Thomas Test
Original Editor - Tyler Shultz
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Purpose[edit | edit source]
The Thomas Test is used to measure the flexibility of the hip flexors.[1]
- Impaired range of motion of the hip may be an underlying cause to other conditions such as: psoas syndrome; patellofemoral pain syndrome[2]; lower back pain[3], osteoarthritis; rheumatoid arthritis.[4]
- Often associated with runners, dancers, and gymnasts who complain of hip "stiffness" and reported "snapping" feeling when flexing at the waist.[5]
Clinically Relevant Anatomy[edit | edit source]
The hip joint is a diarthroidal ball and-socket style joint, formed from the head of the femur as it articulates with the acetabulum of the pelvis. It serves as the main connection between the lower extremity and the trunk, and typically works in a closed kinematic chain.
There are various muscles making up the hip flexor group being tested in the Thomas Test:
| Iliopsoas muscle group |
Main Function |
Additional movement |
| Iliopsoas |
Hip flexion |
External rotation |
| Rectus femoris |
Hip flexion |
Knee extension |
| Tensor fascia lata |
Hip flexion |
Internal rotation, abduction |
| Sartorius |
Hip flexion |
Knee flexion |
Technique[edit | edit source]
An easy test to perform, as shown in this 40 second video.
Thomas Test video provided by Clinically Relevant
The patient should be supine on the examination table, maximally flex both knees, using both arms to ensure that the lumbar spine is flexed and flat on the table and avoids an anterior pelvic tilt.[1]
The patient then lowers the tested limb toward the table, whilst the contralateral hip and knee is still held in maximal flexion to stabilize the pelvis and flatten out the lumbar lordosis.[6] The length of the iliopsoas is measured by the angle of the hip flexion.[7]
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.[7] The lumbar spine must remain flat and in contact with the table during the test.[1] The physiotherapist controls the opposite leg to ensure that it maintains full contact with the table.
Interpretation[edit | edit source]
If the iliopsoas muscle is shortened, or a contracture is present, the lower extremity on the involved side will be unable to fully extend at the hip. This constitutes a positive Thomas test.[9]
The following structures may be considered during a positive test;
| Sign | Structures affected |
|---|---|
| Extended knee | Quadriceps, rectus femoris |
| Flexed hip | Psoas muscles |
| Abducted hip | Tensor fascia lata, iliotibial band |
| Tibia lateral rotation | Biceps femoris |
Reliability[edit | edit source]
Studies that test the reliability of the Thomas study are very limited.
One study has demonstrated that the modified Thomas test has a very good inter-rater reliability.[10] Another has demonstrated that the modified Thomas test, has an average of only moderate levels of reliability.[11] Further research is required to prove or to refute the reliability of the Thomas test.
Peeler & Anderson conducted a study in 2006 examining the reliability of the Thomas test for assessing hip range. Their study calls into question the reliability of the technique when used to score range of motion and iliopsoas muscle flexibility about the hip joint using both goniometer and pass/fail scoring methods.[12]
References[edit | edit source]
- ↑ 1.0 1.1 1.2 Harvey D. Assessment of the flexibility of elite athletes using the modified Thomas test. British Journal of Sports Medicine 1998;32(1):68-70.
- ↑ Tyler TF, Nicholas SJ, Mullaney MJ, McHugh MP. The role of hip muscle function in the treatment of patellofemoral pain syndrome. The American journal of sports medicine 2006;34(4):630-6.
- ↑ Marrè-Brunenghi G, Camoriano R, Valle M, Boero S. The psoas muscle as cause of low back pain in infantile cerebral palsy. Journal of Orthopaedics and Traumatology 2008;9(1):43-7.
- ↑ Adams JC, Hamblen DL. Outline of Orthopaedics. 13th edition. Churchill Livingstone, 2001. p.459.
- ↑ OrthoFixar Thomas test Available: https://www.orthofixar.com/special-test/thomas-test/(accessed 18.1.2022)
- ↑ Konin JG, Brader H. Lumbar Spine Special tests for orthopedic examination. Third edition. USA: Slack Incorporated. 2006. p170.
- ↑ 7.0 7.1 Dr. Jeffrey Tucker. The Psoas and Iliacus: Functional Testing. Available from: https://drjeffreytucker.com/2009/09/the-psoas-and-iliacus-functional-testing/ (accessed 28/11/2020).
- ↑ Liverpool Chiropractic & Sports Injury Clinic. Hip Mobility Assessment | Modified Thomas Test. Available from https://www.youtube.com/watch?v=9fdHMryWbpI (accessed 28/11/2020).
- ↑ Medical Dictionary Thomas Test Available:https://medical-dictionary.thefreedictionary.com/Thomas+test (accessed 18.1.2022)
- ↑ Gabbe BJ, Bennell KL, Wajswelner H, Finch CF. Reliability of common lower extremity musculoskeletal screening tests. Physical Therapy in Sport 2004;5(2):90-7.
- ↑ Clapis PA, Davis SM, Davis RO. Reliability of inclinometer and goniometric measurements of hip extension flexibility using the modified Thomas test. Physiotherapy theory and practice 2008;24(2):135-41.
- ↑ Peeler J, Anderson JE. Reliability of the Thomas test for assessing range of motion about the hip. Physical Therapy in Sport. 2007;8(1):14-21.
