Hi-Lo Test

Original Editor - Lilian Ashraf
Top Contributors - Lilian Ashraf

Purpose[edit | edit source]

Diaphragm (inferior view).jpeg

The diaphragm is the primary muscle of respiration, when it is functioning normally it produces observable breathing mechanics of abdominal motion, anterior-superior chest expansion, and lateral rib expansion, commonly referred to as “diaphragmatic breathing”.[1]

The Hi-Lo Test is used in the assessment of breathing pattern dysfunction, by the observation of abdominal excursion and anterior-posterior chest expansion.[1]

Technique[edit | edit source]

The patient is instructed to place one hand on their chest and the other on their abdomen and breathe normally. Movement in the upper chest and abdomen is observed.[1]

The patients who functionally breathe display visible abdominal expansion movement and no visible superior migration of the thoracic cage.[1]


The test can be done in different positions according to the patient. From supine, sitting or standing.

One study at 2019 looked into the effect of different positions on Hi-Lo test results, it found that as postural demand increased from sitting to standing, frequency of functional breathing decreased, due to increased demand on the diaphragm. Which suggests that Hi-Lo test should be performed from different positions to determine whether the diaphragm is able to respond to increased postural demands.

Evidence[edit | edit source]

One study compared Hi-Lo test with MARM (Manual Assessment of Respiratory Motion), it found that less experienced practitioners with only a small amount of practice and training can use the MARM and Hi Lo with similar levels of accuracy to experienced practitioners.[3]

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 Horris H, Anderson BE, Bay RC, Bliven KC. Clinical breathing mechanics differ based on test and position. Journal of Sport Rehabilitation. 2019 Aug 1;28(6):635-9.
  2. coachkeats. Basic Table Assessments 101 Hi-Lo Breathing Test w/Keats S. Available from: https://www.youtube.com/watch?v=yjLl5NINUEk [last accessed 9/5/2023]
  3. Courtney, R., Cohen, M. and Reece, J., 2009. Comparison of the Manual Assessment of Respiratory Motion (MARM) and the Hi Lo Breathing Assessment in determining a simulated breathing pattern. International Journal of Osteopathic Medicine, 12(3), pp.86-91.