What are your high value tests for the lower limb?

If you were allowed to do only one test per 'joint' area, what would it be, and why is this test so helpful for you?

To start the ball rolling, here are my key lower limb tests.

Foot & Ankle

Yes, the F & A does involve 28 bones (+/—some sesamoids), so more than one joint, but taken as a functional unit, my go-to test is the knee-to-wall (KTW) test to measure dorsiflexion. The KTW test has great inter- and intra-rater reliability, meaning it is good for between therapists and comparing treatments.

Technically the majority of dorsiflexion will be achieved at the talocrural joint, but substitution can come from the subtalar joint (plus the associated 1:1 ratio of pronation so watch out for this compensation). Dorsiflexion is the critical movement for forward motion, so vital for normal gait in running sports and more so in soft sand, ascending hills, riding horses and operating machinery with foot pedals.

Knee

Moving up the kinetic chain, around the knee joint I have Palpation as my preferred objective test.

My subjective history creates a strong indication as to the nature of the injury, possible load and mechanism and I then use my palpation skills to confirm/refute the involvement of individual tissues. Most tissues are superficial so it is my go-to to identify what structures are injured/irritated.

Hip

I find the hip one of the most interesting joints in the body. With a deep socket, it is designed for shock absorption and stability. The muscle structures around it are big and complex. Why do we have 10 external rotators of the hip, given that the shoulder only has 3?

Not to be distracted, my favourite test for the hip joint is the Hip Quadrant Test. I first learned this test during my Manips Postgrad in 1992, and I found it to be simple but illuminating when aiming to determine if the pain source is articular or muscular. A short trial of NSAIDs is also a good backup!

I would love to learn what tests you favour and why.

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