Manual Muscle Testing (MMT). Subjective or Objective?

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Manual Muscle Testing (MMT). Subjective or Objective?

What is MMT?

MMT is something that is studied during our educational experiences during school.  MMT are included within the objective measures section of the physical examination. MMT is performed to assess the strength and function of various muscles.  Strength is scored using a 0-5 scale:2

Manual Muscle Testing (MMT). Subjective or Objective?

Each muscle has a standardized testing position to measure strength efficiently.  Testing positions can be variable and individualized based on clinical presentations of patients, clinician preferences, and personal equipoise.

MMT has been ingrained in our minds as something that is objective.  However, is this true?

Is MMT objective?

The answer is no.  MMT appears to be extremely subjective and may not truly objectively measure muscle strength and performance. For example, one clinician’s 4/5 for shoulder abduction may not be the same as another clinicians. Testing performed between two different clinicians may be highly variable and inaccurate. 

Perhaps there is a need for specific instruments to help us determine muscle strength in our patients.

What can objectively measure strength?

Handheld dynamometers (HHD) are very useful evaluation instruments to help use truly measure an objective measure of strength. These instruments allow the clinician to appropriately measure baseline data, response to specific interventions, and collect statistical data.  Extrapolating all this information is essential to help develop better treatment protocols, be able to monitor patient progress, and provide the basis for future meaningful research. 


Having objective normative values is essential to objectively compare muscular strength.1 Therefore, the use of MMT will not provide these values.1  

By having this information, we can better adjust a patient’s individualized plan of care accordingly. Also, using objective measurements for muscle testing can help develop future research and develop certain protocols and procedures for various medical conditions.

Implementing the use of instruments to collect data needs to be a priority for the future of healthcare.  Being able to do this will ultimately help further the profession and enhance overall clinical outcomes.

Article Written By Eric Trauber, PT, DPT, OCS, CSCS, FAAOMPT

  1. Bohannon RW. Reference values for extremity muscle strength obtained by hand-held dynamometry from adults aged 20 to 79 years. Arch Phys Med Rehabil Vol 78, January 1997: 26-32.
  2. Kendall, F. P., McCreary, E. K., Provance, P. G., Crosby, R. W., Andrews, P. J., & Krause, C. (1993). Muscles, testing and function: With Posture and pain.