Manual Muscle Testing: Test the Strength

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.

muscle tissue
representation muscle tissue

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. Read in-depth about MMT Scales

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 the limb on gravity elimination is 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 the 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 the 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, 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 a 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
  7. Osteoporosis
  8. Postoperative restrictions
  9. Cerebral Palsy
  10. Cardiovascular disease / Brain injury
  11. Dislocated/ unhealed fracture
  12. Myositis ossifications
  13. Parkinson’s disease
  14. Pain
  15. Inflammation /(an inflammatory disease in muscles and or joints)
  16. Severe cardiac & respiratory disease
  17.  Subluxation joint
  18.  Hemophilia

manual muscle testing

PRINCIPLES OF Manual Muscle Testing Scale

  • Position – The patient and therapist position should be comfortable and according to the procedure
  • Stabilization – Stabilization of the proximal part of the limb.
  • Demonstration – Demonstrate the movement to the patient.
  • Application of Grades
  • Application of Resistance – effectively
  • Checking normal strength
  • Objectivity
  • Documentation – Write the findings of the test somewhere.

MATERIALS REQUIRED for MMT

Materials required to perform manual muscle therapy are the following:

  1. Muscle test documentation forms
  2. Pen, pencil, or computer terminal
  3. Pillows, towels, pads, and wedges for positioning
  4. Sheets or other draping linen
  5. Goniometer
  6. Interpreter (if needed)
  7. Assistance for turning, moving, or stabilizing the patient
  8. Emergency call system (if no assistant is available)
  9. Reference material

PRECAUTION

  1. Considered contraindications
  2. Do not harm (Be gentle)
  3. Respect pain
  4. The examiner knows the available ROM
  5. Follow the principles of the 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.

FAQs

Q: How accurate is manual testing?

When applied correctly, manual muscle testing can accurately determine strength deficits and improvements.

Q: Does it require special equipment?

No special equipment is needed beyond examination tables or plinths. The examiner provides the resistance.

Q: Is it painful?

Done properly, manual muscle testing should not cause pain. Pain may indicate an underlying problem.

Q: How long does the assessment take?

Testing major muscle groups usually takes 15-30 minutes. More detailed evaluations take longer.

Q: Who performs manual muscle tests?

Physical and occupational therapists are most commonly trained, but physicians, chiropractors, and athletic trainers may also perform them.

Q: When are tests repeated?

Muscles may be re-tested periodically during rehabilitation to evaluate progress over time.

Q: What conditions are tested for?

Testing helps identify neuromuscular diseases, nerve damage, musculoskeletal injuries, spinal cord issues, and more.

Q: How can I prepare for testing?

Relax muscles before testing. Avoid pain medications that could mask weakness. Wear comfortable clothes that allow movement.

Q: Do tests differ by age?

Yes, testing methods are tailored for pediatric vs. adult populations.

Q: What happens after testing?

Results help guide treatment plans involving stretching, strengthening exercises, pain management, etc.

Q: Where is testing performed?

Testing is done in clinics, hospitals, athletic training rooms, and other healthcare settings.

Q: Is approval needed for the test?

No special approval is required. The need is determined by the evaluating clinician.

Q: Does insurance cover it?

Yes, manual muscle testing is covered by most major insurance plans as part of physical or occupational therapy.

Q: How can I learn to perform MMT?

Formal instruction is offered in PT, OT, and rehabilitation medicine degree programs.

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Author

  • Muskan Thakur

    Muskan Thakur is a passionate and dedicated individual committed to the field of healthcare. With a background in physiotherapy, Muskan has honed her skills as a licensed physiotherapist. Her journey began with obtaining a Bachelor of Physiotherapy (BPT) degree, which laid the foundation for her knowledge and expertise in the field.

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