Manual Muscle

Testing
An evaluation system for
diagnosis of disease or
dysfunction of the musculo-
skeletal and nervous systems
 Purpose
Measures the capability of muscles or
groups to provide support and movement
Diagnostic tool
Postural balance
Gait impairment

Range of motion

Uses little equipment

Obtains information not defined by other
procedures
 Precautions
Do No Harm (use
gentleness)
Know ROM limits
Follow procedure
Record
Promptly
Accurately
 To Get Standardized
Results
Proper training and education
Knowledge base of anatomy,
physiology and neurology of muscle
function
Follow precise testing protocol
Practice, Practice, Practice
A skill developed and maintained
with number of cases
 Validity and Accuracy
Coordinate the muscle testing findings
with other standard diagnostic procedures
The amount of pressure used to test may
vary between persons performing the test.
The amount of strength loss must be
greater than approximately 20to 30% to
be dependably measurable
Comparison of both sides is a better
indicator of loss
 Muscles
3 Types: Skeletal, Smooth, Cardiac
Skeletal around 40% of muscle
composition
Generally voluntarily controlled
Composed of fibers
Work in groups
Movement depends on how the
muscles are attached
 Structure of Muscle

http://en.wikibooks.org/wiki/Anatomy_and_Physiology_of_Animals/Muscles
 How Do Muscles Cause
Movement
Origin- where the muscle is attached
to the bone; this bone will move very
little
Insertion- muscle attachment to
bone with most motion
Belly of muscle- part of muscle that
enlarges on contraction
 Muscle Groups

Quadriceps Trapezius
Hamstrings Latisimus dorsi
Calf Deltoids
Low back Biceps
Abdominals Triceps
Pectoralis major
Rhomboids
 Conduct Strength
Testing
Correct positioning is essential (Start
in extended anatomical position)
Place muscle to be tested in a
supported position directly opposed to
gravity
Exert uniform force directly on the
line opposing movement
Testing of Bicep & Tricep
Support humerus where gravity is
against the bicep and tricep, client in
anatomical position
Move elbow through full ROM
(Passive ROM)
Flexion
Extension

Internal rotation

External rotation
 Maneuver to Assess
Muscle Strength
With arm in full extension, pull
downward on forearm while client
attempts to flex.
With arm flexed, apply pressure against
forearm, ask client to straighten arm.
When performing muscle tests, be sure
to evaluate for asymmetry of the muscle
groups (i.e. atrophy on one side and not
the other) and landmarks prior to testing.
 Use the following scale
to rate strength:
0-No movement, no contraction of the muscle
1- Trace, evidence of muscle contraction but no
joint movement
2- Poor, complete range of motion with gravity
eliminated
3-Fair, complete range of motion against
gravity
4- Good, complete range of motion against
gravity with moderate resistance
5-Normal, complete range of motion against
gravity with maximal resistance without
evidence of fatigue
 Other Test Results
Weakness defined as a strength
below fair in non weight bearing
muscles; below fair + in weight
bearing muscles
Contracture degree of shortness in
muscle, so it cannot move through
ROM
Substitution weak muscles are
supported by other muscles to move
 Active ROM
Instruct client to move the elbow through ROM
Flexion
Extension

Internal rotation

External rotation

Normal ROM is measured by goniometer

Elbow flexion 0-160
Elbow extension 145-0

Elbow pronation (rotation inward) 0-90

Elbow supination (rotation outward) 0-90

 Strength Test Example
Gastrocnemius (Ankle
plantar flexion)
Patient Standing
Rises on toes,
pushing weight
upward
 Case Study to Follow
Take patient hx to determine
diagnosis
Assessment of muscle strength
Set objectives
Implement a plan
Evaluate progress
 Case Study
Drop Foot
weakness of muscles that are involved
in flexing the ankle and toes.
 Clinical Muscle
Evaluation
Typical podiatric ankle strength
evaluation consists of plantar
flexion, dorsiflexion, eversion and
inversion testing
 Dorsiflection Testing
Tibialis Anterior
Support leg above ankle
Apply pressure against medial side,
dorsal surface of the foot, in the
direction of plantar flexion of the ankle
joint and eversion of the foot. Test
dorsiflection directly.
 Dorsiflection Testing
Extensor Hallucis Longus
Stabilize foot in slight plantar flexion
Pressure applied against dorsal surface
of distal and proximal phalanges of the
great toe in direction of flexion. Test big
toe extension.
 Dorsiflection Testing
Extensor Digitorum Longus
Stabilize foot in slight plantar
flexion
Apply pressure against dorsal
surface of the toes in the direction
of flexion. Test extension of toes.
 Summary
Manual Muscle Testing is clinical
tool used to evaluate patient
Need information in order to develop
orthotic treatment plan
 END

Questions?
 Conditions
A list of conditions treatable with
Applied Kinesiology
 All about muscles
http://www.emporia.edu/ksn/v42n1-
january1996/shape.htm
 This power point is based on
information found on the Illinois
Institute of Technology web site where
students developed resources to be
used in education in Latin America. I
modified the original power point to
be used by high school students in the
Healthcare Science classroom.
Pat Rape
 http://www.lhup.edu/yingram/jennife
r/webpage/homepage2.htm
http://www.iit.edu/~ipro309s08/links
.html
http://www.bulowbiotech.com/introm
ov.html
 Careers
http://francistuttle.com/classes/ctp/details.aspx?
PRGID=13
Orthotic & Prosthetic (O & P) Technicians assist the
disabled by fabricating the orthopedic braces
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for their rehabilitation. O & P Technicians are trained
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support services and possess the knowledge to
interact with clinical prosthetists and orthotists. You
will acquire knowledge in polymer processes,
strength of materials and applied biomechanical
principles to develop and totally customize an
orthosis or prosthesis. Providing O & P care involves
the application of clinical and technical processes to
meet patient rehabilitation objectives.