This is Brent of the Brookbush Institute at
the Independent Training Spot here in New
York city, we're doing more goniometric assessments.
In this video we're going to do hip extension range of motion, in Thomas test position,
and I'm going to show you guys a little modification to help increase the reliability of this test.
After we're done I'll talk about all of the restrictions that could be preventing optimal
I'm going to have my friend Melissa come out, she's going to help me demonstrate.now first
thing is first, we talked about this being Thomas test, so I need to get her into Thomas
Thomas test position, she's going to scoot down so that just her sacrum, her tailbone
is on the table, because the last thing I want, go ahead and scoot up a little bit,
is as I'm taking this hip extension range of motion is the table blocking her femur
from being able to descend.
Alright I don't want a range of motion of the table, I want a range of motion of her
So I'm going to have her scoot all the way down, make sure just her tailbone is on there.
Now part of the problems with this Thomas test position has been people will go, ok
hold this knee, and then they'll put this in this position and they'll measure, without
paying too much attention to how much of maybe an anterior pelvic tilt, how much of a lordosis,
or how much of a posterior pelvic tilt has actually occurred at the pelvis.
There's nothing that has given them a consistent position for the pelvis itself.
So to improve that a little bit, what I generally do is I'll go ahead and sneak my fingers under
her lumbar spine.
I'm going to have her pull her leg up until she just flattens out her lumbar spine, so
right there.She just flattens out her lumbar spine, which i know is a certain degree of
posterior pelvic tilt.
I'm going to have her hold her leg right there.
Now this is going to steal some of her hip extension away as far as the goniometer is
concerned, but the benefit I just gained in reliability inter and intra testing reliability
is well worth it.
I want to make sure that every time I come back to this test I can put Melissa in a position
where her pelvis is exactly where I had it last time, so that I'm actually getting a
reading of how much improvement I actually got in hip extension.
it does change our numbers a little bit according to Norkin and White, but like I said the increase
in reliability is worth it.
Now how we are going to measure this , we always have to go back to our two lines and
our pivot point.
So the two lines are going to be one just through her trunk, this imaginary line the
kind of bisects a straight line through her spine,.
Or maybe even just posterior to the mid-axillary line here, you guys can see this, I went ahead
and put a big piece of orange Rock tape right there.
The pivot point is actually her greater trochanter and thats the end of this piece of tape.
So make sure you're not up here on the ilum trying to get a measure of hip extension,
because it will falsify your reading.
The hip joint is actually several inches below that iliiac crest.
And then we have a mid-lateral line at the femur is where the movement arm is going to
So stabilization arm is through that line, pivot point through the greater trochanter,
and then we have the movement arm along that mid-femoral line.
Now I'm going to flip around and put my back to the camera to show you guys kind of how
I would do this test, but hopefully you guys can see the set up.
So once again we already had put her in Thomas test position, alright I will make sure that
I have her lumbar spine, just take the lordosis out, just pulled up a notch to take that lordosis
Right make sure her femur is straight, shes not abducting, adducting, externally or internally
So she's nice and straight there.
I'm going to go ahead and kneel down so that my eye is level with my goniometer there,
and I can see how many degrees I got.
Stabilisation arm through that mid-axillary line, pivot point through the greater trochanter,
and the I have my other, my movement arm through that mid-femoral line, and we have roughly
5 degrees that's a negative 5 degrees of hip extension for Melissa.
Alright, thankyou Melissa.
Now what does that mean, a negative 5 degrees, well 0 to 10 degrees in that position is probably
Alright so I know it says 15-20 in Norkin and White, but remember we took her into a
posterior pelvic tilt which robbed her of some of her extension.
So she's still short of that.
We still could use a little work getting her her optimal hip extension back.
Since this is a range of motion test, i am going to start to thinking towards my restrictions,
what could possibly restrict hip extension.
I'm going to go through y tissues here, so is it muscle, is it joint, is it fascia, is
Muscles guys I know this looks like a big list of muscles but it just comes down to
our hip flexors.
So first maybe psoas and iliacus, then I am going to check out her TFL and her rectus
femoris, and then of course her adductors and her sartorius.
Alright these are all potential structures that could be restricting this range of motion,
and of course I could use my release techniques, my stretching techniques to help elongate
What about the joints, well at the joint I have my anterior capsule could restrict this
Not terribly common that your anterior capsule gets really really tight in somebody, but
it does happen and you'd need to do some posterior to anterior glides.
All the ligaments in the hip, all of the ligaments in the hip actually restrict extension so
something to think about.
Some of that static stretching that we've been doing might actually be affecting these
ligaments that have become adaptively shortened because of some sort of hip dysfunction.
Guys don't forget that just because we're measuring the hip, the proximal joints, the
lumbar spine, the sacroiliac joint, if they become dysfunctional they will change the
tonicity of muscles around the lumbar spine and SI joint.
Some of those muscles directly impact the hip, and could affect this range of motion.
I know that's a few steps away from just looking a the hip, but I would definitely take a look
at those two joints and maybe clear them if I suspected that they were contributing to
this restriction in our hip extension.
So lets say I looked at all of the muscles, and I got the muscles released and stretched
and they're good, I did all of my joint work, she's good there, now where do I go.
Well lets not forget about that fascial component, like all of the lateral and anterior fascia
lata, that stuff can be restricted too.
So all of those pin and stretch techniques, instrument assisted soft tissue mobilizations.
You might want to look into some of that to help start releasing some of those tissues
and get hip extension back.
And of course if Melissa had any feelings of tingling, some parasthesia, some really
burning or electric tightness, I;m going to start thinking towards nerves, specifically
in this test I'm going to start thinking towards femoral nerve.
Of course I wouldn't use goniometry as a nerve test.
This would simply be an indicator that I need to go ahead and do my femoral nerve test,
and try to differentiate and see what I am going to do.
So there you guys go, hip extension goniometry in Thomas test position.
I showed you guys a way to increase reliability, and what that did to range of motion.
And look at all of these potential structures that you have to target to help get somebody
optimal hip extension , to improve your outcomes.