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Trick of the Trade: Hip flexion strength testing

Posted Dec 30 2009 12:00am

Testing lower extremity strength is a crucial part of the examination in patients with low back pain. In Emergency Departments, however, some patients provide a suboptimal effort because of general fatigue or malingering.

How can you differentiate whether asymmetric hip flexion weakness is from suboptimal effort or true weakness?

Trick of the Trade: Hoover's Test
This test is an example of Newton's 3rd law of motion -- For every action there is an equal and opposite reaction.

A supine patient trying to flex a hip joint should normally push the contralateral heel downwards into the gurney for compensatory assistance. Absent downward pressure from the contralateral heel suggests a lack of effort, mimicking a focal weakness. You can optimize your ability to detect subtle contralateral downward pressure by cradling the patient's heels in your palms during hip flexion testing.

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