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TECHNIQUE LIST FOR LOWER EXTREMITY
LOWER EXTREMETIES (HIP: FEMUR-FEMOROACETABULAR JOINT)
The somatic dysfunction is named for the way the muscle likes to go. Ex: A shortened or tight
Abductor (Abduction Somatic Dysfunction) prefers abduction and will be restricted in
adduction.
I.
Muscle Shortening (tight hip muscles)
Diagnostic Findings – Kimberly, P. 276
1. Shortened Hip Extensors (hamstrings): Supine, Direct Method,
ME: 4613.11A, Kimberly, Pgs. 276-277
 OMM Muscle Energy Hamstring Stretching  4731
 Notes: SHORT OR TIGHT HAMSTRING = your somatic dysfunction. Your hamstrings like
to EXTEND AT THE HIP AND FLEX AT THE KNEE. So, you preference of motion for a tight
hamstring will be to do the motion it likes. Therefore, to diagnose which hamstring is
tighter (which is the one you want to treat), you need to REVERSE The diagnosis that the
tight hamstring would normally like to do (so, put the pt into flexion of the hip and
extension of the knee).
2. Shortened (quadriceps): Prone, Direct Method,
ME: 4613.11F, Kimberly, P. 281
 OMM Quadriceps Stretching  4724
 Notes: SHORT OR TIGHT QUADS = your somatic dysfunction. Your quads like to FLEX AT
THE HIP AND EXTEND AT THE KNEE. So, you preference of motion for a tight hamstring
will be to do the motion it likes. Therefore, to diagnose which quads are tighter (which is
the one you want to treat), you need to REVERSE the diagnosis that the tight quads
would normally like to do (so, put the pt into extension of the hip and flexion of the
knee…you really just focus more on flexion at knee here while the pt is prone).
3. Shortened Hip Flexors (Iliopsoas): Supine, Direct Method,
ME: 4613.11G, Kimberly, P. 282
 OMM Muscle Energy Iliopsoas Stretching  4727
 Notes: You best be using a Thomas test to check this out:
o This means when they pull their knee to their chest, the other leg (contralateral
leg) will bend at the knee and it cannot lay flat on the table = + Thomas test =
tight iliopsoas. (if that knee would have stayed flat on the table that is a –
Thomas test = not a tight iliopsoas)
 Absolutely understand you are testing the contralateral (opposite)
psoas when the knee is flexed up….you are not testing the psoas on the
side you are flexing at the knee and bending to the chest.
 Be sure you stand on the same side as the psoas you want to treat, while bracing the
opposite ASIS. Let that leg hang off the table on the side you want to treat (just to
where the femur comes to the edge) and brace at the quads, not on the knee
o This puts that psoas into extension which is exactly opposite the way it likes to
go (you better know that the tightest hip flexor in the body = the iliacus (so this
is included in the iliopsoas).



4. Shortened Hip Adductors: Supine, Direct Method,
ME: 4613.11B, Kimberly, Pgs. 277-278
 OMM Muscle Energy Hip Adduction Stretching  4728
 Notes: If you have SHORT HIP ADDUCTORS = your somatic dysfunction. These like to
adduct, so the preference of motion will be to adduct, meaning it will not like to abduct
at the hip. Therefore, you need to TEST IN ABDUCTION, and whichever has restricted
motion = the side you want to treat.
 Remember to stand on the same side as the dysfunction when treating, and this time
you brace the ASIS ON the side you are treating.
5. Shortened Hip Abductors: Supine, Direct Method,
ME: 4613.11C, Kimberly, P. 278
OMM Muscle Energy Hip Abduction Stretching  4730
Notes: If you have SHORT HIP ABDUCTORS = your somatic dysfunction. These like to abduct,
so the preference of motion will be to abduct, meaning it will not like to adduct at the hip.
Therefore, you need to TEST IN ADDUCTION, and whichever has restricted motion = the side
you want to treat.
Remember to stand on the opposite side of the dysfunction, bracing the ASIS on the side
you are treating.
II.
Rotators
6. Internal Rotation with Posterior Glide
Diagnostic Findings – Kimberly, P. 269
Supine, combined method,
ME: 4611.11A, Kimberly, Pgs. 269-271
 I cannot find a video for this
7. External Rotation with Anterior Glide
Diagnostic Findings – Kimberly, P. 273
Supine, combined method,
ME: 4612.11A, Kimberly, Pgs. 273-275
 I cannot find a video for this
8. Piriformis – Muscle Energy
Nicholas Atlas, P 301
 OMM Muscle Energy Piriformis Stretching  4726
 Notes: You better know that the piriformis is an external rotator when the leg is
extended and when the knee is flexed it is an abductor.
 How to find this TP:
o Have the pt laying prone, find the iliac crest, find the PSIS on both sides, come
medial to the sacral base, and in between this and the ILA there is a midpoint on
the lateral boarder of the sacrum (mark this with a finger). Now find the greater
trochanter, and in between this and where you have your finger = TP
 Stand on the same side as the dysfunction, while your finger is on the TP and your pt is
prone, flex the knee and internally rotate at the hip (the opposite of what the piriformis
likes to do). Do this by letting the foot and leg fall out from the midline towards you.
Have the pt try to resist this by externally rotating (pulling their leg back in towards the
midline)
III.
Counterstrain
(THIS IS INDIRECT…YOU ASSIGN the pain scale, never move your finger off the TP, set it up, and
hold them for about 90 seconds (“Find it, fold it, hold it”), then you move the pt back to the
original position they were in (don’t let them help you and your finger should still be on the
original TP), then reassess)
9. Posas Major TP, Nicholas Atlas, P. 279
 OMM Counterstrain Psoas Tenderpoint  4741
 Notes: How to find this TP:
o Have the pt laying supine, find their ASIS, go 2/3 into the midline, push straight
down
 Stand on the same side as the TP, and since the psoas likes to flex, flex the hips and
knees, and sidebend towards the TP by pulling the ankles towards you until you feel a
release or the pain decreases
10. Iliacus TP, Nicholas Atlas, P. 180
 OMM Counterstrain Iliacus Tenderpoint  4744
 Notes: How to find this TP:
o Have the pt laying supine, find the ASIS, go 1/3 into the midline, push down and
a little lateral
 Stand on the same side as the TP, cross the legs by putting the non-dysfunction leg over
the dysfunctional leg (the one on the side of the TP) (you can remember this by “good
over evil”), flex the hips, let the knee fall out until you feel a release or the pain
decreases
11. Piriformis TP, Nicholas Atlas, P. 193
 OMM Counterstrain Piriformis Stretching 4742
 Notes: How to find this TP:
o Have the pt laying prone, find the iliac crest, find the PSIS on both sides, come
medial to the sacral base, and inbetween this and the ILA there is a midpoint on
the lateral boarder of the sacrum (mark this with a finger). Now find the greater
trochanter, and in between this and where you have your finger = TP
 On the side you want to treat, have the pt prone, hang the leg off the side on the table,
Flex the knee and hip, externally rotate the hip and abduct the leg
o Can add a small amount of compression to the knee
 Myofascial Release
For both of the techniques =
OMM Direct Myofascial Release and Push Pull Technique Iliotibial Band  4739
12. Supine Direct Myofascial Release: Iliotibial Band, Shown on PowerPoint slide.
 Note: Pt should be supine, you should be on the side of the dysfunction, push medially
and posteriorly (about 20lbs of pressure) hold for about 20 sec until you feel a
release, then push further and repeat (this is a direct technique)
13. Fascia Lata / Iliotibial Band Kneading (“Push/Pull”) technique on PowerPoint slide.

Note: Pt should be prone, you should be on the opposite side of the dysfunction. Flex
the knee on the side of the dysfunction, externally rotate that leg at the hip (let the
knee and ankle fall out away from the midline) = push, and at the same time you pull
the IT band towards you with the other hand = pull.
KNEE
a. Popliteal fascia release (see lecture notes)
OMM Supine Popliteal Fascial Release  4713
i. Patient supine
ii. Exert an anterior force with fingers in midline of fossa
iii. While patient extends knee (maintaining heel on table), exert a firm, spreading
force with fingertips (laterally)
iv. Reassess
b. Gastocnemius Counterstrain (see lecture notes)
OMM Counterstrain Gastroc Tenderpoint  4743
i. since this is counterstrain, THIS IS INDIRECT…YOU ASSIGN the pain scale, never
move your finger off the TP, set it up, and hold them for about 90 seconds
(“Find it, fold it, hold it”), then you move the pt back to the original position
they were in (don’t let them help you and your finger should still be on the
original TP), then reassess
ii. Pt should be prone
iii. Identify Counterstrain points at the proximal insertion of the gastrocnemius
(because remember, you have both a medial and lateral head of this
muscle…test both by pressing on it.)
iv. Treatment is usually aimed at the medial head of the gastrocnemius (although
the lateral should also be assessed).
v. The knee is flexed, and the ankle is strongly extended with the patient prone 
add a slight compression force if you’d like
vi. Reassess
c. Interosseous membrane (Kimberly p. 299 – 4633.11A)
OMM Balanced Ligamentous Tension Interosseus Membrane  4745
i. Supine, indirect method
ii. Knee in partial flexion with leg resting on DO’s hands
iii. One thumb on posterior fibula and other thumb on posterior lateral malleolus
(you can invert the foot too)
iv. Balance of ligamentous tension done with respiratory phases
d. Fibular head dysfunction (Kimberly p. 294-298 – 4631.11A, 11B, 11C, 11D; 4632.11A,
11B, 11C)
OMM Diagnosing Fibular Head  4740
 Check both anterior and posterior motion, and then medial and lateral motion
 As you plantar flex, and invert, and adduct = moves the fibular head posterior (and the
lateral malleolus


As you dorsiflex, and evert, and abduct = moves the fibular head anterior (and the
lateral malleolus posterior)
Diagnose the way the “spring better” at the fibular head = the way they like to go
i. Muscle energy techniques for posterior fibular head (4631.11C)
OMM Seated Direct Method Muscle Energy Fibular Head Posterior  4722
1. Patient seated with leg hanging off table
2. DO places thumb behind fibular head posteriorly, applying and anterior
force
3. DO dorsiflexes and everts the foot
4. Patient is instructed to “turn your foot inward” with DO counterforce
5. Recheck after routine time / repeats
ii. Muscle energy technique for anterior fibular head (4632.11B)
OMM Seated Direct Method Muscle Energy Fibular Head Anterior  4723
1. Patient seated with leg hanging off table
2. DO grasps fibular head between thumb and middle finger, applying a
posterior force
3. DO plantarflexes and inverts the foot
4. Patient is instructed to “turn your foot outward” with DO counterforce
5. Recheck after routine time / repeats
TECHNIQUE LIST
ANKLE AND FOOT
I.
Ankle
 Talotibial Joint
1. Deltoid Stretch (Shown in Lab)
OMM Ankle Deltoid Stretch  4765
Notes: dorsiflex and evert while stretching
2. Talus Plantar flexed with anterior glide
OMM Talar Tug Talus Plantar Flexed with Anterior Glide Supine Direct Method HVLA 4778
a. Diagnostic Findings, Kimberly Manual-Pg. 300
b. Supine – Direct Method – HVLA, Kimberly Manual-Pgs. 300-301, 4641.11A
Note: They will like plantar flexion with this, so when you put them into
dorsiflexion, the one that is restricted you treat
- bring into dorsiflexion and give a quick tug
3. Lateral Ankle Fibularis or Peroneus Longus, Brevis, or Tertius
OMM Lateral Ankle Fibularis or Peroneus Longus Brevis Tertius Counterstrain  4780
doesn’t link correctly (you will see today)
a. Counterstrain, Nicholas Atlas, P. 211 (see this for location of TP)
II.
Foot
 Talocalcanel Joint
4. Eversion with anteromedial glide of talus OR inversion with posterolateral glide of
talus
a. Diagnostic Findings, Kimberly Manual-Pg. 303
Notes: KNOW when you invert (supinate)  posterior lateral glide of the talus ,
and when you evert (pronate)  anterior medial glide of the talus
b. Seated – Direct Method – Articulatory with traction, Kimberly Manual, P.
303, 4651.11A
OMM Eversion with Antemedial Glide and Inversion with Posterolateral Glide 
4768
Notes: apply traction  make a figure 8
 Intertarsal Joints
5. Cuboid everted with plantar glide OR Navicular inverted with plantar glide OR
cuneiform plantar glide
a. Diagnostic Findings, Kimberly Manual-Pg. 306
b. Supine – Direct Method – Articulatory with patient cooperation, Kimberly
Manual, Pgs. 307-308, 4652.11B
OMM Cuboid Everted With Planted Glide or Navicular Inverted with Plantar
Glide  4767
Note: For the transverse arch, if any of the three things are wrong then this can
cause a drop in the arch (flat floot):
- Navicular inverted, Cuboid everted, or cuneiform dropped down
 Plantar Fascia
6. Flexion Calcaneus/Quadratus Plantae
a. Counterstrain, Nicholas Atlas, P. 212
OMM Plantar Fascia Flexion Calcaneus Quadratus Plantae  4773
Note – plantar flex the foot and try to wrap the foot around the TP as much as you
can