Manual Muscle Testing

• ROM is always assessed before MMT


• Strength is a major component of MMT; it measures the maximal contraction of a muscle or a muscle group


• We test the client in standing position (required to change only when we measure against gravity)


• First, perform ROM


• Explain procedure to client


• Resistance should be applied to the distal end of the segment into which muscle inserts in the direction the movement came from; initially light resistance & increase to maximal resistance over 2-3 seconds


• Demonstrate procedure to client


• Position limb to be tested against gravity


• Ask client to perform full AROM
  
  
  
  • “Matilda, I would like to take a look at how strong your arms are. I am going to ask you to move your arm in different directions, and then ask you to hold it tight while I am applying pressure. If you experience any pain or discomfort during the assessment please let me know and I will discontinue.”
  
  
  • “Matilda,can you move your arms above your head, towards the ceiling?”
  
  
  
  


• Practitioner needs to observe the client perform the movement.
  
  
  
  • “Matilda, I would like to perform the same movement again.”
  
  
  
  


• Practitioner will stabilize proximally and palpate.
  
  
  
  • “Very good Matilda, now I would like to sustain this position and don’t let me push it down.”
  
  
  
  


• Practitioner applies pressure distally light at first and then increase to maximum resistance over 2-3 seconds.


• Document results of joint AROM as complete, partial, or none


• Document amount of resistance as maximal, moderate, slight

Grading:

• Normal (N)  5          =Max resistance


• Good     (G)  4           =Mod resistance


• Fair        (F)  3           =No resistance (AG)


• Poor       (P)  2          =No resistance (GE)


• Trace     (T)  1           =Palpable at muscle/tendon, no movement


• Zero       (Z)  0          = Nothing palpated

 *Poor & below- anything on gravity eliminated plane (no full ROM)  (P T O)

*Fair & up- anything against gravity (Full ROM) (F G N)

HAND PLACEMENTS

Action	Hand 1	Hand 2	Gravity	Instructions
Shoulder flexion	Top acromion	Above elbow joint	AG	“don’t let me push you down”
Shoulder  abduction	Top acromion	Above elbow joint	AG	“don’t let me push you down”
Shoulder internal rotation	Midhumerus	Distal ulna/radius	GE	“don’t let me push you out”
Shoulder external rotation	midhumerus	Distal ulna/radius	GE	“don’t let me push you in”
Elbow flexion	Midhumerus	Wrist	AG	“don’t let me pull you down”
Elbow extension	Midhumerus	Wrist	AG	“don’t let me push you in”
Supination	“Hold hand”	Midhumerus	AG	“don’t let me flip you over”
Pronation	“Hold hand”	Midhumerus	AG	“don’t let me flip you over”
Wrist flexion	Distal elbow	Palm	AG	“don’t let me push you down”
Wrist extension	Distal elbow	Back of hand	AG	“don’t let me push you down”

Video: http://www.youtube.com/watch?v=RyEK_QBSemQ