Resisted Isometric Movements Flashcards
What is Resisted Isometric Movements?
Also referred to as Muscle Testing. They are the movements tested last in the examination of a joint
Consists of a strong, static (isometric), voluntary muscle contraction
Primarily used to determine whether the contractile tissue is the tissue at fault, although the nerve supplying the muscle is also being tested
Contractile Tissue
With resisted isometric testing, it is used to look for problems of contractile tissue, which consists of muscles, their tendons, attachments (ex. bone) and the nervous tissue supplying the contractile tissue
Both active movements and resisted isometric testing demonstrate symptoms if contractile tissue is affected
Other parts of the assessment will test contractile tissue such as passive movements, functional testing, specific special tests and palpation
Passive movements are usually normal (full and pain free)
Patterns with Lesions of Contractile and Nervous Tissue
No pain and movement is strong
Pain and movement is relatively strong (but not as strong as it should be)
Pain and movement is weak
No pain and movement is weak
Strong and Pain Free Movement
Patterns with Lesions of Contractile and Nervous Tissue
Indicates there is no lesion of the contractile unit being tested or the nervous tissue supplying that contractile unit
Strong and Painful Movements
Patterns with Lesions of Contractile and Nervous Tissue
Indicates a local lesion of the muscle or tendon
Ex. a muscle strain
The amount of strength is usually determined by the amount of pain the patient feels on contraction
Weak and Painful Movements
Patterns with Lesions of Contractile and Nervous Tissue
Indicates a severe lesion around that joint
Ex. a fracture
The weakness that results is usually caused by reflex inhibition of the muscles around the joint, secondary to pain
Weak and Pain-free Movements
Patterns with Lesions of Contractile and Nervous Tissue
Indicates a rupture of a muscle (3rd degree strain) or its tendon or involvement of the peripheral nerve or nerve root supplying that muscle
Neurological involvement or a tendon rupture should be suspected first
Palpating a Muscle
Origin
The attachment site of a muscle that doesn’t move during a muscle contraction.
Usually is proximal or closer to the body.
Insertion
The attachment site that moves during a muscle contraction.
Usually is distal.
Testing a Muscle
An integral part of the physical examination that provides information that no other procedures give. We test both the length and strength of muscles.
Useful for differential diagnosis and treatment.
Muscle imbalances can distort alignment and posture and can cause stress & strain on joints, ligaments and muscles and all of this can cause pain!
Many neuromuscular conditions have muscle weaknesses that sometimes show up in patterns.
Muscle Strength Testing
Testing muscle strength is used to determine whether the muscles are capable of movement and whether they are capable of providing stability and support.
Causes of muscle weakness:
nerve injury, disuse atrophy (in the cast), stretch weakness, pain and fatigue
To treat a weakened muscle depends on the cause of the weakness:
If the muscle is weak due to lack of use then exercise it.
If the muscle is weak due to overwork or fatigue then rest it.
Resisted Isometric Testing
The joint is put in a neutral or resting position so that minimal tension is placed on the inert tissue
The patient is asked to contract the muscle as strongly as possible while the therapist resists to prevent any movement from occurring and to ensure that the patient is using maximum effort
To keep movement to a minimum, it is best for the examiner to position the joint properly and then say to the patient, “don’t let me move you”
Resisted Isometric Testing Procedures
Place the muscle/group to be tested in the test position
Stabilize the rest of the body or proximal to the area being tested
Apply resistance near the distal end of the segment to which the muscle attaches
Make sure the application of resistance is never sudden or uneven, apply resistance slowly and gradually
Hold contraction 5 seconds
Further muscle testing procedures (skip)
Break test - an eccentric break method of muscle testing may be used. This starts as an isometric contraction, but then the therapist applies sufficient force to cause an eccentric contraction or a “break” in the patient’s isometric contraction
After isometric testing, history may indicate doing an Isotonic contraction - Movement of the joint is occurring with resistance.
Eccentric, concentric, or pseudo-isometric contractions can be performed. This requires a lot of skill from the therapist.
Muscle Test Grading
Various assessment scales are used to describe the findings from strength/muscle testing
The most common is numeric scales (1-5, with the addition of a + or - to be more accurate)
If the therapist is having difficulty differentiating between grade 4 and 5, a “break test” can be performed
5 - Normal strength (100%)
4 - Movement against gravity and resistance (75%)
3 - Movement against gravity resistance eliminated (50%)
2 - Movement with gravity eliminated (25%)
1 - Slight contractility but no joint motion
0 - No contraction palpated
Muscle Test Grading
