You can only view 3 videos without an account. Become a Member to access all videos on the website.
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
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.
Related Videos
Hip Flexion Goniometry
Hip Extension Goniometry
Goniometry Hip Internal Rotation (in prone)
Knee Extension with Hip Flexion Goniometry (Hamstring Length Test)
Goniometry: Hip External Rotation at 90 Degrees of Hip Flexion (90/90 Hip ER)
Goniometry: Hip Internal Rotation at 90 Degree of Hip Flexion (90/90 Hip IR)
Ober's Test TFL Flexibility Assessment
Shoulder External Rotation Goniometry
Ely's Test (Rectus Femoris Flexibility Assessment)
Goniometry Hip External Rotation (in Prone)
Femoral Nerve Neurodynamic Tests
Lumbar Movement Assessment
Slump Test
Upper Body Movement Assessment
Straight Leg Raise Test and Well Leg Raise Test