TESTING THE MUSCLE

OF THE LOWER
EXTREMITY

Suci Wulansari

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HIP FLEXION (psoas major and iliacus)

 ROM: 0-120°
Gr 5,4,3
 P: short sitting w/ thighs supported on the table and leg hanging
overside, arm may be use for support.
 T: standing lateral to the leg to be tested.Hand gives resistance over
distal thigh, prox knee joint
 Test: Patients flexes hip to end of range,clearing the table,mainaining
neutral rotation and holding the posisition againts the examiner’s
resistance.
Hints: pengetahuan mengenai ROM hip sangat penting sebelum
melakukan test mmt, karena mempengaruhi hasil pemeriksaan jika ada
tighness ,shg misalnya jika tdp kontraktur fleksi hip,posisi pasien
berbeda.

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 Gb 5.4
Gr 5: thigh clear the table, with
tolerates maximal resistance.

G 4: Hip flexion againts strong to

moderate resistance

Gr 3: P completes test range and

holds the position without resistance.

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Gr 2.
P: side lying with limb t be test
uppermost and supported by
examiner. Trunk in netral
alignment. Lowermost limb may
be flexed for stability.
T: Standing behind patient. Cradle
test limb in one arm with hand
support under the
knee.Opposite hand maintains
trunk alignment at hip. ( fig. 5-6)
I: “bring the knee up toward the
chest”
Gr 2: complete the ROM

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Gr 1,0 (fig 5-7)
 P: Supine,test limb supported by
examiner under calf with hand behind
knee.
 T: standing at side of test limb. Test
limb is supported under calf with hand
behind knee. Free hand palpates the
muscle just distal the inguinal
ligament on the medial side of the
sartorius
 Test: Patients attempts to flex hip

 I: Try to bring the knee up to your

nose.

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Subtitution:
 Use of sartorius will result in external
rotation an adduction of the hip.The
sartorius, because it is superficial, will be
seen and can be palpated in most limb.
(Fig.5-8)

 If the tensor fascia latae substitutes for

the hip flexor, internal rotation and
abduction of the hip will result. If the
patient is tested in supine position,
gravity will cause the limb to external
rotate. The tensor may be seen and
palpated at its origin on the ASIS.

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Hints:
 When the trunk is weak, the test will be more accurate for supine
position
 Hip flexion is not a strong motion,so experience is necessary to
appreciate what constitutes a normal level of resistance.

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HIP FLEKSI,ABDUKSI, dan EXTERNAL ROTASI dengan FLEKSI KNEE
(sartorius)
ROM: tidak spesifik ditentukan
Gr 5,4,3
 P: short sitting w/ thighs supported on
the table and leg hanging overside, arm
may be use for support.
 T: standing lateral to the leg to be
tested. Place one hand on the lateral
side of knee;the other hand grasps the
medial ant surface of the distal leg.
Hand at the knee: resist hip flexion and
abd (down and inward)
Hand at the ankle: resist hip external
rotation (up and outward)
Test: flexes, abd, and ext rotates (T may
demostrates the motion passively
before). “slide your heel up the shin of
your other leg.

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Gr 2 (fig. 5-14)
 P: supine

 T: standing at side of the test

limb.Support limb as
necessary to maintain
alignment.
 T: Patient slides test heel
upward along shin to knee.
 Gr 2: complete desire
movement

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 Gr 1,0 (fig 5-15)
 P: Supine
 T: standing at side of test limb. Cradle
test limb under calf with hand
supporting limb behind knee. Opposite
hand palpates sartorius on the medial
side of thigh where the muscle crosses
the femur or may prefer o palpate near
the muscle origin just below the ASIS.
 Test: try to slide heel up the knee.

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Substitution:
 Substitution by the iliopsoas or the rectus femoris result in pure hip
flexion without abduction and external rotation

Hints:
 The failure of the patients to complete the full ROM in the gr 3 is not an
automatic gr 2, should be tested in the supine position to ascertain
whether the correct gr is 2 or less.
 Never grasp the belly of a muscle during the poor and trace test.

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HIP EXTENSION(gluteus maximus and hamstring)

ROM: 0-20° /0-5°

Gr 5,4,3:
 P: Prone, arms may be overhead or
abducted to hold sides of table
 T: standing at side of the test limb at
level of pelvis.
The hand gives resistance on the
post leg, just above the ankle the
opposite hand ma be used to stabilize
pelvis alignment in the area of post sup
spinae of the iliaca. Alternate position:
the resistance placed on the posterior
thigh just above the knee (less
demanding test).

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Gr 2. (fig. 5-23)
 P: Side lying with test limb uppermost.
Knee sraight and supported by
examiner. Lowermost limb is flexed
 T: Standing behind patient at thigh
level, and supports test limb just
below the knee, cradling the
leg.Opposite hand over the pelvic
crest to maintain hip and pelvic
alignment.
 Test: extend hip through full of ROM
 I: bring your leg back toward me

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 Gr 1,0 (fig. 5-24)
 P: prone
 P: standing on side to be tested at
level of hip. Palpate hamstring
(deep into tissuee with fingers) at
the ischial tuberosity. Palpate the
glut max with deep finger pressure
oer he centre of the buttock and
also over the upper and lower fiber.
 T: Try to extend hip or squeeze te
buttock

HINTS:
be aware that the hip extensor are among the most pwerfull muscle in the body, and
most T will not be able to “break” a gr 5 hip ext. Care should be taken not to
overgrade a gr 4.
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HIP EXTENSION TEST TO ISOLATE GLUTEUS MAXIMUS

Gr 5,4,3 (fig. 5-25)

 P: Prone ith knee flexed to 90°

 T: Standing at side to be test at level of the

pelvis. Hand for resistance is countoured
over the posterior thigh just above the
knee. The opposite hand stabilize the
pelvis.
For gr 3, the knee may need to be
suported (at the ankle) in flexion.
 Test: extends hip through available range

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Gr 2 (Fig 5-26)
 P: Side-lying with test limb uppermost.
Knee is flexe and suported by examiner.
Lowermost hip and knee should be
flexed for stabilility
 T: Standing at behind of patient at thigh
level, cradles uppermost leg with forearm
and hand under the fled knee. Other
hand is on the pelvis to maintain postural
alignment.
 T: extends hip with supported knee flexed

Gr 1.0.identical with hip extensio test (fig. 5-

24)

HINTS:
Hip extension range is less when the knee
is flexed because of tension in the rectus
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minoris.
HIP EXTENSION TESTS MODIFIED FOR HIP FLEXION TIGHTNESS

Gr 5,4,3 (fig. 5-28)

 P: stands with hip flexed and places torso
prone on the table. The arm are used to
hug the tale for support. The knee of
nontest lmb should be flexed to allow test
limb to rest on the floor at start of the test.
 T: Standing at side of limb to test. The
hand used to provide resistance is
countoured over the posterior thigh just
above the knee. The opposite hand
stabilize the pelvis laterally to maintain hip
and pelvis posture.
 Test: extends hip through available ROM/
lift the foot off the floor as high as he can.
the knee in extension all hip extensor
muscles
The knee flexion isolated glut max.

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Gr 2,1,0
Do not test in standing position, must be in side lying position like in hip
extension test/isolated gluteus max.

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SUPINE HIP EXTENSION TEST

If patient cannot lie prone and hip

extension is expected to be >2.
GR 5,4,3,2 (Fig. 5-29)
 P: supine,heels off end of the
table,arms folded across chest or
abdomen.
 T: standing at the end of the table,
both hand are cupped under the
heel.
 Test: P presses limb into table to
maintain full extension as the
examiner raises the limb 24-26 inc fr
the table. The opposite limb almost
always rises involuntary n should not
be consider an abberant test)

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Gr 5. Hip locks in neutral (full ext),
pelvis n back elevate as 1 locked
unit as the limb is raised.(fig.
5.30)
Gr 4. Hips flexes before the pelvis
and back elevate as the limb is
raised.(fig.5-31)
Gr 3. Full elevation of the limb to the
end off straight leg raising range
with little or no elevation of the
pelvis.
Gr 2. Hip flexes fully with only
minimal resistance
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HIP ABDUCTION

ROM 0-45°
Gr 5,4,3
P:Standing-lying with test leg uppermost. Start test w/ the limb slightly
ext beyond the midline and the pelvis rotate slightly
forward.Lowermost leg is flexed
T: Standing behind P
Resistance is contoured across the lat surface of the knee.Palpate
gluteus med just proximal to the greater trochanter.
Resistance may be applied at the anklelonger lever
To distinguish gr 4 and 5resist at the ankle, then knee

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Test: Abduct hip through the complete ROM without flex/rot it in either
direction.

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Gr 2 (fig. 5-37)

P: Supine
T:standing on side of limb being test.
One hand supports and lifts the limb b
holding it under the anle to raise limb just
enough to decrease friction.The other hand
palpates the gluteus medius (prox troch. Mayor)
Tes: abduct

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Gr 1,0 (fig. 5-38)
P: Supine
T:Standing on side limb being tested a level of thigh.
One hand supports the limb under the ankle just above malleoli. The hand
should provide neither resistance nor assistance to movement.Palpate glut med on the
lat aspect of the hip, above troc major.
T: Abd hip/try to bring the leg out to the side

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SUBSTITUTION
 Hip –hike substitution (fig. 5-39)
by approximating pelvis to thorax
using the lateral trunk muscle
moves the limbs through partial abduc
range
 External Rotation and flexion
substitution try to externally rotate
during abduct: oblique action of hip
flexor to substitute for t glut. Medius
(fig. 5-40)
 Tensor fascia lata substitution: if the
test begin with active hip
flexion/flexion hip, it is an opportunity
for the tensor fascia lata to abduct the
hip

 HINTS

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 HINTS

 A gr 4 often masks significant weakness because of the intrinsic great

strenght of these muscle giving resistance at the ankle rather than at
the knee.
 Do not palpate contractile activity of muscle through clothing
 When the patient supine, the weight of opposite limb stabilize the
pelvisnot necessary to manually stabilize the contralateral limb.

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HIP ABDUCTION FROM FLEXED POSITION (tensor fascia lata)

Gr 5,4,3
 P: Side lying. Uppermost limb is flexed to 45° and lies across the
lowermost limb with the foot resting on the table.(fig.5-44)
 T: behind P at the level of pevis. Hand for resistance is placed n lat
surface of the thigh just above the knee.The other hand stabilize on the
crest of ilium.
 Test: abduct hip about 30°.

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Gr 2 (fig. 5-47)
 P: Long sitting position, supporting trunk with hands placed behind body
on table.
 T: Standing at side of limb test, one hand support the limb under the
ankle;the other hand palpates the tensor fascia lata on the prox
anterolateral thigh where it isert into the iliotibial band.
 Test: abduct hip 30°/bring the leg out to the side.

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Gr 1,0 (fig. 5-48)
 P: Long sitting

 T: One hand palpates the insertio of the tensor fascia lata, the other
hand palpates the Tensor on the anterolateral thigh
 Test: Abduct the hip/try to move the leg out to the side.

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 HIP ADDUCTION (Add magnus,brevis,and longus;Pectineus, and Gracilis)

ROM: 0 to 15-20°
Gr 5,4,3
 P: side-lying with test limb lowermost/resting on the table.Non test limb
in 25° of abduction, supported by examiner.The Therapist cradles the
leg with the forearm,the hand supporting the limb on the medial surface
of the knee.
 T: behind the patient at knee level.Resistance to the test limb is placed
on the medial surface of the distal femur, just proximal to the knee
joint,downward.
 Test: adducts hip until the lower limb contacts the upper one.

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Gr 2,1,0 (Fig. 5-56)
 P: Supine. The non test limb is
position in some abduction to prevent
interference with motion of the test
limb.
 T: at side of test limb,one hand
support the ankle and elevate it
slightly from the table surface. The
opposite hand palpates the adductor
mass on the inner aspect of the
proximal thigh
 Test: add without rotation/bring the leg
toward the other one

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SUBSTITUTION
 Hip flexor substitution: by internally rotating
the hip using a osterior pelvic tilt. The patient
will appear to be tring to turn supine from
side lying. (fig. 5-58)
 Hamstring substitution:by externally rotating
the test hip with an anterior pelvic tilt
appear to move toward prone
Maintenance of true side-lying is necessary
for an accurate test.

HINTS
In the supine test position for GR 2,1,0, the
weight of opposite limb stabilize the
pelvisno need for manual stabilize

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HIP EXTERNAL ROTATION (obturator int and eks,Gemellae sup and inf,
Piriformis, Quadratus femoris, Glut max (post))

ROM: 0-45°
Gr 5,4,3
 P: short sitting (trunk may be supported by placing hands flat/fisted at
side)
 T: S it’s a low stool or kneel beside the test limb. Resistance at the
ankle just above the malleolus, as laterally directestion force. The other
hand at the lateral aspect of the distal thigh just above the knee as a
medial directed forced at knee.
 Test: externally rotation

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Gr 2 (fig. 5-64)
 P: supine, the limb is in rotation

 T: standing at side of test limb

 Test: extenarlly rotation hip in available

ROM, one hand may be used to
maintain pelvic alignment at lateral hip/
“Roll the leg out”
Alternate test: shor-sitting, places the
test limb in maximal internal rotation,
instruct paient to return the limb actively
to midline/neutral position againts slight
resistance.
Gr 1,0
 The same as test for grade 2, in supine
position

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HINTS
 There is wide variation in the amount of hip ext rotation ROM that can
be considered Normal.
 THer is greater range of rotation at the hip when flexed than extended,
probably secondary to laxity of joint structure.
 In short sitting test, the patient should not to:

-lift he contralateral buttock off the table or lean in any direction to lift
the pelvis
- increase flexion of the test knee
- abduct the test hip.

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HIP INTERNAL ROTATION(Glut minimus and medius, tensor fascia lata)

ROM: 0-45°
Gr 5,4,3
 P: short sitting, arm may be used for trunk support a sides or crossed
over chest
 T: Sitting/kneeling in front of patient, one hand grasp the lat surface of
the ankle,above malleolus, resistance-> medially directed forced at the
ankle. The opposite hand is over the medial surface of the disal thigh
just above the knee, Resistance laterally directed force at the knee.
 Test: place the limb in the end position of full internal position by the
examiner for best test result.

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Gr 2,1,0 (fig. 5-69)
 P: supine. Test limb in partial
external rotation
 T: Standing net to the test leg,
palpates glut medius proximal to the
greater trochanter and fascia latae)
over the anterolateral hip below the
ASIS.
 Test: internally rotate/roll the leg in
toward the other one.
Alternate test for Gr 2:
short sitting, place the limb
(passive) in maximal extern
rotation. Instruct to return the limb
actively to the midline/neutral
position againts slight resistance

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 HINTS
 In short sitting test, patient not allow assist internal rotation by lifting the
pelvis on the side of the test limb.
 The patient not allow to extend the knee or adduct and extend the hip
during the test because these motion contamines the test by offering
visual distortion to the therapist.
 The same as hints number 2 and 3 in external rotation.

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