Edmund M. Kosmahl, PT, EdD

NAME: ___________________________________________ DATE: _______

Examiner: ______________________________________________

Random pick of one item from each category. Each item worth 5 points. Exam worth 15 points total.

Goniometry or MMT: Item:

Score and Comments:

Manual Stretch: Item:

Score and Comments:

Manual Resistance: Item:

Score and Comments:

CRITERIA - MANUAL STRETCHING AND RESISTANCE LOWER EXTREMITY GONIOMETRY, MMT

GONIOMETRY:

Position in zero position and stabilize proximal joint component. (1 point)

Move part through full range of motion and determine end feel. (1 point)

Identify and palpate bony landmarks. (1 point)

Align goniometer. (1 point)

Read goniometer and record measurement. (1 point)

MANUAL MUSCLE TESTING:

Position subject to provide best stabilization. (1 point)

Stabilize proximal body part. (1 point)

Use test position or test movement. (1 point)

Apply pressure opposite the direction body part moves when the test muscle contracts or allow body part to move through horizontal test movement if too weak. (1 point)

Evaluate and record grade. (1 point)

MANUAL STRETCHING:

choose an appropriate stretching exercise (1 point)

appropriate patient positioning and stabilization (1 point)

appropriate hand placement to make stretch effective (1 point)

appropriate duration and force of stretch (1 point)

other (1 point)

MANUAL RESISTANCE:

choose an appropriate manual resistance exercise (1 point)

appropriate patient positioning and stabilization (1 point)

appropriate hand placement to make exercise effective (1 point)

appropriate amount of resistance (1 point)

other (1 point)

Goniometry:

• hip flexion and extension
• hip abduction and adduction
• hip medial (internal) and lateral (external) rotation
• knee flexion and extension
• ankle dorsiflexion and plantarflexion (subtalar neutral, differentiate for tightness of gastrocnemius)
• calcaneal(subtalar - hindfoot) inversion and eversion
• midtarsal(transverse tarsal) inversion and eversion (alternate goniometer alignment as per Norkin)
• metatarsophalangealjoint dorsiflexion (extension) and plantarflexion (flexion)
• metatarsophalangealjoint abduction and adduction

Manual Muscle Test: (be prepared to use hand-held dynamometer if instructor asks)

iliopsoas

tensor fascia latae

hip adductors

gluteus maximus

sartorius

gluteus minimus

gluteus medius

lateral (external) hip rotators

medial (internal) hip rotators

quadriceps femoris

hamstrings

gastrocnemius

soleus

tibialis posterior

peroneus longus and brevis

tibialis anterior

extensor hallucis longus and brevis

extensor digitorum longus and brevis

flexor digitorum longus

flexor hallucis longus

abductor hallucis

Manual Stretch

low back pain patient with exaggerated lumbar lordosis, limited mobility in lumbar flexion, and tight hip flexors, use contract-relax

status post ankle fracture with tight ankle plantar flexors, use prolonged stretch

low back pain patient with limited lumbar extension and tight hamstrings, use contract-relax-contract

cerebral palsy patient with spasticity and tightness of the hip adductors, use prolonged stretch

healthy runner with lateral knee pain due to tight ilio-tibial band, use prolonged stretch

Manual Resistance

patient has weakness (3/5) of all muscles in right lower extremity after cast removal for fractured tibia (now healed), use PNF diagonals

patient has weakness (4/5) of quadriceps after surgery for torn anterior cruciate ligament (now healed), use manual resistance

patient has weakness (4/5) of hamstrings after herniated lumbar disk, use PNF diagonals

patient has weakness of foot/ankle evertors after sprained ankle (now healed), use manual resistance