Extension Adduction External Rotation

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Joint

Movement

Muscles: principal components (Kendall and McCreary 1993)

Hip

Extension, adduction, external rotation

Adductor magnus, gluteus maximus, hamstrings, lateral rotators

Knee

Extended (positions unchanged)

Quadriceps

Ankle

Plantar-flexion, inversion

Gastrocnemius, soleus, tibialis posterior

Toes

Flexion, medial deviation

Flexor hallucis, flexor digitorum

Grip

Hold the plantar surface of the foot with the palm of your left hand. Your thumb is at the base of the toes to facilitate toe flexion. Be careful not to block the flexion of the toes. Your fingers hold the medial border of the foot, 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 comes underneath the thigh from lateral to medial to hold on the posteromedial side.

Elongated Position

Traction the entire leg while moving the foot into dorsiflexion and eversion. Continue the traction and maintain the internal rotation as you lift the leg into flexion and abduction. If the patient has just completed the antagonistic motion (flexion-abduction-internal rotation), begin at the end of that pattern.

! 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.

Body Mechanics

Stand in a stride position by the patient's left shoulder facing toward the lower right corner of the table. Your inner foot (closest to the table) is in front. Your weight is on the back foot. Allow the patient's motion to pull you forward onto your front foot. When your weight has shifted over the front foot, step forward with your rear foot and continue the weight shift forward.

Alternative Position

You may stand on the right side of the table facing up toward the left hip. Your right hand is on the plantar surface of the patient's foot, your left hand on the posterior thigh. Stand in a stride and allow the patient to push your weight back as the leg kicks down (D Fig. 8.5 d, e).

Stretch

Your proximal hand stretches the hip by giving a quick traction to the thigh. Use the forearm of your distal hand to traction up through the shin while you stretch the patient's foot farther into dorsiflex-ion and eversion.

! Caution

Do not force the hip into more flexion.

Command

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

Movement

The toes flex and the foot and ankle plantar flex and invert. The inversion promotes the hip external rotation, and these motions occur at the same time. The fifth metatarsal leads as the thigh moves down into extension and adduction maintaining the external rotation. Continuation of this motion causes extension with elongation of the left side of the trunk.

Resistance

Your distal hand combines resistance to inversion with approximation through the bottom of the foot. The approximation resists both the plantar flexion and the hip extension. Resisting inversion results in resistance to the hip adduction and external rotation as well. Your proximal hand lifts the thigh back toward the starting position. The lift resists the hip extension and adduction. The placement of your hand, coming from lateral to medial, gives resistance to the external 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 extension (touching the table) and adduction while maintaining external rotation. The thigh has crossed to the right side of the midline.

Abductor Flexed Position
D Fig. 8.5. Extension-adduction-external rotation. a, b Therapist standing on the same side of the table; c same pattern with the patient's other leg flexed; d, e therapist standing on the opposite side of the table

Timing for Emphasis

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

Points to Remember

— The therapist's proximal hand comes from

— End position: the thigh crosses mid-line and

the lateral side of the thigh to the posterior-

the lumbar spine remains in neutral tilt and

medial surface

side bend

— Normal timing: to get the proper direct

— The hip maintains external rotation as well as

movement into the pattern, instead of an

adduction

arcing movement, the foot must move into its

position first

8.3.1 Extension - Adduction - External Rotation with Knee Extension (o Fig. 8.6)

Joint

Movement

Musclcs: principal components (Kendall and McCreary 1993)

Hip

Extension, adduction, external rotation

Adductor magnus, gluteus maximus, hamstrings, lateral rotators

Knee

Extension

Quadriceps

Ankle

Plantar-flexion, inversion

Gastrocnemius, soleus, tibialis posterior

Toes

Flexion, medial deviation

Flexor hallucis, flexor digitorum

Grip

Your distal and proximal grips are the same as the ones used for the straight leg pattern.

Elongated Position

The foot is in dorsiflexion with eversion. The hip and knee are in full flexion with the heel close to the lateral border of the buttock. The knee and heel are aligned with each other and lined up approximately with the lateral border of the left shoulder. The hip has the same amount of rotation as it did in the straight leg pattern. Straighten the knee to check the rotation.

Body Mechanics

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

Alternative Position

You may stand on the opposite side of the table facing up toward the left hip (O Fig. 8.6 c, d).

Stretch

Apply the stretch to the hip, knee, and foot simultaneously. With your proximal (right) hand combine traction of the hip through the line of the femur with a rotary motion to stretch the external rotation. Your distal (left) hand stretches the foot farther into dorsiflexion and eversion and stretches the knee extension by bringing the patient's heel closer to his buttock.

Fig. 8.6. Extension-adduction-external rotation with knee extension. a, b Usual position of the therapist; c, d alternative position on the other side of the table

Fig. 8.6. Extension-adduction-external rotation with knee extension. a, b Usual position of the therapist; c, d alternative position on the other side of the table a c d

! Caution

Don't over-rotate the hip by pulling the foot more lateral than the knee.

Command

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

Movement

The foot and ankle plantar flex and invert. 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. The rotary resistance at the foot also resists the rotation at the knee and hip. 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 resistance to the knee extension motion continues in the same direction (toward the patient's buttock) when the knee is fully extended.

Your proximal hand pulls the thigh back toward the starting position. The pull resists the hip extension and adduction. The placement of your hand, coming from lateral to medial, supplies the resistance to the external rotation. As the hip and knee approach 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.

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 the knee extension. Lock in the knee before it is fully extended and exercise the hip extension.

Points to Remember

Don't over-rotate the hip at the beginning of the movement

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

The movement ends with external rotation in the hip, not just inversion of the foot

8.3.2 Extension - Adduction - External Rotation with Knee Flexion (O Fig. 8.7)

Joint

Movement

Muscles: principal components (Kendall and McCreary 1993)

Hip

Extension, adduction, external rotation

Adductor magnus, gluteus maximus, lateral rotators

Knee

Flexion

Hamstrings, gracilis

Ankle

Plantar-flexion, inversion

Gastrocnemius, soleus, tibialis posterior

Toes

Flexion, medial deviation

Flexor hallucis, flexor digitorum

Position at Start

For this combination place the patient toward the end of the table so that the knee can flex as fully as possible. This is the same placement you used to begin the pattern of flexion-abduction-internal rotation with knee extension (7 Sect. 8.2.2). To protect the patient's back flex the right hip and rest the foot on the end of the table or another support.

Grip

Your distal and proximal grips are the same as those used 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.

Stretch

The stretch comes from the rapid elongation and rotation of the hip, ankle, and foot by both hands simultaneously. With your distal hand you can give increased traction to stretch the knee flexor muscles.

Command

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

Fig. 8.7a,b. Extension-adduction-external rotation with knee flexion

Movement

The foot and ankle plantar flex and invert. 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 uses the resistance to the plantar flexion and inversion to resist the knee flexion as well. The pull is back toward the starting position of knee extension and foot eversion. 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 adduction and external rotation. The knee is flexed over the end of the table and the foot is in plantar flexion with inversion.

! Caution

Do not allow the pelvis to move to the right or go into anterior tilt.

Timing for Emphasis

Lock in the hip extension at any point in the range and exercise the knee flexion. Do not let the hip action change from extension to flexion. Teach the patient to combine hip extension with knee flexion in a smooth motion.

Points to Remember

Resist the flexion of the knee as well as the extension of the hip

Normal timing: the knee flexes smoothly during the entire motion Give traction to the femur during the motion

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Responses

  • seija
    What is external rotation and abduction of the thigh?
    5 months ago
  • marmadoc
    What is external rotation abduction of forward flexion?
    4 months ago

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