Tests of our aims of exercising Tests of our aims of exercising
If the pelvis tilts downwards on the side of the
lifted leg, this is called a positive Trendelenburg’s
sign (Magee 1997). If there is no serious pathol-
ogy this is a reliable test for hip stability, particu-
larly strength of the hip abductors. This stability is
essential for all exercises on one leg. When these
exercises are performed correctly they build up this
stability (see Chapter 6, exercises 8.4 and 8.6, and
Chapter 7, Vkāsana).Sitting on a chair or on the floor
• To test adduction cross one leg over, so that
one thigh is resting on the other one.
• To test abduction spread the legs apart.
• To test external rotation bend the knee and
rest the foot on the other thigh (see Chapter 6,
exercise 8.5, variation c).
Internal and external rotation can also be tested with
straight legs (see Chapter 6, exercise 8.1).Lying on the back
With bent knees, hip flexion and circumduction can
be tested (see Chapter 6, exercise 8.2).
Lying on your back and bending one hip and knee
can also give important information (see Chapter 6,
exercise 7.1). If the straight leg comes off the floor
or the knee bends, a flexion contracture is indicated;
frequently there will be hypertonia of the psoas on
that side. A deviation of that leg to the side indi-
cates hypertonic lateral muscles.Tests for the iliosacral joints
Of the many possibilities for testing the iliosacral
joints we select the following:
Lie on your back with one hip and knee bent (see
Chapter 6, exercise 7.1).
There are three different positions of movement:- Keep bending only as long as the hip is not
moving off the floor at all. This mainly shows
movement in the hip joint. - Bend further so that the hip moves away
from the floor or couch but the curve of the
lumbar spine does not change. This is iliosacral
movement: by changing the direction of the knee
you can reach different joint planes. In most
cases it is sufficient to move the knee towards
the same shoulder and towards the opposite
shoulder.- If you bend even further the lumbar spine will
flatten more.
In hypermobile iliosacral joints precise alignment is
extremely important and pelvic torsion should be
avoided in all exercises and postures.
Tests for the shoulders
Full examination of the shoulder may be exten-
sive and also includes examination of the cervical
spine.
To make it easier for the patient to do the move-
ment in the shoulders and not the lumbar spine and
to avoid tilting the pelvis, self-testing of flexion and
abduction lying on the back is recommended:
Keep the contact of the back of the pelvis and
the middle back unchanged. Keep your arms par-
allel, and move them above your head. Then bring
your arms beside your body. Keeping them on the
floor, slide them sideways and over your head. Find
the painfree range of movement and compare left
and right.
Extension of the shoulders, moving the arms back-
wards, can be tested in sitting. Again it is important
to be aware of the stability of the pelvis and the
lumbar spine (see Chapter 6, exercise 4.9, part 4).
The back of a chair or wall may be a useful measure
of this backwards movement of the arms.
External rotation and abduction and internal rota-
tion and adduction can be tested at the same time
with the Apley scratch test (Magee 1997):- Sit or stand. Again, be aware of the stability of
the pelvis and lumbar spine. - Internally rotate the left arm. Move it
backwards; bend the elbow and touch the back
with the back of the hand, as high as possible
towards the head. - Externally rotate and raise the right arm. Bend
the elbow, touch the neck with the palm, and
slide it down between the shoulder blades as far
as possible. - Feel whether the fingers can touch or overlap. If
not, use a belt to measure the distance between
the hands.