| PRINCIPLES OF PT EVALUATION |
OPT 2103 | OPT 2103.1 Prof. Lacsamana, Prof. Imam | BSPT 2-2
Principles of Manual Muscle Testing
Example: Shoulder Flexion
TOPIC OUTLINE
• Instruct patient to lift the shoulders
A. Manual Muscle Testing • Full ROM is graded 3, 4, or 5
a. Proper Performance of MMT • Grade 3 – normal ROM without resistance
b. MMT Grading • Grades 4 or 5 will vary on the resistance
c. Break Test provided by the PT
d. Active Resistance Test • Gross and partial ROM only, grading will be 2, 1,
B. Patient Preparation or 0
C. Documentation
D. Dynamometry
E. Functional Testing
F. Screening Test
G. Limitation of Manual Muscle Testing
Manual Muscle Testing
• It is an objective assessment of muscle
strength
• ‘Resistance’ in MMT is always a concentric
force provided by the therapist in the opposite
direction
• Two Techniques in MMT: Break Test & Active
Resistance Testing • Position of patient is important because some
position is against gravity or gravity eliminated
Proper Performance of MMT • Patient with full ROM against gravity:
automatic at least Grade 3 (Fair)
Where to Apply? • Full ROM with minimal resistance: Grade 3+
• Range or Position to Test • Resistance provided is moderate and kinaya ng
• Manual Contact patient: Grade 4 (Good)
• Full ROM against gravity position, maximum
How to Apply? resistant, kinaya ng patient: Grade 5
Patient Position Note: Grade 3, 3+, 4 or 5 – all full ROM
• Strong vs Weakened Muscles • Partial ROM Grade 3 and below
• Grade 2+, ONLY for ankle plantar flexors
Stabilization • Grade 2 or 4, different positioning of patient
with full ROM but gravity eliminated
MMT Grading • Grade 2- or 4-, partial ROM, gravity eliminated
• Grade 1, hold muscle belly and instruct patient
Numerical Score Qualitative Score
to try the movement being tested – with
5 Normal (N) contraction without range
4 Good (G)
• Grade 0, hold muscle belly and instruct patient
3 Fair (F) to do movement, no palpable contraction
2 Poor (P)
1 Trace (T) Break Test
0 Zero (no activity) (0) • Manual resistance is applied to the body part
at the end of the available range of motion
• Manual testing starts at Grade 3 (Fair) • Patient is asked to hold the part at that point
• Check range first kung hanggang saan kaya ng and not allow the therapist to “break” the hold
patient with manual resistance
• If (+) painful ROM, apply a “break” before the
onset of pain
• Highest possible grade: Good (4/5)
• Indicate if strength is tested using Break Test
Active Resistance Test
| PRINCIPLES OF PT EVALUATION |
OPT 2103 | OPT 2103.1 Prof. Lacsamana, Prof. Imam | BSPT 2-2
• Manual resistance against active contracting • Must follow correct stabilization and
mm or mm group positioning because each position is either
• Gradual application of resistance all against gravity or gravity eliminated
throughout the ROM • No specific materials or equipment for MMT
• Requires considerable skill & not o Plinth or bed only
recommendable • Case
o Do gross assessment first, onti yung range
Note: malakas ang range or mahina. Kadalasan
• When any condition limits ROM (tightness, alam na ni patient kung ano yung mahina
contracture, adhesions etc.), pt. perform only sakanya “mahina binti ko, nakalaylay yung
on the available ROM paa ko” then do ankle
o Malalaman na agad kahit IE palang
Purpose of MMT o “Kapag naglalakad ako parang hinihila ko
• ROM and MMT are partner (If mag ROM ka mag yung paako lagi” then may foot drop si
MMT ka na den) patient
• MMT is done to check the strength of a specific
muscle
• MMT is performed to check for weakness may MMT Documentation
it be on musculoskeletal or neurologic
conditions. Weakness may be due to: All major muscle of (B) UE & LE are grossly graded 4-
✓ Immobilization causing atrophy 5/5 except for mm of (L) shoulder:
✓ Stroke patients have spastic muscles (L) MMT (R)
2-/5 SH Abductor 5/5
• Used for baseline for treatment
2-/5 SH Flexor 5/5
2-/5 SH External Rotators 5/5
Patient Preparation 2-/5 SH Internal Rotators 5/5
• The patient should be as free as possible from F: Decrease muscle strength on (L) Shoulder Abductor,
discomfort or pain for the duration of each test Flexor, ER & IR
• The environment for testing should be quiet Sig: Decrease strength on (L) sh. Musculatures are 2˚
and nondistracting. to pain inhibition
• The testing surface must be firm to help
stabilize the part being tested Measurement
• Patient position should be carefully organized
so that position changes in a test sequence are Ordinal scales: Hierarchical levels of performance
minimized
• All materials needed for the test must be at Outcome measures
hand
• Make sure that the patient will be able to
endure the resistance given and free from
discomfort.
o Baka mag pigil ng hinga or elevated blood
pressure
o Normal to feel pain as long as it’s not
affecting the overall function of the patient
• Quiet and nondistracting environment
o So that the patient will understand the
instructions clearly
o Neuro patients – if environment is too loud,
patients with short attention span will not
be able to participate properly in MMT and
might give inaccurate grading • Mga muscle groups na need palakasin kapag
• If part being tested is not stabilized, other side ginagawa yung isang activity.
of body might compensate thus affecting the • Ambulation problem – then check squads,
accuracy of the grading gastrocnemius, spine then abdominals (core
muscles)
Topic/s | Page 2 | 4
| PRINCIPLES OF PT EVALUATION |
OPT 2103 | OPT 2103.1 Prof. Lacsamana, Prof. Imam | BSPT 2-2
Examples: • Perform gross checks of bilateral muscle
• Dumating si patient hirap umakyat ng groups: reaching toward the floor, overhead,
hagdanan or hirap maglakad ng mabilis, then and behind the back
do lower ex.
• Common sense lang Measurement
• Hirap uminom ng baso = “Shoulder, elbow, arm” • Ordinal Scales: hierarchical levels of
• Hirap humawak ng kutsara at tinidor = performance
Lumbricals, interossei, basta nasa hand • Outcome Measures
Dynamometry Functional Movement Key Muscles
• Dynamometry is a more precise measurement Bed Mobility Abdominals, Erector
of the force that a muscle can exert and can Spinae, Gluteus
allow for differences in strength to be recorded Maximus
over time Transfers and Squats Gluteus Maximus,
• May require use of a Dynamometer Medius and Obturator
Externus, Piriformis,
Quadriceps
Ambulation and Stair Abdominals, Erector
Climbing Spinae, Gluteus
Maximus and Medius,
Obturator Externus,
Piriformis, Quadriceps,
and Anterior Tibialis and
Gastrocsoleus
Floor Transfers Abdominals, Erector
Spinae, Gluteus
Maximus and Medius,
Obturator Externus,
Piriformis, Quadriceps,
and Anterior Tibialis and
Gastrocsoleus
Fast Gait and JUmping Gastrocsoleus, Gluteus
Maximus and Medius,
Quadriceps
Functional Testing
• An analysis of any functional task shows that Limitations of Manual Muscle Testing
movements are multiplanar and asymmetrical, • Population Variation
incorporate rotation, and are speed and • Objectivity Validity and Reliability
balance dependent
• Sensitivity
• Observation of the individual performing the
• Diagnostic Validity
functional task is the only way to accurately
test functional ability. • Ceiling Effect
• Tester Strength
Screening Tests Introduction
• Observe the patient as he or she enters the
treatment area to detect gross abnormalities • If you are resisting elbow flexion, then resist at
of gait or other aspects of mobility. the volar aspect of forearm then resist for
• Observe the patient doing other everyday flexion
activities such as rising from a chair, • If makakatanggap siya ng resistance then
completing admission or history forms, or pwedeng mag bigay ng 5 for maximal
removing street clothing. resistance and so on.
• Ask the patient to walk on the toes and then on • If from step 1, the patient do AROM then they
the heels. can’t do action against gravity, then you need to
• Ask the patient to grip the therapist's hand. move the patient where the gravity minimize
where they will do action
Topic/s | Page 3 | 4
| PRINCIPLES OF PT EVALUATION |
OPT 2103 | OPT 2103.1 Prof. Lacsamana, Prof. Imam | BSPT 2-2
• Like side lying, the do elbow flexion, or put it on
the table then do elbow flexion.
• You won’t expect the patient to have a grade 1 if
they could do a movement even though it is not
a full range. But, if the patient can do partial
ROM then grade 2
• If there’s some palpable contraction, grade 1
• No activity, grade 0
• The principles you need to observe is same to all
muscle groups
• Need to have muscle groups to to test, need to
know all the muscle groups so that you can Contributors
have an idea to where you can palpate.
Mikke Latorza Emanuel John Rosales
• Know where to begin, when you go up from
grade 3 or from go down from grade 3 Patrick Iglesias Ma. Gelicka Javier
Topic/s | Page 4 | 4
