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Goniometry Hip Internal Rotation (in prone)
Goniometry Hip Internal Rotation (in prone) is a measurement technique used to evaluate the range of motion of the hip joint in the anatomical position of lying on the stomach. The patient is placed in a prone position, with the feet together and the hands grasping the sides of the table. The clinician then places a goniometer over the center of the hip joint, with the stationary arm aligned with the long axis of the lower leg, and the moving arm aligned with the long
Transcript
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This is Brent of the Brookbush Institute
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at the Independent Training Spot, doing
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more goniometry videos here. So in this video we're going to do hip
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internal rotation. Now it's prone hip internal rotation. I'll talk a little
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later in the video why I prefer prone hip internal rotation to that
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traditional Norkin and White seated hip internal rotation measurement. I have my
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friend Jordan Tisdale, great personal trainer at the independent training spot,
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helping us demonstrate today. Now how do we get this setup, well first we need our
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two lines right. We always talk about those two lines; where's my stabilization
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arm going to go, where is my movement arm going to go. Stabilization arm, the
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arm on the protractor is actually going we're going to create a perpendicular
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line to the table, my movement arm is going to go through his tibia, but we
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need to create a line that's going to be consistent. I think a lot of people try
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to go straight through the tibia but the tibia is curved, and then we have this
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crest this anterior crest of the tibia that's also curved, because the origin of
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the tibialis anterior. So just throwing our movement on through the tibia is not
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a great way to go. You guys will see I have this big bright piece of orange
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Rock tape through the middle of his patella, and his tibial tuberosity. So if
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i do this line every time, now i know i'm going to be really really consistent.
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The tibial tuberosity is a point that i can continually measure against. So to
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actually get this measurement I don't want to just pull this way, because as
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you guys can notice is, I just pull like this a little bit Jordan's pelvis starts
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to come up on the opposite side, and that's going to give us a false reading
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there. So what I want to do is I want to stabilize the back of this ilium. I want
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to pull until I feel that nice firm end feel that corresponds with the end of
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his capsule extensibility, and maybe it's iliofemoral ligament extensibility. Once
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I get there, I'm gonna have Jordan hey Jordan can you hold this for me. So
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Jordan can can use just a little bit of muscular force to help hold me in this
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position, but the truth of the matter is, he doesn't have to do much work because
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just letting his leg fall out against gravity is going to pull him against
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that the posterior capsule and iliofemoral ligament. Once i'm here, i'm
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going to set up my my stabilization arm all right, which is the one attached to
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the protractor. Let me get my movement arm straight through that little line i
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created, and i get 33 degrees. 33 degrees with a firm end feel means Jordan's just a
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little restricted. So normal end range would be 40 to 50 degrees. So just to
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review this technique one more time guys, i'm going to stabilize his opposite
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pelvis, pull him to end range, make sure i get that nice firm end feel that
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coincides with posterior capsule and iliofemoral ligament end range. I'm going
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to have Jordan hold this for me a little bit, get into a position where I can
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measure, get my stabilization on. Make sure his knee is
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still in line with this hip. I'm going to get my stabilization arm perpendicular
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table. I'm going to get my movement arm right through the center of that line I
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created through the middle of the patella and tibial tuberosity. Now if I'm
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going to do this absolutely accurately, I have to turn my back on the camera here.
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I would get myself eye level with my measurement and once again I get 33
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degrees and knowing that 40 to 50 degrees is normal, Jordan's just a little
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restricted, thanks Jordan I really appreciate it. So question is once again
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our assessments do one of two things; they either help us clear patients and
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clients for intervention or they help us figure out what we're supposed to be
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doing with them in this case goniometry is giving us an indication of what
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exercises we should do with Jordan to help him improve his movement. So being
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that this is goniometry we're talking about restrictions, what could possibly
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restrict prone internal rotation. First things first, probably muscle. So I'm
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going to look at Jordan and go you know if you can't get into internal rotation
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his piriformis, deep rotators might be a little tight. So
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maybe these need some release and lengthening. If I release and lengthen
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his deep rotators and I still don't get back to optimal what about posterior
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adductor magnus. What about iliopsoas, don't forget iliopsoas is an
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external rotator, and can restrict internal rotation. if I get through all
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of these muscle release and lengthening techniques I'm still not where I want to
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be. I need to look at the joint itself, I need to look at the hip. Should I be
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doing some of these hip mobilizations like a posterior hip mobilization or a
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lateral distraction try to loosen up that hip capsule. I told you guys the
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normal end feel was firm, and that had to do with the ischiofemoral ligament
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and posterior capsule. We might need to start stretching this stuff out a little
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bit to get him his normal range back. Don't forget about the SI joint either
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somebody has SI joint dysfunction on that side I kind of talked about this in
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last video, stiffness at a joint often leads to hyperactivity of the muscles
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that cross that joint. With SI joint that specifically entails the piriformis. If I
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have SI joint dysfunction my piriformis will tighten up, and I'm going
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to get restricted internal rotation. Let's say I go through all this stuff
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and I'm still not back to optimal. Well let's not forget our fascial techniques,
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we got posterior capsule that could be tight., do some mobilizations there. The
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ischiofemoral ligament might need some long-duration stretching, our posterior
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fascia lata, so all of my guys do an instrument assisted soft tissue
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mobilization, and those pin and stretch techniques. Just going through that stuff
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on the posterior hip might help out a little bit, and then although once again
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this is this is a goniometrIc test and not necessarily a neurodynamic test.
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If we get some nerve symptoms, we need to be aware that the femoral nerve could be
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stretched a little bit in this position, and maybe even the saphenous or
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obturator nerve, although this wouldn't be a very good test to differentiate. If
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you get a little bit of nerves sign while doing this, you know you need to do
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further testing to figure out where that's coming from.
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So I hope you guys have lots of ideas on how to improve hip internal
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rotation. I hope you have a good idea how to use goniometry. I look
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forward to hearing about how you guys are using this information to improve
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movement. Thanks
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