What is the Manual Muscle Testing and its Grades

the fundamental components of manual muscle testing are test performance and evaluation of muscle strength and length.

To become proficient in these procedures one must possess a comprehensive and detailed knowledge of muscle function.

Understanding joint motion is crucial because length and strength tests describe joint movements and positions.

It must also include knowledge of the agonistic and antagonistic actions of muscles and their role in fixation and in substitution.

In addition, it requires the ability to palpate the muscle or its tendon, to distinguish between normal and atrophied contour, and to recognize abnormalities of position or movement.

One who possesses a comprehensive knowledge of the actions of muscles and joints can learn the techniques necessary to perform the tests.

Active insufficiency and Passive insufficiency

Active insufficiency = If a muscle which crosses two or more joints produces simultaneous movement at all of the joints that it crosses, it soon reaches a length at which it can no longer generate a useful amount of force.

An example of such insufficiency occurs when one tries to achieve full hip extension with maximal knee flexion. The two-joint hamstrings are incapable of shortening sufficiently to pro duce a complete range of motion of both joints simultaneously

Passive insufficiency = Whenever a muscle’s length limits the full range of motion of any joint or joints it crosses, rather than the arrangement of ligaments or structures of the joint itself, it indicates passive insufficiency.


  1. place the subject in a position that offers the best fixation of the body as a whole (usually supine, prone, or side-lying).
  2. Stabilize the part proximal to the tested part or, as in the case of the hand, adjacent to the tested part. Stabilization is necessary for specificity in testing.
  3. Position the part to be tested precisely in the appropriate antigravity test position whenever necessary to assist in eliciting the desired muscle action and aid in grading.
  4. Use test movements in the horizontal plane when testing muscles that are too weak to function against gravity. Use test movements in antigravity positions for most trunk muscle tests in which body weight offers sufficient resistance.
  5. Apply pressure directly opposite the line of pull of the muscle or the muscle segment being tested. Like the antigravity position, the direction of pressure helps to elicit the desired muscle action.
  6. Apply pressure gradually but not too slowly, allowing the subject to “get set and hold.”
  7. Apply uniform pressure; avoid localized pressure that can cause discomfort.
  8. Use a long lever whenever possible, unless contraindicated.
  9. Use a short lever if the intervening muscles do not provide sufficient fixation for use of a long lever.

Grades of manual muscle testing

GRADE 0= No contraction of the muscle

GRADE 1 = feeble contraction felt in muscle with no visible movement

GRADE -2 =Movement is through partial range of motion

GRADE 2= The muscle tested moves through a complete range of motion.

GRADE +2 = Holds against slight pressure in test position Moves through partial range of motion against gravity

GRADE 3– = Gradual release from test positron occurs

GRADE 3 = Hold the test position (no added pressure)

GRADE 3+ = Hold test position against slight pressure

GRADE 4- = Holds test position against slight to moderate pressure

GRADE 4 = Hold the test position against moderate pressure

GRADE 4+ = Hold test position against moderate to strong pressure

GRADE 5 = Hold test position against strong pressure

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