MANUAL MUSCLE TESTING OF CORE MUSCLES (abdominals)

The principle and techniques of MMT of core

1. MMT OF CORE MUSCLES Presented By: SYEDA TAHANI.

2. INTRODUCTION MMT is the procedure used to evaluate the function and strength of an individual or group of muscles. It is based on the efficiency of the performance of the movement in relation to force of gravity or manual resistance. It helps to determine the extend and degree of muscular weakness.

3. GRADES OF MMT Grade 0 : No contraction or no movement. Grade 1 : Flickering of contraction. Grade 2 : Full ROM eliminating gravity. Grade 3 : Full ROM against gravity. Grade 4 : Full ROM against gravity with minimum resistance. Grade 5 : Full ROM against gravity with maximum resistance.

4. Trunk flexion Muscles : The muscles involved include: PRIME MOVERS: Rectus abdominis. ACESSORY MUSCLES: I nternal abdominal oblique. External abdominal oblique.

5. Patient position : Grade 5 (Normal): Supine with fingertips lightly touching the back of the head For grade 4- Supine with arms crossed over chest For grade 3- Supine with arms at side. For grade 0 to 2- Supine with arms at sides and knees flexed.

6. Therapist position : Grade 3 to 5- Standing at side of table at level of patient's chest to be able to see whether scapulae clear table during test grade 0 to 2- Standing at side of table with the hand used for palpation is placed at the midline of the thorax over the  linea alba , and the four fingers of both hands are used to palpate the rectus abdominis

7. Movement : For grade 3 to 5- Patient flexes trunk through complete range of motion. A  curl-up  is emphasized and trunk is curled until  scapulae  clear table For grade 2- Ask the patient to lift the head from the table. If the scapulae do not clear the table, the Grade is 2. For grade 0 and 1- therapist uses assisted forward lean technique or coughing technique in same position, while palpating rectus abdominis.

8. Trunk extension The involved muscles are:  PRIME MOVERS: Erector spinae, Iliocostalis thoracis, Longissimus thoracis, Spinalis thoracis, Iliocostalis lumborum, Quadratus lumborum. ACESSORY MUSCLES: Semi spinalis, Multi fundus, Rotators.

9. When testing the thoracic and lumbar spine strength a few differences are noted: The Grades 5 and 4 tests for spine extension are different fo r the lumbar and thoracic spines. Beginning at Grade 3, the tests for both spinal levels are combined. Range of Motion are also different: Thoracic spine: 0° to 10°: Lumbar spine: 0° to 25°.

10. Lumbar spine Position of Patient : Prone with hands clasped behind head. Position of Therapist : Standing so as to stabilize the lower extremities just above the ankles if the patient has Grade 5 hip extensor strength. The weight of the head and arms essentially substitutes for manual resistance by therapist. Test : Patient extends the lumbar spine until the entire trunk is raised from the table (clears umbilicus). Instructions to Patient : “Raise your head, shoulders, and chest off the table. Come up as high as you can.” Lumbar spine extension

11. Thoracic spine Position of Therapist : Standing so as to stabilize the lower limbs at the ankle. Test : Patient extends thoracic spine to the horizontal. Instructions to Patient: “Raise your head, shoulders, and chest to table level.” Grade 5 (Normal): Patient is able to raise the upper trunk quickly from its forward flexed position to the horizontal (or beyond) with ease and no sign of exertion Grade 4 (Good): Patient is able to raise the trunk to the horizontal level but does it somewhat laboriously. Grade 3 (Fair): Patient completes the range of motion. Grade 2, Grade 1, and Grade 0 : These tests are identical to the Grade 3 test except that the therapist must palpate the lumbar and thoracic spine extensor muscle masses adjacent to both sides of the spine. The individual muscles cannot be isolated. [3 Thoracic extension .

12. TRUNK ROTATORS PRIME MOVERS: External abdominal oblique. Internal abdominal oblique. ACESSORY MUSCLES: Latissimus dorsi. Multifidus. Semispinalis. Rectus abdominis(combines trunk rotation and flexion.) External abdominal oblique Internal abdominal oblique

13. Patient position Grade 5 : Supine with fingertips to the side of the head. Grade 4 : Supine with arms crossed over the chest. Grade 3 : Supine with arms placed above the plane of the body. Grade 2 : Sitting arms placed at the side. Grade 0 and 1: supine with knees bent and arms placed at the side of the body .

14. Therapist position Grade 3 to 5 : Standing at the side of the table at the level of patients feet and stabilizing just above the ankle and at the knee joint. Grade 2: Standing at the side of the table and stabilizing the pelvis. Grade 0 and 1 : Standing at the level of patients waist. Therapist palpates the muscles with one hand and the other supports the head.

15. movement Grade 2 to 5 : Patient rotates and flexes thorax to one side and repeat to opposite side. Grade 0 and 1 : Palpate the muscle contraction during the attempt to rotate.

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