It is important to use bony landmarks and proper positioning for measuring ROM to be as accurate as you possibly can be. Bony landmarks are needed to align a goniometer in the correct position, to be found to be stabilized when testing muscles, and to be used as reference points when measuring circumference. Using bony landmarks also increases the inter-rater and intra-rater reliability of the measurements that you obtain.
The purpose of the "test position" for MMT is to be as accurate as possible while scoring/grading a patient's ROM and resistance, to determine if they have weak muscles, and to help determine the maximal effort given by the patient.
The gravity eliminated position is relevant for the distinguishing of MMT grading; if a patient has to be measured in the gravity eliminated position, you know automatically that they score less than a 3. Another reason is if the patient has a lot of pain trying to do ROM with gravity resistance, then testing them without the resistance of gravity will be less painful for measuring their ROM. The gravity eliminated position also used is if a patient's muscles are too weak to move against gravity, so lying down in a horizontal position is easier for them for you to test their ROM. Also, while measuring the ROM during gravity eliminated testing, if the patient cannot complete the least partial ROM, then that is a major sign for you that you must observe the muscle or tendon and/or palpate it for them for contraction. One final reason of relevance for the gravity eliminated position is that it helps tell you what position your client should be in while testing ROM. In this type of testing, whatever part of the body you are testing on your patient should be parallel to the ground.
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