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Faculty Advisor(s)

Joaquin Barrios, PT, PhD

Description

Purpose: Hip joint extension mobility is commonly assessed for restriction in clinical practice, most often with the modified Thomas test (MTT). However, the MTT is not without challenges, particularly in regards to achieving and standardizing the proximal pelvis and trunk positioning. The lone 3D validation study on the MTT used a blood pressure cuff under the lumbar lordosis in an attempt to achieve standard positioning, which is not always clinically pragmatic. Therefore, we propose assessing hip extensibility with a novel reverse wall lunge test (RWL) described below, essentially as an upright weight-bearing version of the MTT that also standardizes proximal pelvis, trunk and upper body positioning. The purpose of this ongoing 3D validation study is to concurrently correlate and compare criterion reference hip extension angle data for the RWL and the traditional MTT. We hypothesize that a correlation coefficient at least at the 0.80 level would be observed.

Subjects: 17 participants (11 females, 10 post-surgical for knee disorders, height = 1.75±0.11 m, weight = 80.5±12.5 kg, age = 22.8±1.9 years) provided informed consent and completed all testing.

Methods/Materials: 3D motion capture procedures were used to acquire criterion data for both the RWL and MTT test positions. For the MTT, in brief, the participant stood perched on the edge of a plinth and then reclined with assistance. They grasped the contralateral limb in full flexion. The examiner then lowered the cantilevered test limb into maximal hip extension. For the RWL, the patient was in a half kneel position in front of a wall. The lead limb’s distal foot and knee were placed in contact with the wall, as were both bent elbows with the upper arms in a horizontal orientation. These contact points were used to provide positional standardization of the pelvis and trunk in a highly reproducible as well as functional position. The trail leg was then maximally extended for the assessment of hip extension mobility. Pearson product moment correlation coefficients were generated and Bland-Altman plots were assessed.

Results: The Person product moment correlation coefficient between the hip extension angles during the MTT and the RWL test was r = 0.866. Bland-Altman plot assessment showed a mean bias of 4.2 (95% CI = 1.4 - 7.1) degrees greater hip extension with the RWL.

Conclusion: As hypothesized, a strong correlation was observed between the hip extension data from the tests. The mean bias from the Bland-Altman assessment suggested that the RWL achieved greater maximal hip extension than the MTT.

Clinical Relevance: The RWL test appears to be a valid alternative to the MTT. The RWL test also appears to elicit greater maximal hip extension than the MTT. Clinicians may consider using the novel RWL test position to assess hip extensibility.

Publication Date

5-8-2025

Disciplines

Physical Therapy | Rehabilitation and Therapy

Comments

Presented on February 13, 2025 at APTA Combined Sections Meeting

Concurrent Validation of a Reverse Wall Lunge Test Position to Assess Hip Joint Extension Mobility

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