0:05 This is Brent of the Brookbush Institute at the Independent Training Spot, doing 0:10 more goniometry videos here. So in this video we're going to do hip 0:14 internal rotation. Now it's prone hip internal rotation. I'll talk a little 0:18 later in the video why I prefer prone hip internal rotation to that 0:22 traditional Norkin and White seated hip internal rotation measurement. I have my 0:27 friend Jordan Tisdale, great personal trainer at the independent training spot, 0:30 helping us demonstrate today. Now how do we get this setup, well first we need our 0:40 two lines right. We always talk about those two lines; where's my stabilization 0:43 arm going to go, where is my movement arm going to go. Stabilization arm, the 0:48 arm on the protractor is actually going we're going to create a perpendicular 0:51 line to the table, my movement arm is going to go through his tibia, but we 0:57 need to create a line that's going to be consistent. I think a lot of people try 1:01 to go straight through the tibia but the tibia is curved, and then we have this 1:05 crest this anterior crest of the tibia that's also curved, because the origin of 1:10 the tibialis anterior. So just throwing our movement on through the tibia is not 1:14 a great way to go. You guys will see I have this big bright piece of orange 1:19 Rock tape through the middle of his patella, and his tibial tuberosity. So if 1:25 i do this line every time, now i know i'm going to be really really consistent. 1:29 The tibial tuberosity is a point that i can continually measure against. So to 1:36 actually get this measurement I don't want to just pull this way, because as 1:40 you guys can notice is, I just pull like this a little bit Jordan's pelvis starts 1:45 to come up on the opposite side, and that's going to give us a false reading 1:48 there. So what I want to do is I want to stabilize the back of this ilium. I want 1:53 to pull until I feel that nice firm end feel that corresponds with the end of 2:00 his capsule extensibility, and maybe it's iliofemoral ligament extensibility. Once 2:06 I get there, I'm gonna have Jordan hey Jordan can you hold this for me. So 2:10 Jordan can can use just a little bit of muscular force to help hold me in this 2:14 position, but the truth of the matter is, he doesn't have to do much work because 2:18 just letting his leg fall out against gravity is going to pull him against 2:22 that the posterior capsule and iliofemoral ligament. Once i'm here, i'm 2:27 going to set up my my stabilization arm all right, which is the one attached to 2:32 the protractor. Let me get my movement arm straight through that little line i 2:36 created, and i get 33 degrees. 33 degrees with a firm end feel means Jordan's just a 2:48 little restricted. So normal end range would be 40 to 50 degrees. So just to 2:53 review this technique one more time guys, i'm going to stabilize his opposite 2:57 pelvis, pull him to end range, make sure i get that nice firm end feel that 3:04 coincides with posterior capsule and iliofemoral ligament end range. I'm going 3:09 to have Jordan hold this for me a little bit, get into a position where I can 3:13 measure, get my stabilization on. Make sure his knee is 3:20 still in line with this hip. I'm going to get my stabilization arm perpendicular 3:25 table. I'm going to get my movement arm right through the center of that line I 3:30 created through the middle of the patella and tibial tuberosity. Now if I'm 3:34 going to do this absolutely accurately, I have to turn my back on the camera here. 3:37 I would get myself eye level with my measurement and once again I get 33 3:45 degrees and knowing that 40 to 50 degrees is normal, Jordan's just a little 3:51 restricted, thanks Jordan I really appreciate it. So question is once again 3:56 our assessments do one of two things; they either help us clear patients and 4:01 clients for intervention or they help us figure out what we're supposed to be 4:07 doing with them in this case goniometry is giving us an indication of what 4:11 exercises we should do with Jordan to help him improve his movement. So being 4:17 that this is goniometry we're talking about restrictions, what could possibly 4:20 restrict prone internal rotation. First things first, probably muscle. So I'm 4:26 going to look at Jordan and go you know if you can't get into internal rotation 4:30 his piriformis, deep rotators might be a little tight. So 4:34 maybe these need some release and lengthening. If I release and lengthen 4:38 his deep rotators and I still don't get back to optimal what about posterior 4:43 adductor magnus. What about iliopsoas, don't forget iliopsoas is an 4:49 external rotator, and can restrict internal rotation. if I get through all 4:54 of these muscle release and lengthening techniques I'm still not where I want to 4:57 be. I need to look at the joint itself, I need to look at the hip. Should I be 5:02 doing some of these hip mobilizations like a posterior hip mobilization or a 5:06 lateral distraction try to loosen up that hip capsule. I told you guys the 5:10 normal end feel was firm, and that had to do with the ischiofemoral ligament 5:14 and posterior capsule. We might need to start stretching this stuff out a little 5:18 bit to get him his normal range back. Don't forget about the SI joint either 5:23 somebody has SI joint dysfunction on that side I kind of talked about this in 5:27 last video, stiffness at a joint often leads to hyperactivity of the muscles 5:33 that cross that joint. With SI joint that specifically entails the piriformis. If I 5:37 have SI joint dysfunction my piriformis will tighten up, and I'm going 5:42 to get restricted internal rotation. Let's say I go through all this stuff 5:46 and I'm still not back to optimal. Well let's not forget our fascial techniques, 5:49 we got posterior capsule that could be tight., do some mobilizations there. The 5:55 ischiofemoral ligament might need some long-duration stretching, our posterior 5:59 fascia lata, so all of my guys do an instrument assisted soft tissue 6:02 mobilization, and those pin and stretch techniques. Just going through that stuff 6:07 on the posterior hip might help out a little bit, and then although once again 6:11 this is this is a goniometrIc test and not necessarily a neurodynamic test. 6:16 If we get some nerve symptoms, we need to be aware that the femoral nerve could be 6:23 stretched a little bit in this position, and maybe even the saphenous or 6:27 obturator nerve, although this wouldn't be a very good test to differentiate. If 6:31 you get a little bit of nerves sign while doing this, you know you need to do 6:37 further testing to figure out where that's coming from. 6:40 So I hope you guys have lots of ideas on how to improve hip internal 6:46 rotation. I hope you have a good idea how to use goniometry. I look 6:51 forward to hearing about how you guys are using this information to improve 6:55 movement. Thanks 7:04
