Knee Flexion
Motion occurs primarily at the tibiofemoral joint in the sagittal plane around a coronal axis.
Normal Values:
0° to 135° (135°)
Testing Position:
Client is positioned prone with foot unsupported by the table. Hip is also placed in 0° of flexion, extension, rotation, abduction and adduction. If the knee when fully extended place a towel or roll under the proximal thigh and allow for total knee extension.
Stabilization:
Stabilize the femur to prevent movement of the hip.
Goniometer Placement:
A: Center the goniometer at the lateral joint line.
SA: Using the greater trochanter as a reference, align the arm along the lateral midline of the upper leg.
MA: Align arm with the lateral midline of the fibula, referencing the lateral malleolus.
Assessment:
Maintain goniometric placement and flex the knee to the point of first restriction. Hold and take measurement.
Possible Tight Structures:
Rectus Femoris, knee capsule.
Recording the assessment:
When recording the results make sure that any necessary notes are added to ensure intratester and intertester reliability.
Hip Flexion (Knee Flexed)
Motion occurs primarily at the iliofemoral joint in the sagittal plane around a coronal axis.
Normal Values:
0° to 120° (120°) with knee flexed
Testing Position:
Client is positioned supine with the knee fully flexed, and the hip is in 0° of abduction, adduction, and rotation. Knee is flexed to shorten the hamstrings that would have a limiting effect on hip flexion if they are tight.
Note: If client reports a pinching sensation in the front of the hip during this assessment, the iliopsoas may be tight.
Stabilization:
Stabilize the pelvis to prevent rotation, tilting posteriorly.
Goniometer Placement:
A: Center the goniometer at the lateral thigh using the greater trochanter as a reference.
SA: Lateral midline of the pelvis.
MA: Lateral midline of the femur.
Assessment:
Maintain goniometric placement and flex the hip to the point of first restriction or pelvis rotates posteriorly. Hold and record measurement.
Possible Tight Structures:
Gluteals, adductor magnus, hamstrings
Recording the assessment:
When recording the results make sure that any necessary notes are added to ensure intratester and intertester reliability.
Hip Flexion (Straight Leg)
Motion occurs primarily at the iliofemoral joint in the sagittal plane around a coronal axis.
Normal Values:
0° to 70° – 90° (70° – 90°) with straight leg
Testing Position:
Client is positioned supine with the knee fully extended, and the hip is in 0° of abduction, adduction, and rotation.
Stabilization:
Stabilize the pelvis to prevent rotation, tilting posteriorly. Avoid allowing the pelvis to rise from the table as hip is flexed.
Goniometer Placement:
A: Center the goniometer at the lateral thigh using the greater trochanter as a reference.
SA: Mid-axillary line of the trunk.
MA: Lateral midline of the femur.
Assessment:
Maintain goniometric placement and flex the hip to the point of first resistance or pelvic rotation. Hold and record measurement.
Possible Tight Structures:
Hamstrings, gluteals, gastrocnemius, neural tissue (refer to neurodynamic assessment)
Recording the assessment:
When recording the results make sure that any necessary notes are added to ensure intratester and intertester reliability.
Knee Extension (90/90)
Motion occurs primarily at the iliofemoral and iliofemoral joint in the sagittal plane around a coronal axis.
Normal Values:
0° to 20° – 90° (20° – 90°) (with knee flexed at 90° / hip flexed 90°)
Testing Position:
Client is positioned supine with the hip flexed at 90°, and knee flexed at 90°. Hip is in 0° of rotation, abduction, and adduction.
Stabilization:
Stabilize the pelvis to prevent rotation or a posterior pelvic tilt.
Goniometer Placement:
A: Center the goniometer at the lateral joint line of the iliofemoral joint.
SA: Lateral midline of the femur.
MA: Lateral midline of the fibula.
Assessment:
Passively extend the knee until the first resistance barrier is noted or until the pelvis rotates posteriorly. Hold and record measurement.
Possible Tight Structures:
Hamstrings, gastrocnemius, neural tissue.
Recording the assessment:
When recording the results make sure that any necessary notes are added to ensure intratester and intertester reliability.
Internal Hip Rotation
Motion occurs primarily at the iliofemoral joint in the transverse plane around a longitudinal axis.
Normal Values:
0° to 45° (45o)
Testing Position:
Client is positioned supine with the hip flexed to 90°, and 0° of abduction and adduction. The knee is also flexed to 90°.
Stabilization:
Stabilize the pelvis to prevent lateral tilting, and femoral adduction.
Goniometer Placement:
A: Center the goniometer over the anterior aspect of the patella.
SA: Imaginary line (in the direction of the tibial crest) perpendicular to the anterior midline of the femur.
MA: Anterior midline of the lower leg, referencing the tibia crest.
Assessment:
Maintain goniometric placement and passively internally rotate the femur until the point of first resistance is noted, hold, and record measurement.
Possible Tight Structures:
Piriformis and hip external rotators (gemellus superior, gemellus inferior, obturator externus, obturator internus, quadratus femoris), ischiofemoral ligament, posterior joint capsule.
Recording the assessment:
When recording the results make sure that any necessary notes are added to ensure intratester and intertester reliability.
External Hip Rotation
Motion occurs primarily at the iliofemoral joint in the transverse plane around a longitudinal axis.
Normal Values:
0° to 45° (45o)
Testing Position:
Client is positioned supine with the hip flexed to 90°, and 0° of abduction and adduction. The knee is also flexed to 90°.
Stabilization:
Stabilize the pelvis to prevent lateral tilting, and femoral adduction.
Goniometer Placement:
A: Center the goniometer over the anterior aspect of the patella.
SA: Imaginary line (in the direction of the tibial crest) perpendicular to the anterior midline of the femur.
MA: Anterior midline of the lower leg, referencing the tibia crest.
Assessment:
Maintain goniometric placement and passively externally rotate the femur until the point of first resistance is noted, hold, and record measurement.
Possible Tight Structures:
Tensor fascia latae, gluteus medius, gluteus minimus, hip capsule.
Recording the assessment:
When recording the results make sure that any necessary notes are added to ensure intratester and intertester reliability.
Thomas Test
The test for hip flexor length is often referred to as the Thomas Test or Modified Thomas Test. The Thomas Test can be used to determine the muscle length of the following muscles:
Iliopsoas
Rectus Femoris
Tensor Fasciae Latae (TFL)
Sartorius
For the purpose of this seminar we will look at only two of these muscle length assessments; the iliopsoas and rectus femoris.
Iliopsoas:
Motion occurs primarily at the iliofemoral joint in the sagittal plane around a coronal axis
Normal Values:
0° to -5o (5o)
(Note that the starting position begins with a 5o posterior pelvic tilt)
Testing Position:
The client is positioned supine with the pelvis supported by the table. The opposite hip and knee are fully flexed in a “knee-to-chest” position. The client holds this position manually.
Stabilization:
Stabilize the pelvis to prevent anterior tilting. Stabilize the femur to prevent abduction.
Goniometer Placement:
A: Center the goniometer fulcrum at the greater trochanter.
SA: Lateral midaxillary line of the trunk.
MA: Lateral midline of the femur, referencing the lateral epicondyle.
Assessment:
Extremity to be measured is relaxed and hangs unsupported while client manually holds knee-to-chest position. Palpate the ASIS and passively extend the involved hip until first resistance barrier or motion of the ASIS is noted. The client then actively holds hip in position so measurement can be recorded.
Possible Tight Structures:
Psoas, iliacus, rectus Femoris, tensor fascia latae, sartorius, adductor complex, anterior hip capsule.
Rectus Femoris:
Motion occurs primarily at the iliofemoral and iliofemoral joints in the sagittal plane around a coronal axis.
Normal Values:
0 to 90° (90°)
Testing Position:
Client is positioned supine with pelvis supported by the table. The opposite hip and knee are fully flexed in a “knee-to-chest” position. Client holds this manually.
Stabilization:
Stabilize the pelvis to prevent anterior tilting. Stabilize the femur to prevent abduction.
Goniometer Placement:
A: Center the goniometer at the lateral joint line of the knee.
SA: Using the greater trochanter as a reference, align the arm along the lateral midline of the upper leg.
MA: Align arm with the lateral midline of the fibula, referencing the lateral malleolus.
Assessment:
Measurement includes knee flexion with the rectus femoris pre-stretched.
Possible Tight Structures:
Rectus Femoris, quadriceps muscle group.
Recording the assessment:
When recording the results make sure that any necessary notes are added to ensure intratester and intertester reliability.