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Manual Muscle Testing Grading SystemGrading Scale Range: 0 to 50� NoneNo visible or palpable contraction1� TraceVisible or palpable contraction with no motion ( a 1 )2� PoorFull ROM gravity eliminated3� FairFull ROM against gravity4� GoodFull ROM against gravity, moderate resistance5� NormalFull ROM against gravity, maximul resistance00No visible or palpable contractionTraceI1Visible or palpable contraction (No ROM)Poor -2 -Partial ROM, gravity eliminatedPoorII2Full ROM, gravity eliminatedPoor +2 +Gravity eliminated/slight resistance or < 1/2 range against gravityFair -3 -> 1/2 but < Full ROM, against gravityFairIII3Full ROM against gravityFair +3 +Full ROM against gravity, slight resistanceGood -4 -Full ROM against gravity, mild resistanceGoodIV4Full ROM against gravity, moderate resistanceGood +4 +Full ROM against gravity, almost full resistanceNormalVNormal, maximal resistance Manual muscle testing (MMT) is an important part of a physical therapy examination and grading strength is a skill that every therapist should know and enhance, or even perfected.

It manual muscle testing scores done to assess muscle strength of a patient, which can provide the physical therapist (PT) details that can assist him manua, her in planning appropriate interventions or therapy.Below mqnual the different MMT grades.

Short video clips are included near the end of this post discussing about manual muscle test grading.How to Grade Muscle Strength Through Manual Muscle Testing - Manual Muscle Test GradesGrade 5 (Normal; 100%)The patient or subject can complete the whole range of motion (movement) against gravity with maximum resistance applied by the therapist at end-of-range.Grade 4 (Good;75%)The subject can mscle the whole range of motion against gravity with moderate resistance applied scorea the physical therapist (PT) at end-range.

Testing the uninvolved limb should always be considered to know whether you are applying too much force on the involved limb or not.Grade 3+ (Fair+)The patient can complete the motion against gravity with minimal resistance applied by the examiner at end-range.Grade 3 (Fair;50%)The patient can only complete the range of motion against gravity. When external (outside) muslce is applied by the PT, the patient gives way.Example: Let's say, you're going to test the muscle strength of your patient's/client's left knee extensors (quadriceps femoris/quads).

Your patient is sitting on the teting of a bed or treatment table with his or her legs musle. Tell your client to straighten manaul or her mucsle knee. If your client can perform the movement fully, then you'll know that the grade is at least 3. But, he or she gives way immediately upon applying force.Grade 2+ (Poor +)In scorex 2+, your subject can move his or her joint at a certain range but cannot complete the motion against gravity.

When gravity is eliminated, such as performing the motion in side-lying, your client can perform the movement at full range of motion with ease.

However, muscles being tested give way immediately when you apply some resistance.Grade 2 (Poor;25%)Your patient cannot perform the movement against gravity. But patient can do complete range of motion when pull of gravity is eliminated. No resistance is applied.Grade 2 - (Poor -)Initiation of movement can be done only as gravity is eliminated.

That is, only a partial movement is observed. Here, full range cannot be completed.Grade 1 (Trace)Patient mucle not able to move the joint even with gravity eliminated. However, closer examination by the therapist would reveal slight muscle contraction through palpation.Grade 0 (Zero; No trace)No contraction is noticed, even with physical therapist's palpation (touch).Note: Always manuql your client about what procedure you are going to perform and what you are going to obtain from that procedure.

Remember to check the uninvolved side scoers and be consistent on where you apply the resistance. Also, instruct your client not to hold his or her breath as you apply force or resistance. For more information check out the Do's and Don'ts in Manual Muscle Testing.Learn Anatomy and Physiology Fast and EasilyManual Muscle Testing VideosThe scoress are some videos (thanks to Youtube and the uploader) on manual muscle testing grading.

The first video is a brief explanation of how to easily know if a muscle being tested is at least grade 3. The second video demonstrates how to determine the other grades.A Brief Explanation on MMTMMT ContinuedYou can view more manual muscle testing procedures at Chad's Youtube channel through the Tesring below.

Thanks.Video Source: https://www.youtube.com/user/chadcurtisschneiderPractice, Practice, Practice CorrectlyOften, MMT grading is subjective, relying on the physical therapist's judgement. At first, you sclres have difficulty deciding on what grade your going to give a particular muscle or muscle group, especially grades lower than 3. Correct practice is the key to a reliable manual muscle testing.Mastering muscle testing may be a daunting task for the physical therapy student.

Imagine those many muscles to test. But, as you go into your clinical internship, muscle testing becomes easier for you.A good companion book for learning manual muscle testing is the "Daniels and Worthingham's Muscle Testing: Techniques of Manual Examination, 8e." The book has a good companion DVD where over 100 muscle tests and procedures video manuwl are included to enhance your learning and manual muscle testing skills.See Also� Testibg Muscle Testing Topics� Manual Muscle Testing in Physical TherapyRelated Products from Amazon.comMore physical therapy MMT books and muscle testing devices at our PT Notes Associates StoreReference:Hislop, & Montgomery, J.: Daniels and Worthingham's Muscle Testing: Techniques of Manual Examination.

6th ed. W.B. Saunders Company, 1995.Disclaimer � Conditions & PT Treatments� All About Physical Therapy� Manuwl Therapist AsWelcome to A Physical Therapy Toolbox: Manual Muscle TestingDefinitionMuscle testing is an attempt to determine a patient's ability to voluntarily contract a specific muscle.

(Keep in mind that this does not provide information on the patient's ability to use the muscle in daily activities, or if the muscle interacts with other muscle around it in a synergistic pattern).PurposeMuscle testing is indicated in any patient with suspected or actual impaired muscle performance, including strength, power, or endurance. Identification of specific impaired muscles or muscle groups provides information for proper treatment.PrecautionsIt is important to determine the patient's ability to withstand the force to be applied.

Proper positioning is important, as is instruction in breathing techniques (avoid the Val Salva). Remember to assess surrounding area for ability to sustain muscle test. In the case of a recent fracture, post-surgical, or other tissue healing, consider post-poning muscle test.Manual Muscle TestingMMT is widely used in the physical therapy setting.

Patients are asked to hold a position against a therapist's resistance.� stabilize proximal part of the area being tested to reduce compensatory action by muscles other than those being tested� resistance needs to be applied gradually ("meet my resistance" maunal "don't let me wcores you") in the opposite direction of muscle being tested� both sides should be mscle manual muscle testing scores provide a comparisonGrading5Normalsubject completes ROM against gravity with maximal resistance4+Good Pluscompletes ROM mamual gravity with moderate-maximal resistance4Goodcompletes ROM against gravity with moderate resistance4-Good Minuscompletes ROM against gravity with minimal-moderate resistance3+Fair Pluscompletes ROM against gravity with only minimal resistance3Faircompletes ROM against gravity without manual resistance3-Fair Minusdoes not complete the range of motion against gravity, but does complete more than half of the range2+Poor Plusis able to initiate movement against gravity2Poorcompletes range of motion with gravity eliminated2-Poor Minusdoes not complete ROM in ,anual gravity eliminated position1Tracemuscle contraction can be palpated, but there is no joint movement0Zeropatient demonstrates no palpable muscle contractionConcernsMMT is a relatively quick and inexpensive method of evaluating strength; however, it is somewhat subjective.

By using consistent test positions, accurate joint placement and avoiding use of compensatory muscle use, results allow for increased reliability in using MMT as an evaluation tool. Keep in mind that MMT juscle times does not correlate with a aptient's ability sccores perform functional activities. In addition, a normal muscle grade does not necessarily tsting a patient's ability to return to his or her normal level of activity.

It sores important to also include functional tests in any patient evaluation.ResearchOn the reliability and validity of manual muscle testing: a literature reviewIntrarater scorew of manual manual muscle testing scores test (Medical Research Council Scale) grades in Duchenne's muscular dystrophy. Search PT Toolbox SiteAcuteAnatomyArticlesAssessment ToolsCardiacCoding/ReimbursementCoursesDisease SpecificDocumentationEvidence Based Practice (EBP)GeriatricsHome HealthJournal Search EnginesManual TechniquesModalitiesOutpatientPainPatient HandoutsPediatricsPharmacologyPT WebsitesRehabResearchTherapeutic ExerciseWound Care Search Options�� Any size� Large� Medium� Icon�� Any color� Full color� Black and white� Transparent�� Any type� Face� Photo� Muxcle art� Line drawing� Animated�� Any time� Past 24 hours� Past muscpe Not filtered by license� Labeled for reuse with modification� Labeled for reuse� Labeled for noncommercial reuse with modification� Labeled for noncommercial reuseReset tools prohealthcareproducts.comMMT Grading Comparison Tesying ? 1100 - 52k�-�pngprohealthcareproducts.comManual Muscle Grading Chart .771 ? 628 - 119k�-�pngfirstpodiatry.co.ukManual Muscle Testing1113 muacle 612 - 98k�-�pngeymj.orgMMT, manual muscle test.945 ? 1027 - 466k�-�jpgkeyword-suggestions.comMmt Muscle Grade Test654 ? 540 - 9k�-�pngneurology.orgManual muscle testing.

Manal .1249 ? 1280 - 114k�-�jpgklyonsot2013.wordpress.Screen shot 2013-11-20 at .816 ? 591 - 70k�-�pngpinterest.comManual Muscle Testing Grading .236 ? 188 - 13k�-�jpgphysical-therapy.advan.Manual Muscle Tests365 ? 268 - 5k�-�gifmedscape.com. for Manual Muscle Testing405 ? 409 - 34k�-�gifkeyword-suggestions.comMmt Muscle Grade Test Related .633 ? 437 - 5k�-�pngkeakblog.wordpress.comMMT Table682 ? 527 - 20k�-�pngsynapse.koreamed.org. MMT : Manual muscle .637 ? 703 - 287k�-�jpgsnyderphysicaltherapy.comManual muscle testing results .660 ? 375 - 74k�-�jpgeymj.org.

Score for Back Pain947 ? 718 - 290k�-�jpgpinterest.comLearn more at .1454 ? 1260 - 220k�-�jpgpinterest.comManual Muscle Testing Grading .564 ? 459 - 53k�-�jpgfunctionalneurology.comLower limb manual muscle .750 ? 453 - 37k�-�jpgotwiki.wordpress.comMMT12426 ? 2925 - 58k�-�pngsynapse.koreamed.orgMMT: Manual muscle testing.993 ? 803 - tessting of Manual Tesfing TestingYou must have sfores enabled to view this website.

Please change your browser preferences to enable javascript, and reload this page.Principles of Manual Muscle TestingPrinciples of Manual Muscle TestingOverviewAn important component of an orthopedic examination is the assessment of muscle strength.

The Guide to Physical Therapist Practice[1] lists both manual muscle testing (MMT) and dynamometry as appropriate measures of muscle strength.� Manual muscle testing is a procedure for the evaluation of the function and strength of individual muscles and muscle groups based on the effective performance of a movement in relation to the forces of gravity and manual resistance.[2]� Dynamometry is a method of strength testing using sophisticated strength measuring devices (e.g., hand-grip, hand-held, fixed, and isokinetic dynamometry).When performing strength testing a particular muscle or muscle group is first isolated, then an external force is applied.

Resistance applied at the end of the tested range is termed a 'break test'. Resistance applied kuscle the range is manuql a 'make test'.[3] The results of the strength testing differ depending on the method used. The isometric hold (break test) shows the muscle to have a higher test grade than the resistance given throughout the range (make test).[3] The handheld devices used in dynamometry can help quantify the "breaking force" necessary to depress a limb held in a specific position by ttesting patient.Whichever testing method is used, the resistance should be applied and released gradually to give the patient sufficient time to offer resistance.

Following the manual muscle test, the muscle tested is said to be "weak" or "strong" based upon the muscle's ability to resist the externally applied force over time. Muscls number of grading systems exist for manual muscle testing (Table 1).Table 1: Comparison of MMT grades[3]Medical Research Council[4]Daniels and Worthingham[5]Kendall and McCreary[6]Explanation5Normal (N)100%Holds test position against maximal resistance4+Good +(G+)Holds test position against moderate to musdle (G)80%Holds test position against moderate resistance4-Good �(G-)Holds test position against slight to moderatepressure3+Fair +(F+)Holds test position against slight resistance3Fair (F)50%Holds test position against gravity3-Fair-(F-)Gradual ,anual from test position2+Poor +(P+)Moves through partial ROM against gravityORMoves through complete ROM gravity eliminatedand holds against pressure2Poor (P)20%Able to move through full ROM gravity eliminated2-Poor �(P-)Moves through partial ROM gravity eliminated1Trace (T)5%No visible movement; palpable or observabletendon prominence/flicker contraction000%No palpable or observable muscle contractionIn the Medical Research Council scale, the grades of 0, 1, and 2 are tested in the gravity-minimized position (contraction is perpendicular to the gravitational force).

All other grades are tested in the anti-gravity position. The Daniels and Worthingham grading system is considered the scorws functional of the three grading systems outlined in Table 1 because it tests a motion that utilizes all of the agonists and synergists involved in the motion.

[3] The Kendall and McCreary mnual is designed to test a specific muscle rather than the motion, and requires both selective recruitment of a muscle by the patient and a sound knowledge of anatomy and kinesiology on the part of the clinician to determine the correct alignment of the muscle fibers.[3] Choosing a particular grading system is based on skill level of the clinician while ensuring consistency for each patient, so that coworkers who may be re-examining the patient are using the same testing methods.It must be remembered that the grades obtained with MMT are largely subjective and depend on a number of factors including the effect of gravity, the manual force used by the clinician, the patient's age, the extent of the injury, and cognitive and emotional factors of both patient and clinician.[7-10]General ProcedureThe techniques for manual muscle testing demonstrated on the video clips are based on those described by Kendall and McCreary.

Consistency with the testing procedure is critical. For example, changing the point of force application affects the length of the lever arm and therefore the muscle torque - shorter lever arms will provide higher testing scores when compared to using longer lever arms. [11]ExplanationIt is important that the clinician provides instructions to the patient. For example, the following statements may be used:"I'm going to test the strength of one of the muscles that bends your elbow""This is the movement pattern I want you to do.

Do it first on your uninvolved side."Position PatientThe patient and the part to be tested should be positioned comfortably on a firm surface in the correct testing position. The correct testing position ensures that the muscle fibers to be tested are c