Hip joint flexion extension abduction adduction External rotation Internal rotation

Ms+n 1-psoas major (lumbar 1.gluteus 1.gluteus 1.pectineus(Femoral 1.piriformis 1.gluteus minimus
plexus) maximus(Inferior minimus n +obturator n) 2.quadratus femoris 2.tensor fasciae latae
2-iliacus (femoral n ) gluteal n) 2.gluteus medius 2.adductor magnus 3.obturator internus (superior gluteal n )
2.semitendinosus (superior gluteal (obturator n + 4.gemellus superior
3.semimembranosus n) sciatic n ) (sacral plexus)
(sciatic n ) 3.adductor brevis 5.obturator externus
4.biceps femoris – 4.adductor longus (obturator n )
long head 5.gracilis
(long head –tibial (obturator n )
branch of sciatic)
(short head-peroneal
branch of sciatic )

Accessory -rectus femoris - -tensor fasciae - - -gluteus meduis

ms -pectineus latae -semitendinosus
-tensor fasciae latae -gluteus -semimembranosus
-sartorius maximus(upper
fibers)
Limited by *contact of the thigh *tension of *tension of distal *contact with other *tension of lateral band of *tension of iliofemoral
+abdomen with flexed -iliofmoral ligament band of leg ilio-femoral ligament ligament(hip extended)
knee -hip flexors iliofemoral *when hip is flexed, *hip medial rotators *tension of ischio-
*hamstring tension with &pubocapsular tension of ischio- capsular ligament (hip
extended knee ligaments femoral ligament flexed)
*hip adductors *hip lateral rotators
ROM 0 to 115-125 115-125 to 0 From midline 0-45 From hip abduction 0-45 0-45
-Beyond midline to midline
0 to 10-15 45-0
resistance -proximal to knee joint -proximal to knee -proximal to knee -proximal to knee -Medial surface of the leg, -Proximal to ankle joint
joint joint joint above ankle joint on lateral side

palpation PM: distal to inguinal Upper and lower Lateral aspect of Medial aspect of Behind the greater TFL: near origin,
ligament portion of the ilium , above thigh trochanter posterior and distal to
muscles greater anterior superior spine
trochanter of of ilium

Substitutions Substitutions:
Or -Sartorius cause lat.
isolate Rotation + abduction
Thigh
-tensor fasciae latae
causes medial rotation
+abduction thigh
Weakness -flexion
effect (loss -disability in :
of) *stair climbing
*walking up and down
the incline
*getting up from a
reclined position
*bringing trunk forward
in sitting position before
rising from chair
Contracture *bilateral*
(lead to ) increased lumbar lordosis
*unilateral*
Abd.+external rotation
femur
Isolation : Substitution: Substitution: - -
GM: test performed (Trunk weakness+ -hip flexors
with knee flexion Substitute by -anterior pelvis
ant.and post. hip tilting
muscles and -pelvis forward
lateral rotation + hip
abdominals extension with
)cause shift of the lower fiber of
pelvis gluteus maximus
*bilateral* - - -weakness will lead to -weakness will lead to
GM: *femur medial rotation *lat. rotation of lower
Walking *pronation of the foot extremity in standing
-need crutches *tendency toward knock- and walking
*raising trunk from knee position
forward-bent
position & patient
must push
themselves using
arms
*will bear weight on
extremity in postero-
lateral displacement
of trunk over femur
(hyperextension of
hip joint)
- - - -limitation of medial rotation -
-while standing the toes
directed outward
Hip joint Flex,abd,external R,with Abduction from Knee Flexion extension Ankle Plantar flexion
knee flexion flexed position joint joint
Ms+n 1.Sartorius(femoral n ) 1.tensor fasciae 1.medial hamstring ms 1.quadriceps 1.soleus
latae(superior 2.lateral hamstring ms femoris (femoral n ) 2.gastrocnemius
gluteal n ) 3.planterais
(tibial n )
Accessory ms -hip and knee flexors -gluteus medius -popliteal m - To foot and ankle plantar
-hip external rotators -gluteus -sartorius m flexors
-hip abductors minimus -gracilis m -tibialis posterior
-gastrocnemius m -peroneus longus
-peroneus brevis

To toe,foot,ankle plantar
flexors
-flexor halluces longus
-flexor digitorum longus
Limited by - - *tension of knee *tension of oblique *tension of anterior
extensor muscles popliteal , cruciate, talofibular ligament
*rectus femoris if the collateral ligaments *tension of ankle
hip extended *knee flexors dorsiflexor muscles
*contact of calf with *contact of posterior porion
posterior of talus on tibia
Surface of thigh
ROM Incomplete ROM of hip Incomplete 0 to 120-130 120-130 to 0 0 to 40-45
flexion, abduction, ROM of hip
external rotation flexion,
combined abduction,
 internal rotation
Combined

#when abduct
hip ROM is ~30
resistance -to flexion& abduction -lateral aspect -above ankle -Anterior part of the Non weight bearing test
:above the knee of the thigh leg just over the
-to lateral rotation: & proximal to ankle -side of the heel
above ankle joint knee -plantar surface of forefoot
palpation Near origin, Below Below origin, at Back of the thigh near QF: between patella Above calcenum
anterior superior iliac fascial insertion the knee & tuberosity of tibia
spine of illium on Lateral side
of knee
Substitutions Substitution: - Substitution: -sartorius - -
Or -iliopsoas or rectus flex the hip while knee
isolate femoris: straight pure flexion initiated
flexion -rectus femoris flex hip
while knee flexion is
completed

Isolation :
-BF: test performed
with lower leg lateral
rotation

-ST&SM: test
performed with lower
 leg medial rotation

Weakness - hip flexion, abduction, - weakness will *unilateral* -going up and down -rise on toes
effect (loss lateral rotation lead to LH :lateral stability stairs -transfer weight forward
of) -antro-medial instability *bow leg MH: medial stability -getting up and causing "gastrocnemius
of knee. position down from limp"
*extremity tend -weakness will lead to Sitting -weakness will lead to
to rotate *unilateral* -weakness will lead
laterally from -pelvic rotation to hyperextended knee
the hip -LH: bow leg position in -posterior knee position in non-weight
weight bearing position , lock knee bearing and standing
-MH: knock knee joint by slight positions
position & lateral hyperextension
rotation of leg on -suddenly push in
femur direction of hyper
*bilateral* extension in growing
-Knee Hyperextension children may result
-anterior pelvic tilting in deformity
-lumber lordosis
Contracture -flexion, - hip flexion *bilateral* -restriction of knee -"Equinus" position of foot
(lead to ) abduction,lateral - knock-knee -Knee flexion position flexion and flexed knee
rotation deformity of hip position -Posterior pelvic tilting
with flexion of knee -Flatten lumbar curve
 Foot Dorsiflexion and inversion Inversion from plantar flexion Eversion from plantar flexion
Ms+n 1.tibialis anterior (peroneal n) 1.tibialis posterior (tibial n) 1.peroneus longus
2.peroneus brevis
(peroneal n)
Accessory - -flexor digitorum longus -extensor digitorum longus
ms -flexor halluces longus -peroneus tertius
-gastrocnemius " medial head"
Limited by *tension of lateral tarsal ligament *tension of lateral tarsal ligament *tension of medial tarsal ligaments
*tension of peroneus longus&brevis *tension of peroneal muscle group *tension of tibialis anterior and tibialis posterior ms
*contact of tarsal bones medially *contact between tarsal bones medially *contact of tarsal bones laterally

ROM Dorsiflexion:20 Inversion:35 Eversion:35

resistance - medial border of forefoot -medial border of foot -PB:lateral border of foot
-PL:plantar surface of 1st metatarsal head
-can be tested togather
palpation Medial volar aspect of ankle Between medial malleolus and navicular PB: joint proximal to base of 5th metatarsal bone, lateral
bone border of foot
Substitutions Substitution: - -
Or -by Extensor halluces longus
isolate
Weakness -dorsiflexion of ankle - -strength of eversion & plantar flexion
effect (loss -weakness will lead to -rise on the toes
of) -Eversion of foot -lateral stability of foot
-weakness will lead to
-foot varus position
Contracture - Can be palpated above medial malleolus -everted or valgus foot position
(lead to ) PL:Can be palpated under 1st metatarsal bone head
 Toes & Flexion of metatarsophalangeal joints of Flexion of interphalangeal joints of Extension of metatarsophalangeal joints
hallux toes toes of toes and interphalangeal joints of
hallux
Ms+n 1.lumbricales -4 small ms- 1.flexor digitorum longus 1.extensor digitorum longus
2.flexor hallucis brevis 2.flexor digitorum brevis 2.extensor digitorum brevis
(tibial n) 3.flexor hallucis longus 3.extensor hallucis longus
(tibial n) (deep peroneal n)
Accessory ms -interossei dorsalis and plantares - -
-flexor digitorum brevis&longus
Limited by *tension of extensor muscles tendons *tension of toes extensor muscle *tension of plantar and collateral
*contact of soft parts tendons ligament of toe joints
*contact of soft parts of phalanges
ROM 0 to 25-35 0 to 50-90 0-80
resistance -beneath proximal row of phalanges FDL: beneath the distal , third row of Extension of metatarsophalangeal joints
phalanges of the lateral 4 toes of lateral 4 toes
FDB:beneath middle row of phalanges -EDL&EDB: at proximal phalanges of toes
FHL:beneath the second & distal Extension of metatarsophalangeal joint
hallux phalanx of hallux
-Medial division of EDB: at proximal
phalanx
Extension of interphalangeal joint of
hallux
-EHL: at dorsal surface
palpation - - EDL:dorsal surface of metatarsals
EDB: lateral side of dorsum of foot
anterior to malleolus
st
EHL:dorsal surface of 1
metatarsophalangeal joint & diagonal line
across dorsum of foot to middle of
anterior aspect of ankle
Substitutions - - -
Or isolate
Weakness -transverse arch muscular support -FDL: invert foot & platar flex -
effect (loss of) -weakness will lead to weakness will lead to
-metatarsophalangeal joints -Distal interphalangeal joints of 4
hyperextension due to sole activity of lateral toes hyperextension tendency
flexor digitorum longus -in weight bearing: tendency to valgus
-distal joints flex causes "hammer toe" foot position

-FDB: longitudinal & transverse arches

muscular support
- flex the proximal interphalangeal
joints of 4 lateral toes

-FHL: inversion & plantar flex

weakness will lead to
-interphalangeal joint hyperextension
tendency
-in weight bearing :tendency to valgus
foot position
Contracture - - -
(lead to)

*
 Trunk flexion
MS+n 1.rectus abdominis (lower
intercostal nerves)
Accessory ms -internal obliques
-external obliques (reverse
action)
Limited by *Tension of posterior
longitudinal ligament,
ligamenta flava, interspinal
and supraspinal ligaments
*tension of spinal extensor
muscles
*apposition of lower lips of
vertebral bodies anteriorly with
surfaces of subjacent vertebrae
*compression of intervertebral
fibrocartilages in front
*contact of lower ribs with
abdomen
rotation
1.external oblique (lower
intercostals ns)
2.internal oblique (lower
intercostal, branch from
iliohypogastric ,sometimes ilio-
inguinal ns)
-latissimus dorsi
-semispinalis
-multifidus
-rotatores
-rectus abdominis(combined
trunk rotation and flexion)
*tension of annulus fibrosus
between vertebrae
*tension of oblique abdominal
muscles on side opposite those
being tested.
*in thoracic aera, tension of
costovertebral ligaments
*in lumbar area, interlocking of
articular facets (rotation
negligible)
extension Pelvis elevation
1.sacrospinalis 1.quadratus lumborum
a- iliocostalis dorsi (lumbar plexus)
(adjacent spinal nerves)
b-longissimus dorsi
c-spinalis dorsi
d-iliocostalis lumborum
2.quadratus lamborum
(T12, L1-2)
-semispinales -
-rotatores
-multifidus
*tension of anterior *tension of spinal ligaments
longitudinal ligament of on the opposite side
spine *contact of iliac crest with
thorax
*tension of anterior
abdominal muscles
*contact of spinous
processes
*contact of inferior
articular margins with
laminae
 ROM In back lying, flexion of thorax
on pelvis is possible until
scapulae are raised from table
fixation -reverse action of hip flexor
muscles
-weight of legs and pelvis
resistance - -
palpation Anterior abdominal wall as
patient attempts to cough,
during rapid exhalation or as
patient attempts to lift head
*NOTE* When Umbilicus moves :
-upward, indicates stronger
contraction of upper section of
muscles
-downward, indicates stronger
contraction of lower section
In back lying, rotation of thorax
is possible until scapula on side
of forward shoulder is raised
from table
-reverse action of hip flexors
muscles
As patient attempts to
approximate thorax on left
pelvis on right
Umbilicus moves toward
strongest quadrant if there is a
difference in strength of
opposing oblique muscles
*
` Thoracic spine extends
only to approximately a
straight line
` lumbar spine extend
freely
-contraction of gluteus
maximus and hamstring
muscles
-weight of pelvis&legs
- thoracic spine : on upper
thorax
-lumbar spine: lower
thoracic area
When patient attempts to
raise trunk palpate to
determine degree of
contraction
- -
In standing, pelvis raised on
one side until foot is well
clear of floor (reverse action
of quadratus lumborum)
-contraction of spinal
extensor muscles to fix
thorax
-traction on the extremity
directly opposing the line of
pull
In lumbar area under lateral
edge of erector spine
 Neck flexion extension
Ms+n 1.sternocleidomastoid (spinal accessory and 1.trapezius -upper fibers-
C2,3) (spinal accessory&C3-4)
2.semispinalis capitis 3.semispinalis cervicis (posterior rami of
spinal nerves)
4.splenius capitis
5.splenius cervicis
(posterior rami of middle and lower cervical nerves)
6.sacrospinalis -cervical and capitate section not illustrated-
a.iliostalis cervicis(adjacent spinal nerves)
7.longissimus capitis
8.longissimus cervicis
9.spinalis capitis
10.spinalis cervicis

Accessory ms -longus capitis -multifidus

-longus colli -obliquus capitis superior and inferior
-scalenus anterior -rectus capitis posterior major and minor
-scalenus medius -levator scapulae
-scalenus posterior
-rectus capitis anterior
-infrahyoid group
Limited by *Tension of posterior longitudinal ligament, *tension of anterior longitudinal ligament of spine
ligamenta flava, interspinal and supraspinal *tension of anterior neck muscles
ligaments(ligamentum nuchae) *approximation of spinous processes
*tension of posterior muscles of neck
*apposition of lower lips of vertebral bodies
anteriorly with surfaces of subjacent vertebrae
 *compression of intervertebral fibrocartilages
in front

ROM Cervical spine flexes to just beyond point Cervical spine extends until head contacts posterior muscle
where convexity is straightened (greatest part mass of upper trunk
of motion takes place in atlantooccipital joint)
fixation -contraction of anterior abdominal muscles -contraction of spinal extensors of thorax and depressors of
-weight of thorax and upper extremities scapulae & clavicles
-weight of trunk and upper extremities
resistance -in "bilateral test" On occiput
On forehead
-in "left side"
Above ear
palpation On each side of neck as patient attempts to Posterior area of the neck
flex
Substitutions Isolation:
Or isolate If there is a difference in strength of the two
sternocleidomastoid muscles, they may tested
separately by rotation of head to one side and
flexion of neck
*
Muscles of Ms+n
Face 1.frontalis -frontal belly-
(temporal branches of facial n)
2.corrugator supercilii (temporal and zygomatic branches of facial n)
3.procerus (buccal branches of fascial n)
4.nasalis (buccal branches of fascial n)
Eye 1.orbicularis oculi (temporal and zygomatic branches of facial n)
2.levator palpebrae superioris
3.rectus superior
4.rectus inferior
5.rectus medialis
6.inferior oblique
(oculomotor n)
7.rectus lateralis (abducent n)
8.superior oblique(trochlear n)
Mouth 1.orbicularis oris
2.zygomaticus minor
3.Levator anguli oris
4.zygomaticus major
5.buccinator
6. depressor labii inferioris
(buccal branches of facial n )
7.risorius
8.depressor anguli oris
9. mentalis
(mandibular &buccal branches of facial n )
10.platysma (cervical branch of facial n)
mastication 1.temporalis (deep temporal ns from mandibular division of facial n)
2.masseter (masseteric nerve from mandibular division of trigeminal)
3.plerygoid externus (external pterygoid n from mandibular division of trigeminal)
4.pterygoid internus (internal pterygoid n from mandibular division of trigeminal)
5.mylohyoid (trigeminal n )
6.geniohyoid (C1- via hypoglossal)
7.digastricus (posterior belly, trigeminal;anterior belly, facial)
8.styloyoid (facial n)
9.styreohyoid (C1/2- via hypoglossal)
10.sternohyoid
11.sternothyroid
12.omohyoid
(C1/2/3-via ansa hypoglossi)