for a joint w "pain decreased, range increased"
now ou're in the subacute phase and ready for more ROM going into painful range (only if end feel isn't hard but is capsular)
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according to The Continuum, what do you do for a joint w pain-same, range-same, resistance now limiting factor
- basically it's just a stiff jiont, so you need to work on ROM
- use Grade III and IV mobs
- use mob procedures at limit and/or contract-relax techniques
- these are direction dependant (the pain management techniques are not)
- push the pathological limit to the end of the anatomical limit
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according to The Continuum, what do you do for a joint w "full range w/o pain"
take it out for ice cream
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on the 0-6 mobility scale, which ratings get mob treatment?
- 1 and 2 only
- 3 is normal and doesn't need it
- 4-6 are hypermobile
- 0 is ankylosed
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