The Grading of Quadriceps Muscle Strength

The Grading of Quadriceps Muscle Strength

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Determining the muscular strength of your quadriceps is an important step to a successful physical therapy program. Grading on a scale of zero to 5, physical therapists can estimate the strength, flexibility and responsiveness of your quads. This knowledge can help guide them to prescribe specific strengthening exercises or treatments.

The Quadriceps

The quadriceps are a major muscle group that run from the top of your knee to your pelvis. Your quads are responsible for both hip flexion and knee extension, making them important for physical activities such as running, walking, kicking or jumping.

Testing Muscle Strength

Your doctor can test the strength of your quadriceps with a simple resistance test. Taking one leg at a time, your doctor will exert force on your lower leg while your upper is raised, taking note of your flexibility and ability to withstand pressure. In the first test, he will put gradual downward pressure on your shin as you lift your leg in the air with your knee straightened. In the second test, your knee will be bent and your doctor will put upward pressure on your upper calf. Both legs will be tested in this way, with your doctor taking note of your ability to hold your leg up against gravity and your ability to move through your full range of motion against resistance.

Grading Muscle Strength

Once done with the test, your doctor will assign a value ranging from zero to 5 on the relative strength of your quads. A grade of zero indicates a complete inability to contract the muscle. A grade of 1 indicates only a slight contraction. A grade of 2 indicates you could move your quad through its complete range of motion, but only on a horizontal plane, not against the pull of gravity. A grade of 3 indicates you could hold your leg up off the table against the pull of gravity, but that you could not withstand any additional pressure. A grade of 4 indicates that you could both hold up your leg and withstand a moderate amount of pressure on your shins and calves. A grade of 5 indicates normal, healthy range of motion.


Some doctors and physical therapists give plus and minus grades in addition to the zero to 5 system. These generally indicate progression or regression of the muscle. These grades are subjective, but if done by a professional, are generally reliable. Your doctor can then use these grades to build a plan for rehabilitation.


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