Passive Motion Palpation

Passive Motion Palpation (PMP)

PMP, as a term, is more commonly used in the chiropractic literature. Logan (1995) defines this as “the motion palpation challenge of an articulation without the influence if weightbearing”. Used to test for restrictions/fixations – if present  mobilisation/manipulation/’adjustment’.

Upon palpation of joint should notice ‘joint play’ or a spring feeling at end range of motion. If a ‘fixation’ is present  no ‘joint play’ and a ‘bone on bone’ feel to end range of motion.

Movement of fibula:
Patient supine, start with foot plantarflexed  dorsiflex to resistance while palpating anterior aspect of lateral malleolus – it should separate from tibia. Also palpate proximal head of fibula at knee  should also move with dorsiflexion of foot.

Anterior movement of talus on tibia:
For right foot  patient supine, left hand grips tibia and fibula just above level of talus so it can apply a posterior/push force to tibia. Right hand  thumb across anterior aspect of talus, just below tibia – rest of hand grips rearfoot to pull talus anteriorly.

Posterior movement of talus on tibia:
For right foot  patient supine, left hand grips tibia and fibula posteriorly, at level of talus to pull tibia forward. Right hand, palm and fingers grip arch area with thumb across anterior aspect of talus/dorsal aspect of navicular  apply pressure posteriorly to navicular/talus.

Medial movement of head of talus on tibia:
For right foot  patient supine, thumb pad of right hand on medial malleolus to apply a lateral force to tibia. Thumb of left hand is used to push head of talus medially by pushing over the lateral aspect of the head of talus.

Lateral movement of head of talus on tibia:
For right foot patient supine, thumb pad of left hand on lateral malleolus to apply a medial force to tibia. Thumb of right hand is used to push head of talus laterally by pushing over the medial aspect of the head of talus.

Test for medial ‘spring’ of subtalar joint:
For right foot  patient supine, right hand grips foot over dorsum with index finger around talus head and thumb over cuboid. Left hand grips heel with thumb over lateral aspect of posterior subtalar (talocalcaneal) joint  supinate and abduct forefoot. With thumb apply pressure along line of joint to test for ‘spring’.

Test for lateral ‘spring’ of subtalar joint:
For right foot  patient supine, left hand grips dorsum of foot with index finger over calcaneocuboid joint  adduct and slightly pronate foot. Right hand grips posterior calcaneus with thumb over medial aspect of subtalar joint, applying pressure along medial aspect of joint to test for ‘spring’.

Posterior movement of talus on calcaneus:
For right foot  patient supine, right and grips calcaneus to pull it anteriorly. Left hand grips dorsum of foot with thumb across head of talus, pushing posteriorly.

Anterior movement of talus on calcaneus:
For right foot  patient supine, two fingers of right hand grip posterior aspect of talus to support it level with tip of fibula. Left hand grips plantar aspect of calcaneus in such a way to push it posteriorly.

Lateral movement of talus head on calcaneus:
For right foot  patient supine, thumb pad of right hand applies a lateral force to the medial aspect of the talus head, just anterior to medial malleolus. Thumb pad of left hand applies a medial force to antero-lateral aspect of calcaneus

Medial movement of talus head on calcaneus:
For right foot  patient supine, right hand grips posterior aspect of calcaneus with thumb applying a lateral force to medial aspect of calcaneus. Thumb pad of left hand applies medial force to lateral aspect of talus head.

Medial movement of cuboid on calcaneus:
For right foot  patient supine, with right hand grip heel with thumb on medial side of the anterior tubercle on plantar surface of calcaneus. With left hand, apply medial pressure on lateral aspect of cuboid.

Lateral movement of cuboid on calcaneus:
For right foot  patient supine, fingers of right hand on dorsum of foot, and thumb on plantar surface on the sulcus just proximal to the groove in the cuboid for peroneus longus. Grasp heel with left hand and apply pressure medially on lateral surface of calcaneus.

Plantar movement of calcaneus on cuboid:
For right foot  patient supine, fingers of left hand grip posterior aspect of calcaneus and pad of thumb applies a dorsiflexory force to the plantar aspect of the cuboid. Fingers of right hand grasp lateral aspect of ankle with the thumb applying a plantarflexory force on the distal lateral dorsal aspect of the calcaneus.

Plantar movement of navicular on cuboid:
For right foot  patient supine, fingers of left hand grip posterior aspect of calcaneus and pad of thumb applies a dorsiflexory force to the plantar aspect of the cuboid. Fingers of right hand grasp lateral aspect of ankle with the pad of the thumb applying a plantarflexory force on the dorsal aspect of the navicular – the direction of pressure needs to accommodate the 45º angle of motion between these bones.

Plantar movement of third cuneiform on cuboid:
For right foot  patient supine, fingers of left hand grip posterior aspect of calcaneus and pad of thumb applies a dorsiflexory force to the plantar aspect of the cuboid. Fingers of right hand grasp lateral aspect of ankle with the pad of the thumb applying a plantarflexory force on the dorsal aspect of the third cuneiform – the direction of pressure needs to accommodate the 45º angle of motion between these bones.

Plantar movement of fourth metatarsal on cuboid:
For right foot  patient supine, fingers of left hand grip posterior aspect of calcaneus and pad of thumb applies a dorsiflexory force to the plantar aspect of the cuboid. Fingers of right hand grasp lateral aspect of ankle with the pad of the thumb applying a plantarflexory force on the dorsal aspect of the base of the fourth metatarsal.

Plantar movement of fifth metatarsal on cuboid:
For right foot  patient supine, fingers of left hand grip posterior aspect of calcaneus and pad of thumb applies a dorsiflexory force to the plantar aspect of the cuboid. Fingers of right hand grasp lateral aspect of ankle with the pad of the thumb applying a plantarflexory force on the dorsal aspect of the base of the fifth metatarsal – pressure can be applied more laterally on the tuberosity of the fifth metatarsal to check for some rotation.

Dorsal movements of cuboid:
For right foot  patient supine, the same hand positions as above are maintained for each joint, but a dorsiflexory force is applied to the cuboid as the other bones are stabilised.

Lateral movement of the navicular on the talus:
For right foot  patient supine, pad of thumb of left hand applies a medial force to the lateral aspect of the head of the talus, just in front of the tibia, while the pad of the thumb of the right hand applies a lateral force to the medial aspect of the navicular.

Medial movement of the navicular on the talus:
For right foot  patient supine, pad of thumb of right hand applies a lateral force to the medial aspect of the head of the talus, while the pad of the thumb of the left hand applies a medial force to the lateral aspect of the navicular.

Plantar movement of the talus on navicular:
For right foot  patient supine, fingers of right hand grip calcaneus and thumb provides a stabilising dorsiflexory force to the plantar aspect of navicular. The pad of the thumb applies a plantarflexory force to the dorsal aspect of the head of the talus.

Plantar movement of second cuneiform on the navicular:
For right foot  patient supine, fingers of right hand grip calcaneus and thumb provides a stabilising dorsiflexory force to the plantar aspect of navicular. The pad of the thumb applies a plantarflexory force to the second cuneiform.

Plantar movement of first cuneiform on the navicular:
For right foot  patient supine, fingers of right hand grip calcaneus and thumb provides a stabilising dorsiflexory force to the plantar aspect of navicular. The pad of the thumb applies a plantarflexory force to the first cuneiform - first cuneiform is narrow dorsally.

Dorsal movement of first cuneiform on the navicular:
For right foot  patient supine, fingers of right hand grip calcaneus and pad of thumb applies a dorsiflexory force to the plantar surface of the first cuneiform. The pad of the thumb of the left hand applies a plantarflexory force to the navicular.

Dorsal movement of the second and third cuneiform on the navicular:
Very difficult to distinguish between the plantar surfaces of the second and third cuneiforms. For right foot  patient supine, fingers of right hand grip calcaneus and pad of thumb applies a dorsiflexory force to the plantar surface of the second and third cuneiforms. The pad of the thumb of the left hand applies a plantarflexory force to the navicular.

Dorsal movement of talus on the navicular:
For right foot  patient supine, fingers of right hand grip calcaneus and pad of thumb applies a dorsiflexory force to the plantar surface of the head of the talus. The pad of the thumb of the left hand applies a plantarflexory force to the navicular.

Plantar movement of the first metatarsal on the first cuneiform:
For right foot  patient supine, fingers of right hand grip calcaneus and pad of thumb applies a dorsiflexory force to the plantar surface of the first cuneiform. The pad of the thumb of the left hand applies a plantarflexory force to the base of the first metatarsal.

Plantar movement of the second metatarsal on the first cuneiform:
For right foot  patient supine, fingers of right hand grip calcaneus and pad of thumb applies a dorsiflexory force to the plantar surface of the first cuneiform. The pad of the thumb of the left hand applies a plantarflexory force to the base of the second metatarsal.

Plantar movement of the second cuneiform on the first cuneiform:
For right foot  patient supine, fingers of right hand grip calcaneus and pad of thumb applies a dorsiflexory force to the plantar surface of the first cuneiform. The pad of the thumb of the left hand applies a plantarflexory force to the second cuneiform.

Dorsal movements on the first cuneiform:
For right foot  patient supine, thumb of left hand applies a plantarflexory force to the dorsal aspect of the first cuneiform. The fingers of the right hand grip the calcaneus, while the thumb applies a dorsiflexory force to the plantar aspect of the first metatarsal, then the second metatarsal, then the second cuneiform.

Medial rotation of the first metatarsal on the first cuneiform:
For right foot  patient supine, thumb of right hand is on plantar aspect of foot and fingers on dorsal aspect to provide a lateral resistance to the medial side of the first cuneiform. The thumb of the left hand lies across the bases of the metatarsals with the fingers on the plantar surface  applies a medial pressure to the base of the first metatarsal.

Rotation of the fourth and fifth metatarsals on the cuboid:
For right foot  patient supine, thumb of left hand is plantar with fingers on dorsum to grip cuboid. Grip the fifth and then fourth metatarsal heads with thumb and index finger to test rotation/plantarflexion-dorsiflexion

Dorso-plantar glide of the metatarsophalangeal joints:
For right foot  patient supine, grip metatarsal head(s) with finger and thumb of left hand and grip base of proximal phalanx(s) with thumb and index finger of right hand  move phalanx(s) in a gliding motion in a dorsiflexion-plantarflexion motion.

Dorsal-plantar, medial-lateral and rotation movement of the first metatarsophalangeal joint:
For right foot  patient supine, grasp first metatarsal head with thumb and finger of left hand and grip base of proximal phalanx with thumb and finger of right hand  move joint through dorsiflexion-plantarflexion glide, mediolateral glide and rotation.

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