Then patient actively flexes the toes at the MP joints, keeping the IP joints neutral. The therapist uses both hands to grasp the anterior foot with the fingers across the dorsum of the foot and the thumbs under the proximal phalanges for resistance.
Then patient actively flexes the toes at the PIP joints. The therapist uses both hands to grasp the anterior foot with the fingers across the dorsum of the foot and the thumbs under the distal phalanges for resistance. Then patient actively flexes the toes at the DIP joints. The therapist stabilizes the metatarsal area by contouring hand around the plantar surface of the foot with the thumb curving around the base of the great toe. For resistance, place thumb over the MP joint.
The other hand stabilizes the foot at heel. The patient actively extends MP joint. For resistance, place thumb over the IP joint. The patient actively extends IP joint. MP Extension of Lesser Toes The patient is short sitting with legs hanging over the edge of the table. The therapist uses both hands to stabilize the metatarsals with the fingers on the plantar surface and the thumbs on the dorsum of the foot.
The patient actively extends MP joints of lesser toes. The therapist uses one hand to stabilize the metatarsals with the fingers on the plantar surface and the thumb on the dorsum of the foot. The other hand is used to give resistance with the thumb placed over the dorsal surface of the proximal phalanges of toes.
The patient actively extends PIP joints. The other hand is used to give resistance with the thumb placed over the dorsal surface of the distal phalanges of toes. Most commonly lumbrical tightness can only be demonstrated when joint tightness, interosseous muscle tightness and tendon glide issues have been resolved.
Although lumbrical muscle tightness limits full finger flexion, the position requiring maximum elongation of the lumbrical muscle is the active hook position with MP joint hyperextension. Therefore, even though the limitation is full finger flexion, end range flexion is not the exercise which creates maximum lumbrical muscle elongation.
Reaching the goal of maximum lumbrical muscle elongation is complicated by the fact the extensor digitorum communis is not able to hold the MP joint in hyperextension in the presence of lumbrical muscle tightness or interosseous tightness. As the finger flexes the tightness will pull the MP joint into a neutral position and the active hook will not be fully achieved. For this reason some external device manual positioning or an orthosis is needed to support the MP joint in hyperextension during active IP joint flexion.
Reference Parkes A. J Bone Joint Surg ;53B Download Clinical Pearl No. Disclaimer: BraceLab Clinical Pearls are intended to be an informal sharing of practical clinical ideas; not formal evidence-based conclusions of fact. Orders cannot be changed or cancelled after submission. Please review your order for accuracy before submitting.
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