A) Tendonitis

Shoulder

Speeds

- Long Head Biceps Tendinosis

-Standing

Cats Final Op

-Flex Shoulder at 90, E.X.T and supinate forearm (Arm is straight out)

-Resist Flexion-1 hand on shoulder and wrist

-Repeat in pronation

- (+) Sign: Pain at tendon (bicipital groove)

2) Yergason's

- Long Head Biceps Tendinosis

-Seated

-Elbow flexed at 90 and pronated, stabilized against their body

-Palpate tendon at shoulder

-Other hand: resist S.U.P, E.X.T, and E.X.T rot (hold at hand)

- (+) Sign: Pain at bicipital groove, and tendon popping out

3) Drop Arm Test

- Supraspinatus tendinosis

-Client standing

-A.B.D arm to 90, and they hold

-Client slowly A.D.D back to start

- (+) Sign: Unable to return arm smoothly or if pain

4) Supraspinatus / Empy Can Test

- Supraspinatus tendinosis, strain, weakness

-A.B.D arm to 90 + Horizontal A.D.D humerus to 30, and I.N.T rotate upside down

-Resist A.D.D

- (+) Sign: Pain or weakness

5) Hawkins-Kennedy

- Supraspinatus tendinosis

-Seated or standing

-Flex shoulder and elbow to 90

-Push clients arm into I.N.T rotation, 1 hand on wrist and 1 on elbow

- (+) Sign: Pain

6) Painful Arc

- Supraspinatus / Subacromial Bursa (Pain at 170 to 180 = A.C)

-Standing

-Client A.B.D arm in full range

- (+) Sign: Pain at 60 degrees of A.B.D and beyond slightly 120

7) Infraspinatus

- Infraspinatus tendinosis, strain, weakness

-Standing

-Arm at side with elbow flexed at 90 and humerus I.N.T rotated to 45

-Resist E.X.T rotation

- (+) Sign: Pain or inability to resist

8) Neer Impingement

- Supraspinatus Tendon

-I.N.T rotate humerus (thumbs down), Passively flex client's shoulder full range

(+): Pain

Elbow

Cozen's (Lateral Epicondylitis Test 1)

Common Extensor Tendinosis / Wrist Extensor tendinosis

-Seated

-Stabilize elbow with your Thumb on L.A.T epicondyle (Palpate)

-Client pronates and makes fist and extends wrist.

-Resist wrist E.X.T

(+) Sign: Sudden, severe pain at Common E.X.T tendon

2) Lateral Epicondylitis Test (Method 3 - Maudsley's Test)

Lateral Epicondylitis

-Seated

-Stabilize elbow with your Thumb on L.A.T epicondyle (Palpate)

-Client pronates and makes fist

-E.X.T 3rd digit

-Resist

(+) Sign: Pain at Lateral Epicondyle

Wrist

Finkelstein

DeQuervain's Tenosynovitis

-Seated

-Client make fist + Thumb flexed inside fingers

-Stabilize arm proximal to client's wrist w/ 1 hand

-Other hand: Ulnar deviate wrist

(+) Sign: Pain at A.B.D Poll Longus + E.X.T Poll Brevis tendons

Ankle (1)

Thompson's

Achilles tendon rupture

-Prone

-Feet over edge of table, squeeze calf mm

(+) Sign: Absence of Plantar Flexion

B) Sprains

Shoulder

A.C Shear

A.C Joint pathology

-Seated

-Stand behind client and place cupped hands over clavicle + Spine of Scapula

-Squeeze together

(+) Sign: Pain or excessive movement of joint

Elbow

Varus Elbow

L.C.L

-Seated

-Flex elbow slightly 20 to 30 degrees

-Apply Varus force (Lateral)

(+) Sign: Pain, excessive movement

Sacroiliac (2)

1) S.I Joint Gapping Test

- Anterior S.I Ligament sprain

-Supine

-Cross arm pressure (Lateral + posterior) to medial aspect of A.S.I.S

- (+) Sign: Unilat gluteal or posterior lower limb pain

2) S.I Joint Squish Test

- Posterior S.I Ligament Sprain

-Supine

-One hand on lateral aspect of both A.S.I.S

-Push medially and inferiorly towards each other at 45 degrees

- (+) Sign: Pain at S.I joint

Knee (5)

Anterior Drawer Test

- A.C.L

-Supine

-Knee flexed to 90, Hip flexed to 45, foot flat on table

-Therapist sit on foot to anchor

-Pull tibia Anteriorly (like the glide)

- (+) Sign: Excessive mvmt

2) Posterior Drawer Test

- P.C.L

-Supine

-Knee at 90, Hip 45, foot flat on table

- Therapist Anchors foot by sitting on it

-Grasp Tibia, and push posterior

- (+) Sign: Excessive mvmt

3) Posterior Sag Sign

- P.C.L

-Supine

-Hips flexed at 45, knees flexed to 90, feet flat on table

-Compare sides for Tibia sag

- (+) Sign: Tibia sags posteriorly compared to unaffected

4) Apley's Distraction Test

- M.C.L or L.C.L

-Prone

-Flex knee at 90

-Stabilize clients leg, by putting your knee on back of client's thigh

-Grasp leg proximal to ankle, and do Traction to Tibia

-I.N.T + E.X.T Rotate Tibia

- (+) Sign: Pain on medial or lateral knee

5) Valgus Stress

- M.C.L, or joint capsule, A.C.L, P.C.L

-Supine

-Stabilize lower limb in slight E.X.T rotation: 1 hand on medial malleolus, other on lateral knee

-Knee in 20 to 30 flexion

-Apply Valgus (Medial)

-Repeat in Neutral

- (+) Sign: Pain, excessive mvmt, gapping at medial knee. At 20 to 30 flexion: M.C.L; other ranges: A.C.P, P.C.L

Ankle

Kleiger

- Deltoid Ligament sprain, tear

-Seated

-Legs hang off table

-Hold client foot and E.X.T rotate

(+) Sign: Pain medially and laterally, may feel Talus displacement

2) Anterior Drawer

Anterior TaloFibular Ligament-Laxity or rupture

-Seated or Supine

- Stabilize above ankle and behind calcaneous

-Distract Inferiorly and Superiorly/Anterior back and forth

(+) Sign: Excessive anterior mvmt of Talus

3) Talar Tilt

Deltoid or Calcaneo Fibular Ligaments

-Supine or Sidelying

-Hold foot, move side to side (Inversion/Eversion)

(+): Hypermobility-(Eversion = Deltoid / Inversion = Cal-Fib)

C) Postural Conditions (3)

Ober's

T.F.L, I.T.B - Short

-Sidelying with affected leg on top

-Slight flex bottom leg at hip and knee

-Stand behind client and stabilize pelvis at Iliac crest

-A.B.D and E.X.T Hip

-Flex knee to 90, then relax leg all the way down

(+) Sign: Leg stays in A.B.D/raised

2) Ely's

Rectus Femoris-Short

-Prone

-Flex affected knee, heel to bum

(+): Hip flexes when knee is flexed

3) Thomas'

Hip Flexor contracture -Supine -Flex one hip, knee to chest -Client holds knee (+): If other leg rises off table

D) Scoliosis (4)

Scoliosis Short Leg

Functional Scoliosis due to short limb

-Standing

-Look at Iliac crest and A.C levels bilaterally (for side tilts or back curve)

-Put foot lift (like a stepper) under short leg to correct tilt

(+): Curve is gone

2) Valsalva

Lesion on Spinal Cord (Occupying space)

-Seated

-Hold breath bear down (like taking a crap) and pretend to blow into balloon

(+): Local or radiating pain in dermatome pattern ** Red flag test, if positive send to emergency

3) Scoliosis Small Hemipelvis

Functional Scoliosis d/t small hemipelvis

-Look at Iliac crest and A.C joints (side tilt or back curve)

-Put book under short side to correct lateral tilt

(+): Curve is gone

4) Forward Bend (Rib Hump)

Functional or Postural Scoliosis

-Standing, bend forward, let arms hang, then flex laterally to each side

- (+): Correction of curve to vex side (fxnal scoliosis)

- (+): Lateral flexion does not correct (Structural)

- (+): Correction and rib humping on forward flex (Fxnal)

- (+): no correction or rib humping with forward flexion (Structural)

Don't do Short leg or hemi pelvis, just do forward bend

E) Osteoarthritis (3)

1) Hibbs (Prone Gapping Test)

Posterior S.I joint Dysfunction

-Prone

-Stabilize Pelvis, flex knee to 90, medially rotate hip as far as possible

-Push hip into P.F, and palpate S.I joint

-Look at amount of opening and quality of mvmt

- (+): Hyper/Hypo Mobility

2) Patrick's (Faber)

S.I, Hip joint, or Short Psoas m

-Supine

-Put client's affected foot on knee (Unaffected side, not patella) - '4' shape

-Slowly push knee of test leg (bent) toward table

- (+): Affected knee is above unaff knee (Hip jt path or short Psoas m)

- (+): Pain in S.I joint (S.I joint dysfxn)

Lumbar facet joint irritation or Nerve root compression

-Client extend spine while therapist holds client's shoulders to control mvmt

-Apply overpressure in extension, while client laterally flexes and rotates to affected side

-Go until pain, or range is reached

- (+): Pain in back (Lumbar facet)

- (+): Radiating pain or neuro signs in leg (Nerve root compression)

F) Miscellaneous (1)

Rebound

Appendicitis

-Supine

-Palpate and push down at McBurney's Point (1/3 between A.S.I.S + Umbillicus)

- (+): Pain or tenderness (Red Flag Test)

Conditions

Inflammatory

Fascia, and M.L.D works on everything

Strains

"Lengthen then Strengthen"

Hydrotherapy-hot hydrocollator

1) M.L.D

2) Fascial: Spreading, skin rolling, C/S bow (no O.I.L)

3) Frictions greater than Passive stretch, tell client to use Ice at home (no O.I.L)

4) Trigger Point Release (Compensatory): T.R.P Release greater than Flush, State you would normally stretch, and tell client to use heat at home

5) Muscle Stripping (Compensatory)

6) Muscle Setting

1) Passive stretch

2) Traction (Limbs)

2) Sprain

“Strengthen then Lengthen”

asterisk Hydrocollator

1) Fascial-Spreading, Skin Rolling, C/S Bow

2) M.L.D

3) Frictions greater than Stretch, Tell client to use Ice at home

4) Trigger Point Release: T.R.P Release greater than Flush, State you would normally stretch, and tell client to use heat at home

5) Muscle Stripping

6) Muscle Setting

7) G.T.O/Approx

Remex: (Limbs)

1) Traction (Wrist, ankle, G.H)

2) Stretch

3) Dislocations treated as severe sprain: See above Hydro: Cold compress for atrophy, hot on compensatory

1) Proximal M.L.D

2) Fascial techniques

3) Muscle Setting

Compensatory:

4) Trigger Point

5) Muscle stripping

6) Frictions

7) G.T.O/Muscle approximation

Remex:

1) Traction

2) Stretch compensatory

4) Bursitis

Prepatellar (Right on Patella)

**C.I: Don't compress Bursa, No drag, don't stretch skin, don't contract muscles over bursa**

-Do use techniques Towards bursa, Hydrotherapy Around bursa (Donut)

**If doing other leg as compensatory, then state that and why**

Hydro: Cold Compress Hydro (Donut Around bursa)-5mins

1) Fascial: spreading, Skin Rolling towards bursa

2) M.L.D

3) Trigger Point Release (Compensatory or other leg): T.R.P Release> Flush, State you would normally stretch, and tell client to use heat at home

4) Muscle Setting (Quads)

5) Muscle Stripping (Compensatory or other leg): Muscle Stripping towards bursa

6) G.T.O / Approx (Other Leg)

- Traction on compensatory or other leg

- Stretch on compensatory or other leg

5) Fractures

Hydro: Cold Compress (Cold for atrophy or swelling, if neither, then heat)

1) M.L.D

2) Fascia

3) Muscle Setting (Possible Atrophy)

4) Muscle Stripping (Compensatory)

5) Trigger Point Release (Compensatory): T.R.P Release greater than Flush, State you would normally stretch, and tell client to use heat at home 6) G.T.O / Approx

Remex:

- Stretch on affected

- Traction on compensatory

6) Contusions

- Aims: Restore R.O.M and function of affected tissue -Address adhesions

Hydro: Hydrocollator 1) Fascial

2) M.L.D

3) Muscle stripping

4) G.T.O/Muscle Approx

5) Frictions greater than Stretch, Tell client to use Ice at home

6) Trigger Point Release (Compensatory): T.R.P Release greater than Flush state you would normally stretch and tell client to use heat at home

Remex:

- Passive Stretch

- Traction

7) Tendonitis

Achilles Tendon

1) **Frictions: on tendon (Must Do). State you would Ice and stretch

2) M.L.D

3) Fascial

4) Muscle Stripping (Compensatory): Muscle Stripping, G.T.O/Muscle approx

5) Trigger Point Release (Compensatory): T.R.P release greater than flush and state you would put heat

6) G.T.O / Approx

Remex:

- Stretch

- Traction

B) Postural Conditions

Fascia and Muscle Setting on everything C Curve-Convex side dictates what side scoliosis is on.

Convex side is weak, treat like atrophy, stimulate muscle and use cool hydrotherapy

Concave side is tight, treat like hypertonicity, trigger points, spasm

-Parts that are above or below curve is considered compensatory. (hypertonicity, spasm, M.T.P)

Hydrotherapy

-Hot hydrotherapy on concave side of curve

-Cold hydro on convex side

1) Fascia: Either side

- 2) Muscle Stripping (Concave side)

- 3) Trigger point release (Concave): Flush out, stretch, heat, A.F R.O.M

- 4) G.T.O, O.I, Muscle Approximation (Concave)

5) Muscle Setting: (Convex): Rhomboids, Unilateral on convex side (Light tapotement, then tell client to bring back shoulder back / retract. 3 Rounds)

Remex:

A) P.J.M: Align Spine to midline (Convex)

-Medial Glide on S.P: Push spine back in straight line

B) Passive Stretch

-Concave side Rhomboids: Put hand behind back and push downwards on scapula

9) Pes Planus Hydro: Hydrocollator

1) Fascial: Plantar aspect of foot-Unidirectional spreading/Glide towards toes

2) G.T.O: Achilles tendon

3) Muscle Stripping: Calf

4) M.T.P Release: Calf

5) Muscle Setting: (Do for “Full marks on Effectiveness”)

Remex:

-Tibialis Anterior (Flip to Supine, Recommended as Last technique so you can then do P.J.M and stretch in supine)

A) P.J.M: Glide to Navicular

-Find highest point in medial arch and press superiorly

B) Passive Stretch

- Gastrocs: Dorsiflex ankle, with leg in full extension

- Soleus: Dorsiflex ankle with leg in flexion

10) Hyperlordosis

Anterior Curve of Cervical and Lumbar Spine

Hydro: Hydrocollator

1) Fascial

2) Muscle Stripping

3) M.T.P Release: Erector spinae (E/S) Low back

4) Muscle Approximation: E/S low back

5) Muscle setting: Glut Max (Special consent, Resist hip extension)

Remex:

A) Passive Stretch

-Rectus Femoris (Warm up muscle via A.F or P.R R.O.M prior to stretch) hip ext

B) P.J.M:

1) Anterior-Posterior Glide: Push a vertebrae downward: Using your P.I.P joints around the S.P

11) Hyperkyphosis

Posterior curve of Thoracic Spine

Hydro: Hydrocollator

1) Fascial

2) Muscle Setting: Rhomboids (Retract shoulders/Scapula)

3) T.R.P Release: Upper fibre traps (Flush out, stretch, heat)

4) G.T.O: Splenii muscles at base of occiput

5) Muscle stripping: back or to sub occ (finger strip up neck)

Remex:

A) Passive Stretch

-Pecs (Supine, warm up first with A.F or P.R R.O.M)

B) P.J.M

C) Bowel -Anterior-posterior glide to Thoracic Spine S.P

12) Constipation

Draping with towel covering upper thorax, tell client to hold

Hydro: Hydrocollator (On pecs for stretching)

1) Fascia: Pecs, or hips

2) Deep Diaphragmatic Breathing

3) G.T.O (Pecs) / Approx (Rec Femoris)

4) Muscle Stripping: Subcostal border-strip like Iliacus

5) "Scoop the Poop" Petrissage: lower quadrant of abdominals

Remex:

- Stretch: Pecs or hip

- Traction: Pecs or hip (A.S.I.S Posterior glide?)

Test Protocol

A) Special Ortho Tests

-Say what test, how to do it, ask if they feel pain, Say what (+) Sign is

B) Consent to Treat

C) Client instructions + Wash hands

D) Hydro: State what you're using (hydrocollator, cold compress) and duration, Do visual check, ask for C.I (any metal implants, or on any meds)

E) Treatment: G.S.M then 4 special techniques (Explain to client verbally special techniques)

F) Remex: Passive stretch + traction, State purpose and grade

G) Client Instruction: getting off table, lightheadedness, do you need help, and remove pillows

Miscellaneous

-P.J.M grades 1/2: Decrease pain

- 3/4: Increase R.O.M

-Muscle setting: 3 rounds

-Frictions: 2 rounds flush in between, State you would stretch and ice

-M.L.D: keep it short. Activate terminus @ clavicles, 2 deep breaths, pump at G.H, I.F, knee or elbow joint, then do unidirectional strokes towards heart

Scripts:

: Table summary: Clinical guidelines for explaining five therapeutic techniques to clients. The techniques include MLD, used to address local edema and felt as mild skin pulling, and Passive Stretching and Contract-Relax Stretching, both used to lengthen muscles and improve mobility. While Passive Stretching is a simple pull, Contract-Relax involves a cycle of stretching and resisted movement repeated three times. Finally, GTO and O&I techniques are both used to indirectly reduce muscle tone and tension, with GTO involving pressure where the muscle attaches and O&I involving pressure along the muscle's tendons.

Table summary: A guide to client communication and the purpose of three physical therapy techniques. Trigger Point Release and Peripheral Joint Mobilizations both utilize ischaemic compression to address trigger points or reduce range of movement. For Trigger Point Release, the client is warned that the technique can be painful and create traveling pain, while Joint Mobilizations involve light to heavy pressure as joint surfaces slide. Separately, Isometric Contraction and Muscle Setting Technique involves gentle strengthening where the client contracts a muscle without moving the joint to improve strength in severely weakened muscles or prevent atrophy, resulting in feelings of tension, tightening, or fatigue.