MMT Grade 3 (Fair)
A patient who can barely touch her neck would receive a Manual Muscle Test (MMT) grade of 3 (Fair) on the Medical Research Council (MRC) scale, indicating the ability to move through full range of motion against gravity but without additional resistance.
Understanding the MRC Scale for Neck Flexion
The MRC scale used in manual muscle testing operates on a 0-5 grading system 1:
- Grade 5: Full strength against maximal resistance
- Grade 4: Movement against moderate resistance
- Grade 3: Movement through full range against gravity only (no additional resistance)
- Grade 2: Movement with gravity eliminated
- Grade 1: Trace muscle contraction
- Grade 0: No contraction
Clinical Reasoning
When a patient can "barely touch her neck," this describes:
- Active movement present: The patient can initiate and complete the motion
- Full range achieved: The hand reaches the neck (complete flexion)
- Gravity overcome: The movement occurs against gravitational resistance
- No additional resistance tolerated: The qualifier "barely" indicates weakness that would fail with any added resistance
This clinical picture precisely matches Grade 3 criteria 1, 2.
Testing Technique Considerations
For proper MMT assessment of neck flexors 2:
- Patient positioning: Supine or sitting upright
- Stabilization: Trunk must be stabilized
- Resistance application: For Grade 3, no manual resistance is applied—only gravity
- Palpation: Assess sternocleidomastoid and deep neck flexor activation
The sternocleidomastoid and deep neck flexors are the primary muscles tested for this motion 3, 4.
Clinical Context
Reliability considerations: MMT grading shows excellent reliability for total scores but variable reliability for individual muscle groups 5, 6. The neck flexors demonstrate moderate intrarater reliability (Kappa 0.54-0.64) 5, making consistent examination technique critical.
Common pitfall: Don't confuse Grade 3 with Grade 2. Grade 2 requires gravity-eliminated positioning (side-lying for neck flexion), where the patient moves horizontally. If the patient achieves the motion sitting or supine (against gravity), it's at least Grade 3 2.