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