By :By :Dr. Gehan Shaalan, PT Dr. Gehan Shaalan, PT

Lecturer BMCLecturer BMC

Hip FlexionHip Flexion Starting and Ending Starting and Ending

PositionPosition:: The patient should be lying The patient should be lying

supine in the anatomical supine in the anatomical position.position.

The fulcrum is aligned with The fulcrum is aligned with the greater trochanter of the the greater trochanter of the femur.femur.

The stationary arm is The stationary arm is positioned along the lateral positioned along the lateral midline of the abdomen, midline of the abdomen, using the pelvis for using the pelvis for reference, the moving arm reference, the moving arm along the lateral midline of along the lateral midline of the femur.the femur.

Normal ROM is between 115 Normal ROM is between 115 and 125 degrees. The and 125 degrees. The patient is in 115 degrees of patient is in 115 degrees of knee flexion knee flexion

Hip FlexionHip Flexion

PrecautionPrecaution Allow the knee to flex to prevent a Allow the knee to flex to prevent a

stretch on the hamstring muscle.stretch on the hamstring muscle. Avoid lumbosacral motion. Avoid lumbosacral motion.

Factors limiting motionFactors limiting motion Contact of thigh with pelvis.Contact of thigh with pelvis.

Hip ExtensionHip Extension Starting and Ending Starting and Ending

PositionPosition:: Patient is lying prone Patient is lying prone

with legs together and with legs together and arms at sides.arms at sides.

Goniometer Goniometer positioning is the same positioning is the same as for hip flexion.as for hip flexion.

Normal ROM for hip Normal ROM for hip extension is 10 to 30 extension is 10 to 30 degrees, patient has degrees, patient has 25 degrees of hip 25 degrees of hip extension.extension.

Hip ExtensionHip Extension

PrecautionPrecaution Avoid lumbar extension.Avoid lumbar extension. Keep knee joint extended to prevent Keep knee joint extended to prevent

stretch on the rectus femoris muscle stretch on the rectus femoris muscle

Factors limiting ROMFactors limiting ROM Tension of hip flexor muscles.Tension of hip flexor muscles. Tension of iliofemoral ligament. Tension of iliofemoral ligament.

Hip AbductionHip Abduction Starting PositionStarting Position:: Patient is supine in anatomical Patient is supine in anatomical

position.position. Fulcrum is placed in line with the Fulcrum is placed in line with the

anterior superior iliac spine.anterior superior iliac spine. The moving arm of the The moving arm of the

goniometer is aligned with the goniometer is aligned with the midline of the patella, the midline of the patella, the stationary arm with the ASIS of stationary arm with the ASIS of the opposite side.the opposite side.

Note: This places the goniometer Note: This places the goniometer reading at 90 degrees, to reading at 90 degrees, to determine the actual reading determine the actual reading make sure to read 90 as 0 and make sure to read 90 as 0 and determine the measurement in determine the measurement in that manner.that manner.

Ending PositionEnding Position:: Same as aboveSame as above Normal ROM for hip abduction is Normal ROM for hip abduction is

40 to 50 degrees; the patient has 40 to 50 degrees; the patient has 48 degrees of hip abduction. 48 degrees of hip abduction.

Hip AbductionHip Abduction

PrecautionPrecaution

Prevent lateral rotation of hip joint.Prevent lateral rotation of hip joint.

Factors limiting motionFactors limiting motion

1-Tension of hip adductor muscles.1-Tension of hip adductor muscles.

2-Tension of iliofemoral ligament.2-Tension of iliofemoral ligament.

Hip AdductionHip Adduction Starting PositionStarting Position:: Patient is supine the leg not Patient is supine the leg not

being measured is being measured is abducted to allow full abducted to allow full adduction of the opposite adduction of the opposite leg.leg.

The goniometer positioning The goniometer positioning is the same as for is the same as for abduction, fulcrum at the abduction, fulcrum at the ASIS, moving arm aligned ASIS, moving arm aligned with the midline of the with the midline of the patella, and the stationary patella, and the stationary arm with the ASIS of the arm with the ASIS of the opposite side. Also, opposite side. Also, remember to adjust due to remember to adjust due to the goniometer starting at a the goniometer starting at a reading of 90 degrees.reading of 90 degrees.

Ending PositionEnding Position:: Same as aboveSame as above The normal ROM is 15 to 25 The normal ROM is 15 to 25

degrees. The patient has degrees. The patient has 18 degrees of hip 18 degrees of hip adduction.adduction.

Hip AdductionHip Adduction

PrecautionPrecaution Prevent medial rotation of hip joint. Prevent medial rotation of hip joint.

Factors limiting ROMFactors limiting ROM Contact with opposite limb. Contact with opposite limb.

Hip Medial RotationHip Medial RotationStarting PositionStarting Position:: The patient will be sitting at the The patient will be sitting at the

edge of the table, knees against edge of the table, knees against the table, with their legs dangling the table, with their legs dangling down off the table.down off the table.

The fulcrum is aligned with the The fulcrum is aligned with the patella and both arms of the patella and both arms of the goniometer with the midline of goniometer with the midline of the tibia.the tibia.

Ending PositionEnding Position:: The fulcrum and moving arm The fulcrum and moving arm

remain in the same position as remain in the same position as above.above.

The stationary arm should now be The stationary arm should now be hanging freely but should be hanging freely but should be perpendicular to the floor.perpendicular to the floor.

he normal ROM for internal he normal ROM for internal rotation is 35 to 50 degrees. rotation is 35 to 50 degrees.

Patient has 49 degrees of internal Patient has 49 degrees of internal rotation at the hip rotation at the hip

Hip Medial RotationHip Medial Rotation

PrecautionsPrecautions Prevent the pelvis from lifting off the table.Prevent the pelvis from lifting off the table. Prevent trunk flexion. Prevent trunk flexion.

Factors Limiting ROMFactors Limiting ROM Tension of hip lateral rotator muscles.Tension of hip lateral rotator muscles. When hip is extended (during prone When hip is extended (during prone

position) tension of ischiocapsular ligament.position) tension of ischiocapsular ligament. When hip is flexed (during sitting position) When hip is flexed (during sitting position)

tension of iliofemoral ligament.tension of iliofemoral ligament.

Hip Lateral RotationHip Lateral Rotation Starting PositionStarting Position::   Patient is sitting on the edge of Patient is sitting on the edge of

the table as was done for internal the table as was done for internal rotation. The leg not being rotation. The leg not being measured can either remain off measured can either remain off the table or can be on the table the table or can be on the table depending on the ability of the depending on the ability of the patient. The patient in the patient. The patient in the picture has her leg on the table picture has her leg on the table to her side.to her side.

The goniometer positioning is the The goniometer positioning is the same as for lateral rotation. The same as for lateral rotation. The fulcrum is aligned with the fulcrum is aligned with the patella, and both arms with the patella, and both arms with the midline of the tibia.midline of the tibia.

Ending PositionEnding Position:: The fulcrum and moving arm are The fulcrum and moving arm are

still in the same position.still in the same position. The stationary arm should be The stationary arm should be

hanging freely and perpendicular hanging freely and perpendicular to the floor.to the floor.

Hip Lateral RotationHip Lateral Rotation

PrecautionPrecaution Prevent the pelvis from lifting off the Prevent the pelvis from lifting off the

table.table. Prevent trunk flexion. Prevent trunk flexion.

Factors Limiting ROMFactors Limiting ROM Tension of hip medial rotator Tension of hip medial rotator

muscles.muscles. Tension of iliofemoral ligament. Tension of iliofemoral ligament.