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

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.

Hip Diagonals

in 2 Movement Tests Lower Quarter, 4 Manual Therapy Strategies, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, All Manual Therapy, Manual Stretching, Mobilization, Muscle Energy, Self-mobilization

Hip Diagonals

Hip Diagonals

To treat an ERS Right and/or high tone in the Right Erector Spinae:

The patient starts this exercise in the hands and knees position and is instructed to sit back diagonally as though attempting to sit onto their right hip.
Instruct the patient to sit back as far as they can without holding onto the table with their hands.
Have them hold the position for 5 seconds then come back up to the original hands and knees position without pulling up with their arms.
Have them repeat 8 to 10 times.

Muscle Energy Technique: ERS Dysfunction in the Lower Thoracic Spine

in 2 Movement Tests Lower Quarter, 4 Manual Therapy Strategies, Active Trunk Rotation, All Lower Quarter, All Manual Therapy, Hip ABD Firing Pattern, Muscle Energy, Rolling, Supine Curl Up, Supine Heel slide, Supine Hip ABD and ER

Muscle Energy Technique: ERS Dysfunction in the Lower Thoracic Spine

The therapist places their L index and middle fingers on the L side of the spinous processes and translates the spine towards him looking for any restriction in L to R translation (L side bending). If the restriction is worse in flexion and improves in extension the diagnosis is an ERS R.
To treat the ERS R the therapist has the patient sit up tall initially, then introduces flexion from above down and below up creating an apex for flexion at the palpated segment. L side bending is then introduced by translating the patient’s shoulders from L to R to the feather edge of the L side bending barrier.
The patient is instructed to gently side bend to the R for 5-7 seconds and then relax.
The therapist takes up the slack by further translating the shoulders to the R. This is repeated 3-4 times.

Supine Heel Slide and/or Prone Hip Extension

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

Supine Heel Slide and/or Prone Hip Extension

Hip Flexors

Iliopsoas:

Psoas attaches to the transverse processes and vertebral bodies from T12 to L5
Iliacus attaches to the iliac fossa and sometimes anterior sacral base
Powerful hip flexor and slight ER of the hip, side bends the LS to the same side and rotates away, when hypertonic these muscles limit hip extension
Innervation: Femoral nerve – L2, 3 and 4

Tensor Fascia Latae:

Attached at the anterior iliac crest and ASIS
Inserts into the IT band
Flexes, abducts and internally rotates the hip, externally rotates the knee
Innervation –Superior gluteal n. L4,5 and S1

Rectus Femoris:

Attached to the AIIS and the anterior hip capsule
Flexes the hip and extends the knee
Pain in the front of the knee cap is often a sign of a tight rectus femoris
Innervation – femoral n. L2, 3, and 4

PNF Pelvic Diagonals (Hip Clocks)

in 2 Movement Tests Lower Quarter, 4 Manual Therapy Strategies, All Lower Quarter, All Manual Therapy, Mobilization, Muscle Energy, Pelvic Clocks

PNF Pelvic Diagonals (Hip Clocks)

PNF Pelvic Diagonals (Hip Clocks)

Pelvic diagonals on the right side:

Patient is lying on their left side with their shoulders and hips square on the table and their hips flexed to 60 degrees with their lumbar spine in neutral.

You ask the patient to imagine a clock resting on top of their right hip so that 12 is closest to the shoulder and 6 closest to their feet, 3 is in front and 9 is towards the back.

You tell the patient that we are going to work from 1-2 o’clock (anterior elevation) down to 7-8 o’clock (posterior depression).

Start first by asking the patient to isometrically hold various positions along the diagonal from 1-2 down to 7-8 o’clock then work eccentrically giving you resistance as you pull down towards 7-8 or push up towards 1-2. You finish by asking the patient to pull the hip up towards 1-2 or push down and back towards 7-8 against your resistance.

The patient must avoid activating the right shoulder and right side of the neck during this activity and avoid moving out of the neutral position in their low back.

Manual Therapy for Restricted 9 o’clock – restricted pelvic rotation to the R and/or restricted sacral anterior nutation on the L

Treated as above except the patient is lying on their R side working through the pelvis from 10-11 o’clock (anterior elevation) down to 4-5 o’clock (posterior depression).

All Manual Therapy