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At the completion of this chapter, the reader will be able to:

  1. Understand the importance of manual muscle testing

  2. Perform a gross muscle screening of a patient’s strength

  3. Perform specific manual muscle tests to the shoulder

  4. Perform specific manual muscle tests to the elbow

  5. Perform specific manual muscle tests to the wrist and forearm

  6. Perform specific manual muscle tests to the hand

  7. Perform specific manual muscle tests to the hip

  8. Perform specific manual muscle tests to the knee

  9. Perform specific manual muscle tests to the leg and foot

  10. Perform specific manual muscle tests of the trunk

  11. Describe the strengths and weaknesses of the various grading systems used with manual muscle testing

  12. Interpret the different results that can be obtained from a manual muscle test


Movement of the body or any of its parts involves considerable activity from the nervous and musculoskeletal systems. The nervous system provides cognition, perception, and sensory integration and is primarily involved in the control of movement, while the musculoskeletal system provides the power for movement. If a functional limitation is highlighted during the physical examination of the patient, the clinician must determine the cause of the functional and/or participation restrictions. If the cause is found to be poor muscle performance, a progression of exercises to enhance muscle performance must be initiated. Muscle performance can be assessed by measuring a number of parameters: strength, endurance, and power. A basic overview of the neurologic structures is provided in Chapter 4. This chapter provides an overview of the anatomy and physiology of the musculoskeletal system and then describes how the strength component of muscle performance can be assessed. The improvement of muscle strength is an integral component of most rehabilitation programs. Strength may be defined as the amount of force that may be exerted by an individual in a single maximum muscular contraction against a specific resistance, or the ability to produce torque at a joint.1 Manual muscle testing (MMT), performed grossly or specifically, is a simple way to assess the ability of a muscle, or a group of muscles, to perform a single maximum muscular contraction in an isometric fashion.


The three main types of muscle contraction are2:

  • Isometric. Isometric exercises provide a static contraction with a variable and accommodating resistance without producing any appreciable change in muscle length.

  • Concentric. A concentric contraction produces a shortening of the muscle such that the origin and insertion of the muscle move closer together. A muscle performs a concentric contraction when it lifts a load/weight that is less than the maximum tetanic tension it can generate.

  • Eccentric. An eccentric contraction occurs when a muscle slowly lengthens as it gives in to an external force that is greater than the contractile force it is exerting. In reality, the muscle does not lengthen; it merely returns from its shortened position to its normal ...

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