PASSIVE HIP INTERNAL ROTATION, HIP EXTERNAL ROTATION, HIP FLEXION, AND HIP EXTENSION
ICF category:	Measurement of impairment of body function – mobility of a single joint
Description:	The amount of passive hip rotation, flexion, and extension..
Measurement method	Hip External and Internal Rotation The patient is positioned prone with feet over the edge of the treatment table. The hip measured is placed in 0 degree of abduction, and the contralateral hip is placed in about 30 degrees of abduction. The reference knee is flexed to 90 degrees, and the leg is passively moved to produce hip rotation. Manual stabilization is applied to the pelvis to prevent pelvic movement and also at the tibiofemoral joint to prevent motion (rotation or abduction/adduction), which could be construed as hip rotation. The motion is stopped when the extremity achieves its end of passive joint ROM or when pelvic movement is necessary for additional movement of the leg. The inclinometer is aligned vertically and along the shaft of the tibia, just proximal to the medial malleolus for both medial and lateral rotation ROM measurements.
	Hip Flexion With the patient supine, the examiner passively flexes the hip to 90° and zeros an inclinometer at the apex of the knee. The hip was then flexed until the opposite thigh begins to rise off of the table.
	Hip Extension With the patient supine at the edge of a plinth with the lower legs hanging free off the end of the plinth. The examiner flexes both hips and knees so that the patient’s lumbar region is flat against the tabletop. One limb is held in this position, maintaining the knee and hip in flexion, the pelvis in approximately 10° of posterior tilt, and the lumbar region flush against the tabletop, while the ipsilateral thigh and leg is lowered toward the table in a manner to keep the hip in 0° of hip abduction and adduction. The patient is instructed to relax and allow gravity to lower the leg and thigh toward the floor. The angle of the femur of this lowered leg to the line of the trunk (and table top) is measured. The amount of knee flexion is also monitored to assess the relative flexibility of the two-joint hip flexors.
Nature of variable	Continuous
Units of measurement	Degrees
Measurement properties	Intrarater reliability for passive hip internal and external rotation ranged of motion measures is reported to be excellent (ICCs from 0.96 to 0.99).89 The intrarater reliability for hip flexion measurements is also excellent (ICC = 0.94).65 The reported intrarater reliability for hip extension measurements using the modified Thomas test position is reported to be moderate to excellent with ICCs between 0.70 and 0.89,293 between 0.71 and 0.95,122 between 0.91 and 0.93,58 and 0.98.316 Pua241 reported good intratester reliability with hip flexion and extension range of motion (ICC = 0.97 and 0.86, respectively) with SEMs of 3.5° and 4.7°, respectively.
Instrument variations	Alternate positions for the testing of hip internal rotation, external rotation, flexion, and extension have been described in both short sitting and supine, with the hip and knee in ninety degrees of flexion for the rotation measures.5, 23, 26, 55, 206, 247 Hip extension range of motion assessment has also been described as being assessed in prone.73, 206, 247