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Special Test

Hamstring Flexibility

Hamstring Flexibility is important for knee extension, and hamstring muscles contracture causes the knee flexion deformity.

See Also: Thomas Test

How do you test the Hamstring Flexibility?

The popliteal angle test is the most popular method reported in the literature for assessing hamstring Flexibility, especially in the presence of a knee flexion contracture.

  • The patient is placed in the supine position and the opposite hip is extended.
  • The popliteal angle is determined by measuring the angle that the tibia subtends with the extended line of the femur when the ipsilateral hip is flexed to 90 degrees and the knee of the limb under examination is maximally passively extended to initial tissue resistance.

What is the normal and abnormal popliteal angle ?

  • The popliteal angle is at the maximum of 180 degrees from birth to age 2 years.
  • This angle then decreases to an average of 155 degrees by age 6 years and remains steady thereafter.
  • An angle less than 125 degrees suggests significant hamstring tightness.
See Also: Hamstring Muscles

Fingertip Test

Fingertip Test assesses the Hamstring Flexibility.

The patient is seated, holding one leg ( flexed at the hip and knee) close to the trunk with the ipsilateral arm . The other leg remains extended. The patient is requested to touch the toes of the extended leg with the fingertips of the free arm . This test is then repeated on the contralateral side.

In the presence of a hamstring contracture, the patient can only bring the fingertips into the general area of the foot and complains of “pulling” pain in the posterior thigh. The test is positive when there is a difference between the two sides and symptoms are present. Uniform , painless developmental shortening of the hamstrings is common. Restricted motion can result secondary to a spinal disorder or osteoarthritis of the hip.

Symptoms of nerve root irritation can be excluded by other tests. Shortened hamstrings increase retropatellar pressure and can therefore cause retropatellar symptoms.

Fingertip test
Fingertip Test

Note

Hamstring flexibility can also be assessed with a passive straight leg raise, while ensuring that the lumbar spine is flattened on the treatment table and the pelvis is stabilized. However, this method may be used only if there is full extension at the knee of the leg being examined. Normal hamstring length should allow 80–85 degrees of hip flexion when the knee is extended and the lumbar spine is flattened.

ITB Flexibility

The cardinal sign of iliotibial contracture is the presence in a supine patient of an abduction contracture when the hip and knee are extended, which is eliminated when the hip and knee are flexed.

Other tests include the following:

Retinacula Test: The patient is placed in the side-lying position and the knee is fully flexed. This position tightens the ITB. The clinician applies a medial and oblique force to the patella with the thumbs. Approximately 0.5–1 cm of patella motion should be available.

Ober’s Test: The Ober test for ITB length is described in Ober Test.

Quadriceps Flexibility Test: Quadriceps flexibility is examined by placing the patient in prone position and passively flexing the knee, bringing the heel toward the buttocks. The lumbar spine is monitored and stabilized if necessary to prevent motion. The heel should touch the buttocks. An adaptively shortened rectus femoris is usually the structure that prevents this motion.

Quadriceps Flexibility Test
Quadriceps Flexibility Test: (a) Heel reaches buttock. (b) Restricted range of motion due to shortened quadriceps.

Rectus Femoris Muscle Test: Testing of the rectus femoris muscle is carried out in the supine position. The patient uses his or her hands to hold the unaffected leg in maximal flexion. The examiner flexes the knee of the affected leg, which is hanging over the end of the examination table. One can normally attain knee flexion over 90° easily while keeping the hip extended, but shortening of the rectus femoris muscle causes a decrease in knee flexion to less than 90°.

Rectus Femoris Muscle Stretch Test
Rectus femoris muscle test: (a) 90° knee flexion with extended hip. (b) Restricted knee flexion due to shortening of the rectus femoris muscle.

Related Anatomy

The hamstring muscles group consists of: Semitendinosus; Semimembranosus; Biceps femoris.

MuscleOriginInsertionInnervationMain Actions
SemitendinosusIschial tuberosityMedial surface of superior part of tibiaTibial division of sciatic nerve (L5, S1, and S2)Extend hip joint; flex knee joint and rotate it medially; when hip and knee joints are flexed, can extend trunk.
SemimembranosusIschial tuberosityPosterior part of medial condyle of tibia, reflected attachment forms oblique popliteal ligament to lateral femoral condyleTibial division of sciatic nerve (L5, S1, and S2) Extend hip joint; flex knee joint and rotate it medially; when hip and knee joints are flexed, can extend trunk.
Biceps femorisLong head: ischial tuberosity.
Short head: linea aspera and lateral supracondylar line of femur
Lateral side of head of fibula; tendon is split at this site by fibular collateral ligament of kneeLong head: tibial division of sciatic nerve (L5, S1, and S2).
Short head: common fibular (peroneal) division of sciatic nerve (L5, S1, and S2
Flexes knee joint and rotates it laterally; extends hip joint (e.g., when initiating a walking gait)
Hamstring Muscles anatomy
Hamstring Muscles Anatomy

References

  1. Grelsamer RP, McConnell J: Examination of the patellofemoral joint, The Patella: A Team Approach. Gaithersburg, MD: Aspen, 1998:109–118.
  2. Kuo L, Chung W, Bates E, Stephen J. The hamstring index. J Pediatr Orthop. 1997 Jan-Feb;17(1):78-88. PMID: 8989707.
  3. Thompson NS, Baker RJ, Cosgrove AP, Corry IS, Graham HK. Musculoskeletal modelling in determining the effect of botulinum toxin on the hamstrings of patients with crouch gait. Dev Med Child Neurol. 1998 Sep;40(9):622-5. doi: 10.1111/j.1469-8749.1998.tb15428.x. PMID: 9766740.
  4. Gautam VK, Anand S. A new test for estimating iliotibial band contracture. J Bone Joint Surg Br. 1998 May;80(3):474-5. doi: 10.1302/0301-620x.80b3.8285. PMID: 9619940.
  5. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.
  6. Anne MR Agur and Arthur F Dalley, Grant’s Atlas of Anatomy Book. 13th Edition
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