LOWER LIMB Hip (pelvis and groin) The initial observation should look at the position and posture of the femur compared with the pelvis and lower leg. Posture of the lower limb is complicated, as a number of different factors contribute towards the final posture adapted (2). Look for increased rotation, muscle bulk and general alignment at the hip in normal standing (8).

Gait should be assessed, noting any disturbances, such as unequal time spent on each leg, increased pelvis rotation on either side, or a Trendelenburg gait where the weak abductor muscles cannot maintain good hip and pelvis posture. A test for the Trendelenburg sign is to do a single-leg stand: the pelvis on the opposite side should rise – if the pelvis on the non-standing leg drops, then the test is positive and weak gluteal muscles or an unstable hip are indicated (13). Active and resisted movements in prone and supine lying

are then assessed, documenting any discrepancies for the movements of flexion, extension, abduction, adduction, medial rotation and lateral rotation (2). The therapist should test the hip quadrant by passively

flexing, adducting and medially rotating the hip (8). The following special tests are included in this screening examination: n 90–90 stretch test for hamstring tightness: with active or passive hip flexion to 90°, ask the patient to extend their knee – tight hamstrings result in reduced knee extension. n Thomas test for assessment of tight rectus femoris, iliopsoas or joint capsule: the athlete lies on the edge of the plinth and holds one of their knees into their chest; at the same time, observation of the contralateral leg is noted – tightness results in the hip raising off the plinth. n Anterior labral tear test: the hip is passively flexed, laterally rotated and fully abducted and then taken from this position

towards extension, medial rotation and adduction – pain, apprehension or clicking are deemed as a positive test (2). The athlete may have groin aggravation from other structures, so it may be wise to assess the abdominal area with a sit-up, cough and palpation of the inguinal canal for any signs of a hernia or sports hernia (14).

Knee and patella femoral joint General observation of the knee is taken with the athlete standing. Look for bony deformity, especially at the tibial tuberosity, which could indicate Osgood–Schlatter disease in younger players or the after effects of the disease in older players. Observe whether there is any swelling or muscle wasting, tibial rotation, varus, valgus or hyperextension in standing (2). Lay the patient on the plinth and assess the knee joint

for any swelling. There are two tests. The first test is known as the brush, stroke or wipe test. Starting just below the joint line of the medial side of the patella, use your palm and fingers to stroke proximally towards the player’s hip two or three times to a point about 10cm above the patella. Then, with the opposite hand, stroke distally from this point down the lateral side of the patella. If the test is positive for synovial effusion, then a wave of fluid will pass from one side to the other. The second test is the fluctuation test. Place one hand

about 10cm above the knee. With the other hand, lightly place your thumb and finger beside the patella. Squeeze any fluid in the joint down towards the patella. If there is a joint effusion, then the swelling will be felt under your finger and thumb. This is a sign that intracapsular swelling is present (2). Active, passive and resisted flexion and extension should be tested (12). The ligaments of the knee are tested next, with the

player in supine lying.

CONCLUSION This musculoskeletal screening gives a snapshot of the player’s condition. An example of a simple screening form is given in Box 1. There are numerous reported tests for every conceivable condition, and only a general outline and a few specific tests have been given here. Feel free to add those that give the information required.

References 1. Greene G. Red flags: essential factors in recognising serious spinal pathology. Manual Therapy 2001;6 2. Magee DJ. Orthopaedic Physical Assessment. Elsevier 2008. ISBN 9780721605715 3. Porter SB. Tidy’s Physiotherapy, 13th edn. Butterworth- Heinemann 2003. ISBN 9780750632119 4. Corrigan B, Maitland GD. Vertebral Musculoskeletal Disorders. Butterworth-Heinemann 1998. ISBN 9780750629652 5. Association of Chartered Physiotherapists. New Cervical Pretreatment Assessment Framework: Cervical Artery Dysfunction, Manipulation. Association of Chartered Physiotherapists 2005 6. Norris CM. Back Stability. Human Kinetics 2000. ISBN 9780736000819 7. Turner H. The sacroiliac joint. sportEX Medicine 2004;22:6-12 8. Brukner P, Khan K. Clinical Sports Medicine. McGraw-Hill 2001. ISBN 9780074706510 9. Clarnette RG, Miniaci A. Clinical examination of the shoulder. Medicine and Science in Sports and Exercise

10

1998;30(suppl.1):1–6 10. Hanchard N, Cummins J, Jeffries C. Evidence-Based Clinical Guidelines for the Diagnosis, Assessment, and Physiotherapy Management of Shoulder Impingement Syndrome. Chartered Society of Physiotherapy 2004

11. Mottram SL. Masterclass: dynamic stability of the scapula. Manual Therapy 1997;2:123–131 12. Hengeveld E, Banks K. Maitland’s Peripheral Manipulation. Elsevier 2005. ISBN 9780750655989 13. Anderson K, Strickland SM, Warren R. Hip and groin injuries in athletes. American Journal of Sports Medicine 2001;29:521– 533

14. Elphinston J. Getting to the bottom of things: pelvic stability. sportEX dynamics 2004;2:12-16.

THE AUTHOR

Craig Sedgwick is the head academy physiotherapist at Barnsley Football Club. He also works with the first team and reserve squads. He is a former professional

footballer who trained at Salford University on a Professional Footballers Association sponsored scheme.

sportEX dynamics 2009;22(Oct):7-11