MMT Of Hip Flexion: Manual Muscle Testing

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The manual muscle test for hip flexion to evaluate the iliopsoas (iliacus and psoas major) muscle.


Muscles Involved:

  • Psoas Major
  • Iliacus
  • Rectus femoris

Hip Flexors

Hip Flexion

Grade 5 (Normal), Grade 4 (Good), and Grade 3 (Fair)

Position of Patient:

Short sitting with thighs fully supported on table and legs hanging over the edge. Patient may use arms to provide trunk stability by grasping table edge or with hands on table at each side .

Grade 5

Position of Therapist:

Standing next to limb to be tested. Contoured hand to give resistance over distal thigh just proximal to the knee joint.


Patient flexes hip to end of range, clearing the table and maintaining neutral rotation, holding that position against the examiner's resistance, which is given in a downward direction toward the floor.

Instructions to Patient:

"Lift your leg off the table and don't let me push it down."

  • Explain or demonstrate the movement that is required of the patient.
  • Ask the patient to perform the movement through the full range against gravity.
  • If the patient does not perform or is unable to perform the complete movement, check for these limiting factors:
  • Understanding of the required task
  • Availability of the appropriate range of motion - limitations may be due to soft tissue.


If the patient experiences pain, cramps, or spasms during the testing, the clinical evaluator must determine whether the patient feels that he/she is able to give his best effort in spite of his discomfort. If yes, continue the testing but note under comments that the patient complained of pain.

Grade 5 (Normal):

Thigh clears table. Patient tolerates maximal resistance.

Grade 4 (Good):

Hip flexion holds against strong to moderate resistance. There may be some "give" at the end position.

Grade 3 (Fair):

Grade 3

Patient completes test range and holds the position without resistance.

Knowledge of the ranges of motion of the hip is imperative before manual tests of hip strength are conducted. If the examiner does not have a clear idea of hip joint ranges, especially tightness in the hip flexor muscles, test results will be contaminated.

Grade 2 (Poor):

Position of Patient:

Side-lying with limb to be tested uppermost and supported by examiner.

Trunk in neutral alignment. Lowermost limb may be flexed for stability.

Grade 2

Position of Therapist:

Standing behind patient. Cradle test limb in one arm with hand support under the knee. Opposite hand maintains trunk alignment at hip


Patient flexes supported hip. Knee is permitted to flex to prevent hamstring tension.

Instructions to Patient:

"Bring your knee up toward your chest."

Patient completes the range of motion in side-lying position.

Grade 1 (Trace) and Grade 0 (Zero)

Position of Patient: Supine. Test limb supported by examiner under calf with hand behind knee .

Position of Therapist:

Standing at side of limb to be tested. Test limb is supported under calf with hand behind knee. Free hand palpates the muscle just distal to the inguinal ligament on the medial side of the sartorius.



Patient attempts to flex hip. Instructions to Patient: "Try to bring your knee up to your nose."

Grade 1 (Trace):

Palpable contraction but no visible movement.

Grade 0 (Zero):

No palpable contraction of muscle. 
Grade 1 or 0


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