Podcast
Questions and Answers
What is the primary purpose of assessing end feels during a Range of Motion (ROM) examination?
What is the primary purpose of assessing end feels during a Range of Motion (ROM) examination?
- To determine the speed of movement at the end of the range.
- To identify the characteristic feeling of resistance to motion. (correct)
- To measure the joint's range in degrees.
- To assess the patient’s pain level during movement.
According to Cyriax, what is a 'soft tissue approximation' end feel characterized by?
According to Cyriax, what is a 'soft tissue approximation' end feel characterized by?
- Resistance due to bones contacting each other.
- Resistance due to soft tissues compressing together. (correct)
- No resistance felt at the end of the range.
- A firm, springy resistance at the end of the range.
Which of the following describes a capsular pattern in joint ROM?
Which of the following describes a capsular pattern in joint ROM?
- Full and unrestricted range of motion in all directions. (correct)
- Pain-related inhibition of muscle contraction.
- A predictable pattern of motion loss due to a restriction within the joint capsule.
- A random pattern of motion loss due to external ligament damage.
In the hip, which motion is typically MOST limited in a capsular pattern?
In the hip, which motion is typically MOST limited in a capsular pattern?
When measuring hip flexion with a goniometer in a supine position, where should the fulcrum of the goniometer be placed?
When measuring hip flexion with a goniometer in a supine position, where should the fulcrum of the goniometer be placed?
During hip extension goniometry in a prone position, what is the typical end feel?
During hip extension goniometry in a prone position, what is the typical end feel?
For hip abduction goniometry, where is the stationary arm of the goniometer aligned?
For hip abduction goniometry, where is the stationary arm of the goniometer aligned?
A therapist is measuring hip adduction and notes the patient has restricted range due to the thighs compressing against each other. What type of end-feel is this?
A therapist is measuring hip adduction and notes the patient has restricted range due to the thighs compressing against each other. What type of end-feel is this?
When assessing hip internal rotation in a seated position, where is the fulcrum of the goniometer placed?
When assessing hip internal rotation in a seated position, where is the fulcrum of the goniometer placed?
A physical therapist notes a 'spasm' end feel during hip ROM assessment. What does this typically indicate?
A physical therapist notes a 'spasm' end feel during hip ROM assessment. What does this typically indicate?
What is the minimum hip flexion range generally needed to sit comfortably?
What is the minimum hip flexion range generally needed to sit comfortably?
Approximately how much hip flexion range of motion is required for walking on level surfaces?
Approximately how much hip flexion range of motion is required for walking on level surfaces?
What does a manual muscle test (MMT) grade of 3/5 indicate?
What does a manual muscle test (MMT) grade of 3/5 indicate?
During a manual muscle test for hip flexion against gravity, what is the correct positioning of the patient?
During a manual muscle test for hip flexion against gravity, what is the correct positioning of the patient?
In a hip flexion MMT with gravity eliminated, what is the patient's position?
In a hip flexion MMT with gravity eliminated, what is the patient's position?
When performing an MMT for the iliopsoas, where should resistance be applied when testing against gravity?
When performing an MMT for the iliopsoas, where should resistance be applied when testing against gravity?
During MMT for hip adductors in a gravity-eliminated position, how should the patient be positioned?
During MMT for hip adductors in a gravity-eliminated position, how should the patient be positioned?
In MMT for hip medial rotators, what finding indicates weakness when testing against gravity?
In MMT for hip medial rotators, what finding indicates weakness when testing against gravity?
What is the patient's position for MMT testing of the gluteus maximus against gravity?
What is the patient's position for MMT testing of the gluteus maximus against gravity?
When performing a modified gluteus maximus MMT, what position adjustment is made to minimize hamstring involvement?
When performing a modified gluteus maximus MMT, what position adjustment is made to minimize hamstring involvement?
Which of the following muscles primarily contribute to hip flexion?
Which of the following muscles primarily contribute to hip flexion?
In a Thomas test, what does it mean if extending the knee allows the hip to extend further and become parallel with the table?
In a Thomas test, what does it mean if extending the knee allows the hip to extend further and become parallel with the table?
During the Ober test, what position should the patient be in?
During the Ober test, what position should the patient be in?
In both the Ober and Modified Ober tests, what movement are you assessing at the hip?
In both the Ober and Modified Ober tests, what movement are you assessing at the hip?
A therapist performs the Thomas test, noting that during the initial step the patient's thigh rests parallel to the plinth, and the knee flexes to 90 degrees. How should the therapist document these findings?
A therapist performs the Thomas test, noting that during the initial step the patient's thigh rests parallel to the plinth, and the knee flexes to 90 degrees. How should the therapist document these findings?
What is a primary difference between the traditional Ober test and the Modified Ober test?
What is a primary difference between the traditional Ober test and the Modified Ober test?
After performing the Thomas test on a patient, the therapist documents 'positive Thomas test, 2 joint hip flexor tightness.' What would have been observed during this exam?
After performing the Thomas test on a patient, the therapist documents 'positive Thomas test, 2 joint hip flexor tightness.' What would have been observed during this exam?
An MMT test of hip abduction is performed with the patient positioned in side-lying against gravity. How would the MMT grade of 4/5 be described?
An MMT test of hip abduction is performed with the patient positioned in side-lying against gravity. How would the MMT grade of 4/5 be described?
For MMT testing of hip abduction with the patient positioned in side lying against gravity, where should the therapist apply resistance?
For MMT testing of hip abduction with the patient positioned in side lying against gravity, where should the therapist apply resistance?
What is the purpose of performing the second step in the Thomas Test after an initial positive finding?
What is the purpose of performing the second step in the Thomas Test after an initial positive finding?
What is the MOST important factor to consider when performing a Gross MMT?
What is the MOST important factor to consider when performing a Gross MMT?
Which of the following statements BEST differentiates between capsular and non-capsular ROM restrictions?
Which of the following statements BEST differentiates between capsular and non-capsular ROM restrictions?
According to the content provided, how frequently do the two Ober tests yield the same results?
According to the content provided, how frequently do the two Ober tests yield the same results?
A patient reports hip pain and the physical therapist suspects a capsular pattern restriction. Which of the following ROM assessment findings would MOST likely support this suspicion?
A patient reports hip pain and the physical therapist suspects a capsular pattern restriction. Which of the following ROM assessment findings would MOST likely support this suspicion?
What is the primary difference between a MMT of 2-/5 and an MMT of 2/5?
What is the primary difference between a MMT of 2-/5 and an MMT of 2/5?
What muscles are responsible for hip adduction?
What muscles are responsible for hip adduction?
When performing a MMT for the gluteus minimus, and assessing their action, what is the direction of movement?
When performing a MMT for the gluteus minimus, and assessing their action, what is the direction of movement?
Which of the following muscles are responsible for hip external rotation according to the content provided?
Which of the following muscles are responsible for hip external rotation according to the content provided?
During the Ober Test, the patient's lower, non-tested leg should be bent. What is the main goal?
During the Ober Test, the patient's lower, non-tested leg should be bent. What is the main goal?
According to Cyriax's classification of normal end feels, what sensation characterizes a 'bony/hard' end feel?
According to Cyriax's classification of normal end feels, what sensation characterizes a 'bony/hard' end feel?
Which of the following indicates an 'empty' end feel, as described by Cyriax?
Which of the following indicates an 'empty' end feel, as described by Cyriax?
In the context of joint assessment, what is the primary characteristic of a noncapsular pattern?
In the context of joint assessment, what is the primary characteristic of a noncapsular pattern?
What best describes the pattern of limitation in hip capsular patterns?
What best describes the pattern of limitation in hip capsular patterns?
During goniometric measurement of hip flexion, what bony landmark serves as the fulcrum's placement?
During goniometric measurement of hip flexion, what bony landmark serves as the fulcrum's placement?
To correctly measure hip extension using a goniometer with the patient in prone, how should the stationary arm of the goniometer be aligned?
To correctly measure hip extension using a goniometer with the patient in prone, how should the stationary arm of the goniometer be aligned?
When measuring hip abduction with a goniometer, which anatomical landmark should the moving arm be aligned with?
When measuring hip abduction with a goniometer, which anatomical landmark should the moving arm be aligned with?
During hip adduction goniometry, a therapist notes that soft tissue approximation limits the patient's range of motion. Besides the restriction, which of the following is the MOST likely end feel?
During hip adduction goniometry, a therapist notes that soft tissue approximation limits the patient's range of motion. Besides the restriction, which of the following is the MOST likely end feel?
When measuring hip internal rotation in a seated position with a goniometer, what is the correct alignment for the stationary arm?
When measuring hip internal rotation in a seated position with a goniometer, what is the correct alignment for the stationary arm?
A therapist assesses a patient's hip range of motion and identifies a 'spasm' end feel. What underlying condition should the therapist suspect?
A therapist assesses a patient's hip range of motion and identifies a 'spasm' end feel. What underlying condition should the therapist suspect?
A patient preparing to return to work following hip surgery will be spending the majority of their day seated. What is the MINIMUM hip flexion ROM they should have in order to sit comfortably?
A patient preparing to return to work following hip surgery will be spending the majority of their day seated. What is the MINIMUM hip flexion ROM they should have in order to sit comfortably?
What is the approximate hip flexion range of motion required for level-ground ambulation?
What is the approximate hip flexion range of motion required for level-ground ambulation?
In manual muscle testing, what does a grade of 3+/5 typically indicate?
In manual muscle testing, what does a grade of 3+/5 typically indicate?
When performing a manual muscle test for hip flexion against gravity, where does the therapist apply resistance?
When performing a manual muscle test for hip flexion against gravity, where does the therapist apply resistance?
What is the correct patient position when performing a hip flexion MMT with gravity eliminated?
What is the correct patient position when performing a hip flexion MMT with gravity eliminated?
During MMT of the Tensor Fasciae Latae (TFL) against gravity, which movement should the patient primarily perform?
During MMT of the Tensor Fasciae Latae (TFL) against gravity, which movement should the patient primarily perform?
For MMT testing of the hip adductors in a gravity-eliminated position, how should the patient be positioned?
For MMT testing of the hip adductors in a gravity-eliminated position, how should the patient be positioned?
During MMT for hip medial rotators against gravity, what is the BEST indicator of weakness from the tested leg?
During MMT for hip medial rotators against gravity, what is the BEST indicator of weakness from the tested leg?
A patient is positioned prone with their knee flexed to 90 degrees. Which muscle is MOST appropriately tested with the MMT in this position?
A patient is positioned prone with their knee flexed to 90 degrees. Which muscle is MOST appropriately tested with the MMT in this position?
In a modified gluteus maximus MMT, why is it important to ensure there is adequate knee flexion of the tested leg?
In a modified gluteus maximus MMT, why is it important to ensure there is adequate knee flexion of the tested leg?
In a patient with hip pain, weakness in hip flexion is noted. Which of the following muscles could MOST likely be involved?
In a patient with hip pain, weakness in hip flexion is noted. Which of the following muscles could MOST likely be involved?
During the Thomas test, what does the therapist observe during the initial step to indicate potential tightness of hip flexors?
During the Thomas test, what does the therapist observe during the initial step to indicate potential tightness of hip flexors?
What position are patients in for both the Ober and Modified Ober tests?
What position are patients in for both the Ober and Modified Ober tests?
What motion is assessed during the ober test besides hip adduction?
What motion is assessed during the ober test besides hip adduction?
During the initial assessment of a Thomas test, the patient's thigh does not rest completely parallel to the plinth, and the knee is flexed to approximately 60 degrees. Which statement accurately describes this?
During the initial assessment of a Thomas test, the patient's thigh does not rest completely parallel to the plinth, and the knee is flexed to approximately 60 degrees. Which statement accurately describes this?
How does extending the knee influence the interpretation of the Thomas test?
How does extending the knee influence the interpretation of the Thomas test?
A therapist performs the Thomas test, initially observing that the patient's thigh rests parallel to the plinth, and the knee is flexed to 90 degrees. During the second step, extension of the knee to zero degrees does not change the resting position of the hip. Which of the following is the MOST accurate interpretation?
A therapist performs the Thomas test, initially observing that the patient's thigh rests parallel to the plinth, and the knee is flexed to 90 degrees. During the second step, extension of the knee to zero degrees does not change the resting position of the hip. Which of the following is the MOST accurate interpretation?
During the 2nd step of the Thomas test, the therapist notes that the thigh moves further into extension and rests much closer to the plinth as the knee is passively extended. What does this finding MOST likely indicate?
During the 2nd step of the Thomas test, the therapist notes that the thigh moves further into extension and rests much closer to the plinth as the knee is passively extended. What does this finding MOST likely indicate?
During a gross manual muscle test (MMT) of hip abduction, the patient is able to move their leg away from the midline against moderate resistance. Which of the following would be an appropriate way to document this finding?
During a gross manual muscle test (MMT) of hip abduction, the patient is able to move their leg away from the midline against moderate resistance. Which of the following would be an appropriate way to document this finding?
Why is the second step of the Thomas test important?
Why is the second step of the Thomas test important?
Which factor is MOST crucial in performing Gross MMT?
Which factor is MOST crucial in performing Gross MMT?
As a general rule, what are capsular ROM restrictions?
As a general rule, what are capsular ROM restrictions?
What is a key contradiction to performing the Ober tests?
What is a key contradiction to performing the Ober tests?
Following a motor vehicle accident, a patient presents with hip end-range pain and ROM limitations. Internal rotation is MOST limited when compared to hip flexion, abduction and extension. What pathology is MOST consistent with this ROM restriction?
Following a motor vehicle accident, a patient presents with hip end-range pain and ROM limitations. Internal rotation is MOST limited when compared to hip flexion, abduction and extension. What pathology is MOST consistent with this ROM restriction?
During MMT hip adduction, the therapist applies resistance at the distal tibia into abduction, and places the patient side-lying with the test leg in line with the body. How should the patient be instructed?
During MMT hip adduction, the therapist applies resistance at the distal tibia into abduction, and places the patient side-lying with the test leg in line with the body. How should the patient be instructed?
During MMT testing of the hip internal rotators, where should resistance be applied against gravity?
During MMT testing of the hip internal rotators, where should resistance be applied against gravity?
What compensation might a therapist expect to see during MMT of hip external rotation across gravity in the seated position?
What compensation might a therapist expect to see during MMT of hip external rotation across gravity in the seated position?
During the Ober test, what is the MOST likely reason for the therapist to stabilize the pelvis?
During the Ober test, what is the MOST likely reason for the therapist to stabilize the pelvis?
Why is it important to ensure there is 90 degrees or more of knee flexion (less hip extension) when testing the gluteus maximus with the patient in the prone position?
Why is it important to ensure there is 90 degrees or more of knee flexion (less hip extension) when testing the gluteus maximus with the patient in the prone position?
According to Cyriax, which end feel is characterized by a ROM that is limited sooner than expected and feels squishy?
According to Cyriax, which end feel is characterized by a ROM that is limited sooner than expected and feels squishy?
Which of the following ROM limitations is MOST indicative of a capsular pattern?
Which of the following ROM limitations is MOST indicative of a capsular pattern?
During hip adduction goniometry, which anatomical landmark should the movable arm of the goniometer be aligned with?
During hip adduction goniometry, which anatomical landmark should the movable arm of the goniometer be aligned with?
During goniometric measurement of hip external rotation in a seated position, how should the patient be positioned relative to the testing leg?
During goniometric measurement of hip external rotation in a seated position, how should the patient be positioned relative to the testing leg?
A patient is able to hold the test position against gravity and slight pressure during hip abduction MMT. How would you grade this?
A patient is able to hold the test position against gravity and slight pressure during hip abduction MMT. How would you grade this?
When performing MMT for hip medial rotators against gravity in a seated position, against gravity, where should resistance be applied?
When performing MMT for hip medial rotators against gravity in a seated position, against gravity, where should resistance be applied?
During MMT for hip adductors in a gravity-eliminated position while supine, to isolate the hip adductors, where is stabilization provided?
During MMT for hip adductors in a gravity-eliminated position while supine, to isolate the hip adductors, where is stabilization provided?
During the initial assessment of a Thomas test, the patient's thigh does not rest completely parallel to the plinth, and the knee is flexed to less than 80 degrees. What does this indicate?
During the initial assessment of a Thomas test, the patient's thigh does not rest completely parallel to the plinth, and the knee is flexed to less than 80 degrees. What does this indicate?
In the second step of the Thomas test, if extending the knee allows the hip to extend further and become parallel with the table, this indicates tightness in which muscle group?
In the second step of the Thomas test, if extending the knee allows the hip to extend further and become parallel with the table, this indicates tightness in which muscle group?
During the ober test, the patient's top leg adducts past horizontal, but not fully to the table. How is this documented?
During the ober test, the patient's top leg adducts past horizontal, but not fully to the table. How is this documented?
Flashcards
What are End Feels?
What are End Feels?
The feeling of resistance to motion by a therapist passively moving a joint to its end range.
What are normal end feels?
What are normal end feels?
Normal end feels occur when full ROM is achieved. Examples include soft tissue approximation, bony/hard, and capsular/firm.
What are abnormal end feels?
What are abnormal end feels?
Abnormal end feels occur sooner than expected or in joints where a hard or firm end feel is expected. Examples include Empty, Boggy, Springy, Spasm , Elastic/Stretch
What is a Boggy end feel?
What is a Boggy end feel?
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What is a Springy end feel?
What is a Springy end feel?
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What is a Empty end feel?
What is a Empty end feel?
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What is Spasm end feel?
What is Spasm end feel?
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What is a Elastic/Stretch end feel?
What is a Elastic/Stretch end feel?
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What is Capsular ROM Restriction?
What is Capsular ROM Restriction?
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What is Noncapsular ROM Restriction?
What is Noncapsular ROM Restriction?
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What is the Capsular Pattern?
What is the Capsular Pattern?
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What is the capsular pattern of the hip?
What is the capsular pattern of the hip?
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What is the normal range for hip flexion?
What is the normal range for hip flexion?
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What is the normal end feel for hip flexion?
What is the normal end feel for hip flexion?
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What is the normal range for hip extension?
What is the normal range for hip extension?
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What is the normal end feel for hip extension?
What is the normal end feel for hip extension?
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What is the range for hip abduction?
What is the range for hip abduction?
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What is the normal end feel for hip abduction?
What is the normal end feel for hip abduction?
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What is the range for hip adduction?
What is the range for hip adduction?
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What is the range for hip internal rotation?
What is the range for hip internal rotation?
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What is the normal end feel for internal rotation?
What is the normal end feel for internal rotation?
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What is the Hip external rotation range?
What is the Hip external rotation range?
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What is normal end feel for hip external rotation?
What is normal end feel for hip external rotation?
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For what ROM degrees is hip flexion needed?
For what ROM degrees is hip flexion needed?
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What is Gross MMT?
What is Gross MMT?
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What is tested in the Thomas Test?
What is tested in the Thomas Test?
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What does the Ober test measure?
What does the Ober test measure?
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Study Notes
- Therapeutic Measurement and Testing (PTA 1008) related to the hip
Objectives
- Review bones, joints, ligaments, and musculature of the hip and knee
- Learn the range of motion measurements of the hip and knee using goniometry
- Learn manual muscle test positions for the hip and knee musculature, against and across gravity
- Review dermatomes on and near the hip and knee
- Discuss when range of motion and manual muscle testing are appropriate or inappropriate
- Document the objective section of a note regarding goniometry and strength testing for the hip and knee
- Review normal and abnormal end feels and discuss the capsular patterns of each joint
Principles of ROM: End Feels
- End feels are the feeling of resistance to motion experienced by therapists passively taking a joint to its end range
- End feels are assessed to determine the nature of resistance at the end of PROM and help identify structural limitations
Principles of ROM: Normal End Feels (from Cyriax)
- Normal end feel is as long as full ROM has been achieved.
- Soft tissue approximation: ROM is limited by soft tissues compressing together, eg elbow flexion
- Bony/hard: ROM is limited by bones approximating, eg elbow extension
- Capsular/firm (most common end feel): ROM has a firm resistance feel at the end of the range, eg shoulder flexion
Principles of ROM: Abnormal End Feels from Cyriax
- Empty: no end feel is reached, limited due to complaints of pain or other symptoms
- Boggy: ROM is limited sooner than expected,Feels squishy
- Springy: ROM is limited sooner than expected or in joint expected to have a soft or hard end feel and is rubbery or bouncy
- Spasm: from reflex and reactive muscle contraction
- Elastic/Stretch: contraction from the muscle tendon unit
- reaching a normal end feel before a full range of motion is typically a sign of an abnormality
Principles of ROM
- Capsular restriction only limits the joint capsule and has a particular pattern of Passive motion restriction
- Noncapsular restriction limits any structures that may limit joint motion
- Each joint has its’ own capsular pattern and are described in a specific order moving from most to least
Limitation of motion (more restricted to least restricted)
- For the hip: IR > varied pattern of flexion, abduction, and ext
Goniometry: Hip Flexion
- Hip flexion ranges normally from 0-120 degrees
- Position of patient: supine; B knee extension, B hips in 0° abd/add/rot
- Position of therapist Along side the patient stabilizing the pelvis
- Fulcrum should be placed on the lateral aspect of the hip (greater trochanter)
- Stationary arm placement: lateral midline of the pelvis
- Movable arm: lateral midline of the femur (lateral epicondyle)
- Soft tissue approximation from muscle bulk or capsular/firm from tension in posterior joint capsule and gluteus maximus muscle
Goniometry: Hip Extension
- Hip extension ranges normally from 0-20 degrees
- Position of patient: Prone
- The therapist should be alongside the patient stabilizing the pelvis
- Fulcrum placement: lateral aspect of the hip (greater trochanter)
- Stationary arm placement: lateral midline of the pelvis
- Movable arm placement. lateral midline of the femur (lateral epicondyle)
- Capsular/firm indicates anterior joint capsule and iliofemoral ligament with tension, also less from ischiofemoral and pubofemoral ligaments
Alternative Hip Extension Position
- Position patient in side lying
- The therapist should be alongside the patient and posterior, and should stabilize the pelvis with the base of the cranial oriented hand and/or with the therapist’s anterolateral hip
- Support patient’s LE with caudal positioned hand (and forearm if necessary)
- The patient’s hip should be in neutral add/abd and neutral IR/ER
Goniometry: Hip Abduction
- Hip abduction ranges normally from 0-40 degrees
- Position the patient supine with knees extended and the hips at 0 flex/ext/rot
- Position: Fulcrum should be at the ASIS of the extremity being measured
- Stationary art position: imaginary horizontal line to the contralateral ASIS
- Movable arm should lie on the anterior midline of the femur (middle of patella)
- Capsular/firm: tension in inferior (medial) joint capsule, pubofemoral ligament, ischiofemoral ligament, and inferior band of iliofemoral ligament with abduction
- Passive tension in these muscles may also contribute to end feel: adductor magnus, adductor longus, adductor brevis, pectineus, and gracilis
Goniometry: Hip Adduction
- Hip adduction ranges from 0-20 degrees
- Place the patient is supine with their contralateral limb abducted
- Place the therapist alongside patient
- Fulcrum position: ASIS of the extremity being measured
- Stationary arm: imaginary horizontal line to the contralateral ASIS
- Movable arm: anterior midline of the femur (patella)
- The starting point for reading the goniometer will be near 90 degrees. Take that measurement minus the end measurement to get the hip adduction
- 90 deg – 72 deg = 18 deg hip adduction
- Soft tissue approximation: larger thighs may create a soft tissue end feel prior to capsular restriction
- Capsular/firm results in tension in superior (lateral) joint capsule and superior band of iliofemoral ligament and muscles: gluteus medius, gluteus minimus, and tensor fascia lata
Goniometry: Hip Internal Rotation
- Hip medial/internal rotation: 0-45 degrees
- The patient should be seated with the distal femur supported to align the femur in the acetabulum in neutral, 90 hip and knee flexion
- The therapist will be seated in front of the patient
- Fulcrum Placement: anterior aspect of the patella
- Stationary art placement: perpendicular to the floor
- Movable arm placement: anterior midline of the tibia (between malleoli)
- Capsular/firm: tension in posterior joint capsule and ischiofemoral ligament
- Muscles that contribute include: piriformis, obturator (internus and externus), deep hip ERs, gluteus medius (posterior fibers), and gluteus maximus
Alternative Hip Internal Rotation Position
- Common compensations are trunk or pelvic rotation, knee extension, hip hike, composite ankle eversion and hip abduction
Goniometry: Hip External Rotation
- Hip lateral/external rotation ranges from 0-45 degrees
- The patient should be seated with the distal femur supported to align the femur in the acetabulum in neutral, hips at 90 flexion
- The contralateral knee should be at enough flexion to allow the testing leg to comfortably cross it
- Fulcrum placement is at the anterior aspect of the patella
- Stationary arm placement should be perpendicular to the floor
- The Movable arm placement: anterior midline of the tibia (between malleoli)
- Capsular/firm: tension in anterior joint capsule, iliofemoral ligment, and pubofemoral ligament
- muscles that contributes include: anterior portion of gluteus medius, gluteus minimus, adductor magnus, adductor longus, pectineus, and piriformis
Alternative testing position for Hip External Rotation and compensations
- Alternative testing position Prone
- Common compensations are: Trunk or pelvic rotation, knee extension, hip hike,composite ankle inversion and hip abduction
Functional ROM of the Coxal Joint
- It requires at least 90 degrees of hip flexion can to sit comfortably
- Lower body ADL's usually require > 90 degrees of hip flexion:
- Putting on pants
- Tying shoes
- Putting on socks
- Shaving legs
Functional hip flexion range
- Walking on level surfaces requires 25 degrees of flexion and 20 degrees of hip extension
- Ascending stairs requires about 65 degrees
- Descending stairs requires about 40 degrees
MMT Grading Review
- 5/5 Normal: holds test position against gravity with strong pressure
- 4+/5 Good Plus: hold test position against gravity, moderate-strong pressure
- 4/5 Good: hold test position against gravity, moderate pressure
- 4-/5 Good Minus: hold test position against gravity with slight-moderate pressure
- 3+/5 Fair Plus: able to hold test position against gravity with slight pressure
- 3/5 Fair: holds test position against gravity
- 3-/5 Fair Minus : gradual release from the test position occurs
- = 2+/5Poor Plus: partial range of motion against gravity;OR complete across gravity movement against slight resistance
- 2/5 Poor: complete range of muscle being tested in gravity eliminated
- 2-/5 Poor Minus: partial muscle range of motion in gravity eliminated
- 1/5 Trace: palpable muscle contraction, or tendon prominent, NO joint movement
- 0/5 Zero: no palpable muscle contraction
Group Test Hip Flexion
- Muscles involved are Rectus Femoris, Iliacus, Psoas Major
- Testing position against gravity: the patient will be seated with knees flexed, pts hands on table to prevent leaning backwards
- Stabilization: pelvis by the table
- Movement: into hip flexion (few inches from table)
- Resistance: apply one hand at the distal femur towards hip extension
- Weakness :patient cannot hold the fully flexed position
- Testing position gravity eliminated: side lying, hip at more than 90 flexion
- Stabilization: stabilizes the trunk by the table, leg is supported by the therapist
- Movement: into hip flexion, greater than to 90 degrees
- apply Resistance one hand at the distal femur towards hip extension
- Weakness presents as a reduced ability to flex the hip above 90 degrees
Hip Flexion: Iliopsoas (Focus on the Psoas Major)
- Testing position against gravity: supine with knee extension, slight ER and slight abduction of the hip
- Stabilization: pelvis by the table, opposite iliac crest by therapist
- Movement: into hip flexion
- apply Resistance at the distal tibia into hip extension, abduction
- Weakness presents as an inability hold the position
- Across Gravity the position gravity eliminated: side lying, leg supported by therapist
- Stabilization is achieved by stabilizing the trunk by the table and leg
- Movement presents as hip flexion
- apply Resistance at the distal femur into hip extension and abduction
- Weakness presents as an inability to hold the position
Sartorius
- Testing position against gravity is: Supine, about 70 hip flexion, and hip abduction, about 90 knee flexion -Stabilization comes from the pelvis at the table and distal lower leg needs to be able to resist ER)
- The movement is into ER, abduction and hip flexion with knee in flexed position
- apply Resistance lateral and proximal to the knee into hip extension, adduction, and internal rotation towards knee extension
- Weakness presents dcreased hip flexion, abduction and ER (lateral rotation) and contributes to anteromedial knee instability
Tensor Fasciae Latae (TFL)
- The testing against gravity is: supine, knee extension, some hip flexion
- Stabilization: by the table, allow the patient to hold table,stabilize contralateral pelvis as needed
- The movement done was : abduction, flexion, and internal rotation of the hip (toes in, heal out) with knee extended
- Resistance should be provided at the proximal to the lateral malleolus intoextension and adduction (NONE in the rotation component)
- Weakness presents when the patient fails to stay in IR
Hip Adductors [Adductor Magnus, Adductor Longus, Adductor Brevis, Gracilis, Pectineus
- The testing against gravity involves side lying with leg in line with the body
- Stabilization: upper leg in abduction by therapist, patient holds the table for stability
- Movement involves:moving the lower leg into adduction toward the top leg
- apply Resistance at the proximal to the knee into abduction (toward the table)
- The inability of the patient to adduct against gravity indicates possible weakness in the associated structures .
Group Test: Medial Rotators (TFL, Gluteus Minimus, Gluteus Medius)
- The testing position against gravity is: seated, with pt holding onto table
- Stabilization: is achieved by the table and the medial knee by the therapist (hold)
- The movement is: internal rotation
- apply Resistance at the proximal to the lateral malleolus into lateral rotation
- Weakness results in: The inability of the patient to resist lateral rotation results in difficulty in standing and walking Against gravity position consists of: side lying with support
- Stabilization: is achieved with :support thigh with hip at 90 degrees
- The applied Resistance is against gravity
- Weakness: a reduced ability of the patient to maintain or obtain position indicates associated musculature weakness
- The movement tested is internal rotation
Gluteus Minimus (actions: Abduction, IR and Flexion) (
- The testing position is against gravity and is done by side-lying on opposite side
- Stabilization: achieved: by the table and pelvis to avoid movement
- Movement tested: into pure abduction
- Resistance: apply force at the proximal to the lateral malleolus into adduction (and slight extension)
- weakness:inability to resist with reduced abduction strength
Gluteus Medius (emphasis on posterior portion)
- testing position against gravity: side-lying on opposite side with under leg flexed hip and knee and pelvis rotated slightly forward
- Stabilization:by the table and by therapist of the trunk and pelvis
- apply Resistance:distal lateral lower leg into adduction and slight flexion; do NOT apply pressure against rotation component Weakness:in inability to hold tested limb position, test with Maintain pelvis in order to focus on the Gluteus Medius
Group Test: Lateral Rotators (Piriformis, Obturator Internus and Externus, Gamellus Superior and Inferior, Quadratus Femoris) K 431
- Testing position against gravity- seated, (not actually against gravity Stabilization-- table and counter pressure lateral thigh (hold); -Movement- lateral rotation (ER) pulling foot inwards Resistance :proximal to the medial malleolus pulling outwards
Gluteus Maximus
- Testing: knee flexed to to take pressure of the hamstrings
- Stabilization- at the lumbo-pelvic junction to avoid lumbar
- Movement: into hip
- Resistance: at the distal femur Weakness: inability to lift the leg into extension- shortening of step length or backward trunk lean in abulation
Thomas Test (K 376-381)
- Tests flexibility of the hip flexors:iliacus & psoas Major and two Joint hip flexors
- Two joint hip flexors include rectus femoris, TFL and sartorius
- Position/SetUp Patient starts in standing, backed up to the edge of the plinth at the level just below the buttock
- Patient is asked to hold the non-test leg to the chest. - Therapist slowly lower the patient onto his/her back initial Assessment- Therapist assesses hip -Flexion & Knee Flexion - Thigh comparison to floor
- To make test more specific , Second step for initial positive test : - extend the knee to evaluate 2 jt
- Second Pos- knee may relax or not if Iliopsoas is the limiting element Report in Documentation List the degrees of at point of rest flexion & State the muscles group involved
Ober/Modified Ober Test
Muscle assessment for tight abductor Mod Ober--knee fully extended- Ober--knee flexed and pt is side lying,
- Sequence of testing : PROM then Modified Ober
- Ober Document
- Document at what point you begin to feel the pelvis move and the leg stops (Gajdosik et al, Clin Biomech 2003; 18(1): 77-79) Discrepancy between the Tests knee extension can allow for more hip adduction
- Tests shouldn't be used interchangeably -If the patient has a hip flexion this this Test can't be used *If no difference between tests, abduction is not the issue
Therapeutic Measurement and Testing (TMT) of the Hip
- Documentation relating to Goniometry should follow the given measurement process Documentation relating to MMT should also follow the given measurement process Testing relating to sensation should recordthe type , location, and patient response. Sensory should then be graded between:Intact, Poor, Fair, Good with: 0 = absent; 1= impaired; 2 = intact; or NT= not tested
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