Manualmusletesting

1. Fair
• Position:
• Backlying with hands on
opposite shoulders.
• Stabilization:
• Stabilize pelvis.
• Desired Motion:
• Patient rotates thorax until
scapula on side of forward
shoulder is raised from table.
• Repeat with rotation to opposite
side.

2. Poor
• Position:
• Sitting with arms relaxed at sides.
• Stabilization:
• Pelvis stabilized.
• Desired Motion:
• Patient rotates thorax.
• Repeat with rotation to opposite side.

3. Trace & Zero
• Examiner palpates muscles as patient attempts to approximate
thorax on left and pelvis on right. Repeat on opposite side.
• Note: Observe deviation of umbilicus, which will move toward
strongest quadrant if there is a difference in strength of
opposing oblique muscles.

4. Muscle Testing (Lower
extremity)

5. MUSCLE THAT ACT ON THE
ANTERIOR THIGH (FEMUR)

6. MUSCLE THAT ACT ON THE
POSTERIOR THIGH (FEMUR)

7. Elevation of pelvis
• QUADRATUS LUMBORUM

8. QUADRATUS LUMBORUM
• ORIGIN: Inferior border of 12th rib
• INSERTION
Apices of transverse processes of
L1-4, iliolumber ligament and
posterior third of iliac crest
• ACTION
Fixes 12th rib during respiration
and lateral flexes trunk
• NERVE
Anterior primary rami (T12-L3)

9. QUADRATUS LUMBORUM
• Range of Motion:
• In standing position pelvis may he raised on
one side until foot is well clear of floor.
(Reverse action of Quadratus lumborum.)
• Factors Limiting Motion:
• Tension of spinal ligaments on opposite
side
• Contact of iliac crest with thorax
• Fixation:
• Contraction of spinal extensor muscles (o
fix thorax

10. NORMAL AND GOOD
• Position: Backlying (or Facelying) with lumbar area of
spine in moderate extension. Patient grasps edge of
table to stabilize thorax. (If-arm and shoulder muscles
are weak, an assistant should stabilize thorax.)
• Desired Motion: Patient draws pelvis toward thorax on
one side.
• Resistance is given above ankle joint.

11. FAIR AND POOR
• Position: Backlying with legs straight and with lumbar area of
spine in moderate extension.
• Patient may grasp side of table to stabilize thorax (not shown
in picture).
• Desired Motion: Patient draws pelvis upward toward thorax.
• Slight resistance is given for a fair grade. Completion of range
is graded poor.

12. FAIR (Alternate)
• Standing position.
• Stabilize thorax.
• Desired motion: Patient lifts pelvis toward
thorax through ROM

13. TRACE AND ZERO
• As patient attempts to draw pelvis cranial
ward, a contraction of Quadratus lumborum
may be determined by deep palpation in
lumbar area under lateral edge of Erector
spinae.

14. Sartorius
Origin: Anterior superior iliac spine
Insertion: medial surface of the tibia
Function: Hip flexion, Abduction, and External
Rotation with Knee Position
Nerve supply:
• Psoas major: lumbar plexus
• Iliacus: lumbar plexus

15. Normal and Good
Position: Sitting with thighs supported on the
table and legs dangling off, the patient can
place their hands down for support.
Desired Motion: The patient flex, abduct, and
externally rotate at the hip, and flex at the
knee.
Resistance.
• One hand will be placed on the lateral
surface of the knee, and the other will be
placed on the medial aspect of the ankle.
• The hand at the knee will resist hip flexion
and abduction and the resistance will be
given in a down and inward direction.
• The hand at the ankle will be resisting
external rotation and knee flexion and the
resistance is in an up and outward
direction.
• Ask the patient to, “slide your heel up the
shin of your other leg, don’t let me move
your leg or straighten your knee.”

16. FAIR AND POOR
Position: Sitting with
thighs supported on
the table and legs
dangling off, the
patient can place their
hands down for
support.
Desired Motion: The
patient flex, abduct,
and externally rotate
at the hip, and flex at
the knee.

17. TRACE AND ZERO
• Patient Position:
• Supine, with the therapist supporting the limb.
• The heel should be on the shin of the opposite leg.
• While palpating the sartorius ask the patient to
slide their heel up to their knee.

18. Hip Flexion
• Sartorius
• PSOAS MAJOR
• ILIACUS

19. PSOAS MAJOR
• ORIGIN: Transverse processes of L1-5, bodies of T12-
L5 and intervertebral discs below bodies of T12-L4
• INSERTION: Middle surface of lesser trochanter of
femur
• ACTION:
• Flexes and medially rotates hip
• NERVE:
• Anterior primary rami of L1,2

20. ILIACUS
• ORIGIN: Iliac fossa within abdomen
• INSERTION: Lowermost surface of lesser
trochanter of femur
• ACTION: Flexes medially rotates hip
• NERVE: Femoral nerve in abdomen (L2,3)

21. Hip Flexion
• Range of Motion:
Factors Limiting Motion:
• With knee Hexed, contact of thigh on abdomen
• With knee extended, tension of hamstring muscles
Fixation:
1.Contraction of anterior abdominal muscle to fix lumber
spine and pelvis.
1.Weight at trunk

22. Normal and Good
• Position: Sitting with legs over edge of table.
• Stabilization: Stabilize pelvis.
• Desired Motion: Patient flexes hip through
last part of range of motion.
Resistance is given proximal to knee joint.

23. Fair
• Sitting with legs over edge of table.
• Stabilize pelvis.
• Patient flexes hip through last part of ROM.

24. Poor
• Position: Sidelying with upper leg supported. Trunk
pelvis and legs straight.
• Stabilize pelvis.
• Patient flexes hip through range of motion Knee is
allowed to flex to prevent hamstring tension.

25. TRACE AND ZERO
• Supine with leg supported. It may be
possible to detect contraction in Psoas
major just distal to inguinal ligament on
medial side of Sartorius.

26. Note
• Substitution by Sartorius in hip flexion will cause
lateral rotation and abduction of thigh. Muscle may
be seen and palpated near its origin during the
motion.
• Substitution by Tensor Fasciae Latae in hip flexion
causes medial rotation and abduction of the thigh.
Muscle may be seen and palpated at its origin.

27. Hip Extension
• GLUTEUS MAXIMUS
• BICEPS FEMORIS
• SEMIMEMBRANOSUS
• SEMITENDINOSUS

28. GLUTEUS MAXIMUS
• ORIGIN
Outer surface of ilium behind posterior gluteal line and posterior
third of iliac crest lumbar fascia, lateral mass of sacrum,
sacrotuberous ligament and coccyx
• INSERTION
Deepest quarter into gluteal tuberosity of femur, remaining three
quarters into iliotibial tract (anterior surface of lateral condyle of
tibia)
• ACTION
Extends and laterally rotates hip. Maintains knee extended via
iliotibial tract
• NERVE: Inferior gluteal nerve (L5, S1,2)

29. BICEPS FEMORIS
ORIGIN
Long head: upper inner quadrant of posterior
surface of ischial tuberosity.
• Short head: middle third of linea aspera, lateral
supracondylar ridge of femur
INSERTION
Styloid process of head of fibula. lateral collateral
ligament and lateral tibial condyle
ACTION
Flexes and laterally rotates knee. Long head
extends hip
NERVE
Long head: tibial portion of sciatic nerve. Short
head: common peroneal portion of sciatic nerve
(both L5, S1)

30. SEMIMEMBRANOSUS
• ORIGIN
Upper outer quadrant of posterior surface
of ischial tuberosity
• INSERTION
Medial condyle of tibia below articular
margin, fascia over popliteus and oblique
popliteal ligament
• ACTION
Flexes and medially rotates knee.
Extends hip
• NERVE
Tibial portion of sciatic nerve (L5, S1)