0:04 This is Brent of the Brookbush Institute at the independent training 0:08 spot, doing goniometric assessment. Now in this video we're going to do hip flexion 0:11 range of motion, and then we're going to talk about some of the structures that 0:14 would restrict hip flexion. I'm going to have my friend Melissa come out, she's 0:16 going to help me demonstrate. Now before we get into actually the technique, we need 0:21 to realize that hip flexion has a soft end feel okay, so that's the anterior 0:25 thigh muscles approximating our bellies. Realize that a leaner individuals a firm 0:30 end feel is not abnormal as you just get to the end of the posterior capsule, the 0:36 end of the extensibility of the posterior capsule rather. Now before you 0:40 guys jump all over me for the range of motion I have written up here, I have 110 0:44 to 135 degrees. I tried to create a range of motion that encapsulates a lot of the 0:50 range of motions I see out there from different research, you guys might have 0:54 to do a little bit more research to find out where within this range you should 1:01 be aiming for, for the specific population that you work with. I find 1:04 that with the population I work with a fairly at least recreationally athletic 1:09 if not professionally athletic individuals, 125 is probably a good range, 1:15 give or take 5 degrees. Now as far as setup, we have a stabilization arm that's 1:21 going to go through our mid axillary line, so all I did here was I laid a 1:25 piece of tape down to kind of show you where that line is, from greater 1:28 trochanter to the top of the iliac crest, through the armpit. Now the movement arm 1:33 is going to go from the greater trochanter through the femoral condyle, or or just 1:38 mid femur. The fulcrum is of course through the hip, but we're going to use the 1:43 greater trochanter which is where these two lines meet, as kind of a reference 1:48 point for where the hip rotates. The thing to be careful is Norkin and White 1:53 kind of mention how they want this leg straight, the problem is is if this leg 1:57 is flat on the table and the person that you're measuring has tightness and their 2:01 hip flexors on the side you're not measuring, it'll pull their pelvis into 2:06 an anterior pelvic tilt, which of course is then going to change the measurement you 2:12 get at the hip. So you need to do a little bit of 2:15 palpating here, make sure you grab the ASIS and kind of grab the posterior 2:19 ilium, and make sure that they're not in that anterior pelvic tilt, they don't 2:22 have an excessive lordosis. Make sure they're in neutral to start, and then 2:27 when you're bringing them into hip flexion, you're going to keep their hand 2:31 there, ASIS, posterior ilium, and only pressing the hip flexion until you get 2:37 their pelvis starting to rotate, which means you've hit end of pelvic range. Now 2:42 her lumbar spine is starting to flex, and she goes into a posterior pelvic tilt. So 2:48 just to review here I'm going to palpate, I'm going to push, and right there is where 2:52 I feel her starting to shift at her pelvis. I'm going to have her go ahead and 2:56 hold this for me. Now I normally would not take this measurement by 3:02 leaning over the top of Melissa, this is just to help you guys see where I put 3:07 the goniometer right. So the stabilization arm is going to go right 3:12 through that mid axillary line, you can see I set the fulcrum up on the greater 3:15 trochanter. I then put my movement arm straight through the femoral condyle. All 3:21 right mid femur, I'm going to take this off, and Melissa's got a hundred degrees of 3:29 hip flexion, which if this was the only measurement I was going to take I'd say she 3:34 was restricted. That's definitely not optimal for somebody as athletic as she 3:37 is. Now I'm going to show you guys how I would actually do this test, forgive me 3:42 for turning my back on you. So once again I'm going to make sure she's not in an 3:47 anterior pelvic tilt, so I'm going to kind of palpate her pelvis here, make sure 3:51 she's not in excessive lordosis, looks pretty good to me. 3:55 All right I'm going to then once again palpate her pelvis, palpate her ASIS, 4:01 bring her into as much hip flexion as I can until I start to feel her pelvis 4:06 rotate. I'm then I'm going to have her hold, all right she can use a little bit of 4:11 her muscular power here as well as this other hand, and then I'm going to have my 4:20 stabilization arm along our mid axillary line. I'm going to set my fulcrum up with 4:24 her greater trochanter, I got my movement arm set up going straight through her 4:29 femoral condyle, and we can see once again I got a hundred degrees, so not 4:37 so bad on my intra-tester reliability. So if she had a hundred degrees, now we have 4:44 to start talking about what's restricting her motion, what exercises am 4:48 I going to select for her home exercise program, and what am I going to do 4:52 personally to help get her her range of motion back, Thanks Melissa. 4:55 So let's talk about that, and let's break it down through the same paradigm I've 4:59 been breaking down in all of these videos. What are the muscle , joint, fascial 5:03 and nerve restrictions. So muscular restrictions, let's start with the 5:06 posterior head of the adductor Magnus. If you remember the adductor Magnus has two 5:10 heads, one of them actually extends and externally rotates the head, and it does 5:15 have a propensity to get overactive in individuals. So I would definitely take a 5:19 look at this posterior head of the adductor Magnus, and possibly release and 5:22 stretch. Now some of you guys might be wondering why it isn't gluteus maximus up here, 5:27 well we have both the research to back it up, and of course clinically we just 5:32 don't see an overactive glute max, we don't see an adaptively shortened glute 5:38 max. If you guys think about this I think you can just rationalize the fact that 5:43 nobody has ever walked into your clinic, studio, gym, or a training facility and 5:49 gone you know what my glutes are just too tight, it just doesn't happen 5:54 right, we see a lot on the other side we see people who want tighter glutes, we 5:57 don't really see glutes that are too tight, so they're probably not going to 5:59 restrict your hip flexion range of motion. Your deep rotators can also 6:04 restrict hip flexion if they get really really tight, and start binding down the 6:08 posterior aspect of that joint. And then you guys will notice I have hip flexors 6:13 written down here, well we can't forget that when we deal with joints we're also 6:17 dealing with not just osteokinematics that's flexion and extension and 6:21 external rotation, but we're also dealing with those arthokinematics that slide, 6:24 glide, role. So hip flexors don't just flex the hip, they also glide the 6:34 femoral head anteriorly, and unfortunately if my hip flexors get 6:38 overactive and glide my femoral head anteriorly, that creates this impingement 6:45 or this restriction where I can no longer get any further flexion, because 6:51 while I'm flexing I should actually be going posterior with my femoral head. So 6:56 if you guys get nothing out of release and stretch from these muscles, 6:59 you might try releasing the hip flexors and seeing if that improves this range 7:03 of motion. Now the joint and this is probably the biggest restriction to hip 7:07 flexion, the posterior capsule of the hip does adaptively shorten in individuals 7:13 with compensation patterns, and of course we have our lateral hip distraction and 7:17 our posterior glide, you guys have that self-administered mobilization video I 7:21 did, that will definitely be a big one for this particular restriction. You guys 7:28 can also see I wrote down once again this is kind of a bonus, those lumbar 7:33 spine, so the facet joints of the lumbar spine and the sacroiliac joint, if those 7:37 are dysfunctional they can change muscular activity, they can change the 7:42 tension within that fascial network, that lumbosacral fascial network which may 7:47 also affect hip joint range of motion fascia. So once again I kind of just 7:53 mentioned it here posterior hip and sacral fascia can definitely restrict hip 7:59 flexion, and I might need to use my pin and stretch techniques, or maybe 8:03 instrument assisted soft tissue mobilization, and I know there's a lot of 8:06 other fascial techniques out there that you guys may try here. And of course if I 8:10 pulled somebody into hip flexion, I do have to be aware that muscles, joints, and 8:17 also nerves are involved in every range of motion. I'm not calling this a neuro- 8:20 dynamic test by any means, but if somebody had a geared up sciatic nerve 8:25 and I push them into hip flexion, and all of a sudden that reproduces their 8:28 symptoms, I need to at least be aware that hip flexion does 8:31 stretch the sciatic nerve around the back of the hip a little bit. It closes the 8:35 piriformis and gemellus superior down on the sciatic nerve as well, and it's going to 8:40 lengthen the lumbosacral plexus. If somebody has like some lumbar spine 8:45 pathology, they have a nerve root adhesion, or they have some sort of 8:50 radiculopathy, you may start to reproduce their symptoms. And of course we could go 8:56 backwards through this grasp, maybe they started here, they stopped 9:00 going into hip flexion and that's what caused the restriction. So I just gave 9:05 you a whole lot of information, I hope what you can do with this is you have 9:08 one more test that'll give you a few more ideas, to create even better 9:14 programs, better exercise selection so that you get even better outcomes. I look 9:19 forward to hearing from you guys, I hope you learned a lot from this video.
