Ely's test assesses tight hip flexors. Which finding is considered a positive result?

• A. The knee cannot extend fully while the hip is extended.
• B. The knee flexion is limited or the hip cannot maintain extension.
• C. The patient reports anterior thigh pain.
• D. The pelvis tilts anteriorly.

Answer: (B)

Ely's test looks for tightness of the rectus femoris, a hip flexor that crosses the knee. When a person is prone and the knee is brought toward the buttock, a normal, flexible rectus femoris allows the knee to flex without forcing the hip to move. If the rectus femoris is tight, it resists lengthening as the knee bends, so the knee may not flex fully, and the hip may not stay extended—often the pelvis will tilt anteriorly as the rectus femoris pulls on the hip. Therefore, a positive result is indicated by limited knee flexion during the maneuver or by the hip failing to maintain extension (pelvis tilting anteriorly). Anterior thigh pain is not a specific sign of tight hip flexors, and while a pelvis tilt can occur, the clearest indicators are the knee flexion limitation and loss of hip extension.