Cervical manual muscle testing is a fundamental component of the motor examination, allowing healthcare professionals to assess the strength, functional capabilities, and range of motion (ROM) of the neck muscles. By conducting manual muscle testing, clinicians can identify muscle imbalances, weaknesses, or dysfunctions that may contribute to pain, restricted range of motion, or impaired functional abilities in patients. This comprehensive guide will provide detailed information on the key neck muscles involved in manual muscle testing, outline the grading system used to assess muscle strength, describe the step-by-step evaluation procedures, and include essential equipment, indications, precautions, and contraindications for safe and effective testing.
Equipment required to perform cervical MMT
The following equipment is necessary:
- Goniometer: Used to measure the range of motion during flexion, extension, lateral flexion, and rotation evaluations.
- Tape measure: Used to measure the range of motion during flexion evaluations.
- Soft pillow: Provides support and comfort during patient positioning.
- Plinth or table: Provides a stable surface for patient positioning during evaluation procedures.
💡Also Read, Manual Muscle Testing
Range of Motion (ROM):
During cervical manual muscle testing, the range of motion for different movements is as follows:
- Flexion: Typically ranging from 0 to 45 degrees.
- Extension: Typically ranging from 0 to 45 degrees.
- Lateral Flexion: Typically ranging from 0 to 45 degrees.
- Rotation: Typically ranging from 0 to 90 degrees.
Evaluation Procedures: Step-by-Step Approach
To accurately assess the strength and range of motion of the neck muscles, healthcare professionals follow a systematic evaluation procedure.
Flexion
- ROM: 0° to 45° with a goniometer; 1.0 to 4.3 cm with a tape measure.
PRIMARY MOVER :
| Muscle | Action | Origin | Insertion | Nerve Supply |
|---|---|---|---|---|
| Sternocleidomastoid (SCM) | Flexion, ipsilateral lateral flexion, contralateral rotation | Sternal head: Cranial aspect of the manubrium; Clavicular head: Superior border of the medial clavicle | Lateral surface of the mastoid process, lateral half of the superior nuchal line of the occipital bone | Spinal accessory nerve (C2 and C3 anterior rami) |
- Palpation Site: The anterolateral aspect of the neck.
- Secondary Movers: Rectus capitis anterior, Rectus capitis lateralis, Suprahyoid, Infrahyoid, Platysma, Scalenes, Longus capitis, Longus colli.
MMT for Neck Flexion
| Grade | Position | Palpation | Stabilization | Instructions to Patient | Substitutions | Indication |
|---|---|---|---|---|---|---|
| 0-2 | Patient: Lying on side with head supported by a pillow Therapist: Standing beside the patient | Side of the neck | Lower thorax | “Move your head forward” | Corners of the mouth may be pulled down due to platysma contraction | Torticollis |
| 3-5 | Patient: Supine on a plinth Therapist: Towards the head of the patient | – | Trunk stabilized by weight of the thorax | “Lift your head without lifting your shoulders” | – | Torticollis |
*The 2 SCM muscles may be tested individually by rotation of the head to one side with neck flexion.
Extension
- ROM : 0° – 45°
Primary Movers:
| Muscle | Action | Origin | Insertion | Nerve Supply |
|---|---|---|---|---|
| Splenius Capitis | Slight rotation and lateral flexion of the head | Caudal half of ligamentum nuchae, spinous processes C7-T4 | Occipital bone, lateral third of the superior nuchal line, mastoid process | Lateral branches of the dorsal primary cervical nerves |
| Semispinalis Capitis | Rotation of the spine to the opposite side | Tips of the transverse processes C7-T7 | Between the superior and inferior nuchal lines of the occipital bone | Dorsal primary divisions of the cervical nerves |
| Cervicis Muscles | Lateral flexion and rotation of the head | Spinous processes T3-T6 | Posterior tubercles C1-C3 | Dorsal primary branch of the spinal nerves |
- Palpation Site: Under the lateral borders of the upper trapezius.
- Secondary Mover: Upper trapezius.
MMT for Neck Extension
| Grade | Position | Palpation | Stabilization | Instructions to Patient | Substitutions | Indication | Resistance |
|---|---|---|---|---|---|---|---|
| 0-2 | Patient: Lying on side with head supported by pillow Therapist: Standing beside the patient | Under the lateral border of the trapezius | Weight of the trunk is stabilized on the table | “Try to move your head towards the back” | Patient may use back muscles | Weakness or spasm in neck extensors, blocking head action and sight | – |
| 3-5 | Patient: Prone on the table Therapist: Standing on the sides of the table | – | Weight of the trunk stabilized from the scapula | “Pull your head up without lifting your shoulders” | Patient may lift trunk and use back muscles | Same as above, testing strength of neck extensors | Apply distally on the head |
*Neck lateral flexors and rotator muscles are generally tested in groups.
Lateral Flexion
- ROM: 0° – 45°
| Muscle | Function | Origin | Insertion |
|---|---|---|---|
| SCM (Sternocleidomastoid) | Flexion, rotation, lateral flexion of the head | Sternal head: Sternum (manubrium), Clavicular head: Medial third of the clavicle | Mastoid process of the temporal bone, lateral half of the superior nuchal line |
| Rectus Capitis Lateralis | Lateral flexion and rotation of the head | Transverse process of the atlas (C1) | Basilar part of the occipital bone |
| Obliquus Capitis Superior | Extension and rotation of the head | Transverse process of the atlas (C1) | Occipital bone, between the superior and inferior nuchal lines |
MMT for Neck Lateral Flexion
| Grade | Position | Stabilization | Substitutions | Instructions to Patient | Palpation | Resistance | Indication |
|---|---|---|---|---|---|---|---|
| 0-2 | Patient: Supine Therapist: Standing beside the table | Shoulder is stabilized | Shoulder can be used to substitute movement | “Bend your head towards the sides” | Side of the neck being tested | – | Torticollis or head drop on one side |
| 3-5 | Patient: Lying opposite to the side being tested, head supported by a soft pillow Therapist: Standing beside the table | Shoulder is stabilized | Shoulder can be used to substitute movement | “Bend your neck upward” | Not specified | Apply resistance on the head, hands placed above the ears | Same as above |
Rotation
- ROM – 0° – 90° on both sides.
| Muscle | Action | Origin | Insertion | Nerve Supply |
|---|---|---|---|---|
| SCM (Sternocleidomastoid) | Contralateral rotation | Sternal head: Manubrium, Clavicular head: Medial third of the clavicle | Mastoid process of the temporal bone | Spinal accessory nerve (C2-C3 anterior rami) |
| Other Rotators (Scalene, Semispinalis cervicis, Semispinalis capitis, Spinalis cervicis, Spinalis capitis, Erector spinae) | Rotation and stabilization | Various | Various | Cervical spinal nerves (C2-C8) |
MMT for Neck Rotation
| Grade | Position | Stabilization | Substitutions | Instructions to Patient | Palpation | Resistance | Indication |
|---|---|---|---|---|---|---|---|
| 0-2 | Patient: Sitting Therapist: Standing on the side of the chair | Opposite side shoulder is stabilized | Shoulder can be used to substitute movement | “Rotate your head to the side being tested” (For SCM: Rotate to opposite side) | Side of the neck being tested (For SCM: Palpate opposite side) | – | Weak rotation of the neck |
| 3-5 | Patient: Lying opposite to the side being tested, head supported by a soft pillow Therapist: Standing on the side of the table | Same side shoulder is stabilized | Shoulder can be used to substitute movement | “Rotate your head to the side being tested” (For SCM: Rotate to opposite side) | – | Apply resistance on the head, hands placed above the ears | Same as above |
* After performing the test carefully note the findings of the test in the patient’s assessment record.
Precautions and Contraindications
While performing cervical manual muscle testing, it is important to consider the following precautions and contraindications:
Precautions:
a. Ensure patient comfort and communicate clearly throughout the testing procedure.
b. Use caution when applying resistance to avoid excessive strain or injury to the patient.
c. Take note of any pain, discomfort, or adverse reactions reported by the patient during the evaluation.
d. Adhere to proper body mechanics to avoid strain or injury to the evaluator.
Contraindications:
a. Acute or severe neck pain or inflammation.
b. Recent neck or spinal surgery.
c. Unstable cervical spine.
d. Acute trauma or injury to the neck region.
e. Known or suspected cervical spine fractures or dislocations.
f. Any condition where manual muscle testing may exacerbate symptoms or pose a risk to the patient’s well-being.
Summary
Cervical manual muscle testing is a valuable assessment tool for evaluating neck muscle strength, range of motion, and functional capabilities. By following a systematic approach and using a standardized grading system, healthcare professionals can identify muscle imbalances, weaknesses, and dysfunctions in patients with neck pain or musculoskeletal disorders. It is important to consider the equipment required, indications, precautions, and contraindications to ensure safe and effective testing. Cervical manual muscle testing provides valuable insights for developing appropriate treatment plans, monitoring progress, and optimizing patient outcomes.
FAQs
To evaluate strength impairments from cervical disorders, nerve injuries, postural dysfunction, or other neuromusculoskeletal conditions.
The patient extends the neck while the examiner applies a downward force on top of the head.
Whiplash, arthritis, disc herniation, pinched nerves, torticollis, and post-surgical conditions.
Yes, cervical MMT is covered by most major medical insurance plans.
No special approval is needed beyond the referring provider’s request.
Muskan Thakur is a skilled physical therapist based in Los Angeles, USA. She completed her Bachelor of Physical Therapy (BPT) from Delhi University in 2010. Ms. Thakur furthered her studies by completing a clinical residency program focused on orthopedic physical therapy at Duke University in the United States in 2012. She then attained her Master’s in Public Health (MPH) from the Institute of Public Health in Delhi in 2015. With over 10 years of experience, Ms. Thakur employs a holistic approach combining manual therapy, therapeutic exercise, education, and lifestyle modifications to treat neurological, orthopedic, and musculoskeletal conditions.
