0:06 This is Brent of the Brookbush Institute at the independent training 0:09 spot. In this particular goniometric assessment video we're going to go over 0:13 something I've heard called the hamstring assessment, or possibly knee 0:17 extension at 90, or the 90-90 knee extension assessment. Whatever it happens 0:24 to be I'm going to show it to you guys and then we're going to talk about what 0:27 restrictions it might indicate, and how we're going to potentially create an 0:32 intervention that'll improve that dysfunction. I'm going to have my friend 0:35 Mike Tierney come out from metropolitan fitness, he's been nice enough to let us 0:41 tape up his legs. So I'm going to stand on this side of him which is not how you 0:47 guys would do this assessment, but I'm going to stand on this side of them to show 0:50 where everything goes and how you set this up, and then I'm going to walk 0:54 around the camera and you guys will have to excuse me for turning my back to you, 0:57 and show you how i would actually just go through this assessment. So first 1:02 things first remember we have two lines we got to create for goniometry. We 1:06 have one that's going to go through the stabilization arm which is the arm that 1:10 is attached to the protractor, and the one that that we're going to put the 1:13 movement arm over since the goal of this assessment is to measure essentially 1:20 this angle. Alright we got to create a line through the lateral femur which is 1:25 from lateral condyle to greater trochanter. Alright so I took a nice 1:29 big piece of orange rock tape here and kind of made that easy to visualize, and 1:34 then this line is actually from the last video we did on dorsiflexion goniometric 1:39 assessment, which was from fibular head to lateral malleolus or a line 1:43 straight through the fibular shaft. So 1:49 stabilization arm goes on the femur line, pivot point goes on the lateral condyle 1:59 and I'm set up like that, and then I'm going to take him through his passive 2:03 range of motion until I get that end feel. Go ahead and relax make sure 2:07 they're not helping you out, and I should get a firm end feel that's that muscular 2:11 end feel, it's like soft soft soft and then it comes to a harder stop with a 2:16 little bit of play, a muscular end feel so to speak. Alright and then the weird 2:22 thing about this goniometric assessment once again we're in goniometry 2:26 world, so rather than this being whatever this angle would be in geometry 2:31 we're actually measuring if this is zero degrees, how far from zero are we. So the 2:40 normal is 0 to 20 and Mike here, all right once again i'm going to make sure 2:50 it's hip is in neutral position, 2:55 I'm going to pull up, no abduction, adduction internal rotation of the hip. I'm going 3:00 to go ahead and hold this and tell you guys that Mike is at 45 degrees, optimal 3:10 a 0 to 20 so Mike is a little tight. What are we going do about that we'll talk 3:16 about this in a second. Let me show you guys how I would do this assessment so 3:19 it doesn't look so awkward. So I would once again pull Mike into hip flexion 3:25 here. I would make sure we don't have internal rotation, external rotation, no 3:29 abduction, adduction or abduction. So i'm holding him with his knee right over his 3:35 hip. I'd then go ahead and take him into his passive range hold him here, can you 3:41 help me a little bit, good. Once i got my goniometer set up alright, so I got my 3:49 stabilization arm through that lateral line of the femur. I have my movement arm 3:53 through that lateral line of the fibula. Go ahead and have him relax. Make sure 3:58 i'm at that that end feel that i was looking for. I'm going to grab my goniometer, 4:04 go ahead let him relax, take a look and when I was on this side I 4:10 actually got 41 degrees. I would probably think that this side was more when I was 4:15 on this side, it was a little bit more accurate as this is the position I 4:18 normally do the test in. Thanks Mike. Now as we mentioned in the previous 4:24 video an assessment is only a good assessment if it has a purpose, and most 4:30 assessments they fall under two categories; either they clear our 4:35 patients and clients for intervention, right is this person appropriate for us 4:39 to work with or do we need to refer them to somebody else, or it affects our 4:44 exercise and intervention selection. With goniometric assessment we're really 4:49 looking at restrictions and flexibility type techniques. So what could be 4:54 restricting his motion? Well I said before that this goniometric assessment 4:57 is sometimes just called a hamstring assessment. So we probably want to start 5:01 their the biceps femoris and the semis. If we think one step deeper we could 5:06 think towards postural dysfunction, and in postural dysfunction we see that 5:10 the commonly overactive of these two is usually biceps femoris. So if I see this 5:18 restriction maybe the first thing I want to think about is biceps femoris release 5:22 and lengthening. Well what if I do that I don't get any further range of motion 5:28 increase, Well let's go ahead and think through our other tissues. What about 5:31 fascia, joints, nerves. I'm going to go ahead and think about that TFL VL ITB complex, 5:39 or my iliotibial band will restrict extension. Now I'm not going to be able to 5:45 do too much to lengthen my iliotibial band, but what about the TFL and VL that 5:50 invest in it. Can I affect this musculature and affect how the ITB is 5:56 moving, and will that give me some range of motion back. Joints, so although joint 6:06 restrictions probably won't affect this, because of that hip flexion our 6:10 hamstrings are shortened up pretty quick, but faulty joint motion or arthrokinematic 6:16 dyskinesis can affect muscular function and activity. It might 6:22 be worth me checking tibiofemoral glide, but specifically if I can't get into 6:26 extension does my tibia, is it able to glide anteriorly on my femur, or we can 6:32 flip that around is my femur able to glide posteriorly on my 6:35 tibia. And don't forget about the proximal tibiofibular joint, so related to ankle 6:41 dysfunction was an anterior glide of the distal tibiofibular joint, which then 6:47 posterior glides my proximal tibiofibular joint, and that kind of starts 6:53 relating back to our lower leg dysfunction which also included a tight 6:58 biceps femoris, because that turn the knee out. Hopefully you guys are following 7:01 some of this but at the end of the day know that these two joints can 7:05 potentially restrict knee extension in this position, and then last my sciatic 7:12 nerve if Mike had started complaining about tingling, or a sensation of stretch 7:17 that went all the way from his butt down to his ankle, I might start thinking man 7:22 maybe there is the nerve restriction and I need to do further assessment, further 7:25 neurodynamic testing. Now in future videos I will try to show further 7:32 assessments to get even this long list dialed down to fewer and fewer specific 7:39 techniques, so we get a very pin pointed program. But I hope this video helps you 7:44 guys use this assessment. i hope this video shows you what you can do with 7:49 this assessment, and most importantly that you are using it for the better 7:56 creation of better programs. I will talk with you soon. I hope you guys get great 8:01 outcomes. 8:09
