Proposed Clinical Muscle Grading for Deep Neck Flexors, Multifidus, and Transversus Abdominus
In Physical Therapy, we all can agree that objective measurements are important. For years, we have known about the importance of training the most important stabilizers of the neck and back. The question is why then do we not have a standardized muscle grading system for the strength of these muscles yet. Im hoping to spark interest in researchers to come up with a system to help show improvements and to find objective goals for individuals to hit so they can decrease the chance of recurring back or neck pain. My first year out of physical therapy school in 2009, I had combed the research to find testing procedures to test these muscles. I had found only a test for the deep cervical neck flexors, cervical and lumbar extensors. There was nothing for the transverse abdominis. These are the muscle grading systems that I have came up with, so at least we had a standard test for the clinicians in my clinic. I thought it would be good to share in case other clinics would want to adopt it until more testing research is available.
Cervical
Modified Biering Sorenson |
|---|
1/5 Unable to lift head against gravity |
1+/5: 0-60 sec |
2-/5: 61-121 sec |
2/5: 122-182 sec |
2+/5: 183-243 sec |
3-/5: 244-304 sec |
3/5: 305-365 sec |
3+/5: 366-426 sec |
4-/5: 427-487 sec |
4/5: 488-548 sec |
4+/5: 549-599 sec |
5/5: 600 sec (Norm Based On Research) |
Chin Tuck Head Lift (Head of Bed 0 deg) |
|---|
<3/5: unable to lift head against gravity |
3/5: 0-20 sec |
3+/5: 20-40 sec |
4-/5: 40-60 sec |
4/5: 60-90 sec |
4+/5: 90-119 sec |
5/5: 120 sec (Norm Based On Research) |
Lumbar
Side Plank Test (Side Support Endurance Test) Males | Side Plank Test (Side Support Endurance Test) Females |
<3/5: Unable to lift head against gravity | <3/5: Unable to lift head against gravity |
3/5: 0-20 sec | 3/5: 0-15 sec |
3+/5: 20-40 sec | 3+/5: 15-30 sec |
4-/5: 40-60 sec | 4-/5: 30-45 sec |
4/5: 60-80 sec | 4/5: 45-60 sec |
4+/5: 80-95 sec | 4+/5: 60-75 sec |
5/5: 95 sec (Norm based on research*) | 5/5: 75 sec (Norm based on research*) |
Side Support Endurance Test*
Side Bridge / Plank tests lateral flexors Quadratus lumborum @ 50% MVIC ICC = .96-.99
Positioning: Patient is side lying, legs extended with top foot in front of lower foot, while resting on lower elbow Patient is asked to lift hips off table to horizontal and hold Time is recorded in seconds on each side Normative male = 95 seconds Normative female = 75 seconds
TrA Clinic Muscle Grading |
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2-/5: Unable to pull in draw for 10 sec with gravity(supine) |
2/5: Able to pull in draw for 10 sec with gravity(supine) |
2+/5: Able to pull in draw in supine with alternating UE lift 1 time without loss of draw |
3-/5: Able to pull in draw in supine with alternating LE lift 1 time without loss of draw |
3/5: Able to pull in draw 10 sec against gravity(quadruped) |
3+/5: Able to pull in draw in quadruped with alternating UE lift 1 time without loss of draw |
4-/5: Able to pull in draw in quadruped with alternating LE lift 1 time without loss of draw |
4/5: Able to pull in draw in quadruped with alternating contralateral UE/LE lift 1 time without loss of draw |
4+/5: Able to pull in draw in prone with alternating UE lift 1 time without loss of draw |
5-/5: Able to pull in draw in prone with alternating LE lift 1 time without loss of draw |
5/5: Able to pull in draw in prone with bilateral UE/LE lift |
No research conducted on TrA endurance
Muscular Endurance Testing Timed extensor test (Biering Sorenson) |
|---|
Males | Females |
<3/5 Unable to lift head against gravity | <3/5 Unable to lift head against gravity |
3/5: 1-30 sec | 3/5: 1-37 sec |
3+/5: 31-61 sec | 3+/5: 38-75 sec |
4-/5: 62-92 sec | 4-/5: 76-113 sec |
4/5: 93-123 sec | 4/5: 114-151 sec |
4+/5: 124-144 sec | 4+/5: 152-188 sec |
5/5: 145 sec (Norm Based On Research*) | 5/5: 189 sec (Norm Based On Research*) |
Biering-Sorenson ICC = .93-.99
Positioning: Prone, ASIS/ trunk off table, arms at side, ankles fixed Patient is asked to hold horizontal position
Normative male 23-39 = 97-146 seconds, Normative female 23-39 = 93-189 seconds LBP risk is 3X greater if < 58 seconds
*Alaranta et al. Scad J Rehab Med 1994; 26: 211-15
*Luoto et al. Clin Biomech 1995: 10: 323-4
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