APPLIED KINESIOLOGY RESEARCH ARTICLES IN PEER REVIEWED JOURNALS AS OF SUMMER 2006 On the reliability and validity of manual muscle testing: a literature review, Cuthbert SC, Goodheart GJ Jr. Chiropr Osteopat. 2007 Mar 6;15(1):4 [Epub ahead of print]   ABSTRACT: A body of basic science and clinical research has been generated on the manual muscle test (MMT) since its first peer-reviewed publication in 1915. The aim of this report is to provide an historical overview, literature review, description, synthesis and critique of the reliability and validity of MMT in the evaluation of the musculoskeletal and nervous systems. METHODS: Online resources were searched including Pubmed and CINAHL (each from inception to June 2006). The search terms manual muscle testing or manual muscle test were used. Relevant peer-reviewed studies, commentaries, and reviews were selected. The two reviewers assessed data quality independently, with selection standards based on predefined methodologic criteria. Studies of MMT were categorized by research content type: inter- and intra-examiner reliability studies, and construct, content, concurrent and predictive validity studies. Each study was reviewed in terms of its quality and contribution to knowledge regarding MMT, and its findings presented. 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. Comment: This is a landmark study presenting the basic science and clinical research evidence for the reliability and validity of the manual muscle test and applied kinesiology chiropractic technique. The literature review presents the results of more than 100 peer-reviewed studies related to the manual muscle test (MMT) and the applied kinesiology chiropractic technique (AK). Muscle testing, which is the backbone of AK, now has support for its use in the field of chiropractic to diagnose and treat neuromusculoskeletal dysfunction. The Effects of Chiropractic Care on Individuals Suffering from Learning Disabilities and Dyslexia: A Review of the Literature, Pauli Y. J Vertebral Subluxation Res 2007, Jan 15:1-12.   Objective: To present current mainstream and alternative theories about learning disabilities, with a special emphasis on dyslexia, as well as to systematically review the chiropractic and related literature about the effects of chiropractic care in people suffering from learning disabilities and dyslexia, and to compare chiropractic causal theories to accepted medical models. Methods: Computerized and hand searching of the various databases Mantis, ICL, CRAC as well as the Proceedings of the International College of Applied Kinesiology were conducted with the following index terms: "dyslexia", "learning", "learning disabilities", "learning disorders", "applied kinesiology", and "neurologic disorganization". The retrieved literature was selected or rejected according to predetermined inclusion and exclusion criteria and was subsequently classified according to level of evidence and critically reviewed on predefined methodologic criteria. We also compared the various causal chiropractic theories to accepted mainstream science causal theories of learning disability and dyslexia. Results: Eight studies met our criteria. Four of them belonged to the lowest class of evidence, for a total of 25 anecdotal reports. The remaining four were before/after studies. None of the studies met all of our predefined methodologic criteria. Points of interests and methodologic weaknesses are discussed. Conclusion: All studies reviewed suggested a positive effect of chiropractic care in individuals suffering from learning disabilities and dyslexia. However, the various methodological weaknesses of those studies preclude any definitive conclusions and all the results are therefore to be considered preliminary. Within those limitations, there seem to exist a potential role for chiropractic care in improving various cognitive modalities known to be essential in learning. The model of vertebral subluxation and its effects on cognitive function may serve as a link between the field of chiropractic care and the neuroscience of those disorders. Comment: This paper offers an excellent review of AK concepts regarding the treatment of children with learning disabilities and dyslexia. This is an extensive review and a description of the evidence-base in the literature regarding outcomes for these children who have been treated with AK. Cranial Therapeutic Care: Is There any Evidence? Blum CL, Cuthbert S. Chiropractic & Osteopathy 2006, 14:10. Background: In the commentary by Hartman, (Cranial osteopathy: its fate seems clear, Chiropractic & Osteopathy 2006, 14:10.) he has attempted to elicit a response by making far overreaching statements, which are ironic since Hartman thinly veils himself in a gossamer cloak of science, research, and evidenced-based healthcare.  Hartman has picked an isolated diagnostic procedure or treatment, cerebrospinal fluid (CSF) pulsation palpation, questioned its reliability and validity, and then used this fractional aspect of a method of care to condemn all of cranial therapy.  What can be said by Hartman and fairly so, is that from his review of selected studies regarding CSF palpation as discussed in cranial therapeutic care, further study to investigate its validity and reliability is warranted and this component of cranial diagnosis should not be used at this time as a sole criteria for cranial diagnosis or treatment. Discussion Much of Hartman's position is refuted by, at the very least, reviewing the difference between the gross mechanical aspects of cranial care, which has documentation, and the subtle mechanical aspects, which remain controversial. A comprehensive evidenced based rationale of cranial therapeutics is presented along with three tables listing pertinent studies relating to cranial bone dynamics and the efficacy of cranial manipulative therapy. Conclusion While the onus to do the research is upon those who are proponents of a method of care, there is also an onus upon those who call for its virtual abolition to be familiar with all the published research on the topic and how evidenced based clinical practice is formulated. Lower limb manual muscle testing in the early stages of Charcot-Marie-Tooth disease type 1A, Vinci P, Serrao M, Pierelli F, Sandrini G, Santilli V. Funct Neurol. 2006 Jul-Sep;21(3):159-63. Abstract: Charcot-Marie-Tooth disease (CMT) is a genetically and clinically heterogeneous disorder that affects approximately one in 2,500 individuals. CMT 1A, which is due to a duplication in the area containing the PMP-22 gene on chromosome 17, is the most frequent CMT subtype. To date, there is no consensus among authors about which muscles are weakened in the early stages of CMT, even though this knowledge would be crucial for deciding the most appropriate interventions to restore balance between muscles and prevent the development of deformities. The aim of this study was to evaluate the strength of several lower limb muscles in the early stages of CMT 1A. In a series of 45 patients (age 10-72 years; 21 males, 24 females) affected by CMT 1A, we evaluated 83 non-operated lower limbs that corresponded to the two milder stages of a five-level functional classification. The strength of two foot muscles, seven leg muscles, two thigh muscles, and three pelvic girdle muscles was graded using the manual muscle testing techniques of Daniels and Worthingham; the power of the triceps surae was graded, in the prone position, using a 4-level scale of ability to raise the heel from the floor. Muscle strength was determined on the basis of interobserver agreement estimated by kappa statistics between two observers. The flexor hallucis brevis and lumbricals were very weak in all the limbs; the leg muscles were strong in more than 90% of limbs, except the peronei (strong in 83.13%); all the triceps surae were strong in the prone test, but 16.87% were weak in the standing test; all the proximal muscles were strong. In the large majority of patients in the early stages of CMT 1A, the intrinsic foot muscles are very weak and the leg and proximal muscles are strong. Proposed mechanisms and treatment strategies for motion sickness disorder: A case series, Cuthbert S. Journal Chiro Med, Spring 2006;5(1):22-31. Objective: To present an overview of symptomatic motion sickness disorder, with allopathic and chiropractic approaches for treatment. A convenience sample of three representative cases is presented involving patients with motion sickness, ranging in age from 9 to 66. All three patients had suffered from this condition throughout their lives. Clinical Features: A discussion of the hypothesis of sensory conflict as a causative factor in cases of motion sickness will be given. Specific diagnostic tests and clinical rationales in relation to the diagnosis and chiropractic treatment of patients with motion sickness will be presented. Intervention and Outcome: Following spinal and cranial manipulative treatment the three patients were able to travel long distances without nausea, sickness, or dizziness. The evaluation of these patients' responses to treatment was determined by the doctor's observation, the patients' subjective description of symptoms while riding in a motor vehicle, the Visual Analog Scale for Neck and Associated Pain, and applied kinesiology chiropractic physical assessment tools. Conclusion: Further studies into chiropractic manipulative treatments for sensory conflict and proprioceptive dysfunctions associated with the problem of motion sickness are indicated. The hypothesis of sensory conflict as the cause of motion sickness should be explored more fully by other chiropractic physicians and researchers. The Ileocecal Valve Point and Muscle Testing: A Possible Mechanism of Action, Pollard HP, Bablis P, Bonello R. Chiropr Aust 2006;36(4):122-126 and 159-160.     Can the Ileocecal Valve Point Predict Low Back Pain Using Manual Muscle Testing? Pollard HP, Bablis P, Bonello R. Chiropr Aust 2006;36:58-62   Background: 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. Methods: One hundred (100) subjects with and without low back pain were recruited. Subjects first completed information about their pain status, then the practitioner performed the muscle testing procedure in a separate room. The practitioner provided either a yes or no response to a research assistant as to whether he had determined if the subject had back pain based on the muscle test procedure. Results: Of 67 subjects who reported low back pain, 58 (86.6%) reported a positive test of both low back pain and ICV point test. Of 33 subjects, 32 (97%) with no back pain positively reported no response to ICV point test. Nine (9) subjects (13.4%) reported false negative ICV tests and low back pain, and 1 subject (3%) reported a false positive response for ICV test and no low back pain. Conclusion: The majority of subjects with low back pain reported positive ileocecal valve testing, and all but one of the subjects without low back pain reported negative ileocecal valve testing. The application of ileocecal valve testing as a diagnostic measure of low back pain was found to have excellent measures of sensitivity, specificity and diagnostic competency. This study confirms that the use of this test within the limitations of this study is reliably associated with the presence of low back pain. Further testing is required to investigate all aspects of the diagnostic milieu commonly used by proponents of this form of diagnostic testing. Comment: In AK, the ileocecal valve dysfunction is not related automatically to low back pain though this is a frequent consequence of the problem. Another interesting research question that might have been posed to the subjects of this study would have been whether they had experiencing any digestive difficulties and its relationship to positive MMT outcomes. The finding of excellent sensitivity and specificity in this research report is noteworthy. Electromyogram and force patterns in variably timed manual muscle testing of the middle deltoid muscle, Conable K, Corneal J, Hambrick T, Marquina N, Zhang J. J Manipulative Physiol Ther. 2006 May;29(4):305-14. OBJECTIVE: The objective of the study was to compare force curves and surface electromyogram from examiners and subjects during manual muscle testing with 3 examiner-identified variants of manual muscle testing (MMT)-examiner-started (ESMMT), patient-started (PSMMT), and undifferentiated/near-simultaneous (NSMMT). METHODS: Forty-two volunteer applied kinesiologist doctors tested 36 volunteer students, doctors, and spouses at a professional conference. Start-time difference between examiner and subject muscle contraction, peak force, time of peak force and duration of force was measured. Force and surface electromyogram from examiner and subject were recorded simultaneously during MMT of the middle deltoid muscle for each style of testing used in practice. RESULTS: The congruence between examiner label and timing was as follows: ESMMT, 39%; PSMMT 61%; and NSMMT 28% within 50 milliseconds of simultaneous. Mean subject/examiner start-time difference differed significantly between PSMMT (-0.116 seconds) and both ESMMT (-0.018 seconds) and NSMMT (-0.0053 seconds). No clear cutoff between styles was evident. Peak force ranged from 0.548 to 23.615 lb (mean, 8.806 lb; SD, 4.543 lb), and all styles were significantly different. Duration of force ranged from 0.325 to 3.490 seconds (mean, 1.338 seconds; SD, 0.576 seconds), with NSMMT significantly shorter than ESMMT or PSMMT. The shape of force curves did not differ between styles of muscle testing, but differed between facilitated vs. inhibited tests. CONCLUSIONS: In this group of doctors, neither start-time difference nor the shape of force curves distinguished styles of MMT. Differences in peak force and test duration may account for differences in outcomes when examiners purposely vary their muscle testing style. Applied Kinesiology in Chiropractic, Zhang J, Hambrick T, Conable K. Journal of Chiropractic Education 20(1):112 Abstract: The purpose of the study is to investigate important factors that affect the practice of applied kinesiology (AK) in chiropractic care. The research questions in this survey included AK practitioners' attitude toward research, how they used the doctor-initiated, patient-initiated and simultaneous muscle testing in patient care, and satisfaction with AK practice. This study was conducted through the use of a questionnaire containing 36 questions ranging from demographic factors to factors affecting the practice of AK in chiropractic in the USA. Six hundred and eighty nine surveys were sent to the membership of the ICAK-USA (593 doctors, 96 chiropractic students). One hundred forty-seven surveys were returned to the ICAK-USA Central office. Frequency analysis, mean values, standard deviation and correlations were used for the statistical analysis.A total of 147 AK doctors (120 male, 26 female, one did not report gender) completed the questionnaire. Their ages ranged from 24 to 78 years with an average of 44.6+-11.6. Years in practicing AK ranged from 1 year to 43 years with an average of 14.3+-10.2 years. Doctors expressed strong satisfaction in practicing AK with an average of 6.67+-0.59 (minimum of 4 and maximum 7). This was the highest rating among all the questions as 90 doctors selected 7 in the question. Using doctor-initiated testing (4.30+-2.33) was rated higher than patient-initiated testing (3.92+-2.08). Using simultaneous AK testing was rated between doctor and patient-initiated testing (3.99+-2.30). More doctors differentiate muscle testing styles (61.9%) than do not (32%). Most AK doctors did not use needle acupuncture in their practice, but many of them use non-invasive acupuncture treatment.It was concluded that most AK practitioners very satisfied with the AK technique in their practice. They realized the importance of research in the AK practice. There were no major differences in responses to the survey categorized by preference for doctor-initiated, patient-initiated and simultaneous muscle testing. Intra-rater and inter-rater reliability of the 10-point Manual Muscle Test (MMT) of strength in children with juvenile idiopathic inflammatory myopathies (JIIM), Jain M, Smith M, Cintas H, Koziol D, Wesley R, Harris-Love M, Lovell D, Rider LG, Hicks J Phys Occup Ther Pediatr. 2006;26(3):5-17.   OBJECTIVE: Children with juvenile idiopathic inflammatory myopathies (JIIM) present with muscle inflammation and decreased strength that may affect their functional abilities. The purpose of this study was to determine the intra-rater and inter-rater reliability of the 0 to 10-point manual muscle testing method for children with JIIM. METHODS: For the intra-rater and inter-rater reliability studies, 10 and 9 children with JIIM participated, respectively. For intra-rater reliability, one pediatric therapist completed two assessments in one day with a one-hour break. For inter-rater reliability, four therapists assessed the same child within a single morning. RESULTS: Spearman correlations for intra-rater reliability ranged from 0.70 to 1.00. Kendall's W coefficient for inter-rater reliability of groups of muscles (total, proximal, distal, and peripheral) ranged from 0.51 to 0.76. CONCLUSIONS: The total, proximal, and peripheral Manual Muscle Test (MMT) score, using the 0-10 point scale, has acceptable reliability in JIIM patients. Symptomatic Arnold-Chiari malformation and cranial nerve dysfunction: a case study of applied kinesiology cranial evaluation and treatment, Cuthbert S, Blum C. J Manipulative Physiol Ther. 2005 May;28(4):e1-6. (www.journals.elsevierhealth.com/periodicals/ymmt) Objective: To present an overview of possible effects of Arnold-Chiari malformation (ACM) and to offer chiropractic approaches and theories for treatment of a patient with severe visual dysfunction complicated by ACM. Clinical Features: A young woman had complex optic nerve neuritis exacerbated by an ACM (Type I) of the brain. Intervention and Outcome: Applied kinesiology chiropractic treatment of the spine and cranium was used for treatment of loss of vision and nystagmus. After treatment, the patient's ability to see, read, and perform smooth eye tracking showed significant and lasting improvement. Conclusion: Further studies into applied kinesiology and cranial treatments for visual dysfunctions associated with ACM may be helpful to evaluate whether this single case study can be representative of a group of patients who might benefit from this care. Interexaminer reliability of the deltoid and psoas muscle test, Pollard H, Lakay B, Tucker F, Watson B, Bablis P.   J Manipulative Physiol Ther, Jan 2005:28(1):52-6   Objective: To determine if 2 practitioners of differing skill levels could reliably agree on the presence of a weak or strong deltoid or psoas muscle. Study Design: Interexaminer reliability study of 2 common muscle tests. Main Outcome Measures: Cohen κ (unweighted) scores, observer agreement, and 95% confidence intervals (CIs). Results:The results showed that an experienced and a novice practitioner have good agreement when using repeated muscle test procedures on the deltoid (κ 0.62) and the psoas (κ 0.67). Conclusions:The manual muscle test procedures using the anterior deltoid or psoas showed good interexaminer reliability when used by an experienced and a novice user. These techniques may be used between practitioners in multidoctor assessment/management programs. Investigation of methods and styles of manual muscle testing by AK practitioners, Conable KM, Corneal J, Hambrick T, Marquina N, Zhang J. J Chiropractic Med, 2005 March;4(1):1-10  Objective: Establishing objective descriptive data regarding manual muscle testing (MMT) as used in Applied Kinesiology, including "patient-started" versus "examiner-started" variations, is necessary before research pertaining to the reliability and clinical significance of this procedure is done. This study measured surface electromyography (sEMG) output from experienced MMT practitioners and their tested subjects during the performance of sequential MMT on the same muscle during 3 styles of MMT: normally-done, examiner-started and patient-started. Methods: 21 examiners experienced in MMT and 24 subjects with varying degrees of exposure to MMT were engaged in the study. sEMG was simultaneously recorded from examiner and subject during testing of the middle deltoid muscle. The examiner first tested the middle deltoid muscle of the subject in his/her normal fashion 3 times and identified the MMT style as "examiner-started" or "patient-started." He/she was then asked to perform the other method of MMT. If the examiner said he/she did not know or did not differentiate which form of testing was initially done, he/she then performed one series each of examiner- and patient-started MMT. Results: Nine (approximately 43%) of testers identified their "normally done" muscle test as examiner-started, 4 (19%) as patient-started, and 8 (38%) as simultaneous or undifferentiated. In 64.5% of the MMT described as examiner started, sEMG showed that the examiner's contraction started before the patient's. In tests identified as patient-started, 54% were indeed patient started. Undifferentiated tests were 45% patient-started, 45% examiner-started, and 10% exactly simultaneous. Near simultaneous contractions were observed in 55% of all tracings evaluated and 70% of undifferentiated tests. Conclusions: While many MMT practitioners consider that they are performing either an examiner- or patient-started muscle test, a significant number do not make this distinction routinely. The majority of testers in this study did near-simultaneous testing regardless of label. Examiner and subject start times alone, as measured by sEMG, did not clearly differentiate between theorized forms of manual muscle testing. Evaluation of Chapman's neurolymphatic reflexes via applied kinesiology: a case report of low back pain and congenital intestinal abnormality, Caso ML. J Manipulative Physiol Ther. 2004 Jan;27(1):66. (www.journals.elsevierhealth.com/periodicals/ymmt)   Objective: To describe the applied kinesiologic evaluation of Chapman's neurolymphatic (NL) reflexes in the management of a person with an unusual congenital bowel abnormality and its role in the manifestation of low back pain. The theoretical foundations of these reflexes will be elaborated on and practical applications discussed. Clinical Features: A 29-year-old man had chronic low back pain. Radiographs of the patient's lumbar spine and pelvis were normal. Magnetic resonance imaging (MRI) demonstrated a mild protrusion of the fifth lumbar disk. Oral anti-inflammatory agents, cortisone injections, and chiropractic manipulative therapy provided little relief. Though generally in robust health, the patient was aware of a congenital intestinal abnormality diagnosed when he was a child; it was thought to be of no consequence with regard to his current back condition. Intervention and outcome: The patient's history, combined with applied kinesiology examination, indicated a need to direct treatment to the large bowel. The essential diagnostic indicators were the analysis of the Chapman's neurolymphatic reflexes themselves, coupled with an evaluation of the traditional acupuncture meridians. The primary prescribed therapy was the stimulation of these reflexes by the patient at home. This intervention resulted in the resolution of the patient's musculoskeletal symptomatology, as well as improved bowel function. Conclusion: The rather remarkable outcome from the application of this relatively simple, yet valuable, diagnostic and therapeutic procedure represents a thought-provoking impetus for future study and clinical application. New diagnostic and therapeutic approach to thyroid-associated orbitopathy based on applied kinesiology and homeopathic therapy, Moncayo, R., Moncayo, H., Ulmer, H., Kainz, H. J Altern Complement Med, 2004 Aug;10(4):643-50.   Objectives: To investigate pathogenetic mechanisms related to the lacrimal and lymphatic glands in patients with thyroid-associated orbitopathy (TAO), and the potential of applied kinesiology diagnosis and homeopathic therapeutic measures. Design: Prospective. Settings/location: Thyroid outpatient unit and a specialized center for complementary medicine (WOMED, Innsbruck; R.M. and H.M.). Subjects: Thirty-two (32) patients with TAO, 23 with a long-standing disease, and 9 showing discrete initial changes. All patients were euthyroid at the time of the investigation. Interventions: Clinical investigation was done, using applied kinesiology methods. Departing from normal reacting muscles, both target organs as well as therapeutic measures were tested. Affected organs will produce a therapy localization (TL) that turns a normal muscle tone weak. Using the same approach, specific counteracting therapies (i.e., tonsillitis nosode and lymph mobilizing agents) were tested. Outcome measures: Change of lid swelling, of ocular movement discomfort, ocular lock, tonsil reactivity and Traditional Chinese Medicine criteria including tenderness of San Yin Jiao (SP6) and tongue diagnosis were recorded in a graded fashion. Results: Positive TL reactions were found in the submandibular tonsillar structures, the tonsilla pharyngea, the San Yin Jiao point, the lacrimal gland, and with the functional ocular lock test. Both Lymphdiaral® (Pascoe, Giessen, Germany) and the homeopathic preparation chronic tonsillitis nosode at a C3 potency (Spagyra,® Grödig, Austria) counteracted these changes. Both agents were used therapeutically over 3–6 months, after which all relevant parameters showed improvement. Conclusions: Our study demonstrates the involvement of lymphatic structures and flow in the pathogenesis of TAO. The tenderness of the San Yin Jiao point correlates to the abovementioned changes and should be included in the clinical evaluation of these patients. Manual strength testing in 14 upper limb muscles: a study of inter-rater reliability, Jepsen, J., Laursen, L., Larsen, A., Hagert, CG. Department of Occupational Medicine, Central Hospital, DK-6700 Esbjerg, Denmark. jrj@ribeamt.dk Acta Orthop Scand. 2004 Aug;75(4):442-8.    BACKGROUND: Manual muscle testing has been termed a "lost art" and is often considered to be of minor value. The aim of this investigation was to study the inter-rater reliability of manual examination of the maximal voluntary strength in a sample of upper limb muscles. PATIENTS AND METHODS: The material consisted of a series of 41 consecutive patients (82 limbs) who had been referred to a clinic of occupational medicine for various reasons. Two examiners who were blinded as to patient-related information classified 14 muscles in terms of normal or reduced strength. In order to optimize the evaluation, the individual strength was assessed simultaneously on the right and left sides with the limbs in standardized positions that were specific for each muscle. Information on upper limb complaints (pain, weakness and/or numbness/tingling) collected by two other examiners resulted in 38 limbs being classified as symptomatic and 44 as asymptomatic. For each muscle the inter-rater reliability of the assessment of strength into normal or reduced was estimated by kappa-statistics. In addition, the odds ratio for the relation to symptoms of the definition in agreement of strength was calculated. RESULTS: The median kappa-value for strength in the muscles examined was 0.54 (0.25-0.72). With a median odds ratio of 4.0 (2.5-7.7), reduced strength was significantly associated with the presence of symptoms. INTERPRETATION: This study suggests that manual muscle testing in upper limb disorders has diagnostic potential. Patients with neck pain demonstrate reduced electromyographic activity of the deep cervical flexor muscles during performance of the craniocervical flexion test, Falla DL, Jull GA, Hodges PW Spine. 2004 Oct 1;29(19):2108-14. STUDY DESIGN: Cross-sectional study. OBJECTIVE: The present study compared activity of deep and superficial cervical flexor muscles and craniocervical flexion range of motion during a test of craniocervical flexion between 10 patients with chronic neck pain and 10 controls. SUMMARY OF BACKGROUND DATA: Individuals with chronic neck pain exhibit reduced performance on a test of craniocervical flexion, and training of this maneuver is effective in management of neck complaints. Although this test is hypothesized to reflect dysfunction of the deep cervical flexor muscles, this has not been tested. METHODS: Deep cervical flexor electromyographic activity was recorded with custom electrodes inserted via the nose and fixed by suction to the posterior mucosa of the oropharynx. Surface electrodes were placed over the superficial neck muscles (sternocleidomastoid and anterior scalene). Root mean square electromyographic amplitude and craniocervical flexion range of motion was measured during five incremental levels of craniocervical flexion in supine. RESULTS: There was a strong linear relation between the electromyographic amplitude of the deep cervical flexor muscles and the incremental stages of the craniocervical flexion test for control and individuals with neck pain (P = 0.002). However, the amplitude of deep cervical flexor electromyographic activity was less for the group with neck pain than controls, and this difference was significant for the higher increments of the task (P < 0.05). Although not significant, there was a strong trend for greater sternocleidomastoid and anterior scalene electromyographic activity for the group with neck pain. CONCLUSIONS: These data confirm that reduced performance of the craniocervical flexion test is associated with dysfunction of the deep cervical flexor muscles and support the validity of this test for patients with neck pain. Comment: This paper demonstrates electromyographically what AK physicians find consistently: impairment of neck flexor muscle strength in patients with neck and head pain, or with a history of neck or head injury. The supine hip extensor manual muscle test: a reliability and validity study, Perry J, Weiss WB, Burnfield JM, Gronley JK. -- Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center, Downey, CA 90242, USA. pklab@larei.org Arch Phys Med Rehabil. 2004 Aug;85(8):1345-50.    OBJECTIVES: To define the relative hip extensor muscle strengths values identified by the 4 grades obtained with a supine manual muscle test (MMT) and to compare these values with those indicated by the traditional prone test. DESIGN: Comparison of 4 manual supine strength grades with isometric hip extension joint torque; kappa statistic-determined interrater reliability, and analyses of variance identified between grade differences in torque. SETTING: Pathokinesiology laboratory. PARTICIPANTS: Adult volunteers recruited from local community and outpatient clinics. Reliability testing: 16 adults with postpolio (31 limbs). Validity testing (2 groups): 18 subjects without pathology (18 limbs), and 26 people with clinical signs of hip extensor weakness (51 limbs). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Supine hip extensor manual muscle grade and isometric hip extension torque. RESULTS: Reliability testing showed excellent agreement (82%). Subjects with pathology had significant differences in mean torque (P<.01) for the assigned grade 5 (176 Nm), grade 4 (103 Nm), grade 3 (67 Nm), and grade 2 (19 Nm). Healthy adults showed significant differences between grade 5 (212 Nm) and grade 4 (120 Nm) in mean torque (P<.05). CONCLUSIONS: The supine MMT is a reliable and valid method with which to assess hip extension strength. Lovett Brothers: The Relationship Between The Cervical And Lumbar Vertebra,  Blum CL. The Journal of Vertebral Subluxation Research, Apr 2004; 6(1): 1-3.   Introduction: For years, chiropractors have used the term "Lovett Brothers" to describe the relationship between specific vertebra in the lumbar and cervical spine. Purpose: This paper seeks to investigate the rational behind this "Lovett Brother" relationship and present possible theories for its existence. These theories vary from fascial and myological interrelationships, referred pain patterns, and facilitating tonic neck reflexes involving intersegmental spinal pathways. Discussion: While there have been no definitive studies evaluating the use of "Lovett Brothers" as a diagnostic and treatment modality there have been some reported case studies which support its use. Conclusion: Future research is necessary to further understand this phenomenon that is already readily accepted in the chiropractic profession. Fix foot problems without orthotics, McDowall D.     Int J AK and Kinesio Med, 2004;18.   Abstract: A new approach to supporting the functional movement of the foot without the use of orthotics is discussed. A short review of myo-tendinous attachments of the foot is presented with associated treatments. Epidemiologic studies provide strong support for the clinical advantages of orthoses, yet explanations of foot orthotic mechanisms remain elusive. Researchers await a more complete theoretical understanding of the mechanisms of foot orthotics. Some studies are considering the 3-dimensional effects of subtalar joint motion on the entire kinetic chain. Chiropractors and other manipulators have developed techniques to treat a variety of foot conditions. Some even propose using this area of skill as a bridge to working with physical therapists. Probably the most frequently a chiropractor looks at the feet is indirectly when checking for a leg length discrepancy. At this time the most common observation is usually of foot rotation. Walther describes a variety of approaches to resolving foot problems (5). I will not discuss existing techniques in this paper. The graphics of Netter illustrate the attachments of the lower leg muscles at both their origin on the femur, tibia, and fibula and their insertion on the foot. My observations are an application of Goodheart's work regarding origin-insertion technique recorded in his 1964 manual. I have applied these observations in regard to micro avulsion of the periosteal attachments of the tendons being the initial injury of most foot problems. These foot problems are easily fixed leaving the use of orthotics to chronic pathologies of the foot. Chiropractic Techniques - American Chiropractic Association Christensen MG. American Chiropractic Association (home page on the Internet). Available from: http://www.amerchiro.org/techniques. According to the American Chiropractic Association, Applied Kinesiology is one of the 15 most frequently used chiropractic techniques in the United States, with 43.2% of chiropractors employing this method. "This is an approach to chiropractic treatment in which several specific procedures may be combined. Diversified/manipulative adjusting techniques may be used with nutritional interventions, together with light massage of various points referred to as neurolymphatic and neurovascular points. Clinical decision-making is often based on testing and evaluation muscle strength." Migraines - the Applied Kinesiology and Chiropractic perspective, Hambrick TM. Journal of Bodywork and Movement Therapies, 2003;7(1):37-41   Abstract: A case presentation involving migraine headache is presented. The case is notable in that it contains most of the classical multifactorial elements typically found in instances of migraine headaches. Purely from a structurally based chiropractic perspective, correction of the cervical and thoracic subluxations resulting from the postural distortion is imperative. Further, a comprehensive evaluation of the patient with the standard techniques of Applied Kinesiology is presented which provides additional data that informs the clinical decision-making process and directs therapy. A food allergy was found using AK MMT methods, and this factor was part of the etiology of this patient's migraines. Insult, Interference and Infertility: An Overview of Chiropractic Research, Behrendt, M. Journal of Vertebral Subluxation Research, May 2003:1   www.jvsr.com   Objective: Infertility is distinct from sterility, implying potential, and therefore raises questions as to what insult or interference influences this sluggish outcome. Interference in physiological function, as viewed by the application of chiropractic principles, suggests a neurological etiology and is approached through the mechanism of detection of vertebral subluxation and subsequent appropriate and specific adjustments to promote potential and function. Parental health and wellness prior to conception influences reproductive success and sustainability, begging efficient, effective consideration and interpretation of overall state and any distortion. A discussion of diverse articles is presented, describing the response to chiropractic care among subluxated infertile women. Clinical Features:      Fourteen retrospective articles are referenced, their diversity includes: all 15 subjects are female, ages 22-65; prior pregnancy history revealed 11 none, 2 successful unassisted, 1 assisted, 1 history of miscarriage. 9 had previous treatment for infertility, 4 were undergoing infertility treatment when starting chiropractic care. Presenting concerns included: severe low back pain, neck pain, colitis, diabetes, and female dysfunction such as absent or irregular menstrual cycle, blocked fallopian tubes, endometriosis, infertility, perimenopause and the fertility window within a religious based lifestyle, and a poor responder undergoing multiple cycles of IVF. Chiropractic Care and Outcome:      Outcomes of chiropractic care include but are not limited to benefits regarding neuromuscular concerns, as both historical and modern research describe associations with possible increased physiological functions, in this instance reproductive function. Chiropractic care and outcome are discussed, based on protocols of a variety of arts, including Applied Kinesiology (A.K.), Diversified, Directional Non-Force Technique (D.N.F.T.), Gonstead, Network Spinal Analysis (N.S.A.), Torque Release Technique (T.R.T.), Sacro Occipital Technique (S.O.T.) and Stucky-Thompson Terminal Point Technique. Care is described over a time frame of 1 to 20 months. Conclusion: The application of chiropractic care and subsequent successful outcomes on reproductive integrity, regardless of factors including age, history and medical intervention, are described through a diversity of chiropractic arts. Future studies that may evaluate more formally and on a larger scale, the effectiveness, safety and cost benefits of chiropractic care on both well-being and physiological function are suggested, as well as pursuit of appropriate funding.  Comparison of four tests of quadriceps strength in L3 or L4 radiculopathies, Rainville J, Jouve C, Finno M, Limke J. -- The Spine Center, New England Baptist Hospital, Boston, MA 02120, USA. jrainvil@caregroup.harvard.edu Spine. 2003 Nov 1;28(21):2466-71.   STUDY DESIGN: This prospective cohort study evaluated four office tests of quadriceps strength in symptomatic adults with radiographic evidence of L3 or L4 nerve root compression. OBJECTIVE: The study observed the performance of each test for its ability to detect quadriceps weakness when compared to the asymptomatic side. To determine the potential influence of radicular pain on the performance of the four tests, a control group of patients over the age of 40 with clinical and radiographic L5 or S1 radiculopathies underwent identical testing of quadriceps strength. SUMMARY OF BACKGROUND DATA: The L3 and L4 nerve roots innervate the quadriceps; therefore, quadriceps weakness may be a consequence of L3 or L4 radiculopathies. There are no standardized or validated methods to evaluate quadriceps strength in the clinical office setting. This may lead to inconsistent detection by clinicians of quadriceps weakness in cases of L3 or L4 radiculopathy. METHODS: Thirty-three consecutive patients with L3 or L4 radiculopathies and 19 with L5 or S1 radiculopathies were studied. The four tests of quadriceps strength included: 1) single leg sit-to-stand test; 2) step-up test; 3) knee-flexed manual muscle testing; and 4) knee-extended manual muscle testing. Results from a second examiner repeating the four tests were used to calculate interrater reliability. RESULTS: In L3 and L4 radiculopathies, unilateral quadriceps weakness was detected by the single leg sit-to-stand test in 61%, by knee-flexed manual muscle testing in 42%, by step-up test in 27% and by knee-extended manual muscle testing in 9% of patients. The sit-to-stand test detected weakness in all but one case when weakness was detected by another test. All patients with L5 or S1 radiculopathies could perform the sit-to-stand test. Kappa coefficient was high for sit-to-stand test (0.85), step-up (0.83), and knee-flexed manual muscle testing (0.66), and low for knee-extended manual muscle testing (0.08). CONCLUSION: In L3 and L4 radiculopathies, unilateral quadriceps weakness was best detected by a single leg sit-to-stand test. Patients of similar age with radicular pain caused by L5 or S1 radiculopathies could perform this test. As the interrater reliability of the single leg sit-to-stand test is high, clinicians should consider utilizing this test for assessing quadriceps strength in cases of L3 and L4 radiculopathies. Evidence of Altered Lumbopelvic Muscle Recruitment in the Presence of Sacroiliac Joint Pain, Hungerford B, Gilleard W, Hodges P. Spine 2003; 28(14):1593-1600.   Study Design. Cross-sectional study of electromyographic onsets of trunk and hip muscles in subjects with a clinical diagnosis of sacroiliac joint pain and matched control subjects. Objectives. To determine whether muscle activation of the supporting leg was different between control subjects and subjects with sacroiliac joint pain during hip flexion in standing. Background. Activation of the trunk and gluteal muscles stabilize the pelvis for load transference; however, the temporal pattern of muscle activation and the effect of pelvic pain on temporal parameters has not been investigated. Methods. Fourteen men with a clinical diagnosis of sacroiliac joint pain and healthy age-matched control subjects were studied. Surface electromyographic activity was recorded from seven trunk and hip muscles of the supporting leg during hip flexion in standing. Onset of muscle activity relative to initiation of the task was compared between groups and between limbs. Results. The onset of obliquus internus abdominis (OI) and multifidus occurred before initiation of weight transfer in the control subjects. The onset of obliquus internus abdominis, multifidus, and gluteus maximus was delayed on the symptomatic side in subjects with sacroiliac joint pain compared with control subjects, and the onset of biceps femoris electromyographic activity was earlier. In addition, electromyographic onsets were different between the symptomatic and asymptomatic sides in subjects with sacroiliac joint pain. Conclusions. The delayed onset of obliquus internus abdominis, multifidus, and gluteus maximus electromyographic activity of the supporting leg during hip flexion, in subjects with sacroiliac joint pain, suggests an alteration in the strategy for lumbopelvic stabilization that may disrupt load transference through the pelvis. AK classic case management: enuresis, Goodheart GJ. Int J AK and Kinesio Med, 2003;16: 22-23.   Many doctors and many parents are deeply concerned with the problems that enuresis produces in the children under their care. Attempts have been made to ascribe this troublesome condition to psychic or emotional causes. Efforts have been made to use conditioned reflexes and elaborate moisture sensing devices to alleviate the problem of bed-wetting. Spontaneous cessation of the symptoms sometimes occurs as the child grows older. Fluid restriction and interruption of the child's sleep by the parent to allow the child to void any accumulation of fluids is good management of the situation. This is a physical, functional, structural problem associated with disturbances of the segments, not at the kidney and bladder areas of the spine, but at C3, which is associated with the innervation of the phrenic and intercostals nerves. The respiratory center is located in the lower brain stem and consists of two division, an inspiratory and an expiratory center. This respiratory center is powerfully affected by changes in the CO2 content of the blood, in that, as the CO2 level rises, the respiratory center is stimulated. It vents off or washes out the accumulating CO2 by increasing the depth or frequency of respiration or both. This increase in the depth or the frequency of the respiration must be accomplished by an increased excursion of the diaphragm, and this action must be accomplished by the phrenic nerve, which is basically derived from the segments at cervicals 3, 4, and 5, principally at cervical 3. The depth of sleep varies with children and adults on two distinct curves. In most adults, sleep deepens rapidly to the end of the first hour, then sharply shallows out, and then gradually shallows its curve until the person awakens. In the child the sleep curve is different. There are two periods of deepest sleep in children. The initial period occurs in the first one or two hours. There is a second deep sleep curve at the eighth and ninth hour, following which the curve sharply shallows, as does the adults' curve, as the child nears awakening. It is these different patterns of sleep that are sometimes responsible for the oft told admonition "not to worry", that the child will outgrow the condition. This is occasionally true but is only sheer chance and unpredictable to say the least. As the child sleeps, either at the first deep period or at the second deep period, and as the sleep deepens, there is an occasional sighing respiration as the CO2 is vented off by action of the respiratory center. If the nerve control to the diaphragm is normal, there is no interruption of sleep nor is there any involuntary voiding or urine. Applied Kinesiology and Down syndrome: a study of 15 cases, Cuthbert S. Int J AK and Kinesio Med, 2003;16:16-21.   This essay describes these children's histories, their clinical findings, and their evaluation and treatment using applied kinesiology methods.Down syndrome is the most common readily identifiable cause of intellectual disability, accounting for almost one-third of all cases. It occurs equally in all races with an overall incidence of approximately one in 800 births.Children with Down syndrome will be developmentally slower than their siblings and peers and have intellectual functioning in the moderately disabled range, but the range is enormous and the distance from their peers is the crucial factor where our chiropractic therapeutics can make a profound difference. The ability we possess to repair the neurological disorganization in these children can be affected rapidly with the proper treatment to the cranial-sacral mechanism. Parents are frequently amazed at the speed with which this happens. Once the cranial mechanism is repaired and it begins to move freely, the child becomes a new creature with his/her potentialities greatly improved for normal function. The cranial mechanism must be included in the practice of chiropractic care for the physically and mentally challenged because it is in fact the headquarters for all the functions that operate within the child. This is the part of the body with the greatest disturbances in these cases and should not be ignored. Pediatric case history: cost effective treatment of block naso-lacrimal canal utilizing applied kinesiology tenets, Maykel W. Int J AK and Kinesio Med, 2003;16:34.   Abstract: To present a case discussing the successful treatment of a blocked tear duct in a 14-month-old boy. Through the use of surrogate testing – a technique unique to applied kinesiology – cranial and spinal lesions were specifically identified for correction. This approach provides a safe, cost effective approach and should therefore be considered as a standard first line of treatment for this condition. Further studies should be designed to elucidate this. A 39-year-old female cyclist suffering from total exhaustion caused by over-training and false nutrition, Weiss G. Int J AK and Kinesio Med, 2003;15:39.   Abstract: To present a case involving a 39-year-old competitive female cyclist having menstrual troubles. Nutritional counseling (based on traditional Chinese medicine concepts) was offered and followed. Her menstruation improved and her energy level and cycling performance improved. Treatment to the sacrococcygeal area improved her symptom picture. After cranial correction and nutritional support she improved further and she remained stable. Acupuncture in applied kinesiology: a review, Garten H. Int J AK and Kinesio Med, 2002;14.   Abstract: Acupuncture is a healing art, which is embedded in eastern culture and Traditional Chinese Medicine (TCM).Applied kinesiology (AK) as a Western development has an analytical, logical basis, which is backed up by neurological and other models, and apparently supplies a logical "easy" tool for the use of acupuncture. Difficult and "mystic" tasks like pulse diagnosis and the selection of points seem to be facilitated by the "objective" tool of muscle testing. Yet for the purpose of a "constitutional diagnosis" the diagnosis of pulse points, alarm points, and muscle strength as per AK is not equivalent to a traditional Chinese diagnosis. The AK-specific therapy based on AK-specific pulse diagnosis can furnish only part of the possible acupuncture effects. For constitutional acupuncture treatments a TCM diagnosis has to be established and the treatment has to be done accordingly. The selection of points can be improved by therapy localization and challenge as per AK. Therapy of dysfunctional muscles is a major issue in AK. The AK-specific use of acupuncture of tapping points according to the AK-specific acupuncture diagnosis is by no means a sufficient way of imitating the effects of a needle therapy with the correct manipulation of the needle at the site of the disturbed structure of the muscle (trigger points, tendon avulsions, etc). Musculoskeletal therapy is most effective using concepts derived from manual therapy and myofascial therapy. The practitioner must follow anatomical and palpatory information and use the adequate stimulus as defined by the reflexotherapeutic aspects of acupuncture. Somatotopic reflexotherapy can be used (ear, scalp, hand, and others). Muscle function and the selection of points can be monitored by manual muscle testing. Applied kinesiology for treatment of women with mastalgia, Gregory, W.M., Mills, S.P., Hamed, H.H., Fentiman, I.S. Breast, 2001 Feb;10(1):15-9.   (www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db= pubmed&dopt=Abstract&list_uids=14965552&query_hl=1)   To determine whether an applied kinesiology technique was of benefit to women with breast pain, an open pilot study was conducted in which 88 newly presenting women with self-rated moderate or severe mastalgia were treated by applied kinesiology. This involved a hands-on technique consisting of rubbing a series of 'lymphatic reflex points' while touching painful areas of the breasts. The women were predominantly pre-menopausal, and patients with both cyclical and non-cyclical pain were included in the study. Patients' self-rated pain scores, both before and immediately after applied kinesiology were compared, together with a further score 2 months later. Immediately after treatment there was considerable reduction in breast pain in 60% of patients with complete resolution in 18%. At the visit after 2 months, there was a reduction in severity, duration and frequency of pain of 50% or more in about 60% of cases (P<0.0001). This preliminary study suggests that applied kinesiology may be an effective treatment for mastalgia, without side-effects and merits testing against standard drug therapies. Plantar fascitis, Hambrick T. Journal of Bodywork and Movement Therapies, 2001 Jan:49-55   Abstract:A case presentation involving plantar fascitis is presented. The structural causes of plantar fascitis are reviewed. The specific muscular factors found on AK examination that produce the dropped longitudinal arch of the foot, the separation of the distal tibia and fibula, and the posterior calcaneus are presented. The inflammatory component of this problem is reviewed, and treatment for disturbances in fatty acid metabolism and adrenal function suggested. The importance of evaluating patient's with plantar fascitis in the weight bearing position and during gait is stressed, and evaluation of muscular function during gait is offered. In AK, the effect of specific acupuncture point stimulation upon the function of the ambulatory muscles is presented. Treatment of each of these factors in this patient proved successful in resolving her problem with plantar fascitis. Clinical evaluator reliability for quantitative and manual muscle testing measures of strength in children, Escolar DM, Henricson EK, Mayhew J, Florence J, Leshner R, Patel KM, Clemens PR. Muscle Nerve. 2001 Jun;24(6):787-93.   Abstract: Measurements of muscle strength in clinical trials of Duchenne muscular dystrophy have relied heavily on manual muscle testing (MMT). The high level of intra- and interrater variability of MMT compromises clinical study results. We compared the reliability of 12 clinical evaluators in performing MMT and quantitative muscle testing (QMT) on 12 children with muscular dystrophy. QMT was reliable, with an interclass correlation coefficient (ICC) of >0.9 for biceps and grip strength, and >0.8 for quadriceps strength. Training of both subjects and evaluators was easily accomplished. MMT was not as reliable, and required repeated training of evaluators to bring all groups to an ICC >0.75 for shoulder abduction, elbow and hip flexion, knee extension, and ankle dorsiflexion. We conclude that QMT shows greater reliability and is easier to implement than MMT. Consequently, QMT will be a superior measure of strength for use in pediatric, neuromuscular, multicenter clinical trials.Comment: The I.C.A.K. has always insisted that muscle testing is an art form that is easy to learn but difficult to master. It is the key to diagnostic success in AK. The doctor unable to distinguish the change in muscle strength caused by challenge to the patient's body is reduced in proportion to his ability to diagnose a patient's status. Accurate, consistent, and reproducible MMT is the most important physical talent an AK practitioner will ever develop. This study showed that with training, even previously untrained manual muscle testers could be brought up to a statistically reliable interclass coefficient. Diagnosis via manual muscle testing requires in depth training and consistent application to achieve mastery. The Clinical Utility of Force/Displacement Analysis of Muscle Testing in Applied Kinesiology, Caruso, W., Leisman, G. International Journal of Neuroscience. 2001; 106:147-157.   This study provided a physical record of the phenomena in an AK muscle test. The record allowed the observer to distinguish between conditionally inhibited and conditionally facilitated muscles. This study demonstrates that the difference between these states of muscle function is quantifiable. The authors suggest however that unlike the X-ray of the radiologist and the histological specimen of the clinical pathologist, the objective outcome of an AK muscle test will not be the source of the AK practitioner's judgment; that is, he will continue to rely on his trained perception of the event that produces the record. But the record (conditionally inhibited or conditionally facilitated) will stand after the fact as a piece of objective evidence that others may examine in order to confirm the practitioner's judgment. The role of the scalenus anticus muscle in dysinsulinism and chronic non-traumatic neck pain, Rogowskey TA. Int J AK and Kinesio Med, 2001;12.   Abstract: Investigation into why dysinsulinism often relates to symptoms of cervical spine imbalances led to the discovery that the scalenus anticus muscle was conditionally inhibited when tested as part of an applied-kinesiological exam. This conditionally inhibited muscle is implicated in many of the symptoms associated with chronic neck pain, brachial plexus syndromes, and an unstable cervical spine. Treating dysinsulinism facilitates the scalenus anticus muscle and ameliorates the cervical spine related symptoms. Using applied kinesiology, one can tailor a program that is patient-specific for better insulin tolerance. An applied kinesiology evaluation of facial neuralgia: a case history of Bell's Palsy, Cuthbert S. Int J AK and Kinesio Med, 2001;10:42-45.   Abstract: This case deals with the chiropractic evaluation and treatment of a businesswoman who was referred to my care by her husband. As part of a thorough, whole body evaluation and treatment using applied kinesiology's diagnostic methods, an interesting case of Bell's palsy was treated in this patient, with very satisfying results. Numerous causative problems involving the seventh cranial nerve were found in the evaluation of this patient, and when these causative factors were eliminated, the associated symptomatology disappeared. The anatomy and cranial architecture involved in this case are described. The patient has had no major complaints for over 7 months after the correction of her condition. Job analysis of chiropractic: a project report, survey analysis, and summary of the practice of chiropractic within the United States, Christensen, MG, Delle Morgan, DR. National Board of Chiropractic Examiners, Greeley, CO.   In a survey by the National Board of Chiropractic Examiners in 2000, 43.2% of respondents stated that they used applied kinesiology in their practices, up from 37.2% of respondents who reported they used AK in 1991. A Force/Displacement Analysis of Muscle Testing, Caruso, B., Leisman, G. Perceptual and Motor Skills. 2000; 91:683-692.   Using a force transducer developed by Dr. Caruso, this study demonstrated the difference between muscles that the examiners perceived to be "weak" or inhibited, and those perceived to be "strong" or facilitated. This study also demonstrated that the muscle tests of examiners with over five years of clinical experience using AK procedures had reliability and reproducibility when their outcomes were compared. Also, the perception of inhibition or facilitation made by the examiner was corroborated by test pressure analysis using the instrumentation developed. Changes in strength over time among polio survivors, Klein MG, Whyte J, Keenan MA, Esquenazi A, Polansky M. Arch Phys Med Rehabil, 2000 Aug;81(8):1059-64.   Abstract: OBJECTIVE: To study changes in the strength of different muscle groups in polio survivors over a period of approximately 9 months. DESIGN: Longitudinal study. SETTING: Moss Rehabilitation Research Institute. PARTICIPANTS: One hundred twenty subjects (57 men, 63 women) were studied on three occasions, each 3 to 5 months apart. Subjects were recruited through the Einstein-Moss Post-Polio Management Program. newspaper advertisements, and polio support groups. MAIN OUTCOME MEASURES: Isometric strength of 30 muscle groups (16 in upper extremities, 14 in lower extremities) was measured, using a hand-held dynamometer. RESULTS: Data were analyzed in two separate groups: upper-extremity muscles and lower-extremity muscles. Results for the upper-extremity muscles revealed evidence of a significant deterioration in strength. The amount of deterioration differed among muscles and increased with age. There was also evidence of deterioration in strength in the flexor muscles in the ankle, hip, and knee. However, the rate of deterioration in these muscles was not strongly related to age, time since polio, gender, symptom status, or history of residual weakness. CONCLUSIONS: Strength is deteriorating among polio survivors at a rate higher than that associated with normal aging. This deterioration is not occurring in the extensor, or so-called "weight-bearing" muscles, but is occurring in many of the upper-extremity muscle groups and in the flexor muscles in the lower extremities. Comment: This paper demonstrates what has been long hypothesized (and demonstrated clinically) in chiropractic and AK to be the case, i.e. that neurological function deteriorates in disease states, and that the muscular system reflects this change in state, thus serving as a "somatic window" or "representational system" of neurological function. Applied Kinesiology and the Immune System, Astill-Smith CR. Int J AK and Kinesio Med, 2000;8.   Abstract: Applied kinesiology offers a valuable diagnostic tool for assessing the immune system. Through a series of specific challenges, using chemical or homeopathic biological response modifiers (biomarkers), the practitioner can assess for likely causation and most suitable remedial intervention in both acute and chronic inflammatory disorders. Mechanical force spinal manipulation increases trunk muscle strength assessed by electromyography: a comparative clinical trial, Keller TS, Colloca CJ. J Manipulative Physiol Ther. 2000 Nov-Dec;23(9):585-95.   OBJECTIVE: The objective of this study was to determine whether mechanical force, manually-assisted (MFMA) spinal manipulative therapy (SMT) affects paraspinal muscle strength as assessed through use of surface electromyography (sEMG). DESIGN: Prospective clinical trial comparing sEMG output in 1 active treatment group and 2 control groups. SETTING: Outpatient chiropractic clinic, Phoenix, AZ. SUBJECTS: Forty subjects with low back pain (LBP) participated in the study. Twenty patients with LBP (9 females and 11 males with a mean age of 35 years and 51 years, respectively) and 20 age- and sex-matched sham-SMT/control LBP subjects (10 females and 10 males with a mean age of 40 years and 52 years, respectively) were assessed. METHODS: Twenty consecutive patients with LBP (SMT treatment group) performed maximum voluntary contraction (MVC) isometric trunk extensions while lying prone on a treatment table. Surface, linear-enveloped sEMG was recorded from the erector spinae musculature at L3 and L5 during a trunk extension procedure. Patients were then assessed through use of the Activator Methods Chiropractic Technique protocol, during which time they were treated through use of MFMA SMT. The MFMA SMT treatment was followed by a dynamic stiffness and algometry assessment, after which a second or post-MVC isometric trunk extension and sEMG assessment were performed. Another 20 consecutive subjects with LBP were assigned to one of two other groups, a sham-SMT group and a control group. The sham-SMT group underwent the same experimental protocol with the exception that the subjects received a sham-MFMA SMT and dynamic stiffness assessment. The control group subjects received no SMT treatment, stiffness assessment, or algometry assessment intervention. Within-group analysis of MVC sEMG output (pre-SMT vs post-SMT sEMG output) and across-group analysis of MVC sEMG output ratio (post-SMT sEMG/pre-SMT sEMG output) during MVC was performed through use of a paired observations t test (POTT) and a robust analysis of variance (RANOVA), respectively. MAIN OUTCOME MEASURES: Surface, linear-enveloped EMG recordings during isometric MVC trunk extension were used as the primary outcome measure. RESULTS: Nineteen of the 20 patients in the SMT treatment group showed a positive increase in sEMG output during MVC (range, -9.7% to 66.8%) after the active MFMA SMT treatment and stiffness assessment. The SMT treatment group showed a significant (POTT, P < 0.001) increase in erector spinae muscle sEMG output (21% increase in comparison with pre-SMT levels) during MVC isometric trunk extension trials. There were no significant changes in pre-SMT vs post-SMT MVC sEMG output for the sham-SMT (5.8% increase) and control (3.9% increase) groups. Moreover, the sEMG output ratio of the SMT treatment group was significantly greater (robust analysis of variance, P = 0.05) than either that of the sham-SMT group or that of the control group. CONCLUSIONS: The results of this preliminary clinical trial demonstrated that MFMA SMT results in a significant increase in sEMG erector spinae isometric MVC muscle output. These findings indicate that altered muscle function may be a potential short-term therapeutic effect of MFMA SMT, and they form a basis for a randomized, controlled clinical trial to further investigate acute and long-term changes in low back function. Muscular strength and chiropractic: theoretical mechanisms and health implications, Smith DL, Cox, RH. J Verebralt Subluxation Res, 3(4), 1999-2000.   Abstract: To date, a number of studies have investigated the relationships between chiropractic care and muscular strength. Chiropractic practice philosophy states that correction of vertebral subluxation promotes health through enhancing neurological integrity. Accordingly, chiropractic adjustments aimed at reducing vertebral subluxation should also reduce neurological interference at the involved levels. A reduction of interference to the nervous system would thereby allow muscles to more fully express their functional potential, including an improvement in strength. In the present study, a focused discussion is presented relating vertebral subluxation to muscular strength. Consideration is also given to cardiovascular regulation as a result of improving neuromuscular function. This is followed by an overview of the principal factors affecting muscular strength. Finally, the relevant chiropractic literature pertaining to strength, with potential mechanisms of action, is discussed. A paradigm shift from a disease treatment model to a health enhancement model of chiropractic is afforded by presenting these concepts and conclusion in the current presentation. Comment: The review article demonstrates that 1) the benefits of improved neurological flow of information can improve the functional capabilities of both the muscular and cardiovascular systems, 2) the musculoskeletal/physiological pathways that may account for the efficacy of the adjustment in eliminating fixated joints and improving muscular strength are provided, and 3) clinical MMT, and other forms of testing, should be considered an important way to ascertain and track the patient's neuromuscular status, and that return of muscle strength is a good indicator of the success of that approach. Expanding the Neurological Examination Using Functional Neurologic Assessment Part I: Methodological Considerations, Motyka, T., Yanuck, S. International Journal of Neuroscience. 1999; 97:61-76.   The authors discuss AK as a clinical measure of neurologic function. A review of the literature reveals methodological problems with previous studies of AK as a form of neurologic assessment. The authors discuss the problems with research designs that do not reflect the clinical practice of AK which are common in the literature. They outline principles of AK and recommend that future research reflect more accurately the clinical practice of functional neurologic assessment and AK. Expanding the Neurological Examination Using Functional Neurologic Assessment Part II: Neurologic Basis of Applied Kinesiology, Schmitt, W., Yanuck, S. International Journal of Neuroscience. 1999; 97:77-108.   This paper proposes a neurologic model for many AK procedures. Manual assessment of muscular function is used to identify changes associated with facilitation and inhibition, in response to the introduction of sensory receptor-based stimuli. Muscle testing responses to sensory stimulation of known value are compared with usually predictable patterns based on known neuroanatomy and neurophysiology, guiding the clinician to an understanding of the functional status of the patient's nervous system. The proper understanding of the neurophysiologic basis of muscle testing procedures will assist in the design of further investigations into AK. Accordingly, the neurophysiologic basis and proposed mechanisms of these methods are reviewed. Muscle Test Comparisons of Congruent and Incongruent Self-Referential Statements, Monti, D., Sinnott, J., Marchese, M., Kunkel, E., Greeson, J. Perceptual and Motor Skills. 1999, 88:1019-1028.   This study investigated differences in manual muscle test outcomes 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. Applied Kinesiology Helping Children with Learning Disabilities, Mathews MO, Thomas E, Court L. Int J AK and Kinesio Med, 1999;4.   Abstract:This was a study of a group of 10 children all experiencing learning difficulties and how they responded to Applied Kinesiology (AK) treatment. Treatment involved a patient/therapist contact time of 3 to 4 hours spread over 9 to 12 sessions over a period of 6-12 months. The children were tested before and after treatment by an Educational Psychologist using standardised tests of intelligence to monitor changes in their learning skills. Parents and teachers were asked to complete questionnaires before and after treatment regarding other aspects of the children's educational performance. A health profile was also kept based on parental observation. Results were compared with a control group of 10 children matched for age, IQ and social background who had not received any AK treatment over a similar period. APPLIED KINESIOLOGY AND HOMEOPATHY: A Muscle/Organ/Remedy Correlation, Francis TD. Int J AK and Kinesio Med, 1999;3.   Abstract: Applied kinesiology utilizes manual muscle testing to correct body dysfunction via structural, biochemical and emotional procedures. A basic premise is that there exists a muscle/organ-gland association. Homeopathy utilizes diluted and potentized substances from the plant, animal and mineral kingdoms that in a healthy person would produce similar symptoms as a person who is suffering with illness. There exists a muscle/organ-gland/homeopathic remedy correlation that may be verified utilizing manual muscle testing. Evaluating and Treating Functional Hypothyroidism Utilizing Applied Kinesiology, - Farkas J. Int J AK and Kinesio Med, 1999;3.   Abstract: Although only a very small percentage of patients (approx. 3%) demonstrate thyroid hormone levels which deviate downward from the norm, much clinical evidence suggests that subtler forms of thyroid hypofunction are endemic. This paper reviews thyroid physiology, as well as standard methods for evaluating thyroid function. In addition, an argument will be made for the inclusion of functional thyroid evaluation, as well as the use of non-standard therapies, including those indicated by testing with applied kinesiology. Correlation of Applied Kinesiology Muscle Testing Findings with Serum Immunoglobulin Levels for Food Allergies, Schmitt, W., Leisman, G. International Journal of Neuroscience. 1998; 96:237-244.   Abstract: 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. Comment:This study showed a high degree of correlation between AK procedures used to identify food allergies and serum levels of immunoglobulins for those foods. AK methods in this study consisted of stimulation of taste bud receptors with various foods, and observation of changes in manual muscle testing that resulted. The patient was judged to be allergic to foods that created a disruption of muscle function. Blood drawn subsequently showed that patients had antibodies to the foods which were found to be allergenic through AK assessment. The effects of a pelvic blocking procedure upon muscle strength: a pilot study, Unger, J. Chiropractic Technique, Nov 1998;10(4)   Using a hand-held force transducer, the unit was interposed between the examiner's hand and the subject's appendage being tested. The unit used in this study was interfaced with a computer program that gives statistical analysis for repeated testing reliability. This study found a significant increase in strength in the pectoralis (sternal and clavicular divisions tested separately), anterior deltoid, latissimus dorsi, psoas, tensor fascia lata, adductor, and gluteus medius muscles following the correction of a category II pelvic fault. Jugular Compression in the Diagnosis and Treatment of Cranio-sacral Lesions, Shafer J. Int J AK and Kinesio Med, 1998;2.   Abstract: Manual compression of the jugular veins (Queckenstedt's Maneuver) is regularly used during routine lumbar puncture procedures. In healthy persons, a rise in CSF pressure is expected at the site of puncture during compression of the veins. The author has observed consistent clinical significance in the use of the maneuver for cranio-sacral and dural membrane evaluation and treatment. In patients with a normal metabolic rate and exhibiting normal cranio-sacral, stomatognathic and dural membrane mechanics, compression of the jugular veins causes no change in pre-compression muscle strength. When dysfunction is present, immediate and significant changes in pre-compression muscle strength has been observed. It is hypothesized that the use of the technique during routine applied kinesiology examination is an invaluable aid to cranio-sacral therapy. George Goodheart, Jr., D.C., and a history of applied kinesiology, Green, B.N. and Gin, R.H. J Manipulative Physiol Ther, 1997;20(5):331-337   Abstract: Applied Kinesiology (AK), founded by Michigan chiropractor George J. Goodheart, is a popular diagnostic and therapeutic system used by many health care practitioners. Many of the components in this method were discovered by serendipity and observation. In 1964, Goodheart claimed to have corrected a patient's chronic winged scapula by pressing on nodules found near the origin and insertion of the involved serratus anterior muscle. This finding led to the origin and insertion treatment, the first method developed in AK. Successive diagnostic and therapeutic procedures were developed for neurolymphatic reflexes, neurovascular reflexes and cerebrospinal fluid flow from ideas originally described by Frank Chapman, D.O., Terrence J. Bennett, D.C., and William G. Sutherland, D.O., respectively. Later, influenced by the writings of Felix Mann, M.D., Goodheart incorporated acupuncture meridian therapy into the AK system. Additionally, the vertebral challenge method and therapy localization technique, both based on phenomena proposed by L.L. Truscott, D.C., were added to the AK system. Scholarship has also evolved regarding AK and research on the topic is in its infancy. This paper documents some of the history of AK. Interexaminer Agreement for Applied Kinesiology Manual Muscle Testing, Lawson, A., Calderon, L. Perceptual and Motor Skills. 1997; 84:539-546.   This study demonstrated significant interexaminer reliability for individual tests of the pectoralis major and piriformis muscles, but not for the tensor fascia lata or hamstring, which are essentially tests of groups of muscles at once. The primary importance of this study is that it demonstrates the reliability and reproducibility of muscle testing as a clinical tool, while also highlighting the need for clinicians to be aware of potential inaccuracies involved with the testing of some muscle groups. Internal consistency of manual muscle testing scores, Bohannon RW. Percept Mot Skills, 1997 Oct;85(2):736-8.   Abstract: The internal consistencies of manual muscle test scores of the actions of three upper and three lower extremity muscles were examined among 37 home care patients. The correlations between scores of specific pairs of actions ranged from .01 to .88. Cronbach alphas ranged from .59 to .88. Manual scores of limb muscle strength, therefore, appear to possess suitable internal consistency. Comment: Accurate, precise, repeatable, artful muscle testing is easy to learn, but difficult to master. It is the key to success in both the use of AK and to its value as a method of diagnosis using manual muscle testing itself. Consistently accurate MMT is the most important physical talent an AK practitioner will ever develop. The ability of male and female clinicians to effectively test knee extension strength using manual muscle testing, Mulroy SJ, Lassen KD, Chambers SH, Perry J. J Orthop Sports Phys Ther. 1997 Oct;26(4):192-9.   Abstract: It has been suggested that the accuracy of manual muscle testing is dependent on examiner strength. Our purpose was to relate male and female clinicians' upper extremity strength to their ability to challenge the quadriceps and detect weakness in patients using manual muscle testing. Quadriceps muscles of seven men and 12 women with postpoliomyelitis were tested manually by a male and female clinician while forces were recorded with a hand-held dynamometer. Patients' maximal isometric knee extension force was recorded with a Lido dynamometer and clinicians' maximal vertical push force was recorded with the hand-held dynamometer. Manual muscle testing forces, patient maximum quadriceps forces, and examiner push forces were compared with repeated measures analysis of variance. Female examiners' maximal vertical push force (235.7 +/- 54.3 N) was not significantly different from either female or male patients' maximal quadriceps force (166.8 +/- 66.7 N and 341.6 +/- 123.7 N) but was only 60% and 40% of the isometric knee extension forces generated by a group of normal women and men. Male examiners were significantly stronger (357.0 +/- 93.4 N) than the female but not the male patients and produced 90% and 60% of the normal isometric quadriceps forces for women and men. Examiners gave appropriate grades in 30 of 38 tests. Examiner strength limits detection of moderate quadriceps weakness with manual resistance. Most of the muscle test grades, however, were appropriate, given the examiner's upper extremity strength. Clinicians using manual muscle testing should determine their maximal vertical push force and the extent of weakness they can detect. Grade 4 in manual muscle testing: the problem with submaximal strength assessment, Dvir Z. Clin Rehabil. 1997 Feb;11(1):36-41.   OBJECTIVE: To compare the static moment of force required for a muscle group to support a limb segment against gravity with the maximal dynamic moment it can generate. DESIGN: Based on anthropometric measures of both sexes and theoretical calculations, the estimated anti-gravity static muscular moments (MGM) at the shoulder, elbow, hip and knee joints were compared with published data relating to the isokinetic strength (MIM) of the same muscle groups. RESULTS: The ratio of static to dynamic moment, MGM/MIM, was drastically higher in muscles operating on the proximal compared with the more distal joints. In women, the values of this ratio in the shoulder, hip, elbow and knee muscles were 7-27%, 5-65%, 7% and 5-10% respectively. The corresponding figures in men were 7-21%, 4-44%, 8-10% and 5-8%. The ratios relating to the abductors, flexors and extensors of the hip joint were substantially higher in women than in men. CONCLUSIONS: Since MGM and MIM correspond to grades 3 and 5 in manual muscle testing, the findings of this theoretical analysis indicate that elbow and knee muscles assessed as having grade 4 may generate as low as 10% of their maximal strength. With regard to shoulder and hip muscles the corresponding values are typically around 20% and 30-40%.Coupled with the very limited human precision in sensing of force, these findings indicate that where quantitative targets in muscle strength conditioning are set or when an accurate measure of impairment is being sought, grade 4 cannot and should not serve as a valid criterion. A preliminary inquiry into manual muscle testing response in phobic and control subjects exposed to threatening stimuli, Peterson KB. J Manipulative Physiol Ther. 1996 Jun;19(5):310-6.   Objective: To determine phobic and non-phobic subject response to a provocative threat stimulus and to determine variables that confound the response. Design: Randomized blind examiner test-retest of randomized phobic and control subjects with qualitative, semistructured, information postintervention interview. Setting: Private chiropractic clinic. Subjects: Thirteen phobic individuals, as determined by the Diagnostic and Statistical Manual of Mental Disorders, Third Edition – Revised (DSM-III-R), and 14 control volunteer subjects. Intervention: Manual muscle testing was performed while each subject viewed a threat stimulus (i.e., a cue word on a printed card). The results were recorded as "weak" or "strong." Results: The analysis of the data demonstrates poor inter- (K = -0.19) and intraexaminer reliability (K = -0.14- +0.29). The test for independence for valid muscle testing was strong for both examiners (p = .462, p = 1.00) When confounding variables were corrected for, the validity of muscle testing increased to 91%. Conclusion: This preliminary inquiry demonstrates the need for musculoskeletal, attentional and presensitized subject variables to be controlled to ascertain if muscle testing can be reliably used as a tool to identify emotional arousal. Ear infection: a retrospective study examining improvement from chiropractic care and analyzing for influencing factors, Froehle RM. J Manipulative Physiol Ther. 1996 Mar-Apr;19(3):169-77.   OBJECTIVE: The aims of this study were to determine (a) if the patients improved while under chiropractic care; (b) how many treatments were needed to reach improvement; and (c) which factors were associated with early improvement. DESIGN: Cohort, nonrandomized retrospective study. SETTING: Private chiropractic practice in a Minneapolis suburb. PARTICIPANTS: Forty-six children aged 5 yr and under. INTERVENTION: All treatments were done by a single chiropractor, who adjusted the subluxations found and paid particular attention to the cervical vertebrae and occiput. Sacral Occipital Technique-style pelvic blocking and the doctor's own modified Applied Kinesiology was used. Typical treatment regimen was three treatments per week for 1 wk, then two treatments per week for 1 wk, then one treatment per week. However, treatment regimen was terminated when there was improvement. OUTCOME MEASURE: Improvement was based on parental decision (they stated that the child had no fever, no signs of ear pain, and was totally asymptomatic), and/or the child seemed to be asymptomatic to the treating DC and/or the parent stated that the child's MD judged the child to be improved. A data abstraction form was used to determine number of treatments used and presence of factors possibly associated with early improvement. RESULTS: 93% of all episodes improved, 75% in 10 days or fewer and 43% with only one or two treatments. Young age, no history on antibiotic use, initial episode (vs. recurrent) and designation of an episode as discomfort rather than ear infection were factors associated with improvement with the fewest treatments. CONCLUSION: Although there were several limitations to this study (mostly because of its retrospection but also, significantly, because very little data was found regarding the natural course of ear infections), this study's data indicate that limitation of medical intervention and the addition of chiropractic care may decrease the symptoms of ear infection in young children. Electromyographic Effects of Fatigue and Task Repetition on the Validity of Estimates of Strong and Weak Muscles in Applied Kinesiology Muscle Testing Procedures, Leisman, G., et al. Perceptual and Motor Skills. 1995; 80:963-977.   Abstract: 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 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. Isokinetic Muscle Testing: Is It Clinically Useful?, Almekinders LC, Oman J. J Am Acad Orthop Surg, 1994 Jul;2(4):221-225.   Abstract: The use of computer-driven muscle-testing devices has become increasingly popular during the past two decades. This expensive equipment allows evaluation of muscles and muscle groups in an isokinetic manner. Isokinetic muscle testing is performed with a constant speed of angular motion but variable resistance. Isokinetic dynamometers have been shown to produce relatively reliable data when testing simple, uniaxial joints, such as the knee, as well as when testing the spine in flexion and extension. Isokinetic strength data are generally not helpful in the diagnosis of orthopedic abnormalities. Isokinetic testing can be helpful during the rehabilitation of orthopedic patients, since it allows easy monitoring of progress. It also enables the patient to work on muscle rehabilitation in a controlled manner at higher speeds than are possible with more conventional exercise equipment. An isokinetic rehabilitation program can be easily tailored with concentric and eccentric components that closely resemble muscle actions during occupational and sports activities. Muscle Testing Response to Vertebral Challenge and Spinal Manipulation: A Randomized Controlled Trial of Construct Validity, Haas, M., Peterson, D., Hoyer, D., Ross, G. Journal of Manipulative and Physiologic Therapeutics. 1994; 17(3):141-148.   Objective: To evaluate the relationship of muscle strength response to a provocative vertebral challenge and to spinal manipulation. Design: Prospective double-blind randomized controlled trial: crossover and between subjects designs. Setting: Laboratory: Center for Technique Research. Participants: Sixty-eight naïve volunteers from the student body, staff and faculty of the college. Interventions: Provocative vertebral challenge: standardized 4-5 kg force applied with a pressure algometer to the lateral aspects of the T3-T12 spinous processes. Intervention: manual high velocity low amplitude adjustment or switched-off activator sham. Main Outcome Measures: Piriformis muscle response was defined in two ways: reactivity (a decrease in muscle resistance, yes or no, following a vertebral challenge); responsiveness (the cessation of reactivity following spinal manipulation). Relative response attributable to the maneuver (RRAM): the percent of an outcome attributable to the challenge or adjustment itself. Results: Average RRAM = 16% reactivity to vertebral challenge; average RRAM = 0% responsiveness to spinal manipulation. Six to 10% of muscle tests were positive regardless of examiner, previous finding or intervention. Conclusions: For the population under investigation, muscle response appeared to be a random phenomenon unrelated to manipulable subluxation. In and of itself, muscle testing appears to be of questionable use for spinal screening and post-adjustive evaluation. Further research is indicated in more symptomatic populations, different regions of the spine, and using different indicator muscles. Comment: As described by the I.C.A.K., vertebrae without subluxation, fixation, or other mechanical problems should be negative to challenge. Only 40% of the 68 subjects tested had pain, and only 50% of them had stiffness in the thoracic region. It should be obvious that challenging a normally functioning vertebra should cause a negative result, thereby making positive tests of the thoracic spinal column from T3 to T12 statistically insignificant. General lateral to medial spinous process pressure applied to a vertebra that may be subluxated does not always produce a muscle response. The specific vector of challenge must match the specific subluxation of the vertebra if the rebound phenomenon described in AK diagnosis of vertebral subluxations is to be evaluated. A more specific research design would be to diagnose vertebral subluxations by another method (palpation, radiography, thermography), and then to employ the AK method of vertebral challenge to these specific vertebrae to evaluate the intra- and inter-examiner reliability of this method. Comparison of a hand-held and fixed dynamometer in measuring strength of patients with neuromuscular disease, Brinkmann JR. J Orthop Sports Phys Ther. 1994 Feb;19(2):100-4.   Abstract: While numerous studies report acceptable reliability of hand-held dynamometers, very little information is available on factors affecting measurements and comparisons with other force measurement systems. A hand-held dynamometer was compared to a fixed dynamometer to determine if the two systems of force measurement yielded comparable results. Twenty-one patients with neuromuscular disease were measured for maximal isometric strength of 12 muscle groups with both force measurement systems using standardized positioning and stabilization procedures. Only one of the 12 muscle groups tested demonstrated significantly different force measurements between the two systems. Good association was found between both systems in force measurements, with Pearson correlation coefficients ranging from .76 to .90. We conclude that a hand-held dynamometer and a fixed dynamometer yield comparable results in patients with neuromuscular disease, provided that testing is limited to muscle groups producing relatively low forces. Relationship between two measures of upper extremity strength: manual muscle test compared to hand-held myometry, Schwartz S, Cohen ME, Herbison GJ, Shah A. Arch Phys Med Rehabil. 1992 Nov;73(11):1063-8.   Abstract: One hundred and twenty-two individuals with spinal cord injuries at levels C4-6, Frankel classifications A through D, were evaluated to determine the relationship between the manual muscle test (MMT) and hand-held myometry as accurate methods for measuring muscular strength. More specifically, this study attempted to define a range of myometry scores that could be correlated with discrete MMT grades. It also investigated which of the two modalities (MMT or hand-held myometry) is the best reflection of improvement in muscle strength over time. Sequential motor strength examinations using both modalities were performed at 72 hours, one week, and two weeks post SCI and then one, two, three, four, six, 12, 18, and 24 months post injury. The data analyses included calculations of Spearman ranked correlations, analyses of variance, and linear regressions. Results showed that 22 of 24 correlations between MMT and myometry were significant at p values less than .001. The range of myometry measurements for a particular MMT grade appears to be most specific for MMT scores less than 4 (i.e., poor-plus to good), and less specific for MMT scores greater than or equal to 4. The results of this study also indicate that myometry measurements detect increases in strength over time, which are not reflected by changes in MMT scores. Somatic dyspnea and the orthopedics of respiration, Masarsky CS, Weber M. Chiro Tech 1991;3(1):26-29.   Abstract: Several brief cases are presented in which the symptom of dyspnea was alleviated or abolished following the correction of vertebral subluxation complex or other somatic dysfunctions. In discussing such cases, the term "somatic dyspnea" is suggested to denote air hunger or shortness of breath related to somatic dysfunction. Somatic dyspnea is a condition which may accompany other causes of dyspnea (lung pathology, psychogenic or "functional" causes, etc.), or it can exist alone. In our chiropractic practice, most somatic dyspnea is seen as a secondary condition in patients presenting primarily with orthopedic complaints. When the symptom is secondary, the patient will often not mention it until an examination procedure reproduces it or treatment causes it to improve or disappear. The response to manipulative therapy is sometimes so dramatic and rapid that a strong linkage between the dyspnea and the primary presenting complaint is suggested. Comment: The treatments used in this study come primarily from AK. The "challenge" method is employed for discovery of articular problems; neurolymphatic and neurovascular reflexes (as described by Goodheart) are employed for the diaphragm muscle; evaluation of the meridian system (as modified by Goodheart and others) is used; cranial manipulation (AK methods) were used; and evaluation and treatment of inhibited muscles involved in respiration described. Masarsky and Weber have also published a paper that showing that AK examination and treatment procedures in the treatment of a patient with chronic obstructive pulmonary disease were also beneficial. Masarsky and Masarsky have explicated in great detail the contention in AK that somato-visceral and viscero-somatic methodologies should be a part of the chiropractic approach to patients in their excellent book Somato-visceral aspects of chiropractic: an evidence-based approach. Objective Measurement of Proprioceptive Technique Consequences on Muscular Maximal Voluntary Contraction During Manual Muscle Testing, Perot, C., Meldener, R., Gouble, F.   -- Departement de genie biologique, URA CNRS 858, Universite de technologie, Compiegne. Agressologie. 1991; 32(10):471-474.   This study measured the electrical activity in muscles. It established that there was a significant difference in electrical activity in the muscle, and that this corresponded with the difference found between "strong" versus "weak" muscle testing outcomes by AK practitioners. It further established that these outcomes were not attributable to increased or decreased testing force from the doctor during the tests. In addition, the study showed that manual treatment methods used by AK practitioners to reduce the level of tone of spindle cells in the muscle are in fact capable of creating a reduction in tone of the muscle, as had been observed clinically.   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 that is also necessary in standard clinical manual muscle testing. Failure of the musculo-skeletal system may produce major weight shifts in forward and backward bending, Goodheart, G. Proc Inter Conf Spinal Manip, Washington, DC;May 1990:399-402   Forty patients were evaluated for pre- and post-treatment weight balance. Of the 40 patients, only one had minimal changes in weight upon two scales beneath the feet when both flexing and extending the spine. The treatment protocol employed (applied kinesiology methods) proved to balance the aberrant patterns of weight distribution during flexion and extension of the spine. Reliability of Manual Muscle Testing with a Computerized Dynamometer, Hsieh, C.Y., Phillips, R.B. Journal of Manipulative and Physiological Therapeutics. 1990; 13:72-82.   Abstract: 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 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 a