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Hip Flexion Goniometry

Hip Flexion Goniometry is a method of measuring the range of motion of the hip joint. It involves manually measuring the angle of the hip from a neutral position, usually with a goniometer. This testing helps to evaluate the function and flexibility of the hip, determine the cause of mobility problems, and provide effective treatment options. It is used to accurately diagnose pain, instability, and muscle imbalances, as well as identify limitations associated with sports and other physical activities.

Transcript

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