National Academy of Sports Medicine

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The Brookbush Institute (BOC AP# P10038) is approved by the Board of Certification, Inc. to provide continuing education to Athletic Trainers (ATs). This program is eligible for a maximum of {{credits}} hours/ Category A CEUs. ATs should claim only those hours actually spent in the educational program.

Board Of Certification

Canadian Fitness Professionals

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Athletics and Fitness Association of America

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National Certification Board for Therapeutic Massage & Bodywork

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World Instructor Training Schools

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Yoga Alliance

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Chartered Institute for Management in Sport and Physical Activity

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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.

New York State Education Department's State Board for Physical Therapy

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American Council on Exercise

Manual muscles tests (MMT) for the shoulder external rotators, lower trapezius, serratus anterior, and deep cervical flexors. The compensations, overactive synergists, and interventions for the common underactive muscles in the upper body. Manual muscle testing for neck, shoulder, elbow, and scapular pain, as well as arms fall, scapula elevates, head falls forward, upper body dysfunction, and cervical dysfunction.

Manual Muscle Testing (MMT): Upper 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 the 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 

 confirms a loss of shoulder flexion extensibility, it is likely that manual resistance of shoulder extension (from 180 degrees of shoulder flexion) 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 

 to address this weakness. But, this logic is flawed. Unfortunately, strengthening the 

 may increase activity, further decrease shoulder flexion mobility (by contributing additional shortening), and may result in poor carry-over of results from session to session; even if strengthening the 

 results in initial improvements in strength. Although counter-intuitive based on manual muscle testing alone, we may improve shoulder extension strength more by optimizing length-tension relationships with 

release and lengthening techniques for the latissimus dorsi

. 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: Upper Body

Introduction

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 Lower Body Manual Muscle Testing for an Active Population: 

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

Deep Cervical Flexor Endurance Test

Explain to your patient/client what the assessment entails.

Instruct your patient/client to assume a supine position, with legs in hook-lying position and hands on the stomach.

Have your patient lift their head off the table with chin tucked, so that the most posterior aspect of their occiput is 2.5 cm from the table (the width of your 2nd and 3rd fingers.)

Gently adjust your patient/client's head into test position (upper cervical flexion), and place your 2nd and 3rd finger (stacked on top of one another) under the patient's occiput

Have your patient/client lift their head just enough to remove the pressure from your fingers, but so that they may still feel your fingers on the back of their head.

Your patient or client is instructed to hold this position as long as possible.

For an assessment of "strong", your patient/client should be able to maintain this position, without compensation, for a minimum of 30 seconds.

Four signs indicate an end of the assessment: 

The head lifts completely off the fingers (cervical protraction)

A decrease in the length of the neck/chin line, indicating a loss of upper cervical flexion

Dr. Brent Brookbush Demonstrating Manual Muscle Testing of the Neck Muscles

External Rotator Manual Muscle Test

Instruct your patient/client to assume a seated position with arms by sides and elbows bent to 90°

The test may be more provocative with the shoulder flexed roughly 10°, and the patient/client instructed to gently adduct (squeeze the front of their rib cage with their elbows.

Ensure that your client understands the difference between rotating the arms "out" against resistance (external rotation), and lifting the arm against resistance (abduction).

Ask your patient to hold this position as you apply a moderate lateral to medial force on the outside of their forearms.

Note: This may be done unilaterally, using the opposite hand to help stabilize the torso, or bilaterally as pictured above.

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

Lower Trapezius Manual Muscle Test

Instruct your patient/client to assume a prone position so that the arm to be tested is hanging off the table.

Although it is not noted in any text, this test is most often depicted with the patient facing the arm being tested.

Stabilize the thorax and palpate the scapula with the hand nearest the patient/client.

Have your patient/client raise the arm in the scapular plane to end range.

Instruct your patient to depress and retract their scapula.

Apply a relatively small amount of pressure (toward the floor) to the forearm using the arm furthest from the patient's body.

For an assessment of "strong", your patient/client should be able to maintain the SCAPULA POSITION, without compensation (abduction) with a small external load.

Note: This MMT tests a scapular muscle, not a humeral muscle. A change in scapular position indicates compensation or weakness. If the arm gives way before the scapula (without compensation) then the test result is "strong".

Serratus Anterior Manual Muscle Test

Instruct your patient/client to assume a seated position, at the end of the table so you may approach the arm to be tested from the side.

Correct any postural deviations that may affect test results (forward head, excessive kyphosis, rounded shoulder posture, legs crossed, etc.)

Palpate the scapula and stabilize the thorax with the hand closest to the patient/client's back.

Apply a relatively small amount of pressure to the forearm in a posterior to anterior direction using the arm closest to the front of the patient's body.

For an assessment of "strong", your patient/client should be able to maintain the SCAPULA POSITION, without compensation (abduction) with a moderate external load.

Dr. Brookbush demonstrates a Serratus Anterior Manual Muscle Test with palpation of the inferior angle of the scapula on an athletic female.

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,

Celik D, Dirican A, Baltaci G. (2012). Intrarater reliability of assessing strength of the shoulder and scapular muscles. 

Brookham RL, McLean L, Dickerson CR. (2010). Construct validity of muscle force tests of the rotator cuff muscles: an electromyographic investigation. 

Olson LE, Millar AL, Dunker J, Hicks J, et al. (2006). Reliability of a clinical test for deep cervical flexor endurance. 

Journal of Manipulative and Physiological Therapeutics.

Dimitriadis Z, Kapreli E, Strimpakos N, Oldham J. (2015). Reliability of the chin tuck neck flexion test for assessing endurance of short neck flexors in healthy individuals. 

. 31(4): 299-302. (Only could access abstract)

Schwarts S, Cohen ME, Herbison GJ, Shah A. Relationship between two measures of upper extremity strength: manual muscle test compared to hand-held myometry. Arch Phys Med Rehabil 1992;73(11):1063-8

Wadsworth CT, Krishnan R, Sear M, Harrold J, Nielsen DH. Intratester reliability of manual muscle testing and hand-held dynametric muscle testing. Phys. Ther. 1987;67:1342-1347

Frese F, Brown M, Norton BJ. Clinical reliability of manual muscle testing: middle trapezius and gluteus medius muscles. Phys Ther. 1987;67:1072-1076

Beasley WC. Quantitative muscle testing: Principles and application to research and clinical services. Arch Phys Med Rehabil. 1961;42:398-425

Wintz M. Variations in current manual muscle testing. Phys Ther Rev. 1959; 39:166-475

Cuthbert SCJ, Goodheart GJ. On the reliability and validity of manual muscle testing: a literature review. Chiropr Osteopat. 2007; 15;4.

Bohannon RW. Manual muscle testing: does it meet the standards of an adequate screening test? Clin Rehabil. 2005;19:662-667

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

Edwards RHT, McConnell M. Hand-held dynamometer for evaluating voluntary muscle function. Lancet. 1971;9:757-758

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

Bohannon RW. Hand-held dynamometry: factos influencing reliability and validity. Clin Rehabil. 1998;11:263-264

Wilkholm JB, Bohannon RW. Hand-held dynamometry measurements: tester strength makes a difference J Ortho Sports Phys Ther. 1991;12:191-198

Bibliography

Questions, comments, and criticisms are welcomed and encouraged