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Siobhán O Connor, Noel McCaffrey, Enda Whyte and Kieran Moran


Hamstring injuries are prevalent among team and field sport athletes, and poor flexibility has been theorized as a risk factor. The active knee extension test has been proposed as the gold standard for assessment of hamstring flexibility. Many variations of this test are employed, each of which utilizes a complex apparatus that is difficult to transport, time-consuming to set up, and often unavailable to most clinicians. Thus, a method that utilizes inexpensive and readily available equipment is needed for screening.


To establish the intertester and intratester reliability of a modified active knee extension test that requires minimal equipment.


Reliability study.


Athletic therapy facilities.

Patients or Other Participants:

Fifteen male athletes (19.5 ± 0.6 years) free from any orthopedic or neurological disorders were recruited from a convenience sample of collegiate students.


Three testers participated in three training sessions before data collection. Participants completed three trials of the modified active knee extension test and returned the following week at the same time and day to repeat the process.

Main Outcome Measure(s):

The intraclass correlation coefficient (ICC), 95% confidence interval, and the standard error of measurement were calculated to assess inter- and intratester reliability.


High ICC values were found for intertester reliability (right leg = .98; left leg = .99) and intratester reliability (right leg = .78−.89; left leg = .79−.94).


The modified active knee extension test utilizes readily available equipment and offers a quick, reliable, and low-cost alternative for measurement of hamstring flexibility.

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Teddy W. Worrell, Michael K. Sullivan and Joseph J. DeJulia

This study examined the intratester and intertester reliability of an active-knee-extension test (AKET) for determining hamstring muscle length (flexibility). Three testers performed repeated AKET measurements on 22 subjects. Intraclass correlation coefficients (ICC were used to calculate intratester and intertester reliability. Also, standard error of measurements (SEM) were calculated. The ICC and SEM were .96 and 1.82°, respectively, for Tester 1, .99 and 1.75° for Tester 2, and .99 and 1.80° for Tester 3. Intratester 95% confidence intervals ranged from 60.54 to 69.82°. Intertester ICC and SEM for two testers were .93 and 4.81°, respectively. A 95% intertester confidence interval ranged from 56.35 to 75.21 °; this reveals that intertester AKET values contained more error and suggests that only intratester AKET values should be used when comparing hamstring flexibility values. The AKET may provide a more accurate method for determining hamstring flexibility and quantifying changes that occur as a result of injury and stretching procedures.

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Siobhán O’Connor, Noel McCaffrey, Enda F. Whyte, Michael Fop, Brendan Murphy and Kieran A. Moran

.011197 15665208 17. O’Connor S , McCaffrey N , Whyte E , Moran K . Reliability of a modified active knee extension test for assessment of hamstring flexibility . Int J Athl Ther Train . 2015 ; 20 ( 4 ): 32 – 36 . doi:10.1123/ijatt.2015-0007 10.1123/ijatt.2015-0007 18. Gabbe BJ , Bennell KL

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Noureddin Nakhostin Ansari, Parisa Alaei, Soofia Naghdi, Zahra Fakhari, Shiva Komesh and Jan Dommerholt

School of Rehabilitation, Tehran University of Medical Sciences, in Tehran, Iran. Inclusion criteria were hamstring shortness ≥20° using the active knee extension test (AKET), aged between 18 and 40 years, no history of orthopedic/neurologic disorders in the lower-extremity, no history of low back pain

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Phillip A. Gribble, Kevin M. Guskiewicz, William E. Prentice and Edgar W. Shields

The purposes of this study were to determine the effects of static and hold-relax stretching on hamstring range of motion and to examine the reliability of the FlexAbility LE1000 compared with the goniometrically measured active knee-extension test. Forty-two participants (18–25 years old) were assigned to either a control, static, or hold-relax training group. Participants were stretched four times a week over a 6-week period, with four 30-s stretches per session using a straight-leg-raise method on the FlexAbility LE1000. It was determined that both static and hold-relax techniques significantly improved hamstring flexibility (ISLR: +33.08° ± 9.08° and +35.17° ± 10.39°, respectively). Participants of both techniques reached a plateau in flexibility improvement between Weeks 4 and 5. Thus, static and hold-relax stretching are equally effective in improving hamstring ROM. The FlexAbility LE1000 and the goniometer were both found to be highly reliable. Therefore, either measurement technique could be used successfully to measure hip-flexion ROM.

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Nathaly Gaudreault, Alex Fuentes, Neila Mezghani, Virginie O. Gauthier and Katia Turcot


Decreased flexibility in muscles and joints of lower extremities is commonly observed in runners. Understanding the effect of decreased flexibility on knee walking kinematics in runners is important because, over time, altered gait patterns can make runners vulnerable to overuse injuries or degenerative pathologies.


To compare hamstring and iliotibial-band (ITB) flexibility and knee kinematics in runners and nonrunners.


A descriptive, comparative laboratory study.


Hamstring and ITB flexibility were measured with the active knee-extension test and the modified Ober test, respectively, in both groups of participants. Three-dimensional (3D) walking kinematic data were then recorded at the knee using a motiontracking system.


18 runners and 16 nonrunners.

Main Outcome Measures:

Knee-extension angle (hamstring flexibility) and hip-adduction angle (ITB flexibility). Knee kinematic parameters of interest included knee angle at initial contact, peak knee angles, and knee-angle range in all planes of movement.


The runners had a significantly less flexible ITB than the nonrunners (hip adduction [−] and adduction [+] angles, 3.1° ± 5.6° vs −6.4° ± 4.5°; P < .001). The runners demonstrated a greater mean tibial external-rotation angle at initial contact (7.3° ± 5.8° vs 2.0° ± 4.0°; P = .01) and a smaller mean peak tibial internal-rotation angle (−1.6° ± 3.0° vs −4.2° ± 3.2°; P = .04) than the nonrunners.


This study provides new insight into the relationship between muscle flexibility and 3D knee kinematics in runners. This supports the premise that there is an association between muscle flexibility and transverse-plane knee kinematics in this population.

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Tiago Neto, Lia Jacobsohn, Ana I. Carita and Raul Oliveira

Context: The active-knee-extension test (AKE) and the straight-leg-raise test (SLR) are widely used for flexibility assessment. A number of investigations have tested the reliability of these measures, especially the AKE. However, in most studies, the sample involved subjects with normal flexibility. In addition, few studies have determined the standard error of measurement (SEM) and minimal detectable difference (MDD), which can provide complementary and more clinically relevant information than the intraclass correlation coefficient (ICC) alone. Objectives: This study aimed to determine the AKE and LSR intrarater (test-retest) reliability in subjects with flexibility deficits, as well as the correlation between the 2 tests. Design: Reliability study. Setting: Academic laboratory. Subjects: 102 recreationally active participants (48 male, 54 female) with no injury to the lower limbs and with flexibility deficits in the hamstrings muscle group. Main Outcomes: Intrarater reliability was determined using the ICC, complemented by the SEM and MDD. Measures: All participants performed, in each lower limb, 2 trials of the AKE and the SLR. Results: The ICC values found for AKE and SLR tests were, respectively, .87-.94 and .93-.97. The values for SEM were low for both tests (2.6-2.9° for AKE, 2.2-2.6° for SLR), as well as the calculated MDD (7-8° for AKE, 6-7° for SLR). A moderate to strong, and significant, correlation between AKE and SLR was determined for the dominant limb (r = .71) and the nondominant limb (r = .67). Conclusions: These findings suggest that both AKE and SLR have excellent intrarater reliability. The SEMs and MDDs recorded are also very encouraging for the use of these tests in subjects with flexibility deficits.

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Original Research Reports Reliability of an Active-Knee-Extension Test for Determining Hamstring Muscle Flexibility Teddy W. Worrell * Michael K. Sullivan * Joseph J. DeJulia * 8 1992 1 3 181 187 10.1123/jsr.1.3.181 Research Proprioception Following Anterior Cruciate Ligament Reconstruction

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Giger Werner Nachbauer PhD 7 2015 20 20 4 4 28 28 31 31 10.1123/ijatt.2014-0078 Reliability of a Modified Active Knee Extension Test for Assessment of Hamstring Flexibility Siobhán O Connor MSc, PhD, ARTC Noel McCaffrey MB, MSc, HDipOCCH Enda Whyte MSc, ARTC, MISCP Kieran Moran PhD 7 2015 20

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Landon Lempke, Rebecca Wilkinson, Caitlin Murray and Justin Stanek

criteria: reduced hamstring extensibility of 20° found during the active knee extension test. Exclusion criteria: history of injury that could alter hamstring muscle extensibility (eg, herniated disk, ligament damage, muscle damage), history of neuromuscular surgery within the last 5 y, or engage in