Manual Muscle Testing

Purposes of MMT

To give a baseline for Rx To Dx an injury To set-up a rehabilitation program

The Break Test

Manual resistance is applied to a limb or other body part Manual resistance a force that acts in opposition to a contracting muscle At the end of available range, or at a point in the range where the muscle is most challenged, the patient is asked to hold the part at that point and not allow the examiner to break the hold with manual resistance

Active Resistance Tests

Manual resistance against an actively contracting muscle of muscle group I.e. against the direction of the movement as if to prevent that movement

Application of Resistance
Biceps brachii i.e. when the elbow is straight, the biceps lever is short; leverage increases as the elbow flexes and becomes maximal (most efficient) at 90 degrees, but as flexion continues beyond that point, the lever arm again decreases in length and efficiency. Two joint muscles the point of maximum resistance is generally at or near midrange Apply resistance near the distal end of the segment to which the muscle Resistance should never be sudden or uneven. Apply resistance slowly and gradually, allowing it to build to the maximum tolerable intensity

Side Notes
Knowledge of the location and anatomic features of the muscle in a test Identify patterns of substitution Differences in contour and bulk of the muscle Any deviations from the normal ROM Do not grasp the belly of the muscle Effect of fatigue on the test

Patients influences on the test

They may not be applying true effort They may think it will hurt therefore it will hurt They do not understand the test and what is expected of them Their motor skills may not be developed enough Depression They may be inhibited with you touching their bodies in a particular way

Grading System
Perform bilaterally Practice on normal muscles as much as possible With gravity lifting body part against gravity Gravity eliminated working in a plane parallel with gravity Gravity assisted gravity is used to help assist the movement All gravity assisted movements are eccentric contractions

Function of Muscle
none

Grade
O

Symbol
0

Trace muscle contraction seen or felt, no movement of the limb Gravity eliminated, less than 50% ROM Gravity eliminated; greater than 50% but less than 100% ROM

2-

P-

Function of Muscle
Gravity eliminated, full ROM Against gravity, less than 50% ROM Against gravity greater than 50% but less than 100% ROM Against gravity, full ROM

Grade 2+ 33 3+

Symbol P+ FF F+

Function of Muscle
Against gravity, full ROM holds against minimal resistance Against gravity, full ROM holds against moderate resistance Against gravity, full ROM holds against maximal resistance Against gravity, full ROM cannot be broken

Grade 44 4+ 5

Symbol GG G+ N