MANUAL MUSCLE TESTING PROCEDURES

Key to Muscle Grading

Function of the Muscle Grade

No contractions felt in the muscle 0 0 Zero

No
Movement Tendon becomes prominent or feeble contraction felt T 1 Trace
in the muscle, but no visible movement of the part
MOVEMENT IN HORIZONTAL PLANE
Moves through partial range of motion 1 2- Poor-
Test Moves through complete range of motion 2 2 Poor
Movement
ANTIGRAVITY POSITION
Moves through partial range of motion 3 2+

Gradual release from test position 4 3- Fair-

Holds test position (no added pressure) 5 3 Fair

Test Holds test position against slight pressure 6 3+ Fair+

Position
Holds test position against slight to moderate pressure 7 4- Good-
Holds test position against moderate pressure 8 4 Good

Holds test position against moderate to strong 9 4+ Good+

pressure
Holds test position against strong pressure 10 5 Normal

Modified from 1993 Florence P. Kendall. Author grants permission to reproduce this chart

IMACS FORM 04: MANUAL MUSCLE TESTING PROCEDURES 1

 Preferred Testing Order of Muscle Groups.
This table provides a preferred order to the testing of muscle groups for manual muscle testing.
Generally, for bilateral muscle testing, each muscle group is first tested on the right and then the
left, prior to proceeding to the next muscle group in the list. Some muscle groups are listed here
with anti-gravity testing, but for a weaker patient, these would be tested in a sidelying or supine
position, per the table below (Testing Positions); the re-test for a weaker patient is indicated in
gray scale. The ankle plantar flexors are first tested in prone, and then retested in standing for
scoring purposes. Abbreviations: G.E., gravity eliminated.

POSITION ORDER OF TESTING

SITTING
Trapezius (shoulder elevators) 1
Deltoid middle (shoulder abductors) 2
Biceps brachii (elbow flexors) 3
Wrist extensors (extensor carpi ulnaris/radialis) 4
Wrist flexors (flexor carpi radialis/ulnaris) 5
Iliopsoas (hip flexors) 6
Qudriceps femoris (knee extensors) 7
Ankle dorsiflexors (tibialis anterior) 8
SUPINE
Neck flexors (scalenes, sternocleidomastoid) 9
Trapezius (G.E. test if needed) -
Deltoid middle (G.E. test if needed) -
Gluteus medius (G.E. test if needed) -
SIDELYING (lying on left side-right muscles tested)
Gluteus medius (hip abductors) 10
Iliopsoas (G.E. test if needed) -
Gluteus maximus (G.E. test if needed) -
Hamstrings (G.E. test if needed) -
Biceps brachii (G.E. test if needed) -
Neck flexors (G.E. test if needed) -
Neck extensors (G.E. test if needed) -
PRONE
Neck extensors (longissimus, semispinalis, 11
illiocostaliis, splenius cervicis)
Gluteus maximus (hip extensors) 12
Hamstrings (knee flexors) 13
Ankle plantarflexors (initial test; gastrocnemius) 14
SIDELYING (lying on right side-left muscles tested)
Gluteus medius (hip abductors) 15
Iliopsoas (G.E. test if needed) -
Quadriceps (G.E. test if needed) -
Gluteus maximus (G.E. test if needed) -
Hamstrings (G.E. test if needed) -
Biceps brachii (G.E. test if needed) -
Ankle dorsiflexors (G.E. test if needed) -
STANDING
Ankle plantarflexors (second test if needed) 16

IMACS FORM 04: MANUAL MUSCLE TESTING PROCEDURES 2

 TESTING POSITIONS
Muscle Groups Anti-Gravity Gravity Eliminated
Trapezius Sitting Supine
(shoulder elevators)
Deltoid middle Sitting Supine
(shoulder abductors)
Biceps brachii Sitting Sidelying
(elbow flexors)
Wrist extensors Sitting (pronation) Sitting (neutral)
Wrist flexors Sitting (supination) Sitting (neutral)
Iliopsoas (hip flexors) Sitting Sidelying
Quadriceps femoris Sitting Sidelying
(knee extensors)
Ankle dorsiflexors Sitting Sidelying
Neck flexors Supine Sidelying
Gluteus medius Sidelying Supine
(hip abductors)
Neck extensors Prone Sidelying
Gluteus maximus Prone Sidelying
(hip extensors)
Hamstrings Prone Sidelying
(knee flexors)
Ankle plantarflexors Prone/Standing Sidelying

MMT Considerations to Promote Reliability

MMT Grades Comments
(0 10 scale)
0T Palpation skill may confound the distinction
between the 0 and T score; use trained and
experienced clinicians.
12 Adjust range of motion criterion to accommodate
for muscle contractures.
3 This grade can only be assigned to muscles
tested in the standard (against gravity) testing
position.
4 Gradual descent from testing position to resting
position should last at least 3 seconds
5 Test position should be held for 3 seconds
35 MMT grades in this range should be re-tested
for the next highest grade after 60 seconds of
recovery time.
6 10 MMT grades in this range are heavily influenced
by the stature of the subject and tester. Attempt
to use back-up testers of a similar stature to the
primary tester.
All MMT in this range should involve a force
application time of 3 seconds.

IMACS FORM 04: MANUAL MUSCLE TESTING PROCEDURES 3

 JUVENILE MYOSITIS: STANDARDIZATION OF MMT COMMANDS.

The following are suggested commands for manual muscle testing in pediatric patients.
Variation in the text is acceptable, but the concepts are intended to be uniform between
patients. The instructions would be different for gravity-eliminated testing:

Im going to see how strong you are. When I tell you hold and dont let me push you, you try
really, really hard not to let me move you. You need to be strong like a tree or a power ranger
(use these examples to motivate the child).

1. Upper Trapezius: Now watch me, turn your head like I do and shrug your shoulder up
(demonstrate test position). Now Im going to try to push your shoulder and head apart
and you hold it and dont let me push it apart.

2. Deltoid middle: Hold your arm up in the air like this (demonstrate), and Im going to
push down here and you hold it. Dont let me push it down, hold it up there as hard as
you can.

3. Biceps brachii: Bend your elbow, now dont let me pull your arm down. Hold it hard
and dont let me pull it out.

4. Wrist extensors: Bring your hand back like this (demonstrate) and hold it while I try to
straighten it out. Dont let me straighten your hand. Be strong.

5. Wrist flexors: Bring your hand like this (demonstrate) and hold it while I try to straighten
it. Dont let me straighten your hand. Be strong.

6. Iliopsoas: Lets have you sit. Can you bring your knee up in the air like this
(demonstrate)? Hold it up there while I try to push it down. Hold it hard and dont let me
push it down.

7. Quadriceps: (Sitting) Kick your leg out so it is straight. Now hold it straight while I try to
bend your knee. Be strong and keep it straight.

8. Ankle dorsiflexors: Bring your foot up like this (demonstrate), now hold it while I try to
push it down. Dont let me push it down.

9. Neck flexors: (Supine) Bring your head up off the table, now hold it up there. Now hold
it up there while I try to push it down and dont let me push it. Hold it as hard as you can.

10. Gluteus medius: Can you lie on your side? Now can you lift your leg up in the air?
Make sure you keep your knee straight. Now hold it up there while I try to push your leg.
Hold it hard and be strong.

11. Neck extensors: Lie on your belly, and bring your head up off the table. Now hold it up
there. Im going to try to push your head down and dont let me do it. Hold it as hard as
you can.

12. Gluteus maximus: Lie on your belly, and bend your knee. Now try to lift your whole leg
up in the air (demonstrate passively). Hold it there, while I try to push down and dont let
me push it down. Hold it hard.

IMACS FORM 04: MANUAL MUSCLE TESTING PROCEDURES 4

13. Hamstrings: Bend your knee, and hold it here (use your hand to limit knee flexion to
approximately 45 degrees). I am going to pull here. You hold it and dont let me pull
your leg down. Hold it hard.

14. Ankle plantarflexors: Can you stand up on your tip toes without holding on to the
table? You can hold on to my hand if you need some help.

IMACS FORM 04: MANUAL MUSCLE TESTING PROCEDURES 5