Manual Muscle Testing Flashcards
Capital Extensors (Upper Cervical)
Grade 3
- Patient’s Position: Prone, head off the end of plinth, hands by the sides, pillow at shin for comfort
- ALWAYS place a hand under the patient’s chin for support
- Place the other hand at the back near the neck for stabilisation
- Instructions: Look at the wall
Grade 4/5
- Patient’s Position: Prone, head off the end of plinth, hands by the sides, pillow at shin for comfort
- ALWAYS place a hand under the patient’s chin for support
- Resistance applied over the occiput
- Instructions: Look at the wall, hold don’t let me push it down.
Grade 2
- Patient’s Position: Supine, head on the plinth
- Place both hands under chin of patient and guide the motion
- Instructions: Tilt your chin up, try to keep your head on the plinth
Grade 1
- Patient’s Position: Supine, head on the plinth
- Palpate for contraction of the capital extensors over the base of occiput
- Instructions: Try to tilt your chin up
Cervical Extensors (Lower Cervical)
Grade 3
- Patient’s Position: Prone, head off the end of plinth, hands by the sides, pillow at shin for comfort
- ALWAYS place a hand under the patient’s chin for support
- Place the other hand at the back near the neck for stabilisation
- Instructions: Lift your head from my hand keep looking at the floor
Grade 4/5
- Patient’s Position: Prone, head off the end of plinth, hands by the sides, pillow at shin for comfort
- ALWAYS place a hand under the patient’s chin for support
- Resistance applied over the parieto-occipital area
- Instructions: Push up on my hand but keep looking at the floor. Hold, don’t let me push you down.
Grade 2
- Patient’s Position: Supine, head on the plinth
- Place both hands under the head, fingers distal to occiput at cervical vertebrae for palpation
- Instructions: Try to push your head into my hands
Grade 1
- Patient’s Position: Supine, head on the plinth
- Palpate for contraction of the cervical extensor.
- Instructions: Try to push your head into my hands
Capital and Cervical Extensors
Grade 3
- Patient’s Position: Prone, head off the end of the plinth, arm by the sides, pillow under the shin for comfort.
- ALWAYS place a hand under the chin for support
- Place the other hand at the back of the neck for stabilisation
- Instructions: Raise your head from my hand and look up to the ceiling
Grade 4/5
- Patient’s Position: Prone, head off the end of the plinth, arm by the sides, pillow under the shin for comfort.
- ALWAYS place a hand under the chin for support
- Resistance applied over the parieto-occipital area
- Instructions: Lift your head and look at the ceiling. Hold it. Don’t let me push your head down.
Grade 2
- Patient’s Position: Prone, face into hole
- Place your hand at the neck for stabilisation
- Instructions: Try to raise your head off the bed and look at the ceiling
- Partial ROM
Grade 1
- Patient’s Position: Prone, face into hole
- Place your hand at the neck for stabilisation
- Instructions: Try to raise your head off the bed and look at the ceiling. Palpate for any contraction in the cervical region and base of occiput
Capital Flexion
Grade 3
- Patient’s Position: Supine, head supported on plinth, arms by the side
- Place both hands under the head for stabilisation
- Instructions: Tuck your chin into your neck. Do not raise your head from bed.
Grade 4/5
- Patient’s Position: Supine, head supported on plinth, arms by the side
- Cup both hands under the mandible (chin) for resistance in an upward backward motion.
- Instructions: Tuck your chin into your neck. Do not raise your head from bed. Hold it, do not let me lift up your chin.
Grade 2
- Patient’s Position: Supine, head supported on plinth, arms by the side
- Place both hands under the head for stabilisation
- Instructions: Try to tuck your chin into your neck
- Partial ROM
Grade 1
- Patient’s Position: Supine, head supported on plinth, arms by the side
- Place both hands under the head for stabilisation
- Instructions: Try to tuck your chin into your neck
- CANNOT be palpated, watch for flicker of movemenr
Cervical Flexion
Grade 3
- Patient’s Position: Supine, head supported on plinth, arms at the side
- Place one hand behind the neck, the other hand at the chest for stabilisation
- Instructions: Bring your head off the bed, keeping your eyes on the ceiling. Keep your shoulders off the bed
Grade 4/5
- Patient’s Position: Supine, head supported on plinth, arms at the side
- Place one hand chest for stabilisation
- Resistance over the forehead
- Instructions: Lift your head rom the bed, keep your eyes on the ceiling. Do not lift your shoulder off the bed. Hold, do not let me push your head down.
Grade 2
- Patient’s Position: Supine, head supported on plinth, arms at the side
- Tested unilaterally on both sides. Place both hands/ fingers on sternocleidomastoid muscles for palpation
- Instructions: Roll your head to the left and then to the right.
- Partial ROM
Grade 1
- Patient’s Position: Supine, head supported on plinth, arms at the side
- Tested unilaterally on both sides. Place both hands/ fingers on sternocleidomastoid muscles for palpation
- Instructions: Roll your head to the left and then to the right.
- No movement but tension in sternocleidomastoid muscles
Capital and Cervical Flexors - Combined Cervical Flexors
Grade 3
- Patient’s Position: Supine, head supported on plinth, arms at the side
- Place one hand behind the head for support, the other at the chest for stabilisation.
- Instructions: Bring your chin up on your chest, and do not raise your shoulders
Grade 4/5
- Patient’s Position: Supine, head supported on plinth, arms at the side
- Place one hand chest for stabilisation
- Resistance over the forehead
- Instructions: Bring your head up till your chin is on your chest, and don’t raise your shoulders. Hold it. Don’t let me push you down
Grade 2
- Patient’s Position: Supine, head supported on plinth, arms at the side
- Tested unilaterally on both sides. Place both hands/ fingers on sternocleidomastoid muscles for palpation
- Instructions: Roll your head to the left and then to the right.
- Partial ROM
- Capital flexors rotate the head ipsilaterally and cervical flexors (SCM) contralaterally
Grade 1
- Patient’s Position: Supine, head supported on plinth, arms at the side
- Tested unilaterally on both sides. Place both hands/ fingers on sternocleidomastoid muscles for palpation
- Instructions: Roll your head to the left and then to the right.
- No movement but tension in sternocleidomastoid muscles
- Capital flexors rotate the head ipsilaterally and cervical flexors (SCM) contralaterally
Sternocleidomastoid - Combined Cervical Flexion and Rotation
Grade 3
- Patient’s Position: Supine, head turned to the one side supported on plinth, arms at the side
- Testing contra-lateral muscle
- Place one hand at the back of the head for support
- Instructions: Lift up your head, keeping your head turned.
Grade 4/5
- Patient’s Position: Supine, head turned to the one side supported on plinth, arms at the side
- Testing contra-lateral muscle
- Place one hand at the back of the head for support
- Resistance over temporal area above the ear
- Instructions: Lift up your head, keeping your head turned. Hold it. Don’t let me push your head down
Grade 2
- Patient’s Position: Supine, head turned to the one side supported on plinth, arms at the side
- Testing contra-lateral muscle
- Place one hand at the back of the head for support
- Instructions: Roll your head to the right and then to the left.
- Palpating fingers over the sternocleidomastoid
- Partial ROM
Grade 1
- Patient’s Position: Supine, head turned to the one side supported on plinth, arms at the side
- Testing contra-lateral muscle
- Place one hand at the back of the head for support
- Instructions: Roll your head to the right and then to the left.
- Palpating fingers over the sternocleidomastoid
- Flicker or contraction in muscle but no movement
Trunk Extensors - Sorenson Test
Measures the trunk ability to sustain an antigravity position over time.
Patient’s Position: Prone, with pelvis at the edge of the plinth, secured by belts at Pelvis (butt), Lower limb (thigh) and ankle. With chair placed infront for support at the start.
Patient maintains body with trunk extensors contracting isometrically in the horizontal position for as long as possible, without deviating from the horizontal position more than 6 degrees for more than 6 seconds. Test is terminated after 240 seconds.
Instructions: When I say ‘begin’, fold your arms in front of your chest and raise your head, chest, and trunk from the chair and hold horizontal position as long as you can. I will be timing you. Let me know if you have any back pain.
Trunk Flexors
Grade 3
- Patient’s Position: Supine, with arms outstretched in full extension, legs extended
- Place your hand at cervical region for support
- Ensure the neck flexors are not contributing to trunk flexion, instruct and remind patient to maintain a neutral neck position with chin pointed to the ceiling.
- Do not allow hip flexion or have the feet fixed on the surface as it would activate the hip flexors.
- Ensure that the scapula are lifted off the plinth
- Instructions: Keep your chin pointed to the ceiling as you raise your head, shoulders and arms off the bed
Grade 4
- Patient’s Position: Supine, with arms folded over the chest, legs extended
- Place your hand at cervical region for support
- Ensure the neck flexors are not contributing to trunk flexion, instruct and remind patient to maintain a neutral neck position with chin pointed to the ceiling.
- Do not allow hip flexion or have the feet fixed on the surface as it would activate the hip flexors.
- Ensure that the scapula are lifted off the plinth
- Instructions: Keep your chin pointed to the ceiling as you raise your head, shoulders and arms off the bed
Grade 5
- Patient’s Position: Supine, with hands behind the ears, fingertips lightly touching the back of his head, legs extended
- Place your hand at cervical region for support
- Ensure the neck flexors are not contributing to trunk flexion, instruct and remind patient to maintain a neutral neck position with chin pointed to the ceiling.
- Do not allow hip flexion or have the feet fixed on the surface as it would activate the hip flexors.
- Ensure that the scapula are lifted off the plinth
- Instructions: Keep your chin pointed to the ceiling as you raise your head, shoulders and arms off the bed
Sequence 1 (Head Raise) – Test for Grade 2
- Patient’s Position: Supine, with arms by the side, knees flexed, feet resting on the plinth
- Place hands palpating over the linea alba near the middle between the xiphoid process and symphysis pubis
- Instructions: Try to lift your head from the bed
- Grade 2 - If patient is able to lift the head but without scapulae clearing the plinth
- Move on to sequence 2 if patient is unable to lift the head
Sequence 2 (Assisted forward lean)
- Patient’s Position: Supine, with arms by the side, knees flexed, feet resting on the plinth
- Place hands palpating over the linea alba near the middle between the xiphoid process and symphysis pubis
- Using the other hand to cradle the upper trunk and head off the plinth
- Instructions: Try to lean forward
- Grade 2 – Depression of rib cage
- Grade 1 – No depression of the rib cage but visible or palpable contraction over rectus abdominis
- Move on to sequence 3 if there is no depression of rib cage or there is no contraction
Sequence 3
- Patient’s Position: Supine, with arms by the side, knees flexed, feet resting on the plinth
- Place hands palpating over the linea alba near the middle between the xiphoid process and symphysis pubis
- Using the other hand to cradle the upper trunk and head off the plinth
- Instructions: Try to cough
- Grade 2 – Depression of rib cage
- Grade 1 – Unable to cough but visible or palpable contraction
- Grade 0 – No depression of rib cage, no contraction
Trunk Rotators
Grade 3 (Ipsilateral scapula clears the plinth)
- Testing contralateral muscle – Reaching from right to left knee (rotating to the left), you are testing right trunk rotators
- Patient’s Position: Supine, with arms outstretched in full extension
- Place your hand at ipsilateral scapula for support
- Instructions: Keep your chin pointed to the ceiling as you raise your head, shoulder and arms off the bed. With your chin pointed to the ceiling, lift your head and shoulders from the bed, taking your right elbow towards your left knee.
Grade 4 (Ipsilateral scapula clears the plinth)
- Testing contralateral muscle – Reaching from right to left knee (rotating to the left), you are testing right trunk rotators
- Patient’s Position: Supine, with arms folded infront of the chest
- Place your hand at ipsilateral scapula for support
- Instructions: With your chin pointed to the ceiling, lift your head and shoulders from the bed, taking your right elbow towards your left knee
Grade 5 (Ipsilateral scapula clears the plinth)
- Testing contralateral muscle – Reaching from right to left knee (rotating to the left), you are testing right trunk rotators
- Patient’s Position: Supine, with hands behind the ear, fingertips lightly touching the back of the head
- Place your hand at ipsilateral scapula for support
- Instructions: With your chin pointed to the ceiling, lift your head and shoulders from the bed, taking your right elbow towards your left knee
Grade 2
- Testing contralateral muscle – Reaching from right to left knee (rotating to the left), you are testing right trunk rotators
- Patient’s Position: Supine, with arms outstretched in full extension, legs extended
- Place your hand at ipsilateral scapula for support
- Instructions: Keep your chin pointed to the ceiling, lift your head and reach towards your right knee.
- Patient is unable to clear the scapula off the bed, but there is depression of the rib cage during the movement
Grade 1
- Patient’s Position: Supine with the arms by the side, hips and knee flexed so that the feet are flat on the plinth.
- Cradle the patient (assisted trunk rotation)
- The other hand palpate the contralateral external obliques and for contraction of ipsilateral internal obliques
- Instructions: Try to lift up and turn to your right
- No movement is observed but contraction palpable.
Serratus Anterior
Muscle Action: Scapular Abduction and Upward Rotation
Upper Trapezius, Levator Scapulae and Rhomboids
Muscle Action: Scapular Elevation
Middle Trapezius
Muscle Action: Scapular Adduction
Lower Trapezius
Muscle Action: Scapular Depression, Adduction
Rhomboids
Muscle Action: Scapular Adduction, Downward Rotation
Anterior Deltoid, Coracobrachialis
Muscle Action: Shoulder Flexion
Supraspinatus, Middle Deltoid
Muscle Action: Shoulder Abduction
Latissimus Dorsi, Posterior Deltoid, Teres Major
Muscle Action: Shoulder Extension
Posterior Deltoid
Muscle Action: Shoulder Horizontal Abduction
Pectoralis Major
Muscle Action: Shoulder Horizontal Adduction
Infraspinatus, Teres Minor
Muscle Action: Shoulder External Rotation
