Page Six P H Y S I O T H E R A P Y April 1952

STANDARDISED POSITIONS FOR MUSCLE TESTING
R o be rt J . S. Reynolds, S .R .N ., M .C .S J* .

Superintendent Physiotherapist,

Queen M ary's H o s p ita l fo r  Children, Carshalton

Reprinted fr o m  the■ September, 1950, edition o f Physiotherapy, by kind permission o f the Chartered

Society o f Physiotherapy

SI N C E  1943, in which year the Medical Research Council standardized the calibration of muscle 
charting, we in Queen M a ry ’s H ospital have found 
its use a great help when com paring charts of muscle 
tests carried out at 't h e  original hospitals treating 
poliomyelitis cases in the acute stage w ith our own 
charts of musicle tests carried out by us in the con­
valescent stage. W e  have still found discrepancies in 
those cases where a muscle appears fro m  the chart 
to have become weaker —  a phenomenon which we 
know does not occur in poliomyelitis. W e  have even 
found these discrepancies in charts- of muscle tests 
carried out by our own staff. W e  investigated the 
reason for this, and found that different physio 
therapists tested a muscle, or a group o f muscles, in 
different ways. The use of. accessory muscles accord­
ing to the position used, gives us a varied evaluation 
of the power o f the muscle. W e  have therefore tried 
to find a method of standardizing the positions in 
which the muscles are tested, bearing in m ind the. 
fact that we are endeavouring to find a true evalua­
tion of the muscle, or in some cases a group of 
muscles, elim inating as far as possible the action' of 
accessory muscles and preventing substitution.

O u r  method of testing muscles is outlined below. 
There is stated the muscle or muscle group to be 
tested, the starting position, and the movement to be 
performed. W e  do not change the position to 
eliminate gravity, or have gravity resisting or assist­
in g ; we use the physiotherapist’s hands for these 
purposes. This calls for great skill on the part of 
the physiotherapist.

The patient should be thoroughly warmed before 
muscle testing takes place, preferably by soaking in 
hot water. The test should be carried out in a w arm  
room, so that only the m in im um  of clothing is re­
quired, and all the muscles are exposed to view along 
their complete length. Thus, any substitution of 
muscle is im m ediately detected. A ll testing is carried 
out fro m  two basic positions: lying either prone or 
supine, w ith the arms at the side and the feet over 
the edge o f the plinth. N o  exertion is required to 
m aintain these positions and the entire mental effort 
of the patient can be directed to the muscle being 
tested. N o session should be continued if the patient 
shows evidence o f tiring or lack of concentration.

The physiotherapist supports the lim b where pos­
sible, w ith one hand holding bony prominences and 
w ith the fingers of the other hand directly over the 
insertion of the muscle. There are two exceptions to 
this r u le : internal and external rotation of hip and 
shoulder. In  these exceptional cases it is not suitable 
to have the fingers over the insertion of the muscles 
perform ing the movements.

W ith  the hands and fingers in these positions; 
the physiotherapist is able to support the part in 
norm al alignment, to direct m otion accurately accord­
ing to norm al function, g uid ing  both the brain path 
and the physical effort of. the patient, to register the

least flicker in a muscle, and, if necessary, to give 
resistance or assistance such as the muscle requires to 
ascertain its true value.

The positions and m ovem ents'are the same as those 
used in treatment fo r re-education. This means that 
the procedure is one of norm al routine to the patient 
and not something different', for muscle testing re­
quiring special effort on his part. ' W e  find that any 
extra effort usually calls f o r t h . accessory muscles and, 
substitution. The muscle test is not usually carried1 
out for charting purposes until after the first one or 
two treatments, by which time the physiotherapist 
has had an opportunity of gaining the patient’s co­
operation and of teaching him  that which is required 
of each muscle.

M e th o d  o f T esting

In  practice, we have found it most satisfactory to 
have two people to carry out the test— one doing the 
test, the other m aking the chart. W ith  either a doctor 
and a physiotherapist, or two physiotherapists, in 
attendance, an under-evaluation or an over-evaluatioc 
of a muscle is much less likely to occur.

T ru n k  .

(1) Erector Spinae.— Patient face downwards. F ix  
pelvis. A rm s to side. Raise head, and shoulders.

(2) Rectus A bdom inis.— Patient lies on back. H ands 
across chest on opposite shoulders. Raise head and 
shoulders. (F urth er flexion of the trunk causes the 
hip flexors to come into action.)

(3) A b do m in al Obliques.— Patient lies on back. For 
left obliques roll head and shoulders to lefti and vice 
versa.

(4 ) Quadratus L um borum .— Patient lies face dow n­
wards. Shorten leg by tilting pelvis. (N o  side flexion! 
of trunk, this may be performed by erector spinae 
acting on one side or by the abdominal obliques.)

Low er E x trem ity.

(1) Gluteus M ax im us.— Patient lies face downwards. 
Oppose buttocks to each other. (N o  hip extension; 
this can be carried out by biceps fem oris.)

(2) H ip  Abductors.— Patient lies' on back. H o ld  
foot vertically by heel, w ith leg horizontal. Patient 
abducts leg.

(3) H ip  A dductor.— Patient lies on back. H o ld  foot 
vertically by heel w ith leg horizontal. A bduct leg. 
Patient adducts leg.

(4) H ip  Flexors.— Patient lies on back, Lower leg 
hangs over edge of table. Patient raises thigh off 
table. (N .B .— Differentiate sartorius and psoas.)

(5) H ip  Extensors.— See tests for gluteus maxim us 
and hamstrings. The normal action is initiation by 
biceps femoris, and stabilizing by gluteus maximus.

(6) H ip  R otators.— Patient- lies on back. Place hand 
on knee. Patient rotates hip in both directions.

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April/ 1952 P H Y S I O T H E R A P Y Page Seven

(7) Knee Extensors.— Patient lies on back. H o ld  
knee flexed at 30° w ith hand behind knee. Patient to 
raise foot off table. H e lp to be given by other hand 
behind ankle if necessary. Quadriceps and knee may 
be pushed back against the plinth by strong hip 

extensors. .

(8) Knee Flexors.— Patient face downwards. Patient 
to raise foot off table. Differentiate between inner and 
outer hamstrings by palpation of tendons behind the 

knee.

(9) C a lf Muscles.— Patient face dow nw ard w ith foot 
over edge o f table. Patient to pull the heel back. ' 
(N o t lying supine, push foot dow n; this may be per­
form ed by strong toe flexors.)

(10) Tibialis Anticus.— Patient lies on back. Patient 
to pull foot up and in. Palpate tendon on front of 
ankle if  necessary.

(11) Tibialis Posticus.— Patient lies on back. P a tie n t, 
to pull foot down and in. Palpate tendon distal to 
internal malleolus if necessary. '

(12) Peronetis Tertius.— Patient lies on back. Patient 

to pull foot up and out.

(13)- Peronetis Longus and Brevis.— Patient lies on 
back. Patient to pull foot dow n and out. Note the 
four angle movements requiring pure arid distinct 

muscle action.

(14) Extensor H allucis.— Patient lies on back. Foot 
in m id position. Patient to extend toe.

(15) P lexor H allucis.— Patient lies on back. Foot 
in mid positiori. Patient to flex toe.

(16) Extension and Flexion■ D ig itorum .— A s for ex­
tension and flexion hallucis.

Neck

(1) Neck Flexors.— Patient lies on back. Head well 
over edge of table. Patient elevates head. Look for 
unilateral deviation.

(2) Neck Extensors:—  Patient face downwards. H ead 
well over edge of table. Elevate head.

(3) Sterno-Mastoids.— Patient lies on back. Head 
well over edge of table. Flex neck and rotate head 
to opposite side. Palpate both clavicular and sternal 
heads.

U pper E x trem ity.

(1) Trapezius.— S hrug shoulders in lying position.

(2) Rhom boids.— Patient face downwards. Shoulders 
well down. A pproxim ate scapulae.

(3) Deltoid.—F ix  scapula w ith hand on spine. 
Patient abducts arm  from side.

(4) Internal R otators of Shoulder.— Test fo r in ­
ternal rotation w ith arm, slightly away fr o m  side, at 
20°, and elbow at 90°.

(5) E xternal R otators o f Shoulder ( S p in a ti).— Test 
for external rotation w ith arm , slightly away from  
side,- at 20°, and elbow at 90°.

(6) Pectorals.— Patient lies on back. Adducts arms 
across chest.

(7) Biceps.— Patient li»s on back. A r m  to side, 
palm upwards. Flex tV

- (8) Brachio-Radialis.— Patient lies on back. A rm  
to siĉ e, forearm  in mid- position. Flex elbow.'

(9) Triceps.— Patient lies on back. Test w ith upper 
arm  in both horizontal and vertical positions. Extend 
elbow.

(10) Pronators and Supinators o f Forearm . —  
Patient lies on back. Test w ith forearm  in both 
horizontal and vertical positions. Rotate forearm .

■ (11) W ris t Extensors.— Patient lies on back. F o re ­
arm  vertical. T hum bs and fingers flexed. Extend 
wrist fro m  flexed position: N ote deviation.

(12) W ris t Flexors.— Patient lies on back. F o re ­
arm  vertical. T hum b  and fingers flexed. Flex wrist 
from  extended position. N ote deviation.

(13) .T hum b Extensors.— F ix  wrist and first m eta­
carpal. Patient to extend thumb.

(14) Thum b F le x o rs —  F ix  wrist and first m eta­
carpal. Patient-to flex thumb.

(15) T hum b O pponator.— H a n d  palm upwards. H o ld  
both thum b phalanges extended. Patient to oppose 
thum b to little finger.

(16) T hum b Adductors.— H a n d  palm  downwards. 
A bduct thumb. Patient adducts thumb.

(17) Thumb A bductors.— H a n d  palm  downwards. 
H o ld  both thum b phalanges in order to distinguish 
between extension and true abduction. Patient to 
abduct first metacarpal.

(18) Finger Extensors.— F ix  wrist and metacarpals. 
Flex fingers. Patient extends fingers.

(19) Finger Flexors.— F ix  w rist and metacarpals. 
Extend fingers. Patient flexes fingers. N ote whether 
there is flexion of all phalanges.

(20) Finger A dductors.— H a n d  palm  ’ downwards. 
A bduct fingers. Patient adducts fingers. Test each 
finger individually.

(21) Finger A bductors.— H a n d  palm downwards. 
A dduct fingers. Patient abducts fingers. Test each 
finger individually.

I t  w ill be noticed that all these tests are per­
form ed by using concentric, not eccentric, muscle 
action. W e  find that m ix ing eccentric w ith concentric 
muscle action confuses the patients.

W e  still find difficulty in defining the last two stages 
of the standard calibration, i.e., ‘ (4) A gainst Resist­
ance,’ and ‘ (5) N o rm a l,’ as different physiotherapists 
have varying ideas of these conceptions. W e  endeavour 
to arrive at a standard by com paring the muscle or 
muscle group being tested w ith its fellow  to see 
whether it can be considered ‘norm al.’ I f  the same 
muscle or muscle group of both sides of the body 
is affected, we compare it with the m usculature of ail 
unaffected part of the body. W e  still find this last 
comparison far from  ideal.

Conclusion

By using these standardized positions we have found 
that the number of discrepancies has been reduced 
considerably- and that this method o f testing has 
materially assisted towards the attainment of a true 
evaluation o f initial muscle power, and has helped 
forw ard the im provem ent of muscle which results from  
treatment.

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