The Muscle Weakness Revolution Is Here:

1
Scott C. Cuthbert, DC ICAK USA
The Muscle Weakness Revolution Is Here The
ICAK Should Be Leading It!
2
After 50 years, the research evidence is
suggesting the demise of the hyperactivity-causali
ty 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,
  199169683-694.
• Fryer G, Morris T, Gibbons P. Paraspinal muscles
  and intervertebral dysfunction part two. J Manip
  Physiol Ther. 2004 Jun27(5)348-57.

3
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 bodys 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
4
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 Sherringtons Law of Reciprocal
Inhibition, these two functional states in
muscles are related.
Sherringtons 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 1979274-282.
5
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
6
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.
Karel Lewit
Manohar Panjabi
Craig Liebenson, D.C.
Warren Hammer, D.C. former ICAK author
Kendall Kendall
Vladimir Janda
7

• 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
Doesnt that sound like something someone else we
know said when Dr. Liebenson was still in his
diapers?
8

• It should be noted that Dr. Warren Hammers
  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.
• Hammers obvious enthusiasm for AK was apparent
  in this early work.

9
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 Jandas view of muscle inhibitionsand
fortunate because it has increased our
understanding of the significance of muscle
imbalances in human health
10
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)

• Jandas first postulate the MMT is unreliable
  in any patient who is experiencing pain.

• Jandas second postulate when muscle imbalances
  are found, muscle hypertonicity must be treated
  first (by various physiotherapeutic methods)

• Jandas third postulate when muscle weakness is
  found, THE ONLY method he offers to increase
  muscle strength isexercise (P.T. guided
  exerciseno surprise!)

11

• Jandas 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
practitioners patient! -- was not part of
Jandas program. Vladimir Jandas methods and
approach to the MMT should not be a part of the
AK use of the MMT either!
12
Many researchers have shown how general
functional ability can be measured with simple,
reliable, inexpensive, time-efficient teststests
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
199823(22)2412-2421.
If a test has good Responsiveness, then the
test results should improve as a persons 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?
13
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!
14
Lets take a short break now and dip our retinas
into India!
15
From my first visit to India as a 22-year-old
back-packer, I was completely overwhelmed India
thrilled, surprised, scared and excited me...
16
Taking Dr. Goodheart to Indias holiest city of
temples and showing him around!
Kedara Ghat, Varanasi India
17
The Majesty of India (her peeplez!)
NowBack to our story
18

• The ICAK membership MUST increase the scientific
  literature on AK! The literature is the
  repository of a health professions 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!
19
The Absolute Necessity For AK Descriptive Case
Studies
Heres a hard kick in the head

• In AKs 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
  chiropractors meat potatoes) Where are the
  viscero-somatic papersthe GPs 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, butnothing YET
  has been published about AK and neck pain in a
  PubMed, Index Medicus journal!!

20

• 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.

21

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
22
The Absolute Necessity For AK Descriptive Case
Studies

• Insurance/HMO/PPO reimbursement increasingly
  requires doctors to provide quantitative data
  about the patients progress under treatment
• Since youre already collecting some relevant
  data, its 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 Goodhearts AK effectively -- has the
  brains needed to prepare a case study for
  publication

Enuf sed!
23
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.
24
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
25
Resulting in greater patient access to AK care
26
Show your support for AK by making a contribution
to the ICAK researchthe future of our beloved
method depends upon research.
27
Since The Muscle Weakness Revolution Has Come
The ICAKs days as an unconventional
chiropractic group using the MMT should be
drawing to a closebut 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.
28
Our founders dream is destined to come true