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When OTs Wore White Shoes

The Manual Muscle Test: Low Tech but Still Widely Used

Published August 25, 2014 10:38 AM by Debra Karplus

In occupational therapy school, I remember spending one class session learning about the Manual Muscle Test. Like many of the lessons learned in OT school, I didn't have a sense of their impact in an actual clinical setting. So, I did not really take very seriously the MMT or its uses and implications.

Recently, a few aches and pains caused me to visit a specialist at the recommendation of my general physician. He started asking me a bunch of questions while moving my arms around in different directions.  Then it clicked in my head; he was doing an MMT on me to test my muscle strength.  n my sixties, I had never had one done on me before; thankfully, I have been relatively healthy and very physically active.

As a young therapist, working initially in rehabilitation and mainly settings with mostly geriatric patients, I used the MMT often, but not routinely. Later in my career, when my work became more focused on school-based OT, I used the MMT very rarely. As a travelling OT, I kept a small plastic goniometer in my car glove box on the occasion that I might measure range of motion, but at any unexpected time that I actually needed to measure ROM, my keen mathematical eye and brain could get a rough measurement, if needed.

Searching online, I discovered that in 1912 Harvard orthopedics physician Dr. Robert Lovett created a technique for assessing muscle function against external force, namely gravity. In 1927 in Los Angeles, Dr. Charles L. Lowman developed a numerical system of zero to five, for grading muscle strength and function. Later, the 1930s was a time when the study of kinesiology evolved as a medical discipline.

Poliomyelitis epidemics of the 1940s was a time of expansion for occupational therapy, and also a time when the manual muscle test, as we know it today, was conceived. Grades of plus and minus were added to the existing muscle testing.  Books were written about the MMT and how to perform it correctly for diagnosis and treatment of patients with neurological and orthopedic disabilities.  n 1948, it began its use for the reporting of insurance claims.

The MMT appears not to have changed much in the nearly eight decades since then. Trends have come and gone. Technology, both low tech and high tech, including for documentation have become prevalent in essentially all aspects of rehabilitation and specifically occupational therapy.

What keeps the Manual Muscle Test ever-present as a diagnostic, treatment and reporting and communication tool for the occupational and also physical therapy? First, it is inexpensive; you need essentially no special supplies or equipment to administer this quick and easy assessment. Second, it can be performed virtually anywhere. Whether your patient is seated or confined to bed, there was simple ways to assess their muscle function and strength using the MMT. Finally, the MMT has a track record of universality in both research and clinical settings.

What experiences have you had with the Manual Muscle Test?

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