Goniometric Assessment Joints NASM only chose a select number of joints to be measured Foot Dorisflexion Hip Flexion (Bent knee and 90/90 position) Internal Rotation External Rotation Extension Abduction Shoulder Flexion External Rotation Internal Rotation Measurements were selected because of their overall importance to optimum human movement as well as their ability to correlate to the overhead squat and single movement assessment. The Foot Joint motion being assessed Muscles being assessed Gastrocnemius and soleus Posterior tibialis, peroneus longus, flexor hallicus longus, and flexor digitorum longus. Antagonists potentially underactive if ROM is limited Dorsiflexion of talocrural joint Anterior tibialis Extensor digitorum longus, extensor digitorum brevis, extensor hallicus longus and peroneus tertius. Normal Value- 20o Client Positioning Supine with Knee extended Ankle is subtalar neutral Placement of Goniometer Pressure Axis (A)- Directly below the lateral mallelous near the base Stationary Arm (SA) – Lateral aspect of fibula Movement Arm- (MA) Midline of 5th metatarsal. Hold planter surface of foot right below MTP joints Client/Patient actively DF while you are passively assisting the glide of motion Compensation during Goniometer Assessment Everson of the ankle Flexing of the knee Over Head Squat/ Single Leg Squat Foot compensations ( feet going outward Flattening and/or heels rising) Excessive forward leaning A lack of DF in the ankle has been know to lead to knee injuries. Hip Flexion Joint motion being assessed Muscles being assessed Extension of the tibiofemoral joint Flexion of iliofemoral joint Hamstrings, Gastrocnemius, neural tissue (sciatic nerve) Antagonists potentially underactive if ROM is limited Hip flexor complex Quadriceps complex Normal Value- 20o Client Positioning Supine with Hip flexed and knee flexed to 90o Hip is in neutral (0o rotation, abduction and adduction) Placement of Goniometer Pressure Hold lower leg and thigh of client Passively extend the knee until first compensations Compensation during Goniometer Assessment Axis (A)- lateral joint line of the tibiofemoral joint Stationary Arm (SA) – Lateral midline of femur Movement Arm (MA)- lateral midline of fibula Posterior tilting of the pelvis Hip extension Over Head Squat/ Single Leg Squat Feet turned out (External rotated) Feet flattening Knee moving inward or outward Low back rounding Hip Flexion (Bent Knee) Joint motion being assessed Muscles being assessed Flexion of iliofemoral joint Gluteus maximus, adductor magnus, upper portion of hamstrings Psoas, rectus femoris, hip capsule. Antagonists potentially underactive if ROM is limited Hip flexor complex Hip extensor complex (gluteus maximus) Normal Value- 120o Client Positioning Supine with knee flexed Hip is in neutral (0o rotation, abduction and adduction) Placement of Goniometer Pressure Hold clients knee Passively flex the hip until first compensation. Compensation during Goniometer Assessment Axis (A)- Great trochanter Stationary Arm (SA) – Lateral midline of pelvis Movement Arm (MA)- lateral midline of femur Posterior tilting of the pelvis Adbuction of the femur Over Head Squat/ Single Leg Squat Rounding of the lower back Hip (Internal Rotation) Joint motion being assessed Muscles being assessed Internal rotation of iliofemoral joint Piriformis and hip external rotators and adductor magnus, ischiofemoral ligaments Gluteus medius, gluteus maximus Antagonists potentially underactive if ROM is limited Adductor magnus, TFL, gluteus minimus, glutues medius, adductor longus, adductor brevis, pectineus, gracilis, medial hamstrings. Normal Value- 45o Client Positioning Supine with Hip flexed and knee flexed to 90o 0o of abduction and adduction Placement of Goniometer Pressure Hold lower leg and thigh of client Passively rotate the femur internally until first compensation Compensation during Goniometer Assessment Axis (A)- Anterior aspect of patella Stationary Arm (SA) – parallel to imaginary line down the center of the body Movement Arm (MA)- Anterior midline of the lower leg (referencing the tibial tuberosity). Hip hike ( lateral flexion of spine) on side of measurement Over Head Squat/ Single Leg Squat Knee moving inward or outward Asymmetrical weight shift The Hip (External Rotation) Joint motion being assessed Muscles being assessed External rotation of iliofemoral joint Adductor magnus, iliofemoral ligament, and pubofemoral ligament TFL, gluteus minimus, and gluteus medius Antagonists potentially underactive if ROM is limited Piriformis and hip external rotators and adductor magnus Gluteus medius and gluteus maximus. Normal Value- 45o Client Positioning Supine with hip and knee flexed to 90o \ Placement of Goniometer Pressure Hold lower leg and thigh of client Passively rotate the femur externally until first compensation Compensation during Goniometer Assessment Axis (A)- Anterior aspect of patella Stationary Arm (SA) – parallel to imaginary line down the center of the body Movement Arm (MA)- Anterior midline of the lower leg (referencing the tibial tuberosity). Motion of ASIS Over Head Squat/ Single Leg Squat Knee moving inward or outward Asymmetrical weight shift Hip (Extension) Joint motion being assessed Muscles being assessed Extension of iliofemoral joint Psoas, iliacus, rectus femoris, tensor fascia latae and sartorius Adductor complex and anterior hip capsule Antagonists potentially underactive if ROM is limited Gluteus maximus, glutues medius Hamstring complex, adductor magnus Normal Value- 0-10o Client Positioning Supine with opposite hip flexed Knee of testing leg should be flexed to ~ 90o Placement of Goniometer Pressure Axis (A)- Greater Trochanter Stationary Arm (SA) – lateral midline of the trunk Movement Arm (MA)- Lateral midline of the femur Hold thigh of client Passively allow the hip to extend until first compensation. Compensation during Goniometer Assessment Anterior tilting Low back arching Over Head Squat/ Single Leg Squat Arching of the lower back Excessive forward lean Hip (Abduction) Joint motion being assessed Muscles being assessed Abduction of iliofemoral joint Adductor complex, pubofemoral ligament, iliofemoral ligament, medial hip capsule Medial Hamstrings Antagonists potentially underactive if ROM is limited Gluteus medius, Gluteus minimus, TFL, Satorius Bicep Femoris Normal Value- 40o Client Positioning Supine with knee extend Hip is neutral Placement of Goniometer Pressure Holding Clients lower leg Passively abduct the leg until first compensation Compensation during Goniometer Assessment Axis (A)- ASIS Stationary Arm (SA) – Imaginary line b/w ASIS’s Movement Arm (MA)- Anterior midline of femur Motion of opposite ASIS Hip Hike on side of movement Over Head Squat/ Single Leg Squat Knees moving inward Asymmetrical weight shift Shoulder (Flexion) Joint motion being assessed Muscles being assessed Flexion of Shoulder complex Latissimus dorsi, teres major, teres minor, infraspinatus, subscapularis, pectoralis major, triceps Antagonists potentially underactive if ROM is limited Anterior deltoid, pectoralis major, middle deltoid Lower and middle trapezius, rhomboids. Normal Value- 160o Client Positioning Supine with should neutral Knee’s in hook-lying position Arm in external rotation Placement of Goniometer Pressure Axis (A)- Distal to the acromion process Stationary Arm (SA) – mid-axillary line of upper thorax Movement Arm (MA)- Lateral epicondyle of the humerus Hold arm in external rotation Place thumb on the lateral border of the scapula and passively flex the shoulder until excessive scapular movement is felt or resistance is felt. Over Head Squat/ Single Leg Squat Arching of the lower back Arms falling forward Shoulder (External Rotation) Joint motion being assessed Muscles being assessed External rotation of glenohumeral joint Subscapularis, latissimus dorsi, teres major, pectoralis major, anterior deltoid and anterior glenohumeral joint capsule. Antagonists potentially underactive if ROM is limited Infraspinatus, teres minor, posterior glenohumeral joint capsule Normal Value- 90o Client Positioning Supine with humerus abducted to 90o Elbow flexed to 90o Towel is placed under humerus Placement of Goniometer Pressure Hold arm in external rotation till first resistance Compensation during Goniometer Assessment Axis (A)- Olecranon process Stationary Arm (SA) – Perpendicular to the arm Movement Arm (MA)- Ulnar styloid Upward migration of the humeral head into the hand over the anterior shoulder. Over Head Squat/ Single Leg Squat Arms falling forward Shoulder (Internal Rotation) Joint motion being assessed Muscles being assessed Internal rotation of glenohumeral joint Infraspinatus, teres minor, posterior glenohumeral joint capsule Antagonists potentially underactive if ROM is limited Subscapularis, latissimus dorsi, teres major, pectoralis major, anterior deltoid. Normal Value- 70o Client Positioning Supine with humerus abducted to 90o Elbow flexed to 90o Towel is placed under humerus Placement of Goniometer Pressure Hold arm in internal rotation until first resistance. Compensation during Goniometer Assessment Axis (A)- Olecranon process of elbow Stationary Arm (SA) – Perpendicular to the floor Movement Arm (MA)- Ulnar styloid and olecranon process Upward migration of the humeral head into the hand over the anterior shoulder. Over Head Squat/ Single Leg Squat Arms falling forward Reference National Academy of Sports Medicine. Goniometric assessments. California, 2005 (1-38). Jessica will talk about the next step which is………