Flexion Abduction Internal Rotation o

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Joint

Movement

Muscles: principal components (Kendall and McCreary 1993)

Hip

Flexion, abduction, internal rotation

Tensor fascia lata, rectus femoris, gluteus medius (anterior), gluteus minimus

Knee

Extended (position unchanged)

Quadriceps

Ankle/foot

Dorsiflexion, eversion

Peroneus tertius

Toes

Extension, lateral deviation

Extensor hallucis, extensor digitorum

Fig. 8.2a,b. Flexion-abduction-internal rotation

Movement

The toes extend as the foot and ankle move into dorsiflexion and eversion. The eversion promotes the hip internal rotation, and these motions occur almost simultaneously. The fifth metatarsal leads as the hip moves into flexion with abduction and internal rotation. Continuation of this motion produces trunk flexion with left side-bending.

Resistance

Your distal hand combines resistance to eversion with traction through the dorsiflexed foot. The resistance to the hip abduction and internal rotation comes from resisting eversion. The traction resists both the dorsiflexion and hip flexion. Your proximal hand combines traction through the line of the femur with a rotary force that resists the internal rotation and abduction. Maintaining the traction force will guide your resistance in the proper arc. Too much resistance to the leg does not allow the pelvis to move in the proper direction. Too much resistance to the leg does not allow the pelvis to move freely in the proper direction.

! Caution

Too much resistance to hip flexion may result in strain on the spine.

End Position

The foot is in dorsiflexion with eversion. The knee is in full extension and the hip in full flexion with enough abduction and internal rotation to align the knee and heel approximately with the lateral border of the left shoulder.

to flexion, step forward with your left leg. This position makes it easier to get a good elongation at the beginning of the pattern. See O Fig. 8.3 for an illustration of the alternative position.

Stretch

The response to the stretch comes from a rapid elongation and rotation of the ankle, foot, and hip, by both hands simultaneously.

! Caution

The length of the hamstring muscles or other posterior structures may limit the hip motion. Do not allow the pelvis to move into a posterior tilt.

Timing for Emphasis

Prevent motion in the beginning range of hip flexion and exercise the foot and toes.

Command

"Foot up, lift your leg up and out." "Lift up!"

Points to Remember

— Start with good elongation of the leg, the

— Internal rotation of the hip is necessary, don't

thigh must start across mid-line

move only the foot

— Continuation of the elongation will lengthen

— Give traction to the femur during the motion

the trunk lateral flexors

— The lumbar spine must remain in neutral

8.2.1 Flexion - Abduction - Internal Rotation with Knee Flexion (o Fig. 8.3)

Joint

Movement

Muscles: principal components (Kendall and McCreary 1993)

Hip

Flexion, abduction, internal rotation

Tensor fascia lata, rectus femoris, gluteus medius (anterior), gluteus minimus

Knee

Flexion

Hamstrings, gracilis, gastrocnemius

Ankle/foot

Dorsiflexion, eversion

Peroneus tertius

Toes

Extension, lateral deviation

Extensor hallucis, extensor digitorum

Grip

Your distal and proximal grips remain the same as they were for the straight leg pattern.

Elongated Position

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

Body Mechanics

Stand in the same stride position by the patient's hip as for the straight leg pattern. Again, allow the patient's motion to shift your weight from the front to the back foot. Face the line of motion.

Alternative Positions

You may use the same alternative position, standing on the opposite side of the table, as you used for the straight leg pattern (O Fig. 8.3 c, d).

Stretch

Use the same motions for the stretch that you used with the straight leg pattern. Traction with the distal hand will facilitate the knee flexors.

Command

"Foot up, bend your knee up and out." "Bend up!" Movement

The foot and ankle dorsiflex and evert. The hip and knee motions begin next and both joints reach their end ranges at the same time. Continuation of this motion also causes trunk flexion with lateral flexion to the left.

Resistance

Give traction with your proximal hand through the line of the femur, adding a rotary force, to resist the hip motion. Resist the foot and ankle motion as before with your distal hand. Resist the knee flexion by applying traction through the tibia toward the starting position. The resistance to knee flexion is crucial to successful use of this combination for strengthening the hip and trunk.

End Position

The foot is in dorsiflexion with eversion. The hip and knee are in full flexion with the heel close to the

□ Fig. 8.3. Flexion-abduction-internal rotation with knee flexion. a, b Usual position of the therapist; c, d alternative position on the opposite side of the table 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.

If you extend the patient's knee the position is the same as the straight leg pattern.

Timing for Emphasis

With three moving segments, hip, knee, and foot, you may lock in any two and exercise the third. With the knee bent it is easy to exercise the internal rotation separately from the other hip motions. Do these exercises where the strength of the hip flexion is greatest. You may work through the full range of hip internal rotation during these exercises, but return to the groove before finishing the pattern.

When exercising the patient's foot, move your proximal hand to a position on the tibia and give resistance to the hip and knee with that hand. Your distal hand is now free to give appropriate resistance to the foot and ankle motions. To avoid fatigue of the hip allow the heel to rest on the table.

Points to Remember

End the pattern with maximal flexion in the knee joint

Resist the knee flexion with your distal hand throughout the range of motion The foot should not move lateral to the knee

8.2.2 Flexion - Abduction - Internal Rotation with Knee Extension (o Fig. 8.4)

Joint

Movement

Muscles: principal components (Kendall and McCreary 1993)

Hip

Flexion, abduction, internal rotation

Tensor fascia lata, rectus femoris, gluteus medius (anterior), gluteus minimus

Knee

Extension

Quadriceps

Ankle/foot

Dorsiflexion, eversion

Peroneus tertius

Toes

Extension, lateral deviation

Extensor hallucis, extensor digitorum

Position at Start

For this combination place the patient toward the end of the table so the knee can be flexed as fully as possible.

Grip

Your distal and proximal grips remain the same as they were for the straight leg pattern.

Elongated Position

Traction the entire limb as before, while you move the foot into plantar flexion and inversion. Continue the traction while you flex the knee over the end of the table and position the hip in extension with adduction and external rotation. Tightness in the anterior muscles that cross the hip and knee joints may restrict full hip extension-adduction. Keep the thigh in the diagonal and flex the knee only as much as is possible without pain.

! Caution

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

To protect the patient's back, flex the right hip and rest the foot on the end of the table or another support.

Body Mechanics

Stand in a stride position by the patient's knee. Bend from the hips as you reach down and flex the patient's knee. As the patient lifts his leg with the

□ Fig. 8.4. Flexion-abduction-internal rotation with knee extension. a, b Usual position of the therapist; c, d alternative position at the end of the table knee extending your weight shifts back and then you step back.

Alternative Positions

Stand at the end of the table facing up toward the patient's left shoulder. Lean back so that your body weight helps with the stretch of the hip. As the leg moves into flexion, step forward with your back foot (O Fig. 8.4 c, d).

Stretch

Apply the stretch to the foot, hip, and knee simultaneously. Stretch the hip with the proximal hand, using rapid traction and rotation. Stretch the foot and ankle with your distal hand, using elongation and rotation. Stretch the knee very gently by applying only traction with your distal hand along the line of the tibia.

Resistance

Your distal hand resists the foot and ankle motion with a rotary push. Using the stable foot as a handle, resist the knee extension with a traction force toward the starting position of knee flexion. The rotary resistance at the foot resists the knee and hip rotation as well.

Your proximal hand combines traction through the line of the femur with a twist to resist internal rotation.

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.

Command

"Foot up, bend your hip up and straighten your knee as you go."

Movement

The foot and ankle dorsiflex and evert. The hip motion begins next. When the hip has moved through about 5 ° of flexion the knee begins to extend. It is important that the hip and knee reach their end ranges at the same time.

Timing for Emphasis

The emphasis here is to teach the patient to combine hip flexion with knee extension in a smooth motion.

Points to Remember

Good elongation and rotation in the hip are necessary to facilitate the hip motion Do not cause pain with the stretch of the knee

The hip and knee motions occur together, the end position is a straight leg

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Responses

  • Hiwet Kinfe
    What resists hip internal rotation in flexion?
    2 years ago

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