Thomas Test

Original Editor - Tyler Shultz

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Purpose[edit | edit source]

The Thomas test is often commonly used to rule out hip flexion contracture and psoas syndrome. This is often associated with runners, dancers, and gymnasts who present with hip stiffness when flexing at the waist. The Thomas Test or Iliacus Test or Iliopsoas Test is used to measure the flexibility of the iliopsoas muscle group, the Rectus Femoris, pectineus, gracillus as well as the Tensor Fascia Latae and the sartorius.[1] The hip flexors refer to a group of muscles that allow us to lift our knees and bend from the waist. The hip flexors perform various functions, and where some cross over more than one joint. 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 [2] the hip, as various diseases such as patellofemoral pain syndrome [3], lower back pain[4], osteoarthritis and rheumatoid arthritis[5], may be related to this impaired range of motion.

Description[edit | edit source]

The patient is positioned in supine on the examination table and holds the uninvolved knee to his or her chest, while allowing the involved extremity to lie flat. Holding the knee to the chest flattens out the lumbar lordosis and stabilizes the pelvis. [6][1]

Clinically Relevant Anatomy[edit | edit source]

The hip articulation is true diarthroidal ball and-socket style joint, formed from the head of the femur as it articulates with the acetabulum of the pelvis. This joint serves as the main connection between the lower extremity and the trunk, and typically works in a closed kinematic chain. Please follow the link for a more detailed review of the anatomy of the hip joint.

Iliopsoas muscle group
 Main Function
 		Additional feature
M. Iliopsoas
 thigh flexion
 external rotation
M. Rectus Femoris
 thigh flexion
 knee extension
M. Tensor Fascia Latae
 thigh flexion
 internal rotation, abduction
M. Sartorius
 thigh flexion
 knee flexion

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.[7]The patient then lowers the tested limb toward the table. During the test the contralateral hip is held in maximal flexion.[8] The length of the iliopsoas is measured by the angle of the hip flexion.[9]

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.[10] The lumbar spine must remain flat and in contact with the table during the test.[11] The physiotherapist controls the opposite leg to ensure that it maintains full contact with the table.

Interpretation[edit | edit source]

  • 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.[12]
  • 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.[13][14] The following may be comsidered when evoked during the test;
    • The affected knee stays extended – Shortened length of the Quadriceps
    • The affected hip remains flexed – Short Psoas muscles:
    • Abducted affected hip – Short TFL(tensor fasciae latae)/ ITB(iliotibial band)
    • Contralateral hip flexes without knee extension- Tight Iliopsoas
    • Knee extension – Tight Rectus Femoris
    • Lateral rotation of tibia- Tight Biceps Femoris

Consequences: a reduced range of motion may be patellofemoral pain syndrome[15], lower back pain[16], osteoarthritis and rheumatoid arthritis[17]

Reliability[edit | edit source]

Investigation into the validity of tests are important to know whether our tests are reliable or not.[18] Studies that test the reliability of the Thomas study are very limited.[19] One study has demonstrated that the modified Thomas test has a very good inter-rater reliability.[20] Another has demonstrated that the modified Thomas test, has an average of only moderate levels of reliability.[21] In order to prove or to refute the reliability of the Thomas test, further research is required. Peeler et al., 2006 conducted a study examining the reliability of the Thomas test for assessing hip ROM. Their study callsvinto question the reliability of the technique when used to score ROM and ilio-psoas muscle flexibility about the hip joint using both goniometer and pass/fail scoring methods.[22]

References[edit | edit source]

  1. ↑ 1.0 1.1 Harvey D. Assessment of the flexibility of elite athletes using the modified Thomas test. Br J Sports Med 1998 32: 68-70.
  2. ↑ D Harvey. Assessment of the flexibility of elite athletes using the modified Thomas test. Br J Sports Med 1998 32: 68-70.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ John Crawford Adams, David L. Hamblen; Outline of orthopaedics; Churchill Livingstone, 13th edition, 2001 - 459 pagina's
  6. ↑ Jeff G. Konin, Holly Brader. Lumbar Spine Special tests for orthopedic examination. Third edition. USA. Slack Incorporated. 2006.p170
  7. ↑ ↑ D Harvey. Assessment of the flexibility of elite athletes using the modified Thomas test. Br J Sports Med 1998 32: 68-70.
  8. ↑ Jeff G. Konin, Holly Brader. Lumbar Spine Special tests for orthopedic examination. Third edition. USA. Slack Incorporated. 2006.p170
  9. ↑ ↑ Jeffrey Tucker, DC, DACRB. The Psoas and Iliacus: Functional Testing. Dynamic Chiropractic. September 24, 2007, Vol. 25, Issue 20.
  10. ↑ Jeffrey Tucker, DC, DACRB. The Psoas and Iliacus: Functional Testing. Dynamic Chiropractic. September 24, 2007, Vol. 25, Issue 20.
  11. ↑ D Harvey. Assessment of the flexibility of elite athletes using the modified Thomas test. Br J Sports Med 1998 32: 68-70.
  12. ↑ Mark McKean. Postural Screening using the Thomas Test – Part 1. Pistol Australia. P11-13
  13. ↑ Mark McKean. Postural Screening using the Thomas Test – Part 1. Pistol Australia. P11-13.
  14. ↑ D Harvey. Assessment of the flexibility of elite athletes using the modified Thomas test. Br J Sports Med 1998 32: 68-70.
  15. ↑ 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.
  16. ↑ 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.
  17. ↑ John Crawford Adams, David L. Hamblen; Outline of orthopaedics; Churchill Livingstone, 13th edition, 2001 - 459 pagina's
  18. ↑ 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
  19. ↑ 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).
  20. ↑ 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).
  21. ↑ 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
  22. ↑ Peeler J, Anderson JE. Reliability of the Thomas test for assessing range of motion about the hip. Physical Therapy in Sport. 2007 Feb 1;8(1):14-21.
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