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Trunk flexion manual muscle testing

This is an excerpt from Principles of Goniometry and Manual Muscle Testing With HKPropel Online Video by Abigail Shelley.

Patient position: Supine with hands clasped behind head

Clinician position: At the side of the table at the level of the patient’s chest

• Testing hand: None
• Stabilizing hand: If the patient has weak hip flexors, the clinician should stabilize the pelvis by leaning across the patient with their forearms. Otherwise, no stabilization is needed.

Test motion: The patient flexes through a range of motion until their scapulae clear the table.

Patient instructions: “Tuck your chin and lift your head, neck, and shoulder off the table as if in a sit-up.”

Grading

• Grade 5 (Normal): The patient completes the full range of motion until the inferior angles of the scapulae are off the table. The weight of the patient’s arms will act as resistance for grade 5.
• Grade 4 (Good): The patient crosses their arms over their chest and lifts up, and the inferior angles of their scapulae are off the table.
• Grade 3 (Fair): The patient extends both arms above the plane of the body and completes the full range of motion with the inferior angles of the scapulae off the table.

Sequences for Grades 2 through 0 with Patient in Hook Lying Position

• Sequence 1—head raise: The patient is asked to lift their head. If the scapulae do not clear the table, they receive a grade of 2 (Poor). If the patient cannot lift their head, proceed to sequence 2.
• Sequence 2—assisted forward lean: The clinician cradles the upper trunk and head off the table and asks the patient to lean forward. If the clinician observes depression of the rib cage, a grade of 2 (Poor) is given. If there is no depression of the rib cage but the clinician observes or palpates muscle contraction, a grade of 1 (Trace) is given. If there is no activity, the grade is 0; proceed to sequence 3.
• Sequence 3—cough: Ask the patient to cough. If the patient can cough to any degree and depression of the rib cage occurs, a grade of 2 (Poor) is give. If the patient is unable to cough but there is palpable muscle activity, a grade of 1 (Trace) is given. Lack of any muscle activity is a grade of 0.

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Clinical tip: If the patient is unable to perform this test due to body habitus, document this and try a functional test such as a prone plank.

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