Thomas Test

Original Editor - Tyler Shultz

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Purpose

Hip Flexors

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

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

Relevant Anatomy

Hip flexors perform various functions, and some cross over more than one joint.  They consist of the iliopsoas, rectus femoris, sartorius, tensor fasciae latae, pectineus, gracillus, adductors and a gluteus muscles.

• The iliopsoas muscle that has the strongest pull and compressive effect on our spine. It is attached to the L1-L5 and T1 vertebrae.  A tight psoas often compresses the spine and the discs associated.
• A chronic state of shortening can lead to low back pain.

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

• Patient is supine ,with lower gluteal folds at the end of the table and their hips and knees flexed. (Patient may hold the legs in flexion with their hands).
• Therapist makes sure that the patient’s lower back is in a neutral pelvic tilt.
• Patient keeps the unaffected leg flexed, and slowly lowers the affected leg and lets it extend as far as it can.

Interpretation

Thomas test: 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

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. The lumbar spine must remain flat and in contact with the table during the test.

The physiotherapist controls the opposite leg to ensure that it maintains full contact with the table.

Viewing

An easy test to perform, as shown in this 40 second video.

Thomas Test video provided by Clinically Relevant

This 40 second video shows the modified test.

Reliability

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

1. One study has demonstrated that the modified Thomas test has a very good inter-rater reliability. Another has demonstrated that the modified Thomas test, has an average of only moderate levels of reliability. Further research is required to prove or to refute the reliability of the Thomas test.
2. 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.