Transcript The Muscle Weakness Revolution is here!

Scott C. Cuthbert, DC
ICAK – 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, [79] 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 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
The spine stability system.
From Panjabi.
Active Subsystem
Passive Subsystem
Spinal Muscles
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. Muscles predictably
respond with weakness to pain, inflammation, and/or injury.
Karel Lewit
Manohar Panjabi
Vladimir Janda
Kendall & Kendall
Craig Liebenson, D.C.
Warren Hammer, D.C. –
former ICAK author
Liebenson writes something that we
should all know by heart:
Craig Liebenson (right) with
Robin McKenzie
 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 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:
1) That the MMT is “unreliable” in pain patients
2) That muscle hypertonicity must be treated first
3) 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 22year-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
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 peerreviewed literature and shared
with the scientific community
around the world!
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 secondclass citizens in their own
discipline.
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 publicationworthy 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…