When you want to evaluate a patient with leg
pain, you want to look at the Tensor Fasciea Latae
and iliotibial band.
This is a common problem with runners and
a lot of people who have overuse injuries
The way you do evaluations for
this is called the Ober test
And what you'll do is you have a patient
lay on their side, slightly flexed
and you take their leg and you
extend and ABduct the leg
You hold it and you can
ask them to hold it
and then you say, "can you drop
your leg towards the table?"
and you direct it.
If they can do that, they do not
have a tight Tensor Fasciae Latae
and they have a negative Ober test,
so this is a good sign.
We're gonna talk about some of the
counterstrain points in the lower extremity.
In evaluating, we're gonna start by looking at the
greater trochanter for piriformis tenderpoints
and if you find it on the
greater trochanter that's great
and that's the tender point
that's easy to treat by extending
and ABducting the leg untill
the tenderpoint relaxes
That's one tender point.
You wanna look a little bit below, you
can have about 5-6 inches below
which is the lateral
trochanteric tender point.
and the third place is usually the ischial
tuberosity, we may have a tender point as well.
and those are usually treated with extension
of the leg, internal rotation or flexion.
So those are things you can do
to get rid of those tender points
Let me have you turn over.
Now we're gonna talk about tender points on the
knee because you will have patellar tender points
in the patellar tendon just below the
knee cap, just below the patella.
You may also have a medial or a
lateral patellar tender point.
and because there's limited
motion here, it's gonna be hard
to figure out how you're gonna
go ahead and get that treated.
Whether you extend and you
don't get much extension,
you're gonna give a little
extension and internal rotation.
Medially, if you have a medial tender
point, you're gonna push laterally
and twist a little bit to help treat that
tender point and find a position of ease.
So these are difficult tender points to treat but
once you do get it, you hold it for 90 seconds
find the position of ease and
then reassess afterwards.
There are three tender points in the ankle.
The first tender point to look at is
just inferior to the medial malleolus.
And when you find the position of ease
with that, you want to invert it.
There's a tender point just anterior to
the calcaneus in the ball of the foot.
and that's treated with plantar flexion to try
and relieve and find the position of ease.
And then you have the third point is
just inferior to the lateral malleolus
and that's treated with eversion
to find the position of ease.
I want to demonstrate the test we
have described earlier for the ankle.
We're gonna start with the anterior
drawer test which is testing for the
talofibular ligament or
lateral ligament of the ankle.
You stabilize the tibia and
fibula, grab the calcaneus,
put the patient in 10-15 degrees of
plantarflexion and pull out at the calcaneus.
looking for dimpling at the lateral ligament area,
looking for laxity and looking for looseness.
If the anterior talofibula is intact, you
wanna check for the calcaneaofibular ligament
which is the same position but
just induce some internal rotation
and again push forward, hold, look
for laxity, dimpling or changes.
If you wanna check for the deltoid ligament
on the inside, that's the Klieger test
and you externally rotate and pull forward
as well checking the deltoid ligament
And the last test is the Thompson's test
We'll have you put on your stomach, and
this checks for the achilles tendon
Basically, squeeze the gastrocnemius
and watch the foot motion.
Squeeze the gastrocnemius,
if the foot moves,
then the tendon is intact.
I want to talk about the evaluation of the
fibula, particularly the head of the fibula
So if you wanna examine it, you
wanna bend the knee, take a look,
find the head of the fibula
and look at the motion
See whether you have gliding
anteriorly or posteriorly
Where's the restriction, and
where's the dysfunction.
So if he doesn't move anteriorly, he has
a fibular head restriction anteriorly,
with a posterior fibular
head somatic dysfunction
You were gonna have the opposite motion so
if you move it posteriorly at fibular head,
the other end is gonna move anteriorly
So in order to treat this kind of
dysfunction, you're going to flex,
invert and have him push his
foot out towards my hand
Push through for 2-5 seconds
and monitor the fibular head
Fibular head is an important area where you have
knee pain or other pain on the side of the leg.