Thomas Test: Difference between revisions
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{{#ev:youtube|9fdHMryWbpI}} <ref>Liverpool Chiropractic & Sports Injury Clinic. Hip Mobility Assessment | Modified Thomas Test. Available from https://www.youtube.com/watch?v=9fdHMryWbpI (accessed 28/11/2020).</ref> | {{#ev:youtube|9fdHMryWbpI}} <ref>Liverpool Chiropractic & Sports Injury Clinic. Hip Mobility Assessment | Modified Thomas Test. Available from https://www.youtube.com/watch?v=9fdHMryWbpI (accessed 28/11/2020).</ref> | ||
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.<ref name=":0">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).</ref> The lumbar spine must remain flat and in contact with the table during the test.<ref name="HARVEY" /> The physiotherapist controls the opposite leg to ensure that it maintains full contact with the table. | 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.<ref name=":0">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).</ref> The [[Lumbar Anatomy|lumbar spine]] must remain flat and in contact with the table during the test.<ref name="HARVEY" /> The physiotherapist controls the opposite leg to ensure that it maintains full contact with the table. | ||
== 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 10° hip extension. The knee must be able to make a 90° flexion.<ref name=":1"> | 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 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> | ||
The test is positive when: | The test is positive when: | ||
* Subject is unable to maintain their lower back and sacrum against the table | * 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° | * [[Hip]] has a large posterior tilt or hip extension greater than 15° | ||
* Knee unable to meet more than 80° flexion | * [[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" | ||
| Line 60: | Line 60: | ||
|- | |- | ||
|Extended knee | |Extended knee | ||
|Quadriceps, rectus femoris | |[[Quadriceps Muscle|Quadriceps]], [[Rectus Femoris|rectus femoris]] | ||
|- | |- | ||
|Flexed hip | |Flexed hip | ||
| Line 66: | Line 66: | ||
|- | |- | ||
|Abducted hip | |Abducted hip | ||
|Tensor Fascia | |[[Tensor Fascia Lata|Tensor fascia lata]], [[Iliotibial Tract|iliotibial band]] | ||
|- | |- | ||
|Tibia lateral rotation | |Tibia lateral rotation | ||
|Biceps femoris | |[[Biceps Femoris|Biceps femoris]] | ||
|} | |} | ||
| Line 75: | Line 75: | ||
Studies that test the reliability of the Thomas study are very limited. | 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.<ref> | One study has demonstrated that the modified Thomas test has a very good inter-rater reliability.<ref>Gabbe BJ, Bennell KL, Wajswelner H, Finch CF. [https://www.sciencedirect.com/science/article/abs/pii/S1466853X04000227 Reliability of common lower extremity musculoskeletal screening tests.] Physical Therapy in Sport 2004;5(2):90-7.</ref> Another has demonstrated that the modified Thomas test, has an average of only moderate levels of reliability.<ref name=":2">Clapis PA, Davis SM, Davis RO. [https://www.tandfonline.com/doi/abs/10.1080/09593980701378256 Reliability of inclinometer and goniometric measurements of hip extension flexibility using the modified Thomas test.] Physiotherapy theory and practice 2008;24(2):135-41.</ref> Further research is required to prove or to refute the reliability of the Thomas test. | ||
Peeler | 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 Anatomy|hip joint]] using both goniometer and pass/fail scoring methods.<ref>Peeler J, Anderson JE. [https://www.sciencedirect.com/science/article/abs/pii/S1466853X06001404 Reliability of the Thomas test for assessing range of motion about the hip.] Physical Therapy in Sport. 2007;8(1):14-21.</ref> | ||
== References == | == References == | ||
<references /> | <references /> | ||
Revision as of 13:38, 28 November 2020
Original Editor - Tyler Shultz
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Purpose[edit | edit source]
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, pectineus, gracillis as well as the tensor fascia latae and the sartorius.[1]
Impaired range of motion of the hip may be an underlying cause to other conditions such as patellofemoral pain syndrome[2], lower back pain[3], osteoarthritis and rheumatoid arthritis.[4]
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 a posterior tilt of the pelvis.[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.[5] The length of the iliopsoas is measured by the angle of the hip flexion.[6]
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.[6] 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]
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 10° hip extension. The knee must be able to make a 90° flexion.[8]
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;
| 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.[9] Another has demonstrated that the modified Thomas test, has an average of only moderate levels of reliability.[10] 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.[11]
References[edit | edit source]
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Adams JC, Hamblen DL. Outline of Orthopaedics. 13th edition. Churchill Livingstone, 2001. p.459.
- ↑ Konin JG, Brader H. Lumbar Spine Special tests for orthopedic examination. Third edition. USA: Slack Incorporated. 2006. p170.
- ↑ 6.0 6.1 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).
- ↑ Liverpool Chiropractic & Sports Injury Clinic. Hip Mobility Assessment | Modified Thomas Test. Available from https://www.youtube.com/watch?v=9fdHMryWbpI (accessed 28/11/2020).
- ↑ McKean M. Postural Screening using the Thomas Test, Part 1. Australian Pistol Shooters' Bulletin. 2005:11-13.
- ↑ 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.
- ↑ 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.
- ↑ 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.
