THOMAS

TEST

​• Test positioning

The client lies supine with both knees fully flexed against the chest and the buttocks near the table edge.

The therapist stands with one hand on the client's lumbar spine or iliac crest to monitor lumbar lordosis or pelvic tilt, respectively.

​• Action

The client slowly lowers the test leg until the leg is fully relaxed or until either anterior pelvic tilting or an increase in lumbar lordosis occurs.

​• Positive finding

A lack of hip extension with knee flexion greater than 45 degrees is indicative of iliopsoas muscle tightness.

Full hip extension with knee flexion less than 45 degrees is indicative of rectus femoris muscle tightness.

A lack of hip extension with knee flexion less than 45 degrees is indicative of iliopsoas and rectus femoris muscle tightness.

Hip external rotation during any of the previous scenarios is indicative of iliotibial band tightness.

​• Special considerations & comments

Increases in anterior pelvic tilt and lumbar lordosis must be eliminated in order to prevent false-negative findings.

To further confirm this assessment, the therapist can simply apply pressure on the lower leg in an effort to lower it back to the table.

A return of lumbar lordosis will indicate a positive finding.

The Thomas Test is attributed to Dr. Hugh Thomas, a pioneer in orthopedic surgery, whose work on hip flexor tightness has greatly influenced its application in lumbar spine and lower limb assessments.

Dr. James Cyriax further refined its clinical use.