Test Positioning

When measuring range of motion (ROM), you use a goniometer. The goniometer has an axis, stationary arm, and moving arm. It is important to use bony landmarks to properly place the goniometer in the correct position for measuring ROM. Bony landmarks are also important when palpating in order to identify correct positioning or in certain cases to find possible limitations for ROM due to bone or muscle abnormalities. For example, when testing ROM of shoulder flexion, you would you the bony landmark of the acromion process to line up the axis of the goniometer, the stationary arm would need to be in line with the greater trochanter of the femur, and the moving arm would need to be in line with the lateral epicondyle of the humerus for proper testing position. It is important to be in the proper position for ROM testing to get the most accurate measurements. It can be easy to do compensatory movements when not in the proper test position. Referring to our example of testing shoulder flexion ROM, a compensatory movement would be lumbar extension. 

Manual muscle testing (MMT) is an assessment that measures muscles strength and function. The purpose of MMT is to determine muscle weakness and to collect data on you progress. There is gravity eliminating MMT and MMT against gravity. It is important to know the difference because this is when test positioning comes into play. When doing MMT against gravity, you always want the action you are testing to be going in a upward motion (against gravity). In certain cases, you may have a client who cannot perform the action against gravity and would need to perform gravity eliminating MMT. In gravity eliminated MMT you would need to position the client would need to be in a position that is parallel to the ground to take away the resistance. Test positioning is also important when determining the correct starting position for MMT. You want to have your client positioned in a mid-range position for greatest outcomes. 

Gravity eliminated position is relevant for clients that cannot perform actions against gravity (in an upward motion). For clients that have trouble with completing MMT with resistance would be better tested by gravity eliminated MMT. Gravity eliminated is used for clients with muscle more muscle weakness. 

Image recieved from: https://www.saebo.com/blog/range-motion-exercises-spinal-cord-injuries/