Muscle Testing Procedures

Muscle Testing

• Muscle testing is a manual test of voluntary muscle strength and function as a prime mover.
• Muscle testing is used to assess individual muscle strength and function.

History of Muscle Testing

• Wilhelmine Wright & Robert Lovett (orthopedic surgery professor) created a 1917 book on resistance gravity system (grades 0-6).
• Legg & Janet Merrill (PT) created a 1932 book on muscle testing used in polio.
• Lowman (1940) used muscle testing in physiotherapy.
• Lucille Daiels & Marian Williams (PT) created a 1946 book on manual muscle testing (0-5).

Basic Principles of Muscle Testing

• Learn how much resistance normal muscles can tolerate.
• Start testing on the unaffected side.
• All tests must be bilateral.
• Need to know the normal for the patient.

Factors Considering Muscle Strength

• Ability of the muscle to contract.
• Ability of the muscle to move through its full range.
• Amount of resistance given to the working muscle.

Requirements for Muscle Testing

• Knowledge of muscle and joint structure.
• Knowledge of nerve supply and function of the muscle.
• Knowledge of test procedure and grading of muscles.
• Ability to accurately observe, handle, and palpate the muscle.
• Ability to recognize muscle substitution.

Preparation for Manual Muscle Testing

• Room should be quiet, warm, and well-lit.
• Use a firm examination table.
• Explain the test to the patient.
• Maintain a comfortable, supported position for the patient (allow them to see).
• Review the medical notes.
• Observe patient's posture and muscle wasting.

Technique of Muscle Testing

• Maintain adequate joint fixation.
• Test all joints throughout the range of motion (active or passive).
• Resistance should be provided by the therapist's hand.
• Resistance should be smooth and adjustable, directed opposite to the muscle's line of pull.
• Perform all tests in one position, before moving to another.
• Avoid fatigue in the patient.
• Record the results on the appropriate chart.

Factors During Muscle Testing

• During grades 0-2, provide more support in the horizontal plane.
• During grades 3-5, the position is held against gravity.

Grading Scales (Daniel & Worthingham 1995)

• Grade 5: Full ROM against maximum resistance.
• Grade 4: Full ROM against strong to moderate resistance.
• Grade 3: Full ROM without resistance.
• Grade 2: Partial ROM against gravity.
• Grade 1: Muscle contraction is palpable but no movement.
• Grade 0: No muscle contraction.

Grading Scales (1932 and Other Scales)

• Gone: No contraction felt.
• Trace: Muscle contraction felt (tight), no movement.
• Poor: Movement eliminated against gravity.
• Fair: Can raise part against gravity.
• Good: Can raise part against gravity and resistance.
• Normal: Can over come resistance greater than normal.

Break Test

• Performed at the end of the range of motion (ROM).
• Therapist applies resistance to break a held position.
• The part will move downward.

Active Resistance Test

• Alternative to the break test.
• Therapist applies manual resistance against active muscle contraction, preventing movement.
• Resistance increases gradually to the maximum level the patient can tolerate.

Muscle Testing Scores and Descriptions

• Scores and descriptions of tests and findings for grading muscle scores. (See pages 18 and 19 for these details.)

Manual Muscle Testing of the Upper Extremity

• Topic focused on upper extremities.

Test your knowledge on the correct procedures for muscle testing in therapy. This quiz covers key concepts like resistance application, support scenarios, strength grading, and the differences between active resistance tests and break tests. Enhance your understanding of muscle assessment techniques.