Quixotic1, Lulu54, anyone? What is this called?

[MsWobbles]

Hey, Msers/Limbolanders,

I have a question that has been bugging me for a while.  Last time I was at my nice sleep neurologist's office, he did a muscle strength test of sorts on me but never explained it to me and I can't get ahold of him for an explanation of what happened.  I would appreciate it if any of you know what that test is called and what it means.

The test:  He had me, while seated, extend my legs, one at a time, and push them down as hard as I could on his raised hand for a minute or so.  Then he tested my legs by holding his hand up to the same height and asking me to then raise my legs off the floor up to the height of his hand.  No way could I lift my legs very high - only a couple of inches off the floor.  Anyone know what that test is called, or what it means?  After the test, he just darted out of the room without a word of explanation.  That was the end of my visit that day.  I must have meant something!!

Thanks for any help you can give.

WAF

[tonyad]

   I understand what you have been trying to explain  :)

~Tonya

[MsWobbles]

No he did not keep his hand under the inactive leg while I was trying to raise the other leg. I just had that knee flexed with the foot on the floor. I was seated on a  chair during the entire test.  

My feeling is that he was testing just how weak my muscles are that raise the leg up because he exhausted the opposing muscles (the ones used to press the leg down) so the two groups of muscles could not work together to lift the leg up, i.e. the hip flexors would be all on their own without help from other muscle groups.  Does that make any sense?  Needless to say, the flexors weren't strong.  I couldn't straight-lift my legs more than a couple of inches off the floor (while seated) for days after that test.  

Thanks for your insights.

WAF

[ashleyPT]

Yeah, I'm stumped.  The muscles used to push down into his hand when sittting (hip extensors OR knee flexors depending on the person's mechanics) Are different than any muscle you would need to use to raise your leg straight up (hip flexors).

And to answer the spasticity thing - there isn't really a test for spasticity.  You just move the muscle through normal range at different speeds and then there is a scale to rate it on.  But spasticity is velocity/movement dependent.

Did he keep his hand under the leg that was resting while asking you to raise the other one straight up for the second part?  If yes, then I have an answer for you.

[sunnyinthesnow]

He forced you to contract a muscle for a minute, then do the opposite movement? Use the hamstrings/gluts, then try to squeeze the quads/abs? Is this a test for spasticity?

It sounds like that game you play as a child where you make a fist for a minute, then try to slowly open it..

[MsWobbles]

Hi HVAC, daisy girl, ess, tonyad, and ashleyPT!

Thanks for your insights.  I've had the regular neuro muscle strength assessments before and this wasn't like any of those.  I've already been told I have 4/5 hip flexors for instance on a regular neuro exam.  The test I've described was different and took place after the nice MD had spent about 30 minutes talking with me.  He is a neuro, but he is actually my sleep apnea MD - he was only taking the time to listen to me and try to give me insights about my neuro issues.

I think the first part of the test when I was sitting on a chair and, leg straight, pressed my heel down on his hand for about a minute (he was also sitting) was designed purposely to fatigue the muscles required to push my heel and leg down onto his hand (whatever those muscles are called).  

The second part of the test was, I think, the real test - which was to see how well I could then lift my foot up off the floor without much help from the other muscles which were then fatigued from the first part of the test. I was amazed to see that I could only lift my feet up about 3 inches off the floor (legs straight) after fatiguing the muscles required to press my heels down onto his hand.  What the heck does that prove?  ALS?  MS?  ????  I could not have lifted my feet and legs any higher for a million dollars!

Whatever it was, he quickly left the room after that without a word of explanation.
Makes me kinda nervous.

WAF

[ashleyPT]

If you are sitting and then straighten your knee - which sounds like the first test you described then it's checking quad strength - but he applied resistance for a minute?  Or was a minute just the word you chose.   Resistance is supposed to be given for 5 seconds with MMT - neurologist usually don't hold it long enough and don't do it correctly (to really ***** quad strength to have to all a little flexion to prevent lock out which makes you seem falsely strong).  I've never seen a neuro do that correctly by the way.

I'm confused by the description of the second part.  Bent knee or straight knee? I'm assuming with a bent knee since you said you were sitting - in which case it would be what ess described as hip flexion.  If you were sitting and your knee was straight, then asked to raise your leg - that's different.

Sounds like he was just doing a quick screen.  

[tonyad]

   Hi there....WOW! That was a quick exam!!!!  I would not be happy about that!
you could always call the office and ask for a copy of his notes for that day..BUT, You could ALSO.....be verbal w/ him before he even bigins any exam w/ you. Telling him your thoughts and concerns...This may open up the door for more communication between the two of you...

   Muscle Strength: This involves resisting the neurologist with various muscle groups. Differences in strength between left and right sides are easier to evaluate than symmetrical loss unless the weakness is severe.

   Here is the deal w/ Evaluating Strength:

   At a physical examination, a doctor can obtain information regarding strength in the upper and lower extremities with some simple and routine maneuvers. First, the examining physician can estimate strength loss by comparing the strength of muscle contraction on your the weak side to your normal side.

Physicians frequently report subjective determination of strength by using a scale of 0 to 5 with 5 being normal. For example a doctor might ask you to try to straighten out your leg while the doctor resists such movement. A weaker leg might be reported as 3/5 for the quadriceps muscle (muscle on the front of the thigh) compared to an expected normal of 5/5. Zero means no movement. One means a trace of movement. Two means movement with the help of gravity. Three means movement is possible against gravity, but not against resistance. Four means movement against gravity and resistance by the examining physician. Five means normal.

Errors in this type of subjective testing can be caused by the person’s motivation, variations among people in “normal” strength, and differences in the doctor’s subjective assessment.

  And YES! The name of that test is called Manual Muscle Testing (MMT) as Daisy Girl had stated.

    PLease keep us updated and let us know if you get those notes...when are you supposed to be going back to see this NEURO??

Take Care,
~Tonya

Ess:
this test is performed while sitting and legs dangling over table.  i am sure that you have had this test many times but have it confused w/ something else.

[essdipity]

I haven't seen a test quite like that. For hip flexors, they have you sit with your legs dangling, then tell you to raise one knee and push up while the tester pushes down on the thigh.

Your test sounds like it might be looking for the same things from a different perspective.

ess

[daisy.girl]

sounds like:
MMT Manual Muscle Test is when resistance is given while trying to move different muscles. It is scored on a 1-5 scale.

Were you sitting the entire time?

[HVAC]

Muscle Strength?