00:00:0500:00:10
This is Brent the Brookbush Institute
00:00:0500:00:10
at the Independent Training Spot going
00:00:1000:00:15
over a hip goniometry. So in this video we're doing hip external rotation
00:00:1500:00:19
in that prone position, and I promise in this video I'm going to talk about why i
00:00:1900:00:23
chose the prone position as opposed to that seated position we see in Norkin and
00:00:2300:00:26
and White. I'm going to have my friend Jordan Tisdale come out, great trainer
00:00:2600:00:31
here at the Independent Training Spot. He's let me tape up his legs despite the
00:00:3100:00:35
fact that it might hurt his legs, because of the hair when I take this off.
00:00:3500:00:41
Nonetheless almost the same exact setup as the hip internal rotation in prone.
00:00:4100:00:47
Alright my stabilization arm, that's the one attached to the protractor, is
00:00:4700:00:50
going to be perpendicular to the table, and you guys can see to create a
00:00:5000:00:55
little bit more consistency, I put a big piece of orange Rock tape right through
00:00:5500:01:01
the middle of his patella, to his tibial tuberosity. So that line that I've
00:01:0100:01:05
created, I know I can keep going back to, over and over and over again, and be
00:01:0500:01:11
really really consistent so that if I reassess, I know how much change I've
00:01:1100:01:15
made. Now external rotation we're going to do very similar to hip internal
00:01:1500:01:23
rotation. I'm going to have him find his end range here, notice when i go
00:01:2300:01:26
to find his end range to start, regardless of knowing that i'm going to
00:01:2600:01:30
measure down here, i need to stabilize his pelvis, because i'm sure you guys can
00:01:3000:01:35
see if I just tip him this way, you can see this side of his pelvis just kind of
00:01:3500:01:39
rides up. I want to make sure that doesn't happen because that's adding
00:01:3900:01:47
degrees of motion. Alright so I take him here, find his end range, there it is. I
00:01:4700:01:55
have Jordan hold it, go ahead and hold for me. Go ahead and set up my
00:01:5500:02:00
stabilization arm, alright perpendicular to the table. Movement arm right through the
00:02:0000:02:10
middle of that line, and Jordan has 55 degrees range of motion. Now normal would
00:02:1000:02:18
be 40 to 50, so Jordan here is a little hypermobile. A thing to consider guys is
00:02:1800:02:25
it's just as dangerous, or just as injury provoking or just as outside the norm to
00:02:2500:02:30
be hypermobile, as it is to be hypomobile. So I'm going to go ahead and do
00:02:3000:02:34
this one more time, this will help you guys review and see it one more time, but
00:02:3400:02:38
I also want to make sure I got this measurement accurate, because the
00:02:3800:02:42
hypermobility is not the most common thing in the world. So once again i'm
00:02:4200:02:47
going to stabilize this pelvis, take him to his end range where i get that nice normal
00:02:4700:02:51
firm end feel. I'm going to have them hold that for me, go ahead and hold that
00:02:5100:02:58
Jordan. Set up my stabilization arm, set up my movement arm, and like I said if I'm
00:02:5800:03:01
going to be truly accurate, i'm actually going to get down so that I am eye level
00:03:0100:03:08
with my goniometer. Make sure I can see it accurately. Make sure my stabilization
00:03:0800:03:10
arm is set up.
00:03:1100:03:19
And this time when I got down on the goniometer here I see 50 degrees. So that
00:03:1900:03:25
is normal, thanks Jordan. Now once again we have to go through what does this
00:03:2500:03:30
mean. Well first off let's talk about the restrictions, let's talk about passive
00:03:3000:03:35
range of motion, 40 to 50 degrees. Let's say I got 30 degrees, what would that
00:03:3500:03:41
mean? Well I need to think towards techniques that I could use to get him
00:03:4100:03:46
back to 40 to 50 degrees range of motion. So what are the muscles that would
00:03:4600:03:51
restrict external rotation, that be my internal rotators, specifically those
00:03:5100:03:57
overactive internal rotators, the TFL, gluteus minimus, not gluteus medius, but
00:03:5700:04:02
gluteus minimus, and anterior adapters. So i might do all of my release and
00:04:0200:04:08
lengthening techniques here, what about fascial components, anterior joint capsule.
00:04:0800:04:14
You guys notice I have a star by this, originally when I measured Jordan I saw
00:04:1400:04:19
55 degrees, I saw a little hyperpermobility. That's not totally uncommon
00:04:1900:04:24
for this goniometric assessment. Now what it could mean though is that I have
00:04:2400:04:30
too much laxity, and I think we have a tendency to see too much laxity or too
00:04:3000:04:36
much mobility in this range of motion, because the anterior joint capsule has a
00:04:3600:04:41
tendency to get lax. If we go back through all of that postural dysfunction
00:04:4100:04:44
stuff, when we start looking at like lumbo-pelvic hip complex dysfunction, SI
00:04:4400:04:50
joint dysfunction, we start looking at just what the hip does arthrokinematically.
00:04:5000:04:55
It has a tendency to move anterior and superior, which stretches
00:04:5500:04:59
out that anterior joint capsule a little bit. Now the thing that's supposed to be
00:04:5900:05:03
restricting our range of motion and keeping us for 40 to 50 degrees is
00:05:0300:05:09
actually loose, and allowing us to go further. So kind of keep that in mind as
00:05:0900:05:14
you're doing this assessment, the iliofemoral ligament, pubofemoral
00:05:1400:05:20
ligament, and anterior facia latae are also all things that could restrict our range
00:05:2000:05:23
of motion, so that might be something to think about.
00:05:2300:05:29
Like long passive stretching into internal rotation, or some of our
00:05:2900:05:32
instrument assisted soft tissue mobilization, some of our pin and stretch
00:05:3200:05:38
techniques. We do want to look at our joint of the hip itself, and do maybe
00:05:3800:05:43
some of our passive accessory mobilizations. So does he have normal
00:05:4300:05:48
posterior glide, can i distract his hip normally. Can I do that lateral
00:05:4800:05:53
distraction, does he have normal anterior glide, and once again coming back to the
00:05:5300:05:58
nervous system, you guys notice I set up this same graph for all of my goniometry,
00:05:5800:06:02
just so that I set up a systematic way for me to think through this stuff.
00:06:0200:06:07
Femoral nerve could be indicated, although this is not necessarily a
00:06:0700:06:12
femoral nerve test, and then quite possibly the lateral femoral cutaneous
00:06:1200:06:17
nerve. If I thought any of this, once again i'm going to do further neuro
00:06:1700:06:22
dynamic testing, so that I pinpoint where things are happening. Now in the
00:06:2200:06:27
beginning of both the hip internal rotation goniometry, and hip external
00:06:2700:06:31
rotation goniometry in prone, I mentioned that I don't particularly like
00:06:3100:06:36
the Norkin and White seated hip internal and external rotation goniometry.
00:06:3600:06:42
The reason being is my goal is to get to this right, I want to figure
00:06:4200:06:50
out what structures I'm going to actually do something to. My feelings on
00:06:5000:06:55
this seated position is more often than not, I'm restricted in internal rotation
00:06:5500:07:01
by a TFL that is put into such a shortened position, that it starts to
00:07:0100:07:06
spasm a little bit, or get really really overactive. People start cramping up, well
00:07:0600:07:11
now I have a test that only indicates potentially one structure. I don't know
00:07:1100:07:16
that I've actually hit the end range of that joint. I'm not sure that that just
00:07:1600:07:20
knowing that the TFL gets spastic in that position helps me. It doesn't
00:07:2000:07:24
necessarily help the person move better, and then in external rotation, generally
00:07:2400:07:29
people just start cramping in their adductors. So the range of motion that
00:07:2900:07:33
you'll get from those tests, there's actually research to show that whether
00:07:3300:07:39
you're prone, whether you're seated, whether you do hip 90 90, you get roughly
00:07:3900:07:44
the same ranges of motion. My question to you guys would be, is if you did find a
00:07:4400:07:47
restriction in the seated position, what would you do? As opposed to finding a
00:07:4700:07:54
restriction in this position, which to me I'm going to go after TFL, gluteus
00:07:5400:07:59
minimus. Most of the time that will relieve this restriction. That makes
00:07:5900:08:05
sense. In the other one we did right hip internal rotation, very very indicative
00:08:0500:08:12
of posterior capsule, piriformis and deep rotator tightness. So I have key
00:08:1200:08:17
structures. I'm going to go to in prone right, as opposed to that seated position,
00:08:1700:08:23
where I have a tendency to go. So you're TFL went into spasm, great that doesn't
00:08:2300:08:26
really tell me what I need to do in my intervention. So I hope that all makes
00:08:2600:08:31
sense to you guys. I hope by doing these assessments, explaining where i'm
00:08:3100:08:35
thinking, you guys will be able to use this test to improve your interventions.
00:08:3500:08:38
i look forward to hearing about your outcomes.