MMT (Mannual Muscle Testing): Basics

MMT is a procedure for the evaluation of strength of individual muscle or muscle group, based upon the effective performance of a movement in relation to the forces of gravity or manual resistance through the available ROM.

MMT


Manual Muscle Testing (MMT) is a highly reliable method for assessing strength. Mmt is the most vital part of motor assessment perforn in medical examination.

Muscle testing is an important evaluative tool to assess impairments and deficits in muscle performance, including Strength, Power, or Endurance.

Strength 

Strength is defined as the ability of specific groups of muscle that produces max force to overcome a resistance within a single exertion.

Power 

 Power is defined when a group of muscle is able to produce maximal force in a short amount of time possible.

Endurance 

Endurance is defined as a group of muscles that can generate sub-maximal force over a sustain amount of time or through repeated movements.

Mannual Muscle Testing

Clinically Aim of MMT

  • To get an overview of muscle performance status so that the cause of the problem can be understood.
  • After understanding of problem, can set our treatment goal Like- Need strengthen exercise or flexor exercise etc.
  • Monitoring of condition i.e., Patient is getting better or getting worst within the time.
  • Co-relating its picture with its level of innervation (myotomes).

Why MMT is Performed 

To get some answer such as:

  • Is a particular muscle normal ?
  • Is a muscle weak if yes (how much) ?
  • It is strong enough (how much) ?
  • It is weak on both sides (bilateral symmetrical)
  • It is weak on one side (unilateral)
  • Is proximal muscle are weaker than distal one ?
  • Is distal muscle are weaker than proximal one ?

CRITERIA FOR ASSIGNING A MUSCLE TEST GRADE 

Subjective factors

Include the examiner's impression of the amount of resistance to give before the actual test and then the amount of resistance the patient actually tolerates during the test.

Objective factors

  • Patient can perform full ROM.
  • Patient can hold their affected part if it placed there.
  • Patient can perform movement against gravity.

Muscles Grading System In MMT

Grades are recorded as numerical scores rang from zero (0) (which can show that “ No Activity”) to five (5) ( which can show that “Normal”).


Manual Muscle Testing Grading System



Grading Scale Range: 0 to 5
0
  • None
  • No visible or palpable contraction
    1
  • Trace
  • Visible or palpable contraction with no motion ( a 1 )
    2
  • Poor
  • Full ROM gravity eliminated
    3
  • Fair
  • Full ROM against gravity
    4
  • Good
  • Full ROM against gravity, moderate resistance
    5
  • Normal
  • Full ROM against gravity, maximul resistance


    MMT

    Grde 5 ( Normal ) 

    • The examiner should test normal muscles at every opportunity, especially when testing the contralateral limb in a patient with a unilateral problem.
    • In almost every instance when the examiner cannot break the patient's hold position, a grade of 5 (Normal) is assigned.
    • This value must be accompanied by the ability to complete a full range of motion or maintain end-point range against maximal resistance.


    Grde 4 ( Good ) 

    • Used to designate a muscle group that is able to complete a full range of motion against gravity and can tolerate strong resistance without breaking the test position.
    • The Grade 4 muscle "gives " or "yields" to some extent at the end of its range with maximal resistance.
    • When maximal resistance clearly results in a break, the muscle is assigned a grade of 4 (Good).

    Grde 3 ( fair ) 

    • The muscle or muscle group can complete a full range of motion against only the resistance of gravity.
    • If a tested muscle can move through the full range against gravity but without applying any resistance, and when mild resistance applying ,it causes the motion to break, the muscle is assigned a grade of 3 (Fair).
    • Examiner must be sure that muscle given a grade 3 are not in joint locked position during the test. Eg, Locked elbow when testing elbow extension.


    Grde 2 ( Poor )

    • Muscle can complete the full range of motion in a position that minimizes the force of gravity.
    • This position often is described as the horizontal plane of motion.


    Grade 1 ( Trace )

    • Can detect visually or by palpation some contractile activity in one or more of the muscles that participate in the movement being tested.
    • The examiner also may be able to see or feel a tendon pop up or tense as the patient tries to perform the movement.
    • The examiner should passively move the part into the test position and ask the patient to hold the position and then relax;
    • Examiner can palpate the muscle or tendon, or both, during the patient's attempts to contract the muscle and also during relaxation.

    Grade 0 ( Zero )

    • Muscle is completely quiescent on palpation or visual inspection.
    • No palpation , No contraction


    Rules of testing 

    • Patient position
    • Joint position
    • Check the available passive range of joint
    • Demonstrate desired movement
    • Do not change patient position repeatedly

    Hand Placement

    Hand placement


    Proximal

    At origin of muscle and proximal joint giving stabilization.

    Distal

    Offering resistance or assistance depending upon performance .

    Indication

    • Hemiplegia ( paralysis one side of body )
    • Paraplegia ( paralysis in both lower limb, hips)
    • Diplegia ( affect similar body parts like, both arm or both legs )
    • Monoplegia (paralysis of single area of body , one limb)
    • Quadriplegia ( all four limb affected)
    • Bells palsy
    • GB syndrome (Guilain – Barre :- immune system attack on healthy nerve cells in PNS)
    • Muscular dystrophy ( group of inherited disease that damage and weaken muscle due to the lack of Dystrophin protein)



    Contraindication


    • Fracture
    • Osteomyelitis
    • Hernia
    • CVD
    • Subluxation
    • Dislocation

    Dr Rohit Bhaskar, Physio
    Dr Rohit Bhaskar, Physio Dr. Rohit Bhaskar, Physio is Founder of Bhaskar Health and Physiotherapy and is also a consulting physiotherapist. He completed his Graduation in Physiotherapy from Uttar Pradesh University of Medical Sciences. His clinical interests are in Chest Physiotherapy, stroke rehab, parkinson’s and head injury rehab. Bhaskar Health is dedicated to readers, doctors, physiotherapists, nurses, paramedics, pharmacists and other healthcare professionals. Bhaskar Health audience is the reason I feel so passionate about this project, so thanks for reading and sharing Bhaskar Health.

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