Purpose: hip flexor tightness
How to perform: Patient supine on the table with legs extended out. Examiner checks the patient to see if they have a lordotic curve in the lumbar spine. Patient is then instructed to bring the tested leg’s knee to chest and to hold it at their chest. Examiner than observes to see if the opp. Leg extended lifts off the table or the lordotic curve is recreated within the lumbar spine.
(+): Patient’s extended leg rises off the table and a muscle stretch end feel will be felt. Patient may exhibit increased lordosis curve or recreates a lordotic curve in the lumbar spine = indicates a tight hip flexor
(-): The patient’s extended leg doesn’t rise off the table and the patient doesn’t feel a muscle stretch end feel or the patient doesn’t recreate a lordotic curve in the lumbar spine = Indicates the hip flexor being tested isn’t tight
Purpose: distal or proximal tightness of the rectus femoris
How to perform: Patient is standing next to the edge of the table. The patient is then instructed to grab the knee of the good leg and to pull it to their chest. The patient will then fall back onto the table with the knee to the chest and the other leg hanging off the table. The examiner will then look at the position of the leg hanging off the table to determine where the tightness is in the rectus femoris.
(+):
leg is up and off table = indicates proximal tightness of the rectus femoris
leg has the knee kicked out = Indicates distal tightness of the rectus femoris
(-): the leg isn’t up and off the table or the knee of the leg isn’t kicked up = Indicates no rectus femoris tightness
Purpose: proximal rectus femoris tightness
How to perform: Patient is prone on table. Patient’s legs are extended, Examiner takes the ankle and passively brings the pt’s foot to the butt.
(+): Hip of the same side bringing up will come off table = Indicates proximal rectus femoris tightness
(-): hip of the same side being tested doesn’t come off the table = Indicates there is no proximal rectus femoris tightness
Purpose: IT Band tightness
How to perform: Patient is side-lying on the table with hips stacked upon each other at the edge of the table. Patient’s legs are extended fully. Examiner is at the patient’s back side with one hand on top of the hips and the other under the knee. The examiner than brings the top leg over edge of the table and instructs the patient to relax while the examiner supports the leg as it lowers.
(+): upper leg stays in the air and does not fall down to table = Indicates tight IT band
(-): upper leg lowers and falls down of the edge of the table = Indicates no tight IT band
Purpose: IT band friction syndrome
How to perform: Patient’s legs are hanging off the table. IT band is then pressed into the Gerdy’s Tubercle by the examiner. Patient is then instructed to flex and extend knee.
(+): recreation of pain and/or crepitus felt = Indicated iliotibial band friction syndrome
(-): no recreation of pain and/or crepitus felt = Indicates no IT band friction syndrome
Purpose: 1. Actebaulum, 2. Adductor tightness, 3. SI pain
How to perform: Patient is placed into figure 4 position and in turn instructed to relax. Then the examiner places one hand on the medial side of the knee in the figure 4 position and the other hand on the opposite hip. The examiner then applies a downward force with both hands placed on knee and opposite hip. Patient is then asked where they feel pain.
(+):
Leg in the figure 4 position doesn’t drop when patient tries to relax = indicates adductor tightness
2. Anterior hip pain = Indicates possible acetabular injury
3. Posterior hip pain = indicates possible SI injury
(-): The leg in figure 4 drops as the pt relaxes and/or no anterior pain or posterior hip pain = Indicates no SI injury, acetabulum injury, or adductor tightness
Purpose: Femoral Acetabular Impingement
How to perform: Patient is supine. Place affected pain in a 90 degree position. Examiner will adduct and internal rotate the affected hip to see if there is a recreation of pain
(+): recreation of pain = Indicates femoral acetabular impingement
(-): no recreation of pain = Indicates no femoral acetabular impingement
Purpose: micro-stability
How to perform: Patient is in clam position on the table laying on the unaffected side. Affected leg is abducted and extended and externally rotated as the examiner applies an anterior force to the greater trochanter.
(+): anterior hip pain and/or laxity of anterior capsule of hip = Indicates possible micro-instability
(-): no anterior hip pain and/or laxity of the anterior capsule of the hip = Indicates no micro-instability
Purpose: functional strength of the gluteus medius
How to perform: Patient is standing and the examiner then asks patient to stand on one leg while having support around them.
(+): opposite side hip drops as leg is raised = Indicates weakness of the gluteus medius
(-): the opposite side hip doesn’t drop as leg raises = Indicates no weakness of the gluteus medius
Purpose: Assesses if the hip is the source of the pt's symptoms
How to perform: Patient is supine on table with examiner on affected hip side. The examiner then takes the affected leg slowly into 90 degrees until end range of hip adduction until pelvis raises up to table. Examiner applies longitudinal force to the femur and scours for pain.
(+): recreation of pain or crepitus felt or loss of ROM within the hip = Indicates hip is the source of the pt’s symptoms
(-): no recreation of pain or crepitus felt or loss of ROM within the hip = Indicates hip isn’t the source of the pt’s symptoms
Purpose: SI Joint
How to perform: Patient is supine and legs extended on the table. Examiner than places their right hand on the right ASIS and left hand on the left ASIS. Examiner will then place a dorsal lateral force to the ASIS distracting the SI joint on both sides.
(+): recreation of pain or replication of s/s = Indicates SI joint injury
(-): no recreation of pain or replication of s/s = indicates SI joint injury
Purpose: SI Joint
How to perform: Patient is supine and legs extended on the table. Examiner places arms in a crossed pattern on both ASIS. The examiner then pushes both ASIS outward in turn compressing the SI joint.
(+): recreation of pain or replication of s/s = Indicates SI joint injury
(-): no recreation of pain or replication of s/s = Indicates SI joint injury
Purpose: 1. increase radicular s/s c contraction, 2. tightness of piriformis, 3. Piriformis syndrome
How to perform: The patient is in a clam position with hips stacked upon each other and knees flexed to 45 degrees. The examiner places 1 hand on the top hip and one hand on the lateral aspect of the top knee. Patient then tries to cx and lift top leg up against resistance from examiner. Then the pt brings the top leg down the side of the table, while stabilizing the hip, the examiner then presses down on the lateral side of the knee to provide a stretch.
(+): increase in radicular s/s with contraction and the patient finds relief with the stretch = Indicates piriformis syndrome
(-): no increase in radicular s/s with contraction and the patient finds relief with the stretch = Indicates no piriformis syndrome
Purpose: deep pain, joint issue
How to perform: The patient is asked to describe where the pain is felt within the hip. This test is performed when the test describe pain as deep interior hip pain. The patient will then cup their hand above the greater trochanter with thumb posterior and fingers gripping deep into anterior groin.
(+): The patient describes their pain by making a C formation with their thumb and hand placing on the front and side of the hip = Indicates deep hip joint pain
(-): The patient doesn’t describe their pain by making a C formation with their thumb and hand placing on the front and side of the hip = Indicates no deep hip joint pain
Purpose: Hernia
How to perform: Patient is sitting upward on the table. Examiner asks the patient to bear down to act as if they are moving their bowels to increase the intraabdominal pressure.
(+): recreation of pain or increase in pain felt within the abdominal area (specifically the lower quadrants of the abdominal area) = Indicates hernia
(-): no recreation of pain or increase in pain felt within the abdominal area (specifically the lower quadrants of the abdominal area) = Indicates no hernia
Purpose: intraarticular hip pathology
How to perform: Patient is supine with legs extended. Examiner will hold hand a few inches above the leg. Instruct patient to straight leg raise to the examiner’s hand. The hip is flexed 30-45 degrees. The examiner will then apply resistance and instruct the patient to hold the straight leg raise contraction.
(+): patient is unable to lift and/or go against the resistance applied by the examiner = Indicates intra-articular hip pathology
(-): patient is able to lift leg and/or go against the resistance applied by the examiner = Indicates intra-articular hip pathology
Purpose: Fx
How to perform: Patient is sitting on edge of table with legs hanging off and hands sitting back. One hand will be placed underneath the tested to leg distally. The other hand is placed on the dorsal of the thigh while applying a downward force trying to provoke a response by “breaking the bone”.
(+): Recreation of sharp pain or show of apprehension by the patient = Indicates possible fx
(-): No recreation of sharp pain or show of apprehension of by the patient = Indicates no fx
Purpose: SI joint
How to perform: Patient is in supine position with 1 leg hanging off the side of the table. Other leg on the table, the patient brings the knee to the chest. You apply firm pressure to the knee flexed to the patient’s chest.
(+): Recreation of pain or patient’s symptoms = Indicates possible SI injury
(-): no recreation of pain or patient’s symptoms = Indicates no SI injury
Purpose: ligamentum teres or laxity if ER
How to perform: Patient is supine position, place one hand over the mid-thigh and passively externally and internally rotate the hip to rotate the hip to ends of its range of motion.
(+): the external rotation of the foot is >45 ° after the examiner let’s go of the leg = Indicates possible lax capsule or ligamentum teres tear
(-): The foot does not end in external rotation >45° after the examiner let’s go of the leg = Indicates no lax capsule or ligament teres tear