Testing and Function with Posture and Pain

Florence Peterson Kendall Elizabeth Kendall McCreary Patricia Gelse Provance Mary Mclntyre Rodgers William Anthony Romani Managing Editor Anne Seitz Hearthside Publishing Services Associate Production Manager Kevin Johnson Compositor Maryland Composition Inc. Printer RR Donnelley & Sons WiUard OH Copyright 2005 Lippincott Williams & Wilkins 351 West Camden Street Baltimore, MD 21201 530 Walnut Street Philadelphia, PA 19106 All rights reserved. This book is protected by copyright. No part...

Joints And Articulations Of Shoulder Girdle

Lateral Vs of clavicle, anterior border Anterior surface of sternal Yi of clavicle Crest of greater tubercle of humerus Flexion, medial rotation, and horizontal adduction Sternum, cartilages of six or seven ribs Crest of greater tubercle of humerus Depression of shoulder girdle and adduction of humerus obliquely downward Middle shaft of humerus, opposite deltoid tuberosity Flexion and adduction of shoulder joint Acromion, lateral margin and superior surface Spine of scapula, inferior lip of...

Medial Hamstrings Semitendinosus And Semimembranosus

Origin Tuberosity of the ischium by the tendon common with the long head of the biceps femoris. Insertion Proximal part of the medial surface of the body of the tibia and deep fascia of the leg. Action Flexes and medially rotates the knee joint. Extends and assists in medial rotation of the hip joint. Nerve Sciatic (tibial branch), LA, 5, SI, 2. Origin Tuberosity of the ischium, proximal and lateral to the biceps femoris and the semitendinosus. Insertion Posteromedial aspect of the medial...

Neck Trunk And Lower Extremity Muscle Chart

Trunk-raising Ki-ctus abdominis Internal iihfiquv Leg-lowering Rectus abdominis External ohlique tpWKj M 4 and below 5-7 a ongeofm jon limited wafcJsor T' -p------- ____v '' ye i 11 luiiun '-- e-90 Quadriceps - cannot extend last, 15 of knee in H> 1 - CZ-Qn r---_ - _ _ _ --- ----- L - -_-ZJ- -------------------U, .yricc in fitting___ cannot rise on toes one foot at a time but can come up when rism0 on both at the ---same time k> ut with some forward displacement of the body c- l -7-99...

Info

Joints Definitions & Classification, Chart Range of Motion and Muscle Length Testing Polio Factors Influencing Treatment Grading Strength and Key to Muscle Grading The underlying philosophy of this book is that there is a continuing need toget back to basics. This philosophy is especially pertinent in this era of time-limited treatments and advancing technology. Muscle function, body mechanics, and simple treatment procedures do not change. With respect to muscu-loskeletal problems, the...

Lateral Hamstrings Biceps Femoris

Origin of Long Head Distal part of the sacrotuberous ligament and posterior part of the tuberosity of the ischium. OriAn of Short Head Lateral lip of the linea aspera, proximal h of the supracondylar line, and lateral intermuscular septum. Insertion Lateral side of the head of the fibula, lateral condyle of the tibia, deep fascia on the lateral side of the leg. Action The long and short heads of the biceps femoris flex and laterally rotate the knee joint. In addition, the long head extends and...

Head and Face

Cranial Nerves and Deep Facial Muscles 122 Cervical Nerves and Superficial Facial Temporomandibular Joint Movement 124 Cranial Nerve and Muscle Chart 125 Section II Facial and Eye Muscles 12 6 Facial and Eye Muscles, Charts 126-127 Facial and Eye Muscle Tests 128-133 Section III Facial Paralysis 13 4 The illustration on the following page portrays a sagittal section of the skull at approximately the center of the left orbit, except that the complete eyeball is shown. The muscles illustrated are...

Impression

The site of injury appeared to be in the tensor fasciae latae muscle, with pain referred to the lateral knee via the fascia lata (i.e., the muscle in spasm placing tension on the iliotibial tract whenever the hip was extended). Following the examination, the patient was given moist heat and massage (stroking downward) to the tensor fasciae latae. The patient felt considerable relief of pain in the lying position, but pain was felt in standing. The anterolateral aspect of the left thigh was...

Painful Conditions Of The Upper Back

Pectoralis Minor Length Test

MIDDLE AND UPPER BACK PAIN FROM OSTEOPOROSIS Thoracic kyphosis is a primary deformity in osteoporosis, usually accompanied by compensatory extension of the cervical spine. Complaints of upper middle and low back pain are common and can best be treated by gentle efforts to reduce the postural deformity and prevent further progression before the faulty posture becomes a fixed structural fault. If a support can be tolerated, encourage the patient to use one to help maintain the best possible...

Correct

Computer placed under desk, monitor moved from comer, and platform removed. Monitor at or below eye level. Use of phone headset to relieve neck strain. Chair has proper back support and armrests to remove weight of arms from neck and shoulders. Legs supported by footrest under desk. Massage is an important modality in the treatment of painful neck conditions. The soothing effects of gentle massage can help relax tense muscles. Neck extensor muscles often become short from a faulty forward head...

Tests For Length Of Lumbricales And Interossei

SHORTNESS OF INTRINSIC MUSCLES OF THE HAND In this case, illustrated by the above photographs, a middle-aged woman presented with a complaint that her middle finger occasionally pained rather severely and that a constant, tight, drawing feeling was felt along the sides of this finger. She did not feel that the pain was actually in the joints of the finger. A medical checkup had revealed no arthritis. This person was an avid card player, and the condition was present in the left hand, which was...

Knees

Hyperextension is a fairly common fault, usually associated with lack of firm ligamentous support. It tends to disappear as the ligaments tighten, but if it persists as a postural habit, a corrective effort should be made by postural training. (See page 81.) A degree of knock-knee is common in children and usually first observed when the child begins to stand. The height and build of the child must be taken into consideration when judging whether the deviation is a fault, but in general, it may...

Rectus Abdominis

Rectus Abdominis

Insertion Costal cartilages of the fifth through seventh ribs and xiphoid process of the sternum. Action Flexes the vertebral column by approximating the thorax and pelvis anteriorly. With the pelvis fixed, the thorax will move toward the pelvis with the thorax fixed, the pelvis will move toward the thorax. Nerve T5, 6, T7-11, T12, ventral rami. Weakness Weakness of this muscle results in decreased ability to flex the vertebral column. In the supine position, the ability to tilt the pelvis...

Faulty Head And Neck Positions

Cervical Spine, Good and Faulty Positions For the radiograph on the left, the subject sat erect, with the head and upper trunk in good alignment. For the radiograph on the right, the same subject sat in a typically slumped position, with a round upper back and a forward head. As illustrated, the cervical spine is in extension. Cervical Spine, Extension In Figure A, the head tilts backward, the cervical spine is hyperextended, and the chest and shoulders are elevated. Cervical Spine, Straight...

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Perforating Cutaneous Nerve

Lumbar Plexus, Sacral Plexus 362, 363 Spinal Nerve and Muscle Chart 364 Spinal Nerve and Motor Point Chart 365 Chart of Lower Extremity Muscles 366, 367 Nerves to Muscles Motor & Sensory 368 Cutaneous Nerves of the Lower Limb 369 Movements of Toes, Foot, Ankle and Knee 370, 371 Movements of Hip Joint 372, 373 Treatment of Muscle Length Problems 375 Test for Length of Ankle Plantar Flexors 375 Test for Length of Hip Flexor Muscles 376-380 Problems with Hamstring Length Testing 382 Tests for...

Lateral Rotators Of Hip Joint

Pelvis Rotated Right

Patient Sitting on a table, with the knees bent over the side and the subject holding on to the table. Fixation The weight of the trunk stabilizes the patient during this test. Stabilization is also given in the form of counterpressure, as described below under Pressure. Test Lateral rotation of the thigh, with the leg in a position of completion of the inward arc of motion. Pressure With one hand, the examiner applies counter-pressure at the lateral side of the lower end of the thigh. With the...

Problems With Physical Fitness Tests

When a push-up is performed properly, the scapulae abduct as the trunk is pushed upward. The scapulae move forward to a position that is comparable to that of reaching the arms directly forward. When the serratus anterior muscle is weak, the push-up movement still can be performed, but the scapulae do not move into the abducted position as in a properly performed push-up. If the primary purpose of the push-ups is to test strength and endurance of the arm muscles, it accomplishes that purpose,...

Corrective Exercises Low Back And Abdominals

Exercises in the lying position should be done on a firm surface (e.g., a board on the bed, a treatment table or the floor, with a thin pad or folded blanket placed on the hard surface for comfort). Stretching exercises should be preceded by gentle heat and massage to help relax tight muscles. (Avoid using heat on weak, overstretched muscles.) Stretching should be done gradually, with a conscious effort to relax. Continue until a firm, but tolerable pull is felt, breathing comfortably while...

Sr1

Bunnell's Surgery of the hand, 4th ed. Boyes J11. ed. Philadelphia JB Lippincott. 1964. Campbell EJM. The respiratory muscles and the mechanics of breathing. Chicago Year Book. 1958. Campbell EJM, Agostini E, Davis JN. The respiratory muscles mechanisms and neural control. 2nd ed. Philadelphia WB Saunders, 1970. Capuano-Pucci D, Rheault W, Aukai J. Brucke M, Day R, Pastrick M. Intratester and intertester reliability of the cervical range of motion device. Arch Phys Med Rehabil 1991 72 338-340....

Posterior Pelvic Till

Two types of posture exhibit posterior pelvic tilt, hip joint extension and weakness of the iliopsoas muscle. The flat-back posture, as the name implies, is a straight back in both the lumbar and thoracic areas, except that some degree of flexion in the upper thoracic area accompanies the forward head position. The sway-back posture is one in which there is posterior displacement (i.e., swaying back) of the upper trunk and anterior displacement (i.e., swaying forward) of the pelvis. A long...

Section Iii Neck Muscle Tests

Patient Supine, with the elbows bent and the hands overhead, resting on the table. Fixation Anterior abdominal muscles must be strong enough to give anterior fixation from the thorax to the pelvis before the head can be raised by the neck flexors. If the abdominal muscles are weak, the examiner can provide fixation by exerting firm, downward pressure on the thorax. Children approximately 5 years of age and younger should have fixation of the thorax provided by the examiner. lest Flexion of the...

Postural Examination

Postural Exam

Instead of abandoning the use of exercises in the treatment of scoliosis, attention should be focused on a more scientific approach toward the evaluation and selection of appropriate exercises. Musculoskeletal evaluation should include alignment and muscle tests. Postural alignment tests, both plumb line and segmental, in back, side, and front views should be included (see pp. 64-77). Muscle length tests should include, but not be limited to, hip flexor (see pp. 376-380), hamstring (see pp....

Weakness Testing And Grading

ABDOMINAL MUSCLE IMBALANCE AND UMBILICUS DEVIATIONS With marked weakness and imbalance in the abdominal muscles, it is possible, to some degree, to determine the extent of the imbalance by observing the deviations of the umbilicus. The umbilicus will deviate toward a strong segment and away from a weak segment. If, for example, three segments the left external and the left and right internal obliques are equally strong and the right external is markedly weak, the umbilicus will deviate...

Variations In Length Of Posterior Muscles

Hamstring Lengthening

Normal length of the gastroc-soleus. normal length of the gastroc-soleus. Excessive length of the upper back muscles, slight shortness of the muscles in the mid back and in gastroc-soleus. Hamstrings and low back are normal in length. Excessive flexibility of the back overcompensates for shortness of the hamstrings. This subject is unable to touch his toes because of shortness in the gastroc-soleus, and slight limitation of flexibility in the mid-back area. The upper back shows some excessive...

Back Extensors Testing And Grading

In the trunk extension test for the back extensors, the erector spinae muscles are assisted by the latissimus dorsi, quadratus lumborum, and trapezius. In the prone position, the low back will assume a normal anterior curve. To avoid false interpretations of the test results, it may be necessary to perform some preliminary tests. It is not necessary to do so routinely, however, because close observation of the subject in a prone position and of the movements taking place during trunk extension...

Apparent Leglength Discrepancy Caused By Muscle Imbalance

Tibial Torsion With Pronation

Without any actual difference in leg length, subjects have an appearance of a longer leg on the high side when the pelvis is tilted laterally. In the right photograph below, this appearance has been created by displacing the pelvis laterally. (The feet were anchored to the floor.) If tightness develops in the tensor fasciae latae and iliotibial band on one side, the pelvis will be tilted downward on that side. With gluteus medius weakness on one side, the pelvis will ride higher on the side of...

Upper Abdominal Strengthening

In back-lying position, tilt pelvis to flatten low back on table by pulling up and in with lower abdominal muscles. With arms forward, raise head and shoulders up from table. Do NOT attempt to come to sitting position, but raise upper trunk as high as back will bend. As strength progresses, arms may be folded across chest, and later placed behind head to Increase resistance during the exercise. 2005 Florence P. Kendall and Patricia G. Provance. Authors grant permission to reproduce for personal...

Spinal Nerve And Motor Point Chart

Motor Point Human Body

Lat and Mod. pectoral Ns Pectoralis major Pectoralis nta lat and Mod. pectoral Ns Pectoralis major Pectoralis nta AM poll b Opp poll Fl po4> b (sup h ) I Lumbricfllts I, II Accessory N. (cran XI) Sternocleidomastoid Mid. & low. trap Upper trapezius Suprascapular N. Supraspmatus Infraspinatus Axillary N AM poll b Opp poll Fl po4> b (sup h ) I Lumbricfllts I, II Palmaris brevis Abd. digiti min. Opp. digiti min. Fl. digiti min. Palmar interossei Lumbricales III. IV Dorsal interossei (se Fl....

Temporomandibular Joint Movements

Movements of the temporomandibular joint (TMJ) include depression of the mandible (i.e., opening the mouth), protrusion of the mandible (i.e., movement in a forward direction) retrusion of the mandible (i.e., movement in a posterior direction) and lateral motion of the mandible (i.e., side-to-side movements). Retrusion is very limited compared to protrusion. According to Bourban. two primary movements of the TMJ are rotation about a mediolateral axis and translation along the anteroposterior...

Case 1 Peroneal Nerve Injury

Q I EXT DIGIT LONG Q I PERONEUS TERTI US 0 Dorsal Primary Ramus V Venlral Primary Rams A Arfatr DMsai P Pcsteror DMBD The patient, on whom muscle and sensory tests were done 6 weeks after onset, had fallen through a glass door and sustained a laceration injury of the left leg. Muscle test findings indicated the following Involvement of the nerve branches to the flexor digitorum longus and flexor hallucis longus, without involvement of the tibial nerve and its terminal branches. Involvement of...

Trendelenburg Sign And Hip Abductor Weakness

When body weight is supported, alternately, on one leg, such as in walking, the body must be stabilized on the weight-bearing leg during each step. By reverse action (i.e., origin pulled toward the insertion), strong hip abductors can stabilize the pelvis on the femur in hip joint abduction, as shown in Figure A. The lateral trunk flexors on the left also act by pulling upward on the pelvis. Figure B shows a position of hip joint adduction that results when hip abductors are too weak to...

Section Iv Painful Conditions

Muscle problems associated with pain in the posterior neck are essentially of two types one associated with muscle tightness and the other with muscle strain. Symptoms and indications for treatment differ according to the underlying fault. Both types are quite prevalent. The one associated with muscle tightness usually has a gradual onset of symptoms, whereas the one associated with muscle strain usually has an acute onset. Neck pain and headaches associated with tightness in the posterior neck...

Upper Abdominal Muscles Testing And Grading

Mmt Abdominal Muscle And Photo

Normal (10) Grade * With the hands clasped behind the head, the subject is able to flex the vertebral column (top figure) and keep it flexed while entering the hip flexion phase and coming to a sitting position (bottom figure). The feet may be held down during the hip flexion phase, if necessary, but close observation is required to be sure that the subject maintains the flexion of the trunk. Because many people can do a curled-trunk sit-up with hands clasped behind the head, it is usually...

Rationale for Treatment

Sacroiliac strains do exist As stated by the authors of Posture and Pain, Because the normal range of motion of the joint is small, it takes very little more to be excessive. A tension sufficient to cause ligamentous strain may not appear on x-ray (10). Treatment varies from the conservative approach of nothing other than application of support in the form of a belt, corset, or brace to the use of sophisticated mobilization techniques. In all probability, most sacroiliac strains are the result...

Corrective Exercises Posture

The exercises below are designed to help correct some common postural faults. Additional corrective exercises are located at the end of chapters that follow. Specific exercises are done to improve muscle balance and restore good posture.To be effective they should be done every day for a period of weeks, plus daily practice in assuming and maintaining good posture until it becomes a habit. While working to correct muscle imbalance, it is usually advisable to AVOID the following exercises Lying...

Transversus Abdominis

Transverse Abdominis Muscle Shape

Origin Inner surfaces of cartilages of the lower six ribs, interdigitating with the diaphragm thoracolumbar fascia anterior3 4 of internal lip of the iliac crest and lateral ' of the inguinal ligament. Insertion Linea alba by means of a broad aponeurosis, pubic crest, and pecten pubis. Direction of Fibers Transverse (horizontal). Action Acts likes a girdle to flatten the abdominal wall and compress the abdominal viscera upper portion helps to decrease the infrastemal angle of the ribs, as in...