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This is Brent of the Brookbush
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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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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