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Lower Trapezius Manual Muscle Testing (MMT) for an Active Population
Lower Trapezius Manual Muscle Testing (MMT) is a test used to assess the strength of the lower trapezius muscle in an active population. The test involves squeezing the patient’s shoulder blades together while the patient is in a seated upright position and held in a fixed position. The force of the squeeze is then measured using a hand held dynamometer and the test is graded on a scale of 0-5 with zero being no movement and five being the strongest contraction possible.
Transcript
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This is Brent of the Brookbush
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Institute, and in this video we're going to
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go over lower trap manual muscle testing for an active or athletic population. So
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we're going to go ahead and get rid of that Kendall scale for now. We're going
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to replace it with a simpler scale of strong, weak with compensation, or with
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pain. But we're going to pay closer attention to the details of our test
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because we know in this active or athletic population, we're putting a lot
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of load, a lot of stress on their musculoskeletal system. Sometimes it
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doesn't take a very big change to start leading to some dysfunction and pain. So
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I'm gonna have my friend Melissa come out, she's going to help me demonstrate
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this test. The test is in prone position, unfortunately even if you have a face
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hole cut out, chances are for this test they're not going to be able to get to
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the face hole cut out, because you need their shoulder to hang off the side of
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the table. So you're going to go ahead and have them turn their head towards
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your test position. Now I'm going to go ahead and bring her arm where I want it,
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so it's going to be about 45 degrees, or in line with the lower trap fibers.
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Remember those lower trap fibers kind of come off that medial portion of the
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spine of the scapula here, going down to T6-T12. So I can feel them right in
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there. Now i'm going to start her assuming that she's not cheating now, and
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i pulled her into this position. I'm going to cue her into some depression, retraction,
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and to make sure she's in upward rotation. That inferior angle should be
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bowed out a little bit, because that's what my lower trap does. The first test I
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might do is just go, ok i'm going to let go of your arm. Can you hold this position, and
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see if she can hold it for a few seconds. Not so easy,
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not so easy at all. Then I might have her start over. Okay let's go ahead and
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see if we can do that again. Let's go ahead and come up into the position
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Now I'm going to add a little external resistance, and the
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first thing I get with Melissa is not necessarily weakness, which is not
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uncommon on this test. I don't get weakness, I get scapular elevation. Of
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course the lower trap doesn't do scapular elevation, so what's going on
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here? We have synergistic dominance, we have compensation. The overactive
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synergists for my lower trapezius are going to be muscles like my rhomboids, my
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levator scapulae, potentially even my upper traps trying to stabilize for a
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lower trap that can't hold my scapula back into a little bit of depression, a
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little bit of retraction, an upward rotation. So let me show you guys that
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one more time. You can exaggerate a little bit this time Melissa. I put on
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some external resistance, and she goes straight into this elevated position
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with her scapula. Now just like all of the other manual muscle tests for active
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populations we've been talking about it, is also not uncommon for you to go okay,
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raise your arm, and somebody gets to about there, and can't go any further.
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Don't forget with this particular test, mobility is going to be quite the issue
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as well. If they don't have good thoracic mobility, they won't be able to posteriorly
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tilt their scapula and get themselves into position where they're
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parallel with the table. So that might be thoracic spine mobility. Just getting
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into posterior tipping of the scapula also requires optimal extensibility of
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the pectoralis minor. So something else for you guys to think about with this
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particular test. It's often upper body dysfunction as a whole that is
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contributing to poor performance, not just lower trap. One way to help
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differentiate what's going on is do your mobility work first, and then retest
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the lower trap. So if you do all of the mobility work, and all of a sudden you
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get up here, the range of motion is perfect, and they can hold that position
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with a little bit of external resistance. Maybe the lower trap is strong, you just
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have mobility issues. What you also might find is you do all your mobility work,
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you get your range of motion back, and they're only strong in the range of
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motion they used to have. Which means when you're thinking about your
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activation techniques, you need to be thinking about how am I going to
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strengthen this person through that range of motion they didn't have before
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the mobility work, so that I can get their lower trap functioning well
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through the entire range of motion. So just a real quick review on this test
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here again guys. Make sure you have them prone, head facing you. You're going to go
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ahead and cue them to 45 degrees, or in line with their lower trap fibers.
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Remember those lower trap fibers come off the medial portion of the spine of
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the scapula. I'm going to go ahead and make sure she starts in good position.
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I'm just going to add a little external resistance. Of course now Melissa's
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testing weak, but a very common pattern to also see is go ahead and exaggerate
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for me Melissa, is this elevation of the scapula. I hope you guys took a lot from
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this video. I hope you get a lot from this test as far as refining your
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intervention and exercise selection. I look forward to hearing your results.
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