Muscle strength is very important for all of our functional activities, from heavy work such as climbing stairs or a hill to fine work such as sewing or typing on a keyboard. While losing feeling in a part of the body can be more disabling, losing muscle power always has consequences for our function and our independence, especially as we get much older when our power levels decline anyhow. We may lose muscle power for a wide variety of reasons: disuse; pain; injury; disease or neurological illness. Physiotherapists are skilled at the assessment of muscle power and in progressive strengthening techniques to restore power within the patient's capacity.
Physiotherapists use the Oxford Scale to assess and grade muscle power when a patient's condition suggests this is necessary. A detailed knowledge of muscle anatomy is needed so that the muscle and its tendon can be located accurately and the correct action assessed. The Oxford Scale is a 0-5 scale which is then recorded as 0/5 or 3/5, sometimes with a + or " sign to indicate more or less power but not sufficient to reduce or increase the number. The physiotherapist will position the patient in the appropriate posture to allow accurate assessment and allow good vision and palpation of the appropriate structures.
The physiotherapist will ensure the joint is positioned best for good visibility of the muscle, easy manual palpation of the tendon and muscle belly and the correct alignment for the expected strength of the muscle. Palpating the tendon and muscle, the physiotherapist will ask the patient to perform the muscle action desired, feeling for any contraction or movement. If there is none then the score is 0/5 and 1/5 if there is a just discernable contraction or a twitch, without apparent joint movement. If the joint can be moved through its whole motion but only without gravity resisting then the grade is 2/5, for which the joint needs careful positioning. 3/5 grade would be recorded when the joint can be moved through its range against gravity, an example being straightening the knee from bent in sitting.
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.
Grade three out of five for the shoulder muscles might be the ability to lift the arm above the head, but if this cannot be easily done or to full range then the muscle can be graded as three minus to indicate its inability to be fully grade three. If the physiotherapist can resist the muscle firmly but it still doesn't seem to be strong enough for a five, then the rating can be four plus. Physiotherapists go through all the muscles to be tested and rate them all on a muscle testing chart as a record of the muscle strength, which can be retested over time to chart recovery.
Physiotherapists begin muscle strengthening techniques in a position where gravity is eliminated, allowing a weak muscle to be repetitively exercised. As the patient's ability increases they can perform more functional activities of daily life which strengthens the muscles in a co-ordinated way which reflects normality. Next, resistance against muscle action is increased as muscle strength improves in response to the level of intensity of resistance and not just repetition. High intensity causes muscle fibre breakdown which repairs with increased size and power until the next intensity workout repeats the process. Progression is then moved to functional exercise with bodyweight resistance as dynamic movement is more useful. - 16004
Physiotherapists use the Oxford Scale to assess and grade muscle power when a patient's condition suggests this is necessary. A detailed knowledge of muscle anatomy is needed so that the muscle and its tendon can be located accurately and the correct action assessed. The Oxford Scale is a 0-5 scale which is then recorded as 0/5 or 3/5, sometimes with a + or " sign to indicate more or less power but not sufficient to reduce or increase the number. The physiotherapist will position the patient in the appropriate posture to allow accurate assessment and allow good vision and palpation of the appropriate structures.
The physiotherapist will ensure the joint is positioned best for good visibility of the muscle, easy manual palpation of the tendon and muscle belly and the correct alignment for the expected strength of the muscle. Palpating the tendon and muscle, the physiotherapist will ask the patient to perform the muscle action desired, feeling for any contraction or movement. If there is none then the score is 0/5 and 1/5 if there is a just discernable contraction or a twitch, without apparent joint movement. If the joint can be moved through its whole motion but only without gravity resisting then the grade is 2/5, for which the joint needs careful positioning. 3/5 grade would be recorded when the joint can be moved through its range against gravity, an example being straightening the knee from bent in sitting.
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.
Grade three out of five for the shoulder muscles might be the ability to lift the arm above the head, but if this cannot be easily done or to full range then the muscle can be graded as three minus to indicate its inability to be fully grade three. If the physiotherapist can resist the muscle firmly but it still doesn't seem to be strong enough for a five, then the rating can be four plus. Physiotherapists go through all the muscles to be tested and rate them all on a muscle testing chart as a record of the muscle strength, which can be retested over time to chart recovery.
Physiotherapists begin muscle strengthening techniques in a position where gravity is eliminated, allowing a weak muscle to be repetitively exercised. As the patient's ability increases they can perform more functional activities of daily life which strengthens the muscles in a co-ordinated way which reflects normality. Next, resistance against muscle action is increased as muscle strength improves in response to the level of intensity of resistance and not just repetition. High intensity causes muscle fibre breakdown which repairs with increased size and power until the next intensity workout repeats the process. Progression is then moved to functional exercise with bodyweight resistance as dynamic movement is more useful. - 16004
About the Author:
Jonathan Blood Smyth is Superintendent of a large team of Physiotherapists at an NHS hospital in Devon. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are seeking physiotherapists in Bolton or elsewhere in the UK.
