Muscle Strength Testing: Difference between revisions

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{{#ev:youtube|LjlqP1uMUo0}}<ref>Physiotutors. MRC Scale⎟Muscle Strength Grading. Available from: https://www.youtube.com/watch?v=LjlqP1uMUo0</ref>
{{#ev:youtube|LjlqP1uMUo0}}<ref>Physiotutors. MRC Scale⎟Muscle Strength Grading. Available from: https://www.youtube.com/watch?v=LjlqP1uMUo0</ref>


[http://www.biomedcentral.com/1746-1340/15/4 There are a number of limitations to the usefulness of the Oxford scal]e <ref name="Cuthbert and Goodheart">Cuthbert SC, Goodheart GJ. On the reliability and validity of manual muscle testing: a literature review. Chiropractic &amp; Osteopathy 2007; 15:4</ref>. &nbsp; These include:  
[http://www.biomedcentral.com/1746-1340/15/4 There are a number of limitations to the usefulness of the Oxford scale] <ref name="Cuthbert and Goodheart">Cuthbert SC, Goodheart GJ. On the reliability and validity of manual muscle testing: a literature review. Chiropractic &amp; Osteopathy 2007; 15:4</ref>. &nbsp; These include:  


*Poor functional relevance;  
*Poor functional relevance;  
*Non-linearity ( the difference between grades 3 and 4 is not necessarily the same as the difference between grades 4 and 5);  
*Non-linearity i.e. the difference between grades 3 and 4 is not necessarily the same as the difference between grades 4 and 5;  
*A patient's variability over time (for example, alternating between grades due to fatigue);  
*A patient's variability over time i.e, alternating between grades due to fatigue;  
*Intra-rater reliability  
*Intra-rater reliability;
*Only assesses muscles when contracting concentrically  
*Only assesses muscles when contracting concentrically;
*The difficulty of applying the Oxford scale to all patient's in clinical practice (so that strength is rarely assessed throughout full range as many patients assessed by physiotherapists do not possess full range due to their respective pathology.
*The difficulty of applying the Oxford Scale to all patient's in clinical practice (so that strength is rarely assessed throughout full range as many patients assessed by physiotherapists do not possess full range due to their respective pathology.


Due to these shortcomings, physiotherapists commonly use modifed versions of the Oxford scale in clinical practice (<ref name="Porter" />).
Due to these shortcomings, physiotherapists commonly use modified versions of the Oxford scale in clinical practice. <ref name="Porter" />


== Performing Manual Muscle Tests. ==
== Performing Manual Muscle Tests  ==
Check out strength testing by muscle group
Check out strength testing by muscle group
{| width="800" border="1" cellpadding="1" cellspacing="1"
{| width="800" border="1" cellpadding="1" cellspacing="1"
|-
|-
! scope="col" | 1st Column Heading
! scope="col" | Upper Extremities
! scope="col" | 2nd Column Heading
! scope="col" | Lower Extremities
! scope="col" | 3rd Column Heading
! scope="col" | 4th Column Heading
|-
|-
| 1st column 2nd row
| [[Manual Muscle Testing: Shoulder Flexion|Shoulder Flexion]]
| 2nd column 2nd row
| [[Manual Muscle Testing: Hip Flexion|Hip Flexion]]
| 3rd column 2nd row 
| 4th column 2nd row
|-
|-
| 1st column 3rd row
| [[Manual Muscle Testing: Shoulder Extension|Shoulder Extension]]
| 2nd column 3rd row
| [[Manual Muscle Testing: Hip Extension|Hip Extension]]
| 3rd column 3rd row 
| 4th column 3rd row
|-
|-
| 1st column 4th row
| [[Manual Muscle Testing: Shoulder Abduction|Shoulder Abduction]]
| 2nd column 4th row
| [[Manual Muscle Testing: Hip Abduction|Hip Abduction]]
| 3rd column 4th row 
|-
| 4th column 4th row
|[[Manual Muscle Testing: Shoulder Horizontal Adduction|Shoulder Horizontal Adduction]]
|[[Manual Muscle Testing: Hip Adduction|Hip Adduction]]
|-
|[[Manual Muscle Testing: Scapula Elevation|Scapula Elevation]]
|[[Manual Muscle Testing: Hip External Rotation|Hip External Rotation]]
|-
|[[Manual Muscle Testing: Scapular Retraction/ Adduction|Scapular Retraction/ Adduction]]
|[[Manual Muscle Testing: Hip Internal Rotation|Hip Internal Rotation]]
|-
|[[Manual Muscle Testing: Elbow Flexion|Elbow Flexion]]
|[[Manual Muscle Testing: Knee Flexion|Knee Flexion]]
|-
|[[Manual Muscle Testing: Elbow Extension|Elbow Extension]]
|[[Manual Muscle Testing: Knee Extension|Knee Extension]]
|-
|[[Manual Muscle Testing: Wrist Flexion|Wrist Flexion]]
|[[Manual Muscle Testing: Plantarflexion|Plantarflexion]]
|-
|[[Manual Muscle Testing: Wrist Extension|Wrist Extension]]
|[[Manual Muscle Testing: Dorsiflexion|Dorsiflexion]]
|-
|
|[[Manual Muscle Testing: Ankle Eversion|Ankle Eversion]]
|-
|
|[[Manual Muscle Testing: Ankle Inversion|Ankle Inversion]]
|-
|-
|}
|}


Some guiding principles:  
Some guiding principles:{{#ev:youtube|gDFhiVCMPm8|500}}
 
{{#ev:youtube|gDFhiVCMPm8|500}}<br><div class="researchbox"></div>
 
== References  ==
== References  ==
<references />  
<references />  

Revision as of 22:50, 20 January 2019

Original Editor - The Open Physio project.

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Introduction[edit | edit source]

An assessment of muscle strength is typically performed as part of a patient's objective assessment. This should assist the physiotherapist's clinical reasoning and enable them to reason an appropriate point to begin strengthening rehabilitation from. Muscle strength can be assessed by a number of methods: manually, functionally or mechanically. [1]

The Oxford Scale[edit | edit source]

The Oxford scale is commonly used by physiotherapists to manually assess muscle strength. According to the Oxford scale, muscle strength is graded 0 to 5. The grades are summarised below:

  1. Flicker of movement
  2. Through full range actively with gravity counterbalanced
  3. Through full range actively against gravity
  4. Through full range actively against some resistance
  5. Through full range actively against strong resistance
[2]

There are a number of limitations to the usefulness of the Oxford scale [3].   These include:

  • Poor functional relevance;
  • Non-linearity i.e. the difference between grades 3 and 4 is not necessarily the same as the difference between grades 4 and 5;
  • A patient's variability over time i.e, alternating between grades due to fatigue;
  • Intra-rater reliability;
  • Only assesses muscles when contracting concentrically;
  • The difficulty of applying the Oxford Scale to all patient's in clinical practice (so that strength is rarely assessed throughout full range as many patients assessed by physiotherapists do not possess full range due to their respective pathology.

Due to these shortcomings, physiotherapists commonly use modified versions of the Oxford scale in clinical practice. [1]

Performing Manual Muscle Tests[edit | edit source]

Check out strength testing by muscle group

Upper Extremities Lower Extremities
Shoulder Flexion Hip Flexion
Shoulder Extension Hip Extension
Shoulder Abduction Hip Abduction
Shoulder Horizontal Adduction Hip Adduction
Scapula Elevation Hip External Rotation
Scapular Retraction/ Adduction Hip Internal Rotation
Elbow Flexion Knee Flexion
Elbow Extension Knee Extension
Wrist Flexion Plantarflexion
Wrist Extension Dorsiflexion
Ankle Eversion
Ankle Inversion
Some guiding principles:

References[edit | edit source]

  1. ↑ 1.0 1.1 Porter S. Tidy's Physiotherapy. Edinburgh: Churchill Livingstone, 2013.
  2. ↑ Physiotutors. MRC Scale⎟Muscle Strength Grading. Available from: https://www.youtube.com/watch?v=LjlqP1uMUo0
  3. ↑ Cuthbert SC, Goodheart GJ. On the reliability and validity of manual muscle testing: a literature review. Chiropractic & Osteopathy 2007; 15:4
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