Ely’s Test

What is the Ely’s Test?

Before we discuss the , let’s discuss the rectus femoris, which is what the Ely’s Test will assess.

The rectus femoris is one of the four muscles that make up our quadriceps, and it is the only one of the four that crosses both our hip and knee joints! It’s an important muscle because it primarily helps with hip flexion and straightens our legs from our knee joints. Whenever we walk or run, the rectus femoris is active. Given that, it is key to many things we do, including sitting down and standing up. If you’re an athlete, it’s also important that it’s in tip-top shape so you can do what you need to do for your sport.

What happens if the rectus femoris tightens, gets irritated, or gets injured?

If any of those happen to the rectus femoris, it can make walking, running, and even standing difficult. It can cause pain, discomfort and prevent a person from doing some of the things they enjoy, as well as several activities of daily living.

One problem that a person might have to deal with related to their rectus femoris is rectus femoris spasticity, which is stiffness and increased tone in the muscle. Increased tone and stiffness can lead to the person developing an abnormal gait pattern and can make moving difficult. If left untreated, a person’s risk of falling increases, and falling can cause even more problems that impact movement.

The Ely’s Test was developed specifically to assess a person for the possibility of having rectus femoris spasticity. It does so by flexing the knee and seeing how the hip reacts. If it reacts in a specific way, then there is a good chance that the person might be dealing with the spasticity of that specific muscle.

How to perform the Ely’s Test

The Ely’s Test is one of the easiest tests that a healthcare professional can perform. The instructions for this test are so simple that it can be accomplished within a minute or two! It also doesn’t require much from the healthcare professional conducting it. It’s a non-invasive test, and it is essentially a physical examination technique, so all the professional really needs are two things:

• A comfortable examination bed for the patient because this requires the patient to lie down
• The healthcare professional’s two hands

If you’re performing the Ely’s Test, make sure to have the examination bed ready, and you’re good to go. Just follow these instructions to perform the test:

• Have your patient lie down on the examination bed. Make sure that they are in a prone position and their legs are straightened.
• Once the patient is on the bed, position yourself by the thigh of the patient on either side. You will be checking both legs, so you will have to switch to the other side after checking the first part.
• Place one of your hands on the patient’s lower back.
• Use your other hand to grab either the heel or the ankle (up to you).
• Passively flex your patient’s knee to 90 degrees.
• While flexing the patient’s knee, observe how the hip reacts.
• Switch to the other side of the patient’s body and perform the Ely’s Test again.

See? Doesn’t sound so hard, right?

How to interpret the results of the Ely’s Test

Now that you know how the Ely’s Test is performed and how simple the instructions are, it’s time to know what exactly you need to look out for and how to interpret your observations.

It’s simple! While passively flexing the patient’s knee to 90 degrees, you need to observe how the patient’s hip reacts. The specific reaction you want to see is if the hip involuntarily flexes or tilts itself.

If the hip involuntarily flexes or tilts itself, then the test is positive. If the test is positive, you will need to endorse the patient for further examination to properly confirm the rectus femoral spasticity and other possible problems like Piriformis Syndrome, a ruptured quadriceps tendon, Lumbar Radiculopathy, and more.

If the hip does not involuntarily flex or tilt itself, then the test is negative because those are the specific reactions needed for this test. Even if the patient is in pain, but the specific reactions don’t happen, they are still negative. However, if they are in pain, you still have to endorse them for further examination.

When is it best to conduct the Ely’s Test?

If a patient presents themselves to you for a consultation or check-up and talks about problems in their hip and legs, such as pain or discomfort in their lower back, pain in their hip, pain in their knee, weakness and/or tingling in their legs, and if they have difficulty when walking or running, then there might be a chance they are dealing with rectus femoris spasticity, lumbar radiculopathy, or some other condition. This is one of the best times to conduct the Ely’s Test to gauge the patient’s potential problem.

If the patient’s medical records show you they have a history of back pains, if they live a sedentary lifestyle, if they are overweight or obese, or if they engage in activities that put stress on the lower back and legs, then you have good reason to use the Ely’s Test to check on them.

This test is also included as part of comprehensive examinations. If you recall, we mentioned in one of the previous sections that you need to endorse the patient for further examination. This is because the Ely’s Test alone cannot properly diagnose the patient. This doesn’t mean that the Ely’s Test is unreliable. It is! It points out the possibility of certain problems, and by pointing out those possibilities, a team of healthcare professionals can determine what specific tests to conduct to confirm the specific problems, give a proper diagnosis, and implement the appropriate treatment.

It’s a non-invasive examination technique, so other tests, including imaging tests, can identify or refute whatever suspicions arise based on the results of the Ely’s Test.

Who can conduct the Ely’s Test?

Since the Ely’s Test is a physical examination technique meant for gauging patients with potential lower back, hip, leg, or knee problems, it should only be conducted by certain healthcare professionals. These healthcare professionals must have a thorough understanding of the human anatomy, the musculoskeletal system, and the functions of the hip and thigh musculature. These healthcare professionals are usually the following:

• Orthopedists and orthopedic surgeons
• Physical therapists
• Occupational therapists
• Chiropractors
• Sports physicians

It is best to leave the Ely’s Test to these professionals because they have undergone the necessary training to properly assess patients with musculoskeletal problems. They can make educated interpretations of their observations, determine the needed tests to be conducted, make the appropriate diagnoses, and develop tailor-fitted treatment plans based on the results of a comprehensive examination.

Since the Ely’s Test technically requires the use of a professional's hands to be conducted, plus it requires the flexion of the knee, these specific professionals can perform the technique safely. If the patient is already in pain from certain hip, leg, or knee problems, they will know how to gently perform this to minimize the patient's pain and discomfort.

If a person is not properly trained to conduct physical examination techniques and decides to perform this on a patient, they might do it wrong. They might even end up aggravating or worsening whatever pre-existing condition or injury that the patient might have, so again, it’s best to leave it to the aforementioned professionals.

What are the benefits of the Ely’s Test?

It is a reliable way to assess the possibility of certain problems.

While we did mention that the Ely’s Test should not be the lone assessment to make a diagnosis, it is useful because it can at least help determine the possible problem that a patient might be dealing with. Since it looks for a certain reaction from the hip (flexing or tilting when the knee is flexed to 90 degrees), the possible problems that that reaction could indicate will help professionals determine what goes into the patient’s comprehensive examination.

If the hip flexes or tilts as a result of the Ely’s Test, then they are positive for the possibility of rectus femoral spasticity and other possible problems like Piriformis Syndrome, a ruptured quadriceps tendon, and Lumbar Radiculopathy. The results should determine the specific tests conducted after the Ely’s Test and help narrow things down and confirm the specific problems.

It can also help with making tailor-fitted treatment plans.

Just as the Ely’s Test can determine what particular tests should be included in a comprehensive examination, it can also help professionals decide what should go into the treatment plan based on the Ely’s Test results. Let’s say the other tests can confirm that rectus femoral spasticity is the problem alongside other problems such as ruptured quadriceps tendon and Lumbar Radiculopathy. The treatment should address the spasticity and the ruptured tendon, and Lumbar Radiculopathy. General plans are usually not the best for treating musculoskeletal issues. The treatment should consider the specific problems the patient is dealing with and how they impact their life.

It can be used to monitor the patient down the line.

Let’s stipulate that your team implemented a treatment plan for your patient. Naturally, you’d like to know if the plan is effective and if the patient is improving. One way to find that out is through routine check-ups and repeating the Ely’s Test (as well as other physical examination techniques performed before) to check if the problem(s) are still there.

If the patient’s hip no longer flexes or tilts when flexing their knee to 90 degrees, plus they feel less or no pain at all, the patient is getting better! It’s safe to say that your plan is effective, too! If the hip is still flexing or tilting involuntarily, you might want to adjust your plan and see if the changes will help.

It’s an inexpensive test to conduct.

Just to reiterate, the Ely’s Test is a non-invasive test, and it is a physical examination technique that only requires a comfortable examination bed and a professional’s two hands. You don’t need any special equipment to perform it successfully. The instructions are simple, too, so not only can it be accomplished easily, but it can be accomplished rather quickly!