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

You'll Be Better - The Story of Applied Kinesiology

by George J Goodheart, Jr, DC

Standard Process Tribute to George Goodheart (PDF)| (Standard Process Link)

Time Magazine names George Goodheart to its Top 100 Innovators List for Alternative Health (expired link)

Index: Peer-reviewed Scientific Studies, Literature Reviews & Papers

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

Intrarater reliability of manual muscle testing and hand-held dynametric muscle testing.

Reliability of Manual Muscle Testing with a Computerized Dynamometer

Objective Measurement of Proprioceptive Technique Consequences on Muscular Maximal Voluntary Contraction During Manual Muscle Testing

Thoughts About Muscle Testing

A preliminary inquiry into manual muscle testing response in phobic and control subjects exposed to threatening stimuli.

Correlation of Applied Kinesiology Muscle Testing Findings with Serum Immunoglobulin Levels for Food Allergies.

Muscle Test Comparisons of Congruent and Incongruent Self-Referential Statements

A Force/Displacement Analysis of Muscle Testing

Manual Muscle Testing and Postural Imbalance

The Genito-Urinary System and the Piriformis Muscle: The Anatomy of the Muscle-Organ-Gland Correlation

AK Manual Muscle Testing: As Reliable As The Deep Tendon Reflex?

The Ileocecal Valve Point and Muscle Testing: A Possible Mechanism of Action

Can the Ileocecal Valve Point Predict Low Back Pain Using Manual Muscle Testing?

Common Errors and Clinical Guidelines for Manual Muscle Testing: “The Arm Test” and Other Inaccurate Procedures

What are you Doing about Muscle Weakness?

Evaluation of Applied Kinesiology meridian techniques by means of surface electromyography (sEMG)

Can ankle imbalance be a risk factor for tensor fascia lata muscle weakness?

What Are You Doing About Muscle Weakness? Pt. 2: Cervical Spine

What Are You Doing About Muscle Weakness? Pt. 3: Lumbar Spine

What Are You Doing About Muscle Weakness? Pt. 4:
The Extremities

Muscle Imbalance: The Goodheart and Janda Models.

Technique Summary: Applied Kinesiology

Association of manual muscle tests and mechanical neck pain: Results from a prospective pilot study

The accuracy of kinesiology-style manual muscle testing to distinguish congruent from incongruent statements under varying levels of blinding: Results from a study of diagnostic test accuracy

Bridges between whole-body dysfunctions and the feet: The close examination with Applied Kinesiology.

Menopause, chiropractic examination and treatment, and salivary hormone levels: correlations and outcomes

The accuracy and precision of kinesiology-style manual muscle testing: designing and implementing a series of diagnostic test accuracy studies.

Correlation of manual muscle tests and salivary hormone tests in adrenal stress disorder: A retrospective case series report

Developing the evidence for kinesiology-style manual muscle testing: A series of diagnostic test accuracy studies

Does chiropractic have an answer for recurrent ankle sprains?

Estimating the prevalence of use of kinesiology-style manual muscle testing: A survey of educators

The manual muscle test as a clinical prediction rule for headaches and cranial dysfunctions

Promising Research - the triple entendre
(Presentation at 2015 TFHKA Conference)

Applied Kinesiology: It's Past, Present, and Future

Applied Kinesiology Essentials

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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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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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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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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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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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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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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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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Natural Medicines (formerly Natural Standard - the Authority of Integrative Medicine)

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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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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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Intrarater reliability of manual muscle testing and hand-held dynametric muscle testing.

By Wadsworth CT, Krishnan R, Sear M, Harrold J, Nielsen DH

"Physical therapists require an accurate, reliable method for measuring muscle strength. They often use manual muscle testing or hand-held dynametric muscle testing (DMT), but few studies document the reliability of MMT or compare the reliability of the two types of testing. We designed this study to determine the intrarater reliability of MMT and DMT. A physical therapist performed manual and dynametric strength tests of the same five muscle groups on 11 patients and then repeated the tests two days later. The correlation coefficients were high and significantly different from zero for four muscle groups tested dynametrically and for two muscle groups tested manually. The test-retest reliability coefficients for two muscle groups tested manually could not be calculated because the values between subjects were identical. We concluded that both MMT and DMT are reliable testing methods, given the conditions described in this study. Both testing methods have specific applications and limitations, which we discuss." - PubMed

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Phys Ther. 1987 Sep;67(9):1342-7.

http://www.ncbi.nlm.nih.gov/pubmed/3628487

Reliability of Manual Muscle Testing with a Computerized Dynamometer

By Hseieh CY, Phillips RB

"The purpose of this study was to investigate the reliability of manual dynamometry. Three testers participated and performed the doctor- and patient-initiated testing methods as described in the applied kinesiology literature. Three muscles from each subject were tested. Fifteen normal volunteer adults had their muscles tested by the doctor-initiated method and another 15 had their muscles tested by the patient-initiated method. Each tester took two observations per muscle. The testing procedures were repeated 7 days later. The results showed that the intratester reliability coefficients were 0.55, 0.75 and 0.76 for testers 1, 2 and 3, respectively, when the doctor-initiated method was used; 0.96, 0.99 and 0.97 when the patient-initiated method was used. The intertester reliability coefficients were 0.77 and 0.59 on day 1 and day 2, respectively, for the doctor-initiated method; 0.95 and 0.96 for the patient-initiated method. It is concluded that manual dynamometry is an acceptable procedure for the patient-initiated method and is not acceptable for the doctor-initiated method." - PubMed

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J Manipulative Physiological Therapeutics 2/13/1990 72-82

http://www.ncbi.nlm.nih.gov/pubmed/2407795

Objective Measurement of Proprioceptive Technique Consequences on Muscular Maximal Voluntary Contraction During Manual Muscle Testing

By Perot C, Meldener R, Goubel F.

"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." - PubMed

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Agressologie 1/1/1991 471-4

http://www.ncbi.nlm.nih.gov/pubmed/1844106

Thoughts About Muscle Testing

By Warren Hammer, MS, DC, DABCO

"Muscle testing can be used for determining the possibility of tendinitis, rupture, fracture, and neurological involvement to name a few. Usually testing a muscle that elicits relatively normal strength and pain might be considered a muscle tendon problem.

A recent article on an EMG study of muscle activity in the normal shoulder has changed some of my thoughts about muscle testing.1 I had always heard that muscles should be tested throughout their range of motion since the pain may only occur at a particular range. For example, a supraspinatus muscle may not be painful when tested at zero degrees coronal abduction and may exhibit pain at 90 degrees abduction. This concept allows the clinician to be more specific especially for an individual who experiences pain only at a specific range of testing. The problem with this theory is that as the range of motion changes, synergistic muscles kick in and may be more active than the muscle tested in its neutral position." - Dynamic Chiropractic

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Dynamic Chiropractic 5/24/1991 Vol. 09, Issue 11

http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=44344

A preliminary inquiry into manual muscle testing response in phobic and control subjects exposed to threatening stimuli.

By Peterson KB

"To determine phobic and nonphobic subject response to a provocative threat stimulus and to determine variables that confound the response."

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J Manipulative Physiological Therapeutics 6/19/1996 310-6

http://www.ncbi.nlm.nih.gov/pubmed/8792320.

Correlation of Applied Kinesiology Muscle Testing Findings with Serum Immunoglobulin Levels for Food Allergies.

By Schmitt WH Jr, Leisman G.

"The pilot study attempted to determine whether subjective muscle testing employed by Applied Kinesiology practitioners, prospectively determine those individuals with specific hyperallergenic responses. Seventeen subjects were found positive on Applied Kinesiology (A.K.) muscle testing screening procedures indicating food hypersensitivity (allergy) reactions. Each subject showed muscle weakening (inhibition) reactions to oral provocative testing of one or two foods for a total of 21 positive food reactions. Tests for a hypersensitivity reaction of the serum were performed using both a radio-allergosorbent test (RAST) and immune complex test for IgE and IgG against all 21 of the foods that tested positive with A.K. muscle screening procedures. These serum tests confirmed 19 of the 21 food allergies (90.5%) suspected based on the applied kinesiology screening procedures. This pilot study offers a basis to examine further a means by which to predict the clinical utility of a given substance for a given patient, based on the patterns of neuromuscular response elicited from the patient, representing a conceptual expansion of the standard neurological examination process." - PubMed

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Int J Neurosci 12/1/1998 237-44

http://www.ncbi.nlm.nih.gov/pubmed/10069623.

Muscle Test Comparisons of Congruent and Incongruent Self-Referential Statements

By Monti DA1, Sinnott J, Marchese M, Kunkel EJ, Greeson JM

"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." - PubMed.gov

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Percept Mot Skills 6/1/1999 1019-28

http://www.ncbi.nlm.nih.gov/pubmed/10407911.

A Force/Displacement Analysis of Muscle Testing

By Caruso W, Leisman G.

"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." - PubMed

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Percept Mot Skills 10/1/2000 683-92

http://www.ncbi.nlm.nih.gov/pubmed/11065332.

Manual Muscle Testing and Postural Imbalance

By Kim Christensen, DC, DACRB, CCSP, CSCS

"The best posture is one in which the body segments are balanced in the position of optimal alignment and maximum support, with full mobility available. Optimal posture allows for pain-free movement with a minimum of energy expenditure, and is a sign of vigor and harmonious control of the body.1 One of the most useful diagnostic procedures in chiropractic practice is the manual testing of the muscles responsible for maintaining postural alignment.
This part of an examination provides valuable clinical information, which can be correlated with a patient's history and reported symptoms.

Postural patterns are maintained by a complex arrangement of proprioceptive input, modified by habits, somatotype, and even psychogenic factors, such as self-esteem. Deviations from the ideal, efficient alignment eventually result in the production of chronic pain symptoms, which have been shown to be predictable.2 chiropractic adjustments can improve the segmental misalignments, but comprehensive and effective treatment requires that the muscle imbalances be addressed." - Dynamic Chiropractic

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Dynamic Chiropractic 11/15/2000 Vol. 18, Issue 24

http://www.chiroweb.com/mpacms/dc/article.php?id=31991

The Genito-Urinary System and the Piriformis Muscle: The Anatomy of the Muscle-Organ-Gland Correlation

By Scott Cuthbert, BA, DC

The piriformis muscle and the genitor-urinary system: The anatomy of the muscle-organ-gland correlation.

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The International Journal of Kinesiologic Medicine 12/1/2002

AK Manual Muscle Testing: As Reliable As The Deep Tendon Reflex?

By Marcello Caso, DC, DIBAK

"Manual muscle testing (MMT) was born in the 1950s with the work of two physical therapists (Kendall and Kendall) and their historic text, Muscles: Testing and Function. Since that time, this body of knowledge has been integrated into the standard procedures of orthopedists, neurologists and practitioners of physical medicine worldwide.

In 1964, Goodheart began utilizing the methods of Kendall and Kendall in clinical practice to assess patterns of functional muscular inhibition ("weakness") and determine which treatment options, based on known neurophysiologic parameters, might be viable to restore proper muscular facilitation ('strength'). His clinical research marked the beginning of applied kinesiology (AK). " - Dynamic Chirporactic

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Dynamic Chiropractic 6/16/2003 Vol. 21, Issue 13

http://www.chiroweb.com/mpacms/dc/article.php?id=9243

The Ileocecal Valve Point and Muscle Testing: A Possible Mechanism of Action

By Pollard, Henry P; Bablis, Peter; Bonello, Peter

"The muscle test procedure is a common test used by manual therapists. Fundamental to the vitalistic diagnostic protocols is the application of the muscle test before and after stimulation of points on the body said to represent various anatomical sites and functions. One such point is the ileocecal valve point. This point is said to represent the function of the ileocecal valve and is associated with various syndromes, including low back pain. The authors synthesise new research that provides evidence for the existence of a mechanism to explain this process. Discussion of this literature is important in light of an explanation of a mechanism that has hitherto not been explained adequately in terms of published peer reviewed literature.
Description" - MACQUARIE University, Sydney, Australia

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Chiropractic Journal of Australia 1/1/2006 Vol. 36, Issue 4, p.122-126

http://hdl.handle.net/1959.14/14271

Can the Ileocecal Valve Point Predict Low Back Pain Using Manual Muscle Testing?

By Pollard, Henry P; Bablis, Peter; Bonello, Peter

"According to some technique groups in chiropractic the ileocecal valve may malfunction and be associated with a large array of health problems that can lead to common chronic health issues prevalent in our society. Many tests commonly used in chiropractic are presumed to identify painful and/or dysfunctional anatomical structures, yet many have undemonstrated reliability. Despite this lack of evidence, they form the basis of many clinical decisions. One cornerstone procedure that is frequently used by chiropractors involves the use of manual muscle testing for diagnostic purposes not considered orthopaedic in nature. A point of the body referred to as the ileocecal valve point is said to indicate the presence of low back pain. This procedure is widely used in applied kinesiology (AK) and neuro- emotional technique (NET) chiropractic practice. Objective: To determine if correlation of tenderness of the 'ileocecal valve point' can predict low back pain in sufferers with and without low back pain. It was the further aim to determine the sensitivity and specificity of the procedure. " - MACQUARIE University, Sydney, Australia

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Chiropractic Journal of Australia 1/1/2006 Vol. 36, Issue 2, p.58-62

http://hdl.handle.net/1959.14/12800

Common Errors and Clinical Guidelines for Manual Muscle Testing: “The Arm Test” and Other Inaccurate Procedures

By Walter H Schmitt, Jr, Scott C Cuthbert

The manual muscle test (MMT) has been offered as a chiropractic assessment tool that may help diagnose neuromusculoskeletal dysfunction. We contend that due to the number of manipulative practitioners using this test as part of the assessment of patients, clinical guidelines for the MMT are required to heighten the accuracy in the use of this tool. Practitioners who employ the MMT should use these clinical guidelines for improving their use of the MMT in their assessments of muscle dysfunction in patients with musculoskeletal pain.

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BioMed Central 6/2/2008

http://chiromt.com/content/16/1/16.

What are you Doing about Muscle Weakness?

By Scott Cuthbert, BA, DC

Terms such as muscle tension headache reflect the traditional view that tonically elevated activity of the muscles of the head and neck are responsible for headache pain. Muscle tension itself has been considered synonymous with various forms of back pain. However, evidence suggests this concept will neither lead to an understanding of the actual etiology of these conditions, nor even to descriptions of the functional pathology that causes the pain.

For at least 50 years, it has been declared that most forms of chronic musculoskeletal pain were due to abnormal patterns of muscular activity, but the research has usually been limited to attempts to confirm various versions of the hyperactivity-causality model. The research evidence is now suggesting the demise of the hyperactivity-causality model for musculoskeletal pain.

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Dynamic Chiropractic 5/6/2009 Vol. 27, Issue 10

http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=53765

Evaluation of Applied Kinesiology meridian techniques by means of surface electromyography (sEMG)

By Moncayo R, Moncayo H

The use of Applied Kinesiology techniques based on manual muscle tests relies on the relationship between muscles and acupuncture meridians. Applied Kinesiology detects body dysfunctions based on changes in muscle tone. Muscle tonification or inhibition within the test setting can be achieved with selected acupoints. These acupoints belong to either the same meridian or related meridians. The aim of this study is to analyze muscle sedation and tonification by means of surface electromyography.

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Chin Med 5/29/2009

http://www.ncbi.nlm.nih.gov/pubmed/19480696.

Can ankle imbalance be a risk factor for tensor fascia lata muscle weakness?

By Zampagni ML1, Corazza I, Molgora AP, Marcacci M.

Risk factors that can determine knee and ankle injuries have been investigated and causes are probably multifactorial. A possible explanation could be related by the temporary inhibition of muscular control following an alteration of proprioceptive regulation due to the ankle imbalance pathology. The purpose of our study was to validate a new experimental set up to quantify two kinesiologic procedures (Shock Absorber Test (SAT) and Kendall and Kendall's Procedure (KKP)) to verify if a subtalus stimulus in an ankle with imbalance can induce a non-appropriate response of contralateral tensor fascia lata muscle (TFL).

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J Electromyogr Kinesiol 8/19/2009 651-9

http://www.ncbi.nlm.nih.gov/pubmed/18455436.

What Are You Doing About Muscle Weakness? Pt. 2: Cervical Spine

By Scott Cuthbert, BA, DC

The importance of muscle dysfunction in various pain conditions is increasingly appreciated and the number of papers specifically showing muscle weakness as an element of pain syndromes is rapidly increasing.

Patients with low back pain (LBP) have lower mean trunk strength than asymptomatic subjects.1-10 Lifting strength is also decreased in people with chronic LBP.11-13 Pain itself is possibly a strength-reducing factor, as is the duration of back pain.14 The muscle weakness etiology for low back pain is in line with the common impression that pain makes muscles difficult to use and less powerful.15

Because of this growing body of evidence, the lack of muscle strength has frequently been cited as the suspected etiology of LBP. These studies are one of the reasons Lamb and others argue that manual muscle testing (MMT) has content validity for the evaluation of LBP. Lamb states that MMT has content validity because the test construction is based on known physiologic, anatomic and kinesiologic principles.16 A growing number of papers have specifically described the validity of MMT in relationship to patients with LBP.17 Let's review what the research suggests regarding the potential correlation between "inhibited" or "weak" MMT findings and LBP.

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Dynamic Chiropractic 8/26/2009 Vol. 27, Issue 18

http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=54009

What Are You Doing About Muscle Weakness? Pt. 3: Lumbar Spine

By Scott Cuthbert, BA, DC

The importance of muscle dysfunction in various pain conditions is increasingly appreciated and the number of papers specifically showing muscle weakness as an element of pain syndromes is rapidly increasing.

Patients with low back pain (LBP) have lower mean trunk strength than asymptomatic subjects.1-10 Lifting strength is also decreased in people with chronic LBP.11-13 Pain itself is possibly a strength-reducing factor, as is the duration of back pain.14 The muscle weakness etiology for low back pain is in line with the common impression that pain makes muscles difficult to use and less powerful.15Is there a measurable reason why an athlete will sprain an ankle with a turning activity that has been done thousands of times before with no trauma? Orthopedist Jose Palomar Lever, MD,1 recently evaluated 200 asymptomatic patients for the involvement of ligaments in many of the different joints of the foot.

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Dynamic Chiropractic 11/4/2009 Vol. 27, Issue 23

http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=54009

What Are You Doing About Muscle Weakness? Pt. 4: The Extremities

By Scott Cuthbert, BA, DC

In chiropractic, Goodheart first introduced methods for detecting extremity dysfunctions with the manual muscle test (MMT) for the shoulder in 1964, the foot in 1973, the wrist in 1974, the elbow in 1976 and the ankle in 1977.19 Today, the chiropractic approach to extremity conditions (encouraged by the AK demonstration of the complex interactions in this system) is multi-modal; it considers the body from the feet to the cranium. Many think of the sacrum as the foundation of the spine, but as Gillet and Liekens point out, the ischia are its base when sitting and the feet when standing.20 The importance of the intrinsic and extrinsic muscles of the feet, and their primary role in foot dysfunctions, has been described by many authors.

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Dynamic Chiropractic 11/4/2009

http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=54288.

Muscle Imbalance: The Goodheart and Janda Models.

By Scott Cuthbert, BA, DC

The focus of treatment for muscular imbalance is where the Goodheart and Janda models divide. Goodheart and Janda agreed that the muscles are in fact "the most exposed part of the nervous system." Muscle imbalance therefore brings us back to the nervous system, which is at the core of all human activity - this is where D.D. Palmer started from in the first place.

George J. Goodheart Jr., DC (1918-2008) and Vladimir Janda, MD (1923-2002) influenced generations of practitioners spanning many disciplines. One difference between Goodheart's approach (a chiropractor) and Janda's (a physical therapist) is that muscle inhibitions are identified and treated first with chiropractic manipulative therapy (CMT). In agreement with the literature cited in previous articles, muscle inhibition is seen as an etiological factor and/or common co-factor in neck, low back, and extremity pain and dysfunction.1-4, 5

Goodheart and Janda agreed that "muscles are in fact the most exposed part of the nervous system."

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Dynamic Chiropractic 3/26/2010

http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=54578.

Technique Summary: Applied Kinesiology

By Cuthbert S, Rosner A

Applied Kinesiology (AK) provides an integrated, interdisciplinary approach to health care. George J. Goodheart, D.C., originated AK in 1964. Dr. Goodheart found a technique that could immediately make a muscle that tested weak strong. The technique did not correct all muscles that tested weak but from this initial experience, testing muscles in a precise manner became routine in his examination protocol. The investigation of other causes of muscle weakness and their correction developed into what is currently the practice of AK.

The actual testing of the muscle had been previously and firmly established by Kendall and Kendall, who held that a muscle from a contracted position against increasing applied pressure could either maintain its position (rated as "facilitated" or "strong") or break away and thus be rated as "inhibited" or "weak". The testing of muscle strength itself had been widely practiced in manual medicine for decades by such authorities as Daniels, Worthingham, and the use of the MMT for functional conditions continues today with the work of Janda, Chaitow, Sahrmann, Bergmann, Lewit, Liebenson, and Hammer.

Each of these researchers uses the MMT to diagnose muscular imbalance. In a sense, the early work of Goodheart and Kendall has influenced generations of practitioners spanning many disciplines and has become consensus methodologies across a broad spectrum of professionals.

Even the American Medical Association has accepted that the standard method of MMT used in AK is a reliable tool and advocates its use for the evaluation of disability impairments.

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Chiro Access 3/29/2010

ChiroAccess

Association of manual muscle tests and mechanical neck pain: Results from a prospective pilot study

By Cuthbert SC, Rosner AL, McDowall D.

To determine whether there was a statistical difference for manual muscle test (MMT) findings for cervical muscles in subjects with and without mechanical neck pain (MNP), and to use confidence intervals to evaluate the sensitivity and specificity of the MMT in this group of subjects. A symptomatic group of patients with MNP demonstrated significantly increased MMT findings in the form of reduced strength levels compared to a control group. This evidence suggests that the MMT is potentially a sensitive and specific test for evaluating cervical spine muscular impairments in patients with MNP.

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J Bodyw Mov Ther 4/15/2011 192-200

http://www.ncbi.nlm.nih.gov/pubmed/21419360

The accuracy of kinesiology-style manual muscle testing to distinguish congruent from incongruent statements under varying levels of blinding: Results from a study of diagnostic test accuracy

By Anne Jensen, Richard Stevens, Timothy Kenealy, Joanna Stewart, Amanda Burls

"Healthcare practitioners have been using muscular strength testing to assess neuromusculoskeletal system integrity since early last century. In the 1970s, another application of manual muscle testing (MMT), called Applied Kinesiology (AK), was developed by Dr. George Goodheart. Its premise is that a muscle will be less able to resist a force when there is aberrant nervous input, and muscles are labeled as either strong or weak accordingly. Since then, other MMT techniques have been developed that assess a patient’s response to semantic stimuli. Monti et al. found that, following the speaking of congruent statements, a muscle was able to resist significantly more force compared to after speaking incongruent statements. A congruent statement is defined as one which the speaker believes to be true, whether or not their belief reflects actual reality. It was found that congruent statements usually result in a strong MMTs, while incongruent statements usually result in weak MMTs. While the reproducibility of this assessment tool has been investigated, its accuracy has not yet been firmly established. The aim of this study was to estimate the accuracy of MMT to distinguish congruent from incongruent spoken statements." - Anne Jensen

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University of Oxford 9/19/2011

Dr. Anne Jensen

Bridges between whole-body dysfunctions and the feet: The close examination with Applied Kinesiology.

By Scott Cuthbert, DC

Bridges between whole-body dysfunctions and the feet: The close examination with Applied Kinesiology.

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Dynamic Chiropractic 9/1/2013

http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=56648

Menopause, chiropractic examination and treatment, and salivary hormone levels: correlations and outcomes

By Scott Cuthbert, BA, DC and Anthony Rosner

Fluctuating hormone levels in women at the time of menopause is a common and difficult problem. AK MMT findings were found to closely correlate with salivary hormone levels in 10 women who were successfully treated for menopause-related symptoms using AK methods.

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Chiropractic Journal of Australia 9/1/2013

The accuracy and precision of kinesiology-style manual muscle testing: designing and implementing a series of diagnostic test accuracy studies.

By Dr. Anne Jensen

"Kinesiology-style manual muscle testing (kMMT) is a non-invasive assessment method used by various types of practitioners to detect a wide range of target conditions. It is distinctly different from the muscle testing performed in orthopaedic/neurological settings and from Applied kinesiology. Despite being estimated to be used by over 1 million people worldwide, the usefulness of kMMT has not yet been established. The aim of this thesis was to assess the validity of kMMT by examining its accuracy and precision." - Univ. of Oxford

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University of Oxford 6/19/2014

http://ora.ox.ac.uk/objects/uuid:4fd95394-e812-402e-9195-6c82643eaa15

Correlation of manual muscle tests and salivary hormone tests in adrenal stress disorder: A retrospective case series report

By Scott Cuthbert, DC; Anthony Rosner, PhD, LLD[Hon], LLC; Trevor Chetcuti, DC, DIBAK; and Steve Gangemi, DC, DIBAK

Introduction: The correlations between salivary hormone testing and the manual muscle test have not to our knowledge been reported before. Methods: Correlations between manual muscle tests and salivary hormone tests for 110 participants (83 female, 17 male) experiencing adrenal stress disorder (ASD) are described. Saliva samples were collected and screened for cortisol and dehydroepiandrosterone (DHEA). Results: We observed that patients with signs and symptoms of ASD and abnormal hormone levels on salivary hormone testing demonstrate distinct neuromuscular impairments that could be detected using the MMT. Discussion: Evidence for the linkages between neurohormonal imbalances and muscular imbalances are presented. Conclusion: This physical examination procedure, used within a number of health professions, may warrant further investigation given its utility, noninvasiveness, rapidity, and cost-effectiveness as a day-to-day clinical evaluation and management tool in cases of ASD.

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Townsend Letter 1/1/2015

http://www.townsendletter.com/Jan2015/adrenalstress0115.html

Developing the evidence for kinesiology-style manual muscle testing: A series of diagnostic test accuracy studies

By Anne M. Jensen, Richard Stevens, Amanda Burls

"Kinesiology-style Manual Muscle Testing (kMMT) is estimated to be practiced by over 1 million people worldwide. Despite its prevalence, the clinical validity of kMMT has never been rigorously assessed and its usefulness is frequently questioned.

This paper describes a series of 5 diagnostic test accuracy studies aimed at developing evidence for one application of kMMT: distinguishing false from true statements. The main objectives of Studies 1 and 2 were to estimate the accuracy of this application of kMMT while the objective of Study 3 was to compare these results with grip strength dynamometry. Study 4 assessed the reproducibility of kMMT, and Study 5 varied the emotional valence of stimuli presented." - Anne Jensen

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University of Oxford 1/1/2015

Dr. Anne Jensen

Does chiropractic have an answer for recurrent ankle sprains?

By Scott Cuthbert, BA, DC

Is there a measurable reason why an athlete will sprain an ankle with a turning activity that has been done thousands of times before with no trauma? Orthopedist Jose Palomar Lever, MD, recently evaluated 200 asymptomatic patients for the involvement of ligaments in many of the different joints of the foot.

The research design consisted of spreading apart the ligament and then manual muscle testing 40 different muscles throughout the body to see how this inhibits or facilitates remote muscles.

Twenty-one joints and ligaments were tested in these 200 patients, and the specific correlations between the joints and ligaments and the muscles they affected were listed. Generally, the calcaneal ligaments were found to affect pelvic and lower limb muscles, while the talar ligaments were more involved with neck, upper thoracic and shoulder muscles.

Lever suggests, "Because of the importance of foot proprioception and the foot's relationship to so many body problems from neurological disorganization to gait imbalances, fascial disturbances, and the inhibition of so many muscles when faulted, physical evaluation of patients should include more attention to the feet."

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Dynamic Chiropractic 2/15/2015

http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=56876

Estimating the prevalence of use of kinesiology-style manual muscle testing: A survey of educators

By Anne Marie Jensen

"Manual muscle testing (MMT) is a non-invasive assessment method used by a variety of manual therapists to evaluate neuromusculoskeletal integrity. Goodheart developed a technique, Applied Kinesiology, where muscles are tested, not to evaluate muscular strength, but neural control. Following Goodheart’s work, a third type of MMT emerged, often referred to colloquially as ‘‘muscle testing’’ or ‘‘kinesiology.’’ This type of muscle testing, kinesiology-style MMT (kMMT) typically only uses one muscle, tested repeatedly, to scan for the presence of target conditions, such as stress or food allergies. While AK-MMT has been found to be used by approximately 40% of American chiropractors, little is known about the prevalence of use of kMMT. The aim of this study was to investigate the prevalence of use of kinesiology-style manual muscle testing (kMMT)." - Anne Jensen

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University of Oxford 5/5/2015

Dr. Anne Jensen

The manual muscle test as a clinical prediction rule for headaches and cranial dysfunctions

By Scott Cuthbert, BA, DC

The manual muscle test as a clinical prediction rule for headaches and cranial dysfunctions.

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SOTOUSA Research Conference, 2015 6/1/2015

https://www.youtube.com/watch?v=BLi2Kwyoqw4

Promising Research - the triple entendre (Presentation at 2015 TFHKA Conference)

By Earl Cook with John Thie (posthumously)

Earl Cook is the primary programmer and developer of the eTouch for Health software system. While working closely with Touch for Health (TFH) founder and author, John F. Thie, DC, the importance of research was stressed and became a central theme. Cook then codified the TFH model and then built the software application that tracked clients and individual TFH energy kinesiology balancing sessions. Color-coding of the results of a muscle test (MMT) were introduced as well as a background assignment of 'severity values' based on the degree of unlocking of the muscle test result. Users selected color codes: Green = Locking/Strong/Facilitated; Yellow = Moderately Unlocking/Bouncing/Slightly Weak; Red = Unlocking / Inhibited / Weak; Very Red; Extremely Weak / Unable to test. In the background, the eTouch software uses these color choices to assign and calculate severity codes for each: muscle; acupuncture meridian; Five Element; side of the body; and total score for severity for the person. Cook also introduced the 'Improvement Factor' based upon starting and ending values (Pain/Stress) during balancing sessions and amount of difference between the two values. The eTouch software was used in the last five public presentations by Dr. Thie. The results of these balances were used as a base guideline for comparing 12 years of results from muscle testing. The goal was to see if the Effectiveness of Dr. Thie could be replicated while providing empirical evidence of the efficacy of the Touch for Health modality. Cook also created research tools that are standard in the software so that users of the software around the world can conduct their own research in attempting to replicate the baseline results being presented.

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Laser Solutions, Inc. 6/19/2015

http://www.etouchforhealth.com/research/Earl_Cook_Presentation_061915_Chapel_Hill.pdf

Applied Kinesiology: It's Past, Present, and Future

By Scott Cuthbert, BA, DC

A history of the development of the science and art of Applied Kinesiology, and its influence throughout the world of biomedical therapeutics.

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The American Chiropractor 7/1/2015 28-35

http://drscottschat.blogspot.com/2015/07/applied-kinesiology-its-past-present.html

Applied Kinesiology Essentials

By Scott Cuthbert, BA, DC

Manual muscle testing has inspired and influenced a wide variety of alternative health modalities over the past 50 years, including the now popular Touch for Health and Emotional Freedom technique systems. A basic understanding of the principles and theories of this foundational work can enhance any practitioner's work, and show the underlying coherence of many other seemingly divergent health systems.

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Townsend Letter 1/1/2016 66-70

http://drscottschat.blogspot.com/2016/01/applied-kinesiology-essentials-townsend.html