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Goniometry Hip Internal Rotation (in prone)

Goniometry is a tool used to measure the range of motion in the hips. Learn how to measure internal hip rotation in prone position with a step-by-step video guide. Improve your accuracy with this helpful tutorial!

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Transcript

00:05 - 00:10This is Brent of the Brookbush Institute at the Independent Training Spot, doing
00:10 - 00:14more goniometry videos here. So in this video we're going to do hip
00:14 - 00:18internal rotation. Now it's prone hip internal rotation. I'll talk a little
00:18 - 00:22later in the video why I prefer prone hip internal rotation to that
00:22 - 00:27traditional Norkin and White seated hip internal rotation measurement. I have my
00:27 - 00:30friend Jordan Tisdale, great personal trainer at the independent training spot,
00:30 - 00:40helping us demonstrate today. Now how do we get this setup, well first we need our
00:40 - 00:43two lines right. We always talk about those two lines; where's my stabilization
00:43 - 00:48arm going to go, where is my movement arm going to go. Stabilization arm, the
00:48 - 00:51arm on the protractor is actually going we're going to create a perpendicular
00:51 - 00:57line to the table, my movement arm is going to go through his tibia, but we
00:57 - 01:01need to create a line that's going to be consistent. I think a lot of people try
01:01 - 01:05to go straight through the tibia but the tibia is curved, and then we have this
01:05 - 01:10crest this anterior crest of the tibia that's also curved, because the origin of
01:10 - 01:14the tibialis anterior. So just throwing our movement on through the tibia is not
01:14 - 01:19a great way to go. You guys will see I have this big bright piece of orange
01:19 - 01:25Rock tape through the middle of his patella, and his tibial tuberosity. So if
01:25 - 01:29i do this line every time, now i know i'm going to be really really consistent.
01:29 - 01:36The tibial tuberosity is a point that i can continually measure against. So to
01:36 - 01:40actually get this measurement I don't want to just pull this way, because as
01:40 - 01:45you guys can notice is, I just pull like this a little bit Jordan's pelvis starts
01:45 - 01:48to come up on the opposite side, and that's going to give us a false reading
01:48 - 01:53there. So what I want to do is I want to stabilize the back of this ilium. I want
01:53 - 02:00to pull until I feel that nice firm end feel that corresponds with the end of
02:00 - 02:06his capsule extensibility, and maybe it's iliofemoral ligament extensibility. Once
02:06 - 02:10I get there, I'm gonna have Jordan hey Jordan can you hold this for me. So
02:10 - 02:14Jordan can can use just a little bit of muscular force to help hold me in this
02:14 - 02:18position, but the truth of the matter is, he doesn't have to do much work because
02:18 - 02:22just letting his leg fall out against gravity is going to pull him against
02:22 - 02:27that the posterior capsule and iliofemoral ligament. Once i'm here, i'm
02:27 - 02:32going to set up my my stabilization arm all right, which is the one attached to
02:32 - 02:36the protractor. Let me get my movement arm straight through that little line i
02:36 - 02:48created, and i get 33 degrees. 33 degrees with a firm end feel means Jordan's just a
02:48 - 02:53little restricted. So normal end range would be 40 to 50 degrees. So just to
02:53 - 02:57review this technique one more time guys, i'm going to stabilize his opposite
02:57 - 03:04pelvis, pull him to end range, make sure i get that nice firm end feel that
03:04 - 03:09coincides with posterior capsule and iliofemoral ligament end range. I'm going
03:09 - 03:13to have Jordan hold this for me a little bit, get into a position where I can
03:13 - 03:20measure, get my stabilization on. Make sure his knee is
03:20 - 03:25still in line with this hip. I'm going to get my stabilization arm perpendicular
03:25 - 03:30table. I'm going to get my movement arm right through the center of that line I
03:30 - 03:34created through the middle of the patella and tibial tuberosity. Now if I'm
03:34 - 03:37going to do this absolutely accurately, I have to turn my back on the camera here.
03:37 - 03:45I would get myself eye level with my measurement and once again I get 33
03:45 - 03:51degrees and knowing that 40 to 50 degrees is normal, Jordan's just a little
03:51 - 03:56restricted, thanks Jordan I really appreciate it. So question is once again
03:56 - 04:01our assessments do one of two things; they either help us clear patients and
04:01 - 04:07clients for intervention or they help us figure out what we're supposed to be
04:07 - 04:11doing with them in this case goniometry is giving us an indication of what
04:11 - 04:17exercises we should do with Jordan to help him improve his movement. So being
04:17 - 04:20that this is goniometry we're talking about restrictions, what could possibly
04:20 - 04:26restrict prone internal rotation. First things first, probably muscle. So I'm
04:26 - 04:30going to look at Jordan and go you know if you can't get into internal rotation
04:30 - 04:34his piriformis, deep rotators might be a little tight. So
04:34 - 04:38maybe these need some release and lengthening. If I release and lengthen
04:38 - 04:43his deep rotators and I still don't get back to optimal what about posterior
04:43 - 04:49adductor magnus. What about iliopsoas, don't forget iliopsoas is an
04:49 - 04:54external rotator, and can restrict internal rotation. if I get through all
04:54 - 04:57of these muscle release and lengthening techniques I'm still not where I want to
04:57 - 05:02be. I need to look at the joint itself, I need to look at the hip. Should I be
05:02 - 05:06doing some of these hip mobilizations like a posterior hip mobilization or a
05:06 - 05:10lateral distraction try to loosen up that hip capsule. I told you guys the
05:10 - 05:14normal end feel was firm, and that had to do with the ischiofemoral ligament
05:14 - 05:18and posterior capsule. We might need to start stretching this stuff out a little
05:18 - 05:23bit to get him his normal range back. Don't forget about the SI joint either
05:23 - 05:27somebody has SI joint dysfunction on that side I kind of talked about this in
05:27 - 05:33last video, stiffness at a joint often leads to hyperactivity of the muscles
05:33 - 05:37that cross that joint. With SI joint that specifically entails the piriformis. If I
05:37 - 05:42have SI joint dysfunction my piriformis will tighten up, and I'm going
05:42 - 05:46to get restricted internal rotation. Let's say I go through all this stuff
05:46 - 05:49and I'm still not back to optimal. Well let's not forget our fascial techniques,
05:49 - 05:55we got posterior capsule that could be tight., do some mobilizations there. The
05:55 - 05:59ischiofemoral ligament might need some long-duration stretching, our posterior
05:59 - 06:02fascia lata, so all of my guys do an instrument assisted soft tissue
06:02 - 06:07mobilization, and those pin and stretch techniques. Just going through that stuff
06:07 - 06:11on the posterior hip might help out a little bit, and then although once again
06:11 - 06:16this is this is a goniometrIc test and not necessarily a neurodynamic test.
06:16 - 06:23If we get some nerve symptoms, we need to be aware that the femoral nerve could be
06:23 - 06:27stretched a little bit in this position, and maybe even the saphenous or
06:27 - 06:31obturator nerve, although this wouldn't be a very good test to differentiate. If
06:31 - 06:37you get a little bit of nerves sign while doing this, you know you need to do
06:37 - 06:40further testing to figure out where that's coming from.
06:40 - 06:46So I hope you guys have lots of ideas on how to improve hip internal
06:46 - 06:51rotation. I hope you have a good idea how to use goniometry. I look
06:51 - 06:55forward to hearing about how you guys are using this information to improve
06:55 - 06:58movement. Thanks
07:04 - 07:07

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