Kendall Muscle Testing And Function
Martha Weitz
Anne M. Jensen does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
Muscle testing was first used in the early 20th century to measure muscle weakness in polio victims. Then, in 1949, Kendall and Kendall, two physiotherapists, described specific ways to test individual muscles for other neuromusculoskeletal conditions.
Other studies of kinesiology-style muscle testing, have found that practitioners were able to determine if a spoken statement was true significantly more accurately than guessing whether it was true (69% correct for muscle testing, 49% correct for guessing, p of less than 0.0001). These studies found accuracy had no connection with practitioner experience.
But further studies found that applied kinesiology was not able to predict nutritional needs, nutritional intolerance, thyroid dysfunction, exposure to practitioner-defined noxious stimulus, and chiropractic subluxation detection and correction.
Florence Kendall has dedicated nearly seventy years of her lifeto physical therapy. She played a major role in drafting theoriginal bill that was enacted into law in 1947, legallyestablishing the practice of physical therapy in Maryland. Shewas the Secretary to the Maryland State Board of PhysicalTherapy Examiners from 1969-70, a member of that Board from1971-74, and she has served as a consultant to the Board from1974-97.
Florence Kendall and her husband, Henry, have spent many yearstreating the victims of polio at Children's Hospital andtreating patients in their private therapy practice. Mrs.Kendall's work has set the standard for musculoskeletalevaluation and treatment. She has advanced the physical therapyprofession by working to establish physical therapy as aprofession in Maryland. Serving on the Maryland State Board ofPhysical Therapy Examiners as the Secretary, member, andconsultant, she has protected the citizens of Maryland. Ms.Kendall taught at the University of Maryland, School ofMedicine, Physical Therapy Department and was a Biomechanicsinstructor at the School of Nursing, Johns Hopkins Hospital. Shehas written numerous books and journal articles, and producededucational films. She continues to be a nationally acclaimedlecturer on physical therapy.
Her book, Muscle Testing and Function, originallypublished in 1949, is now in its fourth edition, and has beentranslated into eight foreign languages. A fiftieth anniversaryedition was published in 1999. This document is the "goldstandard" for musculoskeletal assessment. In addition, she hasproduced "Florence Kendall's Muscle Testing Video Library," afive part series evaluating the function and strength of musclesin the human body.
Mrs. Kendall is a founding member of the American PhysicalTherapy Association of Maryland and served as its President from1939-41 and 1957-59. She has been active in the APTA at theState and federal levels and has tirelessly provided years ofservice to the physical therapy profession. She has served as aconsultant to the Surgeon General, United States Army.
Florence Kendall continues to be one of this country's foremostphysical therapists. Her work as a clinician, researcher, andlecturer has earned her many awards and honorary degrees. InDecember 2000, the "Henry O. and Florence P. Kendall ConferenceRoom" was dedicated at the University of Maryland, School ofPhysical Therapy. The "Kendall Historical Collection" of booksat the University of Maryland Health and Human Services Librarywas dedicated in April 2000.
Florence Kendall is a role model for all physical therapists,but especially to women. She clearly demonstrates that a womancan be a good wife and mother, and at the same time be a leaderin her chosen profession. She generously shares her expertisewithin the health care community.
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:
muscle (n.) late 14c., from Middle French muscle "muscle, sinew" (14c.) and directly from Latin musculus "a muscle," literally "little mouse," diminutive of mus "mouse" (see mouse (n.)). So called because the shape and movement of some muscles (notably biceps) were thought to resemble mice. The analogy was made in Greek, too, where mys is both "mouse" and "muscle," and its comb. form gives the medical prefix myo- . Compare also Old Church Slavonic mysi "mouse," mysica "arm;" German Maus "mouse; muscle," Arabic 'adalah "muscle," 'adal "field mouse." In Middle English, lacerte, from the Latin word for "lizard," also was used as a word for a muscle. (Etymology Online )
This is a "must have" text for any human movement professional. Not only for descriptions of the tests themselves, but as a detailed reference for muscular anatomy, function, and common musculoskeletal complaints.
Manual Muscle Testing for an Active Population should likely be used to assess under-active muscles, refine the selection of activation and integration techniques , and as a means of re-assessing the effectiveness of the techniques selected.
The term "weak" relative to human movement science, assessment and intervention is a "poor choice" of terminology, because it implies a need for activation and/or strengthening. The quandary is that length/tension relationships dictate that both short and long muscles (over-active and under-active) muscles may test "weak", despite the propensity of short muscles to become over-active. Applying activation techniques to "weak" over-active muscles, may further exacerbate dysfunction rather than correct the "weakness" noted. For example, it is common to note "weakness" in the short hip flexors in those with an anterior pelvic tilt , despite the decrease in length. Does that imply they should be activated/strengthened? You may find it surprising, or counter-intuitive, but this muscle group will often test "strong" when release and lengthening techniques return normal extensibility and tone.
The Brookbush Institute recommends MMTs are applied to muscles that have been hypothesized as long/under-active based on gross movement assessment/dynamic postural assessment (overhead squat assessment ). For example, an individual exhibiting an anterior pelvic tilt, exhibits increased length and a decrease in activity of those muscles that would prevent excessive hip flexion. The gluteus maximus MMT could be used to confirm that hypothesis and reassess post intervention.
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