SPORT PHYSIOTHERAPY
SPECIAL TESTS
- KNEE -
ACL
• Supine, 30° knee flexion, femur fixated
with physio’s hand, tibia in slight ER
LACHMAN’S
TEST → Try to translate tibia anteriorly
☆ Most Valid
Soft/mushy end feel or tibial translation
anterior >3mm compared to uninjured
• Supine, 45° hip flexion, 90° knee
flexion, fixate position by sitting on foot
ANTERIOR
DRAWER → Palpate (stay on) joint line & pull tibia
TEST anteriorly in explosive movement
Soft/mushy/absent end feel or tibia
translates anteriorly >6mm
• Supine, hip flexed & abducted to 30°,
tibia IR, valgus force on knee
→ Move patient’s leg from knee extension
PIVOT to knee flexion (repeat a few times)
SHIFT TEST
Tibia reduces/jogs backward @
around 30°- 40° of knee flexion
(often makes “klunk” sound & described
as “giving way” feeling when walking)
PCL
• Supine, 45° hip flexion, 90° knee
flexion (both knees)
POSTERIOR → Observe the joint line distal to patella
SAG SIGN
Tibia drop/sags back due to gravity
(confirm by fixating hip & knee in 90°
flex, pt extend knee, tibia will realign)
• Supine, 45° hip flexion, 90° knee
flexion, fixate position by sitting on foot
POSTERIOR
DRAWER → Palpate (stay on) joint line & push tibia
TEST posteriorly in explosive movement
Soft/mushy/absent end feel or tibia
translates posteriorly >6mm
• Supine, 30° knee flexion, stabilized
with physio’s knee, femur fixated with
physio’s hand, tibia neutral
REVERSE
LACHMAN’S
TEST → Try to translate tibia posteriorly
Soft/mushy end feel or tibial translation
posterior is more compared to uninjured
MENISCUS
• Prone, 90° knee flexion, femur fixated
with physio’s knee
→ Distraction + medial/lateral rotation of
tibia
Pain/discomfort or excessive rotation
compared to uninjured side
= Ligament lesion
APLEY’S
TEST
• Prone, 90° knee flexion, femur fixated
with physio’s knee
→ Compression + medial/lateral rotation
of tibia
Pain/discomfort or decreased rotation
compared to uninjured side
= Meniscus lesion
• Supine, 90° hip flexion, full knee flexion
→ Rotate tibia medially & extend knee
(repeat with different angles)
Pain/clicking/locking in knee
= (Posterior) Lateral meniscus damage
MCMURRAY
TEST
• Supine, 90° hip flexion, full knee flexion
→ Rotate tibia laterally & extend knee
(repeat with different angles)
Pain/clicking/locking in knee
= Medial meniscus damage
• Stand on injured leg only, 20° knee
flexion, hold onto physio for stability
THESSALY
TEST → Rotate over the tibia (3x each side)
Pain in joint line during rotations
= Meniscus lesion
MCL
• Supine, legs fully extended, physio’s 1
hand fixate femur, other just ankle
VALGUS → Slight tibia ER & do passive abduction
STRESS TEST of knee joint (redo in 20-30° knee flex)
Excessive gapping on medial side &
reproduction of patient’s pain
LCL
• Supine, legs fully extended, physio’s 1
hand fixate femur, other just ankle
VARUS → Slight tibia ER & do passive adduction
STRESS TEST of knee joint (redo in 20-30° knee flex)
Excessive gapping on lateral side &
reproduction of patient’s pain
PATELLOFEMORAL INSTABILITY
• Supine/sitting with 30° knee flexion &
quads should be relaxed
PATELLO-
FEMORAL → With thumbs press on the medial side of
APPREHEND patella to exert lateral pressure
TEST
Pt may be surprised by displacement or
feel uncomfortable/apprehensive as
patella reaches max lateral displacem.
PATELLOFEMORAL PATHOLOGY
• Supine, physio on injured side place
webspace on patella superior border
CLARKE’S
SIGN → Ask patient to contract quadriceps &
PATELLA apply downward + inferior pressure
GRIND TEST
Pain with movement or inability to
complete test = dysfunction/pathology
KNEE SWELLING
• Supine, legs extended, physio press
down just above supra-patellar pouch
& just below apex of patella
PATELLAR
TAP TEST → Take 1 finger & press down on patella
Floating patella (indication of fluid
accumulation under patella = swelling)
SPORT PHYSIOTHERAPY
SPECIAL TESTS
- ANKLE -
LATERAL ANKLE SPRAIN
• SOEOB, foot in plantarflexion
TALAR TILT
TEST → Grab calcaneus & perform inversion
VARIATIONS
(ATFL) Reproduce pain or find excessive
gapping compared to unaffected side
• SOEOB, foot in neutral (anatomical)
TALAR TILT
TEST → Grab calcaneus & perform inversion
VARIATIONS
(CFL) Reproduce pain or find excessive
gapping compared to unaffected side
• SOEOB, foot in neutral (anatomical)
TALAR TILT
TEST → Grab calcaneus & perform eversion
VARIATIONS
(DELTOID) Reproduce pain or find excessive
gapping compared to unaffected side
• SOEOB, foot in dorsiflexion
TALAR TILT
TEST → Grab calcaneus & perform inversion
VARIATIONS
(PTFL) Reproduce pain or find excessive
gapping compared to unaffected side
ATFL RUPTURE* / CHRONIC ANKLE LAXITY
• Supine, knee slightly flexed, 10-15° PF,
grasp heel & let foot rest on forearm
ANTERIOR
DRAWER → Fixate tibia as close as possible to the
TEST joint line & draw foot anteriorly
anterior translation compared to other
• Supine, 45° hip flexion, 90° knee
flexion, 10-15° PF (towel)
ANTERIOR
DRAWER
→ Fixate foot & push tibia posteriorly
TEST
ALTERNATIVE
Increased translation compared to the
unaffected side
FRACTURES
1. Palpate for tenderness on posterior Lateral Medial
edge of lateral & medial malleolus,
start distally & move 6cm upwards
2. Palpate for pain/tenderness over
navicular bone & 5th metatarsal
OTTAWA’S 3. Let patient walk 4 consecutive steps
RULES (negative if patient can walk/limp)
No pain on palpation & able to walk
(if 3/3 - = almost 100% no fracture)
Pain on palpation & unable to walk
(if 1/3 is + = 25-50% chance of #
and patient needs to go for x-ray) Medial Lateral
ACHILLES TENDON RUPTURE
• Prone, feet hang freely off bed
THOMPSON
TEST → Squeeze calf a couple of times &
CALF observe the plantarflexion of ankle
SQUEEZE
Absent ankle plantarflexion
PERIPHERAL NERVE INJURY
• Supine, 45° hip flexion, 90° knee
flexion, foot flat/foot on lateral edge
TINEL’S
SIGN → Tap anterior to medial malleolus &
posterior to medial malleolus
Tingling/paraesthesia felt distally
DEEP VEIN THROMBOSIS
• Supine, leg extended or 90° hip & knee
flexion with dorsiflexion OR
• SOEOB, hip & knee flexed with DF
HOMAN’S
SIGN/TEST
→ Squeeze calf
Pain on palpation of calf
SYNDESMOSIS
• Supine, 45° hip & 90° knee flexion
→ Squeeze proximal tibia & fibula
SQUEEZE together and apply same compression at
TEST more distal places down to malleoli
Pain on compression = rupture
(#/contusion/compartment ruled out)
• Supine, legs extended, stabilize distal
tibia & fibula with one hand
COTTON
TEST → Apply lateral translation force to foot
Translation > 3-5mm or if “klunk” is
heard/felt = syndesmosis lesion
• SOEOB, 90° knee flexion, feet hanging
DF - ER
STRESS → Grip heel, foot in max dorsiflexion &
TEST apply external rotation stress to foot
Anterolat pain (syndesmosis) reproduced
LOWER LIMB PULSES
TIBIALIS • Foot in plantarflexion
PULSE
ARTERY → Palpate posterior to medial malleolus
• Foot in dorsiflexion
DORSALIS
PEDIS → Palpate between extensor hallucis
ARTERY longus & extensor digitorum tendon
on the dorsum of the foot
• Supine, 45° hip & 90° knee flexion
POPLITEAL → Palpate with all fingers (more on tibia),
ARTERY between two heads of gastrocnemius,
pulling hard on the leg (you will feel the
pulse with one or two of the fingers)
• Supine, 45° hip & 90° knee flexion
FEMORAL
ARTERY → Palpate on the lateral side of rec fem &
inferior to the midway of the inguinal
ligament (ask patient to lift leg to find)
SPORT PHYSIOTHERAPY
SPECIAL TESTS
- HIP&GROIN -
SIJ / INTRA-0ARTICULAR HIP PATHOLOGY
• Supine, lateral malleolus of tested leg
on opposite leg’s knee (flex, abd & ER)
→ Stabilize pelvis at ASIS & giver
overpressure on medial aspect of knee
FABER TEST
Reproduction of patient pain/symptoms
- Pain elicited on ipsilateral side
anteriorly = hip joint disorder
- Pain elicited on contralateral side
posteriorly = SIJ dysfunction
FEMORAL ACETABULAR IMPINGEMENT / LABRAL TEAR
• Supine, 90° hip & knee flexion
FADIR TEST → Adduct & internally rotate hip
Reproduction of patient’s groin pain
(NB compare findings on both sides)
HIP FLEXOR CONTRACTURES / ILIOPSOAS TIGHTNESS
• Supine, neutral pelvis (ASIS = PSIS)
THOMAS → Ask patient to bring knee to chest as far
TEST as possible & hold it afterwards
Opposite leg will lift off the table (can
measure angle at knee for reference)
RECTUS FEMORIS CONTRACTURE
• Supine, legs hanging off plinth @ 90°
KENDALL → Bring knee to chest & hold
TEST
Knee at hanging leg extends > 90°
(to be sure of muscle stretch, ask patient
or palpate rec fem of hanging leg)
ITB Tightness
• Side lying, bottom knee in slight flexion,
abduct & extend top leg, fixate pelvis
OBER’S
TEST → Slowly lower upper leg down to plinth
Upper leg hangs, unable to get down
FEMUR STRESS FRACTURE
• SOEOB, physio’s arm distally under
femur (move proximal if no pain)
FALCRUM
TEST → Press down with webspace above knee
Sharp pain & likely apprehension
SPORT PHYSIOTHERAPY
SPECIAL TESTS
- SHOULDER -
SHOULDER IMPINGEMENT
• Standing/sitting, 90° shoulder flexion in
scapular plane (scaption), full IR, thumbs
JOBE’S
TEST → Apply downward pressure to prevent further
Empty Can elevation of the shoulder & patient resists
Reproduction of pain on injured side
• Sitting, 90° shoulder flexion, slight elbow
flexion, rest humerus on physio’s arm
HAWKINS
KENNEDY → Grip above wrist & perform passive IR
TEST
Provocation of pain = subacromial impingement
(will be negative for pt w. internal impingement)
• Sitting, physio stand behind patient & depress
scapula with opposite hand
NEER’S
TEST → Internally rotate patient’s arm & perform
maximal forced shoulder flexion in GH joint
Reproduction of pain on injured side
SHOULDER INSTABILITY
• Supine, 90° shoulder abduction, flex elbow
APPREHEND → Take shoulder into maximal ER
(CRANK)
TEST Pain during ER (or fear of luxation)
- Anterior = subacromial impingement
- Posterior = post sup glenoid impinge
• Apprehension position where pain is elicited
→ Add posterior glide in glenohumeral joint
SHOULDER
RELOCATE Pain persists = primary impingement
TEST (symptoms independent of position of HH)
Pain elicited in apprehension test disappears
= secondary impingement (pain is elicited
from excessive anterior translation of HH)
• SOEOB, upright posture, palms rest on thighs
→ Load = position HH centrally in glenoid fossa
LOAD & → Shift = translate HH anteriorly & posteriorly
SHIFT TEST
Reproduce symptoms & injured side
translates further than uninjured side
(Normal translation anterior = 25% &
posterior = 50% humeral head diameter)
• Standing, (relaxed) arms by side
SULCUS
SIGN → Pull tested arm distally
Little dip under acromion/feel of subluxation
ROTATOR CUFF LESION
• Standing/sitting, 90° shoulder flexion in
scapular plane (scaption), full ER, thumbs
FULL CAN
TEST → Apply downward pressure & patient resists
Reproduction of pain on injured side
(assess integrity of supraspinatus tendon)
BICEPS PATHOLOGY / SLAP LESION
1. Standing, elbow extended & full supination
→ Patient performs 0-60° shoulder flexion
actively & physio gives resistance
2. Standing, elbow extended & full supination
in 90° shoulder flexion
SPEED’S
→ Patient resists downwards pressure of physio
TEST
Pain in bicipital groove during test ( tension)
= biceps muscle or tendon pathology
To confirm positive test, repeat test with arm
in full pronation & pain will decrease/subside
• Supine, 120° shoulder abduction & 90° elbow
flexion, physio support elbow
BICEPS
LOAD II → Give resistance at wrist in direction of elbow
TEST extension & let patient do elbow flexion
Pain in resisted elbow flexion = SLAP lesion
• Standing, 90° shoulder flex & 10° adduction
→ Patient does full IR & resist downward force
O’BRIENS
TEST → Patient does full ER & resist downward force
Pain provoked in 1st test is less/disappears in
2nd testing position = SLAP lesion
• Standing (physio behind pt), hold affected
arm by wrist at 90° elbow & shoulder flexion
DYNAMIC
LABRAL → Give anterior directed force on proximal
SHEAR humerus & elevate to about 150° & back (±3)
TEST
Pain/feel click in posterior joint line between
90° & 120° shoulder elevation = SLAP lesion
• Standing, 90° elbow flexion & full pronation
→ Physio resist while patient perform supination
& palpate biceps tendon in bicipital groove
YERGASON
TEST
If you feel biceps tendon popping out of
groove = tear of transverse humeral ligament
Tenderness/pain without popping out of
groove = biceps tendinosis or SLAP lesion
POSTERIOR INFERIOR LABRAL TEAR
• SOEOB, physio behind & stabilize scapula, 90°
abduction + elbow flexion with IR
JERK’S → Apply longitudinal force through humerus at
TEST elbow & move arm into horizontal adduction
Sudden “klunk” as humeral head slides off the
back of the glenoid (with abrupt pain felt)
• Sit on chair with back support, 90° shoulder
abduction & 90° elbow flexion (supported)
KIM’S → Apply medial force to glenoid through humerus
TEST with body, place other hand distal to deltoid
with downward posterior force, lift arm
diagonally upwards (maintain 2 forces)
Sudden onset posterior shoulder pain & click
ACROMIOCLAVICULAR JOINT PATHOLOGY
(#1 Cross Body Adduction Test)
• SOEOB, take arm into 90° shoulder flexion
(If all 3 tests positive = high likelihood of AC joint pathology)
ACROMIOCLAVICULAR JOINT PROVOCATION CLUSTER
→ Take arm into maximal horizontal adduction
Produce pain on top of shoulder near AC joint
(#2 AC Resisted Extension Test)
• SOEOB, 90° shoulder &elbow flexion
→ Patient resists horizontal adduction by physio
Produce pain on top of shoulder near AC joint
(#3 Active Compression [O’Brien] Test)
• SOEOB, 90° shoulder flexion, 10° adduction
→ Full IR (thumb ) & pt resist downward force
→ Full ER (palm ) & pt resist downward force
Produce pain on top of shoulder near AC joint
in first test but pain subsides in 2nd test with ER
• SOEOB, physio behind, thumb on posterolateral
aspect of acromion, index + long fingers placed
superiorly to midpart of clavicle
PAXINOS
SIGN → Give pressure with thumb to acromion in
anterior superior direction & and with long
fingers to clavicle in inferior direction
Pain felt in region of AC joint
SCAPULAR DYSKINESIA
• Standing, physio behind fixate clavicle &
scapula spine with 1 hand & grab inferior
angle of scapula with other hand
SCAPULAR
ASSISTANCE
TEST → Ask patient to perform abduction & assess mvt
Patient experience less pain with assisted
movement in comparison to non-assisted
• Standing, physio behind fixate clavicle &
scapula spine with hand & press scapula
SCAPULAR against chest wall with forearm
RETRACTION
TEST → Perform empty can test
Pain during empty can test is reduced
SPORT PHYSIOTHERAPY
SPECIAL TESTS
- ELBOW -
LATERAL ELBOW TENDINOPATHY (TENNIS ELBOW)
• Standing, elbow flexed 90º, fixate humerus
& palpate lateral epicondyle with thumb
MILL’S TEST → Passively pronate patient’s forearm, flex
the wrist & then extend the elbow fully
Sudden pain at lateral epicondyle
• Sit on chair, arm on plinth, stabilize elbow
& palpate lateral epicondyle with thumb
COZEN’S → Ask patient to make a fist, pronate forearm
TEST & do radial deviation, then physio gives
resistance while patient goes into extension
Sudden pain at lateral epicondyle
• Sit on chair, arm on plinth, stabilize elbow
& palpate lateral epicondyle with thumb
3RD DIGIT
EXTENSION
TEST → Ask patient to pronate forearm & do
MAUDSLEY extension of middle finger while you resist
Sudden pain at lateral epicondyle
MEDIAL ELBOW TENDINOPATHY (GOLFER’S ELBOW)
• Standing, elbow flexed 90º, fixate humerus
FLEXOR/ & palpate medial epicondyle with thumb
PRONATOR
TENDINO- → Passively supinate patient’s forearm, extend
PATHY the wrist & then extend the elbow fully
TEST
Sudden pain at medial epicondyle
MCL INSTABILITY
• Standing, fixate humerus in ER, palpate
ulnar collateral ligament just medial
epicondyle, other hand just proximal/medial
VALGUS
to wrist joint
STRESS
TEST
→ Flex elbow ±30º & give abd/valgus force
Increased laxity & pain
• Standing/SOEOB, 90º shoulder abduction,
maximal elbow flexion & external rotation
MOVING → Quickly extend elbow to ±30º (keeping ER)
VALGUS
STRESS If following criteria apply:
TEST a) Patient’s known sudden medial elbow
pain is reproduced
b) Pain should be maximal within the
arc ranges of 120º - 70º if extending
LCL INSTABILITY
• Standing, fixate humerus in ER, palpate
radial collateral ligament, other hand just
VARUS proximal/lateral to wrist joint
STRESS
TEST → Flex elbow ±30º & give add/varus force
Laxity/change in ROM/soft end feel/pain
DISTAL BICEPS TENDON RUPTURE
• Standing/SOEOB, physio next to patient
→ Patient actively flex elbow to 90º & fully
HOOK supinate arm, physio use opposite index
TEST finger & hook under biceps tendon by
bringing it in laterally of the antecubital
fossa and pulling it forward
Unable to hook finger under avulsed tendon
• SOEOB, forearms resting on thighs, slight
pronation, physio next to affected arm
BICEPS
SQUEEZE → Grasp muscle with both hands placed at
TEST distal myotendinous junction & muscle belly
and then squeeze it firmly
No forearm supination observed in testing
