Before beginning the functional assessment of the lower extremity, it is important to perform a postural assessment. Looking at the static posture of an individual can reveal misalignment of the knees, toe out, femoral rotation, and a high or rotated pelvis. Lower crossed syndrome is associated with tight erectors and iliopsoas muscles, as well as inhibited abdominals, gluteus maximus muscles, and hamstrings. Anterior pelvic tilt increases the strain on lengthened muscles and increases the loading of facets.
Patrick’s, Thomas, Obers, and Trendelenberg orthopedic tests can be utilized for assessment of the lower extremity. The Trendelenburg sign assesses the gluteus medius muscle. A positive finding is dropping of the hip on the unsupported side, which indicates gluteus medius weakness. It is also important to utilize the functional movement assessment, such as the squat, single-limb stance, step-down, hip abduction coordination, and gait analysis.
Last, it is important to assess balance and stability, including global and local stability. Global stability is the ability to maintain the center of gravity within the base of support. Local stability is functional stability, and is the ability to maintain joint centration through motion or stabilization. Many individuals come into the chiropractor with a functional instability, which describes repetitive joint instability in the presence of normal joint strength and structure. Proper evaluation of the lower extremity is important in the treatment of an individual with a lower extremity complaint.
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