Manual Muscle Testing

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