Three-Phase Hyperextension Test Special Test
Orthopedic Physical Examination & Clinical Assessment Guide
What is it used for?
- Differentiating the source of pain: Hip vs. SI Joint vs. Lumbar Spine.
How to Perform
- Phase 1 (Hip): Extend the patient's hip while holding the pelvis down.
- Phase 2 (SI Joint): Extend the hip while holding the sacrum down.
- Phase 3 (Lumbar): Extend the hip while holding the lumbar spine down.
Interpretation of Results
- The phase where pain appears helps localize the lesion to that specific anatomical structure.
Clinical Context & Limitations
The Three-Phase Hyperextension Test should be considered as one component of a comprehensive musculoskeletal assessment. No single special test has perfect diagnostic accuracy; thus, clinical decision-making should integrate test results with patient-reported symptoms, mechanism of injury, functional impairment, and relevant imaging.
Clinicians should be aware of potential false-positive results in patients with pain sensitisation, muscle guarding, or poor relaxation. For the Spine region, combining the Three-Phase Hyperextension Test with complementary examination tests significantly improves overall diagnostic confidence.
References
- Clinical Tests for the Musculoskeletal 3rd Ed. Book
