LIVE ONLINE TEACHING

Subject: EXERCISE THERAPY

Topic : MANUAL MUSCLE TESTING, MUSCLE GRADING
Year : II YEAR BPT

Faculty Name : BIJISH KUMAR B

Designation : VICE PRINCIPAL (PESCOP)
Department : PHYSIOTHERAPY

PES Institute of Medical Sciences & Research

LEARNING OBJECTIVES

At the end of the lesson, students will be able to:

• Understand the methods of muscle grading.

• Grade muscles using Manual Muscle Testing
method.
• Conduct a muscle power examination and
document the result.

PES Institute of Medical Sciences & Research

MANUAL MUSCLE TESTING

INTRODUCTION:
• Manual Muscle testing is an important part of
physical examination.
• It is useful in understanding the Muscle tissue
status
• It is useful for establishing a diagnosis,
prognosis, and treatment of neuromuscular and
musculoskeletal disorders.
• It is also effective in determining if progress is
being made during rehabilitation and from that if
adjustments need to be made.
PES Institute of Medical Sciences & Research
• Muscle testing consists of strong, static, isometric muscle
contraction.
• Limiting joint motion and focusing on the muscle allows
for determination of a problem with a muscle or muscles
or possibly if it is a condition in the inert tissues (all tissue
not considered contractile or neurological.
Definition:
• Manual muscle test is a procedure for the evaluation of
strength of individual muscle or muscle group, based
upon the effective performance of a movement in relation
to forces of gravity or manual resistance through the
available Range of motion.

PES Institute of Medical Sciences & Research

• TYPES OF MUSCLE CONTRACTION
• Isometric
• Isotonic
• Isokinetic

• TYPES OF MUSCLE WORK

• Static
• Concentric
• Eccentric

PES Institute of Medical Sciences & Research

GROUP ACTIONS
• Agonists
• Antagonists
• Synergists
• Fixators
RANGE OF MUSCLE WORK
• Outer range: From full stretch to halfway through the
full ROM
• Inner range: From halfway through the full range to full
shortened position
• Middle range: Range between the midpoints of the
Outer range and the Inner range

PES Institute of Medical Sciences & Research

PURPOSE AND USES

• The severity of the problem can be understandable.

(As diagnostic tool)
• Helps in planning treatment goals
• Determines the extend or degree of muscular weakness
resulting from disease, injury
• It's an important tool for the members of the rehabilitation
team
• Prevent deformities by locating affected areas
• In evaluating the prognosis of management

PES Institute of Medical Sciences & Research

METHODS OF GRADING:
MRC Grading

PES Institute of Medical Sciences & Research

OXFORD GRADING:

PES Institute of Medical Sciences & Research

KENDALL SCALE

PES Institute of Medical Sciences & Research

+ OR - GRADES

PES Institute of Medical Sciences & Research

PES Institute of Medical Sciences & Research
PRINCIPLES

• POSITION
• STABILIZATION
• DEMONSTRATION
• APPLICATION OF GRADES
• APPLICATION OF RESISTANCE
• CHECKING NORMAL STRENGTH
• OBJECTIVITY
• DOCUMENTATION

PES Institute of Medical Sciences & Research

POSITION

• Positioning should be comfortable.(In eliminated or

against gravity)
• Not to change position repeatedly

STABILIZATION

• Hand placement
• PROXIMAL HAND: At origin of muscle and proximal joint
• DISTAL HAND: Distally offering resistance

PES Institute of Medical Sciences & Research

DEMOSTRATION

• Desired movement
• Therapist to demonstrate the application of resistance

APPLICATION OF GRADES
• Always start with Grade 3
• Isolation of muscle could be tested

PES Institute of Medical Sciences & Research

APPLICATION OF RESISTANCE

• Manual Resistance is applied distally, slowly and gradually

• Increase or decrease resistance
• Length of the weight arm to be varied on patient’s ability
(short or long lever)
• For Single joint muscles resistance is given at end range.
• For Two joint muscles resistance is given at mid range

CHECKING NORMAL STRENGTH

• Always compare with normal side

PES Institute of Medical Sciences & Research

OBJECTIVITY

• Therapist to palpate and observe the tendon or

muscle response

DOCUMENTATION
• To be documented for further reference

PES Institute of Medical Sciences & Research

INDICATIONS FOR MMT:

 LOWER MOTOR NEURON DISEASE

 OTHER NEUROLOGICAL DISORDER:

• MULTIPLE SCLEROSIS
• MUSCULAR DYSTROPHY
• AMYOTROPIC LATERAL SCLEROSIS
• MYASTHENIA GRAVIS
• GUILLIAN-BARRE SYNDROME (GBS) ETC..

 MUSCULOSKELETAL DISORDERS
PES Institute of Medical Sciences & Research
CONTRINDICATIONS

• Cerebral Palsy
• Cardio vascular disease
• Head injury
• Fractures
• Myositis ossification
• Parkinsons disease
• Pain
• Inflammation
• Osteoporosis
• Haemophilia
• Subluxation
PES Institute of Medical Sciences & Research
PRECAUTIONS:

• TO BE CAUTIOUS ABOUT PATIENTS MEDICAL CONDITION

(ABDOMINAL SURGERY, FRACTURES ETC..)
• FATIGUE
• PHYSICAL RESTRAINTS
• BE GENTLE
• RESPECT PAIN
• PATIENT’S COMFORT
• RECORD ACCURATELY
• CAREFUL WHILE GIVING RESISTANCE
• BONY ANKYLOSIS
• HEMARTHROSIS

PES Institute of Medical Sciences & Research

 LIMITATIONS

• UMN Lesions: Due To Spasticity, Inco-ordination

• Presence Of Pain And Swelling
• Type Of Contraction: Concentric Not Eccentric (Functional)
• Understanding Commands
• Strength Vs Endurance

PES Institute of Medical Sciences & Research

CLIENT REQUIREMENTS

Ability to understand directions.

Motor skills.
Willingness to endure discomfort.
True effort.

PES Institute of Medical Sciences & Research

CRITERIA FOR ASSIGNING A MMT GRADE

Subjective:
• The standard amount of resistance for the test as
perceived by the examiner.
• The amount of resistance the client actually tolerates.
Objective:
• Ability of the client to complete the full AROM..
• The ability to hold in position.
• The ability to move against gravity or to produce obvious
movements.

PES Institute of Medical Sciences & Research

PROCEDURE

• Explanation and Instruction

• Assessment of normal strength
• Proper positioning
• Stabilization
• Substitution or Trick movements
• Conventional methods
• Alternating techniques

PES Institute of Medical Sciences & Research

Explanation and Instruction

• The therapist should explain well and

demonstrate the movement to be performed.

Assessment of normal strength

• Always assess and record the strength of the

unaffected limb to determine the patients
normal strength.

PES Institute of Medical Sciences & Research

Proper positioning

• Patient positioned in well supported and comfortable

position

Stabilization

• Hand placement
• PROXIMAL HAND: At origin of muscle and proximal joint
• DISTAL HAND: Distally offering resistance

PES Institute of Medical Sciences & Research

PES Institute of Medical Sciences & Research
Substitution or Trick movements

• When muscles are weak or paralyzed, other muscles

may take over or gravity may be used to perform
movements

Conventional Methods
• Evidence of contraction
• Gravity as a resistance
• Amount of manual resistance
• Adding “+” or “-” to the grades

PES Institute of Medical Sciences & Research

TECHNIQUE OF MMT

Break test in manual muscle testing, is when resistance is

applied to the body part at the end of the available range of
motion. It's called the brake test because when a therapist
provides resistance, the objective for the patient is to not allow the
therapist to "break" the muscle hold. For one joint muscle
resistance is applied at end of ROM, two joint muscle resistance is
applied at Mid Range

Make Test (Active Resistance test) in manual muscle

testing is when resistance is applied through the body
part through the available range of motion. This type of
manual muscle testing requires skill and experience
and is not the recommended practice.

PES Institute of Medical Sciences & Research

Normal Grade: With the hands clasped behind the head, the subject is able
to flex the vertebral column and keep it flexed while entering the hip flexion
phase and coming to a sitting position. The feet may be held down during
the hip flexion phase, if necessary, but close observation is required to be
sure that the subject maintains the flexion of the trunk.

PES Institute of Medical Sciences & Research

Good Grade: With the arms folded across the chest, the subject is able to
flex the vertebral column and keep it flexed while entering the hip flexion
phase and coming to a sitting position. The strongest force against the
abdominals is at the moment the hip flexors start to raise the trunk. Performing
only the trunk curl is not sufficient for strength testing.

PES Institute of Medical Sciences & Research

Fair Grade: With the arms extended forward, the subject is able to flex the
vertebral column and keep it flexed while entering the hip flexion phase and
coming to a sitting position.

PES Institute of Medical Sciences & Research

When the abdominal muscles are too weak to lift the trunk, the hip flexors
tilt the pelvis forward and hyperextend the low back as they raise the
trunk to a sitting position.

PES Institute of Medical Sciences & Research

INSTRUMENTS

HAND HELD DYNAMOMETER

PES Institute of Medical Sciences & Research

PINCH GUAGE

PES Institute of Medical Sciences & Research

CABLE TENSIOMETER

PES Institute of Medical Sciences & Research

REFERENCE

• Muscle Testing and Function- Florence Peterson kendall,

Elizebath Kendall McCreary
• Kisner, C. & Colby, L.A. (2000). Therapeutic Exercise:
Foundations and Techniques. Info Access and
Distributions Pvt. Ltd.

PES Institute of Medical Sciences & Research

 THANK YOU

PES Institute of Medical Sciences & Research