Chiropractor / Applied Kinesiology test

Members do not see these Ads. Sign Up.

Hi All
A patient for whom I'd prescribed orthoses several years ago contacted me recently at the request of the chiropractor. The chiropractor had seen this patient for a new episode of sciatica related to heavy lifting. During the consultation the chiropractor asked the patient to stretch out her arms, making a fist then pressed down on her arms. He carried out this `test` with and without the patient wearing her orthoses and concluded she was better without them. Apart from altering her C.O.G I can't understand what he was testing.
My questions are :-
1. What is this test ?
2. Is it a valid test ?
3. What was the chiropractor testing for and how can he conclude that the patient is better without her orthoses ?

The patient says that in the last 4 years the orthoses have helped her symptoms enormously and doesn't want to stop wearing them. I am seeing her next week.

Thanks in advance
Deborah

 

Re: chiropractor test

Its an applied kinesiology scam.

See this thread:
Applied kinesiology and foot orthotics: True or scam?

 

Re: chiropractor test

Thanks -

had a sneaking suspicion that might be the case but just wanted it verified.
Deborah

 

Re: chiropractor test

Deborah, sounds like an "Applied Kinesiology" type of test; AKA bull****. Look at it, say what it is... Piece of sh!t.

 

Re: chiropractor test

Raises an interesting practice management point. Another practioner has said your work is bad...using a bogus test... You have the advantage of telling the patient, well theyr'e working fine, don't throw them out. Now you have to think about how much you want to criticize the chiro. How big a town do you live in?

Eric

 

Re: chiropractor test

I'd recommend everyone, patients and colleagues alike to read: "Trick or treatment" by Simon Singh and Edzard Ernst. Corgi Books, 2008. ISBN: 9780552157629

 

Re: chiropractor test

Thanks
I don't like to be overtly critical of other practitioners as I feel it's a bit unprofessional. I don't think the orthoses are related to the sciatica which the patient said was due to heavy lifting. Seems to me that the chiropractor, for whatever reason found it easier to blame the insoles than offer any effective treatment. Who knows !
Deborah

 

Re: chiropractor test

Deborah,

As a practicing chiropractor I am ashamed that a colleague would try to discredit your treatment of your patient. It is abhorrent and unethical, especially because I feel that few chiropractors truly understand the practice of podiatry and especially foot orthoses (nor possess the training and license to comment). Sadly, there are chiropractors out there utilizing methods such as Applied Kinesiology, a practice which is not taught in any formal educational DC program in the U.S. Please don't allow the few to spoil your opinion of the whole. Most of us (DC's) utilize standard evaluation and treatment practices, which is what was taught in our didactic training.

I have expressed my very strong and critical views on AK in threads on PA before. I would suggest calling the offending DC and putting them on notice that practicing podiatry without a license is surely against several laws where you practice, it is also unethical. I admit that I have scrutinized orthoses dispensed by a podiatrist more than once but always instructed the patient to take their concerns to the podiatrist first and without criticizing the DPM's work

It is called interprofessional respect. You were shown none and in my opinion it should not be allowed to stand.

Best regards,

 

Re: chiropractor test

I just got this in my email - very timely. This looks like the "Test" you describe.

 

Re: chiropractor test

Yes that's what was described to me but I still don't understand what the test is trying to demonstrate !

Cheers

Deborah

 

Re: chiropractor test

Isn't it obvious? When your feet are in the perfect, ideal alignment your muscle trains are activated and the tensegrity system of your sketetal chain is locked into a position of maximum efficiency by the uninhibited flow of Chi through your chakras allowing your spiritual energy to energise the vectron receptors in your muscles (by vectron) creating a biokinetic feedback loop healing all your MSK problems and very possibly enhancing your overall wellbeing at the same time.

For goodness sake didn't they teach you that at University?

To paraphrase Simon / Bill. If someone curled one out on your clinic floor you would'nt pick it up, examine it and seek for the universal truth contained therin. There is none. There is nothing this test can demonstrate. Look at it, say what it is. Its a pile of Voodoo ***t. The purvayor of such is a ***t merchant and the patient should not have bought it and treated you to its odour.

The desparately frustrating part about the whole "went to see such and such and they said the insoles were wrong" thing, and this applies to everyone, is that such people NEVER ACTUALLY SAY WHAT THE PATIENT SHOULD HAVE!!!. If they're so flippin transcendantly gifted then why is the patient coming back to you?! If they know what insoles the person SHOULD have then why didn't THEY do it?

This used to happen to me a fair bit with one or two colleagues. I developed the policy that if the referrer thinks they know best and the patient believes them, then its better all around if the patient stays with the referrer. After all if they know the answer, and I don't, then its only good sense for the patient to stay with them to enjoy the friuts of their hindsight. I sent quite a few patients back to such clinicians with exactly that message and often a covering letter to that effect. That seemed to solve the problem. It did create the new situation of "he put some different ones in and they were MUCH worse so I came back to see you" but that is a much more acceptable situation.

Rant over.

 

Re: chiropractor test

I remain open minded on such techniques ( as would be expected). I would be interested in Ted coming back on this as he seems to find it useful in this video.

 

Re: chiropractor test

Thanks Rob
That gave me a laugh and a break from the weekend chores.
I'm seeing the patient on monday and after assessment I will tell her to continue with her insoles and refer to a physiotherapist for her sciatica.
Cheers
Deborah

 

Re: chiropractor test

You're a little teapot short and stout, listen to this bull**** while I empty you out (your wallet, that is).

I too should be interested to hear of the evidence base behind this practice.

 

Re: chiropractor test

Did an internet search between doing the washing and cooking dinner - there's virtually nothing.
Deborah

 

Re: chiropractor test

Good Morning All,

My interest in Applied Kinesiology (AK) started when a chiropractor used it to gain some clinical information on my body's needs. I couldn't dispute the bodily experiences I had with the testing methods and, curious, decided to find some information about it.

The best explanations came from Neuromechanical Basis of Kinesiology (2nd Ed.) by Roger M. Enoka 1994. Enoka helped me understand how ligaments respond to tensile forces (p126), afferent sensory information (p136), proprioceptive and exteroreceptive transduction (p138), the 5 different nerve receptors innervating our joints (p139) and how 'The significance of joint receptors for the normal function of the single joint system has been convincingly demonstrated by the effect of joint pathology on muscle activation.' I.e. how changes in proprioceptive feedback to the brain can 'switch on' and 'switch off' muscles.

Enoka also refers to STOKES M & YOUNG A. (1984)
Investigations of quadriceps inhibition: implications for clinical practice.
Physiotherapy, 70:425-428 and
YOUNG A, STOKES M & ILES JF. (1987)
Effects of joint pathology on muscle. In: The Pathophysiology of Joint Contractures and
their Correction.
Eds A Young & RB Duthie. Clinical Orthopaedics and Related Research, 219:21-27.

The programming of corollary discharges (the signals that are transmitted back to the suprasegmental centres from the brain stem and spinal cord) and how they are influenced by afferent proprioceptive feedback is described by PD Cheney in 'Role of Cerebral Cortex in Voluntary Movements. A Review' (1985) Physical Therapy, 65, p625.

As for there being clinical trials demonstrating how orthotic devices affect the afferent proprioceptive feedback for the programming of corollary efferent discharges, I am not aware of any. This would be an interesting research project.

I do find it interesting that NASA employs the use of vibration platforms in the rehab of proprioception and muscle tonus for astronauts returning from space. This is to prevent the habituation of the astronauts' proprioceptors that occurs in a microgravity environment.

May I ask, have any readers/contributors to this topic used AK in a clinical setting?

I have found that AK is simply another clinical test that can be used in conjunction with other investigations to develop our treatment plans for our patients.

Ted.
I used to have a handle on life, but it broke.

 

Re: chiropractor test

In haste. But briefly, respect to ted (and ian) for having the minerals to come out for what They believe! I think you're wrong but I admire your courage.

 

Re: chiropractor test

Thanks for the come back Ted. I'll have a read.

"I think you're wrong " - What, Rob, me!! Never

 

Re: chiropractor test

In even greater haste, are you saying that Professor Maria Stokes of the School of Health Sciences (in your fair land at Southampton) is wrong?

I don't understand what part of neuroanatomy & neurophysiology you are claiming is 'wrong'. You're going to have to explain your reasoning before I can understand where you are coming from Robert.

Ted

 

Re: chiropractor test

That said.

Here is the thing. The sciencY bit in AK sounds lovely. But as so often with these things, while the words make sense, the sentances often don't.

Let's get down to the nitty gritty. Leave alone the food allergy testing bit, which is easy to test and debunk, what are we talking about here? Can meaningful information about orthoses be derived by testing muscles in the upper body.

I think not. I think this is pure ideomotor effect. The ideomotor effect IS well understood and easily repeatable under test conditions. What we see here, IMO, is simply a test which picks up what the clinician/ client believes, conciously or subconciously. The recent case as an example, a patient with pain goes to a chiro. The question is raised, and the suggestion made, that the problem is the insoles. At best, ideomotor testing just picks up on subconcious belief. Psychologically interesting but clinically insignificant.

But then, why have the debate? If AK is clinically useful it would be the easiest thing in the world to test! The ideomotor effect can be largely removed from the equation by blinding.

So here is an offer. If anyone really believes that AK has clinical application (beyond as a convincer for patients, which is not an entirely useless thing) I'm happy to be proved wrong. Blinding such a study would be tricky, as I suspect it's mainly (though not entirely) the subjects ideomotor impulses being detected rather than the testers. However if AK is kosher, a tester should be able to detect differences in situation. If had 1 subject, who did not know the nature of the test placed in 3 states, insole, sham insole, sham insole with a unilateral insole, say 6 times each in random order ,a tester should be able to detect, blindfold, which state somebody is in pretty consistantly right?

If anyone thinks they can, get in touch! I have £50 which says you can't. I'd even post a fullsome endorsement of AK as a bonus.

Anyone that confident? I don't expect to be killed in the crush!

 

Re: chiropractor test

Sorry ted, your post came through while I was doing mine.
I suspect the lady has many opinions, some of which i'll agree with and some not. But if she believes AK is a repeatable clinical test then yes I thing she is wrong. Ian lives just up the road! He's one of my closest friends and someones who's views I respect enormously. He's also a better podiatrist that I will ever be. But in this I think HE is wrong as well (sorry Ian ).

 

Re: chiropractor test

So let's go back to the neurophysiology: For the brain to coordinate efferent instructions to the body's muscles, it must receive afferent proprioceptive feedback. In gait, the brain must coordinate all efferent impulses to all muscles involved in gait. The deltoids are actively involved in gait (arm swing) and therefore will be part of the efferent messages.

The same sort of testing can be done on muscles closer to the foot. The hamstrings can prove to be convenient.

http://www.youtube.com/watch?v=lccouJQXQME

Professor Stokes is describing and validating the effect of interference of proprioceptive afferent nerve conduction to the brain. She makes no claim whatsoever (as far as I have read) about AK. She does state clearly though, that interference to joint mechanoreceptors has a direct effect on the related muscles' strength due to efferent input, not intrinsic muscle strength.

Think that if you choose, however, I'm referring purely to the neurophysiological effects of muscles when their afferent input is affected negatively. No subconscious 'beliefs', just straight out physiological responses.

For what it's worth, in the demo I did on Mark (the subject in the YouTube clip) he did not have any idea what I was doing or what I was testing for. After the tests were done, I then explained the results we all observed and then repeated the tests a second time.

Yes, I agree! I'm up for your challenge! I'm over your way in April. You set up the test exactly as you deem appropriate and I'll be your subject 'tester'. And you should be the subject (if that's permissible). But let's make it at least £100 'cos by the time I get there, the Aussie $ will probably be close to parity with the £.

What's the speed limit near your place Robert? I'm on my way!

Ted.

 

Re: chiropractor test

Found this recent publication which, I think supports the view that AK isn't scientifically valid.
Hass M, Cooperstein R, Peterson D. Disentangling manual muscle testing and Applied Kinesiology: critique and reinterpretation of a literature review. Chiropractic & Osteopathy 2007,15:11.
They make an important point about separating AK muscle testing from standard orthopaedic and neurological muscle testing.
Cheers
Deborah

 

Re: chiropractor test

http://content.karger.com/ProdukteDB/produkte.asp?Doi=112820

 

Re: chiropractor test

Yes, the evidence does indicate that the broad field of AK is not validated scientifically.

I have seen and heard of practitioners testing (using AK) for food allergies, personal relationship decisions and all manner of bizarre applications. I suspect this is the application of AK for assessing '...the body's energetic balance.' I have no support for this use.

I do, however, see a use for neurological muscle testing because of the effect that podiatric treatment modalities have on bodies' proprioceptive mechanisms. By definition, this would be 'neurological muscle testing' rather than 'applied kinesiology' testing even though their methods can appear similar.

Ted.

 

Re: chiropractor test

Ted you are so on!

Let me know when you're planning to be here. We'll agree protocol before hand, set it up and do it. Hell, let's publish as well.

Me as a subject would introduce gross bias. We'll find one who has little / no knowledge of the test or the study. When I get time, I'll give the protocol some serious thought and start a new thread for it.

 

Re: chiropractor test

Yay Rob! Sounds great!

I will be teaching the Advanced Level 2 FMT (a 1 day Course) in Hyde Park, London, on Thursday Apr 14 and again Sunday Apr 17. I teach the Neurological Muscle Testing topic in this Course so maybe we can coordinate our 'study' to be included as part of the course? We could select a subject (or 2) from the course, or maybe one of the hotel staff?

I do have some conditions though:
1. Let's film the 'testing' component of the study.
2. Writing up the study is an excellent suggestion and I will ask you to see this through.
3. Only cash will be accepted for the £100, maybe we each put £50 on the table and the winner takes all?
4. You must be a subject for the sake of having the 'bodily experience' of the muscle testing. The results of course, would not be included.

The only other question is; Will I still recognise you if you are not wearing the orange beanie?

Cheers,

Ted.

 

Re: chiropractor test

Hi everyone. As the 'testee' in Ted's demonstration I just thought I'd let you know that I experienced a significant loss of strength/function trying to resist downward pressure on my arm, with my 5th and 1st rays elevated. When the pens were removed full function was immediately restored. Can't explain it but believe me it happened!

 

Re: chiropractor test

Hey ted.

14-17 April sounds good. Will pm you with some fine detail.

Happy to film.

Happy to help with a write up. That would have to be done together though. You're the one with the theory behind the process!

£50 each is what I had in mind. Although being made to publish a paper in support of AK would be something money can't buy!

Happy to. Although to be fair I should tell you that I have experianced this sort of muscle testing before, both as subject and tester. I even did a course where it was taught (although that was the food allergy version and I got asked to leave).

I'll be sure to buy a beenie and a can of special brew so you recognise me . I don't look much like my avatar. At least I don't think so...

 

Re: chiropractor test

Robert we can beer after as I will be at said course. Ill pm you the date.

Ted ill keep my questions/thoughts for post match beers. Possibly

 

Re: chiropractor test

Hi Ted
In one of your previous posts you mentioned AK as a type of neurological testing but it isn't really. Proper neuro testing includes EMG and nerve conduction studies. AK involves none of these well established procedures.
Cheers
Deborah

 

Re: chiropractor test

Hi Deborah,

I agree with your comment. I made an error in describing the muscle testing method I use as an AK technique. The benefit of this thread is has been identifying the important distinction between 'Applied Kinesiology' muscle testing and 'Neurological Muscle Testing'.

This is a good point Deborah. I'm not aware though, of how many podiatrists have EMG or nerve conduction facilities in their practices. Therefore, what other options do us regular practitioners have in assessing muscle function in our daily practices?

What I'm looking for are clinical tests that can be useful for clinicians to undertake in their regular practices. I believe that the neurological muscle testing I demonstrated in the YouTube clip is a useful clinical test. It looks very similar to AK testing which (as you highlighted from your reference) is testing a body's bioenergetics (whatever that is). I don't support this type of clinical test in assessing orthotic function or efficacy.

Cheers,
Ted.

 

Re: chiropractor test

I appreciate your willingness with this Rob. I do, however, wish to clarify that it is not my theory behind the process. Rather, I am taking well established scientific facts that neurological impulses are affected by changes in the environment of nerve receptors (proprioceptors in the foot in this discussion).

I note that no one is questioning the well understood neurology of proprioceptors.

My 'theory' as you put it, is rather, a proposal of a clinical test that could be used to measure the influence of orthoses on the proprioceptive neurology of the body using a neurological muscle testing method.

Your proposed study is to test the validity (and reliability?) of using a neurological muscle testing method to measure changes in proprioceptive afferent input from changes in foot posture (with mechanical devices such as orthoses, met domes, pencils or other items as deemed appropriate).

I hope we are on the same page (or at least in the same chapter) here.

Hmmm, this may be a problem. Did you have to leave because of an allergy to lactose or glutens? I would put money (again) on it being lactose and glutens based on the aura emanating from your avatar.

Cheers,
Ted.

 

Re: chiropractor test

As a practicing chiropractor I think most AK tests are scams and are strictly for show and tell. It is too easy to force a positive.
AK is mostly for lazy practitoners who don't have the skill to diagnose with accepted standards. They are also easily dazzled by bs themselves.
As ridiculous as AK is, there is yet another level of bs that goes far beyond the nonsense of regular AK. It's called surrogate muscle testing. It's for patients, such as babies or animals, who cannot respond for themselves.
Example: The practitioner wants to prove a substance, say store bought milk, causes a person's body to go week. Let's say that person is a baby. The mother touches the baby with one hand, and outstretches her other arm while the practitioner pushes down on that outstretched arm to see if milk really does cause the mother's arm to go week. Oh, the milk or milk bottle is somewhere on the baby.
They do the same with dogs and horses--for example, if a certain grass is toxic to a horse, they'll do that same bs test with the horse owner acting as a conduit.
Folks, I used to do 30 chiropractic seminars each year. My audience consisted of chiropractors, equestrians and dog owners. What I described above were not isolated cases. I've seen dozens of these exhibitions. All nonsense. And all quite embarrassing to watch. Whenever I see such displays in public I feel like hiding my head in the nearest pothole.
We've all seen the TV informericals for those cheap orthotics--the scam strength exercises. All nonsense. Just like the tests for the scam bracelets that 'balance energy." All scams.

 

Re: chiropractor test

Say it ain't so!!

We shall see come April.

 

Re: chiropractor test

...only 68 more sleeps (with maybe minus 1 for jetlag!)

 

Re: chiropractor test

Ted,

I do appreciate your passion for the subject of muscle testing and have a few thoughts I’d like to discuss. I’m no expert in the subject but I do enjoy talking out loud, so here goes:

Proprioception is widely defined as “The unconscious perception of movement and spatial orientation arising from stimuli within the body itself” and “The subconscious sensation of body and limb movement and position, obtained from non-visual sensory input from muscle spindles and joint capsules”.

Proprioceptors are afferent organs found in joints, muscles, tendons, skin, joint capsules, ligaments, and bone that provide sensory input to coordinate functions such as joint position sense, balance of mass and equilibrium. The Golgi tendon apparatus are the sensory portion of the deep tendon reflex and are not dependant on forceful contraction to send afferent information, thus degree of force is of no consequence at this level.

Another part of proprioception is actually visual and auditory information but as above it is often denied as contributory and not well understood. Neurology does not even include visual and auditory stimuli in their explanation. Auditory and visual cues I feel very much influence the outcome of all muscle testing (but is it proprioception?), especially when the examiner forces their own cues into the test. An example would be “we are testing your muscle strength to see if these orthoses are correct for you Mrs. Smith. I will first test your muscle strength without standing on the orthoses and then I will test relative to you standing on the orthoses. I feel that we will find that you are much weaker standing on the orthoses Mrs. Smith….we see this subliminal cue all of the time. Additionally as on another thread the angle and degree of force is changed subtly.

Exercises have not been found to improve proprioception, although proprioception does improve balance, body positioning of mass etc. I believe that the word proprioception has been frequently misused to promote the idea that you can improve joint position sense, balance and joint movement detection threshold by improving proprioception (how this is accomplished is what I would like to know – insoles have been suggested by some). None of this to my knowledge has been found to be true, factual or supported by research and known fact.

How we arrive at proprioception and changing proprioception in the periphery via minimal interventions such as foot orthoses or muscle strength actions evades me. Further it evades me how muscle testing of any sort can tell us that an insole is “incorrect for us or changing our balance”? Proprioception is subconscious and layered along with numerous other CNS input and controls. Balance is in fact more strongly controlled by the cerebellum in the CNS, not the organs in the periphery and afferent input via proprioception.

It is an unconscious process we are told by those who know. It is an adaptive process and not a dynamic one effecting muscle firing. It is not efferent but afferent, therefore and EMG cannot measure it, muscle force and vector cannot change it although it will sense the change. It cannot correct balance, merely records fluctuations good and bad and sends this to the brain where the efferent fibers, which are volitional act upon the skeletal muscle. For these reasons I feel that AK muscle testing is non sequitur with regard to the function of muscle and especially muscle action related to sensory input from the outside.

This is partially why I feel that AK is pseudo-science. We also have well established muscle strength evaluation methods that correlate with EMG/NCV testing findings already. I propose that it was created because at the time there was an edict of the American Medical Association in place barring professional relationships of member MD’s with DC’s. Goodheart possibly saw the need for a system that was out of the control of medicine and could be used in the chiropractic office to “evaluate” muscle strength that did not require a referral to an MD or facility. This is only my theory but I feel it is plausible when you understand the history of the chiropractic profession and the AMA’s private war on chiropractic (which later became very public with Wilk et al vs. the AMA and the book In the Public Interest)

From there AK grew into the Medusa that you see today, testing for allergies, nutritional deficiencies and now orthotic efficacy. Is it useful? I highly doubt it. Is it scientific? No, I don’t believe so. It will of course be very interesting to learn of the results of Robert’s test.

Regards,

 

Re: chiropractor test

Hey David

I understood that that was classed as exteroceptive stimulus. Proprioception being from the latin proprius meaning "ones own" or "of self". Exteroceptive being stimulus from outside. But thats hair splitting.

From a psychological point of view there are 4 potential mechanisms at work here. The subject may release easier on purpose. The tester may push harder on purpose. The subject may release more easily in response to subconcious suggestion (ideomotor) or the tester may push harder in response to subconcious suggestion (ideomotor).

We shall see. Blinding the tester removes their ideomotor and deliberate errors. Blinding the subject will remove their concious error, however there is still the possibility of a placebo type effect. If the subject knows it is a test and which is the test condition then there may well be a subconcious response. We're going to get around that by haveing multiple different test states. If the behaviour is the same whatever the location of the pads then all the weakness shows is that something uncomfortable has been placed under the foot.

There is also a rather good way of identifying how much force is being applied without changing the nature of the test. But thats a surprise for Ted .

 

Re: chiropractor test

'Discomfort' due to the change in structure? That would cause a commensurate neurological effect. I'm ok with that.

A surprise for Ted? Why should I be the only one getting such 'gifts'? It's not even Christmas!

David, I'll be coming back to your comprehensive and detailed 'loud talk'.

Stay tuned...

Ted.

 

Re: chiropractor test

David, I have no qualms about what you have written. I have repeatedly stated that I have no training or qualifications or investment in AK. I do however, find it incredibly interesting the 'muscle weakening' effects observed 'seem' to happen when changes in mechanical structures of the feet are introduced. I think this is due to the changes in physical structure affecting the afferent neurological inputs. I'm suggesting that this is separate from AK.

I may be on the right track, or I may not. I don't have a reliable way to prove this either way. Robert, however, seems to have the nouse and experience to be able to set up a 'test' that can prove this one way or the other. I'm up for that! If it ends up costing me some $$, that is a very small price to pay for the knowledge gained.

If we end up with a more satisfying conclusion about clinical 'neurological muscle testing', I'll be thrilled with that. Then all those with opinions on AK can continue on their merry way...

Ted.