Soft Tissue: Lab Midterm

Front 1

Iliopsoas: Prime Movement

Back 1

Flexion of the thigh at the hip

Front 2

Iliopsoas: Synergist/Antagonist

Back 2

Synergist
- Gluteus mediums and piriformis in abduction and external rotation of the thigh

Antagonist
- Gluteus maximus (hip extension)

Front 3

How does iliopsoas play a role in standing and gait?

Back 3

Standing: psoas active, iliacus inactive

Walking: iliacus continuously active, psoas only active during early swing phase

Front 4

Iliopsoas: Pain Referral Pattern

Back 4

1) From iliopsoas trigger points are vertical, along the ipsilateral lumbar spine- from lower thoracics to SI region and upper buttock
2) Ipsilateral anteromedial thigh, just below the groin

Front 5

Iliopsoas: Strength Test

Back 5

- Patient is supine, doctor stands to the side of the patient and stabilizes at contralateral ASIS
- Ipsilateral leg is abducted and lifted up; patient is instructed to resist doctor's pressure

Front 6

Iliopsoas: Length Test

Back 6

- Patient is seated, sitting as close to the edge of the table as they can
- Doctor supports the patient as they lay back onto the table
- Shortness of both one and two joint hip flexors will present with the thigh off the table

Front 7

Iliopsoas: Attachment Points

Back 7

Psoas Major: sides of vertebral bodies, discs and TPs of T12 - L5, passing in front of SI joint to lesser trochanter of the femur

Iliacus: upper 2/3 of iliac fossa to join with psoas tendon to lesser trochanter

Front 8

Rectus Femoris: Prime Movement

Back 8

Flexes the hip; with quadriceps group it extends the knee

Front 9

Rectus Femoris: Synergist/Antagonist

Back 9

Synergist
- With other quads in stabilizing patella, sitting from standing, squatting, backbending, descending stairs

Antagonist
- To hip extensors, knee flexors

Front 10

Rectus Femoris: Attachment Points

Back 10

Tendons attach to AIIS and brim of acetabulum to patella, and through patellar tendon to tibial tuberosity

Front 11

Rectus Femoris: Pain Referral Pattern

Back 11

Trigger points refer to anterior thigh and knee

Front 12

Rectus Femoris: Strength Test

Back 12

- Patient is seated; doctor places hand under thigh and stabilizes at the ankle
- Knee is extended slightly and patient is instructed to resist doctor's pressure

Front 13

Rectus Femoris: Length Test

Back 13

- Patient is seated at the edge of the table
- Doctor supports patient in laying down on the table

Front 14

Rectus Abdominus: Prime Movement

Back 14

- Flexes the trunk, especially lumbar spine
- Contracts eccentrically to "brake" trunk extension from an upright position

Front 15

Rectus Abdominus: Synergist/Antagonist

Back 15

Synergist
- With other abdominals, QL and diaphragm in increasing intra-abdominal pressure

Antagonist
- Thoracolumbar erector spinae

Front 16

Rectus Abdominus: Attachment Points

Back 16

Pubic crest and pubic symphysis to costal cartilage of 5th, 6th and 7th ribs and xiphoid process

Front 17

What is important about rectus abdominus trigger points?

Back 17

UNILATERAL trigger points can produce BILATERAL pain

Front 18

Rectus Abdominus: Pain Referral Pattern

Back 18

- Trigger points in upper rectus refer pain across the mid-back (bilateral lower thoracic pain)
- Trigger points in lowest portion of rectus refer pain bilaterally to SI joints and lumbosacral region
- Lateral and peri-umbilical trigger points may produce sensations of cramping or colic, or diffuse abdominal pain

Front 19

Rectus Abdominus: Strength Test

Back 19

- Patient is supine
- See if patient can lift torso off the table and hold without shaking for 10 - 15 minutes

Front 20

Rectus Abdominus: Functional Test
Dynamic Trunk Flexion

Back 20

- Patient is supine, doctor stabilizes at ankles
- Patient is instructed to lift torso off the table (only until inferior angle of the scapula is off)
- Repeat this 50 times

Failed Test: recruiting hip flexors and SCM

Front 21

Gluteus Maximus: Prime Movement

Back 21

Extend the hip joint

Front 22

Gluteus Maximus: Synergist/Antagonist

Back 22

Synergist
- Assist abduction (gluteus medius and minimus) and external rotation (piriformis) of the hip joint

Antagonist
- Hip flexion (iliopsoas) and internal rotation

Front 23

Gluteus Maximus: Attachment Points

Back 23

Posterior iliac crest, edge of sacrum, coccyx, sacrotuberous and sacroiliac ligaments to gluteal tuberosity and IT band

Front 24

Gluteus Maximus: Pain Referral Pattern

Back 24

Pain referral remains local to the buttock region

Front 25

Gluteus Maximus: Strength Test

Back 25

- Patient prone, doctor stabilizes over hamstring and iliac crest
- Patient is instructed to lift leg and resist doctor's pressure (of the hamstring hand)

Front 26

Gluteus Maximus: Functional Test
Hip Extension

Back 26

- Patient prone
- Doctor place hand about 25-30° above patient's leg and patient is instructed to lift leg to doctor's target point
- Watching pivot point at femoro-acetabular joint; pivot point in lumbar spine (excessive recruitment of erector spinae); excessive recruitment of hamstrings

Front 27

TFL: Primary Movement

Back 27

None! It's primary function is to tense the IT band

Front 28

TFL: Synergist/Antagonist

Back 28

Synergist
- With rectus femoris and psoas major for hip flexion and the swing phase of gait
- With gluteus medius and minimus for abduction

Antagonist
- To hip extensors, adductors and lateral rotators

Front 29

TFL: Trigger Point Referral Pattern

Back 29

- Single TP just below the ASIS
- Pain in hip with referred soreness over trochanter, downward to lateral aspect of the thigh

Front 30

TFL: Strength Test

Back 30

- Patient supine
- Patient's leg is lifted off the table; doctor places hand on the side of the leg below the knee
- Patient is instructed to resist doctor's pressure

Front 31

TFL: Length Test (Ober's Test)

Back 31

- Patient is side-lying
- First, doctor flexes the leg
- Doctor abducts the leg
- Doctor extends the leg past the coronal plane
- Finally, doctor adducts the leg

Front 32

Piriformis: Prime Movement

Back 32

- Externally rotate femur (with "gogo" muscles and quadratus femoris) when hip is neutral (only)
- Abduct femur when hip joint is flexed

Front 33

Piriformis: Synergist/Antagonist

Back 33

Synergist
- Stabilizing hip joint by helping to hold femoral head in acetabulum

Antagonist
- Internal rotators and adductors

Front 34

Piriformis: Attachment Points

Back 34

From anterior surface of sacrum to superior surface of greater trochanter

Front 35

Piriformis: Trigger Point Referral Pattern

Back 35

- To the sacroiliac region, posterior hip joint with spillover to buttock and posterior thigh
- Less commonly, trigger points can mimic UTI symptoms

Front 36

Gluteus Medius: Prime Movement

Back 36

Abdcuts the femoro-acetabular joint

Front 37

Gluteus Medius: Synergist/Antagonist

Back 37

Synergist
- Anterior fibers assist with hip flexion and internal rotation
- Posterior fibers assist with hip extension and external rotation

Antagonist
- Hip abductors

Front 38

Gluteus Medius: Attachment Points

Back 38

From lateral surface of ilium, along iliac crest, between anterior and posterior gluteal lines to the greater trochanter

Front 39

Gluteus Medius: Trigger Point Referral Pattern

Back 39

- Near iliac crest attachment and refer to the low back along the posterior crest of the ilium, to sacrum, and posterolateral aspect of buttock; occasionally extends to proximal posterolateral thigh

Front 40

Gluteus Medius: Strength Test

Back 40

- Patient side-lying in a stacked position (no rotation in lumbar spine), doctor stabilizes at iliac crest
- Leg is abducted and patient is instructed to resist doctor's pressure

Front 41

Gluteus Medius: Functional Test
Hip Abduction

Back 41

- Start with patient side-lying, bottom leg is bent to provide stabilization; top leg is straight
- Patient is instructed to lift leg
- Doctor is looking for recruitment of QL (hip hike), piriformis (external rotation) or hip flexors (leg drifts forward)

Front 42

Lumbar Erectors: Prime Movement

Back 42

- Bilaterally extend trunk (increase lumbar lordosis)
- Bilateraly contract eccentrically to "brake" trunk flexion from upright position
- Unilaterally, laterally bend and rotate trunk ipsilaterally

Front 43

Lumbar Erectors: Antagonist

Back 43

Antagonistic to trunk flexors

Front 44

Lumbar Erectors: Attachment Points

Back 44

Iliocostalis lumborum: from common tendon (medial and lateral crests of sacrum, medial iliac crest) and SPs of T11 to L5, to inferior borders of lower 6 or 7 rib angles

Longissimus Thoracis: from common tendon, and TPs and mamillaries of L1 - L5, to lower 9 ribs and thoracic TPs

Front 45

Lumbar Erectors: Strength Test

Back 45

- Patient prone, doctor stabilizes legs
- Can the patient lift off the table and hold without shaking for 10 - 15 seconds

Front 46

Lumbar Erectors: Length Test

Back 46

- Patient is seated, doctor stabilizes at ASIS
- Have patient flex forward
- Lordosis should reverse prior to anterior pelvic tilt