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Quadratus Lumborum Hands and Knees Self Stretch

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Quadratus Lumborum Hands and Knees Self Stretch

To Stretch the Right Quadratus Lumborum:

  • Have the patient reach forward with the right hand and grasp a solid object. From this position instruct the patient to sit back diagonally towards the right hip, elongating (stretching) the right side of the back.
  • The right arm may be internally rotated (thumb down) or externally rotated (thumb up). Since the latissimus dorsi is an internal rotator of the shoulder internal rotation of the arm places more stretch selectively on the quadratus muscle.
  • Have the patient hold the stretch position for 30 seconds and repeat 2-3 times alternating sides.

Piriformis Stretch Above 90 Degrees of Hip Flexion

in 2 Movement Tests Lower Quarter, 4 Manual Therapy Strategies, Active Trunk Rotation, All Lower Quarter, All Manual Therapy, Manual Stretching, Muscle Energy, Rolling

Piriformis Stretch Above 90 Degrees of Hip Flexion

  • Therapist externally rotates the leg, then adducts the leg towards the opposite shoulder
  • Patient is instructed to push out with both the knee and ankle; if external rotation is more limited, push out with the ankle only
  • Upon relaxation the therapist adds further adduction and/or ER to the new barrier
  • Repeat 3 to 4 times

Piriformis Stretch Below 90 Degrees of Hip Flexion

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Piriformis Stretch Below 90 Degrees of Hip Flexion

  • Therapist stands on the opposite side of the table and places the left hand on the L ASIS to stabilize
  • Patient’s left foot is placed outside of the right knee
  • Therapist adducts the leg to the barrier
  • Patient attempts to abduct the leg for 5 -7 seconds then relaxes
  • Repeat 3 to 4 times

Soft Tissue Mobilization of the Posterior Hip Capsule

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Soft Tissue Mobilization of the Posterior Hip Capsule

  • Patient is positioned with the right hip off the table, but the PSIS is still on the table.
  • The therapist uses both arms to laterally distract the hip.
  • A strap can also be placed around the hip to apply lateral distraction.
  • Therapist slightly adducts and IR the hip then applies a posterior glide thru the femur.
  • If painful in the groin or SI, abduct the hip slightly.
 

Soft Tissue Mobilization of the Posterior Hip Capsule

in 2 Movement Tests Lower Quarter, 4 Manual Therapy Strategies, All Lower Quarter, All Manual Therapy, Mobilization, Rolling

Soft Tissue Mobilization of the Posterior Hip Capsule

Patient is side lying with the treatment side up. The therapist uses the elbow to scour around the posterior aspect of the hip capsule feeling for areas of tension. The therapist can also work from the posterior aspect of the greater trochanter back across the gluteal area to the sacrum and address any tension in the external rotators of the hip with deep friction massage.

Muscle Energy Technique for a FRS Right in R Side Lying

in 2 Movement Tests Lower Quarter, 4 Manual Therapy Strategies, Active Trunk Rotation, All Lower Quarter, All Manual Therapy, Hip ABD Firing Pattern, Hip EXT Firing Pattern, Muscle Energy, Pelvic Clocks, Rolling

Muscle Energy Technique for a FRS Right in R Side Lying

  • Extension is introduced from above down and from below up to the barrier
  • Rotation is then introduced from above down to the feather edge of the barrier
  • The segment to be treated must remain perpendicular to the table
  • Using the R forearm the therapist introduces L side bending thru the pelvis by pushing up in an anterior and superior direction
  • Patient is instructed to push the pelvis caudally to activate the R side benders
  • Upon relaxation the therapist takes up the slack thru the pelvis
  • Repeat 3 to 4 times
  • To finish the patient is asked to extend the top leg (L) back while the therapist maintains the correction

Passive Mobility Testing in Extension with Translation of the Shoulders from Right to Left to Detect FRS R Dysfunctions

in 2 Movement Tests Lower Quarter, Active Trunk Rotation, All Lower Quarter, Hip ABD Firing Pattern

Passive Mobility Testing in Extension with Translation of the Shoulders from Right to Left to Detect FRS R Dysfunctions

  • Patient is prone propped on elbows with their elbows together and hands under their chin.
  • Place your right thumb on the left side of the SP and rest your left forearm over the patient’s shoulders.
  • Translate the patient’s shoulders from right to left as you block the SP and assess for tightness. Repeat from T10 to L3
  • With an FRS R dysfunction you’ll feel a blockage when attempting to draw the spine over your stabilizing L thumb
  • FRS dysfunctions are commonly found with this test anywhere from T11- L2 resulting in a positive FADIR test that is perceived as a tight posterior hip capsule

Hip Clearing with Flexion, Adduction and IR (FADIR Test)

in 2 Movement Tests Lower Quarter, 4 Manual Therapy Strategies, All Lower Quarter, All Manual Therapy, Hip ABD Firing Pattern

Hip Clearing with Flexion, Adduction and IR (FADIR Test)

  • To test the right hip the therapist passively flexes, adducts and IR the hip, aiming the right knee toward the left shoulder
  • Pinching in the groin or anterior hip will limit the patient’s ability to stretch the piriformis
  • Indication of a tight posterior hip capsule or upper lumbar spine dysfunction, ie FRS at L1,2 or L2,3 on the same side as the pinching hip.
 
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