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1. MANUAL MUSCLE TEST
(MMT)
(MUSCLE GRADING)
K ADHI LAKSHMI
BPT-2nd year,
VAPMS College of physiotherapy

2. SYNOPSE :
 INTRODUCTION
 DEFINITION
 GRADES OF MMT
 PRINCIPLES
 PROCEDURE
 INDICATIONS
 CONTRA INDICATIONS
 PRECAUTIONS

3. INTRODUCTION :-
 Manual muscle testing is used to determine the extent and degree of
muscle weakness resulting from disease, injury or disuse.
 The records obtained from these tests provide a base or 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.
 MMT is useful in differential diagnosis, prognosis and treatment of
NEUROMUSCULAR & MUSCULOSKELETAL disorders.
 Basic components of Motor Examination :-
1. Nutrition/Bulk of Muscle
2. Tone
3. Reflexes
4. ROM
5. MMT
6. Functional Assessment

4. GROUP OF MUSCLE ACTION :- AGONIST
ANTAGONIST
SYNERGIST
1. PRIMARY MOVERS/AGONISTS :- A Muscle/Muscle group that makes the major
contribution to movement at the joint.
2. ANTAGONIST :- A Muscle/Group of Muscles has an opposite action to the prime
movers. The Antagonists relaxes as the Agonist moves the part through a
ROM.

5. 3. SYNERGISTS :- Muscle that contracts & works along with the Agonist to produce
the desired movement.

6. DEFINITION :-
 MMT is the most vital part of Motor assessment
performer in medical examination.
 MMT is a procedure for the evaluation of strength of the
individual muscle or group muscle strength, based upon
the effective performance of a movement in relation to
the forces of gravity or MANUAL resistance through the
available ROM.

7. GRADES OF MMT :-
I. MRC Scale
II. OXFORD Scale
III. KENDALL Scale
IV. AND Others

8. MRC Scale EXPLANATION
0 No Contraction
1 Flickering Contraction
2 Full Range of Motion with eliminated gravity
3 Full Range of Motion with against gravity
4 Full ROM with against gravity with minimal resistance
5 Full ROM with against gravity with maximum resistance
MEDICAL RESEARCH COUNCIL
(MRC)SCALE :

9. OXFORD SCALE EXPLANATION
0 No Contraction is present
1 There is a flickering contraction
2 Full Range of Motion with gravity counter balance
*(Eliminated)
3 Full Range of Motion with against gravity
4 Full Range of Motion with against gravity
+added resistance
5 Muscle Function normally.
Oxford scale:-

10. KENDAL SCALE :-

11. + or – grades:-

14. CONTRA-INDICATION OF MMT :-
 Cerebral Palsy
 Pain
 Cardio vascular Disease / Brain Injury
 Dislocation
 Myositis Ossification
 Inflammation
 Parkinson’s Disease
 Severe Cardiac / Respiratory Disease
 Subluxation Joint
 Haemophilia
 Osteoporosis

15. 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

16. Position: (patient position)
1) patient is positioned eliminated or against gravity.
2) not change patient position repeatedly .
3) patient should be in comfortable position .
4) 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 examiner .

17.  Joint position
1) The joint position is also change depend upon their
performance.
2) Distal part of the joint is moved,
3) Place the joint in antigravity position –grade 3 .
4) place the joint in horizontal position –grade 4 .

19. Stabilization :
1) Patient could stabilizes our self during
performed antigravity position.
2) The hand placement of the patient is
important .
Hand placement :
1) Proximal hand – at origin of muscle and
proximal joint giving stabilization.
2) Distal hand – distally offering resistance or
assistance depend upon performance.

21.  Demonstration :
1) Demonstrate the desired movement
2) PT demonstrate the application of
movement or performance to the pt .
APPLICATIONS OF THE GRADES :
1) Always start with GRADE 3
2) Isolation of muscle could be tested .

22. APPLICATION OF RESISTANCE :
1) Resistance is applied slowly and gradually
2) Increasing or decreasing manual resistance
3) Increase length of weight arm
4) Apply presence opposite to the lie of pull
5) it varies between the person
6) Use long lever to applied resistance whenever is possible..

23.  CHECKING NORMAL STRENGTH :
Therapist to check the strength of the
muscle normal side first,
OBJECTIVITY :
Therapist ability to palpate and observe
the tendon or muscle response in very
weak muscle

24.  DOCUMENTATION :
1) Examiners complete testing documentation or
record first.
2) This will for next step of treatment application.
3) And help for checking improvement of treatment.

25. PROCEDURE :-

33. INDICATION OF MMT:
Lower motor neuron disease
Some other neurological disease such as:
 Multiple sclerosis
 Amyotropic lateral sclerosis
 Myasthenia grevis
 Guilian barre syndrome
Some musculo-skeltal disorder

34.  PRECAUTIONS :
1. Consider contraindications
2. Do not harm
3. Respect pain
4. Know the Available ROM
5. Follow the Principles of procedure
6. Comfortable Position
7. Record Accurately
8. Abdomen Surgery
9. Newly united Fractures
10.Ankylosis
11.Prolonged immobilization

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