00:00:0600:00:10
This is Brent of the Brookbush Institute
00:00:0600:00:10
at the Independent Training Spot, doing
00:00:1000:00:13
another goniometric assessment video. In this video we're going to do hip
00:00:1300:00:17
external rotation at 90 degrees, so if you just watched our last video on
00:00:1700:00:22
internal rotation you are all set for this video. I'm going to have my friend
00:00:2200:00:26
Melissa come out. Once again we're setting up the same two lines we've had
00:00:2600:00:31
in the previous three videos. actually. So my stabilization arm is
00:00:3100:00:35
going to be perpendicular to the edge of the table, that's going to be my eyeline.
00:00:3500:00:39
Or it's going to be more appropriately, perpendicular with a line that goes
00:00:3900:00:46
straight down the center of Melissa's body. The movement arm goes straight
00:00:4600:00:50
through the middle of the knee, and I told you guys how I like to line up
00:00:5000:00:54
through the tibial tuberosity, because the tibial crest is not a straight line.
00:00:5400:01:00
So as I did in the previous video, I'm going to go ahead and take Melissa's
00:01:0000:01:06
knee and leg up to 90 degrees, put her knee directly over her hip, no adduction
00:01:0600:01:12
no abduction, no flexion or extension, just right there. I'm going to go into
00:01:1200:01:17
external rotation as far as I can, once again looking for a firm end feel. I'm
00:01:1700:01:21
going to have Melissa hold that for me.
00:01:2200:01:26
I'm going to do the same thing I did in the previous one, I'm going to hold my
00:01:2600:01:30
movement arm and her leg, try to give her a little bit of stability so she can
00:01:3000:01:35
relax a little bit, and I can get a true passive range of motion. Line up straight
00:01:3500:01:44
through that line, and we got 32 degrees. Alright 32 degrees it's a little tight
00:01:4400:01:49
right, passive range of motion 40 to 50 degree with firm end feel. She's a little
00:01:4900:01:52
tight through external rotation. Let's try that one more time, one more time. So
00:01:5200:01:58
I'm going to bring her up, hip directly sorry, knee directly over her hip, no
00:01:5800:02:04
adduction, no abduction, no flexion extension, just directly over. Bring her
00:02:0400:02:13
to her end range, good hold that one. I'm trying to hold her leg a little bit with
00:02:1300:02:23
the movement arm, get my stabilization arm set up, and 32 degrees once again. How's
00:02:2300:02:29
that for some intra-tester reliability, thank You Melissa. So you guys see how to
00:02:2900:02:33
do the technique, now the question is what to do with the technique? Why would
00:02:3300:02:40
I do hip external rotation goniometry? Well obviously if I am measuring
00:02:4000:02:44
flexibility end range and probably thinking more towards restrictions and
00:02:4400:02:50
my flexibility techniques. So what muscles would restrict external rotation
00:02:5000:02:55
with hip flexed to ninety? We start with the piriformis, and I know what you guys
00:02:5500:02:58
are thinking I thought the piriformis was an external rotator, but above 90
00:02:5800:03:01
degrees it actually becomes an internal rotator which I know gets a little
00:03:0100:03:07
confusing, it makes our last couple of graphs seem a little backwards, but
00:03:0700:03:12
nonetheless piriformis will restrict this range of motion. Once again we have
00:03:1200:03:15
the adductors and I talked about this in the previous video, but the adductors
00:03:1500:03:20
because of this position I'm not going to try to differentiate whether it's the
00:03:2000:03:23
anterior adductors, or the posterior adductor Magnus. I'm just going to go
00:03:2300:03:29
ahead and say that the adductors will restrict this range of motion due to the
00:03:2900:03:33
position of the hip. I have the TFL and glute minimus,
00:03:3300:03:38
again these muscles end up on both sides of the graph. I talked about how arthro-
00:03:3800:03:44
kinematically they could restrict hip internal rotation, in this case they are
00:03:4400:03:50
internal rotators so they will restrict hip external rotation. If I release all
00:03:5000:03:54
of these muscles which is probably going to be my first go to right, work on
00:03:5400:03:58
flexibility of these muscles, i'm going to go back to joint. Kind of mentioned in
00:03:5800:04:03
the previous video that these 90-90 hip internal and external rotations, to me
00:04:0300:04:08
are a big sign of arthrokinematic dysfunction at the hip. I'm going to go
00:04:0800:04:12
and check out my posterior inferior capsule, look at maybe the
00:04:1200:04:16
self-administered hip mobilization techniques i showed in the previous
00:04:1600:04:20
video, or i'm going to start looking at some of my manual techniques. Do i need
00:04:2000:04:24
to do a posterior glide, do i need to do that lateral distraction technique that
00:04:2400:04:29
i know a lot of therapists and ATC's are very familiar with. If i get through
00:04:2900:04:33
these two and i still don't have my range of motion back, well what about my
00:04:3300:04:37
fascia, what about that posterior hip and sacral fascia, all this back here that
00:04:3700:04:43
could be restricting that range of motion. I want to maybe loosen that up or
00:04:4300:04:49
reduce adhesions, or or help to improve the extensibility through that range of
00:04:4900:04:52
motion with maybe my pin and stretch, or my instrument assisted soft tissue
00:04:5200:04:59
mobilization. And of course I don't want to forget about if Melissa had some sort
00:04:5900:05:03
of sign like paresthesia of nerve involvement, I know that my sciatic and
00:05:0300:05:08
posterior femoral cutaneous nerve can be lengthened in that position. Or in the
00:05:0800:05:13
case of sciatic nerve impingement between the piriformis and gemellus superior. I want to go ahead
00:05:1300:05:21
and differentiate with further neuro- dynamic tests. Now once again these 90 90
00:05:2100:05:25
hip internal and external rotation assessments I know look very similar to
00:05:2500:05:30
the prone hip internal and external assessments, but I think if you go back
00:05:3000:05:36
through some of these graphs, I think if you practice these these different
00:05:3600:05:40
assessments, try an intervention and go back to the assessments, you're going to
00:05:4000:05:45
find that the restrictions there implying are different.
00:05:4500:05:50
I do happen to use the supine internal and external rotation assessments
00:05:5000:05:55
probably more than anything else for the hip. I find that if I can get these guys
00:05:5500:06:02
back to normal, and if I can get 40 to 50 degrees in both directions, I've done a
00:06:0200:06:07
pretty good job of getting my arthrokinematics and my length tension
00:06:0700:06:13
relationships straight at the hip; and then I can move on to whatever joint or
00:06:1300:06:16
muscular imbalance, other joint or muscular imbalance i think is affecting
00:06:1600:06:19
this person's movement compensation. I hope you guys have learned a lot from
00:06:1900:06:23
this video. I hope you understand how to do this goniometric assessment and
00:06:2300:06:27
feel comfortable with it. It will take a little practice but get on it with a
00:06:2700:06:32
partner, a peer, a co-worker before you try it on your patients and clients. And
00:06:3200:06:36
then of course try to start thinking through your functional anatomy, because
00:06:3600:06:41
every test you do should affect your intervention, affect your exercise
00:06:4100:06:45
selection. You should be doing your assessment to try to improve your
00:06:4500:06:49
outcomes. I look forward to seeing you guys soon.