Kendall Manual Muscle Testing Grades
Alacoque Whitchurch
Manual muscle testing is used in rehabilitation and recovery to evaluate contractile units, including muscles and tendons, and their ability to generate forces. When used as part of rehabilitation, muscle testing is an important evaluative tool to assess impairments and deficits in muscle performance, including strength, power, or endurance.
Identifying impairment in specific muscles or muscle groups is an important part in determining the course of rehabilitation which may include therapeutic exercise, manual therapy, bracing, or functional movement training.
Manual Muscle Testing(MMT) is a method diagnostic evaluation used by physical therapists, chiropractors, physiological researchers and others concerned with establishing effective treatment and tracking progress throughout a specific regimen. The evolution of current methods of manual muscle testing can be traced back to the early 1900s, when gravity tests were used to assess spinal nerve damage. Modern methods for doing physiological testing have adopted standard accepted procedures and grading systems that allow physicians to understand and communicate muscle testing findings.
Muscle testing can be performed using manual strength testing, functional tests, and dynamometry. Manual muscle strength testing is one of the most commonly used form of muscle testing by practitioners. With MMT, the patient is instructed to hold the corresponding limb or appropriate body part to be tested at a specific point in its available range of motion, working against gravity or while the practitioner provides opposing manual resistance to determine the grade to assign the muscle.
MMT is such an important part of a physical therapy examination and grading strength an invaluable skill that when performed appropriately can provide the rehabilitation practitioner necessary information which can assist him or her in planning appropriate interventions, modifications, or treatments. There are specific protocols to use when doing MMT to ensure accurate results.
In 1993, Florence Kendall and two other authors published a guide to performing muscle testing: Muscles: Testing and Function. Detailed below, published by the National Institute of Health is an adaptation from the discussion of muscle testing procedures found in that book, which established a widely accepted grading chart that can be used by physicians to assess patients.
Grade 3 (Fair) : The patient can complete the motion against gravity with no resistance applied by the practitioner. When conducting manual muscle testing this is the level in which the testing begins. If the patient is able to perform at this level, then move on to test for grade 4. If not able to complete this level of testing, then evaluate for grade 2 or lower.
Grade 2 (Poor) : This grade is given when a patient is able to only move through 50% of motion or less in an anti-gravity position (same position as grade 3) or is able to hold position against resistance in a position without gravity.
Advantages of isokinetic testing include the ability to maximally load the muscle throughout its range of motion; stabilization of proximal body parts to prevent substitute motions; measurement of concentric and eccentric loading; and objectivity. As in manual muscle testing, however, isokinetic testing does not necessarily provide an accurate picture of how a muscle will function during actual activities of daily living or sports. In addition, unlike manual muscle testing, it requires specific equipment. The advantages of hand-help and grip dynamometers include:
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Support for this study was provided by the Arthritis Health Professions Association, Arthritis Foundation, National Office, and NIH (NIAMS) Multipurpose Arthritis Center Grant No. AM 30692. The reliability of data gathered with hand-held dynamometers (HHD) and the relationship between HHD measurements and manual muscle tests (MMT) have been assessed only with healthy subjects and patients with neuromuscular disorders, not with homogeneous groups of patients with orthopaedic problems. In this study, HHD and MMT were used to measure the strength of knee extensor muscles of 43 patients with osteoarthritis. Test-retest reliability of HHD was determined, and the two testing systems were compared. The HHD measurements indicated that the knee extensor muscles were weak; the MMT grades indicated good strength. The HHD intraclass correlation coefficient for knee extensor strength measurements was 0.92. The HHD measurements increased as the MMT grades increased. The Kendall tau correlation coefficient between HHD measurements and MMT grades for the knee extensor muscles was 0.24. Hand-held dynamometry is less subjective than MMT, especially at the stronger grades. For the purpose of documenting progress of patients, HHD provides a reliable, quantitative method. The use of HHD with weak examiners, weak patients, and inadequate trunk stabilization is questionable. Hand-held dynamometry is useful for clinical and research settings where isokinetic testing is either unfeasible (ie., home care) or cost-prohibitive. J Orthop Sports Phys Ther 1992;16(3):145-149.
The manual muscle testing procedure was described in this power point, indications, contraindications, limitations of MMT was included. the MMT grading system (scale) was explained well in this PPT.Read less
When a child attends a physical therapy evaluation for a developmental concern (e.g. delayed walking), an orthopedic injury (e.g. sprained ankle), or a neurological condition (e.g. cerebral palsy), the pediatric physical therapist makes important clinical observations as part of the assessment process. From standardized tests, to medical history, to visual inspection, the physical therapy examination process is multi-fold and complex. While Manual Muscle Testing (MMT) is a tried and true method of measuring strength discrepancies in orthopedic and neurological cases in adults, isolating and grading muscle strength in children can be tricky and harder to standardize across practitioners and patients.
Adolescents can be tested using the adult standardized method of manual muscle testing. Depending on the scale used, examiners can give the muscle one of 10 grades and descriptions for strength, such as poor, fair, good, normal, etc. Because MMT is a standardized process, consistency of testing is critical. Muscles are thoroughly tested in gravity-lessened and against-gravity positions. Testing of the unaffected side is also important, to attain a normal baseline for the person being tested.
For further reading on MMT grades and procedures, consult the charts listed in the references provided. Manual Muscle Testing is used by physical therapists, physiatrists, orthopedists, and neurologists alike. It is an important part of the physical examination process. While used primarily in adults, children as young has 4 years of age can be tested using this method.
References:Kendall, F.P., E.K. McCreary, and P.G. Provance, Muscles: Testing and Function, in Posture and Pain. 1993, Baltimore: Williams & Wilkins.Dutton, M. Principles of Manual Muscle Testing, in Orthopedic Examination, Evaluation, and Intervention. Available at _view0/chapter8/manuaul_muscle_testing.html. Accessed July 6th, 2014.Palmer, M.L. and M. Epler, Principles of Examination Techniques, in Clinical Assessment Procedures in Physical Therapy, M.L. Palmer and M. Epler, Editors. 1990, JB Lippincott: Philadelphia. p. 8-36.
Muscle testing can be performed using manual strength testing, functional tests, and dynamometry. Manual muscle strength testing is one of the most commonly used forms of muscle testing used by occupational therapists. Manual muscle testing (MMT) tests the strength of individual muscles in isolation, as well as specific muscle groups.
Active-Assisted Exercise. The patient contracts their muscle, and the therapist or a mechanical device completes the entire ROM. Slings, pulleys, weights, springs, or elastic bands may be used to provide mechanical assistance. This exercise is graded by decreasing the amount of assistance until the patient can perform active exercises.
Example: Structure an activity to encourage the patient to lift his arm up in a vertical plane, against gravity. As the patient will not be able to achieve a complete ROM, place the goal at the highest level which the patient is able to reach.
Manual Muscle Testing(MMT) is an assessment method for the evaluation of muscle weakness used by physiotherapists, chiropractors, and other healthcare professionals to make an effective treatment plan and is also helpful in the progress of muscle strength throughout a specific regimen.
Manual Muscle Testing (MMT) is a vital part of medical examination.
MMT is a procedure for the evaluation of the strength of an individual muscle or muscle group, based on the effective performance of a movement in relation to the force of gravity or manual resistance through the available range of motion
i.e. How efficiently a muscle is working.
With Manual Muscle testing(MMT), the patient is informed to move the limb to be tested in its available range of motion, working against gravity or while the examiner gives opposing manual resistance to check the grade of the muscle.
Manual Muscle testing(MMT) is an essential part of a physiotherapy assessment and grading of muscle strength that help when performed properly. MMT can provide important information which can help therapists in planning appropriate interventions, modifications, or treatments. There are certain protocols to use when performing MMT to ensure quality results.
2. Active Resistance testing:
in manual muscle testing is when resistance is applied through the body part through the available range of motion. This type of manual muscle testing requires skill and experience and is not the recommended practice.