The muscles of the lower quarter include those of the leg, pelvis, and lower back. The muscles prone to tightness are those involved in maintaining a single-leg stance (Janda 1987). Tightness of the hip flexors and tightness of the thoracolumbar extensors are hallmark signs of Janda’s LCS.
The modified Thomas test (figure 7.2, a-e) allows the clinician to assess four different muscles prone to tightness namely, the one-joint hip flexor, iliacus and psoas major, and the two-joint hip flexors, rectus femoris and TFL-ITB. Tightness of the hip flexors limits hip hyperextension in gait and may cause an anterior pelvic tilt. Weakness of the gluteus maximus often is due to facilitation of the hip flexors.
The patient is asked to sit on the edge of the table, with the coccyx and ischial tuberosities touching the table and one foot on the floor. Then, the patient is asked to flex the opposite hip and knee toward the chest and maintain the position with the hands (see figure 7.2a).
The clinician stands beside the leg not being tested, facing the patient. While supporting the patient by placing one hand on the midthoracic spine and the other on the knee, the clinician passively rolls the patient down to the table to the supine position. The clinician needs to ensure that the patient’s knees are flexed, lumbar spine is flexed, and pelvis is in posterior rotation to fix the origin of the hip flexors.
The clinician passively lowers the tested leg until resistance is felt or movement at the pelvis is detected. With the patient’s thigh in the final resting position, the clinician observes whether it is in neutral and parallel to the table or abducted. A normal length of the one-joint hip flexors with the lumbar spine and sacrum flat on the table is indicated by the posterior thigh touching the table (0° of hip extension). With slight overpressure, the thigh should reach 10° to 15° of hyperextension (figure 7.2, b-c). Prominence of a superior patellar groove (figure 7.2d) suggests a short rectus femoris, while prominence of a lateral IT groove suggests a short IT band (see figure 7.2e).
This is an excerpt from Assessment and Treatment of Muscle Imbalance: The Janda Approach.