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Exam 3 LGT
Fibula:
Anterior fibular head
Posterior fibular head
Question 1
A pt reports to your clinic. She works as a grocery store cashier,
has 12 hour shifts, and has worked 7 days a week for the past 9
years. She comes to your office complaining of knee pain, which
you localize to the posterior knee during your examination.
Which of the following statements is most accurate?
A. The force for the appropriate technique for this situation is directed
superiorly and anteriorly.
B. The force for the appropriate technique for this situation is directed
inferiorly and anteriorly.
C. Your left and right thumbs will be applying the activating force
D. You use an indirect force as part of the treatment
E. The pt is asked to participate in the treatment through respiratory
cooperation
Direct MFR: Popliteal Fascia
Procedure:
1. With the patients leg relaxed
place your fingertips just
above the popliteal fossa.
2. Fingers of both hands are
bent with the fingernails of the
two hands facing each other
and thenar eminences about
3 apart to form a plow
shape.
3. Press anteriorly just superior
to popiliteal fossa.
4. Draw the fingers inferiorly
until resistance is felt, then
hold until the release occurs.
Question 2
The fibular head has two primary motions. They are
______ and ______.
A. Anterior; posterior
B. Anteriomedial; posteriorlateral
C. Anteriorlateral; posteriormedial
D. Rotation; flexion
Fibular Head Somatic Dysfunction
The head of the fibula is
grasped between the thumb
and index fingers and moved
anterolaterally and
posteromedially along its
plane of motion
Is there restriction in either
direction?
If the fibular head prefers
anterior motion with restriction
of posterior motion, it is
termed anterior fibular head
somatic dysfunction
Question 3a
A patient presents to your clinic with LE pain which as
been ongoing for several days. Upon examination, you
find that the patients distal aspect of his fibular prefers
posterior motion.
A. Balance the patients fibular head between your thumbs and apply posterior force
while utilizing Muscle Energy to guide the fibula back
B. Grasp the patients fibular head between your thumb and 2 nd digit and dorsiflex
the patients foot, asking them to plantarflex while you apply a posterior force at the
distal fibula
C. Grasp the patients fibular head between your thumb and 2 nd digit and plantarflex
the patients foot, asking them to dorsiflex while you apply an anterior force at the
proximal fibula
D. Grasp the patients fibular head between your thumb and 2 nd digit and plantarflex
the patients foot, asking them to dorsiflex while you apply a posterior force at the
proximal fibula
ME: Fibular Head Anterior
(seated)
Treatment:
1. Patient is seated with legs
hanging.
2. Operator is seated in front of
the patient.
3. Operator grasps fibular head
with thumb and presses
posteriorly.
4. Other hand is used to plantar
flex and invert the foot.
5. Patient is instructed to evert
and dorsiflex foot against
operator counterforce for 3-5
sec.
6. Patient relaxes 2-3 sec and
doc moves to new barrier
7. Repeat several times for
correction.
Question 4
Which of the following pieces of information regarding a
patients history would be most applicable in
differentiating between the use of Direct MFR Popliteal
Fascia vs. Supine Direct Ligamentous Articular Release
Fibular Head and Interosseous Membrane?
REVIEW
JSCS: Gastrocnemius
Treatment:
Treatment is usually aimed
at the medial head of the
gastrocnemius (although
the lateral should also be
assessed).
The ankle is strongly
extended with the patient
prone (pressure is kept
high on the instep to avoid
straining the metatarsals)
REMEMBER: your usual
J-SCS protocol!
Question 6
While on rotations you meet a patient who had just come
back from a camping trip, during which he was forced to run
from a bear. During his escape (the patients, that is), he
fell and injured himself. He now has pain in his lower leg
and ankle you find SD in his knee, fibula, ankle joint.
What is the first treatment youll do (assuming he doesnt
need emergent care)
A. You will call the forest rangers to hunt the bear down
B. You will do cranial manipulation on the pt
C. You will treat the ankle joint first
D. You will treat the knee first
E. You will treat the fibula first
Usually treat the Fibula before the
ankle and foot!
Question 7
The transverse arch is comprised of:
Cuboid
Navicular
Three
Cuneiforms
Proximal
ends of
metatarsals
Question 8
During the Talus Tug technique, which finger(s) is/are
placed on the head of the Talus?
Recheck
Question 9
Usain Bolt comes to your office seeing your expert medical
advice. He recently rolled his ankle while trying to break
the sound barrier by foot. After your workup, you localize
the SD to his Talus. What is MOST LIKELY shift in the
Talus?
A. Anteriomedial
B. Posteriorlateral
C. Anteriolateral
D. Posteriormedial
E. Left shift
Articulatory with Traction:
Talocalcaneal SD
Findings: SUBTALAR JOINT
1. EVERSION OF FOOT:
2. Anteromedial shift of talus
(restriction of foot inversion)
3. INVERSION OF FOOT
4. Posterolateral shift of talus
(restriction of foot eversion)
Treatment Procedure
GAIT
Initial contact Other
Terminal swing terminology:
Heel strike
Foot flat
Loading response
Push-off
Mid-swing Knee bend
Toe-off
Acceleration
Mid-stance
Deceleration
Initial swing
Terminal stance
Preswing
Propulsion and Stability:
A. L2-S1
B. S2-4
C. L1-L5
D. L4-S3
E. T10-L2
Question 12b
Pt presents with hip and buttock pain and discomfort that
radiates down the back of their left thigh (but not past their
left knee).
Sciatica = Radicular pain in the distribution of a sciatic nerve root (L-4, L-5, S-1, S-2,
or S-3), usually producing symptoms along the posterior or lateral aspect of the lower
extremity extending to the ankle or foot
May include pain in the distribution of that root, dermatomal sensory disturbances,
weakness of the muscles innervated by that root, and hypoactive stretch reflexes
Question 13
The true knee joint is composed of _____ ?
Posteriolateral view
Important Points (maybe..)
Normal Q-Angle
10 to 12
Genu Valgus
Angle increased
Knock-kneed
Genu Varus
Angle decreased
Bowlegged
Tibia & Fibula
Proximal Tibiofibular Joint
Separate synovial joint from knee
Same horizontal plane as tibial plateau
Clinical relevance: common fibular n.(aka peroneal n).
posterior to fibular head
Distal Tibiofibular Joint
Syndesmosis joint
Allows fibula to move laterally from tibia
Interosseous Membrane
Fibrous connective tissue between tibia and fibula
Most fibers run inferolateral
Allows sharing of compressive forces & movements
Knee to ankle & Tibia to fibula
Can translate and store somatic
dysfunction from proximal/distal fibula
Reciprocal Motions of the Fibula
Posterior Fibular Head
A. Grade I
B. Grade II
C. Grade III
D. Grade 1a
E. Grade 2b
Types of Inversion Sprains
Grade I: mild lateral ankle pain
with sl. edema, no laxity
(ATF) partial tear
Transverse Arch
Metatarsal Arch
A. Quadratus Lumborum
B. Iliacus
C. Psoas
D. Rectus Femoris (bilat)
E. Sartorius
Diagnosis of Tight / Short
Extensors
Flexion Restriction = Extension Somatic
Dysfunction (S/D)
Slowly increase flexion to
point of resilient barrier
Estimate degree of flexion
(Optimal is 90)
Compare to contralateral limb
The limb that resists
flexion is positive