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NARRATIVE REVIEW

Applied kinesiology: Distinctions in its definitionand interpretation

Anthony L. Rosner, Ph.D., LL.D.[Hon.], LLC a,*,Scott C. Cuthbert, B.A., D.C. b,1

a 1330 Beacon Street, Suite #315, Brookline, MA 02446-3202, USAbChiropractic Health Center, P.C., 255 West Abriendo Avenue, Pueblo, CO 81004, USA

Received 30 August 2011; received in revised form 9 March 2012; accepted 12 April 2012

KEYWORDSProfessional appliedkinesiology;Manual muscletesting;Therapy localization;Challenge;Validity;Reliability;Critique;Diplomate;International Collegeof Applied Kinesiology

Abstract Modification of the motor system in assessing and treating as well as understandingone of the causes of musculoskeletal dysfunctions is a topic of growing importance in health-care. Applied kinesiology (AK) addresses this interest in that it is a system which attempts toevaluate numerous aspects of health (structural, chemical, and mental) by the manual testingof muscles combined with other standard methods of diagnosis. It leads to a variety of conser-vative, non-invasive treatments which involve joint manipulations or mobilizations, myofascialtherapies, cranial techniques, meridian and acupuncture skills, clinical nutrition and dietarymanagement, counseling skills, evaluating environmental irritants, and various reflex tech-niques. The effectiveness of these ancillary treatments is believed to be consistent with theexpanded construct validity of the manual muscle test (MMT), as described, although thisassertion has primarily been tested in outcome studies.

AK and its adjunctive procedures (challenge and therapy localization) are highlighted in thisreview providing details of its implementation as prescribed by an International College ofApplied Kinesiology’s Board of Examiners, cited for its scholarly and scientific activities.Because these procedures are believed to identify specific articular, soft tissue, biochemical,or emotional issues underlying muscle function, the applicability of this diagnostic method forall clinicians treating muscle imbalance disorders is described. As of yet, MMT efficacy intherapy localization and challenge techniques has not been established in published, peer-reviewed research.

A variety of challenges likewise remain for professional AK to establish itself as an emergingscience, with numerous gaps in the literature and testable hypotheses enumerated. Of

* Corresponding author. Tel.: þ1 617 734 3397 (office); fax: þ1 617 734 0989.E-mail addresses: [email protected] (A.L. Rosner), [email protected] (S.C. Cuthbert).

1 Tel.: þ1 719 544 1468.

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Journal of Bodywork & Movement Therapies (2012) 16, 464e487


particular concern are a multiplicity of derivatives of AK that have been described in the liter-ature, which should be greeted with caution in light of the fact that they lack one or more ofthe essential attributes of AK as described in this report. The validity of these studies whichhave been critical of applied kinesiology appears in many instances to be no greater thanseveral of the randomized controlled trials, cohort studies, case control studies, and casestudies found in this communication to support various aspects of applied kinesiology.ª 2012 Elsevier Ltd. All rights reserved.

Introduction: rationale and essentials ofapplied kinesiology

During recent decades, modification of the motor system inboth the assessment and treatment of musculoskeletalsystems has emerged as a topic of growing importance(Vleeming et al., 2007; Lee, 2004; Sahrmann, 2002; Cowanet al., 2001; Suter et al., 2000). Accordingly, increased ordecreased muscle activity and delayed muscular activa-tiondphenomena which affect normal movement patterns(Janda, 1983a)dhave become focal points of both clinicaland research interest. It is with these facts in mind thata review of Applied Kinesiology (AK) e an integrated systemof healthcare which emphasizes muscle function believedto reflect functional neurological responsesdis indicated.

Briefly, AK tests muscles before and after applyinga variety of challenges and treatments, making clinicaljudgments based on short-term changes in the musclethereafter (Walther, 2000). It is generally considered to bea break testing methodology (Kendall et al., 2005), usinga binary grading system with reference to the test muscleas “facilitated” or “strong” corresponding to a grade 5, or“functionally inhibited” or “weak” as shown by a grade 4 orless on a 0e5 scale.

In AK, the response of a particular muscle to resistanceapplied by a trained professional examiner was firstproposed by George Goodheart to be a summation of all theexcitatory and inhibitory inputs of the anterior hornmotoneurons, such that a failure of the muscle in the testcould be linked to a dysfunction of the nervous system(Schmitt and Yanuck, 1999; Goodheart, 1964e1998, 1988).In other words, AK has been proposed to be a study offunctional neurology. Muscle changes evaluated by themanual muscle test (MMT) are suggested to be reflective ofa change in the peripheral or central nervous system, andtreatment is considered to be effective only if it is directedat the correct neural disruption (Schmitt and Yanuck,1999). Disclosed primarily by muscle testing, the afore-mentioned neural disruption has been proposed to bebrought on by disturbances in joint function, lymphaticdrainage, the vascular supply to a muscle or related organ,a nutritional deficiency or excess, imbalances in themeridian system, aberrations in the stomatognathicsystem, or psychosocial stressors (Walther, 2000). Statedmore simply, all these systems are interconnected andassumed to influence each other. AK as a tool in the study offunctional neurology has been suggested to be a significantadjunctive diagnostic probe, used in combination withother clinical findings upon examination. An early study byCarpenter et al. (1977) was executed at the Anglo-European College of Chiropractic to evaluate the musclee

organ association. An organ was irritated, and the muscleassociated with that organ was then tested with a dyna-mometer. Four muscle-organ associations were evaluated:the stomach, the eye, the ear, and lungs. The stomach wasirritated by placing cold water into it; the eye with chlo-rinated water; the ear with sound of a controlled frequencyand decibel rate; and the lungs with cigarette smoke. In allcases, the associated muscle weakened significantly morethan other indicator muscles after the irritation. Subse-quent research was performed by Scoop (1979) to investi-gate AK MMT correlations with allergic patients. This studyemployed a Jaymar dynamometer to confirm the AK MMTfindings. Schmitt and Leisman (1998) also showed a highdegree of correlation between AK procedures used toidentify food allergies and serum levels of immunoglobulinsfor those foods. Blood drawn showed that patients hadantibodies to the foods which were found to be allergenicthrough AK assessment. Conable (2010) evaluated the AKMMT with a thin-film force transducer.

ICAK research has demonstrated correlations betweenpositive MMT findings and other instrumentation thatmeasure muscle force, velocity and timing (Zampagniet al., 2008; Monti et al., 1999; Leisman et al., 1995;Leisman et al., 1989) Moncayo et al. (2004) also monitored32 patients with thyroid-associated orbitopathy (TAO) usinglymph and other thyroid dysfunction measurement toolsand showed that AK-guided treatment ameliorated theTAO. The broad array of AK research that correlates AKprocedures with other diagnostic probes is presented inAppendix 1, and this research is presented in depth fromseveral platforms (Cuthbert and Rosner, 2011;www.icakusa, 2011; Cuthbert and Goodheart, 2007).

The utility of analyzing disturbed body function byassessing changes affecting the muscles has been previouslysupported (Kendall et al., 2005; Lewit, 1999; Janda, 1978,1983a; Kendall and Kendall, 1952). The way to differentiateprevious concepts of postural disturbances and thoseconsequent to biomechanical, biochemical, and/orpsychosocial aberrations and the MMT as used in AK, is thatthe latter investigates the immediate changes in musclefunction as the result of sensorimotor challenges to thesefactors taken collectively. This hypothesis was proposed inlight of the evidence regarding the reliability and validity ofMMT provided in 12 randomized clinical trials, 26 prospec-tive cohort studies, 26 cross-sectional studies, and 10caseecontrol studies recently reviewed (Cuthbert andGoodheart, 2007). It also derives support from 35 casestudies and series shown in Appendix 1, taking intoconsideration the fact that observational studies haverecently become more accepted in constructs of evidence-based medicine (Rosner, 2012). Simons (Simons et al., 1999)

Applied Kinesiology 465


has shown that muscle dysfunction and myofascial triggerpoints specifically result from biomechanical, biochemical,and psychosocial influences. Biochemical and emotionalfactors are now considered fundamental components inholistic models of muscle dysfunction (Chaitow and Delany,2008).

Professional applied kinesiology

The term “professional” preceding applied kinesiology (PAK)represents the practice of applied kinesiology as taught andvalidatedby the International College ofAppliedKinesiology,and its use is granted only to doctors licensed to diagnose.PAK methods are taught around the world by Diplomates inAK, who require over 300 h of classroom study with multipleinstructors and 3 years of clinical practice. The Diplomate isawarded only after (a) two scholarly papers have beenaccepted for publication, (b) one day of written examina-tions is completed with passing grades in the multiple areasof [1] nutrition, [2] biomechanics, [3] viscersomatic reflexes,and [4] musculoskeletal dysfunctions (encompassing spinal,extremity, cranial and stomatognathic disturbances, softtissue disorders relating to myofascial trigger points, strain-counter-strain, myofascial gelosis, peripheral nerveentrapments), and (c) a practical exam is successfullycompleted. This protocol has been applied by the Interna-tional College of Applied Kinesiology (ICAK), a nonprofitfoundation organized to provide a means of quality control(www.icakusa.com, 2011).

The chiropractic historian Joseph Keating describes thecontributions of the ICAK as follows:

“Unfortunately, few chiropractic membership organiza-tions in the U.S. can claim to have been founded or tofunction primarily for scholarly or scientific purposes(The Association for the History of Chiropractic (AHC)and the International College of Applied Kinesinology(ICAK) are exemplary of these few.).There are feworganizations of field doctors that can make a similarclaim (Keating, 1992).”

The ICAK was founded in 1976, and Keating’s earlyrecognition of the purposes of the ICAKdand its yearlypublication of its membership’s research reports laid thegroundwork for establishing an evidence-based practice.For this statement to maintain credibility, an assessment ofthe strengths and weaknesses of the research literatureaddressing the AK procedures in conformity with the ICAKguidelines needs to be made. Such is one of two objectivesof this communication. The other is to address proceduresat variance with professional AK practices which havedrawn substantial criticism in the literature, as will beshown in detail below.

Overview of manual muscle testing in practice

The testing of the muscle is based upon the proceduresand principles of Kendall and Kendall, who, over halfa century ago, established that a given muscle, whentested from a contracted position against increasingapplied pressure from the examiner, could either maintainits position or break away, rated on a scale of 0e5 in terms

of increasing resistance to the examiner (Kendall andKendall, 1952). MMT reveals an imbalance of muscles, inwhich one set of muscles tends to become inhibited whileanother group becomes overactivated in concert (Janda,1978). Janda argued that muscle imbalance was notreadily explainable by anatomical, histological, biochem-ical or physiological attributes of the muscle itself (Janda,1980, 1983a).

Accordingly, the locus of this phenomenon has beensuggested to extend beyond the muscle, detectable by AKtesting which is hypothesized to point to the presumedetiological dysfunction. A stimulus (touch, pressure, stim-ulation, mental-emotional processing, gustatory or olfac-tory sensation)dtermed “challenge” and “therapylocalization (TL)” in AK practice e if corrective in nature,is observed to produce an instantaneous strengthening ofthe inhibited muscle. The research to support this state-ment is described below, in the recent literature review ofCuthbert and Goodheart (2007) and in Appendix 1. Theimmediate effect of these stimuli upon muscle strengthappears to be strongly influenced by patient and doctorrapport (Schmitt and Yanuck, 1999).

Added to the tenets of modern professional appliedkinesiology are the facts that (1) multiple muscle tests areperformed in a series or parallel manner before any diag-nosis is ever made, and (2) injury and pain are not the onlyfactors which can precipitate muscle imbalance. Aspects ofindividual lifestyle, such as stress, fatigue, emotional state,inadequate propriosensory input due the lack of variety ofmovements, and a sedentary lifestyle have been reportedto be common causes as well (Jull et al., 2008; Jull andJanda, 1987). Added to these precipitating factors aresuch nutritional elements as vitamins and minerals, the lackof which has been suggested to produce muscle imbalance(Cuthbert, 2008; Moncayo and Moncayo, 2007; Moncayoet al., 2004; Rogowskey, 2001; Simons et al., 1999;Schmitt and Leisman, 1998; Rochiltz, 1986; Jacobs et al.,1984; Schmitt, 1982; Scopp, 1979; Carpenter et al., 1977).

Observing the change in muscle function after a patientinsalivates a nutritional entity is a frequently used methodof nutritional testing in Applied Kinesiology. While thenerve pathways that produce changes in muscle functionremain unclear, there is evidence in the literature ofefferent response throughout the body resulting fromstimulation of the gustatory and olfactory receptors(Chambers et al., 2009, Guyton and Hall, 2005; Pert, 1986;Fiet et al., 1982, Yamamoto et al., 1982, Behrman andKare, 1968). Indeed, Chambers has observed that exer-cise performance is improved with mouth rinsing bycarbohydrate but not saccharine, supporting the speci-ficity of oral receptors (Chambers et al., 2009), in thisinstance distinguishing carbohydrates from sweetness.Some of the observed reactions to sublinqual stimulationhave included, for example: (1) exercise performance andbrain activity (Chambers et al., 2009), (2) canine pancre-atic secretion (Behrman and Kare, 1968), and (3) alteredplasma levels of estrone, follicle stimulating hormone, andluteinizing hormone (Fiet et al., 1982). While changes inmuscle function have been reported with subjects simplyholding vials of a substance or applying them topicallydtobe discussed below e the ICAK has taken the position thatevaluating nutritional needs by testing muscle function

466 A.L. Rosner, S.C. Cuthbert


should only be done when the patient stimulates thegustatory or olfactory receptors with the substancebeing tested. Despite the complexity of factors involved,this evaluation may become a useful adjunct to the stan-dard methods used in determining a patient’s nutritionalneeds (Cuthbert, 2008; Moncayo and Moncayo, 2007;Moncayo et al., 2004; Rogowskey, 2001; Simons et al.,1999; Schmitt and Leisman, 1998; Rochiltz, 1986; Jacobset al., 1984; Schmitt, 1982; Scopp, 1979; Carpenteret al., 1977).

In addition, AK’s evaluation of the activity of agonistand antagonist muscles is not primarily focused uponmuscle tension and stiffness, but rather upon adaptationsin which muscle inhibition is believed to be more prom-inent. This point has been amplified in the evolution ofviewpoints away from muscle spasm and toward muscleinhibition in the etiology of muscle pain. Indeed, theEditor of the American Journal of Physical Medicine andRehabilitation points out that “in spite of overwhelmingevidence that skeletal muscle spasm is nonexistent,physicians are continually deluged with seductive ads toprescribe expensive muscle relaxants” (Mense and Simons,2001; Johnson, 1989). This assertion is further supportedby the observation that motor function is impaired in 5chronic musculoskeletal pain conditions; i.e., temporo-mandibular disorders, muscle tension headache, fibro-myalgia, chronic low back pain, and muscle sorenessfollowing exercise (Lund et al., 1991). Decreased activa-tion for painful muscles is seen during movements inwhich they act as agonists and increased activation for thepainful muscles’ antagonists (Lund et al., 1991). Thisfinding is consistent with the common impression that painmakes muscles difficult to use and less powerful (Mills andEdwards, 1983). The clinical relevance of this observationis borne out by recently reported impaired patterns ofmuscle activation and control which accompany back(Luomajoki et al., 2008) and neck pain (Falla et al.,2004a, 2004b), the latter correlating with weak andstrong muscle test results obtained by AK practitioners(Cuthbert et al., 2011).

Importantly, according to Travell and Simons, an activemyofascial trigger point (MTrP) will usually inhibit thefunction as well as the endurance of the muscle in which it ishoused as well as those which lie in its target zone of referral(Simons et al., 1999). MTrPs are considered a hallmarkfinding of muscle pain syndromes andwithin clinical practiceare claimed to be a common cause of musculoskeletal painand dysfunction in people presenting for manual therapy(Bianco et al., 2006). Becausemuscles with MTrPs are almostalways inhibited with movement and/or exertion, thehypothesis that hypertonic/tight muscles are the etiologicalcause of musculoskeletal dysfunction ignores the findings ofthe research cited above. “Thus, if the primary source ofpain is musculature, the muscle is likely to have beenturned off, not on (Mense and Simons, 2001).”

The elements of manual muscle testing (MMT)in applied kinesiology

A key element of the effective MMT is to apply pressure orresistance in a manner that allows the subject to exert the

optimal response. This involves making certain that thesubject does not mask a potentially inhibited muscle byrecruiting others to compensate against the pressureexerted by the examiner. This phenomenon, referred to asthe substitution of synergist muscle function to replace orsupplant the muscle being examined, is very common(Goldberg and Neptune, 2007; Kendall et al., 2005; Danielsand Worthingham, 2003; Harms-Ringdahl, 1993; Lund et al.,1991) and demonstrates poor motor control. To minimizethe probability of synergist substitution occurring duringtesting, a precise reckoning of the positions of the patient,examiner, and muscle being tested is required.

Timing may be a critical issue requiring further study, inthat the range of duration of AK muscle testing of themiddle deltoid among experienced examiners ranged from0.3 to 3.5 s (Conable and Rosner, 2011). Elsewhere, someICAK-trained examiners were suggested to vary techniqueenough to create a measurable difference in initiation ofthe MMT, such that the distinction between examiner-started and patient-started testing becomes blurred(Conable et al., 2005). Finally the nature of the verbalinstructions or demonstrations given to the patient maycreate differences in the outcomes of MMT (Hyman, 2000).

An extensive checklist for effective MMT has recentlybeen proposed by Schmitt and Cuthbert (Schmitt andCuthbert, 2008) and is suggested to be the most currentbenchmark against which all AK procedures should bejudged. It is in general conformity with the Technical Rulesfor MMT proposed by Janda (1983a) except where indicatedbelow:

a Is the test a standardized MMT of the muscle or is ita general test such as the “arm test?” The testsaccepted by the ICAK are grounded in the originalstudies of Kendall (Kendall et al., 2005) and Goodheart(Goodheart, 1964e1998). The MMT protocol as suchmust be consistent from test to test on the samepatient and reproducible by others. By testing a generalgroup of muscles (neck flexors or extensors, hipabductors or adductors, pelvic flexors or extensors)rather than one specifically, the tester runs the risk ofobtaining a different response. For example, the “armtest” (Schwartz et al., 2009; Tschernitschek and Fink,2005; Pothmann et al., 2001; Arnett et al., 1999;Sapega, 1990; Brand, 1989; Garrow, 1988; Quintanarand Hill, 1988; LeBoeuf et al., 1988, Kenney et al.,1988; Radin, 1984; Friedman and Weisberg, 1981)tracks all the arm flexors and abductors as a group,while the middle deltoid MMT is believed to isolatea specific muscle (Schmitt and Cuthbert, 2008; Walther,2000). The same problem characterizes several ofJanda’s MMT descriptions, in which groups rather thanindividual muscles are emphasized in the testing(Janda, 1983a, 1983b). For example, specific testing ofthe sternocleidomastoid and upper trapezius musclesare not described in Janda’s MMT in the evaluation ofthe neck, while the roles of the vastus medialis versusthe vastus lateralis are not considered in the quadri-ceps MMT (Janda, 1983a, 1983b).

b On how many muscles is the procedure valid? In theICAK, new diagnostic or manipulative treatment tech-niques are proposed to be evaluated using three



separate and distinct muscles, one of which is thequadriceps femoris tested in the supine position beforethey are considered reproducible and valid. Often the“arm test” has been described in research which failsto be reproduced when applied to another muscle,particularly the quadriceps femoris (Ludtke et al.,2001; Pothmann et al., 2001; Garrow, 1988).

c Are the starting point and direction of force thesame with each muscle testing? These are prescribedto be consistent, the line of force not varying morethan a few degrees from test to test. Failure to complywith these guidelines may result in the substitution ofsynergistic muscles replacing or supplanting themuscle that is being examined, likely altering theoutcome.

d Does the examiner apply the same force with thesame timing on each occasion that the muscle istested, and is the force applied at a constant rate andspeed? The force is suggested to be applied to thepatient at a constant rate until the examiner sensesthat the muscle begins to give way. However, studies byConable suggest that variability in the forces appliedpredominate (Conable et al., 2008). The test is char-acterized by a pre-loading contraction of the testmuscle to maximum isometric force, followed by theexaminer pushing with increased force in the directionof eccentric contraction. The muscle should not betested through the entire range of motion, for, as oneof the primary founders of applied kinesiology has aptlystated, “Once the muscle is in motion, the test is over”(Walther, 2000). Being able to detect this in the mannerwhose validity has been recognized (Cuthbert andGoodheart, 2007) requires considerable training onthe part of the examiner (Caruso and Leisman, 2000;Mendell and Florence, 1990).

e Is the contact point on the patient the same eachtime the muscle is tested? Here the examiner shouldreproduce the contact point as precisely as possible,since the amount of leverage has been shown to affectthe performance of each test (Kendall et al., 2005;Reese, 2005; Daniels and Worthingham, 2003; Walther,2000). Specific data documenting the amount of vari-ability allowed in these matters without altering MMTresults are currently lacking. The position of thepatient during the MMT should also assure the patientthat he or she will not fall off the table, a fear which,without reassurance, could allow the test muscle togive way prematurely.

f Is the point of contact on the examiner the same eachtime the muscle is tested? If this varies, one couldsuggest that the examiner will receive different nerveimpulses from the mechanoreceptors in the fingers andinterpret these as varying amounts of pressure, and,more importantly, the leverage changes and the musclefibers being tested will be different. A more systematicexperimental investigation of this consideration isrecommended.

g Are the examiner’s elbow, arm and forearm in thesame position for each test? This again reduces thepossibility that the examiner will interpret differentamounts of pressure with varying positions. It also isdesigned to avoid having the examiner recruit his or her

whole body weight, overpowering the patient’s muscle.Again, a more systematic experimental investigation ofthis consideration is recommended.

h Are the examiner’s shoulders in the same plane andrelaxed each time the muscle is tested? This likewiseavoids having the examiner leaning over the patient,thus transferring body weight.

i Is the examiner’s body in the same position, engagingthe core muscles in the same way each time thepatient’s muscles are tested? Careful visual inspectionof the patient during the MMT will frequently detectchanges in the test parameters (Kendall et al., 2005;Walther, 2000).

What these factors essentially point to is a premisestated earlierdthat the patient’s reaction to the exam-iner’s applied force in MMT is a complex neural phenom-enon which involves both the sensory and motor systems(Reese 2005; Walther, 2000).

Validation of MMT

In a detailed literature review of manual muscle testing,Cuthbert and Goodheart point out that the careful obser-vance of the principles of MMT described above could befound in 10 studies which yielded statistics (Cohen kappavalues, interclass coefficients or percent agreement at 0.6 orhigher) supporting the reliability of MMT (Cuthbert andGoodheart, 2007). Even when MMT tests were conductedover varying periods of time (1e3 s), a kappa value just under0.6 (0.54) was obtained (Conable, 2010). Specifically, thevalidity of MMT (appropriateness, truthfulness, authenticity(Payton, 1994), and clinical justification or effectiveness ofan observation or measurement) e can be supported fromfive different perspectives, both theoretical and practical:

1. Construct and Content Validity: This measurement canbe used to make a specific inference and is the theo-retical foundation upon which all other types of validitydepend. These are demonstrated through logical argu-ment rather than from experimental data:

a. Properly innervated muscles could generate greatertension than partially innervated ones occurring inpatients with anterior horn cell damage (Lovett andMartin, 1916; Martin and Lovett, 1915), except inthe case of spasm due to damage to the CNS.

b. In a hypothesis as to the causes of chronic back pain,ligament subfailure injuries have been proposed tolead to muscle control dysfunction (Panjabi, 1992).AK attempts to extend this finding by hypothesizingthat this altered muscle function can be determinedby MMT, supported by multiple years of clinicalobservations .

c. Electromyographic activities demonstrate thatpatients with neck pain exhibit greater activation ofaccessory neck muscles during a repetitive upperlimb task compared to asymptomatic controls. Thisis hypothesized to represent an altered pattern ofmotor control, compensating for the reduced



activation of painful muscles (Cuthbert et al., 2011;Falla et al., 2004a, 2004b).

d. Muscle dysfunction and its detection by MMT arerelated to low back pain (Arab et al., 2011; Hodgesand Richardson, 1996; Janda, 1978), anterior kneepain (Mellor and Hodges, 2005), anterior groin pain(Cowan et al., 2004), ankle pain (Zampagni et al.,2008), temporomandibular joint pain(Tschernitschek and Fink, 2005), neck pain(Cuthbert et al., 2011; Falla et al., 2004a, 2004b;Ylinen et al., 2004), and patellofemoral painsyndrome (Cowan et al., 2001). (See Appendix 1)

2. Convergent and Discriminant Validity: MMT is able todemonstrate either strong (convergent) or low(discriminant) correlations between two variables:a. Patients with or without upper limb complaints

could be successfully distinguished with the testingof 14 muscles (Jepsen et al., 2006).

b. The testing of hip extensor muscles discriminatedbetween 16 patients with and 18 patients withoutpost-polio syndrome (Perry et al., 2004).

c. Therapy localization (defined below) to the ileoce-cal valve point produced weakness in MMT, corre-lating with the presence of low back pain in patientswith a sensitivity of 87% with this condition anda specificity of 97% lacking low back pain (Pollardet al., 2006a). The ileocecal valve point is a loca-tion on the body hypothesized to represent thefunction of the ileocecal valve and associated withvarious syndromes, including low back pain (Pollardet al., 2006b).

d. A symptomatic group of patients with mechanicalneck pain demonstrated significantly positive (weak)MMTresults compared to a control group lacking neckpain, suggesting that MMT is potentially a sensitiveand specific test for evaluating cervical spinemuscular impairments in a patient with mechanicalneck pain Specifically, 139 of 148 patients reportingneck pain showed positive MMT results in at least oneof the four MMT tests, while just 30 of 100 patientswithout mechanical neck pain displayed such results,suggesting a sensitivity of 93.9% and a specificity of70% (Cuthbert et al., 2011).

3. Concurrent Validity: The MMT may produce similar andreproducible results when compared to a similar (butnot identical) test that has established its validity asa gold standard, regardless of whether the testing isdone by medical doctors (Lawson and Calderon, 1997),physical therapists (Schwartz et al., 1992; Bohannon,1986, 2001; Marino et al., 1982), or chiropractors(Perot et al., 1991; Caruso and Leisman, 2000):a. Comparisons of MMT test results with those obtained

from a dynamometer have been successful(Bohannon, 2001, 1986; Leisman et al., 1995;Wadsworth et al., 1987; Marino et al., 1982).However, because dynamometry and electromyog-raphymeasure different aspects ofmuscular activity,there is the possibility of obtaining false positive orfalse negative data (Harms-Ringdahl, 1993).

b. For practitioners with five or more years of experi-ence, there is a strong correlation (268 out of 274

tests administered) of the results of MMT and thoseobtained with a force transducer and electro-goniometer (Caruso and Leisman, 2000). Theconcurrent validity of the MMT (in comparison toa force transducer and goniometer) was excellentand confirmed the clinical judgments of the practi-tioners as far as muscle resistance and movement ofthe test muscles was concerned.

c. Sequential examinations with MMT and myometry at11 time points after spinal cord injury extending to24-months revealed 22 of 24 correlations with pvalues <0.001 (Schwartz et al., 1992).

d. Responses of the tibilialis anterior muscle revealedEMG differences that correlated with the differ-ences found between strong and weak MMToutcomes (Perot et al., 1991).

4. Expanding Construct Validity: In 1952, Kendall andKendall were the first to expand the construct validityof the MMT (Kendall et al., 2005). Based on theiranalysis and detailed records of 12,000 cases in thephysical therapy department at the Children’s Hospitalin Baltimore, they found positive MMT findings associ-ated with a broad array of postural disorders andmusculoskeletal symptoms far beyond the post-poliosyndromes and upper motor neuron deficits that theMMT was originally designed for in the first decade ofthe 20th century. Furthermore, muscle dysfunctionshave since been linked to the lymphatic system, thevascular system, cerebrospinal flow and the acupunc-ture system of meridians as well as the nervous system(Walther, 2000) This concept represents aspects of AKtheory which have been amply described in numerousreliability, case and case-series reports, before-aftertrials, nonrandomized controlled trials, observationalstudies and randomized controlled studies (www.icak-usa.com, Leaf, 2010; Frost, 2002; Walther, 2002,2000; Schmitt and Yanuck, 1999; Gin and Green, 1997;Goodheart, 1964e1998) and supported by reliabilityand observational studies. However, they are beyondthe scope of the current discussion and in need ofrandomized controlled trials before the relevance ofeach of these factors can be confidently shown(Cuthbert and Goodheart, 2007). For these reasons, it issuggested in AK that physical, chemical, and mental/emotional disturbances are associated with secondarymuscle dysfunction, affecting the anterior horn of thespinal cord and producing a measurable muscle inhibi-tion which is often followed by the overfacilitation ofan opposing muscle and producing a postural distortion(Cuthbert and Goodheart, 2007). This hypothesis isconsistent with the studies of Lund and othersdescribed above (Lund et al., 1991).

5. Clinical Justification/Effectiveness: Numerous casestudies have supported the appropriateness of AKtechniques for managing clinical conditions whereother treatment options have failed:a. Whereas oral anti-inflammatory agents, cortisone

injections, and chiropractic manipulative therapyprovided little relief of a congenital bowel abnor-mality manifesting as chronic low back pain in a 29-year-old man, the stimulation of Chapman’s neuro-lymphatic reflexes by the patient after their analysis



together with an evaluation of traditional acupunc-ture meridians resolved all symptoms (Caso, 2004).

b. A 10-year-old male with a 3 year history of neck painand headaches and 4 years of asthma attacksresponded favorably to chiropractic (spinal andcranial) treatment guided by applied kinesiology in 5treatments over a 3 week period, remainingsymptom free for 2 years Previous use of medica-tions, visits to the pediatrician and the emergencyroom had kept the asthma in check but did notpermit exercising without significant respiratorydistress. A marked increase of the patient’s readingability to his own grade level was noted as well(Cuthbert and Rosner, 2010a).

c. A 30-year-old male with a right arm contracture,atrophy, and weakness resulting in a general paral-ysis of the forearm and index finger respondedfavorably in 8 treatment sessions to conservativecare guided by AK diagnostic methods, whereasprevious surgical and pharmacological interventionshad failed (Charles, 2011).

d. A consecutive sample of 157 children aged 6e13-years with documented histories of difficulties inreading, learning, social interaction, and schoolperformance received a multimodal chiropractictreatment protocol, including applied kinesiologytechniques. Scores in 8 standardized psychometricand 20 cognitive function tests improved aftertreatment, reflected by the enhanced ability of thepatients to concentrate and maintain focus andattention (Cuthbert and Barras, 2009).

e. Daily stress and occasional total urinary incontinencein 21 patients aged13e90were significantly improvedby chiropractic and applied kinesiology methods,after the identification of several inhibited musclesby MMT. Treatments ranging from 3 to 15 weeksmarkedly improved conditions that had persisted forup to 49 years. These improvements were observedfor at least 2 years (Cuthbert and Rosner, 2011).

Thirty-three indexed, peer-reviewed case and case-series reports of positive experiences for patients(n Z 1e154) treated with AK techniques have been pub-lished (Appendix 1). A review of CHIROACCESS (MANTIS)shows that since 1976, more than 500 outcomes studies(n Z 1e1500) covering a broad array of Type N and Type Oconditions have been published, suggesting the usefulnessof AK technique in the diagnosis and treatment of patients(Cuthbert and Rosner, 2011; www.icakusa, 2011; Cuthbertand Goodheart, 2007).

Biological plausibility of “therapy localization”and “challenge” in the literature

Individuals engaged with AK theory are well aware of twoadjunctive postulates. Therapy localization (TL), strictlydiagnostic, demonstrates a change of muscle facilitationwhen the patient’s hand is placed over an area of suspectedinvolvement, thought to involve the cutaneomotor recep-tors and reflexes. Challenge defines a forceful stimulationimparted through the skin to affect the muscle spindles,

golgi tendon organs, trigger points, and especially jointmechanoreceptors which TL cannot reach. Both areproposed to guide therapeutic interventions (Appendix 1;Walther, 2000). Given the complexity of symptoms ondisplay in the typical patient, including pain and dysfunc-tional tissues or joints, one asks where would it be mostappropriate to initiate treatment. Presumably, the MMTidentifies the dysfunctional tissue in the locomotor system.With further sensorimotor stimulation from TL, followed byspecific challenge to the underlying tissue with the positiveTL, further clues would be offered in a timely fashion as tothe interventions needed to correct this dysfunction.

TL was first proposed by Goodheart, who noted that,when a patient touches an area which is functioningimproperly, the results of the MMT change (Goodheart,1974). For example, if the sacroiliac articulation is dys-functioning (thus causing the proprioceptors or myotomesto be adversely stimulated), the hamstrings may test weak.If the sacroiliac dysfunction is a functional, manipulabledisorder, when the patient places his or her hand over thelesioned area of the sacroiliac joint, the hamstrings, whichpreviously tested weak, will immediately regain normalfunction and test strong (Fig. 1). The articular problem(s)underlying the impaired hamstrings muscle can be quicklyassayed. The patient can rapidly TL the left, then right,sacroiliac joints, the lumbar spinal articulations, theattachment points or belly of the muscle itself, and more.Each of these TLs are followed by a specific MMT to thehamstring muscle. The TL that produces the optimalresponse in the muscle is then treated; i.e, guided bychallenge to the joint or muscle tissue found by the TL.

The essence of TL in theory is that input from low-threshold mechanoreceptors in the skin can modulate

Figure 1 If a sacroiliac somatic dysfunction is the cause ofa hamstrings muscle inhibition, TL to the lesioned portion ofthe sacroiliac joint will strengthen the hamstring muscleimmediately upon retesting.



ongoing activity in muscles. In other words, stimuli that areapplied to different somatic sites may be capable ofinteracting in such a manner that one stimulus controls theneural activity recorded at another site. This has beendemonstrated in a variety of approaches involving objectivemeasurements in the basic sciences, often in animalstudies. Anticipating this, Goodheart hypothesized that theactivity of TL correlates with a spinal gating mechanismreminiscent of the gate control theory of pain perception(Goodheart, 1964e1998; Melzack and Wall, 1973). Specifi-cally, TL stimulates mechanoreceptors, thereby influencingpain perception and muscle function. This is consistent withHilton’s Law, which states that “a nerve trunk whichsupplies the muscles of any given joint also supplies themuscles which move the joint and the skin over the inser-tions of such muscles.” (Chaitow and Delany, 2008, Hilton1863). This would imply that dermatomes are neurologi-cally integrated with myotomes and sclerotomes, producingassociated sensory and motor dysfunction. Should there bean organic or biomechanical encroachment or compressionaffecting the ventral nerve root, for instance, one couldanticipate autonomic impairment in the associated viscer-otomes and dermatomes. This is found in routine AKexaminations.

Many synergistic muscle groups share common afferentinputs (Mense and Simons, 2001). This suggests thatafferent stimulation from muscle spindles in one group ofmuscles supply the motor neurons in which they areembedded, as well as other synergistic muscles (Gielenet al., 1988). Returning to Hilton’s Law, one can thenappreciate a consistency, for the nerve supplying a jointsupplies also the muscles which move the joint and the skincovering the insertion of these muscles.

This discussion is limited to joint, muscle, and skinreceptors. Distinctions of the multiple types of glabrousskin receptors, hair cells, and juxtacapillary receptorsaccording to morphology, sensation, rate of adaptation,and receptive field, is beyond the scope of this paper.

Evidence supporting the biological plausibility of TLis provided in human studies

1. In patients with chronic cervical radiculopathy, lightpressure in the symptomatic arm is painful andaccompanied by a widespread increase in EMG activity.Palpation of adjacent soft tissues is painless andunaccompanied by EMG activity. The light pressureapplied is similar to what happens in TL when thepatient gently touches an area of suspected injury ordysfunction, producing a change in muscle functionthat can be useful in diagnosis (Hall and Quinter, 1996).

2. Taping has been found to alter foot mobility and neu-romotor control of gait in individuals with leg pain(Franettovich et al., 2010) as well as pain-free gripstrength and pressure pain thresholds (Vicenzino et al.,2003). The light pressure applied could serve asa demonstration of what occurs in TL.

3. Strong synaptic coupling exists between the tactileafferents in the sole of the foot and motoneuronssupplying muscles that act about the ankle. This wasshown with microelectrodes which were inserted

percutaneously into the tibial nerve of human subjects,in which reflex modulations of whole muscle electro-myography (EMG) were observed for each of 4 classes oflow-threshold cutaneous mechanoreceptors. Simplystated, this study demonstrates that stimulation of theskin may be responsible for changes in muscle strength,which is the basic tenet of TL. Indeed, the cutaneo-muscular reflexes observed may be themselves a part ofthe mechanism of TL (Fallon et al., 2005; Nicholaset al., 1980).

4. EMG recordings in 15 patients demonstrated thatstimulation of the median nerve reduced the size andnumber of descending corticospinal volleys that wereevoked by transcranial magnetic stimulation in relaxedor active muscle. This suggested that mixed or cuta-neous input from the hand can suppress the excitabilityof the motor cortex at short latency, which maycontribute to the initial inhibition of the cutaneomus-cular reflex. This, in turn, would be expected to reflectin changes in muscular strength in MMT, which would bethe essence of TL (Tokimura et al., 2000).

However, none of these approaches have yet accounted foroperator and patient expectations during the process of TL,which could produce changes in muscle function. Anexperimental procedure which would shed light on thisphenomenon and possibly rule out this confounding factorwould be to assign an intermediary to covertly signal to thepatient whether or not to perform a TL which is hiddenfrom the examiner during a MMT. Although the patient inthis fashion could not be blinded, the examiner would makea judgment free from the bias of observing whether or nota TL has been performed. A step in this direction wasrecently achieved by Pollard and his coworkers, who ob-tained fair to substantial agreement between 2 practi-tioners testing 6 proximal leg muscles when all visual,verbal and nonverbal cues were removed from view of theassessing practitioners. Specifically, participants wereinstructed to avoid all communication with the practi-tioners or give them any visual cues to maintain blinding inthe study. Practitioners, on the other hand, were instructedto exit the room whenever the patient changed position soas to avoid any cues regarding the pain status of theparticipant. The percentage of correct responses from bothpractitioners was represented as kappa scores of 0.21e0.8,depending upon the muscles tested (Pollard et al., 2011).

Other findings supporting the concept of TL occurin animal studies

1. In cats, microelectrode recordings in the thoracic cordreveal that cells located in the lamina 5 respond to boththe fine myelinated afferents from the splanchnic nerveas well as to afferents from the skin, suggesting theconvergence of signals (Hoheisel and Mense, 1990;Pomeranz et al., 1968).

2. In cats, thermal and mechanical stimulation of the skinat various segmental levels elicit reflex changes in theheart rate (Kaufman et al., 1977).

3. In rats, colorectal distention produces a viscerosomaticreflex, as quantified by taking electromyographic EMG



recordings from the external oblique muscle of theupper abdomen (Shafton et al., 2006).

4. In rats, afferent inputs from the skin and viscera affectboth the activity of both the bladder and skeletalmuscle surrounding the urethra (Morrison et al., 1995).

Although these findings could be used to support TL spec-ulations, no research has been published to support thehypothesis that patient hand contact could evoke responsessuch as those using MMT. Such investigations are currentlyin progress.

The third element of AK, as previously described, ischallenge. After an external stimulus is applied, MMT isperformed a second time to determine whether or nota change in muscle strength has occurred. An example ofthis procedure would be to conduct a MMT of a musclecrossing or attaching to the knee. The physical challenge ofreducing the misalignment suspected in the articulation ofthe knee would strengthen the weak muscle, confirming theneurological inhibition that was originating at the knee anddemonstrating the angle of correction needed tostrengthen the inhibited muscles(s). The physical manipu-lation in the direction of the positive challenge would thenabolish the inhibition (Fig. 2). The reader will note thesimilarity to TL, except that TL is restricted to light touchof a cutaneous area and is customarily performed by thepatient.

Both challenge and TL may help to steer the therapistaway from areas that produce no change in musclestrength, such that treatment alternatives to the patientare narrowed and the therapy becomes more efficient.

Cranial challenge has previously been described in theliterature (Cuthbert and Barras, 2009; Cuthbert and Blum,2005).

Sensorimotor challenges: the evolution ofa method of assessment

The visual diagnosis of a specific joint disturbance in thebody and simultaneously evaluating its relationship tospecific local or remote muscle impairments has beendescribed to be “fraught with difficulty” (Lederman,2010). The different elements within the chain of eventsthat a patient performs in front of the examiner occurwithin a fraction of a second, too rapidly to be accessedindividually in the absence of laboratory tools. Therefore,what is actually observed by the examiner who dependsupon visual diagnosis of muscle-joint interactions is thegrand total of how rapidly and smoothly a person’s globalposture changes between two activities. However, it isalmost impossible to make a diagnosis of a specific muscleor joint dysfunction on this basis (Jarosz, 2010; Lederman,2010).

Regarding the assessment of the sacroiliac joint by wayof example, the development and practicality of AK theorycan be best appreciated by the following:

1. Prone Hip Extension:

The Prone Hip Extension (PHE) test was developed byJanda et al. (2006) as a means of assessing motor control ofspecific low back and thigh muscles. Janda claimed that thealtered movement patterns of the muscles proximal to thesacroiliac joints in patients with dysfunctions could bedetected by observation alone, with light palpation addedif the visualization of the imbalance was unclear fora variety of reasons (Fig. 3). During the PHE test, thephysician observed and/or palpated the ipsilateral gluteusmaximus, ipsilateral hamstring, ipsilateral erector spinae,and contralateral erector spinae muscles in order todetermine the order of activation. Janda theorized that themuscle activation sequence during the PHE simulated themuscle recruitment pattern of hip extension during gait(Fig. 4).

2. Form Closure of the Sacroiliac Joint:

Vleeming et al. (2007); Lee (2004) in their “form andforce closure” model of the sacroiliac joint function have

Figure 2 Pressure (“challenge”) in the direction of thearrows will improve the position of the knee somatic dysfunc-tion and strengthen the quadriceps muscle which is presumedto be weak because of the somatic dysfunction. It is suggestedthat manipulative correction in the directions of the arrowswill stabilize the joint somatic dysfunction and its consequentinhibition of the quadriceps muscle. Figure 3 Abnormal PHE test with palpation.



added a sensorimotor challenge for the assessment of jointdysfunction’s influence upon muscular strength and rangeof motion. This method helps diagnose the structuresimplicated in the movement impairments of the PHE test.Vleeming and Lee’s functional tests help the cliniciandetermine the characteristics of form and/or force closureproblems in a particular joint by using tests that identifyimproved function and ranges of motion (Fig. 5).

3. AK sensorimotor challenge

Because of the difficulties in accurately measuring visualchanges in movement patterns, and thereby diagnosing thespecific muscle or joint impairments responsible for thealtered movement patterns found, Goodheart (Goodheart,1973, 1972) developed a method of assessment thatpermitted a specific sensorimotor challenge to a muscle orjoint to be immediately followed by a specific MMT toa local or distant joint or muscle; if these factors wereconnected, then an immediate change in strength of themuscle was seen to occur.

In other words, in the AK model of sacroiliac assess-ment, instead of using a visual test for a change inmovement after the physical challenge to the joint, whathas been defined as the AK sensorimotor challenge isfollowed by a MMT for a change in strength. In mostsacroiliac joint dysfunctions, there will be a combinationof vectors during the challenge procedure that causes the

maximum amount of strengthening of the indicatormuscle. This becomes the optimal vector for correction aswell, the diagnostic test leading to a presumably moreprecise treatment.(Fig. 6).

To sum up, in the AK assessment of the sacroiliac joint,the specific functional strengths of the gluteus maximus,gluteus medius, piriformis, quadriceps, abdominals,hamstrings (biceps femoris, vastus lateralis and medius)and latissimus dorsidcritical to the adequate force closureof the sacroiliac joint (Vleeming et al., 2007) e are tested.Additionally, the effect of stabilization (the AK sensori-motor challenge) of proximal or distal structures like thesacroiliac joints, lumbar vertebral joints, cervical spine(with TL and challenge) upon each of these muscle’sfunctions is an important addition to the AK system ofanalysis. The MMT of each of the muscles involved (andtheir association to one or more structures located locallyor distally) is believed to untangle these complex adapta-tions to sacroiliac joint dysfunctions. In addition, the AKmethods of TL and challenge offer further insight into thePHE test (Fig. 7).

Specifically, Cuthbert (2012) presented an outcomesanalysis of the tests developed by Vleeming et al. (2007);Lee (2004); Janda (1983a) when the AK procedures of TLand challenge were added to these tests. This studydemonstrated that measurable improvements in range ofmotion occurred when TL or challenge were applied toa dysfunctional area in the patient, and producedimprovements in the range of motion of the PHE and formand closure tests.

Figure 4 Abnormal PHE test: In this test there is a lumbarextension, anterior pelvic tilt, and knee flexion.

Figure 5 With “form closure” of the sacroiliac jointaugmented (the sacroiliac joint approximated), the pronestraight leg raise is visually improved.

Figure 6 The AK sacroiliac challenge (right ischium, leftilium) produces immediate strengthening of the previouslyinhibited ipsilateral hamstring muscle.



Nutritional evaluation in AK

The potential of nutritional MMT performed by AK practi-tioners was demonstrated in one positive pilot study whichconfirmed 19 of 21 food allergies by a radio-allergosorbenttest (RAST) and immune complex tests for IgE and IgGagainst 21 foods that produced muscle weakening (inhibi-tion) reactions with oral provocation. Subjects, but notpractitioners, appear to have been blinded in the study(Schmitt and Leisman, 1998). Several failures to confirm thevalidity of nutritional testing have also appeared in theliterature, however.

Because of neurological involvement, training, andpositioning issues raised earlier, MMT in professional AK isa highly complex and skilled undertaking. In a statusstatement published in 1983 and updated in 1987, theInternational College of Applied Kinesiology stated:

“Nutritional evaluation (by muscle testing) should bedone only with the subject tasting the substance. It isalso necessary to evaluate other factors which mayinfluence the perceived muscle strength. Confirmingdiagnostic criteria for the need of any nutrition shouldbe present from the patient’s other diagnostic work-up,which may include history, type of dysfunction, labora-tory tests, physical diagnosis, and dietary inad-equacies.An adequate educational background isneeded in evaluating nutritional needs and manualmuscle testing. (International College of AppliedKinesiology, 1984).”

Accordingly, the likelihood of omitting or misinter-preting essential elements of AK from the derivativeprocedures that have been cited in the literature is high,such that many of the criticisms of MMT in AK may havebeen directed at renderings of AK not performed byindividuals specifically trained in professional AK.Indeed, from the very beginnings of AK, Goodheart wrotethat lingual receptors must be stimulated in order toperform reliable and reproducible nutritional testing. Hisresearch manuals repeatedly state that “holding a glassvial of pills” or “laying pills or substances on the chest”were inappropriate procedures because the responseswere not predictable, to say nothing of inexplicable(Goodheart, 1964e1998). Hambrick (2007) confirms thisby showing that 5 examiners found little correlation

between “on-the-body” testing of toxic substances (thatnormally would inhibit a patient due to their noxiouschemistry) and MMT findings. The taste receptors on thetongue respond to even miniscule concentrations ofsubstances within a fraction of a second of stimulation(Guyton and Hall, 2005). Exposure to taste elicitsa variety of immediate neurological, digestive, endo-crine, circulatory, and renal responses throughout thebody and has been called the cephalic or preabsorptiveresponse (Mattes, 1997).

Critical assessment of AK in the literature

A review of 20 Applied Kinesiology papers sampled froma non-refereed source (International College of AppliedKinesiology, 1981e1987) reported that no studies con-tained all 9 of the methodological attributes judged anddescribed above to be important criteria for researchquality. For example, 12 of 15 studies required a controlgroup but had none; 13 of 14 failed to include a requiredblind assessor, and none presented an acceptable statisticalanalysis. Other criteria deemed to be of importance but notconsistently appearing in the studies included (1) sufficientsample size,(2) inclusion criteria, (3) a reliable test mech-anism, and (4) the use of blind and naı̈ve subjects(Klinkowski and LeBoeuf, 1990).

It is important to note that Klinlowski’s review chosea source of research presentations that circumvented thepeer review process of a typical refereed medical journal.In the more than 20 years since this review was published,the papers which have actually appeared in peer-reviewedjournals as cited in this discussion have shown progressoverall with their use of inclusion criteria, incorporation ofcontrol groups, and use of a more reliable MMT often sup-ported with statistics (Conable, 2010; Cuthbert andGoodheart, 2007). The most critical areas still requiringattention involve sample sizes and the blinding of assessor,subjects and examiners. Large-scale randomized controlledtrials are not yet present in the research portfolio.However, the abundance of observational research studiesappearing in the indexed journals must be noted(Appendix 1), together with the findings that more recentobservational studies have been deemed to possesspredictive abilities similar to those from clinical trials(Benson and Hartz, 2000; Concato, 2000). The fact remainsthat all healthcare interventions are presently in need ofa broad cross-section of clinical research designs to achievecomplete documentation, such that the concept ofevidence-based medicine itself is worth revisiting (Rosner,2012). An indication that this diverse documentation ofAK has already begun to appear in the peer-reviewedjournals is already available (http://www.icakusa.com/wp-content/uploads/2011/08/AK-Research-Compendium-Dr-Scott-Cuthbert-10-08-11-LATEST.pdf).

Generally, many procedures which have derived from AKdo not appreciate that:

1. It is misleading to attach all one’s confidence toobjective measurements of the strengths of muscles(including handheld dynamometry, fixed frame dyna-mometry, and isokinetic measurements). All of these

Figure 7 As Janda proposed (Janda, 1964) in sacroiliacstrains, the ipsilateral gluteus maximus will test weak. With TLto the sacroiliac joint, the gluteus maximus tests strongerdor,in this scenario, the PHE test is improved. TL allows for therapid sensorimotor stimulation of many different areas (e.g.,the upper neck, lumbar spine, and jaw) until the one cor-recting the test or inhibited MMT is found.



yield a vast range of strength scores which do not yethave reliable reference values. Under such circum-stances, their associated errors in clinical determina-tions have not yet been fully established (Dvir andPrushansky, 2008).

2. The investigations byTriano (1982), while correctlyblinding both patient and practitioner from variousnutritional extracts tested, failed to distinguish MMTstrengthening of the latissimus dorsi (LD) when tissuesubstances from a variety of sources were administeredeither sublingually or topically. The LD, originally foundto be inhibited, responded with roughly equal proba-bility despite the source (pancreatic, cardiac, thymic,or testicular) of the extract, contradicting the opinionsof ICAK Diplomate members that the pancreatic extractshould have exhibited a unique strengthening effect.However, numerous flaws substantially weaken thisinvestigation’s conclusions:a. The tests were conducted on lingual receptors

instead of the sublingual species described,a descriptive and rather common error (Goodheart,1983).

b. There is no indication that subjects underwenta washout period prior to testing, such as fasting oravoiding cosmetics or body lotions for at least 12 hbefore experimental procedures were begun.

c. There is no indication of medications taken by thesubjects, which could have confounded results.

d. For the ingested substances, no effort was made torinse the mouth between administrationsdincreas-ing the possibility of carryover.

e. There is no indication that the subjects weremonitored closely enough to avoid changes in thetest position or recruitment of synergistic musclesduring the duration of their individual tests.

f. It has been shown elsewhere that no single nutri-tional factor correlates with a specific muscle perse; rather, the overall health (including emotionalstate) of the patient influences to what extentmuscle function will change in response to nutrients(Leaf, 1985). Reference is made to the quotationstated above regarding the complexity of nutritionaltesting (International College of Applied Kinesiology,1984). The finding that all subjects in response to allsubstances administered using either challengeprocedure (ingestion or topical application) dis-played muscle strengthening only 25% of the time onthe average with little deviation might suggest thatnumerous other confounding factors affectedmuscle reactivity.

Nevertheless, the research repeating Triano’s designincluding the controls suggested above has yet to be per-formed. Triano has correctly pointed out that he wouldwelcome the replication of his study pending an objectivecharacterization of the perceived weak muscle (Triano,1983), but the discouragement of further investigations inhis original article (Triano, 1982) along with the usage ofsuch terms as “obvious lack of foundation” and“purported” are problematical and detract from the needfor objectivity and replication in research (Poortinga,1983).

3. “Kinesiology” as defined by several negative studies(Schwartz et al., 2009; Hall et al., 2008; Haas et al.,2007; Kendler and Keating, 2003; Ludtke et al., 2001;Arnett et al., 1999; Sapega, 1990; Brand, 1989;Quintanar and Hill, 1988; Kenney et al., 1988; Radin,1984; Friedman and Weisberg, 1981) fails to meet theeducational and training standards of MMT describedabove and omits citingdlet alone discussing e most ofthe research literature supporting AK:a. A literature review which is critical of AK (Hall et al.,

2008) discusses various adaptations of a derivativeprocedure called Touch for Health (a derivativeapproach that uses acupressure, massage and touchin order to reduce pain, improve postural balance,and alleviate tension) rather than the specificmethods in AK:

b. Another widely cited study addressing nutritionalMMT evaluated 11 subjects independently by 3examiners for 4 nutrients and failed to demonstrateany correlation of MMT results with either laboratorydeterminations of blood levels of the nutrients ormuscle contraction using a Cybex II dynamometer(Kenney et al., 1988).1] The most apparent problem in this report was that

it utilized two lay persons and a chiropractor usingRidler points as the reflex points for testing. Asearch of PubMed and MANTIS can find no evidencebeyond the Kenny study for the validity of usingRidler points. It was pointed out (Goodheart, 1968)that this approach could not have involvedprofessional AK; rather, the investigation had beencarried out by a majority of persons not licensed ashealth practitioners, thus being ineligible to gainprofessional status in AK from the InternationalCollege of Applied Kinesiology.

2] The typical nutritional test chart presented in thisreport is not a part of AK, nor has it ever beenprinted in the AK literature.

3] The article states that “muscle response fortesting for possible nutritional deficiencies is anintuitive science.” While there may be an elementof intuition which is refined with experience(Caruso and Leisman, 2000; Mendell and Florence,1990), the statement as such fails to justify theauthors’ departure from the protocol observed inAK, outlined earlier in this report.

4] The study failed to demonstrate intra- and inter-examiner reliability among the 3 examiners, incontrast to the data in these respects for AK(Cuthbert and Goodheart, 2007).

c. The “arm test” as described in several investigations(Schwartz et al., 2009; Tschernitschek and Fink,2005; Pothmann et al., 2001; Arnett et al., 1999;Sapega, 1990; Brand, 1989; Garrow, 1988; Quintanarand Hill, 1988; Kenney et al., 1988; Radin, 1984;Friedman and Weisberg, 1981) ignores most of thefacets of AK described above.

d. In evaluating possible effects of nutrient, vitamin,or mineral deficiencies in MMT, numerous studies(Schwartz et al., 2009; Kendler and Keating, 2003;Ludtke et al., 2001; Arnett et al., 1999; Sapega,1990; Brand, 1989; Kenney et al., 1988; Quintanar



and Hill, 1988; Radin, 1984; Friedman and Weisberg,1981) erroneously assume that nutritional chal-lenges can be performed by bypassing the gustatoryor olfactory response, which is an essential compo-nent of AK. Taking such liberties may invite criti-cisms which are not germane to AK.

4. Another widely cited study (Rybeck and Swenson, 1980)addressed to nutritional MMT correctly placed sugar inthe subjects’ mouth while comparing the results of MMTof the latissimus dorsi against a mechanical test (peakreading on a force transducer). While changes in MMTcorrelated with the presence or absence of sugar, theydid not with the force transducer:a. The lack of correlation of MMT and the mechanical

device is not surprising, given that there is aninherent difference in parameters measured inmanual and mechanical testing, as mentionedearlier (Harms-Ringdahl, 1993).

b. Both the sensitivity and reproducibility of themechanical device were not evaluated and could belacking.

5. A presentation of AK available in many bookstores(Hawkins, 2002) creates a lengthy list of statements andassumptions which are at major variance with what hasbeen described by the acknowledged founders of AK(Walther, 2000; Goodheart, 1964-1998) and therequirements of professional training as recognized bythe International College of Applied Kinesiology(www.icakusa.com, 2011). Among the more problem-atical statements are such assertions that:a. Weak muscle testing results are always obtained if

the subject is presented with a statement whichinvolves a falsehood, a political dictator, or evenheavy metal music.

b. Subjects may distinguish original works of art fromcopies by means of AK testing.

c. Numerous calculations drawn from kinesiologicaltesting conclude that the advance of consciousnessthroughout the global population has been littlemore than 5 points during a lifetime.

In presenting a variety of arbitrary assumptions whosevalidity seems unlikely, this work depicts a popularizedform of AK which bears little or no resemblance to theaccredited AK procedures which this communication hasattempted to define.

A randomized controlled trial which appears to refute AKand challenge procedures was published by Haas and hiscoworkers in 1994, employing 68 naı̈ve volunteers from thestudent body, staff and faculty of a chiropractic college.The provocative vertebral challenge applied was a stan-dardized 4e5 kg force delivered with a pressure algometerto the lateral aspects of the T3-T12 spinous processes. Thetherapeutic intervention was a manual high velocity lowamplitude adjustment or switched-off Activator instrumentused as a sham. Reactivity of the piriformis musclefollowing a vertebral challenge was assessed, together withresponsiveness following spinal manipulation. Because thepercent of the reactivity to the vertebral challenge wasonly 16% with 0% responsiveness to spinal manipulation, itwas concluded that the muscle response seemed to bea random occurrence unrelated to the manipulable somatic

dysfunction. The conclusion was that MMT seemed to be ofquestionable use for spinal screening and post-adjustiveevaluation (Haas et al., 1994).

The procedure was well-designed in that the shamprocedure using the zero Activator setting more closelyresembled a true placebo as can be obtained in manualmedicine. It was helpful to the reader that Haas distin-guished manual muscle testing per se from its applicationby AK, the specifics of which have been elegantly outlinedmore recently (Conable and Rosner, 2011), and which, infact, this discussion attempts to emphasize in arriving ata clearer understanding of AK. The concern with Haas’investigation, however, was that the majority of thesubjects investigated (60%) lacked pain with only halfhaving stiffness in the thoracic region. Vertebrae withoutsubluxation (somatic dysfunction), fixation, or othermechanical problems should be negative to challenge.Positive results from challenge to the thoracic spinalcolumn from T3 to T12 in this experiment would thereforebe expected to be scanty. Furthermore, the specific vectorof challenge must match the specific somatic dysfunction ofthe vertebra if changes in MMT are to be found and thechallenge procedure is to be of any use in guiding subse-quent therapeutic interventions. General lateral to medialspinous process pressures applied to a vertebra that may beasymmetrically positioned, do not always produce thesought-after muscle responses.

In summary, the validity of numerous studies which havebeen critical of applied kinesiology appears in manyinstances to be no greater than several of the randomizedcontrolled trials, cohort studies, case control studies, andcase studies found in this communication to support variousaspects of applied kinesiology.

Critical areas of investigation yet to becompleted

For an intervention that is just five decades in existence(Goodheart, 1964e1998), AK despite its suggestive promisehas several areas yet to be firmly tested by the followinggeneral questions in order to be able to secure its scientificbasis:

1. What is the intraobserver repeatability of MMT with orwithout TL over short periods of time? And over longerperiods to assess possible diurnal effects?

2. Are the same effects of TL observed when (a) theexaminer is blinded to the areas touched by thepatient, or (b) the patient is told to expect a specificeffect?

3. What amount of variability of contact points of thepatient and examiner affect the results of the MMT?

4. What are the effects of blinding the patient from theexaminer, both in MMT in the clear (i.e. before specificmuscle testing commences) and with TL?

5. What are the outcomes in nutritional testing with bothpatient and examiner blinded?

6. What factors such as stress, previous exertion, fasting,or lack of sleep affect the results of MMT, either in theclear (i.e. before specific muscle testing commences),with TL, or in the presence of a nutritional substance?



7. What are the effects of commonly used medicationsupon MMT?

Conclusions: a users’ guide to AK

Professional AK, a refinement of muscle testing procedures,may provide a notable array of diagnostic benefits in prac-tice. While certain aspects of its scientific plausibility andvalidity can be supported by the modest evidence describedin this report, several critical areas regarding its repeat-ability in the presence of a multiplicity of confoundingfactors have yet to be established. As of yet, MMTefficacy intherapy localization and challenge techniques has not beenestablished in published, peer-reviewed research. AK’shistorical focus upon aberrations in motor and afferentneural activity allows it to provide insight into a broadspectrum of clinical ailments, often at an early stage andtherefore most amenable to treatment. To avoid some ofthe criticisms which have been leveled against AK,a professional training regimen which benefits from themost extensive support in the literature as described in thiscommunication would be indicated. Various forms of AKwhich display the following characteristics may or may notachieve positive and reproducible results in MMT. Theyshould always be greeted with caution in light of the factthat they lack one or more of the validating attributes of AK:

1. Practitioners who are not licensed by their states toprovide diagnoses;

2. Practitioners who have not had sufficient professionaltraining in AK;

3. Practitioners who do not follow in detail the proceduralrequirements of AK described in this report;

4. MMTs that are conducted in isolation, neither in seriesor parallel fashion with the MMT of additional musclesnor as adjuncts to other diagnostic procedures;

5. MMTs which rely solely rather than partially uponinstrumentation for their validation, given that neuralcomponents evaluated by MMT may not be measurableby the instrumentation employed;

6. Nutritional MMTs that are conducted with subjectsholding rather than tasting the substance of interest,failing to engage the gustatory and/or olfactoryreceptors;

7. Nutritional testing which fails to emphasize individualpatient considerations to account for biochemicalindividuality.

This guide is intended to provide a foundation uponwhich more productive dialogues concerning AK researchand practice can ensue. It also may help to createa clearer channel through which multiple health profes-sions can be expected to collaborate and better managetheir patients.

Acknowledgments

The authors are indebted to Katharine Conable, D.C., andDavid Leaf, D.C., for their critical reading of this manu-script, together with suggestions for its content and clarity. A

ppendix

1

Support

ofAKva

lidity:

characteristicsof33

case

reportsofpositive

exp

erience

sforpatients

(nZ

1e15

4)assessedandtreatedwithAKMMTmethods(RCTsindicatedby**).

Authors,date

Diagn

osis

Subject(s)

RepeatedObservations

Treatm

ents

Outcomes

Cuthbert

and

Rosner(201

2)Urinary

Inco

ntinence

(UI),dailystress

UIand

occ

asionaltotalUI,

requiringsanitary

pads

21AKMMTexa

minationand

symptom

reports.

Positive

MMTofthe

pelvic,pelvic

floor,

and

lumbarspinemuscles

appearedin

eve

ryca

sewithUI.

Spinalmanipulation,

flexion-distraction

treatm

ent,

soft

tissue

treatm

entandpercussion

tomyo

fascialtrigge

rpoints

eeach

ofwhichproduce

dinhibitionin

thepelvic

floor

muscles.

Lumbo-sacralnerverootdysfunction

confirm

edin

13ofthese

caseswithpain

provo

cationtests(AKsensorimotor

challenge

);in

8ca

sesthis

challenge

was

absent.

AKtreatm

entnorm

alize

dsymptomsin

10patients,co

nsiderably

improve

d7ca

ses,

andslightlyim

prove

d4ca

sesfrom

betw

een2and6-ye

ars.

Cuthbert

and

Rosner(201

1)Insomnia,anxiety,

breathlessness,

headach

e

64-year-old

female

AKMMTexa

mination,

visualanalogscale,

symptom

reports,

and

Nijmegianquestionnaire

AKspinal,cranialandsoft

tissuetreatm

entto

address

hyp

erventilationsyndrome,

pinealglandcranialfaults.

After1st65

-min

treatment,

patient

reportedherfatigu

e,brain

fog,

and

anxiety

were

improve

d.Ove

r10

day

period

(4treatments),patient’ssleepdifficu

lties

andan

xiety

syndromeswere

resolvedan

dremainedso

for3ye

ars.

Nijmege

nquestionnaire

forhyp

erventilation

syndromemarke

dly

improve

d.

(continuedonnext

page

)



Appendix

(continued)

Authors,date

Diagn

osis

Subject(s)


Treatm

ents

Outcomes

Charles(201

1)Parsonage

-Turner

Syndrome

30-year-old

male

with

righ

tarm

paralysis

AKMMTexa

minationand

symptom

reports

Spinalmanipulation,soft

tissuetreatm

entto

myo

fascialtrigge

rpoints,

exe

rcisesandstretches.

Improve

drange

ofmotionafterfirst

treatm

entsession.Bytheeighth

treatm

ent,

able

tofullystraightenarm

.Threeye

ars

later,

patientable

tomountain

clim

bwitharm

fullyfunctional

andpain-free.

Cuthbert

and

Rosner(201

1)Urinary

inco

ntinence

(UI),requiringsanitary

pads

13-year-old

female,

followingemergency

appendectomysurgery

AKMMTexa

minationand

symptom

reports

Spinalmanipulation,soft

tissuetreatm

entand

percussionto

myo

fascial

trigge

rpoints

eeach

of

whichproduce

dinhibition

inthepelvic

floormuscles.

Patientexp

erience

darapid

resolutionof

herUI.Asix-ye

arfollow

upco

nfirm

ed

complete

resolutionofsymptoms.

Cuthbert

andRosner

(201

0b)

Seve

redaily

headach

es,

7-ye

ars

duration

56-year-old

female,

following3motor

vehicle

acc

idents

AKMMTexa

mination,

Visualanalogscale,and

symptom

reports

AK-guidedch

iropractic

manipulative

therapyand

cranialeva

luationand

treatm

ent.

8visits

duringa3weekperiodrelieve

dvirtuallyallsymptomatology

withthe

score

of0ontheneck

andlow

back

pain

visualanalogscales(VAS).Thepatient

remainedfreeofheroriginalsymptoms

for8ye

ars.

Cuthbert

andRosner

(201

0a)

Deve

lopmentaldelay

syndromes,

asthma,

andch

ronic

neck

and

headpain

10-year-old

male,using

4medicationsfor

asthma.Poorreader

(unable

tomove

easily

from

onelineoftext

toanotherduring

reading),sufferedeye

strain

whilereading,

andpoormemory

for

classroom

material.

AKMMTexa

mination,

parentalandschool

symptom

reports

AK-guidedch

iropractic

manipulative

therapy,

and

cranialeva

luationand

treatm

ent

Child’s

abilityto

readim

prove

d(in3

weeks,after5treatm

ents),

perform

ing

athisowngradeleve

l.Remainssymptom

freefor2ye

ars.

Masarsky

and

Todres-Masarsky

(201

1)

Eva

luationofdivergent

thinkingafterasingle

chiropractic

intervention

16subjects,

15of

whom

invo

lvedin

creative

thinking

work),age

d28

e73

yoa;

13with

musculoskeletalpains;

2underemotional

stress

Pre-andpost-treatm

ent

invo

lvedMMTand

“alternate

uses”

assessmenttests(an

establishedoutcome

measure

relatedto

divergentthinking).

Subjectsinterviewed1

e9days

aftertreatm

ent

forch

ange

sin

creative

output.

1sessionofAKspinaland

cranialtreatm

ent

Pooleddata

ofthetw

oreportsshow

astatisticallysign

ifica

nt(p

Z.030

189)

short-term

enhance

mentofcreative

thinkingorenergy/

focu

swheninvo

lved

increative

work

followingtreatm

ent.



Masarsky

and

Todres-Masarsky

(201

0)

Eva

luationofdivergent

thinkingafterasingle

chiropractic

intervention

10established

patients,9ofwhom

invo

lvedin

creative

thinkingwork;3under

stress;7with

musculoskeletalpains

Pre-andpost-treatm

ent

invo

lvedMMTand

“alternate

uses”

assessmenttests(an

establishedoutcome

measure

relatedto

divergentthinking).

Subjectsinterviewed2

e8days

aftertreatm

ent

forch

ange

sin

creative

output.

1sessionofAKspinaland

cranialtreatm

ent

6ofthe10

subjectsexp

erience

dapost-

adjustmentim

prove

mentin

their

perform

ance

onthealternate

usestest.

Interview

responsesindicatednew

directionsin

areal-worldcreative

task

for7ofthesubjects,

andrenewed

energytowardacreative

project

already

plannedfor6subjects.

Noneofthe

subjectsga

veanyindicationon

interview

thattheircreativity

had

sufferedin

anyway.

“Take

nasawhole,

theresultssugg

est

short-term

enhance

mentofcreative

thinking

followingach

iropractic

adjustment.”

Cuthbert

andRosner

(201

0c)

Sciaticneuralgia,

plantarfasciitis,

and

restless

legsyndrome

78-year-old

male

AKMMTexa

minationand

symptom

reports

AKspinalandnutritional

treatm

ent

Patientwassymptom

freewithin

3weeks,withnorecu

rrence

ofsymptoms

reportedafter7-ye

ars.

Cuthbert

andRosner

(201

0d)

Recu

rrent,

monthly

ear

infectionssince

the4-

monthsofage

with

seve

repostural

imbalance

and

candidiasis

6-ye

ar-old

female

who

hadundergone

antibiotictreatm

ent25

times

AKMMTexa

minationand

symptom

reports

AKspinal,cranial,and

nutritionaltreatm

ent

Childhasbeensymptom

freefor3ye

ars

since

herfirst4AKtreatm

ents

ove

ra3-

month

period.

Cuthbert

andBarras

(200

9)Deve

lopmentalDelay

Syndromes(dyspraxia,

dyslexia,ADHD,

learningdisabilities)

157ch

ildrenage

d6

e13

-years

(86boys

and

71girls)

MMTandaseriesof8

psych

ometric

testsgive

nto

thech

ildrenbya

certifiedspeech

therapistpre-andpost-

treatm

ent;

i.e.Complex

figu

reofReyTest;Borel

eMaisonnyTest

(Loga

tomes);Porteus

Maze

Test;Oriented

Sign

sTest;Auditory

Memory

Test

ofRey;

Piage

teHeadTests;

Rhythm

Reproduction

Test

ofStamback

;and

FacialMotricityTest

of

Stamback

.

AKspinalandcranial

manipulative

treatm

ent

Themost

commonfeature

inDDSis

motorim

pairments.Psych

ometric

testingeva

luatingco

gnitivefunction

showedgo

odim

prove

ments

afterAK

treatm

entin

childrenwithDDS.

Thesugg

estedlinkbetw

eenmotor

impairments

andDDSdescribedin

the

literature

andthemuscle

inhibitions

foundwithmanualmuscle

testing(M

MT)

inthis

groupofch

ildrenwasco

nfirm

ed.

(continuedonnext

page

)



Appendix

(continued)

Authors,date

Diagn

osis

Subject(s)


Treatm

ents

Outcomes

Monca

yoand

Monca

yo(200

9)6vo

lunteers

with

norm

almuscle

function

4medicalstudents

and

2medicaldoctors

MMTandsEMG

assessmentoftherectus

femorismuscle

Stim

ulationofsedation

point(followedbysEMG

measurementofthe

muscle),

andstim

ulationof

tonifica

tionpoint(followed

bysEMG

measurementof

themuscle),

forstomach

meridian/rectusfemoris

muscle.

Stim

ulationofsedationpointforrectus

femorismuscle

produce

dadecrease

insEMG

amplitude;stim

ulationof

tonifica

tionpointforrectusfemoris

muscle

produce

danincrease

insEMG

amplitude.From

theco

nclusion:“W

ehave

beenable

todemonstrate

oneof

theworkingprinciplesofApplied

Kinesiology

inrelationto

tonifica

tionor

sedationthrough

theuse

ofspecific

acu

puncture

points.”

Garten(200

8)Cervicaldystonia

(spasm

odic

torticollis)

Cuthbert

(200

8)Asthma&

diaphragm

muscle

impairment

10patients

(7male,3

female,betw

eenage

sof3and22

.

AKMMTassessments

and

visualanalogrespiratory

impairmentscales,

self-

orparent-reported

improve

mentin

exe

rcise-induce

dasthma

symptoms,

reductionof

respiratory

distress

with

dailyactivity,

reduction

inthefrequency

of

cough

ingduringtheday

andnight,

andease

of

breathing.

AKmanipulative

treatm

ent

methods

Each

patientable

togo

off

theirasthma

medicationsafterarange

of3e

6visits

(cove

ringarange

of14

days

to5months

time)withoutareturn

oftheirasthma

symptoms.

Allpatients

remainedoff

their

medicationsduringfollow

up

periodrangingfrom

3-monthsto

4ye

ars.

Cuthbert

(200

7)Down’s

syndrome

12ch

ildren(11boys,1

girl),

age

s11

monthsto

10.5

years.

Cranialpalpationand

“surroga

te”manual

muscle

testing

Cranial,spinal,nutritional,

andmeridianAK

treatm

ents.

Correctionofprimary

complaints

inthese

children,including:

vomitingor

spittingupafterfeeding,

gastrointestinaldifficu

lties,

asymmetricalmotionofarm

sorlegs;

mixeddominance

;spellsofce

aseless

crying,

lack

ofsequence

ormissing

stage

sin

motordeve

lopment;

dysfunctionswithvisualandauditory

skills;frequentearinfectionsand

sinusitis.



Cuthbert

(200

5)Motionsick

ness

disorder

1:66

yoafemale

2:45

yoafemale

3:9yo

afemale

Proprioce

ptive

testing

(Freeman-W

ykeand

Hautant’stests),AKMMT

andpalpation

Spinalandcranial

chiropractic

manipulative

therapy(CMT)

1:Able

todrive

carandridein

aboatand

airplanesymptom

freeafter4visits.

2:Able

todrive

carsymptom

freeafter6

visits.

3:Able

todrive

inca

rsymptom

free

after4visits

Cuthbert

and

Blum

(200

5)Opticnerveneuritis

exa

cerbatedbyan

Arnold-Chiari

malform

ation(Typ

eI)

ofthece

rebellum

1:20

yoafemale

AKMMTto

diagn

ose

vertebralsubluxa

tions

andcraniallesions;

ocu

larmuscle

testing,

TMJtesting

CranialandspinalCMT

Patienthadlost

hervisionin

therigh

teye

3weeks

previousto

treatm

ent.

After

1visit,

patientco

uld

see20

-30on

Snelleneye

chart.Visualacu

ity20

-13

after3rdvisitandasymptomatic3ye

ars

later.

Meldener(200

5)Post-surgicalhip

disloca

tion

1:75

yoamale

AKMMTto

diagn

ose

muscularweakn

ess

aroundhip

and

through

outthebody

AKandCMTtherapy,

focu

singontheco

nnection

oftheTMJandocc

lusionto

instabilityofthehip.

Nohip

disloca

tionsince

vertical

dim

ensionwasincreasedwithnew

upper

denturesondoctor’sreco

mmendation.

Chungetal(200

5)Dentalocc

lusion

positionproblems

7:male

3:female

AKMMTduring

applica

tionofanoral

dentalappliance

None

AKMMTreliable

andrepeatable

on

differentdays.MMTusefulto

loca

tethe

kinesiologicocc

lusalpositionforthe

fabrica

tionofanoralappliance

totreat

TMJdisorders.

Caso

(200

4)Conge

nitalbowel

abnorm

ality

relatedto

low

back

pain.

1:29

yoamale

AKMMTto

diagn

ose

large

boweldysfunction

CMTandstim

ulationof

Chapman’s

reflexpoints

by

thedoctorandthepatient

athome.

Resolutionofthepatient’slow

back

pain

aswellasim

prove

dbowelfunction.

Monca

yoetal

(200

4)Thyroid-associated

orbitopathy(TAO)

32patients

withTAO,

23withalong-standing

disease,and9showing

discrete

initialch

ange

s

Positive

TL(patient

touch

esareaof

dysfunctionand

weake

ningocc

urs

on

MMT)reactionswere

foundin

the

submandibulartonsillar

structures,

thetonsilla

pharynge

a,theSa

nYin

Jiaopoint,

thelacrim

al

gland,andwiththe

ocu

larlock

test

ofAK.

AKtreatm

entandhomeo-

pathic

remedies

Change

oflidsw

elling,

ofocu

lar

move

mentdisco

mfort,ocu

larlock

,tonsil

reactivityandTraditionalChinese

Medicinecriteriaincludingtenderness

of

SanYin

Jiao(SP6)

andtongu

ediagn

osis

were

improve

d.Clinicaltrialof3e

6monthsshowedallreleva

ntparameters

improve

d.

Cuthbert

(200

3)Downsyndrome

15ch

ildren

Inform

alreport

bythe

parents

ofch

ild’s

functionandhealth

status.

CMTto

thespineand

cranium,withnutritional

support

asneeded.

Improve

dfinemotorskills;use

ofthe

handsandfinge

rs;abilityto

crawl

bilaterallywitharm

sandlegs;abilityto

standandwalk;decrease

intongu

ethrusting;

problemswithears

andsinuses

were

allim

prove

din

functionasnoted

byparents,teach

ers,anddoctor.

(continuedonnext

page

)



Appendix

(continued)

Authors,date

Diagn

osis

Subject(s)


Treatm

ents

Outcomes

Mayk

el(200

3)Block

ednaso-lacrim

al

canal

1:14

-month

male

AKMMTandinform

al

report

ofch

ild’s

function

andhealthstatusbythe

parents.

CMTto

thespineand

cranium

Childtreated5timesove

ra6-week

periodwithresolutionofhis

eye

problem.

Weiss(200

3)Menstrualdifficu

ltyand

exh

austion

1:39

yoafemale

AKMMTandpatient

report

ofco

ndition

Nutritionalco

unselingand

CMTto

thespineand

cranium

Treatm

entto

thesacroco

ccyg

ealarea

withcranialco

rrectionandnutritional

support

improve

dherenergyleve

land

cyclingperform

ance

.Sp

rieser(200

2)Episodic

paroxy

smal

vertigo

1:17

yoafemale

AKMMTandpatient

report

ofherco

ndition

CMTto

thespineand

cranium

aswellasAK/

meridiantherapy

tech

niques.

After4treatm

ents

and3other

treatm

ents

byaQi-Gongmaster,

the

patientremainedfreeofanyve

rtigoat3

yearfollow

up.

Leaf(200

2)Se

vere

equilibrium

problems

1:48

yoafemale

AKMMTandpatient

report

ofco

ndition

Cervicaltractionof6

poundswhilepatient

walkedfor15

min

Afterce

rvicaltraction-distraction-

patientwasable

tostandwithherfeet

toge

therwithnobodysw

ayand

displaye

dnosign

sofnystagm

us.

Grego

ryetal.

(200

1)Womenwithmoderate

toseve

rebreast

pain

88:females,

predominantly

premenopausal,with

cyclicalandnon-

cyclicalbreast

pain

Tenderness

of

neurolymphaticreflexe

sforthelargeintestine

Reflexstim

ulationof

neurolymphaticreflex

points

bythedoctorandthe

patientathome.

Immediately

aftertreatm

ent,

there

was

considerable

reductionin

breast

pain

in60

%ofpatients

withco

mplete

resolution

in18

%.2monthsafterinitialtreatm

ent,

there

wasareductionin

seve

rity,

durationandfrequency

ofpain

of50

%or

more

in60

%ofca

ses(P

<.01).

Cuthbert

(200

1)Bell’s

Palsy

1:female

AKMMTto

diagn

ose

cranial,ce

rvical,TMJ,

andmuscularim

balance

s

CMTto

thespine,TMJ,

and

cranium

Complete

resolutionoffacialnervepalsy

after6visits

ove

r14

days.

Calhoon(200

1)Multiple

sclerosis

1:43

yoafemale

AKMMTandpatient

report

ofco

ndition

CMTto

thespine,TMJ,

and

cranium

andnutritional

support

26monthsafterinitialvisit,

patienthad

rega

inedherabilityto

write

andco

uld

showerwithoutassistance

forthefirst

timein

2ye

ars.

Mathewsetal

(198

9)**

Learningdisabilities

10ch

ildrenco

mpared

withaco

ntrolgroupof

10ch

ildrenmatched

forage

,IQ

andsocial

back

groundthathad

notrece

ivedany

treatm

entove

ra

similarperiod.

AKMMTexa

minationand

sensory

challenge

s;the

childrenwere

tested

before

andafter

treatm

entbyan

Educa

tionalPsych

ologist

usingstandardizedtests

ofintelligence

tomonitorch

ange

sin

their

learningskills.

AKtreatm

ent

Educa

tionalpsych

ologist’s

testing

demonstratedch

ildrentreatedwithAK

hadanim

prove

mentin

theirlearning

abilitiesduringtheco

urseof9e

12treatm

entsessionsduringaperiodof6

e12

months.



Masarsky

Weber(199

1)So

maticdyspnea

6:malesandfemales

AKMMTexa

mination

methods;

forcedvital

capacity

(FVC)and

forcedexp

iratory

volume

in1s(FEV-1)

measurements

pre-and

post-treatm

ent(post-

treatm

ent

measurements

take

n3

days

laterto

1month

later).

AKtreatm

entincluding

neurolymphaticand

neurova

scularreflexe

swere

employe

dforthe

diaphragm

muscle;

eva

luationofthemeridian

system;cranial

manipulation(AKmethods);

andtreatm

entforinhibited

musclesinvo

lvedin

respiration.

Allpatients

reportedim

prove

mentin

theirbreathingdifficu

lty.

4ofthe6

patients

alsohadim

prove

dFCVandFEV-

1betw

een0.1and0.8L.

Goodheart

(199

0)Im

balance

dweight

bearingonrigh

tand

left

feet

40patients

40patients

were

eva

luatedforpre-and

post-treatm

entweight

balance

.

AKexa

minationand

treatm

ent

Ofthe40

patients,only

onehadminim

al

change

sin

weightupontw

oscales

beneath

thefeetwhenboth

flexingand

extendingthespine.

Masarsky

etal.

(198

8)Chronic

obstructive

pulm

onary

disease

1:male

AKMMTexa

mination

methods;

forcedvital

capacity

(FVC)and

forcedexp

iratory

volume

in1s(FEV-1)

measurements

pre-and

post-treatm

ent,

cove

ring

an8-month

period.

AKexa

minationand

treatm

ent

Improve

ments

were

notedin

forcedvital

capacity,forcedexp

iratory

volumein

1s,

cough

ing,

fatigu

e,andease

of

breathing(signsign

ifica

ntat0.00

5leve

l).Im

prove

mentwasalsonotedin

laryngo

spasm

.

Jaco

bsetal

(198

4)Thyroid

dysfunction

65:malesandfemales

Patients

eva

luatedfor

thyroid

dysfunctionby

AKandlaboratory

testing

None

AKratings

correlatedwithlaboratory

ratings

(rsZ

0.32

,p<

.002

)andwith

laboratory

ratings

(rsZ

0.32

,p<

.005

).Correlationbetw

eenclinicaland

laboratory

diagn

osiswas0.47

,p<

.000

.3AKtherapyloca

liza

tionshad

asign

ifica

ntco

rrelationwiththe

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