Manual Muscle Testing: Hip Extension

Original Editor - Claire Knott

Top Contributors - Claire Knott, Alexandra Stead, Nupur Smit Shah, Lucinda hampton and Wanda van Niekerk  

Introduction

Muscles of the thigh posterior compartment

An assessment of muscle strength is typically performed as part of a patient's objective assessment and is an important component of the physical exam that can reveal information about strength and or neurologic deficits. It is used to evaluate weakness and can be effective in differentiating true weakness from imbalance or poor endurance. See Muscle Strength Testing.

Ranges of motion knowledge of the hip is needed to be able to conduct correctly manual tests of hip strength. If hip extension range is limited incorrect positioning with give incorrect answer. eg in the presence of a hip flexion contracture, the patient must be standing and leaning over the edge of the table to test hip extension strength. This position decreases the influence of the flexion contracture allowing the patient to move against gravity through the available range. Range of Motion hip extension, 0° to 20°.

Muscles

The main hip extensors are:

• Gluteus Maximus
• Semitendinosus
• Semimembranosus
• Biceps Femoris

Patient Positioning

Prone Hip Extension

For Grades 3 to 5 (of the Oxford Scale):

• The patient is in prone. Arms can be overhead, rested down by sides or abducted to hold sides of table.
• This position can be modified in the case of severe hip flexion tightness or pain. In this case, the patient stands with hips flexed and places torso prone on the table. The arms are used to “hug” the table for support. The knee of the non-test limb should be flexed to allow the test limb to rest on the floor at the start of the test.

Grades 0 to 2 (of the Oxford Scale):

• Patient is in side lying ('gravity minimal' position)

Therapist Position

• Standing at side of limb to be tested at level of pelvis.
• The hand used to provide resistance is contoured over the posterior thigh just above the knee. The opposite hand stabilises the pelvis laterally to maintain hip and pelvis posture.

To Test

• Patient extends hip through entire available range of motion. Resistance is given straight downward toward to the floor. (No resistance is given in the Grade 3 test.)
• For grades 4 to 5, apply resistance through distal thigh in the direction opposite to hip extension.

To satisfy grade 5 'normal muscle' performance criteria, the patient must have the ability to move through complete range of motion (active resistance testing) or maintain an end point range (break testing) against maximum resistance.

Manual muscle testing of the Gluteus Maximus

• The Procedure for hip extensors and gluteus maximus is almost the same, the only difference is when testing the gluteus maximum, the knee can to be flexed to 90 degrees in prone lying position and then resistance applied to an extended hip.

This 90 second video goes through the test.

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