Manual Muscle Testing Flashcards
Measurable force exerted by a muscle or group of muscles to overcome resistance in one maximal effort
Strength
Ability to contract a muscle repeatedly over a period of time
Endurance
Work produced per unit of time (product of speed and strength)
Power
Three primary approaches used to determine muscle strength
Isotonic
Isokinetic
Isometric
Testing of strength using constant external resistance
Isotonic
Since constant (isotonic) muscle tension rarely occurs, contraction is usually referred to as
Concentric or eccentric
Assess the con and ecc strength of muscle using ____________
Free weights, resistance machines
T/F gross strength of muscle groups is assessed rather than the strength of the individual muscles
T
An isolines if dyanamometer allows measurement of strength by having subject provide resistance through the ROM at a _________
Constant velocity
The isokinetic dynamometer provided _______ values at specific points in the ROM or throughout full ROM
Peak torque
Disadvantages to isokinetic
Cost of equipment is high
Considered non-functional since a muscle strength is assessed in non-weight bearing
During an isometric contraction, the muscle length remains _______ throughout the contraction
Almost the same
How is isometric muscle strength tested
Having the muscle generate force against an immovable resistance
What issues are eliminated in isometric contraction
Since muscle length is unchanged, issues with variability in muscle length and velocity of joint motion are eliminated
Most common methods of isometric testing
MMT and HHD
Manual muscle testing and Handheld dynamometry
What type of contraction is MMT
Isometric
Disadvantage of isometric contraction
Provides muscle strength data at only one point in ROM
Patients with significant muscle weakness are best assessed using
Manual muscle testing
T/F HHD and other instrumented forms of muscle testing are sensitive enough to detect low levels of strength
F
Patient’s with strength in the range of Good (4) to Normal (5) should be tested
- Using HHD
- strength testing (10 rep max)
- isokinetic dynamometry
- not MMT
Method of choice for the assessment of muscle strength of patient whose muscle test grades fall below Fair+ (3+)
MMT
What is manual muscle testing designed to measure?
Muscle strength which is defined as ability of muscle to develop isometric tension against resistance.
Some neuromusculoskeletal diseases that MMT is used to assess muscle strength
- spinal cord injuries
- Gillian-barre syndrome
- muscular dystrophy
- multiple sclerosis
- RA & OA
Manual muscle testing assists the PT in (4)
1- diagnosis and prognosis by determining level of lesion
2- planning treatment program
3- evaluating progress or regression of patient
4-basic starting point for developing an exercise program for the patient
T/F we can eliminate gravity when performing a MMT
F we can lessen gravity, but cannot eliminate
Why is palpating of muscle being tested important?
There can be an active contraction even if limb movement is not observed
Where does the examiner apply resistance force
Perpendicular to the distal end of the distal segment of the bone being tested
Difference between make vs. break test
MAKE - patient exerts a max force against the resistance applied on the limb by the examiner throughout the ROM - patient is instructed to pull or push as hard as they can
BREAK - patient holds the position of the limb and the examiner applies max resistance until the patient’s maximal muscular effort is overcome and the limb begins to move. - patient is instructed, do not let me move your arm
Required to ensure desired action occurs at the specific muscle we are testing
Stabilization (Fixation)
Occurs when muscle or muscle groups attempt to compensate for the lack of function of a weak or paralyzed muscle
Substitution
Classic example of substitution
Hip hike using QL to substitute for a weak gluteus medius
*Substitution can never be allowed
Development of tension by the muscle varies based on both,
Muscle physiology issues
Patient issues
Muscle physiology issues (4)
1 - number and firing rate of motor units activated
2 - length of muscle at time of contraction
3 - cross-sectional area of muscle
4 - fiber type composition of muscle
Patient issues (5)
1- variation in true effort 2- willingness to suffer pain or discomfort 3- cognition and language 4- fatigue and age 5- psychological issues
What can a PT control during MMT (4)
1- correct patient positioning
2- proper point of application of resistance
3- use of proper stabilization techniques
4- motivation of patient
PT can demonstrate by passively moving distal segment through ROM, if
Patient does not understand
Patient is extremely weak
From starting position, ask patient to perform required movement, then
Palpate muscle and maintain stabilization
Observe for substitutions
If patient can complete full ROM against gravity,
PT applies resistance with palpation hand at END of the ROM in the exact opposite direction of the movement
If patient can complete full ROM against gravity, apply resistance for ______ seconds instructing the patient to ________.
Continue to apply resistance until _____ or until resistance was held for _______.
4-5
Continually hold
Patient breaks
4-5 sec
If patient cannot complete full ROM against gravity,
Reposition the patient in gravity lessened position and repeat the procedure we previously used WITHOUT applying resistance
Higher levels of inter-rated reliability are attained when
The uniform method of MMT is used by all testers
MMT is more valid for grades of
3 or lower
Importance of the order of muscle testing when performing a MMT
- to prevent fatigue of proximal muscles, order of the muscles we are testing from proximal to distal
- MMT progression should be planned to prevent frequent change of patient position
The PT should be very cautious when using MMT:
- to assess muscle strength in the presence of spasticity or increased muscle tone as a result of a neurological impairment
- when significant pain or muscle guarding is present
Against gravity grades
3,3+,4,5
Movement though the full ROM against gravity
3, F, Fair
Movement through the full ROM against gravity and able to hold against minimum resistance
3+,F+, Fair plus
Movement through the full ROM against gravity and able to hold against moderate resistance
4,G, Good
Movement through the full ROM against gravity and able to hold against maximum resistance
5,N,Normal
Gravity lessened grades
0,1,2-,2,2+,3-
No evidence of contraction by vision or palpation
0,0,zero
Slight contraction, but NO MOVEMENT
1,Tr, Trace
Movement through partial ROM in gravity-lessened position
2-,P-, poor minus
Movement through full ROM in gravity-lessened position
2,P,Poor
Movement through full ROM in gravity-lessened position and up to 1/2 ROM against gravity
2+,P+, poor plus
Movement through full ROM in gravity-lessened position and more than 1/2 ROM against gravity
3-,F-, Fair minus
Muscle performance includes what 3 things
Strength
Endurance
Power
