Stand between the patient’s partially abducted leg and the table, facing the head of the table, so that all control of the tested leg is achieved by using your lateral arm/hand which holds and supports the leg at the ankle while your table-side hand rests on the inner thigh, palpating the muscles which are being tested. This palpating hand (often called a ‘listening’ hand in osteopathy) must be in touch with the skin, moulded to the contours of the tissues being assessed, but should exert no pressure, and should be completely relaxed.
Abduction of the tested leg is introduced passively by the outside hand/arm, until the first sign of resistance (‘effort’) is noted by the hand which is providing the motive force, i.e. the one holding the leg.
As you approach this point of resistance can you sense a tightening of the tissues in the mid-inner thigh which your table-side hand is touching?
This is ‘bind’. If this sensation is not clear then take the leg back towards the table and out again but this time go past the point where easy movement is lost and effort begins, and towards its end of range. Here you will certainly sense ‘bind’. As you once more take the leg back towards the table you will note a softening, a relaxation, an ‘ease’, in these same tissues.
Go through the same sequence with the other leg, becoming increasingly familiar with the sense of these two extremes, and try to note the very moment at which you can palpate the transition from ease to bind, not the extreme range of movement but where it first begins, whether you are moving from ease to bind or the other way. Normal excursion of the straight leg into abduction is around 45º, and by testing both legs in the manner described you can evaluate whether they are both tight and short, or whether one is and the other is not. Even if both are tight and short one may be more restricted than the other.
The point at which you first feel bind (or where the hand carrying the leg feels the first sign that effort is required) is the resistance barrier which will be referred to over and over again in future articles, it is the place where an isometric contraction can be introduced when Muscle Energy release methods are used, as will be outlined in future articles.
Leon Chaitow DO practices at The Hale Clinic London (0171-631-0156). He teaches widely in the UK, Europe and the USA, and is author of major textbooks including ‘Soft tissue Manipulation’ (available from Green Library). He is a senior lecturer on the University of Westminster’s MA in Therapeutic Bodywork.