Scott C. Cuthbert, Scott C. Cuthbert, DCDC

ICAK – USAICAK – USA

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 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

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]

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 C: Selected Writings of Sir Charles Sherrington, Ed. Brown DD. Oxford: Oxford University Press; 1979:274-282.

Sherrington’s law states that decreased activity of certain muscles leads to facilitation – and thus increased activity and tension – of their antagonist muscles.

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.

Control Subsystem

Neural

Passive Subsystem

Spinal ColumnActive Subsystem

Spinal Muscles

The spine stability system. From Panjabi.

The works of Panjabi, Janda, Lewit, Jull, Sahrmann, Bergmark, Hammer, Liebenson and many others have confirmed the

findings of the Kendalls and Goodheart. Muscles predictably

respond with weakness to pain, inflammation, and/or injury.

Manohar Panjabi

Vladimir Janda

Karel Lewit

Craig Liebenson, D.C. Warren Hammer, D.C. – former ICAK authorKendall & Kendall

Craig Liebenson (right) with Robin McKenzie

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.

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 is unfortunate because of three BIG

PROBLEMS in Janda’s view of muscle

inhibitions…and fortunate because 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 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 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 three postulates:1)That the MMT is “unreliable” in pain patients2)That muscle hypertonicity must be treated first3)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.

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?

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.

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

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!!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…!!

Here’s a hard kick in the head…

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…

…Resulting in greater patient

access to AK care

Show your support for

AK by making a contribution

to the ICAK research…the future of our

beloved method

depends upon research.

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.

Our founder’s dream is destined to come true…