A new self-diagnostic test for biceps femoris muscle strains

Clin J Sport Med. 2006 Mar;16(2):166-9. doi: 10.1097/00042752-200603000-00014.


Objective: We compared a self-performed diagnostic test that we have been using since 1987, with other commonly used clinical tests for biceps femoris muscle-strain injuries.

Setting: Private practice focusing on sports injuries.

Patients: One-hundred forty professional male soccer players (ages 17 to 33 years) with a history and clinical findings of a pulled hamstring muscle (patients with direct trauma were excluded) had an ultrasound-proven grade I or II biceps femoris muscle injury.

Interventions: In these ultrasound-positive patients, the "taking off the shoe" test (TOST) was performed by the patient himself on both the affected and unaffected legs; and the physician then performed the resisted range of motion, passive range of motion, and active range of motion tests.

Results: The TOST had a sensitivity and specificity of 100%, and a positive predictive value and an negative predictive value of 100% for biceps femoris injury as found on ultrasound. The other muscle tests had an average sensitivity of 57%, specificity of 100%, accuracy of 79%, and negative predictive value of 70%.

Conclusion: This preliminary, nonblinded observational study of the TOST found it to be more reliable than other commonly used clinical tests for hamstring tears. The clinical value of this easy-to-perform test should be evaluated in a prospective fashion.

MeSH terms

  • Adolescent
  • Adult
  • Humans
  • Leg Injuries / diagnosis*
  • Male
  • Muscle, Skeletal / injuries*
  • Self-Examination / methods
  • Sensitivity and Specificity
  • Shoes
  • Thigh / injuries*