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Scott C. Cuthbert, DC ICAK – USA. “The Muscle Weakness Revolution” Is Here: The ICAK Should Be Leading It!.
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Scott C. Cuthbert, DC ICAK – USA “The Muscle Weakness Revolution” Is Here: The ICAK Should Be Leading It!
After 50 years, the research evidence is suggesting the demise of the hyperactivity-causality model for neuromusculoskeletal pain. The lack of convincing evidence to support the belief in hyperactivity as an etiological factor in neuromusculoskeletal conditions has been pointed out in recent reviews of several chronic neuromusculoskeletal disorders. [See Handout] • Lund JP. et al. The pain-adaptation model: a discussion of the relationship between chronic musculoskeletal pain and motor activity, Canadian Journal of Physiology and Pharmacology, 1991;69:683-694. • Fryer G, Morris T, Gibbons P. Paraspinal muscles and intervertebral dysfunction: part two. J Manip Physiol Ther. 2004 Jun;27(5):348-57.
Controlled clinical studies have shown that dysfunction and pain specifically in the ankle, [3] knee, [4-6] lumbar spine, [7-9] temporomandibular joint, [10] and cervical spine [11-14] will produce inhibited muscles. [See Handout] These data indicate that the body’s reaction to injury and pain is not primarily increased muscular tension and stiffness; rather muscle inhibition is often more significant. [15-17] [See Handout] These studies highlight the fact that the measurement of neuromuscular performance should be recognized as a fundamental contribution to restorative and rehabilitative treatment programs in the healing professions
The most consistent “finding” in contemporary research during the evaluation of patients with spinal dysfunction and pain is muscular imbalance, with certain muscles tending toward inhibition and others toward hyperactivity. Because of Sherrington’s Law of Reciprocal Inhibition, these two functional states in muscles are related. ** Sherrington’s law states that decreased activity of certain muscles leads to facilitation – and thus increased activity and tension – of their antagonist muscles. ** Sherrington C: Selected Writings of Sir Charles Sherrington, Ed. Brown DD. Oxford: Oxford University Press; 1979:274-282.
A major reason that the MMT should be added to the standard chiropractic and manual medical diagnostic methods taught in the colleges is that most parameters of dysfunction identified in low-back and neck pain patients have not been shown to precede the pain, but rather only to accompany it. An important exception is muscle strength, which can predict future low-back and neck pain in asymptomatic individuals. The spine stability system. From Panjabi. Control Subsystem Neural Active Subsystem Spinal Muscles Passive Subsystem Spinal Column
The works of Panjabi, Janda, Lewit, Jull, Sahrmann, Bergmark, Hammer, Liebenson and many others have confirmed the findings of the Kendalls and Goodheart. Musclespredictably respondwith weaknessto pain, inflammation, and/or injury. Karel Lewit Manohar Panjabi Craig Liebenson, D.C. Warren Hammer, D.C. – former ICAK author Kendall & Kendall Vladimir Janda
Liebenson writes something that we should all know by heart: • Functional pathology of the muscle system is the most common clinical finding in pain patients presenting to chiropractors, osteopaths, neurologists, rheumatologists, orthopedists, and physical therapists. • Yet this disorder of the muscle system is routinely ignored in the diagnosis and treatment of these patients. Craig Liebenson (right) with Robin McKenzie Doesn’t that sound like something someone else we know said when Dr. Liebenson was still in his diapers…?
It should be noted that Dr. Warren Hammer’s extraordinary productivity in chiropractic and soft tissue research writing began with work regarding AK! • In the 1977, 1978, 1981 “Collected and Selected Papers of the ICAK” • Dr. Hammer wrote AK articles on Split Brain dysfunction, the Vertebral Challenge method, and Temporal Tap methods. • Hammer’s obvious enthusiasm for AK was apparent in this early work.
In their writings on muscle imbalances and the use of the MMT to detect it (in their view the major factor causing the chiropractic subluxation and neuromusculoskeletal dysfunction generally), both Liebenson and Hammer have depended upon the work of Vladimir Janda This isunfortunate because of three BIG PROBLEMS in Janda’s view of muscle inhibitions…and fortunatebecause it has increased our understanding of the significance of muscle imbalances in human health
Janda has three postulates that have retarded the use of MMT by clinicians who have been influenced by him… (this was due to his background in rehabilitative neurology, who used the MMT to assess neurologically injured patients) • Janda’s first postulate: the MMT is “unreliable” in any patient who is experiencing pain. • Janda’s second postulate: when muscle imbalances are found, muscle hypertonicity must be treated first (by various physiotherapeutic methods)… • Janda’s third postulate: when muscle weakness is found, THE ONLY method he offers to increase muscle strength is…exercise (P.T. guided exercise…no surprise!)
Janda’s three postulates: That the MMT is “unreliable” in pain patients That muscle hypertonicity must be treated first And that the best method to strengthen hypotonic or weak muscles is exercise… Emerged from his observations that among individuals with neurologic diseases spasticity (e.g. cerebral palsy) usually favored certain muscles (i.e. extremity flexors, adductors, and internal rotators) and paralysis (e.g. stroke) favored other muscles (i.e. extremity extensors, abductors, and external rotators). The use of the MMT for functional neurological assessments on patients with biomechanical problems – the chiropractic and general practitioner’s patient! -- was not part of Janda’s program. Vladimir Janda’s methods and approach to the MMT should not be a part of the AK use of the MMT either!
Many researchers have shown how general functional ability can be measured with simple, reliable, inexpensive, time-efficient tests…tests that have obvious “face-validity”. The MMT qualifies on each of these counts. Simmonds MJ, Olson SL, Jones S, et al. Psychometric characteristics and clinical usefulness of physical performance tests in patients with low back pain. Spine 1998;23(22):2412-2421. If a test has good ‘Responsiveness’, then the test results should improve as a person’s health status improves. The MMT has shown “excellent” responsiveness because it accurately shows change when it has occurred in the patient. What other physical diagnostic test shows this kind of reliability and responsiveness to neuromuscular changes in patients?
Because the operational definition of the MMT for physical therapists, orthopedists, and neurologists is the same as that for chiropractors who use the MMT as taught in AK, the research conducted in these other disciplines is useful evidence regarding the reliability and validity of the MMT for chiropractors. Because of this research even the American Medical Association, in its Guides to the Evaluation of Permanent Impairment, 5th edition, has accepted the MMT as a reliable and valid method for evaluating functional, non-pathological, radicular, and non-radicular conditions!
Let’s take a short break now and dip our retinas into… India!
From my first visit to India as a 22-year-old back-packer, I was completely overwhelmed: India thrilled, surprised, scared and excited me...
Taking Dr. Goodheart to India’s holiest city of temples and showing him around…! Kedara Ghat, Varanasi India
The Majesty of India (her peeplez!) Now…Back to our story
The ICAK membership MUST increase the scientific literature on AK! The literature is the repository of a health profession’s collective efforts to acquire new knowledge and understanding, and includes its observations, predictions, experiments and speculations. AK physicians who cannot (or do not) follow the scientific literature can never be more than second-class citizens in their own discipline. Dr. Goodheart answered the call for clinical research in his practice – with astonishing results for over 69 years (much of it published!). All of his research must be reproduced in the peer-reviewed literature and shared with the scientific community around the world!
The Absolute Necessity For AK Descriptive Case Studies Here’s a hard kick in the head… • In AK’s 44 year history, there have ONLY BEEN THREE PUBLISHED PAPERS in peer-reviewed journals involving a simple, descriptive case study of patients with uncomplicated mechanical neck pain treated by adjustment/manipulation (the chiropractor’s “meat & potatoes”) Where are the viscero-somatic papers…the GP’s “meat & potatoes”? • None of these have appeared in JMPT!! • There are legends, there is our clinical lore, there is our “in house” certainties about the subject, there are even 10+ RCTs of chiropractic treatment for neck pain patients, but…nothing YET has been published about AK and neck pain in a PubMed, Index Medicus journal…!!
Although no one can deny your right to “private research,” research and commentaries are not considered “science” until they become publicly available through scientific publishing. Private, uncritical evidence does not count and unreported evidence is no evidence at all, and data which have not been subjected to critical review are viewed with extra suspicion, if considered at all.
ICAK must aim for greater professional recognition throughout the healing arts by translating our Evidence-Based Outcomes Research into greater political clout & influence for AK
The Absolute Necessity For AK Descriptive Case Studies • Insurance/HMO/PPO reimbursement increasingly requires doctors to provide quantitative data about the patient’s progress under treatment • Since you’re already collecting some relevant data, it’s only a bit of a stretch to organize that information into publication-worthy case reports • Anyone with the gray matter needed to survive a chiropractic college curriculum -- then to practice Goodheart’s AK effectively -- has the brains needed to prepare a case study for publication Enuf sed!
How does your support of AK research impact your practice? By becoming an AK researcher or research money contributor, you help fund research resulting in outcomes that increase the body of AK evidence. Increased outcomes and a better informed public and therapeutic community leads to broader utilization, which POSITIVELY IMPACTS THE SUCCESS OF YOUR PRACTICE.
Your donations and membership dues…. Enables ICAK to fund pilot studies… Leading to research published and disseminated… Which is provided to policymakers and healthcare administrators…
Show your support for AK by making a contribution to the ICAK research…the future of our beloved method depends upon research.
Since “The Muscle Weakness Revolution” Has Come… The ICAKs days as an “unconventional” chiropractic group using the MMT should be drawing to a close…but it will be up to you and me to prove to others the value of what we do and to lead “The Muscle Weakness Revolution” that is occurring throughout the scientific literature and the healing arts.
