Manual Muscle Testing Overview

Manual Muscle Testing

• Manual muscle testing evaluates the strength and function of individual muscles or muscle groups.
• It's based on the ability to perform a movement against gravity and manual resistance within available range of motion (ROM).

Purpose of Muscle Testing

• Differential Diagnosis: Identifying the cause of muscle weakness or dysfunction.
• Treatment Planning: Guiding the development of a treatment strategy based on the muscle's strength and function.
• Prognosis: Determining the likely outcome of a condition based on the current muscle strength.

Limitations of Muscle Testing

• Neurological Disorders: Loss of cortical control due to central nervous system lesions can affect the results.
• Alteration in Muscle Tone: Changes in muscle tone can skew the evaluation of muscle strength.
• Altered Reflex Activity: Abnormal reflexes can impact the assessment.

Requirements for Therapists

• Anatomy Knowledge: Understanding joint motions, muscle origins, insertions, and functions is crucial.
• Observational Skills: Identifying muscle substitutions, trick movements, and muscle wasting is very important
• Accurate Surface Anatomy Knowledge: Having a good grasp of the best locations for palpating the relevant muscles/tendons.

Terminology: Muscular Strength

• Muscular strength: maximum tension or force exerted by a muscle or muscle group in one maximal effort. Factors include:
  • Type of muscle contraction
  • Limb velocity
  • Joint angle

Terminology: Muscular Endurance

• Muscular endurance: The ability of a muscle or a muscle group to perform repeated contractions against minimal to moderate resistance for a period of time.

Terminology: Range of Motion (ROM)

• Range of motion is the full extent of movement a muscle can accomplish from a fully stretched position to a maximally shortened position.
• ROM is divided into outer, middle, and inner sections. -Outer ROM: from full stretch to halfway through the full range. -Inner ROM: from halfway through the full range to fully shortened. -Middle ROM: the region between the mid-points of the outer and inner ranges.

Terminology: Active Insufficiency

• Active insufficiency: A muscle that crosses two or more joints reaches a shortened position where it no longer effectively generates tension during simultaneous movement across all joints.

Terminology: Types of Muscle Contractions

• Isometric (Static): Muscle tension without movement; origin and insertion don't change position; no length change.
• Isotonic: Muscle develops constant tension against a load or resistance.
  • Concentric: Muscle shortens as tension is developed; origin and insertion move closer together.
  • Eccentric: Muscle lengthens as tension is developed; origin and insertion move farther apart.

Functional Classification of Muscles

• Prime Mover (Agonist): Muscle primarily responsible for a movement.
• Antagonist: Muscle that opposes the action of the prime mover.
• Synergist: Muscle that assists the prime mover in a movement or prevents unwanted movements.

Individual vs. Group Muscle Testing

• Muscles with similar actions can be tested together or individually, depending on the specific assessment goals.

Assessment Procedure

• Patient Positioning: Essential for accurate performance of the assessment.
• Stabilization: Therapist or supportive devices that maintain the patient's stability during testing.
• External Forces: Applying or accommodating for forces (belts, sandbags) on the patient during testing.
• Explanation and Instruction: Clear and concise instructions.
• Substitution and Trick Movements: Identifying and analyzing potentially misleading patterns of movement that might mimic muscle function when assessing strength..

Manual Grading of Muscle Strength

• Manual grading of muscle strength is based on evidence of and the amount of resistance needed from the therapist.
  • Lowest Grade (+): Only assessed in the outer range of motion.
  • Highest Grade (-): Only assessed in the inner range of motion, usually indicative of full movement.

Conventional Grading

• Numerical and letter-based grades quantify the patient’s ability to move with or against gravity and/or resistance. Specific examples are detailed in the documents.

Factors Affecting Muscle Strength and Range of Motion

• Age
• Sex
• Type of muscle contraction(eccentric/ concentric/isometric)
• Fatigue level
• Level of repetitions
• Motivation level
• Body type
• Dominance
• Occupation
• Level of pain
• Muscle size
• Speed of muscle contraction
• Joint position/angle
• Previous training
• Disease present
• Trauma present
• Inflammation
• Pain present

MMT Assessment Contraindications and Precautions

• Contraindications (e.g., inflammation, pain) prevent or require modification of the assessment.
• Precautions (e.g., prior surgery, cardiovascular problems) might necessitate modifying or limiting the assessment to avoid aggravating the condition. Specific limitations and procedures are detailed in the documents.

Joint Range of Motion (ROM)

• Purpose: To establish the existing ROM (database &/or compare) and to assist in diagnosing goals for treatment; help diagnose joint limitations.
• Goniometry: Used to measure the amount of movement in a joint. Goniometers and/or arthrometers are used to assess.
• Factors Affecting ROM: Age, sex, body type, joint structures (like ligaments, capsules, tendons, and dense/regular connective tissues), posture, muscles, and sometimes disease or trauma.

Methods to Increase ROM Measurement Reliability

• Removing restrictive clothing.
• Using consistent positions in the assessment.
• Measuring at the same time of day, when possible.

Types of Motion

• Active ROM: The patient moves the body structure themselves.
• Passive ROM: The therapist moves the body structure.

Instruments for Measurement

• Goniometer: A tool used for measuring joint angles.
• Universal Goniometer: Suitable for many joints and commonly used for assessment of joint range of motion.
• Goniometers/Arthrometers: Instruments with varying sizes, shapes, and/or appearance.

Movement Terminology

• Angular Movements: Movements like flexion, extension, abduction, and adduction.
• Rotation Movements: Internal (medial), external (lateral) rotation; circumduction; scapular rotation; opposition of little finger and thumb, various tilts of pelvis, scapula

Assessment Contraindications (specifically for MMT and ROM)

• Immediately Following Surgical Procedures: Procedures involving tendons, ligaments, muscles, joint capsules, or skin.
• Dislocations/Unhealed Fractures: Can limit testing or require modification.
• Myositis Ossificans: A condition where bone forms in muscle tissue.
• Medication for Pain or Muscle Relaxants: May impact muscle function.
• Infections or Inflammatory Conditions: May limit joint mobility.
• Disruption of Soft Tissues: e.g., tendons, muscles, ligaments.
• Osteoporosis

Assessment of Active Range of Motion

• The patient moves through the normal range of motion of the affected joint(s) and the joints immediately proximal and distal to these.
• Active movement observed and assessed one movement at a time, and bilaterally if possible.

Assessment of Passive Range of Motion

• Therapist determines the maximum range of motion at the joint.
• Therapist systematically moves through the range of passive motion to assess the quality of the movement and identify end feel points.

End Feel

• The therapist feels the end point of passive range of motion.
• This identifies which structures limit further movement.
  • Normal (Physiologic): Full ROM, movement stops when it hits normal anatomy.
  • Abnormal (Pathologic): Decreased or increased ROM, or movement stops earlier due to an issue other than normal joint structures.

Methods to Assess End Feel

• Movement isolated to the joint being assessed.
• Relaxed patient; therapist stabilizes. -Detailed descriptions in the document for each end feel type.

This quiz covers the fundamentals of manual muscle testing, including its purpose in differential diagnosis, treatment planning, and prognosis. It also addresses the limitations faced by therapists during evaluations and the essential knowledge required in anatomy. Test your understanding of this important assessment technique!