OLYMPUS DIGITAL CAMERA
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?

BouncingBallsTrick 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.
Photo1_HooverSignsm

Michelle Lin, MD
ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD

@M_Lin

Professor of Emerg Med at UCSF-Zuckerberg San Francisco General. Founder of ALiEM @aliemteam #PostitPearls https://t.co/7v7cgJqNEn
Michelle Lin, MD