Question
If a client tests out at a 5 out of 5 for hip strength on a manual muscle test, but you still have concerns that there are needs that should to be addressed, what are other tests that you can perform to further assess the client?
Answer
I do have access to a handheld dynomometer, and I have started to make a lot more use of it. I also use stabilization straps, because part of the problem is that the amount of force that someone exerts is relative to the resistance that they receive. So if you give a small amount of resistance, they will not give as much effort. So when my client is really strong as compared to me, I can't give enough resistance to truly test them without the stabilization straps.
If you do not have access to a hand-held dynomometer, I would recommend the use of repeated contractions. Instead of 1 manual muscle test, I may do 5 or 6 repeated contractions. I am looking at quality. I may have someone who is a 5 out of 5 according to how we teach PT students to manual muscle test, but with repeated contractions I can tell if there is a weakness. Comparing both sides is critical.
The other thing I like to do is to use a lot of different screening tools. There is a lot to be said for the single leg squat and repeated repetitions of it. One of the areas that I am directing my research toward is establishing correlations between muscle activity of the hip and knee and the ability to do a single leg squat. Does this person have good control or not? I think the single leg squat in dynamically examining a patient is a big thing.
I have another method that I use when I have a runner who says "I am OK until I start to run for 15 minutes and then I start to have weakness." I will do manual muscle testing; then I will put them on the treadmill and run them until they have pain. Then, I will take them off and test them again. I will compare sides using this method, and a lot of times it will give me the information that I need.
Probably the biggest thing that I am really paying attention to these days are the hip extensors. I think that the gluteus maximus might be more important than the gluteus medius. If you told me 5 years ago that I would say that, I would have thought that you were crazy. Back then, I thought that it was all about the gluteus medius.
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