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Grades 3 to 5 - Patient is in prone, knee extended
Grades 0-2 - Patient is in side lying, knee extended ('gravity minimal' position)
Therapist to stand at test side in prone
If patient is in side lying, therapist to stand behind the patient support the lower leg through movement as required.
Patient actively flexes the knee through range.
For grades 4 to 5 apply resistance through the distal tibia and fibula in a direction opposite to flexion To satisfy grade 5 'normal muscle' performance criteria, the patient must have the ability to move through complete range of motion (active resistance testing) OR maintain an end point range (break testing) against maximum resistance.
Biasing Muscle Groups
To bias laterally-inserting muscles: externally rotate the tibia in combination with flexion
To bias medially-inserting muscles: internally rotate the tibia in combination with flexion
↑Hislop H, Avers D, Brown M. Daniels and Worthingham's muscle Testing-E-Book: Techniques of manual examination and performance testing. Elsevier Health Sciences; 2013 Sep 27.
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