manual muscle testing lecture notes by Dr.gokulakrishnan

Manual Muscle Testing (MMT) is a method diagnostic evaluation used by physical therapists, chiropractors, physiological researchers and others concerned with establishing effective treatment and tracking progress throughout a specific regimen.

1. MUSCLE GRADING MANUAL MUSCLE TESTING GOKULAKRISHNAN.J .,MPT(Sports Medicine) Assisstant Professor

2. LEARNING OBJECTIVES At the end of the session students will be able to: Define manual muscle testing Identify Indication & contraindications Understand the principle to grading Demonstrate the skill to grade

3. INTRODUCTION Manual M uscle Testing (MMT ) is a method diagnostic evaluation used by physical therapists, chiropractors, physiological researchers and others concerned with establishing effective treatment and tracking progress throughout a specific regimen.

4. MMT is the most commonly used method for documenting impairments in muscle strength.

5. HISTORY Manual muscle testing was developed in response to the need to assess muscle strength losses during the polio outbreak in early part of the 20th century. The development of this original method is credited to Wilhelmine Wright and Robert W. Lovett, MD.

6. The Modern understanding of Muscle Testing has been built on scientific work going back to 1915. Robert M. Lovett, M.D. developed early muscular testing in an effort to better understand muscle weakness in people suffering from Polio

7. Frank Chapman, in 1920, created a map of neurolymphatic reflex points on which Applied Kinesiology based part of its diagnostic process . Then, in the 1949 book entitled, “Muscles, Testing and Function,” spouses Henry and Florence Kendall described various muscle tests to assess each muscle group (Kendall & Kendall, 1949).

8. Finally, in 1964, Chiropractor George Goodheart published his Applied Kinesiology Research Manual ( Goodheart , 2007). Goodheart demonstrated how a tester could apply the Kendall’s muscular tests to locations on Chapman’s neurolymphatic map to indicate if a certain organ was stressed ( Goodheart , 2007).

9. DEFINITION MMT Is a procedure for the evaluation of the function and strength of individual muscles and muscles group based on effective performance of a movement in relation to the forces of gravity and manual resistance through the availble ROM.

10. According to Walther (1988 ) state Presently the best 'instrument' to perform manual muscle testing is a well-trained examiner, using his perception of time and force with knowledge of anatomy and physiology of muscle testing." Regardless of the methods or equipment one uses to standardize MMT in a clinical or research setting, it is most important that the test protocol be highly reproducible by the original examiner and by others.

11. According to Kendall et al (1993) state " As tools, our hands are the most sensitive, fine tuned instruments available. One hand of the examiner positions and stabilizes the part adjacent to the tested part. The other hand determines the pain-free range of motion and guides the tested part into precise test position, giving the appropriate amount of pressure to determine the strength.

12. All the while this instrument we call the hand is hooked up to the most marvelous computer ever created. It is the examiner's very own personal computer and it can store valuable and useful information of the basis of which judgments about evaluation and treatment can be made. Such information contains objective data that is obtained without sacrificing the art and science of manual muscle testing to the demand for objectivity."

13. INDICATIONS Lower motor neuron diseases Post polio syndrome Polymyopathy Radiculopathy Spinal muscular atrophy

14. Amyotropic lateral Sclerosis. M yasthenia gravis. Guillain barre syndrome. Multiple sclerosis. Muscular dystrophy .

15. MUSCULOSKELETAL DISORDERS Arthritis Bursitis Tendinitis Strain Sprain

16. CONTRAINDICATIONS Cerebral palsy Cardio vascular disease/ brain injury Dislocated/unhealed fracture Myositis ossifications Parkinson’s disease Pain

17. Inflammation / ( inflammatory disease in muscle and or joints ) Severe cardiac & respiratory disease Subluxation joint Hemophilia Osteoporosis

18. PRECAUTION Considered contraindications Do not harm ( be gentle ) Respect pain Examiner know the available ROM Follow the principles of procedure

19. Take care of patient comfort Record accurately Extra care taken to giving resisted exercise Abdomen surgery or hernia Newly united fracture

20. Bony ankylosis Hematoma If patients take muscle relaxers and or pain medications Prolonged immobilization

21. PRINCIPLE Position ❖ Stabilization ❖ Demonstration Checking normal strength

22. Application of resistance Application of grades ❖ Objectivity ❖ Documentation

23. POSITION PATIENT POSITION : Patient is positioned eliminated or against gravity. (patient depend upon testing on muscle or muscles group) . Do not change patient position repeatedly the patient should be as free as possible from discomfort or pain for the duration of each test.

24. It may be necessary to allow some patients to move or be positioned differently between tests. Patient position should be carefully organized so that position changes in a test sequence are minimized.

25. The patient’s position must permit adequate stabilization of the part or parts being tested by virture of body weight or with help provided by the examiner.

26. JOINT POSITION The joint position is also changed depend upon their performance. Distal part of the joint is moved. Place the joint in antigravity position grade 3 . Place the joint in horizontal position grade 4 .

27. STABILIZATION Patient could stabilizes our self during performed antigravity position. The hand placement of the therapist is important.

28. HAND PLACEMENT PROXIMAL HAND – At origin of muscle & proximal joint giving stabilization. DISTAL HAND – distally offering resistance or assistance depend upon performance.

29. DEMONSTRATION Demonstrate the desired movement therapist demonstrate the application of movement or performance to the patient.

30. CHECKING NORMAL STRENGTH Therapist to check the strength of the muscle normal side first .

31. APPLICATIONS OF RESISTANCE Resistance is applied slowly & gradually . increasing or decreasing manual resistance. Increasing length of weight arm. Apply presence opposite to the line of pull ( GRADE 4,5) apply force distally. It various between the persons. Use long lever to applied resistance whenever it possible.

32. APPLICATIONS OF GRADES Always start with GRADE 3 ( if you start to examine the muscle power, first you should test the grade 3 ) isolation of muscle could be tested.

33. OBJECTIVITY Therapist ability to palpate and observe the tendon or muscle response in very weak muscles.

34. DOCUMENTATION Examiners complete testing documentation or record first. This will help for next step of treatment applications. And help for checking improvement of treatment.

35. TYPES OF MUSCLE TESTING Make or break test Active resistance test

36. MAKE OR BREAK TEST Resistance applied at the end of tested range is termed as break test. Resistance applied throughout the test is called make test. Patient is instructed to complete the test movement and then hold the segment against resistance

37. The isometric hold ( break test ) shows the muscle to have a higher grade muscle resistance is applied at end of ROM . For two joint muscle it is applied at mid range.

38. ACTIVE RESISTANCE TEST It is a alternative to the break test . it is the application of resistance against an actively contracting muscles or group muscles . During the motion, the examiner gradually increase the amount of resistance untill it reaches the maximum level .

39. GRADING SYSTEM Medical Research Council (MRC ) Plus & Minus grade Daniels & Worthingham Kendall & Kendal

40. MEDICAL RESEARCH COUNCIL (MRC) GRADING

41. PLUS & MINUS GRADE

42. DANIELS & WORTHINGHAM

43. KENDALL & KENDAL

44. DOCUMANTATION SHEET

45. REFFERENCES Daniels and Worthingham's Muscle Testing: Techniques of Manual Examination, 8th edition Muscles: Testing and Function with Posture and Pain Book by Florence Peterson Kendall Muscle Testing: A Concise Manual Book by Earle Abrahamson

46. THANK YOU…..