APPLIED KINESIOLOGY RESEARCH

-- Edited by Scott Cuthbert, D.C.

APPLIED KINESIOLOGY RESEARCH ARTICLES IN PEER REVIEWED JOURNALS AS OF WINTER 2005

Symptomatic Arnold-Chiari malformation and cranial nerve dysfunction: a case study of applied kinesiology cranial evaluation and treatment, Cuthbert, S., Blum, C.

J Manipulative Physiol Ther. 2005 May;28(4):e1-6.

( www.journals.elsevierhealth.com/periodicals/ymmt )

Objective: To present an overview of possible effects of Arnold-Chiari malformation (ACM) and to offer chiropractic approaches and theories for treatment of a patient with severe visual dysfunction complicated by ACM. Clinical Features : A young woman had complex optic nerve neuritis exacerbated by an ACM (Type I) of the brain. Intervention and Outcome : Applied kinesiology chiropractic treatment of the spine and cranium was used for treatment of loss of vision and nystagmus. After treatment, the patient's ability to see, read, and perform smooth eye tracking showed significant and lasting improvement. Conclusion : Further studies into applied kinesiology and cranial treatments for visual dysfunctions associated with ACM may be helpful to evaluate whether this single case study can be representative of a group of patients who might benefit from this care.

Evaluation of Chapman's neurolymphatic reflexes via applied kinesiology: a case report of low back pain and congenital intestinal abnormality, Caso, M.L.

J Manipulative Physiol Ther. 2004 Jan;27(1):66.

( www.journals.elsevierhealth.com/periodicals/ymmt )

Objective : To describe the applied kinesiologic evaluation of Chapman's neurolymphatic (NL) reflexes in the management of a person with an unusual congenital bowel abnormality and its role in the manifestation of low back pain. The theoretical foundations of these reflexes will be elaborated on and practical applications discussed. Clinical Features : A 29-year-old man had chronic low back pain. Radiographs of the patient's lumbar spine and pelvis were normal. Magnetic resonance imaging (MRI) demonstrated a mild protrusion of the fifth lumbar disk. Oral anti-inflammatory agents, cortisone injections, and chiropractic manipulative therapy provided little relief. Though generally in robust health, the patient was aware of a congenital intestinal abnormality diagnosed when he was a child; it was thought to be of no consequence with regard to his current back condition. Intervention and outcome : The patient's history, combined with applied kinesiology examination, indicated a need to direct treatment to the large bowel. The essential diagnostic indicators were the analysis of the Chapman's neurolymphatic reflexes themselves, coupled with an evaluation of the traditional acupuncture meridians. The primary prescribed therapy was the stimulation of these reflexes by the patient at home. This intervention resulted in the resolution of the patient's musculoskeletal symptomatology, as well as improved bowel function. Conclusion : The rather remarkable outcome from the application of this relatively simple, yet valuable, diagnostic and therapeutic procedure represents a thought-provoking impetus for future study and clinical application.

J Manipulative Physiol Ther , Jan 2005:28(1):52-6

Objective : To determine if 2 practitioners of differing skill levels could reliably agree on the presence of a weak or strong deltoid or psoas muscle. Study Design : Interexaminer reliability study of 2 common muscle tests. Main Outcome Measures : Cohen ? (unweighted) scores, observer agreement, and 95% confidence intervals (CIs). Results:   The results showed that an experienced and a novice practitioner have good agreement when using repeated muscle test procedures on the deltoid ( ? 0.62) and the psoas ( ? 0.67).

Conclusions: The manual muscle test procedures using the anterior deltoid or psoas showed good interexaminer reliability when used by an experienced and a novice user. These techniques may be used between practitioners in multidoctor assessment/management programs.

Acta Orthop Scand. 2004 Aug;75(4):442-8. 

BACKGROUND: Manual muscle testing has been termed a "lost art" and is often considered to be of minor value. The aim of this investigation was to study the inter-rater reliability of manual examination of the maximal voluntary strength in a sample of upper limb muscles.   PATIENTS AND METHODS: The material consisted of a series of 41 consecutive patients (82 limbs) who had been referred to a clinic of occupational medicine for various reasons. Two examiners who were blinded as to patient-related information classified 14 muscles in terms of normal or reduced strength. In order to optimize the evaluation, the individual strength was assessed simultaneously on the right and left sides with the limbs in standardized positions that were specific for each muscle. Information on upper limb complaints (pain, weakness and/or numbness/tingling) collected by two other examiners resulted in 38 limbs being classified as symptomatic and 44 as asymptomatic. For each muscle the inter-rater reliability of the assessment of strength into normal or reduced was estimated by kappa-statistics. In addition, the odds ratio for the relation to symptoms of the definition in agreement of strength was calculated.   RESULTS: The median kappa-value for strength in the muscles examined was 0.54 (0.25-0.72). With a median odds ratio of 4.0 (2.5-7.7), reduced strength was significantly associated with the presence of symptoms.   INTERPRETATION: This study suggests that manual muscle testing in upper limb disorders has diagnostic potential.

The supine hip extensor manual muscle test: a reliability and validity study, Perry J, Weiss WB, Burnfield JM, Gronley JK.

-- Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center, Downey, CA 90242, USA. pklab@larei.org

Arch Phys Med Rehabil. 2004 Aug;85(8):1345-50. 

OBJECTIVES: To define the relative hip extensor muscle strengths values identified by the 4 grades obtained with a supine manual muscle test (MMT) and to compare these values with those indicated by the traditional prone test.   DESIGN: Comparison of 4 manual supine strength grades with isometric hip extension joint torque; kappa statistic-determined interrater reliability, and analyses of variance identified between grade differences in torque. SETTING: Pathokinesiology laboratory.   PARTICIPANTS: Adult volunteers recruited from local community and outpatient clinics. Reliability testing: 16 adults with postpolio (31 limbs). Validity testing (2 groups): 18 subjects without pathology (18 limbs), and 26 people with clinical signs of hip extensor weakness (51 limbs).

INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Supine hip extensor manual muscle grade and isometric hip extension torque. RESULTS: Reliability testing showed excellent agreement (82%). Subjects with pathology had significant differences in mean torque (P<.01) for the assigned grade 5 (176 Nm), grade 4 (103 Nm), grade 3 (67 Nm), and grade 2 (19 Nm). Healthy adults showed significant differences between grade 5 (212 Nm) and grade 4 (120 Nm) in mean torque (P<.05). CONCLUSIONS: The supine MMT is a reliable and valid method with which to assess hip extension strength.

Insult, Interference and Infertility: An Overview of Chiropractic Research, Behrendt, M.

Journal of Vertebral Subluxation Research, May 2003:1

www.jvsr.com

Objective: Infertility is distinct from sterility, implying potential, and therefore raises questions as to what insult or interference influences this sluggish outcome. Interference in physiological function, as viewed by the application of chiropractic principles, suggests a neurological etiology and is approached through the mechanism of detection of vertebral subluxation and subsequent appropriate and specific adjustments to promote potential and function. Parental health and wellness prior to conception influences reproductive success and sustainability, begging efficient, effective consideration and interpretation of overall state and any distortion. A discussion of diverse articles is presented, describing the response to chiropractic care among subluxated infertile women.  Clinical Features:      
Fourteen retrospective articles are referenced, their diversity includes: all 15 subjects are female, ages 22-65; prior pregnancy history revealed 11 none, 2 successful unassisted, 1 assisted, 1 history of miscarriage. 9 had previous treatment for infertility, 4 were undergoing infertility treatment when starting chiropractic care. Presenting concerns included: severe low back pain, neck pain, colitis, diabetes, and female dysfunction such as absent or irregular menstrual cycle, blocked fallopian tubes, endometriosis, infertility, perimenopause and the fertility window within a religious based lifestyle, and a poor responder undergoing multiple cycles of IVF.  Chiropractic Care and Outcome:      Outcomes of chiropractic care include but are not limited to benefits regarding neuromuscular concerns, as both historical and modern research describe associations with possible increased physiological functions, in this instance reproductive function. Chiropractic care and outcome are discussed, based on protocols of a variety of arts, including Applied Kinesiology (A.K.), Diversified, Directional Non-Force Technique (D.N.F.T.), Gonstead, Network Spinal Analysis (N.S.A.), Torque Release Technique (T.R.T.), Sacro Occipital Technique (S.O.T.) and Stucky-Thompson Terminal Point Technique. Care is described over a time frame of 1 to 20 months.  Conclusion: The application of chiropractic care and subsequent successful outcomes on reproductive integrity, regardless of factors including age, history and medical intervention, are described through a diversity of chiropractic arts. Future studies that may evaluate more formally and on a larger scare, the effectiveness, safety and cost benefits of chiropractic care on both well-being and physiological function are suggested, as well as pursuit of appropriate funding. 

Spine. 2003 Nov 1;28(21):2466-71

STUDY DESIGN: This prospective cohort study evaluated four office tests of quadriceps strength in symptomatic adults with radiographic evidence of L3 or L4 nerve root compression. OBJECTIVE: The study observed the performance of each test for its ability to detect quadriceps weakness when compared to the asymptomatic side. To determine the potential influence of radicular pain on the performance of the four tests, a control group of patients over the age of 40 with clinical and radiographic L5 or S1 radiculopathies underwent identical testing of quadriceps strength. SUMMARY OF BACKGROUND DATA: The L3 and L4 nerve roots innervate the quadriceps; therefore, quadriceps weakness may be a consequence of L3 or L4 radiculopathies. There are no standardized or validated methods to evaluate quadriceps strength in the clinical office setting. This may lead to inconsistent detection by clinicians of quadriceps weakness in cases of L3 or L4 radiculopathy. METHODS: Thirty-three consecutive patients with L3 or L4 radiculopathies and 19 with L5 or S1 radiculopathies were studied. The four tests of quadriceps strength included: 1) single leg sit-to-stand test; 2) step-up test; 3) knee-flexed manual muscle testing; and 4) knee-extended manual muscle testing. Results from a second examiner repeating the four tests were used to calculate interrater reliability. RESULTS: In L3 and L4 radiculopathies, unilateral quadriceps weakness was detected by the single leg sit-to-stand test in 61%, by knee-flexed manual muscle testing in 42%, by step-up test in 27% and by knee-extended manual muscle testing in 9% of patients. The sit-to-stand test detected weakness in all but one case when weakness was detected by another test. All patients with L5 or S1 radiculopathies could perform the sit-to-stand test. Kappa coefficient was high for sit-to-stand test (0.85), step-up (0.83), and knee-flexed manual muscle testing (0.66), and low for knee-extended manual muscle testing (0.08). CONCLUSION: In L3 and L4 radiculopathies, unilateral quadriceps weakness was best detected by a single leg sit-to-stand test. Patients of similar age with radicular pain caused by L5 or S1 radiculopathies could perform this test. As the interrater reliability of the single leg sit-to-stand test is high, clinicians should consider utilizing this test for assessing quadriceps strength in cases of L3 and L4 radiculopathies.

Evidence of Altered Lumbopelvic Muscle Recruitment in the Presence of Sacroiliac Joint Pain, Hungerford B, Gilleard W, Hodges P

Spine 2003; 28(14):1593-1600

Study Design. Cross-sectional study of electromyographic onsets of trunk and hip muscles in subjects with a clinical diagnosis of sacroiliac joint pain and matched control subjects.
Objectives . To determine whether muscle activation of the supporting leg was different between control subjects and subjects with sacroiliac joint pain during hip flexion in standing. Background . Activation of the trunk and gluteal muscles stabilize the pelvis for load transference; however, the temporal pattern of muscle activation and the effect of pelvic pain on temporal parameters has not been investigated. Methods . Fourteen men with a clinical diagnosis of sacroiliac joint pain and healthy age-matched control subjects were studied. Surface electromyographic activity was recorded from seven trunk and hip muscles of the supporting leg during hip flexion in standing. Onset of muscle activity relative to initiation of the task was compared between groups and between limbs. Results . The onset of obliquus internus abdominis (OI) and multifidus occurred before initiation of weight transfer in the control subjects. The onset of obliquus internus abdominis, multifidus, and gluteus maximus was delayed on the symptomatic side in subjects with sacroiliac joint pain compared with control subjects, and the onset of biceps femoris electromyographic activity was earlier. In addition, electromyographic onsets were different between the symptomatic and asymptomatic sides in subjects with sacroiliac joint pain. Conclusions . The delayed onset of obliquus internus abdominis, multifidus, and gluteus maximus electromyographic activity of the supporting leg during hip flexion, in subjects with sacroiliac joint pain, suggests an alteration in the strategy for lumbopelvic stabilization that may disrupt load transference through the pelvis.

Applied kinesiology for treatment of women with mastalgia, Gregory, W.M., Mills, S.P., Hamed, H.H., Fentiman, I.S.

Breast, 2001 Feb;10(1):15-9.

( www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db =

pubmed&dopt=Abstract&list_uids=14965552&query_hl=1 )

The Clinical Utility of Force/Displacement Analysis of Muscle Testing in Applied Kinesiology, Caruso, W., Leisman, G.

International Journal of Neuroscience . 2001; 106:147-157.

This study provided a physical record of the phenomena in an AK muscle test. The record allowed the observer to distinguish between conditionally inhibited and conditionally facilitated muscles. This study demonstrates that the difference between these states of muscle function is quantifiable. The authors suggest however that unlike the X-ray of the radiologist and the histological specimen of the clinical pathologist, the objective outcome of an AK muscle test will not be the source of the AK practitioner's judgment; that is, he will continue to rely on his trained perception of the event that produces the record. But the record (conditionally inhibited or conditionally facilitated) will stand after the fact as a piece of objective evidence that others may examine in order to confirm the practitioner's judgment.

A Force/Displacement Analysis of Muscle Testing, Caruso, B., Leisman, G.  

Perceptual and Motor Skills. 2000; 91:683-692.

Using a force transducer developed by Dr. Caruso, this study demonstrated the difference between muscles that the examiners perceived to be "weak" or inhibited, and those perceived to be "strong" or facilitated. This study also demonstrated that the muscle tests of examiners with over five years of clinical experience using AK procedures had reliability and reproducibility when their outcomes were compared. Also, the perception of inhibition or facilitation made by the examiner was corroborated by test pressure analysis using the instrumentation developed.

Expanding the Neurological Examination Using Functional Neurologic Assessment Part I: Methodological Considerations, Motyka, T., Yanuck, S.

International Journal of Neuroscience . 1999; 97:61-76.

The authors discuss AK as a clinical measure of neurologic function. A review of the literature reveals methodological problems with previous studies of AK as a form of neurologic assessment. The authors discuss the problems with research designs that do not reflect the clinical practice of AK which are common in the literature. They outline principles of AK and recommend that future research reflect more accurately the clinical practice of functional neurologic assessment and AK.

Expanding the Neurological Examination Using Functional Neurologic Assessment Part II: Neurologic Basis of Applied Kinesiology, Schmitt, W., Yanuck, S.

International Journal of Neuroscience . 1999; 97:77-108.

This paper proposes a neurologic model for many AK procedures. Manual assessment of muscular function is used to identify changes associated with facilitation and inhibition, in response to the introduction of sensory receptor-based stimuli. Muscle testing responses to sensory stimulation of known value are compared with usually predictable patterns based on known neuroanatomy and neurophysiology, guiding the clinician to an understanding of the functional status of the patient's nervous system. The proper understanding of the neurophysiologic basis of muscle testing procedures will assist in the design of further investigations into AK. Accordingly, the neurophysiologic basis and proposed mechanisms of these methods are reviewed.

Muscle Test Comparisons of Congruent and Incongruent Self-Referential Statements, Monti, D., Sinnott, J., Marchese, M., Kunkel, E., Greeson, J.

Perceptual and Motor Skills . 1999, 88:1019-1028.

This study investigated differences in manual muscle test outcomes after exposure to congruent and incongruent semantic stimuli. Muscle testing with a computerized dynamometer was performed on the deltoid muscle group of 89 healthy college students after repetitions of congruent (true) and incongruent (false) self-referential statements. The order in which statements were repeated was controlled by a counterbalanced design. The combined data showed that approximately 17% more total force over a 59% longer period of time could be endured when subjects repeated semantically congruent statements (p<.001). Order effects were not significant. Over all, significant differences were found in muscle test responses between congruent and incongruent semantic stimuli.

The effects of a pelvic blocking procedure upon muscle strength: a pilot study, Unger, J.

Chiropractic Technique, Nov 1998;10(4)

Using a hand-held force transducer, the unit was interposed between the examiner's hand and the subject's appendage being tested. The unit used in this study was interfaced with a computer program that gives statistical analysis for repeated testing reliability. This study found a significant increase in strength in the pectoralis (sternal and clavicular divisions tested separately), anterior deltoid, latissimus dorsi, psoas, tensor fascia lata, adductor, and gluteus medius muscles following the correction of a category II pelvic fault.

Correlation of Applied Kinesiology Muscle Testing Findings with Serum Immunoglobulin Levels for Food Allergies, Schmitt, W., Leisman, G.

International Journal of Neuroscience . 1998; 96:237-244.

This study showed a high degree of correlation between AK procedures used to identify food allergies and serum levels of immunoglobulins for those foods. AK methods in this study consisted of stimulation of taste bud receptors with various foods, and observation of changes in manual muscle testing that resulted. The patient was judged to be allergic to foods that created a disruption of muscle function. Blood drawn subsequently showed that patients had antibodies to the foods which were found to be allergenic through AK assessment.

George Goodheart, Jr., D.C., and a history of applied kinesiology, Green, B.N. and Gin, R.H.

J Manipulative Physiol Ther, 1997;20(5):331-337

Abstract: Applied Kinesiology (AK), founded by Michigan chiropractor George J. Goodheart, is a popular diagnostic and therapeutic system used by many health care practitioners. Many of the components in this method were discovered by serendipity and observation. In 1964, Goodheart claimed to have corrected a patient's chronic winged scapula by pressing on nodules found near the origin and insertion of the involved serratus anterior muscle. This finding led to the origin and insertion treatment, the first method developed in AK. Successive diagnostic and therapeutic procedures were developed for neurolymphatic reflexes, neurovascular reflexes and cerebrospinal fluid flow from ideas originally described by Frank Chapman, D.O., Terrence J. Bennett, D.C., and William G. Sutherland, D.O., respectively. Later, influenced by the writings of Felix Mann, M.D., Goodheart incorporated acupuncture meridian therapy into the AK system. Additionally, the vertebral challenge method and therapy localization technique, both based on phenomena proposed by L.L. Truscott, D.C., were added to the AK system. Scholarship has also evolved regarding AK and research on the topic is in its infancy. This paper documents some of the history of AK.

Interexaminer Agreement for Applied Kinesiology Manual Muscle Testing, Lawson, A., Calderon, L.

Perceptual and Motor Skills. 1997; 84:539-546 .

This study demonstrated significant interexaminer reliability for individual tests of the pectoralis major and piriformis muscles, but not for the tensor fascia lata or hamstring, which are essentially tests of groups of muscles at once. The primary importance of this study is that it demonstrates the reliability and reproducibility of muscle testing as a clinical tool, while also highlighting the need for clinicians to be aware of potential inaccuracies involved with the testing of some muscle groups.

The ability of male and female clinicians to effectively test knee extension strength using manual muscle testing, Mulroy SJ, Lassen KD, Chambers SH, Perry J .

J Orthop Sports Phys Ther. 1997 Oct;26(4):192-9.

Abstract: It has been suggested that the accuracy of manual muscle testing is dependent on examiner strength. Our purpose was to relate male and female clinicians' upper extremity strength to their ability to challenge the quadriceps and detect weakness in patients using manual muscle testing. Quadriceps muscles of seven men and 12 women with postpoliomyelitis were tested manually by a male and female clinician while forces were recorded with a hand-held dynamometer. Patients' maximal isometric knee extension force was recorded with a Lido dynamometer and clinicians' maximal vertical push force was recorded with the hand-held dynamometer. Manual muscle testing forces, patient maximum quadriceps forces, and examiner push forces were compared with repeated measures analysis of variance. Female examiners' maximal vertical push force (235.7 +/- 54.3 N) was not significantly different from either female or male patients' maximal quadriceps force (166.8 +/- 66.7 N and 341.6 +/- 123.7 N) but was only 60% and 40% of the isometric knee extension forces generated by a group of normal women and men. Male examiners were significantly stronger (357.0 +/- 93.4 N) than the female but not the male patients and produced 90% and 60% of the normal isometric quadriceps forces for women and men. Examiners gave appropriate grades in 30 of 38 tests. Examiner strength limits detection of moderate quadriceps weakness with manual resistance. Most of the muscle test grades, however, were appropriate, given the examiner's upper extremity strength. Clinicians using manual muscle testing should determine their maximal vertical push force and the extent of weakness they can detect.

Grade 4 in manual muscle testing: the problem with submaximal strength assessment, Dvir Z.

Clin Rehabil. 1997 Feb;11(1):36-41.

OBJECTIVE: To compare the static moment of force required for a muscle group to support a limb segment against gravity with the maximal dynamic moment it can generate. DESIGN: Based on anthropometric measures of both sexes and theoretical calculations, the estimated anti-gravity static muscular moments (MGM) at the shoulder, elbow, hip and knee joints were compared with published data relating to the isokinetic strength (MIM) of the same muscle groups. RESULTS: The ratio of static to dynamic moment, MGM/MIM, was drastically higher in muscles operating on the proximal compared with the more distal joints. In women, the values of this ratio in the shoulder, hip, elbow and knee muscles were 7-27%, 5-65%, 7% and 5-10% respectively. The corresponding figures in men were 7-21%, 4-44%, 8-10% and 5-8%. The ratios relating to the abductors, flexors and extensors of the hip joint were substantially higher in women than in men. CONCLUSIONS: Since MGM and MIM correspond to grades 3 and 5 in manual muscle testing, the findings of this theoretical analysis indicate that elbow and knee muscles assessed as having grade 4 may generate as low as 10% of their maximal strength. With regard to shoulder and hip muscles the corresponding values are typically around 20% and 30-40% Coupled with the very limited human precision in sensing of force, these findings indicate that where quantitative targets in muscle strength conditioning are set or when an accurate measure of impairment is being sought, grade 4 cannot and should not serve as a valid criterion.

A preliminary inquiry into manual muscle testing response in phobic and control subjects exposed to threatening stimuli

J Manipulative Physiol Ther. 1996 Jun;19(5):310-6.

Objective: To determine phobic and non-phobic subject response to a provocative threat stimulus and to determine variables that confound the response. Design: Randomized blind examiner test-retest of randomized phobic and control subjects with qualitative, semistructured, information postintervention interview. Setting: Private chiropractic clinic. Subjects: Thirteen phobic individuals, as determined by the Diagnostic and Statistical Manual of Mental Disorders, Third Edition - Revised (DSM-III-R), and 14 control volunteer subjects. Intervention: Manual muscle testing was performed while each subject viewed a threat stimulus (i.e., a cue word on a printed card). The results were recorded as "weak" or "strong." Results: The analysis of the data demonstrates poor inter- (K = -0.19) and intraexaminer reliability (K = -0.14- +0.29). The test for independence for valid muscle testing was strong for both examiners (p = .462, p = 1.00) When confounding variables were corrected for, the validity of muscle testing increased to 91%. Conclusion: This preliminary inquiry demonstrates the need for musculoskeletal, attentional and presensitized subject variables to be controlled to ascertain if muscle testing can be reliably used as a tool to identify emotional arousal.

Electromyographic Effects of Fatigue and Task Repetition on the Validity of Estimates of Strong and Weak Muscles in Applied Kinesiology Muscle Testing Procedures, Leisman, G., et al.  

Perceptual and Motor Skills. 1995; 80:963-977.

Abstract: The study investigated the effects of fatigue and task repetition on the relationship between integrated electromyogram and force output during subjective clinical testing of upper extremity muscles. Muscles were studied under two conditions differing in nature and duration of constant force production (SHORT-F) and (LONG-F). The findings included a significant relationship between force output and integrated EMG, a significant increase in efficiency of muscle activity with task repetition, and significant difference between Force/integrated EMG ratios for muscles labeled "Strong" and "Weak" in the LONG-F condition. This supports Smith's 1974 notion that practice results in increased muscular efficiency. With fatigue, integrated EMG activity increased strongly and functional (force) output of the muscle remained stable or decreased. Fatigue results in a less efficient muscle process. Muscles subjectively testing "Weak" or "Strong" yield effects significantly different from fatigue.

Muscle Testing Response to Vertebral Challenge and Spinal Manipulation: A Randomized Controlled Trial of Construct Validity, Haas, M., Peterson, D., Hoyer, D., Ross, G.  

Journal of Manipulative and Physiologic Therapeutics . 1994; 17(3):141-148.

Objective: To evaluate the relationship of muscle strength response to a provocative vertebral challenge and to spinal manipulation. Design: Prospective double-blind randomized controlled trial: crossover and between subjects designs. Setting: Laboratory: Center for Technique Research. Participants: Sixty-eight naïve volunteers from the student body, staff and faculty of the college. Interventions : Provocative vertebral challenge: standardized 4-5 kg force applied with a pressure algometer to the lateral aspects of the T3-T12 spinous processes. Intervention: manual high velocity low amplitude adjustment or switched-off activator sham. Main Outcome Measures: Piriformis muscle response was defined in two ways: reactivity (a decrease in muscle resistance, yes or no, following a vertebral challenge); responsiveness (the cessation of reactivity following spinal manipulation). Relative response attributable to the maneuver (RRAM): the percent of an outcome attributable to the challenge or adjustment itself. Results: Average RRAM = 16% reactivity to vertebral challenge; average RRAM = 0% responsiveness to spinal manipulation. Six to 10% of muscle tests were positive regardless of examiner, previous finding or intervention. Conclusions: For the population under investigation, muscle response appeared to be a random phenomenon unrelated to manipulable subluxation. In and of itself, muscle testing appears to be of questionable use for spinal screening and post-adjustive evaluation. Further research is indicated in more symptomatic populations, different regions of the spine, and using different indicator muscles.

Comment: As described by the I.C.A.K., vertebrae without subluxation, fixation, or other mechanical problems should be negative to challenge. Only 40% of the 68 subjects tested had pain, and only 50% of them had stiffness in the thoracic region. It should be obvious that challenging a normally functioning vertebra should cause a negative result, thereby making positive tests of the thoracic spinal column from T3 to T12 statistically insignificant. General lateral to medial spinous process pressure applied to a vertebra that may be subluxated does not always produce a muscle response. The specific vector of challenge must match the specific subluxation of the vertebra if the rebound phenomenon described in AK diagnosis of vertebral subluxations is to be evaluated. A more specific research design would be to diagnose vertebral subluxations by another method (palpation, radiography, thermography), and then to employ the AK method of vertebral challenge to these specific vertebrae to evaluate the intra- and inter-examiner reliability of this method.

Relationship between two measures of upper extremity strength: manual muscle test compared to hand-held myometry, Schwartz S, Cohen ME, Herbison GJ, Shah A .

Arch Phys Med Rehabil. 1992 Nov;73(11):1063-8.

Abstract: One hundred and twenty-two individuals with spinal cord injuries at levels C4-6, Frankel classifications A through D, were evaluated to determine the relationship between the manual muscle test (MMT) and hand-held myometry as accurate methods for measuring muscular strength. More specifically, this study attempted to define a range of myometry scores that could be correlated with discrete MMT grades. It also investigated which of the two modalities (MMT or hand-held myometry) is the best reflection of improvement in muscle strength over time. Sequential motor strength examinations using both modalities were performed at 72 hours, one week, and two weeks post SCI and then one, two, three, four, six, 12, 18, and 24 months post injury. The data analyses included calculations of Spearman ranked correlations, analyses of variance, and linear regressions. Results showed that 22 of 24 correlations between MMT and myometry were significant at p values less than .001. The range of myometry measurements for a particular MMT grade appears to be most specific for MMT scores less than 4 (i.e., poor-plus to good), and less specific for MMT scores greater than or equal to 4. The results of this study also indicate that myometry measurements detect increases in strength over time, which are not reflected by changes in MMT scores.

Objective Measurement of Proprioceptive Technique Consequences on Muscular Maximal Voluntary Contraction During Manual Muscle Testing, Perot, C., Meldener, R., Gouble, F.

-- Departement de genie biologique, URA CNRS 858, Universite de technologie, Compiegne.

Agressologie . 1991; 32(10):471-474.

This study measured the electrical activity in muscles. It established that there was a significant difference in electrical activity in the muscle, and that this corresponded with the difference found between "strong" versus "weak" muscle testing outcomes by AK practitioners. It further established that these outcomes were not attributable to increased or decreased testing force from the doctor during the tests. In addition, the study showed that manual treatment methods used by AK practitioners to reduce the level of tone of spindle cells in the muscle are in fact capable of creating a reduction in tone of the muscle, as had been observed clinically.

Response of Tibialis anterior muscle to a "proprioceptive technique" used in applied kinesiology was investigated during manual muscle testing using a graphical registration of both mechanical and electromyographic parameters. Experiments were conducted blind on ten subjects. Each subject was tested ten times, five as reference, five after proprioceptive technique application reputed to be inhibitory. Results indicated that when examiner-subject coordination was good an inhibition was easily registered. Therefore reliability of the proposed procedure is mostly dependent upon satisfactory subject-examiner coordination that is also necessary in standard clinical manual muscle testing.

Failure of the musculo-skeletal system may produce major weight shifts in forward and backward bending, Goodheart, G.

Proc Inter Conf Spinal Manip, Washington, DC;May 1990:399-402

Reliability of Manual Muscle Testing with a Computerized Dynamometer, Hsieh, C.Y., Phillips, R.B.

Journal of Manipulative and Physiological Therapeutics . 1990; 13:72-82.

Abstract: The purpose of this study was to investigate the reliability of manual dynamometry. Three testers participated and performed the doctor-and-patient-initiated testing methods as described in the applied kinesiology literature. Three muscles from each subject were tested. Fifteen normal volunteer adults had their muscles tested by the doctor-initiated method and another and another 15 had their muscles tested by the patient-initiated method. Each tester took two observations per muscle. The testing procedures were repeated 7 days later. The results showed that the intratester reliability coefficients were 0.55, 0.75 and 0.76 for testers 1, 2 and 3, respectively, when the doctor-initiated method was used; 0.96, 0.99 and 0.97 when the patient-initiated method was used. The intertester reliability coefficients were 0.77 and 0.59 on day 1 and day 2, respectively, for the doctor-initiated method; 0.95 and 0.96 for the patient-initiated method. It is concluded that manual dynamometry is an acceptable procedure for the patient-initiated method and is not acceptable for the doctor-initiated method.

Comment: Numerous hand-held dynamometers have been developed to quantify the manual muscle test. These are units that are interposed between the examiner's hand and the subject's limb being tested. There is a constant effort to upgrade the hand-held units. These units can measure many aspects of the manual muscle test, but none of them has all of the measuring capacities that are in each of them separately. To date none of these units have been capable of measuring the manual muscle test as used in applied kinesiology with consistent reliability. This study does show a correlation, but it does not validate the complete system of manual muscle testing as used in AK. It appears that the major difference between testing against fixed transducers - whether isometric or concentric - is that the muscle is required to simply produce power; in manual muscle testing, the muscle is required to adapt to the changing pressure of the examiner's force. This requires effective functioning in the gamma system adjusting the neuromuscular spindle cell, and proper interpretation of its afferent supply and response by the nervous system.

A Review of the Research Papers Published by the International College of Applied Kinesiology from 1981 to 1987, Klinkoski, B., LeBoeuf, C.

J Manipulative Physiol Ther, 1990;13:190-194

Abstract: Applied Kinesiology (AK) is a diagnostic and therapeutic approach used by a large number of chiropractors. AK seminars are conducted worldwide; during these seminars mention is frequently made of the presence of supportive research. A review was undertaken of the type and scientific quality of 50 papers which had been published between 1981 and 1987 by the International College of Applied Kinesiology, 20 of which were classified as research papers. These were subjected to further scrutiny relating to criteria considered crucial in research methodology, namely, a clear identification of sample size, inclusion criteria, blind and naïve subjects and statistical analysis. Although some papers satisfied several of these criteria, none satisfied all seven of them. As none of the papers included adequate statistical analyses, no valid conclusions could be drawn concerning their report of findings.

Comment: It may be that the "controlled clinical trial" cannot be realized in practice; a "dream of reason" leading its ghostly existence on the pages of research journals and largely disregarded in practice. The positive patient outcomes as a result of applied kinesiology chiropractic that are described in the papers reviewed in this article may have greater weight than data from designed research protocols involving human subjects. In "controlled clinical trials" it is not possible to control all of the variables in individual patients in the study, and therefore it may only be naively assumed that every detail of an idealized research methodology have been met. However, in the evolving health care system, self-assessed, or subjective measures of a patient's response to treatment are gaining credibility. The unreliability of physical, mechanistic measurements in defining outcomes has led to a shift toward using patient-reported perceptions as outcome measures. For example, patient-reported symptoms of disability have been found to be more predictive of outcomes such as returning to work than diagnostic tests or signs such as x-rays or orthopedic examinations of physical abnormalities. Applied kinesiology's emphasis on health rather than disease, and treatment of the whole person rather than the symptoms, makes it difficult to fully describe or detect the effects of AK therapies in patients' function through currently existing physiologic measures or "controlled clinical trials."

Somatosensory Evoked Potential Changes During Muscle Testing, Leisman, G., Shambaugh, P., Ferentz, A.

International Journal of Neuroscience. 1989; 45:143-151.

This study measured the way the central nervous system is functioning when muscles test strong versus when they test weak. Clear, consistent and predictable differences were identified in the central nervous system between weak and strong muscle test outcomes. This supports the idea that manual muscle testing outcome changes reflect changes in the central nervous system.

Cybernetic Model of Psychophysiologic Pathways: II. Consciousness of Effort and Kinesthesia, Leisman, G.  

Journal of Manipulative and Physiological Therapeutics . 1989; 12(3):174-191.

Abstract: This paper describes a series of experiments directed toward the following questions: a) do signals from musculotendinous receptors reach consciousness?, and b) does feed-forward information of muscular force and expected extent of voluntary movement exist? To answer these questions, data from voluntary compression of springs and strain-gauge have been analyzed in healthy young subjects. By successive elimination of information from other sources, it was possible to verify that receptors in muscles and tendons do signal movement magnitude and muscular tension to the cerebral cortex, and that this information does reach consciousness. There also exists a feed-forward mechanism signaling parameters of voluntary contraction. However, it is unclear whether peripheral, subcortical or intracortical loops are directly involved.

Cybernetic Model of Psychophysiologic Pathways: III. Impairment of Consciousness of Effort and Kinesthesia, Leisman, G.  

Journal of Manipulative and Physiological Therapeutics . 1989; 12(4):257-265.

Abstract: It is unclear whether peripheral, subcortical or intracortical loops are directly involved between receptors in muscles and tendons and the cerebral cortex in signaling movement magnitude and muscular tension information. Previous experiments have indicated that this information does reach consciousness. Data from voluntary compression of springs and strain-gauge were analyzed in patients with unilateral lesions of the cerebral hemispheres. It was found that the perception of signals of muscular tension is abolished by lesions of the contralateral cortex near the central sulcus. It was concluded that the possibility exists of separate cortical projection areas for kinesthetic signals from muscles and from joints.

Clinical Reliability of Manual Muscle Testing, Frese, E., Brown, M., Norton, B.J.   .

Physical Therapy. 1987; 67:1072-1076

Abstract: The purposes of this study were to develop a protocol to examine the reliability of manual muscle testing in a clinical setting and to use that protocol to assess the interrater reliability of manually testing the strength of the middle trapezius and gluteus medius muscles. One hundred ten patients with various diagnoses participated as subjects, and 11 physical therapists participated as examiners in this study. The results showed that interrater reliability for right and left middle trapezius and gluteus medius muscles were low. The percentage of therapists obtaining a rating of the same grade or within one third of a grade ranged from 50% to 60% for the four muscles. This study indicates that using manual muscle testing to make accurate clinical assessments of patient status is of questionable value.

Comment: This study demonstrates that manual muscle testing as a diagnostic tool is only as good as the operator conducting the test. The study notes that the 11 physical therapists who were the examiners were recent graduates of a physical therapy program, with only an average of 2.3 years of clinical experience. Two different types of manual muscle testing procedures were also employed during this study, thereby increasing the variability of outcomes. The methods of manual muscle testing used in this study were not those taught by the I.C.A.K., and the numerous variables in a manual muscle test (patient positioning, accuracy of timing during the test, and consistency of the type of testing done on the patients by the examiners) were not accounted for, any one of which may influence the perception of strength or weakness on testing.

Diagnosis of thyroid dysfunction: applied kinesiology compared to clinical observations and laboratory tests, Jacobs, G, Franks, T, Gilman, G.

J Manipulative Physiol Ther, 1984;7(2):99-104

Abstract: Sixty-five patients presenting to three clinics were independently evaluated for thyroid dysfunction by applied kinesiology (AK), a clinical protocol, and laboratory testing. Each was rated on a scale of 1 (unquestionably hypothyroid) to 7 (unquestionably hyperthyroid). AK ratings correlated with laboratory ratings (r s = .32, p < .002) and with laboratory ratings (r s = .32, p < .005). Correlation between clinical and laboratory diagnosis was .47, p < .000. Three AK therapy localizations had a significant correlation with the laboratory diagnosis (p < .05). Two of these (right neurovascular-left brain and left neurolymphatic-right brain) were points associated with thyroid function. The third, ventral hand on the glabella with the other on the external occipital protuberance, is associated with pituitary function. AK enhanced but did not replace clinical/laboratory diagnosis of thyroid dysfunction. Preliminary evidence indicates that there may be a significant correlation between certain AK tests and an elevated LDH in the serum.

The Efficacy of Manual Assessment of Muscle Strength Using a New Device, Marino, M., Nicholas, J.A., Gleim, G., Rosenthal, P., Nicholas, S.J.  

-- Institute of Sports Medicine and Athletic Trauma of Lenon Hill Hospital, New York

American Journal of Sports Medicine . 1982; 10:360-364.

Abstract: The purpose of this study was to compare the manual assessment of muscle strength with a small, hand-held (by the examiner) force-measuring device developed by the Institute of Sports Medicine and Athletic Trauma (ISMAT). One hundred twenty-eight patients presented with a known lower extremity orthopedic pathology. All patients were clinically evaluated for hip abductor and hip flexor weakness in standard positions using the "break test" technique. All 128 patients were then evaluated with the ISMAT Manual Muscle Tester, a small-hand held device with recorded the peak force (kg) required to break a muscle contraction. Three bilateral measures of hip abduction and hip flexion were recorded, averaged, and compared to the subjective clinical evaluation using a Chi-square analysis. Bilateral values which were within 5% of each other were not considered significant and therefore not included in the calculations. The average hip abduction and hip flexion scores measured by the ISMAT tester were consistent with the examiner's perception of muscle weakness (P less than 0.001). The results demonstrate consistent detection of muscle weakness by the ISMAT Manual Muscle Tester over a broad range of testing conditions.

Muscle Strength Testing as a Diagnostic Screen for Supplemental Nutrition Therapy: A Blind Study, Triano, J.

Journal of Manipulative and Physiological Therapeutics . 1982; 5:179.

Abstract: A controlled study of the reliability of clinical muscle testing as an index of nutritional assessment is presented. Both participating clinicians and patients were unaware of the nature of the substances being tested for their effect on the latissimus dorsi muscle. Previously identified "weak" muscles were used to observe for a "strengthening" effect as a result of topical and sublingual exposure to specific nutritional supplements.

Comment: This study reports that there is no one-to-one association between certain muscle weaknesses and a specific nutrient that always strengthens the muscle. This assertion has never been made by the I.C.A.K. The most serious problem with this study is that its negative conclusions are much broader than its data supports, because they lack the statistical power to justify such a broadly negative (or positive) conclusion. Furthermore, research on AK nutritional testing requires a much more complex design. There are many factors that can cause a muscle to test weak that need to be taken into consideration.

Applied kinesiology: an experimental evaluation by double blind methodology, Jacobs, G.

J Manipulative Physiol Ther, 1981;4:141-145

Abstract: The object was to develop a double blind experiment for testing the premise of a muscle testing procedure referred to as Applied Kinesiology (A.K.). In a non-blind test there was a significant difference (P<.05) in muscle response to lump sugar versus the same amount in a 10 ml solution of distilled H 2 0. It was not possible to demonstrate significant differences in response to sweet and non-sweet sugar solutions of various concentrations, to fresh sesame oil and heated, or to fresh corn oil and aged corn oil when stimuli were applied in a double blind experiment. It was concluded on the basis of the parameters of this study that the AK response generally expected did not occur.

Comment: This study demonstrated a random muscle weakening on gustatory stimulation with refined sugar. The "AK response generally expected" was that muscles would weaken upon gustatory stimulation with refined sugar. This is an example of experimental bias against sugar. In some patients sugar will cause improved muscle function depending on the patient's physiological status at the time. None of the literature from the I.C.A.K. suggests that all individuals weaken on oral stimulation with refined sugars. This double-blind study did demonstrate, however, an 81.9% agreement between two testers, indicating good inter-examiner reliability.

Effects of an Applied Kinesiology Technique on Quadriceps Femoris Muscle Isometric Strength, Grossi, J.A.  

Physical Therapy . 1981; 61:1011-1016.

Abstract: The effect of either the muscle spindle cell receptor technique of applied kinesiology or a placebo technique on isometric strength of the right quadriceps femoris muscle group was studied among 20 normal human subjects. Peak, perpendicular maximal values of isometric quadriceps femoris muscle force was measured by a force transducer. Three training sessions consisting of three trials of peak maximal contractions of the isometric quadriceps femoris muscle were performed by all subjects. After the three training sessions, matched pairs of subjects were formed from a rank order list of each subject's mean values of isometric quadriceps femoris muscle strength on the third session. One subject of a matched pair was then randomly assigned to either an experimental (applied kinesiology) or control (placebo) group for the testing session. No significant differences in mean values of isometric quadriceps femoris muscle strength between the matched pairs for control and experimental subjects were noted. Within the context of a normal population, the applied kinesiology technique does not appear to augment isometric quadriceps femoris muscle strength.

Comment: This study investigates something that is not a part of applied kinesiology and concludes that the treatment protocol used is ineffective. This study was conducted on normally functioning subjects, and attempted to increase a muscle's strength by neuromuscular spindle technique. Applied kinesiology manipulation of the neuromuscular spindle cell is designed to treat an abnormally functioning muscle that is hypertonic or tests weak on manual muscle testing due to the dysfunctioning muscle spindle cell. One must first identify that the muscle is dysfunctional and then that it is due to the neuromuscular spindle cell. Under those conditions treatment to the neuromuscular spindle cell is appropriate. It makes little sense to try to make a normal muscle more normal by this technique, as was attempted in this study.

The effect of oral administration of refined sugar on muscle strength, Rybeck, D., Swenson, R.

J Manipulative Physiol Ther, 1980;3:155-161

Abstract: The discipline of Applied Kinesiology has described a weakening of major muscle groups in certain experimental subjects upon refined sugar being placed in the mouth. Manual muscle testing, particularly of the latissimus dorsi muscle, has been associated clinically with sugar metabolism. The weakening phenomenon was investigated using an isometric, mechanically measured, test of the latissimus dorsi and a manual test of the same muscle in 73 subjects. Tests were conducted blind prior to and following sugar being placed in the mouths of the experimental group and nothing being given to the controls. The mechanical test showed no statistically significant change upon sugar administration while the manual test revealed a statistically significant difference (p = 0.0062) between the control and the experimental groups. Alternative explanations for the "weakening" phenomenon observed in the experimental group with manual muscle testing are discussed as are possible explanations for the apparent inability of the mechanical test to distinguish the control from the experimental group.

Comment: As noted previously, it is not expected that everyone will weaken when sugar is placed in the mouth. On a clinical basis it is observed that patients who have sugar handling stress more frequently weaken when sugar is placed in the mouth than does the random population. The failure of the manual muscle test to correlate with the mechanical transducer finding is supported by studies by Blaich and Mendenhall showing the difference between manual muscle testing and the Cybex II instrument testing.

New diagnostic and therapeutic approach to thyroid-associated orbitopathy based on applied kinesiology and homeopathic therapy, Moncayo, R., Moncayo, H., Ulmer, H., Kainz, H.

J Altern Complement Med, 2004 Aug;10(4):643-50.

Objectives: To investigate pathogenetic mechanisms related to the lacrimal and lymphatic glands in patients with thyroid-associated orbitopathy (TAO), and the potential of applied kinesiology diagnosis and homeopathic therapeutic measures. Design: Prospective.

Settings/location: Thyroid outpatient unit and a specialized center for complementary medicine (WOMED, Innsbruck; R.M. and H.M.). Subjects: Thirty-two (32) patients with TAO, 23 with a long-standing disease, and 9 showing discrete initial changes. All patients were euthyroid at the time of the investigation. Interventions: Clinical investigation was done, using applied kinesiology methods. Departing from normal reacting muscles, both target organs as well as therapeutic measures were tested. Affected organs will produce a therapy localization (TL) that turns a normal muscle tone weak. Using the same approach, specific counteracting therapies (i.e., tonsillitis nosode and lymph mobilizing agents) were tested. Outcome measures: 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 recorded in a graded fashion. Results: Positive TL 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. Both Lymphdiaral® (Pascoe, Giessen, Germany) and the homeopathic preparation chronic tonsillitis nosode at a C3 potency (Spagyra,® Grödig, Austria) counteracted these changes. Both agents were used therapeutically over 3-6 months, after which all relevant parameters showed improvement. Conclusions: Our study demonstrates the involvement of lymphatic structures and flow in the pathogenesis of TAO. The tenderness of the San Yin Jiao point correlates to the abovementioned changes and should be included in the clinical evaluation of these patients.

Applied Kinesiology (AK), Perle, S.

Chiro Technique, 7(3);Aug 1995:103-107

Abstract: Applied Kinesiology (AK) intends to be a comprehensive interdisciplinary approach to health care. It postulates that human disease can be seen as an alteration in the function in structural, chemical, and/or mental aspects of the body. Unique to AK is the use of manual muscle testing procedures to aid in the diagnosis of the structural, chemical and/or mental aspects of a disease process. After treatment, AK again uses manual muscle testing procedures to determine the effectiveness of the treatment. Therefore, manual muscle testing is used both to diagnose specific dysfunction and to assess outcomes.

Neuromuscular relaxation and CCMDP. Rolfing and applied kinesiology (article in Italian), Santoro, F., Maiorana, C., Geirola, R.

Dent Cadmos. 1989 Nov 15;57(17):76-80.

Applied Kinesiology: Muscle Response In Diagnosis, Therapy And Preventive Medicine, Meal G.

Eur J Chiro , Jun 1986;34(2):107

Quantification of the Inhibition of Muscular Strength Following the Application of a Chiropractic Maneuver, Perot, D., Goubel, F., Meldener, R.  

Journale de Biophysique et de Biomecanique . 1986; 32(10):471-474.

Applied kinesiology and dentistry, Goodheart, G.J.

Basal Facts, 9(2);1987:69-73

Abstract: This paper presents the applied kinesiology approach for treating structurally based disorders of the temporomandibular joint through an integrated approach to patient care. This approach may require close cooperation between dental orthopedic and chiropractic professionals in evaluating and treating patients. Dental occlusion is suggested to be part of a larger pattern of function that includes the spine, pelvis, cranium, and neuromuscular systems that span them. The jaws, cranium, spine and pelvis are considered as interdependent parts of the whole body system. The AK protocol for evaluation of these factors is presented, and specific techniques for the diagnosis and treatment the musculature of the stomatognathic system are offered.

Applied kinesiology and colon health, White, P.

Basal Facts, 1985;7(2):143-50.

Abstract: A review of the physiology of the gastro-intestinal tract is given, as well as the anatomical and bio-chemical factors that may disturb normal function in the colon. A protocol of AK evaluation is offered for the examination of the gastro-intestinal tract. The ileocecal valve's importance for normal colon health is described, and dietary and nutritional advice is given for disturbances in the colon.

Uses of applied kinesiology for dentists, Walther, D.S.

Basal Facts, 1985;7(2):133-41.

Abstract: This paper also describes the applied kinesiology approach for treating structurally based disorders of the temporomandibular joint through an integrated approach to patient care. This approach may require close cooperation between dental orthopedic and chiropractic professionals in evaluating and treating patients. Dental occlusion is suggested to be part of a larger pattern of function that includes the spine, pelvis, cranium, and neuromuscular systems that span them. The jaws, cranium, spine and pelvis are considered as interdependent parts of the whole body system. The AK protocol for evaluation of these factors is presented, and specific techniques for the diagnosis and treatment of the musculature of the stomatognathic system are offered.

Applied dental kinesiology: temporomandibular joint dysfunction, Glassley DP  

Basal Facts , 1983;5(2):65-6

Neurophysiologic Inhibition of Strength Following Tactile Stimulation of the Skin, Nicholas, J.A., Melvin, M., Saraniti, A.J.

American Journal of Sports Medicine . 1980; 8:181-186.

An Experimental Evaluation of Kinesiology in Allergy and Deficiency Disease Diagnosis, Scopp, A.

Journal of Orthomolecular Psychiatry . 1979; 7(2):137-8.

Factors Influencing Manual Muscle Tests in Physical Therapy, Nicholas, J. A., Sapega, A., Kraus, H., Webb, J.N.  

Journal of Bone and Joint Surgery . 1978; 60-A:186-190.

Applied Kinesiology: An opinion, Diamond, J. M.D.

J Int Acad Prevent Med, July 1977:97

Applied kinesiology using the acupuncture meridian concept: critical evaluation of its potential as the simplest non-invasive means of diagnosis, and compatibility test of food and drugs - Part I, Omura, Y.

Int J Acupuncture & Electro-Therapeut Res, 4:165-183

Applied kinesiology: its use in veterinary diagnosis, Tiekert, C.G.

Vet Med Small Animal Clinician, Nov 1981:1621-1623

Kinesiology and Dentistry, Goodheart, G.

J Amer Soc Psychosomatic Disease,  1976;6:16-18