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