MUSCLE TEST
THE GRADING
SYSTEM
By- Rituraj Rastogi
ALPINE SKI HOUSE
INTRODUCTION
Manual muscle testing is used to determine the extent and degree of
muscular weakness resulting from disease, injury or disuse. The
records obtained from these tests provide a base for planning
therapeutic procedures and periodic re-testing. Muscle testing is an
important tool for all members of health team dealing with physical
residuals of disability.
ALPINE SKI HOUSE 2
DEFINITION OF MMT
• Manual muscle test (MMT) is a procedure
for the evaluation of strength of individual
muscle or muscles group, based upon the
effective performance of a movement in
relation to the forces of gravity or Manual
Resistance through the available Range of
motion (ROM).
• MMT is the most vital part of motor
assessment performed in Medical
Examination.
ALPINE SKI HOUSE 3
PURPOSES AND
USES OF MMT:
CLINICAL USES :
i. The severity of problem can be understand. (It is
diagnostic Tool)
ii. We can planning our treatment goals.
iii. Determine the extend & degree of muscular
weakness resulting from disease, injury.
iv. Correlating muscle picture with in level
innervations (myotoms) .
v. MMT is an Important tool for all the members of the
Rehabilitation team.
vi. Prevents deformities by locating problem areas.
vii. Help and Evaluate effectiveness of treatment to the
therapist. ALPINE SKI HOUSE
THE GRADING
SYSTEM
Grades for a manual muscle test are recorded as
numerical scores ranging from zero (0), which
represents no activity, to five (5), which represents a
"normal" or best-possible response to the test or as
great a response as can be evaluated by a manual
muscle test. Because this text is based on tests of
motions rather than tests of individual muscles, the
grade represents the performance of all muscles in that
motion.
The 5 to 0 system of grading is the most commonly
used convention. Each numerical grade can be paired
with a word that describes the test performance in
qualitative terms. These qualitative terms, when
written, are capitalized to indicate that they too
represent a score. This does not mean that the test
grades are quantitative in any manner.
ALPINE SKI HOUSE 5
THE GRADING
SYSTEM
ALPINE SKI HOUSE 6
INDICATIONS
OF MMT
1)Lower Motor Neuron (LMN) Disease.
2) Some other Neurological (Neuromuscular )disease.
Such as,
• Multiple Sclerosis
• Muscular dystrophy
• Amyotropic Lateral Sclerosis
• Myasthenia Gravis.
• Guillian - barre syndrome (GBS), etc....
3) Some Musculoskeletal disorders. ALPINE SKI HOUSE 7
CONTRAINDICATIONS
OF MMT
1) Cerebral Palsy
2) Cardio vascular disease / Brain injury
3) Dislocated/ unhealed fracture
4) Myositis ossifications
5) Parkinson’s disease
6) Pain
7) Inflammation /(inflammatory disease in muscles
and or joints)
8) Severe cardiac & respiratory disease .
ALPINE SKI HOUSE
THE GRADE 5
(NORMAL) MUSCLE
Position of Patient: Prone with head off end of table. Arms at sides.
Position of
Therapist: Standing next to patient's head. One hand is placed over
the parietooccipital area to give resistance, which is directed both
down and forward. The other hand is below the chin, ready to catch
the head if muscles give way during resistance.
Test: Patient extends head and neck through available range of
motion by lifting head and looking up. Instructions to Patient: "Lift
your head and look at the ceiling. Hold it. Don't let me push your
head down."
ALPINE SKI HOUSE
THE GRADE 5 (NORMAL) MUSCLE
Neck extension 4and5 degree
Grade 5 (Normal): Patient completes
available range of motion against
maximal resistance.
ALPINE SKI HOUSE
THE GRADE 5 (NORMAL) MUSCLE
Neck flexion 4and5 degree
Grade 5 (Normal): Patient completes available
range of motion and tolerates strong resistance.
(This combined flexion test is stronger than the
capital or cervical component alone.)
ALPINE SKI HOUSE
THE GRADE 4
(GOOD) MUSCLE
Position of Patient: Prone with head off end of table. Arms at
sides. Position of
Therapist: Standing next to patient's head. One hand is placed
over the parietooccipital area to give resistance, which is directed
both down and forward. The other hand is below the chin, ready
to catch the head if muscles give way during resistance.
Test: Patient extends head and neck through available range of
motion by lifting head and looking up. Instructions to Patient: "Lift
your head and look at the ceiling. Hold it. Don't let me push your
head down."
ALPINE SKI HOUSE
THE GRADE 4 (GOOD) MUSCLE
Neck extension 4and5 degree
Grade 4 (Good): Patient
completes available range of
motion against moderate
resistance.
ALPINE SKI HOUSE
THE GRADE 4 (GOOD) MUSCLE
Neck flexion 4and5 degree
Grade 4 (Good): Patient completes available
range of motion and tolerates moderate
resistance.
ALPINE SKI HOUSE
THE GRADE 3 (FAIR)
MUSCLE
Position of Patient: Supine with head supported on table.
Arms at sides.
Position of Therapist: Standing at side of table at about
chest level. No resistance is given to the head motion. In
the presence of trunk weakness, the thorax is stabilized.
Test: Patient flexes neck with chin tucked until the
available range is completed. Instructions to Patient:
"Bring your chin up on your chest. Don't raise your
shoulders."
ALPINE SKI HOUSE 15
THE GRADE 3 (FAIR) MUSCLE
Neck extension 3 degree
Grade 3 (Fair): Patient completes available range of
motion without resistance except that of gravity.
Alternate Test for.
Grade 3: This test is used when the patient has
trunk or hip extensor weakness. The test is identical
to the previous test except that stabilization of the
upper back is provided by the therapist
ALPINE SKI HOUSE
THE GRADE 3 (FAIR) MUSCLE
Neck flexion 3 degree
Grade 3 (Fair): Patient completes available range
of motion without resistance.
ALPINE SKI HOUSE
THE GRADE 2
(POOR) MUSCLE
Position of Patient: Patient prone with head
fully supported on table. Arms at sides.
Position of Therapist: Standing next to patient's
upper trunk. Both hands on cervical region and
base of occiput for palpation.
Test: Patient attempts to raise head and look
up. Instructions to Patient: "Try to raise your
head off the table and look at the ceiling."
ALPINE SKI HOUSE 18
THE GRADE 2 (POOR) MUSCLE
Neck extension 2degree
Grade 2 (Poor): Patient moves through
partial range of motion.
ALPINE SKI HOUSE
THE GRADE 2 (POOR) MUSCLE
Neck flexion 2 degree
Grade 2 (Poor): Patient completes partial
range of motion.
ALPINE SKI HOUSE
GRADE 1 (TRACE)
MUSCLE
Position of Patient: Patient prone with head
fully supported on table. Arms at sides.
Position of Therapist: Standing next to patient's
upper trunk. Both hands on cervical region and
base of occiput for palpation.
Test: Patient attempts to raise head and look up.
Instructions to Patient: "Try to raise your head
off the table and look at the ceiling."
ALPINE SKI HOUSE 21
GRADE 0 (ZERO)
MUSCLE
Position of Patient: Patient prone with head
fully supported on table. Arms at sides.
Position of Therapist: Standing next to patient's
upper trunk. Both hands on cervical region and
base of occiput for palpation.
Test: Patient attempts to raise head and look up.
Instructions to Patient: "Try to raise your head
off the table and look at the ceiling."
ALPINE SKI HOUSE 22
GRADE 0 (ZERO) MUSCLE
Sternoclidomastoid 0 degree
Grade 0 (Zero): No palpable activity in
muscles.
ALPINE SKI HOUSE
GRADE 0 (ZERO) MUSCLE
Neck flexion 0 degree
Grade 0 (Zero): No palpable activity in
muscles.
ALPINE SKI HOUSE
THANK
YOU
ALPINE SKI HOUSE
