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Minnesota State University, Mankato

Minnesota State University, Mankato
Athletic Training

Manual Muscle Testing

Page address: http://ahn.mnsu.edu/athletictraining/spata/hipmodule/muscletesting.html

Gluteus Maximus

Origin
Posterior gluteal line of ilium and portion of bone superior and posterior to it, posterior surface of lower part of sacrum, side of coccyx, aponeurosis of erector spinae, sacrotuberous ligament, and gluteal aponeurosis
Insertion
Larger proximal portion and superficial fibers of distal portion of muscle into iliotibial tract of fascia lata
Deep fibers of distal portion into gluteal tuberosity of femur
Action
Extends, laterally rotates, and lower fibers assist in adduction of the hip joint
The upper fibers assist in abduction
Through its insertion into the iliotibial tract, helps to stabilize the knee in extension
Nerve
Inferior glueteal L5, S1–2
Patient
Prone with knee flexed 90° or more
(The more the knee is flexed, the less the hip will extend, due to restricting tension of the Rectus femoris anteriorly)
Fixation
Posteriorly, the back muscles, laterally, the lateral abdominal muscles, and, anteriorly, the opposite hip flexors fix the pelvis to the trunk
Test
Hip extension with knee flexed
Pressure
Against the lower part of the posterior thigh in the direction of hip flexion
See Test

Gluteus Medius

Origin
External surface of ilium between iliac crest and posterior gluteal line dorsally, and anterior gluteal line ventrally, gluteal aponeurosis
Insertion
Oblique ridge on lateral surface of greater trochanter of femur
Action
Abducts the hip joint
The anterior fibers medially rotate and may assist in flexion of the hip joint; the posterior fibers laterally rotate and may assist in extension
Nerve
Superior gluteal L4–5, S1
Patient
Side–lying with underneath leg flexed at hip and knee, and pelvis rotated slightly forward to place the posterior Gluteus medius in an antigravity position
Fixation
The muscles of the trunk and the examiner stabilize the pelvis
Test (emphasis on posterior portion)
Abduction of hip with slight extension and slight external rotation
Knee is maintained in extension
Pressure
Against the leg, near the ankle, in the direction of adduction and slight flexion; do not apply pressure against the rotation component
See Test

Gluteus Minimus

Origin
External surface of ilium between anterior and inferior gluteal lines, and margin of greater sciatic notch
Insertion
Anterior border of greater trochanter of femur, and hip joint capsule
Action
Abducts, medially rotates, and may assist in flexion of the hip joint
Nerve
Superior gluteal L4–5, S1
Patient
Side–lying
Fixation
The examiner stabilizes the pelvis
Test
Abduction of the hip in a position neutral between flexion and extension, and neutral in regard to rotation
Pressure
Against the leg in the direction of adduction and very slight extension
See Test

Hip Adductors (Pectineus, Adductor magnus, Gracilis, Adductor brevis, Adductor longus)

Action
Adduction of the hip joint
In addition, the Pectineus, Adductor brevis, and Adductor longus flex the hip joint
Patient
Lying on the right side to test right (and vice versa), body in straight line, with lower extremities and lumbar spine straight
Fixation
The examiner holds the upper leg in abduction
The patient should hold on to the table for stability
Test
Adduction of the underneath extremity upward from the table without rotation, flexion, or extension of the hip, or tilting the pelvis
Pressure
Against the medial aspect of the distal end of the thigh in the direction of abduction
Pressure is applied at a point above the knee to avoid strain of the tibial collateral ligament
See Test

Hip Internal Rotators (Tensor fasciae latae, Gluteus minimus, and Gluteus medium)

Action
Medial rotation of the hip joint
Patient
Sitting on a table with knees bent over side of table, holding on to table
Fixation
The weight of the trunk stabilizes the patient during this test
Stabilization is also given in the form of counterpressure as described below under Pressure
Test
Medial rotation of the thigh, with the leg is position of completion of outward arc of motion
Pressure
Counterpressure is applied by one hand of the examiner at the medial side of the lower end of the thigh
The other hand of the examiner applies pressure to the lateral side of the leg above the ankle, pushing the leg inward in an effort to rotate the thigh laterally
See Test

Iliopsoas

Origin
Ventral surfaces of transverse processes of all lumbar vertebrae, sides of the bodies and corresponding interverebral discs of the last thoracic and all lumbar vertebrae and membranous arches that extend over the sides of the bodies of the lumbar vertebrae
Insertion
Lesser trochanter of femur
Nerve
Lumbar plexus L1–4
Action
With the origin fixed, the Iliopsoas flexes the hip joint by flexion the femur on the truck as in supine alternate leg raising, and may assist in lateral rotation and abduction of the hip joint
With the insertion fixed and acting bilaterally, the Iliopsoas flexes the hip joint by flexion the trunk on the femur as in the sit–up from supine position
Also, acting bilaterally with the insertion fixed, will increase the lumbar lordosis; acting unilaterally, assists in lateral flexion of the trunk toward the same side
Patient
Supine
Fixation
The examiner stabilizes the opposite iliac crest
The Quadriceps stabilize the knee in extension
Test
Hip flexion in a position of slight abduction and slight lateral rotation
Pressure
Against the anteromedial aspect of the leg in the direction of extension and slight abduction
See Test

Biceps Femoris

Origin of Long Head
Distal part of sacrotuberous ligament, and posterior part of tuberosity of ischium
Origin of Short Head
Lateral lip of linea aspera, proximal two thirds of upracondylar line, and lateral intermuscular septum
Insertion
Lateral side of head of fibula, lateral condyle of tibia, deep fascia on lateral side of leg
Action
The long and short heads of the Biceps femoris flex and laterally rotate the knee joint
In addition, the long head extends and assists in lateral rotation of the hip joint
Nerve to Long Head
Sciatic (tibial branch) L5, S1–3
Nerve to Short Head
Sciatic (peroneal branch) L5, S1–2
Patient
Prone
Fixation
The examiner should hold the thigh firmly down on the table
Test
Flexion of the knee between 50° and 70° with the thigh in slight lateral rotation, and the leg in slight lateral rotation on the thigh
Pressure
Against the leg proximal to the ankle in the direction of knee extension
Do not apply pressure against the rotation component
See Test

Semitendinosus

Origin
Tuberosity of ischium by tendon common with long head of Biceps femoris
Insertion
Proximal part of medial surface of body of tibia, and deep fascia of leg
Action
Flexes and medially rotates the knee joint
Extends and assists in medial rotation of the hip joint
Nerve
Sciatic (tibial branch) L4–5, S1–2
Patient
Prone
Fixation
The examiner should hold the thigh firmly on the table
Test
Flexion of the knee between 50° and 70° with the thigh in medial rotation, and the leg medially rotated on the thigh
Pressure
Against the leg proximal to the ankle in the direction of knee extension
Do not apply pressure against the rotation component
See Test

Semimembranosus

Origin
Tuberosity of ischium, proximal and lateral to Biceps femoris and Semitendinosus
Insertion
Posteromedial aspect of medial condyle of tibia
Action
Flexes and medially rotates the knee joint
Extends and assists in medial rotation of the hip joint
Nerve
Sciatic (tibial branch) L4–5, S1–2
Patient
Prone
Fixation
The examiner should hold the thigh firmly on the table
Test
Flexion of the knee between 50° and 70° with the thigh in medial rotation, and the leg medially rotated on the thigh
Pressure
Against the leg proximal to the ankle in the direction of knee extension
Do not apply pressure against the rotation component
See Test

Quadriceps

Origin of Rectus Femoris
Straight head from anterior inferior iliac spine
Reflected head from groove above rim of acetabulum
Origin of Vastus Lateralis
Proximal part of intertrochanteric line, anterior and inferior borders of greater trochanter, lateral lip of gluteal tuberosity, proximal one half of lateral lip of linea aspera, and lateral intermuscular septum
Origin of Vastus Intermedius
Anterior and lateral surfaces of proximal two thirds of body of femur, distal one half of linea aspera, and lateral intermuscular septum
Origin of Vastus Medialis
Distal one half of intertrochanteric line, medial lip of linea aspera, proximal part of medial supracondylar line, tendons of Adductor longus and Adductor magnus, and medial intermuscular septum
Insertion
Proximal border of patella and through patellar ligament to tuberosity of tibia
Nerve
Femoral L2–4
Patient
Sitting with knees over side of table, holding on to table
Fixation
The examiner may hold the thigh firmly down on the table, or, because the weight of the trunk is usually sufficient to stabilize the patient during this test, the examiner may put a hand under the distal end of the thigh to cushion that part against table pressure
Test
Extension of the knee joint without rotation of the thigh
Pressure
Against the leg above the ankle, in the direction of flexion
See Test

Sartorius

Origin
Anterior superior iliac spine and superior half of notch just distal to spine
Insertion
Proximal part of medial surface of tibia near anterior border
Action
Flexes, laterally rotates, and abducts the hip joint
Flexes and assists in medial rotation of the knee joint
Nerve
Femoral L2–3
Patient
Supine
Fixation
None necessary on the part of the examiner
The patient may hold on to the table
Test
Lateral rotation, abduction, and flexion of the thigh, with flexion of the knee
Pressure
Against the anterolateral surface of the lower thigh, in the direction of hip extension, adduction and medial rotation, and against the leg in the direction of knee extension
The examiner must resist the multiple action test movement by a combined resistance movement
See Test

Tensor Fascia Latae

Origin
Anterior part of external lip of iliac crest, outer surface of anterior superior iliac spine, and deep surface of fascia lata
Insertion
Into ilitotibial tract of fascia lata at junction of proximal and middle thirds of thigh
Actions
Flexes, medially rotates, and abducts the hip joint; tenses the fascia lata; and may assist in knee extension
Nerve
Superior gluteal L4–5, S1
Patient
Supine
Fixation
The patient may hold on to the table
Quadriceps action is necessary to hold the knee extended
Usually no fixation is necessary by the examiner, but if there is instability and the patient has difficulty in maintaining the pelvis firmly on the table, then one hand of the examiner should support the pelvis anteriorly on the opposite side
Test
Abduction, flexion and medial rotation of the hip with the knee extended
Pressure
Against the leg in the direction of extension and adduction
Do not apply pressure against the rotation component
See Test