MANUAL MUSCLE TESTING English Version Sample

CONTENTSAbdominals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Opponens Pollicus . . . . . . . . . . . . . . . . . . . . . . 85Adductors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Pectoralis Major Clavicular . . . . . . . . . . . . . . 87Biceps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Pectoralis Major Sternum . . . . . . . . . . . . . . . 90Brachioradialis . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Pectoralis Minor . . . . . . . . . . . . . . . . . . . . . . . . . 93Coracobrachialis . . . . . . . . . . . . . . . . . . . . . . . . 28 Peroneus Brevis . . . . . . . . . . . . . . . . . . . . . . . . . 95Deltoid anterior division . . . . . . . . . . . . . . . . . 30 Peroneus Longus . . . . . . . . . . . . . . . . . . . . . . . . 97Deltoid middle division . . . . . . . . . . . . . . . . . . 32 Peroneus Tertius . . . . . . . . . . . . . . . . . . . . . . . . . 99Deltoid posterior division . . . . . . . . . . . . . . . . 34 Piriformis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101Extensor Carpi Radialis . . . . . . . . . . . . . . . . . 36 Popliteus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104Extensor Carpi Ulnaris . . . . . . . . . . . . . . . . . . 37 Pronator Quadratus . . . . . . . . . . . . . . . . . . . . 106Extensor Digitorum Longus . . . . . . . . . . . . . 38 Pronator Teres . . . . . . . . . . . . . . . . . . . . . . . . . . 108Extensor Hallucis Longus Quadratus Lumborum . . . . . . . . . . . . . . . . . . 110and Brevis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Quadriceps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112Flexor Carpi Radialis . . . . . . . . . . . . . . . . . . . . 42 Rhomboids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118Flexor Carpi Ulnaris . . . . . . . . . . . . . . . . . . . . . 43 Sacrospinalis . . . . . . . . . . . . . . . . . . . . . . . . . . . 120Flexor Digitorum Longus . . . . . . . . . . . . . . . 44 Sartorius . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123Flexor Hallucis Longus . . . . . . . . . . . . . . . . . 45 Serratus Anterior . . . . . . . . . . . . . . . . . . . . . . . 126Gastrocnemeus . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Soleus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129Gluteus Maximus . . . . . . . . . . . . . . . . . . . . . . . . 51 Sternocleidomastoid . . . . . . . . . . . . . . . . . . . 131Gluteus Medius Subscapularis . . . . . . . . . . . . . . . . . . . . . . . . . . 135and Minimum . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Supinator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138Gracilis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Supraspinatus . . . . . . . . . . . . . . . . . . . . . . . . . . 140Hamstrings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Tensor Fascia Lata . . . . . . . . . . . . . . . . . . . . . 142Iliacus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Teres Major . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145Iliopsoas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Teres Minor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148Infraspinatus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Tibialis Anterior. . . . . . . . . . . . . . . . . . . . . . . . . . 150Latissimus Dorsi . . . . . . . . . . . . . . . . . . . . . . . . . 72 Tibialis Posterior . . . . . . . . . . . . . . . . . . . . . . . . 152Levator Scapula . . . . . . . . . . . . . . . . . . . . . . . . . 75 Trapezius Lower Division . . . . . . . . . . . . . . . 154Medial Neck Flexors . . . . . . . . . . . . . . . . . . . . . 77 Trapezius Middle Division . . . . . . . . . . . . . . 157Neck Extensors . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Trapezius Upper Division . . . . . . . . . . . . . . . 160Opponens Digiti Minimi . . . . . . . . . . . . . . . . . 84 Triceps Brachii . . . . . . . . . . . . . . . . . . . . . . . . . . 163 11

ABDOMINALSThe abdominal muscles are made up of the Transverse Abdominis Rectus AbdominisRectus Abdominis, Transverse Abdominis,Abdominal External Obliques, and Abdominal External Oblique Abdominis Internal Oblique AbdominisInternal Obliques. Internal Oblique AbdominisTransverse Abdominis Origin: thoracolumbar fascia; anterior two-Origin: internal surfaces of 7th to 12th costal thirds of iliac crest; lateral half of inguinalcartilages; thoracolumbar fascia; anterior ligament.three quarters of internal edge of iliac crest; Insertion: inferior borders of ribs 10 to 12;lateral third of inguinal ligament. linea alba; pubis via the conjoint tendon.Insertion: linea alba with aponeurosis of Action: compresses and supports abdominalinternal oblique, pubic crest, and pecten viscera in standing position; gives anteriorpubis via conjoint tendon. support to the lumbar spine flexes lumbarAction: compresses and supports abdominal spine and draws pelvis and thorax together;viscera in standing position; assists in forced laterally flexes and rotates vertebral columnexpiration. bringing the contralateral shoulder anteriorly.Rectus AbdominisOrigin: pubic symphysis and pubic crest.Insertion: xyphoid process and 5th to 7thcostal cartilages.Action: flexes trunk supports abdominalviscera in standing position; holds rib cageand pubis together; gives anterior supportto the lumbar spine; with the aid of gluteusmaximus, keeps pelvis from going intoanterior tilt.External Oblique AbdominisOrigin: external surfaces of ribs 4 to 12; the5 superior attachments interdigate with theserratus anterior, and the lower 3 interdigatewith latissimus dorsi and their attachments.Insertion: linea alba; pubic tubercle; anteriorhalf of iliac crest.Action: compresses and supports abdominalviscera in standing position; gives anteriorsupport to the lumbar spine flexes vertebralcolumn and draws pubis toward xyphoidprocess; assists rectus abdominis in obtaininganterior pelvic stability with the gluteusmaximus; unilateral action assists in lateralbending, or rotates the vertebral column,bringing the ipsilateral shoulder anteriorly. 13

ABDOMINALS CLINICAL*General Abdominals Rectus Abdominis• Low back pain. • Difficulty lifting head off table.• Difficulty flexing trunk, touchingtoes, and sitting up from a lying Oblique Abdominalsdown position.• Narcolepsy. • Difficulty turning body (rotating• Duodenal “dumping syndrome”. thorax) i.e., skiing, hitting a tennis• Paroxysms of sneezing. ball, looking over shoulder in car.• On rare occasion, found to be weak • Internal obliques - pain in testiclecontralateral to “frozen shoulder”. (cremasteric muscle).• Weakness is associated with • Internal obliques - inguinal hernia.sagittal suture jamming.• Hyperlordosis associated Transverse Abdominiswith bilateral weakness(bilateral gluteus maximus weakness). • Lateral abdominal wall bulges during sitting.• Sway back posture.*Courtesy of Drs. Walter Schmitt and Kerry McCord - Quintessential Applications: A(K) Clinical Protocol (QA)The following applies to all divisions of the abdominal muscles:Innervation Acupuncture meridianVentral rami of T5-T12 iliohypogastric associationand ilioinguinal nerves. Small intestine.Chapman’s reflexes Common subluxationsAnterior: medial thigh. T5-T12.Posterior: L5/PSIS. Meric TS lineNeurovascular point T6 and T7.Parietal eminences 2 inches posteriorto frontal parietal suture. Associated pointNutrition S1 and sacroiliac joint (small intestine).Vitamin E. Visceral associationDuodenal substance. Small intestine. 14

ABDOMINALSPOSTURE General Abdominals unilateral weakness: elevated hip and low shoulder on side opposite to weakness. Transverse General Abdominals Abdominis bilateral weakness: sway back posturelateral abdominal or hyperlordosis. wall bulges and lumbar spine is 15 concave on side of weakness.

ABDOMINALSGeneral Abdominals TestPosition Examiner stabilizes by placing a hand or forearm over the thighs or over the shins -Seated with legs and feet on table. depending on the relative strength of examiner and patient - while the other hand contactsDescription the posterior surface of the outermost forearm and directs force straight back toward trunkPatient is seated on table with legs extended extension.along table, hips flexed to approximately 70degrees, and knees slightly bent.The spine is kept as straight as possible andthe arms are crossed over chest, with closedfists resting over anterior shoulders (to avoidtherapy localization). 16

ABDOMINALSCommon errorsSpine is flexed or starting position Too much flexion at the hips.is too far forward.Substitution with neck flexors. 17

ABDOMINALSRectus Abdominis TestPositionSeated with legs and feet on table.DescriptionPatient is seated with legs extended along table,hips flexed to approximately 70 degrees,and knees slightly bent. The spine is kept asstraight as possible and the arms are crossedover chest, closed fists resting over anteriorshoulders (to avoid therapy localization).Examiner stabilizes with one hand over theipsilateral, distal thigh, while the other handis placed on the posterior surface of theoutermost forearm to direct force straight backtoward trunk extension.Oblique Abdominals TestPosition In the above example, the left external abdominal obliques and theSeated with legs and feet on table. right internal abdominal obliques are being tested simultaneously.DescriptionPatient is seated with legs extended alongtable, hips flexed to approximately 70 degrees,and knees slightly bent. With the arms crossed,fists resting over anterior shoulders (to avoidtherapy localization), patient maximally rotatesthe spine to one side. Examiner stands on theopposite side to which the patient has rotatedand stabilizes with a hand or forearm on thethighs or shins, while the other hand contactsthe lateral surface of the ipsilateral humerusto direct force posteriorly in line with theshoulders. In this way the ipsilateral externalobliques and the contralateral internal obliquesare tested simultaneously. 18

ADDUCTORSPectineus Adductors Brevis Adductors Longus Adductors MagnusThe adductor muscles are divided into Insertion: a line that runs from the greaterPectineus, Adductor Brevis, Adductor trochanter along linea aspera, medialLongus, and Adductor Magnus. supracondylar line, and ending at the adductor tubercle of the medial condyle ofPectineus the femur. Action: adducts femur fibers arising fromOrigin: superior surface of pubis. ischium and ramus of ischium assist inInsertion: pectineal line of femur from lesser extension of femur while fibers arising fromtrochanter to linea aspera. ramus of pubis aid in flexion of femur.Action: adduction, flexion, and internalrotation of femur. CLINICAL*Adductor Brevis • Difficulty crossing legs. • Medial thigh pain (origin-insertionOrigin: body and inferior ramus of pubis. injuries of adductor magnus).Insertion: pectineal line and proximal part of • Difficulty with hip flexion.linea aspera of femur. • Lower groin pain.Action: adducts femur with some assistance • Tight in positive FABER Patrick’sin flexion. sign (weak on opposite side). • Elbow problemsAdductor Longus (common Chapman’s reflex). • Thumb problemsOrigin: body of pubis inferior to pubic crest. (common Chapman’s reflex).Insertion: middle third of linea aspera of femur. • Category 2 ilium (LiLL).Action: adducts femur with some assistancein flexion. *Courtesy of Drs. Walter Schmitt and Kerry McCord Quintessential Applications: A(K) Clinical Protocol (QA)Adductor MagnusOrigin posterior bers: ischial tuberosity.Origin anterior bers: ramus of ischiumand pubis. 19

ADDUCTORSInnervation NutritionPectineus: obturator Vitamin E;and femoral (L2-L4). male or female organ gland substance.Adductor Brevis: obturator (L2-L4).Adductor Longus: obturator (L2-L4). Acupuncture meridian associationAdductor Magnus: obturator andsciatic (L2-S1). Circulation sex (pericardium).Chapman’s reflexes Common subluxationsAnterior: anterior chest wall (L2-sacrum).behind areola (not in breast tissue).Posterior: below inferior angle Meric TS lineof scapula. L5.Neurovascular point Associated pointOn lambdoidal suture betweenlambdoid and asterion. T4, T5 (circulation sex). Visceral association Reproductive organs and glands.POSTURE Unilateral Bilateral weakness: weakness: genu varus; genu varus contralateral (bowed legs). pelvic elevation. 20

ADDUCTORSTest 1Position knees kept in full extension, patient adducts the femur on the side to be tested. ExaminerSide-lying. then contacts the medial, distal portion of the same femur, or leg, and directs pressureDescription toward abduction (straight down toward the table).Patient lies on side with entire body straightand the leg to be tested in contact with thetable. Examiner stands behind patient andabducts the patient’s non-tested leg by pullingup toward the ceiling. This is done in order toget the leg out of the way of the test. With bothCommon errorPoor stabilization in side-lying testallows patient’s trunk and pelvis torotate. 21

ADDUCTORSTest 2Position The other hand then contacts the medial, distal leg on the side being tested and pullsSupine. away from the midline, using the leg as a lever to impart pressure toward abductionDescription and slight extension of the femur.Keeping both knees locked in extension, N.B. The degree of femur external rotationsupine patient externally rotates the femur and the vector of test pressure can varyon the side being tested to about 20 or 30 slightly depending on which adductor muscledegrees. is being tested.Examiner stands at the foot of the table anduses one hand to stabilize the lower leg of thenon-tested side. 22

BICEPS BRAChIITendon Coracoid Origin long head: supraglenoid tubercle ofof long process scapula. head Origin short head: tip of coracoid process. Tendon of Insertion: tuberosity of the radius and fascia short head of forearm via bicipital aponeurosis. Innervation: musculocutaneous (C6-C7). Radial Bicipital Action: flexes forearm and humerus andtuberosity aponeurosis supinates forearm when the motion is resisted. CLINICAL* Chapman’s reflexes• Slipped bicipital tendon. Anterior: 4th and 5th intercostal• Bilateral weakness and/or space.bilateral shoulder problems Posterior: C2 (T4-T5).induced by hyperinsulinism.• Radius subluxations. Neurovascular point• Difficulty (pain, limited rangeof motion) on elbow flexion. Frontal bone eminences.• Difficulty (pain, limited rangeof motion) on forearm supination Nutritionespecially against resistance.• Pain and difficulty using Betaine hydrochloride; duodenala screwdriver. substance; chlorophyll substance.• Long head can rupture at origin(classic “popeye” sign). Acupuncture meridian association*Courtesy of Drs. Walter Schmitt and Kerry McCordQuintessential Applications: A(K) Clinical Protocol (QA) Stomach. Common subluxations C5, C6. Meric TS line T5. Associated point T12, L1 (stomach). Visceral association Stomach. 23

BICEPS BRAChII TestPOSTURE Position Seated or supine. Description Patient fully supinates forearm and flexes elbow to approximately 45 degrees. Examiner uses one hand to stabilize the posterior, distal humerus, while the other hand contacts the anterior, distal forearm and directs pressure toward extension.Hyperextended elbow.Common errorExcess forearm flexion. 24

Manual Muscle Testing a practical guideprovides full-color photos and instructionon how to perform accurate muscle testingfor diagnostic purposes. Each section containsuseful clinical information associated with eachmuscle and photos depicting the posturaldistortions that occur when individual musclesbecome weak. Included inside each bookis an instructional DVD in which Dr. Morrisondemonstrates proper technique based on thoseused in traditional Applied Kinesiology.This book, and its associated DVD, serve asindispensable guides both for students andhealth care professionals of all types who wishto enhance their diagnostic skills and gaindeeper insight into patient problems.Dr. Robert Morrison has been practicingChiropractic and Applied Kinesiology since 2001.He is the former president of ICAK Italy and aninternational lecturer. He currently resides in toNew York City.www.robertmorrison.info