• Manual Muscle Testing (MMT) is a clinician-administered measure of muscle strength
  • Three different versions of grading scales for the MMT have been developed to date, each of which can be found below, in the Availability section

Clinical Considerations

The MMT has since been adapted for use as the ASIA Motor Score, and for muscle strength testing in the Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP).

ICF Domain

Body Functions ▶ Neuromuscular Functions

Administration

  • Each muscle or muscle group is individually tested, and rated in terms of strength against gravity and/or resistance
  • Administration time depends on the muscle tested; <1 minute for each muscle

Number of Items

N/A

Equipment

Does not require any specialized equipment.

Scoring

Each muscle is rated 0-5.

Languages

English

Training Required

No formal training is required, but should be administered by professionals.

Availability

Refer to:

  1. Daniels and Worthingham’s Muscle Testing protocol
  2. Muscles Testing and Function (Kendall & McCreary)
  3. Aids to the examination of the peripheral nervous system (Medical Research Council)

# of studies reporting psychometric properties: 9

Interpretability

MCID: not established
SEM: not established
MDC: not established

Reliability

  • Inter-rater Reliability:
    Agreement = 82%-84%

(Savic et al. 2007; n=45; 38 males, 7 females; 24 AIS-A, 13 AIS-D, 29 thoracic)

Agreement of wrist extensors and elbow flexors = 0.96, 094

(Bye et al. 2021; n=60; 48 males, 12 females; mean age: 55 years; ASIA: 17A, 14B, 13C, 16D; median (IQR) time since injury: 4 (1.5 to 24) months)

Validity

  • High correlation with Spinal Cord Independence Measure (SCIM III):
    • Sum of MMT scores from multiple upper-limb muscles with:
      SCIM Self-care items: r = 0.70-0.89
      SCIM Self-care total: r = 0.84
      SCIM Respiration & Sphincter: r = 0.68
      SCIM Mobility: r = 0.71
      SCIM Total: r = 0.78
    • Single upper-limb muscle MMT scores with SCIM Self-care total:
      r = 0.36-0.82

(Rudhe et al. 2009; N=29; 16 males; ASIA A-D; mean (SD) time since injury: 4.5 (3) months)

  • Moderate to High correlation with Walking Index for SCI (WISCI):
    WISCI Level: r = 0.647-0.663
    WISCI Speed: r = 0.494-0.539

(Burns et al. 2011; n=75; 79% males; tetraplegia and paraplegia; patients able to ambulate ≥10m, 88% AIS-D)

Responsiveness

No values were reported for the responsiveness of the MMT for the SCI population.

Floor/Ceiling Effect

No values were reported for the presence of floor/ceiling effects in the MMT for the SCI population.

Reviewers

Dr. Vanessa Noonan, Dr. Carlos L. Cano-Herrera, Elsa Sun

Date Last Updated

31 December 2024

Beninato M, O’kane KS, Sullivan PE. Relationship between motor FIM and muscle strength in lower cervical-level spinal cord injuries. Spinal Cord. 2004;42(9):533-40.
http://www.ncbi.nlm.nih.gov/pubmed/15224086

Burns AS, Delparte JJ, Patrick M, Marino RJ, Ditunno JF. The reproducibility and convergent validity of the walking index for spinal cord injury (WISCI) in chronic spinal cord injury. Neurorehabil Neural Repair. 2011;25(2):149-57.
http://www.ncbi.nlm.nih.gov/pubmed/21239706

Bye E, Glinsky J, Yeomans J, Hungerford A, Patterson H, Chen L, Harvey L. The inter-rater reliability of the 13-point manual muscle test in people with spinal cord injury. Physiother Theory Prac. 2021;37(10)1126-1131
https://pubmed.ncbi.nlm.nih.gov/31674263/

Fujiwara T, Hara Y, Akaboshi K, Chino N. Relationship between shoulder muscle strength and functional independence measure (FIM) score among C6 tetraplegics. Spinal Cord. 1999;37(1):58-61.
http://www.ncbi.nlm.nih.gov/pubmed/10025698

Herbison GJ, Isaac Z, Cohen ME, Ditunno JF. Strength post-spinal cord injury: myometer vs manual muscle test. Spinal Cord. 1996;34(9):543-8.
http://www.ncbi.nlm.nih.gov/pubmed/8883189

Noreau L, Vachon J. Comparison of three methods to assess muscular strength in individuals with spinal cord injury. Spinal Cord. 1998;36(10):716-23.
http://www.ncbi.nlm.nih.gov/pubmed/9800275

Rudhe C, Van hedel HJ. Upper extremity function in persons with tetraplegia: relationships between strength, capacity, and the spinal cord independence measure. Neurorehabil Neural Repair. 2009;23(5):413-21.
http://www.ncbi.nlm.nih.gov/pubmed/19261766

Savic G, Bergström EM, Frankel HL, Jamous MA, Jones PW. Inter-rater reliability of motor and sensory examinations performed according to American Spinal Injury Association standards. Spinal Cord. 2007;45(6):444-51.
http://www.ncbi.nlm.nih.gov/pubmed/17387316

Schwartz S, Cohen ME, Herbison GJ, Shah A. Relationship between two measures of upper extremity strength: manual muscle test compared to hand-held myometry. Arch Phys Med Rehabil. 1992;73(11):1063-8.
http://www.ncbi.nlm.nih.gov/pubmed/1444773