ATC 222
Athletic Injuries
Manual Muscle Testing
Single and Multiple Joint Muscle Principles: (Kendall, McCreary, Provance 1993)
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The optimal test position for a single joint muscle is at the end range of motion.
The optimal test position for a multiple joint muscle is within the mid-range of its overall
length.
A single joint muscle can be differentiated from a multiple joint muscle that crosses the
same joint, by shortening the multiple joint muscle at the other joint, therefore putting it at
a mechanical disadvantage.
When testing a multi-joint muscle, it must be lengthened over at least one of the joints.
Cramping may occur if a multiple joint muscle is shortened at all applicable joints.
Basic Procedural Rules of MMT: (Kendall, McCreary, Provance 1993)
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Place patient is position that offers the best fixation of the body as a whole (supine, prone,
side-lying).
Stabilize the part proximal to the tested part.
Place the tested part in an anti-gravity position when appropriate.
Apply pressure directly opposite the line of pull of the muscle.
Apply pressure gradually, but not too slowly.
Use a long lever arm whenever possible, unless contraindicated.
Use a short lever arm if intervening muscle do not provide sufficient fixation with a long
lever arm.
Manual Muscle Strength Grading Chart
Grade
Percentage
Description
5 (Normal)
100
4 (Good)
75
3 (Fair)
50
2 (Poor)
25
Complete range of motion against gravity with full
resistance
Complete range of motion against gravity with some
resistance
Complete range of motion against gravity with no
resistance
Complete range of motion with gravity eliminated
1 (Trace)
10
0 (Zero)
0
Evidence of slight contractility with no evidence of
joint motion even with gravity eliminated
No evidence of muscle contractility
Specific Muscle Tests
(Kendall, McCreary, Provance 1993)
Ankle, Foot, and Leg
Tibialis Anterior: Patient is supine or sitting with the ankle/foot in a dorsiflexed and inverted
position. Stabilize the leg above the ankle joint and apply pressure to the medial, dorsal aspect
of the foot.
Tibialis Posterior: Patient is supine with the ankle/foot in a plantar flexed and inverted position.
Stabilize the leg above the ankle joint and apply pressure to the medial, plantar aspect of the foot.
Peroneus Longus and Brevis: Patient is supine with the ankle/foot in a plantar flexed and everted
position. Stabilize the leg above the ankle joint and apply pressure to the lateral, plantar aspect
of the foot.
Soleus: Patient is prone with knee flexed 90 degrees and the ankle in plantar flexion. Stabilize
the leg proximal to the ankle and apply pressure to the calcaneus in a dorsiflexion direction.
Gastrocnemius: Patient is prone with the knee extended and the ankle in plantar flexion.
Stabilization provided by table. Apply pressure to calcaneus and forefoot in a dorsiflexion
direction.
Extensor Digitorum Longus/Brevis: Patient is sitting or supine with extension of 2-5 digits.
Fixation applied to the calcaneus with the ankle slightly plantar flexed. Apply pressure to the
dorsal surface of the toes in the direction of flexion.
Extensor Hallucis Longus: Patient is sitting or supine with extension of the first digit. Stabilize
the foot at the calcaneus with the ankle in slight plantar flexion. Apply pressure to the dorsal
surface of the toe in the direction of flexion.
Hip and Knee
Semitendinosus and Semimembranosus: Patient is prone with knee flexed between 50 and 70
degrees and the knee and hip in internal rotation. Stabilize the thigh against the table and apply
pressure proximal to the ankle in the direction of knee extension.
Biceps Femoris: Patient is prone with the knee flexed between 50 and 70 degrees and the knee
and hip in slight external rotation. Stabilize the thigh against the table and apply pressure
proximal to the ankle in the direction of knee extension.
Quadriceps: Patient in short sitting position on end of table with knee extended. Stabilize the
thigh against the table and apply pressure to the anterior aspect of the leg above the ankle.
Iliopsoas: Patient is supine with the hip in slight flexion, abduction, and external rotation.
Stabilize the opposite iliac crest and apply pressure to the anteromedial aspect of the leg just
proximal to the ankle.
Sartorius: Patient is supine with hip in FABER. Apply pressure to the anterolateral surface of
the lower thigh, in the direction of hip extension, adduction, and medial rotation, and against the
leg in the direction of knee extension.
General Hip Flexor Test: Patient is in short sitting position on end of table with knee flexed to
90 degrees and thigh slightly lifted off of table. Stabilize the ipsilateral shoulder and apply
pressure to the anterior, distal thigh.
Medial Hip Rotators: (TFL, Gluteus minimus, gluteus medius) Patient is in short sitting
position on end of table with hip internally rotated. Counter pressure is applied to medial aspect
of knee joint. Pressure is applied to lateral leg just above the ankle.
Lateral Hip Rotators: (Piriformis, quadratus femoris, obturator internus, obturator externus,
gemellus su0perior, gemellus inferior) Patient is in short sitting position on end of table with hip
externally rotated. Counter pressure is applied to lateral aspect of knee joint. Pressure is applied
to medial leg just above the ankle.
Gluteus Medius: Patient is side lying with underneath leg flexed at the hip and knee. The leg to
be tested is placed in abduction with slight extension and external rotation of the hip while the
knee is extended. Stabilize at the iliac crest. Apply pressure to the lateral leg just above the
ankle.
Gluteus Maximus: Patient is prone with the flexed to 90 degrees or more. Stabilize the lower
back area and apply pressure to the posterior thigh.
Hip Adductors: (Pectineus, Adductor magnus/brevis/longus, gracilis) Patient is supine with
non-test leg slightly abducted. No stabilization needed. Support test leg slightly off of the table
by lifting at the distal leg and apply pressure in the direction of abduction.
Wrist, Elbow, and Shoulder
Palmaris Longus: Patient is sitting or supine with wrist flexed and hand cupped. No
stabilization needed. Apply pressure to the thenar and hypothenar eminences in the direction of
wrist extension.
Extensor Digitorum: Patient is sitting or supine with extension of the 2-5th MP joints and the IP
joints relaxed. Stabilize dorsal wrist to avoid wrist extension and apply pressure to the dorsal
surface of the proximal phalanges in the direction of flexion.
Flexor Digitorum Superficialis/Profundus: Patient is supine or sitting with wrist in neutral
position. Stabilization at the MP or PIP joint. Pressure is applied to the middle phalange or
distal phalange in the direction of extension.
Flexor Carpi Radialis: Patient is supine or sitting with wrist flexed and deviated toward the
radius and the forearm supinated. Stabilization applied to the dorsal forearm. Pressure is applied
to the thenar eminence in the direction of extension toward the ulnar side.
Flexor Carpi Ulnaris: Patient is supine of sitting with the wrist flexed and deviated toward the
ulna. Stabilization is provided to the dorsal forearm. Pressure is applied to the hypothenar
eminence in the direction of extension toward the radial side.
Extensor Carpi Radialis Longus/Brevis: Patient is sitting with the forearm supported on the table
and elbow flexed 30 degrees. Wrist should be extended and deviated toward the radius.
Stabilization provided by the table. Pressure is applied to the dorsum of the wrist in the direction
of wrist flexion and ulnar deviation.
Extensor Carpi Ulnaris: Patient is sitting or supine with the wrist extended deviated toward the
ulna. The forearm is in full pronation and rests on the table for support or by the examiner.
Pressure is applied to the dorsum of the hand along the 5th metacarpal in the direction of flexion
and radial deviation.
Brachioradialis: Patient is sitting or supine with elbow flexed approximately 45 degrees and
radio-ulnar joint in neutral. Stabilize the bottom of the elbow while pressure is applied to the
distal forearm in the direction of extension.
Biceps Brachii/Brachialis: Patient is supine or sitting with elbow flexed approximately 45
degrees and radio-ulnar joint supinated. Stabilize the bottom of the elbow while pressure is
applied to the distal forearm in the direction of extension.
Triceps Brachii/Anconeus: Test 1: Patient is prone with shoulder in 90 degrees of abduction and
neutral rotation. Stabilize the humerus on the table top. With the elbow extended, apply
pressure to the distal forearm in the direction of elbow flexion.
Triceps Brachii/Anconeus: Test 2: Patient is supine with shoulder flexed 90 degrees and elbow
in near full extension. With counter pressure over the biceps brachii, apply pressure to the distal
forearm in the direction of elbow flexion.
Supraspinatus: Patient is sitting or standing with arm at side. No fixation needed. Apply
pressure to distal forearm as patient initiates abduction. (Alternate test is empty can test)
Middle Deltoid: Patient is sitting with the shoulder abducted to 90 degrees and in neutral
rotation. No fixation needed unless scapular stabilizers are weak, then stabilize the scapula.
Apply pressure to the distal humerus or forearm.
Anterior Deltoid: Patient is sitting with shoulder in slight abduction, flexion, and external
rotation. No stabilization need unless scapular stabilizers are weak. Apply pressure to the distal
humerus in the direction of adduction and extension.
Posterior Deltoid: Patient is sitting with shoulder is slight extension, abduction, and internal
rotation. No stabilization needed unless scapular stabilizers are weak. Apply pressure to the
distal humerus in the direction of adduction and flexion.
Teres Major: Patient is prone with the shoulder extended, adducted, and internally rotated so
that the dorsal surface of hand rests on the posterior iliac crest. No stabilization need. Apply
pressure to the elbow in the direction of abduction and flexion.
Pectoralis Major (Upper Fibers): Patient is supine with elbow extended and shoulder in 90
degrees flexion with slight internal rotation and slight horizontal adduction. Apply stabilization
to the opposite shoulder to keep in on the table. Apply pressure to the forearm in the direction of
horizontal abduction.
Pectoralis Major (Lower Fibers): Patient is supine with elbow extended and shoulder in 90
degrees flexion with slight internal rotation and slight horizontal adduction. Apply stabilization
to the opposite iliac crest to keep the pelvis on the table. Apply pressure to the forearm in the
direction of horizontal abduction and flexion.
Latissimus Dorsi: Patient is prone with shoulder adducted to side and slightly extended and in
internal rotation. Fixation to lateral aspect of hip if needed. Apply pressure to the forearm in the
direction of abduction and slight flexion.
Internal Rotators (Latissimus dorsi, pectoralis major, subscapularis, teres major): Patient is
supine with arm at side resting on table and elbow at 90 degrees. Counter pressure is applied to
the distal end of the lateral humerus. Apply pressure to the forearm in the direction of external
rotation.
External Rotators (Infraspinatus, teres minor): Patient is supine with the arm at side resting on
table and elbow at 90 degrees. Counter pressure is applied to the distal end of the medial
humerus. Apply pressure to the forearm in the direction of internal rotation.
Upper Trapezius: Patient is sitting with shoulder elevated and neck laterally flexed. Apply
pressure in the direction of shoulder depression and lateral neck flexion in the opposite direction.
Middle Trapezius: Patient is prone with shoulder abducted 90 degrees and in external rotation.
Fixation on the opposite scapula if necessary. Apply pressure to the forearm in the direction of
transverse adduction.
Lower Trapezius: Patient is prone with shoulder at edge of table and abducted to approximately
130 degrees and externally rotated. Fixation on the opposite scapula if necessary. Apply
pressure to the forearm in the direction of the floor.
Rhomboids: Patient is prone with the shoulder in 90 degrees of abduction and internally rotated.
Fixation to opposite scapula if necessary. Apply pressure to the forearm in the direction of
transverse adduction.
Serratus Anterior: Patient is sitting with the shoulder flexed to 120-130 degrees and neutral
rotation. No fixation is necessary. Apply pressure to the dorsal surface of the arm between the
shoulder and the elbow in the direction of extension.