MMT Common Substitutions

Question 1

Scapular Adduction (Retraction)

Answer 1

Rhomboids- substitute for middle trap in adduction of scapula causing downward rotation to occur simultaneously

Question 2

Shoulder Flexion

Answer 2

1. Using the biceps brachii by externally rotating shoulder in absence of a deltoid
2. Using upper trapezius in shoulder elevation
3. Using the pec major resulting in horizontal adduction
4. May lean back or try to elevate shoulder girdle

Question 3

Shoulder Abduction

Answer 3

1. Using the biceps brachii by externally rotating the shoulder and flexing the elbow
2. Watch for shoulder elevation of lateral flexion of trunk to opposite side

Question 4

Shoulder Horizontal Abduction

Answer 4

Triceps Brachii- maintain elbow in flexion to prevent substitution by the long head

Question 5

Elbow Flexion

Answer 5

Keep wrist flexor muscles relaxed because strongly contracted wrist flexors may assist in elbow flexion

Question 6

Elbow Extension

Answer 6

1. via External Rotation: occurs in sitting with arms abducted when externally rotating the shoulder causing the elbow to fall into extension
2. via Horizontal Adduction: with the distal end fixed, the pt horizontally adducts arm causing elbow to fall into extension

Question 7

Forearm Supination

Answer 7

Pt may externally rotate and adduct arm across the body during motion

Question 8

Forearm Pronate

Answer 8

Pt may internally rotate or abduct during motion

Question 9

Wrist Extension

Answer 9

Occurs when finger extensors are allowed to participate

Question 10

Hip Flexion

Answer 10

Keep pelvis and spine in neutral to eliminate influence of pelvis

Question 11

Hip Flexion, Abduction, and External Rotation with Knee Flexion

Answer 11

1. By ilipsoas or rectus femoris resulting in true hip flexion without abduction or external rotation
2. Pt will attempt to use knee flexors, external rotators, and TFL in the presence of weakness

Question 12

Hip Extension

Answer 12

1. Rotation of pelvis

2. Flexion of knee to substitute hamstrings for gluteus maximus

Question 13

Hip Abduction

Answer 13

1. Hip-hike substituting
2. External rotation and flexion
3. TFL substitution

Question 14

Hip Adduction

Answer 14

1. Hip flexors (appears to be turning supine from side-lying)

Question 15

Hip External Rotation

Answer 15

1. Lift contralateral buttock off table or lean in any direction to lift pelvis
2. Increase flexion of test knee
3. Abduct the test hip

Question 16

Hip Internal Rotation

Answer 16

1. Lift contralateral buttock off table or lean in any direction to lift pelvis
2. Increase flexion of test knee
3. Adduct the test hip

Question 17

Knee Flexion

Answer 17

1. Hip Flexion

2. Gastroc

Question 18

Knee Extension

Answer 18

1. Pelvis rising from table

2. Hip internal rotators in side-lying

Question 19

Foot DF and Inversion

Answer 19

Keep toes relaxed so they don’t contribute to motion

Question 20

Foot Inversion

Answer 20

Keep toes flexors relaxed so they don’t contribute to motion

Question 21

Cervical Flexion

Answer 21

Platysma substitutes for weak SCM causing corners of mouth to pull down

Question 22

Elevation of Pelvis

Answer 22

Substitute with lateral trunk flexion using the abdominals. Spinal extensors may be used without the Quadratus Lumborum

Question 23

Trunk Flexion

Answer 23

1. if weak lumbar extensory muscles, abdominal muscles will cause posterior tilt

Question 24

Trunk Rotation

Answer 24

If pec major is active, the shoulder will shrug or raise from table to limit rotation of trunk