Muscle Length Testing

Why Assessment? All fitness, performance, and rehabilitation programs should start with an assessment. The goal of assessment is to refine exercise and technique recommendations, with the intent of improving client or patient outcomes. This course describes Muscle Length Testing (MLTs)

• Muscle Length Testing (MLT) - "Muscle length testing involves elongating the muscle in the direction opposite of its action while assessing its resistance to passive lengthening (1)"

Why Muscle Length Tests? MLTs are used to identify changes in muscle extensibility that may be contributing to movement impairment and/or symptoms. Generally, positive muscle length tests indicate a loss of extensibility of one or more muscles. This may imply release, mobilization, and/or lengthening techniques are recommended. When used in conjunction with dynamic postural assessment, and a continuous interval measure (e.g. goniometry), these tests can aid in differentiating which muscles are affected by alterations in joint motion.

• For example, If an Overhead Squat Assessment results in the identification of an anterior pelvic tilt (excessive lordosis) , and this is followed up with a measurement technique (continuous interval measure) like hip extension goniometry implying a measurable loss of hip extension range of motion (ROM), this still only provides enough information to implicate all hip flexors as potentially short/over-active. However, muscle length testing can be used to aid in identifying which hip flexors are exhibiting a loss of extensibility. A positive Ely's Test  implies rectus femoris over-activity, Ober's Test implies tensor fascia latae over-activity, and the Modified Thomas Test , implies iliacus/psoas over-activity. Identification of which muscles exhibit over-activity may aid in refining recommendations for specific techniques, and an integrated intervention plan (combination of optimal techniques).

The Brookbush Institute recommends that these assessments are added to the repertoire of all movement professionals (personal trainers, fitness instructors, physical therapists, massage therapists, chiropractors, occupational therapists, athletic trainers, etc.).

Muscle Length Tests Covered in this Course

This course includes a quick review of the research demonstrating the reliability, accuracy (sensitivity and specificity), and relevance of each test, a description of test results and interpretation of findings, and thorough descriptions of how to perform the techniques including videos with a breakdown of anatomical landmarks, the optimal position for the extremities, client and practitioner positioning, the use of tape measurer or goniometer, etc.

• Lat Length Test
  • External Rotation Goniometry for Differentiation
• Ely's Test (Rectus Femoris )
• Ober's Test (Tensor Fasciae Latae )
• Thomas' Test (Iliacus/Psoas )
• Hamstring Length Test
• Gastroc/Soleus Length Test

Printable PDF of the Movement Assessment Template:

• Movement Assessment Template

Pre-approved credits for:

• Integrated Manual Therapist (IMT) Certification

Pre-approved for Continuing Education Credits for:

• Athletic Trainers
• Chiropractors
• Group Exercise Instructors
• Massage Therapists
• Occupational Therapists
• Personal Trainers
• Physical Therapists
• Physical Therapy Assistants

This Course Includes:

• AI Tutor
• Text and Illustrations
• Audio Voice-over
• Technique Videos
• Practice Exam
• Pre-approved Final Exam

1. Florence Peterson Kendall, Elizabeth Kendall McCreary, Patricia Geise Provance, Mary McIntyre Rodgers, William Anthony Romani, Muscles: Testing and Function with Posture and Pain: Fifth Edition © 2005 Lippincott Williams & Wilkins
2. Helen J. Hislop, Dale Avers, Marybeth Brown. Daniels and Worthingham's Muscle Testing: Techniques of Manual Examination and Performance Testing: 9th Edition. © 2014 Elsevier: Saunders
3. Dutton, M. (2012). Dutton's Orthopaedic Examination Evaluation and Intervention. McGraw Hill Professional.
4. Magee, D. J. (2014). Orthopedic physical assessment. Elsevier Health Sciences.
5. Chad E. Cook, Eric J. Hegedus. Orthopedic Physical Examination Tests: Second Edition © 2013 Pearson Education Inc.
6. Sahrmann SA. (2001). Movement impairment syndromes of the shoulder girdle. In: Sahrmann et al., Movement Impairment Syndromes. St. Louis, MO: Mosby. 193-261.
7. Phillip Page, Clare Frank , Robert Lardner , Assessment and Treatment of Muscle Imbalance: The Janda Approach © 2010 Benchmark Physical Therapy, Inc., Clare C. Frank, and Robert Lardner
8. Karel Lewit. Manipulative Therapy: Musuloskeletal Medicine © 2007 Elsevier
   • Latissimus Dorsi Muscle Length Test (Poor Validity, although Shoulder Flexion is a Reliable Goniometric Assessment - See Goniometry)
9. Borstad JD, Briggs MS. (2010). Reproduciblity of a measurement for latissimus dorsi muscle length. Physiotherapy Theory and Practice. 26(3): 195-203.
   • Ely's Test (Fair to high reliability, more reliable with a goniometer)
10. Peeler J, Anderson JE. (2008). Reliability of the ely’s test for assessing rectus femoris muscle flexibility and joint range of motion. Journal of Orthopaedic Research. 793-799.
    • Ober's Test (reliable 11, 13, 14 not a valid measure of ITB 12 (think tfl glute min, glute med and joint capsule)
11. Reese NB, Bandy WD. (2003). Use of an inclinometer to measure flexibility of the iliotibial band using ober test and the modified ober test: differences in magnitude and reliability of measurements. JOSPT. 33(6): 326-330.
12. Willett GM, Keim SA, Shostrom VK, Lomneth CS. (2016). An anatomic investigation of the ober test. AJSM. Advanced print.
13. Dishun HC, Fischer CJ, Studer KC, Cade DL. (2002). The relationship between femoral torsion and performance of the ober tests. Medicine & Science in Sports & Exercise. 34(5) Supplement 1.
14. Ferber R, Kendall KD, McElroy L. (2010). Normative and critical criteria for iliotibial band and iliopsoas muscle flexibility. Journal of Athletic Training. 45(4): 344-348
    • Modified Thomas Test (moderate to high reliability, lower for rectus femoris length, higher when pelvic tilt is controlled)
15. Wakefield CB, Halls A, Difilippo N, Cottrell GT. (2015). Reliability of goniometric and trigonometric techniques for measuring hip-extension range of motion using the modified Thomas test. Journal of Athletic Training. 50(5): 460-466.
16. Peeler JD, Anderson JE. (2008). Reliability limits of the modified Thomas test for assessing rectus femoris muscle flexibility about the knee joint. Journal of Athletic Training. 43(5): 470-476.
17. Peeler J, Leiter J. (2013). Using digital photography to document rectus femoris flexibility: a reliability study of the modified Thomas test. Physiotherapy Theory and Practice. 29(4): 319-327.
18. Kim G, Ha S. (2015). Reliability of the modified Thomas test using a lumbo-pelvic stabilization. J. Phys. Ther. Sci. 27:447-449.
19. Vigotosky AD, Lehman GJ, Beardsley C, et al. (2016). The modified Thomas test is not a valid measure of hip extension unless pelvic tilt is controlled. PeerJ. 4:e2325; DOI 10.7717/peerj.2325.
    • Hamstring Length Test (In all 3 Studies Active Knee Extension resulted in high validity and reliability)
20. Gajdosik R, Lusin G. (1993). Hamstring muscle tightness: reliability of an active-knee-extension test. Phys Ther. 63: 1085-1088.
21. Rakos DM, Shaw KA, Fedor RL, et al. (2001). Interrater reliability of the active-knee-extension test for hamstring length in school-aged children. Pediatric Physical Therapy. 13: 37-41.
22. Worrell TW, Sullivan MK, DeJulia JJ. (1992). Reliability of an active-knee-extension test for determining hamstring muscle flexibility. JSR. 1(3): 181-187
    • Gastrocnemius and Soleus Length Test (Valid and Reliable for to show muscle length imbalances in the gastrocnemius and soleus)
23. Wang SS, Whitney SL, Burdett RG, et al. (1993). Lower extremity muscular flexibility in long distance runners. JOSPT. 17(2): 102-107.
24. Teyhen DS, Shaffer SW, Lorenson CL, et al. (2011). Reliability of lower quarter physical performance measures in healthy service members. US Army Medical Department Journal. July: 37-50.
25. Smith TO, Clark A, Neda S, et al. (2012). The intra- and inter-observer reliability of the physical examination methods used to assess patients with patellofemoral joint instability. The Knee. 19(4): 404-410.
    • Goniometry
26. Boone, D. C., Azen, S. P., Lin, C. M., Spence, C., Baron, C., & Lee, L. (1978). Reliability of goniometric measurements. Physical Therapy, 58(11), 1355-1360.
27. Rothstein, J. M., Miller, P. J., & Roettger, R. F. (1983). Goniometric reliability in a clinical setting. Physical Therapy, 63(10), 1611-1615.
28. Dougherty J, Walmsley S, and Osmotherly PG. (2014). Passive range of movement of the shoulder: a standardized method for measurement and assessment of intrarater reliability . Journal of Manipulative and Phsyiological Therapeutics. 38(3): 218-224.
29. Mullaney MJ, McHugh MP, Johnson CP, Tyler TF. (2010). Reliability of shoulder range of motion comparing goniometer to a digital level. Physiotherapy Theory & Practice. 26(5): 327-333.
    • Biceps Femoris Over-activity
30. Tateuchi, H., Taniguchi, M., Mori, N., Ichihashi, N. Balance of hip and trunk muscle activity is associated with increased anterior pelvic tilt during prone hip extension (2013) Journal of Electromyography and Kinesiology 22 (3). 391-397
31. Hungerford, B., Gilleard, W., Hodges, P. (2003) Evidence of altered lumbopelvic muscle recruitment in the presence of sacroiliac joint pain. Spine 28(14), 1593-1600
32. Jung, H., Kang, S., Park, J., Cynn, H., & Jeon, H., (2015). EMG activity and force during prone hip extension in individuals with lumbar segmental instability. Manual Therapy, 20(3), 440-444