Welcome to A Physical Therapy Toolbox: Manual Muscle Testing

Muscle testing is an attempt to determine a patient's ability to voluntarily contract a specific muscle. (Keep in mind that this does not provide information on the patient's ability to use the muscle in daily activities, or if the muscle interacts with other muscle around it in a synergistic pattern).

Muscle testing is indicated in any patient with suspected or actual impaired muscle performance, including strength, power, or endurance. Identification of specific impaired muscles or muscle groups provides information for proper treatment.

It is important to determine the patient's ability to withstand the force to be applied. Proper positioning is important, as is instruction in breathing techniques (avoid the Val Salva). Remember to assess surrounding area for ability to sustain muscle test. In the case of a recent fracture, post-surgical, or other tissue healing, consider post-poning muscle test.

Manual Muscle Testing
MMT is widely used in the physical therapy setting. Patients are asked to hold a position against a therapist's resistance.

  • stabilize proximal part of the area being tested to reduce compensatory action by muscles other than those being tested
  • resistance needs to be applied gradually ("meet my resistance" or "don't let me move you") in the opposite direction of muscle being tested
  • both sides should be tested to provide a comparison

5Normalsubject completes ROM against gravity with maximal resistance
4+Good Plus completes ROM against gravity with moderate-maximal resistance
4Goodcompletes ROM against gravity with moderate resistance
4-Good Minuscompletes ROM against gravity with minimal-moderate resistance
3+Fair Pluscompletes ROM against gravity with only minimal resistance
3Faircompletes ROM against gravity without manual resistance
3-Fair Minusdoes not complete the range of motion against gravity, but does complete more than half of the range
2+Poor Plusis able to initiate movement against gravity
2Poorcompletes range of motion with gravity eliminated
2-Poor Minusdoes not complete ROM in a gravity eliminated position
1Tracemuscle contraction can be palpated, but there is no joint movement
0Zeropatient demonstrates no palpable muscle contraction

MMT is a relatively quick and inexpensive method of evaluating strength; however, it is somewhat subjective. By using consistent test positions, accurate joint placement and avoiding use of compensatory muscle use, results allow for increased reliability in using MMT as an evaluation tool. Keep in mind that MMT often times does not correlate with a aptient's ability to perform functional activities. In addition, a normal muscle grade does not necessarily indicate a patient's ability to return to his or her normal level of activity. It is important to also include functional tests in any patient evaluation.

On the reliability and validity of manual muscle testing: a literature review

Intrarater reliability of manual muscle test (Medical Research Council Scale) grades in Duchenne's muscular dystrophy.

photo    photo    photo    photo