Muscle Length Testing

Mr. R van Bever Donker

2017

Lower Quadrant

Modified Thomas Test

• Patient (P) sits on foot end of plinth (ischial tuberosities at

the edge), holds on to 1 knee, rolls backwards onto plinth,
both legs flexed
• Therapist (T) stands next to plinth on side of the tested leg,
support P while rolling back
• P pulls knee up towards the chest until the lumbar spine
flattens onto the table, ensuring that the sacrum does not
lift off the table into Lx-pelvic flexion
• P uses both hands holding the knee to support this flat back
position
• T passively positions and supports the leg to be tested in 90°
hip and knee flexion in the midline of the body

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 Modified Thomas Test

• T passively lowers the leg down towards the plinth

while monitoring the maintenance of the lumbo-
pelvic position
• Ideally the hip should passively extend sufficiently
to allow the thigh to rest off the table with the lx-
pelvic region in the flat back position, the femur in
the midline of the body and the knee flexed to 90°
(+ or - 5°)
• There should be no hip rotation/abd/add or tibial
lateral rotation for a normal Thomas test

Modified Thomas Test

• If shortened rectus femoris (RF)- the knee is passively

extended to unload tension from RF and hip ROM observed
(should increase extension if RF tight)
• If shortened ITB then hip will be in some abduction
• If shortened ilio-psoas (or ant hip capsule) knee is passively
extended to unload RF and hip ROM is observed. Should
remain same

Piriformis

• In neutral hip it is an external rotator, beyond 60° it becomes

an internal rotator
• In neutral
• Prone
• Internally rotate both lower limbs (feet move outward) to compare
ROM, normal is 45°
• At 90°
• Supine
• Hip flexed to 90°
• Externally rotate hip
• Ensure the hip remains in 90° flexion during test – no abduction /
adduction

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 Tensor Fascia Latae (TFL)

• P in side lying, with back close to edge of plinth.

Limb to be tested lying superior
• T takes the upper leg – straight knee – into some
abduction
• Then into some hip extension (to place TFL over the
greater trochanter)
• Then adduction of the straight leg
• Careful that the pelvis remains stabilized and
movement is not due to lateral trunk flexion

Hamstrings

• Method 1 – passive SLR

• Pt supine
• neutral spine, upper-limbs, lower-limbs
• Grasp ankle below malleoli (IF and thumb)
• Palpate ASIS – be sure to be able to feel for pelvic
movement
• Slowly lift the straight leg until pelvis posterior tilts
• NB= be sure to feel for increase tone changes ie
resistance to movement prior to pelvic rotation
• NB = can change to support knee if indicated and observe
pelvis for movement

Hamstrings

• Method 2 – active knee extension (AKE)

• Starting position as above
• Passively bring testing limb up to 90° hip flexion and
support the tibia with caudad forearm
• Place hand of supporting (caudad) arm behind knee,
cephalad hand palpates ASIS as above
• Patient actively extends the knee – knee ROM is assessed
• NB = look at effort of technique, greater effort equals
tighter or increased tone of hamstrings, or weak quads
(relate to clinical findings)

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 Hamstrings

• Method 3 – passive knee extension in 90°

• Starting position as above until supporting tibia with
caudad arm
• Change hands – cephalad hand stabilizes knee and
ensure 90° hip flexion is maintained, caudad hand
grasps ankle below malleoli (IF and thumb) and
passively extends the knee

Quadriceps

• Vastes group
• Pure knee flexion with hip flexed (this also checks the ROM at
the knee joint
• Whole group (vastes and rectus Femoris)
• In prone
• Pt lying flat, head down on plinth
• Cephalad hand on pelvis
• Caudad hand grasps ankle and gently flexes the knee until
touching buttocks
• NB = look for anterior pelvic tilt during movement (can stabilize
pelvis and do again)
• NB = feel for increased tension / tone prior to pelvic movement

Soleus

• Pt prone / pt supine with hip and knee flexed / patient

standing with knee flexed
• NB = the knee must be flexed
• Pt prone
• Knee flexed to 90°, apply maximal dorsiflexion within
comfort
• Supine
• Knee flexed to 90°, apply maximal dorsiflexion within
comfort (also assesses ankle joint DF ROM)
• Standing
• Place foot with toes against wall, flex knee until patella
touches wall. Heel must not lift off floor (normal). Increase
distance from wall and measure as needed (also assesses
ankle joint DF ROM)

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 Gastrocnemius

• Pt prone / pt supine with knee extended / patient

standing with knee extended
• Prone
• Foot off end of bed with sufficient rom to fully dorsiflex
• Apply dorsiflexion
• Supine
• Ensure knee extended, apply dorsiflexion
• Standing
• Place foot on an an incline board, keeping knee extended
move pelvis anteriorly to increase DF

Upper Quadrant

Erector Spinae

• Patient in 4 point kneeling

• Rounded back (increased Tx kyphosis)
• Sits back on haunches leaving the hands where they
are
• T observes movement, back should remain curved
as pelvis tilts posteriorly
• If thoracic ES tight the thoracic spine will lose kyphosis
during the movement
• If remains rounded then move one hand across to other
hand – spine should laterally flex evenly. Compare to
other side

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 Latissimus Dorsi

• P supine
• GHJ is externally rotated, fully flexed with some
abduction
• Arm should lie flat on plinth
• Signs of shortness
• Arm cannot lie flat
• Inferior angle of scapula ‘pops’ laterally
• Arching of Tx and Lx spine
• Correct by – crook lying, posterior pelvic tilt, ensure
inferior angle scapula remains behind chest wall.
Done bilaterally can be a stretch at home

Levator Scapula (LS)

• P supine
• Scapular depression
• Contralateral lateral flexion
• Contralateral Rotation (away from side being
tested)
• Cervical flexion (nose into armpit)
• Release scapular depression – if can go further
into flexion then +LS

Upper Fibres of Trapezius (UFT)

• P supine
• Scapular depression
• Contralateral lateral flexion
• Ipsilateral rotation (to the side being tested)
• Cervical flexion (ear to armpit)
• Release scapular depression – if can go further into
flexion then +UFT

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 Sternocleidomastoid (SCM)

• P supine
• Head off end of plinth
• Tuck chin in (retraction)
• Lateral flexion away
• Ipsilateral Rotation (towards testing side)
• Ipsilateral mastoid process should move away from
sternum laterally and posteriorly

Scalenes

• Anterior scalene
• P supine, head off end of plinth, slight Extension of neck
• Rotation towards testing side.
• Lateral flexion away
• Intermediate (middle) scalene
• P supine, head off end of plinth, slight Extension of neck
• Lateral flexion away
• Posterior scalene
• P supine, head off end of plinth, slight Extension of neck
• Rotation away from testing side
• Lateral flexion away

Pectoralis Minor

• P supine, arms by side

• Locate arch of acromion process (not head of
humerus)
• Compare height of arch on left and right
• Tight pec minor results in higher acromion

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 Pectoralis Major

• P supine
• Clavicular portion
• Abduct humerus to 90°
• Lateral rotation of humerus
• Elbow and forearm should lie flat on plinth
• Sternocostal portion
• Abduct to around 120°
• Lateral rotation humerus
• Elbow and forearm should lie flat on plinth

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