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Length Tension
Testing
Length Tension Testing
• Assessment of length tension in skeletal muscle from the use of clinical
reasoning, interpretation and subjective and objective assessment
findings
• Assessment Findings Include: referral pain, neuromusculoskeletal
interaction or neuromeningeal identification (nerve restrictions or
nervous system responsiveness/sensitivity), positional observation,
ROM, palpation, and overall activation and flexibility of the muscle
• Range of motion and end feel of muscle is assessed from the therapists
hand moving and stabilizing the structure - sense the tension in the
muscle
• End feel = Joint restriction
• Normal muscle = will feel soft  will contract voluntary with EMG
activity
• Tense muscle = will feel stiff, like a well done steak  contributes to
muscle spasm and pain, EMG not under voluntary control because of
decreased contractile ability
• Symptoms during stretch noted
Soleus Muscle
Origin (Proximal) Attachment:
Posterior proximal half, on the surface of the tibia, along soleal
line  proximal 1/3 posterior fibula
Insertion:
Posterior Calcaneus
Action:
Plantar Flexion
Nerve:
Tibial Nerve root (S1,S2)
Soleus Length Tension Test
Patient Position:
- Supine lying position with leg hanging over edge of bed
Action:
- One hand supports knee in a slight flexed position, while other
hand and forearm supports plantar aspect (bottom) of the
foot
- Patients ankle is dorsiflexed, while range of motion and end
feel of muscle is assessed (hand moving and hand stabilizing
sense the tension in the muscle)
- Symptoms during stretch noted
PICTURE
(Soleus mm length ,2010)
Piriformis Muscle
Origin (Proximal) Attachment:
Anterior surface of lateral sacrum
Insertion:
Greater trochanter of femur, along upper medial surface
Action:
Laterally rotates the thigh at hip joint, If hip is flexed it will
abduct the thigh
Nerve:
Sacral Plexus (S1,S2)
Piriformis Length Tension Test
Patient:
- Supine lying with hip flexed at 100° and knee flexed at 90°
Action:
- Therapist stabilizes innominate and supports distal aspect of
the tibia and fibula with hand and forearm
- Hip is adducted and laterally rotated
- Range of motion and end feel of hip is assessed (hand moving
and hand stabilizing sense the tension in the muscle)
- Symptoms during stretch noted
PICTURE
(Cram, 2013)
Hamstring (3 Muscles)
Origin (Proximal) Attachment:
Biceps Femoris: Ischial tuberosity
Semimembranosus: Ischial tuberosity
Semitendinosus: Ischial tuberosity
Insertion:
Biceps Femoris: Head of fibula and lateral condyle of tibia
Semimembranosus: Posterior medial condyle of tibia
Semitendinosus: Proximal tibia, medial to tibial tuberosity
Action: Extends thigh at the hip
Nerve: Tibial portion of sciatic nerve (L5,S1,S2)
Hamstring Length Tension Test
Patient:
- Lying supine
Action:
- Therapist palpates anterior iliac spine and iliac crest
- Distal aspect of tibia and fibula are supported by a hand
- Leg is taken into hip flexion with the knee extended
- When right innominate starts to posteriorly rotate, flexibility
of the hamstring is exhausted
- Range of motion and end feel of hamstring is assessed (hand
moving and hand stabilizing sense the tension in the muscle)
- Symptoms during stretch noted
PICTURE
(Hamstring rehab protocol,2013)
Quadriceps (4 Muscles)
Origin (Proximal) Attachment:
Rectus Femoris: Anterior Iliac spine and illium above the accetabulum
Vastus Lateralis: Greater trochanter
Vastus Medialis: Intertrochantric line
Vastus Intermedius: Anterior and lateral shaft of femur
Insertion:
Quadriceps tendon, to base of patella into tibial tuberosity from the
patellar ligament
Action:
Extends leg at the knee joint
Nerve:
Femoral Nerve (L2,L4)
Quadriceps Length Tension
Test
Patient:
- Lying on stomach with legs extended
Action:
- Therapist stabilizes the sacroiliac joint
- Distal aspect of tibia and fibula is supported by therapists
hand
- Therapist flexes knee joint to target the quadriceps
- Range of motion and end feel of quadriceps is assessed (hand
moving and hand stabilizing sense the tension in the muscle)
- Symptoms during stretch noted
PICTURE
(Schafer, 1985)
Trapezius Muscle
Origin (Proximal) Attachment:
Medial superior nuchal line and external protuberance of the
occipital bone, ligamentum nuchae and spinous processes of C7T12
Insertion:
Clavicle (lateral), acromion, and spine of scapula
Action:
Upper Fibers – Elevate and upwardly rotate scapula (extend
neck)
Middle Fibers – Adduct scapula (retract)
Lower Fibers – Depress scapula
Nerve:
C3,C4 and accessory cranial N.
Trapezius Length Tension Test
(Upper Fibers)
Patient:
- Sitting position on a chair
Action:
- Patient actively flexes craniovertebral joint (articulation
between cranium and vertebral column)
- Therapist stabilizes lateral 1/3 clavicle and acromion with
one hand and stabalizes the top of the head with the
other hand
- Therapist passively flexes and rotates the head down
towards the patients shoulder
- Range of motion and end feel of trapezius is assessed
(hand moving and hand stabilizing sense the tension in
the muscle)
- Symptoms during stretch noted
PICTURE
(Boost physio, 2012)
ARTICLE - Upper Trapezius Muscle Activity During
the Brachial Plexus Tension Test in Asymptomatic
Subjects
• The brachial plexus tension test (BPTT) is used to test the dynamics of the neural
tissues of the upper quadrant – using contralateral cervical lateral flexion
• The upper trapezius muscle and the nerves of the brachial plexus share common
anatomical locations and are jointly affected by the BPTT movements.
• This study investigated the relationship between the BPTT and the upper trapezius
muscle activity - tested the range of neural tissue extensibility in asymptomatic
subjects.
• Thought that upper trapezius shortening is an adaptation to protect less extensible
neural tissue from the action of stretching (upper limb movements)
• 20 healthy male subjects tested (age 18-30)
• BBTT = shoulder depression, glenohumeral abduction, and external rotation, forearm
supination, wrist and finger extension and elbow extension
• Contralateral cervical lateral flexion (CCFL) was added as a final BBTT component
• Base Line Pre- Test  Maximum voluntary contraction (MVC) was recorded (EMG)
while subject was lying supine during shoulder abduction and external rotation
• After MVC , BPTT was performed, paused at shoulder depression when pain felt and
at limits of elbow extension and contralateral cervical lateral flexion (CCFL) - - Pain
rating was recorded (scale 0-10)
• Results revealed that those with lesser neural extensibility exhibited greater upper
trapezius muscle activity during the BPTT
• No difference between groups in the levels of pain perceived.
Palmaris Longus
Origin (Proximal) Attachment:
Medial epicondyle of humerus
Insertion:
Flexor retinaculum and palmer aponeurosis
Action:
Flexes hand at the wrist joint, tenses palmer aponeurosis
Nerve:
Median N. (C7,C8)
Palmaris Longus Length Tension
Test
Patient:
- Lying supine
Action:
- Therapist stabilizes patients distal humerus and extends the
patients elbow and wrist with all of the patients fingers and
thumb extended
- Range of motion and end feel of palmaris longus is assessed
(hand moving and hand stabilizing sense the tension in the
muscle)
- Symptoms during stretch noted
PICTURE
(Morphopedics, 2009)
ARTICLE - Reliability of Upper Limb Tension
Test 1 in Normal Subjects and Patients With
Carpal Tunnel Syndrome
• Four neural tension tests in upper extremity (ULTT)
• ULTT1 – evaluates upper quadrant nerve system tension, and the
corresponding structures tension , particularly median N.
• ULTT1 (through movement and tension) is thought to help with the
diagnosis of carpal tunnel syndrome
• Upper limb tension test consisted of elbow extension , shoulder
depression, shoulder abduction and external rotation, forearm
supination , and wrist and elbow extension
• Believed that the median N. is stretched during ULTT1
• Subjects: two groups (healthy and patients)
• 23 healthy subjects (age 18-25)
• 12 CTS patients (age 25-50)
• Results determined that ULTT1 is reliable and can be used to diagnose
and help manage carpal tunnel syndrome
Work Cited
Boost physio. (2012). Retrieved from http://www.boostphysio.com/blog/tag/hendon-physio/
Cram. (2013). Retrieved from http://www.cram.com/flashcards/clskspecial-tests-2460528
Get body smart . (2014). Retrieved from
http://www.getbodysmart.com/ap/muscularsystem/wris
thanddigits/palmarislongus/tutorial.html
Hamstring rehab protocol using lengthened state eccentrics. (2013). Retrieved from
http://activeptblog.com/2013/10/14/hamstring-rehab
protocol-using-lengthened-state-eccentrics/
Morphopedics . (2009). Retrieved from http://morphopedics.wikidot.com/elbow-joint
Sanzo , P., & MacHutchon, M. (2007). Length tension testing of the lower quadrant. Thunder Bay: Active
Potential Rehabilitation Services.
Sanzo , P., & MacHutchon, M. (2007). Length tension testing of the upper quadrant. Thunder Bay: Active
Potential Rehabilitation Services.
Schafer, R. (1985). The motion palpation institute & acapress. Retrieved from http://www.chiro.org/
ACAPress/The_Pelvis.html
Soleus mm length . (2010). Retrieved from https://www.google.ca/search?q=soleus length
test&rlz=1C1KMZB_enCA564CA564&espv=210&es_sm=93&source=lnms&tbm=isch
&sa=X&ei=PdU0U7iLKojmrQHctoGYCQ&ved=0CAYQ_AUoAQ&biw=1366&bih=667