Hip flexes fully with only minimal resistance felt therapist should check to ensure that the resistance felt exceeds the weight of the limb; see Figure This finding validates the gluteus medius as a pelvic stabilizer.
Side-lying with test leg uppermost. Start test with the limb slightly extended beyond the midline and the pelvis rotated slightly forward Figure Lowermost leg is flexed for stability. Hand used to give resistance is contoured across the lateral surface of the knee. The hand used to palpate the gluteus medius is just proximal to the greater trochanter of the femur see Figure No resistance is used in a Grade 3 test. To distinguish a Grade 5 from a Grade 4 result, first apply resistance at the ankle and then at the knee Figure Applying resistance at the ankle creates a longer lever arm, thus requiring more patient effort to resist the movement.
If the patient cannot hold the limb in the test position with the resistance at the ankle but can at the knee, the grade is Grade 4. The therapist is reminded always to use the same lever in a given test sequence and in subsequent comparison tests. Patient abducts hip through the complete available range of motion without flexing the hip or rotating it in either direction.
Resistance is given in a straight downward direction. Completes available range and holds end position against maximal resistance. Completes available range and holds against heavy to moderate resistance or with resistance given at the knee. Completes range of motion and holds end position without resistance Figure Standing on side of limb being tested.
One hand supports and lifts the limb by holding it under the ankle to raise limb just enough to decrease friction. This hand offers no resistance, nor should it be used to offer assistance to the movement.
On some smooth surfaces, such support may not be necessary Figure Note: Figures and show therapist on opposite side of patient to avoid obscuring test positions. The other hand palpates the gluteus medius just proximal to the greater trochanter of the femur Figure Keep your kneecap pointing to the ceiling. Completes range of motion supine with no resistance and minimal to zero friction. Standing at side of limb being tested at level of thigh.
One hand supports the limb under the ankle just above the malleoli. The hand should provide neither resistance nor assistance to movement see Figure Palpate the gluteus medius on the lateral aspect of the hip just above the greater trochanter.
This movement may be detected by observing the lateral trunk and hip move clothing aside and palpating the gluteus medius above the trochanter. This could allow the oblique action of the hip flexors to substitute for the gluteus medius. A grade of 4 often masks significant weakness because of the intrinsic great strength of these muscles.
Giving resistance at the ankle rather than at the knee is helpful in overcoming this problem. However, respect the long lever arm and apply resistance carefully, assessing whether the patient can adequately resist the movement through the long lever arm.
This is one of the cardinal principles of manual muscle testing. It is not necessary, therefore, to use a hand to manually stabilize the contralateral limb. Two-joint muscle. No specific range of motion can be assigned solely to the tensor. Standing behind patient at level of pelvis. Hand for resistance is placed on lateral surface of the thigh just above the knee. Hand providing stabilization is placed on the crest of the ilium Figure Resistance is given downward toward floor from the lateral surface of the distal femur.
No resistance is given for the Grade 3 test. Completes available range; holds end position against maximum resistance. Completes available range and holds against strong to moderate resistance. Completes movement; holds end position but takes no resistance Figure Patient is in long-sitting position, supporting trunk with hands placed behind body on table.
Note: Figure deliberately shows therapist on wrong side to avoid obscuring test positions. One hand supports the limb under the ankle; this hand will be used to reduce friction with the surface as the patient moves but should neither resist nor assist motion.
The other hand palpates the tensor fasciae latae on the proximal anterolateral thigh where it inserts into the iliotibial band. One hand palpates the insertion of the tensor at the lateral aspect of the knee. The other hand palpates the tensor on the anterolateral thigh Figure Testing the Muscles of the Lower Extremity.
Chapter 6. Gastrocnemius and Soleus Test. Grade 5 Normal , Grade 4 Good , and Grade 3 Fair Position of Patient: Short sitting with thighs fully supported on table and legs hanging over the edge.
Position of Therapist: Standing next to limb to be tested. Grading Grade 5 Normal : Thigh clears table. Patient tolerates maximal resistance. Grade 4 Good : Hip flexion holds against strong to moderate resistance.
Grade 3 Fair : Patient completes test range and holds the position without resistance Figure Helpful Hint The position of the pelvis influences the action of the hip flexors.
Grade 2 Poor Position of Patient: Side-lying with limb to be tested uppermost and supported by therapist Figure Position of Therapist: Standing behind patient. Test: Patient flexes supported hip. Grading Grade 2 Poor : Patient completes the range of motion in side-lying position. Position of Therapist: Standing at side of limb to be tested. Test: Patient attempts to flex hip. Grading Grade 1 Trace : Palpable contraction but no visible movement.
Grade 0 Zero : No palpable contraction of muscle. Helpful Hint The hip flexors are rather small muscles and therefore do not provide a lot of force, especially as compared with the quadriceps or gluteus maximus.
Range of Motion Because this is a two-joint muscle, no specific range-of-motion value can be assigned solely to the sartorius. Position of Therapist: Standing lateral to the leg to be tested. Test: Patient flexes, abducts, and externally rotates the hip and flexes the knee see Figure Instructions to Patient: Therapist may demonstrate the required motion passively and then ask the patient to repeat the motion, or the therapist may place the limb in the desired end position.
Grading Grade 5 Normal : Holds end point against maximal resistance. Grade 4 Good : Tolerates moderate to heavy resistance. Grade 3 Fair : Completes movement and holds end position but takes no resistance Figure Grade 2 Poor Position of Patient: Supine. Test: Patient slides test heel upward along shin to knee. Grading Grade 2 Poor : Completes desired movement. Position of Therapist: Standing on side to be tested. Test: Patient attempts to slide heel up shin toward knee.
Grading Grade 1 Trace : Therapist can detect slight contraction of muscle; no visible movement. Grade 0 Zero : No palpable contraction. Substitution Substitution by the iliopsoas or the rectus femoris results in pure hip flexion without abduction and external rotation.
Helpful Hint The therapist is reminded that failure of the patient to complete the full range of motion in the Grade 3 test is not an automatic Grade 2. Muscle Origin Insertion Gluteus maximus Ilium posterior gluteal line Iliac crest posterior medial Femur gluteal tuberosity Sacrum dorsal surface of lower part Coccyx side Sacrotuberous ligament Aponeurosis over gluteus medius Iliotibial tract of fascia lata Semitendinosus Ischial tuberosity upper area, inferomedial impression via tendon shared with biceps femoris Aponeurosis between the two muscles Tibia proximal medial shaft Pes anserinus Semimembranosus Ischial tuberosity superolateral impression Tibia medial condyle, posterior aspect Oblique popliteal ligament of knee joint Aponeurosis over distal muscle variable Biceps femoris long head Ischial tuberosity inferomedial impression via tendon shared with semitendinosus Sacrotuberous ligament Fibula head Tibia lateral condyle 1 Aponeurosis Others Adductor magnus inferior Gluteus medius posterior.
Position of Therapist: Standing at side of limb to be tested at level of pelvis. Alternate Position: The hand that gives resistance is placed on the posterior thigh just above the knee Figure Test: Patient extends hip through entire available range of motion.
Grading Grade 5 Normal : Patient completes available range and holds test position against maximal resistance. Grade 4 Good : Patient completes available range against strong to moderate resistance.
Grade 3 Fair : Completes range and holds the position without resistance Figure Helpful Hints Knowledge of the ranges of motion of the hip is imperative before manual tests of hip strength are conducted.
Grade 2 Poor Position of Patient: Side-lying with test limb uppermost. Position of Therapist: Standing behind patient at thigh level. Test: Patient extends hip through full range of motion.
Keep your knee straight. Grading Grade 2 Poor : Completes range of extension motion in side-lying position. Position of Therapist: Standing on side to be tested at level of hips. Test: Patient attempts to extend hip in prone position or tries to squeeze buttocks together. Grading Grade 1 Trace : Palpable contraction of either hamstrings or gluteus maximus but no visible joint movement.
Position of Therapist: Standing at the side to be tested at the level of the pelvis. Test: Patient extends hip through available range, maintaining knee flexion. Grading Grade 5 Normal : Completes available range of motion and holds end position against maximal resistance. Grade 4 Good : Limb position can be held against heavy to moderate resistance. Grade 3 Fair : Completes available range of motion and holds end position but takes no resistance Figure Position of Therapist: Standing behind the patient at thigh level.
Test: Patient extends hip with supported knee flexed. Grading Grade 2 Poor : Completes available range of motion in side-lying position. Grade 1 Trace and Grade 0 Zero This test is identical to the Grades 1 and 0 tests for aggregate hip extension see Figure Test: Patient extends hip through available range, but hip extension range is less when the knee is flexed.
Resistance is applied downward toward floor and forward. Grading Grade 5 Normal : Completes available range of hip extension. Grade 4 Good : Completes available range of hip extension. Grade 3 Fair : Completes available range and holds end position without resistance. Grade 2 Poor , Grade 1 Trace , and Grade 0 Zero Do not test the patient with hip flexion contractures and weak extensors less than Grade 3 in the standing position. Helpful Hint The modified hip extensor test is the preferred test for people who are not able or are unwilling to lay prone.
PLATE 6. Supine Hip Extension Test An alternate hip extensor test is the supine hip extension test. Position of Therapist: Standing at end of table. Grading Grade 5 Normal : Hip locks in neutral full extension throughout this test. Grade 4 Good : Hip flexes before pelvis and back elevate and lock as the limb is raised by the therapist.
Grade 2 Poor : Hip flexes fully with only minimal resistance felt therapist should check to ensure that the resistance felt exceeds the weight of the limb; see Figure Test: Patient abducts hip through the complete available range of motion without flexing the hip or rotating it in either direction.
Hold it. Grading Grade 5 Normal : Completes available range and holds end position against maximal resistance. Grade 4 Good : Completes available range and holds against heavy to moderate resistance or with resistance given at the knee. Grade 3 Fair : Completes range of motion and holds end position without resistance Figure Position of Therapist: Standing on side of limb being tested.
Test: Patient abducts hip through available range. Grading Grade 2 Poor : Completes range of motion supine with no resistance and minimal to zero friction. Position of Therapist: Standing at side of limb being tested at level of thigh. Test: Patient attempts to abduct hip. Grading Grade 1 Trace : Palpable contraction of gluteus medius but no movement of the part.
Range of Motion Two-joint muscle. Position of Therapist: Standing behind patient at level of pelvis. Grading Grade 5 Normal : Completes available range; holds end position against maximum resistance. Grade 4 Good : Completes available range and holds against strong to moderate resistance. Grade 3 Fair : Completes movement; holds end position but takes no resistance Figure Grade 2 Poor Position of Patient: Patient is in long-sitting position, supporting trunk with hands placed behind body on table.
Position of Therapist: One hand palpates the insertion of the tensor at the lateral aspect of the knee. Only gold members can continue reading. Log In or Register to continue. L1-L5 vertebrae transverse processes TL5 vertebral bodies sides and their intervertebral discs. Femur lesser trochanter; joins tendon of psoas major Femoral shaft below lesser trochanter.
Tibia shaft, proximal medial surface Capsule of knee joint via slip Medial side fascia of leg. You need a partner -- preferably a physical therapist -- to properly perform this test. To do the test: Lie down on your stomach with your legs out straight. Bend one knee so that it's at a degree angle.
Then, hold your leg in place while your partner tries to push the leg down to the ground. The purpose of this test is to isolate your hamstring and test its strength against your partners. Your partner will grade the amount of strength that you have from zero to five. A score of zero means that there's no activity in the muscle at all, it's just limp.
A three means that you can hold your foot in place without any resistance. A four means that you can resist your partner, but not for long. A five means that you can hold your leg in place against your partner. You can get even more specific in manual muscle tests by testing each side of your hamstrings. Test the lateral hamstrings in the same position on your stomach with your leg bent. This time, point your toes to the outside and twist your leg out slightly.
To test the medial two hamstring muscles, turn your toes in slightly and rotate your leg towards the middle of your body. You can test your hamstrings without the help of a partner with a single leg bridge test. Lie on the ground on your back. Bend your knees and bring both feet close to your heels. Bridge your hips up as high as you can.
Then, kick one leg out straight and hold your hips up in the air as long as you can. Then, do the same thing with the other leg. This is a great way to test each of your hamstrings individually. Whichever leg can't hold the pose as long needs a little extra strengthening in the gym.
If neither leg can hold you up then you need to work on both hamstrings. Fitness Workouts Leg Exercises. Henry is a freelance writer and personal trainer living in New York City.
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