What is the Hoover Test used for?

Diagnosing Malingering or Functional Weakness (checking if effort is genuine).

How do you perform the Hoover Test?

Position: Patient supine. Action: Examiner cups hands under both heels. Ask patient to lift one leg (Straight Leg Raise).

What is a positive result for the Hoover Test?

Normal: When lifting one leg, the patient instinctively pushes down with the opposite heel (examiner feels pressure).Positive (Malingering): Patient claims they cannot lift the leg, but the examiner feels no downward pressure from the opposite heel (indicates lack of effort).

What is the diagnostic accuracy of the Hoover Test?

Specificity: 100% for lack of effort.

Hoover Test – Spine Special Test

What is it used for?

Diagnosing Malingering or Functional Weakness (checking if effort is genuine).

How to Perform

Position: Patient supine.
Action: Examiner cups hands under both heels. Ask patient to lift one leg (Straight Leg Raise).

Interpretation of Results

Normal: When lifting one leg, the patient instinctively pushes down with the opposite heel (examiner feels pressure).
Positive (Malingering): Patient claims they cannot lift the leg, but the examiner feels no downward pressure from the opposite heel (indicates lack of effort).

Diagnostic Accuracy

Specificity: 100% for lack of effort.

Clinical Context & Limitations

The Hoover Test should be considered as one component of a comprehensive musculoskeletal assessment. No single special test has perfect diagnostic accuracy; thus, clinical decision-making should integrate test results with patient-reported symptoms, mechanism of injury, functional impairment, and relevant imaging.

Clinicians should be aware of potential false-positive results in patients with pain sensitisation, muscle guarding, or poor relaxation. For the Spine region, combining the Hoover Test with complementary examination tests significantly improves overall diagnostic confidence.