Lower Body Goniometric Assessment: Technique and potential restricting structures
Goniometry of the lower body, including ankle dorsiflexion, knee extension, knee flexion, hip internal rotation, hip external rotation, hip abduction, hip flexion and hip extension goniometric assessments. A list of potential muscles, fascia, and neural structures that may restrict motion at the hip, knee, and ankle joints.
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Course Description: Goniometry: Lower Body
Why Assessment? All fitness, performance, and rehabilitation programs should start with an assessment. The goal of assessment is to refine technique selection, with the intent of improving client and patient outcomes. This course describes the reliable goniometric assessments used to assess range of motion (ROM) of the lower extremity (Note, reliable = ankle dorsiflexion goniometry is included, and ankle inversion goniometry is not).
- Goniometry - "refers to the measurement of angles, in particular, the measurement of angles created at human joints by the bones of the body (1)"
Why Goniometry? Most often, goniometric assessments highlight osteokinematic hypomobility (loss of joint ROM), aiding in the selection of release, mobilization, and stretching techniques. Less often, goniometry will highlight hypermobility (excessive joint ROM) and imply a need for activation, stabilization, and conditioning techniques. For an introduction to specific terminology, defining "good assessments," defining what goniometry measures, and best use, please check out:
Why Add Goniometry to Movement Assessment? Goniometry adds an assessment with continuous interval measures to movement assessments that only provide binary or discrete values. Assessments that only provide binary values include the Overhead Squat Assessment (OHSA) , the gastroc/soleus length test , the Functional Movement Screen, static postural assessments, the L.E.F.T. Test, and mobility-dependent special tests such as the FABER (Patrick's) Test and FADDIR Test .
- For example, if an Overhead Squat Assessment (OHSA) results in the identification of Excessive Forward Lean , and your intervention improves but does not completely resolve Excessive Forward Lean , your reassessment with the OHSA will appear the same on paper. With the OHSA you either have Excessive Forward Lean or you do not, there is no reliable method for tracking "some improvement". However, if you follow the OHSA with Dorsiflexion Goniometry you can reliably track improvements in dorsiflexion range of motion (ROM) of just 5 degrees. Note, you could also use Dorsiflexion Goniometry and Hip Extension Goniometry to aid in deducing whether interventions for addressing ankle mobility or hip mobility should be prioritized (e.g. if hip extension ROM is normal, but dorsiflexion ROM is restricted, then ankle mobilization might be prioritized).
The Brookbush Institute recommends that these assessments are added to the repertoire of all sports medicine professionals (personal trainers, fitness instructors, physical therapists, massage therapists, chiropractors, occupational therapists, athletic trainers, etc.).
Goniometric Assessments Covered in this Course
Each goniometric assessment in this course includes a list of potentially affected structures, and those structures are hyperlinked to courses that cover specific interventions for those structures. Predictive Models of Postural Dysfunction were used to aid in considering all muscular, articular, fascial, and neural structures that may restrict each motion.
- Hip Internal Rotation at 90 Degrees of Hip Flexion
- Hip External Rotation at 90 Degrees of Hip Flexion
- Hip Internal Rotation in Prone
- Hip External rotation in Prone
- Hip Extension
- Hip Flexion
- Hip Abduction
- Knee Flexion
- Knee Extension with Hip Flexion (Hamstring Length Test)
- Knee Extension
- Dorsiflexion
Printable PDF of the Movement Assessment Template:
Pre-approved credits for:
Pre-approved for Continuing Education Credits for:
- Athletic Trainers
- Chiropractors
- Group Exercise Instructors
- Massage Therapists
- Occupational Therapists
- Personal Trainers
- Physical Therapists
- Physical Therapy Assistants
- Yoga Instructors
This Course Includes:
- AI Tutor
- Text and Illustrations
- Audio Voice-over
- Technique Videos
- Practice Exam
- Pre-approved Final Exam
Course Study Guide: Lower Body Goniometric Assessment
Introduction
Hip Internal Rotation at 90 degrees of Flexion (90/90 Hip IR)
Hip External Rotation at 90 degrees of Flexion (90/90 Hip ER)
Hip Internal Rotation in Prone
Hip External Rotation in Prone
Hip Extension (Thomas Test Position)
Hip Flexion Goniometry
Hip Abduction Goniometry
Knee Flexion Goniometry
Knee Extension with Hip Flexion Goniometry (Hamstring Length Test)
Knee Extension Goniometry
Dorsiflexion Goniometry
Bibliography
- Cynthia C. Norkin, D. Joyce White. Measurement of Joint Motion: A Guide to Goniometry 3rd Edition. Copyright (C) 2003 by F.A. Davis Company
- Dr. Mike Clark & Scott Lucette, “NASM Essentials of Corrective Exercise Training” © 2011 Lippincott Williams & Wilkins
- Donald A. Neumann. Kinesiology of the Musculoskeletal System: Foundations of Rehabilitation – 2nd Edition © 2012 Mosby, Inc.
- Cynthia C. Norkin, Pamela K. Levangie, Joint Structure and Function: A Comprehensive Analysis: Fifth Edition © 2011 F.A. Davis Company
- David G. Simons, Janet Travell, Lois S. Simons, Travell & Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition,© 1999 Williams and Wilken
- Tom Myers, Anatomy Trains: Second Edition. © 2009 Elsevier Limited
- David Butler. The Sensitive Nervous System © 2000 NOI Group
- Michael Shacklock. Clinical Neurodynamics: A New System of Musculoskeletal Treatment © 2005 Elsevier Limited
- Miller, P. J. (1985). Assessment of joint motion. Measurement in physical therapy, 103-136.
- Lea, R. D., & Gerhardt, J. J. (1995). Range-of-motion measurements. J Bone Joint Surg Am, 77(5), 784-798.
- Ekstrand, J., Wiktorsson, M., Oberg, B., & Gillquist, J. (1982). Lower extremity goniometric measurements: a study to determine their reliability. Archives of physical medicine and rehabilitation, 63(4), 171-175.
- Gajdosik, R. L., & Bohannon, R. W. (1987). Clinical measurement of range of motion. Physical Therapy, 67(12), 1867-1872.
- Bovens, A. M., van Baak, M. A., Vrencken, J. G., Wijnen, J. A., & Verstappen, F. T. (1990). Variability and reliability of joint measurements. The American Journal of Sports Medicine, 18(1), 58-63.
- Both Upper and Lower
- Boone, D. C., Azen, S. P., Lin, C. M., Spence, C., Baron, C., & Lee, L. (1978). Reliability of goniometric measurements. Physical Therapy, 58(11), 1355-1360.
- Rothstein, J. M., Miller, P. J., & Roettger, R. F. (1983). Goniometric reliability in a clinical setting. Physical Therapy, 63(10), 1611-1615.
- Lower Body
- Prather H, Harris-Hayes M, Hunt D, Steger-May K, Mathew V, Clohisy JC. Hip range of motion and provocative physical examination tests reliability and agreement in asymptomatic volunteers. PM R. 2010, 2(10): 888-895.
- Poulsen E, Christensen HW, Penny JO, Overgaard S, Vach W, Hartvigsen J. Reproducibility of range of motion and muscle strength measurements in patients with hip osteoarthritis – an inter-rater study. BMC Musculoskeletal Disorders. 2012, 13:242
- Konor MM, Morton S, Eckerson JM, Grindstaff TL. Reliability of three measures of ankle dorsiflexion range of motion. Int J Sports Phys Ther. 2012, 7(3): 279-287.
- Powden CJ, Hoch JM, Hoch MC. Reliability and minimal detectable change of the weight-bearing lunge test: a systematic review. Man Ther. 2015, 20(4): 524-532. (lunge test)
- Gogia, P. P., Braatz, J. H., Rose, S. J., & Norton, B. J. (1987). Reliability and validity of goniometric measurements at the knee. Physical therapy, 67(2), 192-195.
- Small Joint Reliability
- Hellebrandt, F. A., Duvall, E. N., & Moore, M. L. (1949). The measurement of joint motion. Part III: Reliability of goniometry. Phys Ther Rev, 29(6), 302-7.
- Additional Research
- Vigotosky AD, Lehman GJ, Beardsley C, et al. (2016). The modified Thomas test is not a valid measure of hip extension unless pelvic tilt is controlled. PeerJ. 4:e2325; DOI 10.7717/peerj.2325
- Fahrer, H., Rentsch, H. U., Gerber, N. J., Beyeler, C., Hess, C. W., & Grunig, B. (1988). Knee effusion and reflex inhibition of the quadriceps. A bar to effective retraining. Bone & Joint Journal, 70(4), 635-638.
- Torry, M. R., Decker, M. J., Viola, R. W., D O’Connor, D., & Steadman, J. R. (2000). Intra-articular knee joint effusion induces quadriceps avoidance gait patterns. Clinical Biomechanics, 15(3), 147-159.
- Hopkins, J. T., Ingersoll, C. D., Krause, B. A., Edwards, J. E., & Cordova, M. L. (2001). Effect of knee joint effusion on quadriceps and soleus motoneuron pool excitability. Medicine and Science in Sports and Exercise, 33(1), 123-126.
- Jensen, K., & Graf, B. K. (1993). The effects of knee effusion on quadriceps strength and knee intraarticular pressure. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 9(1), 52-56.
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