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Disentangling manual muscle testing and Applied Kinesiology: critique and reinterpretation of a literature review

Mitchell Haas*, Robert Cooperstein and David Peterson

Chiropractic & Osteopathy 2007, 15:11  doi:10.1186/1746-1340-15-11

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Disentangling manual muscle testing and Applied Kinesiology: critique and reinterpretation of a literature review. A reply

Scott Cuthbert   (2007-08-31 03:15)  Chiropractic physician email

Letter to the Editor

Disentangling manual muscle testing and Applied Kinesiology: critique and reinterpretation of a literature review. A reply

We would like to comment on this paper by Haas, Cooperstein, and Peterson where they critique our publication. The validity of the MMT for neuromusculoskeletal (NMS) diagnosis (its construct and content validity [1-2], convergent and discriminant validity [3], concurrent and predictive validity [4-5]) was presented in our paper after peer review and accepted by Haas, Cooperstein, and Peterson. The internal validity was strong in a number of the papers reviewed. These studies were time-series experiments that help to rule out rival explanations for beneficial clinical changes following treatment [6].

We disagree with Haas et al’s interpretation that the science of the MMT is markedly negative and their exclusion of its positive findings for the chiropractic profession is curious.

We believe the following 3 questions remain affirmatively answered: “1) Is MMT worthy of scientific merit? 2) Can new techniques using MMT be critiqued for scientific merit? 3) Is there evidence that adds scientific support to chiropractic techniques that use MMT?”

The reliability of the MMT (test-retest, intra- and inter-examiner reliability) was recognized as excellent also (Cohen’s kappa values were greater than .75 in 11 papers) [2-4]. In fact comparisons of the reliability coefficients for MMT are often more reliable than palpation (the most commonly used, widely taught and investigated form of chiropractic diagnosis) [4-5, 8-9].

Considerable evidence was presented that substantiates a relationship between muscle strength and function in neuromusculoskeletal (NMS) disorders [2-3, 10-13]. Logically this relationship would apply to the assessment of chiropractic interventions that affect NMS function by monitoring the relative strength or weakness of related muscles during the course of treatment.

Two types of a limited number of studies provided further justification for the “entanglement” of MMT in chiropractic diagnostic methods:

1) Studies that show improvements in muscle strength and function after manipulative therapy [14-21],

2) Studies that show a consistent relationship between a clinical condition and muscle inhibition [2-3, 10-13].

Haas et al discuss studies showing negative outcomes that employed what they characterize as “AK procedures”[22-30]. However, a review of the negative studies they present shows they did not follow (especially regarding nutritional and non-musculoskeletal diagnosis) methods taught by the International College of Applied Kinesiology (ICAK), and a critique of these papers has been published by the ICAK and Dr. Goodheart [31-32].

They are correct in pointing out that these studies were negative, but incorrect to infer that these studies evaluated AK methods of diagnosis or treatment. It was for this reason that we did not include these papers in our original review concerning the reliability and validity of the MMT.

We agree with them that it is reasonable to make a distinction between standardized MMT and non-standardized MMT. It is the second type of MMT that can tarnish the reputation of clinicians using it as part of their diagnostic regimen. In our opinion Haas et al have used non-AK research studies to condemn MMT as a pre- and post-assessment tool for evaluating the efficacy of chiropractic treatment.

It appears from the available resources that Haas and Peterson have published one clinical experiment (in 1994) testing the claims of chiropractic manual muscle testers, and from this broadly assert that AK, a multimodal diagnostic and treatment system with a 40-year history, is insupportable [23].

However if MMT is reliable and valid for NMS diagnosis then logically this reliability and validity remains when a chiropractor uses MMT.

References:

1) Lamb RI: Manual Muscle Testing. In: Measurement in physical therapy. Edited by Rothstein JM. New York: Churchill Livingstone; 1985:47-55.

2) Michener LA, Boardman ND, Pidcoe PE, Frith AM: Scapular muscle tests in subjects with shoulder pain and functional loss: reliability and construct validity. Phys Ther 2005 Nov, 85(11):1128-38.

3) Jepsen JR, Laursen LH, Hagert CG, Kreiner S, Larsen AI: Diagnostic accuracy of the neurological upper limb examination I: inter-rater reproducibility of selected findings and patterns. BMC Neurol 2006 Feb16, 6:8.

4) Wadsworth CT, Krishnan R, Sear M, Harrold J, Nielsen DH: Intrarater reliability of manual muscle testing and hand-held dynametric muscle testing. Phys Ther 1987 Sep, 67(9):1342-1347.

5) Lawson A, Calderon L: Interexaminer Agreement for Applied Kinesiology Manual Muscle Testing. Percepl Mot Skills 1997, 84:539-546.

6) Payton OD: Research: The Validation of Clinical Experience. Philadelphia, FA Davis; 1994.

7) In Fundamentals of Chiropractic, 2003. Faye LJ, Scaringe JG. Chapter 10: Palpation: The Art of Manual Assessment.

8) Pollard H, Lakay B, Tucker F, Watson B, Bablis P: Interexaminer reliability of the deltoid and psoas muscle test. J Manipulative Physiol Ther 2005, 28(1):52-6.

9) Goodheart G: Failure of the musculo-skeletal system may produce major weight shifts in forward and backward bending. In: Proc Inter Conf Spinal Manip May 1990; Washington, DC: 399-402.

10) Lovett RW, Martin EG: Certain aspects of infantile paralysis with a description of a method of muscle testing. JAMA 1916 Mar 4, LXVI(10):729-33.

11) Lund JP, Donga R, Widmer CG, Stohler CS: The pain-adaptation model: a discussion of the relationship between chronic musculoskeletal pain and motor activity. Canadian Journal of Physiology and Pharmacology 1991, 69:683-694.

12) Escolar DM, Henricson EK, Mayhew J, Florence J, Leshner R, Patel KM, Clemens PR: Clinical evaluator reliability for quantitative and manual muscle testing measures of strength in children. Muscle Nerve 2001 Jun, 24(6):787-93.

13) Schmitt W, Leisman G: Correlation of Applied Kinesiology Muscle Testing Findings with Serum Immunoglobulin Levels for Food Allergies. International Journal of Neuroscience 1998, 96:237-244.

14) Masarsky CS, Weber M: Somatic dyspnea and the orthopedics of respiration. Chiro Tech 1991, 3(1):26-29.

15) Perot C, Meldener R, Gouble F: Objective Measurement of Proprioceptive Technique Consequences on Muscular Maximal Voluntary Contraction During Manual Muscle Testing. Agressologie 1991, 32(10):471-474.

16) Cuthbert S, Blum C: Symptomatic Arnold-Chiari malformation and cranial nerve dysfunction: a case study of applied kinesiology cranial evaluation and treatment. J Manipulative Physiol Ther 2005 May, 28(4):e1-6.

17) Cuthbert S: Applied Kinesiology: An Effective Complementary Treatment for Children with Down Syndrome. Townsend Letter: The Examiner of Alternative Medicine 2007, 288:94-107.

18) Caso ML: Evaluation of Chapman’s neurolymphatic reflexes via applied kinesiology: a case report of low back pain and congenital intestinal abnormality. J Manipulative Physiol Ther 2004 Jan, 27(1):66.

19) Gregory WM, Mills SP, Hamed HH, Fentiman IS: Applied kinesiology for treatment of women with mastalgia. Breast 2001 Feb, 10(1):15-9.

20) Monti D, Sinnott J, Marchese M, Kunkel E, Greeson J: Muscle Test Comparisons of Congruent and Incongruent Self-Referential Statements. Perceptual and Motor Skills 1999, 88:1019-1028.

21) Mathews MO, Thomas E, Court L: Applied Kinesiology Helping Children with Learning Disabilities. Int J AK and Kinesio Med 1999;4.

22) Tschernitschek H, Fink M: "Applied kinesiology" in medicine and dentistry--a critical review. Wien Med Wochenschr 2005, 155:59-64.

23) Haas M, Peterson D, Hoyer D, Ross G: Muscle testing response to provocative vertebral challenge and spinal manipulation: a randomized controlled trial of construct validity. J Manipulative Physiol Ther 1994, 17:141-148.

24) Triano JJ: Muscle strength testing as a diagnostic screen for supplemental nutrition therapy: a blind study. J Manipulative Physiol Ther 1982, 5:179-182.

25) Ludtke R, Kunz B, Seeber N, Ring J: Test-retest-reliability and validity of the Kinesiology muscle test. Complement Ther Med 2001, 9:141-145.

26) Garrow JS: Kinesiology and food allergy. Br Med J (Clin Res Ed) 1988, 296:1573-1574.

27) Pothmann R, von FS, Hoicke C, Weingarten H, Ludtke R: Evaluation of applied kinesiology in nutritional intolerance of childhood. Forsch Komplementarmed Klass Naturheilkd 2001, 8:336-344.

28) Kenney JJ, Clemens R, Forsythe KD: Applied kinesiology unreliable for assessing nutrient status. J Am Diet Assoc 1988, 88:698-704.

29) Rybeck CH, Swenson R: The effects of oral administration of refined sugar on muscle strength. J Manipulative Physiol Ther 1980, 3:155-161.

30) Friedman MH, Weisberg J: Applied kinesiology--double-blind pilot study. J Prosthet Dent 1981, 45:321-323.

31) ICAK-International and ICAK USA websites, “Applied Kinesiology Research and Literature Compendium” [http://www.icakusa.com/scientificresearch.php] and [http://www.icak.com/college/research/publishedarticles.shtml.] Accesed August 28, 2007.

32) Goodheart GJ, Jr.: Muscle strength testing as a diagnostic screen for supplemental nutrition therapy: a blind study [Letter]. J Manipulative Physiol Ther 1983, 6:87.

Competing interests

None declared

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