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Gluteus Medius Manual Muscle Testing (MMT) for an Active Population
Gluteus Medius Manual Muscle Testing (MMT) is an assessment technique used to evaluate the muscle strength of the gluteus medius in an active population. The MMT examination assesses gluteus medius strength by testing the resistance of its contraction to manual pressure. It is a quick, inexpensive, and highly effective assessment tool which is well suited to evaluate gluteus medius strength in individuals who participate in activities such as running, jumping, and weightlifting. The
Transcript
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This is Brent of the Brookbush Institute,
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...blank
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today we're talking about gluteus medius
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manual muscle testing for an active
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population. So since we're testing for an
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active population I'm actually going to
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go ahead and set that Kendall scale
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aside, that one through five with pluses
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and minuses, where we test can the person
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move against gravity through a full
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range of motion. Can they resist a little
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bit of external resistance from the
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manual practitioner. We're going to go
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ahead and replace that scale with strong,
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weak with compensation or with pain, and
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although that sounds simpler we're also
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going to make the test itself more
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provocative, so that we can see if it is
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in fact the gluteus medius that is weak,
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strong, or whether this particular
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movement pattern is being overrun by
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those overactive synergists. I'm going to
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have my friend Melissa come out, she's
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going to help me demonstrate.
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Now first things first we want to set up,
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actually just like we set up for the
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Kendall manual muscle testing for
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gluteus medius. We want to make sure she
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has a nice neutral spine, the one thing I
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see on this test a little bit, and even
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gluteus medius activation which isn't
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great, is sometimes I see people prop
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their head up right; as soon as you prop
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your head up your spine is kind of
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curved this way, we have a shorter
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quadratus lumborum on this side, we have
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shorter erector spinae on the side that
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we're testing that could lead to
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compensation and reinforcing patterns I
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don't really want to reinforce. So let's
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go ahead and have her lay her head down,
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make sure she's neutral all the way
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across. The next thing I'm going to do is
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I'm going to stabilize her pelvis with
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my webspace from index finger to thumb,
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by going just over the top of her iliac
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crest. So I don't want to try to control
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her from here, I'm going to try to
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control her from the top of her iliac
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crest. I think you get a lot more sensory
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feedback into your fingers as well, you
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know as we're watching for anterior pelvic
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tilt or posterior pelvic tilt, or her
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like rotation of the pelvis. I'm going to
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go ahead and have her straighten her leg back.
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Good, and in the in the traditional
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manual muscle test you'd have the person
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abduct and then you push down into
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adduction right, problem with that is is
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that doesn't just test our gluteus
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medius, there's other abductors, if she's
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up here and I just keep putting her up
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here to make her very tired, she's also
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going to start trying to use her TFL and
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gluteus minimus, but I want to test gluteus
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medius. I know that's a very important
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muscle. I know it's a muscle that has a
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propensity to get under active. I want to
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make sure that's what I'm testing. So how
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am I going to do that, I'm going to make sure
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her pelvis is stacked, that she's not
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rolling back.
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I'm going to have her go ahead and
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abduct, and then she's going to have to
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extend a little bit for me, and you guys
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as soon as you try to put somebody in
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this position, you're going to see your
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first two most common compensations;
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either they try to go into an anterior
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pelvic tilt, alright so their pelvis
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rotates this way, or as I pull them up
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and back, rather than coming back into
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abduction and extension of the femur
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relative to their pelvis, they're just
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going to roll their pelvis back, so
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they're leg went in the same direction but
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they're actually in abduction and
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flexion, we don't want that either. Those
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are both big compensation patterns, and
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big hints that something's not right
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with their gluteus medius. Let's try this
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one more time, I'm going to go ahead and
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pull her up and back into extension,
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really stabilize her pelvis so I can get
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her her leg in the position I'm looking
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for, and we might just start by having
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her hold this position without
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resistance. All right you guys can even
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slide your thumb down since it's right
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here and see kind of palpate their
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gluteus medius, is that gluteus medius
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firing, can you feel those fibers firm
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underneath your thumb contracting hard.
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Good, tough. Okay, a little bit all right.
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So now we get into adding a little bit
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of resistance. So we're going to go up
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and back, and rather than just pushing
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straight down, all right let's go ahead
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and resist those posterior fibers
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through all planes, by using a pincer or
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lumbrical grip over her calcaneus. Rather
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than just pushing her straight down, i'm going to
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get fancy and go ahead and push her
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into adduction with a little bit of
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flexion. So now she has to extend
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into my hand, and I'm also going to try
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to internally rotate her leg a little
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bit. So relax for a second for me. I'm
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going to try to push her kind of this
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way. Don't go too far into flexion, but
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just like you're trying to take her toes
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and rather than put them right on top of
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her other toes, you're trying to put her
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toes right in front of other toes. All
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right so go ahead and hold up here for
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me, hold hold hold hold hold, ready to
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resist.
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Alright Melissa is doing a very good job
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acting right now. If she was able to
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resist that much force guys, the test
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would be strong, that would be awesome. It
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would be great to see somebody with a
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strong gluteus medius, unfortunately i
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don't see that test result very often.
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What i usually get is somebody who has a
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hard time even holding this position
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right, which then would we just put weak,
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that's that's a weak gluteus medius. Of
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all I have to do is like put a couple
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fingers like this and I can push them
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over, that's a weak gluteus medius. I
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think the sign you guys are going to get
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most commonly though is with
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compensation, and here's the two big
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compensations you're going to see; either
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you're going to go to push down just
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like we were talking about right, so that
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down, a little bit forward, a little bit
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of internal rotation, you're going to go to
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push like that, and their pelvis is going
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to try to flip back on you. If their
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pelvis tries to flip back on you, now
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what they've done is they have
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relatively put their femur in flexion, so
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now they're trying to use those
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abductors that are also flexors, which is
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her TFL and gluteus minimus, to try to
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resist you. The other thing you might see
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is when you go to push down, you can
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actually feel her leg slide away from
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you into flexion. Once again trying to
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bias the test into flexion, trying to
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use that TFL and gluteus minimus to try
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to resist you. So you have weak where you
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just push down, but then we have the most
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common thing I see which is this with
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compensation, and I think you guys got
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the hint there from both of my examples
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with the pelvis turning forward, the leg
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sliding forward, that somehow flexion is
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involved. Well if we kind of go back to
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our general human movement science, we go
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back to those predictive models of
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dysfunction, we kind of know that
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inhibition of the gluteus medius is
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going to lead to synergistic dominance
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by the TFL and gluteus minimus, and this
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is not a great thing. TFL and the gluteus
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minimus are also internal rotators, we
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know internal rotation at the hip is is
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related to both hip dysfunction as well
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as knee dysfunction;
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and so if we get a sign of with
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compensation on our provocative gluteus
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medius test here, we know we've got some
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work to do. We probably need to calm down
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the TFL and gluteus minimus with things
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like release of lengthening techniques,
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and we know we're going to have some
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work to do on that gluteus medius to get
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it active, and to get it taking over the
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role it's supposed to be taking over,
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which is the prime mover of abduction. I
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hope you guys can see from doing this
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test, alright so I'm going to stabilize
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her pelvis, up you know abduction and
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extension here, that this definitely
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biases the test more towards gluteus
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medius; and instead of just doing that
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abduction test where people will often
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trust very strong, because they can use
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those overactive synergists, we're
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basically taking those out. And all of a
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sudden that's where I think everybody
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will start saying their movement
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assessments match their manual muscle
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tests, because all things being equal
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shouldn't they match up. All right if I
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see knees bow in, my gluteus medius
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should probably test weak in most
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individuals. And I think doing it this
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way that's what you'll start to find. I
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hope you guys enjoy testing the gluteus
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medius, I think you'll find with a lot of
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individuals they're not as strong as
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they think they are, and then start doing
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some of those gluteus medius activation
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exercises, and see if this test changes.
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You could start doing an assessment for
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gluteus medius, do your activation
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circuit and then immediately reassess,
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and I think you guys will start to see
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how this test can change. I think you'll
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see how gluteus medius activation
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exercises can really have a big benefit,
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and I think you'll see a huge
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improvement in your outcomes. I look
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forward to talking to you guys again
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