Spine MMT Practical

AIM – TO UNDERSTAND & PRACTICE THE MMT OF SPINE
MMT is method to determine the capability of muscle or muscle groups to function in movement or their ability to
provide stability and support i.e. the method to determine strength of a muscle
PREREQUITIS FOR ACCURATE MANUAL MUSCLE TESTING
• Make sure to communicate with the patient all the components of the test and the results you are looking
to obtain from the test.
• Work with the non-dominant (or non-injured) side first and keep consistent when applying pressure.
• Remind your patient to breathe naturally during the test, because breath holding can increase a forced
result.
• Make sure the patient is dressed in loose clothing and has full range of movement.
• Place the patient in an adequately supported position, so they are able to completely concentrate their
effort on the body part being test.
• Always test first in an antigravity position. If muscles are too weak to function against gravity, they are
then tested in the horizontal plane.
• Resistance needs to be applied directly opposite the “line of pull” of the muscles being tested.
• Plan out the test first, testing all the muscles that should be examined in one position before changing to
another. This reduces any inefficiency during testing and makes the most of treatment time.
• Always provide adequate stabilization to unrelated joint/s so as to avoid unnecessary compensation. For
example, stabilization of the shoulder will prevent extra movements when the patient is resisting elbow
bending (flexion).
• Always test both sides in order to compare strength or muscle grade of both limbs to get the most
accurate picture of strength and/or impairment.
MUSCLE TESTING PROCEDURES:
1. Explanation and instruction:
The therapist demonstrates and / or explains briefly the movement to be performed and / or passively
moves the patient's limb through the test movement.
2. Assessment of normal muscle strength:
The strength of the uninvolved limb should be initially assessed and recorded to determine the patient’s
normal strength and to demonstrate the movement before assessing the strength of the involved side, considering
the factors that affect strength.
3. Patient position:
The patient is placed in a certain position to isolate the muscle or muscle group to be tested in either
gravity elimination or against-gravity position. The patient should be comfortable and well supported. The muscle
or muscle group being tested should be placed in full outer range, with only slight tension.
4. Stabilization:
The site of attachment of the muscle origin should be stabilized, so the muscle has a fixed point from
which to pull. Substitutions and trick movements are avoided by making use of the following methods:
a) The patient's normal muscles: For example, the patient holds the edge of the plinth when hip flexion is tested
and uses the scapular muscles when gleno-humeral flexion is performed.
b) The patient's body weight: It is used to help fix the proximal parts (shoulder or pelvic girdles) during movement
of the distal ones.
c) The patient’s position: For example, when assessing hip abduction strength in side lying, the patient holds the
non-tested limb in hip and knee flexion in order to tilt the pelvis posteriorly and to fix the pelvis and lumbar spine.
d) External forces: They may be applied manually by the therapist or mechanically by devices such as belts and
sandbags.
e) Substitution and trick movements: When muscles are weak or paralyzed, other muscles may take over or
gravity may be used to perform movements normally carried out by the weak muscles.
GRADES
5 Normal Complete range of motion (ROM) against gravity with full resistance.
4 Good* Complete ROM against gravity with some resistance (reduced fine movements
and motor control)
3 Fair* Complete ROM against gravity but with no resistance.
2 Poor* Complete ROM with gravity eliminated.
1 Trace Evidence of slight contractility. No joint motion or inability to achieve complete
ROM with gravity eliminated.
0 Zero No evidence of contractility.
OBLIQUS INTERNUS ABDOMINUS
GRADE 0 and 1 supine
Left lower limb flexed, foot resting on table
Ask subject to raise left hemipelvis, rotating it towards right shoulder
Palpate the obliques internus abdominus above and medially to the anterior superior iliac spine contraction may be
witness during cough or expiration
Grade 0 –no contraction felt
Grade 1 – contraction is felt but there is no joint movement
Grade 2 – subject same position ( Refer Fig 1)
Ask subject to raise and rotate his left hemipelvis towards his right shoulder
Grade 2 complete if subject lifts his hemipelvis in incomplete range of movement
Fig 1 – Grade 2 Oblique Internus Abdominus
Grade 3
Same test performed in full range of movement
Grade 4 and 5
Same test against resistance
Hold right shoulder in place
Resistance to the movement is placed on the anterior aspect of the iliac creast
Grade 4 power is sub- normal
Grade 5 power is normal
INFRA UMBLICAL PORTION OF RECTUS ABDOMINUS
GRADE 0 AND 1 – Subject Supine
Lower limb flexed
Ask the subject to lift his feet
Palpate on each side of the linea alba between the infra umbilical and supra pubic regions
GRADE 2 Subject Supine
Lower limb are raised passively to 90 degree, lumber region of spine flattened on table
Examiner stabilize pelvis
Ask the subject to hold this position

Grade 3
Same test lower limb held at 60 degree ( Refer Fig 2)
Fig 2 – Grade 3 Infra Umblicus Portion of Rectus Abdominus
GRADE 4
lower limb held at 45 degree
Grade 5
Lower limb held just above the treatment table
MOVEMENT WHICH WERE DEMONSTRATED:-
• Supra Umblicus Portion Of Rectus Abdominus

• Oblique Externus Abdominus
• Transverse Abdominus
• Erector Spinae

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AIM – TO UNDERSTAND & PRACTICE THE MMT OF SPINE

PREREQUITIS FOR ACCURATE MANUAL MUSCLE TESTING

MUSCLE TESTING PROCEDURES:

1. Explanation and instruction:

2. Assessment of normal muscle strength:

GRADE 0 and 1 supine

Left lower limb flexed, foot resting on table

Ask subject to raise left hemipelvis, rotating it towards right shoulder

Grade 0 –no contraction felt

Grade 1 – contraction is felt but there is no joint movement

Grade 2 – subject same position ( Refer Fig 1)

Grade 2 complete if subject lifts his hemipelvis in incomplete range of movement

Fig 1 – Grade 2 Oblique Internus Abdominus

Same test performed in full range of movement

Same test against resistance

Hold right shoulder in place

Grade 4 power is sub- normal

Grade 5 power is normal

INFRA UMBLICAL PORTION OF RECTUS ABDOMINUS

GRADE 0 AND 1 – Subject Supine

Lower limb flexed

Ask the subject to lift his feet

GRADE 2 Subject Supine

Examiner stabilize pelvis

Ask the subject to hold this position

Same test lower limb held at 60 degree ( Refer Fig 2)

Fig 2 – Grade 3 Infra Umblicus Portion of Rectus Abdominus

lower limb held at 45 degree

Lower limb held just above the treatment table

MOVEMENT WHICH WERE DEMONSTRATED:-

• Supra Umblicus Portion Of Rectus Abdominus

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