2 Movement Tests Lower Quarter

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Counter Stretch for the Hamstrings (Neural Tension Self Mobilization)

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, Self Stretch, Self-mobilization

Counter Stretch for the Hamstrings (Neural Tension Self Mobilization)

  • The patient is standing with the feet approximately hip width apart and places both hands on top of a counter or table top with the hands shoulder width apart.
  • Have the patient bend their knees but have them keep their heels flat on the floor. The patient is instructed to lift their sit bones up and back, toward the ceiling to achieve a neutral spine.
  • Instruct the patient to push their hands against the table top to assist in extending and elongating the thoracic spine.
  • Instruct the patient to straighten their elbows and attempt to elongate the spine, dropping the chest towards the floor.
  • Finally, have the patient straighten the knees maintaining a neutral lumbar spine, while lifting the sit bones towards the ceiling.
  • They straighten and bend their knees on/off approximately 10-12 times. They should not feel pain in the low back with this stretch.
  • Do not allow the patient to hyperextend the knees or drop their head during the stretch.

Wall Stretch for the Hamstrings (Neural Tension Self Mobilization)

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, Self Stretch, Self-mobilization

Wall Stretch for the Hamstrings (Neural Tension Self Mobilization)

  • The patient is standing with the feet approximately hip width apart and places both hands against the wall with the hands shoulder width apart.
  • Have the patient bend their knees but have them keep their heels flat on the floor. The patient is then instructed to lift their sit bones up and back, toward the ceiling to achieve a neutral spine while lengthening the back of the leg.
  • Instruct the patient to push their hands against the wall to assist in elongating the thoracic spine.
  • Instruct the patient to straighten their elbows and attempt to elongate the spine, dropping the chest towards the floor.
  • Finally, have the patient straighten their knees while maintaining a neutral lumbar spine as they try to lift the sit bones towards the ceiling.
  • They straighten and bend their knees on/off approximately 10-12 times. They should not feel pain in the low back with this stretch.
  • Do not allow the patient to hyperextend the knees or drop their head during the stretch.
  • You may have to instruct the patient to begin this exercise with their hands much higher up the wall if they are not able to achieve and maintain a neutral lumbar spine while extending the knees.
  • As their flexibility improves the patient can slowly lower the placement of their hands on the wall.
  • The goal is for the patient’s hands to be placed on the wall at the same height as the hips, maintaining a neutral lumbar spine while fully straightening both knees.

Supine Left Hamstring Stretch with a Belt with Hip Adduction and Internal Rotation

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, Rolling, Self Stretch, Self-mobilization

Supine Left Hamstring Stretch with a Belt with Hip Adduction and Internal Rotation

  • The patient is lying supine and places a belt around the ball of the left foot.
  • Starting with the L knee flexed and with the left hip flexed to 90 degrees, instruct the patient to try to straighten the L knee as much as possible while maintaining dorsiflexion at the left ankle using the belt.
  • Then instruct the patient to keep the L knee as straight as possible as they bring the leg across the body into adduction and internal rotation to put an additional stretch on the sciatic nerve and lateral hamstrings.
  • The stretch is held for only 5 seconds and then released by bringing the left leg back to the midline while still maintaining a straight knee and dorsiflexion of the L ankle.
  • Instruct the patient to repeat this on/off stretch 10 times.
  • Then have the patient repeat on the right side.

Supine Left Hamstring Stretch with a Belt

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, Functional Integration, Self-mobilization

Supine Left Hamstring Stretch with a Belt

  • The patient is lying supine and places a belt around the ball of the left foot.
  • Starting with the L knee flexed and with the left hip flexed to 90 degrees, instruct the patient to try to straighten the L knee as much as possible while maintaining dorsiflexion at the left ankle using the belt.
  • The stretch is only held for 5 seconds and then released by bending the left knee.
  • Instruct the patient to repeat this on/off stretch 10 times while keeping the left knee pointing straight up towards the ceiling.
  • Then have the patient repeat on the right side.

Costovertebral Joint Mobilization with Long Sitting Slump Stretch

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

Costovertebral Joint Mobilization with Long Sitting Slump Stretch

Treatment for Regional Pain Syndrome involving the Right Leg (Adapted from Cleland and McRae, 2002).:

  • Patient is long sitting with a belt wrapped around the balls of the feet.
  • The patient attempts to straighten the knees as much as possible and pull the toes up using the belt.
  • The patient flexes forward as far as possible and drops the head down.
  • The therapist side bends and rotates the patient to the left and holds the patient in this position.
  • The therapist then applies a PA grade III or IV mobilization to ribs 8 through 12 to mobilize the costovertebral joints from T8-12 on the right side.
  • Patient reports on any relief or change in symptoms in the R leg.

Slump Sitting Mobilization

in 2 Movement Tests Lower Quarter, 4 Manual Therapy Strategies, All Lower Quarter, All Manual Therapy, Manual Stretching, Mobilization, Nerve Glides

Slump Sitting Mobilization

  • Patient sitting at the edge of the table with the neck and trunk flexed, arms behind the back.
  • Therapist stabilizes the head and neck in flexion and passively straightens the leg to the barrier.
  • The therapist then immediately releases the tension by bending the knee.
  • Therapist repeatedly straightens and bends the knee 8-10 times.
  • Patient is then instructed to sit up tall and rock the pelvis forward (6:00) and backward (12:00) to release any tension in the low back.
  • Repeat this sequence with the other leg and then with both legs.
  • Further mobilization can be done by holding dorsiflexion of the ankle while straightening of the knee.

Counter Stretch with Manual Pressure at L5 or L4

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

Counter Stretch with Manual Pressure at L5 or L4

  • Patient stands with the feet approximately hip width apart and places both hands on top of a counter or table top with the hands shoulder width apart. Patient pushes their hands against the table to assist in extending the thoracic spine.
  • Patient instructed to bend their knees but keep the heels flat on the floor, lift their sit bones up and back, towards the ceiling to achieve a neutral spine.
  • Actively the patient straightens the elbows and attempts to elongate the spine, dropping the chest towards the floor.
  • Finally, have the patient straighten the knees while maintaining a neutral lumbar spine, keeping the sit bones lifting towards the ceiling.
  • Patient notes where they feel pain
  • Therapist then applies strong PA pressure on the spinous process of L5 and the patient attempts to straighten the knees again and reports any change/improvement in pain behind the knees or down the leg.
  • If there is no change in symptoms therapist applies unilateral PA pressure on the lamina of L5, first on one side then the other and patient reports any change in symptoms
  • If no change is reported with manual pressure at L5 the process is repeated at L4
  • The goal is for the patient to report an improvement in their symptoms (less pain behind the knee or leg) when the therapist maintains a PA glide at L4 or L5
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