1. Length Tension Testing

2. Length Tension Testing
Assessment of length tension in skeletal muscle from the use of clinical reasoning, interpretation and subjective and objective assessment findings
Assessment Findings Include: referral pain, neuromusculoskeletal interaction or neuromeningeal identification (nerve restrictions or nervous system responsiveness/sensitivity), positional observation, ROM, palpation, and overall activation and flexibility of the muscle
Range of motion and end feel of muscle is assessed from the therapists hand moving and stabilizing the structure - sense the tension in the muscle
End feel = Joint restriction
Normal muscle = will feel soft  will contract voluntary with EMG activity
Tense muscle = will feel stiff, like a well done steak  contributes to muscle spasm and pain, EMG not under voluntary control because of decreased contractile ability
Symptoms during stretch noted

3. Soleus Muscle
Origin (Proximal) Attachment: Posterior proximal half, on the surface of the tibia, along soleal line  proximal 1/3 posterior fibula Insertion: Posterior Calcaneus Action: Plantar Flexion Nerve: Tibial Nerve root (S1,S2)

4. Soleus Length Tension Test
Patient Position:
Supine lying position with leg hanging over edge of bed
Action:
One hand supports knee in a slight flexed position, while other hand and forearm supports plantar aspect (bottom) of the foot
Patients ankle is dorsiflexed, while range of motion and end feel of muscle is assessed (hand moving and hand stabilizing sense the tension in the muscle)
Symptoms during stretch noted

5. PICTURE
(Soleus mm length ,2010)

6. Piriformis Muscle
Origin (Proximal) Attachment: Anterior surface of lateral sacrum Insertion: Greater trochanter of femur, along upper medial surface Action: Laterally rotates the thigh at hip joint, If hip is flexed it will abduct the thigh Nerve: Sacral Plexus (S1,S2)

7. Piriformis Length Tension Test
Patient:
Supine lying with hip flexed at 100° and knee flexed at 90°
Action:
Therapist stabilizes innominate and supports distal aspect of the tibia and fibula with hand and forearm
Hip is adducted and laterally rotated
Range of motion and end feel of hip is assessed (hand moving and hand stabilizing sense the tension in the muscle)
Symptoms during stretch noted

8. PICTURE
(Cram, 2013)

9. Hamstring (3 Muscles)
Origin (Proximal) Attachment: Biceps Femoris: Ischial tuberosity Semimembranosus: Ischial tuberosity Semitendinosus: Ischial tuberosity Insertion: Biceps Femoris: Head of fibula and lateral condyle of tibia Semimembranosus: Posterior medial condyle of tibia Semitendinosus: Proximal tibia, medial to tibial tuberosity Action: Extends thigh at the hip Nerve: Tibial portion of sciatic nerve (L5,S1,S2)

10. Hamstring Length Tension Test
Patient:
- Lying supine
Action:
Therapist palpates anterior iliac spine and iliac crest
Distal aspect of tibia and fibula are supported by a hand
Leg is taken into hip flexion with the knee extended
When right innominate starts to posteriorly rotate, flexibility of the hamstring is exhausted
Range of motion and end feel of hamstring is assessed (hand moving and hand stabilizing sense the tension in the muscle)
Symptoms during stretch noted

11. PICTURE
(Hamstring rehab protocol,2013)

12. Quadriceps (4 Muscles)
Origin (Proximal) Attachment: Rectus Femoris: Anterior Iliac spine and illium above the accetabulum Vastus Lateralis: Greater trochanter Vastus Medialis: Intertrochantric line Vastus Intermedius: Anterior and lateral shaft of femur Insertion: Quadriceps tendon, to base of patella into tibial tuberosity from the patellar ligament Action: Extends leg at the knee joint Nerve: Femoral Nerve (L2,L4)

13. Quadriceps Length Tension Test
Patient:
Lying on stomach with legs extended
Action:
Therapist stabilizes the sacroiliac joint
Distal aspect of tibia and fibula is supported by therapists hand
Therapist flexes knee joint to target the quadriceps
Range of motion and end feel of quadriceps is assessed (hand moving and hand stabilizing sense the tension in the muscle)
Symptoms during stretch noted

14. PICTURE
(Schafer, 1985)

15. Trapezius Muscle
Origin (Proximal) Attachment: Medial superior nuchal line and external protuberance of the occipital bone, ligamentum nuchae and spinous processes of C7-T12 Insertion: Clavicle (lateral), acromion, and spine of scapula Action: Upper Fibers – Elevate and upwardly rotate scapula (extend neck) Middle Fibers – Adduct scapula (retract) Lower Fibers – Depress scapula Nerve: C3,C4 and accessory cranial N.

16. Trapezius Length Tension Test (Upper Fibers)
Patient:
Sitting position on a chair
Action:
Patient actively flexes craniovertebral joint (articulation between cranium and vertebral column)
Therapist stabilizes lateral 1/3 clavicle and acromion with one hand and stabalizes the top of the head with the other hand
Therapist passively flexes and rotates the head down towards the patients shoulder
Range of motion and end feel of trapezius is assessed (hand moving and hand stabilizing sense the tension in the muscle)
Symptoms during stretch noted

17. PICTURE
(Boost physio, 2012)

18. ARTICLE - Upper Trapezius Muscle Activity During the Brachial Plexus Tension Test in Asymptomatic Subjects
The brachial plexus tension test (BPTT) is used to test the dynamics of the neural tissues of the upper quadrant – using contralateral cervical lateral flexion
The upper trapezius muscle and the nerves of the brachial plexus share common anatomical locations and are jointly affected by the BPTT movements.
This study investigated the relationship between the BPTT and the upper trapezius muscle activity - tested the range of neural tissue extensibility in asymptomatic subjects.
Thought that upper trapezius shortening is an adaptation to protect less extensible neural tissue from the action of stretching (upper limb movements)
20 healthy male subjects tested (age 18-30)
BBTT = shoulder depression, glenohumeral abduction, and external rotation, forearm supination, wrist and finger extension and elbow extension
Contralateral cervical lateral flexion (CCFL) was added as a final BBTT component
Base Line Pre- Test  Maximum voluntary contraction (MVC) was recorded (EMG) while subject was lying supine during shoulder abduction and external rotation
After MVC , BPTT was performed, paused at shoulder depression when pain felt and at limits of elbow extension and contralateral cervical lateral flexion (CCFL) - - Pain rating was recorded (scale 0-10)
Results revealed that those with lesser neural extensibility exhibited greater upper trapezius muscle activity during the BPTT
No difference between groups in the levels of pain perceived.

19. Palmaris Longus
Origin (Proximal) Attachment: Medial epicondyle of humerus Insertion: Flexor retinaculum and palmer aponeurosis Action: Flexes hand at the wrist joint, tenses palmer aponeurosis Nerve: Median N. (C7,C8)

20. Palmaris Longus Length Tension Test
Patient:
Lying supine
Action:
Therapist stabilizes patients distal humerus and extends the patients elbow and wrist with all of the patients fingers and thumb extended
Range of motion and end feel of palmaris longus is assessed (hand moving and hand stabilizing sense the tension in the muscle)
Symptoms during stretch noted

21. PICTURE
(Morphopedics, 2009)

22. ARTICLE - Reliability of Upper Limb Tension Test 1 in Normal Subjects and Patients With Carpal Tunnel Syndrome
Four neural tension tests in upper extremity (ULTT)
ULTT1 – evaluates upper quadrant nerve system tension, and the corresponding structures tension , particularly median N.
ULTT1 (through movement and tension) is thought to help with the diagnosis of carpal tunnel syndrome
Upper limb tension test consisted of elbow extension , shoulder depression, shoulder abduction and external rotation, forearm supination , and wrist and elbow extension
Believed that the median N. is stretched during ULTT1
Subjects: two groups (healthy and patients)
23 healthy subjects (age 18-25)
12 CTS patients (age 25-50)
Results determined that ULTT1 is reliable and can be used to diagnose and help manage carpal tunnel syndrome

23. Work Cited
Boost physio. (2012). Retrieved from Cram. (2013). Retrieved from special-tests Get body smart . (2014). Retrieved from thanddigits/palmarislongus/tutorial.html Hamstring rehab protocol using lengthened state eccentrics. (2013). Retrieved from protocol-using-lengthened-state-eccentrics/ Morphopedics . (2009). Retrieved from Sanzo , P., & MacHutchon, M. (2007). Length tension testing of the lower quadrant. Thunder Bay: Active Potential Rehabilitation Services. Sanzo , P., & MacHutchon, M. (2007). Length tension testing of the upper quadrant. Thunder Bay: Active Potential Rehabilitation Services. Schafer, R. (1985). The motion palpation institute & acapress. Retrieved from ACAPress/The_Pelvis.html Soleus mm length . (2010). Retrieved from length test&rlz=1C1KMZB_enCA564CA564&espv=210&es_sm=93&source=lnms&tbm=isch &sa=X&ei=PdU0U7iLKojmrQHctoGYCQ&ved=0CAYQ_AUoAQ&biw=1366&bih=667