Table of Contents
Manual Muscle Testing
Manual muscle testing (MMT) is the procedure of evaluating the strength of muscle individually or a muscle group. Simultaneously, the performance of the muscle against the resistance of gravitational force or manual force applied by the therapist is also evaluated. The movement is performed by the person actively. MMT is also referred to as motor testing, muscle strength grading, or other synonyms. MMT is a part of the motor examination. This test is different from the resisted range of motion(ROM) and myotome testing as this test the muscle strength, but ROM is checked for the joint while, checking the myotome we get to know about the innervation of muscle root.
CLINICAL USES
1. Diagnostic Tool
2. During the planning of treatment goals.
3. To determine the extent & degree of muscular weakness resulting from disease, or injury.
4. Correlating muscle picture with the level innervations (myotomes).
5. MMT is an important tool for all rehabilitation team members.
6. Prevents deformities by locating problem areas.
7. Help and Evaluate the effectiveness of treatment to the therapist.
Manual Muscle Testing Scale
There are many scales of MMT but mostly the Oxford scale is in use.
OXFORD SCALE/ MEDICAL RESEARCH COUNCIL MANUAL MUSCLE TESTING SCALE(MRC- MMTS)
6-point ordinal scale:
0: No palpable movement
1: Flicker is present on palpation but there is no resultant movement occur.
2: Movement of limb seen in gravity eliminated plane.
3: Motion occurs against gravity.
4: Movement occurs against gravity and minimum to moderate resistance.
5: Limb movement occurs against gravity and maximum resistance.
Limitations
There are some limitations to this scale:-
1. Poor relevance of functional ability.
2. No linear relation i.e. there is no same difference between 3-4 grade as in 4-5 grade.
3. Alteration in the grade of muscle due to fatiguability of muscle or overworked muscle.
4. Intra-rater reliability
The scale only measures the strength of muscle during concentric contraction. Hence, because of these limitations therapists use the modified form of scale.
MODIFIED Manual Muscle Testing SCALE: +/- SCALE
(0) :
No flicker felt on palpation
(1) :
The flicker of muscle is felt on palpation but does not result in movement of the limb.
(1+) :
Movement of the limb on gravity elimination, less than half ROM.
(2-) :
The motion of limb on gravity elimination, more than half ROM.
(2) :
Movement of the limb on gravity elimination, through full ROM.
(2+) :
The limb’s motion against gravity is less than half ROM.
(3-) :
Movement of limb against gravity, more than half ROM.
(3) :
The motion of limb against gravity, through full ROM.
(3+) :
Limb’s motion against gravity, and minimal to moderate resistance, less than half ROM.
(4-) :
The motion of the limb against gravity, and minimal to moderate resistance, more than half ROM.
(4) :
Movement of limb against gravity, and moderate resistance, through full ROM.
(5) :
The motion of limb against gravity, and maximal resistance, through full ROM.
Manual Muscle testing Kendall scale is also used.
MUSCLE STRENGTH AND WEAKNESS
Muscle strength tells us, basically the ability and efficiency of muscle to perform. The maximal amount of tension or force that a muscle or muscle group can voluntarily exert in a maximal effort; when the type of muscle contraction, limb velocity, and joint angle are specified. Meanwhile, the muscle strength depends on:-
Combination of morphology and neutral factors including cross-section area of muscle and architecture, musculotendinous stiffness, recruitment and synchronization of the motor unit, rate coding, and neuromuscular inhibition.
Muscle weakness can be due to neurological weakness, or muscular or postural imbalance.
INDICATIONS OF MMT
1. Neurological causes – Stroke, brain injury, spinal cord injury (SCI), neuropathy, amyotrophic lateral sclerosis (ALS).
Lower Motor Neuron (LMN) Disease
Some other Neurological (Neuromuscular ) diseases. Such as, Multiple Sclerosis, Muscular dystrophy, Myasthenia Gravis, Guillain – barre syndrome (GBS), etc.
2. Musculoskeletal disorders
3. Sports injury rehabilitation. For eg. ACL repair.
4. Joint replacement
5. Before, gait and balance examination.
6. In patients with risk of falls.
7. To check the progress of the rehabilitation program.
CONTRAINDICATIONS OF MMT
1. Severe renal failure
2. Hypophosphataemia
3. Patients who must control sodium intake e.g. congestive heart failure, hypertension, cirrhosis of the liver
4. Metabolic or respiratory alkalosis,
5. Hypocalcaemia or hypochlorhydria
6. Joint instability or inflammation
6. Osteoporosis
7. Postoperative restrictions
8. Cerebral Palsy
9. Cardiovascular disease / Brain injury
10. Dislocated/ unhealed fracture
11. Myositis ossifications
12. Parkinson’s disease
13. Pain
14. Inflammation /(an inflammatory disease in muscles and or joints)
15. Severe cardiac & respiratory disease
16. Subluxation joint
17. Hemophilia
PRINCIPLES OF Manual Muscle Testing Scale
1) Position – The patient and therapist position should be comfortable and according to procedure
2) Stabilization – Stabilization of the proximal part of the limb.
3) Demonstration – Demonstrate the movement to the patient.
4) Application of Grades
5) Application of Resistance – effectively
6) Checking normal strength
7) Objectivity
8) Documentation – Write the findings of the test somewhere.
MATERIALS REQUIRED
a. Materials needed include the following:
b. Muscle test documentation forms
c. Pen, pencil, or computer terminal
d. Pillows, towels, pads, and wedges for positioning
e. Sheets or other draping linen
f. Goniometer
g. Interpreter (if needed)
h. Assistance for turning, moving or stabilizing the patient
i. Emergency call system (if no assistant is available)
j. Reference material
PRECAUTION
1) Considered contraindications
2) Do not harm (Be gentle)
3) Respect pain
4) Examiner knows the available ROM
5) Follow the principles of procedure
6) Take care of the patient’s comfort
7) Record accurately
8) Extra care is taken to give Resisted Exercise
9) Abdomen surgery or hernia
10) Newly united fracture
11) Bony ankylosis
12) Hematoma
13) If patients take muscle relaxants and or pain medications
14) Prolonged immobilization
Manual muscle testing is widely used to test muscle strength in rehabilitation programs.
We can check muscle strength by various methods. But, keep the precautions and contraindications in mind.
Follow the standard procedure of MMT for better reliability of the test.
It can be performed on muscles individually in a particular position or on a group of muscles with the same action on that joint.
SUMMARY
Manual muscle testing is the widely used procedure to test muscle strength in rehabilitation programs.
We can check muscle strength by various methods. But, keep the precautions and contraindications in mind.
Follow the standard procedure of MMT for better reliability of the test.
It can be performed on muscles individually in a particular position or on a group of muscles with the same action on that joint.
Various scales are discussed in the article.
Also, Check our article on Movement Therapy