Hip Orthopedic Tests

Hip Orthopedic Test:

Hip and Pelvis Examination

• Ely’s Test
• Faber Test
• Gaenslen’s Test
• Gluteus Maximus Strength Test
• Hamstring Strength Test
• Hip Adductor Length
• Hip Quadrant Test (Scouring Test)
• Iliopsoas Strength Test
• Ober’s Test
• Pace Abduction Test
• Piriformis Length Test
• Posterior SI Joint Provocation
• SI Joint Gapping Test
• SI Joint Motion/ Gillet’s Test
• SI Joint Squish Test
• Straight Leg Raise Test
• Supine To Sit Test
• Thomas Test
• Trendelenburg’s Sign

Hip Orthopedic Test / Hip Orthopedic Exam: Ely`s Test

Testing for: Rectus Femoris Contracture or Shortness

Procedure:

• Client is prone
• Flex client’s affected knee
• Try to bring the heel to the glutes
• Make sure their affected leg does not abduct

Positive Sign: the pelvis on the affected side flexes as you try to get the heel touch their glute ( affected side)

 

Hip Orthopedic Test/ Hip Orthopedic Exam: Faber Test

Testing for: hip pathology and psoas muscle shortness/spasm

Procedure:

• Client is supine and their legs are extended
• Place client’s foot of the affected side on the other knee

Positive Sign: The affected hip stays above level of the unaffected knee

 

Hip Orthopedic Test/ Hip Orthopedic Exam: Gaenslen’s Test

Testing for: Hip or Sacroiliac Joint Dysfunction

Procedure:

• Client is sidelying on the unaffected side
• Client flexes the hip and knee of the unaffected leg towards their chest
• Therapist is behind the client, stabilizes client’s pelvis with onehand
• Therapist hyperextends the client’s affected leg at the hip

Positive Sign: Pain in the hip and Si joint area

 

Hip Orthopedic Test/ Hip Orthopedic Exam: Gluteus Maximus Strength Test

Testing for: strength of the gluteus maximus

Procedure:

• Client is prone
• The client’s knee on the affected side is flexed 90°
• Therapist stabilizes the affected hip with one hand
• Client extends the affected hip and holds the hip/leg in extension
• If client can hold their hip in extension against gravity, it indicates Grade 3 on the strength scale
• Therapist tries to put a downward pressure as the client tries to hold their affecte hip in extension
• Client can resist the therapist pressure indicates Grade 5 strength

Hip Orthopedic Test/ Hip Orthopedic Exam: Hamstring Strength Test

Purpose: to locate hamstring strain

Procedure:

• Client is prone, and their knees are flexed around 70° 
• Therapist stabilizes the affected pelvis and the posterior tibia on the affected side 
• Assess Medial Hamstrings ( semitendinosus and semimembranosus) – slightly internally rotate femur. Client holds this position against gravity ( Grade 3 strength). As client holds the position, therapist attempts to extend the affected knee.  

Positive Sign – pain deep in the hamstrings indicates strain in the semimembranosus muscle while pain that is more superficial indicates strain in the semitendinosus muscle

• Assess Lateral Hamstring ( biceps femoris) – slightly externally rotate client’s femur and holds their knee in 70° flexion against gravity ( Grade 3 strength). As client holds the position, therapist attempts to extend the affected knee.  

Positive Sign – pain in the lateral hamstrings indicates biceps femoris strain

 

Hip Orthopedic Test/ Hip Orthopedic Exam: Hip Adductor Length Test

Assessing For: the length of the adductor muscles

Procedure:

• Client Is supine
• Client places the plantar surface of their foot on the medial aspect of the knee on the unaffected side. The affected hip is abducted, flexed and internally rotated and their affected knee is flexed.
• Stabilize the hip on the unaffected side as you apply a posterolaterally directed pressure on the affected knee

Positive Sign: hip adductors shortness indicated with reduced range of motion of the affected femur when you apply the posterolaterally directed pressure

 

Hip Orthopedic Test/ Hip Orthopedic Exam: Hip Quadrant Test aka ( Scouring Test )

Testing for: joint capsule tightness or hip pathology

Procedure:

• Client is supine
• Therapist Flexes and adducts the client’s affected hip, until there is some resistance
• Therapist maintain the resistance and moves the client’s hip through an arc into abduction

Positive Sign: pain, early leathery end feel, crepitus in the movement

 

Hip Orthopedic Test/ Hip Orthopedic Exam: Iliopsoas Strength Test

Testing for: iliopsoas weakness

Procedure:

• Client is supine, with their knees in extension 
• Stabilize the unaffected pelvis 
• Client flexes their affected hip at 30° and slightly externally rotates it  
• Client holds this position ( Grade 3 strength) 

Positive Sign: Client cannot hold the affected leg off the table ( in flexion and slight external rotation). To test Grade 5 Strength, therapist may try to put a downward pressure as the client tries to keep the leg off the table in resistance.

 

Hip Orthopedic Test/ Hip Orthopedic Exam: Ober’s Test

Assessing For: the length of the Iliotibial band and Tensor Fascia Lata

Procedure:

• Client is sidelying close to the edge of the table on the unaffected leg. Therapist stands behind the client. 
• Flex hip and knee of the unaffected leg that is at the bottom 
• Stabilize the client’s pelvis with one hand 
• With the other hand grasping the medial aspect of the client’s affected knee, passively hyperabduct and extend the affected femur at the hip. 
• Allow the affected leg to lower without rotating 

Positive Sign: the affected leg stays abducted and does not lower.

 

Hip Orthopedic Test/ Hip Orthopedic Exam: Pace Abduction Test

Testing for: the strength of the piriformis muscle

Procedure:

• Client is seated, with their hips flexed 90 ° and their knees together 
• Therapist places both hands on the lateral side of the knees , holding them together 
• Client attempts to move their knees apart while the therapist resists 

Positive Sign: piriformis weakness if the client cannot move their knees apart. Pain is present in the area of the piriformis indicates piriformis trigger points

 

Hip Orthopedic Test/ Hip Orthopedic Exam: Piriformis Length Test

Assessing For: the length of the piriformis muscle

Procedure:

• Client is prone with their knees close together 
• Client flexes both their knees to 90° 
• Slowly separate the lower legs away from the midline, while keeping the knees together ( the internal rotation of the femur stretches both piriformis muscles) 
• The normal internal rotation would be ( 45°-50°) from the midline 

Positive Sign: short piriformis muscle is indicated if the internal rotation is less than 45°

 

Hip Orthopedic Test/ Hip Orthopedic Exam: Posterior SI Joint Provocation

Testing for: SI joint dysfunction

Procedure:

• Client is sidelying on the unaffected side
• Therapist brings affected hip into flexion
• Therapist places one hand on the client’s ASIS on the affected side, and therapist other hand on the ischial tuberosity on the same side
• Therapist attempts to posteriorly rotate the client’s affected pelvis

Positive Sign: pain around the SI joint indicates SI joint dysfunction

 

Hip Orthopedic Test/ Hip Orthopedic Exam: SI joint Gapping Test

Purpose: to assess the integrity of the anterior ligaments of the SI joints

Procedure:

• Client is supine
• Therapist applies a lateral and inferior pressure to the medial sides of the client’s Anterior Superior Iliac Spines. ( Therapist crosses their arm in order to push easier)

Positive Sign: anterior ligament sprain if there is Unilateral Gluteal or Posterior Leg Pain

 

Hip Orthopedic Test/ Hip Orthopedic Exam: SI joint motion or Gillet’s Test

Testing for: Mobility of the Sacroiliac joint

Procedure:

• Client is standing, may hold on to something for stability
• Therapist is behind the client. Therapist palpates the PSIS of the client’s affected side with their thumb
• Therapist places their other thumb on the S2 process of the client’s sacrum
• Client flexes the hip and knee of the affected side, raising their knee as high as they can, while standing on the unaffected side.

Positive Sign: SI joint hypomobility if the thumb on the affected side moves superiorly instead of inferiorly as the knee lifts

 

Hip Orthopedic Test/ Hip Orthopedic Exam: SI joint Squish Test

Purpose: to assess the integrity of the posterior ligaments of the SI joints

Procedure:

• Client is supine
• Therapist places one hand on the lateral side of each of the client’s Anterior Superior Iliac Spines
• Therapist apply pressure from lateral to medial ( 45 °) and then posteriorly.

Positive Sign: pain local to the Sacroiliac joint indicates posterior SI ligament sprain

 

Hip Orthopedic Test/ Hip Orthopedic Exam: Straight Leg Raise

Purpose: To determine the cause of low back pain

Procedure:

• Client is supine.
• Place their affected leg in adduction and internal rotation
• Raise the affected leg by grasping it around the heel and flexing the hip ( their affected knee should be extended).
• Flex the hip until the client feels pain ( usually around 70-80 degrees of flexion)
• Slowly lower the leg until no pain is felt by the client.
• Dorsiflex the client’s affected foot ( this stretches their sciatic nerve)

Positive Signs:

Hamstring Tightness – pain in the back of their thigh and knee during hip flexion

Lumbar or SI Joint Dysfunction – pain in the low back after 70 degrees of hip flexion only ( no foot dorsiflexion)

Sciatic Nerve Involvement – pain down the leg during passive dorsiflexion

Space Occupying Lesion or Disc Herniation – pain down their opposite leg ( the one that is not raised)

 

Hip Orthopedic Test/ Hip Orthopedic Exam: Supine to Sit Test

Testing for: Functional leg length discrepancy

Procedure:

• Client is supine and knees are extended
• Therapist compares the levels of both malleoli
• Client sits up while therapist takes a note of the malleoli levels

Positive Sign:

• Anterior Hip bone Rotation: One leg is longer when client is supine, then shorter when client is stting up
• Posterior Hip bone rotation: One leg is shorter when client is supine, then longer when client is sitting up

Hip Orthopedic Test/ Hip Orthopedic Exam: Thomas Test

Testing for: Hip flexor muscle contracture or shortness

Procedure:

• Client is supine , with lower gluteal folds at the end of the table and their hips and knees flexed. Client may hold the legs in flexion with their hands.
• Therapist makes sure that the client’s lower back is not so high off the table.
• Client keeps the unaffected leg flexed, and slowly lowers the affected leg and lets it extend as far as it can

Positive Sign:

• Short QUADS: the affected knee stays extended
• Short Psoas muscles: the hips remains flexed
• Short TFL/ ITB: Abducted hip

Hip Orthopedic Test/ Hip Orthopedic Exam: Trendelenburg’s Sign

Testing for: the strength of the Gluteus Medius Muscle

Procedure:

• Client is standing
• Therapist stands behind client, paying attention to the client’s PSIS and iliac spines
• Client stands on the affected leg

Positive Sign: gluteus medius is weak if the pelvis on the affected side pops out or drops