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Knee Extension with Hip Flexion Goniometry (Hamstring Length Test)

This test is used to assess the length of the hamstring muscle by measuring the angle of the knee extension with simultaneous hip flexion. It is designed to assess the range of motion of the lower extremity and to provide a quantitative measure of tightness of the hamstring muscles. This test can help determine if stretching, physiotherapy, and further evaluation is necessary in cases of hamstring tightness or injury. It is a simple, quick and inexpensive measurement that can be performed in any clinical setting.

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. 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.