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Explanation of muscle length tests, including the reliability, validity, and relevance of the Ely's Test, Ober's Test, Thomas Test, Gastros/Soleus Length Test, Lat Length Test, and the Hamstring Length Test. How to use muscle length tests, outcomes (what muscle length tests show), and recommended interventions. 

Muscle Length Testing

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 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 involves elongating the muscle in the direction opposite of its action while assessing its resistance to passive lengthening (1)"

 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.

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 

 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).

 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.

Printable PDF of the Movement Assessment Template:

Course Description: Muscle Length Testing

Introduction

 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, these tests may help to differentiate which muscles are affected by alterations in joint motion. For example, if a patient/client exhibits an 

, it is implied by this type of test that all hip flexors are potentially short/over-active. However, if followed by 

, it may be possible to determine whether maladaptive changes in flexibility have occurred in the 

Dr. Brent Brookbush demonstrating the Ely's Test

The Difference Between a Good Assessment and a Bad Assessment

Good tests, assessments, and are the evaluations valid, reliable, and relevant:

 - Validity is a weakness of muscle length tests (MLTs) due to the number of potential structures that may restrict the range of motion (ROM) at each joint. That is, the problem lies in defining these tests by a single muscle, rather than by all the structures that may limit joint motion.

 has low validity likely contributing to low reliability (9); however, 

 has high reliability (26-29). This test is likely not effective as a means of determining whether the 

 is the structure restricting shoulder flexion; however, it may be a useful "quick test" for shoulder flexion ROM.

 has been proposed as an iliotibial band (ITB) length test, cadaveric research by Wellet et al.(12) showed that cutting the iliotibial band had little impact on test results. This test is likely an assessment of 

, and potentially superior hip capsule extensibility (12).

The traditional Thomas Test (not the test shown below) is not a valid measure of 

 is only a valid test for extensibility imbalances between the 

 and is not valid as a measure of overall extensibility (23 - 25).

 Overall the reliability of MLTs is good, better when a goniometer is used to track changes; however, there are a couple of exceptions.

 has low validity, likely contributing to low reliability (9); however, 

 has high reliability (26-29). Although this test is likely not effective as a means of determining whether the 

 is the structure restricting shoulder flexion, it may be useful as a "quick test" for shoulder flexion ROM.

 are more reliable when a goniometer or inclinometer is used to track changes (10, 11, 15)

 is more reliable when an active range of motion ROM is used, rather than passive ROM (20-22).

 has low to fair reliability; however, if the pelvic position is controlled (as taught below) reliability increases (18, 19)

 Of our 3 assessment categories, MLTs are generally used to refine exercise/intervention selection:

: Tests, assessments, and evaluations are used to assist the professional in determining which techniques, modalities and exercises will best address movement impairments, patient/client's complaints, and/or desired goals.

Most often, reliable MLTs highlight hypo-mobility in osteokinematic range of motion, implying which release, flexibility, and mobility techniques may be appropriate. That is, 

will assist the human movement professional in building a more refined flexibility/mobility routine.

 Less often, MLTs will highlight hyper-mobility implying the need for activation and stabilization techniques.

How to use Muscle Length Tests

 is performed to determine the segment(s) that exhibits dysfunction and the pattern of compensation, muscle length tests related to the dysfunctional segment can be used to refine exercise selection. Generally, the addition of MLT's can imply one of 3 types of changes to a corrective exercise/intervention plan.

 - For Example, an individual exhibits the sign "

 is negative (flexibility is normal). This may imply that the 

 is not over-active and does not need to be addressed, despite its potential to contribute to this compensation pattern.

 is over-active and contributing to dysfunction, despite the fact that the 

 is not normally considered a contributor to hip abduction or external rotation.

Confirms Findings of Gross Movement Assessment

 is positive. This aids in confirming a restriction in shoulder flexion.

Muscle Length Tests Covered in this Article

External Rotation Goniometry for Differentiation

Dr. Brent Brookbush demonstrating a muscle length test

Latissimus Dorsi Muscle Length Test (Lat Length Test)

 (Indicating Restriction): Patient/client cannot achieve 180° of shoulder flexion/abduction - the patient/client is unable to lay their arms on the table or floor behind them.

Negative Test Result (Indicating No Restrictions)

 - If the patient or client can lay their arms flat on the table with the legs up (no excessive lordosis) or down, then it is unlikely the 

 or other internal rotators of the shoulder (

Positive Test Results indicating a Short/Over-active 

Shoulder flexion with legs flat increases lumbar lordosis

Bringing the legs up decreases range of motion (ROM) when compared to legs flat

Positive Test Results indicating Short/Over-active Shoulder Internal Rotators

 play a larger role in shoulder restriction)

Restriction in shoulder flexion ROM with legs flat (no increase in lumbar lordosis)

Restriction in shoulder flexion ROM, raising the legs does not reduce ROM further

Using Shoulder External Rotation (ER) Goniometry to Differentiate between the 

 is done at 90° of shoulder abduction placing the latissimus dorsi in a relatively shortened position.

If the Lat Length Test is positive, and ER goniometry demonstrates restriction, then the 

If the Lat Length Test is positive, and ER goniometry demonstrates normal ROM, then it is likely that only the 

Note: It has been my experience that this last group of individuals, generally have changes in latissimus dorsi length and activity stemming from 

Lumbo Pelvic Hip Complex Dysfunction (LPHCD)

Shoulder Internal Rotator Release and Lengthening

Joint Mobilizations: Upper Body (Self-administered)

Ely's Test (Rectus Femoris Flexibility Assessment)

 (Indicating Restriction): Patient/client cannot achieve knee flexion resulting in heel within a few inches of their buttock.

 - Patient/client can achieve knee flexion resulting in heel within a few inches of their buttock, with a soft end feel and without compensation (anterior pelvic tilt).

Patient/client cannot achieve knee flexion resulting in the heel being within 5" of the buttock.

Patient/client exhibits a hard or springy end feel during knee flexion (may imply joint dysfunction, i.e. effusion, arthrokinematics dyskinesis).

Patient/client can achieve knee flexion resulting in the heel being within a few inches of the buttock, but only by adopting an anterior pelvic tilt.

Joint Mobilizations: Lower Body (Self-administered)

Ober's Test (Tensor Fasciae Latae Flexibility Assessment)

 (Indicating Restriction): Patient/client cannot achieve any adduction beyond neutral with the femur held in 0° of flexion/extension, 0º of internal/external rotation, and the pelvis held in a neutral.

 - Patient/client can achieve adduction past neutral with the femur held in 0° of flexion/extension, 0º of internal/external rotation, and pelvis neutral.

Patient/client's femur appears stuck in an abducted position.

Patient/client's femur internally rotates and flexes as the femur is lowered into some adduction.

Patient/client adopts an anterior pelvic tilt or rolls their pelvis back as the femur is lowered into some adduction.

Hip Internal Rotator: Release and Lengthening

Modified Thomas' Test (Psoas and Iliacus Flexibility Assessment)

 (Indicating Restriction): Patient/client cannot maintain the leg being tested on the table with the femur in 0º of internal/external rotation when the pelvis is posteriorly tilted until no curvature remains in the lumbar spine.

 - Patient/client can maintain the leg being tested on the table, with the femur in 0º of internal/external rotation, as the contralateral knee is pulled toward the chest until the lumbar spine is flat and the pelvis is posteriorly tilted.

As the patient/client pulls the contralateral knee toward the chest, the knee of the leg being tested leaves the table.

As the patient/client pulls the contralateral knee toward the chest, the leg being tested externally rotates.

Hamstring Length Test

 (Indicating Restriction): The client or patient cannot achieve the lower leg near vertical (less than 20º of knee flexion), with the hip flexed to 90°.

 but can be used as a "quick test" indicating the optimal or restricted range of motion.

 - The client/patient can achieve the lower leg near vertical (less than 20º of knee flexion), with the hip flexed to 90°.

Positive Test Results indicating Short/Over-active Hamstrings (

ROM is restricted (less than 20º of knee flexion)

Terminal knee extension can only be achieved if the client/patient's hip is internally rotated, externally rotated, or abducted.

Predictive Models of Postural Dysfunction

 to our Results on the Hamstring Length Test:

 is presumed over-active based on the predictive models of 

, as well as 3 studies that show an increase in 

 pelvic tilt, lumbar spine instability, and/or sacroiliac joint dysfunction (30-32). This implies that a Positive Hamstring Length Test most often indicates over-activity of the 

Hip External Rotator: Release and Lengthening

Gastroc/Soleus Length Test

 (Indicating Restriction): Restriction in ankle dorsiflexion with knee extended or bent. For a review of "Ankle Dorsiflexion Goniometry" - 

 - Client/patient exhibits normal dorsiflexion with knee extended. No need to test again with knee bent.

Positive Test Result indicating a Short/Over-active 

A restriction in dorsiflexion is noted with knee extended; dorsiflexion improves when the knee is flexed.

 (and potentially all other plantar flexors)

A restriction in dorsiflexion is noted with knee extended that does not change when the knee is flexed.

This result is the major weakness of this test. If the 

 is restricting dorsiflexion no additional information can be gained. The 

 alone, or potentially all plantar flexors (

If Dorsiflexion Increases When the Knee is Flexed, Further Differentiation may be Possible:

With the knee flexed, if everting the foot increases dorsiflexion then it is likely that the 

 are contributing to a restriction in dorsiflexion.

With the knee flexed, if inverting the foot increases dorsiflexion then it is likely that the 

 is contributing to a restriction in dorsiflexion

Florence Peterson Kendall, Elizabeth Kendall McCreary, Patricia Geise Provance, Mary McIntyre Rodgers, William Anthony Romani

Dutton's Orthopaedic Examination Evaluation and Intervention

Sahrmann SA. (2001). Movement impairment syndromes of the shoulder girdle. In: Sahrmann et al., Movement Impairment Syndromes. St. Louis, MO: Mosby. 193-261.

Manipulative Therapy: Musuloskeletal Medicine

Latissimus Dorsi Muscle Length Test (Poor Validity, although Shoulder Flexion is a Reliable Goniometric Assessment - See Goniometry)

Borstad JD, Briggs MS. (2010). Reproduciblity of a measurement for latissimus dorsi muscle length. 

Ely's Test (Fair to high reliability, more reliable with a goniometer)

Peeler J, Anderson JE. (2008). Reliability of the ely’s test for assessing rectus femoris muscle flexibility and joint range of motion. 

Ober's Test (reliable 11, 13, 14 not a valid measure of ITB 12 (think tfl glute min, glute med and joint capsule)

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. 

Willett GM, Keim SA, Shostrom VK, Lomneth CS. (2016). An anatomic investigation of the ober test. 

Dishun HC, Fischer CJ, Studer KC, Cade DL. (2002). The relationship between femoral torsion and performance of the ober tests. 

Ferber R, Kendall KD, McElroy L. (2010). Normative and critical criteria for iliotibial band and iliopsoas muscle flexibility. 

Modified Thomas Test (moderate to high reliability, lower for rectus femoris length, higher when pelvic tilt is controlled)

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. 

Peeler JD, Anderson JE. (2008). Reliability limits of the modified Thomas test for assessing rectus femoris muscle flexibility about the knee joint. 

Peeler J, Leiter J. (2013). Using digital photography to document rectus femoris flexibility: a reliability study of the modified Thomas test. 

Kim G, Ha S. (2015). Reliability of the modified Thomas test using a lumbo-pelvic stabilization. 

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. 

Hamstring Length Test (In all 3 Studies Active Knee Extension resulted in high validity and reliability)

Gajdosik R, Lusin G. (1993). Hamstring muscle tightness: reliability of an active-knee-extension test. 

Rakos DM, Shaw KA, Fedor RL, et al. (2001). Interrater reliability of the active-knee-extension test for hamstring length in school-aged children. 

Worrell TW, Sullivan MK, DeJulia JJ. (1992). Reliability of an active-knee-extension test for determining hamstring muscle flexibility. 

Gastrocnemius and Soleus Length Test (Valid and Reliable for to show muscle length imbalances in the gastrocnemius and soleus)

Wang SS, Whitney SL, Burdett RG, et al. (1993). Lower extremity muscular flexibility in long distance runners. 

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:

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. 

Boone, D. C., Azen, S. P., Lin, C. M., Spence, C., Baron, C., & Lee, L. (1978). 

Rothstein, J. M., Miller, P. J., & Roettger, R. F. (1983). 

Dougherty J, Walmsley S, and Osmotherly PG. (2014). Passive range of movement of the shoulder: a standardized method for measurement and 

Journal of Manipulative and Phsyiological Therapeutics.

Mullaney MJ, McHugh MP, Johnson CP, Tyler TF. (2010). 