MMT Chapter 6 Lower Extremity

Other muscles of hip flexion

Rectus femoris; sartorius; TFL; Pectineus; Adductor Longus, Brevis, Magnus; Glut med

Primary muscles knee extension

Rectus femoris; vastus intermedialis, lateralis, medialis longus & oblique;

Hip flexion ROM

0-120*

Knee flexion ROM

0-135*

Hip Adduction ROM

0-15/20*

Hip extension ROM

0-20*

Hip External rotation ROM

0-45*

Hip abduction ROM

0-45*

Hip internal rotation ROM

0-45*

Knee extension ROM

135-0*

Test position knee extension (Grades 5-3)

pt EOB; pad under thigh to keep it horizontal; PTA attempts to flex pt's straightened leg

Grade 3 MMT hip extension

pt completes ROM & hold position against gravity - no resistance (test leg straight)

Grade 5 MMT hip extension

pt completes ROM and holds position against max resistance (test leg straight)

Grade 4 MMT hip extension

pt completes ROM and holds position against strong to moderate resistance (test leg straight)

Grade 1 hip extension alternate position

pt prone, PTA beside, palpating hamstrings at ischial tuberosity; pt attempts to extend hips or squeeze buttocks together; PTA feels for contraction

MMT positions - knee flexion Grades 5-3

pt prone, PTA on test side; resistance hand posterior just above ankle; other hand over hamstrings. PTA attempting to straighten leg. (leg less than 90* knee flexion and internally rotated will isolate the semi-memb & semi-tend. Externally rotated leg will test lateral hamstrings ( biceps femoris)

Hip extension to isolate Glut Max

pt prone, same test as extension except knee is flexed to 90*

Test position - hip extension

pt prone; PTA at test side, resisting just above the ankle (alternate - resisting hand just above knee), other hand stabilizes at the ilium

Hip external rotation test position (Grade 5-3)

pt short sitting EOB, PTA seated beside or kneeling, resistance hand just above malleolus; counter pressure form other hand at lateral knee. pt externally rotates then resists PTAs attepts to turn the leg out. 5=holds against max resist; 4=holds against mod resist; 3= holds end position but no resistance.

Alternate position for Grade 2 hip flexion

pt side lying, test limb on top & supported by PTA; PTA behind pt; pt attempts to flex. Grade 2 = complete ROM w/no gravity

Postion for MMT hip adbudction

pt side-lying, test leg on top,straight & slightly extended, lower leg flexed for stability. PTA behind pt, resisting at lateral knee and stabilizing just proximal to greater trochanter

Grade 2 hip extension alternate position

pt side-lying, test limb on top & supported by PTA from behind, bottom leg flexed for stability pt brings leg backward through ROM toward PTA, completes ROM

Alternate knee flexion (grade 2-1)

pt side-lying; test limb on top & supported by PTA, lower limb flexed for stability. 2=completes ROM; Grade 1, pt prone; PTA supports limb in flexion, askes patient to bend knee & feels for contraction of med & lat hamstrings just above the knee

Primary Muscles of hip extention

Glut Max; Semitendinosus, Semimembranosus, Biceps femoris (long head)

Other muscles of hip abduction

Glut max, TFL, Obturator internus, gemellus superior, gemelus inferior, satorius

Primary muscles of hip abduction

Glut med; glut min

Primary muscles of hip internal rotation

Glut min; TFL; glut med

Other muscles knee flexion

Gracilis; TFL; sasrtorius; popliteus; gastrocnemius; plantaris

Other muscles of hip adduction

Obturator externus, lower glut max

Primary muscles hip external rotation

Obturator externus; Obturator internus; Quadratus femoris; Piriformis; Gemellus superior; Semellus inferior; Glut Max

Other muscles of hip flexion

Adductor magnus Glut med

Main muscles of hip adduction

Adductor magnus, longus, brevis; Pectineus; Gracilis

Grade 5 hip abduction

Completes ROM and holds against max resistance

Grade 4 hip abduction

Completes ROM and holds against moderate resistance

Grade 3 hip abduction

Completes ROM and holds end position against gravity; no resistance

Primary muscles knee flexion

LH Biceps femoris; SH biceps femoris; semi-membranosus; semitendinosus

Primary muscles - Hip flexion

Psoas major/Iliacus (iliopsoas)

Grade 5-3 MMT test

Pt seated edge of table, PTA next to pt; pt flexes at hip (lifting thigh off table w/no rotation); PTA pushes down, pt resists. Grade 5=pt holds against max resistance; 4=holds against mod resist w/some give; 3=completes range agains gravity, no resistance from PTA

Other muscles of hip external rotation

Sartorius; Biceps femoris; glut med; psoas major; adductor magus, longus; popliteus

Hip internal rotation position (Grade 5-3)

Seated EOB, PTA places leg in internal rotation & provides stabilization at medial knee; resistance at ankle.

Other muscles of hip internal rotation

Semitendinosus; semimembranosus, adductor magnus; adductor longus

Alternate hip extensor test if pt cannot lie prone

Supine w/feet off the end of the table; PTA at end of table cupping heel, PTA tries to lift the leg off the table, pt resists.

Other knee extension muscles

TFL

Alternate position knee extension (Grades 2-1)

grade 2: side lying; lower limb flexed, test limb on top & supported in 90* knee flexion, pt attempts to straighten leg. Grade 2 = ROM w/no resistance; Grade 1-pt supine; PTA holds test limb slightly off table in extension; pt attempts to push limb toward table; PTA feeling for contraction of patellar tendon or quads.

Modified hip extension for hip flexion tightness (grades 5-3)

pt standing, hips flexed, leaning on table, PTA on test side providing resistance just above the knee; other hand stabilizing pelvis on the test side. Knee extended to test all hip muscles, knee flexed to isolate glut max.

Alternate position for Grade 1 hip flexion

pt supine, PTA beside & supporting the limb in flexion, feeling for palpation just distal to the inguinal ligament, medial side of sartorius

Grade 2 & 1position hip abduction

pt supine, PTA on test side lifting limb at the ankle to reduce friction (support only); other hand palpates to feel glut med just proximal to greater trochanter. Grade 2 = ROM w/no rsistance & no gravity; Grade 1 = palpable contraction but no movement

Alternate position hip external rotation (grades 0-2)

pt supine; test leg internally rotated, pt attempts to externally rotate the hip. Grade 2 completes ROM, no gravity; Grade 1 feeling for contraction of external rotators

Alternate hip internal rotation position (Grades 2-1)

pt supine; test limb in partial external rotation; pt attemps to internally rotate, PTA looking for movement (2) or contraction (palpate glut med)