Testing lower extremity strength is a crucial part of the examination in patients with low back pain. In Emergency Departments, however, some patients provide a suboptimal effort because of general fatigue or malingering.
How can you differentiate whether asymmetric hip flexion weakness is from suboptimal effort or true weakness?
Trick of the Trade: Hoover’s Test
This test is an example of Newton’s 3rd law of motion — For every action there is an equal and opposite reaction.
A supine patient trying to flex a hip joint should normally push the contralateral heel downwards into the gurney for compensatory assistance. Absent downward pressure from the contralateral heel suggests a lack of effort, mimicking a focal weakness. You can optimize your ability to detect subtle contralateral downward pressure by cradling the patient’s heels in your palms during hip flexion testing.
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