Manual Muscle Testing Of Knee Flexion

The Manual Muscle Test for Knee flexion to evaluate the Semimembranosus ,Semitendinosus ,Biceps femoris (long and short heads) muscles.

MMT

Table of content

1- Manual Muscle Testing Of Knee Flexion

2- Which Muscles Involved

3- HAMSTRING MUSCLES IN AGGREGATE

4-MEDIAL HAMSTRING TEST

5- LATERAL HAMSTRING TEST (BICEPS FEMORIS)

6- Grading

The knee flexors include the set of hamstrings, gracilis, sartorius, gastrocnemius, plantaris, and popliteus. Interestingly, most of these knee flexors also internally or externally rotate the knee.

Knee Flexor Muscles Involved:

•Semimembranosus

•Semitendinosus

•Biceps femoris—long and short heads

•Gracilis and sartorius

•Gastrocnemius and plantaris

•Popliteus
MMT

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

There are three basic muscle tests for the hamstrings at Grades 5 and 4. The examiner should test first for the aggregate of the three hamstring muscles (with the foot in midline).

Only if there is deviation (or asymmetry) in the movement or a question in the examiner's mind is there a need to test the medial and lateral hamstrings separately.

HAMSTRING MUSCLES IN AGGREGATE

Position of Patient:

Prone with limbs straight and toes hanging over the edge of the table. Test may be started in about 45° of knee flexion.

HAMSTRING MUSCLES IN AGGREGATE

Position of Therapist:

Standing next to limb to be tested. Hand giving resistance is contoured around the posterior surface of the leg just above the ankle . Resistance is applied in the direction of knee extension for Grades 5 and 4.

The other hand is placed over the hamstring tendons on the posterior thigh (optional).

Test:

Patient flexes knee while maintaining leg in neutral rotation.

Instructions to Patient:

"Bend your knee. Hold it! Don't let me straighten it."

MEDIAL HAMSTRING TEST (SEMITENDINOSUS AND SEMIMEMBRANOSUS)

Position of Patient:

Prone with knee flexed to less than 90°. Leg in internal rotation (toes pointing toward midline).

MEDIAL HAMSTRING TEST

•Prone, knee flexed, heel turned out- toes pointed in, slight plantar flexion

Position of Therapist:

(Seated) Hand giving resistance grasps the leg at the ankle. Resistance is applied in an oblique direction (down and out) toward knee extension.

Test:

Patient flexes knee, maintaining the leg in internal rotation (heel toward examiner, toes pointing toward midline).

LATERAL HAMSTRING TEST (BICEPS FEMORIS)

Position of Patient:

Prone with knee flexed to less than 90°. Leg is in external rotation (toes pointing laterally).

This is the situation that, when observed, indicates asymmetry and the need to test the medial and lateral hamstrings separately.

If the biceps femoris is stronger than the medial hamstrings, the leg will externally rotate during knee flexion. Similarly, if the semitendinosus and semimembranosus are the stronger components, the leg will internally rotate during knee flexion.

•Prone, knee flexed, heel turned in- toes pointed out, slight plantar flexion

LATERAL HAMSTRING TEST

Position of Therapist:

( seated) Therapist resists knee flexion at the ankle using a downward and inward force .

Test:

Patient flexes knee, maintaining leg in external rotation (heel away from examiner, toes pointing toward examiner).

Grading the Hamstring Muscles (Grades 5 to 3)

Grade 5 (Normal):

for All Three Tests: Resistance will be maximal, and the end knee flexion position (approximately 90°) cannot be broken.

Grade 4 (Good):

for All Three Tests: End knee flexion position is held against strong to moderate resistance.

Grade 3 (Fair) :

for All Three Tests: Holds end range position but tolerates no resistance.

Grade- 3

Grade 2 (Poor) :

In tests for Grades 3 and 2, the knee may be placed in a 10° flexed position to start the test when gastrocnemius weakness is present (the gastrocnemius assists in knee flexion).

Position of Patient:

Side-lying with test limb (uppermost limb) supported by examiner. Lower limb flexed for stability.

Grade- 2

Position of Therapist:

Standing behind patient at knee level. One arm is used to cradle thigh, providing hand support at medial side of knee. Other hand supports the leg at the ankle just above the malleolus .

Test:

Patient flexes knee through available range of motion.

Instructions to Patient:

"Bend your knee."

Grading

Grade 2 (Poor):

Completes available range of motion in side-lying position.

Grade 1 (Trace) and Grade 0 (Zero)

Position of Patient:

Prone. Limbs are straight with toes extending over end of table. Knee is partially flexed and supported at ankle by examiner.

Grade- 1 or 0

Position of Therapist:

Standing next to test limb at knee level. One hand supports the flexed limb at the ankle .

The opposite hand palpates both the medial and the lateral hamstring tendons just above the posterior knee.

Test:

Patient attempts to flex knee. Instructions to Patient: "Try to bend your knee."

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

Manual Muscle Testing Of Knee Flexion

The Manual Muscle Test for Knee flexion to evaluate the Semimembranosus ,Semitendinosus ,Biceps femoris (long and short heads) muscles.

Table of content

1- Manual Muscle Testing Of Knee Flexion 2- Which Muscles Involved 3- HAMSTRING MUSCLES IN AGGREGATE 4-MEDIAL HAMSTRING TEST 5- LATERAL HAMSTRING TEST (BICEPS FEMORIS) 6- Grading

The knee flexors include the set of hamstrings, gracilis, sartorius, gastrocnemius, plantaris, and popliteus. Interestingly, most of these knee flexors also internally or externally rotate the knee.

Knee Flexor Muscles Involved:

•Semimembranosus

•Semitendinosus

•Biceps femoris—long and short heads

•Gracilis and sartorius

•Gastrocnemius and plantaris

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

There are three basic muscle tests for the hamstrings at Grades 5 and 4. The examiner should test first for the aggregate of the three hamstring muscles (with the foot in midline).

Only if there is deviation (or asymmetry) in the movement or a question in the examiner's mind is there a need to test the medial and lateral hamstrings separately.

HAMSTRING MUSCLES IN AGGREGATE

Position of Patient:

HAMSTRING MUSCLES IN AGGREGATE

Position of Therapist:

Standing next to limb to be tested. Hand giving resistance is contoured around the posterior surface of the leg just above the ankle . Resistance is applied in the direction of knee extension for Grades 5 and 4.

The other hand is placed over the hamstring tendons on the posterior thigh (optional).

Test:

Patient flexes knee while maintaining leg in neutral rotation.

Instructions to Patient:

"Bend your knee. Hold it! Don't let me straighten it."

MEDIAL HAMSTRING TEST (SEMITENDINOSUS AND SEMIMEMBRANOSUS)

Position of Patient:

Prone with knee flexed to less than 90°. Leg in internal rotation (toes pointing toward midline).

MEDIAL HAMSTRING TEST

•Prone, knee flexed, heel turned out- toes pointed in, slight plantar flexion

Position of Therapist:

(Seated) Hand giving resistance grasps the leg at the ankle. Resistance is applied in an oblique direction (down and out) toward knee extension.

Test:

Patient flexes knee, maintaining the leg in internal rotation (heel toward examiner, toes pointing toward midline).

LATERAL HAMSTRING TEST (BICEPS FEMORIS)

Position of Patient:

Prone with knee flexed to less than 90°. Leg is in external rotation (toes pointing laterally).

This is the situation that, when observed, indicates asymmetry and the need to test the medial and lateral hamstrings separately.

If the biceps femoris is stronger than the medial hamstrings, the leg will externally rotate during knee flexion. Similarly, if the semitendinosus and semimembranosus are the stronger components, the leg will internally rotate during knee flexion.

•Prone, knee flexed, heel turned in- toes pointed out, slight plantar flexion

•Prone, knee flexed, heel turned in- toes pointed out, slight plantar flexion

Position of Therapist:

( seated) Therapist resists knee flexion at the ankle using a downward and inward force .

Test:

Patient flexes knee, maintaining leg in external rotation (heel away from examiner, toes pointing toward examiner).

Grading the Hamstring Muscles (Grades 5 to 3)

Grade 5 (Normal):

for All Three Tests: Resistance will be maximal, and the end knee flexion position (approximately 90°) cannot be broken.

Grade 4 (Good):

for All Three Tests: End knee flexion position is held against strong to moderate resistance.

Grade 3 (Fair) :

for All Three Tests: Holds end range position but tolerates no resistance.

Grade- 3

Grade 2 (Poor) :

In tests for Grades 3 and 2, the knee may be placed in a 10° flexed position to start the test when gastrocnemius weakness is present (the gastrocnemius assists in knee flexion).

Position of Patient:

Side-lying with test limb (uppermost limb) supported by examiner. Lower limb flexed for stability.

Grade- 2

Position of Therapist:

Standing behind patient at knee level. One arm is used to cradle thigh, providing hand support at medial side of knee. Other hand supports the leg at the ankle just above the malleolus .

Test:

Patient flexes knee through available range of motion.

Instructions to Patient:

"Bend your knee."

Grading

Completes available range of motion in side-lying position.

Grade 1 (Trace) and Grade 0 (Zero)

Position of Patient:

Prone. Limbs are straight with toes extending over end of table. Knee is partially flexed and supported at ankle by examiner.

Grade- 1 or 0

Position of Therapist:

Standing next to test limb at knee level. One hand supports the flexed limb at the ankle .

The opposite hand palpates both the medial and the lateral hamstring tendons just above the posterior knee.

Test:

Patient attempts to flex knee. Instructions to Patient: "Try to bend your knee."

Grading

Grade 1 (Trace):

Tendons become prominent, but no visible movement occurs.

Grade 0 (Zero):

No palpable contraction of the muscles; tendons .

1- Manual Muscle Testing Of Knee Flexion

2- Which Muscles Involved

3- HAMSTRING MUSCLES IN AGGREGATE

4-MEDIAL HAMSTRING TEST

5- LATERAL HAMSTRING TEST (BICEPS FEMORIS)

6- Grading