The goal of passive range of motion assessment is to assess the osteokinematic movements of a joint to evaluate the range of motion in degrees and if range of motion is limited, to evaluate the end-feel. According to studies by Charlton et al. (2015) and Prather at al. (2010) passive range of motion assessment of the hip joint had moderate to excellent intra-tester reliability and poor to excellent inter-tester reliability depending on the  movement that was examined. The following table shows standard values for passive hip range of motion:

For flexion of the patient in supine lying position close to the long edge of the treatment bench. Then palpate the anterior superior iliac spine on the side to be examined to monitor one’s end range of motion is reached and the pelvis starts to move. With the other hand grab on to the distal femur with the lower leg can rest on your forearm or stay in a flexed position. Then move into flexion and assess the end-feel.

For extension, have the patient in prone lying position close to the long edge of the bench. Then, fixate the pelvis at the ischial tuberosity with the hypothenar aspect of one hand. With the other hand grab onto the distal femur and perform passive hip extension and assess the end-feel.

For internal rotation, the first option is to test in 90 degrees of flexion while the patient lies supine. So bring the patient’s leg into flexion while your forearm supports the lower leg and your hand can cup the knee to protect it against valgus torque when you perform internal rotation. You can also assess internal rotation with the hip in neutral. This can be done supine with the leg hanging over the edge of the bench or in prone position where you again fixate the ischial tuberosity.

For external rotation, the same applies as for internal rotation. So you can test in both 90° of hip flexion in supine position or in neutral hip position Fro abduction the patient lies in supine position close to the long edge of the bench. With one hand palpate the ipsilateral anterior superior iliac spine with the thumb. The remaining fingers of that hand can stay in contact with the bench. With your other hand, pick up the patient’s leg at the knee so that the patient’s lower leg is supported on your forearm and perform abduction passively, while your other hand monitors movement at the pelvis. Once you approach the end range and assess the end feel.

For adduction, the patient lies in supine position with the foot of the non-tested leg placed laterally to the knee of the leg to be examined. The patient’s leg is supported on your forearm and the thumb of the other hand palpates the anterior superior iliac spine on the contralateral side to monitor movement at the pelvis.

If you want to learn how to assess active range of motion in the hip joint, click here.

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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References

McKay MJ, Baldwin JN, Ferreira P, Simic M, Vanicek N, Burns J, 1000 Norms Project Consortium. Normative reference values for strength and flexibility of 1,000 children and adults. Neurology. 2017 Jan 3;88(1):36-43.

Soucie JM, Wang C, Forsyth A, Funk S, Denny M, Roach KE, Boone D, Hemophilia Treatment Center Network. Range of motion measurements: reference values and a database for comparison studies. Haemophilia. 2011 May;17(3):500-7.BibTeXEndNoteRefManRefWorks

Charlton PC, Mentiplay BF, Pua YH, Clark RA. Reliability and concurrent validity of a Smartphone, bubble inclinometer and motion analysis system for measurement of hip joint range of motion. Journal of Science and Medicine in Sport. 2015 May 1;18(3):262-7.

Prather H, Harris-Hayes M, Hunt DM, Steger-May K, Mathew V, Clohisy JC. Reliability and agreement of hip range of motion and provocative physical examination tests in asymptomatic volunteers. PM&R. 2010 Oct 1;2(10):888-95.