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Manual Muscle Testing / Monitoring

 Dr. George J. Goodheart, Jr., DC
Background
Scientific Studies and Literature Reviews
Sources
Abstract by Earl Cook

Status: Active

Last Update: May 1, 2011

Abstract

Manual muscle testing / monitoring (MMT) is used in Applied Kinesiology (AK) and Touch for Health (TFH), albeit with similar, but different purposes. In AK and the chiropractic profession, the muscle test is used as a complementary diagnostic tool in the evaluation of the musculoskeletal and nervous systems. In TFH, a non-diagnositic discipline practiced by lay people as well as professionals, the muscle test is used as a biofeedback tool used to indicate whether a muscle can 'lock' and test strong and serve as a monitor of the body's subtle energetic system and stress levels. In TFH, the goal is to holistically balance a person by using the MMT as an indicator. In this process, inhibited muscles become facilitated with an assumption that locking (strong) muscles are an indication of energetic balance and the free flow of energy throughout the systems.

In their Literature Review, On the Reliability and Validity of Manual Muscle Testing, published March 2007 in Chiropractic & Osteopathy, Scott C Cuthbert and George J Goodheart, Jr. [S1] reviewed basic science and research that has been conducted on the MMT since 1915, when the first peer-reviewed publication occurred. The full study can be seen at this link: http://www.chiroandosteo.com/content/15/1/4

Cuthbert and Goodheart concluded:

The MMT employed by chiropractors, physical therapists, and neurologists was shown to be a clinically useful tool, but its ultimate scientific validation and application requires testing that employs sophisticated research models in the areas of neurophysiology, biomechanics, RCTs, and statistical analysis.

In other studies, the following results have been found.

Leisman G, Shambaugh P, Ferentz AH () [S3] state:
"In all subjects the baseline (no muscle test) and control "strong" muscle test recordings were comparable while the recording from the "weak" muscle test showed increased amplitudes in contralateral layer components. These findings suggest a neurologic basis for manual muscle testing."

Leisman G, Zenhausern R, Ferentz A, Tefera T, Zemcov A (1995) [S4] state:
"Fatigue results in a less efficient muscle process. Muscles subjectively testing "Weak" or "Strong" yield effects significantly different from fatigue."

Monti DA, Sinnott J, Marchese M, Kunkel EJ, Greeson JM (1999) [S5] state:
"Over-all, significant differences were found in muscle-test responses between congruent and incongruent semantic stimuli."

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Background

Time Magazine names George Goodheart to its Top 100 Innovators List for Alternative Health

Standard Process Tribute to George Goodheart (PDF)

Selene River Press Video Tribute to Goodheart and Dr. Royal Lee (scroll to bottom of page)

Scientific Studies and Literature Reviews

S1. On the reliability and validity of manual muscle testing: a literature review

Scott C Cuthbert 1, George J Goodheart Jr 2

1-Chiropractic Health Center, 255 West Abriendo Avenue, Pueblo, CO 81004, USA

2-Goodheart Zatkin Hack and Associates, 20567 Mack Avenue, Grosse Pointe Woods, MI 48236-1655, USA

In this review, Cuthbert and Goodheart use the International College of Applied Kinesiology's (ICAK) definition of the MMT:

"Within the chiropractic profession, the ICAK has established an operational definition for the use of the MMT:

"Manual muscle tests evaluate the ability of the nervous system to adapt the muscle to meet the changing pressure of the examiner's test. This requires that the examiner be trained in the anatomy, physiology, and neurology of muscle function. The action of the muscle being tested, as well as the role of synergistic muscles, must be understood. Manual muscle testing is both a science and an art. To achieve accurate results, muscle tests must be performed according to a precise testing protocol.

The following factors must be carefully considered when testing muscles in clinical and research settings:
• Proper positioning so the test muscle is the prime mover
• Adequate stabilization of regional anatomy
• Observation of the manner in which the patient or subject assumes and maintains the test position
• Observation of the manner in which the patient or subject performs the test
• Consistent timing, pressure, and position
• Avoidance of preconceived impressions regarding the test outcome
• Nonpainful contacts – nonpainful execution of the test
• Contraindications due to age, debilitative disease, acute pain, and local pathology or inflammation"

In physical therapy research, the "break test" is the procedure most commonly used for MMT, and it has been extensively studied [20-22]. This method of MMT is also the main test used in chiropractic, developed originally from the work of Kendall and Kendall [21,23].

In physical therapy the "break test" has the following operational definition [20-22]. The subject is instructed to contract the tested muscle maximally in the vector that "isolates" the muscle. The examiner resists this pressure until the examiner detects no increase in force against his hand. At this point an additional small force is exerted at a tangent to the arc created by the body part being tested. The initial increase of force up to a maximum voluntary strength does not exceed 1 sec., and the increase of pressure applied by the examiner does not exceed a 1-second duration. "Strong" muscles are defined as those that are able to adapt to the additional force and maintain their contraction with no weakening effect. "Weak" muscles are defined as those unable to adapt to the slight increase in pressure, i.e., the muscle suddenly becomes unable to resist the test pressure.""

Kendall et al (1993) [21] state:
"As tools, our hands are the most sensitive, fine tuned instruments available. One hand of the examiner positions and stabilizes the part adjacent to the tested part. The other hand determines the pain-free range of motion and guides the tested part into precise test position, giving the appropriate amount of pressure to determine the strength. All the while this instrument we call the hand is hooked up to the most marvelous computer ever created. It is the examiner's very own personal computer and it can store valuable and useful information of the basis of which judgments about evaluation and treatment can be made. Such information contains objective data that is obtained without sacrificing the art and science of manual muscle testing to the demand for objectivity."

According to Walther (1988) [23]:
"Presently the best 'instrument' to perform manual muscle testing is a well-trained examiner, using his perception of time and force with knowledge of anatomy and physiology of muscle testing."

Cuthbert and Goodheart conclude by saying, "Regardless of the methods or equipment one uses to standardize MMT in a clinical or research setting, it is most important that the test protocol be highly reproducible by the original examiner and by others."

Results
More than 100 studies related to MMT and the applied kinesiology chiropractic technique (AK) that employs MMT in its methodology were reviewed, including studies on the clinical efficacy of MMT in the diagnosis of patients with symptomatology. With regard to analysis there is evidence for good reliability and validity in the use of MMT for patients with neuromusculoskeletal dysfunction. The observational cohort studies demonstrated good external and internal validity, and the 12 randomized controlled trials (RCTs) that were reviewed show that MMT findings were not dependent upon examiner bias.

Conclusion
The MMT employed by chiropractors, physical therapists, and neurologists was shown to be a clinically useful tool, but its ultimate scientific validation and application requires testing that employs sophisticated research models in the areas of neurophysiology, biomechanics, RCTs, and statistical analysis.

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Published: 1. Chiropractic & Osteopathy 2007, 15:4doi:10.1186/1746-1340-15-4

The electronic version of this article is the complete one and can be found online at:

http://www.chiroandosteo.com/content/15/1/4

Received by Chiropractic & Osteopathy:
14 February 2007
Accepted:
6 March 2007
Published:
6 March 2007
© 2007 Cuthbert and Goodheart; licensee BioMed Central Ltd.

The information provided on this website under the terms of the Creative Commons Attribution License

The references below are the citations in the Literarture Review by Cuthbert and Goodheart (2007).
3. Green BN, Gin RH: George Goodheart, Jr., D.C., and a history of applied kinesiology. J Manipulative Physiol Ther 1997, 20(5):331-337. PubMed Abstract
4. Walther DS: Applied Kinesiology, Synopsis. 2nd edition. Pueblo, CO: Systems DC; 2000.
5. Walther DS: Applied Kinesiology, Chapter 6. In Principles and Practice of Manual Therapeutics: Medical Guides to Complementary & Alternative Medicine. Edited by: Coughlin P. Philadelphia: Churchill-Livingstone: Elsevier Science; 2002.
6. Goodheart GJ: Applied Kinesiology Research Manuals. Detroit, MI: Privately published yearly; 1964.
7. Frost R: Applied Kinesiology: A training manual and reference book of basic principals and practices. Berkeley, CA: North Atlantic Books, Berkeley; 2002.
8. Leaf D: Applied Kinesiology Flowchart Manual, III. Plymouth, MA: Privately published; 1995.
Back to top 9. Maffetone P: Complementary Sports Medicine: Balancing traditional and nontraditional treatments. Champaign, IL: Human Kinetics; 1999.
20. Karin Harms-Ringdahl: Muscle Strength. Edinburgh: Churchill Livingstone; 1993.
21. Kendall FP, McCreary EK, Provance PG: Muscles: Testing and Function. Baltimore, MD: Williams & Wilkins; 1993.
22. Daniels L, Worthingham K: Muscle Testing – Techniques of Manual Examination. 7th edition. Philadelphia, PA: W.B. Saunders Co; 2002.
23. Walther DS: Applied Kinesiology, Synopsis. 2nd edition. Pueblo, CO: Systems DC; 2000.
24. Barbano RL: Handbook of Manual Muscle Testing. Neurology. 2000, 54(5):1211.
25. Martin EG, Lovett RW: A method of testing muscular strength in infantile Paralysis. JAMA LXV(18):1512-3. 1915 Oct 30
26. Lovett RW, Martin EG: Certain aspects of infantile paralysis with a description of a method of muscle testing. JAMA LXVI(10):729-33. 1916 Mar 4
27. Shambaugh P: Changes in Electrical Activity in Muscles Resulting from Chiropractic Adjustment: A Pilot Study. J Manipulative Physiol Ther 1987, 10(6):300-304. PubMed Abstract
28. Koes BW, Bouter LM, van Mameren H, et al.: A blinded randomized clinical trial of manual therapy and physiotherapy for chronic back and neck complaints: physical outcome measures.
J Manipulative Physiol Ther 1992, 15(1):16-23.
PubMed Abstract
29. Koes BW, Bouter LM, van Mameren H, et al.: Randomized clinical trial of manipulative therapy and physiotherapy for persistent back and neck complaints: results of one year follow up.
BMJ 1992, 304:601.
PubMed Abstract | PubMed Full Text
30. Meade TW, Dyer S, Browne W, et al.: Low back pain of mechanical origin: randomized comparison of chiropractic and hospital outpatient treatment.
BMJ 1990, 300:1431.
PubMed Abstract
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S2. Objective measurement of proprioceptive technique consequences on muscular maximal voluntary contraction during manual muscle testing.

Perot C, Meldener R, Goubel F

Département de génie biologique, URA CNRS 858, Université de technologie, Compiègne.

Response of Tibialis anterior muscle to a "proprioceptive technique" used in applied kinesiology was investigated during manual muscle testing using a graphical registration of both mechanical and electromyographic parameters. Experiments were conducted blind on ten subjects. Each subject was tested ten times, five as reference, five after proprioceptive technique application reputed to be inhibitory. Results indicated that when examiner-subject coordination was good an inhibition was easily registered. Therefore reliability of the proposed procedure is mostly dependent upon satisfactory subject-examiner coordination which is also necessary in standard clinical manual muscle testing.

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Published: 1: Agressologie. 1991;32(10 Spec No):471-4.

National Institute of Health www.MedLine

PMID: 1844106 [PubMed - indexed for MEDLINE]

S3. Electromyographic effects of fatigue and task repetition on the validity of estimates of strong and weak muscles in applied kinesiological muscle-testing procedures.

Leisman G, Zenhausern R, Ferentz A, Tefera T, Zemcov A

Institute of Biomedical Engineering and Rehabilitation Services of Touro College, Dix Hills, NY 11746, USA.

The study investigated the effects of fatigue and task repetition on the relationship between integrated electromyogram and force output during subjective clinical testing of upper extremity muscles. Muscles were studied under two conditions differing in the nature and duration of constant force production (SHORT-F) and (LONG-F). The findings included a significant relationship between force output and integrated EMG, a significant increase in efficiency of muscle activity with task repetition, and significant difference between Force/integrated EMG ratios for muscles labeled "Strong" and "Weak" in the LONG-F condition. This supports Smith's 1974 notion that practice results in increased muscular efficiency. With fatigue, integrated EMG activity increased strongly and functional (force) output of the muscle remained stable or decreased. Fatigue results in a less efficient muscle process. Muscles subjectively testing "Weak" or "Strong" yield effects significantly different from fatigue.

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Published: 1: Percept Mot Skills. 1995 Jun;80(3 Pt 1):963-77.

National Institute of Health www.MedLine

PMID: 7567418 [PubMed - indexed for MEDLINE]

S4. Somatosensory evoked potential changes during muscle testing.

Leisman G, Shambaugh P, Ferentz AH.

Neuroscience Institute, New York Chiropractic College, Glen Head 11545.

Fifteen naive subjects with no known neurological problems were tested by means of manual muscle testing to determine two "strong" and one "weak" muscle on a limb contralateral to the stimulated side. Somatosensory evoked potentials (SEP) were then recorded from contralateral median nerve stimulation while a naive tester tested the three previously identified muscles. In all subjects the baseline (no muscle test) and control "strong" muscle test recordings were comparable while the recording from the "weak" muscle test showed increased amplitudes in contralateral layer components. These findings suggest a neurologic basis for manual muscle testing.

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Published: 1: Int J Neurosci. 1989 Mar; 45(1-2):143-51.

National Institute of Health www.MedLine

PMID: 2714940 [PubMed - indexed for MEDLINE]

S5. Interexaminer agreement for applied kinesiology manual muscle testing.

Lawson A, Calderon L.

Institute for Biomedical Engineering and Rehabilitation Services, Touro College, Dix Hills, NY 11746, USA.

Two trials of the interexaminer reliability of Applied Kinesiology manual testing were conducted. On the first trial three clinicians, each with greater than ten years of experience with muscle testing procedures, tested 32 healthy individuals to estimate their agreement on the strength or weakness of right and left piriformis and right and left hamstring muscles. Significant agreement between examiners was found for piriformis muscles, but little significant agreement was noted when hamstrings were tested. In a second study, the same three examiners tested 53 subjects for strength or weakness of the pectoralis and tensor fascia lata muscles bilaterally. Significant interjudge agreement was found for pectoralis muscles, but no significant concordance could be found when the tensor fascia lata was examined.

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Published 1: Percept Mot Skills. 1997 Apr;84(2):539-46.

National Institute of Health www.MedLine

PMID: 9106846 [PubMed - indexed for MEDLINE]

S6. Applied Kinesiology unreliable for assessing nutrient status.

Kenney JJ, Clemens R, Forsythe KD.

Pritikin Longevity Center, Santa Monica, California.

Note: The expression in the abstract, "exposed to" when describing how a known safe food or substance is tested is unclear. AK has an assessment technique for food and nutrition that can best be described as vibrationally-based while the Food Assessments in Touch for Health are bio-chemically-based in comparison. So this study may or may not have direct relevance to Touch for Health due to different testing methods.

Applied Kinesiology is a technique used to assess nutritional status on the basis of the response of muscles to mechanical stress. In this study, 11 subjects were evaluated independently by three experienced applied kinesiologists for four nutrients (thiamin, zinc, vitamin A, and ascorbic acid). The results obtained by those applied kinesiologists were compared with (a) one another, (b) standard laboratory tests for nutrient status, and (c) computerized isometric muscle testing. Statistical analysis yielded no significant interjudge reliability, no significant correlation between the testers and standard biochemical tests for nutrient status, and no significant correlation between mechanical and manual determinations of relative muscle strength. In addition, the subjects were exposed in a double-blind fashion to supplements of thiamin, zinc, vitamin A, and ascorbic acid and two placebos (pectin and sucrose) and then re-tested. According to applied kinesiology theory, "weak" (indicating deficiency) muscles are strengthened when the subject is exposed to an appropriate nutritional supplement. Statistical analysis revealed no significant differences in the response to placebo, nutrients previously determined (by muscle testing) to be deficient, and nutrients previously determined (by muscle testing) to be adequate. Even though the number of subjects (11) and nutrients (4) tested was limited, the results of this study indicated that the use of applied kinesiology to evaluate nutrient status is no more useful than random guessing.

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Published 1: J Am Diet Assoc. 1988 Jun;88(6):698-704.

National Institute of Health www.MedLine

PMID: 3372923 [PubMed - indexed for MEDLINE]

S7. Muscle test comparisons of congruent and incongruent self-referential statements.

Monti DA, Sinnott J, Marchese M, Kunkel EJ, Greeson JM.

Jefferson Medical College, Philadelphia, PA 19107-5004, USA.

This study investigated differences in values of manual muscle tests after exposure to congruent and incongruent semantic stimuli. Muscle testing with a computerized dynamometer was performed on the deltoid muscle group of 89 healthy college students after repetitions of congruent (true) and incongruent (false) self-referential statements. The order in which statements were repeated was controlled by a counterbalanced design. The combined data showed that approximately 17% more total force over a 59% longer period of time could be endured when subjects repeated semantically congruent statements (p < .001). Order effects were not significant. Over-all, significant differences were found in muscle-test responses between congruent and incongruent semantic stimuli.

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Published 1: Percept Mot Skills. 1999 Jun;88(3 Pt 1):1019-28.

National Institute of Health www.MedLine

PMID: 10407911 [PubMed - indexed for MEDLINE]

S8. A force/displacement analysis of muscle testing.

Caruso W, Leisman G.

Parker College of Chiropractic, Research Institute.

Manual muscle testing procedures are the subject of a force and displacement analysis. Equipment was fabricated, tested, and employed to gather force, displacement, and time data for the purpose of examining muscle-test parameters as used by clinicians in applied kinesiology. Simple mathematical procedures are used to process the data to find potential patterns of force and displacement which would correspond to the testing of strong and weak muscles of healthy subjects. Particular attention is paid to the leading edge of the force pulses, as most clinicians report they derive most of their assessment from the initial thrust imparted on the patient's limb. An analysis of the simple linear regression of the slope (distance vs force) of the leading edge of a force pulse indicates that a significantly large slope is indicative of weak muscles (as perceived by the clinician), and a small slope is indicative of strong muscles. Threshold criteria for slopes are specified to create a model that may discriminate between strong and weak muscles. The model is accurate 98% of the time compared to judgments of clinicians with more than 5 years of experience but is considerably lower for clinicians with less than five years of experience (64%). this accuracy rate indicates that the model is reliable in predicting the clinician's perception of muscle strength, and it also indicates that the testing procedure for muscle strength used by experienced clinicians in applied kinesiology are reliable. The experiment lays the groundwork for studies of the objectivity of muscle-strength assessment in applied kinesiology.

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Published 1: Percept Mot Skills. 2000 Oct;91(2):683-92.

National Institute of Health www.MedLine

PMID: 11065332 [PubMed - indexed for MEDLINE]

S9. Applied Kinesiology Monograph

Natural Standard - the Authority of Integrative Medicine

Natural Standard states:

Natural Standard was founded by clinicians and researchers to provide high quality, evidence-based information about complementary and alternative therapies. This international multidisciplinary collaboration now includes contributors from more than 100 eminent academic institutions.

For each therapy covered by Natural Standard, a research team systematically gathers scientific data and expert opinions. Validated rating scales are used to evaluate the quality of available evidence. Information is incorporated into comprehensive monographs which are designed to facilitate clinical decision making. All monographs undergo blinded editorial and peer review prior to inclusion in Natural Standard databases.

Natural Standard is impartial; not supported by any interest group, professional organization, product manufacturer. Institutional subscriptions, custom content and licensing are available.

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Published 1: http://www.naturalstandard.com/
S10. Muscle Imbalance: The Goodheart and Janda Models
By Scott Cuthbert, BA, DC, BCAO

According to Scott Cuthbert, BA, DC, BCAO, evidence suggests measurable muscular inhibition (weakness) is associated with injury, inflammation and pain. This evidence is part of the rationale for the chiropractic physician's use of the manual muscle test (MMT) for the assessment of muscular inhibition in patients.

Muscular imbalance is the combination of weakness and hypertonicity (tightness); however, there are differing approaches as to the diagnosis and treatment of these muscular imbalance phenomena that are a fundamental component for patients with manipulable disorders.

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Dynamic Chirporactic, Volume 28, Number 7: http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=54578

Sources

You'll Be Better - The Story of Applied Kinesiology
by
George J. Goodheart, Jr., D.C.
(
ICAK Adaption from Chapter One)
History of Applied Kinesiology

by George J Goodheart, Jr.

Remembering Wellness in Touch for Health Kinesiology - a History, Context and Vision For Touch For Health, the First 25 Years and the Next Millennium
by John F. Thie, D.C.
1994 Review
Remembering the first 25 Years

by John F. Thie