Positioning: Patient lies supine while the examiner stands on the involved side and passively flexes and adducts the patient’s hip. Patient’s involved knee is also in full flexion.
Action: Examiner applies a downward pressure along the shaft of the femur while adducting and externally rotating the hip. The examiner then repeats this motion but with abduction and internal rotation of the hip.
Positive Findings: Pain, catching/grinding, or patient apprehension is indicative of hip joint pathology such as arthritis, osteochondral defects, avascular necrosis, or acetabular labrum defects.
Positioning: The patient lies supine with both knees flexed against the chest and the buttocks near the edge of the table. The examiner stands with one hand on the lumbar spine or iliac crest to monitor lumbar lordosis or pelvic tilt
Action: The patient slowly lowers the test leg until the leg is fully relaxed, or until anterior pelvic tilting or an increase in lumbar lordosis occurs
Positive Findings: A lack of hip extension with knee flexion greater than 45 degrees is indicative of the iliopsoas tightness. Full hip extension with knee flexion of less than 45 degrees is indicative of rectus femoris tightness. Any hip external rotation is indicative of IT band tightness.
Positioning: The patient lies on the unaffected side with the affected leg in slight hyperflexion. The patient flexes the unaffected knee towards the chest.
Action: The examiner stabilizes the pelvis and extends the patient’s affected leg
Positive Findings: Pain in the sacroiliac region may be indicative of the sacroiliac joint dysfunction
Positioning: The patient lays on the unaffected side with the affected leg at 60 degrees of hip flexion and relaxed knee flexion. The examiner stands with the proximal hand on the patient’s pelvis and the distal hand on the subject’s knee.
Action: The examiner applies a downward force on the subject’s knee
Positive Findings: Tightness or pain in the hip or buttock areas are indicative of piriformis tightness. Pain in the buttock and posterior thigh is indicative of sciatic nerve impingement secondary to piriformis tightness.
Special Tests
Positioning: The patient lies supine with knees and hips extended and parallel.
Action: With a tape measure, the examiner measures from the most distal point of the anterior superior iliac spine (ASIS) to the most distal point of the medial malleolus.
Positive Findings: A difference of more than one centimeter is indicative of discrepancies in either the length of the femur or tibia, or in the angle of the femoral neck inclination.
Positioning: The patient lies supine with knees and hips extended and parallel.
Action: With a tape measure, the examiner measures from the umbilicus to the most distal point of the medial malleolus
Positive Findings: A difference of more than one centimeter is indicative of abnormal pelvic positioning
Positioning: The patient lies prone. The examiner stands on the affected side and places one hand over the ipsilateral pelvic region
Action: The examiner passively flexes the subject’s knee and notes the reaction of the hip joint. The opposite side is also tested for comparison
Positive Findings: If the hip flexes when the knee flexes, it is indicative of a tight rectus femoris
Positioning: The patient lies supine while the examiner places a hand on each side of the iliac crests and anterior superior iliac spines.
Action: The examiner compresses downward and inward at a 45 degree angle
Positive Findings: Pain is indicative of sacroiliac joint dysfunction
Reference
Positioning: Patient is supine
Action: The patient flexes, abducts, and externally rotates the involved leg until the foot rests on top of the opposite knee. The examiner then slowly abducts the knee towards the table.
Positive Findings: When the involved leg does not abduct below the level of the uninvolved leg, it may be indicative of iliopsoas, sacroiliac, or hip joint abnormalities
Positioning: Patient stands on one leg
Action: The patient stands on one leg for approximately ten seconds then switches legs and repeats
Positive Findings: When the pelvis on the unsupported side drops lower than the supported side, it is indicative of a weak gluteus medius on the supported side.
Positioning: Patient lies on unaffected side with hips and knees extended. The examiner stands with the proximal hand stabilizing the pelvis and the distal hand supporting the superior lower leg.
Action: The examiner abducts and extends the hip and then allows the leg to lower.
Positive Findings: The inability of the leg to adduct is indicative of iliotibial (IT) band tightness.
Positioning: The patient lies on the unaffected side with the hip and knee slightly flexed. The examiner places one hand on the lateral aspect of the patient’s pelvis while the other hand supports the patient’s leg.
Action: The patient slightly flexes his or her head while the examiner extends the patient’s hip approximately 15 degrees and flexes the patient’s knee
Positive Findings: Pain along the anterior thigh may be indicative of decreased mobilization of the femoral nerve