Hip Resisted Isometric Testing

Resisted Isometric Strength Testing can give you a quick indication of your patient’s muscular status and possible pain provocation. To quantify muscle strength, you could use the MRC scale, but you should make sure to test both sides.

To conduct resisted isometric testing, you should place the joint in a resting or neutral position, as stress on the inert structures is minimal and any symptoms produced are then likely to be caused by problems in musculotendinous tissues.

Make sure to inform your patient properly on what you’re going to do. You could say: “I’m going to give resistance to this movement and please do not let me move you.”During resisted isometric testing, the limb should not move, thus inducing an isometric contraction.

You should have good anatomy knowledge when conducting resisted isometric testing to know which muscles could be affected. For example, the gluteus maximus is the only muscle that is involved in all of the following movements: extension, adduction, and external rotation.

So if your patient is complaining about pain during all of these three movements. You can be pretty sure that the gluteus maximus is affected.

For flexion, bring the hip into roundabout 60 degrees of flexion, support the lower leg, and give resistance into extension.

To assess extension, bring the leg into roundabout 30 degrees of flexion and give resistance into flexion direction.

To conduct resisted isometric testing for adduction, pick up the leg, put one hand distal to the knee and one hand proximal to the knee and ask your patient to bring the legs together while you give resistance.

To conduct resisted isometric testing in the direction of abduction, pick up the leg, put one hand distal to the knee, and one hand proximal to the knee, and ask your patient to move the leg outwards.

To conduct resisted isometric testing for internal rotation of the hip, flex your patient’s hip to 90 degrees and ask your patient to move the ankle outwards while you give resistance.

To conduct resisted isometric testing of the hip in the direction of external rotation, flex your patient’s hip to about 90 degrees and then ask your patient to move the ankle inwards while you give resistance.

When conducting resisted isometric testing of the hip joint, you would also assess extension and flexion at the knee joint because the rectus femoris muscle as well as the hamstrings are biarticular muscles that run over both the hip and the knee joint.

For knee flexion, have one hand proximal to the ankle joint, flex the hip to roundabout 30 degrees, and ask your patient to give resistance.

For extension, place your underarm under the leg and have your hand rest on the opposite leg. Put the other hand proximal to the ankle joint and ask your patient to extend the leg.

When you apply resistance to a certain movement, make sure to hold that resistance for at least 5 seconds.

Other parts of basic hip joint assessment are:

• Active Range of Motion (AROM) Assessment of the Hip
• Passive Range of Motion (PROM) Assessment of the Hip

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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