patient’s anterior leg above the ankle. Offer resistance to knee extension, and notetheamount of resistance the patient can overcome. Test both limbs in order to compare thestrength of each, and evaluate them according to the standardized grading scale for musclestrength. Following is a detailed illustration of the dermatomes of the lower extremitiesand of the above- mentioned test for knee extension.Neurologic Level L4: The muscle predominantly innervated at this root nerve level isthetibialis anterior, which does dorsiflexion with inversion. To test this muscle, ask the patientto sit on the treatment table. With one hand, stabilize the patient’s leg by holdingit justabove the ankle. Instruct the patient to dorsiflex and invert h/her foot. With your free hand,hold the patient’s foot and ask h/her to resist your attempt to move the foot intoplantarflexion and eversion. Test both feet in the same manner in order to compare thestrength of each, and evaluate them according to the standardized grading scale for musclestrength. Following is an illustration of neurologic level L4 and of the above-mentionedmuscle test for dorsiflexion with inversion:Neurologic Level L5: The muscles found within this myotome are the extensor hallucislongus (big toe extensor), extensor digitorum (heel walk) and the gluteus medius (the mostpowerful abductor of the hip.) A common test for hip abduction is to ask the patientto lieon h/her side with both legs extended, careful not to flex at the hip. Place one hand onh/her pelvis to stabilize it and ask h/her to fully abduct it. Place your free hand on thelateral knee at the joint and ask the patient to resist your attempt to push the legintoadduction. Test both sides in the same manner in order to compare the strength of each,and evaluate them according to the standardized grading scale for muscle strength.Following is an illustration of neurologic level L5 and of the above-mentioned test for hipabduction:Neurologic Level S1: The muscles found within this myotome are the peroneus longus(plantarflexion with eversion) peroneus brevis (toe walk) and gluteus maximus (hipextension.) To test for hip extension, ask the patient to lie face down on the treatment tableand bend the leg at the knee (this relaxes the hamstrings.) Stabilize the hip by placing yourforearm over the iliac crest, and ask the patient to hyperextend h/her hip. Place your otherhand on the thigh below the gluts and ask the patient to resist your attempt to pushthethigh back down on the table. Test both sides in the same manner in order to comparethestrength of each, and evaluate them according to the standardized grading scale for musclestrength. Following is an illustration of neurologic level S1 and of the above-mentionedtest for hip extension.
As healthcare professionals, Therapeutic Massage Therapists need to be as educated andknowledgeable about the workings of the human neuromuscular system as possible.Knowledge not only enables us to better educate our clients as to the injury and recoveryprocess, it also helps us facilitate our clients’ recovery process from myofascial pain anddysfunction. Having knowledge of dermatomes and myotomes may help us to differentiatebetween dysfunction resulting from myofascial trigger points and that resulting fromnerveroot injury. Myofascial trigger points don’t match dermatomal and myotomal patterns;knowing the patterns of each may help a Massage Therapist to discern between them.However, since numbness and tingling may be due to either myofascial tightness impingingon a nerve or nerve root damage, and since Massage Therapists do not diagnose, it’simportant to refer a client to a physician for a definitive diagnosis of symptoms.
K. Anderson, J. Hall.
Sports Injury and Management
: Philadelphia: Williams &Wilkins, 1995.1.Cramer, A. Darby.
Basic and Clinical Anatomy of theSpine, Spinal Cord, and Ans.
Carlsbad, California: Mosby, 1995.2.Hoppenfeld, Stanley.
. Philadelphia: J.B. Lippincott Co., 1997.3.Marieb, Elaine N.
Essentials of Human Anatomy and Physiology, 4
RedwoodCity, California: The Benjamin/Cummings Publishing Co., Inc., 1993.4.Tyldesley, J. Grieve.
Muscles, Nerves and Movement, Kinesiology in Daily Living.
Oxford, London: Blackwell Scientific Publications, 1989.5.34213 Pacific Coast Hwy., Ste. A, Dana Point, CA 92629(949) 496-2821e-mail:firstname.lastname@example.orgFor questions or comments about this web site send e-mail to:email@example.com
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