Mmt Substitutions

Front 1

iliopsoas

Back 1

(1) abdominals will posteriorly tilt the pelvis
(2) Sartorius-patient will laterally rotate or abduct
(3) Rectus femoris-patient will posteriorly tilt pelvis or lean trunk backwards
(4) TFL-patient will medially rotate or abduct

Front 2

sartorius

Back 2

(1) Iliopsoas: palpate for correct muscle
(2) lateral rotators-keep the motion combined and fluid
(3) Rectus femoris and hip abductors (will cause a combined flexion abduction); palpate for correct muscle and ask for smooth, combined motion

Front 3

TFL

Back 3

(1) posterior gluteus medius-keep hip flexed and medially rotated
(2) hip flexors-make sure the motion is combined hip flexion and abduction
(3) sartorius-keep hip in medial, not lateral rotation

Front 4

hip medial rotators

Back 4

(1) Peroneals: patient may evert foot, giving appearance of hip medial rotation
(2) Quad: patient may extend knee and appear to be rotating
(3) Adductors: adduction may give appearance of medial rotation
(4) Medial hamstrings: will substitute and medially rotate; palpate
(5) Hip hikers: hiking the hip will give appearance of rotation; STABILIZE the pelvis

Front 5

hip lateral rotators

Back 5

(1) tibialis anterior and posterior and long toe flexors-patient may invert the foot giving the appearance of lateral rotation
(2) Hip abductors and/or flexors
(3) Lateral hamstrings may substitute; palpate
(4) Sartorius: patient may lift off the table, flexing during lateral rotation (don't allow flexion)

Front 6

hip adductors

Back 6

(1) medial hamstrings-make sure the knee stays extended and palpate
(2) Hip flexors: don't allow the patient to flex the hip
(3) Gluteus maximus: don't allow the patient to extend the hip

Front 7

Gluteus medius

Back 7

(1) lateral abdominals-don't allow hip hiking
(2) tensor fascia latae-don't allow patient to medially rotate or flex and then abduct, make sure hip is neutral
(3) Gluteus maximus: patient may extend hip farther
(4) Pushing against the table with the opposite LE can cause hip abduction on tested LE
(5) Rectus femoris: patient may activate by laterally rotating the hip

Front 8

gluteus maximus

Back 8

(1) Hamstrings: make sure knee is relaxed in flexion (knee may extend when using hamstrings)
(2) Adductor magnus: keep hip in neutral abduction/adduction
(3) posterior gluteus medius: don't allow hip to abduct or laterally rotate
(4) make sure lumbar spine is not extending

Front 9

quadriceps femoris

Back 9

(1) hamstrings-do not allow the patient to flex the knee and then relax suddenly and allow the leg to "bounce" into extension
(2) rectus femoris-patient may lean backward and extend their hips
(3) patient may dorsiflex foot or rotate the leg, giving the appearance of more extension

Front 10

hamstrings

Back 10

(1) sartorius: make sure the hip does not flex or laterally rotate; keep hip in neutral and palpate
(2) Gracilis: make sure the patient does not adduct the hip
(3) Gastrocnemius: Do not allow the patient to dorsiflex the ankle to lengthen the gastrocnemius

Front 11

tibialis anterior

Back 11

(1) extensor digitorum and extensor hallucis longus-make sure the toes are relaxed, not extended
(2) tibialis posterior-do not allow the patient to plantarflex-make sure ankle stays in dorsiflexion

Front 12

Tibialis posterior

Back 12

(1) Tibialis anterior-keep patient in slight plantar flexion-do not allow them to move into dorsiflexion
(2) Gastroc-do not allow too much plantarflexion-relaxed position
(3) Flexor digitorum and flexor hallucis longus-make sure toes are relaxed, not going into too much flexion

Front 13

Fibularis Muscles

Back 13

(1) Extensor digitorum longus-make sure toes are relaxed
(2) Peroneus tertius-do not allow the ankle to dorsiflex
(3) Toe flexors-do not allow inversion and plantar flexion
(4) Gastroc-do not allow excessive plantar flexion

Front 14

gastrocnemius

Back 14

(1) Soleus-make sure the knee stays extended
(2) Upper extremity action pushing against table (against gravity)
(3) Toe flexors-only allow forefoot action
(4) Tightness of heel cords could cause appearance of plantarflexion when subject leans forward
(5) Tibialis posterior-do not let the subject invert the foot to get more range

Front 15

soleus

Back 15

(1) do not allow the knee to extend (gastrocnemius)
(2) Toe flexors-do not allow forefoot movement
(3) Tibialis posterior-do not allow foot to invert
(4) Fibularis muscles-do not allow foot to evert

Front 16

Extensor digitorum longus and brevis

Back 16

(1) Do not allow too much plantar flexion-will stretch extensor tendons and produce extension by passive tension
(2) FDL/FDB: release of flexion may cause appearance of toe extension (do not allow toe flexion)

Front 17

extensor hallucis longus and brevis

Back 17

(1) Flexor hallucis/brevis-by flexing the toe and then relaxing, it gives the false view that the great toe extended; don't allow great toe flexion
(2) Abduction using the intrinsics can cause extension of toe

Front 18

Lumbricales

Back 18

Flexor digitorum longus and brevis: do not allow the patient to flex the IP joints (requires complete MP flexion and IP extension to determine performance)

Front 19

Flexor Hallucis Longus/Brevis

Back 19

(1) Extensor Hallucis Longus/Brevis: patient may extend the great toe and then relax, giving the appearance of toe flexion
(2) Adduction of the toe may give appearance of flexion
(3) Other toes may overlap, helping to flex the great toe; do not allow this to happen; manually keep them out of the way
(4) For flexor hallucis brevis, do not allow IP flexion (longus trying to take over)

Front 20

Flexor digitorum longus/brevis

Back 20

(1) do not allow patient to dorsiflex, because flexor tendons will stretch
(2) Stabilize to eliminate intrinsics
(3) EDL/EDB: extending the toes and then releasing will give the appearance of flexion, do not allow extension
(4) Do not allow the toes to cross over one another and help

Front 21

abductor hallucis

Back 21

(1) Flexor hallucis longus/brevis-do not allow great toe flexion
(2) extensor hallucis longus/brevis-do not allow great toe extension