Yoga as Therapeutic Exercise: A Practical Guide for Manual Therapists

(Jacob Rumans) #1
3

Chapter
Diagnosis

Tests of our aims of exercising Tests of our aims of exercising

Standing active examination for
hip and spinal mobility

Stand   with    your    feet    as   close  together    as   possible.  
Keep the knees straight throughout the movement
test. Perform side-bending, rotation, bending back-
wards, and bending forwards. Find and document
the painfree range of movement.
To test yourself you can slide your hands down
the sides of your legs for side-bending, and down
the backs of your legs when bending backwards.
When you bend forwards you can measure the dis-
tance from your fingertips to the floor. You may like
to use a stick lined up beside your legs: make a mark
on this stick to indicate how far you get down, and
observe your development over a period of time.
Rotation can also be tested sitting on a chair, turn-
ing to either side, and observing the angle of rotation
(see Chapter 6, exercise 2.8).
Note that hip mobility and thigh muscle tone
influence the result. When testing forward bending
in particular it is useful to decide the main limit at
the outset. If short hamstrings restrict hip flexion
the lumbar spine will be more curved. If the lumbar
spine itself is restricted it will show less curve from
the side (Sammut & Searle-Barnes 1998).
To test the hamstrings lie on your back and raise
one leg, keeping that knee straight (see Chapter 7,
āsana Supta Pādāgu hāsana). Check the angle of
hip flexion.

Tests for the feet


It   is  essential  to   observe    the transverse  and longi-
tudinal arches of the feet during standing and how
they change with exercising (see Chapter 6, exer-
cises 10.4 and 10.6).
Active mobility without weight-bearing can be
tested sitting with straight legs. Move the feet into
plantar- and dorsiflexion, inversion and eversion,
and circumduction. Move the toes in all possible
directions. Extension of the big toe is particularly
important for gait (see Chapter 6, exercise 10.3).
To test these abilities with weight-bearing, stand
and invert and evert your feet, then raise the heels
and stand on the heels, raising the forefoot (see
Chapter 6, exercise 10.9). Toe extension can be
tested in squatting with the heels raised. The hands
can be supported on a couch.

While   wear    and tear    of   the    soles   of   the    shoes   
may not help to judge improvement over just a few
weeks, it is a useful diagnostic tool at the outset or
over a longer period.

Tests for the knees


Look    into    the mirror  for:
• valgus or varus
• swelling around the joints
• shape and position of the kneecap
• shape of the quadriceps muscle, which is very
important for good function of the knee joint.
Tighten both thighs simultaneously. Observe
whether the kneecaps move evenly upwards.
To test flexion and extension without weight-
bearing:
• Stand on one foot. Support yourself against a
table or wall using the hand on the same side.
Bend and stretch the other knee.
• Sit on a chair. Bend and stretch one knee at a
time; when you are stretching the knee the leg
is horizontal.
• Test flexion in the knee hug position, lying on
your back (see Chapter 6, exercise 1.4, Figure
6.4).
To test flexion and extension on weight-bearing,
look in the mirror:
• Stand on both feet. Stretch both knees; observe
whether they can stretch equally.
• Raising your heels, squat down as far as
possible. Look for deviations and stability.

Tests for the hips


Here    we   have   chosen  positions   in   which  it   is  easy   to  
test movement. Some movements can also be per-
formed in different positions.

Standing
To test extension of the hip, stand on one foot.
Support yourself with the hand of this same side
against a wall or table. Keep your pelvis stable (you
can control this with your free hand) and move your
leg backwards.
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