Orthopedic Exam / Special Tests for Physical Therapy: HIP Tests / PELVIS Tests
The Thomas test is used to rule out hip flexion contracture and psoas syndrome. Often associated with runners, dancers, and gymnasts who complain of hip stiffness when flexing at the waist. The hip flexor is a group of muscles that allow us to lift our knees and bend at the waist.
Hip flexors perform various functions, and where some cross over more than one joint. They consist of the iliopsoas, rectus femoris, sartorius, tensor fasciae latae, pectineus, gracillus, adductors and a gluteus muscles.
It is the iliopsoas muscle that has the strongest pull and compressive effect on our spine. It is attached to the L1-L5 and T1 vertebrae. A tight psoas can compress the spine and the discs associated. A chronic state of shortening can lead to an increased anterior pelvic tilt which is very harmful to the discs, especially the L5-S1. A tight iliac muscle also corresponds to a tight psoas.
Hip flexor pain is usually felt in the upper groin region, where the thigh meets the pelvis.
- Testing for hip flexor muscles contracture or shortness.
Video Demo Instructions, Procedure, Positive Test:
Special Test: Thomas Test Video Demo (Procedure below)
Special Test: Thomas Test: PROCEDURE:
- Patient is supine ,with lower gluteal folds at the end of the table and their hips and knees flexed. (Patient may hold the legs in flexion with their hands).
- Therapist makes sure that the patient’s lower back is not so high off the table.
- Patient keeps the unaffected leg flexed, and slowly lowers the affected leg and lets it extend as far as it can.
Thomas Test: POSITIVE SIGNS:
- The affected knee stays extended – Short QUADS:
- The affected hip remains flexed – Short Psoas muscles:
- Abducted affected hip – Short TFL(tensor fasciae latae)/ ITB(iliotibial band)
- Contralateral hip flexes without knee extension- Tight Iliopsoas
- Knee extension – Tight Rectus Femoris
- Lateral rotation of tibia- Tight Biceps Femoris