Manual Muscle Manual Muscle TestingTesting

An evaluation system for An evaluation system for diagnosis of disease or diagnosis of disease or

dysfunction of the musculo-dysfunction of the musculo-skeletal and nervous systemsskeletal and nervous systems

PurposePurpose

Measures the capability of muscles or Measures the capability of muscles or groups to provide support and groups to provide support and movementmovement

Diagnostic toolDiagnostic tool Postural balancePostural balance Gait impairmentGait impairment Range of motionRange of motion

Uses little equipmentUses little equipment Obtains information not defined by Obtains information not defined by

other proceduresother procedures

PrecautionsPrecautions

Do No Harm (use Do No Harm (use gentleness)gentleness)

Know ROM limitsKnow ROM limits Follow procedureFollow procedure Record Record

PromptlyPromptly AccuratelyAccurately

To Get Standardized To Get Standardized Results Results

Proper training and educationProper training and education Knowledge base of anatomy, Knowledge base of anatomy,

physiology and neurology of muscle physiology and neurology of muscle functionfunction

Follow precise testing protocolFollow precise testing protocol Practice, Practice, PracticePractice, Practice, Practice A skill developed and maintained A skill developed and maintained

with number of caseswith number of cases

Validity and AccuracyValidity and Accuracy

Coordinate the muscle testing findings with Coordinate the muscle testing findings with other standard diagnostic proceduresother standard diagnostic procedures

The amount of pressure used to test may The amount of pressure used to test may vary between persons performing the test.vary between persons performing the test.

The amount of strength loss must be greater The amount of strength loss must be greater than approximately 20to 30% to be than approximately 20to 30% to be dependably measurabledependably measurable

Comparison of both sides is a better Comparison of both sides is a better indicator of lossindicator of loss

MusclesMuscles

3 Types: Skeletal, Smooth, Cardiac3 Types: Skeletal, Smooth, Cardiac Skeletal around 40% of muscle Skeletal around 40% of muscle

compositioncomposition Generally voluntarily controlledGenerally voluntarily controlled

Composed of fibersComposed of fibers Work in groupsWork in groups Movement depends on how the Movement depends on how the

muscles are attachedmuscles are attached

Structure of MuscleStructure of Muscle

http://en.wikibooks.org/wiki/Anatomy_and_Physiology_of_Animals/Muscles

How Do Muscles Cause How Do Muscles Cause MovementMovement

Origin- where the muscle is attached Origin- where the muscle is attached to the bone; this bone will move very to the bone; this bone will move very littlelittle

Insertion- muscle attachment to Insertion- muscle attachment to bone with most motionbone with most motion

Belly of muscle- part of muscle that Belly of muscle- part of muscle that enlarges on contractionenlarges on contraction

Muscle GroupsMuscle Groups

QuadricepsQuadriceps HamstringsHamstrings CalfCalf Low backLow back AbdominalsAbdominals Pectoralis majorPectoralis major RhomboidsRhomboids

TrapeziusTrapezius Latisimus dorsiLatisimus dorsi DeltoidsDeltoids BicepsBiceps TricepsTriceps

Conduct Strength Conduct Strength TestingTesting

Correct positioning is essential (Start Correct positioning is essential (Start in extended anatomical position)in extended anatomical position)

Place muscle to be tested in a Place muscle to be tested in a supported position directly opposed to supported position directly opposed to gravitygravity

Exert uniform force directly on the Exert uniform force directly on the line opposing movement line opposing movement

Testing of Bicep & TricepTesting of Bicep & Tricep

Support humerus where gravity is Support humerus where gravity is against the bicep and tricep, client against the bicep and tricep, client in anatomical positionin anatomical position

Move elbow through full ROM Move elbow through full ROM (Passive ROM)(Passive ROM) FlexionFlexion ExtensionExtension Internal rotationInternal rotation External rotationExternal rotation

Maneuver to Assess Maneuver to Assess Muscle StrengthMuscle Strength

With arm in full extension, pull With arm in full extension, pull downward on forearm while client downward on forearm while client attempts to flex.attempts to flex.

With arm flexed, apply pressure against With arm flexed, apply pressure against forearm, ask client to straighten arm.forearm, ask client to straighten arm.

When performing muscle tests, be sure When performing muscle tests, be sure to evaluate for asymmetry of the muscle to evaluate for asymmetry of the muscle groups (i.e. atrophy on one side and not groups (i.e. atrophy on one side and not the other) and landmarks prior to the other) and landmarks prior to testing.testing.

Use the following scale Use the following scale to rate strength: to rate strength:

0-No movement, no contraction of the muscle0-No movement, no contraction of the muscle 1- Trace, evidence of muscle contraction but 1- Trace, evidence of muscle contraction but

no joint movementno joint movement 2- Poor, complete range of motion with gravity 2- Poor, complete range of motion with gravity

eliminatedeliminated 3-Fair, complete range of motion against 3-Fair, complete range of motion against

gravitygravity 4- Good, complete range of motion against 4- Good, complete range of motion against

gravity with moderate resistancegravity with moderate resistance 5-Normal, complete range of motion against 5-Normal, complete range of motion against

gravity with maximal resistance without gravity with maximal resistance without evidence of fatigueevidence of fatigue

Other Test ResultsOther Test Results

Weakness – defined as a strength Weakness – defined as a strength below fair in non weight bearing below fair in non weight bearing muscles; below fair + in weight muscles; below fair + in weight bearing musclesbearing muscles

Contracture – degree of shortness in Contracture – degree of shortness in muscle, so it cannot move through muscle, so it cannot move through ROMROM

Substitution – weak muscles are Substitution – weak muscles are supported by other muscles to movesupported by other muscles to move

Active ROMActive ROM

Instruct client to move the elbow through Instruct client to move the elbow through ROMROM FlexionFlexion ExtensionExtension Internal rotationInternal rotation External rotationExternal rotation

Normal ROM is measured by goniometerNormal ROM is measured by goniometer Elbow flexion 0-160 Elbow flexion 0-160 Elbow extension 145-0 Elbow extension 145-0 Elbow pronation (rotation inward) 0-90 Elbow pronation (rotation inward) 0-90 Elbow supination (rotation outward) 0-90Elbow supination (rotation outward) 0-90

Strength Test ExampleStrength Test Example

Gastrocnemius (Ankle Gastrocnemius (Ankle plantar flexion)plantar flexion)

Patient StandingPatient Standing Rises on toes, Rises on toes,

pushing weight pushing weight upwardupward

Case Study to FollowCase Study to Follow

Take patient hx to determine Take patient hx to determine diagnosisdiagnosis

Assessment of muscle strengthAssessment of muscle strength Set objectivesSet objectives Implement a plan Implement a plan Evaluate progressEvaluate progress

Case StudyCase Study

Drop FootDrop Foot weakness of muscles that are involved weakness of muscles that are involved

in flexing the ankle and toes. in flexing the ankle and toes.

Clinical Muscle Clinical Muscle EvaluationEvaluation

Typical podiatric ankle strength Typical podiatric ankle strength evaluation consists of plantar evaluation consists of plantar flexion, dorsiflexion, eversion and flexion, dorsiflexion, eversion and inversion testinginversion testing

Dorsiflection TestingDorsiflection Testing

Tibialis AnteriorTibialis Anterior Support leg above ankleSupport leg above ankle Apply pressure against medial side, Apply pressure against medial side,

dorsal surface of the foot, in the dorsal surface of the foot, in the direction of plantar flexion of the ankle direction of plantar flexion of the ankle joint and eversion of the foot. Test joint and eversion of the foot. Test dorsiflection directly.dorsiflection directly.

Dorsiflection TestingDorsiflection Testing

Extensor Hallucis LongusExtensor Hallucis Longus Stabilize foot in slight plantar flexionStabilize foot in slight plantar flexion Pressure applied against dorsal surface Pressure applied against dorsal surface

of distal and proximal phalanges of the of distal and proximal phalanges of the great toe in direction of flexion. Test big great toe in direction of flexion. Test big toe extension.toe extension.

Dorsiflection TestingDorsiflection Testing

Extensor Digitorum LongusExtensor Digitorum Longus Stabilize foot in slight plantar Stabilize foot in slight plantar

flexionflexion Apply pressure against dorsal Apply pressure against dorsal

surface of the toes in the direction surface of the toes in the direction of flexion. Test extension of toes.of flexion. Test extension of toes.

SummarySummary

Manual Muscle Testing is clinical Manual Muscle Testing is clinical tool used to evaluate patient tool used to evaluate patient

Need information in order to develop Need information in order to develop orthotic treatment planorthotic treatment plan

ENDEND

Questions?Questions?

Conditions Conditions

A list of conditions treatable with A list of conditions treatable with Applied Kinesiology Applied Kinesiology

All about musclesAll about muscles

http://www.emporia.edu/ksn/v42n1-http://www.emporia.edu/ksn/v42n1-january1996/shape.htmjanuary1996/shape.htm

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Pat RapePat Rape

http://www.lhup.edu/yingram/http://www.lhup.edu/yingram/jennifer/webpage/homepage2.htm jennifer/webpage/homepage2.htm

http://www.iit.edu/~ipro309s08/http://www.iit.edu/~ipro309s08/links.htmllinks.html

http://www.bulowbiotech.com/http://www.bulowbiotech.com/intromov.htmlintromov.html

CareersCareers http://francistuttle.com/classes/ctp/details.aspx?http://francistuttle.com/classes/ctp/details.aspx?

PRGID=13PRGID=13 Orthotic & Prosthetic (O & P) Technicians assist the Orthotic & Prosthetic (O & P) Technicians assist the

disabled by fabricating the orthopedic braces disabled by fabricating the orthopedic braces (orthoses) and artificial limbs (prostheses) necessary (orthoses) and artificial limbs (prostheses) necessary for their rehabilitation. O & P Technicians are for their rehabilitation. O & P Technicians are trained and skilled to provide comprehensive O & P trained and skilled to provide comprehensive O & P technical support services and possess the technical support services and possess the knowledge to interact with clinical prosthetists and knowledge to interact with clinical prosthetists and orthotists. You will acquire knowledge in polymer orthotists. You will acquire knowledge in polymer processes, strength of materials and applied processes, strength of materials and applied biomechanical principles to develop and totally biomechanical principles to develop and totally customize an orthosis or prosthesis. Providing O & P customize an orthosis or prosthesis. Providing O & P care involves the application of clinical and technical care involves the application of clinical and technical processes to meet patient rehabilitation objectives. processes to meet patient rehabilitation objectives.