The ability of male and female clinicians to effectively test knee extension strength using manual muscle testing

It has been suggested that the accuracy of manual muscle testing is dependent on examiner strength. Our purpose was to relate male and female clinicians' upper extremity strength to their ability to challenge the quadriceps and detect weakness in patients using manual muscle testing. Quadriceps muscles of seven men and 12 women with postpoliomyelitis were tested manually by a male and female clinician while forces were recorded with a hand-held dynamometer. Patients' maximal isometric knee extension force was recorded with a Lido dynamometer and clinicians' maximal vertical push force was recorded with the hand-held dynamometer. Manual muscle testing forces, patient maximum quadriceps forces, and examiner push forces were compared with repeated measures analysis of variance. Female examiners' maximal vertical push force (235.7 +/- 54.3 N) was not significantly different from either female or male patients' maximal quadriceps force (166.8 +/- 66.7 N and 341.6 +/- 123.7 N) but was only 60% and 40% of the isometric knee extension forces generated by a group of normal women and men. Male examiners were significantly stronger (357.0 +/- 93.4 N) than the female but not the male patients and produced 90% and 60% of the normal isometric quadriceps forces for women and men. Examiners gave appropriate grades in 30 of 38 tests. Examiner strength limits detection of moderate quadriceps weakness with manual resistance. Most of the muscle test grades, however, were appropriate, given the examiner's upper extremity strength. Clinicians using manual muscle testing should determine their maximal vertical push force and the extent of weakness they can detect.