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Questions and Answers
What is the grading for a muscle that has no palpable or visible contraction?
What is the grading for a muscle that has no palpable or visible contraction?
Which factor is NOT mentioned as affecting muscle strength?
Which factor is NOT mentioned as affecting muscle strength?
What grade indicates a muscle can perform full range of motion against gravity?
What grade indicates a muscle can perform full range of motion against gravity?
Which of the following conditions is contraindicated for resistance training?
Which of the following conditions is contraindicated for resistance training?
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What is the action of the hip flexors?
What is the action of the hip flexors?
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What is the nerve supply for the iliacus muscle?
What is the nerve supply for the iliacus muscle?
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Which muscle acts as a synergist in hip flexion?
Which muscle acts as a synergist in hip flexion?
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Which is a method to increase reliability in muscle strength assessment?
Which is a method to increase reliability in muscle strength assessment?
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What term describes a muscle that counteracts unwanted movements from the prime mover?
What term describes a muscle that counteracts unwanted movements from the prime mover?
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Which type of synergist involves multiple muscles contracting together to achieve a movement that cannot be performed by a single muscle?
Which type of synergist involves multiple muscles contracting together to achieve a movement that cannot be performed by a single muscle?
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During wrist extension, which muscles must work collectively to prevent deviation and achieve the desired movement?
During wrist extension, which muscles must work collectively to prevent deviation and achieve the desired movement?
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What is the role of a stabilizing or fixating synergist during movement?
What is the role of a stabilizing or fixating synergist during movement?
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In a manual muscle test, which aspect is primarily evaluated?
In a manual muscle test, which aspect is primarily evaluated?
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What action does the antagonist perform in relation to the agonist during muscle movement?
What action does the antagonist perform in relation to the agonist during muscle movement?
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Which of the following statements about manual muscle testing is true?
Which of the following statements about manual muscle testing is true?
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What is the effect of significant weakness in the anterior abdominal muscles on walking?
What is the effect of significant weakness in the anterior abdominal muscles on walking?
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What best describes the prime mover in muscle terminology?
What best describes the prime mover in muscle terminology?
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What is a common effect of bilateral contracture of the hip flexors?
What is a common effect of bilateral contracture of the hip flexors?
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What is the correct position for a patient while testing hip strength?
What is the correct position for a patient while testing hip strength?
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What is the role of the sartorius muscle during hip flexion tests?
What is the role of the sartorius muscle during hip flexion tests?
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How is Grade 5 hip flexion strength defined?
How is Grade 5 hip flexion strength defined?
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What common limitation of motion occurs with a flexed knee during hip tests?
What common limitation of motion occurs with a flexed knee during hip tests?
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What should be the primary instruction given to the patient during the hip flexion strength test?
What should be the primary instruction given to the patient during the hip flexion strength test?
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What is the impact of having a hip flexion contracture on testing hip extension strength?
What is the impact of having a hip flexion contracture on testing hip extension strength?
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What is the correct position for the patient during the Grade 2 test of hip flexion?
What is the correct position for the patient during the Grade 2 test of hip flexion?
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Which muscle is primarily responsible for hip flexion, abduction, and external rotation?
Which muscle is primarily responsible for hip flexion, abduction, and external rotation?
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In the Grade 5 assessment, what does the patient need to do to demonstrate a normal level of function?
In the Grade 5 assessment, what does the patient need to do to demonstrate a normal level of function?
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What position should the therapist adopt during the Grade 5 evaluation?
What position should the therapist adopt during the Grade 5 evaluation?
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Which of the following best describes the movement instructions for a Grade 3 test?
Which of the following best describes the movement instructions for a Grade 3 test?
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What is a common challenge when assessing hip flexion strength?
What is a common challenge when assessing hip flexion strength?
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What is critical to maintain while testing the limb in a supine position during Grade 2?
What is critical to maintain while testing the limb in a supine position during Grade 2?
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What should be done to ensure the patient does not experience hamstring tension during the test?
What should be done to ensure the patient does not experience hamstring tension during the test?
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Study Notes
Manual Muscle Testing Definition
- Evaluates individual muscle function and strength based on movement performance against gravity and manual resistance.
Terminology
- Prime Mover (Agonist): Muscle primarily responsible for joint movement.
- Antagonist: Muscle acting opposite to the prime mover (relaxes during movement).
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Synergist: Muscle assisting the prime mover (three types):
- Neutralizing Synergists: Prevent unwanted movements by the prime mover.
- Conjoint Synergists: Multiple muscles working together to produce movement that none could achieve individually.
- Stabilizing (Fixating) Synergists: Control movement at proximal joints to provide a stable base for distal movement.
Grading Muscle Strength
- Zero (0): Paralyzed (no contraction).
- Trace (1): Flicker or visible/palpable contraction.
- Poor (2): Full range of motion (ROM) with gravity eliminated.
- Fair (3): Full ROM against gravity.
- Good (4): Full ROM against gravity + moderate resistance.
- Normal (5): Full ROM against gravity + maximal resistance + hold at the end of ROM.
Factors Affecting Muscle Strength
- Age
- Sex
- Type of muscle contraction
- Muscle size
- Speed of muscle contraction
- Previous training effect
Contraindications for Manual Muscle Testing
- Inflammation
- Pain
- Osteoporosis (resistance contraindicated)
Reliability and Subjectivity in MMT
- To increase reliability:
- Perform MMT at the same time of day to avoid varying levels of fatigue.
- Use the same therapist and environment for testing.
- Maintain consistent patient positioning.
MMT Considerations
- Substitution and Trick Movements: Weak muscles can be compensated for by other muscles or gravity.
-
Preventing Substitutions:
- Use of normal muscles for proximal stabilization.
- Utilize the patient's body weight for shoulder or pelvis girdle fixation.
- Employ appropriate patient positioning.
- Implement external forces (e.g., therapist pressure, belts).
Hip Flexors
-
Origin:
- Psoas Major: Transverse processes of L1-L5, vertebral bodies of T12-L5.
- Iliacus: Anterior 2/3 of iliac fossa.
- Insertion: Both insert at lesser trochanter of the femur.
-
Nerve Supply:
- Psoas Major: Lumbar plexus (L2-L4 nerve roots).
- Iliacus: Lumbar plexus (Femoral nerve, L2-L3).
- Action: Powerful hip flexion.
- Synergist Muscles: Rectus Femoris (RF), Sartorius, Tensor Fasciae Latae (TFL).
Hip Flexion - MMT Procedure
-
Grade 5 (Normal), Grade 4 (Good), Grade 3 (Fair):
- Patient Position: Short sitting with thighs supported on a table and legs hanging over the edge. Arms can stabilize by grasping the table edge.
- Therapist Position: Standing next to the test limb. One hand provides resistance over the distal thigh, the other stabilizes the trunk.
- Test: Patient flexes the hip fully against the downward resistance given by the therapist.
- Instructions: "Lift your leg off the table and don't let me push it down."
-
Grade 2 (Poor):
- Patient Position: Side-lying with the test limb uppermost and supported by the examiner. Trunk in neutral alignment.
- Therapist Position: Standing behind the patient, cradling the test limb with one hand and supporting the knee with the other.
- Test: Patient flexes the supported hip (knee flexion permitted).
- Instructions: "Bring your knee up towards your chest."
- Helpful Hint: For weak trunk, the test may be more accurate in supine position.
Sartorius Muscle
- Origin: Anterior superior iliac spine and part of the notch between anterior iliac spines.
- Insertion: Superomedial surface of the tibia.
- Nerve Supply: Femoral nerve.
- Action: Hip flexion, abduction, and external rotation.
- Other Actions: Works as hip and knee flexor, hip external rotator, and hip abductor.
Hip Flexion, Abduction, and External Rotation with Knee Flexion - MMT Procedure
-
Grade 5 (Normal), Grade 4 (Good), Grade 3 (Fair):
- Patient Position: Short sitting with thighs supported on a table and legs hanging over the side. Arms can be used for support.
- Therapist Position: Standing lateral to the test leg. One hand on lateral knee resisting hip flexion and abduction.
- Test: Patient flexes, abducts, and externally rotates the hip while flexing the knee.
- Instructions: Therapist demonstrates the motion and asks the patient to repeat, "Hold it! Don't let me move your leg or straighten your knee." (Alternative: "Slide your heel up the shin of your other leg.") - Grade 2 (Poor):
- Patient Position: Supine with the heel of the test limb placed on the opposite shin.
- Therapist Position: Standing at the side of the test limb, giving support as needed.
- Test: Patient slides the test heel upwards along the shin toward the knee.
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Description
This quiz explores the fundamental concepts of manual muscle testing, including key terminology such as prime movers and synergists. Test your understanding of muscle strength grading and how it reflects individual muscle function against resistance. Perfect for students and professionals in physical therapy and athletic training.
