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Isolation Test.

To isolate the hamstrings, use an


active resistive manual muscle test. Instruct the patient to flex the knee on the involved side while the doctor contacts the
posterior distal tibia with the palm of the hand to apply resistance to the knee flexion (Figure 1 4-30). Look for reactivity of the
PD leg in Position #1.
Adjustment. To adjust for hamstring involvement, use two thrusts. First, contact the myotendon junction of the medial hamstrings.
The LOD is directed posterior to anterior (Figure 14-3 1 ). The second contact is at the myotendon junction of the lateral
hamstrings. The LOD is also directed posterior to anterior (Figure 1 4-32). Be aware of any varicosities or Baker's cysts in this
area, and avoid adjustive contact with them by altering the contact point as needed.
Quadriceps Involvement
When a patient presents with a patellofemoral tracking problem, chondromalacia of the patella, external rotation of the tibia, or
myofascial pain of the quadriceps muscles, consider testing for dysfunction of the quadriceps.
Isolation Test. To isolate for quadriceps
involvement, use an active resistive manual
muscle test. With the patient's knee in less than 90 degrees of flexion, instruct the patient to straighten the leg while the doctor
contacts the anterior distal tibia and applies resistance to knee extension (Figure 1 4-33 ). Look for reactivity of the PD leg in
Position #1.
Adjustment. Place the patient in a supine position. The contact point for quadriceps involvement is the vastus medialis myotendon
junction, just medial and slightly superior to the patella. The LOD is anterior to posterior (Figure 1 4-34).
Gastrocnemius Involvement
When a patient presents with hypertonicity of the calf muscles, myofascial pain of the gastrocnemius muscle, chronic Achilles
tendonitis, or a superior calcaneus, consider testing for neuroarticular dysfunction of the gastrocnemius muscle.
Isolation Test To isolate the gastrocnemius,
use an active resistive manual muscle test. With the patient's knee in less than 90 degrees of flexion, instruct the patient to
plantarflex the foot while the doctor contacts the plantar surface of the foot, applying resistance to plantar flexion (Figure 14-35).
Look for reactivity of the PD leg in Position #1.

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