Functional Testing Protocol - HIP
NAME: __________________________ DOB: __________ MRN: ____________ DATE: _________
Involved: R or L DATE OF SURGERY: _____________ PHYSICIAN: __________________________
Return to Sport Test
Test Dynamic R L %
Valgus *
(Y/N)
Hand-Held Dynamometer Hip Abduction N/A
Hip Extension N/A
Hip ER N/A
Anterior:
Y-Balance Posterolateral:
Leg Length (ASIS to medial malleolus):
Posteromedial:
________ cm Composite: N/A N/A
Single Leg Vertical
Single Leg Hop with Fatigue Protocol
Cross-Over Hop
Medial Triple Hop
Figure 8 Hop
Leg Press Body weight:____
Percentage of Body Weight: Seat setting:_____
☐ 75%________ ☐ 100% _______
other % ______
Additional Comments:
* Dynamic Valgus is defined as the kneecap being medial to the great toe during the test
Sports Medicine and Performance Center | sportsmedicine.kansashealthsystem.com | Phone: 855-898-9275
pg. 1
Functional Testing Instructions
Warm-up
Allow 5-minute bike or elliptical warm-up with moderate resistance.
Demonstration and practice trials
The examiner may demonstrate each test. A maximum of two practice trials will be allowed for each test.
Scoring
Limb symmetry index (LSI) greater than or equal to 90% (involved vs. uninvolved limb) is required for each test, except
for Composite Y-balance scoring, which is based on limb length norms.
Hand-Held Dynamometry
Place HHD in mobilization belt with proper stabilization as shown in pictures below. The
best of 2 trial should be recorded.
Hip abduction
Patient Position: sidelying, testing limb up
Limb Position: hip and knee 0 degrees, contralateral hip and knee slightly flexed
HHD position: distal lateral thigh with strap stabilized underneath table
Hip extension
Patient Position: prone
Limb Position: 90 degrees knee flexion
HHD position: distal posterior thigh with strap stabilized underneath table
Hip External Rotation
Patient Position: seated
Limb Position: 90 degrees hip and knee flexion, trunk upright, foot not in contact with
ground
HHD position: medial ankle with strap stabilized with table from lateral side
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pg. 2
Y-balance
Standing with one leg on the center platform with toes behind the red line and hands placed firmly on hips, the subject
is instructed to push the indicator with the toes in the desired direction as far as they can while maintaining balance
and return to starting position under control. The heel must stay in contact with the platform during the test. The
subject may not touch the free leg to the ground during the movement to keep balance or put their foot on the top of
the reach indicator to gain support. Once the subject has completed three successful trials with the uninvolved leg they
will repeat the process with the involved leg before moving on to the next direction. The best of the three reaches is
recorded as the patient’s reach distance. Reach distances should be recorded to the nearest centimeter. For the Y-
balance anterior, a difference of >4cm between limbs constitutes a failed test. Composite score is determined by the
following equation: Anterior + Posterolateral + Posteromedial divided by (3 x leg length) multiplied by 100
Leg Press
Choose appropriate percentage of body weight based on current strength of the involved limb. Subject will perform a
single-leg leg press for 60 seconds, trying for as many repetitions as possible. Repetitions will not be counted if the
subject uses the opposite limb for support or loses proper form including dynamic valgus. Each repetition must be
performed from 0-90 degrees.
Single Leg Vertical Leap
The subject is to jump off one leg without an approach step but may land on two legs. The object is to measure the
maximal vertical jump, comparing uninvolved to involved. Devices such as the Vertec or the Just Jump
(https://www.power-systems.com), or best methods available, should be used to objectify vertical leap. Three trials
are performed on each side, accepting the best score from each of the three trials for comparison.
Hop Tests
Three trials are performed on each limb, and the best score for each limb is recorded. Start with lead toe behind
marked line and measure to the nearest centimeter or ½ inch. Landing must be maintained for a minimum of two
seconds while the toe measurement is being recorded. A failed attempt consists of loss of balance, touching the floor
with arms or opposite leg, an additional short hop on landing, or presence of dynamic valgus.
Single Leg Hop after fatigue protocol
Prior to performing the single leg hop test, participants perform a unilateral step-down from a 12-inch box,
tapping their heel to the floor each time, and completing this as many times as possible on a single limb for
two minutes. After performing the 2-minute fatigue protocol, single leg hop for distance is performed on the
same limb for 3 repetitions. The best score is recorded. This same protocol is then repeated on the opposite
limb.
Cross-Over Hop
Standing on one leg, perform three successive hops crossing over a 15-cm wide strip or marker, landing on the
same limb. The first hop should be lateral in respect to the direction of the crossover. There should be no
pauses between hops.
Sports Medicine and Performance Center | sportsmedicine.kansashealthsystem.com | Phone: 855-898-9275
pg. 3
Medial Triple Hop
Standing on one leg perpendicular to the measuring tape, hop as far as possible in the medial direction with 3
successive hops on the same limb. There should be no pause between hops.
Dingenen B, Truijen J, Bellemans J, Gokeler A. Test–retest reliability and discriminative ability of forward, medial and rotational single-leg hop
tests. Knee. 2019;26(5):978-987. doi:10.1016/j.knee.2019.06.010
Figure 8 Hop
With two cones placed 5 meters (16 ft., 5 in.) apart, the participant will hop as fast as possible on one limb
twice around the cones in a figure 8 pattern, with time being recorded. Failed test consists of inability to
maintain figure 8 course path or touching down with opposite limb. The best time from two trials is recorded.
(**See below for calculation instructions for timed values.)
Caffrey E, Docherty CL, Schrader J, Klossnner J. The Ability of 4 Single-Limb Hopping Tests to Detect Functional Performance Deficits in Individuals
With Functional Ankle Instability. J Orthop Sport Phys Ther. 2009;39(11):799-806. doi:10.2519/jospt.2009.3042
**Timed calculation instructions
First: work out the difference (decrease) between the two values. Then: divide the decrease by the non-
operative and multiply the answer by 100.This gives you the percentage difference. Then subtract the
percentage difference from 100.
For example:
Non-operative leg: 8 seconds
Operative leg: 10 seconds
10-8= 2 (difference) divided by 8 (original value) = .25 x 100 = 25% (percentage difference)
100 – 25= 75 % (final value)
Sports Medicine and Performance Center | sportsmedicine.kansashealthsystem.com | Phone: 855-898-9275
pg. 4
References
1. Burnham JM, Yonz MC, Robertson KE, McKinley R, Wilson BR, Johnson DL, Ireland ML, Noehren B.
Relationship of Hip and Trunk Muscle Function with Single Leg Step-Down Performance: Implications
for Return to Play Screening and Rehabilitation. Phys Ther Sport. 2016;22:66-73.
2. Butler RJ, Lehr ME, Fink ML, Kiesel KB, Plisky PJ. Dynamic Balance Performance and Noncontact Lower
Extremity Injury in College Football Players: An Initial Study. Sports Health. 2013;5(5):417-422.
3. Caffrey E, Docherty CL, Schrader J, Klossnner J. The Ability of 4 Single-Limb Hopping Tests to Detect
Functional Performance Deficits in Individuals With Functional Ankle Instability. J Orthop Sport Phys
Ther. 2009;39(11):799-806. doi:10.2519/jospt.2009.3042
4. Dingenen B, Truijen J, Bellemans J, Gokeler A. Test–retest reliability and discriminative ability of
forward, medial and rotational single-leg hop tests. Knee. 2019;26(5):978-987.
doi:10.1016/j.knee.2019.06.010
5. Garrison JC, Shanley E, Thigpen C, Geary R, Osler M, Delgiorno J. The Reliability of the Vail Sport Test
As a Measure of Physical Performance Following Anterior Cruciate Ligament Reconstruction. Int J
Sports Phys Ther. 2012; 7(1):20-30.
6. Garrison JC, Bothwell JM, Wolf G, Aryal S, Thigpen CA. Y Balance Test Anterior Reach Symmetry at
Three Months is Related to Single Leg Functional Performance at Time of Return to Sports. Int J Sports
Phys Ther. 2015;10(5):602-611.
7. Hardesty K, Hegedus EJ, Ford KR, Nguyen A-D, Taylor JB. Determination of Clinically Relevant
Differences in Frontal Plane Hop Tests in Women’S Collegiate Basketball and Soccer Players. Int J
Sports Phys Ther. 2017;12(2):182-189.
http://www.ncbi.nlm.nih.gov/pubmed/28515972%0Ahttp://www.pubmedcentral.nih.gov/articlerend
er.fcgi?artid=PMC5380860.
8. Hébert LJ, Maltais DB, Lepage C, Saulnier J, Crête M. Hand-Held Dynamometry Isometric Torque
Reference Values for Children and Adolescents. Pediatr Phys Ther. 2015;27(4):414-423.
doi:10.1097/PEP.0000000000000179
9. Hébert LJ, Maltais DB, Lepage C, Saulnier J, Crête M, Perron M. Isometric Muscle Strength in Youth
Assessed by Hand-held Dynamometry. Pediatr Phys Ther. 2011;23(3):289-299.
doi:10.1097/PEP.0b013e318227ccff
10. Kivlan BR, Carcia CR, Christoforetti JJ, Martin RL. Comparison of Range of Motion, Strength, and Hop
Test Performance of Dancers With and Without a Clinical Diagnosis of Femoroacetabular
Impingement. Int J Sports Phys Ther. 2016;11(4):527-535.
11. Kivlan BR, Clemente FR, Phelps AL. Functional hip tests for dancers . 2013;8(4):360-369.
12. Kivlan BR. Functional Performance Testing of the Hip in Athletes. Int J Sports Phys Ther. 2012;7(4):402-
412.
13. Malloy PJ, Morgan AM, Meinerz CM, Geiser CF, Kipp K. Hip External Rotator Strength Is Associated
With Better Dynamic Control of the Lower Extremity During Landing Tasks. J strength Cond Res.
2016;30(1):282-291. doi:10.1519/JSC.0000000000001069.
14. Reid A, Birmingham TB, Stratford PW, Alcock GK, Giffin JR. Hop testing provides a reliable and valid
outcome measure during rehabilitation after anterior cruciate ligament reconstruction. Phys Ther.
2007;87(3):337-349.
15. White AK, Klemetson CJ, Farmer B, Katsavelis D, Bagwell JJ, Grindstaff TL. COMPARISON OF CLINICAL
FATIGUE PROTOCOLS TO DECREASE SINGLE-LEG FORWARD HOP PERFORMANCE IN HEALTHY
Sports Medicine and Performance Center | sportsmedicine.kansashealthsystem.com | Phone: 855-898-9275
pg. 5
INDIVIDUALS. Int J Sports Phys Ther. 2018;13(2):143-151.
http://www.ncbi.nlm.nih.gov/pubmed/30090672. Accessed September 11, 2019.
16. Wörner T, Nilsson J, Thorborg K, Granlund V, Stålman A, Eek F. Hip Function 6 to 10 Months After
Arthroscopic Surgery: A Cross-sectional Comparison of Subjective and Objective Hip Function,
Including Performance-Based Measures, in Patients Versus Controls. Orthop J Sport Med. 2019;7(6):1-
10. doi:10.1177/2325967119844821
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Sports Medicine and Performance Center | sportsmedicine.kansashealthsystem.com | Phone: 855-898-9275
pg. 6
Hip-RSI Scale
Instructions: Please answer the following questions referring to your main sport prior to injury. For each question, circle the
number between the two descriptions to indicate how you currently feel relative to the two extremes.
1. Are you confident that you can perform at your previous level of sport participation?
Not at all confident 0 10 20 30 40 50 60 70 80 90 100 Fully confident
2. Do you think you are likely to reinjure your hip by participating in your sport?
Extremely likely 0 10 20 30 40 50 60 70 80 90 100 Not likely at all
3. Are you nervous about playing your sport?
Extremely nervous 0 10 20 30 40 50 60 70 80 90 100 Not nervous at all
4. Are you confident that you could play your sport without concern for your hip?
Not at all confident 0 10 20 30 40 50 60 70 80 90 100 Fully confident
5. Do you find it frustrating to have to consider your hip with respect to your sport?
Extremely frustrating 0 10 20 30 40 50 60 70 80 90 100 Not at all frustrating
6. Are you fearful of reinjuring your hip by playing your sport?
Extremely fearful 0 10 20 30 40 50 60 70 80 90 100 Not fearful at all
Sports Medicine and Performance Center | sportsmedicine.kansashealthsystem.com | Phone: 855-898-9275
pg. 7
