Manual Muscle Testing: Hip Flexion

Original Editor - Claire Knott

Top Contributors - Claire Knott, Whitney Wagganer, Lucinda hampton, Kim Jackson, Wanda van Niekerk and Tony Varela  

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Introduction[edit | edit source]

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 the comparison of the involved leg versus the uninvolved leg. This test can help the therapist determine what strength the patient was at prior to injury or trauma. It is used to evaluate weakness and can be effective in differentiating true weakness from imbalances or poor endurance. See Muscle Strength Testing

Muscles Involved[edit | edit source]

There are four main muscles that flex the hip. There are two-joint muscles which are the Sartorius, Tensor Fasciae Latae, and Rectus Femoris. These muscles cross both the knee and the hip. Conversely, there is only a single one-joint muscle, known as the Iliopsoas, which only crosses at the hip.

Image 1: Anterior hip/thigh muscles.

Patient Positioning[edit | edit source]

  • Grades 3 to 5 - Patient is in short sitting with thighs supported
  • Grades 0-2 - Patient is in side lying ('gravity minimal' position)

Therapist Position[edit | edit source]

  • Therapist to stand next to test side
  • Palpation over hip flexors

To Test[edit | edit source]

  • Patient actively flexes the hip
  • For grades 4 to 5 apply resistance over the distal femur in a direction opposite to flexion[1]
  • 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.

References[edit | edit source]

  1. Hislop H, Avers D, Brown M. Daniels and Worthingham's muscle Testing-E-Book: Techniques of manual examination and performance testing. Elsevier Health Sciences; 2013 Sep 27.