Physical Therapy Evaluation: Manual Muscle Testing, Posture, Special Tests, and Neurological Assessment

Comprehensive vocabulary flashcards covering manual muscle testing procedures and grades, postural deviations, special orthopaedic diagnostic tests of the spine and pelvis, and clinical neurological examination techniques.

Fascicular Arrangement

The structural pattern of muscle fascicles (such as parallel, fusiform, circular, triangular, and pennate) that determines a muscle's power and range of motion; longer fibers produce greater range of motion, whereas greater total cross-sectional area produces greater power.

Muscle Strength

The force exerted by a muscle to overcome resistance in one maximal effort, directly quantified clinically using Manual Muscle Testing (MMT).

Muscle Power

The amount of work produced per unit of time, defined mathematically as the product of muscle strength and movement speed.

Muscle Endurance

The capacity of a muscle to contract repeatedly over an extended period without failure.

Break Test

A procedure in Manual Muscle Testing where manual resistance is applied against gravity at the completion of a joint's available range of motion.

Make Test

A procedure in Manual Muscle Testing in which manual resistance is applied against an actively contracting muscle group, matching the patient's resistance without overcoming it up to a maximal level.

Grade 5 (Normal)

Manual muscle test score where the patient completes full active range of motion against gravity and holds the position against maximal resistance.

Grade 4 (Good)

Manual muscle test score where the patient completes full active range of motion against gravity and tolerates moderate resistance, but yields to maximal resistance.

Grade 3 (Fair)

Manual muscle test score indicating the patient can complete full active range of motion against gravity but cannot hold against any applied resistance.

Grade 2 (Poor)

Manual muscle test score indicating the patient can complete full range of motion only when placed in a gravity-eliminated plane.

Grade 1 (Trace)

Manual muscle test score where no joint movement occurs, but visible or palpable muscle contraction is detected by the clinician upon palpation.

Grade 0 (Zero)

Manual muscle test score indicating complete absence of visible or palpable muscle contraction.

Grade 3+ (Fair Plus)

Manual muscle test grade assigned when a patient completes full range of motion against gravity and can hold against minimal resistance.

Grade 2+ (Poor Plus)

Manual muscle test grade assigned when a patient can initiate movement against gravity, but cannot complete the range of motion.

One-Repetition Maximum (1-RM) Test

The gold standard of standardized muscle strength assessment, defined as the maximal load a patient can move through a full range of motion exactly one time in a controlled manner with proper technique.

Chair Stand Test (5STS)

A functional assessment evaluating lower extremity muscle mobility and functional strength by timing a patient during sit-to-stand transitions.

Handheld Dynamometry

A method of strength evaluation using a portable device placed between the clinician's hand and the patient's body to quantify mechanical force directly at the point of contact.

Isokinetic Dynamometry

A method of testing utilizing a stationary electromechanical unit to measure torque and range of motion at constant angular velocities during isometric, concentric, and eccentric contractions.

Line of Gravity (LOG)

An imaginary vertical line that represents the direction of the body's gravitational force acting through its center of gravity; for stability, it must fall within the base of support.

Center of Gravity (COG)

The imaginary point where the body's entire mass is evenly balanced, located at the level of the $12\text{th}$ thoracic vertebra in children and the $2\text{nd}$ sacral vertebra ($S_1$ in males) in adults.

Primary Spinal Curves

The kyphotic curvatures of the thoracic and sacral regions that are present at birth when the entire spine is flexed.

Secondary Spinal Curves

The lordotic curvatures that develop postnatally in the cervical spine (around $3\text{ months}$ when lifting the head) and lumbar spine (around $6\text{ to }8\text{ months}$ when sitting and walking).

Postural Pain Syndrome

A postural condition marked by pain induced by sustained static positions that is relieved by physical activity, presenting prior to significant structural adaptive contracture.

Postural Dysfunction

A condition where chronic muscular and structural strength or flexibility imbalances predispose spinal or peripheral joints to overuse and tissue injury.

Lower Crossed Syndrome

A postural pattern characterized by anterior pelvic tilt and hyperlordosis, caused by tightness of the iliopsoas and lumbar erector spinae paired with weakness of the abdominals and gluteal muscles.

Upper Crossed Syndrome

A postural imbalance featuring a forward head posture and rounded shoulders, driven by tight upper trapezius, levator scapulae, and pectorals alongside weak deep neck flexors, rhomboids, lower trapezius, and serratus anterior.

Sway Back Posture

A relaxed standing posture where the pelvis shifts anteriorly in posterior pelvic tilt with hip extension, causing the thoracic spine to shift posteriorly and flatten the lower lumbar lordosis.

Gibbus (Humpback Deformity)

A sharp posterior angulation in the upper thoracic vertebral column caused by localized anterior vertebral body collapse, commonly seen after tuberculosis.

Dowager's Hump

An excessive thoracic kyphosis common in postmenopausal women with osteoporosis, resulting from anterior wedge collapse of consecutive thoracic vertebral bodies.

Structural Scoliosis

An irreversible, progressive lateral spinal deformity with fixed bony rotation that does not disappear during Adam's forward bending test.

Non-Structural (Functional) Scoliosis

A flexible, non-progressive lateral curvature of the spine without fixed bony deformity that typically straightens out during forward flexion.

Torticollis (Wryneck)

A cervical deformity characterized by unilateral shortening and contracture of the sternocleidomastoid muscle, pulling the head into ipsilateral lateral flexion and contralateral rotation.

Body Mass Index (BMI)

An anthropometric calculation of body fatness determined using the formula $\text{BMI} = \frac{\text{Weight in kg}}{(\text{Height in meters})^2}$.

True Leg Length Measurement

A structural limb measurement taken with a tape measure from the anterior superior iliac spine (ASIS) to the medial or lateral malleolus; a difference greater than $1.5\,\text{cm}$ indicates a structural leg length discrepancy.

Apparent Leg Length Measurement

A functional limb length measurement taken from the umbilicus to the medial or lateral malleolus, reflecting pelvic tilts or spinal compensation rather than true bony discrepancy.

Fat Caliper (Skinfold Caliper)

An anthropometric device used to assess subcutaneous body fat composition by measuring skinfold thickness in millimeters.

Figure-of-Eight Measurement

A standardized tape measurement protocol applied around anatomical landmarks of the ankle to assess joint edema and swelling.

Adam's Forward Bending Test

A postural screening maneuver where the standing patient bends forward with arms hanging down; asymmetry of the rib cage (rib hump) or paraspinal musculature indicates structural scoliosis.

Craniocervical Flexion Test (CCFT)

A cervical muscle test using an inflatable pressure sensor inflated to $20\,\text{mmHg}$ to assess the deep cervical flexors as the patient performs progressive head-nodding increments up to $30\,\text{mmHg}$; failing to reach $26\,\text{mmHg}$ is positive.

Deep Neck Flexor (DNF) Endurance Test

An isometric endurance test in which a supine patient performs a maximal chin tuck and lifts the occiput $2.5\,\text{cm}$ off the table; normal hold time averages $38.9\,\text{seconds}$, while symptomatic patients fail at $20\,\text{seconds}$ or less.

Foraminal Compression (Spurling) Test

A three-stage provocative cervical assessment applying axial downward pressure to reproduce radicular arm pain indicative of cervical nerve root encroachment.

Reverse Spurling Sign

A finding during the Spurling compression test where pain radiates to the side opposite lateral flexion, indicating cervical muscle spasm rather than nerve root compression.

Cervical Distraction Test

A special test where the clinician applies axial traction to the occiput and chin; relief of radicular arm symptoms indicates reduced cervical nerve root compression.

Jackson Compression Test

A modified foraminal compression maneuver where axial downward pressure is applied while the patient's cervical spine is rotated to one side.

Upper Limb Neurodynamic Test 1 (ULNT 1)

A neural tension test biasing the median nerve ($C_5-C_7$) consisting of scapular depression, shoulder abduction to $110^\text{o}$, wrist/finger extension, forearm supination, shoulder external rotation, and elbow extension.

Lhermitte Sign

A sudden, sharp electric shock-like sensation radiating down the spine and into the extremities provoked by passive cervical and hip flexion, indicating dural irritation or cervical myelopathy.

Vertebral Artery (Cervical Quadrant) Test

A provocative vascular screening test involving passive cervical extension, side flexion, and rotation held for $30\,\text{seconds}$ to identify vertebral artery compromise producing dizziness, nystagmus, or visual disturbances.

Hautant's Test

A two-part screening test performed with eyes closed to differentiate dizziness of proprioceptive origin (Part 1, neutral neck) from vertebrobasilar insufficiency (Part 2, neck extended and rotated).

Dix-Hallpike Maneuver

A diagnostic maneuver for Benign Paroxysmal Positional Vertigo (BPPV) where a patient is transitioned rapidly from sitting to supine with the head rotated $30-45^\text{o}$ and extended $20-30^\text{o}$ off the plinth to provoke torsional nystagmus.

Cervical Flexion Rotation Test

An upper cervical mobility test where full passive neck flexion locks the lower cervical segments to isolate $C_1-C_2$ rotation; normal rotation is $45^\text{o}$, and limitation suggests cervicogenic headache.

Slump Test (ST1)

A progressive neural tension maneuver consisting of thoracolumbar slump, cervical flexion, knee extension, and ankle dorsiflexion to evaluate irritation of the spinal cord, lumbosacral nerve roots, or sciatic nerve.

Straight Leg Raise (Lasègue's Test)

A neurodynamic assessment where the relaxed lower extremity is passively flexed at the hip with knee extended to detect lumbosacral nerve root ($L_4-S_1$) irritation or disc herniation.

Crossed Straight Leg Raise Test (SL5 / Well-Leg Raise)

Performance of a straight leg raise on the asymptomatic lower extremity that reproduces radicular pain in the symptomatic opposite leg, highly specific for a large disc herniation.

Passive Lumbar Extension Test

An instability test where both lower extremities are passively lifted simultaneously $30\,\text{cm}$ off the table while traction is applied; low back pain or a feeling of the spine 'coming off' confirms radiographic instability.

Prone Segmental Instability Test

An instability assessment where posterior lumbar pressure elicits pain while the patient rests prone with feet on the floor, which subsequently disappears when the patient lifts their feet off the floor due to protective extensor activation.

Stork Standing Lumbar Extension Test

An active lumbar extension test performed while balancing on one leg; ipsilateral pain indicates spondylolysis or a pars interarticularis stress fracture.

Bicycle Test of Van Gelderen

A cycling test designed to differentiate neurogenic claudication from vascular claudication: symptoms brought on by upright/extended pedaling resolve when leaning forward into lumbar flexion.

Hoover's Test

A malingering test where the examiner places hands under both calcanei while the patient attempts active straight leg raising; absence of downward counter-pressure under the opposite heel indicates feigned weakness.

Gapping Test

An anterior sacroiliac joint stress test performed by applying a downward and outward force to both anterior superior iliac spines simultaneously.

Gaenslen's Test

A sacroiliac joint stress test where one hip is held in maximal flexion against the abdomen while the opposite hip is hyperextended over the edge of the plinth.

Piedallu's Sign

A sacroiliac joint hypomobility test where palpation of the posterior superior iliac spines (PSIS) in sitting reveals that a lower PSIS moves higher upon forward trunk flexion.

Supine to Sit Test (Long Sitting Test)

A test evaluating pelvic torsion or functional leg length differences by comparing the relative migration of the medial malleoli as the patient moves from supine to long sitting.

Yeoman's Test

A prone physical examination test in which the clinician flexes the patient's knee to $90^\text{o}$ and extends the hip to stress the anterior sacroiliac ligament.

Arousal

The physiological readiness of the central nervous system for activity, graded clinically as alert, lethargic, obtunded, stupor, or coma.

Stereognosis

A combined cortical sensory function defined as the ability to identify a familiar object by tactile manipulation alone without visual input.

Graphesthesia

A cortical sensory capability defined as the recognition of numbers, letters, or designs traced directly on the skin.

Dysdiadochokinesia

A cerebellar impairment characterized by the inability to perform rapid, alternating movements smoothly (e.g., alternating pronation and supination).

Dysmetria

A cerebellar motor sign defined as the inability to properly judge distance or range during voluntary movements, resulting in undershooting or overshooting.

Dyssynergia

A cerebellar deficit causing movement decomposition, where actions are executed in fragmented sequential steps rather than a single fluid sequence.

Titubation

Rhythmic, oscillatory movements of the head or axial trunk resulting from cerebellar lesions.

Rebound Phenomenon

The inability of an opposing muscle group to halt a forceful contraction when isometric manual resistance is suddenly released by the clinician.

Athetosis

A basal ganglia impairment manifesting as slow, continuous, involuntary writhing or twisting movements of the extremities.

Chorea

A basal ganglia motor symptom characterized by rapid, irregular, involuntary jerky contractions of muscle groups.

Spasticity

A velocity-dependent increase in muscle tone and resistance to passive stretch associated with upper motor neuron lesions, frequently presenting with a clasp-knife response.

Rigidity

A uniform, velocity-independent increase in muscle tone and resistance throughout the full passive range of movement, commonly associated with basal ganglia pathology.

Ishihara Test

A diagnostic screening test utilizing pseudoisochromatic color plates to assess color vision mediated by Cranial Nerve II (Optic Nerve).

Chvostek Test

A diagnostic maneuver for facial nerve (CN VII) irritation where tapping over the parotid gland overlying the masseter muscle elicits facial muscle twitching.

COWS Mnemonic

The expected physiological nystagmus response during the caloric temperature test for vestibular nerve function: Cold water produces nystagmus to the Opposite side, while Warm water produces nystagmus to the Same side.

Arrangement of Fascicles

The organizational pattern of skeletal muscle bundles that dictates muscle power and range of motion; categorized into parallel, fusiform, circular, triangular, and pennate (unipennate, bipennate, and multipennate).

Muscle Strength

The force exerted by a muscle to overcome resistance in a single maximal effort; measured clinically using manual muscle testing (MMT).

Muscle Power

The work produced per unit of time, defined as the product of strength and speed.

Muscle Endurance

The physiological capacity of a muscle to perform repeated contractions over time.

Break Test

A manner of manual muscle testing where external manual resistance is applied at the end of the range of motion against gravity.

Make Test

A manner of manual muscle testing where manual resistance matches the patient's active contraction without overcoming it, progressively increasing up to a maximal level.

Grade 5 (Normal)

Manual muscle test grade assigned when a patient completes full active range of motion against gravity and holds position against maximal manual resistance.

Grade 4 (Good)

Manual muscle test grade assigned when a patient completes full range of motion against gravity and yields to maximal resistance, tolerating only moderate resistance.

Grade 3 (Fair)

Manual muscle test grade assigned when a patient completes full range of motion against gravity without tolerating any added resistance.

Grade 2 (Poor)

Manual muscle test grade assigned when a patient is able to complete full range of motion only when gravity is eliminated.

Grade 1 (Trace)

Manual muscle test grade assigned when the therapist can palpate or observe faint muscle contraction without producing joint movement.

Grade 0 (Zero)

Manual muscle test grade assigned when there is complete absence of visible or palpable muscle contraction upon palpation.

One-Repetition Maximum (1-RM) Test

The gold standard standardized strength test measuring the maximal load a patient can move exactly one time through full range of motion in a controlled manner with proper form.

Isokinetic Dynamometry

A strength testing method using a stationary, electromechanical device that measures torque and range of motion produced during isometric, concentric, and eccentric contractions at a constant speed.

Line of Gravity (LOG)

An imaginary vertical line that represents the direction of the body's gravitational force acting through its center of gravity; must fall within the base of support for an object to maintain stability.

Center of Gravity (COG)

The imaginary point in an object where its entire weight is evenly distributed; situated at the level of the 12th thoracic vertebra ($\text{T12}$) in children, and at the 2nd sacral vertebra ($\text{S2}$, or $\text{S1}$ in males) in adults.

Postural Pain Syndrome

A postural condition wherein joint and muscular pain is relieved with activity, though strength and flexibility imbalances may develop over time.

Postural Dysfunction

A clinical state where adaptive shortening and muscle weakness predispose joint complexes and tissues to injury or overuse syndromes that normal structures could otherwise sustain.

Lower Crossed Syndrome

A common postural muscle imbalance featuring increased lumbar lordosis, anterior pelvic tilt, and an increased lumbosacral angle ($> 30^\circ$), driven by tight hip flexors (iliopsoas, rectus femoris, tensor fasciae latae) and tight erector spinae, crossed with weak abdominal muscles and weak gluteals.

Sway Back Posture

A relaxed or slouched alignment where the pelvis shifts anteriorly with posterior pelvic tilt ($\text{PPT}$), accompanied by hip extension, flattened lower lumbar spine, posterior thoracic segment displacement, and forward head posture.

Upper Crossed Syndrome

A postural distortion pattern presenting with forward head posture and rounded shoulders, characterized by tightness in the upper trapezius, levator scapulae, and pectoralis major/minor, paired with weakness in the deep neck flexors, rhomboids, lower trapezius, and serratus anterior.

Gibbus Deformity

A sharp posterior angulation forming a prominent hump in the upper thoracic vertebral column, typically resulting from anterior vertebral body collapse due to tuberculosis.