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

00:00:0500:00:10
This is Brent of the Brookbush Institute
00:00:0500:00:10
at the Independent Training Spot, doing
00:00:1000:00:14
more goniometry videos here. So in this video we're going to do hip
00:00:1400:00:18
internal rotation. Now it's prone hip internal rotation. I'll talk a little
00:00:1800:00:22
later in the video why I prefer prone hip internal rotation to that
00:00:2200:00:27
traditional Norkin and White seated hip internal rotation measurement. I have my
00:00:2700:00:30
friend Jordan Tisdale, great personal trainer at the independent training spot,
00:00:3000:00:40
helping us demonstrate today. Now how do we get this setup, well first we need our
00:00:4000:00:43
two lines right. We always talk about those two lines; where's my stabilization
00:00:4300:00:48
arm going to go, where is my movement arm going to go. Stabilization arm, the
00:00:4800:00:51
arm on the protractor is actually going we're going to create a perpendicular
00:00:5100:00:57
line to the table, my movement arm is going to go through his tibia, but we
00:00:5700:01:01
need to create a line that's going to be consistent. I think a lot of people try
00:01:0100:01:05
to go straight through the tibia but the tibia is curved, and then we have this
00:01:0500:01:10
crest this anterior crest of the tibia that's also curved, because the origin of
00:01:1000:01:14
the tibialis anterior. So just throwing our movement on through the tibia is not
00:01:1400:01:19
a great way to go. You guys will see I have this big bright piece of orange
00:01:1900:01:25
Rock tape through the middle of his patella, and his tibial tuberosity. So if
00:01:2500:01:29
i do this line every time, now i know i'm going to be really really consistent.
00:01:2900:01:36
The tibial tuberosity is a point that i can continually measure against. So to
00:01:3600:01:40
actually get this measurement I don't want to just pull this way, because as
00:01:4000:01:45
you guys can notice is, I just pull like this a little bit Jordan's pelvis starts
00:01:4500:01:48
to come up on the opposite side, and that's going to give us a false reading
00:01:4800:01:53
there. So what I want to do is I want to stabilize the back of this ilium. I want
00:01:5300:02:00
to pull until I feel that nice firm end feel that corresponds with the end of
00:02:0000:02:06
his capsule extensibility, and maybe it's iliofemoral ligament extensibility. Once
00:02:0600:02:10
I get there, I'm gonna have Jordan hey Jordan can you hold this for me. So
00:02:1000:02:14
Jordan can can use just a little bit of muscular force to help hold me in this
00:02:1400:02:18
position, but the truth of the matter is, he doesn't have to do much work because
00:02:1800:02:22
just letting his leg fall out against gravity is going to pull him against
00:02:2200:02:27
that the posterior capsule and iliofemoral ligament. Once i'm here, i'm
00:02:2700:02:32
going to set up my my stabilization arm all right, which is the one attached to
00:02:3200:02:36
the protractor. Let me get my movement arm straight through that little line i
00:02:3600:02:48
created, and i get 33 degrees. 33 degrees with a firm end feel means Jordan's just a
00:02:4800:02:53
little restricted. So normal end range would be 40 to 50 degrees. So just to
00:02:5300:02:57
review this technique one more time guys, i'm going to stabilize his opposite
00:02:5700:03:04
pelvis, pull him to end range, make sure i get that nice firm end feel that
00:03:0400:03:09
coincides with posterior capsule and iliofemoral ligament end range. I'm going
00:03:0900:03:13
to have Jordan hold this for me a little bit, get into a position where I can
00:03:1300:03:20
measure, get my stabilization on. Make sure his knee is
00:03:2000:03:25
still in line with this hip. I'm going to get my stabilization arm perpendicular
00:03:2500:03:30
table. I'm going to get my movement arm right through the center of that line I
00:03:3000:03:34
created through the middle of the patella and tibial tuberosity. Now if I'm
00:03:3400:03:37
going to do this absolutely accurately, I have to turn my back on the camera here.
00:03:3700:03:45
I would get myself eye level with my measurement and once again I get 33
00:03:4500:03:51
degrees and knowing that 40 to 50 degrees is normal, Jordan's just a little
00:03:5100:03:56
restricted, thanks Jordan I really appreciate it. So question is once again
00:03:5600:04:01
our assessments do one of two things; they either help us clear patients and
00:04:0100:04:07
clients for intervention or they help us figure out what we're supposed to be
00:04:0700:04:11
doing with them in this case goniometry is giving us an indication of what
00:04:1100:04:17
exercises we should do with Jordan to help him improve his movement. So being
00:04:1700:04:20
that this is goniometry we're talking about restrictions, what could possibly
00:04:2000:04:26
restrict prone internal rotation. First things first, probably muscle. So I'm
00:04:2600:04:30
going to look at Jordan and go you know if you can't get into internal rotation
00:04:3000:04:34
his piriformis, deep rotators might be a little tight. So
00:04:3400:04:38
maybe these need some release and lengthening. If I release and lengthen
00:04:3800:04:43
his deep rotators and I still don't get back to optimal what about posterior
00:04:4300:04:49
adductor magnus. What about iliopsoas, don't forget iliopsoas is an
00:04:4900:04:54
external rotator, and can restrict internal rotation. if I get through all
00:04:5400:04:57
of these muscle release and lengthening techniques I'm still not where I want to
00:04:5700:05:02
be. I need to look at the joint itself, I need to look at the hip. Should I be
00:05:0200:05:06
doing some of these hip mobilizations like a posterior hip mobilization or a
00:05:0600:05:10
lateral distraction try to loosen up that hip capsule. I told you guys the
00:05:1000:05:14
normal end feel was firm, and that had to do with the ischiofemoral ligament
00:05:1400:05:18
and posterior capsule. We might need to start stretching this stuff out a little
00:05:1800:05:23
bit to get him his normal range back. Don't forget about the SI joint either
00:05:2300:05:27
somebody has SI joint dysfunction on that side I kind of talked about this in
00:05:2700:05:33
last video, stiffness at a joint often leads to hyperactivity of the muscles
00:05:3300:05:37
that cross that joint. With SI joint that specifically entails the piriformis. If I
00:05:3700:05:42
have SI joint dysfunction my piriformis will tighten up, and I'm going
00:05:4200:05:46
to get restricted internal rotation. Let's say I go through all this stuff
00:05:4600:05:49
and I'm still not back to optimal. Well let's not forget our fascial techniques,
00:05:4900:05:55
we got posterior capsule that could be tight., do some mobilizations there. The
00:05:5500:05:59
ischiofemoral ligament might need some long-duration stretching, our posterior
00:05:5900:06:02
fascia lata, so all of my guys do an instrument assisted soft tissue
00:06:0200:06:07
mobilization, and those pin and stretch techniques. Just going through that stuff
00:06:0700:06:11
on the posterior hip might help out a little bit, and then although once again
00:06:1100:06:16
this is this is a goniometrIc test and not necessarily a neurodynamic test.
00:06:1600:06:23
If we get some nerve symptoms, we need to be aware that the femoral nerve could be
00:06:2300:06:27
stretched a little bit in this position, and maybe even the saphenous or
00:06:2700:06:31
obturator nerve, although this wouldn't be a very good test to differentiate. If
00:06:3100:06:37
you get a little bit of nerves sign while doing this, you know you need to do
00:06:3700:06:40
further testing to figure out where that's coming from.
00:06:4000:06:46
So I hope you guys have lots of ideas on how to improve hip internal
00:06:4600:06:51
rotation. I hope you have a good idea how to use goniometry. I look
00:06:5100:06:55
forward to hearing about how you guys are using this information to improve
00:06:5500:06:58
movement. Thanks