00:06 - 00:09This is Brent of the Brookbush Institute at the independent training
00:09 - 00:13spot. In this particular goniometric assessment video we're going to go over
00:13 - 00:17something I've heard called the hamstring assessment, or possibly knee
00:17 - 00:24extension at 90, or the 90-90 knee extension assessment. Whatever it happens
00:24 - 00:27to be I'm going to show it to you guys and then we're going to talk about what
00:27 - 00:32restrictions it might indicate, and how we're going to potentially create an
00:32 - 00:35intervention that'll improve that dysfunction. I'm going to have my friend
00:35 - 00:41Mike Tierney come out from metropolitan fitness, he's been nice enough to let us
00:41 - 00:47tape up his legs. So I'm going to stand on this side of him which is not how you
00:47 - 00:50guys would do this assessment, but I'm going to stand on this side of them to show
00:50 - 00:54where everything goes and how you set this up, and then I'm going to walk
00:54 - 00:57around the camera and you guys will have to excuse me for turning my back to you,
00:57 - 01:02and show you how i would actually just go through this assessment. So first
01:02 - 01:06things first remember we have two lines we got to create for goniometry. We
01:06 - 01:10have one that's going to go through the stabilization arm which is the arm that
01:10 - 01:13is attached to the protractor, and the one that that we're going to put the
01:13 - 01:20movement arm over since the goal of this assessment is to measure essentially
01:20 - 01:25this angle. Alright we got to create a line through the lateral femur which is
01:25 - 01:29from lateral condyle to greater trochanter. Alright so I took a nice
01:29 - 01:34big piece of orange rock tape here and kind of made that easy to visualize, and
01:34 - 01:39then this line is actually from the last video we did on dorsiflexion goniometric
01:39 - 01:43assessment, which was from fibular head to lateral malleolus or a line
01:43 - 01:48straight through the fibular shaft. So
01:49 - 01:59stabilization arm goes on the femur line, pivot point goes on the lateral condyle
01:59 - 02:03and I'm set up like that, and then I'm going to take him through his passive
02:03 - 02:07range of motion until I get that end feel. Go ahead and relax make sure
02:07 - 02:11they're not helping you out, and I should get a firm end feel that's that muscular
02:11 - 02:16end feel, it's like soft soft soft and then it comes to a harder stop with a
02:16 - 02:22little bit of play, a muscular end feel so to speak. Alright and then the weird
02:22 - 02:26thing about this goniometric assessment once again we're in goniometry
02:26 - 02:31world, so rather than this being whatever this angle would be in geometry
02:31 - 02:40we're actually measuring if this is zero degrees, how far from zero are we. So the
02:40 - 02:50normal is 0 to 20 and Mike here, all right once again i'm going to make sure
02:50 - 02:54it's hip is in neutral position,
02:55 - 03:00I'm going to pull up, no abduction, adduction internal rotation of the hip. I'm going
03:00 - 03:10to go ahead and hold this and tell you guys that Mike is at 45 degrees, optimal
03:10 - 03:16a 0 to 20 so Mike is a little tight. What are we going do about that we'll talk
03:16 - 03:19about this in a second. Let me show you guys how I would do this assessment so
03:19 - 03:25it doesn't look so awkward. So I would once again pull Mike into hip flexion
03:25 - 03:29here. I would make sure we don't have internal rotation, external rotation, no
03:29 - 03:35abduction, adduction or abduction. So i'm holding him with his knee right over his
03:35 - 03:41hip. I'd then go ahead and take him into his passive range hold him here, can you
03:41 - 03:49help me a little bit, good. Once i got my goniometer set up alright, so I got my
03:49 - 03:53stabilization arm through that lateral line of the femur. I have my movement arm
03:53 - 03:58through that lateral line of the fibula. Go ahead and have him relax. Make sure
03:58 - 04:04i'm at that that end feel that i was looking for. I'm going to grab my goniometer,
04:04 - 04:10go ahead let him relax, take a look and when I was on this side I
04:10 - 04:15actually got 41 degrees. I would probably think that this side was more when I was
04:15 - 04:18on this side, it was a little bit more accurate as this is the position I
04:18 - 04:24normally do the test in. Thanks Mike. Now as we mentioned in the previous
04:24 - 04:30video an assessment is only a good assessment if it has a purpose, and most
04:30 - 04:35assessments they fall under two categories; either they clear our
04:35 - 04:39patients and clients for intervention, right is this person appropriate for us
04:39 - 04:44to work with or do we need to refer them to somebody else, or it affects our
04:44 - 04:49exercise and intervention selection. With goniometric assessment we're really
04:49 - 04:54looking at restrictions and flexibility type techniques. So what could be
04:54 - 04:57restricting his motion? Well I said before that this goniometric assessment
04:57 - 05:01is sometimes just called a hamstring assessment. So we probably want to start
05:01 - 05:06their the biceps femoris and the semis. If we think one step deeper we could
05:06 - 05:10think towards postural dysfunction, and in postural dysfunction we see that
05:10 - 05:18the commonly overactive of these two is usually biceps femoris. So if I see this
05:18 - 05:22restriction maybe the first thing I want to think about is biceps femoris release
05:22 - 05:28and lengthening. Well what if I do that I don't get any further range of motion
05:28 - 05:31increase, Well let's go ahead and think through our other tissues. What about
05:31 - 05:39fascia, joints, nerves. I'm going to go ahead and think about that TFL VL ITB complex,
05:39 - 05:45or my iliotibial band will restrict extension. Now I'm not going to be able to
05:45 - 05:50do too much to lengthen my iliotibial band, but what about the TFL and VL that
05:50 - 05:56invest in it. Can I affect this musculature and affect how the ITB is
05:56 - 06:06moving, and will that give me some range of motion back. Joints, so although joint
06:06 - 06:10restrictions probably won't affect this, because of that hip flexion our
06:10 - 06:16hamstrings are shortened up pretty quick, but faulty joint motion or arthrokinematic
06:16 - 06:22dyskinesis can affect muscular function and activity. It might
06:22 - 06:26be worth me checking tibiofemoral glide, but specifically if I can't get into
06:26 - 06:32extension does my tibia, is it able to glide anteriorly on my femur, or we can
06:32 - 06:35flip that around is my femur able to glide posteriorly on my
06:35 - 06:41tibia. And don't forget about the proximal tibiofibular joint, so related to ankle
06:41 - 06:47dysfunction was an anterior glide of the distal tibiofibular joint, which then
06:47 - 06:53posterior glides my proximal tibiofibular joint, and that kind of starts
06:53 - 06:58relating back to our lower leg dysfunction which also included a tight
06:58 - 07:01biceps femoris, because that turn the knee out. Hopefully you guys are following
07:01 - 07:05some of this but at the end of the day know that these two joints can
07:05 - 07:12potentially restrict knee extension in this position, and then last my sciatic
07:12 - 07:17nerve if Mike had started complaining about tingling, or a sensation of stretch
07:17 - 07:22that went all the way from his butt down to his ankle, I might start thinking man
07:22 - 07:25maybe there is the nerve restriction and I need to do further assessment, further
07:25 - 07:32neurodynamic testing. Now in future videos I will try to show further
07:32 - 07:39assessments to get even this long list dialed down to fewer and fewer specific
07:39 - 07:44techniques, so we get a very pin pointed program. But I hope this video helps you
07:44 - 07:49guys use this assessment. i hope this video shows you what you can do with
07:49 - 07:56this assessment, and most importantly that you are using it for the better
07:56 - 08:01creation of better programs. I will talk with you soon. I hope you guys get great
08:01 - 08:03outcomes.
08:09 - 08:11