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Table 4 Characteristics of 14 studies examining the Clinical Relevance, Predictive Validity and Accuracy of MMT (RCTs indicated by **)

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

Authors, date Diagnosis Subjects Repeated Observations Treatments Outcomes
Jepsen et al 93 (2006) ** Upper limb pain 41 patients, 19 with upper limb pain MMT, with examiners blinded as to patient pain status. None Reduced strength of upper limb muscles was significantly associated with the presence of symptoms. A median odds ratio of 4.0 (2.5–7.7).
Pollard et al 54 (2006) ** Low back pain 67 of 100 patients have low back pain MMT with therapy localization to an Ileo-cecal valve reflex point None Of 67 subjects who reported low back pain, 58 (86.6%) reported a positive test of both low back pain and ICV point test. Of 33 subjects, 32 (97%) with no back pain positively reported no response to ICV point test. Nine (9) subjects (13.4%) reported false negative ICV tests and low back pain, and 1 subject (3%) reported a false positive response for ICV test and no low back pain. The ileocecal valve test as a diagnostic measure of low back pain was found to have excellent measures of sensitivity, specificity and diagnostic competency.
Niemuth et al 99 (2005) ** Single leg overuse injury 30 recreational injured runners (17 female, 13 male) and 30 noninjured runners (16 female, 14 male) served as controls. Muscle strength of the 6 major muscle groups of the hip was recorded using a hand-held dynamometer. None No significant side-to-side differences in hip group muscle strength were found in the noninjured runners (P = 0.62–0.93). Among the injured runners, the injured side hip abductor (P = 0.0003) and flexor muscle groups (P = 0.026) were significantly weaker than the noninjured side. In addition, the injured side hip adductor muscle group was significantly stronger (P = 0.010) than the noninjured side.
Michener et al 64 (2005) 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 .89 to .96. The standard error of the measure (90% confidence interval [CI]) ranged from 1.3 to 2.7 kg; the minimal detectable change (90% CI) ranged from 1.8 to 3.6 kg. 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 100 (2004) 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.
Rainville et al 101 (2003) sciatica 33 patients with L3 or L4 radiculopathy; 10 patients with L5 or S1 radiculopathy To test quadriceps strength with MMT None Knee flexed MMT weakness of the quadriceps showed kappa coefficient of (0.66). Patients with radicular pain caused by L5 or S1 could perform the quadriceps test. Weakness of quadriceps correlated with L3 or L4 radiculopathy.
Great Lakes ALS Study Group 65 (2003) amyotrophic lateral sclerosis (ALS) 63 patients with ALS Compared test reliability of MMT and maximal voluntary isometric contraction (MVIC) scores among institutions and test validity by comparing change over time between MMT and MVIC. None Reproducibility between MVIC and MMT was equivalent. Sensitivity to detect progressive weakness and power to detect this change, however, favored MMT. In multicentered trials, uniformly trained physical therapists reproducibly and accurately measure strength by both MMT and MVIC. 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 (2001) 13 college athletes with low back pain Of 163 athletes (100 male, 63 female), 5 of 63 females and 8 of 100 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. athletic trainers for LBP unrelated to blunt trauma over the ensuing year Logistic regression analysis indicated that for female athletes, the percentage difference between the right and left hip extensors was predictive of whether treatment for LBP was required over the ensuing year (P = 0.05). 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.
Monti et al 103 (1999) None 89 healthy college students To determine the differences in MMT outcomes after exposure to congruent and incongruent semantic stimuli None Approximately 17% more total force over a 59% longer period of time could be endured when subjects repeated semantically congruent statements (p < .001). Over all, significant differences were found in muscle test responses between congruent and incongruent semantic stimuli.
Schmitt et al 104 (1998) 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.K. muscle screening procedures. These serum tests confirmed 19 of the 21 food allergies (90.5%) suspected based on the applied kinesiology screening procedures.
Goodheart 105 (1990) 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 (1984) Thyroid dysfunction 65 patients Patients evaluated for thyroid dysfunction by MMT, and laboratory testing. AK and labor-atory examina-tion MMT ratings correlated with clinical ratings (rs = .36, p < 0.002) and with laboratory ratings (rs = .32, p < 0.005). Correlation between clinical and laboratory diagnosis was .47, p < 0.000. Three AK TL points had a significant correlation with the laboratory diagnosis (p < .05). "AK enhanced but did not replace clinical/laboratory diagnosis of thyroid dysfunction."
Scoop 106 (1979) Allergy 10 subjects Subjects with unilateral weak muscles were given either a placebo or the nutrient that is hypothesized in AK to be associated with the muscle. Muscle tone was measured by a Jaymar dynamometer and with AK MMT methods. Nutrition The increase in muscle tone approximately 10 seconds after ingestion was 21% for the nutrient group and was a statistically significant (p < 0.05) increase in comparison with the placebo group. In the cerebral allergy testing part of the study, a 15% decrease in muscle tone of the pectoralis major clavicular was used as the criterion for cerebral allergy. 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 .81. Observation of clinical results obtained with muscle testing suggests the method has substantial clinical utility. Pearson Product-Moment Correlation between testers was .91, suggesting that muscle testing is reliable between testers.
Carpenter et al 107 (1977) 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. 4 organ muscle associations were evaluated: the eye, ear, stomach, and lung. 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 139 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.