Modified Thomas Test

 

As a result of issues arisen from the postural assessment, gait analysis and OHS assessement observing an excessive lumbar lordosis causing APT, it has been decided to perform the Modified Thomas Test (MTT) to assess hip extension flexibility (TFS, Illiotibial band (ITB), Illipsoas, psoas major, and quadriceps (Kim and Park, 2021). Kendall et al., (2005) stated that tightness of the one-joint hip flexors such as iliopsoas, pectineus, and adductor longus and brevis) will occur when subjects are unable to extend hip to a neutral position whereas, two-joint hip flexors tightness (rectus femoris (RF), TFS and sartorius) will occur when knee cannot flex beyond. The client sat supine on the edge of the box, held unilaterally knee against the chest to flattern the back and rolled back on the box (Figure 1 and 2) (Clapis et al., 2008) maintaining the non-tested leg held against his chest fully relaxing the tested leg (Mills et al., 215).  A positve test will result when both one/two joints hip flexors shorteness and lift up from the box  and knee extends (>90°) caused by tight psoas major, illiacus, RM, TFL, sartorios, pectinus and adductor complex muscles (Kendall et al., 2005). Findings of this test are summarized in table  1.

Peeler and Leiter (2012) investigated rectus femoris flexibility implementin MTT and  using digital photos on twenty-eight student. Authors found an excellent intra-rater reliablity among experienced and non-experienced examiners (ICC= 0.90-0.95). Furthermore, Mills et al., (2015) investigated hip-flexor tightness on 20 female soccer players using MTT and found that subjects with tightness in the hip flexors had less gluteus maximus (GM) activation (p<0.008) and lower GM:RF co-activation ratio (p<0.004). Diverse alternative methodological approaches, such as the use of an inclinometer rather than a goniometer, digital photography, comparison by goniometer, and a pass/fail scoring system, have been proposed to enhance the clinical reliability of the MTT (Mill et al., 2015).

       Figure 1. Visual illustration of client performing MTT on box testing left leg. 

          Figure 2. Visual illustration of client performing MTT on box testing left leg. 

Table 1. Movement compensation for Modified Thomas Test assessment (Kendal et al., 2005).

Summary of  Modified Thomas Test Movement Compensations
Observations	Compensation	Muscle Tightness
Lumbar spine	Slightly increase Lordosis	Hip Flexors
LEFT SIDE Shortness of two-joint hip flexors. (positive test)	Posterior thigh does touch table Knee extends >90°	Rectus femoris, tensor fasciae latae, sartorius
RIGHT SIDE Shortness of one-joint hip flexors. (positive test)	Posterior thigh does not touch box ( slightly lifted)  Knee flexes >80°	Iliopsoas, pectineus, adductor longus/brevis/magnus

 

 References:

Clapis, P. A., Davis, S. M., and Davis, R. O. (2008) ‘Reliability of inclinometer and goniometric measurements of hip extension flexibility using the modified Thomas test.’ Physiotherapy Theory and Practice, 24(2), pp.135–141.

Kendall, F.P., McCreary, E.K., and Provance, P.G. (2005) Muscles testing and function, 5th ed, .Baltimore, MD, Williams & Wilkins.

Kim, S., and Park, J. (2021). ‘Patients with chronic unilateral anterior knee pain experience bilateral deficits in quadriceps function and lower quarter flexibility: a cross-sectional study.’ Physiotherapy Theory and Practice,pp. 1–13.

Mills, M., Frank, B., Goto, S., Blackburn, T., Cates, S., Clark, M., Aguilar, A., Fava, N., Padua, D (2015) ‘Effect of Restricted Hip Flexor Muscle Length on Hip Extensor Muscle Activity and Lower Extremity Biomechanics in College-Aged Female Soccer Players.’ International Journal of Sports Physical Therapy, 10(7), pp. 946-54.

Peeler, J., and Leiter, J. (2012)’Using digital photography to document rectus femoris flexibility: A reliability study of the modified Thomas test.’ Physiotherapy Theory and Practice, 29(4, pp. 319–327.