Principles of Manual Muscle Testing PDF

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Principles of Manual Muscle Testing (MMT)  Determinants of Muscle Performance o Strength – force produced by muscle (size/amount of recruitment of sarcomere) o Endurance – amount of time muscle can maintain the force o Power – maximal amount of contraction in the shortest amount of time o *Which of the following does MMT measure? Strength o Amount of force is measured by using resistance on the muscle o MMT can also be applied to endurance and power by modifying the test.  Why perform MMT? *from Braddom o Establishes baseline strength o Determine functional ability / need for adaptive equipment o Confirm diagnosis o Suggest prognosis  Grading System o 5 – normal o 4 – good o 3 – fair o 2 – poor o 1 – trace o 0 – zero o *in documentation e.g., biceps brachii 5/5, 4/5, 3/5, 2/5, 1/5, 0/5  Considerations for Grading o Available range of motion o Movement against gravity  Depends on patient positioning o Presence of resistance  Dependent on therapist  Grading System o Grade 5 completes ROM against gravity with maximum resistance o Grade 4 completes ROM against gravity with moderate resistance o Grade 3 completes ROM against gravity with no resistance o Grade 2 partial completion of ROM against gravity or complete ROM without gravity o Grade 1 no movement but muscle still contracts identified by palpation o Grade 0 no movement

 Grading System: + or – grading o 3+ completes ROM against gravity with minimum resistance o 3(F) complete against gravity without resistance o 3- partial rom against gravity o 2+ initiates rom against gravity o 2(p) completes ROM without gravity o 2- initiate rom without gravity  Methods of Testing o Break test  Application of resistance at end range  Therapist attempts to “break” the maintained position  Useful for patients with LOM  Take note of what angle the resistance was given o Active Resistance  Application of resistance at beginning of range as patient goes through the range  Requires more skill  Length-Tension relationship (specific ranges of the joint muscles get stronger/can produce more force)  Special Considerations o Limitation of Passive Motion  Utilize Break Test within available ROM  Reaching the end of the patient’s AVAILABLE ROM is considered complete in MMT grading o Hand Function  Handheld dynamometry** o Generalized Weakness  Functional Muscle Testing**

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*Handheld Dynamometry  Patient grasps handle till PT counts to 3  Measures force of grip of patient  Measures in kilogram of force  Sitting position, elbow 90 degrees  Shoulder and wrist in neutral position  Do 3 times with interal of rest o *pinch dynamometry  Testing for pinch strength o *Functional Muscle Testing  Have patient perform functional tasks  UE: reaching, grasping  Spine: looking in various direction, trunk bending/twisting  LE: sit-to-stand, ambulation, transfers  Describe qualitatively which muscles  Limitations of MMT o Objectivity  Clinical experience as a factor (should adjust amount of resistance for each patient) o Validity/reliability of testing  Presence of pain  Strength of Tester o Difficulty between grade 2 & 3 or 4 & 5 o Sensitivity  Ceiling effect – 5/5  Population or Gender variations  Procedures for testing o Introduce self, establish rapport, vital signs, sanitization, permission o Explain procedure & rationale for testing  Perform mmt to get baseline data for strength  To identify which muscles are weak and giving you impairments  Etc. o Perform Gross assessment o

Ask patient to perform active range of motion (if done will have grade 3)  At the end range, when you apply resistance it is grade 5  Note for asymmetry o Select specific muscle for testing o Measure grade 3  Able to perform -> go higher  Unable to perform -> go lower o If patient can do grade 3, apply maximum resistance for grade 5 if the patient can PT should stop, but if the patient breaks, give moderate resistance to assess for grade 4 o If patient can’t do grade 3, reposition patient to remove gravity for assessment of grade 2, if patient can PT should stop testing, but if the patient cannot and there is no movement, PT must palpate in order to distinguish from grade 1 or grade 0.  Documentation o O > MMT> all muscle groups of B UE/LE & spine are grade 5/5 using standard MMT except:  R biceps brachii 3/5 (break test @ 70 degrees flex)  R quadriceps 3/5 (break test @45 degrees flex)  Etc., o O>FMT>  Overhead reaching: Pt presents with decrease (L) shoulder flexion on forward reaching, exhibits increased trunk extension  Sit to stand – Pt performs complete (B) hip & knee extension during sit to stand task...