Ok, so I actually do manual muscle test but not the way you are taught in school. Let me explain.

In PT school I had to manual muscle test coracobrachialis…

In PT school we are taught how to target and manual muscle test every single muscle in the human body…it was daunting and it felt like I would never be able to remember all of it. Since I wouldn’t be able to remember all of the tests I felt like there was no way I would be a good PT, the struggle was real.

Well, now that I have graduated and I practice on my own I have come to the realization that most (almost all) manual muscle tests are a waste of time. Yes…I hardly every manual muscle test anything.

I will tell you the 3 reasons I manual muscle test.

1. Neurological weakness

More than wanting to grade the quadriceps (or even worse the VMO..) a 4-/5 so that I can strengthen it because of this or that. I look to see if there is profound weakness side to side in patients, to help rule in a true neurological compromise, from a nerve root irritation for example. It doesn’t matter to me whether the quad is a 4/5 or 3+/5 or whatever, it does matter to me if there is a profound in knee extension compared to the other side. Most of the good PTs I know use manual muscle testing in this fashion as more of a myotomal test than a true muscle test.

2. To “paint a picture of dysfunction”

Sometimes patients present with movement pattern dysfunction (see SFMA for my definition of movement dysfunction) with areas of true muscular weakness contributing to that dysfunction. I will do a quick manual muscle test on a few muscle groups that I know are weak after seeing a few movement patterns (aka hip abductors in a gross looking squat or single leg stance) to confirm that they are truly weak. I check the hip abductors and extensors often but again I don’t really care if it is a 4- or 4+….it just matters that it isn’t a 5/5. In other words, it’s a way for me to document, to myself/other PTs/ insurance companies, that there is a weakness present. It’s a pretty terrible way to measure progress due to subjectivity and average inter-rater reliability (depending on the study).

3. To make insurance companies happy

Insurance companies love numbers and progress. Manual muscle tests, while poor at showing progress objectively, are any easy way to show that a patient is improving. I usually will say a patient is 4-/5 to “paint the picture” of weakness and as the patient progresses and is able to complete movement patterns more functionally (again SFMA) I will retest the muscle and document progress.

What does this mean for you, the student? My point is not to be lazy in your examination to make you frustrated that you have to learn this stuff, but simply to say when you get out of school (big caveat) you will find that you can spend your time more effectively and get more diagnostically relevant information with other tests.