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Knee Flexion Goniometry
Knee Flexion Goniometry is a form of clinical assessment used to measure the range of motion in the knee. It is performed using a goniometer, which is a device used to measure angles. During the assessment, an examiner records the angle between the thigh and shin at several different points during a knee flexion and extension range of motion. The results from goniometry are then used to diagnose injuries, follow recovery after an injury, or to monitor progress in a rehabilitation program
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. Today we are doing goniometric assessments, so we're looking at
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the range of motion of the knee and knee flexion. I'm going to have my friend Melissa
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come out, she's gonna help me demonstrate this test, and then once I've showed you
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how to do this test we'll talk about what could possibly restrict this range of
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motion. So first things first I need my two lines and my pivot points. So i had a
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mid femoral line that i'm going to use, a line that goes straight through my
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fibula from fibular head to lateral malleolus, and my pivot point is actually
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the lateral condyle of my femur. Now the way we're going to do knee flexion is we
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have to do it in a little hip flexion so that this test doesn't become biased
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towards just one muscle, which we'll talk about in a second with the Ely's test. So
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real easy guys all you have to do is basically sandwich their leg together, a
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normal end feel actually on this one a little different than some of the other
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tests we did, is actually soft it should be a soft end feel, should be the
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approximation of her hamstrings to her calves, a squishy feeling. Alright then i
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would go ahead and put my stabilization arm through the femur, femoral head is my
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pivot point, and my movement arm goes through the fibula, and we have a hundred
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and thirty-seven degrees of the flexion, which is normal. Alright so let me show
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you how I would actually do that test guys, because obviously I wouldn't just
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lean over somebody and squish them from the other side. So
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I would go ahead and start here, make sure I have a good position so I can
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look straight down on her knee and make sure it's in alignment. Then take her into
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hip flexion, make sure I don't pull her into internal rotation or external rotation,
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I'm not pushing her into adduction as I do this. I just want nice pure knee
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flexion, make sure I get a good end feel nice and soft, alright and then once I
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have it there I can use her foot to plant if I want, or maybe with some
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people you might have to hold it in place. I'm going to kneel down so that
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I'm eye level with my goniometer and I can get as accurate a read as possible.
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Make sure I line up those lines as well as I possibly can too. All right once
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again pivot points femoral head, movement arm straight through the greater
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trochanter, or I'm sorry stabilization arms straight through the greater
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trochanter, move then arms straight through the fibula right down to that
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lateral malleolus, and I actually got a bit more range of motion this time
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about 145 degrees, and i'll have to watch the video to see how I messed that up
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when I was on the other side, thank you Melissa. So fairly easy range of motion
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to test with with knee flexion in hip flexion. The question is now what does
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that show us restriction of? Well to tell you the truth muscular restriction is
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not as common on this test, and you'll see the first muscle i have written up
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here is the articularis genu which some of you may not have even heard of.
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The articularis genu plays a role at the knee to help draw the anterior
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capsule out of the way so it doesn't get pinched as we go into knee extension. If
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it gets tight however it can tighten that anterior capsule and restrict us
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from going all the way into knee flexion. Then I list all the vastus muscles,
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because the vastus muscles don't really have a propensity to get tight in
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individuals, and then you'll notice I list the rectus femoris because for
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the rectus femoris to restrict that position, would be highly unlikely
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considering we're shortening it at the hip. So once again guys
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this particular range of motion muscular restriction not all that common, to be
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quite honest if I had to guess the most common reason why knee flexion gets
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restricted, it's going to be this fancy word for swelling right, a fusion. So you
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get these people who kind of have chronic dysfunction at the knee and they
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start to get the swelling, well that swelling fills up the joint capsule like
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a balloon. Once you take up all of the stretch in the anterior capsule of the
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knee you can't push it into flexion. In fact people sometimes feel it, they
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almost feel like their knee is going to burst when you start pushing it into
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that position. Of course for a fusion we might need to use ice, we might need to
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use wraps, we might need just just some time, or if it's chronic we may need to
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start looking towards referring out and finding out what else is going on inside
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of that knee that keeps bringing this effusion back. After a fusion we have
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anterior capsule tightness somewhat common, don't forget about your patella
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femoral joint and joint mechanics. So something like patella Alta where you
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have that rise of the patella because of a super tight rectus femoris, or super
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tight vastus lateralis for that matter might be affecting the flexion, so that's
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not necessarily the tibial femoral joint with the patella getting in the way, and
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you might need to release and stretch your rectus femoris and vastus lateralis.
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Your proximal tib/fib joint guys I put this up here not because it necessarily
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restricts flexion as much as it can be a source of pain that you find it when you
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squish somebody into flexion, as it gets somebody try that, the soft tissues
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trying to push that proximal fibular head anteriorly and it does not want to
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go. In fact this leads to the only nerve finding that I sometimes get in this
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test which is sometimes you put somebody into flexion as far as you can, it
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pinches all the soft tissues, shoves the proximal fibular head forward and
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pinches on that common fibular nerve. Alright so now you know you have a
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little bit of dysfunction at the knee, and the
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proximal tib/fib joint. And of course fascial restrictions are my anterior fascia
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lata. So all those pin and stretch, instrument assisted soft tissue
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mobilization techniques we can do to help relieve any restriction we might
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have. Now I do have to bring Melissa out here for one more knee test that I know
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you all have seen. I'm going to have you lay on your belly this time. In another video I
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actually already discussed this, we talked about the Eli test. All right and
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then the Eli test I go ahead and palpate, all right the tops of her PSIS alright, and
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I'm going to go ahead and push her knee until I feel her getting pulled into an
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anterior pelvic tilt, which would push her PSIS that way, and I would feel it
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in my fingers. Problem with this test as far as knee flexion goniometry is it
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basically biases this test to almost a single muscle once you get past
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a certain amount of degrees. I'm sure we could use this test for some other, to
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implicate some other structures but right here what i'm doing right now, this
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is all rectus femoris guys. So once I pull her all the way back in a neutral
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hip extension, I have her rectus femoris lengthened up at the hip, and this is
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just lengthening it even further. Great test, great test that you can use within
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your assessments if you suspect rectus femoris tightness. But if you're just
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looking for knee kinematics and you're just looking at what is going on to
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restrict knee motion, I would once again have somebody flip over
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and go right back to my knee flexion goniometry this way. I hope that
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makes sense, i hope i have given you guys a ton of things to think about as far as
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improving this range of motion. I did forget to mention one thing, we didn't
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talk about ligaments at the knee. The ligaments at the knee guys and there is a
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reason i didn't mention them, the ligaments of the knee almost all are
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biased towards extension, I know some of you guys who've seen post-surgical
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ligament repairs have seen a lot of restriction in flexion, and that's just
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because a lot of the ligaments at the knee actually stayed taught throughout
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the entirety of knee flexion or knee extension. So if you have an ACL or PCL
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reconstruction, let's say you might have a limit in overall range of motion at
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this knee in both extension and flexion, i think the thing to remember though is
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if we're not talking about a reconstruction we're not talking about a
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ligament damage, this doesn't implicate any particular ligament. Knee extension
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does, knee flexion does not. I hope I gave you guys a ton of information to look at,
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a ton of techniques to think about to improve this range of motion. I hope I've
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helped your assessments go a little deeper so that your exercise selection
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is that much more sophisticated. I'll look forward to hearing from you guys
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