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.
If there is no muscle activity, either visible or with the physiotherapist feeling the tendon and muscle belly after several attempts by the patient to perform the muscle action then the muscle is graded as zero. A small muscle contraction such as a twitch, without any joint movement, is rated as one. When the muscle can do its joint action but without the force of gravity resisting the movement then this is graded as two, but the joint needs to be in the right position for correct testing. If the muscle can perform its typical action against the force of gravity then it is rated as three. An example is bending the elbow whilst standing up, where the biceps is working against gravity.
If the muscle can move the joint through the full movement both against gravity and against some resistance such as bodyweight then the Oxford Scale grading is 4/5. It is a professional judgment as to the resistance to be applied for the test, and the physiotherapist will have in mind the health, age, activity and weight of the patient. If a muscle is to be graded 5/5 it must be of normal power, but as this will vary greatly between individuals the physiotherapist must make an estimation of the expected full muscle power for that particular patient. Grade 5 for a frail sick person will be very different from grade 5 for a young, fit sports person.
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. - 14130
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.
If there is no muscle activity, either visible or with the physiotherapist feeling the tendon and muscle belly after several attempts by the patient to perform the muscle action then the muscle is graded as zero. A small muscle contraction such as a twitch, without any joint movement, is rated as one. When the muscle can do its joint action but without the force of gravity resisting the movement then this is graded as two, but the joint needs to be in the right position for correct testing. If the muscle can perform its typical action against the force of gravity then it is rated as three. An example is bending the elbow whilst standing up, where the biceps is working against gravity.
If the muscle can move the joint through the full movement both against gravity and against some resistance such as bodyweight then the Oxford Scale grading is 4/5. It is a professional judgment as to the resistance to be applied for the test, and the physiotherapist will have in mind the health, age, activity and weight of the patient. If a muscle is to be graded 5/5 it must be of normal power, but as this will vary greatly between individuals the physiotherapist must make an estimation of the expected full muscle power for that particular patient. Grade 5 for a frail sick person will be very different from grade 5 for a young, fit sports person.
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. - 14130
About the Author:
Jonathan Blood Smyth is Superintendent of a large team of Physiotherapists at an NHS hospital in Devon. He specialises in orthopaedic issues and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for physiotherapists in Birmingham or elsewhere in the UK.
No comments:
Post a Comment