Hip Manual Muscle Testing

Hip flexion

Muscles: Iliopsoas, quads, sartorius, TFL

Grade 4 & 5: Patient is seated at the end of the bed, holding onto the bed. Examiner stands on the testing side, resistance is applied to the distal femur.

Grade 3: Patient is seated at the end of the bed, holding onto the bed. “Raise your knee to the ceiling.”

Grade 2: Sidelying, test leg up and lower leg flexed. Examiner cradles the test leg and the opposite hand stabilizes the hip. “Bring your knee to your chest.”

Grade 1: Palpate distal to inguinal ligament on medial side of sartorius.

Substitution for hip flexion

Sartorius - external rotation of the hip

Rectus femoris - extension of the knee

TFL - internal rotation and abduction of the hip

Adductors - adduction of the hip

Iliopsoas - Grade 3 and above

Patient is supine-lying, hip flexed, knee extended, slight external rotation.

Examiner stands on opposite side of testing limb, stabilizing the opposite iliac crest. Resistance is on anteromedial aspect of testing leg.

Sartorius - Grade 3 and above

Grade 3: Patient is seated, hip flexed, abducted and externally rotated, and knee flexed. Examiner sits on test side. Resistance is applied on the distal thigh and anteromedial surface of leg.

Grade 2: Patient is supine, heel of test limb placed on contralateral shin (slides shin up to knee).

Palpate: Medial side of thigh where muscle crosses femur or origin below ASIS.

Hip extension

Muscles: Hamstring, gluteus maximus

Grade 4 & 5: Resistance is applied on the knee or ankle

Grade 3: Patient prone, arms can be overhead or holding onto the bed. Examiner is on test side. “Raise your leg to the ceiling.”

Grade 2: Side-lying, test leg up and lower leg flexed. Examiner cradles the test leg and the opposite hand stabilizes the hip. “Bring your leg back towards me.”

Grade 1: Palpate on the gluteus Maximus.

Gluteus Maximus - Grade 3

Alternative test

Patient is prone, knee flexed to 90°, hip extended. Examiner stands on test side, one hand stabilizes the hip. Resistance is applied on the distal femur.

Alternative: Prone with test hip in full external rotation, knee extended, hip extended. Examiner stands on test side and stabilizes over the pelvis. Resistance is applied on distal femur.

Hip abductors

Muscles: Gluteus medius and minimus, sartorius, TFL

Grade 4 & 5: Resistance is applied on the lateral knee.

Grade 3: Patient is side-lying, lower leg flexed. Test leg is slightly extended and pelvis rotated forward. Examiner is on test side. “Raise your leg to the ceiling.”

Grade 2: Supine. Examiner stabilizes pelvis. “Bring your leg to the side.”

Grade 1: Palpate on the gluteus medius on the greater trochanter.

Substitution for hip abduction

Lateral trunk muscle - hip hiking

External rotators - hip flexion

TFL - hip flexion

Tensor fascia lata

Grade 3: Patient is side-lying, lower leg is extended and test leg is in 45° of hip flexion and abducted to 30°. Examiner stand behind test leg and stabilizes pelvis. Resistance is applied on lateral distal femur.

Alternative: Supine, test limb in partial abduction and medially rotated, knee extended. Patient raises thigh into 45° of hip flexion. Resistance is applied on the anterolateral aspect of ankle.

Grade 2: Long-sitting, leaning backward to 45° and abducts leg to 30°

Palpation: Insertion of TFL on lateral aspect of knee.

Gluteus minimus - Grade 3

Patient is side-lying, lower leg bent and test limb abducted.

Examiner stands behind test limb and stabilizes hip. Resistance is applied on the lateral ankle.

Gluteus medius - Grade 3

Patient is side-lying, lower leg bent and test limb abducted. Slight extension and external rotation of the leg.

Examiner stands behind test limb and stabilizes hip. Resistance is applied on the lateral ankle.

Hip adduction

Muscles: Adductor magnus, adductor longis, adductor brevis, pectineus, gracilis

Grade 4 & 5: Resistance is applied on the medial distal femur.

Grade 3: Patient is side-lying, upper non-testing leg is extended and abducted to 25° and lower test leg is extended. “Lift your bottom leg to your top leg.”

Grade 2: Supine. Non-test leg is slightly abducted. “Bring your leg inwards to the other leg.”

Grade 1: Palpate adductor mass on the proximal medial thigh.

Hip external rotation

Muscles: Piriformis, quadratus femur, obturator internus, obturator externus, gemellus superior, gemellus inferior

Grade 4 & 5: Resistance is applied on the medial ankle.

Grade 3: Patient is short-sitting. Examiner kneels at test limb and applies counterpressure laterally on top of the knee.

Grade 2: Supine, leg extended. Test limb is in internal rotation.“Roll your leg out.”

Grade 1: External rotators are not palpable except the gluteus Maximus. Look for any discernible movement.

Substitution for external rotation

Lateral trunk leaning

Hip internal rotation

Muscles: TFL, gluteus minimus, gluteus medius (ant. fibers)

Grade 4 & 5: Resistance is applied on the medial ankle.

Grade 3: Patient is short-sitting. Examiner kneels on the opposite side of test limb and applies counterpressure medially on top of the knee.

Grade 2: Supine, leg extended. Test limb is in external rotation. “Roll your leg in.”

Grade 1: Palpate gluteus medius over greater trochanter. TFL below the ASIS.

Substitution for hip internal rotation

Pelvic elevation