338 Canine Sports Medicine and Rehabilitation
valid remeasurements, which are taken
throughout the course of treatment to deter-
mine whether muscle bulk is returning within
an expected time frame. Current evidence
regarding validity and reliability of Gulick
measurements is inconsistent. In one study,
intra-rater reliability improved when the tester
used the same device for repeat measurements
(Baker et al., 2010). Another study indicated
that thigh circumference measurements with a
Gulick may not produce a valid measurement
(Bascunan et al., 2016). Muscle strength must be
tested separately as muscle circumference is not
directly correlated with muscle torque (Stevens
et al., 2004). See Chapter 5 for a detailed descrip-
tion of Gulick measurements.
In human physical therapy, strength has been
determined with a manual muscle test (MMT),
a 1–5 rating scale requiring volitional open‐
chain muscle contraction through full joint
range of motion (Perry et al., 2004). In the canine
patient, the traditional MMT cannot be used. To
strength test the canine patient, closed‐chain
contractions must be observed in a functional
standing position and the data captured in the
canine manual muscle test (C‐MMT) developed
by this author. This test requires rigorous study
to determine validity and rater reliability. Three
categories of strength are defined:● <3/5 (poor): the muscle group is unable to
provide the force required to maintain a
static standing position;
● 3/5 (fair): the muscle group is able to pro-
vide the force required to maintain a static
standing position;
● 3+/5 (good): the muscle group is able to
provide more force than is required to main-
tain a static standing position.For C‐MMT strength testing, a stifle‐height
box or step is required. The strength test is initi-
ated from the least strenuous testing position to
the most strenuous testing position. To com-
plete the test (Figure 13.4), the dog is positioned
in a standing position and the limb opposite the
testing limb is lifted into a non‐weight‐bearing
position; the therapist observes the standing
limb. If the limb is unable to maintain the posi-
tion, as observed by increased dorsal glide of
the scapula (weakness of serratus ventralis),
increased shoulder flexion (weakness of biceps
and supraspinatus), increased elbow flexion
(weakness of triceps), increased carpal extension(A) (B)Figure 13.4 Canine manual muscle testing allows the therapist to determine baseline isometric strength in a functional
standing position. (A) The patient is placed in a standing position and the contralateral limb is lifted into a non‐weight‐
bearing position. The therapist observes changes in the position of the scapula on the thorax and changes in the joint
angle as the contralateral limb is lifted. Inability to maintain scapular and joint angles indicates a strength score of <3/5.
The ability to maintain the position requires further testing. (B) The patient is placed in a standing position with the
pelvic limbs on a box increasing weight bearing through the thoracic limbs. The contralateral limb is lifted into a
non‐weight‐bearing position. The therapist observes changes in the position of the scapula on the thorax and changes in
the joint angle as the contralateral limb is lifted. Inability to maintain scapular position and joint angles indicates a
strength score of 3/5. Ability to maintain the position indicates a strength score of 3+/5.