Lecture 1

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​ 🞂​ Define muscle test and its uses
​ 🞂​ Realize types of muscle contraction

​ 🞂​ Identify factor affecting muscle contraction

​​🞂​ Identify grading system

​ 🞂​ Realize principles and factor affecting

muscle test

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​ 🞂​ Manual muscle testing is used to determine the extent and
degree of muscle weakness resulted from disease, injury or
disuse. The records obtained from this procedure provide a
base for planning therapeutic program and periodic
retesting.
​ 🞂​ Muscle testing is an important tool for all members in health
team dealing with physical residuals of disability

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​ 🞂​Definition: it is a method by which
muscle strength is defined and measured.

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Muscle Strength

​ 🞂​ The maximal amount of tension or force that a

muscle can voluntarily exert in one maximal effort.
​ 🞂​ Muscular endurance:
​ 🞂​ The ability of a muscle or a muscle group to
perform repeated contractions against resistance
or maintain an isometric contraction for a period
of time.

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 ◦ Group muscle test:
🞂​ In which group of muscles responsible for specific
movement are examined.
◦ Individual muscle test:
🞂​ Specific muscle has a specific action is examined.
◦ Functional muscle test:
🞂​ It depends on the ability of the subject to
successfully perform functional movements.

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 Individual Versus Group Muscle Test
​ 🞂​ Muscles with a common action or actions may
be tested as a group or a muscle maybe tested
individually.

​ 🞂​ For ex., flexor Carpiulnaris and flexor Carpiradialis

maybe tested together as a group in the action of
wrist flexion. Flexor carpiulnaris maybe tested more
specifically in the action of wrist flexion with ulnar
deviation.

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 To establish base line information for the patient
before muscle reeducation or exercises.
 To help in prognosis: through comparing the initial
results with the results obtained during
reevaluation.
 To assess the ability of the patient to use functional
devices as orthotics and splints.
 To help in diagnosis of certain diseases as
myopathies and muscular dystrophies which affect
proximal muscles, intrinsic hand weakness may
suggest ulnar nerve lesion.
 To determine the level of nerve root compression.

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RANGE OF MUSCLE WORK:
The full range in which a muscle work refers to the
muscle, changing from a position of full stretch and
contracting to a position of maximal shortening.
The full range is divided into three parts:
1. Outer range: From a position where the muscle is
fully stretched to a position halfway through the full
range of motion.
2. Inner range: From a position halfway through the
full range of motion to a position where the muscle is
fully shortened.
3. Middle range: The portion of the full range between
the mid-point of the outer range and the midpoint of
the inner range.

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​ 🞂​ In this course, we will focus on the make test
method which necessitate the performance of
the movement through the FROM,
​​🞂​ i. MRC Scale

​ 🞂​ ii. OXFORD Scale

​ 🞂​ iii. KENDALL Scale

​ 🞂​ iv. And Others.

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​ 🞂​ Grade fair is objective because it
depends only on the effect of gravity (no
manual resistance applied)

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 If the patient performed less
than ½ ROM in the higher
Add + to the grade grade
Example: grade 4+ (shoulder
abductors)

If the patient could not

complete the full ROM (more
Add – to the grade than ½) of the range was
performed
Grade 3- (elbow flexors)

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​​🞂​ Functional: if the muscle
performed the desired action
​​🞂​ Sub-functional: if
partial movement
occurred
​​ 🞂​ Zero: of no movement
was observed

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• Fatigue:
The examiner must be aware that some
musculoskeletal disorders or weaknesses cause
muscles to fatigue more easily and rapidly than
normal. So the examiner should examine muscles in
various areas of the body rather than several muscles
around single joint or limb. For example, test a few
hand muscles then move to the lower extremity, then
come back to the upper limb.

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• Position:
when applying MMT the patient may be situated in
one of two positions anti-gravity position (AG) or
gravity minimal position (GM). The position of the
patient should be relaxed and supported position and
allow the therapist to easily apply the test and the
stabilization of the proximal segment. The therapist
should be aware of good biomechanical principles
and can use proper body mechanics and body weight
rather than muscle power during application of the
procedures.

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• Stabilization:
stabilization may be applied by the therapist hands,
or by external aid as belt or the help of physical
therapy assistant, or provided by the patient's Owen
body weight. The tester stabilizes the proximal
segment while contraction of the muscle(s) moves
the distal segment

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​​🞂​ Substitution:
It occurs when the tested muscle(s) is very
weak or the applied resistance is too strong,
in which the patient try to use the adjacent,
stronger, muscles to perform the desired
action. Application of proper and good
stabilization as well as choosing the
appropriate positioning minimizes
substitution

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🞂​ Position:
◦ against / gravity minimal
◦ Avoid frequent position changes
🞂​ Stabilization: proximal part of the joint
🞂​ Demonstration: of the desired motion (passive ROM / therapist
perform it)
​​🞂​ Assessment of Normal Muscle Strength
🞂​ Application of grades: start always with grade 3 (Fair(
🞂​ Application of resistance: distal part of segment Or distal
extremity
🞂​ Objectivity: use the same procedures every time
🞂​ Documentation: to facilitate repetition of the test

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POSITION:
PATIENT POSITION:
 Patient is positioned Eliminated or Against
gravity. (Patient depend upon testing on muscle
or muscles group.)
 Do not change patient position repeatedly.
 The patient should be as free as possible from
discomfort or pain for the duration of each test.
 Patient position should be carefully organized
so that position changes in a test sequence are
minimized. The patient' s position must permit
adequate stabilization of the part or parts being
tested by virtue of body weight or with help
provided by the examiner.

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JOINT POSITION:
The joint position is also changed depend upon
their performance.
Distal part of the joint is moved.

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 )2STABILIZATION:
Patient could stabilizes our self during performed
Antigravity position.
The hand placement of the therapist is important.
HAND PLACEMENT:
I. PROXIMAL HAND – At Origin of muscle & proximal

joint giving stabilization.

II. DISTAL HAND – Distally offering resistance or

Assistance depend upon performance.

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 )DEMONSTRATION:
Demonstrate the desired movement.
Therapist demonstrate the application of
movement or performance to the patient.
​ 🞂​ ) APPLICATIONS OF GRADES:
Always start with GRADE 3 (If you start to
examine the muscle stregnth, first you should test
the grade .)3
Isolation of muscle could be tested.

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 )APPLICATIONS OF RESISTANCE:
Resistance is applied slowly & gradually.
Increasing or decreasing manual resistance.
Increasing length of weight arm.
Apply presence opposite to the line of pull (Grade
)4,5
Apply force distally.
It varies between the persons.
Use long lever to applied resistance whenever it
possible.

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CHECKING NORMAL STRENGTH:
Therapist to check the strength of the muscle
normal side first.
OBJECTIVITY:
use the same procedures every time

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 )8DOCUMENTATION:
Examiners complete testing documentation or
Record first.
This will help for next step of treatment
applications.
And help for checking improvement of treatment.

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​​🞂​ Cerebral palsy
​ 🞂​ Cardiovascular disease

​ 🞂​ Dislocated / unhealed fructure

​ 🞂​ Myositis ossofication

​ 🞂​ Parkinsons disease

​​🞂​ Sever pain

​ 🞂​ Sever cardiac and respiratory

problems
​ 🞂​ Unhealed fracture

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 Understanding of command affect the
​ 🞂​
results:
◦ Child , elderly, low IQ
​ 🞂​ The experience and the muscle power of
the therapist may affect the results
(subjective)

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