Lower Extremity

Action Normal (5) Good (4) Fair (3) Poor (2) Trace (1) Zero (0)
Full ROM Full ROM Full ROM Full ROM Palpable No Contraction
Max. Resistance Mod. Resistance (-) Resistance (-) Gravity/ Contraction
Limited ROM
Hip Flexion • Sitting dangling with hands gripping the edge of the • Side-lying with • Supine: attempt to flex the hip
• Psoas Major & table: flex hip to end range, hold against resistance limb tested on • Position: cradles limb for support
Iliacus • Position: resistance on distal thigh and proximal to knee top with
support by
therapist: flex
supported hip,
can have knee
flexion
• Position: behind,
cradles limb

HIp Flexion, • Sitting dangling with arms used for support: flex, abduct • Supine with • Supine: attempt to slide the heel up
Abduction, and external rotate the hip with knee flexed heel of limb from shin to knee
External Rotation • Position: stands lateral on side tested, one hand on lateral tested on • Postion: at the side of the limb,
w/ Knee Flexion knee & other medial-anterior to distal leg contralateral cradling it for support
• Sartorius shin: slide the
heel up from shin
to knee
• Postion: at the
side of the limb,
cradling it for
support

Hip Extension • Prone with arms overhead/holding sides of table: extend • Side-lying with • Prone: attempts to extend hip or
• Gluteus Maximus the hip at available ROM with resistance limb tested on squeeze butt together
& Hamstring • Position:resistance on the posterior leg above the ankle or top with
posterior thigh above the knee (latter is harder = shorter support by
lever arm) therapist:
Extends hip to
full ROM
• Position: behind
patient, supports
limb below knee,
other hand on
pelvic crest

Hip Extension • Prone with knee flexed to 90o: extend the hip to available • Side-lying with • Prone: attempts to extend hip or
(Isolating Gluteus ROM maintaining knee flexion tested limb on squeeze butt together
Maximus) • Position: resistance on posterior thigh above knee, other top with knee
• Gluteus Maximus stabilizes pelvis flexed and
& Hamstring supported by
the PT: extends
the hip with knee
flexed
• Position: behind
the patient,
cradle limb

Hip Extension • Standing with hip flexed and torso prone on table, arms • Side-lying: do • Side-lying: do any of the other hip
(Hip Flexion hugging the table for support: extend the hip through any of the other extension tests of the same grade
Tightness) available ROM hip extension
• Gluteus Maximus • Position: resistance on the posterior thigh above the knee tests of the same
& Hamstring grade

**general: position is on side tested, except when stated and for grade 3 Page 1 of 4
 Lower Extremity
Hip Extension • Heels off the end of table, arms folded over the chest or abdomen: press heel N/A
(Supine) onto PT’s cupped hands, attempt to keep full extension as legs are raised approx.
• Gluteus Maximus to 35 inches off table
& Hamstring • Position: at the end of the table, hands cupped under the heel
• Measure the hip range to assure the approx. 35 inches/65o of hip flexion
• Normal: Hip locks in neutral throughout, pelvis and back elevate as one, opposite
limb rises involuntarily
• Good: Hip flexes before pelvis and back; flexion doesn’t exceed 30o before
locking, other leg would rise involuntarily but knee flexes a bit
• Fair: Full elevation, little of no elevation of pelvis
• Poor: Hip flexes fully with minimal resistance

Hip Abduction • Side-lying with leg on top, limb extended beyond • Supine: abduct • Supine: attempts to abduct the hip
• Gluteus Medius midline, pelvis rotated slightly forward & lower leg hip to available • Position: hand support the limb, above
& Gluteus flexed for stability: Abduct hip with complete ROM range the malleoli, the other palpates at the
Mminimus • Position: Behind patient, resistance on the lateral of the • Position: one hip above greater trochanter
knee, other hand palpates muscles proximal to greater hand supports
trochanter and lifts limb
tested, no
resistance or
assistance

Hip Abduction • Side-lying, uppermost limb is flexed to 45o and lies • Long sitting • Long sitting: attempts to abduct the
(Flexed Position) across lower limb with foot resting on table: abduct hip with hands hip
• Tensor Fasciae through approx. 30o of motion behind body: • Position: hand palpates on insertion
Latae • Position: behind the patient, resistance on lateral thigh abducts hip to on lateral knee, the other on
above the knee, stabilization on crest of ilium 30o of motion anterolateral thigh
• Position: hand
supports limb
under ankle, the
other palpates on
proximal
anterolateral
thigh

Hip Adduction • Side-lying with limb resting on table, uppermost is • Supine with • Supine: attempts to adduct the hip
• Adductors abducted 25o: adduct the hip until they come in contact non-test limb • Position: supports limb under ankle,
Magnus, Brevis, • Position: behind patient, resistance on medial of distal with a bit of other palpates
and Longus, femur, cradles upper limb abduction:
Pectineus & adduct hip
Gracilis without rotation,
toes always on
ceiling
• Position:
supports ankle
and elevates it to
lessen friction

Hip External • Short Sitting/Sitting Dangling: externally rotates the hip • Supine: external • Supine with test limb in IR: attempt
Rotation • Position: Sit on low chair or kneel beside limb tested; rotation of hip to to ER
• Internal resistance hand is on medial ankle above the malleolus, available ROM
Obturator, moves laterally • Position:
External supports the limb
Obturator, in internal
Gemelli Superior rotation
and Inferior, • Alternate: short
Piriformis, sitting, limb in
Quadratus max. IR and
femoris, patient actively
Posterior Gluteus brings it to
Maximus midline with
slight resistance

**general: position is on side tested, except when stated and for grade 3 Page 2 of 4
 Lower Extremity
Hip Internal • Short Sitting/Sitting Dangling with arms at sides/ • Supine with test • Supine with limb in ER: attempt to IR
Rotation crossed over chest: end position of full IR limb in partial hip
• Gluteus Minimus, • Position: sitting/kneeling in front, hand on lateral ankle and ER: IR hip • Position: next to the limb
Medius & Tensor resistance is towards opposite direction through available
Fasciae Latae ROM
• Position: stand
next to test limb

Knee Flexion Hamstring Mm. in Aggregate: • Side-lying with • Prone with limb straight and toes
• Biceps Femoris, • Prone with limbs straight and toes at the edge of the test limb over end of table: flex the knee
Semitendinous, table: flex the knee while maintain neutral rotation supported, • Position: support flexed limb at ankle
Semimembranou • Position: resistance on the posterior leg above the ankle lower is flexed:
s Medial Hamstring Test: (SemiTen. + SemiMem.) flex knee to
• Prone with knee flexed less than 90o, leg in IR: flex knee available ROM
• Position: resistance on ankle • Position: behind
Lateral Hamstring Test: (Biceps Fem.) the patient, one
• Prone with knee flexed less than 90o, leg in ER: flex knee arm cradles
• Position: resistance on ankle thigh, support on
medial knee

Knee Extension • Short Sitting/Sitting Dangling: extends knee through • Side-lying with • Supine: Extend the knee
• Quadratus available ROM but not past 0o test limb on top, • Alternate: therapist hand on flexed
Femoris • Position: Resistance is over the distal leg above the ankle lower limb is knee, palpate while px tries to extend
• Place wedge/hand under distal thigh for cushion flexed: Extend
the knee through
available ROM
• Position:
behind, cradle
limb tested

Ankle • Standing on dominant leg with non-tested knee flexed, 1 • Prone with feet • Prone with feet at end of table:
Plantarflexion or 2 fingers on table for support: heel raises at end of table: attempt to plantar flex
• Gastrocnemius & • Position: lateral view plantar flexes • Position: end of the table, palpating
Soleus • Normal: min. 25 raises ankle to available major muscles
• Good: 2-24 raises ROM
• Fair: one correct raise • Position: end of
table, hand
under and above
ankle and on the
sole of foot

Foot Dorsiflexion • Sitting/Supine: dorsiflex the ankle and inverts foot with toes relaxed
and Inversion • Position: sitting on stool in front of patient, one hand behind leg above ankle and other on dorsum
• Tibialis Anterior

Foot Inversion • Sitting with ankle in slight plantarflexion: invert the foot • Sitting/Supine: attempts to invert the
• Tibialis Posterior • Position: Sits on low stool in front, hand stabilizing ankle above malleoli foot
• Position: sitting on low stool or
standing in front of the patient

Foot Eversion • Sitting/Standing: evert foot with depression of 1st metatarsal head and • Short Sitting/Supine
and plantarflexion • Position: Sits on low stool/standing at
Plantarflexion • Position: on low stool or at end of table end of table; palpate the tendon of
• Peroneus longus brevis
& brevis

**Other tests for • Isolation of Peronus Longus: resistance on plantar surface of head of the 1st metatarsal toward dorsiflexion and inversion
foot • Foot Eversion with Dorsiflexion (only if peronus rertius is present): evert and dorsiflex the foot

Hallux MP Flexion • Sitting dangling/Supine: plantar flexes the big toe

• Lumbricales and • Position: on low stool in front of the patient or standing on side near the patient’s foot, place foot on lap
Flexor Hallucis
Brevis

Toe MP Flexion • Sitting with foot on PT’s lap/Supine: flexes the later four toes at the MP joint with IP joints neutral
• Lumbricales and • Position: on low stool in front of patient or standing next to table beside foot
Flexor Hallucis
Brevis

**general: position is on side tested, except when stated and for grade 3 Page 3 of 4
 Lower Extremity
Hallux and Toe • Sitting with foot on PT's lap/Supine: flexes the toes or big toe
DIP and PIP • Position: on short stool in front of patient, standing on side of table near the foot
Flexion
• Flexor Digitorum
Longus, Brevis
and Flexor
Hallucis Longus

Hallux and Toe • Sitting with foot on PT's lap/Supine: extend lateral four toes or big toe
MP and IP • Position: Sitting on low stool in front of patient or stand near the foot
Extension • Lateral Toes: stabilize metatarsals with fingers on plantar surface and thumb on the dorsum of foot
• Extensor • Hallux: stabilize the metatarsal area by contouring the thumb around the base of the hallux
digitorum longus,
brevis and
Extensor Hallucis
Longus

**general: position is on side tested, except when stated and for grade 3 Page 4 of 4