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MANUAL MUSCLE TESTING

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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

Grading for MMT:


Grade
5

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

Full ROM against


gravity, maximal
resistance
Full ROM against
gravity, moderate
resistance
Full ROM against
gravity, slight
resistance

Full ROM against


gravity
Atleast 50% ROM
against gravity,
slight resistance
Full ROM, gravity
eliminated

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

Trapezius (upper fibers)


MMT for grade 5, 4 and 3
Patient Position:
Patient is sitting with back facing the therapist.
Therapist and Patient Instructions:
Therapist should be standing behind the patient
with hands placed over the acromial ends of the
clavicle and scapula. The resistance is then placed in a
downward direction. PTs ask the patient to shrug
your shoulders and hold it. Dont let me push them
down. The therapist attempts to push the patients
shoulder down.
MMT for grade 2, 1 and 0
Patient position:
Patient will be in prone postion on the table with
arms at sides.
Therapist and Patient Instructions:
Therapist should be standing on the side of the
patient to be tested. The trapezius should be palpated
while asking the patient to raise your shoulder to your
ear

Scapular Adduction (Retraction)


MMT for grade 5, 4 and 3

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.

Scapular Depression and Abduction

Therapist and Patient Instructions:


The Trapezius should be palpated
while the patient tries to lift the arm off
the table.

MMT for Grades 5, 4 and 3

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

Anterior Deltoid, Coracobrachialis ,


and Supraspinatus
MMT for Grades 5,4 and 3
Patient Position:
Patient should be sitting, shoulder
flexed to 90 degrees, hand pronated.
Therapist and Patient Instructions:
Resistance should be given at the
humerus just above the elbow in a
downward direction. The other hand may
be placed on the shoulder to stabilize.

Ask the patient to raise your arm to the


height of your shoulder , make sure your
palm faces the ground , hold it there and
dont let me push it down.

angle of the scapula. Ask the patient to lift arm up as


high as you can, dont let me push it back down.

MMT for Grades 2, 1 and 0

MMT for grades 5, 4 and 3

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

To isolate Latissimus Dorsi

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.

Latissimus dorsi, Teres major, and Posterior


deltoid

Alternate Test for Shoulder Extension


, isolate Latissimus Dorsi

MMT for Grades 5, 4 and 3

Have the patient sit on the table


with arms at sides, hands flat on the
table. Therapist should stand behind the
patient and palpate the latissimus dorsi.
Then the patient will lift his/her buttocks
off the table, bearing their body weight on
their hands. If the patient can perform
this action it is a grade 5. If patient is
unable to lift off the table then an
alternate test should be used to establish
lower ratings.

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

MMT for Grades 2, 1 and 0


Patient Position:
Patient is lying prone with arms at
sides palm facing up.
Therapist and patient Instructions:
Ask the patient to lift their arm off
the table as high as they can. The
therapist should palpate the latissimus
dorsi at the thoracic wall, and the
posterior deltoid just above the axilla.

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

Middle deltoid and Supraspinatus


MMT for Grades 5, 4 and 3

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:

Sitting with the arm in 90 degrees


abduction supported at the elbow by
the therapist. Therapist is standing
just behind the arm cradling it for
support.
Therapist and Patient Instructions:
- Therapist palpates the deltoid and
supraspinatus while the patient tries

Therapist and Patient Instructions:


- Ask the patient to try and bring elbow back,
demonstrate to make the explanation easier.
Palpate the posterior deltoid.

Shoulder Horizontal Adduction


Pectoralis major
MMT for Grade 5, 4 and 3

Shoulder Horizontal Abduction


Posterior Deltoid
MMT for Grades 5, 4 and 3

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.
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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

Same as above except the therapist


should now support the limb at the
wrist.
Therapist and Patient Instructions:
- Patient attempts to horizontally adduct
, the therapist should be palpating the
pectoralis major muscle at the
clavicle.

Elbow Flexion
Biceps brachii, Brachialis, and
Brachioradialis

Patients positioning is the same , except the


forearm is now pronated and the stabilizing
hand is under the elbow joint. Testing procedure
is the same as above.

MMT for Grades 2, 1 and 0


Patient Position
- Patient should be lying prone , arm ,at side.
Therapist and Patient Instructions:
- Have the patient try to flex their elbow, palpate
the flexors on the forearm.

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

Patient is sitting , Arm is abducted at


the shoulder 90 degrees and the
forearm is flexed at the elbow. The
therapist supports the limb.
Therapist and Patient Instructions:
- Therapist should palpate the triceps of
the posterior arm proximal to the
olecranon process, ask the patient to
straighten out his/her arm.

MMT for Grades 2, 1 and 0


Patient Position:
- Same as above, therapist should support arm at
the elbow.
Therapist and Patient Instructions:
- The same instructions as above are used except
the motion should be done without resistance
.Palpate the supinator and biceps for contractile
activity.

Forearm Supination

Forearm Pronation

Supinator and Biceps brachii

Pronator teres and Pronator quadrates

MMT for grades 5, 4 and 3


Patient Position
Patient is sitting , Arm is abducted at
the shoulder 90degrees and the
forearm is flexed at the elbow. The
therapist supports the limb
Therapist and Patients Instructions:
The therapist should palpate the
triceps of the posterior arm proximal
to the olecranon process, ask the
patients hands as if going to shake it;
resistance is applied in a clockwise
direction. The stabilizing hand is
placed under the elbow joint. Tell the
patient to try to turn your palm up,
dont let me push it down.

MMT for grades 2, 1 and 0


Patient Position:
- Patient is sitting with arm at side and elbow
flexed 90 degrees , wrist is in hand shaking
position.
Therapist and patient Instructions:
- The therapist takes the patients hand just above
the wrist ;resistance is applied in a
counterclockwise direction from the therapists
points of view. The stabilizing hand is under the
elbow. Tell the patient to Try to turn your palm
down , dont let me pull it up.

14

MMT for grades 2, 1 and 0


Patient Position:
- Same as above, therapist should support arm at
the elbow .
Therapist and Patient Instructions :

The same instructions as above are used except


the motion should be done without resistance.
Palpate the pronators for contractile activity.
15

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.

MMT for Grades 5, 4 and 3


Patient Position:
- Sitting with forearm and elbow
supported in table, forearm is
pronated.
16
Therapist and Patient Instructions :
Resistance is applied at the metacarpals in the
direction of wrist flexion. The stabilizing hand is place
around the wrist. Ask the patient to . bring your wrist
up . dont let me pull it down.
MMT for Grades 2, 1 and 0
Patient Position:
Forearm is pronated and supported on table .
Therapist and Patient Instructions :
Ask the patient to try and bend his/her wrist
back. Palpate the extensor tendons at the wrist for
activity.

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

can be at sides or holding onto the edge of the table


for balance
Therapist and Patient Instructions:
The therapist should be next to the limb being
tested the resistance hand is placed over the thigh just
proximal to the knee, and resistance is given
downward toward the floor.

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 flexion, Abduction and


External Rotation with knee
position
Sartorius
MMT for grades 5, 4 and 3
Patient position:
Sitting with thighs supported on
the table and legs gangling off the patient
can place their hands down for support.
The patient should flex at the knee. It
may be easiest to demonstrate the
motion for the patient.
18
Therapist and Patient Instructions:
The therapist will be using both hands for
resistance. One hand will be placed on the lateral
surface of the knee, and the other will placed on the
medial aspect of the ankle. The hand at the knee will
resist hip flexion and abduction and the resistance will
be given in a down and inward direction. The hand at
the ankle will be resisting external rotation and knee
flexion and the resistance is in an up and outward
direction. Ask the patient to slide your heel up the
shin of your other leg, dont let me move your leg, or
straighten your knee.
MMT for Grades 2, 1 and 0
Patient position:

Supine, with the therapist supporting the limbs,


the heel should be on the shin of the opposite leg.
Therapist and Patient Instructions:
While palpating the Sartorius ask the patient to
slide their heel up to their knee.

iliac spine to maintain hip alignment. Ask


the patient to, lift your leg off the table,
dont let me push it back down.

Gluteus maximus, biceps femoris,


semitendinosus, and semimmebranosus

To isolate the gluteus maximus:


The test is done in the same
manner as above except the patient
should now have 90 degrees of the knee
flexion. This will isolate the gluteus
maximus.

MMT for grade 5, 4 and 3

MT for grades 2, 1 and 0

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

slightly, then abducted. The leg on the table is flexed


for stability.
Therapist and Patient Instructions:
The therapist will be standing behind the
patient. Resistance will given in a downward direction
on the lateral aspect of the thigh just above the knee.
The stabilizing hand will be placed just proximal to the
greater trochanter. Ask the patient to lift your leg up
and dont let me push it back down
MMT for grades 2, 1 and 0
Patient position:
Supine position
Therapist and Patient Instructions:
The therapist should hold the limb being tested
at the ankle and lift this leg up off the table just
enough to decrease friction.
21
Use the other hand to palpate
gluteus medius and minimus just
proximal to the greater trochanter. Ask
the patient to try and slide their leg off
the table while keeping their knee pointed
to the ceiling.

Hip Abducted from flexed position


Tensor faciae latae

MMT for grades 5, 4 and 3


Patient position:
Patient is in side lying postion, hip
is flexed 45 degrees and lying across the
limb underneath it, the foot should be
resting on the table.
Therapist and Patient Instructions:
Resistance is given on the thigh
just above the knee in a downward
direction. The stabilizing hand is placed
on the crest of the ilium. Ask the patient
to lift your leg and dont let me push it
down
MMT for grades 2, 1 and 0
Patient position:
Patient is in sitting position on the
table with both legs completely supported
on the table. The patient can lean
backwards if comfortable and also for
stabilization.
22
Therapist and Patient Instructions:
The therapist should have one hand holding the
leg up slightly under the ankle to reduce friction. The
other hand should be palpating the tensor faciae latae
where it inserts into the iliotibial band.try the patient
slide their both leg out to the side.

Hip Adduction

Adductor magnus, adductor brevis, adductor


longus, pectineus, and gracilis
MMT for grades 5, 4 and 3
Patient position:
Patient should be in side lying with the limb
being tested resting on the table. The therapist will
support the limb not being tested.
Therapist and Patient Instructions:
Standing behind the patient place the resistance
hand on the medial thigh just above the knee.
Resistance is given in a downward direction. Ask the
patient to lift your bottom leg up to your top leg,
dont let me push it down
MMT for grades 2, 1 and 0
Patient position:
Supine with the limb not being tested slightly
abducted.
Therapist and Patient Instructions:
Using one hand support the ankle and hold the
leg slightly off the table to decrease friction. Use the
other hand to palpate the adductors on the medial
proximal thigh while the patient tries to move their leg
in toward the other one.
23

Hip external Rotation

Obturator internus, obturator


externus, gamellae superior,
gamellae inferior, piriformis,
quadtratus femoris, gluteus
maximus (posterior)

MMT For grade 5, 4 and 3


Patient position:
Sitting with legs dangling off the
table. The patient can place hands on the
table for support and balance. The patient
should externally rotate at the hip.
Therapist and Patient Instructions:
The therapist should place one
hand on the lateral aspect of the knee
and the other hand above the medial
malleolus. The resistance will be inward
at the knee and outward at the ankle to
create a sort of rotary resistance. The
patient should be in the end position for
testing. End positioning means that the
patient is trying to hold the movement at
the end of ROM. Ask the patient to bring
your leg inward towards your other leg,
dont let me turn your leg out.
MMT for grades 2, 1 and 0
Patient position:
Patient should be in supine position
with the test limb internally rotated.
24
Therapist and Patient Instructions:
While palpating the external rotators ask the patient
to try and roll their leg out.

Biceps femoris, semitendinosus, and


sememembranosus

Hip internal Rotation

Gluteus minimus, gluteus medius, and tensor


faciae latae

MMT for grades 5, 4 and3

MMT for grades 5, 4 and 3

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

Therapist and Patient Instructions:


Standing next to the limb being
tested, place the resistance hand on the
posterior leg just superior to the ankle.
Resistance is in the direction of knee
extension or essentially downward toward
the table. The stabilizing hand should be
on the posterior thigh over the hamstring
tendons. Ask the patient to, bring your
heel to your buttocks, dont let me
straighten it.
Alternate test to isolate
semitendinosdus and
semimembranosus and test to
isolated Biceps femoris
Patient position:
Patient positioning is the same as
above except to isolate the
semitendinosus and semimebranosus the
leg should be internally rotated. Ask the
patient to point their toes inward.

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

Rectus femoris, vastus intermedius, vastus


lateralis, vastus medialis longus, vastus
medialis oblique

The therapist should be on the side of the limb


being tested.
The resistance hand should be placed on the anterior
leg just above the ankle.
27
Resistance is given downward in
the direction of knee flexion.
The stabilizing hand should be on
the posterior thigh just above the knee to
prevent any rotation. Make sure that the
patient is not hyper extended at the knee
before performing the test as this might
lock it into position. Ask the patient to
straighten your leg and dont let me
bend it.
MMT for grades 2, 1 and 0
Patient position:
Patient is in supine postion
Therapist and Patient Instructions:
The therapist should palpate the
quadtriceps tendon between the thumb
and two to four fingers. Ask the patient to
try and push the back of your knee
down and into the table.

Plantar flexion

MMT for grade 5, 4 and 3

Gastrocnemius and soleus

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:

MMT for grade 5, 4 and 3


Patient position:
Patient stands on limb to be tested
with knee extended, other leg raised off

the floor. The patient may place one or


two fingers on the table for balance.
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

Therapist and Patient Instructions:


Therapist is in sitting on stool beside the limb
being tested. The heel of the patient can be resting on
the therapists thigh. The resistance hand should be
placed around the dorsum and medial aspect of the
foot. Resistance is given down and out toward
eversion.
29
The stabilizing hand is around the
posterior leg just above the ankle. Have
the patient turn your foot up and in,
dont let me push it down.

MMT for grades 2, 1 and 0

MMT for grades 2, 1 and 0

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.

Therapist and Patient Instructions:


Palpate the Achilles tendon and instruct the
patient to point their toes down.

Dorsiflexion and Inversion


Tibialis anterior

MMT for grades 5, 4 and 3


Patient position:
Sitting with the patients heel resting on the
thigh of the therapist. Patients foot should be
dorsiflexed and inverted.

Therapist and Patient Instructions:


Palpate the tendon of tibialis
anterior in-between the malleoli and with
the other hand palpate the muscle just
lateral to the tibia while asking the
patient to try and turn their foot up and
in.

Inversion

Tibialis posterior

MMT for grades 5, 4 and 3


Patient position:
Sitting with ankle in slight plantar flexion.
Therapist and Patient Instructions:
Sitting next to test limb place the
resistance hand over the dorsum and
medial side of the foot at the metatarsal
heads. The stabilizing hand is placed
around the posterior ankle just above the
malleoli.
30
Resistance is given in the direction of eversion
and toward slight dorsiflexion, almost as if pulling up
and around laterally. Ask the patient to turn your foot
down and in toward your other foot, dont let me push
it out
MMT for grades 2, 1 and 0
Patient postion:
Same as above, except the heel of the patient
should be resting on the therapists thigh. Refer to
starting position picture for dorsiflexion and inversion.
Therapist and Patient Instructions:
Palpate the tibialis posterior tendon between the
navicular bone and the medial malleolus and the belly
of the muscle while the patient tries to invert their
foot.

MMT for grades 5, 4 and 3


Patient position:
Sitting with ankle in a neutral position
Therapist and Patient Instructions:
Sitting on a stool besides the patients test limb,
one hand stabilize by gripping around the ankle.
Resistance is given around the dorsum and lateral
border of the foot.
31
Resistance is in the direction of
inversion and slight dorsiflexion, or in an
up and medial direction. Ask the patient
to turn your foot down and out, dont let
me push it in.
Alternate test to isolate peroneus tertius
Testing procedure is similar as
above except the foot is now everted and
dorsiflexed. Resistance is given in the
direction of inversion and plantarflexion.
MMT for grade 2, 1 and 0
Patient position:
Same as above

Eversion with Plantar flexion


Peroneus longus and peroneus brevis

Therapist and Patient Instructions:

Palpate the tendon of peroneus


longus posterior to the lateral malleolus
and behind peroneus brevis. The tendon
of peroneus brevis can be palpated
proximal to the base of the fifth
metatarsal. The belly of these muscles
can also be palpated while the patient
everts and plantar flexes.

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TABLE OF CONTENTS
GENERAL CONCEPTS
MMT.......................................1
UPPER
EXTREMITY..2

Scapular Abduction and Upward and


Rotation..2
Scapular
Elevation.3
Scapular Adduction (Retraction)
3

Scapular Depression and


Adduction5
Scapular Depression and
Abduction..5
Shoulder
Flexion6
Shoulder
Extension..7
Shoulder
Scaption.9
Shoulder
Abduction.9
Shoulder Horizontal
Abduction.10
Shoulder Horizontal
Adduction.11
Elbow
Flexion.
.12
Elbow
Extension..
.13
Forearm Supination..
.14
Forearm
Pronation..1
5
Wrist
Flexion.
..16

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