Leg Lowering Test

Original Editor - Khloud Shreif
Top Contributors - Khloud Shreif and Kim Jackson

Introduction

Double leg lowering test (DLLT) general test to assess the core muscles, is like curl up and sit-up test used to assess the abdominal muscles. DLLT is more challenging test than curl-up developed to assess and examine lower abdominal muscle fibers and will be more representative to be used in the lumbar stabilization program but unlike crul-up or sit-up in which they work to flex the trunk against gravity, during DLLT the muscles work eccentrically during lowering the limbs[1][2].

Purpose

The purpose of the test to assess abdominal muscles and the ability of muscles to maintain the posterior pelvic tilting position against the load (lowering both lower limbs from the vertical position).

The test shows great association for rectus abdominis muscle, moderate association with the external oblique, internal oblique, and transversus abdominis[3]

Technique

It is important to be a landmark to ensure if the abdominal muscles can contract enough and keep the pelvis in the posterior tilting position or not. We can use a pressure cuff, or our hand to palpate a bony landmark.

Procedures:

  • The subject lies supine on a flat surface, both arms rested across his chest or under the head. Head, and arms be fixed.
  • First, the examiner raises the patient's lower leg vertically as high as it is possible to assess the flexibility of the hamstring.
  • The examiner explains the procedure to the patient and he/she try it once.
  • Blood pressure cuff placed at the pelvis level and inflated for about 40 mmHg.
  • The subject is instructed to lower both legs with the extended knee from the vertical position down while keeping the pelvis in the posterior tilting position, and the pressure cuff used as feedback to try to maintain the starting inflated pressure.
  • During the test, if the pressure on your hand or the cuff is decreased, stop the test and the angle should be measured as follows (angle measure from the table before pelvis tilt anterior):

starting position: 90॰ from the table

Poor(2/2): Able to reach 75-90॰ from the table.

Fair(3/3): Able to reach 46-75॰ from the table.

Good(4/4): Able to reach 16-45॰ from the table.

normal(5/5): 0-15॰ from the table[2].

[4]

Hip flexors and abdominal muscles work eccentrically together to control the lowering of the limb, as legs lower there is an increase in the resistance to hold the pelvis in position.

Evidence

Reliability

Intraclass correlation coefficient.98[1].

A prospective descriptive study carried on to investigate the kinematic movement of the pelvis during DLLT on a sample consist of 17 young fit adults, divided into two groups, the first group instructed to do the test while trying to control the pelvis, and the second group descends without trying to control the pelvis tilting.

the study concluded, there was a natural tendency for anterior pelvic tilting that increase through the range, anterior pelvic tilt 1° for 3.6° of lower limb lowering from early DLLT[5].

References

  1. 1.0 1.1 Krause DA, Youdas JW, Hollman JH, Smith J. Abdominal muscle performance as measured by the double leg-lowering test. Archives of physical medicine and rehabilitation. 2005 Jul 1;86(7):1345-8.
  2. 2.0 2.1 O'Sullivan PB, Phyty GD, Twomey LT, Allison GT. Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine. 1997 Dec 15;22(24):2959-67.
  3. Haladay DE, Denegar CR, Miller SJ, Challis J. Electromyographic and kinetic analysis of two abdominal muscle performance tests. Physiotherapy theory and practice. 2015 Nov 17;31(8):587-93.
  4. Lauren Green. Double Leg Lowering Test - A Core Stability Assessment. Available from: http://www.youtube.com/watch?v=tvGf9MwdLCE[last accessed 25/1/2021]
  5. Zannotti CM, Bohannon RW, Tiberio D, Dewberry MJ, Murray R. Kinematics of the double-leg-lowering test for abdominal muscle strength. Journal of Orthopaedic & Sports Physical Therapy. 2002 Sep;32(9):432-6.