Resisted Abduction Test

Original Editor - User Name
Top Contributors - Stacy Lawrence, Stacy Callow, George Prudden, Vidya Acharya and Wanda van Niekerk

Purpose

The Resisted Abduction Test—a "make" test for hip abductor strength—is designed to assess the integrity and function of the gluteus medius and minimus. It’s clinically applied to evaluate suspected gluteal tendinopathy or hip abductor weakness, especially in individuals with lateral hip pain.

Technique

1. Patient position: side-lying on the unaffected side, the lower leg flexed for stability.
2. Examiner placement: Stand on the lateral aspect of the elevated leg, placing the hand just above the lateral malleolus.
3. Procedure:
   • Instruct the patient to abduct the top leg against the examiner's resistance gradually ("a make test")
   • Ask the patient to hold for 3-5 seconds at maximum contraction.
   • Monitor for muscle weakness, pain reproduction, or compensatory hip hike.

Variation: The "break test" involves applying increasing resistance until the patient's resistance is overcome. This requires greater strength from the examiner. Using a belt-fixed dynamometer or a fixed device is an excellent alternative if maximum force is required.

Test Modification: Supine lying is an alternative position on the examination table. Hip and knee positioned at zero degrees extension. Legs separated to shoulder width. Pelvic stabilization may be required.

Normal Strength Values & Grading Criteria

Manual Muscle Testing Grading (0-5 Scale)

• Grade 5 (Normal): Patient can complete full range of motion against strong manual resistance
• Grade 4 (Good): Patient can complete full range of motion against moderate resistance
• Grade 3 (Fair): Patient can complete full range of motion against gravity only (no additional resistance)
• Grade 2 (Poor): Patient can complete full range of motion with gravity eliminated
• Grade 1 (Tace): Palpable muscle contraction but no visible movement
• Grade 0 (Zero): No palpable muscle contraction

Evidence

Based on Ieiri A, et al. findings (2015), normal hip strength values using hand-held dynamometry in healthy adults demonstrate:

• Excellent reliability for inter rater measurements (ICC>0.090) when standardized positioning and technique are employed.
• Good to excellent interrater reliability (ICC 0.80-0.95) with experienced examiners
• Strength values typically range from 15-25% of body weight in healthy adults, with variations based on age, sex, and activity level.

Reliability studies:

• Hip abductor strength measured in side-lying position with the use of a handheld dynamometer showed higher intrarater reliability (*ICC 0.89-0.95) with hand fixation and excellent reliability (ICC 0.96-0.97) with a belt-fixed device.

*ICC (intraclass correlation coefficient)

Clinical Significance

Positive Test Findings

A positive test (indicating weakness) may suggest:

• Hip abductor muscle strain or tear
• Greater Trochanteric Pain Syndrome
• Hip joint pathology (arthritis, labral tears)
• Lumbar spine dysfunction affecting L4-S1 nerve roots
• Post surgical weakness following hip procedures

Functional Implications

• Hip abductor weakness is associated with:
• Trendelenburg gait pattern
• Increased risk of falls in elderly populations
• Patellofemoral pain syndrome
• Iliotibial band syndrome
• Lower back pain

Although no scientific evidence has been published examiner can consider a few factors which might affect reliability.

• Examiners experience and strength
• Patient positioning consistency
• Dynamometer placement
• Stabilization technique
• Patient motivation and effort

Contraindications and Precautions

Absolute Contraindications

• Acute hip fracture
• Recent hip surgery (first 6-12 weeks)
• Acute muscle tear or strain
• Severe hip inflammation

Relative Contraindications

• Chronic hip pain during movement
• Pregnancy (third trimester)
• Significant osteoporosis
• Patient inability to understand instructions

Precautions

• Avoid testing immediately after intense physical activity
• Consider patient fatigue and motivation levels
• Ensure proper warm-up if testing athletes
• Monitor for compensatory movement patterns