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This activity is provided by the Texas Board of Physical Therapy Examiners Accredited Provider 2309052TX and meets continuing competence requirements for physical therapist and physical therapist assistant licensure renewal in Texas.

Texas Physical Therapy Association

New York Physical Therapist just a disclaimer The Brookbush Institute (B2C Fitness) is recognized by the New York State Education Department's State Board for Physical Therapy as an approved provider of physical therapy and physical therapist assistant continuing education.

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Approved for {{credits}} CEUs by CPTA #CPTAAP-36

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Approved by CATA and 1 course contact hour = 0.4 CATA CEUs

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Massage Therapist Association of Saskatchewan, Inc.

Approved as a primary activity CEUs.  1 credit = 2 primary hours

Massage Therapists’ Association of Nova Scotia

Manual Muscle Testing (MMT): Lower Body Audio

Manual muscles tests (MMT) for the gluteus medius, gluteus maximus, tibial internal rotators, tibialis anterior, and tibialis posterior. The compensations, overactive synergists, and interventions for the common underactive muscles in the lower body. Manual muscle testing for hip, back, SIJ, knee, and ankle pain, as well as feet flatten, feet turn out, knee bow in, knee bow out, anterior pelvic tilt, excessive forward lean, asymmetrical weight shift, lower body dysfunction, lumbopelvic hip complex dysfunction, and sacroiliac joint dysfunction.

Manual Muscle Testing (MMT): Lower Body

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Brookbush Institute

I have almost completed my CPT certification and am half-way through the Human Movement certification to inform my massage practice. The different modalities of reading, watching audiovisual materials, and attending live or recorded webinars have been important to my learning style and for review.

Brookbush Institute has the most detailed, specific and effective tools for online learning for movement and/or bodywork professionals. I love the combination of the videos as well as the text available online.

I recently completed the CPT course. It was demanding yet practical. I would highly recommend it for anyone wanting an education about human movement.

I have my personal trainer certificate through here and am almost finished my human movement specialist certification. Overall, the education that Brookbush has packaged together for clinicians and trainers is invaluable. I am a physio assistant so coming from more of a rehab background I appreciate that this education has been beneficial both as a trainer and in a rehab setting. I love that I have been able to do all learning at my own pace and able to work around my schedule. Thank you for setting up this platform! Highly recommend :)

I have been a massage therapist for 10 yrs and I feel like all the “pieces” I’ve learned throughout the yrs have been put into place and can see the full picture. I am also a member to tons of great content since I love to learn! I plan to get my CPT through them as well.

I have been following Brent Brookbush for nearly a decade- back when I was a personal Trainer and now as a Physical Therapist. BBI is an incredible resource for any movement nerds and corrective exercise specialists! The information is thorough with multiple real world applications. I am looking forward to an in-person Manual Therapist course the second they do one a little bit closer to Virginia ;)

I have taken both the Human Movement Specialist and Certified Personal Trainer certificate programs and have found the value in understanding the how and ways the body moves and functions and from evidence, non-biased, outcome, conceptual, theoretical, and practical approach to helping my clients/patients look better, feel better, and move better.

Over the last years I've returned time and again to Brookbush Institute for stellar coursework as I've worked toward a Human Movement Specialist certification. (I'm currently ACE CPT, and in training with Anatomy Trains for Structural Integration Manual Therapy.) Every Brookbush Institute module is fantastic and each one includes detailed informational videos, written descriptions of how to-do, and, more importantly, why to-do!

I am a 70 yr old chiropractor and no other healthcare provider was able to come up with an exercise protocol particular to my structural and balances and muscle deficits and keep me in the game. And as for continuing education on human skeletal movement, the website is phenomenal full of great exercises for particular mechanical dysfunction.

The H.M.S. is the most valuable certificate I have earned and was a fraction of the the cost of my others. Define the best bang for your buck!

Brookbush is the most efficient Personal Training Certification I have ever come across. All the lessons are well thought out and very straight to the point.

I am getting my Master's degree in Kinesiology, and I would like to say that I have benefited greatly from the rich, comprehensive, well-documented scientific content of Brookbush Institute that links theory to practical applications. Proudly I've got my CPT certificate, and I am on my way to get my HMS certificate.

Having courses count towards different certifications makes it so users can transition seamlessly from one certification to another. In my case, going from earning the BI CPT to earning the BI HMS was an easy decision and I am proud to have earned both certifications. I have also had the pleasure of going to a Live HMS workshop that was well taught by Instructor Boettcher and that was excellent to see how the methods and techniques are implemented.



I have been a member of BBI for years and every course I have taken has been incredibly informative. I learn more from these courses than I do at local CEU courses for my PTA license. I also earned my CPT and HMS certifications through the platform. It was so convenient and the content was top notch! Forever member.

We learn principles in academia, we learn cool new modalities via whatever specialty certification, but BBI really concentrates on the nuances of passive treatment and they do a fantastic job. The format in which BBI instructs soft tissue specialists (DPTs, Chiros, ATs) like myself feels like almost like an apprenticeship. You get a thoroughly detailed explanation of the “why’s”, and a visual comprehension of how to apply. Personally, I believe application is where the good and the great are distinguished.

Brookbush has been incredibly helpful since I was in massage school and now as I’m in my career! I run my own practice and it gives me the resources I need to not only improve what I already know, but also help me navigate better, more efficient ways of treatment.

Totally loving the convenience and affordability of this program with my crazy lifestyle! I feel like I am getting a quality education without a massive cost! My favorite part is the videos I can watch in the courses. I learn so much better that way. Once I really spent more time on the site, I figured out how to maneuver around a lot better! I enjoy the sense of humor, as well as the easy explanation, and short tests. And if I am really tired, I can have the computer read me the lessons. 😁

Challenging concepts are explained in very understandable terms without dumbing down the material, and I find this program to be superior in quality to other personal training programs.

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Integrated Manual Therapist

All fitness, performance, and rehabilitation programs should start with an assessment. The goal of assessment is to refine technique selection, with the intent of improving client and patient outcomes. 

This course describes potential additions to a comprehensive movement assessment that are most commonly referred to as "manual muscle testing" (a.k.a. MMT, MMTs, muscle testing, strength testing, muscle strength testing, strength assessment, strength measures, manual resistance, etc.). The tests included in this course are intended for muscles prone to inhibition (e.g. underactive, hypotonic, phasic, exhibiting muscle weakness, etc.).

It is important that the intent of manual muscle tests, the length of a muscle group, the activity of a muscle group, and the testing position are considered prior to their application. Any muscle that has adopted a compensatory change in length or activity (altered length/tension relationship) may test "weak", "with compensation", or "with pain". 

For example, if an individual presents with an 

 confirms a loss of hip flexor extensibility, it is likely that manual resistance of the hip flexors would result in a finding of "weakness" or "with compensation". If the intention of manual muscle testing is to address muscles assessed as "weak" or "with compensation" with strengthening exercises, then we might assume that we should strengthen the hip flexors. But, this logic is flawed. Unfortunately, strengthening the hip flexors may increase activity, further decrease hip extension mobility (by contributing additional shortening), and may result in poor carry-over of results from session to session; even if strengthening the hip flexors results in initial improvements in hip flexor strength. 

Although counter-intuitive based on manual muscle testing alone, we may improve hip flexor strength more by optimizing length-tension relationships with 

release and lengthening techniques for the hip flexors

. For these reasons, manual muscle tests are likely best applied to muscles that are implicated as inhibited by a dynamic movement assessment (e.g. the 

), and performed as pre/post tests to confirm the effectiveness of selected activation, strengthening, stability, integration, and/or conditioning techniques.

 recommends that these assessments are added to the repertoire of all sports medicine professionals (personal trainers, fitness instructors, physical therapists, massage therapists, chiropractors, occupational therapists, athletic trainers, etc.).

For a complete introduction to manual muscle testing (for an active population) including definitions of specific terminology, "why?" manual muscle testing, basic procedures, comparing traditional versus Brookbush Institute recommended scoring, amount of external resistance, what muscles should be tested, length/tension relationships, defining a “good assessment,” and best use check out:

Manual Muscle Tests Covered in this Course:

Printable PDF of the Movement Assessment Template:

Course Description: Manual Muscle Testing: Lower Body

Introduction to manual muscle testing

Course Study Guide: Manual Muscle Length Testing - Lower Body

For an introduction to manual muscle testing (for an active population) including definitions of specific terminology, "why?" manual muscle testing, basic procedures, comparing traditional versus Brookbush Institute recommended scoring, amount of external resistance, what muscles should be tested, length/tension relationships, defining a “good assessment,” and best use check out: 

For Upper Body Manual Muscle Testing for an Active Population: 

The intent of this course is to provide a review of common lower body manual muscle tests including technique, test position, the definition of a "strong" result, common compensation, over-active synergists, provocative testing, and implicated techniques.

Introduction

Explain to your patient/client what the assessment entails.

Instruct your patient/client to assume a side-lying position, with the bottom leg bent to roughly 60° of hip flexion and 60° of knee flexion.

Approaching the patient from behind, place the hand closest to the hip on the iliac crest. This hand will aid in stabilizing the client's pelvis and decreasing the contribution of the lateral flexors of the lumbar spine.

Instruct your patient to lift (abduct) their top leg

The test may be more provocative with a bias toward hip extension (past neutral) and hip external rotation (approximately 10°).

If necessary manually guide the client/patient into the appropriate test position.

Instruct your patient/client to hold this position, as you apply a moderate downward force (into adduction) on the distal tibia.

Again, this test may be more provocative if the practitioner uses a lumbrical grip around the calcaneus and adds a small amount of force pushing into hip flexion and internal rotation, to accompany the downward force into adduction.

For an assessment of "strong", your patient/client should be able to maintain this position, without compensation, with an application of a moderate external force.

Manual Muscle Test for the Gluteus Medius

Gluteus Medius Manual Muscle Test

Instruct your patient/client to assume a prone position; their hands may be placed under the forehead for comfort

Approaching the patient/client from the side you wish to test, place one hand over the lumbar spine and posterior ilium, and the other hand just proximal the knee/distal portion of the hamstrings.

Instruct your patient to lift (extend) the leg closest to you, without arching their back or driving the opposite knee into the table.

Traditionally this test is done with the knee passively flexed, and the motion is cued "heel to ceiling".

The test may be more provocative if the patient/client is cued to draw in, extend the knee, plantarflex the ankle and extend the toes (triple extension), and the motion is tested with resisted abduction (into the practitioner's thigh) and extension of the hip.

If necessary manually guide the client/patient through the appropriate test position; you can monitor the activity of the 

 and motion of the pelvis with the hand over the lumbar spine.

Instruct your patient/client to hold this position as you apply a strong downward force (posterior to anterior) on the distal femur.

For an assessment of "strong", your patient/client should be able to maintain this position, without compensation, when a strong external force is applied.

Gluteus Maximus Manual Muscle Test 

Instruct your patient/client to assume a reclined seated position; they may be propped by a seat-back, hands, or elbows.

Have your patient/client bring the test leg into 90° of hip flexion and 90° of knee flexion.

Instruct your patient/client to maximally dorsiflex their ankle; this reduces the amount of motion available at the ankle in the transverse plane (abduction, pronation).

Approaching the patient/client from the side, use the hand nearest their torso to palpate the outside of the knee and joint line.

Instruct your patient to turn their foot "inward" as far as they can. You may guide them into end-range tibial internal rotation, as this can be a difficult motion for patient's/client's to understand.

Use your other hand to hook around the inside of the foot, wrapping your fingers around the posterior calcaneus. Your patient/client's first metatarsal should be abutting your forearm.

Instruct your patient/client to hold this position as you apply a moderate rotatory force outward.

This test may be more provocative if the patient/client is cued to push their knee "out" (hip abduction and external rotation, similar to a 

) into the opposite hand, as they try to maintain their foot "in".

For an assessment of "strong", your patient/client should be able to maintain this position, without compensation, with a relatively small external load.

Tibial Internal Rotator Manual Muscle Testing

Tibial Internal Rotator Manual Muscle Test

Instruct your patient/client to assume a long sit position.

Approach your patient or client from the dorsal surface of the foot, and either sit or stand to ensure that you can get your forearms parallel to the horizontal plane.

Instruct your patient to maximally plantarflex and invert their ankle ("point the foot inward").

You may guide them into position, as "inversion" can be a difficult motion for patient's/client's to understand.

Use one hand to brace the leg by placing your palm on the lateral tibia, just proximal to the lateral malleolus.

Instruct your patient/client to hold this position as you apply a moderate force obliquely from medial to lateral and distal to proximal on the first metatarsal head.

Adding toe extension and applying force to the first metatarsal head may aid in the inhibition of the 

flexor hallucis longus and flexor digitorum longus

, resulting in a more provocative test for an active population

Tibialis Posterior Manual Muscle Testing

Instruct your patient/client to maximally dorsiflex and invert their ankle ("pull the foot up and in toward the knee").

Using both hands, wrap your fingers around the dorsum of the foot, near the ankle joint.

Note: For this test, do not apply force to the distal portion of the metatarsals. Given the amount of force that will be needed to test the tibialis anterior, this could be hazardous to the tarsometatarsal joint.

Instruct your patient/client to hold this position as you apply a strong force from dorsal to plantar (toward your body).

Adding toe flexion may aid in the inhibition of the 

extensor hallucis longus and extensor digitorum longus

For an assessment of "strong", your patient/client should be able to maintain the end-range position, without compensation (toe extension), with an application of a strong external force. It is not uncommon for a client to test strong when allowed to hold a position close to neutral, but be unable to hold a position at the end range dorsiflexion. It is the Brookbush Institute's stance, that the inability to hold end-range dorsiflexion, is a "weak" test.

Dr. Brent Brookbush Demonstarting the Tibilias Anterior Manual Muscle Test

Tibialis Anterior Manual Muscle Testing

Florence Peterson Kendall, Elizabeth Kendall McCreary, Patricia Geise Provance, Mary McIntyre Rodgers, William Anthony Romani

NASM Essentials of Corrective Exercise Training

Carolyn Richardson, Paul Hodges, Julie Hides. Therapeutic Exercise for Lumbo Pelvic Stabilization – A Motor Control Approach for the Treatment and Prevention of Low Back Pain: 2nd Edition © 2004 Elsevier Limited

Diagnoses and Treatment of Movement Impairment Syndromes,

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Mahoney K, Hunt A, Daley D, Sims S, et al. (2009). Inter-tested reliability and precision of manual muscle testing and hand-held dynamometry in lower limb muscles of children with spina bifida. 

Physical & Occupational Therapy in Pediatrics.

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Mulroy SJ, Lassen KD, Chamgers SH, Perry J. The ability of male and female clinicians to effectively test knee extension strength using manual muscle testing. J Orthop Sports Phys Ther. 1997;26:192-199

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Marino M, Nicholas JA, Gleim GW, et al. The efficacy of manual assessment of muscle strength using a new device. Am J Sports Med. 1982;10:360-364

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Bibliography

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