MMT Of Knee Extension : ( Manual Muscle Testing), Grades

Manual Muscle Testing Of Knee Extension

The Manual Muscle Test for Knee flexion to evaluate the Quadriceps muscles.

Table of content 1- Manual Muscle Testing Of Knee Extension 2- Which Muscles Involved 6- Grading

The quadriceps femoris muscles are tested together as a functional group. Any given head cannot be separated from any other by manual muscle testing.

The rectus femoris is isolated from the other quadriceps during a hip flexion test.

Knowledge of the patient's hamstring range of motion is imperative before conducting tests for knee extension strength.

MMT

Straight-leg raising (SLR) range dictates the optimal position for the knee extension test in the sitting position. In short sitting for Grades 5, 4, and 3, the less the range of SLR, the greater the backward trunk lean. Range of SLR also informs the examiner of the "available range" within the patient's comfort zone for side-lying tests.

Knee Extensors Muscles Involved:

•Rectus femoris

•Vastus intermedius

•Vastus lateralis

•Vastus medialis longus

•Vastus medialis oblique

Grade 5 (Normal), Grade 4 (Good), and Grade 3 (Fair)

Position of Patient:

Short sitting. Place wedge or pad under the distal thigh to maintain the femur in the horizontal position.

An experienced examiner may replace the padding under the thigh with his or her hand .

Hands rest on the table on either side of the body for stability, or may grasp the table edge.

The patient should be allowed to lean backward to relieve hamstring muscle tension.

Do not allow the patient to hyperextend the knee because this may lock it into position.

Position of Therapist:

Standing at side of limb to be tested. The hand giving resistance is contoured over the anterior surface of the distal leg just above the ankle. For Grades 5 and 4, resistance is applied in a downward direction (toward the floor) in the direction of knee flexion.

Test:

Patient extends knee through available range of motion but not beyond 0°.

Instructions to Patient:

"Straighten your knee. Hold it! Don't let me bend it."

Grading :

Grade 5 (Normal):

Holds end position against maximal resistance. Most physical therapists will not be able to break the Normal knee extensors.

Grade 4 (Good)::

Holds end position against strong to moderate resistance.

Grade 3

Grade 3 (Fair)::

Completes available range and holds the position without resistance .

Grade 2 (Poor):

Position of Patient:

Side-lying with test limb uppermost. Lowermost limb may be flexed for stability. Limb to be tested is held in about 90° of knee flexion. The hip should be in full extension.

Grade 2

Position of Therapist:

Standing behind patient at knee level. One arm cradles the test limb around the thigh with the hand supporting the underside of the knee . The other hand holds the leg just above the malleolus.

Test:

Patient extends knee through the available range of motion. The therapist supporting the limb provides neither assistance nor resistance to the patient's voluntary movement.

This is part of the art of muscle testing that must be acquired. Be alert to activity by the internal rotators (see Substitution, below).

Instructions to Patient:

"Straighten your knee."

Grade 1 (Trace) and Grade 0 (Zero):

Position of Patient:

Supine.

Position of Therapist:

Standing next to limb to be tested at knee level. Hand used for palpation should be on the quadriceps tendon just above the knee with the tendon "held" gently between the thumb and fingers.

The examiner also may want to palpate the patellar tendon with two to four fingers just below the knee .

Grade 1

Test:

Patient attempts to extend knee. As an alternate test, the therapist may place one hand under the slightly flexed knee; palpate either the quadriceps or the patellar tendon while the patient tries to extend the knee.

Instructions to Patient:

"Push the back of your knee down into the table." OR "Tighten your kneecap" (quadriceps setting).

For Alternate Test:

"Push the back of your knee down into my hand."

Grading:

Grade 1 (Trace): :

Contractile activity can be palpated in muscle through the tendon. No joint movement occurs.

Grade 0 (Zero): :

No palpable contractile activity.

• In Short • QUADRICEPS: 1. Position of Patient: With the patient sitting with the trunk approximately perpendicular to the floor, the leg is extended – but not locked – in extension at the knee. Trunk extension is allowed only if significant hamstring tightness precludes assuming the recommended testing position. 2. Position of Therapist: The therapist stands at the side of the tested limb and the testing hand is placed over anterior surface of distal leg just above the ankle. The other hand is placed under the distal thigh. 3.Test: The patient extends the knee through available range of motion but do not allow knee to “lock” into extension during the test. 4. Instructions to Patient: “Straighten your knee and hold it, don’t let me bend .