Manual Muscle Testing

Dr. Sweta Upadhyay

MPT (Ortho.)
The Grading System

⚪ Numerical scores – ranging from zero (0)

to five (5)

⚪ Based on tests of motions rather than

tests of individual muscles, the grade
represents the performance of all muscles
in that motion
Numerical score Qualitative score

5 Normal (N)

4 Good (G)

3 Fair (F)

2 Poor (P)

1 Trace (T)

0 Zero (0)
OVERVIEW OF TEST PROCEDURES
⚪ The break test

⚪ Active resistance test

The Break Test

⚪ Manual resistance is applied to a limb or

other body part after it has completed its
ROM or after it has been placed at end
range by the examiner

⚪ Resistance – force in opposition to a

contracting muscle – in direction of “line of
pull” of a muscle(s)
⚪ The patient is asked to hold the part at
that point and not allow the examiner to
break the hold with manual resistance
Active Resistance Test

⚪ The application of manual resistance

against an actively contracting muscle or
muscle group

⚪ Gradually increase the amount of manual

resistance until it reaches the maximal
level

⚪ Requires considerable skill and experience

Application of Resistance

⚪ Follow the basic of muscle length-tension

relationship and joint mechanics

⚪ One joint muscle – at the end of the range

⚪ Two joint muscle – at or near midrange

⚪ The point of resistance – near the distal

end of the segment to which the muscle
attaches, except …
⚪ Patient with transfemoral amputation…

⚪ Testing the vertebroscapular muscles

⚪ Application of manual resistance should

never be sudden or uneven (jerky) – apply
resistance slowly and gradually
⚪ Resistance is applied at a 90° angle to the
primary axis of the body part

⚪ Influence of weight of limb plus gravity

⚪ “Gravity minimal” (GM) – “Gravity

eliminated”
● The body part is supported on the smooth, flat
surface in a way that friction force is minimal.
⚪ Variations to antigravity and gravity-
minimal positions
The Examiner and the Values of the
Muscle Test

⚪ The knowledge and skill of the examiner

determine the accuracy and defensibility
of MMT

⚪ Knowledge of the location and anatomic

features of the muscle

⚪ Knowledge of the direction of muscle

fibers and their “line of pull”
⚪ Knowledge of the function of participating
muscles

⚪ Consistent use of a standardized method

⚪ Consistent use of proper positioning and

stabilization techniques
⚪ Ability to identify patterns of substitutions

⚪ Ability to detect contractile activity

⚪ Sensibility

⚪ Awareness of any deviation

⚪ Ability to identify muscle with same
innervation – comprehensive evaluation
and accurate interpretation

⚪ Knowledge of the relationship of the

diagnosis to the sequence and extent of
the test

⚪ Ability to modify test procedures

⚪ Knowledge of the effect of fatigue on the
test results

⚪ Understanding of the effect of sensory

loss on the movement

⚪ The patient with open wounds and other

conditions
⚪ The patient who must be evaluated under
difficult conditions
⚪ Avoid shortcuts

⚪ Good communication – listen to patient –

understanding and respect between
therapist and patient. The patient is the
best guide to a successful muscle test
Influence of the Patient on the Test

⚪ True effort of the patient

⚪ The patient’s willingness

⚪ The patient’s ability to understand the test

requirements may be limited –
comprehension and language barriers
⚪ Lassitude and depression

⚪ Cultural, social and gender issues may be

associated with palpation and exposure of
a body part for testing

⚪ The size and non-comparability between

big and small muscles
CRITERIA FOR ASSIGNING A
MUSCLE TEST GRADE
An accurate grade is important not only to
establish a functional diagnosis but also
to assess the patient’s progress during
period of recovery and treatment
⚪ The Grade 5 (Normal) Muscle

⚪ The Grade 4 (Good) Muscle

⚪ The Grade 3 (Fair) Muscle

⚪ The Grade 2 (Poor) Muscle

⚪ The Grade 1 (Trace) Muscle

⚪ The Grade 0 (Zero) Muscle

Plus (+) and Minus (-) Grades

⚪ The Grade 3+ (Fair+) Muscle

⚪ The Grade 2+ (Poor+) Muscle

⚪ The Grade 2 – (Poor - ) Muscle

Available Range of Motion
Screening Tests

⚪ In the interests of time and cost-efficient

care – rarely necessary to perform a
muscle test for entire body

⚪ To screen for areas that need definitive

testing – number of maneuvers to rule out
parts that do not need testing
⚪ Observation of the patient before the
examination
● Gross abnormality of gait
● Sit and rise from a chair, fill out admission or
history form, or remove clothing
● Walk on the toes and then on the heels
● Grip the examiner’s hand
Preparing for the Muscle Test

⚪ The patient should be as free as possible

from discomfort or pain for the duration of
each test

⚪ The environment should be quite and

nondistracting

⚪ The plinth – firm to stabilize the body part

and height should be adjustable
⚪ Patient position changes in a test
sequence should be minimum

⚪ All materials needed for the test must be

at hand
Materials needed…
● Muscle test documentation form
● Pen or pencil
● Pillows, towels, pads
● Goniometer
● Assistance for turning, moving, or stabilizing
the patient