The Hip Lag Sign

[Nick Law]

Anyone seen/used this test? Seems like a slight nuance to simple sidelying hip abduction testing. However, I have seen another study that showed that gluteus medius is maximally engaged when the hip is in IR vs. ER (see attached)

Also, interesting that though a positive test correlated very well with MRI confirmed damage, it was not correlated to pain or function.

Also key to recognize the test corresponds to “damage” which includes simple “atrophy.”

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[Kyle Feldman]

We started using this in fellowship.
They really like the test based on the article.

I think the endurance aspect of the test is really what is important

[Stephanie Roane]

Hey Nick,

I feel like I’ve heard of this test but have not used it clinically myself. Sounds like a nice diagnostic test to utilize. I have a couple hip patient’s that would fit the inclusion criteria in my caseload that I have in mind to try it on. Unfortunately I’m not blinded to their symptomatic hip, but I’ll let you know if I find it useful. However the change of only 10cm from the hold position is pretty insignificant in my eyes. Seems like there would be a lot of error in assessing only that min amount of movement. But I’ll let you know how it goes.

Sorry to just jump on board with this discussion forum several months later. Good post and articles. Thanks for posting.

[Laura Thornton]

Thanks for sharing this article Nick, and yes, sorry for the very late response.

This diagnostic test reminds me of some of the aspects of external rotation lag sign of the shoulder, minus the proximal stabilization.

I have a hard time believing that a lot of these individuals will be able to achieve the full testing position, especially the 10 degrees of hip extension needed. Hip extension is so commonly lacking in those with hip pathology. I’m not convinced that this test would be more useful over an active movement from neutral into abduction/IR/extension and assessing associated pain during the test.

I do appreciate the added proximal pelvic stabilization as a piece of the test, however I would add it might be beneficial to repeat the test without manual pelvic stabilization, to assess gluteus medius role in both functions.

I would proceed with caution with using this test in isolation for gluteus medius/minimus pathology, at least for physical therapists. There’s no distinction between the spectrum of pathology, from atrophy, tendinopathy, or rupture. The authors claim that based on positive test results, a referral to a surgeon for an endoscopic procedure would be appropriate, which I think is premature, due to limited correlation between pain and disability.

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