What indicates two-joint hip flexor tightness in the Thomas Test?

• A. The thigh stays elevated
• B. The leg approximates to the table when straightening the knee
• C. The hip cannot move past a certain angle
• D. The patient feels no pain

Answer: (B)

In the context of the Thomas Test, two-joint hip flexor tightness, particularly involving the iliopsoas and rectus femoris, is indicated when the leg approximates the table upon straightening the knee. This phenomenon occurs because the rectus femoris, which crosses both the hip and knee joints, becomes tight when the hip is flexed. As the knee is straightened, the tension created can pull on the hip flexor, preventing the thigh from descending toward the table.

When assessing for tightness, the elevation of the thigh and the position of the leg provide valuable information. If the leg stays elevated rather than dropping down, it suggests tightness in the hip flexors. However, the specific answer illustrating two-joint hip flexor tightness is when the leg does not move close to the table upon straightening the knee, contradicting what would be expected in a normal test.

It's important to recognize that pain can be a subjective experience and isn't the primary indicator of tightness. Therefore, a lack of pain does not provide definitive information regarding muscle flexibility or tightness.