0:05 This is Brent the Brookbush Institute at the Independent Training Spot going 0:10 over a hip goniometry. So in this video we're doing hip external rotation 0:15 in that prone position, and I promise in this video I'm going to talk about why i 0:19 chose the prone position as opposed to that seated position we see in Norkin and 0:23 and White. I'm going to have my friend Jordan Tisdale come out, great trainer 0:26 here at the Independent Training Spot. He's let me tape up his legs despite the 0:31 fact that it might hurt his legs, because of the hair when I take this off. 0:35 Nonetheless almost the same exact setup as the hip internal rotation in prone. 0:41 Alright my stabilization arm, that's the one attached to the protractor, is 0:47 going to be perpendicular to the table, and you guys can see to create a 0:50 little bit more consistency, I put a big piece of orange Rock tape right through 0:55 the middle of his patella, to his tibial tuberosity. So that line that I've 1:01 created, I know I can keep going back to, over and over and over again, and be 1:05 really really consistent so that if I reassess, I know how much change I've 1:11 made. Now external rotation we're going to do very similar to hip internal 1:15 rotation. I'm going to have him find his end range here, notice when i go 1:23 to find his end range to start, regardless of knowing that i'm going to 1:26 measure down here, i need to stabilize his pelvis, because i'm sure you guys can 1:30 see if I just tip him this way, you can see this side of his pelvis just kind of 1:35 rides up. I want to make sure that doesn't happen because that's adding 1:39 degrees of motion. Alright so I take him here, find his end range, there it is. I 1:47 have Jordan hold it, go ahead and hold for me. Go ahead and set up my 1:55 stabilization arm, alright perpendicular to the table. Movement arm right through the 2:00 middle of that line, and Jordan has 55 degrees range of motion. Now normal would 2:10 be 40 to 50, so Jordan here is a little hypermobile. A thing to consider guys is 2:18 it's just as dangerous, or just as injury provoking or just as outside the norm to 2:25 be hypermobile, as it is to be hypomobile. So I'm going to go ahead and do 2:30 this one more time, this will help you guys review and see it one more time, but 2:34 I also want to make sure I got this measurement accurate, because the 2:38 hypermobility is not the most common thing in the world. So once again i'm 2:42 going to stabilize this pelvis, take him to his end range where i get that nice normal 2:47 firm end feel. I'm going to have them hold that for me, go ahead and hold that 2:51 Jordan. Set up my stabilization arm, set up my movement arm, and like I said if I'm 2:58 going to be truly accurate, i'm actually going to get down so that I am eye level 3:01 with my goniometer. Make sure I can see it accurately. Make sure my stabilization 3:08 arm is set up. 3:11 And this time when I got down on the goniometer here I see 50 degrees. So that 3:19 is normal, thanks Jordan. Now once again we have to go through what does this 3:25 mean. Well first off let's talk about the restrictions, let's talk about passive 3:30 range of motion, 40 to 50 degrees. Let's say I got 30 degrees, what would that 3:35 mean? Well I need to think towards techniques that I could use to get him 3:41 back to 40 to 50 degrees range of motion. So what are the muscles that would 3:46 restrict external rotation, that be my internal rotators, specifically those 3:51 overactive internal rotators, the TFL, gluteus minimus, not gluteus medius, but 3:57 gluteus minimus, and anterior adapters. So i might do all of my release and 4:02 lengthening techniques here, what about fascial components, anterior joint capsule. 4:08 You guys notice I have a star by this, originally when I measured Jordan I saw 4:14 55 degrees, I saw a little hyperpermobility. That's not totally uncommon 4:19 for this goniometric assessment. Now what it could mean though is that I have 4:24 too much laxity, and I think we have a tendency to see too much laxity or too 4:30 much mobility in this range of motion, because the anterior joint capsule has a 4:36 tendency to get lax. If we go back through all of that postural dysfunction 4:41 stuff, when we start looking at like lumbo-pelvic hip complex dysfunction, SI 4:44 joint dysfunction, we start looking at just what the hip does arthrokinematically. 4:50 It has a tendency to move anterior and superior, which stretches 4:55 out that anterior joint capsule a little bit. Now the thing that's supposed to be 4:59 restricting our range of motion and keeping us for 40 to 50 degrees is 5:03 actually loose, and allowing us to go further. So kind of keep that in mind as 5:09 you're doing this assessment, the iliofemoral ligament, pubofemoral 5:14 ligament, and anterior facia latae are also all things that could restrict our range 5:20 of motion, so that might be something to think about. 5:23 Like long passive stretching into internal rotation, or some of our 5:29 instrument assisted soft tissue mobilization, some of our pin and stretch 5:32 techniques. We do want to look at our joint of the hip itself, and do maybe 5:38 some of our passive accessory mobilizations. So does he have normal 5:43 posterior glide, can i distract his hip normally. Can I do that lateral 5:48 distraction, does he have normal anterior glide, and once again coming back to the 5:53 nervous system, you guys notice I set up this same graph for all of my goniometry, 5:58 just so that I set up a systematic way for me to think through this stuff. 6:02 Femoral nerve could be indicated, although this is not necessarily a 6:07 femoral nerve test, and then quite possibly the lateral femoral cutaneous 6:12 nerve. If I thought any of this, once again i'm going to do further neuro 6:17 dynamic testing, so that I pinpoint where things are happening. Now in the 6:22 beginning of both the hip internal rotation goniometry, and hip external 6:27 rotation goniometry in prone, I mentioned that I don't particularly like 6:31 the Norkin and White seated hip internal and external rotation goniometry. 6:36 The reason being is my goal is to get to this right, I want to figure 6:42 out what structures I'm going to actually do something to. My feelings on 6:50 this seated position is more often than not, I'm restricted in internal rotation 6:55 by a TFL that is put into such a shortened position, that it starts to 7:01 spasm a little bit, or get really really overactive. People start cramping up, well 7:06 now I have a test that only indicates potentially one structure. I don't know 7:11 that I've actually hit the end range of that joint. I'm not sure that that just 7:16 knowing that the TFL gets spastic in that position helps me. It doesn't 7:20 necessarily help the person move better, and then in external rotation, generally 7:24 people just start cramping in their adductors. So the range of motion that 7:29 you'll get from those tests, there's actually research to show that whether 7:33 you're prone, whether you're seated, whether you do hip 90 90, you get roughly 7:39 the same ranges of motion. My question to you guys would be, is if you did find a 7:44 restriction in the seated position, what would you do? As opposed to finding a 7:47 restriction in this position, which to me I'm going to go after TFL, gluteus 7:54 minimus. Most of the time that will relieve this restriction. That makes 7:59 sense. In the other one we did right hip internal rotation, very very indicative 8:05 of posterior capsule, piriformis and deep rotator tightness. So I have key 8:12 structures. I'm going to go to in prone right, as opposed to that seated position, 8:17 where I have a tendency to go. So you're TFL went into spasm, great that doesn't 8:23 really tell me what I need to do in my intervention. So I hope that all makes 8:26 sense to you guys. I hope by doing these assessments, explaining where i'm 8:31 thinking, you guys will be able to use this test to improve your interventions. 8:35 i look forward to hearing about your outcomes. 8:45
