Manual muscle testing of the shoulder

This causes the muscles to hold onto the dysfunctional movement pattern. When you have your muscles tested, your will know which muscles are weakened. This restores proper alignment and function.

You will then be progressed through appropriate exercises to strengthen and retrain the weakened muscles. You will still be working out both sides, however emphasis will be placed on strengthening and restoring healthy movement patterns.

Pressure:Against the forearm in the direction of horizontal abduction. Pectoralis Major Lower Supine Place one hand on the iliac crest to keep pelvis maintained on the table. Test:Have elbow extended in the air have them adduct toward the oppositie illiac crest. Pressure:Against the forearm obliquel in a lateral and cranial direction.

The techniques that we describe for manual muscle testing are basically those described by Kendall and Kendall. It is designed to be easily held in the palm of the hand and reports the force in kilograms. The test is begun by first stabilizing the patient with the limb held in the desired position. The examiner instructs the patient to resist as hard as possible and then gradually applies a force to depress the limb.

The device records the peak force during the movement but care must be taken to stop applying force before the limb touches the side of the body, the floor or the table, depending on the motion being tested. The average of three trials in which a maximum effort is supplied following some practice trials gives the most reliable results. Allow at least 15 seconds between trials. This may add an important measure of objectivity to clinical practice, and potentially increase a patient's awareness about their body and their body's ability for improvement as a result of the therapy given.

To provide the strongest evidence for the use of chiropractic MMT techniques, more randomized controlled clinical trials RCTs and systematic reviews will be essential. Although RCTs will be required to document a cause-effect relationship between treatment and outcome, they are frequently impractical projects for the practicing clinician. This is frustrating because it is the clinician who depends on scientific proof that these techniques work.

Work so far in this area remains largely limited to reliability and observational studies. Unfortunately, there have not been significant efficacy studies in this area, nor have there been many significant efficacy studies conducted in the chiropractic research arena in general [ ].

These 19 case studies demonstrate how the practicing clinician may help narrow the gap between practice and research. Although case reports cannot prove a treatment's effectiveness, they can describe the performance of techniques in a way that can initiate an hypothesis for a future RCT. After 42 years of development and research, the chiropractic profession's use of MMT and AK chiropractic technique has become one of the many diagnostic methods from which some doctors of chiropractic draw their clinical procedures.

In the last forty years we have become more aware of the nervous system. This awareness has allowed us to evaluate patients more completely and from an integrated neuromuscular perspective. This holistic system of approach for the evaluation of neuromuscular function continues to be updated on a regular basis with new and exciting research. Much of the evaluation and treatment of patients using MMT and manual methods remains and will always remain an art.

However, we must provide these artistic endeavors with a solid scientific foundation. Although this narrative literature review offers considerable evidence about the reliability and validity of MMT as an examination tool, most of the rigorous, systematic research on this form of examination has emerged in just the past 30 years.

Although evaluation of patients using MMT methods have been investigated with RCTs, prospective cohort studies, retrospective studies, single-subject case series and case reports, many questions about the MMT remain unanswered.

One shortcoming is the lack of RCTs to substantiate or refute the clinical utility efficacy, effectiveness of chiropractic interventions based on MMT findings.

Also, because the etiology of a muscle weakness may be multifactorial, any RCT that employs only one mode of therapy to only one area of the body may produce outcomes that are poor due to these limitations.

A limitation of this review may involve research published outside the main databases searched, as well as research articles involving some form of muscle testing but not using the terms manual muscle test , manual muscle testing , or applied kinesiology as they may not have been accessed and included here.

In addition this paper has not critically rated each study for its internal and external validity. Such a systematic review should be the subject of future research. Hopefully this literature review has stimulated a desire for others to review the current MMT literature and become an effective user of and contributor to chiropractic MMT research [ , ]. SCC acquired the papers and constructed the literature review.

National Center for Biotechnology Information , U. Journal List Chiropr Osteopat v. Chiropr Osteopat. Published online Mar 6. Author information Article notes Copyright and License information Disclaimer.

Corresponding author. Scott C Cuthbert: moc. Received Feb 14; Accepted Mar 6. This article has been cited by other articles in PMC. Abstract Introduction A body of basic science and clinical research has been generated on the manual muscle test MMT since its first peer-reviewed publication in Results More than 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.

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.

Review The role of the muscle system in spinal function has become increasingly well acknowledged. For the purposes of this review we define MMT as a diagnostic tool and AK as a system for its use and therapy based on the findings of the MMT In this paper we pose the following questions: 1 "Is the MMT approach worthy of scientific merit? Operational Definitions and History of the Manual Muscle Test In order to be meaningful, all measurements must be based on some type of operational definition.

Within the chiropractic profession, the ICAK has established an operational definition for the use of the MMT: "Manual muscle tests evaluate the ability of the nervous system to adapt the muscle to meet the changing pressure of the examiner's test. Kendall et al [ 21 ] state: "As tools, our hands are the most sensitive, fine tuned instruments available. Results Research on the Reliability of the MMT One way researchers determine if a clinical test is consistent and repeatable over several trials is to analyze its reliability.

Good interexaminer reliability shown between experienced and novice examiners. Predictive validity of MMT in patients with symptomatic post-polio syndrome affecting hip extensor muscles was excellent.

Escolar et al 56 12 children with muscular dystrophy 12 novice and experienced examiners To determine reliability of quantitative muscle testing QMT, an instrument for measuring strength compared to MMT MMT was not as reliable among novice examiners as QMT.

Caruso and Leisman 36 27 volunteers who knew nothing about MMT or AK 2 examiners To show the difference between "weak" and "strong" muscles, using MMT and dynamometer testing Study showed that examiners with over 5 years experience using AK had reliability and reproducibility Perception of "inhibition" or weakness made by examiner was corroborated by test pressure analysis using the dynamometer.

Physical therapists A double-blind, multicenter trial to document the effects of prednisone on muscle strength in patients with Duchenne's muscular dystrophy DMD. Reliability of muscle strength grades obtained for individual muscle groups and of individual muscle strength grades was analyzed using Cohen's weighted Kappa. The reliability of grades for individual muscle groups ranged from.

The reliability of individual muscle strength grades ranged from. Concluded that the MMT was reliable for assessing muscle strength in boys with DMD when consecutive evaluations are performed by the same physical therapist.

Barr et al 42 36 boys Upper and lower extremities were evaluated by MMT for function, range of motion, and strength. The data were analyzed using intraclass correlation coefficients ICCs. Results confirm and extend observations by others that these assessment measures are sufficiently reliable for use in multiinstitutional collaborative efforts.

These results can be used to design clinical trials that have sufficient statistical power to detect changes in the rate of disease progression.

Hsieh and Phillips 46 15 asymptomatic subjects 3 chiropractors To determine the reliability of manual dynamometry using AK style of MMT, comparing doctor-initiated and patient-initiated MMT Intratester reliability and correlation coefficients for testers 1, 2, and 3 were 0. The intertester reliability coefficients were 0. Wadsworth et al 45 5 muscle groups on 11 patients physical therapists To compare the intrarater reliability of MMT and hand-held dynamometer tests The correlation coefficients were high and significantly different from zero for four muscle groups tested dynametrically and for two muscle groups tested manually.

The test-retest reliability coefficients for two muscle groups tested manually could not be calculated because the values between subjects were identical. Concluded that both MMT and dynamometry are reliable testing methods, given the conditions described in this study. Florence et al 34 Patients with Duchenne Muscular Dystrophy physical therapists To evaluate the intraobserver and interobserver reliability of MMT evaluation procedures to assess the efficacy of treatment of Duchenne muscular dystrophy.

Showed there was significant improvement in the degree of consistency of a given examiner's MMT scores when the examiner had more clinical experience and training in MMT. Author's concluded that MMT demonstrated reliability for an evaluation method that provided an objective foundation on which to claim if a drug or therapeutic procedure does or does not have an effect in treating Duchenne muscular dystrophy.

Jacobs 44 65 patients with suspected thyroid dysfunction 2 chiropractors To compare AK diagnostic findings with laboratory findings This double-blind study demonstrated an Open in a separate window. Research On the Validity of MMT The next section of Results looks at the relationship between muscle strength as measured by MMT findings and the functional status of patients with a variety of symptoms.

Construct and content validity of MMT Construct and content validity are two types of theoretical or conceptual validity. Authors, date Subjects Design Findings and statistics Hossain et al 90 Literature review Gait analysis studies reviewed show an orderly sequence of muscle activation — this contributes to efficient stabilization of the joint and effective weight transfer to the lower limb.

Gluteus maximus fibres — lying almost perpendicular to the joint surfaces are oriented for this purpose. Biceps femoris is another important muscle that can also influence joint stability by its proximal attachment to sacrotuberous ligament. Altered pattern of muscle recruitment has been observed in patients with low back pain. Because of its position as a key linkage in transmission of weight from the upper limbs to the lower, poor joint stability could have major consequences on weight bearing.

It is proposed that sacro-iliac joint dysfunction can result from malrecruitment of gluteus maximus motor units during weight bearing, resulting in compensatory biceps femoris over activation. The resulting soft tissue strain and joint instability may manifest itself in low back pain. This thesis was also proposed by Janda A reduced performance of the craniocervical flexion test is associated with dysfunction of the deep cervical flexor muscles. Electromyographic activity of the abdominal, and lumbar multifidus muscles recorded by surface electrodes.

Contraction of transversus abdominis was significantly delayed in patients with low back pain with all movements. The delayed onset of contraction of transversus abdominis indicated a deficit of motor control and is hypothesized to result in inefficient muscular stabilization of the spine.

Mean trunk strength ratios were inversely related to disability score P less than. Findings imply that myoelectric signal levels, trunk strength ratios, and ranges of trunk motion may be used as objective indicators of low-back pain disability. The main findings were that good isometric endurance of the back muscles may prevent first-time occurrence of low back trouble LBT in men and that men with hypermobile backs are more liable to contract LBT. Maximum voluntary isometric strengths were measured during attempted flexion, extension, and lateral bending from an upright standing position.

The strength ratios for attempted extension were particularly low for patients with sciatica. Karvonen et al 77 male conscripts. Weak leg extensors showed associations with a history of low back insufficiency and of sick leave due to the back and with current hip pain. Men with a history of lumbago and of hip and knee complaints performed poorly during 12 min of running. The questionnaire and strength measurements proved suitable for studying low back syndrome in its early stages.

Addison et al 76 16 male and 17 female patients with chronic LBP Maximum voluntary trunk strengths in the standing position were measured during attempted flexion, extension, and lateral bending. The trunk strengths of these patients were then compared with those of healthy subjects and with those of patients with low-back disorders who sought treatment as outpatients of a general orthopaedic office practice. When compared with healthy subjects, the patients seeking hospitalization had significantly smaller strengths during attempted extension relative to their strengths during attempted flexion or lateral bending.

The Convergent and Discriminant Validity of MMT Convergent validity exists when a test, as predicted, demonstrates a strong correlation between two variables.

Concurrent Validity of MMT The concurrent validity of MMT has also been examined in several studies comparing strength scores obtained by MMT with strength readings obtained using quantitative instruments. Convergent and construct validity of MMT and dynamometry measurements demonstrated. Caruso and Leisman 36 27 volunteers with no knowledge about MMT or AK 2 examiners To show the difference between "weak" and "strong" muscles, using MMT and dynamometer testing Study showed that examiners with over 5 years experience using AK had reliability and reproducibility when their outcomes were compared.

MMTs of "weak" or "strong" muscles showed significantly different electromyographic measurements and demonstrated a high correlation between testing methods. Schwartz et al 96 patients with spinal cord injuries at C4—C6 physical therapists Relationship between MMT and hand-head myometry compared Sequential examinations with MMT and myometry were made at 72 hours, 1 week, and 2 weeks post-spinal cord injury and at 1, 2, 3, 4, 6, 12, 18, and 24 months post-injury.

Results showed that 22 of 24 correlations between MMT and myometry were significant at p values less than. Perot et al 57 10 subjects Chiropractors To measure and compare both electromyographic and MMT results after proprioceptive techniques to both strengthen and weaken muscles Response of tibialis anterior muscle to proprioceptive technique showed a significant EMG difference that corresponded to the difference found between "strong" and "weak" MMT outcomes.

AK proprioceptive procedure to reduce muscle tone found to correlate with MMT outcomes. Hsieh and Phillips 46 15 asymptomatic subjects 3 chiropractors To determine the concurrent validity of manual dynamometry using AK style of MMT, comparing doctor-initiated and patient-initiated MMT Intratester reliability and correlation coefficients for testers 1, 2, and 3 were 0.

Wadsworth et al 45 5 muscle groups on 11 patients physical therapist To compare the concurrent reliability of MMT and hand-held dynamometer tests The correlation coefficients were high and significantly different from zero for four muscle groups tested dynametrically and for two muscle groups tested manually.

Conclusion that both MMT and dynamometry are reliable testing methods, given the conditions described in this study. Bohannon 97 50 patients physical therapist To determine the relationship between MMT word scores and dynamometer force scores using Kendall tau. MMT scores and dynamometer test scores were significantly correlated p less than 0. Percentage MMT and dynamometer test scores were significantly different p less than 0. These results suggest that the two procedures measure the same variable-strength.

The average hip abduction and hip flexion scores measured by the HHD were consistent with the examiner's perception of muscle weakness P less than 0. Triano and Davis 98 10 patients with "reactive muscle" phenomena described in AK chiropractor In patients with reactive muscle pairs between the rhomboid and deltoid muscles , EMG and MMT findings were compared.

Study demonstrated that the reactive muscle phenomenon is, in fact, a physiologic imbalance of muscle measurable by EMG and MMT and was not a psychologic suggestion or an overpowering of the tested arm by brute force. These data showed that the deltoid-rhomboid "reactive muscle" represents a real physiological phenomenon.

None Reduced strength of upper limb muscles was significantly associated with the presence of symptoms. A median odds ratio of 4. The ileocecal valve test as a diagnostic measure of low back pain was found to have excellent measures of sensitivity, specificity and diagnostic competency. Muscle strength of the 6 major muscle groups of the hip was recorded using a hand-held dynamometer.

Michener et al 64 Shoulder pain 40 patients with shoulder pain and functional loss Hand held dynamometer testing performed as MMT for the lower trapezius, upper trapezius, middle trapezius, and serratus anterior muscles. Concurrently, surface electromyography sEMG data were collected for the 4 muscles.

The same procedures were performed 24 to 72 hours after the initial testing by the same tester. None Intraclass correlation coefficients for intratester reliability of measurements of isometric force obtained using an HHD ranged from.

Construct validity assessment, done by comparing the amounts of isometric muscle activity sEMG for each muscle across the 4 muscle tests, revealed that the muscle activity of the upper trapezius and lower trapezius muscles was highest during their respective tests.

Moncayo et al Thyroid associated orbitopathy TAO 32 patients with TAO, 23 with a long-standing disease, and 9 showing discrete initial changes Positive TL patient touches area of dysfunction and weakening occurs on MMT 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 of AK.

AK treatment and homeo-pathic remedies 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 improved. Clinical trial of 3—6 months showed all relevant parameters improved.

Patients with radicular pain caused by L5 or S1 could perform the quadriceps test. Weakness of quadriceps correlated with L3 or L4 radiculopathy.

Sensitivity to detect progressive weakness and power to detect this change, however, favored MMT. The authors found MMT to be the preferred measure of global strength because of its better Pearson correlation coefficients, essentially equivalent reproducibility, and more favorable coefficient of variation. Nadler et al 66 13 college athletes with low back pain Of athletes male, 63 female , 5 of 63 females and 8 of males required treatment for LBP.

A dynamometer incorporated into a specially designed anchoring station was used for testing the hip extensors and abductors. The maximum force generated for the hip abductors and extensors was used to calculate a percentage difference between the right and left hip extensors and abductors. Validity shown that hip muscle imbalance is associated with LBP occurrence in female athletes. Research supports the need for the assessment and treatment of hip muscle imbalance in individuals with LBP.

Over all, significant differences were found in muscle test responses between congruent and incongruent semantic stimuli. Schmitt et al Allergies 17 subjects To determine whether subjective muscle testing employed by Applied Kinesiology practitioners, prospectively determine those individuals with specific hyperallergenic responses. None 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. These serum tests confirmed 19 of the 21 food allergies Goodheart Imbalanced weight bearing on right and left feet 40 patients 40 patients were evaluated for pre- and post-treatment weight balance. AK examin-ation and treatment Of the 40 patients, only one had minimal changes in weight upon two scales beneath the feet when both flexing and extending the spine.

Jacobs et al 44 Thyroid dysfunction 65 patients Patients evaluated for thyroid dysfunction by MMT, and laboratory testing. Correlation between clinical and laboratory diagnosis was. The muscle testing method was then compared to results obtained by a Philpott-type fast with progressive reintroduction of foods. Correlation between foods identified as provocative by muscle testing and by the fast was.

Observation of clinical results obtained with muscle testing suggests the method has substantial clinical utility. Pearson Product-Moment Correlation between testers was. Carpenter et al None 80 students The muscles hypothesized in AK to be associated with certain organs were tested with an instrument after irritation of the related organs.

Then a control muscle was tested. The stomach was irritated by placing cold water into it; the eye with chlorinated water; the ear with sound of a controlled frequency and decibel rate; and the lung with cigarette smoke. None In 80 subjects, a total of organs were irritated. In all cases, the associated muscle weakened significantly after the irritation. The control muscle also weakened, but to a much lesser degree.

Authors, date Diagnosis Subjects Repeated Observations Treatments Outcomes Cuthbert Motion sickness disorder 1: 66 yoa female 2: 45 yoa female 3: 9 yoa female Proprioceptive testing Freeman-Wyke and Hautant's tests , AK MMT and palpation Spinal and cranial chiropractic manipulative therapy CMT 1: Able to drive car and ride in a boat and airplane symptom free after 4 visits.

After 1 visit, patient could see 20—30 on Snellen eye chart.