OMM Practical 1 Block 1

Week 1 ROM
(Point is to look for TART during all these exercises)
Active ROM
(Standing – Feet shoulder width apart)
 Flexion at the hips
o Ask partner to bend forward and touch tip of toes without bending knees
 Extension at the hips
o Ask partner to look back over head while keeping knees straight. Estimate from
lateral view number of degrees from vertical in the sagittal plane
 Sidebending at the waist
o Ask partner to sidebend without flexion or extension. Observe from anterior or
posterior view. Evaluate fingertip distance
 Active Shoulder Flexion and Extension
o Ask partner to raise hand in sagittal plane until elevated as far as possible. The ask
partner to extend their arm backwards. Evaluate from lateral view degrees of
flexion and extension
 L and R arm Flexion (180 degrees)
 L and R arm Extension (50 degrees)
 Active Shoulder Abduction:
o Ask partner to raise hands in the coronal plane and try to have dorsums of hands
touch over their head; elbows straight! Note any restrictions
 Abduction of L and R arm (180 degrees)
 Shoulder Active Horizontal Abduction and Adduction
o Start with arm straight out in front and ask partner to bring arm across body. Then
have them return to starting position and move arm posteriorly. Evaluate shoulder
and what is happening there.
 R and L arm horizontal adduction (45-50 degrees)
 R and L arm horizontal abduction (130-145 degrees)
 ACTIVE Shoulder internal and external rotation
o Arm held perpendicular to ground with elbow flexed at 90 degrees. When move
forearm away from body in transverse plane, get external rotation. When forearm
moves toward body get internal rotation. View from lateral side
 R and L external and internal rotation (90degrees)
Seated
 Active rotation of the spine
 o Ask partner to cross their arms and look as far left and right as possible without
moving hips. Evaluate from above, use nose or chin as indicator; standing behind
patient
o Also evaluate thoracic and spine rotation by observing acromion on both
shoulders
 Active Elbow Flexion and Extension
o Ask partner to flex elbow and then extend it. Lateral view
 R and L flexion (135 degrees)
 R and L extension (0-8 degrees)
 Forearm supination and pronation
o Pronation (70-90 degrees)
o Supination (90-110 degrees)
 Active wrist flexion/palmar flexion and extension/dorsiflexion
o Have partner flex and extend both wrists
 R and L wrist flexion (90 degrees)
 R and L wrist extension (70 degrees)
 Wrist abduction/radial deviation and adduction/ulnar deviation
o Evaluate using line from center of wrist that goes through middle finger
 All normal degrees here are 60
 Hip internal and external rotation
o Have patient invert ankle (external rotation) and evert ankle (internal rotation)
 All degrees should be approximately 45
 Ankle plantar flexion and dorsiflexion
o Dorsiflexion R and L foot (20 degrees)
o Plantar flexion R and L foot (45 degrees)
 Ankle Inversion and Eversion
o Inversion (35 degrees)
o Eversion (20 degrees)
Supine
 Active Hip flexion (when pelvis moves, hit end point)
o Knee straight (90 degrees)
o Knee flexed (135 degrees)
o Note: Hip ROM when knee is flexed or straight is different because of the hip
extensors, the hamstrings, which are 2 joint muscles. So when knee flexed, can
flex hip further.
 Hip internal and external rotation
o Flex hip and knee to 90/90 degrees and keep other leg straight and flat. Ask
patient to rotate flexed leg away from other leg (internal rotation)
o Then have patient rotate flexed leg towards other leg (external rotation)
 R and L ext and int rotation 45 degrees
 Hip Abduction
 o Abduct straight leg
 R and L hip (45 degrees)
Prone
 Active Hip Extension
o Lift thigh off table (20 degrees)
 Knee flexion
o Flex knee (R and L knee 130 degrees)

Passive ROM
Standing
 Shoulder Passive horizontal abduction and adduction
 PASSIVE shoulder internal and external rotation
Seated
 Passive rotation of the cervical spine
o One hand stabilizes shoulder, other on top of patient’s head and gently rotate head
to left and right. Posterior view
 L and R rotation (90 degrees)
 Passive sidebending of the cervical spine.
o One hand holds shoulder, other gently sidebends head left and right. Posterior
view
 R and L sidebending (45 degrees)
 Passive flexion/extension of the cervical spine
o Flex and extend patient’s head- lateral view and use jaw as a measure of angle
 Flexion (90 degrees)
 Extension (45 degrees)
 Passive Elbow Flexion and Extension
o Expect increase in flexion, but not extension, why??
 Forearm supination and pronation
 Passive wrist flexion/palmar flexion and extension/dorsiflexion
 Wrist abduction/radial deviation and adduction/ulnar deviation
 Hip internal and external rotation
 Ankle plantar flexion and dorsiflexion
 Ankle Inversion and Eversion
Supine
 Hip internal and external rotation
 Passive Hip flexion
o Knee Straight
 o Knee flexed
 Hip Abduction and adduction
o Abduct straight leg
o Adduct by picking up passive leg and crossing examined leg under it

Prone
 Passive Hip Extension
 Knee flexion

Week 2: Soft Tissue

1. Cervical, forward bending 1. pg. 83

2. Cervical, contralateral traction 2. pg. 84
3. Cervical, suboccipital release 3. pg. 86
4. Thoracic, prone pressure 4. pg. 94
5. Lumbar, prone pressure 5. pg. 105
6. Lumbar, prone pressure, counterleverage 6. pg. 109

Week 3 BASIC STRUCTURAL SCREENING EXAMS

Standing and Seated

1. INITIAL OBSERVATION
a. GENERAL: briefly observe habitus, gross asymmetries, obvious deformities, difficulty in
moving from sit to stand and gait
b. GAIT
i. General: limp, asymmetry, smooth/hesitant/uneven steps
ii. Feet: Foot position—toes in or out and heel to toe weight transfer
iii. Knees: Knock knee (valgus) bowlegged (varus)
 iv. Hip motion—lateral and vertical
v. HAT: HEAD, ARMS, TORSO—arm swing, side to side excursion, and head
movement
c. STANDING
i. Proprioception/Balance
1. Squat on both feet (observe motion down and up)
a. If elderly, have patient hold on to object (desk, chair, table) for
support and the need for assistive device
2. Stand on one leg with eyes open from 10-15 seconds
a. Looking for declination (wobble)
b. Note differences on both sides
3. Trendelenberg sign
a. Stand BEHIND patient
b. Observe the hip (iliac crest) on the unsupported side (should be
ABOVE the corresponding landmark on the supported side)
i. If not, suspect gluteus medius weakness, hip
dislocation, fractured femoral head or severe coxa vara
(abnormal shaft-neck angle of femur)
2. ANTERIOR SCREENING EVALUATION
a. FACE: passive—observe for facial asymmetry (eyes, nose, jaw, lips)
i. SMILE (observe mouth and cheeks)
ii. FROWN (observe forehead lines)
b. EARS: observe earlobes and mastoid processes for asymmetry
i. PALPATE mastoid processes (below and behind ear)—more reliable landmark
than the mandible of the jaw
c. TMJ (Temporomandibular Joint)
i. Observe jaw relative to rest of skull
ii. Ask patient to slowly “open wide” and close his/her mouth
iii. PALPATE the TMJ bilaterally
1. Back line of the jaw—mandibular ramus and condyle until you feel a
bone (zygomatic process) at top of the jaw
2. Ask patient to slowly open and close mouth
3. Observe deviation from straight line by observing tip of jaw (mentum)
4. Deviation=often muscle imbalance of the lateral/medial pterygoid
muscles (controls jaw opening/closing)
5. Note any asymmetry
d. STATIC HEAD POSITION
i. Centered? Left or right?
ii. Tilted or rotated?
e. ACROMION PROCESSES
i. Check left and right for levelness
ii. May put thumbs at tips of the patient’s acromion processes and hold thumbs
horizontal—observe an imaginary line across the medial border of the thumb
f. CARRYING ANGLE
i. Angle at the elbow formed by the humerus and the forearm when the arm is in
the anatomic position
ii. Different for men and women—why? Women generally have wider hips
g. RIB CAGE
i. Left and right
ii. Observe costal margin if possible
h. ILIAC CREST
i. PALPATE iliac crests with forefingers horizontal to the ground and pointing to
the rear
ii. Look across tops of fingers for levelness
i. GREATER TROCHANTERS
i. Palpate the bony prominence about 3-4 in. below iliac crest
ii. Check for levelness (same finger position as above)
iii. Why evaluate iliac crest AND greater trochanters? What different information
will each landmark give?
1. Guessing- iliac crest will show if problem with pelvis, greater
trochanters tell if issue with femur and problem with femur could
explain why knock knee or bowleg.
 j.KNEES
i. Visually observe knees—is the leg from hip to ankle relatively straight?
ii. Are knees close together?—knock knee (genu valgum)
iii. Are knees widely spread apart?—bowleg (genu varus)
k. FEET AND ARCHES
i. Look for asymmetry in foot angulation in static standing position
ii. Excessive medial deviation (pigeon toed) or lateral deviation (duck feet)
iii. Arches—flat foot (pes planus) and lateral deviation of the foot often go together
3. LATERAL SCREENING EVLAUATION
a. GRAVITY LINE
i. Ideal posture causes least stress on joints and least muscular effort
ii. Ideal gravity lines runs through: Earlobebodies of cervical
vertebraeacromion processbodies of lumbar vertebraeslightly posterior
to the hip jointslightly anterior to the axis of the knee jointjust anterior to
the lateral malleolus
b. HEAD AND NECK POSITION
i. Is head centered over shoulders?
ii. Is head protracted (head forward)? Student stretch?
1. What muscles will need to be treated?
c. SHOULDER POSITION
i. Are shoulders protracted (forward, hunched)?
ii. Are shoulders retracted (“military brace”)?
d. VERTEBRAL CURVES
i. Cervical lordosis
ii. Thoracic kyphosis
iii. Lumbar lordosis
iv. Are any accentuated, reduced or absent?
e. KNEES
i. Look for hyperextension of knees (genu recurvatum)
4. POSTERIOR SCREENING EVALUATION
a. EARS
i. Check for symmetry
b. SHOULDERS (Functional exam)
i. Ask patient to raise arms overhead to touch the backs of their hands overhead
(may need to demonstrate this for patient)
ii. Observe ROM, approximation of the arms to the ears, and the elbows which
should not be flexed
iii. Ask patient to bring arms forward and touch hands together at shoulder level
1. Observe motion, quality and ROM
c. ACROMION PROCESS (PALPATE)
i. Evaluate for asymmetry in coronal plane (superior or inferior)
d. INFERIOR BORDERS OF SCALPULAE (PALPATE)
i. Observe for symmetry in coronal plane (superior or inferior)
e. ILIAC CRESTS (PALPATE)
 i. Palpate for symmetry
ii. Why repeat this evaluation in this view?
f. PELVIS (STATIC)
i. SIT ON STOOL!!
ii. Find PSIS (just lateral and inferior to the sacral sulci)
iii. Static exam (asymmetry indicates pelvic rotation)
g. PELVIS (FUNCTIONAL EXAM)—STANDING FLEXION TEST
i. Place thumbs on base of PSIS and ask patient to bend forward at the waist—SIT
ON STOOL
ii. Follow movement by keeping thumbs at inferior border of PSIS
iii. Note and record if one side moves further than the other
1. Side that moves furthest indicates an innominate dysfunction on that
side
h. SPINE (SCOLIOSIS SCREEN/SCHEUERMANN’S DISEASE)
i. Observe for lateral curvature—SIT ON STOOL
ii. Ask patient to bend at waist slowly and observe curvature of spine with eyes at
level of curve
iii. Note asymmetry between the muscle masses on the left/right of vertebral
column
iv. Asymmetry is called scoliosis
v. Significant bending (flexion) in mid thoracic area (excessive kyphosis) without
lateral curvature is Scheuermann’s disease
i. SPINE (FUNCTIONAL EVALUATION-FLEXION ROM)
i. Ask patient to bend forward with knees straight as far as he/she can
comfortably
ii. Observe distance from fingertip to hand or hand landmark (DIP, PIP, MCP, Palm)
that contacts the floor

NOTE: Dr. Morris will consider g-i to be 3 parts in one exercise so all 3 are part of one.

j.SPINE (FUNCTIONAL EVALUATION-SIDEBENDING)

i. Ask patient to sidebend without flexion or extension—attempting to reach floor
with fingertips
ii. Observe distance from fingertip to floor
iii. Side with greater distance may have a lumbar somatic dysfunction
k. FEET
i. Observe arches and Achilles tendon
ii. Look for angulation of Achilles tendon (hind foot-valgus, varus?)—indicating
structural foot problems
5. SEATED SCREENING EVALUATION (Examinee is seated)
a. Observe landmarks noted in standing evaluation with patient seated (from BEHIND
patient)
i. Note differences from standing evaluation
ii. Lower half of body is no longer supporting the upper body and by deduction you
may infer where some of the asymmetries originate.
 iii. Check head, ears, acromion
b. CERVICAL SPINE
i. AROM and PROM for
1. Flexion/extension
2. Left and right sidebending
3. Left and right rotation
4. Note ROM differences, end feel and quality of motion
c. CERVICAL MUSCULATURE (PALPATION)
i. Palpate muscles of cervical spine starting at lower border of occiput
ii. Move down the cervical muscles both immediately paraspinal and lateral to the
vertebrae
iii. Follow muscles across shoulders to acromion processes
iv. Palpate for tissue texture changes, tenderness, and hyper/hypotonicity
d. TISSUE TEXTURE CHANGE OF THORACIC, RIBS, AND LUMBAR
i. Palpate back musculature parallel to vertebral column (erector spinae muscles)
1. Note asymmetries
ii. Palpate further lateral over the ribs to the lateral border of the scalpulae
1. Note asymmetries
iii. Palpate down to iliac crests to include the lumbar spine
iv. Is there a difference between the shape of the spinous processes of the
thoracic and lumbar spine?
e. UPPER THORACIC SPINE (FUNCTIONAL EVALUATION)
i. Palpate upper thoracic area (T1-T4)
1. With your other hand, gently move the head—sidebending left and right
2. Feel movement of thoracic vertebrae as you move the head and note
any restrictions or changes in position (vertebral rotation as indicated by
one transverse process becoming more prominent with movement) of
vertebra
f. MID THORACIC SPINE (FUNCTIONAL EVALUATION)
i. Palpate mid thoracic (T5-T9) area with one hand
ii. With other hand, placed mid-way between neck (cervicothoracic junction) and
acromion, push the shoulder down towards the table to induce sidebending
iii. Palpate for restrictions or asymmetry of each vertebra
g. LOWER THORACIC AREA (FUNCTIONAL EVALUATION)
i. Palpate lower thoracic area with one hand
ii. With other hand, placed at tip of shoulder, push down towards the table
h. SACRUM AND PSIS (STATIC EVALUATION)
i. Place hands on iliac crests and allow thumbs to drop into sacral sulci
ii. Evaluate sulci for symmetry (left/right, superior/inferior) and depth
iii. Palpate PSIS for same characteristics
iv. Note differences between sitting and standing assessments of static position
v. Why palpate both when they are so close together? (Sacral sulci will tell if
asymmetry with sacrum, PSIS looks for asymmetry with pelvis)
i. SEATED FLEXION TEST
 i. Place thumbs on inferior border of PSIS
ii. With patient’s feet supported, ask patient to bend forward as far as they can
comfortable and monitor motion of PSIS
iii. The PSIS that moves last indicates a somatic dysfunction on that side. If the
laterality of the test is different between the standing and seated flexion test,
what does that tell you about where the problems may be?

Week 4 Osteopathic Screening Exam

Supine and Prone

Supine

1. HIP FLOP (SUPINE)

a. Have patient lift his/her hips off the table and let their hips drop to the table.
b. Purpose—to center the body on the table (if knees are not aligned, there could be a
problem with the femur or innominate rotation)
2. LEG LENGTHS (SUPINE)
a. Place thumbs under medial malleoli so that thumbs point toward the table
b. Evaluate relative leg lengths by sighting across the tops of your thumbs.
c. If there is a discrepancy, where could it be? (leg lengths could differ)
3. LOWER EXTREMITY FASCIAL DRAG (SUPINE)
a. Gently grasp ankles with a minimum of force distract the legs (pull gently)
b. Assess for any differences in restrictions
c. Gently sway legs side to side and evaluate for restrictions (this checks for leg abductors
and adducters)
4. STRAIGHT LEG RAISE (SUPINE)
a. Evaluate from position LATERAL to patient
b. Grasp ankle posteriorly (from below) with one hand and monitor the ASIS and
innominate with the other, once it moves we started measuring hip.
c. Raise ankle, flexing the whole leg, until resistance is felt
d. Note carefully where arc of movement and innominate begins to move.
e. NROM (PASSIVE)= 90 DEGREES (look for pain between 20-70 degrees)
i. More difficult to attain with age and/or sedentary occupation
f. Note any back pain with maneuver and note quality of maneuver
i. Diagnostic for bulging disk
5. KNEE, DISTAL LEG (INTERNAL AND EXTERNAL ROTATION—SUPINE)
a. From LATERAL position to patient, grasp knee with one hand and ankle with other hand
b. Pick up the leg to isolate movement of the lower leg
c. You may place your knee under patient’s knee for stability and support
d. Place hand on knee to evaluate the joint motion and other hand to control the ankle
e. Gently rotate the lower leg—internally and externally rotate (toes will go clockwise or
counterclockwise) for range of motion
 f. Note end feel and quality of motion and differences between lower leg motions
g. THIS LOOKS FOR knee and ankle problems
6. HIP (INTERNAL AND EXTERNAL ROTATION—SUPINE)
a. Flex the knee 90 degrees and the hip to 90 degrees
b. Rotate femur and lower leg by bringing ankle closer and further away from you.
c. Evaluating motion at the hip joint for range of motion and quality of motion
7. ASIS EVALUATION FOR INOMINATE ROTATION (SUPINE)
a. Evaluate ASIS for symmetry
b. Dominant eye should be over midline of patient
c. Holding thumbs pointing to each other (in a transverse line across body) will help
accuracy of diagnosis
8. ILIAC CREST EVALUATION FOR INMINATE SHEAR
a. Move hands up to iliac crests
b. Index finger and second digit should be pointed towards the floor—rest fingers on the
upper surface of the iliac crests and observe for symmetry (keeping dominant eye
midline)
9. ASIS COMPRESSION FOR EVALUATION OF THE SI (SACROILIAC) JOINTS (SUPINE)
a. GENTLY place palms on ASIS and gently compress each ASIS in turn (many people are
sensitive here)
b. Focus attention on SI joints on the other side of the body as they are compressed
against the table and note the feel of the joints
c. Is there a restriction? Is there the feeling of motion at the joint or is there a feeling of
stiffness or hardness with compressions on side or the other?
d. Side with restriction=side with restricted SI joint
10. PUBIC SYMPHYSIS EVALUATION (SUPINE)
a. Dominant eye should be midline and explain purpose of exam
b. Gently bring the heel of hand down from the belt line to the pubic symphysis
c. Once bony prominence is felt, move your hands so that the thumbs now approximate
the upper border of the symphysis with the tips of the thumbs pointing toward each
other at the midline
d. Evaluate for symmetry—superior and inferior
11. LUMBAR EVALUATION (SUPINE)
a. Slide hands to the posterior of the iliac crests and gently lift each side alternately
b. Evaluating rotational component of lumbar spine
c. Evaluate for restriction by noting which side seems to lift easier or further
d. Record the side that doesn’t move as restricted side—“Lumbar vertebrae restricted in
rotation to the patient’s right/left”
12. RIB AND RESPIRATORY MOTION EVALUATION (SUPINE)
a. Gently lace your hands on the lower ribs staying well below the bra line of female
patients
b. Dominant eye over the patient’s midline
c. Place your fingers between the lower ribs (usually 7-8-9-10) and palpate the motion of
the ribs as the patient breathes
 d. FOLLOW the breathing—let your touch be gentle so you are not impairing the affect of
the patient’s breathing
e. Listen with your hands for two things:
i. Independent motion of each rib
ii. Relative excursion of the whole lower rib cage
13. THORACIC CAGE COMPLIANCE (SUPINE)
a. Follow the evaluation of the ribs and overall motion of the thoracic cage by evaluating
thoracic cage compliance
b. With your hands still on the lateral aspects of the lower rib cage, “spring” the cage by
alternating compression and release with compression in the medial/midline direction
c. Evaluate for ability of the ribs to compress and release easily, an easy springing feeling
d. THEN, evaluate for compliance in an anterior/posterior (AP) direction by placing your
hand, carefully, on the sternum avoiding contact with breast tissue in female breasts
e. Gentle compress towards the table in a springing motion along the AP axis
14. UPPER RIB MOTION/STERNUM (SUPINE)
a. Place the lateral border of your hands on the sternocostal margin (border between the
sternum and ribs)—make sure no contact with female breast tissue
b. With your hands relaxed, listen (with gentle palpation) to the excursion of the anterior
chest wall, noting if there is any asymmetry in the motion between left and right in
either inhalation or exhalation
c. The ribs on one side may come up sooner but be equal at maximum inhalation or may
not get as full a movement as the other side
d. Movement may be early or late compared to the other side and the function—
inhalation or exhalation
15. DIAGRAPHGM SCREEN (SUPINE)
a. With your hands just below the ribs, evaluate the motion of the thoracic (respiratory)
diaphragm (some patients may find this surprisingly tender)
b. Evaluate for symmetry of motion left and right and tenderness along the costal margin
c. Evaluation in this position is usually across the front of the body between mid-axillary
lines (sides of the body). The tip of the 12 th rib is often the mid-axillary line
16. THORACIC INLET AND CLAVIES (SUPINE)
a. Place your hands so that the fingertips are at the anterior border of the trapezius just
lateral to the neck and let your hands drop down to evaluate the tissue of the inlet and
your palms rest on the clavicles.
b. Palpate the tissue around the neck and the relative motion of the clavicles during
respiration.
c. THEN, ask patient to shrug his/her shoulders and assess motion at the sternoclavicular
junction with your thumbs or fingertips at the joint
d. Evaluate for tenderness, asymmetry, tissue restrictions, and restriction of clavicular
movement
17. CERVICAL MOTION (SUPINE and NON WEIGHT BEARING)
a. SEATED at the patient’s head
b. Palpate the paraspinal musculature (the articular pillars) of the cervical spine listening
with your hands for TART signs from the occiput to (T-1)
 c. Note any asymmetry of the vertebrae
d. Cradle patient’s occiput with both hands and evaluate the motion of the following levels
i. OA joint, C2, C3, C4, C5, C6
ii. Check for rotation left and right and sidebending left and right
iii. Note asymmetries/tenderness
18. TMJ AND JAW MOTION (SUPINE)
a. SEATED at patient’s head
b. Place fingertips just below the cheek bones (zygomatic processes) just anterior to the
ears on both sides of the patient’s head
c. Ask patient to slowly open his/her jaw as far as he/she can comfortably and then slowly
close (may need to be repeated 3-4x)
d. Evaluate for deviation left or right on opening or closing (each of which uses different
muscles)
e. Palpate the temporomandiublar joint under your fingertips for any asymmetry in motion
and for clicks, pops, or sliding motions
19. CRANIAL MOTION ASSESSMENT (SUPINE)DEFERRED FOR FIRST YEAR STUDENTS
a. SEATED at patient’s head
b. Using vault hold, evaluate the primary respiratory mechanism of the patient
c. Note your findings
d. Just recorded for completeness 
20. MESENTERIC GANGLIA EVALUATION (SUPINE)
a. Note location of xiphoid process and the umbilicus
b. Palpate the linea alba between those two points mentally dividing the distance into
thirds
c. Feel for hypertonicity but be gentle (some people are sensitive here)
d. Upper third=celiac ganglion
e. Middle=superior mesenteric ganglia
f. Just above umbilicus=inferior mesenteric ganglia

PRONE

21. ILIAC CREST (PRONE)

a. As in the other positions, check for symmetry
22. SACRAL SULCI (PRONE)
a. With the head in neutral, locate sacral sulci (at lumbosacral junction)
b. Evaluate for depth and position by palpation
c. Note whether there is symmetry left and right for both measures
d. Also note tenderness with palpation
23. INFERIOR LATERAL ANGLES (ILA) (PRONE)
a. Palpate gently down the sacrum until inferior border is found
b. Palpate gently along the inferior border finding the medial structures, coccyx, and
lateral edge which forms almost a right angle
c. Note whether the left and right angles are symmetric
d. Posterior is away from the table, posterior to the body, while inferior is a border that is
closer to the feet (the finding may be in either or both of these directions)
24. ISCHIAL TUBEROSITY (PRONE)
a. Find “sit bones” by palpating UP the posterior aspect of the thigh until you come to the
gluteal fold
b. Progress into the muscle about the middle of the posterior thigh until you palpate bone
c. Move slightly medial until you find the most inferior aspect of that bone which is called
the tuberosity of the ischium
d. Palpate and record any asymmetry and tenderness
25. FEMORAL EXTENSION OR HIP FLEXOR EVALUATION (PRONE)
a. From a position LATERAL to the patient, lift a leg by grasping just above the knee (to
AVOID knee bending) with other hand palpating the sacrum
b. Left the leg to the physiologic barrier noting ROM and any movement at the sacrum
c. NROM is about 20 degrees
26. KNEE EXTENSORS (PRONE)
a. Evaluate extensors of the knee (quadriceps primarily) by bringing the ankle towards the
buttock (gluteus maximus)
b. NROM is contact with foot to gluteus
c. Most clinicians allow for about 4 inches or the width of a fist
d. Compare ROM for both legs
27. SOFT TISSUE, FASCIAL RESTRICTION, THORAX AND LUMBAR (PRONE)
a. With palm flat on back, move the tissue in caudal, cranial and lateral directions noting
any restrictions
b. Repeat until the major areas of the posterior thorax are covered
c. THEN, with one hand on upper thorax and the other cupping the contralateral ASIS,
gently pull with the hand holding the ASIS while pushing with the hand on the upper
thorax—evaluate for restrictions along the para spinal areas from upper thorax to
lumbar
d. Note restrictions for tenderness for both the soft tissue (surface restrictions) and deeper
“push pull” fascial restrictions
28. SOFT TISSUE, FASCIAL RESTRICTIONS, LOWER EXTREMITIES (PRONE)
a. Evaluate the surface areas for restrictions by moving the soft tissue in four (or more)
directions
b. Note fascial restriction from hip to knee and from below knee to ankle
c. Note: the posterior tissue at the knee can be very sensitive
29. REGIONAL SPRINGING—THORAX, LUMBAR, SACRUM
a. Place palm on upper thorax
b. Gently spring the vertebral column by pressing and releasing against the upper vertebra
c. Feel for restriction and the (limited) amount of pressure necessary to spring the area
d. Repeat all the way down the vertebral column to the sacrum)

Impaired or altered function of related components of the somatic (body framework) system;
skeletal, arthrodial, and myofascial structures, and related vascular, lymphatic and neural
elements.