Ely's Test (Rectus Femoris Flexibility Assessment)

Ely's Test is a commonly used method for assessing the flexibility of the Rectus Femoris, a major muscle of the thigh. During the test, the patient is asked to lie flat with the knee bent at 90° angle, and then to extend the leg, keeping the hips on the surface. The therapist then evaluates how far the leg can straighten. A decreased flexibility of the Rectus Femoris may indicate a certain degree of impairment of the knee joint, and other muscle

Transcript

00:00:0000:00:04
This is Brent, and I'm excited to go
00:00:0400:00:07
we're going to do the Ely test, but first let me explain how I personally would
00:00:0700:00:09
use this a test like this.
00:00:0900:00:13
This is a specific flexibility test for a specific muscle group.
00:00:1300:00:19
This becomes important after I've done a dynamic movement assessment, something
00:00:1900:00:23
like the overhead squad. The limit of something like an overhead squat, is it
00:00:2300:00:29
implies joint actions. That is, we are determining what joint action occurred
00:00:2900:00:35
to get somebody outside of optimal posture. If we have a joint action to
00:00:3500:00:41
look at, it then only implies a group of muscles. In the Ely test,
00:00:4100:00:45
what I'm trying to determine is which of my hip flexors are tight. So like, let's
00:00:4500:00:49
say, I have something like an excessive forward lean. Excessive forward lean is
00:00:4900:00:55
excessive hip flexion. Excessive hip flexion would imply that my psoas,
00:00:5500:00:59
iliacus, rectus femoris, or TFL could be tight.
00:00:5900:01:05
Now I'm going to go to something like my Ely test, Thomas test, or Ober's test, to
00:01:0500:01:09
determine which of those structures are tight, and which need to be included in
00:01:0900:01:11
my exercise program.
00:01:1100:01:14
So here we go. We're starting with the Ely test. I'm going to have my friend Yvette
00:01:1400:01:19
come out and I'll show you guys how to perform this very simple, very easy, test.
00:01:1900:01:23
Now first things first, they lie prone. Make sure they're in a comfortable
00:01:2300:01:26
position. You have your kinetic chain checkpoints lined up.
00:01:2600:01:29
You don't want to start your assessment already out of alignment.
00:01:3000:01:35
Next thing I'm going to do, is I'm going to find her PSIS, alright, her posterior
00:01:3500:01:40
superior iliac spine, and you guys can do that if you haven't done that before, you
00:01:4000:01:44
can kind of google some pictures and see where those are located.
00:01:4400:01:47
If you guys have ever seen somebody with their pants hanging a little low in the back,
00:01:4700:01:51
and they get those two little dimples in the back right here.
00:01:5100:01:57
Those are pretty close to the PSIS. You can also just feel the ilium, until you
00:01:5700:02:01
get to these two bony notches, just lateral to the spine.
00:02:0100:02:04
So what I'm going to do is I'm going to take my index finger and my thumb,
00:02:0500:02:10
and put those on her PSIS. Next thing I'm going to do, since this is a rectus
00:02:1000:02:15
femoris test, is I'm going to go ahead and take her foot in neutral position
00:02:1500:02:19
here, and just try to push it towards her backside.
00:02:1900:02:23
Now for the most part, I use this as a pass/fail test.
00:02:2300:02:29
You should be able to get to the heel within a couple inches of the back side,
00:02:2900:02:34
or actually touching the back side, without any compensation, and with a
00:02:3400:02:37
fairly soft end feel.
00:02:3700:02:42
Now, Yvette's not really terribly tight, but she is a little tight, and here is how I can
00:02:4200:02:47
tell. As I push her towards her backside, I actually feel the pressure of
00:02:4700:02:51
her PSIS pushing in to my thumb.
00:02:5100:02:56
So what does that mean? It means she's going into an anterior pelvic tilt. Her
00:02:5600:03:02
rectus femoris, a hip flexor, is pulling her pelvis this way. So we got
00:03:0200:03:06
just a little bit of tightness in her rectus femoris. And if I test the
00:03:0600:03:09
other leg,
00:03:1000:03:16
I actually already feel, feel some pressure here, and then you guys will get
00:03:1600:03:18
to see another compensation start to happen.
00:03:1800:03:22
She does a couple things here, and I don't know if you guys can see it, but
00:03:2200:03:27
she actually starts to rotate up this way, as she tries to, as this rectus femoris
00:03:2700:03:32
tries to pull this side of her pelvis into an anterior pelvic tilt. She
00:03:3200:03:39
also starts to deflect into abduction a little bit. So I start
00:03:3900:03:45
feeling pressure in my index finger here, at her PSIS. She starts to rotate up
00:03:4500:03:50
towards me, and I'm actually seeing just a little bit of deflection this way.
00:03:5000:03:55
So those are all signs that her rectus femoris is tight. Now, she's not terribly
00:03:5500:03:57
tight, and I'm pushing pretty hard.
00:03:5700:04:00
You'll be surprised. You'll find some people and it's like, stuck right here.
00:04:0000:04:05
Now if I had somebody where I thought the rectus femoris was not only tight, but
00:04:0500:04:10
a key structure in their dysfunction, something I really wanted to keep track
00:04:1000:04:10
of,
00:04:1000:04:17
I do think this test is simple enough, and reliable enough, that I may take a
00:04:1700:04:20
goniometer to this test.
00:04:2100:04:30
And all I would do is go through my same exact steps, and when I feel that first
00:04:3000:04:31
resistance barrier,
00:04:3100:04:35
all right Yvette, can you hold that for me? Good. I would have her hold that
00:04:3500:04:36
position.
00:04:3600:04:41
My stability arm goes through the center of my knee joint and I can palpate her
00:04:4100:04:48
joint line here, and then through her greater trochanter, and then the movement
00:04:4800:04:49
arm,
00:04:4900:04:55
we line up with the lateral malleolus. And I'm going to make this up, because
00:04:5500:05:02
this is actually not her end range, but that's 62 degrees. Now, what I would
00:05:0200:05:07
do is, I would then implement my corrective programming and either, at the
00:05:0700:05:10
end of every session, or maybe at the end of every week, or at the end of every two
00:05:1000:05:15
weeks, I would go ahead and reassess to make sure that we are getting gains. Of
00:05:1500:05:17
course, if I'm not getting gains,
00:05:1700:05:22
there's something wrong with my program and I need to change what I'm doing with
00:05:2200:05:22
her.
00:05:2200:05:27
I hope you guys enjoy the simple test. I hope it helps refine your exercise
00:05:2700:05:30
selection and exercise program. I look forward to talking to you guys again