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Manual Muscle Testing (MMT) is a way to check muscular strength. It is scored on a point scale as follows:


0 (zero) 

No evidence of contractility*

1 (trace) 

Evidence of slight contractility (no joint motion)

2 (poor) 

Complete range of motion with gravity eliminated

3 (fair) 

Complete range of motion against gravity

4 (good) 

Complete range of motion against gravity with some resistance

5 (normal) 

Complete range of motion against gravity with full resistance


It’s important to do MMT to check strength in people with spina bifida for many reasons. Specifically, the test helps us:

  • Develop a baseline against which we can compare the results of future tests
  • Decide on appropriate orthoses (braces)
  • Identify patients’ strengths and weaknesses (We use this information to develop a plan for addressing motor and mobility issues.)
  • Develop a strengthening program
  • Identify changes in an MMT that might indicate a tethered cord

MMT should be done every year by a physical and occupational therapist before seeing the neurologist. The therapists will test for strength in hands, arms, legs and feet. Therapists at Gillette or health care providers who have experience testing people with spina bifida can do the MMT.

If MMT is done by an outside health care provider, please call Gillette Rehabilitation at 651-229-3900 for a copy of the MMT form you’ll need to complete.

Once MMT has been done, results are sent to your doctor. The doctor uses the information to help determine whether there is a tethered cord.

(* How much stimulus it takes to make the muscle contract)

This information is for educational purposes only. It is not intended to replace the advice of your health care providers. If you have any questions, talk with your doctor or others on your health care team. If you are a Gillette patient with urgent questions or concerns, please contact Telehealth Nursing at 651-229-3890.