Knee muscle test

Dr.Heba haridy
Grade 2,1,0 Factors limiting Contractures/
Muscle Grade 3,4,5 Substitutions Effect of weakness
Palpation the motion tightness
Extension(130-0)

Patient 1- Disability to
position short Grade 2:Side going up, down
sitting lying from a stair
Apply When the 2- Disability to get
resistance on grade 1,0: patient is side up,down from a
anterior aspect supine and lying chair
Quadriceps
of tibia palpate Tension of (as in the 3- Patient walks with 1- Range of
femoris ( rectus
Commond tendon of popliteal , Grade 2 test), lock knee by knee flexion
femoris ,vastus
grade Quadriceps cruciate, and he may use slight hyper will be
lateralis ,vastis
3:straight your just above collateral the hip extension limited.
medialis ,vastus
leg patella ligaments of internal 4- Continuous 2- Shortness of
intermedius)
Grade 4: as commond the knee joint rotators to push suddenly rectus
grade 3 + grade 2: try to substitute for by force thrust femoris will
Insersion
donot let me straight your 2-Tension of the in the be limited
:pattelar tendon
push your leg leg knee flexor quadriceps, direction of hip
tibial tibrosity
down grade 1,o : muscles. allowing hyperextensio extension
N.supply:femoral
Grade 5:As press your the knee to n in growing
N
grade 4 + at knee down as fall into children may
the end of a quadriceps extension. result in a
range hold, set very marked
hold ..relax degree of
deformity.
Flexion .
Hamstring (
Patient 1- Hyperextension of
1- Shortness of
semimembanosus position prone knee
1-Tension of hamstring
,semitendinosus+ with feet 2- Bilateral
knee extensor will result
lateral hamistring outside plinth Grade 2:Side hamstring
biceps femoris ) muscles, Substitution by in: limiting
Apply lying weakness lead to
Accessory ms particularly the 1-sartorius of knee
resistance on grade 1,0: anterior pelvic tilt
(gracllis sartrorius Rectus action(flexion extension
popliteal ms )
posterior prone with so increase
Femoris if the abduction when hip is
aspect of leg slight Lumbar lordosis
hip lateral rotation flexed
Commond supported 3- If unilateral
is extended 2-hip flexor 2- Contracture
grade 3:bend flexion of the hamstring
due to passive applying hip of both
your leg leg and weakness lead
insufficiency flexion medial +
Grade 4: as palpate pelvic rotation
of this ms 3- lateral
grade 3 + tendon 4- Weakness of
2- Contact of gastrocnemis hamstring
Don't let me On the Lateral hamstring
calf with the 4-Gracilis will result
straighten your posterior (biceps): bow leg
posterior substitution: in: knee
leg aspect of the position lead to
surface contributes a flexion +
Grade 5:As thigh above loss lateral
of the hip adduction posterior
grade 4 + at medial and stability of knee
thigh(soft end motion. tilting of
the end of lateral tibial 5- Weakness Medial
feel). pelvis +
range hold, condyles hamstring: knock
flatting of
hold ..relax knee lead to loss
lumbar
medial stability
spine

Fixation of knee joint

1-contraction of iliocostalis lamborum( back ms ) and quadratus lamborum muscles.
2-weight of thigh and pelvis on knee
Knee extension
Grade 5 (Normal), Grade 4 (Good), and Grade 3 (Fair)
• Position of Patient: Short sitting. Place wedge or pad under the distal thigh to maintain the femur in the horizontal
position.
Hands rest on the table on either side of the body for stability or may grasp the table edge. The patient should be allowed
to lean backward to relieve hamstring muscle tension.
• Position of Therapist: Standing at side of limb to be tested. The hand giving resistance is contoured the anterior surface
of the distal leg just above the ankle.
For Grades 5 and 4, resistance is applied in a downward direction (toward the floor) in the direction of knee flexion.
• Test: Patient extends knee through available range of motion but not beyond 0°.
• Instructions to Patient: "Straighten your knee. Hold it! Don't let me bend it."
Grading
• Grade 5 (Normal): Holds end position against maximal resistance.
Grade 4 (Good): Holds end position against moderate resistance.

• Grade 3 (Fair): Completes available range and holds the position without resistance
Grade 2 (Poor)
Position of Patient: Side lying with test limb uppermost. Lowermost
limb may be flexed for stability. Limb to be tested is held in about 90° of knee flexion.
The hip should be in full extension.
Position of Therapist: Standing behind patient at knee level. One arm
cradles the test limb around the thigh with the hand supporting the under side of
the knee .The other hand holds the leg just above the malleolus.
Test: Patient extends knee through the available range of motion. The
therapist supporting the limb provides neither assistance nor resistance
to the patient's voluntary movement. This is part of the art of muscle
testing that must be acquired. Be alert to activity by the internal rotators
see Substitution, below).
Instructions to Patient: "Straighten your knee."
Grading

Grade 2 (Poor): Completes available range of motion.

Grade 1 (Trace) and Grade 0 (Zero)
Position of Patient: Supine.

Position of Therapist: Standing next to limb to be tested at knee level. Hand used for palpation should be on the quadriceps tendon just
above the knee with the tendon "held" gently between the thumb and fingers. The examiner also may want to palpate the patellar tendon
with two to four fingers just below the knee .
• Test: Patient attempts to extend knee. As an alternate test, the therapist may place one hand under the slightly flexed knee; palpate either
the quadriceps or the patellar tendon while the patient tries to extend the knee.
• Instructions to Patient: "Push the back of your knee down into the table." OR "Tighten your kneecap" (quadriceps setting). For Alternate
• Test: "Push the back of your knee down into my hand."
 KNEE FLEXION
Main Muscle
Hamstring
a. Medial Hamstring Muscles:
- Semitendinosus.
- Semimembranosus.
Originated: from ischial tuberosity
Insertion:Medial surface of tibia
Nerve supply : tibial nerve
b. Lateral Hamstring Muscles:
- Biceps femoris
- Long head
- Short head
Originated :from ischial tuberosity
Insertion:Lateral side of the head of the fibula
Nerve supply: all innervated from tibial part of sciatic nerve except short head of biceps
femoris innervated by common peroneal nerve

N.B : Action of Hamstring

The hamstrings cross and act upon two joints – the hip and the Knee- and as such are termed biarticular muscles so action of hamstring
extension on the hip joint and flexion on the knee joint
- Medial hamstring apply flexion knee with medial rotation of tibia
- Lateral hamstring apply flexion knee with lateral rotation of tibia
Grade 5 (Normal), Grade 4 (Good), and Grade 3 (Fair)
There are three basic muscle tests for the hamstrings at Grades 5 and 4. The examiner should test first for the aggregate of the three
hamstring muscles (with the foot in midline).
Only if there is deviation (or asymmetry) in the movement or a question in the examiner's mind is there a need to test the medial and lateral
hamstrings separately.
Hamstring Muscles in Aggregate
• Position of Patient: Prone with limbs straight and toes hanging over the edge of the table.
• Position of Therapist: Standing next to limb to be tested.
Hand giving resistance on the posterior surface of the leg just above the ankle.
Resistance is applied in the direction of knee extension for Grades 5 and 4.
• Test: Patient flexes knee while maintaining leg in neutral rotation.
• Instructions to Patient: "Bend your knee. Hold it! Don't let me straighten it.
• Position of Therapist: Hand giving resistance grasps the leg at the ankle. Resistance is applied in an oblique direction (down and out)
toward knee extension .
Position of Patient: Prone with knee flexed to less than 90°. Leg in internal rotation (toes pointing toward midline) for Medial Hamstring
Test (Semitendinosus and Semimembranosus)
Lateral Hamstring Test (Biceps Femoris)
• Position of Patient: Prone with knee flexed to less than 90°. Leg is in external rotation (toes pointing laterally toward examiner, heel
pointing toward midline).
• Position of Therapist: Therapist resists knee flexion at the ankle using a downward and inward force

• Grade 2 (Poor): Completes available range of motion in side-lying position.

• Position of Patient: Prone. Limbs are straight with toes extending over end of table. Knee is partially flexed and supported at ankle by
examiner.
• Position of Therapist: Standing next to test limb at knee level. One hand supports the flexed limb at the ankle , The opposite hand palpates
both the medial and the lateral hamstring tendons just above the posterior knee. Test: Patient attempts to flex knee.
• Instructions to Patient: "Try to bend your knee."
Grading
• Grade 1 (Trace): Tendons become prominent, but no visible movement occurs.
• Grade 0 (Zero): No palpable contraction of the muscles; tendons do not stand out