The Log Roll Test

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Purpose:[edit | edit source]

The log roll test (or passive rotation test) is a special test used to assess the integrity of the hip joint. The test is used to screen for hip pathologies including labral tears, ligamentous laxity, and impingement[1].

Clinically Relevant Anatomy:[edit | edit source]

The hip is a ball and socket joint formed by the head of the femur and the acetabulum of the pelvic bone. The main function of the hip is to support the weight of the upper body during sitting and standing, at rest and in motion[1].

The femoral head is the area of the femur that contacts the acetabulum of the pelvic bone. The femoral head contains the ligamentum teres, which supplies blood flow to the femur bone as well as stability. The ligamentum teres is located intra-capsular. Injuries to this area can result in osteonecrosis of the femoral head.

The capsular ligaments of the hip include the iliofemoral ligament (Y-ligament), the pubofemoral ligament, and the ischiofemoral ligament. All of these ligaments limit/prevent extension of the hip. The iliofemoral ligament is the strongest ligament in the body and prevents hyperextension. The pubofemoral ligament prevents abduction and extension of the hip. Finally, the ischiofemoral ligament is the weakest of the three ligaments and prevents excess extension.

The acetabulum is the area of the pelvic bone where the ilium, ischium, and pubis fuse together. This area allows for the proximal transmission of weight from axial skeleton to the lower extremities. The articular surface of the acetabulum is covered by a thickened layer of hyaline cartilage.

The labrum of the hip has three surfaces: the internal articular surface, the external articular surface, and the basal surface. The internal articular surface is adjacent to the joint and is avascular, causing decreased rate of healing in the event of injury. The external articular surface contacts the joint capsule and is vascularized. The basal surface is attached to the acetabular bone and ligaments. The overall function of the labrum is to provide joint stability, absorb shock, lubricate the joint, and distribute pressure. Since the labrum of the hip is cartilage, it allows for more support to the joint by holding the bones in their proper places and provides cushioning to the joint [2].

The nerves surrounding the hip include the femoral, obturator, and superior gluteal nerves.

Summary of Potential Pathologies at the Hip:[edit | edit source]

  • Labral tears: Common mechanisms of injury for labral tears include, but are not limited to, trauma, impingement, laxity, and abnormal bone structure.[3] Labral tears may present as hip or groin pain that are aggravated by sitting or standing for prolonged periods of time. An individual experiencing a labral tear may also report symptoms of locking, clicking, or catching of the hip.[4]
  • Iliofemoral ligament laxity: In general, a ligamentous laxity may present with symptoms similar to that of hip microinstability. Symptoms may include, but are not limited to, chronic groin pain, tendinitis from dynamic stabilizer overload, or pistoning of the femoracetabular joint.[5]
  • Femoral Acetabular impingement (FAI): Femoral acetabular impingement causes changes to the structure of the acetabulum and proximal femur, that if changes are severe enough may lead to tearing of the labrum.[6] It is important to note that there are multiple types of femoral acetabular impingement, with the two most common being Cam impingement and Pincer impingement.
  • Cam Impingement: is caused by abnormalities of the femur due to overgrowth of the femoral neck. This abnormality leads to incorrect contact of the femur and the acetabulum mainly specifically during combined movements of hip flexion, adduction and internal rotation[7]. Often many times individuals with Cam impingement don't realize they have the condition due to it being fairly asymptomatic their lives. It is observed that the demographic most affected by this type of impingement are young male athletes[8].
  • Pincer Impingement: is caused by abnormality of the acetabulum due to the rim of the acetabulum being significantly increased more than normal. Over time this type of impingement can eventually lead to what is called an impaction type injury through years of degeneration [8] .  It has been observed that the demographic that tends to be the most susceptible to this type of impingement are middle aged female athletes [8].

Technique:[edit | edit source]

  1. The patient assumes a supine position.
  2. Standing beside the patient, the clinician uses his/her more cephalic hand to grasp the patient's distal anterior femur and his/her more caudal hand to grasp the distal anterior tibia.
  3. The clinician passively moves the patient’s femur through the available range of internal rotation.
  4. The clinician passively moves the patient's femur through the available range of external rotation[9].

The log roll test should move the articular surface of the femoral head along the acetabulum without stressing any of the surrounding extra-articular structures[10].

Positive Test Results:

  • Pain reported during the test is positive for an intra-articular pathology.
  • Noticeable joint hyper-mobility or increased external and internal rotation range of motion of the hip is positive for ligamentous or capsular laxity.
  • Clicking or popping noted result in a positive test for the presence of an acetabular labral tear[1].
  • If the rotational mobility component of this test is restricted or painful this would indicate hip pathology[9].

Note: The absence of a positive log roll test does not exclude the hip as a source of symptoms.[1]

Evidence:[edit | edit source]

When positive the log roll test the test will result rule in the presence of hip pathology. However, the finding of a negative log roll test does not exclude the hip as a source of the symptoms[1]. This is because the log roll test is highly sensitive and has the chance of producing false positive tests. The sensitivity for the log roll test for a femoral neck stress fracture was 100% and the specificity was 33%[11].

Related Physiopedia Pages:[edit | edit source]

Hip Examination

Hip Anatomy

Functional Anatomy of the Hip

Reference:[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 1.4 OrthoFixar. Log roll test. (cited 3 May 2023). Available from: https://orthofixar.com/special-test/log-roll-test/ (accessed 8 March 2024).
  2. ↑ PennMedicine. Labral Tear. Available from: https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/labral-tears#:~:text=The%20labrum%20is%20a%20rim,provides%20cushioning%20to%20the%20joint. (accessed 21 March 2024).
  3. ↑ Su T, Chen GX, Yang L. Diagnosis and treatment of labral tear. Chinese Medical Journal. 2019; 132(2): 211–219
  4. ↑ Dutton M, Hip Joint Complex, In: McGraw-Hill Education. Dutton's Orthopedic Examination Evaluation and Intervention 5th edition. New York: McGraw Hill / Medical, 2019. p 824-921
  5. ↑ Philippon, M. J., Bolia, I., Locks, R., & Briggs, K. (2016). Microinstability of the hip: A previously unrecognized pathology. Muscles, Ligaments and Tendons Journal, 354–360. https://doi.org/10.11138/mltj/2016.6.3.354
  6. ↑ Ejnisman, L., Ricioli Júnior, W., Queiroz, M. C., Vicente, J. R. N., Croci, A. T., & Polesello, G. C. (2020). Femoroacetabular Impingement and Acetabular Labral Tears - Part 1: Pathophysiology and Biomechanics. Revista brasileira de ortopedia, 55(5), 518–522. https://doi.org/10.1055/s-0040-1702964
  7. ↑ Dutton M, Hip Joint Complex, In: McGraw-Hill Education. Dutton's Orthopedic Examination Evaluation and Intervention 5th edition. New York: McGraw Hill / Medical, 2019. p 893-894
  8. ↑ 8.0 8.1 8.2 Dutton M, Hip Joint Complex, In: McGraw-Hill Education. Dutton's Orthopedic Examination Evaluation and Intervention 5th edition. New York: McGraw Hill / Medical, 2019. p 894-895
  9. ↑ 9.0 9.1 Magee DJ., Orthopedic Physical Assessment, 6th edition, St. Louis: Elsevier Saunders, 2014.
  10. ↑ Byrd J.W. Evaluation of the hip: History and physical examination. North American Journal Of Sports Physical Therapy. 2007; 2:237.
  11. ↑ Rahman L.A., Adie S, Naylor J.M., Mittal R, So S, Harris I.A. A systematic review of the diagnostic performance of orthopedic physical examination tests of the hip. BMC Musculoskeletal Disorders. 2013; 14:257
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