Functional Lower Extremity Tests

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Functional Lower Extremity Tests

Clinicians have been known to struggle, on occasion, with the criteria for an individual to safely return to activity after an injury.  What tests are the best ones to use?  Are there are statistics to confirm the value of a test?  Do normalize values exist for the population you are testing?   All of these questions have very limited answers.

This blog will share 6 lower extremity functional tests to assess strength, symmetry, balance, and/or agility.  The tests selected do not require any expensive equipment to perform.  The tests described are:

Functional LE List of Tests

Hop for DistanceHop for Distance Test is performed by standing on 1 leg and hopping as far as possible onto same leg.  The patient must “stick” the landing for the hop to be scored/measured.  The task should be repeated 3 times on each leg with the average distances used for comparison.  If the involved leg distance is less than 85% of uninvolved leg, the test is deemed positive.  There is also a significant correlation between the Hop for Distance Test and isokinetic knee extension peak torque production at 240°/second.

Crossover Test 1 Crossover Test 2Crossover Hop Test requires a straight line to be marked on the floor. The patient starts standing on 1 leg on 1-side of the line.  The patient performs 3 hops with the same leg with each hop landing on the other side of the line.  In other words, start to the right of the line and hop to the left, to the right, and to the left again.  Each hop should be as far forward as possible.  The task is repeated 3 times on each leg with the average the distances used for comparison.  The patient should not touch the other foot down on the ground or land on the line for an effort to be scored/measured.  If the involved leg distance is less than 85% of uninvolved leg, the test is deemed positive.  Like the Hop for Distance Test, the Cross-over Hop Test has been correlated with isokinetic knee peak torque performance at the following velocities:

                    • at 180°/sec = 0.69
                    • at 300°/sec = 0.64
                    • at 450°/sec = 0.53

Maximal Controlled Leap Test has the patient stand on 1-foot with his/her hands on the hips.  The patient “leaps forward” as far as possible to land on the contralateral foot.  The patient must “stick” the landing for the task to be scored/measured.  The task should be repeated 3 times on each leg with the average distances used for comparison. If the involved leg distance is less than 85% of uninvolved leg, the test is deemed positive.

Illinois TestIllinois Agility Test requires the set-up of 8 cones as displayed in the diagram.  The sequence of the test requires the patient to:

  • start at cone “1”
  • run 10 meters to cone “2”
  • run 10 meters to cone “3”
  • weave around cones “3, 4, 5, and 6” and back through “5, 4, and 3”
  • run 5 meters to cone “7”
  • and finally 5 meters to cone “8”

 

The ratings for this test are gender specific:Illinois Test Norms

 

 

 

 

 

T-Test also requires a course set-up.  In this case, 4 cones are places in the shape of a “T.”   The patient will:T-Test

  • start at cone “A”
  • run 5 yards forward to cone “B”
  • touch the base of cone “B” with the right hand
  • shuffle left 5 yards & touch the base of cone “C” with left hand
  • shuffle right 10 yards & touch the base of cone “D” with right hand
  • shuffle left 5 yards & touch the base of cone “B”
  • then back pedal past the starting point at cone “A”

The time is recorded from the start to the finish.  There are no standards for this test and obviously no right to left comparisons.  The best comparison is pre- and post-injury assessment but that requires the forethought of doing pre-season testing to have this data available.

Zig ZagZig Zag Run Test involves the set up of 5 cones as displayed.  Again, the sequence of the task is specific.  The patient:

  • starts at cone “A”
  • zig zags around the cones in the following order “B – C – D – B – E – A”

The run does not require the patient to touch the cones with his/her hand or foot.  Although there are normative values provided for this test, they are not sport specific nor gender specific.  Like the  Zig Zag Run, the comparison would need to be pre- versus post-injury to be applied to a given individual.

Zig Zag Norms

Normative values are only one set of metrics for a given test.  Sensitivity, specificity, and reliability are also important.  The following table provides details on each of tests:

Test Statistical Data
Hop for Distance Test Sensitivity = 38-58%

Specificity = 98%

ICC uninjured = 0.88 – 0.96

ICC ACL reconstruction = 0.80 – 0.92

Crossover Hop Test ICC uninjured = 0.85 – 0.96

ICC ACL reconstructed = 0.84 – 0.98

Maximal Controlled Leap Test No statistical data reported
Illinois Agility Test No statistical data reported
T-Test ICC = 0.94-0.98
Zig Zag Run Test Inter-tester ICC: athletes = 0.97, non-athletes = 0.97

Intra-tester ICC: athletes = 0.92, non-athletes = 0.94

 

In summary, these tests are a few of many tests available to assess strength, symmetry, balance, and/or agility.  The paucity of data is understandable given the number of possible combinations for gender and sports.  The best scenario is to have pre-season data to which to compare.  When that is not available, the next best thing could be comparison to another individual who plays the same position in a sport or performs a similar task.  Granted that is not ideal but it could be better than no data at all.

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