Thomas Test for contracture of the hip

• This test is performed in the clinic to check the contracture of the hip.
• This clinical test is performed by the therapist the test.
• Impaired range of motion[ ROM ] of the hip is an underlying cause of other conditions like patellofemoral pain syndrome psoas syndrome, rheumatoid arthritis, lower back pain osteoarthritis.
• Often associated with the runners, dancers & gymnasts which is complained of the hip stiffness & reported of snapping sound feeling when flexing at to the waist.

Purpose of the Thomas Test :

• This Thomas test is used to for measure the flexibility of the flexors of hip .
• It is used to assess a hip flexion contracture.
• Mostly most common contracture is hip.

What is the Technique of the Thomas Test?

• Starting position is supine with the lower gluteal folds at the end of the table & hips & knees are flexed.
• The patient is holding the legs inflection with the hands.
• The therapist is must be sure to check the patient’s lower back into a neutral pelvic tilt.
• Then Patient is keep the unaffected leg flexed, & slowly lowers to the affected leg & lets its legs extend as far as possible.

Interpretation of the Thomas Test :

• When this test is positive following structures are considered to affect.

Sign	Structures affected
Abducted hip	Iliotibial band, Tensor fascia lata
Flexed hip	Psoas muscles
Tibia lateral rotation	Biceps femoris
Extended knee	Extended knee Quadriceps, rectus femoris

• If a contracture is present, the patient’s straight leg rises off the table & a muscle stretch end feel will be left.
• The angle of contracture can be measured.
• If the lower limb is pushed down onto the table, the patient may exhibit an increased lordosis, again, this result indicates a positive test.
• When doing the test, if measurements are taken, the examiner must be sure the restriction is in the hip & not the pelvis/lumbar spine.
• If the leg does not lift off the table but abducts as the other leg is flexed to the chest, it is called the J sign/stroke & is indicative of a tight IT band [ iliotibial band ] on the extended leg side.

Modification of the Thomas Test :

• The modified version of this test is patient is lies down on the back,
• At the very edge of the table, with both legs are hanging freely.
• The patient is then to flex their knee & pull it back to the chest as close as to can, using both arms while doing.
• Another leg is hanging the lumbar spine remains flat & in contact with the table during the test.

Reliability of the Thomas Test:

• Reliability of the Thomas test are very limited.
• One study is demonstrated to the modified Thomas test a very good inter-rater reliability.
• Another study is demonstrated that the modified Thomas test to the average of only moderate levels of reliability.
• Further research is required to prove/refute the reliability of the Thomas test.

• Peeler & Anderson has conducted a study in 2006 examining the reliability of the Thomas test for assessing hip range.
• Their study calls into question the reliability of the technique when to used to score of range of motion & iliopsoas muscle flexibility about the hip joint use both goniometer & pass/fail scoring methods.