General lower-body assessments
If you are clueless on how to assess a clients lower body function, then try this exemplary template, to get some information on the overall ability of the patients strength, mobility and stability.
The following tests will be described shortly, with regards to their informative value and which tests might be useful for which clientele.
Tests for Strength:
Bunkie Test for adductors
The bunkie test is a timed test for the adductor musculature. This test is especially advisable for athletes that participate in sports where groin pain / adductor injuries are common (such as in soccer). The test in itself in no more than holding a "copenhagen plank" (which is basically a side plank where we will support out own bodyweight with the adductors of the involved leg) for time.
A good time to work towards is at least 30 seconds per side. But more important than overall time is to balance out any side to side differences in holding time. As unilateral strength differences will increase risk of injury. Good performance on this test (<40 seconds) is correlated with better sprinting and agility performance (Van Pletzen & Venter, 2012)..
Single-leg Squat Test
Here you can test for leg-axis stability, as well as abductor, gluteus and quadriceps strength.
You will want to look out if the patient can keep the knee in axis and if the pelvis stays horizontal. If there is a tilt in the pelvis or inward motion of the knee, an abductor weakness is likely to be present (Crossley et al., 2011). Which is a strong predictor of anterior knee pain.
Tests for Balance and Stability:
Star Excursion Balance Test (Y-Balance Test)
This test can be easily constructed on your own, by sticking 3 stripes of tape down on the floor and then measuring the distance with a simple meter band. Then have the person reach in all 3 directions (of an upside down Y) and measure how far they got.
With this test you can check for ankle stability as well as hip strength. Left to right asymmetries of >4cm will reveal increased injury risk for athletes (Plisky et al., 2006).
Tests for Mobility:
Knee to Wall test
The knee to wall test is used to measure ankle dorsiflexion. Put down a meter band in front of a wall, place your foot next to it (start with your toes at 10cm) and then try to reach the wall with your knee by flexing it (while keeping the heel in contact with the ground).
Here two things are of interest:
- The reached distance. As a reach of <10cm (or a persons first width) suggests ankle dorsiflex restriction.
- The area of tension: does the patient feel tension on the back (around achilles tendon -> suggesting muscular tension) or compression at the front (suggesting restriction in the tibia to talus gliding ability)
This test has been shown to be reliable even for a unexperienced tester (Konor et al., 2012) and low scores (less than 10 cm) are a strong predictor for lower extremity injury occurrence (Gabbe et al., 2004).
Quadriceps mobility
Have the client lie prone and manually flex their knee by pushing their lower leg towards their butt. Of interest is the distance between heel and butt.
If the patient can touch the butt with the heel, no restriction in mobility is present. More than 15 cm suggests strong shortening of the quadriceps and everything below that a slight restriction.
Hamstrings mobility
In order to test hamstring mobility, have the patient perform an active straight leg raise. He should be able to effortlessly lift the heel above the patella of the other leg. If that is not the case, a shortening of the backside of the leg is likely the case.
As a lack of hamstring flexibility has been shown to be an additional risk factor for hamstrung injuries (Clark, 2008), it is recommended to be tested for, especially in athletes.
Summary:
If you aim to assess your client's overall physical abilities in the lower extremities, consider having them perform the tests mentioned above, either individually or collectively. These tests hold particular significance for physically active individuals, as any limitations detected can highlight areas that require additional focus within a training protocol or therapy session. Moreover, all the aforementioned tests are relatively straightforward to conduct and provide practitioners with a readily reproducible means to track their clients' progress following training or therapy sessions.
Literature:
Clark, R. A. (2008). Hamstring injuries: Risk assessment and injury prevention. Annals of the Academy of Medicine, Singapore, 37(4), 341–346.
Crossley, K. M., Zhang, W.-J., Schache, A. G., Bryant, A., & Cowan, S. M. (2011). Performance on the single-leg squat task indicates hip abductor muscle function. The American Journal of Sports Medicine, 39(4), 866–873. https://doi.org/10.1177/0363546510395456
Gabbe, B. J., Finch, C. F., Wajswelner, H., & Bennell, K. L. (2004). Predictors of lower extremity injuries at the community level of Australian football. Clinical Journal of Sport Medicine: Official Journal of the Canadian Academy of Sport Medicine, 14(2), 56–63. https://doi.org/10.1097/00042752-200403000-00002
Konor, M. M., Morton, S., Eckerson, J. M., & Grindstaff, T. L. (2012). Reliability of three measures of ankle dorsiflexion range of motion. International Journal of Sports Physical Therapy, 7(3), 279–287.
Plisky, P. J., Rauh, M. J., Kaminski, T. W., & Underwood, F. B. (2006). Star Excursion Balance Test as a predictor of lower extremity injury in high school basketball players. The Journal of Orthopaedic and Sports Physical Therapy, 36(12), 911–919. https://doi.org/10.2519/jospt.2006.2244
Van Pletzen, D., & Venter, R. E. (2012). The Relationship between the Bunkie-Test and Physical Performance in Rugby Union Players. International Journal of Sports Science & Coaching, 7(3), 543–553. https://doi.org/10.1260/1747-9541.7.3.543