Length Tension Testing Length Tension Testing Assessment of

Length Tension Testing

Length Tension Testing • Assessment of length tension in skeletal muscle from the use of clinical reasoning, interpretation and subjective and objective assessment findings • Assessment Findings Include: referral pain, neuromusculoskeletal interaction or neuromeningeal identification (nerve restrictions or nervous system responsiveness/sensitivity), positional observation, ROM, palpation, and overall activation and flexibility of the muscle • Range of motion and end feel of muscle is assessed from therapists hand moving and stabilizing the structure - sense the tension in the muscle • End feel = Joint restriction • Normal muscle = will feel soft will contract voluntary with EMG activity • Tense muscle = will feel stiff, like a well done steak contributes to muscle spasm and pain, EMG not under voluntary control because of decreased contractile ability • Symptoms during stretch noted

Soleus Muscle Origin (Proximal) Attachment: Posterior proximal half, on the surface of the tibia, along soleal line proximal 1/3 posterior fibula Insertion: Posterior Calcaneus Action: Plantar Flexion Nerve: Tibial Nerve root (S 1, S 2)

Soleus Length Tension Test Patient Position: - Supine lying position with leg hanging over edge of bed Action: - One hand supports knee in a slight flexed position, while other hand forearm supports plantar aspect (bottom) of the foot - Patients ankle is dorsiflexed, while range of motion and end feel of muscle is assessed (hand moving and hand stabilizing sense the tension in the muscle) - Symptoms during stretch noted

PICTURE (Soleus mm length , 2010)

Piriformis Muscle Origin (Proximal) Attachment: Anterior surface of lateral sacrum Insertion: Greater trochanter of femur, along upper medial surface Action: Laterally rotates the thigh at hip joint, If hip is flexed it will abduct the thigh Nerve: Sacral Plexus (S 1, S 2)

Piriformis Length Tension Test Patient: - Supine lying with hip flexed at 100° and knee flexed at 90° Action: - Therapist stabilizes innominate and supports distal aspect of the tibia and fibula with hand forearm - Hip is adducted and laterally rotated - Range of motion and end feel of hip is assessed (hand moving and hand stabilizing sense the tension in the muscle) - Symptoms during stretch noted

PICTURE (Cram, 2013)

Hamstring (3 Muscles) Origin (Proximal) Attachment: Biceps Femoris: Ischial tuberosity Semimembranosus: Ischial tuberosity Semitendinosus: Ischial tuberosity Insertion: Biceps Femoris: Head of fibula and lateral condyle of tibia Semimembranosus: Posterior medial condyle of tibia Semitendinosus: Proximal tibia, medial to tibial tuberosity Action: Extends thigh at the hip Nerve: Tibial portion of sciatic nerve (L 5, S 1, S 2)

Hamstring Length Tension Test Patient: - Lying supine Action: - Therapist palpates anterior iliac spine and iliac crest - Distal aspect of tibia and fibula are supported by a hand - Leg is taken into hip flexion with the knee extended - When right innominate starts to posteriorly rotate, flexibility of the hamstring is exhausted - Range of motion and end feel of hamstring is assessed (hand moving and hand stabilizing sense the tension in the muscle) - Symptoms during stretch noted

PICTURE (Hamstring rehab protocol, 2013)

Quadriceps (4 Muscles) Origin (Proximal) Attachment: Rectus Femoris: Anterior Iliac spine and illium above the accetabulum Vastus Lateralis: Greater trochanter Vastus Medialis: Intertrochantric line Vastus Intermedius: Anterior and lateral shaft of femur Insertion: Quadriceps tendon, to base of patella into tibial tuberosity from the patellar ligament Action: Extends leg at the knee joint Nerve: Femoral Nerve (L 2, L 4)

Quadriceps Length Tension Test Patient: - Lying on stomach with legs extended Action: - Therapist stabilizes the sacroiliac joint - Distal aspect of tibia and fibula is supported by therapists hand - Therapist flexes knee joint to target the quadriceps - Range of motion and end feel of quadriceps is assessed (hand moving and hand stabilizing sense the tension in the muscle) - Symptoms during stretch noted

PICTURE (Schafer, 1985)

Trapezius Muscle Origin (Proximal) Attachment: Medial superior nuchal line and external protuberance of the occipital bone, ligamentum nuchae and spinous processes of C 7 T 12 Insertion: Clavicle (lateral), acromion, and spine of scapula Action: Upper Fibers – Elevate and upwardly rotate scapula (extend neck) Middle Fibers – Adduct scapula (retract) Lower Fibers – Depress scapula Nerve: C 3, C 4 and accessory cranial N.

Trapezius Length Tension Test (Upper Fibers) Patient: - Sitting position on a chair Action: - Patient actively flexes craniovertebral joint (articulation between cranium and vertebral column) - Therapist stabilizes lateral 1/3 clavicle and acromion with one hand stabalizes the top of the head with the other hand - Therapist passively flexes and rotates the head down towards the patients shoulder - Range of motion and end feel of trapezius is assessed (hand moving and hand stabilizing sense the tension in the muscle) - Symptoms during stretch noted

PICTURE (Boost physio, 2012)

ARTICLE - Upper Trapezius Muscle Activity During the Brachial Plexus Tension Test in Asymptomatic Subjects • The brachial plexus tension test (BPTT) is used to test the dynamics of the neural tissues of the upper quadrant – using contralateral cervical lateral flexion • The upper trapezius muscle and the nerves of the brachial plexus share common anatomical locations and are jointly affected by the BPTT movements. • This study investigated the relationship between the BPTT and the upper trapezius muscle activity - tested the range of neural tissue extensibility in asymptomatic subjects. • Thought that upper trapezius shortening is an adaptation to protect less extensible neural tissue from the action of stretching (upper limb movements) • 20 healthy male subjects tested (age 18 -30) • BBTT = shoulder depression, glenohumeral abduction, and external rotation, forearm supination, wrist and finger extension and elbow extension • Contralateral cervical lateral flexion (CCFL) was added as a final BBTT component • Base Line Pre- Test Maximum voluntary contraction (MVC) was recorded (EMG) while subject was lying supine during shoulder abduction and external rotation • After MVC , BPTT was performed, paused at shoulder depression when pain felt and at limits of elbow extension and contralateral cervical lateral flexion (CCFL) - - Pain rating was recorded (scale 0 -10) • Results revealed that those with lesser neural extensibility exhibited greater upper trapezius muscle activity during the BPTT • No difference between groups in the levels of pain perceived.

Palmaris Longus Origin (Proximal) Attachment: Medial epicondyle of humerus Insertion: Flexor retinaculum and palmer aponeurosis Action: Flexes hand at the wrist joint, tenses palmer aponeurosis Nerve: Median N. (C 7, C 8)

Palmaris Longus Length Tension Test Patient: - Lying supine Action: - Therapist stabilizes patients distal humerus and extends the patients elbow and wrist with all of the patients fingers and thumb extended - Range of motion and end feel of palmaris longus is assessed (hand moving and hand stabilizing sense the tension in the muscle) - Symptoms during stretch noted

PICTURE (Morphopedics, 2009)

ARTICLE - Reliability of Upper Limb Tension Test 1 in Normal Subjects and Patients With Carpal Tunnel Syndrome • Four neural tension tests in upper extremity (ULTT) • ULTT 1 – evaluates upper quadrant nerve system tension, and the corresponding structures tension , particularly median N. • ULTT 1 (through movement and tension) is thought to help with the diagnosis of carpal tunnel syndrome • Upper limb tension test consisted of elbow extension , shoulder depression, shoulder abduction and external rotation, forearm supination , and wrist and elbow extension • Believed that the median N. is stretched during ULTT 1 • Subjects: two groups (healthy and patients) • 23 healthy subjects (age 18 -25) • 12 CTS patients (age 25 -50) • Results determined that ULTT 1 is reliable and can be used to diagnose and help manage carpal tunnel syndrome

Work Cited Boost physio. (2012). Retrieved from http: //www. boostphysio. com/blog/tag/hendon-physio/ Cram. (2013). Retrieved from http: //www. cram. com/flashcards/clskspecial-tests-2460528 Get body smart. (2014). Retrieved from http: //www. getbodysmart. com/ap/muscularsystem/wris thanddigits/palmarislongus/tutorial. html Hamstring rehab protocol using lengthened state eccentrics. (2013). Retrieved from http: //activeptblog. com/2013/10/14/hamstring-rehab protocol-using-lengthened-state-eccentrics/ Morphopedics. (2009). Retrieved from http: //morphopedics. wikidot. com/elbow-joint Sanzo , P. , & Mac. Hutchon, M. (2007). Length tension testing of the lower quadrant. Thunder Bay: Active Potential Rehabilitation Services. Sanzo , P. , & Mac. Hutchon, M. (2007). Length tension testing of the upper quadrant. Thunder Bay: Active Potential Rehabilitation Services. Schafer, R. (1985). The motion palpation institute & acapress. Retrieved from http: //www. chiro. org/ ACAPress/The_Pelvis. html Soleus mm length. (2010). Retrieved from https: //www. google. ca/search? q=soleus length test&rlz=1 C 1 KMZB_en. CA 564&espv=210&es_sm=93&source=lnms&tbm=isch &sa=X&ei=Pd. U 0 U 7 i. LKojmr. QHcto. GYCQ&ved=0 CAYQ_AUo. AQ&biw=1366&bih=667