Muscle strength scale in physiotherapy


Muscle strength grading is a system used by physical therapists (PT) to determine how a muscle or group of muscles is working. Your physique can test your muscle strength during the initial assessment and then at regular intervals to determine your progress during rehab.

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Measuring muscle strength can be an important component of your rehabilitation plan, especially if a physical therapist believes that muscle weakness is contributing to your pain and limited mobility. There are several ways to measure muscle strength that provide both objective and observable results.

Determination of force

Muscle strength is defined as the ability of a muscle to contract and create force with a single effort. Muscle strength is different from muscular endurance, the latter of which is determined by the amount of time a muscle can perform a specific task until failure. That said, muscle strength and endurance are essential for optimal physical function and mobility.

There are many things that can limit muscle strength, including:

If you are referred to physical education , muscle strength will almost always count, regardless of your condition. This includes not only evaluating the larger muscles, such as the biceps or hamstrings , but also the smaller muscles, such as the wrist and hand, in carpal tunnel surgery .

Other tests commonly performed during the evaluation will measure your flexibility, gait , range of motion , balance , coordination, and mobility . These baseline results help the PT track his progress during rehab.

Physics professionals use two methods to measure muscle strength: the manual muscle test and the torsion test.

Manual muscle testing

Manual muscle testing (MMT) is the most popular way to assess muscle strength. For this test, the PT will push your body in specific directions while resisting pressure. A score or score is then assigned based on how much it was able to withstand the pressure.

Muscle strength is measured using MMT on a five-point scale:

  • 0/5 – A score of 0/5 means that you cannot perform a noticeable contraction in a particular muscle. This can happen if a muscle is paralyzed, such as after a stroke , spinal cord injury , or cervical or lumbar radiculopathy . Sometimes pain can prevent muscle contraction entirely.
  • 1/5 : A score of 1/5 occurs when a muscle contraction is felt but no movement occurs. In this case, the muscle is not strong enough to lift a certain part of the body against gravity or move it into a position with reduced gravity. A slight contraction can be detected by palpation (physical touch), but not enough for movement.
  • 2/5 : A score of 2/5 is awarded when a muscle can contract but cannot fully move a part of the body against gravity. However, when gravity is reduced or eliminated with a change in body position, the body part will be able to move through its full range of motion.
  • 3/5 : With a score of 3/5, you can fully contract a muscle and body part in its full range of motion against gravity. But when resistance is applied, the muscle cannot maintain the contraction.
  • 4/5 : A score of 4/5 indicates that the muscle lends itself to maximum resistance. The muscle can contract and provide resistance, but at maximum resistance, the muscle cannot withstand the contraction.
  • 5/5 : A score of 5/5 indicates that the muscle is functioning normally and can maintain its position even when maximum resistance is applied .

Although manual muscle testing is based on subjective observation, the criteria and definitions are considered clear enough to provide relatively reliable results .

Sometimes a physicist can estimate his strength in two-fold increments using the + or – sign. For example, a score of 4 + / 5 means that your muscle withstood maximum resistance, but was able to provide some resistance during testing. A score of 4-5 means that your muscle was not on the brink of collapse during the test .

MMT is popular because it is inexpensive and readily available. It is simple to implement and requires no special equipment. That said, the method is least reliable in the range of good (4/5) to normal (5/5), and the results often vary significantly between PCs .

Dynamometric tests

Another method of measuring muscle strength is called dynamometry and involves a handheld device known as a dynamometer. Dynamometric tests evaluate the relationship between muscle length and tension, which means that the amount of tension a muscle now exerts during isometric contraction is now dependent on the length of the muscle .

The test is performed by placing a part of the body in a position where gravity does not act on it. Once the dynamometer is placed against the muscle, the person presses it for a few seconds. The value is then displayed in pounds or kilograms. Some devices are digital, while others are spring loaded .

To quantify your relative muscle strength, the dynamometer readings are compared to the reference (expected) values for a person of your age and gender. These readings are used to track your progress during physical therapy.

In addition to the standard isokinetic dynamometers that are used to measure key muscle groups such as elbows, hips, shoulders, or knees, there are manual dynamometers that can measure grip strength and even grip strength.

Get the word of drug information

If you experience muscle weakness that results in a loss of functional mobility, speak with your doctor about investigating possible causes. You may be referred to an orthopedic surgeon if the cause is believed to be a musculoskeletal system, or to a neurologist if the muscle weakness is believed to be caused by a nerve disorder.

Only with the correct diagnosis can the physical therapist make a proper evaluation and work out an effective rehabilitation program.

Frequently asked questions

  • The Muscle Strength Scale, also known as Muscle Strength Assessment or Manual Muscle Testing (MMT), is a system that assesses muscle strength on a scale of 0 to 5 based on the ability of the muscles of the upper or lower extremities to withstand gravity. or manual force, examiner pressure.

  • Muscle strength classification can be performed by health professionals, nurses, physical therapists, occupational therapists, chiropractors , and other health professionals who are properly trained in this technique.

  • The muscle strength classification is commonly used to measure muscle strength in people with a known or suspected neurological condition, such as a stroke . But it can be used by anyone who complains of muscle weakness to distinguish true weakness from imbalance or endurance problems.

  • Assessment of muscle strength is a subjective test that requires correct technique to obtain reliable results. For this test, the examiner will apply pressure, including gravity, to key parts of the body to determine which muscle activation (contraction) occurs in the expected range of motion of the associated joint.

  • If a neurological problem is suspected, the abductors, elbow flexors, elbow extensors, wrist extensors, toe flexors, internal hand muscles, hip flexors , knee extensors, big toe extensors, foot and plantar flexors can be tested, as each is activated by a specific nerve root . in the spine .

  • Muscle strength is commonly assessed on the Medical Research Council Manual Muscle Testing Scale, which measures strength as a function of muscle activation and joint range of motion (ROM) as follows:

    • 0: no muscle activation
    • 1: Full ROMless Muscle Track Activation
    • 2: Muscle activation by gravity and full ROM
    • 3: Muscle activation against gravity with full ROM
    • 4: muscle activation versus some resistance with full rom
    • 5: Muscle activation versus impedance with full ROM

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