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Muscle testing
Muscle testing consists of strong, static,
isometric muscle contraction. Limiting joint motion and
focusing on the muscle allows for determination of a
problem with a muscle or possibly if it is a condition in
the inner tissues
Value
Normal
Description
Good
3+
Fair Plus
Fair
2+
Poor plus
Poor
2-
Poor minus
Atleast 50%
ROM, gravity
eliminated
Trace
Visible or palpable
contraction
Zero
No muscle
Contraction
UPPER EXTREMITY
Scapular Abduction and Upward
and Rotation
Serratus Anterior
MMT for grades 5, 4 and 3
Patient position:
Patient should be in supine with
shoulder flexed to 90 degrees. The
shoulder should be raised off the table.
Therapist and patient Instructions:
Therapist stands over the patient,
resistance is given over the hand in a
downward direction. The stabilizing hand
is placed around the wrist.
MMT for grade 2, 1 and 0
Patient Position:
Patient sitting with entire arm in
same postion as above except now the
arm is resting on the table and the
scapula is not abducted.
Therapist and Patient Instructrions:
Palpate the serratus anterior while
you ask the patient to slide the arm
forward on the table
Scapular Elevation
3
Patient Position:
Patient should be in prone position
with the shoulder at the edge of the table.
The arm should be abducted to 90
degrees, the elbow should be bent at 90
degrees. The forearm is perpendicular to
the floor.
Therapist and Patient Instructions:
Resistance hand should be placed
at the distal end of the humerus. The
stabilizing hand should be on the medial
and superior border of the scapula. The
therapist should ask the patient to lift
your elbow toward the ceiling and hold it.
Dont let me push it down. The examiner
should be pushing down on the elbow
while the patient holds it up.
MMT for Grades 2, 1 and 0
Patient position:
Patient should be in the same
position as above for the normal test,
except in this position the therapist needs
to hold the patients arm so that the
weight of the limb is supported.
Therapist and Patient Instructions:
The trapezius should be palpated
while asking the patient to, lift your
elbow toward the ceiling
your arm off the table as high as you can .Dont let me
push it back down.
MMT for Grades 2, 1 and 0
4
Scapular Depression and Adduction
Trapezius (lower fiber)
Patient Position:
Patient should be in prone position with arm
abducted at the shoulder about 145 degrees. The
elbow should be extended.
Therapist and patient Instructions:
The trapezius should be palpated while asking
the patient to, lift your elbow toward the ceiling.
5
Patient Position:
The positioning is the same as for
the normal test. However , in this position
rather than giving resistance just above
the elbow you will now support the limb
just above the elbow.
Shoulder Flexion
Trapezius(lower fibers)
Patient Position:
Patient should be lying prone with arm abducted
at the shoulder about 145 degrees .The elbow should
be extended.
Therapist and patient Instructions:
The resistance is given downward toward the
floor at a position just above the elbow on the
humerus. The therapist should stabilize at the inferior
angle and medical border of the scapula. The patient
should raise his arm to the level of his ear and hold it
there against the resistance. Ask the patient to,raise
6
Patient Position:
Sitting with arm at side and the elbow just
slightly flexed.
Therapist and Patient Instructions:
The therapist should palpate the deltoid by
placing the thumb and forefinger around the anterior
surface of the deltoid, then palpate the
coracobrachialis and supraspinatus as well. Ask the
patient to try and raise his/her arm.
Shoulder Extension
Patient Position:
Patient position is the same as for the above test
except the shoulder is shrugged to the level of the
chin.
7
Therapist and Patient Instructions:
The therapist holds the wrist with
both hands and will push the arm toward
the head while the patient pushes down
toward the feet . Ask the patient to ,push
down toward your feet , dont let me push
your arm up.
Patient Position
Patient is lying prone with arms at sides palm
facing up.
Therapist and Patient Instructions:
Patient should lift arm off the table as high as
they can .Resistance is placed in a downward direction
at the humerus just above the elbow. The stabilizing
hand is placed on the medical border and inferior
Patient Position:
Patient will be standing , trunk flexed to about 90
degrees , the shoulder and arm in the same position as
the above . The trunk flexion allows for the movement
to be performed in a gravity-eliminated position.
Therapist and Patient Instructions:
Ask the patient to try and raise his arm in this
position. Palpate the deltoid and supraspinatus.
Shoulder Abduction
8
Shoulder Scaption
Deltoid and Supraspinatus
MMT for Grades 5, 4 and 3
Patient Instructions:
Patient is sitting with shoulder flexed to 90 degrees,
the shoulder Is then moved ghalfway between flexion
and abduction.
Therapist and Patient Instructions:
In shoulder scaption, resistance is placed at the
humerus above the elbow and applied in a downward
direction . The stabilizing hand is placed on the
shoulder . In order to describe this motion to the
patient to , raise arm to shoulder height and halfway
between straight ahead and out to the side , dont let
me push it down.
MMT for Grades 2, 1and 0
9
Patient Position:
Patient should be sitting with
shoulder abducted to 90 degrees, hand
pronated.
Therapist and Patient Instructions:
Resistance is placed at the
humerus just above the elbow and is
applied in a downward direction. The
stabilizing hand is on the shoulder .Ask
the patient to , lift your arm out to your
side to shoulder height, dont let me
push it down.
MMT for Grades 2, 1 and 0
Patient Position:
10
Patient Position:
- Patient is prone , shoulder is abducted to 90
degrees and elbow is flexed to 90 degrees off
the edge of the table.
Therapist and patient Instructions:
- Resistance is given at the humerus just above
the elbow. Stabilizing hand is on the shoulder.
Ask the patient to lift arm up off the table,
dont let me push it down.
MMT for Grades 2, 1,and 0
Patient Position:
- Sitting with test arm in same position as above ,
arm is supported by the therapist.
Patient Position
- Patient is supine with about 60degrees of
shoulder abduction and 90 degrees of elbow
flexion.
Therapist and Patient Instructions:
o Resistance is given at the wrist the
therapist pulls back towards the shoulder
while the patient pulls min toward the hip.
11
The patient then pushes out toward the
shoulder while the therapist pulls over
the deltoid. To test the clavicular head ask
the patient to move your arm up and
in , dont let me pull it back. For the
sternal head, move your arm down and
in, dont let me pull it back.
MMT for Grades 2, 1 and 0
Patient Position
Elbow Flexion
Biceps brachii, Brachialis, and
Brachioradialis
Elbow Extension
MMT for Grades 5, 4 and 3
Patient Position
- Patient is sitting with slight shoulder
flexion and the elbow flexed past 90
degrees ,forearm is supinated.
Therapist and Patient Instructions:
- Ask the patient to , hold your elbow
bent, dont let me straighten it out.
Resistance is given at the wrist in a
downward direction. The stabilizing
hand is placed one the shoulder.
12
Alternate Test for Elbow Flexion
- This alternate test is performed if the biceps and
brachialis are weak. Pronating the hand will
instead use the brachioradialis , extensor carpi
radialis longus, pronator teres, and other wrist
flexors.
Triceps Brachii
MMT for Grades 5, 4 and 3
Patient Position
- Patient is prone on the table with the shoulder
abducted to 90degrees, the entire arm should
be off the table and the therapist can stabilize
the arm at the humerus just above the elbow.
The elbow should be in full extension.
Therapist and Patient Instructions:
- At the wrist resistance is applied in a downward
direction.Ask the patient to ,Straighten your
elbow. The elbow should be in full extension.
13
MMT for Grade 2, 1 and 0
Patient Position
Forearm Supination
Forearm Pronation
14
Wrist Flexion
Flexor carpi radialis and Flexor carpi
ulnaris
MMT for Grades 543
Patient Position:
- Sitting ,forearm is supinated
Therapist and Patient Instructions :
- Resistance is given at the hand in the
direction of wrist extension. The
stabilizing hand is placed around the
wrist. Ask the patient to keep your
fingers relaxed , bend your wrist ,
dont let me straighten it out.
MMT for Grades 2, 1 and 0
Patient Position:
- Sitting with forearm supported on
table . Have the ulnard side of the
forearm resting on the table.
Therapist and Patient Instructions :
- Ask the patient to ,try and bend your
wrist. Palpate the tendons of the
flexors at the wrist.
Wrist Extension
Extensor carpi radialis longus ,
Extensor carpo radialis brevis ,
extensor carpi ulnaris.
LOWER EXTREMITY
Hip Flexion
Psoas major and iliacus
MMT for grades 5, 4 and 3
Patient position:
Sitting, the thighs should be supported on the
table and the legs hanging off the edge. The patient
should have his/her knee raised off the table. Hands
17
The stabilizing hand should be placed at
the hip to maintain trunk alignment. Ask
the patient to lift your leg off the table,
dont let met push it down
MMT for grades 2, 1 and 0
Patient position:
Patient will be lying on their side
with the limb not being tested on the
table (this limb can be flexed for
stability) and the tested limb being
cradled in the therapists arm.
Therapist and Patient Instruction:
Palpate the psoas major and
iliacus while the patient tries to flex at the
hip. Ask the patient to lift your knee up
towards your chest.
Hip extension
19
Position:
Prone position on the table with
the hip in extension.
Therapist and Patient Instructions:
The therapist is standing aside the
limb being tested at the level of the
pelvis. The hand providing resistance is
placed at the thigh just abouve the knee.
If an insufficient amount of the resistance
is given in this position the hand can be
placed at the ankle. Also, make sure your
testing manner is consistent and
performed bilaterally. The stabilizing hand
can be placed on the posterior superior
Patient position:
Patient is side lying position with
the therapist cradling the test limb.
20
Therapist and Patient Instructions:
Palpate the gluteus maximus while asking the
patient to bring your leg back towards me
Hip Abduction
Guteus medius and maximus
MMT for grade 5, 4 and 3
Patient position:
Patient is in side lying position with slight
extension at the hip and the pelvis shifted forward
Hip Adduction
Patient position:
Prone position with knee flexed to
about 45 degrees, and the opposite foot
hanging off the table.
Patient postion:
Sitting hands can be placed on the table for
support. Leg should be internally rotated at the hip.
Therapist and Patient Instructions:
The therapist should place one hand on the
medial aspect of the k nee and the other hand just
above the lateral malleolus. Resistance will be in an
outward direction at the knee and in an inward
direction at the ankle to create a rotary resistance. The
patient should be in the end position for testing. Ask
the patient to move your leg outward, dont let me
pull it back in
MMT for grades 2, 1 and 0
Patient position:
Supine with the limb being tested in external
rotation.
Therapist and Patient Instructions:
Palpate the internal rotators and ask the patient
to ty and roll their leg in toward their other leg.
25
Knee flexion
26
To isolate the biceps femoris the leg should be
externally rotated, have the patient point their toes
outward.
Therapist and Patient Instructions:
Hand positioning is the same as above. The
resistance should now be in a down and out direction
toward knee extension for the semitendinosus and
semimembranosus. For isolation of the biceps femoris,
the resistance will be down and inward.
MMT for grades 2, 1 and 0
Patient position:
Prone with knee flexed slightly but supported by
rhe examiner at the ankle.
Therapist and Patient Instructions:
While supporting the leg at the ankle ask the
patient to try and flex their knee. Palpate the
hamstring tendons.
Knee Extension
Plantar flexion
Patient position:
Sitting the patient can lean backward slightly to
relieve hamstring tension can place his/her hands on
the table for stability. The knee should be in extension.
Therapist and Patient Instructions:
28
The patient should now perform twenty heel
raises. Tell the patient to rise up on your toes and
down, do this twenty times
Alternate test to isolate the soleus
The test is the same as above except the test
limb is slightly flexed at the knee
Patient position:
Prone on the table with the foot hanging off the
edge.
Patient position:
Patient is in sitting with the heel of
their foot resting on the thigh of the
therapist. Refer to starting position n
picture.
Inversion
Tibialis posterior
32
TABLE OF CONTENTS
GENERAL CONCEPTS
MMT.......................................1
UPPER
EXTREMITY..2
Wrist
Extension
..16
17
LOWER EXTREMITY
Hip
Flexion17
Hip flexion, Abduction
and External Rotation
with knee
position
.18
Hip
extension29
Hip
Abduction.21
Hip Abducted from
flexed
position
22
Hip
Adduction.23
Hip external
Rotation24
Knee
flexion.
.25
Hip internal
Rotation.26
Knee
Extension
27
Plantar
flexion..
..28
Dorsiflexion and
Inversion.29
Inversion
..30
Eversion w/ Plantar
flexion31