Hoover Test

Use the Hoover Test to check functional weakness in the lower extremity, detect suspected malingering, or diagnose mild cases of hemiparesis in patients.

By Nate Lacson on Aug 2, 2025.

Fact Checked by Ericka Pingol.

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What is a Hoover sign?

Hoover's sign is a clinical tool used to distinguish between organic and functional weakness in the lower limbs. First described by Charles Franklin Hoover in the early 20th century, this test is essential for identifying functional neurological disorders, such as conversion disorder, and detecting potential malingering. It is also useful in assessing conditions like suspected stroke and other neurological impairments.

The test evaluates the interplay of hip extension and the involuntary extension reflex in the opposite limb. Specifically, it works on the principle that when a patient exerts effort to lift one leg, the leg occurs with a compensatory downward pressure in the contralateral heel, as a result of normal motor mechanisms (Fuller & Manford, 2010). This sign relies on the natural coordination between the limbs during movement. By observing these responses, the test helps differentiate between functional disorders and structural or neurological issues.

Healthcare professionals—including neurologists, physiatrists, and physical therapists—regularly use Hoover's sign to evaluate patients experiencing voluntary hip extension weakness. With a sensitivity of 63% and a specificity of 100% (Mehndiratta et al., 2014), the test is highly effective in diagnosing functional neurological disorders and ensuring the appropriate management of patients.

Hoover Test Template

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How to use our Hoover Test template

Our Hoover Test template provides step-by-step guidance, reminders to avoid false positives, and fields to record observations. Follow these steps to use it effectively:

Step 1: Access the template

Click the “Use template” button to open it in the Carepatron app. You can customize it there before you fill it out digitally or print it out. Alternatively, you download a printable, ready-to-use copy by clicking the “Download” button.

Step 2: Administer the test

Follow the procedure outlined in the template to conduct the Hoover Test accurately:

Position the patient supine on an examination table, ensuring they are comfortable.
Stand at the patient’s feet and cup their calcaneus (heel) with both hands. Place your left hand on their right heel and your right hand on their left heel.
Ask the patient to press both heels down against your hands to ensure engagement.
Request an active straight leg raise of the uninvolved side while maintaining light resistance under both heels. Observe whether the contralateral leg applies downward pressure, indicating proper contralateral hip function.
Repeat the test for the other side to ensure consistent results.

Step 3: Record and interpret the results

After completing the test, use the template’s fields to record your findings:

Negative: No downward pressure is felt under the contralateral leg when the unaffected limb is raised.
Positive: Downward pressure is sensed under the contralateral leg when the unaffected limb is raised, suggesting a functional or voluntary effort.

Interpret the results carefully. A positive Hoover’s sign may indicate functional disorders, such as conversion disorder, or reveal inconsistencies in voluntary movement. Also, take note of the possibility for false positives; positive signs do not necessarily mean non-organic weakness, especially since genuine paralysis may be difficult to differentiate from non-organic limb weakness (Ziv et al., 1998).

Step 4: Discuss results with the patient

Once the results are documented, explain the findings to the patient. If malingering is suspected, address the issue delicately to uncover underlying stressors or psychosocial factors. Offer next steps for treatment or further testing if functional disorders are indicated.

By following these steps, healthcare professionals can utilize the Hoover Test template to ensure accurate assessments, document findings systematically, and foster productive patient discussions.

When to conduct the Hoover assessment

The Hoover assessment is a valuable diagnostic tool, especially when evaluating patients with suspected functional disorders or other types of lower limb weakness. It is most effective in the following scenarios:

Suspected functional weakness: Conduct the test if you suspect a functional disorder, such as conversion disorder, where symptoms like motor weakness cannot be fully explained by organic causes.
Uncertain diagnosis: When neurological assessments yield ambiguous results, the Hoover Test helps differentiate between organic and functional weakness.
Hemiparesis evaluation: Use the test to assess mild hemiparesis, which may occur after a suspected stroke or similar conditions impacting one side of the body.
Tracking recovery: Incorporate the Hoover Test during follow-up visits to monitor improvement or worsening of functional motor issues, ensuring that interventions are effective.

By integrating the Hoover Test into clinical practice, practitioners can efficiently assess lower extremity weakness, especially when functional disorders are suspected, and guide the next steps in patient management.

Benefits of these free Hoover's Test templates

Our free Hoover's Test template simplifies the process of assessing functional weakness and suspected malingering. Here are its key benefits:

Streamlined process: The template provides step-by-step instructions for performing the test, ensuring accuracy and consistency in practice.
Consistent documentation: With fields for patient details, results, and observations, it offers a structured way to record findings for better communication and reference.
Improved patient-provider communication: The template supports meaningful discussions about the test results, encouraging transparency and collaboration in diagnosis and treatment.
Accessible anytime: The template is digitally editable, downloadable, and compatible with various devices, making it easy for healthcare professionals to access and use whenever needed.

This powerful tool saves time while improving diagnostic clarity, making it an essential resource for healthcare providers assessing functional weakness.

References

Fuller, G., & Manford, M. (2010). Neurology: An illustrated colour text. Elsevier Saunders.

Mehndiratta, M. M., Kumar, M., Nayak, R., Garg, H., & Pandey, S. (2014). Hoover’s sign: Clinical relevance in neurology. Journal of Postgraduate Medicine, 60(3), 297–299. https://doi.org/10.4103/0022-3859.138769

Ziv, I., Djaldetti, R., Zoldan, Y., Avraham, M., & Melamed, E. (1998). Diagnosis of “non-organic” limb paresis by a novel objective motor assessment: The quantitative Hoover’s test. Journal of Neurology, 245(12), 797–802. https://doi.org/10.1007/s004150050289

Commonly asked questions

Hoover's sign is a clinical test used to detect functional weakness or malingering in the lower extremities. It evaluates involuntary hip extension on the contralateral side when the patient attempts voluntary hip flexion.

The examiner cups both of the patient's heels and asks them to lift one leg. Pressure from the contralateral leg should be felt in the examiner’s hand. Lack of expected pressure or effort can indicate functional weakness or malingering.

The Hoover's sign of the chest or abdomen is unrelated to the leg test and is associated with COPD. It describes the inward movement of the lower ribs during inspiration due to diaphragmatic dysfunction or hyperinflation.