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  1. Disentangling manual muscle testing and Applied Kinesiology: critique and reinterpretation of a literature review. A reply

    Scott Cuthbert, Chiropractic physician

    31 August 2007

    Letter to the Editor

    Disentangling manual muscle testing and Applied Kinesiology: critique and reinterpretation of a literature review. A reply

    We would like to comment on this paper by Haas, Cooperstein, and Peterson where they critique our publication. The validity of the MMT for neuromusculoskeletal (NMS) diagnosis (its construct and content validity [1-2], convergent and discriminant validity [3], concurrent and predictive validity [4-5]) was presented in our paper after peer review and accepted by Haas, Cooperstein, and Peterson. The internal validity was strong in a number of the papers reviewed. These studies were time-series experiments that help to rule out rival explanations for beneficial clinical changes following treatment [6].

    We disagree with Haas et al’s interpretation that the science of the MMT is markedly negative and their exclusion of its positive findings for the chiropractic profession is curious.

    We believe the following 3 questions remain affirmatively answered: “1) Is MMT worthy of scientific merit? 2) Can new techniques using MMT be critiqued for scientific merit? 3) Is there evidence that adds scientific support to chiropractic techniques that use MMT?”

    The reliability of the MMT (test-retest, intra- and inter-examiner reliability) was recognized as excellent also (Cohen’s kappa values were greater than .75 in 11 papers) [2-4]. In fact comparisons of the reliability coefficients for MMT are often more reliable than palpation (the most commonly used, widely taught and investigated form of chiropractic diagnosis) [4-5, 8-9].

    Considerable evidence was presented that substantiates a relationship between muscle strength and function in neuromusculoskeletal (NMS) disorders [2-3, 10-13]. Logically this relationship would apply to the assessment of chiropractic interventions that affect NMS function by monitoring the relative strength or weakness of related muscles during the course of treatment.

    Two types of a limited number of studies provided further justification for the “entanglement” of MMT in chiropractic diagnostic methods:

    1) Studies that show improvements in muscle strength and function after manipulative therapy [14-21],

    2) Studies that show a consistent relationship between a clinical condition and muscle inhibition [2-3, 10-13].

    Haas et al discuss studies showing negative outcomes that employed what they characterize as “AK procedures”[22-30]. However, a review of the negative studies they present shows they did not follow (especially regarding nutritional and non-musculoskeletal diagnosis) methods taught by the International College of Applied Kinesiology (ICAK), and a critique of these papers has been published by the ICAK and Dr. Goodheart [31-32].

    They are correct in pointing out that these studies were negative, but incorrect to infer that these studies evaluated AK methods of diagnosis or treatment. It was for this reason that we did not include these papers in our original review concerning the reliability and validity of the MMT.

    We agree with them that it is reasonable to make a distinction between standardized MMT and non-standardized MMT. It is the second type of MMT that can tarnish the reputation of clinicians using it as part of their diagnostic regimen. In our opinion Haas et al have used non-AK research studies to condemn MMT as a pre- and post-assessment tool for evaluating the efficacy of chiropractic treatment.

    It appears from the available resources that Haas and Peterson have published one clinical experiment (in 1994) testing the claims of chiropractic manual muscle testers, and from this broadly assert that AK, a multimodal diagnostic and treatment system with a 40-year history, is insupportable [23].

    However if MMT is reliable and valid for NMS diagnosis then logically this reliability and validity remains when a chiropractor uses MMT.


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    Competing interests

    None declared