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Hip Extension Goniometry

Learn how to accurately measure hip extension using the goniometry technique with this step-by-step video tutorial. Perfect for physical therapists or medical professionals!

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00:06 - 00:10This is Brent of the Brookbush Institute at the Independent Training Spot here in New
00:10 - 00:13York city, we're doing more goniometric assessments.
00:13 - 00:17In this video we're going to do hip extension range of motion, in Thomas test position,
00:17 - 00:24and I'm going to show you guys a little modification to help increase the reliability of this test.
00:24 - 00:29After we're done I'll talk about all of the restrictions that could be preventing optimal
00:29 - 00:30range.
00:30 - 00:33I'm going to have my friend Melissa come out, she's going to help me demonstrate.now first
00:33 - 00:39thing is first, we talked about this being Thomas test, so I need to get her into Thomas
00:39 - 00:40test position.
00:40 - 00:45Thomas test position, she's going to scoot down so that just her sacrum, her tailbone
00:45 - 00:49is on the table, because the last thing I want, go ahead and scoot up a little bit,
00:49 - 00:55is as I'm taking this hip extension range of motion is the table blocking her femur
00:55 - 00:57from being able to descend.
00:57 - 01:01Alright I don't want a range of motion of the table, I want a range of motion of her
01:01 - 01:02hip joint.
01:02 - 01:07So I'm going to have her scoot all the way down, make sure just her tailbone is on there.
01:07 - 01:13Now part of the problems with this Thomas test position has been people will go, ok
01:13 - 01:19hold this knee, and then they'll put this in this position and they'll measure, without
01:19 - 01:25paying too much attention to how much of maybe an anterior pelvic tilt, how much of a lordosis,
01:25 - 01:30or how much of a posterior pelvic tilt has actually occurred at the pelvis.
01:30 - 01:35There's nothing that has given them a consistent position for the pelvis itself.
01:35 - 01:42So to improve that a little bit, what I generally do is I'll go ahead and sneak my fingers under
01:42 - 01:43her lumbar spine.
01:43 - 01:48I'm going to have her pull her leg up until she just flattens out her lumbar spine, so
01:48 - 01:54right there.She just flattens out her lumbar spine, which i know is a certain degree of
01:54 - 01:56posterior pelvic tilt.
01:56 - 01:59I'm going to have her hold her leg right there.
01:59 - 02:06Now this is going to steal some of her hip extension away as far as the goniometer is
02:06 - 02:13concerned, but the benefit I just gained in reliability inter and intra testing reliability
02:13 - 02:14is well worth it.
02:14 - 02:22I want to make sure that every time I come back to this test I can put Melissa in a position
02:22 - 02:27where her pelvis is exactly where I had it last time, so that I'm actually getting a
02:27 - 02:31reading of how much improvement I actually got in hip extension.
02:31 - 02:37it does change our numbers a little bit according to Norkin and White, but like I said the increase
02:37 - 02:39in reliability is worth it.
02:39 - 02:42Now how we are going to measure this , we always have to go back to our two lines and
02:42 - 02:43our pivot point.
02:43 - 02:49So the two lines are going to be one just through her trunk, this imaginary line the
02:49 - 02:52kind of bisects a straight line through her spine,.
02:52 - 02:57Or maybe even just posterior to the mid-axillary line here, you guys can see this, I went ahead
02:57 - 03:00and put a big piece of orange Rock tape right there.
03:00 - 03:06The pivot point is actually her greater trochanter and thats the end of this piece of tape.
03:06 - 03:10So make sure you're not up here on the ilum trying to get a measure of hip extension,
03:10 - 03:12because it will falsify your reading.
03:12 - 03:16The hip joint is actually several inches below that iliiac crest.
03:16 - 03:23And then we have a mid-lateral line at the femur is where the movement arm is going to
03:23 - 03:24go.
03:24 - 03:29So stabilization arm is through that line, pivot point through the greater trochanter,
03:29 - 03:34and then we have the movement arm along that mid-femoral line.
03:34 - 03:38Now I'm going to flip around and put my back to the camera to show you guys kind of how
03:38 - 03:47I would do this test, but hopefully you guys can see the set up.
03:47 - 03:51So once again we already had put her in Thomas test position, alright I will make sure that
03:51 - 03:59I have her lumbar spine, just take the lordosis out, just pulled up a notch to take that lordosis
03:59 - 04:00out.
04:00 - 04:06Right make sure her femur is straight, shes not abducting, adducting, externally or internally
04:06 - 04:07rotating.
04:07 - 04:08So she's nice and straight there.
04:08 - 04:14I'm going to go ahead and kneel down so that my eye is level with my goniometer there,
04:14 - 04:17and I can see how many degrees I got.
04:17 - 04:25Stabilisation arm through that mid-axillary line, pivot point through the greater trochanter,
04:25 - 04:33and the I have my other, my movement arm through that mid-femoral line, and we have roughly
04:33 - 04:405 degrees that's a negative 5 degrees of hip extension for Melissa.
04:40 - 04:43Alright, thankyou Melissa.
04:43 - 04:50Now what does that mean, a negative 5 degrees, well 0 to 10 degrees in that position is probably
04:50 - 04:51optimal.
04:51 - 04:55Alright so I know it says 15-20 in Norkin and White, but remember we took her into a
04:55 - 04:59posterior pelvic tilt which robbed her of some of her extension.
04:59 - 05:01So she's still short of that.
05:01 - 05:05We still could use a little work getting her her optimal hip extension back.
05:05 - 05:10Since this is a range of motion test, i am going to start to thinking towards my restrictions,
05:10 - 05:13what could possibly restrict hip extension.
05:13 - 05:19I'm going to go through y tissues here, so is it muscle, is it joint, is it fascia, is
05:19 - 05:20it nerve.
05:20 - 05:23Muscles guys I know this looks like a big list of muscles but it just comes down to
05:23 - 05:25our hip flexors.
05:25 - 05:29So first maybe psoas and iliacus, then I am going to check out her TFL and her rectus
05:29 - 05:34femoris, and then of course her adductors and her sartorius.
05:34 - 05:38Alright these are all potential structures that could be restricting this range of motion,
05:38 - 05:44and of course I could use my release techniques, my stretching techniques to help elongate
05:44 - 05:46those tissues.
05:46 - 05:53What about the joints, well at the joint I have my anterior capsule could restrict this
05:53 - 05:54motion.
05:54 - 05:59Not terribly common that your anterior capsule gets really really tight in somebody, but
05:59 - 06:05it does happen and you'd need to do some posterior to anterior glides.
06:05 - 06:11All the ligaments in the hip, all of the ligaments in the hip actually restrict extension so
06:11 - 06:12something to think about.
06:12 - 06:15Some of that static stretching that we've been doing might actually be affecting these
06:15 - 06:24ligaments that have become adaptively shortened because of some sort of hip dysfunction.
06:24 - 06:31Guys don't forget that just because we're measuring the hip, the proximal joints, the
06:31 - 06:35lumbar spine, the sacroiliac joint, if they become dysfunctional they will change the
06:35 - 06:40tonicity of muscles around the lumbar spine and SI joint.
06:40 - 06:44Some of those muscles directly impact the hip, and could affect this range of motion.
06:44 - 06:51I know that's a few steps away from just looking a the hip, but I would definitely take a look
06:51 - 06:55at those two joints and maybe clear them if I suspected that they were contributing to
06:55 - 06:58this restriction in our hip extension.
06:58 - 07:03So lets say I looked at all of the muscles, and I got the muscles released and stretched
07:03 - 07:08and they're good, I did all of my joint work, she's good there, now where do I go.
07:08 - 07:14Well lets not forget about that fascial component, like all of the lateral and anterior fascia
07:14 - 07:17lata, that stuff can be restricted too.
07:17 - 07:22So all of those pin and stretch techniques, instrument assisted soft tissue mobilizations.
07:22 - 07:25You might want to look into some of that to help start releasing some of those tissues
07:25 - 07:27and get hip extension back.
07:27 - 07:34And of course if Melissa had any feelings of tingling, some parasthesia, some really
07:34 - 07:40burning or electric tightness, I;m going to start thinking towards nerves, specifically
07:40 - 07:43in this test I'm going to start thinking towards femoral nerve.
07:43 - 07:48Of course I wouldn't use goniometry as a nerve test.
07:48 - 07:54This would simply be an indicator that I need to go ahead and do my femoral nerve test,
07:54 - 07:57and try to differentiate and see what I am going to do.
07:57 - 08:00So there you guys go, hip extension goniometry in Thomas test position.
08:00 - 08:06I showed you guys a way to increase reliability, and what that did to range of motion.
08:06 - 08:12And look at all of these potential structures that you have to target to help get somebody
08:12 - 08:15optimal hip extension , to improve your outcomes.
08:15 - 08:16I look forward to hearing from you guys soon.

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