Manual Muscle Strength Testing: Validity & Reliability


Young Doctors SmilingGet certified as a Balanced Muscle Strength Screener – Legs in 4-6 weeks! Time varies based on background in anatomy and biology.

Manual muscle strength testing has been around at least since 1915 with over 6 textbooks on the topic currently in publication. Let’s first define exactly what we are talking about when we describe manual muscle strength testing for this article.

Muscle testing falls broadly into 2 major categories. One category uses testing to measure strength based upon the functional capacity of the muscle and the directly affiliated nerves. The other category utilizes muscle testing as a method of gaining insights into remote areas of the body or even other people. This article is addressing the first category of measuring direct muscle strength.

Muscle testing may be done using equipment, manual methods or a hybrid of the two. State of the art testing where documentation is required for insurance or legal cases typically involves sophisticated equipment (i.e. Cybex, Biodex). While muscle strength testing with this type of equipment can be extremely accurate, it tends to be limited in the number of different muscles that can be measured and takes extensive amounts of time and money to perform.

Manual muscle testing for strength utilizes the examiner’s senses to evaluate how much strength the subject is capable of producing with each test. Accuracy suffers to some degree because of this and results are recorded in a semi-quantative manner (i.e. 0-100%) rather than in pounds of force. On the plus side, manual testing offers a much broader range of muscles that can be measured and can be done in a much quicker time frame and lower cost.

Hybrid systems utilize devices that the examiner holds in their hand to measure the peak force that subjects can exert with their muscles. These hybrid systems are somewhere in between the sophisticated systems and purely manual methods regarding the number of different muscles that can be tested and the accuracy of the results, time and cost.

Cuthbert & Goodheart did a peer reviewed, nationally indexed study of over 100 research articles done on purely manual muscle testing methods. There findings concluded that there was “good reliability and validity in the use of MMT [manual muscle testing] for patients with neuromusculoskeletal dysfunction. The observational cohort studies demonstrated good external and internal validity, and the 12 randomized controlled trials (RCTs) that were reviewed show that MMT findings were not dependent upon examiner bias.” (1)

More recently (2010), Fan and others, did a study on inter-rater reliability of manual muscle strength testing for intensive care patients.  They found “MMT has excellent inter-rater reliability in trained examiners and is a reliable method of comprehensively assessing muscle strength.” (2)

In 2000, Gregson found that using the Medical Research Council scale for manual muscle strength testing provided reliable results for all muscle groups tested. (3)

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3 – Gregson JM. Reliability of measurements of muscle tone and muscle power in stroke patients. Age Ageing. 2000;29:223–228

What’s the #1 reason women don’t workout?


woman-curlingWomen who didn’t workout reported more often they didn’t have enough time! That means they don’t place enough value on staying fit. How can women see the value in a workout routine? A couple big factors are: 1) they need to know that exercising is going to help and 2) that the exercises won’t cause problems.

The largest preventable risk factor for the development of arthritis is muscle imbalances.  The best way to correct these11 imbalances is through exercises.  When you consider that the #2 reason for all doctor visits is arthritis and how many people get joint replacements for chronic arthritis, starting an exercise program begins to sound like it could be well worth the time.

It is not enough to just do exercises.  They need to be the correct exercises.  This is why it is important get tested for individual muscle strength first before beginning an exercise program.  Muscle imbalances can be acquired by many different reasons including: traumas; accumulation of imbalanced every day activities; imbalanced exercise programs; crooked seats; saggy beds and more. Over time, if not addressed and corrected, pain, injury, drug therapies, surgery, and osteoarthritis diseases can develop.

Good health is good motivation!

Battle of the Boxes II, CrossFit Competition – August 17


amrap-fitness-logoThe Diagnosis Foundation will be exhibiting and performing balanced muscle strength screenings at a CrossFit fundraising competition, Battle of the Boxes II.

The DxF Screening is free and open to the public.  The competition is a team event from other CrossFit Boxes.

When: The events will take place on Saturday, August 17, 2013 beginning 8:15 am.

Where: AMRAP Fitness / CrossFit South Rockland, 80 Red School House Rd, Unit 110, Chestnut Ridge, NY

Activities include:

  • DxF Free Health & Fitness Screening: Balanced Muscle Strength testing of 12 muscles in the legs.  Designed to improve athletic performance, decrease injuries and prevent certain forms of osteoarthritis
  • This is a team event – 2 men, 2 women
  • Divisions: Open (ages 16 to 39), Masters (40+)
  • Awards

Proceeds will go to The Crohn’s & Colitis Foundation of America. The Crohn’s & Colitis Foundation of America (CCFA) was founded in 1967 to find cures for Crohn’s disease and ulcerative colitis and improve the quality of life of adults and children affected by these diseases.

For additional info:

What is the #1 reason for missing a workout?


People Exercising at a GymnasiumLower back pain is the #1 reason men miss a workout. It is estimated that 80% of men will experience lower back pain at one point or another in their life. Treating low back pain without understanding the underlying cause of it, can result in the wrong treatment plan and ultimately may produce more back pain. The Diagnosis Foundation asks: What is the cause of your back pain? One quick way to begin to understand what is causing the back pain, is to be screened for individual muscle imbalances. For instance, the psoas muscle can play a role in back pain because it attaches to the lower spine. If the muscle becomes too strong in relation to the muscles opposing it, it can pull the lower spine forward. Only a slight distortion is needed before discomfort sets in. If left undiagnosed, chronic back issues can develop.

Where does the US rank in health systems?


doctor bag-MS

How often do you hear or read: “Eat Healthy and Exercise”? If this advice was heeded then, why are so many people still unhealthy? According the the World Health Organization, the US doesn’t even rank in the top 25 health systems (1) despite having the most healthcare expenditures per person. What are the factors that impact this statistic?

One of the motivating factors to build the Diagnosis Foundation (DxF) was the eat healthy and exercise advice and what could people do to better understand exactly what each individual needs in terms of what diet/supplements are needed and what exercise(s) to do. The DxF believes that the public is beyond the “eat healthy and exercise advice.” We, as a whole, are so much more knowledgeable with the internet at our fingertips. That empowers people! We like that a lot!

However, It is that “fingertip knowledge” that can be precisely overwhelming!  The supplement industry is one of the fastest growing industries in the world! Forbes states that last year alone the vitamin, mineral, and supplement industry earned about $32 billion in revenue (2). That means more and more people are driven to understand how they can be healthy while using information/research to support their physical well being with supplements. That is the great part! But still, how do you know what you need to take and how do you know what exercises to do?

The DxF has been addressing these questions. We promote understanding why before a treatment plan is in place.

No healthcare reform needed here! We are creating new avenues for people to empower themselves!  Our first empowering program is our Balanced Muscle Strength (BMS) screenings. Unsure of what exercises to do? Our BMS screenings are the first to take a “snapshot” look at possible underlying cause(s) or muscle imbalances that can fester and possibly lead to disease or surgery years down the road. Each BMS participant is empowered to make choices about treatment. We’ve seen it! We love the engagement of all participants! Knowledge is power and these screenings provide participants with useful health information (data sheet) that they take with them. We’ve seen trainers alter routines on the spot to account for collected data! If participants choose to do further investigation and evaluation of the underlying cause, they are referred to their own health care provider or our new DxProvider database of professionals. We now offer BMS screenings for free!

More empowering DxF programs we have developed for the NOW empowerment:

A certification course in Balanced Muscle Strength – Legs . The public response to our screenings motivated us to offer new career options. So many people loved our work and wanted to be able to help others be fit and healthy we launched our certification course this spring! It is open to everyone. We even have options for those who are already in the bodywork field. It is offered at an introductory price!

As for long term goals, the DxF has outlined facilities development to expand and meet the public need for empowerment. In addition, we are also developing a career path for a Doctor of Holistic Diagnosis (DHDx) that would only diagnosis for underlying causes before treatment options were considered by the patient.

We believe this care would improve the our standings among other health systems and reduce the cost expenditures person.

If you would like any more information about how you can be empowered or if you have any comments, please email me directly:

Occupy Your Health, You Have the Power!

Pamela Wallman, Chief Administrative Officer DxF



23rd Joe Koziarz Memorial 5K Run – July 20



The Diagnosis Foundation will be exhibiting and performing balanced muscle strength screenings at the 23rd Annual Joe Koziarz Memorial 5K Run.  This event is open to the public and the Health Fair / DxF Screening is free.

When: The events will take place on Saturday, July 20, 2013   Race day check-in starts 7 am.  Race begins 8:30

Where: Main Street & Mill Road, Westhampton Beach

Activities include:

  • DxF Free Health & Fitness Screening: Balanced Muscle Strength testing of 12 muscles in the legs.  Designed to improve runner’s athletic performance, decrease injuries and prevent certain forms of osteoarthritis.
  • Health Fair & other medical screenings
  • Kids 1 mile fun run
  • 5K Run –  Course runs through the scenic roads and lanes of the Village of Westhampton Beach.
  • Professionally timed with Electronic Chip devices
  • Awards

Proceeds to benefit the Town of Southampton Police Atletic League (PAL), The Joe Koziarz Memorial Hurricane Scholarship Fund at the Westhampton Beach Senior High School & the Peconic Bay Medical Center Emergency Room in Riverhead.

For additional info:

Trivia Question


What is the largest muscle group in the body and one of the top calorie burners?  Buttocks - Wiki

The glutes are the biggest muscle group. The bigger the muscle the more calories it burns. Plus, strengthening the glutes helps with posture. Glutes that are too weak can result in lower back issues as the pelvis will tilt forward causing stress on the spine. How do you know if your glutes are strong?

The Science of Healthy Competition


Blur of Runners Competing in Marathon

Researchers at the University of Oxford found that people who train in groups can boost their pain tolerance more than those who work out alone. The scientists aren’t sure why, but they think group exercise may contribute to an underlying endorphin surge. No training partners? Pop in a pair of earphones. Music can also make strenuous exercise seem easier.

It takes a community to be fit!


Group of Friends Jumping Together




The Diagnosis Foundation (DxF) has been working with the CrossFit community for about 9 months. We’ve been performing free screenings at local boxes and competitions in the NYC metro area. One thing we have observed through these screenings, it is the most fit community of people! It takes a community to raise fit people! Excellent job!

Integrating Details with Chopra’s Spiritual Solutions


I see you

Deepok Chopra gives excellent advice in his video: Diseases can be cured without medicine! He states 85% of origins of disease can be traced back to factors such as:

  • obesity
  • stress
  • insufficient sleep
  • unhealthy relationships
  • lack of exercise

The Diagnosis Foundation is also promoting finding the origins or underlying causes of disease. We advocate objectively testing all of the above factors and prioritizing these factors in contributing to your disease. For instance, when we seek to understand why a person is obese we may ask: does he/she have a malabsorption issue causing cravings for more foods? Is there an essential nutrient deficiency causing cravings? Are there psychological factors, etc.? This is just one simple example to find objective answers to underlying causes of a condition. 

As an example how to treat without finding the underlying cause, the FDA has just approved a new drug to treat obesity. While this might help a person initially lose weight, the underlying cause remains untreated and will manifest in another disease. Have you had experience with someone who seeks to find the underlying causes or origins before treatment? We’d love to hear from you! We are compiling a DxProvider Data Base for the public to reference.