Thomas Test

Description

Patient should be lied on his back and must then maximally flex both knees, using both arms. One limb is then lowered toward the table. [1] [2]

[3]

Clinically Relevant Anatomy

Iliopsoas muscle group
Main Function
Additional feature
M. Iliopsoas
thigh flexion
external rotation
M. Rectus Femoris
thigh flexion
knee extension
M. Tensor Fascia Latae
thigh flexion
internal rotation, abduction
M. Sartorius
thigh flexion
knee flexion

 

Purpose

The Thomas Test or Iliacus Test or Iliopsoas Test is used to measure the flexibility of the iliopsoas muscle group, the M. Rectus Femoris, as well as the M. Tensor Fascia Latae and the M. Sartorius.[2]Measuring the flexibility of this muscle is not useful, because we don’t have a  standard meeting length of muscle. The most important aspect of this test is that of the range of motion [4] of  the hip, as various diseases such as patellofemoral pain syndrome [5], lower back pain[6], osteoarthritis and rheumatoid arthritis[7], may be related to this impaired range of motion.

Technique

The patient should be supine, using the whole length of the table. The patient must then maximally flex both knees, using both arms. This ensures that the lumbar spine is flexed and flat on the table and avoids a posterior tilt of the pelvis.[8] The patient then lowers the<span style="mso-spacerun:yes" /> tested limb toward the table. During the test the contralateral hip is held in maximal flexion.[9] The length of the iliopsoas is measured by the angle of the hip flexion.[10]

A modified version of the test is one in which the patient lies down on their back, at the very edge of the table, with both legs hanging freely. The patient must then flex their knee and pull it back to their chest as close as they can, using both arms while doing so. The other leg can hang down.[11] The lumbar spine must remain flat and in contact with the table during the test.[12] The physiotherapist controls the opposite leg to ensure that it maintains full contact with the table.[13] 

  •  Negative result: The lower back and the sacrum should remain on the table. The hip can make a 10° posterior tilt or a  10° hip extension. The knee must be able to make a 90° flexion.[14]

patient is not able to maintain their lower back and sacrum against the table. Otherwise if the hip has a large posterior tilt or hip extension greater than 15°, or if the knee is not able to meet flexion of 80° or more.[15][16]

Consequences: a reduced range of motion may be a sign of one of these diseases:  patellofemoral pain syndrome[17], lower back pain[18], osteoarthritis and rheumatoid arthritis[19]

Reliability of the test: Investigation into the validity of tests are important to know whether our tests are reliable or not.[20] Studies that test the reliability of the Thomas study are very limited.[21] One<span style="mso-spacerun:yes" /> study has demonstrated that the modified Thomas test has a very good inter-rater reliability.[22] Another has demonstrated that the modified Thomas test, has an average of only moderate levels of reliability.[23] In order to prove or to refute the reliability of the Thomas test, further research is required. 

Resources

http://www.humankinetics.com/excerpts/excerpts/learn-to-assess-muscle-length

Clinical Bottom Line

When examining patients with LBP, hip, and/or knee conditions, the Thomas test can be useful in determining associated impairments.

Recent Related Research (from Pubmed)

  •  The influence of corrective exercises in a water environment on the shape of the antero-posterior curves of the spine and on the functional status of the locomotor system in children with Io scoliosis.


  •  Normative and critical criteria for iliotibial band and iliopsoas muscle flexibility.

References

  1. Jeff G. Konin, Holly Brader. Lumbar Spine Special tests for orthopedic examination. Third edition. USA. Slack Incorporated. 2006.p170
  2. 2.0 2.1 Harvey D. Assessment of the flexibility of elite athletes using the modified Thomas test. Br J Sports Med 1998 32: 68-70.
  3. Physiotutors. Thomas Test ⎟ Iliopsoas Tightness. Available from: https://www.youtube.com/watch?v=NMDd-4NspHs
  4. ↑ D Harvey. Assessment of the flexibility of elite athletes using the modified Thomas test. Br J Sports Med 1998 32: 68-70.
  5. ↑ Tyler TF, Nicholas SJ, Mullaney MJ, McHugh MP. The role of hip muscle function in the treatment of patellofemoral pain syndrome. Am J Sports Med. 2006 Apr; 34(4):630-6.
  6. ↑ G. Marrè-Brunenghi, R. Camoriano, M. Valle and S. Boero; The psoas muscle as cause of low back pain in infantile cerebral palsy; J Orthop Traumatol. 2008 March; 9(1): 43–47.
  7. John Crawford Adams, David L. Hamblen; Outline of orthopaedics; Churchill Livingstone, 13th edition, 2001 - 459 pagina's
  8. ↑ D Harvey. Assessment of the flexibility of elite athletes using the modified Thomas test. Br J Sports Med 1998 32: 68-70.
  9. Jeff G. Konin, Holly Brader. Lumbar Spine Special tests for orthopedic examination. Third edition. USA. Slack Incorporated. 2006.p170
  10. ↑ Jeffrey Tucker, DC, DACRB. The Psoas and Iliacus: Functional Testing. Dynamic Chiropractic. September 24, 2007, Vol. 25, Issue 20.
  11. ↑ Jeffrey Tucker, DC, DACRB. The Psoas and Iliacus: Functional Testing. Dynamic Chiropractic. September 24, 2007, Vol. 25, Issue 20.
  12. ↑ D Harvey. Assessment of the flexibility of elite athletes using the modified Thomas test. Br J Sports Med 1998 32: 68-70.
  13. ↑ DAVID C. ELAND, DO; TIFFANI N. SINGLETON, BS; ROBERT R. CONASTER, MS; JOHN N. HOWELL, PHD; ALFRED M. PHELEY, PHD; MELYNDA M. KARLENE, DO; JOYNITA M. ROBINSON, DO. The “iliacus test”: New information for the evaluation of hip extension dysfunction. J Am Osteopath Assoc. 2002 Mar;102(3):130-42.
  14. ↑ Mark McKean. Postural Screening using the Thomas Test – Part 1. Pistol Australia. P11-13
  15. ↑ Mark McKean. Postural Screening using the Thomas Test – Part 1. Pistol Australia. P11-13.
  16. ↑ D Harvey. Assessment of the flexibility of elite athletes using the modified Thomas test. Br J Sports Med 1998 32: 68-70.
  17. ↑ Tyler TF, Nicholas SJ, Mullaney MJ, McHugh MP. The role of hip muscle function in the treatment of patellofemoral pain syndrome. Am J Sports Med. 2006 Apr; 34(4):630-6.
  18. ↑ G. Marrè-Brunenghi, R. Camoriano, M. Valle and S. Boero; The psoas muscle as cause of low back pain in infantile cerebral palsy; J Orthop Traumatol. 2008 March; 9(1): 43–47.
  19. John Crawford Adams, David L. Hamblen; Outline of orthopaedics; Churchill Livingstone, 13th edition, 2001 - 459 pagina's
  20. Phyllis A Clapis, PT, DHSc, OCS1, Susan Mercik Davis and Ross Otto Davis; Reliability of inclinometer and goniometric measurements of hip extension flexibility using the modified Thomas test; Physiotherapy Theory and Practice ; 2008, Vol. 24, No. 2 , Pages 135-141
  21. Belinda J Gabbea, Kim L Bennellb, Henry Wajswelnerc, Caroline F Fincha; Reliability of common lower extremity musculoskeletal screening tests; Physical Therapy in Sport, Volume 5, Issue 2, Pages 90-97 (May 2004).
  22. Belinda J Gabbea, Kim L Bennellb, Henry Wajswelnerc, Caroline F Fincha; Reliability of common lower extremity musculoskeletal screening tests; Physical Therapy in Sport, Volume 5, Issue 2, Pages 90-97 (May 2004).
  23. Phyllis A Clapis, PT, DHSc, OCS1, Susan Mercik Davis and Ross Otto Davis; Reliability of inclinometer and goniometric measurements of hip extension flexibility using the modified Thomas test; Physiotherapy Theory and Practice ; 2008, Vol. 24, No. 2 , Pages 135-141