Manual Muscle Testing: Plantarflexion

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Muscles Involved:

• Gastrocnemius
• Soleus

OR

• Soleus only

Patient Positioning

For testing gastrocnemius and soleus together:

• Grades 3-5 - Test in standing on test leg, knee extended, patient can hold stable object such as a table or bench for balance
• Grades 0-2 - Test in side-lying position, knee extended and ankle off plinth.

For testing soleus only:

• Grades 3-5 - Test in standing on test leg, knee slightly FLEXED, patient can hold stable object such as a table or bench for balance
• Grades 0-2 - Test in side-lying with testing side knee bent to 90 degrees.

Joint start Position

In standing test start position, start with ankle in plantar grade.

In side-lying test start position, start at mid point between available dorsiflexion and plantar flexion range.

Therapist Position

Both gastrocnemius and soleus together and soleus only:

• Grades 3-5 - Therapist to position comfortably with a lateral view of the movement being performed
• Grades 0-2 - Therapist to position at the feet

To Test

• Patient to perform plantar flexion in the form of single-limb heel raise

Grading

Grading for plantar flexion differs from the standard 0-5 grades. The system for grading the strength of standing plantar flexion relies on the range of motion and the number of quality repetitions that the patient is able to complete during testing.

Grade 5 - Full ROM, 4-5 quality repetitions in standing test position

Grade 4 - Full ROM, 2-3 quality repetitions in standing test position

Grade 3 - Full ROM, 1 quality repetition in standing test position

Grade 2 - movement through range, resistance eliminated (prone test position)

Grace 1 - potentially movement through some amount of range however minimal, flicker of muscle contractile activity palpated by therapist

Grade 0 - No movement & no contractile activity palpated