Download Pelvis and Hip

Pelvis and Hip: Evaluation and Treatment of Somatic Dysfunction
Description
Pelvic
anatomy
-hip is a region  the articulation of the femoral head with the acetabulum; a
“ball & socket” joint or enarthrosis which allows 360 degrees motion
-joint stability  deep fit of the head of the femur into the acetabulum, a strong
fibrous articular capsule, & strong fibrous articular capsule , & strong muscles
crossing the joint & inserting below the femoral head
-synovial membranes lines the articular capsule
-referred pain is commonly felt in the buttock, thigh, groin, knee, & even foot
Hx
PE of hip
Pain - location, intensity, quality
Numbness - tingling, note distribution, intensifiers
Weakness - motor difficulties, gait
Trauma Hx - position, audible pops, deformation, bruising, swelling, fractures, falls
-attention should be on structure & function
-initial survey of patient  general appearance, body proportions, & ease of
movement
*consider the abilities of the patient & their corresponding ADLs
-systematic exam  including visual inspection of anatomy, palpation of bony
landmarks/joint/soft tissue structures; ROM testing
Pictures/Misc.
Description
-evaluate the inguinal region for hernias (direct & indirect) as well as vascular
competency (femoral artery/vein)
-palpate & evaluate the bursa of the hip region
*most common is the trochanteric bursa
-inspect hips anteriorly & posteriorly (standing)
-note any asymmetry in the iliac crest height, the size of the buttocks, or the
number & level of gluteal folds
-palpate the hips & pelvis w/patient supine  note any instability, tenderness, or
crepitus
-not any anatomical landmarks  iliac crests, iliac tubercle, ASIS, PSIS, greater
trochanter, ischial tuberosity, & sciatic nerve distribution
GAIT OBSERVATION
-ambulate the patient  observation of gain can give many clues to the etiology
hip/pelvic area pain
-normal goat has a smooth & continuous rhythm  width of the base (heel-towidth space) should be 2-4 inches
-weight-bearing phase is where the majority of hip associated problems are
exhibited  constitutes 60% of the total ambulatory cycle
-contralateral abductor contraction assists in stabilizing the pelvis & to maintain
balance  results in raising of the ipsilateral hip
-always look above & below any joint!!  is it a back or lumbar (spinal) etiology?
A knee or even ankle etiology?
NEUROLOGIC EXAM
-DTRs
-sensation (dermatomes)
-muscle strength (L4, L5 & S1)
Pictures/Misc.
Description
-special tests
-Straight Leg Raise  Assessment for sciatic nerve compression/irritation
*Sciatic pain vs. hamstring pain
*Normal straight leg raise ≈90° without pain/symptoms
*Keeping knee extended, Dr flexes hip until pt reports pain
-Braggards test  assessment for sciatic n. compression (sciatic vs. hamstring
pain)
* Lower leg 5 degrees, then dorsiflex foot to stretch sciatic nerve
-Laseque’s test  Tests for pain specific to sciatic n. origin
*Once pain is reported on SLR, Dr flexes knee & hip about 5° further. At new
endpoint Dr. extends knee. Some actually bring the flexed knee to 90 and THEN
straighten the knee to stretch the sciatic n.
*This removes hamstring pain while adding stress onto sciatic n.
*Considered abnormal if pt reports return of pain, especially if pain radiates past
knee
-Heel walk/toe walk
Pictures/Misc.
Description
ROM exam
Pictures/Misc.
-Examine the range of motion of the hips by asking the patient to perform the
following movements:
-While supine, raise the leg with the knee extended above the body  Expect up
to 90 degrees of hip flexion
-While either standing or prone, swing the straightened leg behind the body
without arching the back  Expect hip hyperextension of 30 degrees or less
-While supine, raise one knee to the chest while keeping the other leg straight 
Expect hip flexion of 120 degrees
-While supine, swing the leg laterally and medially with knee straight. With the
adduction movement, passively lift the opposite leg to permit the examined leg full
movement  Expect some degree of both abduction and adduction
-While supine, flex the knee keeping the foot on the table and then rotate the leg
with the flexed knee toward the other leg  Expect internal rotation of 40
degrees
-While supine, place the lateral aspect of the foot on the knee of the other leg;
move the flexed knee toward the table (Patrick test)  Expect 45 degrees of
external rotation
Neuro exam
-To test hip flexion strength, apply resistance while the patient maintains flexion
of the hip when the knee is flexed and then extended  Muscle strength can also
be evaluated during abduction and adduction, as well as by resistance to
uncrossing the legs while seated
L4
-motor  muscles responsible for foot inversion
-DTR  patellar reflex
-sensory  medial aspect of leg and foot
SCIATIC NERVE: L4-5/S1-2-3
-The combination of 2 nerves: Tibial branch (L45/S1-3) and the Common Fibular or Peroneal
branch (L4-5 / S1-2). Bifurcation occurs at the
approximate level of the popliteal fossa
-Largest nerve in the body
Description
Pictures/Misc.
-Exits the pelvis through the Greater Sciatic
Foramen just below the piriformis m  No gluteal
branches but does have a branch to the hip joint
-Travels just lateral to the ischial tuberosity and
along the posterior midline deep to the
musculature. Localized at the midway point
between the greater trochanter of the hip and the
ischial tuberosity.
L5
-motor = extension of extensor hallucis longus m. against resistance (ask pt to
walk on heels)
-no reflex!
-sensory = lateral side of leg and dorsum of foot
-“Walk on heels”
-Origins – L4-S3
-Components  Tibial nerve & Common peroneal
nerve
-Pathway  Through greater sciatic notch,
Beneath piriformis into posterior thigh (10%
through), Just proximal to popliteal fossa, it
branches off into common peroneal and tibial
nerves
-Somatic Dysfunction  Piriformis: innervated S12
Description
S1
-motor  muscles responsible for eversion (ask pt to walk on their toes)
-Achilles tendon reflex
-sensory  lateral malleolus and lateral aspect of foot
-“Walk on your toes”
Pictures/Misc.
Description
Hip exam
summary
-Inspect the hips for symmetry and level of gluteal folds
-Palpate hips and pelvis for the following
 Instability
 Tenderness
 Crepitus
-Test range of motion by the following maneuvers
 Flexion (120 degrees), extension (90 degrees) and hyperextension (30
degrees)
 Adduction (30 degrees) and abduction (45 degrees)
 Internal rotation (40 degrees)
 External rotation (45 degrees)
Special
testing for hip
& pelvis
-Test muscle strength of hips with the following maneuvers
 Knee in flexion and extension
 Abduction and adduction
-Thomas Test
*iliopsoas tightness (thigh off table)
*rectus femoris tightness (knee flexion >90 degrees)
*tensor fascia latae (knee lateral to ASIS)
*IT band (foot external rotation)
*key is to hold opposite knee tightly to chest
-FABERE/Patrick’s
*Flexion, ABduction, External Rotation
*Pain reproduced before the SI joint is engaged (early ROM) indicates pain is in
the acetabulum/femoral joint
*Pain after the SI joint is engaged (late ROM) indicates SI as source of pain
-Ely’s test
*rectus femoris tightness
*flexion of knee flexes or pulls hip off table
-Hibb’s Test
*pt prone- flex knee to 90 degree
*IR & ER hip while monitoring pelvis
*can use monitoring hand to confirm engagement of SI joint
Pictures/Misc.
Description
*pain early probably from hip, later is more likely SI
-Scrub test
*Pt supine & hip flexed
*Compress femoral head into acetabulum and maintain compressive force as you
move hip through circular range of motion
*Reproduction of pain indicates intra-articular source of pain
-leg length discrepancy  functional vs anatomic
*check below both medial malleoli after balancing/straightening pelvis
*treat any dysfunctions you find, & reassess
OMM TESTING
-standard flexion test
*positive on side where the thumb moves further superiorly
Pictures/Misc.
Description
Hip pain
overview
-When evaluating patients with hip pain it is likely to be from these sources:
*hip joint, soft tissues around the hip and pelvis, pelvic bones, sacroiliac joint,
referred pain from lumbar spine
-The hip joint is one part of the pelvic girdle: (ilium, pubic ramus, and sacrum) and
contains two joints the SI and the acetabular (hip) joint
Imaging
studies
-Watch the patient walk!
-Plain film X-rays: most useful for bony-severe arthritic abnormalities, trauma, and
late course inflammatory disorders
-CT Scan: provides superior detail of osseous structures, identifies intra-articular
loose bodies, early changes of osteonecrosis
Snapping Hip
Syndrome
-MRI: test of choice to identify soft tissue, meniscal, cartilaginous, ligamentous,
tendinous, and bony abnormalities
-AKA coxa saltans
-IT band slips over the greater trochanter producing a “snap” or “click”
*hip flexion & extension can cause voluntary “snap”
-often has associated bursitis & resultant pain
*pain is posterolateral area
-more common in young women  d/t greater Q-angle
-Etiology  Several causes: Bursitis, Labral tear, Physiological
-Tendons around the hip subluxates over bony prominences, most commonly
Iliotibial band over greater trochanter, may also be from Iliopsoas tendon
subluxates over the pectineal eminence
-Mechanism  Iliopsoas bursitis, overuse, prominence of pelvic brim, muscle
tightness
-History  Pain and snapping around the trochanteric area; Iliopsoas felt in groin
area, both experience pain but movement not hampered
Pictures/Misc.
Description
Fascia lata
syndrome
-lateral thigh pain
-pain to palpation & trigger points
-enlargement/inflammation of the tensor fascia lata d/t overuse or as a result of
protection in injury
Pictures/Misc.
Description
Osteitis pubis
-midline pelvis & groin pain w/radiation toward the hip
-common to  athletes, pregnancy, post-op bladder & prostate surgery
-inflammatory d/t overuse of the adductors & gracilis mm
-XR will demonstrate widening of the pubic symphysis & sclerosing
-tx w/NSAIDs & rest
Meralgia
Paresthetica
-Compressive inflammation of the Lateral Femoral Cutaneous Nerve
-Pain distribution: hip, thigh, groin (proximal anterior aspect of the leg/thigh),
gains a “burning” or “tingling” quality
-May be reproducible by tapping over the ASIS as the nerve enters the thigh under
the inguinal ligament near the ASIS
-Risk factors: obesity, tight belts, pregnancy, focal trauma, post-op appendectomy
or hysterectomy, sports w/ repetitive hip flexion
-Treatment: rest / ice / NSAIDs
Pictures/Misc.
Description
Obturator &
ilioinguinal
nerve
entrapment
-both result from direct pressure to the nerve involved
-Obturator N. aggravated most by hip flexion
-ilioinguinal N. aggravated most by hip hyperextension
-common reasons to develop  overuse, trauma to area, sx to the area
Piriformis
syndrome
-Compression of the Sciatic Nerve or irritation of the nerve due to piriformis
activation (active or passive/spasm)
*can be d/t lack of stretching, sitting on wallet
-Pain localized to the buttocks and hamstring mm
*May be able to palpate a hypertonic piriformis m
-Hip flexion and internal rot will reproduce the pain
Groin strain
(adductors)
-Tx: rest, ice, NSAIDs
-tearing of adductor muscle
-powerful over stretch, abduct, external rotation common in soccer
-pain which mediates along the medial thigh, inability to run, cut, start & stop
-PE  pain over muscle group, incr. w/resistance, possible defect
-MRI
-Tx  rest, ice, stretch
Pictures/Misc.
Description
Avulsion fxs
-Etiology  ASIS (sartorius), AIIS (rectus), Ischial (hamstring)
-Mechanism  Chronic, Acute concentric/eccentric
-History: Males, adolescents, local pain, limit motion
-Physical Findings: tenderness, limit ROM & weakness on MMT
-Imaging: AP pelvis, Oblique (iliac crest), CT
-Treatment: Ice, stretch, gradual return (>2cm ORIF)
Bursitis
-synovial lined sacs found at areas of friction in the body  designed to reduce
friction between muscle & bone, ligaments, tendons, etc.
-w/trauma or prolonged inflammation, communication between the bursa & a
joint may occur
-may require joint aspiration to assess inflammatory vs infectious quality as a
“septic joint” may present with sx very similar to bursitis
GREATER TROCHANTERIC BURSITIS
-Pain that originates over the greater trochanteric bursa that may radiate the
entire length of the leg (knee and ankle but not foot)
-Etiology: Trauma to the bursa
Pictures/Misc.
Description
-Mechanism: trauma acute or repetitive
-History: Localized pain, worse rising from chair, lessens with early movement then
worsens with extended movement; patients report night pain and cannot lay on
affected side ;increases with hip flex/ext
-Physical Findings: Local pain, swelling at greater trochanter, pain cephalad to this
suggest tendinosis of gluteus medius tendon (Trendelenburg test is positive and
limp)
-Imaging: x-ray only to rule out other injury
-Treatment: Rest, Ice, NSAIDS, Injection, Correct biomechanics
OA
-a gradual & progressive pain
-pain increases w/motion & improves at rest
-may be assoc. w/a previous injury (fx or recurrent dislocations) or an underlying
rheumatologic, metabolic, or endocrine disorder
-Tx  rest, NSAIDs, gentle exercises to main ROM
Pictures/Misc.
Description
Hip pointer
-etiology  direct trauma to ASIS, iliac crest
-commonly a collision in sports
-anterior/lateral pain after direct blow, pain localized
-local swelling, pain, ecchymosis
-XR  R/o fx
Osteomyelitis
-Tx  pain control, NAIDs, injections
-A fungal or bacterial infection of the bone: Staph & Stept, Tuberculosis
(M.tuberculosis) in developing nations
-80% spreads from contiguous structures
*20% hematogenous spread: more common in Peds (long bones) and if in an
adult is more common in the spine
-Pain at the site and often w/ erythema & edema
-Imaging will be normal at the start; w/ progression will show demineralization &
lytic lesions
*MRI is preferred study  Biopsy is conformational
Psoas abscess
-Tx IV Abx
-presents as abdominal pain w/radiation toward the hip
*may also have nausea, flank pain, fever, limp
-w/hip flexion, it will increase pain as this engages the Psoas
-muscle thought to be susceptible to infection d/t rich blood supply & proximity to
lymphatic channels
-most common bacteria isolated is S. aureus (80%)
-CT definitive for dx
-Tx  IV abx & surgical incision and drainage (open vs precut)
Pictures/Misc.
Description
Hip
dislocation
- Dislocation of femoral head from acetabulum
-anterior, posterior, or central
*10% are anterior  usu. d/t MVA  extremity effected is often held in
abduction & external rotation
*90% are posterior  usu. d/t MVA (slamming your flexed knee into the seat or
dash w/resultant posterior forces)  extremity is shortened, internally rotated, &
adducted
-Etiology  Genetic, instability of joint
Mechanism  Direct blow with hip abducted (i.e. impact while slamming on
brakes), non-contact
-History  Pain, inability to move, numbness
-Physical Findings  Short leg, hip adducted, severe pain, inability to move;
Evaluate sciatic nerve function by asking patients to move toes and ankle and
checking sensation on plantar and dorsal aspects of foot
-tx  closed reduction
Hip fx
-a traumatic event
- Falls account for ~90% of femoral neck fx’s (namely in the elderly)
-May or may not accompany a dislocation
-It is possible to ambulate on a hip fracture
-Disruption of the blood flow to the femoral head is a consideration
Pictures/Misc.
Description
-Plain XR of Pelvis / Hip is the study of choice
-Treatment is surgical v non-surgical: orthopedist’s choice in relation to
type/severity of fx, age of pt, etc.
Acetabular fx
-traumatic etiology  often MVA w/associated femur, hip dislocation, knee injury
*traumatic force driven toward the acetabular surface
-XR may demonstrate the fx but CT more definitive
-may have concomitant sciatic nerve injury
-Tx  surgical vs. non-surgical
Avascular
necrosis
-bone infarction d/t disrupted or lack of blood flow
-acute trauma
-chronic stress/repetitive injury
-pain radiation can be universal to hip region
-XR may demonstrate one loss/decr. Density
*MRI more definitive
-often requires joint replacement
Pictures/Misc.
Description
Slipped
capital
femoral
epiphysis
“SCiFE”
-Pediatric condition
-A loss of the alignment of the femoral epiphysis
-Symptoms include early fatigue/pain w activity. Pain in hip and/or knee with even
mild activity
*Develop a limp
-Arises due to rapid bone growth and activity in prepubescent children
-May lead to avascular necrosis, increasing slippage, or degenerative arthritis
-Treatment may be conservative v surgical fixation depending on the severity
Pictures/Misc.
Description
Septic
arthritis
-can be a rapid development w/resultant joint destruction
-hematogenous etiology
- Commonly Staph aureus but need to consider gonococcal and chlamydial in the
sexually active patient
*Sickle Cell Pts susceptible to Salmonella
-An acute hot, swollen, and tender joint (with pain on ROM testing) is septic
arthritis until proven otherwise
-Joint aspiration may or may not prove or disprove: aspirate WBC Ct > 50,000
cells/mm3 (~64% sensitive) +/- ESR > 30mm/h (~96% sensitive but non-specific)
Anterior hip
pain
-Tx  antibiotic (often Vancomycin IV + organism directed additional)
DEGENERATIVE JOINT DISEASE (OA, COXALGIA, DJD)
-Loss of articular cartilage at the hip joint
-Etiology: Trauma, infection genetic , idiopathic
-History: Gradual onset, anterior groin pain but may be buttock or lateral thigh,
initially relieved by rest ,worse with weight bearing may proceed to night pain and
limited motion
-Physical Findings: Limited ROM (Internal rotation), then loss of flexion and
extension; antalgic gait and abductor lerch; Positive Trendelenburg
-Imaging: x-ray
-Treatment: Strengthening, physical therapy for ROM – Surgical replacement
OSTEONECROSIS
-Loss of trabecular bone in the femoral neck usually during 3rd and 4th decade
-Etiology?: Trauma (hip dislocation or femoral neck fracture), alcohol abuse steroid
use, RA, SLE; other risks: sickle cell, radiation, Crohn’s, Caisson’s
Pictures/Misc.
Description
-History: Gradual onset, groin pain but may be buttock or lateral to hip, may be
sudden if femoral neck collapses
LABRAL TEAR
-Etiology  tear of the fibrocartilaginous labrum usually due to high impact
trauma; tear usually anterior labrum
-Mechanism: Running, Hyperextension at hip, trauma
-History: Deep sharp anterior hip pain, deep clicking or snapping, sense of
instability
-Physical Findings: Anterior hip pain with hip into extension, pain with anterior
stress
-Imaging: MRI
Lateral
femoral
cutaneous
nerve
entrapment
-Treatment: Rest, Surgical repair
-Pain and burning (dysesthesia) or hypoesthesia over lateral thigh  they may
complain of groin pain and pain at SI joint
*no motor involvement this is sensory nerve
-Risks: obesity, tight clothing, surgery, trauma; nerve exits pelvis near ASIS
-Effects young muscular women who extend their hips, women with scoliosis and
joggers
-rarely pathologic intra-abdominal/pelvic process
Pictures/Misc.
Description
Psoas
Syndrome
General
Osteology
Major
Extensors of
the Hip
Patient forward bent
Leans ipsilateral to psoas spasm
Ipsilateral foot everted
Non-neutral L1 or L2 sidebent ipsilaterally
Marked Ipsilateral psoas spasm
Sacral rotation on Ipsilateral oblique axis
Contralateral pelvic side shift
Contralateral piriformis spasm with tender point
Pain in contralateral hip
-Innominate, Femur, Patella, Tibia, Fibula, Tarsals (7- Talus, Calcaneus, Navicular,
Cuboid, Cuneiforms (3)), Metatarsals (5), Phalanges (14)
-Gluteus Maximus  strongest
-Adductor Magnus
-Hamstrings  Biceps Femoris (red), Semitendinosus (blue), Semimembranosus
(green)
*Origin: Ischial Tuberosity
*Insertion: Fibula/ Tibia
Pictures/Misc.
Description
Hip Flexors
-Iliopsoas  Strongest flexor of thigh
*Composition- Psoas major & Iliacus
*Origin – T12-L5 (lateral surface of vertebral bodies)
*Insertion – Lesser trochanter of femur
-Rectus Femoris (blue)
*Origin: AIIS/ Ilium
*Insertion: Patellar Tendon
*Crosses both Hip and Knee
*Action: Flexes thigh at hip and extends leg at the knee
What muscles comprise the quadriceps?  Rectus femoris, Vastus lateralis, Vastus
medialis, Vastus intermedius
Abductors
-Gluteus Medius (L4-S1) Sup Gluteal N (light blue)
*Origin: Outer surface of Ilium
*Insertion: Greater trochanter of femur
-Gluteus Minimus (L4-S1) Sup Gluteal N (white)
*Origin: Outer surface of Ilium, below origin of gluteus medius
*Insertion: Greater trochanter of femur
-Piriformis
*Origin: Anterior surface of sacrum
*Insertion: Greater trochanter of femur
*Action: Abducts flexed thigh; Externally rotates extended thigh
*Sciatic Nerve passes anterior to piriformis!
Pictures/Misc.
Description
Adductors
-Minor muscles: Gracilis, Gluteus Maximus, Pectineus
-Adductor Magnus
*Origin: Inferior pubic ramus; Ischial Tuberosity
*Insertion: Adductor Tubercle of Femur
*Action:
-Adductor portion: adducts and med rotates hip.
-Hamstring portion: extends hip
-Adductor longus
*Origin: superior pubic ramus & ant side of symphysis
*Insertion: femur (medial lip in middle third)
-Adductor Brevis
*Origin: Inferior pubic ramus
*Insertion: Femur (medial lip in upper middle third)
Pictures/Misc.
Description
External
Rotators
-Piriformis (green)
*Origin: Anterior surface of sacrum & sacrotuberous ligament
*Insertion: Superior border of greater trochanter of femur
*Action: Laterally rotate extended thigh; abduct flexed thigh; steady femoral
head in acetabulum
-Obturator Internus (orange)
*Origin: Pelvic surface of obturator membrane & surrounding bones
*Insertion: Medial surface of greater trochanter
-Superior and Inferior Gemelli (yellow)
*Origin: ischial tuberosity (i) & ischial spine (s)
*Insertion: Medial surface of greater trochanter
-Quadratus Femoris (purple)
*Origin: Lateral border of ischial tuberosity
*Insertion: Quadrate tubercle on intertrochanteric crest of femur & area inferior
to it
*Action: Laterally rotates thigh; steadies head in acetabulum
Pictures/Misc.
Description
-Sartorius (light blue)
*Origin: ASIS & superior part of notch inferior to it
*Insertion: Superior part of medial surface of tibia
*Action: Flexes, abducts, lat rotates thigh at hip. Flexes, med rotates leg at knee
-Obturator Externus (yellow)
*Origin: Margins of obturator foramen & obturator membrane
*Insertion: Trochanteric fossa of femur
*Action: Laterally rotates thigh; steadies head of femur in acetabulum
-Gluteus Maximus (purple)
*Origin: Ilium posterior to posterior gluteal line; dorsal surface of sacrum &
coccyx; & sacrotuberous ligament
*Insertion: Iliotibial tract & gluteal tuberosity of femur
*Action: Extends thigh and assists in lateral rotation; steadies thigh & assists in
rising from sitting position
Internal
Rotators
-Tensor Fascia Lata (orange)
*Origin: ASIS, anterior part of iliac crest
*Insertion: Iliotibial tract, which attaches to lateral condyle of tibia
*Action: Abducts and medially rotates thigh
-Anterior Fibers of Gluteus Minimus (green)
*Origin: External surface of ilium between anterior & inferior gluteal lines
*Insertion: Anterior surface of greater trochanter of femur
*Action: Abducts and med rotates thigh. Tilts pelvis on walking.
-Pectineus (light blue)
*Origin: Superior ramus of pubis
*Insertion: Pectineal line of femur, just inferior to lesser trochanter
*Action: Adducts and flexes thigh; assists with medial rotation of thigh
Pictures/Misc.
Description
Acetabulum
-Ball-and-Socket Joint
-Acetabular fossa – path for hip joint to receive arterial supply via the Ligamentum
capitus femoris (round ligament)
-Common dislocation  Posterior & Inferior
FEMOROACETABULAR JOINT
-Iliofemoral Ligament
*Anterior aspect
*Y-shaped (“Bigelow”)
*Tenses with full hip extension
*Strongest ligament in the body
-Pubofemoral Ligament  Anterior aspect
-Ischiofemoral Ligament  Posterior aspect; Prevents hyperextension
Iliotibial Band
-Thickened portion of deep fascia
-Extends from  Iliac crests, past the knee, to the lateral side of proximal tibia
-Tendon insertion for tensor fasciae latae & gluteus maximus
-Location for viscerosomatic reflexes  colon, bladder
DIAGNOSTIC TESTS
-Ober’s Test  tests for contractures of iliotibial tract
*Patient lateral recumbent with tested side facing up
*Knee is flexed 90˚, hip abducted 40˚ and extended to its limit
*While hip extension & knee flexion maintained with pelvis stabilized, limb is
gently adducted toward the examination table
TREATMENT
-Supine Direct Myofascial Release for Tight Iliotibial band
*Palpate along iliotibial band for tightest point
Pictures/Misc.
Description
*Using pad of thumb (reinforcing with other thumb), press medially and
posteriorly on this point, using 10-30 lbs. of pressure
*Maintain pressure until release is felt
-kneading type treatment
*Stand side opposite extremity to be treated
*Flex knee to 90 degrees
*Use fingers of cephalad hand to pull IT band towards you
*Simultaneously carry foot away from self, increasing tension on IT band
*Continue with kneading motion
Pictures/Misc.