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Knee Extension with Hip Flexion Goniometry (Hamstring Length Test)

Find out how to measure hamstring length and evaluate knee extension with hip flexion with goniometry in this detailed video. Learn how to accurately assess hamstring muscle tightness, which plays an important role in injury prevention and post-injury rehabilitation.

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Transcript

00:06 - 00:09This is Brent of the Brookbush Institute at the independent training
00:09 - 00:13spot. In this particular goniometric assessment video we're going to go over
00:13 - 00:17something I've heard called the hamstring assessment, or possibly knee
00:17 - 00:24extension at 90, or the 90-90 knee extension assessment. Whatever it happens
00:24 - 00:27to be I'm going to show it to you guys and then we're going to talk about what
00:27 - 00:32restrictions it might indicate, and how we're going to potentially create an
00:32 - 00:35intervention that'll improve that dysfunction. I'm going to have my friend
00:35 - 00:41Mike Tierney come out from metropolitan fitness, he's been nice enough to let us
00:41 - 00:47tape up his legs. So I'm going to stand on this side of him which is not how you
00:47 - 00:50guys would do this assessment, but I'm going to stand on this side of them to show
00:50 - 00:54where everything goes and how you set this up, and then I'm going to walk
00:54 - 00:57around the camera and you guys will have to excuse me for turning my back to you,
00:57 - 01:02and show you how i would actually just go through this assessment. So first
01:02 - 01:06things first remember we have two lines we got to create for goniometry. We
01:06 - 01:10have one that's going to go through the stabilization arm which is the arm that
01:10 - 01:13is attached to the protractor, and the one that that we're going to put the
01:13 - 01:20movement arm over since the goal of this assessment is to measure essentially
01:20 - 01:25this angle. Alright we got to create a line through the lateral femur which is
01:25 - 01:29from lateral condyle to greater trochanter. Alright so I took a nice
01:29 - 01:34big piece of orange rock tape here and kind of made that easy to visualize, and
01:34 - 01:39then this line is actually from the last video we did on dorsiflexion goniometric
01:39 - 01:43assessment, which was from fibular head to lateral malleolus or a line
01:43 - 01:48straight through the fibular shaft. So
01:49 - 01:59stabilization arm goes on the femur line, pivot point goes on the lateral condyle
01:59 - 02:03and I'm set up like that, and then I'm going to take him through his passive
02:03 - 02:07range of motion until I get that end feel. Go ahead and relax make sure
02:07 - 02:11they're not helping you out, and I should get a firm end feel that's that muscular
02:11 - 02:16end feel, it's like soft soft soft and then it comes to a harder stop with a
02:16 - 02:22little bit of play, a muscular end feel so to speak. Alright and then the weird
02:22 - 02:26thing about this goniometric assessment once again we're in goniometry
02:26 - 02:31world, so rather than this being whatever this angle would be in geometry
02:31 - 02:40we're actually measuring if this is zero degrees, how far from zero are we. So the
02:40 - 02:50normal is 0 to 20 and Mike here, all right once again i'm going to make sure
02:50 - 02:54it's hip is in neutral position,
02:55 - 03:00I'm going to pull up, no abduction, adduction internal rotation of the hip. I'm going
03:00 - 03:10to go ahead and hold this and tell you guys that Mike is at 45 degrees, optimal
03:10 - 03:16a 0 to 20 so Mike is a little tight. What are we going do about that we'll talk
03:16 - 03:19about this in a second. Let me show you guys how I would do this assessment so
03:19 - 03:25it doesn't look so awkward. So I would once again pull Mike into hip flexion
03:25 - 03:29here. I would make sure we don't have internal rotation, external rotation, no
03:29 - 03:35abduction, adduction or abduction. So i'm holding him with his knee right over his
03:35 - 03:41hip. I'd then go ahead and take him into his passive range hold him here, can you
03:41 - 03:49help me a little bit, good. Once i got my goniometer set up alright, so I got my
03:49 - 03:53stabilization arm through that lateral line of the femur. I have my movement arm
03:53 - 03:58through that lateral line of the fibula. Go ahead and have him relax. Make sure
03:58 - 04:04i'm at that that end feel that i was looking for. I'm going to grab my goniometer,
04:04 - 04:10go ahead let him relax, take a look and when I was on this side I
04:10 - 04:15actually got 41 degrees. I would probably think that this side was more when I was
04:15 - 04:18on this side, it was a little bit more accurate as this is the position I
04:18 - 04:24normally do the test in. Thanks Mike. Now as we mentioned in the previous
04:24 - 04:30video an assessment is only a good assessment if it has a purpose, and most
04:30 - 04:35assessments they fall under two categories; either they clear our
04:35 - 04:39patients and clients for intervention, right is this person appropriate for us
04:39 - 04:44to work with or do we need to refer them to somebody else, or it affects our
04:44 - 04:49exercise and intervention selection. With goniometric assessment we're really
04:49 - 04:54looking at restrictions and flexibility type techniques. So what could be
04:54 - 04:57restricting his motion? Well I said before that this goniometric assessment
04:57 - 05:01is sometimes just called a hamstring assessment. So we probably want to start
05:01 - 05:06their the biceps femoris and the semis. If we think one step deeper we could
05:06 - 05:10think towards postural dysfunction, and in postural dysfunction we see that
05:10 - 05:18the commonly overactive of these two is usually biceps femoris. So if I see this
05:18 - 05:22restriction maybe the first thing I want to think about is biceps femoris release
05:22 - 05:28and lengthening. Well what if I do that I don't get any further range of motion
05:28 - 05:31increase, Well let's go ahead and think through our other tissues. What about
05:31 - 05:39fascia, joints, nerves. I'm going to go ahead and think about that TFL VL ITB complex,
05:39 - 05:45or my iliotibial band will restrict extension. Now I'm not going to be able to
05:45 - 05:50do too much to lengthen my iliotibial band, but what about the TFL and VL that
05:50 - 05:56invest in it. Can I affect this musculature and affect how the ITB is
05:56 - 06:06moving, and will that give me some range of motion back. Joints, so although joint
06:06 - 06:10restrictions probably won't affect this, because of that hip flexion our
06:10 - 06:16hamstrings are shortened up pretty quick, but faulty joint motion or arthrokinematic
06:16 - 06:22dyskinesis can affect muscular function and activity. It might
06:22 - 06:26be worth me checking tibiofemoral glide, but specifically if I can't get into
06:26 - 06:32extension does my tibia, is it able to glide anteriorly on my femur, or we can
06:32 - 06:35flip that around is my femur able to glide posteriorly on my
06:35 - 06:41tibia. And don't forget about the proximal tibiofibular joint, so related to ankle
06:41 - 06:47dysfunction was an anterior glide of the distal tibiofibular joint, which then
06:47 - 06:53posterior glides my proximal tibiofibular joint, and that kind of starts
06:53 - 06:58relating back to our lower leg dysfunction which also included a tight
06:58 - 07:01biceps femoris, because that turn the knee out. Hopefully you guys are following
07:01 - 07:05some of this but at the end of the day know that these two joints can
07:05 - 07:12potentially restrict knee extension in this position, and then last my sciatic
07:12 - 07:17nerve if Mike had started complaining about tingling, or a sensation of stretch
07:17 - 07:22that went all the way from his butt down to his ankle, I might start thinking man
07:22 - 07:25maybe there is the nerve restriction and I need to do further assessment, further
07:25 - 07:32neurodynamic testing. Now in future videos I will try to show further
07:32 - 07:39assessments to get even this long list dialed down to fewer and fewer specific
07:39 - 07:44techniques, so we get a very pin pointed program. But I hope this video helps you
07:44 - 07:49guys use this assessment. i hope this video shows you what you can do with
07:49 - 07:56this assessment, and most importantly that you are using it for the better
07:56 - 08:01creation of better programs. I will talk with you soon. I hope you guys get great
08:01 - 08:03outcomes.
08:09 - 08:11

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