Manual Muscle
Testing
An evaluation system for diagnosis of
disease or dysfunction of the musculoskeletal and nervous systems
Purpose
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Measures the capability of muscles or groups to
provide support and movement
Diagnostic tool
Postural balance
 Gait impairment
 Range of motion
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Uses little equipment
Obtains information not defined by other
procedures
Precautions
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Do No Harm (use
gentleness)
Know ROM limits
Follow procedure
Record
Promptly
 Accurately
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To Get Standardized Results
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Proper training and education
Knowledge base of anatomy, physiology and
neurology of muscle function
Follow precise testing protocol
Practice, Practice, Practice
A skill developed and maintained with number
of cases
Validity and Accuracy
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Coordinate the muscle testing findings with
other standard diagnostic procedures
The amount of pressure used to test may vary
between persons performing the test.
The amount of strength loss must be greater
than approximately 20to 30% to be dependably
measurable
Comparison of both sides is a better indicator of
loss
Muscles
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3 Types: Skeletal, Smooth, Cardiac
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Skeletal around 40% of muscle composition
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Generally voluntarily controlled
Composed of fibers
Work in groups
Movement depends on how the muscles are
attached
Structure of Muscle
http://en.wikibooks.org/wiki/Anatomy_and_Physiology_of_Animals/Muscles
How Do Muscles Cause
Movement
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Origin- where the muscle is attached to the
bone; this bone will move very little
Insertion- muscle attachment to bone with most
motion
Belly of muscle- part of muscle that enlarges on
contraction
Muscle Groups
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Quadriceps
Hamstrings
Calf
Low back
Abdominals
Pectoralis major
Rhomboids
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Trapezius
Latisimus dorsi
Deltoids
Biceps
Triceps
Conduct Strength Testing
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Correct positioning is essential (Start in extended
anatomical position)
Place muscle to be tested in a supported position
directly opposed to gravity
Exert uniform force directly on the line opposing
movement
Testing of Bicep & Tricep
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Support humerus where gravity is against the
bicep and tricep, client in anatomical position
Move elbow through full ROM (Passive ROM)
Flexion
 Extension
 Internal rotation
 External rotation
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Maneuver to Assess Muscle
Strength
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With arm in full extension, pull downward on
forearm while client attempts to flex.
With arm flexed, apply pressure against forearm,
ask client to straighten arm.
When performing muscle tests, be sure to
evaluate for asymmetry of the muscle groups
(i.e. atrophy on one side and not the other) and
landmarks prior to testing.
Use the following scale to rate
strength:
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0-No movement, no contraction of the muscle
1- Trace, evidence of muscle contraction but no joint
movement
2- Poor, complete range of motion with gravity
eliminated
3-Fair, complete range of motion against gravity
4- Good, complete range of motion against gravity with
moderate resistance
5-Normal, complete range of motion against gravity
with maximal resistance without evidence of fatigue
Other Test Results
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Weakness – defined as a strength below fair in
non weight bearing muscles; below fair + in
weight bearing muscles
Contracture – degree of shortness in muscle, so
it cannot move through ROM
Substitution – weak muscles are supported by
other muscles to move
Active ROM
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Instruct client to move the elbow through ROM
Flexion
 Extension
 Internal rotation
 External rotation
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Normal ROM is measured by goniometer
Elbow flexion 0-160
 Elbow extension 145-0
 Elbow pronation (rotation inward) 0-90
 Elbow supination (rotation outward) 0-90
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Strength Test Example
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Gastrocnemius (Ankle
plantar flexion)
Patient Standing
Rises on toes, pushing
weight upward
Case Study to Follow
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Take patient hx to determine diagnosis
Assessment of muscle strength
Set objectives
Implement a plan
Evaluate progress
Case Study
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Drop Foot
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weakness of muscles that are involved in flexing the
ankle and toes.
Clinical Muscle Evaluation
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Typical podiatric ankle strength evaluation
consists of plantar flexion, dorsiflexion, eversion
and inversion testing
Dorsiflection Testing
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Tibialis Anterior
Support leg above ankle
 Apply pressure against medial side, dorsal surface of
the foot, in the direction of plantar flexion of the
ankle joint and eversion of the foot. Test
dorsiflection directly.
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Dorsiflection Testing
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Extensor Hallucis Longus
Stabilize foot in slight plantar flexion
 Pressure applied against dorsal surface of distal and
proximal phalanges of the great toe in direction of
flexion. Test big toe extension.
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Dorsiflection Testing
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Extensor Digitorum Longus
Stabilize foot in slight plantar flexion
 Apply pressure against dorsal surface of the toes
in the direction of flexion. Test extension of
toes.
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Summary
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Manual Muscle Testing is clinical tool used to
evaluate patient
Need information in order to develop orthotic
treatment plan
END
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Questions?
Conditions
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A list of conditions treatable with Applied
Kinesiology
All about muscles
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http://www.emporia.edu/ksn/v42n1january1996/shape.htm
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This power point is based on information found
on the Illinois Institute of Technology web site
where students developed resources to be used
in education in Latin America. I modified the
original power point to be used by high school
students in the Healthcare Science classroom.
Pat Rape
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http://www.lhup.edu/yingram/jennifer/webpa
ge/homepage2.htm
http://www.iit.edu/~ipro309s08/links.html
http://www.bulowbiotech.com/intromov.html
Careers
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http://francistuttle.com/classes/ctp/details.aspx?PRGID=13
Orthotic & Prosthetic (O & P) Technicians assist the disabled
by fabricating the orthopedic braces (orthoses) and artificial
limbs (prostheses) necessary for their rehabilitation. O & P
Technicians are trained and skilled to provide comprehensive
O & P technical support services and possess the knowledge
to interact with clinical prosthetists and orthotists. You will
acquire knowledge in polymer processes, strength of materials
and applied biomechanical principles to develop and totally
customize an orthosis or prosthesis. Providing O & P care
involves the application of clinical and technical processes to
meet patient rehabilitation objectives.