MMT Procedures

Question 1

Anterior neck flexors

Answer 1

Patient position: Supine, shoulders in 90° of abduction. elbows in 90° of flexion with hands resting near the head, palms facing up

Local position: Patient’s chin tucked to the sternum. Flex the cervical spine by lifting the head off the table. Patient instructed to hold chin tuck.

Direction of Examiner pressure: Against the forehead towards the table

Question 1

Anterolateral Neck flexors

Answer 1

Patient Position: Supine, shoulders in 90° of abduction. elbows in 90° of flexion with hands resting near the head, palms facing up

Local Position: Rotate patient’s head towards the opposite side and add flexion of the cervical spine

Direction of examiner pressure: Press against the temples and side of patients face towards the table

Question 2

Posterolateral neck extensors

Answer 2

Patient Position: Prone, shoulders in 90° of abduction. elbows in 90° of flexion with hands resting near the head, palms facing up

Local position: Rotate patient’s head towards the same side, extend the cervical spine

Direction of examiner pressure: Against the posterior and lateral side of the head towards the table

Question 3

Upper trapezius

Answer 3

Patient postion: Seated with their back towards the examiner

Local position: Rotate patient’s head towards the opposite side, lateral flex and extend the cervical spine. Patient instructed to lift shoulder up towards the head

Direction of examiner pressure: Place one hand on the patient shoulder and the other hand on the side of the head, apply pressure down on the shoulder and up towards the head (as if to separate the head and shoulders)

Question 4

Middle Trapezius

Answer 4

Patient position: Prone, patient’s head rotated towards opposite side

Local position: Shoulder abducted 90˚ with external rotation, elbow is fully extended, scapula is retracted

Direction of examiner pressure: against distal forearm towards the ground

Question 5

Rhomboids and Levator Scapulae

Answer 5

Patient position: Prone

Local position: Shoulder is in adduction and minimal extension and external rotation, complete elbow flexion, scapula is retracted and lifted towards the head

Direction of examiner pressure: Place one hand on the back of the patients elbow, apply pressure towards shoulder flexion and abduction

Question 6

Lower Trapezius

Answer 6

Patient position: Prone, patients head rotated to the opposite side

Local position: Shoulder abduction to 135˚ with external rotation, elbow in full extension. Patient instructed to retract and depress scapula

Direction of examiner pressure: Against forearm towards the floor

Question 7

Serratus Anterior

Answer 7

Patient position: seated

Local position: Shoulder flexion to 120° with elbow in full extension

Direction of examiner pressure: Against distal humerus towards shoulder extension

Question 8

Anterior, Middle, and Posterior Deltoid

Answer 8

Patient position: Seated

Local Position:
Anterior - Shoulder abducted to 90 ° with minimal flexion, Elbow flexed to 90°
Middle - Shoulder is abducted 90°, elbow flexed to 90°
Posterior - Shoulder abducted to 90 ° with minimal xtension, Elbow flexed to 90°

Direction of examiner pressure:
Anterior - Against distal humerus in the direction of shoulder adduction and extension

Middle - Against distal humerus in the direction of shoulder adduction

Posterior - Against distal humerus in the direction of shoulder adduction and flexion

Question 9

Shoulder internal rotators

Answer 9

Patient Position: Prone with the head rotated to the opposite side

Local Position: Shoulder abduction to 90°with humerus parallel to the table, elbow flexion to 90. Patient instructed to move into maximal internal rotation

Direction of examiner pressure: Pressure applied to the distal forearm on the anterior side towards external rotation

Question 10

Subscapularis and Teres Major

Answer 10

Patient postion: Prone with the head rotated to the opposite side

Local position: Patient places the back of hand on low back

Direction of examiner pressure: Pressure applied to the distal humerus towards shoulder abduction and flexion

Question 11

Shoulder External rotators

Answer 11

Patient position: Prone with the head rotated to the opposite side

Local position: Shoulder abduction to 90°with humerus parallel to the table, elbow flexion to 90°, patient instructed to move into maximum external rotation

Direction of examiner pressure: Against distal forearm in the direction of internal rotation

Question 12

Pectoralis Major (clavicular portion)

Answer 12

Patient position: Supine

Local position: Shoulder flexion to 90° with minimal internal rotation and horizontal adduction (reaching towards the opposite shoulder), elbow in full extension

Direction of examiner pressure: Against the proximal forearm pulling the arm away from the opposite shoulder towards horizontal abduction

Question 13

Pectoralis major (sternal portion)

Answer 13

Patient position: Supine

Local position: Shoulder flexion to 135° with minimal internal rotation, shoulder horizontal adduction towards the opposite hip, elbow in full extension

Direction of examiner pressure: Against the proximal forearm, pulling the arm away from the opposite hip towards shoulder flexion and horizontal abduction

Question 14

Pectoralis Minor

Answer 14

Patient position: supine

Local position: Palms of hands rested on the stomach. Patient instructed to lift shoulder towards the ceiling

Direction of examiner pressure: Against the anterior side of the shoulder towards the table

Question 15

Latissimus Dorsi

Answer 15

Patient Position: Prone, patient’s head rotated towards the opposite side

Local position: Shoulder extension, internally rotation, and adduction

Direction of examiner pressure: Against distal forearm in the direction of shoulder flexion

Question 16

Coracobrachialis

Answer 16

Patient position: seated

local position: Shoulder with minimal flexion, elbow in full flexion with supination

Direction of examiner pressure: Against distal humerus in the direction of shoulder extension and abduction

Question 17

Biceps brachii

Answer 17

Patient position: seated

Local position: Elbow flexion to 70-90° with forearm supination

Direction of examiner pressure: Against distal forearm towards elbow extension

Question 18

Brachialis

Answer 18

Patient Position: Supine or seated

Local position: Elbow flexion to 70-90°, pronation of forearm

Direction of pressure: Against distal forearm into elbow extension

Question 19

Brachioradialis

Answer 19

Patient Position: supine or seated

Local Position: Elbow flexion to 70-90°, forearm is halfway between pronation and supination (dorsal side facing away from patient)

Direction of pressure: Against distal forearm into elbow extension

Question 20

Triceps brachii and Anconeus

Answer 20

Patient Position: Supine

Local position: Shoulder flexion to 90°, minimal elbow flexion

Direction of pressure: Against distal forearm into elbow flexion

Question 21

Supinator and biceps brachii

Answer 21

Patient position: supine

Local position: Elbow flexion to 90° with forearm supination

Direction of pressure: Examiner hand around the wrist, turning the forearm into pronation.

Question 22

Pronator teres and pronator quadratus

Answer 22

patient position: Supine

Local position: Elbow flexion to 45°, forearm pronation

Direction of pressure: Examiner hand around the wrist, turning the forearm into supination.

Question 23

Quadriceps

Answer 23

Patient position: Seated

Local position: knee almost in full extension

Direction of examiner pressure: Against anterior ankle into knee flexion

Question 24

Hamstrings

Answer 24

Patient Position: Prone Local position: Knee flexion to 50-70°, hip rotation is neutral Direction of examiner pressure: Against distal lower leg into knee extension

Question 25

Popliteus

Answer 25

Patient position: Seated off edge of table (knee in 90° flexion) Local position: Patient instructed to move lower leg in and out of full external and internal rotation. Direction of examiner pressure: no pressure applied

Question 26

Gastrocnemius

Answer 26

Patient position: Standing with full knee extension Local position: Patient instructed to go from foot flat position to max plantar flexion as many times as possible. Direction of examiner pressure: No pressure applied. 5/5 = 20 full-range repetitions 4/5 = 10-19 full range repetitions 3/5 = 1-9 full range repetitions

Question 27

Soleus

Answer 27

Patient position: Standing with minimal knee flexion Local position: Patient instructed to go from foot flat position to max plantar flexion as many times as possible. Direction of examiner pressure: No pressure applied. 5/5 = 20 full-range repetitions 4/5 = 10-19 full range repetitions 3/5 = 1-9 full range repetitions

Question 28

Fibularis Longus and Brevis

Answer 28

Patient position: Supine with minimal internal rotation of the leg Local position: Ankle plantar flexion and eversion. Heel supported off table by examiner. Direction of examiner pressure: Against lateral aspect of foot in the direction of dorsiflexion and eversion

Question 29

Tibialis Anterior

Answer 29

Patient position: Seated or supine Local position: ankle dorsiflexion and inversion Direction of examiner pressure: Against medial border of foot in the direction of plantar flexion and eversion

Question 30

Tibialis Posterior

Answer 30

Patient position: Seated with minimal external rotation of the leg Local position: Ankle plantar flexion and inversion Direction of examiner pressure: Against medial side of foot in the direction of dorsiflexion and eversion

Question 31

Gluteus Maximus

Answer 31

Patient position: Prone Local position: Extension of hip Direction of examiner pressure: Against distal-posterior femur in the direction of hip flexion

Question 32

Gluteus Medius

Answer 32

Patient position: Side lying, with testing leg on top Local position: Abduction of hip with minimal external rotation and minimal extension, full knee extension Direction of examiner pressure: Against distal-lateral lower leg in the direction of adduction and flexion

Question 32

Gluteus Minimus

Answer 32

Patient position: Side lying, with testing leg on top Local position: Abduction of hip with neutral rotation, full knee extension Direction of examiner pressure: Against distal-lateral lower leg in the direction of adduction

Question 33

Tensor Fascia Latae

Answer 33

Patient position: Supine Local position: Hip in flexion with abduction and internal rotation, knee in full extension Direction of examiner pressure: Against distal lower leg in the direction of hip extension and adduction

Question 34

Hip Flexors

Answer 34

Patient position: Seated Local position: Knee flexion to 90°, hip flexion to midpoint between neutral and full flexion Direction of examiner pressure: Against anterior-distal thigh into hip extension

Question 35

Psoas Major

Answer 35

Patient position: Supine Local position: Knee in full extension, Hip in flexion and abduction with external rotation Direction of examiner pressure: Against distal leg in the direction of hip extension and minimal abduction

Question 36

Sartorius

Answer 36

Patient position: Supine Local position: Hip flexion to 90° with external rotation and abduction, knee in flexion Direction of examiner pressure: Examiner pushes on knee into hip extension and adduction. Examiner also pulls medial-distal lower leg in the directions of internal rotation and knee extension

Question 37

Hip Adductors

Answer 37

Patient position: side lying Local position: Examiner lifts and supports top leg in abduction. Patient instructed to adduct bottom leg off the table. Direction of examiner pressure: Against distal-medial thigh of bottom leg in the direction of abduction.

Question 38

Hip external rotators

Answer 38

Patient position: Seated (hip and knee flexion to 90°) Local position: Hip in external rotation Direction of examiner pressure: Against distal-medial lower leg in the direction of internal rotation

Question 39

Hip internal rotators

Answer 39

Patient position: Seated (hip and knee flexion to 90°) Local position: hip in internal rotation Direction of examiner pressure: Against distal-lateral lower leg in the direction of external rotation