0:05 This is Brent of the Brookbush 0:07 Institute at the independent training 0:09 spot, going over goniometric assessment. 0:11 In this video we're going to do hip 0:12 abduction goniometry, as well as talk 0:14 about those structures that could 0:16 restrict hip abduction. I'm going to have my 0:19 friend Melissa come out, she's going to 0:20 help me demonstrate this technique. Now 0:22 before we go through the demonstration 0:24 and the setup, we should know that we're 0:26 looking for a firm end feel, or at least 0:28 under normal conditions the end feel is 0:31 firm as we hit the end of the 0:32 extensibility of the inferior capsule, 0:34 and we're looking for between 35 and 45 0:37 degrees to be optimal. Now this setup we 0:41 got to go through our two lines right, so 0:43 our stabilization arm is from ASIS to ASIS, 0:45 that's what this yellow line here is, 0:48 and our movement arm is going to go from 0:50 ASIS through the middle of the patella. 0:52 Now our fulcrum is right over the ASIS 0:56 which kind of points to why this isn't 1:00 my favorite goniometric assessment. 1:02 Alright so i'm going to put my 1:03 stabilization arm here and my movement 1:06 arm here, but then you guys can see 1:08 pretty clearly as I move Melissa, what's 1:12 actually pivoting is our hip which is 1:14 way down here. So the fact that I'm 1:17 putting the fulcrum higher than where 1:20 the pivot point of the hip actually is, 1:23 skews this measurement a bit; and it 1:25 depends on what population you're 1:27 working with, but if you deal with 1:29 individuals of really varied sizes, 1:30 like let's say you have somebody who's 1:32 6 foot 6, and then you have somebody who's 5 foot 2, 1:35 you'll notice that the person who's 6 foot 6 1:38 because that fulcrum is higher than the 1:41 actual pivot point, it's skewed, it makes 1:44 them look tighter than they actually are. 1:46 But let's say I needed this assessment 1:49 because Melissa here we knew had tight 1:53 adductors, and we wanted a way to keep 1:56 track over time. That would be probably 1:57 the only reason why I would actually use 1:59 this goniometric assessment, is to keep 2:01 track of change. So once again let me 2:04 kind of show you guys how this sets up. 2:07 So this would be stabilization arm from 2:08 ASIS to ASIS, movement arm ASIS to mid 2:12 patella, and the big thing you have to 2:14 watch out for is stabilization of the 2:16 pelvis so that she doesn't shift 2:19 upward this way, and I get this weird 2:21 combination of abduction and lateral 2:24 flexion of the spine measurement. So I 2:27 would normally be on her other side, but 2:29 what I would do, let's go ahead and hold 2:31 over her greater trochanter, pull her to 2:34 the end of abduction without lateral 2:38 flexion right, and then once she hits 2:40 end range, give you guys a little trick; 2:42 as long as I don't pull her any further, 2:45 I can just go ahead and let her lower 2:48 leg drop off the table right, and let the 2:52 rest of her thigh stabilize this range 2:54 of motion, so that I can take my time on 2:57 my setup ,and ensure that i am accurate 3:02 as possible, and I'm getting roughly 36 3:09 degrees. So we have normal abduction for 3:13 Melissa. Let me show you guys how I would 3:14 do this in the correct position, excuse 3:17 me for turning my back to you guys. So 3:20 once again I would stabilize, alright 3:23 stabilize her pelvis right over iliac 3:25 crest. I'm going to pull her to end range 3:28 till I feel that end feel that firm end 3:31 feel, and then like I said I'm just going 3:33 to go ahead and drop her lower leg over, 3:36 set up my goniometer, stabilization arm 3:40 across the ASIS, fulcrum over the ASIS 3:44 movement arm right through a imaginary line 3:46 that goes through the patella. You guys 3:48 can see I've marked off with tape here, 3:49 and then going to look at my measurement, 3:52 and I got roughly 30 degrees that time. I 3:56 would be willing to bet this set up when 4:00 I was back to the camera, is probably 4:03 more accurate than me reaching across 4:04 her body, which would be not an 4:06 appropriate way to do this goniometric 4:07 assessment. So let's talk about what 4:10 could be restricting her motion. If she 4:12 was at 30 degrees which is a little shy 4:13 of 35, thank you Melissa. So muscles, I 4:17 know you guys are already on top of this 4:19 one, this one's actually pretty easy. If 4:20 I'm restricted into abduction, it's 4:24 my adductors that are likely to be 4:27 short and overactive, but notice that I 4:30 have 4:31 the orange with stars again like I did 4:33 in the last video. Sometimes people get 4:36 pulled into abduction they'll get a 4:37 pinching, and once again that's that 4:39 arthrokinematic dysfunction possibly 4:43 being caused by over activity in the 4:46 abductors themselves, specifically those 4:48 with the propensity to get overactive, 4:50 the TFL in the glute minimus. So if you had 4:53 released and stretched the adductors, 4:55 still getting a pinch try releasing the 4:58 TFL and glute minimus, pull them back out and 5:00 see if you get a better range of motion 5:02 and less symptoms. The joint, this is a 5:06 big one with the inferior capsule, we 5:09 even said here that the normal end range 5:11 being firm is probably the end of 5:14 inferior capsule extensibility. So if 5:17 somebody was restricted don't forget 5:20 about your inferior mobilizations to try 5:23 to lengthen that inferior capsular, and 5:25 improve capsule extensibility, and the 5:28 pubofemoral ligament would also be 5:30 involved. so maybe long sustained 5:32 stretches could help. Fascia, medial fascia 5:35 lata right, so you guys know this medial 5:37 thigh fascia, don't forget about all of 5:40 your fascial techniques. I know this is an 5:42 area that you know we don't like to mess 5:44 around in much because it can be 5:46 uncomfortable, but if this was something 5:48 that was restricting your client or 5:50 patient and keeping them from getting to 5:53 optimal, you need to do what you need to 5:55 do regardless of this being a little 5:57 uncomfortable, you need to start in 5:59 gently and go ahead and start working on 6:01 that fascial restriction. And of course if 6:04 we're working with joint motions we do 6:06 have to think about what nerves could 6:08 potentially be lengthened, and in this 6:10 position we have the obturator nerve, we 6:12 have some people who do get a 6:13 sensitivity there, and then of course we 6:16 move on to our neurodynamic testing, and 6:18 see if there's some sort of restriction 6:21 or some sort of sensitivity that we need 6:24 to address. So there you guys go, not one 6:27 of my particularly favorite goniometric 6:29 assessments, I don't use it very often, 6:31 but it is important to have in your 6:32 arsenal; and it's important to understand 6:34 all the restrictions to abduction 6:37 because you will see this at some point 6:40 in your practice, or at some point in 6:43 your training career. I hope I've given 6:44 you guys a lot 6:45 to think about as far as what you could 6:47 address if you see a restriction. I hope 6:49 you get great outcomes. I hope you 6:50 understand assessment testing a little 6:52 better, thank you.
