Ober Test Overview | Iliotibial Band Tightness

The Ober Test is used for iliotibial band syndrome (Tight ITB) or for tensor fascia latae TFL contraction or inflammation.

How do you do the Ober test?

• The patient is in lateral position with the affected hip upward, unaffected knee and hip should be flexed to flatten the lumbar spine curve.
• The examiner Stands behind the patient and firmly stabilizes the pelvic/ greater trochanter with the left hand to prevent movement of the pelvis.
• Then the examiner grasps the distal end of the patient’s affected leg with his right hand and flexes the leg to a right angle at the knee joint, and extends and abducts the hip joint.
• Then he slowly lowers the leg toward the table -adducting the hip- until motion is restricted.
• Make sure that the hip does not internally rotated and flexed during the test, and the pelvis must be stabilized, as allowing the thigh to drop in flexion and internal rotation would ‘give in’ to the tight tensor fascia latae (TFL) and not accurately test the length.

See Also: Thomas Test

A goniometer can be used to quantify the results. The proximal arm is aligned with both ASISs, and the distal arm is aligned with the midline of the thigh. An inclinometer can be placed over the lateral femoral condyle. If the leg remains in abduction relative to 0°, it is recorded as a negative value. If the leg adducts past 0°, it is recorded as a positive value.

See Also: IT Band Friction Syndrome

Another way of doing the test where both sides can be compared is by doing it in prone position on a fat surface. The examiner stands on the side opposite the side being tested and places the hip to be tested in maximum abduction at the hip, holding the lower leg near the ankle. The examiner ensures that the pelvis is fattened without any flexion at the hip by using the other hand. Now the examiner tries to adduct the limb with the knee in 90° flexion, and the angle between the vertical axis of the body and the thigh quantifies the residual abduction beyond which adduction is not possible.

What does a positive Ober test mean?

Ober test is considered positive or negative in these conditions:

If the ITB is normal, the leg will adduct with the thigh dropping down slightly below the horizontal and the patient won’t experience any pain; in this case, the Ober’s test is negative (the hip must be able to adduct past the midline of the body.).

If the ITB is tight, the leg would remain in the abducted position and the patient would experience lateral knee pain, in this case, the Ober’s test is positive.

Modified Ober Test

The modified Ober test is performed with patient side-lying with examined leg up, the knee of the tested leg is extended, the examiner abducts and extends the hip until the hip is in line with the trunk. Examiner allows gravity to adduct hip as much as possible.

Ober & Modified Obers Test Accuracy

There are No studies support the accuracy of the Obers test for measuring iliotibial band tightness.

A study by Reese and Bandy was performed to determine the intrarater reliability of the Ober test and the modified Ober test for the assessment of IT band flexibility using an inclinometer to measure the hip adduction angle and to determine if a difference existed between the measurements of IT band flexibility between the Ober and the modified Ober test.

This study concluded that the use of an inclinometer to measure hip adduction using both the Ober test and the modified Ober test appears to be a reliable method for the measurement of IT band flexibility, and the technique is quite easy to use.

In one study by Melchione & Sullivan found that the intratester and intertester reliability of ober test are very good (ICC = 0.94 and 0.73, respectively).

However, given that the modified Ober test allows significantly greater hip adduction ROM than the Ober test, the two examination procedures should not be used interchangeably as a measurement of IT band flexibility.

Notes

• A contracted, nonelastic quadriceps muscle and shortened hamstring muscles cause an increase in the retropatellar pressure.
• Shortening of the iliotibial tract can lead to chronic pain on the lateral side and over its connection to the lateral patellar retinaculum as well as leading to functional disturbances in the femoro-patellar joint.
• Stretching the iliotibial tract often helps in lateral displacement of the patella with excessive lateral pressure.
• Even though the tension in the iliotibial tract is greater when the knee is extended, Ober described the test with flexed knee.
• In addition, when the knee is bent, the femoral nerve may be stretched during the course of the ober test.
• If neurologic symptoms occur, such as paresthesias and/or radiating pain, then there is suspicion of L3–L4 nerve root irritation.
• Pain over the greater trochanter suggests trochanteric tendinopathy or bursitis.

Related Anatomy:

 Tensor fasciae latae (tensor fasciae femoris):

• Tensor fasciae latae originates from Anterior iliac crest.
• It inserts on Iliotibial band.
• Innervated by the Superior gluteal nerve (L4-S1).

Iliotibial Band:

The iliotibial band is a thickening of fascia that runs over the lateral side of the femur, it’s also known as Maissiat’s band.

Proximally, it originates from the deep fascia of the thigh, gluteus maximus, and tensor fascia lata (TFL).

Distally it inserts on Gerdy’s tubercle on the proximal/lateral tibia. Proximal ITB function includes:

1. Hip extension
2. Hip abduction
3. Lateral hip rotation.

ITB function depends on the position of the knee joint:

• 0 degrees/full extension to 20 to 30 degrees of flexion: Active knee extensor: The ITB lies anterior to the lateral femoral epicondyle.
• 20 to 30 degrees of flexion to full flexion ROM: Active knee flexor: ITB lies posterior relative to the lateral femoral epicondyle

Reference

1. Willett, Gilbert M.; Keim, Sarah A.; Shostrom, Valerie K.; Lomneth, Carol S. (11 January 2016). “An Anatomic Investigation of the Ober Test”. The American Journal of Sports Medicine. 44 (3): 696–701.
2. Ober, F. R. (1936). “The role of the iliotibial band and fascia lata as a factor in the causation of low-back disabilities and sciatica”. Journal of Bone and Joint Surgery. 18: 105–110.
3. Scott Hyland; Steven Graefe; Matthew Varacallo: Anatomy, Bony Pelvis and Lower Limb, Iliotibial Band (Tract)
4. Reese NB, Bandy WD. Use of an inclinometer to measure flexibility of the iliotibial band using the Ober test and the modified Ober test: differences in magnitude and reliability of measurements. J Orthop Sports Phys Ther. 2003 Jun;33(6):326-30. doi: 10.2519/jospt.2003.33.6.326. PMID: 12839207.
5. Melchione W.E. & Sullivan M.S., 1993, ‘Reliability of measurements obtained by use of an instrument designed to indirectly measure iliotibial band length’, Journal of Orthopaedic & Sports Physical Therapy 18, 511–515. 10.2519/jospt.1993.18.3.511.
6. 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.
7. Herrington, L, Rivett, N, and Munro, S: The relationship between patella position and length of the iliotibial band as assessed using Ober’s test. Man Ther, 11:182, 2006.
8. Reese, NB, and Bandy, WD: Use of an inclinometer to measure flexibility of the iliotibial band using the Ober test and modified Ober test: differences in the magnitude and reliability of measurements. J Orthop Sports Phys Ther, 33:326, 2003.
9. Campbel’s Operative Orthopaedics 13th Edition Book
10. Clinical Tests for the Musculoskeletal System 3rd Ed. Book.
11. Netter’s Orthopaedic Clinical Examination An Evidence-Based Approach 3rd Edition Book.