MMT Flashcards
Strength
Endurance
Power
Strength= Maximum force that can be generated by a muscle Endurance= The ability of a muscle or a muscle group to perform repeated contractions against resistance or maintain an isometric contraction for a period of time. Power= Rate at which work is done P=FxV
Musculoskeletal conditions frequently show patterns of muscle imbalance
Associated with handedness
Habitually Poor posture
Occupation or sports related activities that consistently use the same muscles without adequate exercise of opposing muscles
passive and active insufficiency
Passive insufficiency: when full ROM of any joint or joints that a muscle crosses is limited by that muscle’s length
Active insufficiency= The active insufficiency of a muscle that crosses two or more joints occurs when the muscle produces simultaneous movement at all the joints it crosses and reaches such a shortened position that it no longer has the ability to develop effective tension. Lack of muscle strength
Pressure
the external force that is applied by the examiner to determine their strength of the muscle holding in the test position (for grades of 3 + or higher) i.e. slight, moderate, strong (is somewhat subjective to interpretation)
Resistance
the external force that opposes the test movement. The resistance may be the force of gravity or a force that is supplied by the examiner. Resistance may vary according to body weight (i.e. back extensor test), arm positions (i.e. upper abdominal test), or leg positions (lower ab test).
Where is pressure applied?
Place where you apply pressure: depends on muscle insertions, strength of intervening muscles and leverage. *general rule: pressure is applied near the distal end of the part on which the muscle is inserted. For example: pressure is applied near the distal end of the forearm during the biceps test.
What are contributing factors to grading above a fair.
Both the length of the lever and the amount of pressure are closely related with respect to grading above a fair. Using a long lever gives the examiner a mechanical advantage and allows more sensitive grading of the muscle strength.
How is pressure placed fast or slow
Pressure must be applied GRADUALLY to determine the degree of strength above fair in muscles. The patient must be allowed to “get set and hold” the test position against the examiner’s pressure
When do substitution occur?
Substitution results from one or more muscles attempting to compensate for the lack of strength in another muscle or group of muscles.
It is a good indicator that the muscle being tested is weak, an adequate fixation has not been applied or that the subject has not been given adequate instruction concerning how to perform the test.
For accurate muscle examinations, no substitutions should be permitted.
gravity
Gravity is a form of resistance that is basic to manual muscle testing, and it is used in the tests of the trunk, neck and extremity muscles. It is a factor in only 60% of the extremity muscles.
What body parts is gravity not to be considered in?
Gravity is NOT considered in the tests of finger and toe muscles because the weight of the part is so small in comparison with the strength of the muscle that the effect of gravity on the part is negligible.
Supination / pronation of the forearm are rotation movements in which the effect of gravity does not contribute
What is the purpose of horizontal plane testing?
Testing muscles that are very weak involve movements in the horizontal plane of a supporting surface where the resistance by gravity is decreased.
Avoid use of phrases such as “gravity-lessened”, “gravity-decreased”, or “gravity – minimized”
You will refer to it as the horizontal plane
Testing and grading procedures are modified during exam for what demographics
Testing and grading procedures are modified during exam of infants and children to the age of 5 or 6 years. The ability to determine a child’s muscle strength up to the grade of fair is usually not difficulty, but grading strength avoe fair depends on the cooperation of the child in holding against resistance or pressure. The textbook (Kendall) suggests recording as “apparently normal” which indicates that although strength may in fact be normal, one cannot be sure (due to poor cooperation of the child).
What is the grading scale documentation look like
Normal (N) (5) Good Plus (G+) (4+) Good (G) (4) Good Minus (G-) (4-) Fair Plus (F+) (3+) Fair (F) (3) Fair Minus (F-) (3-) Poor Plus (P+) (2+) Poor (P) (2) Poor Minus (P-) (2-) Trace (T) (1) Zero (0)
Standardization of muscle testing techniques related to grading strength above fair requires a specific place in the
Standardization of muscle testing techniques related to grading strength above fair requires a specific place in the arc of motion where the part is held by the subject as manual pressure is applied.
class I
Class I: these are one- joint muscles that actively shorten through range to completion of joint motions (examples: triceps (medial and lateral heads), deltoid, pect. Major, glut max, iliopsoas, and soleus
class II
Class II: two-joint and multijoint muscles that act like one joint muscles by actively shortening over both or all joints and exhibit maximal strength at completion of range. (examples: Sartorius, tibialis anterior and posterior and peroneus longus, brevis and tertius)
class III
two-joint muscles that shorten over one-joint and lengthen over the other to provide midrange of the overall muscle length for maximal contraction and strength (as represented by the length-tension curve): examples: Rectus femoris, hamstrings, and gastrocnemius
class IV
Class IV: two-joint or multijoint muscles that physiologically act in one direction but are prevented from overshortening by the coordinated action of synergic muscles: example 2 jt muscle: the biceps act to flex the shoulder joint and the elbow joint. If acting to flex both joints simultaneously, the muscle would become overshortened. To prevent this, the shoulder extensors, as synergists, extend the shoulder joint, thereby lengthening the biceps over the shoulder joint when the elbow is maximally flexed
Grading (3)
Fair (3) indicates that a muscle can hold the part in test position against the resistance of GRAVITY, but cannot hold if even SLIGHT pressure is added.
Whether the part is placed in the test position or actively moves to that position, grading above fair is determined by the ability to hold the part in test position against varying degrees of pressure applied by examiner
grading +(3+) and grading -(3-)
Fair – (3-): gradual release from the test position occurs
Fair +(3+): holds the test position (against gravity) against SLIGHT pressure
grading: 4-
Good Minus(G-) (4-) Subject holds test position against gravity and against slight to moderate pressure
