Skeletal Muscle

 Human body contains over 400 skeletal muscles

 40-50% of total body weight
 Functions of skeletal muscle
 Force production for locomotion and breathing
 Force production for postural support
 Heat production during cold stress
Structure of Skeletal Muscle:
Connective Tissue Covering
 Epimysium (upon, outside)
 Surrounds entire muscle
 Perimysium (around)
 Surrounds bundles of muscle fibres
 Fascicles (bundle)
 Endomysium (within)
 Surrounds individual muscle fibres
Structure of Skeletal Muscle:
Microstructure
 Sarcolemma (flesh – husk)
 Muscle cell membrane
 Myofibrils (muscle – fibres)
 Threadlike strands within muscle fibres
 Actin (thin filament)
 Troponin
 Tropomyosin
 Myosin (thick filament)
Structure of Skeletal Muscle:
The Sarcomere
 Further divisions of myofibrils
 Z-line
 A-band
 I-band
 Within the sarcoplasm
 Sarcoplasmic reticulum
 Storage sites for calcium

 Transverse tubules
 Terminal cisternae
Muscular Contraction
 The sliding filament model
 Muscle shortening occurs due to the movement of the
actin filament over the myosin filament
 Formation of cross-bridges between actin and myosin
filaments
 Reduction in the distance between Z-lines of the
sarcomere
Types of Muscle Contraction
 Isometric
 Muscle exerts force without changing length
 Pulling against immovable object
 Postural muscles
 Isotonic (dynamic)
 Concentric
 Muscle shortens during force production

 Eccentric
 Muscle produces force but length increases
Isotonic and Isometric Contractions
Grade 5 (Normal) : Pasien dapat menggerakkan atau
mempertahankan posisi anggota tubuh melawan gravitasi
dan tahanan maksimal.
Grade 4 (Good) : Pasien dapat menggerakkan atau
mempertahankan posisi anggota tubuh melawan gravitasi
dan tahanan minimal sampai sedang.
Grade 3 (Fair) : Pasien hanya dapat menggerakkan atau
mempertahankan posisi anggota tubuh melawan
gravitasi. Tidak bisa melawan tahanan minimal sekalipun.
Grade 2 (Poor) : Pasien bisa menggerakkan anggota
badannya sesuai ROM bila gaya gravitasi dikurangi (butuh
tenaga bantuan)
Grade 1 (Trace) : Pasien tidak bisa menggerakkan anggota
tubuhnya sama sekali, namun ada kontraksi otot, baik
yang terlihat maupun teraba.
Grade 0 (Zero) : Tidak ada kontraksi otot, baik dari inspeksi
maupun palpasi.
Sering ditambahkan tanda (+) atau (-) untuk menjelaskan
keadaan yang berada di antara dua grade di atas.
The Break Test
Tahanan diberikan pada anggota tubuh setelah mencapai ROM
maksimal atau pada posisi di mana otot yang diuji bekerja
paling maksimal.

Active Resistance Test

Tahanan diberikan bersamaan dengan gerakan anggota tubuh,
ditingkatkan perlahan seiring gerakan.
Butuh keahlian dan pengalaman → subyektif

Tahanan tidak boleh diberikan secara tiba-tiba atau tidak stabil.

Harus perlahan dan gradual → memberi waktu untuk mencapai
intensitas toleransi maksimum.
Diberikan pada dekat ujung distal dari segmen ekstrimitas
di mana otot menempel.
Kecuali pada:
 Hip abductors : seharusnya di distal femur di atas lutut
→ diberikan di ankle.
 Vertebroscapular muscles: seharusnya di scapula →
diberikan di lengan.
 Kontraindikasi pada area distal : nyeri atau luka.
1. Kontraktur sendi
2. Nyeri
3. Spastisitas
4. Histeria dan Malingering
MMT Table
Function of Muscle Grade Symbol
None 0 0
Trace muscle contraction 1 T
seen or felt, no movement
of the limb
Gravity eliminated, less 2- P-
than 50% ROM
Gravity eliminated; 2 P
greater than 50% but less
than 100% ROM
Gravity eliminated, full 2+ P+
ROM
Against gravity, less than 3- F-
50% ROM
Against gravity greater 3 F
than 50% but less than
100% ROM
 Function of Muscle Grade Symbol
Against gravity, full 3+ F+
ROM
Against gravity, full 4- G-
ROM holds against
minimal
resistance
Against gravity, full 4 G
ROM holds against
moderate
resistance
Against gravity, full 4+ G+
ROM holds against
maximal
resistance
Against gravity, full 5 N
ROM cannot be broken