Introduction to muscle testing

Dr. Mohamed Salah

 Lecture Objectives
• Define the manual muscle testing.
• Recognize the functional classification of the muscle.
• List the types of the muscle testing.
• Distinguish between grades of manual muscle test.
• Explain the testing procedures.
• Recognize the contraindications and precautions of manual
muscle testing.
• Identify the factors affecting muscle strength.
• Describe the limitations of manual muscle testing.
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 Manual muscle testing
• Is a procedure for the evaluation of
the function and strength of
individual muscle and muscle
groups based on effective
performance of a movement in
relation to the forces of gravity and
manual resistance.

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 Manual muscle testing
• To assess muscle strength the
therapist must have knowledge of
anatomy (including joint motions,
muscle origins and insertions, and
muscle function) and surface
anatomy (to know where a muscle
or its tendon is best palpated).

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 Manual muscle testing
• The therapist must be a good observer and has
experience in muscle testing to detect:
➢Minimal muscle contraction,
➢Muscle wasting,
➢Substitutions or trick movements.
• A consistent testing is essential to assess
accurately a patient's present status,
progress, and the effectiveness of the
treatment program.
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 Functional Classification of Muscle
• Prime Mover or Agonist: A muscle or muscle
group that has the major contribution to
movement at the joint.
• Antagonist: A muscle or muscle group that has
an opposite action to the prime mover(s). The
antagonist relaxes as the agonist moves the
part through a ROM.
• Synergist: Muscles that work together with
the prime mover to produce a common action
(desired movement).
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 Functional Classification of Muscle
Neutralizing or Counteracting Synergists
• These are muscles that contract to prevent
unwanted movements produced by the
agonist.
• For example, when the long finger flexors
contract to produce finger flexion the wrist
extensors contract to prevent wrist flexion
from occurring.

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 Functional Classification of Muscle
Conjoint Synergists:
• Two or more muscles that work together to produce the
desired movement. When the muscles contracting alone,
it would be unable to produce the movement.
• Example: When the muscles contract as a group the
radial and ulnar deviation are cancelled and wrist
extension results.
• 1. Extensor carpi radialis longus.
(Radial deviation)
• 2. Extensor carpi radialis brevis.
• 3. Extensor carpi ulnaris. (Ulnar deviation)
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 Functional Classification of Muscle
Stabilizing or Fixating Synergists:
• Muscles that prevent movement or
control the movement at the
proximal joints
• It provides a fixed or stable base
from which the distal moving
segment can effectively work.

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 Types of manual muscle test
• Group muscle test: Muscles with a common
action may be tested as a group.
• Individual muscle test: Testing individual
muscle working in a group responsible for
doing action.
• Functional muscle test: Special type applied
as a quick evaluation to a certain functional
activity and applied to specific muscles (facial
muscles).

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 Testing Procedure
• Explanation and Instruction.
• Assessment of Normal Muscle Strength.
• Choosing patient and therapist positions.
• Provide stabilization.
• Verbal command.

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 Grade of muscle test against the gravity
with maximum
The patient can resistance plus hold at
perform the the end of motion.
movement through
full range of against gravity with mild to
motion moderate resistance.
against gravity

with gravity elimination.

Flicker contraction
 Grade of muscle test

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 Contraindications and precautions of
manual muscle testing
1. Inflammation is present in the region.
2. Pain is present. Pain will inhibit muscle contraction.
• Extra care must be taken where resisted movements might
aggravate the condition, such as:
➢Patients with a history or at risk of cardiovascular problems
➢Patients who have had abdominal surgery
➢Fatigue
➢Overwork
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 Factors affecting muscle strength
• Age: Muscle strength increases from birth to a maximum point
between 20 and 30 years of age then gradual deterioration in
muscle mass with age.
• Gender. Men are generally stronger than women
• Type of Muscle Contraction
➢ Eccentric contraction
➢ Isometric contraction
➢ Concentric contraction

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 Factors affecting muscle strength
• Muscle Size: The larger the cross-sectional
area of a muscle, the greater the strength of the
muscle.
• Speed of Muscle Contraction: When a
muscle contracts concentrically, the force of
contraction decreases as the speed of
contraction increases.
• Previous Training Effect: Strength may
increase as one becomes familiar with and
learns the test situation.
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 Limitations of manual muscle testing
• Population Variation: adults or specific subpopulations such as
athletes, sedentary, and aged adults.
• Objectivity: Manual muscle testing is dependent primarily on
the judgment of the examiner.
• Validity and Reliability: It varies according to the muscle
tested, the experience of the examiner, the age of the patient,
and the condition being tested.
• Sensitivity: Manual muscle testing also lacks sensitivity.
• Tester Strength: It requires the tester to exert greater force than
the patient in any given muscle.
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 Muscle testing terminology
• Muscle Strength: This is the maximal amount of tension or
force that the muscle can exert.
• Active Insufficiency: The ability of a two-joint muscle to
actively shortened over the two joints without loosing tension.
• Muscle Fatigue: is a diminished response of the muscle to
generate force by repeated contraction. It may be due to a lack
of energy stores or oxygen, a buildup of lactic acid.

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