Extension Abduction Internal Rotation o Fig 811

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Joint

Movement

Muscles: principal components (Kendall and McCreary 1993)

Hip

Extension, abduction, internal rotation

Gluteus medius, gluteus maximus (upper), hamstrings

Knee

Extended (positions unchanged)

Quadriceps

Ankle

Plantar-flexion, eversion

Gastrocnemius, solcus, peroneus longus and brevis

Toes

Flexion, lateral deviation

Flexor hallucis, flexor digitorum

Grip

Distal Hand

Hold the foot with the palm of your left hand along the plantar surface. Your thumb is at the base of the toes to facilitate toe flexion. Your fingers hold the medial border of the foot while the heel of your hand gives counter pressure along the lateral border.

! Caution

Do not squeeze or pinch the foot.

Proximal Hand

Your right hand holds the posterior lateral side of the thigh.

Elongated Position

Traction the entire leg while moving the foot into dorsiflexion and inversion. Continue the traction and maintain the external rotation as you lift the leg into flexion and adduction.

! Caution

Do not try to push the hip past the limitation imposed by hamstring length. Do not allow the pelvis to move into a posterior tilt.

If the patient has just completed the antagonistic motion (flexion-adduction-external rotation), begin at the end of that pattern.

Body Mechanics

Stand in a stride position facing the patient's right shoulder. Your weight is on the front foot. Allow the patient to push you back onto your rear foot, then step back and continue to shift your weight backward. Keep your elbows close to your sides so you can give the resistance with your body and legs.

Stretch

The proximal hand gives a stretch by rapid traction of the thigh. Use the forearm of your distal hand to traction up through the shin while you stretch the patient's foot farther into dorsiflexion and inversion.

Patioents Foot Everts

Fig. 8.11a-c. Extension-abduction-internal rotation

Fig. 8.11a-c. Extension-abduction-internal rotation b a c

! Caution

Do not force the hip into more flexion.

Command

"Point your toes, push your foot down and kick down and out." "Push!"

Movement

The toes flex and the foot and ankle plantar flex and evert. The eversion promotes the hip internal rotation; these motions occur at the same time. The thigh moves down into extension and abduction, maintaining the internal rotation. Continuation of this motion causes extension with left side bending of the trunk.

Resistance

Your distal hand combines resistance to eversion with approximation through the bottom of the foot. The approximation resists both the plantar flexion and the hip extension. The resistance to the hip abduction and internal rotation comes from the resisted eversion. Your proximal hand lifts the thigh back toward the starting position. The lift resists the hip extension and abduction. The placement of your hand, coming from lateral to posterior, gives resistance to the internal rotation.

As the hip approaches full extension, continue to give approximation through the foot with your distal hand and approximate through the thigh with your proximal hand.

End Position

The foot is in plantar flexion with inversion and the toes are flexed. The knee remains in full extension. The hip is in as much hyperextension as possible while maintaining the abduction and internal rotation.

Timing for Emphasis

Use approximation with Repeated Contractions or Combination of Isotonics to exercise the hyperex-

tension hip motion. Lock in the hip at the end of the range and exercise the foot and toes.

Points to Remember

Resist the hip extension all the way through the motion The lumbar spine remains in neutral tilt and side-bend

8.5.1 Extension - Abduction - Internal Rotation with Knee Extension (o Fig. 8.12)

Joint

Movement

Muscles: principal components (Kendall and McCreary 1993)

Hip

Extension, abduction, internal rotation

Gluteus medius, gluteus maximus (upper), hamstrings

Knee

Extension

Quadriceps

Ankle

Plantar-flexion, eversion

Gastrocnemius, soleus, peroneus longus and brevis

Toes

Flexion, lateral deviation

Flexor hallucis, flexor digitorum

Grip

Your grips are the same as for the straight leg pattern.

Elongated Position

The foot is in dorsiflexion with inversion. The hip and knee are in full flexion with the heel close to the right buttock. The knee and heel are aligned with each other and lined up approximately with the right shoulder.

Body Mechanics

Your body mechanics are the same as for the straight leg pattern.

Stretch

Apply the stretch to the hip, knee, and foot simultaneously. With your proximal hand combine traction of the hip through the line of the femur with a rotary motion to stretch the internal rotation. Your distal hand stretches the foot farther into dorsiflex-ion and inversion as you stretch the knee extension by bringing the patient's heel closer to the buttock.

Command

"Push your foot down and kick down and out." "Kick!"

Movement

The foot and ankle plantar flex and evert. The hip motion begins next. When the hip extension has completed about 5° of motion the knee begins to extend. It is important that the hip and knee reach their end ranges at the same time.

Resistance

Your distal hand resists the foot and ankle motion with a rotary push. Using the foot as a handle, resist the knee extension by pushing the patient's heel back toward the buttock. The angle of this resistance will change as the knee moves further into extension. The rotary resistance at the foot resists the knee and hip rotation as well.

The resistance to the knee extension motion continues in the same direction when the knee is full extended.

Hip Abduction And Internal Rotation

Fig. 8.12a,b. Extension-abduction-internal rotation with knee extension

Fig. 8.12a,b. Extension-abduction-internal rotation with knee extension b a

Your proximal hand lifts the thigh back toward the starting position. The lift resists the hip extension and abduction. The placement of the hand from lateral to posterior gives resistance to the internal rotation. As the hip and knee approaches full extension, give approximation through the foot with your distal hand and approximate through the thigh with your proximal hand.

The knee takes more resistance than the hip. Your two hands must work separately.

End Position

The end position is the same as the straight leg pattern.

Points to Remember

Timing: The hip extends at the same rate as the knee

Your distal hand resists the extension of the knee by pushing the heel toward the buttock

Resistance with your distal hand to the knee extension at the beginning of the motion will prevent over rotation of the hip

Timing for Emphasis

Prevent knee extension at the beginning of the range and exercise the hip motions. Lock in hip extension in mid-range and exercise knee extension. Lock in the knee before it is fully extended and exercise the hip extension.

8.5.2 Extension - Abduction - Internal Rotation with Knee Flexion (o Fig. 8.13)

Joint

Movement

Muscles: principal components (Kendall and McCreary 1993)

Hip

Extension, abduction, internal rotation

Gluteus medius, gluteus maximus (upper)

Knee

Flexion

Hamstrings, gracilis

Ankle

Plantar-flexion, eversion

Soleus, peroneus longus and brevis

Toes

Flexion, lateral deviation

Flexor hallucis, flexor digitorum

Position at Start

For this combination place the patient closer to the side of the table. This is the same position you used to begin the pattern of flexion-adduction-external rotation with knee extension. To protect the patient's back flex the right hip and rest the foot on the table.

Grip

Your grips are the same as those for the straight leg pattern.

Elongated Position

Position the limb as you did for the straight leg pattern.

Body Mechanics

Use the same body mechanics as for the straight leg pattern. As the pattern nears end range, bend at your hips as you reach down to continue resisting the knee flexion. You may turn your body to face toward the foot of the table as the knee and hip reach their end range.

Stretch

The response to the stretch comes from the rapid elongation and rotation of the hip, ankle, and foot by both hands simultaneously. You can give a little extra traction movement to the knee with your distal hand to elongate the knee flexor muscles further.

Points to Remember

Timing: The foot moves first, then the knee and hip move together End the movement with full hip extension and as much knee flexion as possible without causing lumbar hyperextension

Command

"Push your foot and toes down, push your hip down, and bend your knee as you go."

Movement

The foot and ankle plantar flex and evert. The hip motion begins next. When the hip extension has completed about 5° of motion the knee begins to flex. It is important that the hip and knee reach their end ranges at the same time.

Resistance

Your distal hand resists the plantar flexion and eversion and uses that force to resist the knee flexion as well. The force is back toward the starting position of knee extension and foot inversion. Your proximal hand resists the hip motion as it did for the straight leg pattern. As the hip approaches full extension, approximate through the thigh with your proximal hand.

End Position

The hip is extended with abduction and internal rotation. The knee is flexed over the side of the table and the foot is in plantar flexion with eversion.

! Caution

Do not allow the pelvis to go into anterior tilt.

Timing for Emphasis

Lock in the hip extension at any point in the range and exercise the knee flexion.

! Caution

Do not let the hip action change from extension to flexion.

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