The Toe Touch Test is a standing forward-bend assessment used to observe how close the client can reach toward the floor or toes while keeping the knees extended. It is commonly used as a simple screen of posterior-chain flexibility, hamstring length, lumbar flexion contribution, hip hinge strategy and general movement tolerance.
A positive or limited finding may include inability to reach the toes or floor, familiar symptom reproduction, marked asymmetry, excessive knee flexion, protective guarding or altered movement strategy. However, the Toe Touch Test does not diagnose hamstring tightness, low back pain, disc pathology or any specific condition. It should be interpreted with other flexibility, range of motion, strength, neurological and functional assessment findings.
The Toe Touch Test, often abbreviated as TTT, is a simple standing movement assessment. The client stands upright and bends forward to reach toward the toes or floor. The professional observes range, movement quality, symptom response and compensations.
Although the test looks simple, it is influenced by many factors. These include hamstring flexibility, calf flexibility, hip flexion range, pelvic motion, lumbar flexion, trunk control, neural sensitivity, balance, confidence, pain, body proportions and movement strategy.
Because of this, the Toe Touch Test should not be interpreted as a direct measure of one structure. A limited toe touch does not automatically mean the hamstrings are tight. A full toe touch does not automatically mean the lumbar spine, hips or hamstrings are normal.
For Measurz users, the Toe Touch Test is useful because it can be recorded as a practical baseline and retested over time. The result can be combined with straight leg raise, passive knee extension, lumbar range of motion, hip range of motion, neurological screen findings, strength testing and functional movement tests.
Test name: Toe Touch Test / TTT
Region: Lumbar spine, pelvis, hips and posterior chain
Primary purpose: Assess standing forward-bend reach and movement strategy
Commonly associated assessment areas: Hamstring flexibility, posterior-chain mobility, lumbar flexion tolerance, hip hinge strategy, movement confidence
Positive or limited finding: Inability to reach the toes or floor, familiar symptoms, protective guarding, compensation or marked restriction
Negative or expected finding: Comfortable forward bend with no familiar symptoms and movement consistent with client goals and baseline
Main limitation: It does not identify one cause of restriction or diagnose a condition.
The Toe Touch Test is a standing forward-bend assessment.
The client stands with the feet together or hip-width apart, depending on the protocol, and reaches toward the toes or floor while keeping the knees extended. The result may be recorded as:
Fingertip-to-floor distance
Whether the client reaches the toes
Whether the client reaches the floor
Movement quality
Symptom response
Compensations
Side-to-side weight shift
Knee flexion or guarding
For Measurz, fingertip-to-floor distance is usually the most useful numerical result because it can be retested consistently.
The Toe Touch Test may be used to support assessment reasoning around:
Posterior-chain flexibility
Hamstring flexibility
Lumbar flexion tolerance
Hip hinge strategy
General mobility screening
Movement confidence
Low back or posterior thigh symptom response
Baseline movement capacity
Progress tracking
Sport, gym or workplace movement demands
It is often used because it is quick, familiar and easy to explain.
The Toe Touch Test assesses standing forward-bend capacity and symptom response.
It may provide information about:
Fingertip-to-floor distance
Posterior-chain mobility
Hip flexion contribution
Lumbar flexion contribution
Pelvic motion
Hamstring flexibility contribution
Calf contribution
Neural sensitivity contribution
Movement confidence
Symptom reproduction
Movement strategy
It does not directly assess:
Hamstring length in isolation
Lumbar disc status
Nerve root compression
Specific tissue pathology
Strength
Motor control in isolation
Readiness for sport or work
Diagnosis
Treatment need
The Toe Touch Test may be useful for clients with:
General mobility goals
Sport or gym movement demands
Low back stiffness
Posterior thigh tightness
Reduced forward-bend tolerance
Movement confidence concerns
Hamstring flexibility monitoring
Return-to-training monitoring
Baseline and retest needs in Measurz
It may also be useful in education because it demonstrates how multiple body regions contribute to one simple movement.
Consider using the Toe Touch Test when:
Standing forward bending is relevant to the client’s goals
Hamstring or posterior-chain mobility is being assessed
Lumbar flexion tolerance is relevant
You need a simple baseline movement screen
You want to monitor change over time
The client can safely stand and bend forward
You are combining it with more specific tests
It is best used alongside more targeted assessments rather than in isolation.
Use caution or avoid the test when:
The client has severe or worsening neurological symptoms
Red flag features are present
Recent major trauma is reported
Dizziness or balance issues make forward bending unsafe
Forward bending is highly irritable
The client has acute severe low back pain
The client has been advised to avoid lumbar flexion
The professional cannot monitor the test safely
Stop the test if symptoms increase sharply, dizziness occurs, neurological symptoms appear, the client feels unsafe, or the client asks to stop.
To perform the Toe Touch Test in Measurz, you may need:
Measurz app
Ruler, tape measure or measuring stick
Flat floor surface
Pain rating scale
Notes field for symptoms and movement quality
Optional video recording for education or retest comparison
A tape measure or ruler allows fingertip-to-floor distance to be recorded more objectively.
Ask the client to stand on a flat surface, barefoot or in consistent footwear.
Record footwear conditions because shoes can affect reach distance.
Decide whether the test will use:
Feet together
Feet hip-width apart
Knees fully extended
Natural knee position
Fingertip-to-floor distance
Toe-touch yes/no result
For repeat testing, keep the setup the same.
The client stands upright with:
Feet in the selected position
Knees extended but not forcefully locked
Arms relaxed in front
Weight evenly distributed
Eyes forward before starting
Breathing relaxed
The professional stands to the side and slightly in front of the client to observe movement and ensure safety.
The professional should be able to monitor:
Balance
Knee position
Lumbar movement
Pelvic movement
Symptom response
Fingertip-to-floor distance
No manual contact is usually required.
If balance support is needed, the test may not be comparable with standard testing and should be recorded as modified.
Do not manually push the client into range.
The client should move actively and comfortably.
The client bends forward toward the toes or floor.
The movement should be:
Slow
Controlled
Comfortable
Stopped at the first point of limitation or symptom concern
Not bounced
Tell the client:
“Stand tall, keep your knees straight, and slowly reach toward your toes as far as you comfortably can. Do not bounce. Tell me if you feel any familiar symptoms.”
A positive or limited finding may include:
Unable to reach toes or floor when that is relevant to the assessment goal
Increased fingertip-to-floor distance compared with baseline
Familiar low back, buttock, posterior thigh or calf symptoms
Protective guarding
Excessive knee flexion
Marked side-to-side weight shift
Fear or apprehension
Dizziness or unsafe balance response
Clear change from previous Measurz result
Record the exact reason the test was considered limited or positive.
A negative or expected finding may include:
Comfortable forward bend
No familiar symptoms
Fingertips reach the toes or floor if that is the target
Movement is similar to baseline or expected for the client
No concerning compensations
No unsafe response
A negative or expected finding does not mean all individual structures are normal.
Stop the test if:
Pain increases sharply
Symptoms refer or worsen in a concerning way
Numbness, tingling or neurological symptoms occur
Dizziness occurs
Balance becomes unsafe
The client asks to stop
The test cannot be performed without compensation that invalidates the result
The Toe Touch Test should be performed slowly and without bouncing. It should be modified or avoided if forward bending is unsafe or highly irritable.
A limited Toe Touch Test may suggest reduced forward-bend capacity. This may be influenced by hamstring flexibility, calf flexibility, hip flexion, pelvic motion, lumbar flexion, neural sensitivity, pain, guarding, confidence, body proportions or movement strategy.
If the test reproduces familiar low back or leg symptoms, this should be recorded carefully and interpreted alongside neurological screening and other lumbar tests where relevant.
A limited test does not confirm hamstring tightness, lumbar pathology or neural involvement on its own. More specific testing is needed to explore likely contributors.
An expected or negative Toe Touch Test may suggest that standing forward bending is tolerated and not a major limitation in that session. However, it does not exclude low back, hip, hamstring or neural involvement in other positions or higher-load tasks.
The finding is more meaningful when interpreted with:
History
Symptom behaviour
Straight Leg Raise
Passive Knee Extension
Lumbar range of motion
Hip flexion range
Calf flexibility
Neurological screen where relevant
Functional movement assessment
Sport or work demands
Previous Measurz baseline
The Toe Touch Test should not be considered a diagnostic orthopaedic test for a specific condition.
At the time of writing, high-quality peer-reviewed diagnostic accuracy evidence reporting sensitivity, specificity or likelihood ratios for the Toe Touch Test as a stand-alone test for low back pain, hamstring injury, disc pathology or neural involvement appears limited.
Instead, the best available evidence supports the Toe Touch Test as a reliable flexibility or movement measure in certain populations.
Relevant reliability evidence includes:
Condition or presentation: Hamstring flexibility measurement
Population: Young healthy adults
Test variation: Standing Toe Touch Test as one of four hamstring flexibility tests
Reference standard: Repeated assessment by different raters and repeated sessions
Sensitivity: Not applicable for diagnosis
Specificity: Not applicable for diagnosis
Likelihood ratios: Not applicable for diagnosis
Reliability: Excellent inter-rater and test-retest reliability was reported across the flexibility tests studied
Key limitation: Findings from young healthy adults may not generalise to people with acute pain, neurological symptoms, older adults, post-operative populations or sport-specific injury presentations.
Plain-language interpretation:
TTT is useful as a repeatable movement and flexibility measure.
TTT should not be used to diagnose a specific condition.
The result should be interpreted with more specific tests when symptoms are present.
Numerical change over time is more useful than a single pass/fail result.
The Toe Touch Test can be reliable when the protocol is standardised.
Reliability improves when:
Foot position is consistent
Footwear condition is consistent
Knee position is standardised
The same measurement method is used
Fingertip-to-floor distance is recorded
Warm-up conditions are recorded
Symptoms are recorded
The same stopping criteria are used
The same number of trials is used
A 2022 study in young healthy adults reported excellent reliability across common hamstring flexibility tests including the Toe Touch Test. However, reliability evidence is population-specific and should not be assumed for every group.
Validity should be interpreted carefully. The Toe Touch Test is valid as a standing forward-bend measure, but it is not valid as a stand-alone measure of isolated hamstring length, lumbar pathology or neural involvement.
Common errors include:
Bouncing at end range
Allowing uncontrolled knee flexion
Not recording foot position
Not recording footwear
Not measuring fingertip-to-floor distance
Treating inability to touch toes as a diagnosis
Assuming limitation is always hamstring tightness
Ignoring symptom reproduction
Ignoring dizziness or balance concerns
Comparing warmed-up and non-warmed-up results directly
Limitations include:
It is influenced by multiple body regions
It does not isolate hamstrings
It does not diagnose low back pain
It does not diagnose disc or nerve involvement
It can be affected by body proportions
It can be affected by confidence and pain
It can be affected by warm-up
A single result is less useful than repeated measures over time
The Toe Touch Test may be useful for:
General mobility screening
Posterior-chain flexibility tracking
Standing forward-bend tolerance
Baseline and retest documentation
Monitoring mobility programs
Sport and gym movement preparation
Client education
Comparing movement before and after warm-up
Recording symptom response
Supporting Measurz progress reports
In Measurz, it can be recorded alongside Straight Leg Raise, Passive Knee Extension, lumbar range of motion, hip range of motion, calf flexibility, Prone Instability Test, Kemp’s Test, neurological screen findings and functional movement assessments.
Record:
Test name: Toe Touch Test
Result: fingertips-to-floor distance, touches toes, touches floor, limited, unclear or unable to test
Measurement unit
Foot position
Footwear condition
Knee position
Pain score
Symptom location
Symptom quality
Whether symptoms were familiar
Dizziness or balance response
Movement quality
Compensations
Warm-up status
Number of trials
Reason for stopping if relevant
Related findings
Interpretation confidence
Retest date if relevant
Recording these details improves repeatability, communication, client education, assessment reasoning, monitoring over time, team consistency and reporting quality.
Straight Leg Raise
Passive Knee Extension
Sit and Reach Test
Lumbar flexion range of motion
Hip flexion range of motion
Calf flexibility assessment
Slump Test
Prone Instability Test
Kemp’s Test
Pheasant Test
Squat assessment
Hinge assessment
It measures standing forward-bend reach and provides general information about posterior-chain flexibility, lumbar flexion contribution, hip motion and movement strategy.
It can provide information related to hamstring flexibility, but it does not isolate the hamstrings.
A positive or limited finding may include inability to reach the target, familiar symptom reproduction, guarding, excessive compensation or a meaningful worsening from baseline.
No. The result may be influenced by hamstrings, calves, hips, lumbar spine, neural sensitivity, pain, confidence or body proportions.
No. The movement should be slow and controlled without bouncing.
Usually yes, but avoid aggressive locking. If knee flexion occurs, record it.
Yes. It provides a simple numerical value that can be tracked over time.
No. It is a movement screen, not a diagnostic test.
The Toe Touch Test assesses standing forward-bend reach and movement strategy.
It is influenced by multiple body regions, not just the hamstrings.
It is useful as a repeatable flexibility and mobility measure when the protocol is standardised.
It should not be used to diagnose low back pain, hamstring injury, disc pathology or neural involvement.
Reliability evidence in young healthy adults supports its use as a flexibility measure.
Measurz recording should include fingertip-to-floor distance, symptoms, foot position, knee position, movement quality and retest conditions.
Ayala, F., Sainz de Baranda, P., De Ste Croix, M., & Santonja, F. (2012). Absolute reliability of five clinical tests for assessing hamstring flexibility in professional futsal players. Journal of Science and Medicine in Sport, 15(2), 142–147. https://doi.org/10.1016/j.jsams.2011.10.002
Hui, S. S.-C., Yuen, P. Y., Morrow, J. R., & Jackson, A. W. (1999). Comparison of the criterion-related validity of sit-and-reach tests with and without limb length adjustment in Asian adults. Research Quarterly for Exercise and Sport, 70(4), 401–406. https://doi.org/10.1080/02701367.1999.10608060
Liu, H., Shen, Y., Xiong, Y., Zhou, H., Mao, Y., Shen, Q., Hong, W., Liu, M., Liu, Y., Qiu, L., Zhang, Z., & Jia, Y. (2022). Psychometric properties of four common clinical tests for assessing hamstring flexibility in young adults. Frontiers in Physiology, 13, 911240. https://doi.org/10.3389/fphys.2022.911240
Mayorga-Vega, D., Merino-Marban, R., & Viciana, J. (2014). Criterion-related validity of sit-and-reach tests for estimating hamstring and lumbar extensibility: A meta-analysis. Journal of Sports Science & Medicine, 13(1), 1–14.
