Apley’s Test

Apley’s Test—often called the Apley Compression (Grind) and Distraction Test—is a physical exam maneuver used to assess for meniscal tears and to help differentiate these from ligamentous injuries in the knee. It is a standard orthopedic tool for evaluating knee pain after trauma, twisting, or mechanical symptoms (locking/catching).

How the Test is Performed

• Client position: Prone (lying on their stomach), knees extended, with the tested knee flexed to 90°.

• The examiner anchors the thigh to the table (often using their own knee or hand).

• Apley Compression:

  • A firm downward force is applied to the heel, compressing the tibia into the femur while internally and externally rotating the leg.

  • Positive for meniscus injury: Pain, clicking, restriction, or decreased rotation during compression.

• Apley Distraction:

  • The examiner pulls upward (distracts) on the lower leg, relieving pressure on the meniscus, and again applies internal/external rotation.

  • Positive for ligament injury: Increased pain or excessive rotation during distraction, as this loads the collateral ligaments.

• Compare findings to the opposite (unaffected) leg.

Clinical Significance

• Compression pain/restriction: Suggests meniscal tear (medial or lateral depending on pain location).

• Distraction pain: Suggests ligament injury (MCL/LCL), since distraction removes meniscus load but stresses ligaments.

• The test is most useful in conjunction with other knee exams (McMurray’s, Thessaly, Drawer tests) and clinical history, as its specificity is higher than sensitivity (better for “ruling in” tears).

• Further imaging (MRI) may be required for definitive diagnosis.

Assessment

• Use Apley’s Test for clients with knee pain after trauma, twisting, or reports of locking, catching, or instability.

• Record whether pain is produced during compression, distraction, internal/external rotation, and which side (medial/lateral) is most affected, as this guides further referral and manual therapy choices.

Treatment

• If positive (meniscal pathology):

  • Avoid deep tissue work, vigorous mobilization, or loaded rotation/flexion around the symptomatic knee.

  • Focus on gentle soft tissue release for supporting musculature (quads, hamstrings, calves), pain management, and activity modification to prevent aggravation.

  • Educate clients to avoid deep squats, twisting, and pivoting until cleared by a professional.

  • Refer for further orthopedic/physiotherapist assessment and imaging if necessary.

• If positive (ligament injury on distraction):

  • Apply similar precautions, emphasizing gentle techniques and stability.

Safety and Referral

• Refer promptly if mechanical symptoms (locking, giving way), significant swelling, or acute instability are present, or with strong clinical suspicion of meniscus or ligament tears.

• Document clinical findings for multidisciplinary team communication.