Manual Muscle Test (MMT)

MANUAL MUSCLE TEST
(MMT)
5) PRINCIPLES OF MMT:
1) Position
2) Stabilization
3) Demonstration
4) Application of Grades
5) Application of Resistance
6) Checking normal strength
7) Objectivity
8) Documentation
1) POSITION :
PATIENT POSITION:
 Patient is positioned Eliminated or Against gravity. (Patient depend upon testing
on muscle or muscles group).
 Do not change patient position repeatedly.
 The patient should be as free as possible from discomfort or pain for the duration
of each test. It may be necessary to allow some patients to move or be positioned
differently between tests.
 Patient position should be carefully organized so that position changes in a test
sequence are minimized. The patient' s position must permit adequate stabilization
of the part or parts being tested by virtue of body weight or with help provided by the
examiner.
JOINT POSITION:
 The joint position is also changed depend upon their
performance.
 Distal part of the joint is moved.
 Place the joint in Antigravity position- Grade 3
 Place the joint in Horizontal position – Grade 4
2) STABILIZATION :
 Patient could stabilizes our self during performed Antigravity position.
 The hand placement of the therapist is important.
H A N D PLACEMENT:
I. PROXIMAL H A N D – At Origin of muscle & proximal joint giving
stabilization.
II. DISTAL H A N D – Distally offering resistance or Assistance
depend upon
performance.
3) DEMONSTRATION:
 Demonstrate the desired movement.
 Therapist demonstrate the application of movement or performance to the
patient.
4) APPLICATIONS OF GRADES:
 Always start with GRADE 3 (If you start to examine the muscle power, first
you should test the grade 3).
 Isolation of muscle could be tested.
5) APPLICATIONS OF RESISTANCE:
 Resistance is applied slowly & gradually.
 Increasing or decreasing manual resistance.
 Increasing length of weight arm.
 Apply presence opposite to the line of pull (Grade 4,5)
 Apply force distally.
 It varies between the persons.
 Use long lever to applied resistance whenever it possible.
6) CHECKING NORMAL STRENGTH:
 Therapist to check the strength of the muscle normal side first.
7) OBJECTIVITY:
 Therapist ability to palpate and observe the tendon or muscle response in
very weak muscles.
8) DOCUMENTATION:
 Examiners complete testing documentation or Record first.
 This will help for next step of treatment applications.
 And help for checking improvement of treatment.
7) INDICATIONS OF MMT:
1) Lower Motor Neuron (LMN) Disease.

2) Some other Neurological (Neuromuscular )disease. Such as,
 Multiple Sclerosis
 Muscular distrophy
 Amyotropic Lateral Sclerosis
 Myasthenia Gravis.
 Guillian - barre syndrome (GBS), etc....
3) Some Musculoskeletal disorders.
8) 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 .
Cont.
9) Subluxation joint
10) Hemophelia
11) Osteoporosis
9) PRECAUTION:
1) Considered contraindications
2) Do not harm (Be gentle)
3) Respect pain
4) Examiner know the available ROM.
5) Follow the principles of procedure
6) Take care of patient comfort
7) Record accurately.
8) Extra care taken to giving Resisted Exercise.
Cont.
9) Abdomen surgery or hernia

10) Newly united fracture
11) Bony ankylosis
12) Hematoma
13) If patients take muscle relaxers and or pain medications
14) Prolonged immobilization
 Extra care must be taken where Resisted movements might
aggravate the condition:
 Patients with history at risk of having cardiovascular problems.
 Abdominal surgery or herniation of abdominal wall to avoid stress on the
abdominal wall.
 Fatigue exacerbate the patients condition.
 Patient with extreme debility, for example,
 Malnutrition
 Malignancy
 And Severe COPD.

10) LIMITATION OF MMT:
1) UMN LESIONS :
Spastic muscle have poor control from higher centers thus its better to go for
voluntary control assessment rather than MMT.
2)RESTICTED ROM DUE TO TCD’S (Transcranial Doppler) :
TCD’s can give faulty interpretation about MMT, thus in case always mention about
the MMT within available range along with Grade.
3) PRESENCE OF PAIN & SWELLING:
pain and swelling increases the intra articular tension causing irritation of
joint and can affect the MMT result, thus in case always mention about
presence of pain along with Grade.
4) TYPES OF CONTRACTION :
MMT gives idea about Quality of concentric contraction only. (Not
Eccentric which is more functional).
5) UNDERSTANDING OF COMMANDS:
 Paediatric Age group < 5 years
 IQ
 Higher functions.
6) STRENGTH Vs ENDURANCE:
MMT give knowledge about only the strength and not endurance.
7) Subjectivity (patient) HOOVERS sign
8) And following methods also Limit the MMT ;

 Showing the Co-ordination
 Showing pictures of gross / patient muscle contraction
 Showing the ability of client to use muscle power
 Showing the how much joint ROM the individual is working
through.
11) PROCEDURE:
1) Explanation & Instruction

2) Assessment of normal muscle strength
3) Properly positioned the patient
4) Stabilization
5) Substitution movements & Trick movements
6) Conventional methods
7) Alternating techniques.

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MANUAL MUSCLE TEST

1) Lower Motor Neuron (LMN) Disease.

9) Abdomen surgery or hernia

 And Severe COPD.

8) And following methods also Limit the MMT ;

1) Explanation & Instruction

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