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Knee Extension Goniometry

Knee Extension Goniometry is an assessment technique used to measure the degree of extension of the knee joint. This method can be used to assess the range of motion and flexibility of the patient's knee joint. Goniometry involves the use of a goniometer, which is a device used to measure the angle of the joint. The measurements obtained from Goniometry can be compared with normative data to establish if the patient's knee joint is functioning within normal ranges. Knee Extension G

Transcript

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This is Brent of the Brookbush Institute
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at the independent training spot in New
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York City, going over goniometric assessment. Now in this video we're going
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to go over knee extension goniometry which is something some of us are going
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to use a little bit, and some of us are going to use a whole lot, especially if
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you're in like an orthopedic rehab facility where you're doing a lot of
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knee replacements. Either way it's an important to have this assessment in
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your repertoire and have a good understanding of it, because just a
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slight loss of knee extension can lead to pretty significant losses and
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function, and definitely can lead to some knee pain. I'm going to have my friend
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Melissa come out, she's going to help me demonstrate this assessment. Now just
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like all of our other goniometric assessments we have a stabilization arm
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line and we have a movement arm line, and these lines are actually the same lines
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we've used for all of the other knee goniometry. So it's mid femur which
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is greater trochanter, through lateral condyle, and then joint line here, and
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then I just kept that line going straight through the fibular head and
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the lateral malleolus, because that would be the midpoint of her lower leg there.
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Now the fulcrum is going to be the joint line itself, the only caveat to this
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technique is if you look at the range of motion that is normal for knee extension,
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you'll see that this is 0 to 5 degrees. Now that's not five degrees this way
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five degrees, that's actually five degrees of what some would term hyper
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extension is normal right. So if I give her just a little bit of force this way
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you can actually see that her knee bows up, and that's a totally normal range of
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motion. Now to measure that I can't ask Melissa to hold hyper hold
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hyperextension go ahead and hold it, it just feels weird right. So she ends up
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contracting a lot of muscles to try to stabilize the joint, you probably end up
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with more neutral. The easiest way to measure this is have something
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underneath their ankles, I just grabbed a foam roll here because there's that's
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convenient, there's lots of foam rolls around here at ITS. So if i push her
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into her end range get that nice firm and feel i'm looking for, and she can
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kind of relax into that end feel, now as soon as I pull my hands up,
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she's where I need her to be for me to pull out my goniometer and take this
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measurement. All right so stability arm, fulcrum through the joint line, and then
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movement arm, and I got two degrees. Now of course doing goniometry like this is
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really terrible technique, so I'm going to turn my back to you guys, once again
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walk you through, walk you through this whole technique. So once again i got my
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stabilization arm, i got my movement arm, and I know where my fulcrum is going to
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be. I'm going to go ahead and throw her ankles up on this bolster or foam roll,
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I'm going to go ahead and push and make sure i feel that firm and feel. Alright
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once I know I have that firm and feel I'm going to go ahead and get down to eye
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line here, now I have to keep in mind that the mid femoral line is not going
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to be parallel to my table like it has been in other techniques we've used, it's
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going to kind of slope down towards her hip. So I got to be careful that I
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measure from that point, then as I go through my movement arm here, make sure
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my fulcrums lined up, I actually get two degrees of hyper extension or a negative
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2 degrees. Thank you Melissa. Now that's normal range of motion. But
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what would have happened if I got five degrees the other way, somebody with five
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degrees of less than optimal knee extension can't even lock their knee, and
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that's going to potentially lead to some dysfunction right, think of how hard
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your quads would have to work all the time even during standing, if you
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couldn't even lock your knee. So if I have somebody who has a knee extension
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restriction, I need to start thinking of all of those tissues that could restrict
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that range of motion, and what techniques could I possibly use to improve that
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range of motion. So starting with my muscles, I know that all of my flexors
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are going to contribute to a lack of knee extension. So my hamstrings of
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course and we know biceps femoris has a propensity to get over active in a lot
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of individuals, my gastrocnemius, probably my lateral gastroc more specifically, and my
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popliteus which has a propensity to get overactive and develop trigger points,
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are all muscles that maybe I could release, maybe I could lengthen with some
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stretching techniques. Then we move on to joint here and we see a whole lot of the
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joint itself, the the capsule the ligaments that are holding my femur to
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my tibia, a lot of them restrict extension. My popliteal ligaments, my
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collateral ligaments, that's lateral and medial, my cruciate ligaments right
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that's anterior and posterior. From the perspective of this guys, think about all
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those individuals who go in for anterior cruciate ligament repairs or lateral
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collateral ligament repairs like do you think they're going to have a limit of
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knee extension? Probably. So now the question is how do we affect the joint
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itself, when I start thinking about my arthrokinematics, start thinking about
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the fact that the tibia right, my lower leg, has to glide anteriorly to and to
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make sure i get to terminal extension. If I don't have that that gliding
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anteriorly of the tibia, then I can hit end rage extension. A lot of the
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individuals who end up with surgical repairs here, they lose that ability,
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and then I have to start thinking about my techniques again after I get through
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my soft tissue stuff. Maybe I'm going to do my femur on tibia anterior to
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posterior mobilizations, or if they can flip them over into prone and I could
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do my tibia on femur posterior to anterior mobilizations. And if I want to
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get really fancy I can focus maybe more on the lateral compartment of the knee
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joint, to make sure that I'm not stuck in tibial external rotation. I hope you guys
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caught all that. Don't forget the patella femoral joint and the proximal tibia tibia,
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sorry that should say tibiofibular joint here guys. Let me rewrite that all
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right. So your proximal tibia fibula joint and your patella femoral joint
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lock into all those soft tissues right, and if they they attached all these soft
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tissues they can create overactivity, if their dysfunctional, so my proximal
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fibula being stuck posteriorly, might need to be mobilized anteriorly. My patella
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femoral of course we could go on for hours about patella femoral alignment,
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and and how it moves and glides and and tilts. Make sure you get some of those
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techniques in your repertoire. Fascia so all of those who are using fascial
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techniques. The posterior fascia lata of course that fascia over my hamstrings, my
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posterior crural fascia, the fascia over my calf. And my popliteal fascia, actually
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the fascia in the back of my knee can all restrict terminal knee extension here.
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And if you're using assisted instrument, assisted soft tissue mobilization, or
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your pin and stretch techniques, or myofascial release techniques, these are
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all areas to work on, but don't forget the lateral fascia lata on the iliotibial
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band. There is kind of a cross over there guys where the iliotibial band will
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assist in some flexion right, and if it's bound down, if it's tight, it
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will resist extension right. I think that turnover happens at about 30 degrees, but
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it's definitely worth investigating with your fascial techniques if you're having
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a hard time getting somebody back to normal knee extension. Now of course if i
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had pushed on Melissa's knee and i got any sort of nerve symptom, i might think
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common fibular or tibial nerves. Now goniometric assessments aren't great ways
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of assessing nerve neurodynamics, but if I started thinking okay wait a second
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she's feeling something here, it seems to be kind of one of those nerve symptoms, I
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need to do my neurodynamic tests, and I'm going to probably start
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differentiating here. So guys there's a huge graph for a very small range of
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motion that happens to be very important. I hope you guys will start using this
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knee extension goniometry, at least experimenting with it on your colleagues,
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see who has optimal and who doesn't, and start asking them about their history of
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maybe knee pain, knee dysfunction, knee surgery, and see if you guys can start
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putting some pieces together. And then of course with all of the graphs that are put
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up here guys it's not to intimidate, it's not to make this look an overwhelming
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amount of information, it's just to give you as many possibilities as you can
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think of, as many tissues as I can think of to address, so that when somebody
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comes in you have lots of tools in your toolbox, a huge arsenal to use to get
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them back to optimal motion. I look forward to hearing about you guys's