30 SECTION 1 Evaluation
30 degrees
20 degrees
0 degrees
0 degrees
FIGURE 1-18 Hip adduction. Patient position: supine, knee extended. Plane
of motion: frontal. Normal range of motion: 0 to 30 degrees. Movements the
patient should avoid: trunk rotation. Goniometer placement: axis over knee
joint through longitudinal axis of femur, stationary arm remains at 0 degrees,
movement arm remains parallel to anterior tibia.
135 degrees
50 degrees
FIGURE 1-21 Ankle dorsiflexion and plantar flexion. Patient position: sitting
or supine with knee flexed to 90 degrees. Plane of motion: sagittal. Normal
range of motion: dorsiflexion, 0 to 20 degrees; plantar flexion, 0 to 50 degrees.
Goniometer placement: axis is on sole of foot below lateral malleolus, station-
0 degrees ary arm remains along shaft of fibula (this is perpendicular to 0 degrees),
movement arm remains parallel to fifth metatarsal.
FIGURE 1-19 Knee flexion. Patient position: prone or sitting, hip in neutral.
Plane of motion: sagittal. Normal range of motion: 0 to 135 degrees. Goniom-
eter placement: axis on lateral knee joint, stationary arm remains at 0 degrees, Table 1-11 Manual MuscleTesting
movement arm remains parallel to fibula laterally.
Grade Term Description
5 Normal Full available ROM is achieved against gravity and
is able to demonstrate maximal resistance.
4 Good Full available ROM is achieved against gravity and
is able to demonstrate moderate resistance.
3 Fair Full available ROM is achieved against gravitybut
is not able to demonstrate resistance.
2 Poor Full available ROM is achieved only with gravity
eliminated.
1 Trace A visible or palpable contraction is noted, with
no joint movement.
0 Zero No contraction is identified.
Modified from Cutter NC , Kevorkian CG: Handbook of manual muscle testing,
New York
1999, :McGraw-Hill, with permissionof McGraw-Hill.
ROM, Range of motion.
CNS disease) are not appropriate for standard manual
muscle testing methods. 74
Assessment Techniques. Manual muscle testing takes
45 degrees
0 degrees 35 degrees into account the weight of the limb without gravity, with
gravity, and with gravity plus additional manual resis -
FIGURE 1-20 Hip internal and external rotation. Patient position: supine or tance.74 Most examiners use the Medical Research Council
sitting, hip at 90 degrees flexion, knee at 90 degrees flexion. Plane of motion:
transverse. Normal range of motion: internal, 0 to 35 degrees; external, 0 to Scale, where grades of 0 to 2 indicate gravity-minimized
45 degrees. Movements the patient should avoid: hip flexion movement, knee positions, and grades 3 to 5 indicate increasing degrees of
movement. Goniometer placement: axis over knee joint through longitudinal resistance applied as an isometric hold at the end of the
axis of femur, stationary arm remains at 0 degrees, movement arm remains test range (Table 1-11 ). 74 A muscle grade of 3 is functionally
parallel to anterior tibia.
important because antigravity strength implies that a limb
can be used for activity, whereas a grade of less than 3
to age 20 years, plateau until older than 30 years before implies that the limb will require external support and is
declining. 74 Muscles that are predominantly type 1 or prone to contracture. 81 Interrater reliability is relatively
slow-twitch fibers (e.g., soleus muscle) tend to be fatigue consistent for grades 1 to 3. There is significant variability
resistant and can require extended stress on testing (such for muscle grades 4 and 5. 6 Other pitfalls encountered in
as several standing toe raises) to uncover weakness. 74 testing strength are outlined in Table 1-12 . For measure -
Type 2 or fast-twitch fibers (e.g., sternocleidomastoid) ment errors to be reduced, one hand should be placed
fatigue quickly, and weakness can be more straightforward above and one below the joint being tested. As detailed in
to uncover abnormalities. Patients who cannot actively extended Tables 1-13 and 1-14 , the examiner’s hands
control muscle tension (e.g., those with spasticity from Text continued on p. 36
