CLIENT ASSESSMENT HIP

GENERAL FLEXIBILITY n Test hamstring flexibility by sit and reach test (see box 2). n Check iliotibial band flexibility in long sitting (see box 2).

MUSCLE STRENGTH TESTING This can be extremely useful – use your own resistance if no machines are available. Note that groups of muscles often produce more than one direction of movement. n Hip flexors – iliopsoas, rectus femoris, sartorius n Hip extensors – gluteus maximus and hamstrings n Hip abductors and internal rotators – gluteus medius and minimus, tensor fascia lata n External rotators – piriformis, superior and inferior gemellus, obturator externus and internus n Hip adductors – adductor magnus, longus and brevis, gracilis n Knee extensors and hip flexors - quadriceps group n Knee flexors and hip extensors - hamstring group

SPECIFIC TESTS As with most joints there are many special tests for the hip joint. The ones outlined below are used commonly.

Ober’s test Performing the test: Patient on side lying on the unaffected side. Upper knee bent to 90o

BOX 1: HIP JOINT RANGE OF MOVEMENT BOX 1: HIP JOINT RAN

The hip joint is a multi-axial, ball and socket joint. Range of movement:-

Flexion Extension

Internal rotation External rotation Abduction Adduction

Flexion with bent knee up to

90o 30o 40o 50o 50o 30o 130o

Skyline test Performing the test: Patient supine with both hips flexed to about 45o and knees flexed to 90o

. Look at the

Figure 1: Ober’s test

Figure 2: Quadrant test

height of each patella from the foot of the couch to see any tibial length discrepancies. For femur length look at the lateral view. Results: Positive if one knee is higher than other. This demonstrates tibial length inequality. One knee more anterior to the other means femoral discrepancy is demonstrated. The cause of leg length discrepancy may be congenital, the result of a previous fracture, bone growth disorders or degenerative joint disease. If leg length discrepancy is found it is essential to have full leg measurements and appropriate scans carried out. Be aware if you try to measure leg length there are many external factors which can affect the result eg. muscle spasm/ shortening, habitual posture or poor biomechanics.

Figure 3: Skyline test

Thomas test Performing the test: Patient supine flexes one knee to chest and grasps this leg behind the knee to gently pull to end range, while keeping the other leg straight. Check for any lifting of the straight leg. Results: Positive result for hip contracture, tight rectus femoris or iliopsoas if any lifting of straight leg.

. Stabilise the pelvis

with one hand, hold top leg at ankle. Abduct, extend and then internally rotate hip. BE CAREFUL NOT TO STRESS KNEE JOINT. Results: If hip pain is felt this is positive for hip pathology. If trochanteric pain is elicited this is positive for trochanteric bursitis.

Quadrant test Performing the test: Patient supine, affected leg hip and knee at 90o

Figure 4: Thomas test . Hold

leg at ankle and on top of knee joint. Combine hip flexion, adduction and internal rotation. If you reproduce the patient’s pain you can suspect intra- articular hip pathology. Results: Pain or crepitus demonstrates hip pathology, possibly osteoarthritis or synovitis. If no result on rotation of joint, try full circumduction if patient can tolerate the movement. Again a positive result indicates arthritis or synovitis.

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Figure 5: Trendelenburg test

Trendelenburg test Performing the test: Patient standing, ask to stand on one leg. Check the iliac crests. Repeat to stand on other leg. Results: Positive result if the iliac crest on the standing leg is high with the non-weight bearing one low. This demonstrates hip abductor weakness, gluteal muscles weak, general poor musculature, possible earlier disease eg. Perthes, poliomyelitis, hip dislocation or fracture.

NOTE As stated in a previous article (1) it is always worth searching around the whole area when dealing with the hip joint and using extra tests such as x-ray, scans and gait analysis to assist accurate assessment and successful treatment.

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