Rectus femoris length was tested with the patient in prone using passive knee flexion. On the left, increased knee flexion was associated with increased hip flexion indicating a positive test for reduced muscle length. Hamstring length was assessed using the 90/90 test position. This test has very good test–retest reliability (intraclass coefficients [ICC] larger than 0.9 (Bullock-Saxton & Bullock, 1994; Nelson, 1991)). Asymmetry between sides was noted, with 101 less knee extension ROM available on the left. Decreased muscle length was found in hip external rotators on the left using a test described by Bullock-Saxton and Bullock (1994) that has very good test–retest repeatability (ICC40.9), and also for the tensor fasciae latae using Ober’s test.
Strength of lower extremity musculature was deter-mined by using an isometric break test for manual muscle testing (MMT) as described by Hislop and Montgomery (1995). Although the repeatability of MMT is poor, there were no isokinetic testing devices available during the examination and treatment of this patient. The examiner rated left quadriceps and ham-string muscle groups at four out of five, and the right lower extremity at five out of five. Additionally, the examiner noted diminished ability of the patient to perform a strong contraction of the left quadriceps muscle during a setting exercise of the quadriceps.