Leg Lowering Test

The Leg Lowering Test (DLLT – Double Leg Lowering Test) is a clinical examination used to assess strength and control of the lower abdominal muscles, particularly the rectus abdominis and the deep core muscles (transversus abdominis, internal oblique, and external oblique). The test challenges the patient’s ability to maintain a posterior pelvic tilt during eccentric control as both legs are lowered from 90° hip flexion toward the surface.

This assessment is important because weakness or poor control of the core muscles can lead to increased anterior pelvic tilt, poor posture, and low back pain.

Purpose

The purpose of the Leg Lowering Test is to:

• Evaluate strength and endurance of the abdominal muscles, especially the lower portion of rectus abdominis

• Assess the patient’s ability to control pelvic position during dynamic movement

• Identify potential causes of low back pain related to core weakness

Clinically Relevant Anatomy

• Rectus abdominis: Primarily responsible for maintaining posterior pelvic tilt during leg lowering

• Transversus abdominis and internal/external obliques: Support the abdominal wall and stabilize the lumbopelvic region

• Iliopsoas and rectus femoris: Hip flexors activated during leg lowering, but may contribute to anterior tilt if the core is weak

Execution

Patient position:

• The patient lies supine with arms crossed over the chest and head resting on the floor

Test movement:

• The therapist places fingertips under the patient’s lumbar spine (lordosis). Alternatively, a pressure biofeedback cuff can be used, inflated to 40 mmHg

• The patient lifts both legs to 90° hip flexion (vertical). Knees may be bent initially and then extended

• The patient actively presses the lower back into the floor or against the cuff by drawing in the abdomen

• The patient lowers the legs slowly while maintaining stable pressure on the therapist’s fingers or the cuff

• When the pressure decreases (or the therapist feels the lumbar spine “lift”), the test stops and the angle is measured.

Scoring:

• 90° – very poor (starting position)

• 75° – poor

• 60° – below average

• 45° – average

• 30° – above average

• 15° – good

• 0° (horizontal) – excellent

Interpretation

• Positive test (weakness): Inability to maintain lumbar stability and loss of pressure early, often above 60°

• Good control: Ability to maintain stability down to 15° or horizontal

Evidence

• One study found a weak correlation (ρ = 0.24) between DLLT and core strength testing

• Median DLLT score was 4, with an average pressure reduction of 9 mmHg on biofeedback cuff

• Kinematic analysis of the pelvis showed a natural tendency toward anterior tilt, with 1° of pelvic tilt for every 3.6° of leg lowering

Clinical Relevance

• The test is simple to perform yet provides valuable information about the patient’s ability to stabilize the lumbar spine during dynamic movement

• Relevant for athletes, patients with low back pain, and in rehabilitation training

• Often combined with other core strength tests for a comprehensive assessment

Limitations

• Requires proper patient instruction and understanding of correct lumbar stabilization

• Difficult to perform in patients with acute low back pain or severe core weakness

• Limited validity and only low-to-moderate correlation with other core strength tests

Summary

The Leg Lowering Test is a functional and demanding assessment of core strength and stability in the abdominal and pelvic region. Performed in supine, it involves controlled lowering of the legs while maintaining lumbar stability. It provides useful information about rectus abdominis function and pelvic control, but should be interpreted alongside other clinical findings for a complete picture of core strength.

Kilder:

1. Top end sports Straight Leg Lift Abdominal Strength Test : https://www.topendsports.com/testing/tests/abdominal-strength.htm

2. Krause DA, Youdas JW, Hollman JH, Smith J. Abdominal muscle performance as measured by the double leg-lowering test. Archives of physical medicine and rehabilitation. 2005 Jul 1;86(7):1345-8.

3. O'Sullivan PB, Phyty GD, Twomey LT, Allison GT. Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine. 1997 Dec 15;22(24):2959-67.

4. Haladay DE, Denegar CR, Miller SJ, Challis J. Electromyographic and kinetic analysis of two abdominal muscle performance tests. Physiotherapy theory and practice. 2015 Nov 17;31(8):587-93.

5. Gjennomgått - Trukket

6. Rathod SR, Vyas NJ, Sorani DM. Relationship between double leg lowering test and core strength test of the lumbar spine in normal healthy individuals. Journal of Mahatma Gandhi Institute of Medical Sciences. 2021 Jan 1;26(1):23. : https://www.jmgims.co.in/article.asp?issn=0971-9903;year=2021;volume=26;issue=1;spage=23;epage=27;aulast=Rathod

7. Zannotti CM, Bohannon RW, Tiberio D, Dewberry MJ, Murray R. Kinematics of the double-leg-lowering test for abdominal muscle strength. Journal of Orthopaedic & Sports Physical Therapy. 2002 Sep;32(9):432-6.