Manual Muscle Testing

1
Manual Muscle Testing

• An evaluation system for diagnosis of disease or
  dysfunction of the musculo-skeletal and nervous
  systems

2
Purpose

• Measures the capability of muscles or groups to
  provide support and movement
• Diagnostic tool
• Postural balance
• Gait impairment
• Range of motion
• Uses little equipment
• Obtains information not defined by other
  procedures

3
Precautions

• Do No Harm (use gentleness)
• Know ROM limits
• Follow procedure
• Record
• Promptly
• Accurately

4
To Get Standardized Results

• Proper training and education
• Knowledge base of anatomy, physiology and
  neurology of muscle function
• Follow precise testing protocol
• Practice, Practice, Practice
• A skill developed and maintained with number of
  cases

5
Validity and Accuracy

• Coordinate the muscle testing findings with other
  standard diagnostic procedures
• The amount of pressure used to test may vary
  between persons performing the test.
• The amount of strength loss must be greater than
  approximately 20to 30 to be dependably
  measurable
• Comparison of both sides is a better indicator of
  loss

6
Muscles

• 3 Types Skeletal, Smooth, Cardiac
• Skeletal around 40 of muscle composition
• Generally voluntarily controlled
• Composed of fibers
• Work in groups
• Movement depends on how the muscles are attached

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Structure of Muscle
http//en.wikibooks.org/wiki/Anatomy_and_Physiolog
y_of_Animals/Muscles
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How Do Muscles Cause Movement

• Origin- where the muscle is attached to the bone
  this bone will move very little
• Insertion- muscle attachment to bone with most
  motion
• Belly of muscle- part of muscle that enlarges on
  contraction

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Muscle Groups

• Quadriceps
• Hamstrings
• Calf
• Low back
• Abdominals
• Pectoralis major
• Rhomboids

• Trapezius
• Latisimus dorsi
• Deltoids
• Biceps
• Triceps

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Conduct Strength Testing

• Correct positioning is essential (Start in
  extended anatomical position)
• Place muscle to be tested in a supported position
  directly opposed to gravity
• Exert uniform force directly on the line opposing
  movement

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Testing of Bicep Tricep

• Support humerus where gravity is against the
  bicep and tricep, client in anatomical position
• Move elbow through full ROM (Passive ROM)
• Flexion
• Extension
• Internal rotation
• External rotation

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Maneuver to Assess Muscle Strength

• With arm in full extension, pull downward on
  forearm while client attempts to flex.
• With arm flexed, apply pressure against forearm,
  ask client to straighten arm.
• When performing muscle tests, be sure to evaluate
  for asymmetry of the muscle groups (i.e. atrophy
  on one side and not the other) and landmarks
  prior to testing.

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Use the following scale to rate strength

• 0-No movement, no contraction of the muscle
• 1- Trace, evidence of muscle contraction but no
  joint movement
• 2- Poor, complete range of motion with gravity
  eliminated
• 3-Fair, complete range of motion against gravity
• 4- Good, complete range of motion against gravity
  with moderate resistance
• 5-Normal, complete range of motion against
  gravity with maximal resistance without evidence
  of fatigue

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Other Test Results

• Weakness defined as a strength below fair in
  non weight bearing muscles below fair in
  weight bearing muscles
• Contracture degree of shortness in muscle, so
  it cannot move through ROM
• Substitution weak muscles are supported by
  other muscles to move

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Active ROM

• Instruct client to move the elbow through ROM
• Flexion
• Extension
• Internal rotation
• External rotation
• Normal ROM is measured by goniometer
• Elbow flexion 0-160
• Elbow extension 145-0
• Elbow pronation (rotation inward) 0-90
• Elbow supination (rotation outward) 0-90

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Strength Test Example

• Gastrocnemius (Ankle plantar flexion)
• Patient Standing
• Rises on toes, pushing weight upward

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Case Study to Follow

• Take patient hx to determine diagnosis
• Assessment of muscle strength
• Set objectives
• Implement a plan
• Evaluate progress

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Case Study

• Drop Foot
• weakness of muscles that are involved in flexing
  the ankle and toes.

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Clinical Muscle Evaluation

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

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Dorsiflection Testing

• Tibialis Anterior
• Support leg above ankle
• Apply pressure against medial side, dorsal
  surface of the foot, in the direction of plantar
  flexion of the ankle joint and eversion of the
  foot. Test dorsiflection directly.

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Dorsiflection Testing

• Extensor Hallucis Longus
• Stabilize foot in slight plantar flexion
• Pressure applied against dorsal surface of distal
  and proximal phalanges of the great toe in
  direction of flexion. Test big toe extension.

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Dorsiflection Testing

• Extensor Digitorum Longus
• Stabilize foot in slight plantar flexion
• Apply pressure against dorsal surface of the toes
  in the direction of flexion. Test extension of
  toes.

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Summary

• Manual Muscle Testing is clinical tool used to
  evaluate patient
• Need information in order to develop orthotic
  treatment plan

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END

• Questions?

25
Conditions

• A list of conditions treatable with Applied
  Kinesiology

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All about muscles

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

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• This power point is based on information found on
  the Illinois Institute of Technology web site
  where students developed resources to be used in
  education in Latin America. I modified the
  original power point to be used by high school
  students in the Healthcare Science classroom.
• Pat Rape

28

• http//www.lhup.edu/yingram/jennifer/webpage/homep
  age2.htm
• http//www.iit.edu/ipro309s08/links.html
• http//www.bulowbiotech.com/intromov.html

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Careers

• http//francistuttle.com/classes/ctp/details.aspx?
  PRGID13
• Orthotic Prosthetic (O P) Technicians assist
  the disabled by fabricating the orthopedic braces
  (orthoses) and artificial limbs (prostheses)
  necessary for their rehabilitation. O P
  Technicians are trained and skilled to provide
  comprehensive O P technical support services
  and possess the knowledge to interact with
  clinical prosthetists and orthotists. You will
  acquire knowledge in polymer processes, strength
  of materials and applied biomechanical principles
  to develop and totally customize an orthosis or
  prosthesis. Providing O P care involves the
  application of clinical and technical processes
  to meet patient rehabilitation objectives.