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Goniometry: Hip External Rotation at 90 Degrees of Hip Flexion (90/90 Hip ER)

Goniometry: Hip External Rotation at 90 Degrees of Hip Flexion (90/90 Hip ER) is a functional movement test to measure hip joint range of motion. The test involves the patient placed in a supine (lying down) position with the hips and knees flexed at 90 degrees. The hip is then gently rotated outwardly to measure external range of motion relative to the patient's contralateral side. The 90/90 Hip ER is a standardized clinical measure and

Transcript

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This is Brent of the Brookbush Institute
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at the Independent Training Spot, doing
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another goniometric assessment video. In this video we're going to do hip
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external rotation at 90 degrees, so if you just watched our last video on
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internal rotation you are all set for this video. I'm going to have my friend
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Melissa come out. Once again we're setting up the same two lines we've had
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in the previous three videos. actually. So my stabilization arm is
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going to be perpendicular to the edge of the table, that's going to be my eyeline.
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Or it's going to be more appropriately, perpendicular with a line that goes
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straight down the center of Melissa's body. The movement arm goes straight
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through the middle of the knee, and I told you guys how I like to line up
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through the tibial tuberosity, because the tibial crest is not a straight line.
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So as I did in the previous video, I'm going to go ahead and take Melissa's
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knee and leg up to 90 degrees, put her knee directly over her hip, no adduction
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no abduction, no flexion or extension, just right there. I'm going to go into
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external rotation as far as I can, once again looking for a firm end feel. I'm
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going to have Melissa hold that for me.
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I'm going to do the same thing I did in the previous one, I'm going to hold my
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movement arm and her leg, try to give her a little bit of stability so she can
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relax a little bit, and I can get a true passive range of motion. Line up straight
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through that line, and we got 32 degrees. Alright 32 degrees it's a little tight
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right, passive range of motion 40 to 50 degree with firm end feel. She's a little
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tight through external rotation. Let's try that one more time, one more time. So
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I'm going to bring her up, hip directly sorry, knee directly over her hip, no
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adduction, no abduction, no flexion extension, just directly over. Bring her
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to her end range, good hold that one. I'm trying to hold her leg a little bit with
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the movement arm, get my stabilization arm set up, and 32 degrees once again. How's
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that for some intra-tester reliability, thank You Melissa. So you guys see how to
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do the technique, now the question is what to do with the technique? Why would
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I do hip external rotation goniometry? Well obviously if I am measuring
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flexibility end range and probably thinking more towards restrictions and
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my flexibility techniques. So what muscles would restrict external rotation
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with hip flexed to ninety? We start with the piriformis, and I know what you guys
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are thinking I thought the piriformis was an external rotator, but above 90
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degrees it actually becomes an internal rotator which I know gets a little
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confusing, it makes our last couple of graphs seem a little backwards, but
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nonetheless piriformis will restrict this range of motion. Once again we have
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the adductors and I talked about this in the previous video, but the adductors
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because of this position I'm not going to try to differentiate whether it's the
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anterior adductors, or the posterior adductor Magnus. I'm just going to go
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ahead and say that the adductors will restrict this range of motion due to the
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position of the hip. I have the TFL and glute minimus,
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again these muscles end up on both sides of the graph. I talked about how arthro-
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kinematically they could restrict hip internal rotation, in this case they are
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internal rotators so they will restrict hip external rotation. If I release all
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of these muscles which is probably going to be my first go to right, work on
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flexibility of these muscles, i'm going to go back to joint. Kind of mentioned in
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the previous video that these 90-90 hip internal and external rotations, to me
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are a big sign of arthrokinematic dysfunction at the hip. I'm going to go
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and check out my posterior inferior capsule, look at maybe the
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self-administered hip mobilization techniques i showed in the previous
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video, or i'm going to start looking at some of my manual techniques. Do i need
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to do a posterior glide, do i need to do that lateral distraction technique that
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i know a lot of therapists and ATC's are very familiar with. If i get through
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these two and i still don't have my range of motion back, well what about my
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fascia, what about that posterior hip and sacral fascia, all this back here that
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could be restricting that range of motion. I want to maybe loosen that up or
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reduce adhesions, or or help to improve the extensibility through that range of
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motion with maybe my pin and stretch, or my instrument assisted soft tissue
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mobilization. And of course I don't want to forget about if Melissa had some sort
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of sign like paresthesia of nerve involvement, I know that my sciatic and
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posterior femoral cutaneous nerve can be lengthened in that position. Or in the
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case of sciatic nerve impingement between the piriformis and gemellus superior. I want to go ahead
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and differentiate with further neuro- dynamic tests. Now once again these 90 90
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hip internal and external rotation assessments I know look very similar to
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the prone hip internal and external assessments, but I think if you go back
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through some of these graphs, I think if you practice these these different
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assessments, try an intervention and go back to the assessments, you're going to
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find that the restrictions there implying are different.
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I do happen to use the supine internal and external rotation assessments
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probably more than anything else for the hip. I find that if I can get these guys
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back to normal, and if I can get 40 to 50 degrees in both directions, I've done a
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pretty good job of getting my arthrokinematics and my length tension
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relationships straight at the hip; and then I can move on to whatever joint or
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muscular imbalance, other joint or muscular imbalance i think is affecting
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this person's movement compensation. I hope you guys have learned a lot from
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this video. I hope you understand how to do this goniometric assessment and
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feel comfortable with it. It will take a little practice but get on it with a
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partner, a peer, a co-worker before you try it on your patients and clients. And
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then of course try to start thinking through your functional anatomy, because
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every test you do should affect your intervention, affect your exercise
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selection. You should be doing your assessment to try to improve your
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outcomes. I look forward to seeing you guys soon.