Hip External Rotation

Range of motion: 0-45

Grade 5 (Normal), Grade 4 (Good), and Grade 3 (Fair)

• Position of Patient: Short sitting. (Trunk may be supported by placing

hands flat or fisted at sides.

• Position of Therapist: Sits on a low stool or kneels beside limb to be

tested. The hand that gives resistance grasps the ankle just above the
malleolus. Resistance is applied as a laterally directed force at the ankle.
The other hand, which will offer counterpressure, is contoured over the
lateral aspect of the distal thigh just above the knee.

Resistance is given as a medially directed force at the knee. The two forces
are applied in counter directions for this rotary motion.
• Test: Patient externally rotates the hip. This is a test where it is preferable
for the examiner to place the limb in the test end position rather than to ask
the patient to perform the movement.

• Instructions to Patient:

Grade 5 (Normal): "move your leg inward, don’t let me turn it out& hold.

Patient complete the range & holds at end of range against maximum
resistance.

Grade 4 (Good): move your leg inward, Don’t let me turn it out.

Patient complete the range against moderate resistance

Grade 3 (Fair): move your leg inward

Patient complete the range without resistance

• N.B: In short sitting tests, the patient should not be allowed to use the
following motions, lest they add visual distortion and contaminate the test
results:

a. Lift the contralateral buttock off the table or lean in any direction to lift
the pelvis.

b. Increase flexion of the tested knee.

c. Abduct the tested hip.

Grade 2 (Poor)

• Position of Patient: Supine. Test limb is in internal rotation.

• Position of Therapist: Standing at side of limb to be tested.

• Test: Patient externally rotates hip in available range of motion. One hand
may be used to maintain pelvic alignment at lateral hip.

• Instructions to Patient: "Roll your leg out."

• Grade 2 (Poor): Completes external rotation range of motion. As the hip

rolls past the midline, minimal resistance can be offered to offset the
assistance of gravity.

• Alternate Test for Grade 2: With the patient short sitting, the therapist
places the test limb in maximal internal rotation. The patient then is
instructed to return the limb actively to the midline (neutral) position
against slight resistance. Care needs to be taken to ensure that gravity is
not the predominant force. If this motion is performed satisfactorily, the
test is assessed as a Grade 2.

Grade 1 (Trace) and Grade 0 (Zero)

• Position of Patient: Supine with test limb placed in internal rotation.

Position of Therapist: Standing at side of limb to be tested.

• Test: Patient attempts to externally rotate hip.

• Instructions to Patient: "Try to roll your leg out."

Grading

• Grade 1 (Trace) and Grade 0 (Zero): The external rotator muscles,

except for the gluteus maximus, are not palpable. If there is any discernible
movement (contractile activity), a grade of 1 should be given.

Hip Internal Rotation

Range of motion: 0- 45
Grade 5 (Normal), Grade 4 (Good), and Grade 3 (Fair)

• Position of Patient: Short sitting. Arms may be used for trunk support at
sides or may be crossed over chest.

• Position of Therapist: Sitting or kneeling in front of patient. One hand

grasps the lateral surface of the ankle just above the malleolus.

Resistance is given (Grades 5 and 4 only) as a medially directed force at

the ankle. The opposite hand, which offers counterpressure, is contoured
over the medial surface of the distal thigh just above the knee. Resistance
is applied as a laterally directed force at the knee.

Note the counter directions of the force applied.

• Test: The limb should be placed in the end position of full internal
rotation by the examiner for best test results.

the patient to perform the movement.

• Instructions to Patient:

Grade 5 (Normal): "move your leg outward, don’t let me turn it in & hold.

Patient completes the range & holds at end of range against maximum
resistance.

Grade 4 (Good): move your leg outward, don’t let me turn it in.
Patient completes the range against moderate resistance.

Grade 3 (Fair): move your leg outward.

Patient completes the range without resistance.

N.B:

• In the short sitting tests, do not allow the patient to assist internal
rotation by lifting the pelvis on the side of the limb being tested.
• Neither should the patient be allowed to extend the knee or adduct and
extend the hip during performance of the test.

Grade 2 (Poor)

• Position of Patient: Supine. Test limb in partial external rotation.

• Position of Therapist: Standing next to test leg. Palpate the gluteus

medius proximal to the greater trochanter and the tensor fasciae latae over
the anterolateral hip below the ASIS.

• Test: Patient internally rotates hip through available range.

• Instructions to Patient: "Roll your leg in toward the other one.

Grading

• Grade 2 (Poor): Completes the range of motion. As the hip rolls inward
past the midline, minimal resistance can be offered to offset the assistance
of gravity.

• Alternate Test for Grade 2: With patient short sitting, the examiner
places the test limb in maximal external rotation. The patient then is
instructed to return the limb actively to the midline (neutral) position
against slight resistance. Care needs to be taken to ensure that gravity is
not the predominant force. If this motion is performed satisfactorily, the
test may be assessed as a Grade 2.

Grade 1 (Trace) and Grade 0 (Zero)

• Position of Patient: Patient supine with test limb placed in external

rotation.

• Position of Therapist: Standing next to test leg.

• Test: Patient attempts to internally rotate hip. One hand is used to palpate
the gluteus Medius (over the posterolateral surface of the hip above the
greater trochanter). The other hand is used to palpate the tensor fasciae
latae (on the anterolateral surface of the hip below the ASIS).

• Instructions to Patient: "Try to roll your leg in."

• Grade 1 (Trace): Palpable contractile activity in either or both muscles.

• Grade 0 (Zero): No palpable contractile activity.

Effect of weakness of hip muscles:

• Weakness of the hip flexors:

1. Decreased Mobility: Hip flexors are essential for activities such as

walking, running, and climbing stairs. Weakness in these muscles
can lead to decreased mobility.

2. Compensatory Movement Patterns: When hip flexors are weak,

other muscles may compensate, leading to altered movement
patterns. This compensation can put additional strain on other
muscle groups, potentially leading to overuse injuries or imbalances.

3. Lower Back Pain: Weak hip flexors can lead to an anterior pelvic
tilt, where the pelvis tilts forward, increasing the curve in the lower
back.

4. Poor Posture: Weak hip flexors can contribute to poor posture,

particularly when sitting for extended periods. It can lead to
slouching or a rounded back, placing strain on the spine and
surrounding muscles.

5. Decreased Core Stability: Weakness in these muscles can

compromise the stability of the core, which is essential for
maintaining proper alignment and preventing injuries during various
activities.

6. Reduced Athletic Performance: In athletes, weak hip flexors can

hinder performance, especially in activities that require explosive
movements such as sprinting, jumping, or kicking.

7. Increased Risk of Falls: Weak hip flexors can affect balance and
coordination, increasing the risk of falls, especially in older adults.
 8. Difficulty in Activities of Daily Living: Weak hip flexors can make
simple tasks such as getting up from a chair, bending down, or lifting
objects more challenging and less efficient.

Weakness of the hip extensors:

1. Decreased Hip Stability: Weakness in these muscles can lead to

decreased hip stability, potentially increasing the risk of injuries,
such as strains or sprains.
2. Impaired Walking and Running Mechanics: Weakness in these
muscles can result in inefficient movement patterns, causing
compensation in other areas of the body and potentially leading to
overuse injuries.
3. Increased Risk of Lower Back Pain: Weakness in the hip
extensors can lead to overcompensation by the lower back muscles,
increasing the risk of lower back pain and discomfort.
4. Poor Posture: Weak hip extensors can contribute to a posterior
pelvic tilt, where the pelvis tilts backward, flattening the lumbar
curve and leading to a rounded back posture. This can put strain on
the spine and surrounding muscles, leading to postural issues and
discomfort.
5. Compromised Balance and Stability: Weakness in these muscles
can compromise balance and stability, increasing the risk of falls or
injuries.
6. Knee and Ankle Issues: Weak hip extensors can lead to altered
lower limb mechanics, potentially contributing to issues such as
knee valgus (knock-knees) or ankle instability. This can increase the
risk of injuries to the knees and ankles during activities such as
squatting or jumping.
 7. Difficulty with Activities of Daily Living: Weak hip extensors can
make everyday tasks such as standing up from a seated position,
climbing stairs, or lifting objects more challenging and less efficient.
• Weakness in the hip abductors:
1. Decreased Hip Stability: Weakness in these muscles can lead to
decreased hip stability, potentially increasing the risk of falls or
injuries, particularly during dynamic movements.
2. Increased Risk of Hip and Knee Injuries: weakness in the hip
abductors can contribute to excessive hip adduction (movement
toward the midline of the body) and knee valgus (knock-knees),
which can predispose individuals to conditions such as IT band
syndrome, patellofemoral pain syndrome, and ACL injuries.
3. Compromised Gait Mechanics: Weakness in these muscles can
lead to compensatory movement patterns, such as a Trendelenburg
gait, where the pelvis drops on the opposite side of the weak hip
abductors during the stance phase of walking. This can result in
inefficient movement and increased stress on other joints and
muscles.
4. Lower Back Pain: Weakness in the hip abductors can contribute to
pelvic instability and altered lumbar spine mechanics, potentially
leading to lower back pain and discomfort.
5. Impaired Balance and Stability: Weakness in these muscles can
compromise balance and stability, increasing the risk of falls,
particularly in older adults.
6. Difficulty with Functional Activities: Weak hip abductors can
make functional activities such as climbing stairs, getting out of a
chair, or standing on one leg more challenging and less efficient.
• Weakness in the hip adductors:
1. Decreased Hip Stability: Weakness in these muscles can lead to
decreased hip stability, potentially increasing the risk of falls or
injuries, especially during dynamic movements.
2. Increased Risk of Hip and Knee Injuries: weakness in the hip
adductors can contribute to excessive hip abduction (movement
away from the midline of the body) and knee varus (bow-legged
appearance), which can predispose individuals to conditions such as
IT band syndrome, patellofemoral pain syndrome, and medial
collateral ligament (MCL) injuries.
3. Compromised Gait Mechanics: Weakness in these muscles can
lead to compensatory movement patterns, such as excessive hip
sway or lateral trunk lean, which can result in inefficient movement
and increased stress on other joints and muscles.
4. Lower Back Pain: Weakness in the hip adductors can contribute to
pelvic instability and altered lumbar spine mechanics, potentially
leading to lower back pain and discomfort.
5. Impaired Balance and Stability: Weakness in these muscles can
compromise balance and stability, increasing the risk of falls,
particularly in older adults.
6. Difficulty with Functional Activities: Weak hip adductors can
make functional activities such as walking, climbing stairs, and
transitioning between sitting and standing more challenging and less
efficient.
7. Altered Athletic Performance: Hip adductors are essential for
controlling movements in sports that involve cutting, pivoting, and
change of direction, such as soccer, basketball, and hockey.
• Weakness in the hip external rotators:
1. Decreased Hip Stability: Weakness in these muscles can lead to
decreased hip stability, potentially increasing the risk of injuries,
such as strains or dislocations.
2. Increased Risk of Hip and Knee Injuries: Weak hip external
rotators can lead to altered lower limb mechanics, potentially
increasing the risk of injuries to the hips, knees, and ankles.
3. Compromised Movement Patterns: Weakness in these muscles
can lead to compensatory movement patterns, such as excessive
internal rotation of the hip or knee valgus (knock-knees), which can
result in inefficient movement and increased stress on other joints
and muscles.
4. Lower Back Pain: Weakness in the hip external rotators can
contribute to altered pelvic mechanics and lumbar spine stability,
potentially leading to lower back pain and discomfort.
5. Impaired Balance and Stability: Weakness in these muscles can
compromise balance and stability, increasing the risk of falls,
particularly in older adults.
6. Difficulty with Functional Activities: Weak hip external rotators
can make functional activities such as walking, climbing stairs, and
transitioning between sitting and standing more challenging and less
efficient.
7. Altered Athletic Performance: Hip external rotators are essential
for controlling movements in sports that involve rotation and change
of direction, such as soccer, baseball, and tennis. Weakness in these
muscles can impair performance and increase the risk of injuries
during these activities.
• Weakness in the hip internal rotators:
1. Decreased Hip Stability: Weakness in these muscles can lead to
decreased hip stability, potentially increasing the risk of injuries,
such as strains or dislocations.
2. Increased Risk of Hip and Knee Injuries: Weak hip internal
rotators can lead to altered lower limb mechanics, potentially
increasing the risk of injuries to the hips, knees, and ankles.
3. Compromised Movement Patterns: Weakness in these muscles
can lead to compensatory movement patterns, such as excessive
external rotation of the hip or knee varus (bow-legged appearance),
which can result in inefficient movement and increased stress on
other joints and muscles.
4. Lower Back Pain: Weakness in the hip internal rotators can
contribute to altered pelvic mechanics and lumbar spine stability,
potentially leading to lower back pain and discomfort.
5. Impaired Balance and Stability: Weakness in these muscles can
compromise balance and stability, increasing the risk of falls,
particularly in older adults.
6. Difficulty with Functional Activities: Weak hip internal rotators
can make functional activities such as walking, climbing stairs, and
transitioning between sitting and standing more challenging and less
efficient.
7. Altered Athletic Performance: Hip internal rotators are essential
for controlling movements in sports that involve rotation and change
of direction, such as soccer, basketball, and tennis. Weakness in
these muscles can impair performance and increase the risk of
injuries during these activities.