0:06 This is Brent of the Brookbush Institute at the Independent Training Spot here in New 0:10 York city, we're doing more goniometric assessments. 0:13 In this video we're going to do hip extension range of motion, in Thomas test position, 0:17 and I'm going to show you guys a little modification to help increase the reliability of this test. 0:24 After we're done I'll talk about all of the restrictions that could be preventing optimal 0:29 range. 0:30 I'm going to have my friend Melissa come out, she's going to help me demonstrate.now first 0:33 thing is first, we talked about this being Thomas test, so I need to get her into Thomas 0:39 test position. 0:40 Thomas test position, she's going to scoot down so that just her sacrum, her tailbone 0:45 is on the table, because the last thing I want, go ahead and scoot up a little bit, 0:49 is as I'm taking this hip extension range of motion is the table blocking her femur 0:55 from being able to descend. 0:57 Alright I don't want a range of motion of the table, I want a range of motion of her 1:01 hip joint. 1:02 So I'm going to have her scoot all the way down, make sure just her tailbone is on there. 1:07 Now part of the problems with this Thomas test position has been people will go, ok 1:13 hold this knee, and then they'll put this in this position and they'll measure, without 1:19 paying too much attention to how much of maybe an anterior pelvic tilt, how much of a lordosis, 1:25 or how much of a posterior pelvic tilt has actually occurred at the pelvis. 1:30 There's nothing that has given them a consistent position for the pelvis itself. 1:35 So to improve that a little bit, what I generally do is I'll go ahead and sneak my fingers under 1:42 her lumbar spine. 1:43 I'm going to have her pull her leg up until she just flattens out her lumbar spine, so 1:48 right there.She just flattens out her lumbar spine, which i know is a certain degree of 1:54 posterior pelvic tilt. 1:56 I'm going to have her hold her leg right there. 1:59 Now this is going to steal some of her hip extension away as far as the goniometer is 2:06 concerned, but the benefit I just gained in reliability inter and intra testing reliability 2:13 is well worth it. 2:14 I want to make sure that every time I come back to this test I can put Melissa in a position 2:22 where her pelvis is exactly where I had it last time, so that I'm actually getting a 2:27 reading of how much improvement I actually got in hip extension. 2:31 it does change our numbers a little bit according to Norkin and White, but like I said the increase 2:37 in reliability is worth it. 2:39 Now how we are going to measure this , we always have to go back to our two lines and 2:42 our pivot point. 2:43 So the two lines are going to be one just through her trunk, this imaginary line the 2:49 kind of bisects a straight line through her spine,. 2:52 Or maybe even just posterior to the mid-axillary line here, you guys can see this, I went ahead 2:57 and put a big piece of orange Rock tape right there. 3:00 The pivot point is actually her greater trochanter and thats the end of this piece of tape. 3:06 So make sure you're not up here on the ilum trying to get a measure of hip extension, 3:10 because it will falsify your reading. 3:12 The hip joint is actually several inches below that iliiac crest. 3:16 And then we have a mid-lateral line at the femur is where the movement arm is going to 3:23 go. 3:24 So stabilization arm is through that line, pivot point through the greater trochanter, 3:29 and then we have the movement arm along that mid-femoral line. 3:34 Now I'm going to flip around and put my back to the camera to show you guys kind of how 3:38 I would do this test, but hopefully you guys can see the set up. 3:47 So once again we already had put her in Thomas test position, alright I will make sure that 3:51 I have her lumbar spine, just take the lordosis out, just pulled up a notch to take that lordosis 3:59 out. 4:00 Right make sure her femur is straight, shes not abducting, adducting, externally or internally 4:06 rotating. 4:07 So she's nice and straight there. 4:08 I'm going to go ahead and kneel down so that my eye is level with my goniometer there, 4:14 and I can see how many degrees I got. 4:17 Stabilisation arm through that mid-axillary line, pivot point through the greater trochanter, 4:25 and the I have my other, my movement arm through that mid-femoral line, and we have roughly 4:33 5 degrees that's a negative 5 degrees of hip extension for Melissa. 4:40 Alright, thankyou Melissa. 4:43 Now what does that mean, a negative 5 degrees, well 0 to 10 degrees in that position is probably 4:50 optimal. 4:51 Alright so I know it says 15-20 in Norkin and White, but remember we took her into a 4:55 posterior pelvic tilt which robbed her of some of her extension. 4:59 So she's still short of that. 5:01 We still could use a little work getting her her optimal hip extension back. 5:05 Since this is a range of motion test, i am going to start to thinking towards my restrictions, 5:10 what could possibly restrict hip extension. 5:13 I'm going to go through y tissues here, so is it muscle, is it joint, is it fascia, is 5:19 it nerve. 5:20 Muscles guys I know this looks like a big list of muscles but it just comes down to 5:23 our hip flexors. 5:25 So first maybe psoas and iliacus, then I am going to check out her TFL and her rectus 5:29 femoris, and then of course her adductors and her sartorius. 5:34 Alright these are all potential structures that could be restricting this range of motion, 5:38 and of course I could use my release techniques, my stretching techniques to help elongate 5:44 those tissues. 5:46 What about the joints, well at the joint I have my anterior capsule could restrict this 5:53 motion. 5:54 Not terribly common that your anterior capsule gets really really tight in somebody, but 5:59 it does happen and you'd need to do some posterior to anterior glides. 6:05 All the ligaments in the hip, all of the ligaments in the hip actually restrict extension so 6:11 something to think about. 6:12 Some of that static stretching that we've been doing might actually be affecting these 6:15 ligaments that have become adaptively shortened because of some sort of hip dysfunction. 6:24 Guys don't forget that just because we're measuring the hip, the proximal joints, the 6:31 lumbar spine, the sacroiliac joint, if they become dysfunctional they will change the 6:35 tonicity of muscles around the lumbar spine and SI joint. 6:40 Some of those muscles directly impact the hip, and could affect this range of motion. 6:44 I know that's a few steps away from just looking a the hip, but I would definitely take a look 6:51 at those two joints and maybe clear them if I suspected that they were contributing to 6:55 this restriction in our hip extension. 6:58 So lets say I looked at all of the muscles, and I got the muscles released and stretched 7:03 and they're good, I did all of my joint work, she's good there, now where do I go. 7:08 Well lets not forget about that fascial component, like all of the lateral and anterior fascia 7:14 lata, that stuff can be restricted too. 7:17 So all of those pin and stretch techniques, instrument assisted soft tissue mobilizations. 7:22 You might want to look into some of that to help start releasing some of those tissues 7:25 and get hip extension back. 7:27 And of course if Melissa had any feelings of tingling, some parasthesia, some really 7:34 burning or electric tightness, I;m going to start thinking towards nerves, specifically 7:40 in this test I'm going to start thinking towards femoral nerve. 7:43 Of course I wouldn't use goniometry as a nerve test. 7:48 This would simply be an indicator that I need to go ahead and do my femoral nerve test, 7:54 and try to differentiate and see what I am going to do. 7:57 So there you guys go, hip extension goniometry in Thomas test position. 8:00 I showed you guys a way to increase reliability, and what that did to range of motion. 8:06 And look at all of these potential structures that you have to target to help get somebody 8:12 optimal hip extension , to improve your outcomes. 8:15 I look forward to hearing from you guys soon.
