to be more representative of glenohumeral movement (Awan et al., 2002).
However, there is a learning element for the measurer in this test, which could affect standardisation on subsequent testing.
Active knee extension test/passive knee extension test
This test is considered to be more specific to hamstrings as opposed to the straight leg raise where neural structures are often a limiting factor (Sullivan et al., 1992;
de Weijer et al., 2003). The active knee extension (AKE) was proposed by Gajdosk and Lusin (1983) as a modification of the straight leg raise but there has been some argument about its inter- tester reliability (Worrell et al., 1991).
Consequently the test has since been modified to a passive version and both intra-and inter-tester reliability has been reported elsewhere (Gajdosik et al., 1993).
● The subject to be tested lies supine with to be tested held at 90 hip flexion and 90 knee flexion. The contralateral leg is straight.
● AKE – the subject actively extends the knee whilst maintaining the hip at 90 or
● Passive knee extension (PKE) – the subject’s knee is passively extended whilst maintaining the hip at 90.
● Range of movement is measured by the angle of knee flexion using goniometer, inclinometer or motion analysis software.
Hip abduction – adductors/groin
● The subject lies supine with legs straight.
● The tester fixes the opposite hip over the pelvis.
● The subject then slides their leg out to the side as far as possible whilst keeping their toes pointed upwards.
● The angle of abduction can then be measured from the midline using a goniometer, inclinometer or motion analysis software.
Tip: Rotation of the pelvis or the hip can alter the range of movement signifi-cantly and therefore need to be standardised between tests.
Hip adduction – tensor fascia latae and iliotibial band
The iliotibial band is a structure that can become shortened in a variety of sports involving running. Adduction of the hip is therefore a useful movement to assess the length of tensor fascia latae and the iliotibial band.
● The subject lies on their side with the leg to be tested uppermost and with their back close to the edge of the testing surface.
● The upper leg is dropped off the edge of the surface, behind the body.
● The angle of drop can be measured using a goniometer, inclinometer or motion analysis software.
Tip: Anything less than 10⬚ of movement is generally regarded as abnormal (Kendall et al., 1997).
Thomas test
The Thomas test is a specific test for hip flexor flexibility as described by Kendall et al. (1997). It can be modified through altering knee flexion to include or exclude rectus femoris as a component in the range. Maintaining a straight knee excludes rectus femoris. Adding knee flexion in the test position will assess the length of rectus femoris following assessment of the hip flexors.
● The subject leans back against the edge of a treatment couch or table.
● The non-test thigh is held firmly as closely to the chest as possible.
● The subject lowers into a supine position on the treatment couch or table, whilst maintaining the hip position of the non-test leg.
● The angle of the test thigh to the floor can be measured using a goniometer, inclinometer or motion analysis software (Figure 10.5).
● Rectus femoris range can then be measured by passively flexing the knee.
● The knee angle can then be measured using a goniometer, inclinometer or motion analysis software.
Note that the Thomas test is a sensitive test but requires an appropriate testing surface that is not always possible when testing in the field. The following test also assesses hip flexor movement.
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Figure 10.5 Measuring hip flexor length using the Thomas test
Prone hip extension
● The subject lies prone on the test surface.
● The test leg is lifted whilst keeping the knee in extension.
● The angle of the leg to the test surface can then be measured using a goniometer, inclinometer or motion analysis software (Figure 10.6).
● Adding knee flexion to this movement will introduce rectus femoris as an additional component in the test.
Tip: Ensure that the pelvis is kept in contact with the test surface to prevent the subject from rotating the trunk in order to compensate for any lack of movement.
Typical range of movement would be 10⬚.
Hip rotation
Isolated hip rotation is a useful measure for some sports, particularly when links have been made with limited hip movement through the kinetic chain to upper limb injuries, particularly in sports involving throwing (Kibler, 1995, Kraemer, et al., 1995). The following test is useful for isolating hip movement easily but a limitation is that it will be most transferable to sporting activities that happen in some flexion, which is not the case for throwing activities. However, limitations of hip rotation in a throwing position are often still highlighted by testing in this position but adaptation of the test to be performed in supine might need to be considered for some screening situations.
Figure 10.6 Measuring hip flexor length in prone lying
Internal rotation
● The subject lies supine with the test hip and knee at 90 and the foot relaxed.
● The hip is moved into internal rotation (foot away from midline of body).
● The angle of rotation can be measured using a goniometer, inclinometer or motion analysis software.
External rotation
● The subject lies supine with the test hip and knee at 90 and the foot relaxed.
● The hip is moved into external rotation (foot towards midline of body).
● The angle of rotation can be measured using a goniometer, inclinometer or motion analysis software.
Knee extension
Although knee flexion is frequently measured as an outcome measure following injury and also during function to assess efficacy in activities such as landing, it is not usually regarded as a measure of flexibility and knee measurement has therefore been restricted to extension for these purposes.
Knee extension, or more importantly hyperextension, is a commonly used measure of general flexibility in athletes.
● The subject lies supine with knees straight.
● Extension, or hyperextension is then performed passively or actively, depending on the required protocol.
● The angle is then measured from the tibia to the horizontal using a goniometer, inclinometer or motion analysis software.
Tip: This test can also be performed in standing but care should be taken to standardise hip and ankle positions, which can confound the readings.
Ankle dorsiflexion
The ankle joint has two major plantar flexors, gastrocnemius and soleus. The former is a two joint muscle, extending over the knee, whilst the latter is a single joint muscle originating from the tibia. It is therefore important that both the following dorsiflexion tests are completed to ensure assessment of the flexibility of both muscles.
Ankle dorsiflexion with straight knee – gastrocnemius bias
● The subject is in stride standing and leans forward onto arms (Figure 10.7).
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● The pelvis is kept in posterior tilt, the hip and knee in extension.
● The rear foot is taken as far back as possible whilst still keeping the heel on the floor.
● The angle of the lower leg to the foot is then measured from the horizon-tal or the dorsum of the foot, using a goniometer, inclinometer or motion analysis software.
Ankle dorsiflexion with bent knee – soleus bias
● The subject is in stride standing and leans forward onto arms (Figure 10.8).
● The pelvis is kept in posterior tilt, the hip in extension.
● The rear foot is taken as far back as possible whilst still keeping the heel on the floor additional dorsiflexion can then be achieved through knee flexion.
● The angle of the lower leg to the foot is then measured from the horizon-tal or the dorsum of the foot, using a goniometer, inclinometer or motion analysis software.
Figure 10.7 Measuring gastrocnemius length in stride standing
Ankle dorsiflexion with bent knee – soleus bias – alternative method
● The subject is in stride standing and leans forward onto arms.
● The test leg is placed up against a wall.
● The foot is then placed as far from the wall as possible whilst still being able to maintain the knee in contact with the wall and the heel on the floor.
● The maximal distance where this position can be achieved is then recorded with a tape measure.
Ankle plantar flexion
● The subject lies supine with knees straight. A rolled towel may need to be put under the calf or the feet placed over the edge of a bed to allow heel movement.
● The toes are pointed down, either actively or passively depending on the chosen protocol.
Figure 10.8 Measuring soleus length in stride standing 96 NICOLA PHILLIPS
● The angle of the dorsum of the foot to plantigrade (90 to the tibia) using a goniometer, inclinometer or motion analysis software.