We depend on our muscles to allow us to do all the functional activities we want to perform, from walking to climbing stairs to typing and doing precise work. Our muscles can deliver huge amounts of power and endurance as well as highly co-ordinated and skilled manipulations. Loss of feeling may be more important in a limb but loss of sufficient muscle power compromises our independence particularly as we get older and find difficulty performing routine actions for ourselves. Muscle power can be reduced by a large number of causes including not using them when ill and forced to rest, pain from injury or operations, stroke or other neurological condition, disease and illness. The assessment and treatment of muscle weakness is a routine skill in physiotherapy.
The Oxford Scale is the rating system used by physiotherapists for the assessment and recording of muscle power when required. Knowledge of muscle anatomy is vital so that the joint can be positioned correctly and the tendon and muscle palpated so whether there is any muscle action can be judged. The muscle is rated on the Oxford Scale from one to five and written down as 2/5 or 4/5, at times with a plus or minus sign to show the muscle has more or less strength but not enough to go down or up the scale. The physiotherapist ensures the joint is in the optimal position to enable the muscle to function easily and for easy visualisation of the tendon and muscle.
Grade 0 is no action discernable in the muscle at all, with the physiotherapist palpating the muscle belly or tendon as the patient attempts to perform the activity several times. Grade 1 is a twitch as the muscle undergoes a small contraction but is not strong enough to perform any of its specified joint movement. Grade 2 indicates a muscle strong enough to perform its designated joint movement when the force of gravity is eliminated, making it much easier to perform. The joint must be accurately positioned for this to be tested correctly. Grade 3 is a muscle strong enough to perform the joint action to the full range against gravity but with no resistance applied. An example here would be lifting the arm above the head.
Grade 4 means that the muscle can move the joint through range both against gravity and against resistance such as a weight or the physiotherapist's manual resistance. The amount of resistance is not stated but has to be judged as reasonable for the age, weight, health and normal status of the patient. Grade 5 muscle power is normal power, but this again is a judgment for the patient as a young rugby player will have much greater normal power than an elderly lady, although both might be Grade 5. Some parts of the body cannot have their strength tested manually as the muscles are too strong for the hands to resist appropriately. Bodyweight will need to be the resistance here.
If the patient lifts their arm up above their head but finds it difficult to do and cannot quite get the arm fully up then the physiotherapist might record this as 3- as the grade is not fully three but it is too strong for grade 2. If some resistance can be applied by the physiotherapist but the muscle still does not seem to be of fully normal strength then the rating cannot be a 5, but rather a 4+. A muscle testing chart is used to record the physiotherapist's testing and can be used to chart progress in muscle power over time.
Muscle strengthening begins with encouraging muscle activity with gravity counterbalanced if the muscle is weak. Once a functional level of muscle activity is reached the patient can be encouraged to perform normal daily activities to power up their muscles. At a higher level resistance must be added as it is the intensity of work which develops muscle strength. This causes a breakdown of muscle fibres which regenerate with increased strength, a cycle which can be repeated with increased levels of applied intensity of resistance. Once simple resistance has been managed, the patient is taught to perform dynamic exercises using their bodyweight as this is the ultimate expression of muscle strength. - 16004
The Oxford Scale is the rating system used by physiotherapists for the assessment and recording of muscle power when required. Knowledge of muscle anatomy is vital so that the joint can be positioned correctly and the tendon and muscle palpated so whether there is any muscle action can be judged. The muscle is rated on the Oxford Scale from one to five and written down as 2/5 or 4/5, at times with a plus or minus sign to show the muscle has more or less strength but not enough to go down or up the scale. The physiotherapist ensures the joint is in the optimal position to enable the muscle to function easily and for easy visualisation of the tendon and muscle.
Grade 0 is no action discernable in the muscle at all, with the physiotherapist palpating the muscle belly or tendon as the patient attempts to perform the activity several times. Grade 1 is a twitch as the muscle undergoes a small contraction but is not strong enough to perform any of its specified joint movement. Grade 2 indicates a muscle strong enough to perform its designated joint movement when the force of gravity is eliminated, making it much easier to perform. The joint must be accurately positioned for this to be tested correctly. Grade 3 is a muscle strong enough to perform the joint action to the full range against gravity but with no resistance applied. An example here would be lifting the arm above the head.
Grade 4 means that the muscle can move the joint through range both against gravity and against resistance such as a weight or the physiotherapist's manual resistance. The amount of resistance is not stated but has to be judged as reasonable for the age, weight, health and normal status of the patient. Grade 5 muscle power is normal power, but this again is a judgment for the patient as a young rugby player will have much greater normal power than an elderly lady, although both might be Grade 5. Some parts of the body cannot have their strength tested manually as the muscles are too strong for the hands to resist appropriately. Bodyweight will need to be the resistance here.
If the patient lifts their arm up above their head but finds it difficult to do and cannot quite get the arm fully up then the physiotherapist might record this as 3- as the grade is not fully three but it is too strong for grade 2. If some resistance can be applied by the physiotherapist but the muscle still does not seem to be of fully normal strength then the rating cannot be a 5, but rather a 4+. A muscle testing chart is used to record the physiotherapist's testing and can be used to chart progress in muscle power over time.
Muscle strengthening begins with encouraging muscle activity with gravity counterbalanced if the muscle is weak. Once a functional level of muscle activity is reached the patient can be encouraged to perform normal daily activities to power up their muscles. At a higher level resistance must be added as it is the intensity of work which develops muscle strength. This causes a breakdown of muscle fibres which regenerate with increased strength, a cycle which can be repeated with increased levels of applied intensity of resistance. Once simple resistance has been managed, the patient is taught to perform dynamic exercises using their bodyweight as this is the ultimate expression of muscle strength. - 16004
About the Author:
Jonathan Blood Smyth is a Senior Physiotherapist at an NHS hospital in the South-West of the UK. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for physiotherapists in Manchester.
