The manual muscle testing procedure was described in this power point, indications, contraindications, limitations of MMT was included. the MMT grading system (scale) was explained well in this PPT.
This document describes various mat activities (MAT) used in physical therapy. It discusses 9 principles of MAT including concentration, control, fluidity, etc. It then describes different MAT positions and exercises including rolling, prone on elbows, prone on hands, supine on elbows, pull ups, lifting, quadruped position, kneeling, and sitting. The goals of MAT are to facilitate balance, promote stability, mobilize and strengthen the trunk and limbs, and train for functional activities. Details are provided on how to perform several example MAT exercises and positions.
This document defines joint mobilization techniques and provides guidelines for their use. It describes mobilization as a manual therapy that uses passive joint movement to increase range of motion or decrease pain. Accessory joint movements like gliding and traction are explained. Precautions and contraindications for mobilization are outlined. A grading scale from I to V is presented to indicate the amplitude of oscillations used in different mobilization techniques.
This document discusses balance, fall prevention, and balance assessment and training. It defines balance as control of the center of mass over the base of support. Age-related changes and diseases that impact balance components are reviewed. Valid tools to measure balance include the Berg Balance Scale, Timed Up and Go test, and Functional Reach test. Balance training exercises discussed include calf stretches, heel/toe raises, soft surface stance, and exercises using movable surfaces like Swiss balls and tilt boards. Both hard and soft surfaces are used to challenge static and dynamic balance.
The document discusses goniometry, which is the measurement of joint angles using a goniometer. It outlines what goniometry is, the importance and types of goniometers, how to measure range of motion for various joints including the shoulder, wrist, hip and hand, and considerations for validity and reliability when performing goniometric measurements. Proper procedures and positioning for accurate goniometric assessment of different joints are described.
Joint mobilization refers to a technique of manual therapy by which a therapist applies a brief stretch of 30s or less through traction and gliding along a joint surface.
Frenkel exercises are a series of movements developed to treat patients with loss of proprioception. The exercises start simple and increase in difficulty, using visual and auditory cues to facilitate restoration of smooth, coordinated movement. Key principles are concentration, precision, and repetition of movements like limb motions and transfers of weight. Exercises progress from lying to sitting to standing positions and incorporate movement of the legs, arms, and whole body. The goal is to improve coordination, balance, proprioception and control through attention to rhythmic counting and placement of limbs in specific positions.
Suspension therapy involves suspending parts of the body in the air using ropes, slings, and other equipment attached to fixed points above. This allows for increased range of motion, muscle strengthening, and other benefits by reducing friction and gravity's effects. There are different types of suspension including vertical, axial, and pendular suspension, each providing support or movement in different ways. Various materials like ropes, slings, cleats, and frames are used to safely suspend and move body parts for therapeutic goals like improved flexibility, circulation, and muscle properties.
This document describes various mat activities (MAT) used in physical therapy. It discusses 9 principles of MAT including concentration, control, fluidity, etc. It then describes different MAT positions and exercises including rolling, prone on elbows, prone on hands, supine on elbows, pull ups, lifting, quadruped position, kneeling, and sitting. The goals of MAT are to facilitate balance, promote stability, mobilize and strengthen the trunk and limbs, and train for functional activities. Details are provided on how to perform several example MAT exercises and positions.
This document defines joint mobilization techniques and provides guidelines for their use. It describes mobilization as a manual therapy that uses passive joint movement to increase range of motion or decrease pain. Accessory joint movements like gliding and traction are explained. Precautions and contraindications for mobilization are outlined. A grading scale from I to V is presented to indicate the amplitude of oscillations used in different mobilization techniques.
This document discusses balance, fall prevention, and balance assessment and training. It defines balance as control of the center of mass over the base of support. Age-related changes and diseases that impact balance components are reviewed. Valid tools to measure balance include the Berg Balance Scale, Timed Up and Go test, and Functional Reach test. Balance training exercises discussed include calf stretches, heel/toe raises, soft surface stance, and exercises using movable surfaces like Swiss balls and tilt boards. Both hard and soft surfaces are used to challenge static and dynamic balance.
The document discusses goniometry, which is the measurement of joint angles using a goniometer. It outlines what goniometry is, the importance and types of goniometers, how to measure range of motion for various joints including the shoulder, wrist, hip and hand, and considerations for validity and reliability when performing goniometric measurements. Proper procedures and positioning for accurate goniometric assessment of different joints are described.
Joint mobilization refers to a technique of manual therapy by which a therapist applies a brief stretch of 30s or less through traction and gliding along a joint surface.
Frenkel exercises are a series of movements developed to treat patients with loss of proprioception. The exercises start simple and increase in difficulty, using visual and auditory cues to facilitate restoration of smooth, coordinated movement. Key principles are concentration, precision, and repetition of movements like limb motions and transfers of weight. Exercises progress from lying to sitting to standing positions and incorporate movement of the legs, arms, and whole body. The goal is to improve coordination, balance, proprioception and control through attention to rhythmic counting and placement of limbs in specific positions.
Suspension therapy involves suspending parts of the body in the air using ropes, slings, and other equipment attached to fixed points above. This allows for increased range of motion, muscle strengthening, and other benefits by reducing friction and gravity's effects. There are different types of suspension including vertical, axial, and pendular suspension, each providing support or movement in different ways. Various materials like ropes, slings, cleats, and frames are used to safely suspend and move body parts for therapeutic goals like improved flexibility, circulation, and muscle properties.
The document discusses proprioceptive neuromuscular facilitation (PNF), a technique developed by Herman Kabat that uses movements and patterns to improve neuromuscular function. It defines key PNF terms and outlines principles such as motor development occurring from head to toe. The basic procedures are described, including manual contacts, stretch, and maximal resistance. Upper and lower extremity diagonal patterns are explained along with their component motions. Rhythmic initiation is also summarized.
Russian current is a medium-frequency current delivered in bursts at 2500 Hz. It produces strong muscle contractions through synchronous motor nerve depolarization. Key characteristics include a carrier frequency of 2500 Hz, burst frequency of 50 Hz, burst duration of 10 ms, and a 10/50/10 training protocol. Russian current is indicated for muscle strengthening, reducing muscle spasm and edema, such as following knee ligament injuries or surgery.
This document defines and describes different types of passive range of motion (PROM) exercises. It begins by defining PROM as movements produced by an external force during muscular inactivity or reduced range of motion. There are three main types of PROM discussed: relaxed PROM, forced PROM, and continuous passive motion (CPM). Relaxed PROM is performed slowly through pain-free range by a therapist, while forced PROM exerts external force to end range. CPM uses a machine to passively move the joint continuously after surgery. The goals of PROM are to maintain range of motion, mobility, and prevent contractures while allowing for healing. Precautions are discussed as well as limitations compared to active exercises.
Joint mobilization is a manual therapy technique used to modulate pain, increase range of motion, and treat joint dysfunctions. It involves passive movement of joints and surrounding soft tissues at varying speeds and amplitudes. There are 5 types of joint movement - roll, slide, spin, compression, and distraction. Mobilization techniques are graded based on amplitude and location within the range of motion. Lower grades are used for pain modulation while higher grades aim to increase mobility. Proper positioning, stabilization, direction, and patient response are important considerations when applying mobilization.
Stretching involves applying tension to muscles and connective tissues to increase flexibility and range of motion. There are several types of stretching including static, cyclic, ballistic, PNF, and mechanical. The key factors in stretching are proper alignment, stabilization, low intensity, and long duration to minimize muscle resistance and maximize tissue elongation. Stretching can be done manually, through self-stretching exercises, or using mechanical devices.
suspension therapy in details with the principles, indications, benefits, advantages and disadvantages, materials required for performing activities using suspension techniques.
PNF is an exercise technique based on neurophysiological principles that uses resistance, manual contact, and stretching to facilitate muscle contraction and improve mobility through techniques like contract-relax, slow reversal, and rhythmic stabilization. It is commonly used in orthopedic and neurological rehabilitation to increase strength, flexibility, coordination and functional mobility through specific patterns targeting different areas of the body like the upper and lower extremities. Research has found PNF techniques are effective in rehabilitation of injuries to the knee, shoulder, and hip and its use has increased in ankle rehabilitation as well.
The document discusses principles of joint mobilization including using lower grades to reduce pain and higher grades to increase mobility. It outlines convex-concave rules for determining glide direction in different joints. Treatment glides are described to improve range of motion in various joints like the shoulder, knee, ankle and elbow. Open-packed positions and grades of movement are also defined. The goal of a joint mobilization treatment is to increase range of motion through appropriate gliding techniques.
This document provides an overview of posture, including definitions, types, mechanisms, patterns, principles of re-education, and presentation of good posture. It defines posture as the body's position either at rest or during movement. There are inactive postures for rest and active static and dynamic postures that require muscle coordination. Posture is maintained through complex reflexes involving muscles, eyes, ears, and joints. Good posture is efficient with minimal effort, while poor posture is inefficient and causes unnecessary muscle strain. Re-education of posture focuses on identifying and treating causes, gaining patient cooperation, relaxation/mobility exercises, and establishing new posture habits through repetition and education.
A chronicle on muscle strengthening:
MMT is a procedure for the evaluation of strength of individual
muscle or muscles group, based upon the effective performance of a movement in relation to the forces of gravity or manual resistance through the available ROM.
Functional re-education aims to retrain patients' movements and activities that they already know but cannot properly perform due to illness or injury. The goal is to increase independence through a tailored program of progressive exercises. Exercises may include rolling, sitting, kneeling, standing, and walking activities. Principles include thorough assessment, task-specific treatment, and avoiding discouragement to build confidence and independence over time.
this PPT contain detailed kinetics & kinematics of ankle joint & all joints of foot complex, muscles of ankle & foot complex, plantar arches & weight distribution during standing.
The document discusses gait and the gait cycle. It defines gait as a person's pattern of walking and notes walking patterns can differ between individuals. The gait cycle is defined as the period from one heel strike to the next heel strike of the same limb. The gait cycle consists of the stance phase, when the foot is on the ground, and the swing phase, when the foot is off the ground. Temporal and distance variables are used to analyze gait, including single limb support time, stride length, and degree of toe out. The document also reviews the kinematics and kinetics of normal gait.
- Stand behind patient
- Hold guarding belt posteriorly
- Provide support to trunk
Patient:
- Hold handrail with unaffected hand
- Place crutch/cane on step above
- Bring affected LE forward and place foot on step
- Bring unaffected LE forward and place foot on same step
- Repeat for each step
Descending stairs :-
• Therapist – postero-lateral on unaffected side
• Maintain wide BOS
• Take step only when patient is not moving
Patient:
- Hold handrail with unaffected hand
- Place crutch/cane on step below
- Bring unaffected LE back and place foot on step below
- Bring affected LE back and
The Faradic Galvanic (FG) test assesses lower motor neuron problems by stimulating muscles with different electric currents. A brief tetanic contraction indicates intact innervation, while a sluggish response suggests denervation. The test involves using faradic current to search for motor points and elicit fast contractions in innervated muscles. Galvanic current then produces slow contractions in denervated muscles. However, the FG test is inaccurate and unreliable, correctly interpreting muscle reactions in only 50% of cases.
The document provides information on different types of low frequency therapeutic currents, including:
1) Faradic current, which is a short-duration interrupted current ranging from 0.1-1 msec at 50-100 Hz, used to produce near normal muscle contraction and relaxation.
2) Galvanic current, which is a direct current that flows continuously in one direction, and an interrupted form used for denervated muscle stimulation.
3) Sinusoidal currents, which are evenly alternating 50 Hz waves similar to mains current, providing 100 pulses per second.
4) Diadynamic currents, which are variations of sinusoidal currents involving single or double-phase rectification of alternating current produced
Introduction , Muscle and Postural tone,Aim,Types :General and Local Relaxation,Additional methods of relaxation :Consciousness of breathing,PRE,Contrast method, Reciprocal method,passive movement and pendular swinging.
BIOMECHANICS OF HIP JOINT BY Dr. VIKRAMVicky Vikram
The hip joint is a ball-and-socket joint that allows flexion, extension, abduction, adduction, and rotation. It is formed by the acetabulum of the pelvis articulating with the femoral head. The primary function is to support the weight of the upper body. Key biomechanical aspects include the angles of inclination and torsion of the femur, congruence of the joint surfaces, and forces transmitted during weight bearing that are balanced by the joint capsule and trabecular bone structure. Motion occurs through tilting and rotation of the pelvis on a fixed femur. Surrounding muscles provide dynamic stability and control movement.
This document discusses interferential therapy (IFT), including its history, principles, instrumentation, applications, effects, and precautions. Some key points:
- IFT was developed in the 1950s and involves applying two medium frequency alternating currents slightly out of phase to produce a low frequency effect for therapeutic purposes.
- The interference of the currents produces an amplitude-modulated frequency that can stimulate tissues in a manner similar to low frequency electrotherapy.
- IFT is used for pain relief, muscle stimulation, increasing blood flow, and reducing edema through its physiological effects on tissues from 10-150 Hz.
- Proper electrode placement and current parameters are important to achieve the intended effects while avoiding contraindic
Manual Muscle Testing (MMT) is a clinical assessment technique used by healthcare professionals to evaluate the strength and function of individual muscles or muscle groups. It involves the systematic application of resistance while the patient contracts specific muscles, allowing the examiner to assess the muscle's ability to generate force and produce movement. Here's a detailed overview:
1. **Purpose**: MMT is used to:
- Identify muscle weakness or imbalance.
- Assess the extent and location of neuromuscular dysfunction.
- Monitor changes in muscle strength over time.
- Guide treatment planning and rehabilitation interventions.
2. **Procedure**:
- **Patient Positioning**: The patient is positioned appropriately to isolate and activate the muscle being tested.
- **Instruction**: Clear instructions are provided to the patient regarding the desired movement and level of effort.
- **Stabilization**: Adjacent joints or body segments may be stabilized to prevent compensatory movements.
- **Resistance Application**: The examiner applies resistance, typically manually, in the direction opposite to the muscle's action, gradually increasing it while the patient contracts the muscle.
- **Observation**: The examiner observes the quality of muscle contraction, noting factors such as initiation, strength, endurance, and any signs of fatigue or compensation.
- **Grading**: Muscle strength is graded on a scale ranging from 0 to 5:
- 0: No contraction detected.
- 1: Muscle flicker, but no movement.
- 2: Movement occurs, but not against gravity.
- 3: Movement against gravity, but not against resistance.
- 4: Movement against some resistance, but not full strength.
- 5: Full strength, normal movement against full resistance.
3. **Applications**:
- **Clinical Diagnosis**: MMT helps identify muscle weakness or dysfunction associated with various conditions, such as neuromuscular disorders, orthopedic injuries, and neurological impairments.
- **Treatment Planning**: Assessment findings from MMT guide the selection of appropriate therapeutic interventions, including strengthening exercises, manual therapy techniques, and functional training.
- **Rehabilitation Monitoring**: Serial MMT evaluations track changes in muscle strength and function during the rehabilitation process, informing progression and adjusting treatment goals as needed.
4. **Considerations**:
- **Reliability and Validity**: MMT results may vary based on factors such as examiner experience, patient cooperation, and testing conditions. Standardized protocols and repeated assessments can enhance reliability.
- **Limitations**: MMT may not be suitable for assessing deep muscles or muscles affected by pain, and results may be influenced by factors such as fatigue, motivation, and neurological impairment.
- **Clinical Judgment**: Interpretation of MMT findings requires clinical judgment,.
Manual muscle testing (MMT) is used to evaluate the strength of individual muscles or muscle groups. It involves applying resistance through the available range of motion to determine how effectively a muscle is working. MMT provides information about muscle strength, patterns of weakness, and whether a condition is improving or worsening over time. While subjective, MMT remains a vital part of motor assessment and can help clinicians understand the cause of problems and plan treatment goals like muscle strengthening exercises.
The document discusses proprioceptive neuromuscular facilitation (PNF), a technique developed by Herman Kabat that uses movements and patterns to improve neuromuscular function. It defines key PNF terms and outlines principles such as motor development occurring from head to toe. The basic procedures are described, including manual contacts, stretch, and maximal resistance. Upper and lower extremity diagonal patterns are explained along with their component motions. Rhythmic initiation is also summarized.
Russian current is a medium-frequency current delivered in bursts at 2500 Hz. It produces strong muscle contractions through synchronous motor nerve depolarization. Key characteristics include a carrier frequency of 2500 Hz, burst frequency of 50 Hz, burst duration of 10 ms, and a 10/50/10 training protocol. Russian current is indicated for muscle strengthening, reducing muscle spasm and edema, such as following knee ligament injuries or surgery.
This document defines and describes different types of passive range of motion (PROM) exercises. It begins by defining PROM as movements produced by an external force during muscular inactivity or reduced range of motion. There are three main types of PROM discussed: relaxed PROM, forced PROM, and continuous passive motion (CPM). Relaxed PROM is performed slowly through pain-free range by a therapist, while forced PROM exerts external force to end range. CPM uses a machine to passively move the joint continuously after surgery. The goals of PROM are to maintain range of motion, mobility, and prevent contractures while allowing for healing. Precautions are discussed as well as limitations compared to active exercises.
Joint mobilization is a manual therapy technique used to modulate pain, increase range of motion, and treat joint dysfunctions. It involves passive movement of joints and surrounding soft tissues at varying speeds and amplitudes. There are 5 types of joint movement - roll, slide, spin, compression, and distraction. Mobilization techniques are graded based on amplitude and location within the range of motion. Lower grades are used for pain modulation while higher grades aim to increase mobility. Proper positioning, stabilization, direction, and patient response are important considerations when applying mobilization.
Stretching involves applying tension to muscles and connective tissues to increase flexibility and range of motion. There are several types of stretching including static, cyclic, ballistic, PNF, and mechanical. The key factors in stretching are proper alignment, stabilization, low intensity, and long duration to minimize muscle resistance and maximize tissue elongation. Stretching can be done manually, through self-stretching exercises, or using mechanical devices.
suspension therapy in details with the principles, indications, benefits, advantages and disadvantages, materials required for performing activities using suspension techniques.
PNF is an exercise technique based on neurophysiological principles that uses resistance, manual contact, and stretching to facilitate muscle contraction and improve mobility through techniques like contract-relax, slow reversal, and rhythmic stabilization. It is commonly used in orthopedic and neurological rehabilitation to increase strength, flexibility, coordination and functional mobility through specific patterns targeting different areas of the body like the upper and lower extremities. Research has found PNF techniques are effective in rehabilitation of injuries to the knee, shoulder, and hip and its use has increased in ankle rehabilitation as well.
The document discusses principles of joint mobilization including using lower grades to reduce pain and higher grades to increase mobility. It outlines convex-concave rules for determining glide direction in different joints. Treatment glides are described to improve range of motion in various joints like the shoulder, knee, ankle and elbow. Open-packed positions and grades of movement are also defined. The goal of a joint mobilization treatment is to increase range of motion through appropriate gliding techniques.
This document provides an overview of posture, including definitions, types, mechanisms, patterns, principles of re-education, and presentation of good posture. It defines posture as the body's position either at rest or during movement. There are inactive postures for rest and active static and dynamic postures that require muscle coordination. Posture is maintained through complex reflexes involving muscles, eyes, ears, and joints. Good posture is efficient with minimal effort, while poor posture is inefficient and causes unnecessary muscle strain. Re-education of posture focuses on identifying and treating causes, gaining patient cooperation, relaxation/mobility exercises, and establishing new posture habits through repetition and education.
A chronicle on muscle strengthening:
MMT is a procedure for the evaluation of strength of individual
muscle or muscles group, based upon the effective performance of a movement in relation to the forces of gravity or manual resistance through the available ROM.
Functional re-education aims to retrain patients' movements and activities that they already know but cannot properly perform due to illness or injury. The goal is to increase independence through a tailored program of progressive exercises. Exercises may include rolling, sitting, kneeling, standing, and walking activities. Principles include thorough assessment, task-specific treatment, and avoiding discouragement to build confidence and independence over time.
this PPT contain detailed kinetics & kinematics of ankle joint & all joints of foot complex, muscles of ankle & foot complex, plantar arches & weight distribution during standing.
The document discusses gait and the gait cycle. It defines gait as a person's pattern of walking and notes walking patterns can differ between individuals. The gait cycle is defined as the period from one heel strike to the next heel strike of the same limb. The gait cycle consists of the stance phase, when the foot is on the ground, and the swing phase, when the foot is off the ground. Temporal and distance variables are used to analyze gait, including single limb support time, stride length, and degree of toe out. The document also reviews the kinematics and kinetics of normal gait.
- Stand behind patient
- Hold guarding belt posteriorly
- Provide support to trunk
Patient:
- Hold handrail with unaffected hand
- Place crutch/cane on step above
- Bring affected LE forward and place foot on step
- Bring unaffected LE forward and place foot on same step
- Repeat for each step
Descending stairs :-
• Therapist – postero-lateral on unaffected side
• Maintain wide BOS
• Take step only when patient is not moving
Patient:
- Hold handrail with unaffected hand
- Place crutch/cane on step below
- Bring unaffected LE back and place foot on step below
- Bring affected LE back and
The Faradic Galvanic (FG) test assesses lower motor neuron problems by stimulating muscles with different electric currents. A brief tetanic contraction indicates intact innervation, while a sluggish response suggests denervation. The test involves using faradic current to search for motor points and elicit fast contractions in innervated muscles. Galvanic current then produces slow contractions in denervated muscles. However, the FG test is inaccurate and unreliable, correctly interpreting muscle reactions in only 50% of cases.
The document provides information on different types of low frequency therapeutic currents, including:
1) Faradic current, which is a short-duration interrupted current ranging from 0.1-1 msec at 50-100 Hz, used to produce near normal muscle contraction and relaxation.
2) Galvanic current, which is a direct current that flows continuously in one direction, and an interrupted form used for denervated muscle stimulation.
3) Sinusoidal currents, which are evenly alternating 50 Hz waves similar to mains current, providing 100 pulses per second.
4) Diadynamic currents, which are variations of sinusoidal currents involving single or double-phase rectification of alternating current produced
Introduction , Muscle and Postural tone,Aim,Types :General and Local Relaxation,Additional methods of relaxation :Consciousness of breathing,PRE,Contrast method, Reciprocal method,passive movement and pendular swinging.
BIOMECHANICS OF HIP JOINT BY Dr. VIKRAMVicky Vikram
The hip joint is a ball-and-socket joint that allows flexion, extension, abduction, adduction, and rotation. It is formed by the acetabulum of the pelvis articulating with the femoral head. The primary function is to support the weight of the upper body. Key biomechanical aspects include the angles of inclination and torsion of the femur, congruence of the joint surfaces, and forces transmitted during weight bearing that are balanced by the joint capsule and trabecular bone structure. Motion occurs through tilting and rotation of the pelvis on a fixed femur. Surrounding muscles provide dynamic stability and control movement.
This document discusses interferential therapy (IFT), including its history, principles, instrumentation, applications, effects, and precautions. Some key points:
- IFT was developed in the 1950s and involves applying two medium frequency alternating currents slightly out of phase to produce a low frequency effect for therapeutic purposes.
- The interference of the currents produces an amplitude-modulated frequency that can stimulate tissues in a manner similar to low frequency electrotherapy.
- IFT is used for pain relief, muscle stimulation, increasing blood flow, and reducing edema through its physiological effects on tissues from 10-150 Hz.
- Proper electrode placement and current parameters are important to achieve the intended effects while avoiding contraindic
Manual Muscle Testing (MMT) is a clinical assessment technique used by healthcare professionals to evaluate the strength and function of individual muscles or muscle groups. It involves the systematic application of resistance while the patient contracts specific muscles, allowing the examiner to assess the muscle's ability to generate force and produce movement. Here's a detailed overview:
1. **Purpose**: MMT is used to:
- Identify muscle weakness or imbalance.
- Assess the extent and location of neuromuscular dysfunction.
- Monitor changes in muscle strength over time.
- Guide treatment planning and rehabilitation interventions.
2. **Procedure**:
- **Patient Positioning**: The patient is positioned appropriately to isolate and activate the muscle being tested.
- **Instruction**: Clear instructions are provided to the patient regarding the desired movement and level of effort.
- **Stabilization**: Adjacent joints or body segments may be stabilized to prevent compensatory movements.
- **Resistance Application**: The examiner applies resistance, typically manually, in the direction opposite to the muscle's action, gradually increasing it while the patient contracts the muscle.
- **Observation**: The examiner observes the quality of muscle contraction, noting factors such as initiation, strength, endurance, and any signs of fatigue or compensation.
- **Grading**: Muscle strength is graded on a scale ranging from 0 to 5:
- 0: No contraction detected.
- 1: Muscle flicker, but no movement.
- 2: Movement occurs, but not against gravity.
- 3: Movement against gravity, but not against resistance.
- 4: Movement against some resistance, but not full strength.
- 5: Full strength, normal movement against full resistance.
3. **Applications**:
- **Clinical Diagnosis**: MMT helps identify muscle weakness or dysfunction associated with various conditions, such as neuromuscular disorders, orthopedic injuries, and neurological impairments.
- **Treatment Planning**: Assessment findings from MMT guide the selection of appropriate therapeutic interventions, including strengthening exercises, manual therapy techniques, and functional training.
- **Rehabilitation Monitoring**: Serial MMT evaluations track changes in muscle strength and function during the rehabilitation process, informing progression and adjusting treatment goals as needed.
4. **Considerations**:
- **Reliability and Validity**: MMT results may vary based on factors such as examiner experience, patient cooperation, and testing conditions. Standardized protocols and repeated assessments can enhance reliability.
- **Limitations**: MMT may not be suitable for assessing deep muscles or muscles affected by pain, and results may be influenced by factors such as fatigue, motivation, and neurological impairment.
- **Clinical Judgment**: Interpretation of MMT findings requires clinical judgment,.
Manual muscle testing (MMT) is used to evaluate the strength of individual muscles or muscle groups. It involves applying resistance through the available range of motion to determine how effectively a muscle is working. MMT provides information about muscle strength, patterns of weakness, and whether a condition is improving or worsening over time. While subjective, MMT remains a vital part of motor assessment and can help clinicians understand the cause of problems and plan treatment goals like muscle strengthening exercises.
Basic concepts of Manual Muscle Testing (MMT)JebarajFletcher
Manual muscle testing is a procedure used to evaluate muscle strength. It involves manually applying resistance against a patient's movement through their available range of motion. There are several types of manual muscle tests including tests of individual muscles, muscle groups, and functional tests. The results are often graded on a scale like the Oxford scale. Manual muscle testing provides important information for diagnoses, evaluating treatment effectiveness, and tracking patient progress. It requires skill and standardization to obtain reliable results.
This document discusses muscle strength testing. It defines muscle strength as the maximal force a muscle can exert during contraction. Various methods are described to test muscle strength, including using devices like a cable tensiometer, strain gauge, or dynamometer, as well as manual muscle testing. The most common manual muscle testing scale ranges from 0 to 5, where 0 is no contraction and 5 is normal strength against maximum resistance. Resisted isometric contractions can also be performed to evaluate the degree of pain and strength during maximum effort without movement.
The document defines various terms related to resistance exercise such as resisted exercise, strength, power, endurance, isometric muscle work, isotonic muscle work, and types of muscle contractions. It describes the principles of resistance exercise including overload, SAID, reversibility, and individual variability. It discusses ranges of muscle work, group actions of muscles, and indications for resistance exercise. Overall, the document provides an overview of key concepts in resistance training.
manual muscle testing by K Adhi lakshmi vapms copvrkv2007
Manual muscle testing (MMT) involves grading the strength of individual muscles or muscle groups on a scale based on their ability to perform movements against gravity or resistance. Key aspects of MMT include positioning and stabilizing the patient, demonstrating the movement, applying the appropriate grade of resistance, and documenting the results objectively. MMT is useful for assessing muscle weakness from various neuromuscular and musculoskeletal conditions and monitoring the effectiveness of treatment over time. Contraindications include certain neurological or orthopedic injuries or diseases that could be exacerbated by strength testing.
-MET is a type of osteopathic manipulative treatement used in osteopathic therapy, physical therapy, massage therapy and occupational therapy.
- A form of diagnosis and treatment in which the patient's muscles are actively used on request, from a precisely controlled position, in a specific direction, and against a distinctly executed physician counterforce. 1.Dr. TJ Ruddy:
first osteopathic doctor to use muscle energy in the
1940’s and 1950’s, he referred to it as resistive duction,
which he defined as a series of muscle contractions against
resistance; used techniques mainly in the C‐spine.2.Dr. Fred Mitchell, Sr.: has been titled the Father of
muscle energy.
-He took Dr. Ruddy’s principles and incorporated them into manual medicine to any body region/ articulation.
-He believed that pelvis was the key to musculoskeletal system.
Muscle energy technique, a manual therapy technique with a long term history and 8 variations which can be used in various condition to treat muscle as well as joints. This slide show consists of detailed history, variations/types and summary of MET in detail.
Therapeutic exercise aims to treat diseases and injuries. There are two main types - passive and active movements. Passive movements are externally assisted and aim to maintain range of motion. Active movements involve patient effort and can be assisted, free, or resisted. The document outlines guidelines for applying range of motion exercises safely and effectively based on a patient's condition and goals. Progressive resistance training is also discussed as a method to gradually increase muscle strength over time.
Occupational therapy uses purposeful and therapeutic activities to help people participate in daily tasks according to their goals. Therapeutic activities include exercises focused on improving range of motion, strength, or a specific function as well as purposeful activities where the focus is on completing a meaningful task. Occupational therapists evaluate clients, develop customized intervention plans involving different types of exercises and activities, and assess outcomes to ensure goals are met.
This document discusses muscle energy technique (MET), a manual therapy procedure that involves voluntary muscle contraction against resistance applied by a therapist. It describes the types of muscle contractions involved - isotonic, eccentric, concentric, and isometric. MET uses post-isometric relaxation and reciprocal inhibition to facilitate muscle lengthening. Indications for MET include acute muscle spasm and restricted joints, while contraindications are acute injuries and unstable joints. Benefits of MET include restoring normal muscle tone, strengthening weak muscles, and improved joint mobility. Guidelines are provided for safely applying light contractions over multiple repetitions.
This document discusses muscle energy technique (MET), a manual therapy that uses precisely controlled voluntary muscle contractions against resistance applied by a therapist. It describes the types of muscle contractions used in MET, including isotonic, eccentric, concentric, and isometric contractions. MET can utilize post-isometric relaxation or reciprocal inhibition to lengthen or relax muscles. The document provides examples of procedures and discusses indications like acute muscle spasm or restricted joints, as well as contraindications like fractures or unstable joints. Potential benefits of MET include restoring normal muscle tone, strengthening weak muscles, and improving joint mobility.
This document discusses active movement and resisted exercise. It defines active movement as voluntary movement performed using one's own strength. Resisted exercise involves applying an external force in opposition to muscular contraction to increase tension and develop muscle power and endurance. The document outlines various techniques for resisted exercise, including proper positioning, stabilization, applying traction, and using the correct resisting force matched to the individual's ability. It recommends low resistance with high repetitions to develop endurance and high resistance with low repetitions to build power and muscle size.
The document defines and describes various aspects of resistance exercises. It discusses types of muscle contractions like isotonic, isometric and eccentric. It explains principles of resistance training like overload and specificity. It describes adaptations to resistance training including neural, muscular and bone changes. Determinants of resistance training programs are outlined including intensity, time, volume and periodization. Guidelines for progressive resistance exercises and precautions are provided.
This document provides an introduction to therapeutic exercise and range of motion techniques. It discusses different types of movements including active, passive, assisted and resisted motions. The goals and indications for range of motion exercises like passive and active are explained. Principles, procedures and applications of range of motion techniques are outlined. Different types of assisted and resisted exercises are also described along with their uses.
Mobility and Flexibility of soft tissues (muscles, tendons, fascia, joint capsule, and skins) surrounding the joint along with adequate joint mobility, are necessary for normal ROM.
Mobility: is the ability of segments of the body to move through range of motion for functional activities.
Flexibility: is the ability to move a single joint or series of joints smoothly and easily through an unrestricted, pain –free ROM.
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To Compare The Effect Of Proprioceptive Neuromuscular Facilitation and Static...ijtsrd
Background: Flexibility is an important physiological component of physical fitness and reduced flexibility can cause inefficiency in the workplace and is also a risk factor for low back pain. Increasing hamstring flexibility was reported to be an effective method for increasing hamstring muscle performance.Objective: To compare the effects of modified hold-relax proprioceptive neuromuscular facilitation stretching technique and static stretching on flexibility of hamstring muscle.Materials and Methods: In this comparative study 60 subjects were selected by convenience sampling and research design was comparative and experiment in nature. Subjects were selected on the basis of inclusion criteria. Subjects were divided into two groups, group A and group B allocating alternate subjects to group A and group B, 30 in each group. Group A was treated with Proprioceptive Neuromuscular Facilitation with cryotherapy and Group B was treated with Static Stretching with cryotherapy. Baseline assessment was taken on pre stretch, post stretch and after 24 hours using Active Knee Extension test and Modified back saver sit and reach test.Results: Both the groups showed significant improvement in hamstring flexibility. (p0.05).Conclusion: Thus we concluded that the Proprioceptive Neuromuscular Facilitation Stretching Technique and Static Stretching both are effective to improve flexibility of hamstring muscle and clinically both the interventions are equally effective. Tanu Kapila | Dilpreet Kaur | Jaspinder Kaur"To Compare The Effect Of Proprioceptive Neuromuscular Facilitation and Static Stretching on Flexibility of Hamstring Muscle: A Comparative Study" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-1 | Issue-5 , August 2017, URL: http://www.ijtsrd.com/papers/ijtsrd2266.pdf http://www.ijtsrd.com/other-scientific-research-area/other/2266/to-compare-the-effect-of-proprioceptive-neuromuscular-facilitation-and-static-stretching-on-flexibility-of-hamstring-muscle-a-comparative-study/tanu-kapila
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3. 1) INTRODUCTION:
Manual muscle testing is used to determine the extent and degree of
muscular weakness resulting from disease, injury or disuse. The records
obtained from these tests provide a base for 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.
4. Muscular strength:
The maximal amount of tension or force that a muscle or muscle group can
voluntarily exert in a maximal effort; when type of muscle contraction, limb
velocity and joint angle are specified.
Muscular endurance:
The ability of a muscle or a muscle group to perform repeated contractions
against resistance or maintain an isometric contraction for a period of time.
Muscle power:
Power is defined as the generate as much force as fast as possible.
Power does require strength and speed to develop force quickly.
POWER = strength speed.
5. TYPES OF MUSCLE WORK:
1. Isometric contraction: Tension is developed in the muscle but no movement
occurs; the origin and insertion of the muscle do not change their positions and
hence, the muscle length does not change.
2. Isotonic contraction: The muscle develops constant tension against a load or
resistance. There are two types:
a) Concentric contraction: Tension is developed in the muscle and the origin and
insertion of the muscle move closer together; so the muscle shortens.
b) Eccentric contraction: Tension is developed in the muscle and the origin and
insertion of the muscle move further a part; so the muscle lengthens.
6.
7. RANGE OF MUSCLE WORK:
The full range in which a muscle work refers to the muscle, changing from a
position of full stretch and contracting to a position of maximal shortening.
The full range is divided into three parts:
1. Outer range: From a position where the muscle is fully stretched to a
position halfway through the full range of motion.
2. Inner range: From a position halfway through the full range of motion to a
position where the muscle is fully shortened.
3. Middle range: The portion of the full range between the mid-point of the
outer range and the midpoint of the inner range.
8.
9. GROUP OF MUSCLE ACTION:
1. Prime mover or agonist:
A muscle or muscle group that makes the major contribution to movement at the joint.
2. Antagonist:
A muscle or a muscle group that has an opposite action to the prime movers. The
antagonist relaxes as the agonist moves the part through a range of motion.
3. Synergist:
A muscle that contracts and works along with the agonist to produce the desired
movement.
10.
11. There are three types of synergists:
a) Neutralizing or counter-acting synergist
b) Conjoint synergist
c) Stabilizing or fixating synergist
a) Neutralizing or counter-acting synergists:
Muscles contract to prevent any unwanted movement produced by the prime
mover. For example, when the long finger flexors contract to produce finger
flexion, the wrist extensors contract to prevent wrist flexion from occurring.
12. b) Conjoint synergists:
Two or more muscles work together to produce the desired movement. For
example, wrist extension is produced by contraction of extensor carpi radialis
longus, carpi radialis brevis and extensor carpi ulnaris muscles. If the
extensor carpi radialis longus or brevis contracts alone, the wrist extends
and radially deviates, while if the extensor carpi ulnaris contracts alone, the
wrist extends and ulnarly deviates. When the muscles contract as a group,
the deviation action is cancelled, and the common action occurs.
13. c) Stabilizing or fixating synergists:
These muscles prevent or control the movement at joints proximal to the
moving joint to provide a fixed or stable base, from which the distal moving
segment can effectively work. For example, if the elbow flexors contract to lift
an object off a table anterior to the body, the muscles of the scapula and
gleno-humeral (shoulder) joint must contract to either allow slow controlled
movement or no movement to occur at the scapula and gleno-humeral joint
to provide the elbow flexors with a fixed origin from which to pull. If the
scapular muscles do not contract, the object cannot be lifted as the elbow
flexors will act to pull the shoulder girdle downward.
14. 2) DEFINITION OF MMT:
Manual muscle test (MMT) is a procedure for the evaluation of strength of
individual muscle or muscles group, based upon the effective
performance of a movement in relation to the forces of gravity or Manual
Resistance through the available Range of motion (ROM).
MMT is the most vital part of motor assessment performed in Medical
Examination.
15. BASIC COMPONENTS OF MOTOR EXAMINATION:
i. Nutrition or Bulk of muscle
ii. Tone
iii. Reflexes
iv. Range of motion (ROM)
v. Manual muscle test (MMT)
vi. Functional Assessment
*Important of the Sequence
16. Individual versus group muscle test:
Muscles with a common action or actions may be tested as a group or each
muscle may be tested individually. For example, flexor carpi ulnaris and flexor
carpi radialis muscles may be tested together as a group in wrist flexion. Flexor
carpi ulnaris may be tested more specifically in the action of wrist flexion with
ulnar deviation. On the other hand, Flexor carpi radialis longus and brevis may
be tested more specifically in the action of wrist flexion with radial deviation.
17. 3) Purposes and uses of MMT:
CLINICAL USES :
i. The severity of problem can be understand. (It is diagnostic Tool)
ii. We can planning our treatment goals.
iii. Determine the extend & degree of muscular weakness resulting from
disease, injury.
iv. Correlating muscle picture with in level innervations (myotoms) .
v. MMT is an Important tool for all the members of the Rehabilitation team.
vi. Prevents deformities by locating problem areas.
vii. Help and Evaluate effectiveness of treatment to the therapist.
18. WHY MMT IS PERFORMED? :
To get some answers such as:-
i. Is a particular muscle is normal?
ii. Is it weak? (How much weak)
iii. Is it strong enough? (How much strong)
iv. Is it weak on both the side (bilateral symmetrical)?
v. Is it weak only on one side (Unilateral)?
vi. Is proximal muscles are weaker than the proximal one?
vii. Is there any particular pattern of muscle weakness?
19. 4) GRADES OF MMT:
i. MRC Scale
ii. OXFORD Scale
iii. KENDALL Scale
iv. And Others .
29. 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
30. 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.
31. 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
32.
33. 2) STABILIZATION :
Patient could stabilizes our self during performed Antigravity position.
The hand placement of the therapist is important.
HAND PLACEMENT:
I. PROXIMAL HAND – At Origin of muscle & proximal joint giving
stabilization.
II. DISTAL HAND – Distally offering resistance or Assistance depend upon
performance.
34.
35.
36. 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.
37. 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.
38. 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.
39. 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.
40. 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.
41. 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 .
43. 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.
44. 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
45. 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.
46. 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.
47. 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.
48. 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.
51. The plinth or mat table for testing must be firm to help stabilize the part being
tested. The ideal is a hard surface, minimally padded or not padded at all. The
hard surface will not allow the trunk or limbs to "sink in. " Friction of the surface
material should be kept to a minimum. When the patient is reasonably mobile a
plinth is fine, but its width should not be so narrow that the patient is terrified of
falling or sliding off. When the patient is severely paretic, a mat table is the
more practical choice. The height of the table should be adjustable to allow the
examiner to use proper leverage and body mechanics.
52. Materials needed include the following:
• Muscle test documentation forms
• Pen, pencil, or computer terminal
• Pillows, towels, pads, and wedges for positioning
• Sheets or other draping linen
• Goniometer
• Interpreter (if needed)
• Assistance for turning, moving, or stabilizing the patient
• Emergency call system (if no assistant is available)
• Reference material
53. 1) EXPLANATION & INSTRUCTION:
The therapist demonstrate 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 STRENGHT:
Always assess and record the strength of the unaffected side limb to
determined the patient’s normal strength.
54. 3) PROPERLY POSITINED THE PATIENT:
The patient is positioned to isolate the muscle (or) muscles group to be tested in either
gravity eliminated or Against gravity positioned.
55. 3) STABILIZATION:
I. PROXIMAL HAND – At Origin of muscle & proximal joint giving
stabilization.
II. DISTAL HAND – Distally offering resistance or Assistance depend upon
performance.
The plinth or mat table for testing must be firm to
help stabilize the part being tested.
56. 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.
57. 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.
58.
59.
60. 4) CONVENTIONAL METHODS:
Manual grading of muscle strength is based on three factors:
* Evidence of contraction: No palpable or observable muscle contraction (grade 0) or a palpable
or observable muscle contraction with no joint motion (grade 1).
* Gravity as a resistance: The ability to move the part through the full available range of motion
with gravity eliminated (grade 2) or against gravity (grade 3).
* Amount of manual resistance: The ability to move the part through the full available range of
motion against gravity and against moderate manual resistance (grade 4) or maximal
manual resistance (grade 5).
* Adding (+) or (-) to the whole grades: This is needed to denote variation in the range of
motion. Movement through less than half of the available range of motion is denoted by a “+”
(outer range), while movement through greater than half of the available range of motion is
denoted by “-“ (inner range).
62. Numerals Letters Description
Against gravity tests: The patient is able to move through:
5 N (normal) The full available ROM against gravity and against maximal manual resistance, with hold at the
end of the ROM (for about 3 seconds).
4 G (good) The full available ROM against gravity and against moderate manual resistance.
4- G - (good -) Greater than one half of the available ROM against gravity and against moderate manual
resistance.
3+ F + (fair +) Less than one half of the available ROM against gravity and against minimal manual resistance.
3 F (fair) The full available ROM against gravity.
3- F - (fair -) Greater than one half of the available ROM against gravity.
2+ P + (poor +) Less than one half of the available ROM against gravity.
Gravity eliminated tests: The patient is able to actively move through:
2 P (poor) The full available ROM with gravity eliminated.
2- P - (poor -) Greater than one half the available ROM with gravity eliminated.
1+ T + (trace +) Less than one half of the available ROM with gravity eliminated.
1 T (trace) None of the available ROM with gravity eliminated and there is palpable or observable flicker
contraction.
0 0 (zero) None of the available ROM with gravity eliminated and there is no palpable or observable muscle
63. SCREENING TEST:
A screen test is a method used to control muscle strength assessment, avoid unnecessary
testing and avoid fatiguing and / or discouraging the patient. The therapist may screen the
patient through the information gained from:
1. The previous assessment of the patient's active range of motion.
2. Reading the patient's chart or previous muscle test result.
3. Observing the patient while performing functional activities. For example, shaking the patients
hand may indicate the strength of grasp (finger flexors).
4. All muscle testing procedures must begin at a particular grade; this is usually grade “fair”. The
patient is instructed to actively move the body part through full range of motion against
gravity. Based upon the results of this initial test, the muscle test is either stopped or
proceeds.
64. FACTORS AFFECTING STRENGTH:
1). Age:
A decrease in strength occurs with increasing age due to deterioration in muscle
mass. Muscle fibers decrease in size and number; there is an increase in
connective tissue and fat and the respiratory capacity of the muscle decreases.
Strength apparently increases for the first 20 years of life, remains at this level
for 5 or 10 years and then gradually decreases throughout the rest of life. The
changes in muscular strength by aging are different for different groups of
muscles. The progressive decrease in strength is clearer in the forearm flexors
and muscles that raise the body (anti-gravity muscles).
65. 2). Sex:
Males are generally stronger than females. The strength of males
increases rapidly from 2 to 19 years of age at a rate similar to
weight and more slowly and regularly up to 30 years. After that, it
declines at an increased rate to the age of 60 years. The strength
of females is found to increase at a more uniform rate from 9 to 19
years and more slowly to 30 years, after which it falls off in a
manner similar to males. It has been found that women are more
28 to 30% weaker than men at 40 to 45 years of age.
66. 3). Type of muscle contraction:
More tension can be developed during an eccentric contraction than during an
isometric contraction. The concentric contraction has the smallest tension
capability.
4). Muscle size:
The larger the cross-sectional area of a muscle, the greater the strength of this
muscle will be. When testing a muscle that is small, the therapist would expect
less tension to be developed rather than if testing a large, thick muscle.
67. 5). Speed of muscle contraction:
When a muscle contracts concentrically, the force of contraction decreases as
the speed of contraction increases. The patient is instructed to perform each
movement during muscle test at a moderate pace.
6). Previous training effect:
Strength performance depends up on the ability of the nervous system to
activate the muscle mass. Strength may increase as one becomes familiar
with the test situation. The therapist must instruct the patient well, giving him
an opportunity to move or be passively moved through the test movement at
least once before muscle strength is assessed.
68. 7). Joint position:
It depends on the angle of muscle pull and the length-tension relationship. The tension
developed within a muscle depends upon the initial length of the muscle. Regardless of the type
of muscle contraction, a muscle contracts with more force when it is stretched than when it is
shortened. The greatest amount of tension is developed when the muscle is stretched to the
greatest length possible within the body (if the muscle is in full outer range).
8). Fatigue:
As the patient fatigues, muscle strength decreases. The therapist determines the strength of
muscle using as few repetitions as possible to avoid fatigue.
The patient's level of motivation, level of pain, body type, occupation and dominance are other
factors that may affect strength.
69. BREAK TEST:
Resistance applied at the end of tested range is termed as BREAK TEST.
For one joint muscle resistance is applied at End of ROM.
For two joint muscle resistance is applied at Mid Range.
The isometric hold (break test) shows the muscle to have a higher grade than the
make test.
MAKE TEST:
Resistance is applied throughout the test is called MAKE TEST.
70. INDICATIONS OF BREAK TEST:
1. When movement is contraindicated
2. When there is pain in movement
3. When we have to assess the quality of strength and not the quantity?.
72. HAND HELD
DYNAMOMETER:
This Device operate on
principle of compression.
Application of external force
to the dynamometer
compress a steel spring and
moves a pointer.
77. CABLE
TENSIOMETER:
Force during knee extension
increased force on cable
depresses a riser over which
cable passes, this deflects the
pointer and indicates amount
of force applied.
78.
79. REFERENCE :
Daniels and Worthingham’s -MUSCLE TESTING.
MUSCLE TESTING AND FUNCTION – Florence Peterson Kendall, Elizabeth Kendall McCreary,
Patricia Geise Provance.
MUSCULOSKETAL ASSESSMENT- Hazel M.Clarkson,
ESSENTIAL OF EXERCISE PHYSIOLOGY – Victor C.Katch, William D. McArdle, Frank I. Katch.