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