Thomas Test: Difference between revisions
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'''Original Editor '''- [[User:Tyler Shultz|Tyler Shultz]], [[User:Aurelie Canas-Perez|Aurelie Canas-Perez]] | '''Original Editor '''- [[User:Tyler Shultz|Tyler Shultz]], [[User:Aurelie Canas-Perez|Aurelie Canas-Perez]] | ||
'''Lead Editors''' - Your name will be added here if you are a lead editor on this page. [[Physiopedia:Editors|Read more.]] | '''Lead Editors''' - Your name will be added here if you are a lead editor on this page. [[Physiopedia:Editors|Read more.]] | ||
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== Definition/Description == | == Definition/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. <ref>↑ D Harvey. Assessment of the flexibility of elite athletes using the modified Thomas test. Br J Sports Med 1998 32: 68-70.</ref><ref>Jeff G. Konin, Holly Brader. Lumbar Spine Special tests for orthopedic examination. Third edition. USA. Slack Incorporated. 2006.p170</ref> | 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. <ref>↑ D Harvey. Assessment of the flexibility of elite athletes using the modified Thomas test. Br J Sports Med 1998 32: 68-70.</ref><ref>Jeff G. Konin, Holly Brader. Lumbar Spine Special tests for orthopedic examination. Third edition. USA. Slack Incorporated. 2006.p170</ref> | ||
<center>{{#ev:youtube|q4MFh4aFmfM}} |</center> | <center>{{#ev:youtube|q4MFh4aFmfM}} |</center> | ||
== Clinically Relevant Anatomy == | == Clinically Relevant Anatomy == | ||
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M. Sartorius: Main function → thigh<span class="wordentry1"><span lang="EN-US"> flexion</span></span><span lang="EN-US"> </span><span lang="EN" style="mso-ansi-language:EN"><span style="mso-spacerun:yes"> </span><br> <span style="mso-spacerun:yes"> </span><span style="mso-spacerun:yes"> </span></span><span class="wordentry1"><span lang="EN-US">Additional | M. Sartorius: Main function → thigh<span class="wordentry1"><span lang="EN-US"> flexion</span></span><span lang="EN-US"> </span><span lang="EN" style="mso-ansi-language:EN"><span style="mso-spacerun:yes"> </span><br> <span style="mso-spacerun:yes"> </span><span style="mso-spacerun:yes"> </span></span><span class="wordentry1"><span lang="EN-US">Additional | ||
feature</span></span><span lang="EN" style="mso-ansi-language:EN">→knee flexion</span> | feature</span></span><span lang="EN" style="mso-ansi-language:EN">→knee flexion</span> | ||
== | == Purpose<br> == | ||
<span lang="EN" style="mso-ansi-language:EN">The Thomas Test or Iliacus Test | <span lang="EN" style="mso-ansi-language:EN">The Thomas Test or Iliacus Test or Iliopsoas Test | ||
is used to measure the flexibility of the iliopsoas muscle group, the M. Rectus | is used to measure the flexibility of the iliopsoas muscle group, the M. Rectus | ||
Femoris, the M. Tensor Fascia Latae and the M. Sartorius </span><span lang="EN-US"> | Femoris, as well as the M. Tensor Fascia Latae and the M. Sartorius</span><span lang="EN-US">.<ref>↑ D Harvey. Assessment of the flexibility of elite athletes using the modified Thomas test. Br J Sports Med 1998 32: 68-70.</ref></span><span lang="EN-US" style="color:black;mso-bidi-font-style: italic">Measuring the flexibility of this muscle is not useful, because we | ||
don’t have a <span style="mso-spacerun:yes"> </span>standard meeting length of muscle.</span><span lang="EN-US" style="mso-ansi-language:EN"> </span><span lang="EN" style="mso-ansi-language:EN">The most important aspect of this test is that | don’t have a <span style="mso-spacerun:yes"> </span>standard meeting length of muscle.</span><span lang="EN-US" style="mso-ansi-language:EN"> </span><span lang="EN" style="mso-ansi-language:EN">The most important aspect of this test is that | ||
the range of motion<sup> <ref>↑ D Harvey. Assessment of the flexibility of elite athletes using the modified Thomas test. Br J Sports Med 1998 32: 68-70.</ref></sup> of <span style="mso-spacerun:yes"> </span>the hip | of the range of motion<sup> <ref>↑ D Harvey. Assessment of the flexibility of elite athletes using the modified Thomas test. Br J Sports Med 1998 32: 68-70.</ref></sup> of <span style="mso-spacerun:yes"> </span>the hip, as various diseases<span style="mso-spacerun:yes"> such</span> as </span><span class="wordentry"><span lang="EN-US">patellofemoral pain syndrome <ref>↑ 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.</ref></span></span><span lang="EN" style="mso-ansi-language:EN">, l</span><span lang="EN-US" style="color:#212121">ower back pain<ref>↑ 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.</ref>, [[Osteoarthritis|osteoarthritis]] | ||
and rheumatoid arthritis<ref>John Crawford Adams, David L. Hamblen; Outline of orthopaedics; Churchill Livingstone, 13th edition, 2001 - 459 pagina's</ref></span><span lang="EN-US">. | and rheumatoid arthritis<ref>John Crawford Adams, David L. Hamblen; Outline of orthopaedics; Churchill Livingstone, 13th edition, 2001 - 459 pagina's</ref></span><span lang="EN-US">, may be related to this impaired range of motion.</span> | ||
== Technique == | == Technique == | ||
<span lang="EN" style="mso-ansi-language:EN"> | <span lang="EN" style="mso-ansi-language:EN">The patient should | ||
be supine, using the whole length of the table. The patient must then maximally | 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 | 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.<ref>↑ D Harvey. Assessment of the flexibility of elite athletes using the modified Thomas test. Br J Sports Med 1998 32: 68-70.</ref><sup> </sup>The | and flat on the table and avoids a posterior tilt of the pelvis.<ref>↑ D Harvey. Assessment of the flexibility of elite athletes using the modified Thomas test. Br J Sports Med 1998 32: 68-70.</ref><sup> </sup>The | ||
patient | 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.<ref>Jeff G. Konin, Holly Brader. Lumbar Spine Special tests for orthopedic examination. Third edition. USA. Slack Incorporated. 2006.p170</ref> The length of the iliopsoas is measured by the angle of the hip flexion.<ref>↑ Jeffrey Tucker, DC, DACRB. The Psoas and Iliacus: Functional Testing. Dynamic Chiropractic. September 24, 2007, Vol. 25, Issue 20.</ref></span> | ||
<span lang="EN" style="mso-ansi-language:EN">A modified version of the test is | <span lang="EN" style="mso-ansi-language:EN">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 | both legs hanging freely. The patient must then flex their knee and pull it back | ||
to | to their chest as close as they can, using both arms while doing so. The other | ||
leg can hang down.<ref>↑ Jeffrey Tucker, DC, DACRB. The Psoas and Iliacus: Functional Testing. Dynamic Chiropractic. September 24, 2007, Vol. 25, Issue 20.</ref><sup> </sup>The lumbar spine must remain flat and in | leg can hang down.<ref>↑ Jeffrey Tucker, DC, DACRB. The Psoas and Iliacus: Functional Testing. Dynamic Chiropractic. September 24, 2007, Vol. 25, Issue 20.</ref><sup> </sup>The lumbar spine must remain flat and in | ||
contact with the table during the test<sup>.<ref>↑ D Harvey. Assessment of the flexibility of elite athletes using the modified Thomas test. Br J Sports Med 1998 32: 68-70.</ref></sup> The physiotherapist | contact with the table during the test<sup>.<ref>↑ D Harvey. Assessment of the flexibility of elite athletes using the modified Thomas test. Br J Sports Med 1998 32: 68-70.</ref></sup> The physiotherapist | ||
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*<span class="wordentry"><span lang="EN-US">[http://www.netterimages.com/image/8349.htm Positive result]: When the | *<span class="wordentry"><span lang="EN-US">[http://www.netterimages.com/image/8349.htm Positive result]: When the | ||
</span></span>patient | </span></span> | ||
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.<ref>↑ Mark McKean. Postural Screening using the Thomas Test – Part 1. Pistol Australia. P11-13.</ref><ref>↑ D Harvey. Assessment of the flexibility of elite athletes using the modified Thomas test. Br J Sports Med 1998 32: 68-70.</ref> | |||
<u><span lang="EN" style="mso-ansi-language:EN">Consequences:</span></u><sup><span lang="EN" style="mso-ansi-language:EN"> </span></sup><span lang="EN" style="mso-ansi-language:EN">a reduced range of motion may be a sign of one of | <u><span lang="EN" style="mso-ansi-language:EN">Consequences:</span></u><sup><span lang="EN" style="mso-ansi-language:EN"> </span></sup><span lang="EN" style="mso-ansi-language:EN">a reduced range of motion may be a sign of one of | ||
Line 74: | Line 69: | ||
of the test: </span></u><span lang="EN-US">I</span><span lang="EN" style="mso-ansi-language:EN">nvestigation into the validity of tests are | of the test: </span></u><span lang="EN-US">I</span><span lang="EN" style="mso-ansi-language:EN">nvestigation into the validity of tests are | ||
important to know whether our tests are reliable or not.<ref>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</ref><sup> </sup>Studies | important to know whether our tests are reliable or not.<ref>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</ref><sup> </sup>Studies | ||
that test the reliability of the Thomas study are very limited.<ref>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).</ref><sup> | that test the reliability of the Thomas study are very limited.<ref>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).</ref><sup> </sup>One<sup><span style="mso-spacerun:yes" /></sup> study has<span style="mso-spacerun:yes"> </span>demonstrated that the modified Thomas test has a very good inter-rater reliability.<ref>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).</ref><span style="mso-spacerun:yes"> </span>Another has demonstrated that the modified Thomas test, has an average of only moderate levels of reliability.<ref>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</ref></span><span lang="EN"> </span><span lang="EN" style="mso-ansi-language:EN">In order to prove or to refute the reliability of the | ||
One <sup> | Thomas test, further research is required. </span> | ||
Thomas test further research is required. </span> | |||
== | == Resources <br> == | ||
'''<span lang="EN" />''' ↑ The “iliacus test”: New information for the evaluation Assessment of the flexibility of elite athletes using the modified Thomas test. | |||
↑ Iliotibial band Friction Syndrome. | |||
↑ Postural Screening using the Tomas Test- Part 1 <br> | |||
== Clinical Bottom Line == | == Clinical Bottom Line == | ||
When examining patients with LBP, hip, and/or knee conditions, the Thomas test can be useful in determining associated impairments. <br> | |||
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | ||
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*<span lang="EN-US"> Normative </span>and critical criteria for iliotibial band and iliopsoas muscle flexibility. | *<span lang="EN-US"> Normative </span>and critical criteria for iliotibial band and iliopsoas muscle flexibility. | ||
</div> | </div> | ||
== References<br> == | |||
== References == | |||
<references /> | <references /> | ||
[[Category:Vrije_Universiteit_Brussel_Project]] [[Category:Musculoskeletal/Orthopaedics]] [[Category:Hip]] | |||
[[Category:Vrije_Universiteit_Brussel_Project]] |
Revision as of 02:59, 2 June 2013
Original Editor - Tyler Shultz, Aurelie Canas-Perez
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
Definition/Description[edit | edit source]
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]
Clinically Relevant Anatomy[edit | edit source]
Iliopsoas muscle group[3]
M.iliopsoas: Main
function → thigh flexion
Additional
feature→external rotation
M. Rectus Femoris: Main
function → thigh flexion
Additional
feature→knee
extension
M. Tensor Fascia Latae: Main function → thigh flexion
Additional
feature→internal rot., abduction
M. Sartorius: Main function → thigh flexion
Additional
feature→knee flexion
Purpose
[edit | edit source]
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.[4]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 [5] of the hip, as various diseases such as patellofemoral pain syndrome [6], lower back pain[7], osteoarthritis and rheumatoid arthritis[8], may be related to this impaired range of motion.
Technique[edit | edit source]
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.[9] 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.[10] The length of the iliopsoas is measured by the angle of the hip flexion.[11]
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.[12] The lumbar spine must remain flat and in contact with the table during the test.[13] The physiotherapist controls the opposite leg to ensure that it maintains full contact with the table.[14]
- 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.[15]
- Positive result: When the
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.[16][17]
Consequences: a reduced range of motion may be a sign of one of these diseases: patellofemoral pain syndrome[18], lower back pain[19], osteoarthritis and rheumatoid arthritis[20]
Reliability of the test: Investigation into the validity of tests are important to know whether our tests are reliable or not.[21] Studies that test the reliability of the Thomas study are very limited.[22] One<span style="mso-spacerun:yes" /> study has demonstrated that the modified Thomas test has a very good inter-rater reliability.[23] Another has demonstrated that the modified Thomas test, has an average of only moderate levels of reliability.[24] In order to prove or to refute the reliability of the Thomas test, further research is required.
Resources
[edit | edit source]
<span lang="EN" /> ↑ The “iliacus test”: New information for the evaluation Assessment of the flexibility of elite athletes using the modified Thomas test.
↑ Iliotibial band Friction Syndrome.
↑ Postural Screening using the Tomas Test- Part 1
Clinical Bottom Line[edit | edit source]
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)[edit | edit source]
- 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
[edit | edit source]
- ↑ ↑ D Harvey. Assessment of the flexibility of elite athletes using the modified Thomas test. Br J Sports Med 1998 32: 68-70.
- ↑ Jeff G. Konin, Holly Brader. Lumbar Spine Special tests for orthopedic examination. Third edition. USA. Slack Incorporated. 2006.p170
- ↑ ↑ D Harvey. Assessment of the flexibility of elite athletes using the modified Thomas test. Br J Sports Med 1998 32: 68-70.
- ↑ ↑ D Harvey. Assessment of the flexibility of elite athletes using the modified Thomas test. Br J Sports Med 1998 32: 68-70.
- ↑ ↑ D Harvey. Assessment of the flexibility of elite athletes using the modified Thomas test. Br J Sports Med 1998 32: 68-70.
- ↑ ↑ 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.
- ↑ ↑ 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.
- ↑ John Crawford Adams, David L. Hamblen; Outline of orthopaedics; Churchill Livingstone, 13th edition, 2001 - 459 pagina's
- ↑ ↑ D Harvey. Assessment of the flexibility of elite athletes using the modified Thomas test. Br J Sports Med 1998 32: 68-70.
- ↑ Jeff G. Konin, Holly Brader. Lumbar Spine Special tests for orthopedic examination. Third edition. USA. Slack Incorporated. 2006.p170
- ↑ ↑ Jeffrey Tucker, DC, DACRB. The Psoas and Iliacus: Functional Testing. Dynamic Chiropractic. September 24, 2007, Vol. 25, Issue 20.
- ↑ ↑ Jeffrey Tucker, DC, DACRB. The Psoas and Iliacus: Functional Testing. Dynamic Chiropractic. September 24, 2007, Vol. 25, Issue 20.
- ↑ ↑ D Harvey. Assessment of the flexibility of elite athletes using the modified Thomas test. Br J Sports Med 1998 32: 68-70.
- ↑ ↑ 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.
- ↑ ↑ Mark McKean. Postural Screening using the Thomas Test – Part 1. Pistol Australia. P11-13
- ↑ ↑ Mark McKean. Postural Screening using the Thomas Test – Part 1. Pistol Australia. P11-13.
- ↑ ↑ D Harvey. Assessment of the flexibility of elite athletes using the modified Thomas test. Br J Sports Med 1998 32: 68-70.
- ↑ ↑ 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.
- ↑ ↑ 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.
- ↑ John Crawford Adams, David L. Hamblen; Outline of orthopaedics; Churchill Livingstone, 13th edition, 2001 - 459 pagina's
- ↑ 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
- ↑ 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).
- ↑ 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).
- ↑ 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