Hip Muscles
Dr. Tamer Emam
Testing Muscles of the Lower Extremity
1. Hip Flexion.
2. Hip flexion, abduction and external (lateral)
rotation with knee flexion.
3. Hip Extension.
4. Hip abduction.
5. Hip Abduction from flexed position
6. Hip Adduction
7. Hip External Rotation
8. Hip Internal rotation
Hip Flexion
1- ANATOMY:
Agonist / Prim mover : Psoas major and iliacus
Origin:
Psoas major: transverse processes of L1-L5 and the vertebral bodies of
T12-L5
Iliacus: anterior 2/3 of iliac fossa
Insertion:
Psoas major: lesser trochanter of the femur
Iliacus: lesser trochanter of the femur
Nerve Supply:
Psoas major: lumbar plexus , nerve root from L1-to-L4
Iliacus: lumbar plexus, Femoral nerve L2-L4
Action: powerful hip flexion
Synergist / Accessory Muscles:
Rectus Femoris (RF), Sartorius, Tensor fasciae latae (TFL) and
Pectineus.
2- Range of motion: 0 to 115-1250
3- Stabilization:
1. contraction of anterior abdominal muscles to fix lumbar spine
and pelvis.
2. weight of trunk.
4- Effect of weakness and contracture:
1- Difficulty in: climbing stair, walking up or down the incline, getting up
from a reclined position.
2- In marked weakness: walking is difficult because the leg must brought
forward by pelvic motion.
3- Effect of contracture: Bilateral– Increased lumbar lordosis.
Unilateral–hip abduction combined with external
rotation.
5- Factor Limiting of motion:
- With knee flexed, contact of thigh on abdomen.
- With knee extended, tension of Hamstring Muscles.
6- Substitution:
*Sartorius: external rotation and abduction of the hip
*Tensor fasciae latae: internal rotation and abduction of the hip.
7-Procedures:
a- Position of Patient:
b- Position of Therapist : inner hand, Outer hand, Direction of Resistance
c- Test
d- Instruction to patient
The patient is short sitting with thighs
fully supported and legs hanging over
the edge. The therapist stands next to
the test leg. The therapist places one
hand on the distal thigh and proximal
knee, and applies resistance in a
downward direction as the patient
actively flexes at the hip
TEST PROCEDURES
GRADES “3” FAIR
Patient position: sitting with legs over the edge of table. Patient grasp the edge
of table to stabilize pelvis or arms may be crossed on the chest if patient is stable
enough.
Therapist position and grasp: therapist stand beside the tested leg, proximal
hand is pressing the iliac crest down to stabilize pelvis.
.Command:
Raise up your leg vertically toward your chest (in mid line)……relax
GRADES “4” AND “5”
GRADES “4” AND “5”
Patient position: the same as grade 3.
Therapist and Patient Instructions: same as for grade 3 plus Resistance is
applied proximal to the knee joint.
.
Resistance:
Grade 4: a moderate leading resistance is given directly opposite to the line of
motion.
Grade 5: a maximum resistance is given in the same manner as grade 4 plus
hold at the end of ROM.
Command:
The same as grade 3 plus…. Hold when test grade 5…. Relax
Grades 4 and 5 “good and normal”
MMT FOR GRADES 2 “POOR”
Patient position: side lying with affected leg down, trunk, pelvis and legs are
straight. Upper leg is supported.
Therapist and Patient Instructions: therapist stand behind the patient, the
proximal hand stabilize the pelvis, and distal hand support the upper leg.
Command:
With flexed knee move your leg toward your chest…..relax
MMT FOR GRADES 1 AND 0 “TRACE AND
ZERO”
Patient position: supine lying, both legs are extended and affected leg nears the
edge of the table.
Therapist and Patient Instructions: therapist stand beside the table, distal
hand supporting the affected leg, the proximal hand palpate contraction in psoas
major just distal to inguinal ligament.
.Command:
Try to pull your leg toward your chest….relax
Hip flexion, abduction, and external
rotation with knee flexion
1- ANATOMY: Agonist / Prim mover : Sartorius
Origin: anterior superior iliac spine (ASIS)
Insertion: upper medial surface of body of tibia
Action: - flexes hip and knee
- With flexed hip, laterally rotates the thigh
Nerve supply: branches of femoral nerve, L2-L3-L4
Synergist / Accessory Muscles:
hip and knee flexors. hip external rotators, and
hip abductor.
2- Range of motion:
NO specific ROM because of two-joint muscle.
3- Fixation:
a. Contraction of abdominal muscles to fix pelvis.
b. Weight of trunk.
4-Effect of weakness and contracture:
effect of weakness: loss of antro- medial instability of
the knee joint.
effect of contracture: flexion, abduction and lat. Rot.
Deformity of the hip with knee flexion.
5- Factor Limiting of motion:
Non, because incomplete range of motion.
6- Substitution:
Iliopsoas or the Rectus Femoris results in pure hip flexion
without abduction and external rotation.
7- Procedures:
a- Position of Patient:
b- Position of Therapist : inner hand, Outer hand, Direction of
Resistance
c- Test
d- Instruction to patient.
The patient is short sitting with thighs
supported on table and legs hanging over
side. The therapist stands lateral to the test
leg while placing one hand on the lateral
side of the knee and using the other hand to
grasp the medial anterior surface of the
distal leg. Hand at knee gives downward
and inward resistance. Hand at ankle gives
downward and outward resistance. Patient
flexes, abducts, and externally rotates the
hip and flexes the knee.
TEST PROCEDURES
Grades “3” fair
Patient position: sitting with legs over the edge of the table. Heel of limb to be
tested in front of opposite ankle.
Therapist position and grasp: therapist stand beside the patient. The proximal
hand stabilizes the pelvis.
Command:
Raise your heel up to knee with flexion, abduction and lateral rotation of hip and
flexion of knee ……relax.
GRADES “4” AND “5”
Patient position: the same as grade 3.
Therapist and Patient Instructions: same as for grade 3 plus proximal hand is
placed the knee to resist hip flexion and abduction. Distal hand above ankle to
resist hip lateral rotation.
Resistance:
Grade 4: a moderate leading resistance is given directly opposite to the line of
motion.
Grade 5: a maximum resistance is given in the same manner as grade 4 plus hold at
the end of ROM.
Command:
The same as grade 3 plus…. Hold when test grade 5…. Relax
Grades 4 and 5 “good and normal”
MMT for Grades 2 “poor”
Patient position: supine lying, with heal of limb to be tested on opposite ankle.
Therapist position and instruction: therapist stand beside the patient, the proximal
stabilize the pelvis.
Command:
Slide your heel along leg to knee with flexion, abduction and external rotation of
hip and knee flexion ……relax
MMT for Grades 1 and 0 “trace and zero”
Patient position: same as grade 2 with hip flexed and lateral rotated.
Therapist and Patient Instructions: same as grade 2 but therapist one hand
supporting leg under knee and proximal hand palpate near the origin of sartorius
muscle just below ASIS.
Command:
Try to pull your thigh towards you, flexing hip joint … relax
Hip Extension
1. ANATOMY:
Prim mover / agonist: Gluteus maximus and Hamstring
Origin of Gluteus maximus
– outer rim of ilium (medial aspect)
– dorsal surface of sacrum and coccyx
– sacrotuberous ligament
Insertion of Gluteus maximus :
– Illiotibial tract of fascia lata(primary insertion)
– gluteal tuberosity of femur
Action of Gluteus maximus :
– powerful extensor of hip
– laterally rotates thigh
– upper fibers aid in abduction of thigh
– fibers of IT band stabilize a fully extended knee
Nerve supply of Gluteus maximus : inferior gluteal nerve,
L5,S1,S2
Synergist / Accessory Muscles:
Adductor magnus (inferior part), Gluteus medius (post part),
2- Range of motion: 0 to 10- 150 degrees (hyper)
3- Fixation
a. Contraction of ilio costalis lumborum and quadratus lumborum muscle.
b. Weight of trunk.
4- Effect of weakness and contracture:
1- Effect of weak. Bilaterally makes walking difficult., difficult in raising the
trunk from foreword-bent position.
2- Patient must push themselves to an upright position by using their arms
during walk.
3- Effect of contracture: walking with Hyper extension deformity.
5-Factor Limiting of motion:
a. Tension of iliofemoral ligament.
b. Tension of hip flexor muscles.
6-Substitution:
by extending lumbar spine.
Therapist must support the pelvis.
7- Procedures:
a- Position of Patient:
b- Position of Therapist : inner hand, Outer hand, Direction of Resistance
c- Test
d- Instruction to patient
The patient lies prone on the table. The
therapist stands on the side of the test leg, at
pelvis level. One hand stabilizes the pelvis,
and the other hand is placed on the distal calf.
The hand on the distal calf applies resistance
in a downward direction ad the patient
actively extends at the hip.
TEST PROCEDURES
Grades “3” fair
Patient position: half prone lying with flexed knee, affected leg away from the
therapist, and sound leg supported on a stool.
Therapist position and grasp: therapist stand beside the table at level of hip joint,
proximal hand support the pelvis.
.Command:
Raise up your leg ……relax
GRADES “4” AND “5”
Patient position: the same as grade 3.
Therapist and Patient Instructions: same as for grade 3 plus Resistance is applied
proximal to the knee joint..
Resistance:
Grade 4: a moderate leading resistance is given directly opposite to the line of
motion.
Grade 5: a maximum resistance is given in the same manner as grade 4 plus hold at
the end of ROM.
Command:
The same as grade 3 plus…. Hold when test grade 5…. Relax
Grades 4 and 5 “good and normal”
MMT FOR GRADES 2 “POOR”
Patient position: side lying with affected leg down, hip flexion and knee extension.
Upper leg supported.
Therapist and Patient Instructions: therapist stand behind the patient, the
proximal hand stabilize the pelvis, and distal hand support the upper leg
Command:
Move your leg backward……relax
MMT FOR GRADES 1 AND 0 “TRACE AND
ZERO”
Patient position: same as grade 3.
Therapist and Patient Instructions: same as grade 3 but therapist palpates with
two hands the upper and lower portion of the muscle.
Command:
Squeeze your buttocks… relax
Alternate position of hip extension but isolate gluteus maximus
To isolate gluteus maximus, all positions must be associated with knee flexion
Hip abduction
1- ANATOMY: Prim mover/ agonist: ( Gluteus medius and
Gluteus minimus)
Gluteus medius: Origin: from the outer surface of the ilium,
posterior gluteal line(behind) and anterior gluteal line(below).
– upper fascia (AKA gluteal aponeurosis)
Insertion: lateral aspect of greater trochanter of femur
Action: - anterior and lateral fibers abduct and medially rotate the
thigh
- the posterior fibers laterally rotate and may assist in
extension.
- stabilizes the pelvis and prevents free limb from sagging
during gait
Nerve: superior gluteal nerve, L4,5,S1
Gluteus minimus Origin: outer aspect of ilium (between anterior
and inferior gluteal lines)
Insertion:
– greater trochanter (anterior to medius)
– articular capsule of hip joint
Action: - abduct and medially rotate the thigh
– stabilizes the pelvis and prevents free limb from sagging
during gait
Nerve: superior gluteal nerve, L4,5,S1
Hip abduction
Synergist / Accessory Muscles:
Upper fiber of Gluteus maximus, Sartorius, TFL.
2- Range of motion: 0 to 45 degrees
3- Fixation:
a. Contraction of lateral abdominal muscles and latissimus dorsi.
b. Weight of trunk.
4- Effect of weakness and contracture:
Effect of weakness: unilateral: positive (trendlingburgh test)
Bilateral: waddling gate
Effect of contracture: positive Ober’s test
5- Factor Limiting of motion:
–
Tension of distal band of iliofemoral ligament and pubocapsular
ligament.
–
Tension of hip adductor muscle.
6- Substitution:
- Patient may “hike hip” by approximating pelvis to thorax using lateral trunk
muscles.
- hip external rotation with flexion.
- TFL substitution
7- Procedures:
a- Position of Patient:
b- Position of Therapist : inner hand, Outer hand,
Direction of Resistance
c- Test
d- Instruction to patient.
The patient is side lying with test leg uppermost. The
therapist stands behind the patient and stabilizes
with one hand at the hip. This hand is proximal to
the greater trochanter. The other hand applies
resistance across the lateral surface of the knee.
Patient abducts hip against downward resistance.
TEST PROCEDURES
Grades “3” fair
Patient position: side lying and affected leg is upper and slightly extended while
lower leg is flexed for balance.
Therapist position and grasp: therapist stand behind the patient, proximal hand
support the pelvis.
.Command:
Raise up your leg without lateral rotation of hip ……relax
GRADES “4” AND “5”
Patient position: the same as grade 3.
Therapist and Patient Instructions: same as for grade 3 plus Resistance is applied
proximal to the knee joint..
Resistance:
Grade 4: a moderate leading resistance is given directly opposite to the line of
motion.
Grade 5: a maximum resistance is given in the same manner as grade 4 plus hold at
the end of ROM.
Command:
The same as grade 3 plus…. Hold when test grade 5…. Relax
Grades 4 and 5 “good and normal”
MMT FOR GRADES 2 “POOR”
Patient position: supine lying with legs extended, the affected leg is away from the
therapist.
Therapist position and instruction: therapist stand beside the table, the proximal
hand stabilize the pelvis, and distal hand grasp around the ankle to fix leg on the
table.
Command:
Move your leg outward without lateral rotation……relax
MMT FOR GRADES 1 AND 0 “TRACE AND
ZERO”
Patient position: same as grade 2.
Therapist and Patient Instructions: same as grade 2 but therapist one hand grasp
the ankle of affected leg and other hand is placed on lateral aspect of the ilium
above greater trochanter to palpate contraction.
Command:
Try to move your leg outward without lateral rotation… relax
Hip Abduction from flexed position
1- ANATOMY:
Prim mover /agonist ( Tensor Fascia Latae):
Origin: - anterior aspect of iliac crest
- anterior superior iliac spine (ASIS)
Insertion: anterior aspect of IT band, below greater
trochanter
Action:
– medially rotate & abduct a flexed thigh
– tenses IT tract to support femur on
the tibia during standing
Nerve: superior gluteal nerve, L4,L5,S1
Synergist / Accessory
Gluteus medius, and Gluteus minimus
2- Range of motion:
No specific Rom, because of two-joint muscle.
3-Fixation:
1. Contraction of lateral abdominal muscles and latissimus dorsi
2. weight of trunk.
4- Effect of weakness and contracture:
Effect of weakness : pt walks with Leg with tendency to rotate hip
laterally
Effect of shortness: Bilaterally– results in anterior pelvic tilt and
sometimes bilateral knock-knees,
Unilateral– results in lateral pelvic tilt.
Effect of contracture: hip flexion, and knock knees.
5-Factor Limiting of motion:
- Non, ROM incomplete
6-Substitution:
by Hip lateral rotator muscles.
7- Procedures:
a- Position of Patient:
b- Position of Therapist : inner hand, Outer hand, Direction of
Resistance
c- Test
d- Instruction to patient.
The patient is side lying with test leg
uppermost, and hip flexed to 45 degrees.
The therapist stands behind the patient and
stabilizes with one hand at the hip. This
hand is proximal to the greater trochanter.
The other hand applies resistance across the
lateral surface of the knee. Patient abducts
hip against downward resistance.
Hip Adduction
1- ANATOMY: Prim mover /agonist (Adductors magnus,
Adductors Brevis, Adductors Longus, Pectineus and
Gracilis)
Origin
Insertion
Adductors magnus
Ischial tuberosity (inf-lat)
Femur (linea aspera)
Adductors Brevis
Pubis
Femur (linea aspera)
Adductors Longus
Pubis
Femur (linea aspera)
Pectineus
Pubis
Femur (linea aspera)
Gracilis
Pubis
Femur (linea aspera)
Action: Hip Adduction
Nerve supply: All Adductors are supply by Obturator nerve (L2,3,4)
Pectineus is supplied by Femoral n.(L2-L3)
Synergist / Accessory Muscles:
Obturator externus, Gluteus maximus.
2- Range of motion: 0 to 15- 20
3- Fixation:
by Weight of trunk
4- Effect of weakness and contracture:
- Effect of weakness : patient unable to adduct the leg during walking.
- Effect of shortness: patient walks with adducted legs.
- Effect of contracture: unable to abduct leg during gate cycle.
5- Factor Limiting of motion:
1. Contact with opposite limb.
2. When hip is flexed, tension of ischiofemoral ligament
6- Substitution:
by 1. hip flexor muscles.
2. Hamstring muscle.
7- Procedures:
a- Position of Patient:
b- Position of Therapist : inner hand, Outer hand, Direction of
Resistance
c- Test
d- Instruction to patient.
The patient is side lying with the test leg
lowermost and resting on the table. The
uppermost leg is abducted to 25 degrees and
supported by the examiner. The therapist
stands behind the patient at the knee level.
The resistance hand is placed on the distal
medial femur of the test leg. Resistance is
applied in a downward motion while the
patient actively adducts.
TEST PROCEDURES
Grades “3” fair:
Patient position: side lying and affected leg is down and upper leg is abducted 25
degrees and supported.
Therapist position and grasp: therapist stand behind the patient, both hands
support the upper leg.
Command:
Raise up your leg until contact the other leg ……relax
GRADES “4” AND “5”
Patient position: the same as grade 3.
Therapist and Patient Instructions: same as for grade 3 plus distal hand support the
upper leg and proximal hand is placed proximal to the knee joint to give resistance.
Resistance:
Grade 4: a moderate leading resistance is given directly opposite to the line of motion.
Grade 5: a maximum resistance is given in the same manner as grade 4 plus hold at the
end of ROM.
Command:
The same as grade 3 plus…. Hold when test grade 5…. Relax
Grades 4 and 5 “good and normal”
Grade 2 “poor”:
Patient position: supine lying, the affected leg is away from the therapist and
abducted 45 degrees.
Therapist position and instruction: therapist stand beside the table, the proximal
hand stabilize the pelvis, and distal hand grasp around the ankle to fix leg on the
table.
Command:
Move your leg toward the other leg without rotation……relax
Grades 1 and 0 “trace and zero”
Patient position: same as grade 3.
Therapist and Patient Instructions: same as grade 2 but therapist one hand grasp
the ankle of affected leg and other hand is placed on medial aspect of the thigh to
palpate contraction.
Command:
Try to move your leg outward without lateral rotation… relax
Hip External Rotation
1- ANATOMY: Prim mover /agonist (Obturators internus and externus, Gemellae
superior and inferior, Piriformis, Quadratus Femoris, Gluteus maximus
“posterior”
Origin
Insertion
Obturators internus
Ischium and Pubis
Femur (trochanteric fossa )
Obturators externus
Ischium and Pubis
Femur (greater trochanter)
Gemellae Superior
Ischium
Femur (greater trochanter)
Gemellae Inferior
Ischial tuberosity
Femur (greater trochanter)
Piriformis
Sacrum
Femur (greater trochanter)
Quadratus Femoris
Ischial tuberosity
Femur
Gluteus Maximus
Ilium , sacrum
Femur (gluteal tuberosity)
Nerve supply:
Obturators internus:
Nerve to Obturators internus (L5-S1)
Obturators externus:
Nerve to Obturators externus (L3-L4)
Gemellae Superior:
Nerve to Gemellae Superior (L5-S1)
Gemellae Inferior:
Nerve to Gemellae Inferior (L5-S1)
Piriformis:
Nerve to Piriformis (S1-S2)
Quadratus Femoris:
Nerve to Quadratus Femoris (L5-S1)
Gluteus Maximus:
Inferior gluteal n.(L5-S2)
Action: Hip lateral rotation
Synergist / Accessory Muscles:
Sartorius, Biceps femoris, Adductors magnus and longus
2- Range of motion:
3- Fixation:
0 to 45
by Weight of trunk
4- Effect of weakness and contracture:
- Effect of weak : result in medial rot. accompaied by foot pronation with knockknees.
- Effect of contracture: result in abduction position with limited medial rot. Of the hip
accompained by outward position of the toes in standing position
5- Factor Limiting of motion:
1. Tension of lateral band of iliofemoral ligament.
2. Tension of hip medial rotator muscles.
6- Substitution:
- Sartorius ( Hip flex,abd, and ext rot.)
7- Procedures:
a- Position of Patient:
b- Position of Therapist : inner hand, Outer hand, Direction of
Resistance
c- Test
d- Instruction to patient.
The patient is short sitting. The therapist
sits on a stool or kneels beside patient.
The therapist places one hand at the
lateral aspect of the distal thigh and
applies resistance in a medial direction.
The other hand grasps the medial ankle
just above the malleolus, and applies
resistance in a lateral direction. The patient
is actively externally rotating at the hip.
TEST PROCEDURES
Grades “3” fair:
Patient position: sitting with legs over the edge of the table. Patient grasps edge of
the examining table to stabilize the pelvis.
Therapist position and grasp: therapist stand in front of the patient, on side of
affected leg. The proximal hand applies pressure above the knee to prevent
abduction and flexion of the hip.
Command:
Bring your foot over the other leg keeping your thigh in contact with table ……relax
GRADES “4” AND “5”
Patient position: the same as grade 3.
Therapist and Patient Instructions: same as for grade 3 plus distal hand is placed on
medial surface of the leg just above the ankle to give resistance.
Resistance:
Grade 4: a moderate leading resistance is given directly opposite to the line of motion.
Grade 5: a maximum resistance is given in the same manner as grade 4 plus hold at the
end of ROM.
Command:
The same as grade 3 plus…. Hold when test grade 5…. Relax
Grades 4 and 5 “good and normal”
Grade 2 “poor”:
Patient position: supine lying, the affected leg is in medial rotation and away from
the therapist.
Therapist position and instruction: therapist stand beside the table, the proximal
hand is placed on the anterosuperior iliac spine to stabilize the pelvis.
Command:
Turn your leg outward ……relax
Grades 1 and 0 “trace and zero”
Patient position: same as grade 2.
Therapist and Patient Instructions: same as grade 2 but therapist one hand is
palpating deeply for muscle contraction behind the greater trochanter.
Command:
Try to turn your leg outward … relax
Hip Internal Rotation
1- ANATOMY:
Prim mover /agonist ( Gluteus minimus and medius, Tensor fascia
latae):
Origin
Gluteus Minimus
Ilium (outer surface)
Action: Hip medial rotation
Nerve supply:
Gluteus Minimus: Superior gluteal n.(L4-S1)
Action : Hip medial rotation
Synergist / Accessory Muscles:
Tensor fascia latae, Gluteus minimus and medius.
Insertion
Femur (greater trochanter)
2- Range of motion: 0 to 45
3- Fixation:
- Weight of trunk
4- Effect of weakness and contracture:
- walking with lat. Rot.
5- Factor Limiting of motion:
1. when hip is extended, tension of iliofemoral Ligament.
2. when hip is flexed, tension of ischiocapsular ligament.
3. tension of hip lateral rotator muscles.
6- Substitution:
by lifting the pelvis on the tested side.
7- Procedures:
a- Position of Patient:
b- Position of Therapist : inner hand, Outer hand, Direction of
Resistance
c- Test
d- Instruction to patient.
The patient is short sitting. The therapist
sits on a stool or kneels beside patient.
The therapist places one hand at the
medial aspect of the distal thigh and
applies resistance in a lateral direction.
The other hand grasps the lateral ankle
just above the malleolus, and applies
resistance in a medial direction. The
patient is actively internally rotating at the
hip.
TEST PROCEDURES
Grades “3” fair:
Patient position: sitting with legs over the edge of the table. Patient grasps edge of
the examining table to stabilize the pelvis.
Therapist position and grasp: therapist stand in front of the patient, on side of
affected leg. The proximal hand applies pressure above the knee to prevent
adduction and flexion of the hip.
Command:
Bring your leg outward keeping your thigh in contact with table ……relax
GRADES “4” AND “5”
Patient position: the same as grade 3.
Therapist and Patient Instructions: same as for grade 3 plus distal hand is placed on
lateral surface of the leg just above the ankle to give resistance.
Resistance:
Grade 4: a moderate leading resistance is given directly opposite to the line of motion.
Grade 5: a maximum resistance is given in the same manner as grade 4 plus hold at the
end of ROM.
Command:
The same as grade 3 plus…. Hold when test grade 5…. Relax
Grades 4 and 5 “good and normal”
Grades “poor”:
Patient position: supine lying, the affected leg is in lateral rotation and away from
the therapist.
Therapist position and instruction: therapist stand beside the table, the proximal
hand is placed on the anterosuperior iliac spine to stabilize the pelvis.
Command:
Turn your leg inward ……relax
Grades 1 and 0 “trace and zero”
Patient position: same as grade 2.
Therapist and Patient Instructions: same as grade 2 but therapist one hand is
palpating deeply for muscle contraction near its origin posterior and distal to
anterior superior iliac spine, distal hand grasps around the ankle.
Command:
Try to turn your leg inward … relax
FLEXIBILITY TESTS
TRENDELENBURG SIGN
• Procedure: subject assumes unilateral stance
without upper extremity assistance. Examiner
observes patient from behind.
• Interpretation:
– Normal: Hip on opposite side should rise slightly
– Abnormal
• Dropping of pelvis on the opposite side
• Shifting center of gravity over stance leg
*These findings indicate abductor weakness of stance
leg
• Thomas Test:
FLEXIBILITY
– Procedure: Patient in supine, both knees brought
to chest. Patient holds unaffected leg, keeping
their back flat against the table. The tests leg is
allowed to drop into extension. Next the knee is
allowed to drop into flexion
– Interpretation:
• Hip should extend to 0 degrees; if this is not achieved,
tightness of one-joint hip flexors is indicated
• If able to achieve full hip extension, but note 80
degrees of knee flexion, then tightness of the two joint
hip flexors (rectus femoris) is indicated
• Abduction of the hip and/or external rotation of the
tibia indicate ITB tightness
THOMAS TEST: NORMAL ILIOPSOAS AND
RECTUS FEMORIS
THOMAS TEST: TIGHT ILIOPSOAS AND RECTUS
FEMORIS
FLEXIBILITY
• Ober’s Test:
– Procedure: Patient in side-lying with test side
up. The knee may extended or flexed to 90 or
30 degrees. The hip is maintained in slight
extension. The test leg is abducted, then
allowed to lower toward the table with the
pelvis stabilized
– Interpretation:
• Normal: able to abduct parallel to the examining
surface
• Inability to adduct to parallel indicates tightness of
the ITB
OBER’S TEST: NORMAL ITB/TFL
OBER’S TEST: TIGHT ITB/TFL
FLEXIBILITY
• Hamstring Flexibility
1. Passive Straight Leg Raise
– Normal: should achieve at least 80 degrees of hip flexion
– Reproduction at 45 degrees or less may indicate lumbar
radiculopathy
2. Popliteal Angle
• Patient is supine with test leg’s hip flexed to 90
degrees
• The knee is passively extended
• Interpretation
– Normal: Angle of flexion should be 15 to 20 degrees or
less
– Abnormal: If angle of flexion is greater than 15 to 20
degrees, this is indicative of hamstring tightness
ELY’S TEST
• Procedure: Patient in prone. The knee of
tested leg is flexed by the examiner
• Interpretation:
– Normal: Able to fully flex the knee without
creating hip flexion
– Abnormal: Flexion of the hip prior to full knee
flexion indicates Rectus Femoris tightness