Telehealth Exams

Transverse abdominus activation exam
PT position: standing next to patient palating muscle
Pt position: supine hooklying
Hand placement: inferior/medial auto ASIS feeling for tension/muscle activation
Cues: end of slow exhale, draw in the lower abdomen slightly, resume breathing, as if you're trying to pull these two bones together
Compensations: pelvic tilt/rib depression/narrowing, sternal/rib elevation, bearing down on pelvic floor
Clinical scenario in which to use this: pt with chronic LBP may have decreased activation this muscle
What constitutes a (+) test? Difficulty isolating muscle, maintaining tension while breathing (Quality of activation compared to non affected side, timing of recruitment, amount of tension)

Transverse abdominals exercise
Patient position/set up: supine hooklying, lifting one leg up off table, placing down, lifting other leg up off table
Environmental set up: pt supine on table
Clear instruction to patient: End of slow exhale- contract TA, lift leg up and slowly lower as you inhale and maintain contraction (make sure to incorporate breathing)
Correct dosage/prescription: 2x15/neuro re ed
One progression up or down: static holds of legs up in air, or regress to activation with breathing
-Progress: quadruped rock back, standing, sit to stand, squat

L/S multifidus activation exam
PT position: Standing next to patient
Pt position: Quadruped with pad under one knee
Hand placement: lateral to L5, sacral sulcus, abdominal wall for co-contraction
Motion: Raise pelvis of unpadded side to level out the pelvis, slight anterior pelvic tilt, lordosis apex at L5
(Can use dowel on pelvic for external cue)
Clinical scenario in which to use this: pt with chronic/recurrent LBP in which muscle can become inhibited
What constitutes a (+) test? Inability to recruit muscle/compensation=thigh moving fwd or backward, high lordosis, apex at T12
*Origin/insertion: sacrum/lower lumbar to lower cervical TP- SP of vertebra 2-5 superior
(Quality of activation compared to non affected side, timing of recruitment, amount of tension)

L/S multifidus exercise
Patient position/set up: Quadruped with one leg up on pad, performing leg kick backs
Environmental set up: patient on ground, with one knee elevated on pad
Clear instruction to patient: lift your (R/L) knee up to match the height of the other knee, now holding that position, slowly extend your (R/L) leg and then return it to that position where it stays elevated
Correct dosage/prescription: neuro-re ed, 2x15 depending on fatigue/ability to maintain position
One progression up or down: regress to static holds
Multifidus action: ipsalateral SB, contra rotation, extension

Hip MWM for add/IR in lunge
PT position: High kneeling, facing patient's back
Pt position: standing in a lunge position with leg being mobilized in extension
Hand placement: Forearm/elbow closest to the patients extended leg contacts ipsalateral PSIS
Plane of movement/direction of force: mobilizing hand grasps the medial femur with fingers pointed anteriorly and provides IR force to femur
Clinical scenario in which to use this: limited in hip extension/IR during trailing limb posture with gait
Outcome measure to determine skill success: gait evaluation, IR ROM

Limb vs. lumbopelvic disassociation
Bent knee fallout, SL hip abd, quadruped rocking
PT position: Standing next to patient
Pt position: Quadruped
Compensations: observe is lumbopelvic motion (flex/post tilt or ext/ant tilt) occurs prior to hips reaching 120º flexion, asymmetrical movement towards on side, pain
Pt instruction: Rock backwards as if to place buttocks on heels (monitor their symptoms)
Clinical scenario in which to use this: pt with LBP in which you observe functional movements where their movements appear to be all together/ unable to move spine separate from hips
What constitutes a (+) test? Inability to differentiate lumbar movement from pelvis movement

Special test for hip laxity- log roll
PT position: at side of patient
Pt position: supine
Hand placement: at patients anterior femur and tibia, rolling leg into IR/ER observing for any clicking, popping, or excessive ROM compared to opposite side
Clinical scenarior in which to use this: Pt describing pain with flexion based activities, feels clicking in their hip with certain movements, potentially more hypermobile joint- labral pathology
What constitutes a (+) test? Specific test— pain,clicking, excessive ROM considered positive

Hip joint mobilization during loading phase of running
Using lunge MWM
PT position: holding mob belt or tie it around secure object
Pt position: stepping in and out of fwd lunge with band as close to their joint line as possible
Hand placement: N/A
Plane of movement/direction of force: band providing a lateral distraction force at the hip
Clinical scenarior in which to use this: pain with loading phase of running
Outcome measure to determine skill success: running

Exercise to activate quads during gait
Facilitation in standing with quadriceps
Patient position/set up- standing facing away from PT
PT: kneeling behind patient, should placed under patients buttocks on the involved side
Hands: therapist hands around involved limb on anterior part
Environmental set up: pt something to hold onto if needed
Clear instruction to patient: sit back on my shoulder then come off my shoulder (while therapist provides loading cue)
Correct dosage/prescription: 2x20 neuro re ed
One progression up or down: pt stand on uneven surface, squat lower
-femur coming forward

Exam skill for L/S segmental mobility
Physiological flexion/extension
PT position: facing patient with their legs on your thighs, moving pt into flexion and extension feeling motion at spine
Pt position: Sidelying with legs flexed, resting knees on PT hip crease
Hand placement: palpating interspinous spaces to feel separation of SP
Clinical scenario in which to use this: pt with lumbar mobility deficits
What constitutes a (+) test? Movement dysfunction identified if lack of segmental motion occurs

Exam skill for lumbar instability
Prone instability test:
PT position: standing next to patient with arms in PA position
Pt position: positioned in prone with torso on the edge of plinth, lower extremities over edge of table resting on floor, when PT gives pressure if pt feels pain, their asked to raise legs off floor, PA pressure is applied again
Hand placement: performs a PA pressure over lumbar SP with light pressure using pisiform contact
Plane of movement/direction of force: PA
Clinical scenarior in which to use this: aberrant movement pattern, gower's sign, instability patient
What constitutes a (+) test? Symptoms are reproduced when feet are on the floor & decrease or disappear when feet are raises

L/S segmental manipulation
PT position: side of patient
Pt position: side lying, arms crossed, with one leg flexed up to segment, trunk rotated down to segment
Hand placement: hand that rotated upper body weaved through patients arms and palpating segment, lower arm along ilium
Plane of movement/direction of force: upper arm force is going posterior, lower arm pushing ilium anterior/inferior
Clinical scenario in which to use this: pt has hypomobile segment without distal symptoms, acute onset

L3-L4 segmental opening procedure
PT position: side of pt
Pt position: sidelying with towel roll under their spine, to SB to involved segment, thigh used to flex up to segment, trunk rotated down to segment
Hand placement: one hand palpating SP, other hand along ilium providing traction
Plane of movement/direction of force: upper arm stabilizing segment, lower arm providing traction
Clinical scenarior in which to use this: pt with stenosis, mobility deficits
Outcome measure to determine skill success: standing endurance? SLR? Pain with extension?

Correction for R trunk lateral shift
PT position: squatted down so shoulder is at same height at patient trunk, on patients R
Pt position: standing
Hand placement: hand at patient's pelvis, chest into side of patient's trunk
Plane of movement/direction of force: pull pelvis to the R, push trunk to the L
Clinical scenarior in which to use this: HNP, visible lateral trunk shift

Long axis hip traction
PT position: standing at foot of table
Pt position: supine with leg in open packed position 30º flex/30ºabduction/10ºER
Hand placement: above malleoli
Plane of movement/direction of force: distract leg in inferior direction
Clinical scenarior in which to use this: hip OA, SIJ up slip
Outcome measure to determine skill success: relief of pain

T/S Manipulation in supine
PT position: pt lies supine with hands clasped around the neck or thorax
Pt position: therapist standings at side of table facing the head of table
Hand placement: fixation: hand is stabilized at patient's spine on adjacent TP's, mobilizing hand place along with therapist's sternum, on patients elbows or crossed arms
Plane of movement/direction of force: thrust directed downward towards the table
Clinical scenario in which to use this: limited mobility at t/s
Outcome measure to determine skill success: T/S ROM

T/S Manipulation in prone
PT position: therapist stand at side of patient
Pt position: prone with arms relaxed and scapula abducted
Hand placement: force applied through the TP's of adjacent segments, via therapist pisiforms, take up clack of soft tissues with skin lock, sternum directed over segment
Plane of movement/direction of force: mobilize desired segment anteriorly along angle of vertebral bodies (pay att to curvature of the spine)— downward & cranial direction on superior segment & down and caudal on inferior segment
Clinical scenario in which to use this: pt with decreased mobility t/s
Outcome measure to determine skill success:
What constitutes a (+) test?

Talocrural traction manipulation (for DF or PF ROM)
PT position: standing in lunge position facing patient
Pt position: supine, with foot off the edge of table
Hand placement: bilateral fingers are interlaced over anterior neck of talus and thumbs are placed on plantar foot to patients foot is held in DF. Compress sides of foot, body weight to create max DF slight EV until joint end feel is felt.
Plane of movement/direction of force: quick weight shift backward & slightly down creates thrust force, make sure ankle DOES NOT PF.
Clinical scenarior in which to use this: limited DF or PF
Outcome measure to determine skill success: DF/PF ROM

Subtalar joint mob
PT position:
Pt position:
Hand placement:
Plane of movement/direction of force:
Clinical scenarior in which to use this:
Outcome measure to determine skill success:
What constitutes a (+) test?

Joint mob to improve knee extension
Tibia PA with ER
PT position: side of leg being mobilized
Pt position: supine, leg straight
Hand placement: cranial hand on femur, caudal hand gripping tibia posteriorly proving PA with ER force
Plane of movement/direction of force: PA with ER motion (screw home mechanism)
Clinical scenarior in which to use this: limited extension in gait
Outcome measure to determine skill success: ROM/gait mechanics

Joint mob to improve knee flexion
Tibiofemoral AP MWM
PT position: standing next to patient side that you're mobilizing
Pt position: supine, leg bent with belt around ankle
Hand placement: stabilizing hand on femur, mobilizing hand on tibia providing AP force along joint line while pt pulls belt to increase flexion motion at the knee
Plane of movement/direction of force: AP along tib/femur joint line
Clinical scenarior in which to use this: pt limited flexion ROM
Outcome measure to determine skill success: flexion ROM

Rib exam in sitting
PT position: therapist stands to the side opposite of the involved rib
Pt position: pt sits on treatment table with both arms on the contralateral knee
Hand placement: supports torso with one arm over the patient's chest. Position to torso in rotation and SB toward the PT to make contralateral ribs more prominent, move rib by rib palpating for tenderness/prominence. (SB away for rib spring)
Plane of movement/direction of force: rib spring- move rib in ventral direction
Clinical scenario in which to use this: pt with rib discomfort, pain with breathing/coughing
What constitutes a (+) test? Prominent rib, reproduction of symptoms, pain with rib spring

Rib Manipulation in supine
PT position: stands at side of patient, facing head of table
Pt position: lies supine with arms crossed across chest
Hand placement: fixation- reaches across thorax and stabilizes the desired segment on the dorsal aspect of the patient, using IP contact on the SP of the adjacent segment using thenar eminence contact of the patients CV joint. Moving hand-approximates their sternum with the patient's upper extremities
Plane of movement/direction of force: applies an AP mobilization force by applying dorsal directed force through patient's upper extremities
Clinical scenario in which to use this: pt with pin point rib pain, increased rib prominence on symptomatic side
Outcome measure to determine skill success: pain?

Seated t/s segmental motion exam
PT position: stands facing patient
Pt position: sitting on edge of treatment table with arms folded across chest
Hand placement: palpating finger in interspinous space; remaining pat of hand placed to provide stabilization on T/s and ribs, moving arm placed on patient's crossed arms
Plane of movement/direction of force: flexion/extension, combined: extension rotation & SB opp direction, flexion rotation and SB same direction
Clinical scenario in which to use this: assessing mobility at the t/s in someone who has pain or postural deficits
What constitutes a (+) test? Limited mobility, quality of range, symptom provocation

Passively correct for L anterior rotated innominate fault
PT position: lateral stance position, supporting patient's leg with forearm and hip crease
Pt position: sidelying with symptomatic side up, ipsa hip flexion for post rotation, contra hip extended to stabilize sacrum
Hand placement: firm and comfortable grip of iliac crest and ischial tuberosity
Plane of movement/direction of force: passively mobilize innominate into posterior rotation while flexing hip during weight shift, can increase max post rotation by wrapping leg around PT body
Clinical scenario in which to use this: pt demonstrates L ant rotated innominate
Outcome measure to determine skill success: recheck gillet march or palpate landmarks

Passively correct for R posterior rotated innominate fault
Ant rotation mobilization prone w/ or w/o belt
PT position: standing at near side of table in staggered stance
Pt position: prone at edge of table with ipsilateral leg in full extension, contra leg in full hip flexion with foot on floor, pillow under abdomen if needed
Hand placement: sacrum for stabilization, distal femur of ipsilateral leg
Plane of movement/direction of force: passive hip extension with sacral stabilization to induce an anterior rotation, graded mobilization or static hold
Clinical scenario in which to use this: pt has R post rotated innominate
Outcome measure to determine skill success: gillet march test, palpating innominate

Active correct for L anterior rot innominate fault
Using glutes on L, hip flexors on R
PT position: standing at foot of table in staggered stance
Pt position: supine hook lying, hips flexed
Hand placement: tibial tuberosity of ipsalateral leg, anterior distal femur of contralateral leg
Plane of movement/direction of force: progressive force of hip extension on ipsilateral leg and hip flexion on contralateral leg- hold force 3secx3, return legs to table add hip adduction force 3secx3
Clinical scenarior in which to use this:
Outcome measure to determine skill success:
What constitutes a (+) test?

Actively correct for R post rotated innominate fault
R hip flexors and L hip extensors
PT position: standing at foot of table in staggered stance
Pt position: supine hook lying, bilateral hips 90º flexion
Hand placement: tibial tuberosity of contralateral leg, anterior distal femur of ipsa leg
Plane of movement/direction of force: add progressive force of hip flexion on ipsilateral leg and hip extension on contra leg hold 3secx3, bilateral hip adduction 3 sec x 3
Clinical scenarior in which to use this: pt presents with R post rotated innominate
Outcome measure to determine skill success: gillet march, innominate symmetry palpation in standing

Correction for L innominate upslip fault
PT position: staggered stance position, elbows extended
Pt position: supine with arms and legs resting at sides
Hand placement: firm and comfortable drip of distal tibia above ankle
Plane of movement/direction of force: passively position patient's hip into capsular tension (30 abd/30flex/10ER to start) apply gentle traction to hip joint until resistance felt and pause, apply high velocity thrust x3
Clinical scenarior in which to use this: pt presents with up slip positional asymmetry
Outcome measure to determine skill success: check pelvis positioning
*Best to use prone technique because usually associated with posterior rotation as well

Special test for hip impingement- FADIR
PT position: alongside hip to be tested
Pt position: close to side of table and supine with hip flexed and foot on surface of table
Hand placement: more cranial hand on distal femur, caudal hand and torso cradling tibia
Plane of movement/direction of force: passively flex, adduct, and IR hip to patient's available ROM as you assess for ROS
Clinical scenario in which to use this: hip pain with flexion
What constitutes a (+) test? Reproduction of symptoms at the anterior hip
-running, hip flexion

Special test for hip impingement-FABER
PT position: Along side limb to be tested
Pt position: supine with both legs extended on table
Hand placement: one hand on pelvis, other hand on leg guiding down to table
Movement: flex, abduct, ER- stabilize opposite ASIS and lower the right leg towards the table, distance from knee to surface of table is asymmetric
Clinical scenario in which to use this: hip pain, limited range
What constitutes a (+) test? 3-4cm difference side to side, ROS and/or loss of motion
-pain in anterior hip, pain near the SIJ

Special test for hip labral tear- Click test
PT position: therapist stabilizes pelvis
Pt position: pt side lying
Hand placement: passively flex hip 50-100º, while moving into flexion allow the leg to move into adduction and IR of the hip
Clinical scenario in which to use this: labral pathology
What constitutes a (+) test? Presence of click is positive

3 versions of hip lateral traction
Pt supine, quadruped, or standing
PT position: standing by side of hip being treated
Pt position: supine with leg being treated flexed up, quadruped, standing with leg being treated on ground, opposite leg up on chair
Hand placement: mob belt around thigh as close to groin as can get either around pt's hips OR PT holding mob belt
Plane of movement/direction of force: providing lateral glide to femur, vary angle with joint capsule limitation
Clinical scenarior in which to use this: limited flexion/extension of hip
Outcome measure to determine skill success: ROM/movement analysis

4 directions of patellar mobs
Med/Lat & Caudad/Cephalad & Med/Lat Rotations, Med/Lat Tilt
Inferior- flexion
Superior- extension
Medial-
Lateral-

Standing SIJ motion exam (March test)
Modified Gillet
PT position: kneeling facing patients back
Pt position: patient facing away from PT with hand on table
Hand placement: palpate inferior aspect of R PSIS and the S2 spinous process when assessing R innominate mobility
Plane of movement/direction of force: lift your R knee toward your chest and now your L knee, examine independent mobility of the innominate bones relative to the sacrum
What constitutes a (+) test?
(+) sign is that there is reduced innominate motion on sacrum one side vs the other, S2 moving with PSIS
—90 degrees of hip flexion, enough to get S2 moving

Standing SIJ motion exam (fwd bend test)
PT position: kneeling behind pt
Pt position: standing facing away from therapist
Hand placement: palpate the inferior aspect of both PSIS with thumbs while fingers reach towards iliac crests
-Examine mobility of the innominate bones (PSIS) relative to each other, do they move equally and together?
-Pt bend forward as far as possible or until symptoms occur
-initial motion is from the hips then lumbar spine followed by sacrum motion and then innominate motion
What constitutes a (+) test? (+) sign is that there is reduced innominate motion on on side vs other
-tests of HYPOMOBILITY- side that does NOT move as much is the affected side
Why would you test this SIJ— STS difficulty, misstepped off a curb, low back pain differentiation

Standing hip joint mob for extension
Lateral glide of hip IR in ext MWM
PT position: high kneeling,facing patient's back
Pt position: standing in a lunge position with leg being mobilized into extension
Hand placement: forearm/elbow closest to patient's extended leg contacts ipsalateral PSIS, other hand grasps medial femur pulling leg into IR
Plane of movement/direction of force: IR movement at femur with stabilization at pelvis
Clinical scenario in which to use this: pt lacking terminal hip extension in gait

Standing hip joint mob for flexion
Hip IR in flexion MWM
PT position: high kneeling on side of patient's leg being mobilized
Pt position: in a lunge position with hip being mobilized in flexion
Hand placement: contralateral PSIS to promote pelvis rotation to the side of the hip being mobilized, (L PSIS to promise R pelvic on femur rotation for R hip IR)
Plane of movement/direction of force: on patients femur to promote neutral femur position while providing R pelvic on femur rotation
Clinical scenarior in which to use this: limited hip flexion
Outcome measure to determine skill success: hip flexion ROM
-standing lateral mobilization as well

Hip joint mob for anterior capsule mobility
Prone anterior glide
PT position: on same side of table as patient
Pt position: prone, with ipsa leg extended on table and contra leg bent with foot on ground
Hand placement: mob belt around patients distal femur and then around therapist, stand up to provide extension moment then provide PA force to mid femur
Plane of movement/direction of force: PA
Clinical scenarior in which to use this: presents with limited flexion
Outcome measure to determine skill success: hip flexion ROM
—

Dorsal manip of cuboid
PT position: standing in a lunge position facing the patient
Pt position: prone with foot off edge of table
Hand placement: foot is grasped with both hands so thumbs overlie the cuboid
Plane of movement/direction of force: foot held in midrange DF with thumb contact on tarsal bone firm but relaxed. With a quick snap generated through wrist ulnar deviation, ankle is whipped moving to the ending position. Ankle ends in nearly max end range PF (Cuboid force=ventral and slightly lateral)
Clinical scenarior in which to use this: limited mid foot mobility, subluxed cuboid
Outcomes: improved Peroneal strength, someone with inversion ankle sprain resulting in plantar subluxation of the cuboid—> peroneals trying to eccentrically control ankle inversion sprain since it wraps around the cuboid can cause subluxation

Exam for midtarsal mobility (talonavicular joint)
R foot
PT position: seated with pt's foot in hand
Pt position: prone on table with feet off
Hand placement: grasp calcaneous with R hand move into full eversion, use lumbricals grip on navicular with thumb on plantar surface, assess movement of navicular in frontal plane (assess in full eversion and inversion)
Plane of movement/direction of force: frontal plane motion
Clinical scenarior in which to use this: limited or excessive mid foot motion
Less motion when foot is in inversion

Exam for midtarsal mobility (calcanecuboid joint)
R foot
PT position: seated with pt's foot in hand
Pt position: prone on table
Hand placement: grasp calcaneus with L hand and move into full eversion, use pincher grip on cuboid with thumb plantar surface, assessment movement of cuboid in the transverse plane , assess in full eversion & inversion
Plane of movement/direction of force: transverse plane
Clinical scenarior in which to use this: limited or excessive motion of the mid foot

Exam to determine L ant rot innominate fault
March test
PT position:
Pt position:
Hand placement:
Plane of movement/direction of force:
Clinical scenarior in which to use this:
Outcome measure to determine skill success:
What constitutes a (+) test?

Exam to determine R post rot innominate falut
Fwd bend test
PT position:
Pt position:
Hand placement:
Plane of movement/direction of force:
Clinical scenarior in which to use this:
Outcome measure to determine skill success:
What constitutes a (+) test?

SIJ Provocation test
-Distraction (supine)
-Thigh Thrust (supine)
-Compression (sidelying)
-Sacral thrust (prone)

SIJ alleviation tests
Active SLR with compression
PT position: at side of table
Pt position: supine
Hand placement: along bilateral iliac crest providing compression
Plane of movement/direction of force: inward
Clinical scenarior in which to use this: SIJ dysfunction
What constitutes a (+) test? Raise leg=pain or weakness or limited movement, raise leg with compression=increased movement, decrease pain, increased strength (+)
-More instability like