MMT The Hip

Question 0

MMT hip flexion, abduction, and external rotation with knee flexion

Answer 0

Sartorius (L2-L3): femoral nerve
Grades 5,4,3: pt in short sitting
-Pt flexes, abducts and ER the hip and flexes knee
-Hand on lateral knee and other hand on medial-anterior surface of distal leg
-Resistance is down and in at the knee and up and out at the ankle
Grades 2,1,0: pt in supine
-“Slide your heel up to your knee”
-Palpate on medial side of thigh where it crosses the femur or just below the ASIS
** do not assign a grade 2/5 until actually having the pt perform in supine
** use care not to grab the calf muscle belly during the poor and trace tests

Question 1

MMT hip flexion

Answer 1

Psoas major (L2-L4) and Ilioacus (L2-L4): femoral nerve
Grades 5,4,3: short sitting
Pt flexes hip to end range
Resistance given at distal end of femur
“Lift your leg off the table, don’t let me push you down”
Grade 2: side lying
Limb that is being tested is superior. You give support under the knee. Bend the knee up
Grades 1,0: supine
Limb supported under calf, palpates just distal to inguinal ligament and medial sartorius
** test more accurate in supine when trunk is weak
** avoid any hip rotation during testing

Question 2

MMT hip extension

Answer 2

Gluteus Maximus (L5-S2): inferior gluteal nerve
Semitendinosus, semimembranosus, and biceps femoris- long head: (L5-S2) sciatic nerve
All hip extensor muscles
Grades 5,4,3: prone, knee extended
Grade 2: side lying, knee extended and leg supported under knee
Grade 1,0: prone, Palpate
*resistance given at distal end of femur- if very strong you can give resistance at lower leg
Isolate gluteus maximus
Grades 5,4,3: prone, knee flexed to 90 degrees
Grade 2: side lying, knee flexed and supported
Grade 1,0: prone

Question 3

MMT hip abduction

Answer 3

Gluteus medius and gluteus minimus (L4-S1): superior gluteal nerve
Grades 5,4,3: pt in side lying, bottom knee bent, lifting superior leg up to ceiling. Resistance given at distal lateral end of femur
Grades 2,1,0: pt in supine, Palpate on lateral side of hip
**be aware of substitutions: hip hiking, ER, flexion, TFL
**keep in mind that these muscles are very strong and it may be difficult to differentiate between a 4 and a 5

Question 4

MMT hip abduction from flexed position

Answer 4

Tensor fasciae latae (TFL) (L4-S1): superior gluteal nerve
Grades 5,4,3: pt in side lying, uppermost limb flexed at hip to 45 degrees, keeping knee extended, lift leg to ceiling
Grades 2,1,0: pt in long sitting

Question 5

MMT hip adduction

Answer 5

Adductor Magnus, adductor brevis, adductor longus (L2-L4)
Gracilis (L3-L4) obturator nerve
Pectineus (L2-L3) femoral nerve
Grades 5,4,3: pt in side lying, leg being tested lying on table
Grades 2,1,0: pt in supine
***cross top leg over and bend knee OR hold top leg and give resistance to lower leg at distal end of femur

Question 6

MMT hip external rotation

Answer 6

Obturator externus, obturator internus, Quadratus femoris, gemellus superior, gemellus inferior, gluteus Maximus
Grades 5,4,3: pt in short sitting
-give resistance on medial ankle (lateral force), other hand on lateral knee for support
-“don’t let me turn your leg out”
Grades 2,1,0: pt in supine
-test limb in IR then moves leg to ER
-“try to roll your leg out” or “roll your toes out”
**use a towel under the knee for support
**deep muscles! can’t really palpate

Question 7

MMT hip internal rotation

Answer 7

Gluteus minimus, TFL, gluteus medius (L4-S1): superior gluteal nerve
Grades 5,4,3: pt in short sitting
-give resistance on lateral ankle (medial force), other and on medial knee for support
-“don’t let me turn your leg in”
Grades 2,1,0: pt in supine
**test limb in ER then moves leg to IR
**keep pelvis stabilized during sitting tests
***grade 2 make sure they are going through complete range of motion