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Hip Flexion Goniometry

Do you want to increase your range of hip motion? Learn the goniometric procedure for measuring hip flexion with this step-by-step video tutorial. Quickly assess and accurately track your wins!

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00:04 - 00:08This is Brent of the Brookbush Institute at the independent training
00:08 - 00:11spot, doing goniometric assessment. Now in this video we're going to do hip flexion
00:11 - 00:14range of motion, and then we're going to talk about some of the structures that
00:14 - 00:16would restrict hip flexion. I'm going to have my friend Melissa come out, she's
00:16 - 00:21going to help me demonstrate. Now before we get into actually the technique, we need
00:21 - 00:25to realize that hip flexion has a soft end feel okay, so that's the anterior
00:25 - 00:30thigh muscles approximating our bellies. Realize that a leaner individuals a firm
00:30 - 00:36end feel is not abnormal as you just get to the end of the posterior capsule, the
00:36 - 00:40end of the extensibility of the posterior capsule rather. Now before you
00:40 - 00:44guys jump all over me for the range of motion I have written up here, I have 110
00:44 - 00:50to 135 degrees. I tried to create a range of motion that encapsulates a lot of the
00:50 - 00:54range of motions I see out there from different research, you guys might have
00:54 - 01:01to do a little bit more research to find out where within this range you should
01:01 - 01:04be aiming for, for the specific population that you work with. I find
01:04 - 01:09that with the population I work with a fairly at least recreationally athletic
01:09 - 01:15if not professionally athletic individuals, 125 is probably a good range,
01:15 - 01:21give or take 5 degrees. Now as far as setup, we have a stabilization arm that's
01:21 - 01:25going to go through our mid axillary line, so all I did here was I laid a
01:25 - 01:28piece of tape down to kind of show you where that line is, from greater
01:28 - 01:33trochanter to the top of the iliac crest, through the armpit. Now the movement arm
01:33 - 01:38is going to go from the greater trochanter through the femoral condyle, or or just
01:38 - 01:43mid femur. The fulcrum is of course through the hip, but we're going to use the
01:43 - 01:48greater trochanter which is where these two lines meet, as kind of a reference
01:48 - 01:53point for where the hip rotates. The thing to be careful is Norkin and White
01:53 - 01:57kind of mention how they want this leg straight, the problem is is if this leg
01:57 - 02:01is flat on the table and the person that you're measuring has tightness and their
02:01 - 02:06hip flexors on the side you're not measuring, it'll pull their pelvis into
02:06 - 02:12an anterior pelvic tilt, which of course is then going to change the measurement you
02:12 - 02:15get at the hip. So you need to do a little bit of
02:15 - 02:19palpating here, make sure you grab the ASIS and kind of grab the posterior
02:19 - 02:22ilium, and make sure that they're not in that anterior pelvic tilt, they don't
02:22 - 02:27have an excessive lordosis. Make sure they're in neutral to start, and then
02:27 - 02:31when you're bringing them into hip flexion, you're going to keep their hand
02:31 - 02:37there, ASIS, posterior ilium, and only pressing the hip flexion until you get
02:37 - 02:42their pelvis starting to rotate, which means you've hit end of pelvic range. Now
02:42 - 02:48her lumbar spine is starting to flex, and she goes into a posterior pelvic tilt. So
02:48 - 02:52just to review here I'm going to palpate, I'm going to push, and right there is where
02:52 - 02:56I feel her starting to shift at her pelvis. I'm going to have her go ahead and
02:56 - 03:02hold this for me. Now I normally would not take this measurement by
03:02 - 03:07leaning over the top of Melissa, this is just to help you guys see where I put
03:07 - 03:12the goniometer right. So the stabilization arm is going to go right
03:12 - 03:15through that mid axillary line, you can see I set the fulcrum up on the greater
03:15 - 03:21trochanter. I then put my movement arm straight through the femoral condyle. All
03:21 - 03:29right mid femur, I'm going to take this off, and Melissa's got a hundred degrees of
03:29 - 03:34hip flexion, which if this was the only measurement I was going to take I'd say she
03:34 - 03:37was restricted. That's definitely not optimal for somebody as athletic as she
03:37 - 03:42is. Now I'm going to show you guys how I would actually do this test, forgive me
03:42 - 03:47for turning my back on you. So once again I'm going to make sure she's not in an
03:47 - 03:51anterior pelvic tilt, so I'm going to kind of palpate her pelvis here, make sure
03:51 - 03:55she's not in excessive lordosis, looks pretty good to me.
03:55 - 04:01All right I'm going to then once again palpate her pelvis, palpate her ASIS,
04:01 - 04:06bring her into as much hip flexion as I can until I start to feel her pelvis
04:06 - 04:11rotate. I'm then I'm going to have her hold, all right she can use a little bit of
04:11 - 04:20her muscular power here as well as this other hand, and then I'm going to have my
04:20 - 04:24stabilization arm along our mid axillary line. I'm going to set my fulcrum up with
04:24 - 04:29her greater trochanter, I got my movement arm set up going straight through her
04:29 - 04:37femoral condyle, and we can see once again I got a hundred degrees, so not
04:37 - 04:44so bad on my intra-tester reliability. So if she had a hundred degrees, now we have
04:44 - 04:48to start talking about what's restricting her motion, what exercises am
04:48 - 04:52I going to select for her home exercise program, and what am I going to do
04:52 - 04:55personally to help get her her range of motion back, Thanks Melissa.
04:55 - 04:59So let's talk about that, and let's break it down through the same paradigm I've
04:59 - 05:03been breaking down in all of these videos. What are the muscle , joint, fascial
05:03 - 05:06and nerve restrictions. So muscular restrictions, let's start with the
05:06 - 05:10posterior head of the adductor Magnus. If you remember the adductor Magnus has two
05:10 - 05:15heads, one of them actually extends and externally rotates the head, and it does
05:15 - 05:19have a propensity to get overactive in individuals. So I would definitely take a
05:19 - 05:22look at this posterior head of the adductor Magnus, and possibly release and
05:22 - 05:27stretch. Now some of you guys might be wondering why it isn't gluteus maximus up here,
05:27 - 05:32well we have both the research to back it up, and of course clinically we just
05:32 - 05:38don't see an overactive glute max, we don't see an adaptively shortened glute
05:38 - 05:43max. If you guys think about this I think you can just rationalize the fact that
05:43 - 05:49nobody has ever walked into your clinic, studio, gym, or a training facility and
05:49 - 05:54gone you know what my glutes are just too tight, it just doesn't happen
05:54 - 05:57right, we see a lot on the other side we see people who want tighter glutes, we
05:57 - 05:59don't really see glutes that are too tight, so they're probably not going to
05:59 - 06:04restrict your hip flexion range of motion. Your deep rotators can also
06:04 - 06:08restrict hip flexion if they get really really tight, and start binding down the
06:08 - 06:13posterior aspect of that joint. And then you guys will notice I have hip flexors
06:13 - 06:17written down here, well we can't forget that when we deal with joints we're also
06:17 - 06:21dealing with not just osteokinematics that's flexion and extension and
06:21 - 06:24external rotation, but we're also dealing with those arthokinematics that slide,
06:24 - 06:34glide, role. So hip flexors don't just flex the hip, they also glide the
06:34 - 06:38femoral head anteriorly, and unfortunately if my hip flexors get
06:38 - 06:45overactive and glide my femoral head anteriorly, that creates this impingement
06:45 - 06:51or this restriction where I can no longer get any further flexion, because
06:51 - 06:56while I'm flexing I should actually be going posterior with my femoral head. So
06:56 - 06:59if you guys get nothing out of release and stretch from these muscles,
06:59 - 07:03you might try releasing the hip flexors and seeing if that improves this range
07:03 - 07:07of motion. Now the joint and this is probably the biggest restriction to hip
07:07 - 07:13flexion, the posterior capsule of the hip does adaptively shorten in individuals
07:13 - 07:17with compensation patterns, and of course we have our lateral hip distraction and
07:17 - 07:21our posterior glide, you guys have that self-administered mobilization video I
07:21 - 07:28did, that will definitely be a big one for this particular restriction. You guys
07:28 - 07:33can also see I wrote down once again this is kind of a bonus, those lumbar
07:33 - 07:37spine, so the facet joints of the lumbar spine and the sacroiliac joint, if those
07:37 - 07:42are dysfunctional they can change muscular activity, they can change the
07:42 - 07:47tension within that fascial network, that lumbosacral fascial network which may
07:47 - 07:53also affect hip joint range of motion fascia. So once again I kind of just
07:53 - 07:59mentioned it here posterior hip and sacral fascia can definitely restrict hip
07:59 - 08:03flexion, and I might need to use my pin and stretch techniques, or maybe
08:03 - 08:06instrument assisted soft tissue mobilization, and I know there's a lot of
08:06 - 08:10other fascial techniques out there that you guys may try here. And of course if I
08:10 - 08:17pulled somebody into hip flexion, I do have to be aware that muscles, joints, and
08:17 - 08:20also nerves are involved in every range of motion. I'm not calling this a neuro-
08:20 - 08:25dynamic test by any means, but if somebody had a geared up sciatic nerve
08:25 - 08:28and I push them into hip flexion, and all of a sudden that reproduces their
08:28 - 08:31symptoms, I need to at least be aware that hip flexion does
08:31 - 08:35stretch the sciatic nerve around the back of the hip a little bit. It closes the
08:35 - 08:40piriformis and gemellus superior down on the sciatic nerve as well, and it's going to
08:40 - 08:45lengthen the lumbosacral plexus. If somebody has like some lumbar spine
08:45 - 08:50pathology, they have a nerve root adhesion, or they have some sort of
08:50 - 08:56radiculopathy, you may start to reproduce their symptoms. And of course we could go
08:56 - 09:00backwards through this grasp, maybe they started here, they stopped
09:00 - 09:05going into hip flexion and that's what caused the restriction. So I just gave
09:05 - 09:08you a whole lot of information, I hope what you can do with this is you have
09:08 - 09:14one more test that'll give you a few more ideas, to create even better
09:14 - 09:19programs, better exercise selection so that you get even better outcomes. I look
09:19 - 09:24forward to hearing from you guys, I hope you learned a lot from this video.

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