0:06 This is Brent of the Brookbush Institute at the Independent Training Spot, doing 0:10 another goniometric assessment video. In this video we're going to do hip 0:13 external rotation at 90 degrees, so if you just watched our last video on 0:17 internal rotation you are all set for this video. I'm going to have my friend 0:22 Melissa come out. Once again we're setting up the same two lines we've had 0:26 in the previous three videos. actually. So my stabilization arm is 0:31 going to be perpendicular to the edge of the table, that's going to be my eyeline. 0:35 Or it's going to be more appropriately, perpendicular with a line that goes 0:39 straight down the center of Melissa's body. The movement arm goes straight 0:46 through the middle of the knee, and I told you guys how I like to line up 0:50 through the tibial tuberosity, because the tibial crest is not a straight line. 0:54 So as I did in the previous video, I'm going to go ahead and take Melissa's 1:00 knee and leg up to 90 degrees, put her knee directly over her hip, no adduction 1:06 no abduction, no flexion or extension, just right there. I'm going to go into 1:12 external rotation as far as I can, once again looking for a firm end feel. I'm 1:17 going to have Melissa hold that for me. 1:22 I'm going to do the same thing I did in the previous one, I'm going to hold my 1:26 movement arm and her leg, try to give her a little bit of stability so she can 1:30 relax a little bit, and I can get a true passive range of motion. Line up straight 1:35 through that line, and we got 32 degrees. Alright 32 degrees it's a little tight 1:44 right, passive range of motion 40 to 50 degree with firm end feel. She's a little 1:49 tight through external rotation. Let's try that one more time, one more time. So 1:52 I'm going to bring her up, hip directly sorry, knee directly over her hip, no 1:58 adduction, no abduction, no flexion extension, just directly over. Bring her 2:04 to her end range, good hold that one. I'm trying to hold her leg a little bit with 2:13 the movement arm, get my stabilization arm set up, and 32 degrees once again. How's 2:23 that for some intra-tester reliability, thank You Melissa. So you guys see how to 2:29 do the technique, now the question is what to do with the technique? Why would 2:33 I do hip external rotation goniometry? Well obviously if I am measuring 2:40 flexibility end range and probably thinking more towards restrictions and 2:44 my flexibility techniques. So what muscles would restrict external rotation 2:50 with hip flexed to ninety? We start with the piriformis, and I know what you guys 2:55 are thinking I thought the piriformis was an external rotator, but above 90 2:58 degrees it actually becomes an internal rotator which I know gets a little 3:01 confusing, it makes our last couple of graphs seem a little backwards, but 3:07 nonetheless piriformis will restrict this range of motion. Once again we have 3:12 the adductors and I talked about this in the previous video, but the adductors 3:15 because of this position I'm not going to try to differentiate whether it's the 3:20 anterior adductors, or the posterior adductor Magnus. I'm just going to go 3:23 ahead and say that the adductors will restrict this range of motion due to the 3:29 position of the hip. I have the TFL and glute minimus, 3:33 again these muscles end up on both sides of the graph. I talked about how arthro- 3:38 kinematically they could restrict hip internal rotation, in this case they are 3:44 internal rotators so they will restrict hip external rotation. If I release all 3:50 of these muscles which is probably going to be my first go to right, work on 3:54 flexibility of these muscles, i'm going to go back to joint. Kind of mentioned in 3:58 the previous video that these 90-90 hip internal and external rotations, to me 4:03 are a big sign of arthrokinematic dysfunction at the hip. I'm going to go 4:08 and check out my posterior inferior capsule, look at maybe the 4:12 self-administered hip mobilization techniques i showed in the previous 4:16 video, or i'm going to start looking at some of my manual techniques. Do i need 4:20 to do a posterior glide, do i need to do that lateral distraction technique that 4:24 i know a lot of therapists and ATC's are very familiar with. If i get through 4:29 these two and i still don't have my range of motion back, well what about my 4:33 fascia, what about that posterior hip and sacral fascia, all this back here that 4:37 could be restricting that range of motion. I want to maybe loosen that up or 4:43 reduce adhesions, or or help to improve the extensibility through that range of 4:49 motion with maybe my pin and stretch, or my instrument assisted soft tissue 4:52 mobilization. And of course I don't want to forget about if Melissa had some sort 4:59 of sign like paresthesia of nerve involvement, I know that my sciatic and 5:03 posterior femoral cutaneous nerve can be lengthened in that position. Or in the 5:08 case of sciatic nerve impingement between the piriformis and gemellus superior. I want to go ahead 5:13 and differentiate with further neuro- dynamic tests. Now once again these 90 90 5:21 hip internal and external rotation assessments I know look very similar to 5:25 the prone hip internal and external assessments, but I think if you go back 5:30 through some of these graphs, I think if you practice these these different 5:36 assessments, try an intervention and go back to the assessments, you're going to 5:40 find that the restrictions there implying are different. 5:45 I do happen to use the supine internal and external rotation assessments 5:50 probably more than anything else for the hip. I find that if I can get these guys 5:55 back to normal, and if I can get 40 to 50 degrees in both directions, I've done a 6:02 pretty good job of getting my arthrokinematics and my length tension 6:07 relationships straight at the hip; and then I can move on to whatever joint or 6:13 muscular imbalance, other joint or muscular imbalance i think is affecting 6:16 this person's movement compensation. I hope you guys have learned a lot from 6:19 this video. I hope you understand how to do this goniometric assessment and 6:23 feel comfortable with it. It will take a little practice but get on it with a 6:27 partner, a peer, a co-worker before you try it on your patients and clients. And 6:32 then of course try to start thinking through your functional anatomy, because 6:36 every test you do should affect your intervention, affect your exercise 6:41 selection. You should be doing your assessment to try to improve your 6:45 outcomes. I look forward to seeing you guys soon. 6:55
