Thomas Test

What is a Thomas Test?

A physical examination procedure called the Thomas Test or hip flexor strain test measures hip flexor length and determines whether hip flexor muscle tightness and hip flexion contracture are present. It is an easy, noninvasive test that physical therapists, sports medicine physicians, primary care physicians, or orthopedic surgeons can perform to assess the hip joint for muscle length, strength, and overall mobility.

Medical professionals and physical therapists can use the Thomas Test as a helpful screening tool when determining the severity of injuries, measuring the patient’s progress, gauging a patient’s flexibility and range of motion, and assessing the effectiveness of their current treatment strategy. Furthermore, it can help assess whether stretching or strengthening activities during physical therapy are required and whether more sophisticated medical treatment is required to treat tight hip flexors.

How to perform the Thomas Test?

After you obtain a printable Thomas Test PDF, proceed to follow the steps below to quickly, effortlessly, and correctly perform the hip flexor test or Thomas Test.  

Step 1: Position the patient

Instruct the patient to lie flat on their back on an examination table or any flat surface with their legs straight. It's important that the patient lies supine, their lumbar spine is fixed and flexed, and that they maintain the proper pelvic position for accurate testing. Also, do remember to account for the patient's pelvic tilt for accurate results.

Step 2: Lift the leg and flex the knee

Gently lift your patient's left or right leg to a 90-degree angle, keeping the knee straight. Afterward, passively flex one of the patient's knee joint toward their chest. Ensure that the other extended leg is relaxed.

Step 3: Observe the position of the opposite leg

Observe the position of the patient's opposite leg to determine if hip flexor muscle tightness or flexion contracture is present. If the patient's posterior thigh does touch the table and their knee is short of or goes beyond 80 degrees, it indicates a positive Thomas test.

Step 4: Repeat and record results

Repeat the test with the other leg to evaluate both hips. Afterward, record the test results using Carepatron's free Thomas Test template.

Thomas Test results

The following interpretations of the test results can help in diagnosing the condition of the hip flexors (Kendall et al, 2005; Physiopedia, 2019):

Positive test results

• When the posterior thigh does not touch the table with the knee fully extended, it indicates shortness in both one-joint (iliopsoas) and two-joint hip flexors (such as the rectus femoris).
• If the posterior thigh touches the table and the knee can extend, this result indicates shortness in the two-joint hip flexors.
• In cases where the posterior thigh does not contact the table, but the knee flexes beyond 80°, this suggests shortness in the one-joint hip flexors.
• If abduction occurs during hip extension, with lateral deviation of the patella and maintained knee extension when abduction/adduction is restricted, this finding indicates shortness in the tensor fasciae latae.
• When three or more of these factors (abduction, flexion, external rotation of the hip, and knee flexion) are observed, it suggests tightness, indicating shortness in the sartorius muscle. This can lead to altered mechanics during activities such as walking or running.

Negative result

A negative result, where the posterior thigh touches the table and the knee flexes to about 80°, indicates typical length of the hip flexors. This suggests that the hip flexors are functioning well and are not excessively tight, supporting normal hip mechanics and range of motion.

Benefits of using a free Thomas Test template

Using a free Thomas Test template like ours can provide several benefits for healthcare professionals and physical therapists, including:

Time-saving

The Thomas Test Templates are made to be simple to use and might help medical professionals save time while recording test results. There is no need to generate a unique document for each patient because the templates may be printed and utilized immediately.

Accuracy

To ensure accuracy and consistency in documentation, the templates offer a straightforward and concise manner to report the test results. This can aid in preventing mistakes or discrepancies during the assessment process.

Improved communication

Sharing the templates with patients or other healthcare professionals will improve teamwork and communication in patient care. This can ensure that everyone engaged in the patient's treatment knows how flexible and mobile their hips are.

Cost-effective

Healthcare practitioners without access to pricey documentation software or templates might save money using the free Thomas Test Templates. Smaller clinics or practices with fewer resources may find this to be very helpful.

References

Kendall, F., et al. (2005) Muscle testing and function with posture and pain. 5th Edition, Lippincott Williams & Wilkins Publisher, Philadelphia.

Physiopedia. (2019). Thomas test. https://www.physio-pedia.com/Thomas_Test

Vigotsky, A. D., Lehman, G. J., Beardsley, C., Contreras, B., Chung, B., & Feser, E. H. (2016). The modified Thomas test is not a valid measure of hip extension unless pelvic tilt is controlled. PeerJ, 4, e2325. https://doi.org/10.7717/peerj.2325