Thomas Test: Difference between revisions

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== Purpose ==
== Purpose ==
The Thomas Test (also known as Iliacus Test or Iliopsoas Test) is used to measure the flexibility of the hip flexors, which includes the iliopsoas muscle group, the [[Rectus Femoris|rectus femoris]], [[Pectineus Muscle|pectineus]], [[Gracilis|gracillis]] as well as the [[Tensor Fascia Lata|tensor fascia latae]] and the [[sartorius]].<ref name="HARVEY">Harvey D. [https://bjsm.bmj.com/content/bjsports/32/1/68.full.pdf Assessment of the flexibility of elite athletes using the modified Thomas test.] British Journal of Sports Medicine 1998;32(1):68-70.</ref>  
[[File:Hip flexors.png|alt=Hip Flexors|thumb|300x300px|Hip Flexors]]
The Thomas Test is used to measure the flexibility of the [[Hip Flexors|hip flexors]].<ref name="HARVEY">Harvey D. [https://bjsm.bmj.com/content/bjsports/32/1/68.full.pdf Assessment of the flexibility of elite athletes using the modified Thomas test.] British Journal of Sports Medicine 1998;32(1):68-70.</ref>
 
# Impaired range of motion of the hip may be an underlying cause to other conditions such as: psoas syndrome; [[Patellofemoral Pain Syndrome|patellofemoral pain syndrome]]<ref>Tyler TF, Nicholas SJ, Mullaney MJ, McHugh MP. [https://www.researchgate.net/profile/Malachy_Mchugh2/publication/7406016_The_Role_of_Hip_Muscle_Function_in_the_Treatment_of_Patellofemoral_Pain_Syndrome/links/53e0de210cf2d79877a50852.pdf The role of hip muscle function in the treatment of patellofemoral pain syndrome.] The American journal of sports medicine 2006;34(4):630-6.</ref>; [[Low Back Pain|lower back pain]]<ref>Marrè-Brunenghi G, Camoriano R, Valle M, Boero S. The psoas muscle as cause of low back pain in infantile cerebral palsy. Journal of Orthopaedics and Traumatology 2008;9(1):43-7.</ref>, [[osteoarthritis]]; [[Rheumatoid Arthritis|rheumatoid arthritis]].<ref>Adams JC, Hamblen DL. Outline of Orthopaedics. 13th edition. Churchill Livingstone, 2001. p.459.</ref>
# Often associated with runners, dancers, and gymnasts who complain of hip "stiffness" and reported "snapping" feeling when flexing at the waist.<ref>OrthoFixar [https://www.orthofixar.com/special-test/thomas-test/ Thomas test] Available: https://www.orthofixar.com/special-test/thomas-test/<nowiki/>(accessed 18.1.2022)</ref>


Impaired range of motion of the hip may be an underlying cause to other conditions such as [[Patellofemoral Pain Syndrome|patellofemoral pain syndrome]]<ref>Tyler TF, Nicholas SJ, Mullaney MJ, McHugh MP. [https://www.researchgate.net/profile/Malachy_Mchugh2/publication/7406016_The_Role_of_Hip_Muscle_Function_in_the_Treatment_of_Patellofemoral_Pain_Syndrome/links/53e0de210cf2d79877a50852.pdf The role of hip muscle function in the treatment of patellofemoral pain syndrome.] The American journal of sports medicine 2006;34(4):630-6.</ref>, [[Low Back Pain|lower back pain]]<ref>Marrè-Brunenghi G, Camoriano R, Valle M, Boero S. The psoas muscle as cause of low back pain in infantile cerebral palsy. Journal of Orthopaedics and Traumatology 2008;9(1):43-7.</ref>, [[Osteoarthritis|osteoarthritis]] and [[Rheumatoid Arthritis|rheumatoid arthritis]].<ref>Adams JC, Hamblen DL. Outline of Orthopaedics. 13th edition. Churchill Livingstone, 2001. p.459.</ref>
== Clinically Relevant Anatomy  ==
== Clinically Relevant Anatomy  ==
The [[Hip Anatomy|hip joint]] is a diarthroidal ball and-socket style joint, formed from the head of the [[femur]] as it articulates with the acetabulum of the [[pelvis]]. It serves as the main connection between the lower extremity and the trunk, and typically works in a closed kinematic chain.   
The [[Hip Anatomy|hip joint]] is a diarthroidal ball and-socket style joint, formed from the head of the [[femur]] as it articulates with the acetabulum of the [[pelvis]]. It serves as the main connection between the lower extremity and the trunk, and typically works in a [[Closed Chain Exercise|closed kinematic chain.]]  
   
   
There are various muscles making up the hip flexor group being tested in the Thomas Test:  
There are various muscles making up the hip flexor group being tested in the Thomas Test:  
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<clinicallyrelevant id="83479983" title="Thomas Test" />
<clinicallyrelevant id="83479983" title="Thomas Test" />


The patient should be supine on the examination table, maximally flex both knees, using both arms to ensure that the lumbar spine is flexed and flat on the table and avoids an anterior tilt of the pelvis.<ref name="HARVEY" />
The patient should be supine on the examination table, maximally flex both knees, using both arms to ensure that the [[Lumbar Anatomy|lumbar spine]] is flexed and flat on the table and avoids an anterior [[Pelvic Tilt|pelvic tilt]].<ref name="HARVEY" />


The patient then lowers the tested limb toward the table, whilst the contralateral hip and knee is still held in maximal flexion to stabilize the pelvis and flatten out the lumbar lordosis.<ref>Konin JG, Brader H. Lumbar Spine Special tests for orthopedic examination. Third edition. USA: Slack Incorporated. 2006. p170.</ref>&nbsp;The length of the iliopsoas is measured by the angle of the hip flexion.<ref name=":0" />
The patient then lowers the tested limb toward the table, whilst the contralateral hip and knee is still held in maximal flexion to stabilize the pelvis and flatten out the lumbar lordosis.<ref>Konin JG, Brader H. Lumbar Spine Special tests for orthopedic examination. Third edition. USA: Slack Incorporated. 2006. p170.</ref>&nbsp;The length of the iliopsoas is measured by the angle of the hip flexion.<ref name=":0" />
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== Interpretation ==
== Interpretation ==
The Thomas test is negative when the subject's lower back and the sacrum is able to remain on the table. The hip can make a 10° posterior tilt or a &nbsp;10° hip extension. The knee must be able to make a 90° flexion.<ref name=":1">McKean M. Postural Screening using the Thomas Test, Part 1. Australian Pistol Shooters' Bulletin. 2005:11-13.</ref>
If the iliopsoas muscle is shortened, or a contracture is present, the lower extremity on the involved side will be unable to fully extend at the hip. This constitutes a positive Thomas test.<ref>Medical Dictionary Thomas Test Available:https://medical-dictionary.thefreedictionary.com/Thomas+test (accessed 18.1.2022)</ref>


The test is positive when:
* Subject is unable to maintain their lower back and sacrum against the table
* [[Hip]] has a large posterior tilt or hip extension greater than 15°
* [[Knee]] unable to meet more than 80° flexion
The following structures may be considered during a positive test;
The following structures may be considered during a positive test;
{| class="wikitable"
{| class="wikitable"

Revision as of 01:37, 18 January 2022

Original Editor - Tyler Shultz

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Purpose[edit | edit source]

Hip Flexors
Hip Flexors

The Thomas Test is used to measure the flexibility of the hip flexors.[1]

  1. Impaired range of motion of the hip may be an underlying cause to other conditions such as: psoas syndrome; patellofemoral pain syndrome[2]; lower back pain[3], osteoarthritis; rheumatoid arthritis.[4]
  2. Often associated with runners, dancers, and gymnasts who complain of hip "stiffness" and reported "snapping" feeling when flexing at the waist.[5]

Clinically Relevant Anatomy[edit | edit source]

The hip joint is a diarthroidal ball and-socket style joint, formed from the head of the femur as it articulates with the acetabulum of the pelvis. It serves as the main connection between the lower extremity and the trunk, and typically works in a closed kinematic chain.

There are various muscles making up the hip flexor group being tested in the Thomas Test:

Iliopsoas muscle group
 Main Function
 		Additional movement
Iliopsoas
 Hip flexion
 External rotation
Rectus femoris
 Hip flexion
 Knee extension
Tensor fascia lata
 Hip flexion
 Internal rotation, abduction
Sartorius
 Hip flexion
 Knee flexion

Technique[edit | edit source]

Thomas Test video provided by Clinically Relevant

The patient should be supine on the examination table, maximally flex both knees, using both arms to ensure that the lumbar spine is flexed and flat on the table and avoids an anterior pelvic tilt.[1]

The patient then lowers the tested limb toward the table, whilst the contralateral hip and knee is still held in maximal flexion to stabilize the pelvis and flatten out the lumbar lordosis.[6] The length of the iliopsoas is measured by the angle of the hip flexion.[7]

[8]

A modified version of the test is one in which the patient lies down on their back, at the very edge of the table, with both legs hanging freely. The patient must then flex their knee and pull it back to their chest as close as they can, using both arms while doing so. The other leg can hang down.[7] The lumbar spine must remain flat and in contact with the table during the test.[1] The physiotherapist controls the opposite leg to ensure that it maintains full contact with the table.

Interpretation[edit | edit source]

If the iliopsoas muscle is shortened, or a contracture is present, the lower extremity on the involved side will be unable to fully extend at the hip. This constitutes a positive Thomas test.[9]

The following structures may be considered during a positive test;

Sign Structures affected
Extended knee Quadriceps, rectus femoris
Flexed hip Psoas muscles
Abducted hip Tensor fascia lata, iliotibial band
Tibia lateral rotation Biceps femoris

Reliability[edit | edit source]

Studies that test the reliability of the Thomas study are very limited.

One study has demonstrated that the modified Thomas test has a very good inter-rater reliability.[10] Another has demonstrated that the modified Thomas test, has an average of only moderate levels of reliability.[11] Further research is required to prove or to refute the reliability of the Thomas test.

Peeler & Anderson conducted a study in 2006 examining the reliability of the Thomas test for assessing hip range. Their study calls into question the reliability of the technique when used to score range of motion and iliopsoas muscle flexibility about the hip joint using both goniometer and pass/fail scoring methods.[12]

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 Harvey D. Assessment of the flexibility of elite athletes using the modified Thomas test. British Journal of Sports Medicine 1998;32(1):68-70.
  2. ↑ Tyler TF, Nicholas SJ, Mullaney MJ, McHugh MP. The role of hip muscle function in the treatment of patellofemoral pain syndrome. The American journal of sports medicine 2006;34(4):630-6.
  3. ↑ Marrè-Brunenghi G, Camoriano R, Valle M, Boero S. The psoas muscle as cause of low back pain in infantile cerebral palsy. Journal of Orthopaedics and Traumatology 2008;9(1):43-7.
  4. ↑ Adams JC, Hamblen DL. Outline of Orthopaedics. 13th edition. Churchill Livingstone, 2001. p.459.
  5. ↑ OrthoFixar Thomas test Available: https://www.orthofixar.com/special-test/thomas-test/(accessed 18.1.2022)
  6. ↑ Konin JG, Brader H. Lumbar Spine Special tests for orthopedic examination. Third edition. USA: Slack Incorporated. 2006. p170.
  7. ↑ 7.0 7.1 Dr. Jeffrey Tucker. The Psoas and Iliacus: Functional Testing. Available from: https://drjeffreytucker.com/2009/09/the-psoas-and-iliacus-functional-testing/ (accessed 28/11/2020).
  8. ↑ Liverpool Chiropractic & Sports Injury Clinic. Hip Mobility Assessment | Modified Thomas Test. Available from https://www.youtube.com/watch?v=9fdHMryWbpI (accessed 28/11/2020).
  9. ↑ Medical Dictionary Thomas Test Available:https://medical-dictionary.thefreedictionary.com/Thomas+test (accessed 18.1.2022)
  10. ↑ Gabbe BJ, Bennell KL, Wajswelner H, Finch CF. Reliability of common lower extremity musculoskeletal screening tests. Physical Therapy in Sport 2004;5(2):90-7.
  11. ↑ Clapis PA, Davis SM, Davis RO. Reliability of inclinometer and goniometric measurements of hip extension flexibility using the modified Thomas test. Physiotherapy theory and practice 2008;24(2):135-41.
  12. ↑ Peeler J, Anderson JE. Reliability of the Thomas test for assessing range of motion about the hip. Physical Therapy in Sport. 2007;8(1):14-21.
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