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Hip Abduction Goniometry
Hip Abduction Goniometry is a specialized form of physical therapy used to assess a patient's joint mobility and flexibility. It is used to measure the range of motion of the hip joint, as well as flexibility in the muscle tissues of the back and abdomen. Hip abduction goniometry uses a hand-held goniometer, which is a tool that measures the angle of an extremity, to measure the range of motion. Hip Abduction Goniometry is beneficial for assessing hip
Transcript
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This is Brent of the Brookbush
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...blank
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Institute at the independent training
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spot, going over goniometric assessment.
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In this video we're going to do hip
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abduction goniometry, as well as talk
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about those structures that could
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restrict hip abduction. I'm going to have my
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friend Melissa come out, she's going to
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help me demonstrate this technique. Now
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before we go through the demonstration
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and the setup, we should know that we're
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looking for a firm end feel, or at least
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under normal conditions the end feel is
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firm as we hit the end of the
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extensibility of the inferior capsule,
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and we're looking for between 35 and 45
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degrees to be optimal. Now this setup we
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got to go through our two lines right, so
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our stabilization arm is from ASIS to ASIS,
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that's what this yellow line here is,
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and our movement arm is going to go from
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ASIS through the middle of the patella.
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Now our fulcrum is right over the ASIS
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which kind of points to why this isn't
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my favorite goniometric assessment.
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Alright so i'm going to put my
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stabilization arm here and my movement
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arm here, but then you guys can see
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pretty clearly as I move Melissa, what's
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actually pivoting is our hip which is
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way down here. So the fact that I'm
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putting the fulcrum higher than where
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the pivot point of the hip actually is,
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skews this measurement a bit; and it
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depends on what population you're
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working with, but if you deal with
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individuals of really varied sizes,
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like let's say you have somebody who's
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6 foot 6, and then you have somebody who's 5 foot 2,
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you'll notice that the person who's 6 foot 6
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because that fulcrum is higher than the
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actual pivot point, it's skewed, it makes
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them look tighter than they actually are.
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But let's say I needed this assessment
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because Melissa here we knew had tight
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adductors, and we wanted a way to keep
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track over time. That would be probably
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the only reason why I would actually use
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this goniometric assessment, is to keep
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track of change. So once again let me
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kind of show you guys how this sets up.
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So this would be stabilization arm from
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ASIS to ASIS, movement arm ASIS to mid
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patella, and the big thing you have to
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watch out for is stabilization of the
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pelvis so that she doesn't shift
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upward this way, and I get this weird
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combination of abduction and lateral
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flexion of the spine measurement. So I
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would normally be on her other side, but
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what I would do, let's go ahead and hold
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over her greater trochanter, pull her to
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the end of abduction without lateral
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flexion right, and then once she hits
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end range, give you guys a little trick;
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as long as I don't pull her any further,
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I can just go ahead and let her lower
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leg drop off the table right, and let the
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rest of her thigh stabilize this range
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of motion, so that I can take my time on
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my setup ,and ensure that i am accurate
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as possible, and I'm getting roughly 36
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degrees. So we have normal abduction for
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Melissa. Let me show you guys how I would
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do this in the correct position, excuse
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me for turning my back to you guys. So
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once again I would stabilize, alright
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stabilize her pelvis right over iliac
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crest. I'm going to pull her to end range
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till I feel that end feel that firm end
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feel, and then like I said I'm just going
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to go ahead and drop her lower leg over,
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set up my goniometer, stabilization arm
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across the ASIS, fulcrum over the ASIS
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movement arm right through a imaginary line
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that goes through the patella. You guys
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can see I've marked off with tape here,
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and then going to look at my measurement,
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and I got roughly 30 degrees that time. I
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would be willing to bet this set up when
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I was back to the camera, is probably
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more accurate than me reaching across
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her body, which would be not an
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appropriate way to do this goniometric
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assessment. So let's talk about what
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could be restricting her motion. If she
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was at 30 degrees which is a little shy
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of 35, thank you Melissa. So muscles, I
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know you guys are already on top of this
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one, this one's actually pretty easy. If
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I'm restricted into abduction, it's
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my adductors that are likely to be
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short and overactive, but notice that I
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have
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the orange with stars again like I did
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in the last video. Sometimes people get
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pulled into abduction they'll get a
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pinching, and once again that's that
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arthrokinematic dysfunction possibly
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being caused by over activity in the
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abductors themselves, specifically those
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with the propensity to get overactive,
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the TFL in the glute minimus. So if you had
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released and stretched the adductors,
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still getting a pinch try releasing the
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TFL and glute minimus, pull them back out and
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see if you get a better range of motion
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and less symptoms. The joint, this is a
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big one with the inferior capsule, we
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even said here that the normal end range
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being firm is probably the end of
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inferior capsule extensibility. So if
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somebody was restricted don't forget
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about your inferior mobilizations to try
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to lengthen that inferior capsular, and
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improve capsule extensibility, and the
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pubofemoral ligament would also be
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involved. so maybe long sustained
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stretches could help. Fascia, medial fascia
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lata right, so you guys know this medial
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thigh fascia, don't forget about all of
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your fascial techniques. I know this is an
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area that you know we don't like to mess
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around in much because it can be
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uncomfortable, but if this was something
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that was restricting your client or
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patient and keeping them from getting to
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optimal, you need to do what you need to
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do regardless of this being a little
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uncomfortable, you need to start in
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gently and go ahead and start working on
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that fascial restriction. And of course if
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we're working with joint motions we do
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have to think about what nerves could
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potentially be lengthened, and in this
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position we have the obturator nerve, we
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have some people who do get a
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sensitivity there, and then of course we
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move on to our neurodynamic testing, and
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see if there's some sort of restriction
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or some sort of sensitivity that we need
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to address. So there you guys go, not one
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of my particularly favorite goniometric
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assessments, I don't use it very often,
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but it is important to have in your
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arsenal; and it's important to understand
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all the restrictions to abduction
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because you will see this at some point
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in your practice, or at some point in
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your training career. I hope I've given
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you guys a lot
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to think about as far as what you could
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address if you see a restriction. I hope
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you get great outcomes. I hope you
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understand assessment testing a little
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