By  Phil Plisky, PT, DSc, ATC, OCS, CSCS & Adam Devery, ATC, PTA, CSCS 

You’ve been working with a patient and it is now time for return to play testing. Hop Testing is a measure of power and energy-storing that can help you test neuromuscular control, strength, and patient’s confidence in the affected limb. This testing series will include three tests: single-leg hop, single-leg triple hop, and single-leg triple crossover hop.

Should you include timed hop? Only if you have timing gates. In our research, the limb symmetry differences identified using a stopwatch were almost always within the error measure. Therefore, it probably shouldn't be used to detect limb symmetry differences unless automated timing is used.

How do I perform hop testing for return to sport?

The nice thing with hop testing is that you will only need a tape measure, tape, and a dowel. You’ll start by securing the tape measure (10 m) to the floor creating a start and finish line with tape. 

Single Leg Hop Testing Procedure

We’ll start with the step-by-step procedure for the single-leg hop.

Instructions:

1. You will have the person start on a single foot as close to the starting line as they can without allowing toes to extend on or past the line.
2. For the hop, instruct the person to assume a single leg stance, not to move the feet, but flex at the knee, hip and ankle, and jump forwards as far as they can and as safely as they can
3. Let the person know that they may use their arms in any fashion, but can’t take a running start
4. Advise the person that they do need to stick the landing, maintaining balance for two seconds. When administering the test for performance, the athlete does not need to stick the landing.
5. Use the yardstick/dowel to mark the landing for the measurement which is taken at the heel to the nearest half centimeter (e.g. 120.0, 120.5, 121.0 cm) 
6. Allow the person to return to the start line and test the opposite foot (about 15-20 seconds)

There are three things that would make the test not count and need to be repeated: if the patient loses their balance or can't maintain balance for 2 seconds (i.e. can't stick the landing), takes a running start, or any other part of their body besides the hopping foot touch the ground while landing.

How it should be scored :

The athlete can take one practice attempt for each side and three attempts will be scored per side with a maximum of six trials. All measurements are taken at the heel of the landing foot. 

Single Leg Triple Hop Testing Procedure

The instructions are the same as the first test except that the athlete will hop three times for distance. They should not let their momentum diminish and act as if they are a spring until the last hop. On the last hop they must maintain balance for two seconds (i.e. stick the landing). 

Single Leg Triple Cross-Over Hop Testing Procedure

With the crossover hop, you will need another tape measure (or a least a taped line) to secure to floor parallel 6” apart. 

The instructions will remain the same as the single leg triple hop, just that now the athlete will hop three times with a lateral component crossing the line. The athlete will hop the direction of the leg being tested (i.e. for the right foot, R-L-R). They should not let their momentum diminish and act as if they are a spring until the last hop maintaining balance for two seconds. 

Instructions:

1. The person will start on a single foot as close to the starting line as they can without allowing toes to extend onto or past the line
2. For the hop, instruct the person to hop as far as they can and as safely as they can three times crossing over the two lines 6” apart without pausing to compose themselves between hops with the first hop being lateral to the testing leg
3. Let the person know that they may use their arms in any fashion and that they may use any type of method to begin their first hop as long as they do not take a running start and they only hop on their testing foot
4. Let the person know that they may start when they are ready (e.g. first jump on right is to right and first jump on left is to the left)
5. Advise the person that they have to stick their landing on the third hop; feel free to let your momentum carry you forward  (they may put the non-tested foot down at the end as long as the tested leg lands first). When administering the test for performance, the athlete does not need to stick the landing.
6. Use the yardstick/dowel to mark the landing for the measurement which is taken at the heel to the nearest half centimeter (e.g. 450.0, 450.5, 451.0 cm) 
7. Allow the person to return to the start line and test the opposite foot (about 15-20 seconds)

What can cause a failed attempt and require the hop to be repeated?

• A test is considered failed if the person loses balance or the non-test leg makes contact with the floor at any time other than the end position where the person may put their non-test leg down as their momentum carries them forward 
• Running start
• First hop is not lateral to testing leg
• Hopping foot does not cross over the 6” gap or lands on the tape measure
• Hand touches the ground

 Verbal cues provided to the person:

• “Please jump as far as you can and safely as you can for three hops crossing over the two lines each time” 
• “On your third hop, you have to stick a landing for two seconds.”
• “You may use your hands any way you wish to keep your balance or propel you further”
• “Do you have any questions? If not, you may start when you are ready.”

 Scoring: 

• There will be one practice trial per side and then three test trials per side
• All measurements will be taken at the end of the person’s third hop, where the heel of the testing leg strikes the ground.

What is a passing score on hop testing?

While I have an entire article dedicated to this concept, the bottom line is that Munro & Herrington 2011 found that the average LSI for the four hop tests was 100% (98.38 to 101.61%.) and that 100% of healthy subjects have at least an LSI of 90%. Based on these results, the researchers advocate that the return to sport LSI criteria be increased to 90%.

But if normal is 100% and our re-injury rate is so high, I suggest hop testing LSI should at least be above 95% and recommend it to be above 97%-100%. 

For more information about hop testing and other return to sport tests, check out these resources:

Why 90% limb symmetry index is not enough

Discharge and Return to Sport Part 1: Know When They Are Ready

Discharge and Return to Sport Part 2: Lower Body

Normative Data for Hop Testing

 Single-Hop Testing Norms in Females Youth - Collegiate

Single-Hop Testing Norms in Males Youth - Collegiate 

Triple-Hop Testing Norms in Females High School - Collegiate

Triple-Hop Testing Norms in Males High School  - Collegiate

References

​​Cacolice PA, Carcia CR, Scibek JS, Phelps AL. THE USE OF FUNCTIONAL TESTS TO PREDICT SAGITTAL PLANE KNEE KINEMATICS IN NCAA-D1 FEMALE ATHLETES. Int J Sports Phys Ther. 2015;10(4):493-504.

Dingenen B, Truijen J, Bellemans J, Gokeler A. Test-retest reliability and discriminative ability of forward, medial and rotational single-leg hop tests. Knee. 2019 Oct;26(5):978-987. doi: 10.1016/j.knee.2019.06.010. Epub 2019 Aug 17. PMID: 31431339.

​​Eechaute C, Vaes P, Duquet W. The dynamic postural control is impaired in patients with chronic ankle instability: reliability and validity of the multiple hop test. Clin J Sport Med. 2009 Mar;19(2):107-14. doi: 10.1097/JSM.0b013e3181948ae8. PMID: 19451764.

Holm I, Tveter AT, Fredriksen PM, Vøllestad N. A normative sample of gait and hopping on one leg parameters in children 7-12 years of age. Gait Posture. 2009 Feb;29(2):317-21. doi: 10.1016/j.gaitpost.2008.09.016. Epub 2008 Nov 18. PMID: 19019681.

Myers BA, Jenkins WL, Killian C, Rundquist P. Normative data for hop tests in high school and collegiate basketball and soccer players. Int J Sports Phys Ther. 2014;9(5):596-603.

Reid, Andrea, et al. Hop Testing Provides a Reliable and Valid Outcome Measure during Rehabilitation after Anterior Cruciate Ligament Reconstruction. Physical Therapy, vol. 87, no. 3, 2007, pp. 337–349., https://doi.org/10.2522/ptj.20060143. 

Scinicarelli, G.; Trofenik, M.; Froböse, I.; Wilke, C. The Reliability of Common Functional Performance Tests within an Experimental Test Battery for the Lower Extremities. Sports 2021, 9, 100. https://doi.org/10.3390/ sports9070100  

Co-author Information

Adam Devery, ATC, PTA, CSCS