Manual Muscle Testing
By The McCord Family on YouTube |
Purpose: Test the strength of the muscles in the lower extremity as part of the physical therapy examination. In certain conditions, such as in vascular compromise (compartment syndrome, venous insufficiency, lymphedema, arterial insufficiency), strength grades will be reduced. Strength grades may also be reduced by other pathologies such as neurological or orthopedic/musculoskeletal conditions.
Procedure: Have the patient move the extremity into its end range motion using the muscle to be tested. Have the patient hold this position. The examiner provides resistance at end range to the distal segment to which the muscle attaches. The examiner tries to "break" the patient's hold. The muscle is graded on its ability to maintain the position. General rules:
MMT grades: 5 Normal subject completes ROM against gravity with maximal resistance 4+ Good Plus completes ROM against gravity with moderate-maximal resistance 4 Good completes ROM against gravity with moderate resistance 4- Good Minus completes ROM against gravity with minimal-moderate resistance 3+ Fair Plus completes ROM against gravity with only minimal resistance 3 Fair completes ROM against gravity without manual resistance 3- Fair Minus does not complete the range of motion against gravity, but does complete more than half of the range 2+ Poor Plus is able to initiate movement against gravity 2 Poor completes range of motion with gravity eliminated 2- Poor Minus does not complete ROM in a gravity eliminated position 1 Trace muscle contraction can be palpated, but there is no joint movement 0 Zero patient demonstrates no palpable muscle contraction For grades 4,5- resistance applied perpendicular to the line of gravity Grade 3- completes FULL against gravity Grades 2, 1, 0- tested in “gravity minimum” position, muscle contraction is parallel to line of gravity Normal Result: Strength grades of 5/5 are normal. Abnormal Result: Any muscle grade below 5/5. This does not necessarily indicate function, only that there is muscle weakness. |
References
Hislop, H., Avers, D., & Brown, M. (2013). Daniels and Worthingham's muscle testing: Techniques of manual examination and performance testing. Elsevier Health Sciences.
Hislop, H., Avers, D., & Brown, M. (2013). Daniels and Worthingham's muscle testing: Techniques of manual examination and performance testing. Elsevier Health Sciences.
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