T+M practical (trunk/hip)

rectus abdominis

muscles involved in trunk flexion MMT

rectus abdominis, external abdominal oblique

muscles involved in alternative trunk flexion MMT

external and internal abdominal obliques

muscles involved in trunk rotation MMT

erector spinae (thoracic and lumbar portions), multifidus, semispinalis thoracis, quadratus lumborum

muscles involved in trunk extension MMT

quadratus lumborum, iliocostalis lumborum

muscles involved in pelvic elevation MMT

supine, LE extended, lumbar spine flat, pelvic posterior tilt

patient position for trunk flexion (rectus abdominis only)

none

stabilization for trunk flexion (rectus abdominis only)

anterior aspect of abdomen lateral to midline

palpation for trunk flexion (rectus abdominis only)

flexes trunk while maintaining posterior pelvic tilt

patient action for trunk flexion (rectus abdominis only)

none

resistance for trunk flexion (rectus abdominis only)

both scapula clear surface

goal for trunk flexion (rectus abdominis only)

5: hands behind head

4: arms crossed on chest

3+: arms extended

3: arms extended, scapula do not FULLY clear

2: arms extended, only head and neck clear

1: palpable contraction

0: no contraction

grading positions for trunk flexion (rectus abdominis only)

supine with arms across chest, hips flexed to 90º, knees extended

patient position for trunk flexion alternative test with leg lowering

none, but one hand placed under patient's lumbar spine

stabilization for trunk flexion alternative test with leg lowering

anterior aspect of trunk, lateral to midline

palpation for trunk flexion alternative test with leg lowering

lowers leg toward table slowly with knees extended and back flat

patient action for trunk flexion alternative test with leg lowering

none

resistance for trunk flexion alternative test with leg lowering

no contraction

0 muscle grade for trunk flexion alternative test with leg lowering

palpable contraction

1 muscle grade for trunk flexion alternative test with leg lowering

patient lowers legs to >75º from table

2 muscle grade for trunk flexion alternative test with leg lowering

patient lowers legs to 70º from table

3 muscle grade for trunk flexion alternative test with leg lowering

patient lowers legs to 60º from table

3+ muscle grade for trunk flexion alternative test with leg lowering

patient lowers to 45º from table

4- muscle grade for trunk flexion alternative test with leg lowering

patient lowers legs to 30º

4 muscle grade for trunk flexion alternative test with leg lowering

patient lowers legs to 15º

4+ muscle grade for trunk flexion alternative test with leg lowering

patient lowers legs all the way to the table

5 muscle grade for trunk flexion alternative test with leg lowering

supine with hands behind neck, lower extremities full extended

patient position for trunk rotation

anterior lower extremities

stabilization for trunk rotation

anterolateral abdominal wall lateral to the rectus abdominis for EO

palpation for trunk rotation

flexes and rotates trunk to clear both scapulae

patient action for trunk rotation

not needed

resistance for trunk rotation

5: hands behind head

4: arms crossed in front of chest

3: arms extended

grade positions for trunk rotation

seated, arms at side. hands not allowed to grip table

gravity eliminated position for trunk rotation

pelvis

gravity eliminated stabilization for trunk rotation

anterolateral abdominal wall lateral to the rectus abdominis for EO

gravity eliminated palpation for trunk rotation

turn to side

gravity eliminated patient action for trunk rotation

prone with hands behind neck, lower extremities extended

patient position for trunk extension

over posterior aspect of patient's thighs and pelvis

stabilization for trunk extension

lateral to spinous processes of lumbar and thoracic vertebrae

palpation for trunk extension

extends trunk

patient action for trunk extension

not needed

resistance for trunk extension

sternum clears table

goal for trunk extension

5: hands behind head

4: hands low back

3: hands at side

2: hands at side, partial ROM

1: palpable contraction

0: no contraction

trunk extension grade positions

supine (or prone) with tested hip slight abduction, feet off table

patient position for pelvic elevation

patient holds table

stabilization for pelvic elevation

above posterior iliac crest lateral to erector spinae

palpation for pelvic elevation

elevate pelvis

patient action for pelvic elevation

proximal to ankle, pull

resistance for pelvic elevation

5: hold against max resistance

4: hold against mod resistance

3: hold against min resistance

2: full ROM, no resistance

1: palpable contraction

0: no motion, no contraction

grading for pelvic elevation

iliacus, psoas major

Muscle(s) tested in hip flexion

- seated

- legs dangle from table

- hold table edge with hands

patient position for hip flexion

ipsilateral iliac crest

stabilization for hip flexion

N/A, hard to palpate

palpation for hip flexion

flexes hip

patient action for hip flexion

anterior aspect of distal thigh into hip extension

resistance for hip flexion

sartorius movement (hip flexion + abduction + lateral rotation)

common substitution for hip flexion

- side lying on side tested

- hip extended

- knee flexed

patient position for gravity eliminated hip-flexion

standing behind patient, stabilize pelvis and support uppermost leg

stabilization for gravity eliminated hip-flexion

flex hip with knee flexed

patient action for gravity eliminated hip-flexion

standard

grading for gravity eliminated hip-flexion

sartorius

muscle(s) involved in testing hip flexion + abduction + lateral rotation

- seated

- legs dangle from table

- hold table edge with hands

patient position for hip flexion + abduction + lateral rotation

ipsilateral iliac crest

stabilization for hip flexion + abduction + lateral rotation

anterior thigh

palpation for hip flexion + abduction + lateral rotation

slide heel up shin of opposite leg

patient action for hip flexion + abduction + lateral rotation

- one hand on distal thigh into hip extension and adduction

- one hand on medial ankle into hip IR

resistance for hip flexion + abduction + lateral rotation

standard

grading for hip flexion + abduction + lateral rotation

hip flexion only (iliacus, psoas major)

substitution for hip flexion + abduction + lateral rotation

- supine

- heel of tested side on CL ankle

- CL leg extended

patient position for gravity eliminated hip flexion + abduction + lateral rotation

gluteus maximus, semitendinosus, semimembranosus, biceps femoris

muscle(s) involved in testing hip extension (NOT glute max specific)

prone, legs extended

patient position for hip extension (NOT glute max specific)

posterosuperior pelvis

stabilization for hip extension (NOT glute max specific)

posteroinferior pelvis, posterosuperior thigh

palpation for hip extension (NOT glute max specific)

extend hip with knee extended

patient action for hip extension (NOT glute max specific)

posterior distal thigh

resistance for hip extension (NOT glute max specific)

- side lying on side to be tested

- tested hip in slight flexion

patient position for gravity eliminated hip extension (NOT glute max specific)

- in front of patient

- support upper leg

- stabilize pelvis

stabilization for gravity eliminated hip extension (NOT glute max specific)

extend hip with knee extended

patient action for gravity eliminated hip extension (NOT glute max specific)

- prone with hip in extension

- knee in 90° flexion

patient position for hip extension (gluteus maximus specific)

posterosuperior pelvis

stabilization for hip extension (gluteus maximus specific)

posteroinferior pelvis

palpation for hip extension (gluteus maximus specific)

extend hip with knee in 90º flexion

patient action for hip extension (gluteus maximus specific)

distal thigh into hip flexion

resistance for hip extension (gluteus maximus specific)

- side lying on side to be tested

- test limb in slight hip flexion

- knee 90º flexion

patient position for gravity eliminated hip extension (gluteus maximus specific)

- stand in front of patient

- support upper leg

- stabilize pelvis

stabilization for gravity eliminated hip extension (gluteus maximus specific)

posteroinferior pelvis

palpation for gravity eliminated hip extension (gluteus maximus specific)

extend hip with knee in 90º flexion

patient action for gravity eliminated hip extension (gluteus maximus specific)

gluteus medius, gluteus minimus

muscle(s) involved in the testing of hip abduction

- sidelying

- limb to be tested is uppermost

- hip in slight extension

- neutral rotation

patient position for hip abduction

pelvis from behind

stabilization for hip abduction

gluteus medius above greater trochanter on lateral aspect of pelvis

palpation for hip abduction

abduct hip without rotating hip and pelvis

patient action for hip abduction

lateral aspect of distal thigh into hip adduction

resistance for hip abduction

pelvis posterior rotation, allowing substitution by TFL

substitutions for hip abduction

supine with hip in full adduction, knee extended

patient position for gravity eliminated hip abduction

anterolateral aspect of ipsilateral pelvis

stabilization for gravity eliminated hip abduction

hip lateral rotation, allowing substitution by hip flexors

substitution for gravity eliminated hip abduction

TFL

muscle(s) involved in MMT for hip abduction with flexion

- sidelying

- limb to be tested is uppermost

- hip in 45º flexion

- neutral rotation

patient position for hip abduction with flexion

lateral pelvis from behind

stabilization for hip abduction with flexion