On the reliability and validity of manual muscle testing: a literature review

Coulter ID: Chiropractic: a philosophy for alternative health care. 1999, Oxford: Butterworth-Heinemann

Strang V: Essential principles of chiropractic. 1984, Davenport, IA: Palmer College of Chiropractic

Green BN, Gin RH: George Goodheart, Jr., D.C., and a history of applied kinesiology. J Manipulative Physiol Ther. 1997, 20 (5): 331-337.

Walther DS: Applied Kinesiology, Synopsis. 2000, Pueblo, CO: Systems DC, 2

Walther DS: Applied Kinesiology, Chapter 6. Principles and Practice of Manual Therapeutics: Medical Guides to Complementary & Alternative Medicine. Edited by: Coughlin P. 2002, Philadelphia: Churchill-Livingstone: Elsevier Science

Goodheart GJ: Applied Kinesiology Research Manuals. 1964, Detroit, MI: Privately published yearly

Frost R: Applied Kinesiology: A training manual and reference book of basic principals and practices. 2002, Berkeley, CA: North Atlantic Books, Berkeley

Leaf D: Applied Kinesiology Flowchart Manual, III. 1995, Plymouth, MA: Privately published

Maffetone P: Complementary Sports Medicine: Balancing traditional and nontraditional treatments. 1999, Champaign, IL: Human Kinetics

Christensen MG, Delle Morgan DR: Job analysis of chiropractic: a project report, survey analysis, and summary of the practice of chiropractic within the United States. National Board of Chiropractic Examiners. 1993, Greeley, CO, 78-

Christensen MG, Delle Morgan DR: Job analysis of chiropractic in Australia and New Zealand: a project report, survey analysis, and summary of the practice of chiropractic within Australia and New Zealand. National Board of Chiropractic Examiners. 1994, Greeley, CO, 92: 152-

American Chiropractic Association Database. Accessed February 15, 2007, [ http://www.amerchiro.org/techniques ]

LeBoeuf C: A Survey of Registered Chiropractors Practicing in South Australia in 1986. J Aust Chiro Assoc. 1988, 105-10.

Touch for Health Database. Accessed February 15, 2007 See also: A moment of silence for Dr. John Thie, Dynamic Chiropractic 2005;23(19). http://www.chiroweb.com/archives/23/19/11.html , [ http://www.touch4health.com/books.htm ]

Swinkels RA, Bouter LM, Oostendorp RA, Swinkels-Meewisse IJ, Dijkstra PU, de Vet HC: Construct validity of instruments measuring impairments in body structures and function in rheumatic disorders: which constructs are selected for validation? A systematic review. Clin Exp Rheumatol. 2006, 24 (1): 93-102.

Kaminski M, Boal R, Gillette RG, Peterson DH, Vilinave TJ: A model for the evaluation of chiropractic methods. J Manipulative Physiol Ther. 1987, 10: 61-4.

Fletcher RH, Fletcher SW, Wagner EH: Clinical epidemiology: the essentials. 1988, Philadelphia, PA: Williams & Wilkins, 3

Janda V: Movement patterns in the pelvic and hip region with special reference to pathogenesis of vertebrogenic disturbances. PhD thesis. 1964, Charles University, Prague

Bohannon RW: Manual muscle testing: does it meet the standards of an adequate screening test?. Clin Rehabil. 2005, 19 (6): 662-7. 10.1191/0269215505cr873oa.

Karin Harms-Ringdahl: Muscle Strength. 1993, Edinburgh: Churchill Livingstone

Kendall FP, McCreary EK, Provance PG: Muscles: Testing and Function. 1993, Baltimore, MD: Williams & Wilkins

Daniels L, Worthingham K: Muscle Testing – Techniques of Manual Examination. 2002, Philadelphia, PA: W.B. Saunders Co, 7

Walther DS: Applied Kinesiology, Synopsis. 2000, Pueblo, CO: Systems DC, 2

Barbano RL: Handbook of Manual Muscle Testing. Neurology. 2000, 54 (5): 1211-

Martin EG, Lovett RW: A method of testing muscular strength in infantile Paralysis. JAMA. LXV (18): 1512-3. 1915 Oct 30

Lovett RW, Martin EG: Certain aspects of infantile paralysis with a description of a method of muscle testing. JAMA. LXVI (10): 729-33. 1916 Mar 4

Shambaugh P: Changes in Electrical Activity in Muscles Resulting from Chiropractic Adjustment: A Pilot Study. J Manipulative Physiol Ther. 1987, 10 (6): 300-304.

Koes BW, Bouter LM, van Mameren H, et al: A blinded randomized clinical trial of manual therapy and physiotherapy for chronic back and neck complaints: physical outcome measures. J Manipulative Physiol Ther. 1992, 15 (1): 16-23.

Koes BW, Bouter LM, van Mameren H, et al: Randomized clinical trial of manipulative therapy and physiotherapy for persistent back and neck complaints: results of one year follow up. BMJ. 1992, 304: 601-

Meade TW, Dyer S, Browne W, et al: Low back pain of mechanical origin: randomized comparison of chiropractic and hospital outpatient treatment. BMJ. 1990, 300: 1431-

Fleiss JL: The Design and Analysis of Clinical Experiments. 1986, New York: John Wiley & Sons

Feinstein AR, Cicchetti DV: High agreement but low kappa: I. The problems of two paradoxes. J Clin Epidemiol. 1990, 43 (6): 543-9. 10.1016/0895-4356(90)90158-L.

Brennan P, Silman A: Statistical methods for assessing observer variability in clinical measures. BMJ. 304 (6840): 1491-4. 1992 Jun 6

Florence JM, Pandya S, King WM, Robison JD, Signore LC, Wentzell M, Province MA: Clinical trials in Duchenne dystrophy. Standardization and reliability of evaluation procedures. Phys Ther. 1984, 64 (1): 41-5.

Mendell JR, Florence J: Manual muscle testing. Muscle Nerve. 1990, 13 (Suppl): S16-20. 10.1002/mus.880131307.

Caruso B, Leisman G: A Force/Displacement Analysis of Muscle Testing. Perceptual and Motor Skills. 2000, 91: 683-692.

Lilienfeld AM, Jacobs M, Willis M: A study of the reproducibility of muscle testing and certain other aspects of muscle scoring. Phys Ther Rev. 1954, 34: 279-289.

Blair L: The role of the physical therapist in the evaluation studies of the poliomyelitis vaccine field trials. Phys Ther Rev. 1955, 37: 437-447.

Iddings DM, Smith LK, Spencer WA: Muscle testing: part 2. Reliability in clinical use. Phys Ther Rev. 1961, 41: 249-256.

Silver M, McElroy A, Morrow L, Heafner BK: Further standardization of manual muscle test for clinical study: applied in chronic renal disease. Phys Ther. 1970, 50: 1456-1466.

Frese E, Brown M, Norton BJ: Clinical Reliability of Manual Muscle Testing. Phys Ther. 1987, 67: 1072-1076.

Barr AE, Diamond BE, Wade CK, Harashima T, Pecorella WA, Potts CC, Rosenthal H, Fleiss JL, McMahon DJ: Reliability of testing measures in Duchenne or Becker muscular dystrophy. Arch Phys Med Rehabil. 1991, 72: 315-319.

Perry J, Weiss WB, Burnfield JM, Gronley JK: The supine hip extensor manual muscle test: a reliability and validity study. Arch Phys Med Rehabil. 2004, 85 (8): 1345-50. 10.1016/j.apmr.2003.09.019.

Jacobs G: Applied kinesiology: an experimental evaluation by double blind methodology. J Manipulative Physiol Ther. 1981, 4: 141-145.

Wadsworth CT, Krishnan R, Sear M, Harrold J, Nielsen DH: Intrarater reliability of manual muscle testing and hand-held dynametric muscle testing. Phys Ther. 1987, 67 (9): 1342-1347.

Hsieh CY, Phillips RB: Reliability of Manual Muscle Testing with a Computerized Dynamometer. J Manipulative Physiol Ther. 1990, 13: 72-82.

Florence JM, Pandya S, King WM, Robison JD, Baty J, Miller JP, Schierbecker J, Signore LC: Intrarater reliability of manual muscle test (Medical Research Council scale) grades in Duchenne's muscular dystrophy. Phys Ther. 1992, 72 (2): 115-22. discussion 122-6.

Lawson A, Calderon L: Interexaminer Agreement for Applied Kinesiology Manual Muscle Testing. Percepl Mot Skills. 1997, 84: 539-546.

Leisman G, Zenhausern R, Ferentz A, Tefera T, Zemcov A: Electromyographic effects of fatigue and task repetition on the validity of estimates of strong and weak muscles in applied kinesiological muscle-testing procedures. Percept Mot Skills. 1995, 80: 963-77.

Marino M, Nicholas JA, Gleim GW, Rosenthal P, Nicholas SJ: The efficacy of manual assessment of muscle strength using a new device. Am J Sports Med. 1982, 10 (6): 360-4.

Basmajian JV: Muscles Alive – Their Functions Revealed by Electromyography. 1978, Baltimore, MD: Williams & Wilkins Co, 4

MacConaill NA, Basmajian JV: Muscles and Movements – A Basis for Human Kinesiology. 1977, Huntington, NY: Robert E. Krieger Publishing Co

Rosenbaum R: Carpal tunnel syndrome and the myth of El Dorado. Muscle & Nerve. 1999, 22: 1165-1167. 10.1002/(SICI)1097-4598(199909)22:9<1165::AID-MUS1>3.0.CO;2-1.

Pollard HP, Bablis P, Bonello R: Can the Ileocecal Valve Point Predict Low Back Pain Using Manual Muscle Testing?. Chiropr Aust. 2006, 36: 58-62.

Pollard H, Lakay B, Tucker F, Watson B, Bablis P: Interexaminer reliability of the deltoid and psoas muscle test. J Manipulative Physiol Ther. 2005, 28 (1): 52-6. 10.1016/j.jmpt.2004.12.008.

Escolar DM, Henricson EK, Mayhew J, Florence J, Leshner R, Patel KM, Clemens PR: Clinical evaluator reliability for quantitative and manual muscle testing measures of strength in children. Muscle Nerve. 2001, 24 (6): 787-93. 10.1002/mus.1070.

Perot C, Meldener R, Gouble F: Objective Measurement of Proprioceptive Technique Consequences on Muscular Maximal Voluntary Contraction During Manual Muscle Testing. Agressologie. 1991, 32 (10): 471-474.

Payton OD: Research: The Validation of Clinical Experience. 1994, Philadelphia, FA Davis

Kendall HO, Kendall FP, Boynton DA: Posture and Pain. 1952, Baltimore: Williams & Wilkins Company

Janda V: Muscle Function Testing. 1983, London: Butterworths

A number of chiropractic "name techniques" have evolved from AK that also employ MMT as part of their diagnostic system, including: Neuro Emotional Technique (N.E.T.); Neural Organization Technique (N.O.T.); Clinical Kinesiology; Contact Reflex Analysis (C.R.A.); Total Body Modification (T.B.M.), and others.

Schmitt WH, Yannuck SF: Expanding the Neurological Examination Using Functional Neurological Assessment Part II: Neurologic Basis of Applied Kinesiology. Intern J Neuroscience. 1999, 97: 77-108.

Lamb RI: Manual Muscle Testing. Measurement in physical therapy. Edited by: Rothstein JM. 1985, New York: Churchill Livingstone, 47-55.

Michener LA, Boardman ND, Pidcoe PE, Frith AM: Scapular muscle tests in subjects with shoulder pain and functional loss: reliability and construct validity. Phys Ther. 2005, 85 (11): 1128-38.

Great Lakes ALS Study Group: A comparison of muscle strength testing techniques in amyotrophic lateral sclerosis. Neurology. 61 (11): 1503-7. 2003 Dec 9

Nadler SF, Malanga GA, Feinberg JH, Prybicien M, Stitik TP, DePrince M: Relationship between hip muscle imbalance and occurrence of low back pain in collegiate athletes: a prospective study. Am J Phys Med Rehabil. 2001, 80 (8): 572-7. 10.1097/00002060-200108000-00005.

Panjabi M: A hypothesis of chronic back pain: ligament subfailure injuries lead to muscle control dysfunction. Eur Spine J. 2005 Jul 27.

Hodges PW, Moseley GL: Pain and motor control of the lumbopelvic region: effect and possible mechanisms. J Electromyogr Kinesiol. 2003, 13 (4): 361-70. 10.1016/S1050-6411(03)00042-7.

Pickar JG: Neurophysiological effects of spinal manipulation. Spine J. 2002, 2 (5): 357-71. 10.1016/S1529-9430(02)00400-X.

Lund JP, Donga R, Widmer CG, Stohler CS: 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.

Falla DL, Jull GA, Hodges PW: Patients with neck pain demonstrate reduced electromyographic activity of the deep cervical flexor muscles during performance of the craniocervical flexion test. Spine. 29 (19): 2108-14. 2004 Oct 1

Mellor R, Hodges PW: Motor unit synchronization is reduced in anterior knee pain. J Pain. 2005, 6 (8): 550-8. 10.1016/j.jpain.2005.03.006.

Cowan SM, Schache AG, Brukner P, Bennell KL, Hodges PW, Coburn P, Crossley KM: Delayed onset of transversus abdominus in long-standing groin pain. Med Sci Sports Exerc. 2004, 36 (12): 2040-5. 10.1249/01.MSS.0000147587.81762.44.

Cowan SM, Bennell KL, Hodges PW, Crossley KM, McConnell J: Delayed onset of electromyographic activity of vastus medialis obliquus relative to vastus lateralis in subjects with patellofemoral pain syndrome. Arch Phys Med Rehabil. 2001, 82 (2): 183-9. 10.1053/apmr.2001.19022.

Nummi J, Jarvinen T, Stambej U, Wickstrom G: Diminished dynamic performance capacity of back and abdominal muscles in concrete reinforcement workers. Scand J Work Environ Health. 1978, 4 (Suppl 1): 39-46.

Addison R, Schultz A: Trunk strengths in patients seeking hospitalization for chronic low-back disorders. Spine. 1980, 5 (6): 539-44. 10.1097/00007632-198011000-00009.

Karvonen MJ, Viitasalo JT, Komi PV, Nummi J, Jarvinen T: Back and leg complaints in relation to muscle strength in young men. Scand J Rehabil Med. 1980, 12 (2): 53-9.

MacNeill T, Warwick D, Andersson G, Schultz A: Trunk strength in attempted flexion, extension, and lateral bending in healthy subjects and patients with low-back disorders. Spine. 1980, 5 (6): 529-38.

Nordgren B, Schele R, Linroth K: Evaluation and prediction of back pain during military field service. Scand J Rehabil Med. 1980, 12 (1): 1-8.

Mayer TG, Gatchel RJ, Kischino N, Keeley J, Capra P, Mayer H, Barnett J, Mooney V: Objective assessment of spine function following industrial injury. A prospective study with comparison group and one-year follow-up. Spine. 1985, 10 (6): 482-93. 10.1097/00007632-198507000-00002.

Rantanen J, Hurme M, Falck B, Alaranta H, Nykvist F, Lehto M, Einola S, Kalimo H: The lumbar multifidus muscle five years after surgery for a lumbar intervertebral disc herniation. Spine. 1993, 18 (5): 568-74. 10.1097/00007632-199304000-00008.

Hides JA, Richardson CA, Jull G: Multifidus muscle recovery is not automatic after resolution of acute first-episode low back pain. Spine. 1996, 21: 2763-2769. 10.1097/00007632-199612010-00011.

Hodges PW, Richardson CA: Inefficient muscular stabilization of the lumbar spine associated with low back pain. Spine. 1996, 21: 2640-2650. 10.1097/00007632-199611150-00014.

Chaffin DB, Park KS: A longitudinal study of low-back pain as associated with occupational weight lifting factors. Am Ind Hyg Assoc J. 1973, 34 (12): 513-25.

Biering-Sorensen F: Physical measurements as risk indicators for low-back trouble over a one-year period. Spine. 1984, 9 (2): 106-19. 10.1097/00007632-198403000-00002.

Mayer TG, Barnes D, Nichols G, Kishino ND, Coval K, Piel B, Hoshino D, Gatchel RJ: Progressive isoinertial lifting evaluation. II. A comparison with isokinetic lifting in a disabled chronic low-back pain industrial population. Spine. 1988, 13 (9): 998-1002. 10.1097/00007632-198809000-00006.

Nachemson A, Lindh M: Measurement of abdominal and back muscle strength with and without low back pain. Scand J Rehabil Med. 1969, 1 (2): 60-3.

Cox JM: Low Back Pain: Mechanism, Diagnosis and Treatment. 1999, Baltimore: William & Wilkins, 439, 406-Sixth

Goodall RM, Hammes MR: Electronic comparison of toe strengths for diagnosis of lumbar nerve root lesions. Med Biol Eng Comput. 1986, 24: 555-557. 10.1007/BF02443976.

Hossain M, Nokes LDM: A model of dynamic sacro-iliac joint instability from malrecruitment of gluteus maximus and biceps femoris muscles resulting in low back pain. Medical Hypotheses. 2005, 65 (2): 278-281. 10.1016/j.mehy.2005.02.035.

Triano J, Schultz A: Correlation of objective measure of trunk motion and muscle function with low-back disability ratings. Spine. 1987, 12: 561-5. 10.1097/00007632-198707000-00010.

McNeill T, Warwick D, Andersson G, Schultz A: Trunk strengths in attempted flexion, extension, and lateral bending in healthy subjects and patients with low-back disorders. Spine. 1980, 5 (6): 529-38. 10.1097/00007632-198011000-00008.

Jepsen JR, Laursen LH, Hagert CG, Kreiner S, Larsen AI: Diagnostic accuracy of the neurological upper limb examination I: inter-rater reproducibility of selected findings and patterns. BMC Neurol. 6: 8-10.1186/1471-2377-6-8. 2006 Feb 16

Deyo R: Understanding the accuracy of diagnostic tests. Essentials of the Spine. Edited by: Weinstein JN, Rydevik ABL, Sonntag VKH. 1995, New York: Raven Press, 65-

Bohannon RW: Measuring knee extensor muscle strength. Am J Phys Med Rehabil. 2001, 80 (1): 13-8. 10.1097/00002060-200101000-00004.

Schwartz S, Cohen ME, Herbison GJ, Shah A: Relationship between two measures of upper extremity strength: manual muscle test compared to hand-held myometry. Arch Phys Med Rehabil. 1992, 73 (11): 1063-8.

Bohannon RW: Manual muscle test scores and dynamometer test scores of knee extension strength. Arch Phys Med Rehabil. 1986, 67 (6): 390-2.

Triano J, Davis B: Experimental Characterization of The Reactive Muscle Phenomenon. Chiro Econ. 1976, 44-50.

Niemuth PE, Johnson RJ, Myers MJ, Thieman TJ: Hip muscle weakness and overuse injuries in recreational runners. Clin J Sport Med. 2005, 15 (1): 14-21. 10.1097/00042752-200501000-00004.

Moncayo R, Moncayo H, Ulmer H, Kainz H: New diagnostic and therapeutic approach to thyroid-associated orbitopathy based on applied kinesiology and homeopathic therapy. J Altern Complement Med. 2004, 10 (4): 643-50.

Rainville J, Jouve C, Finno M, Limke J: Comparison of four tests of quadriceps strength in L3 or L4 radiculopathies. Spine. 28 (21): 2466-71. 10.1097/01.BRS.0000090832.38227.98. 2003 Nov 1

Hungerford B, Gilleard W, Hodges P: Evidence of Altered Lumbopelvic Muscle Recruitment in the Presence of Sacroiliac Joint Pain. Spine. 2003, 28 (14): 1593-1600. 10.1097/00007632-200307150-00022.

Monti D, Sinnott J, Marchese M, Kunkel E, Greeson J: Muscle Test Comparisons of Congruent and Incongruent Self-Referential Statements. Perceptual and Motor Skills. 1999, 88: 1019-1028.

Schmitt W, Leisman G: Correlation of Applied Kinesiology Muscle Testing Findings with Serum Immunoglobulin Levels for Food Allergies. International Journal of Neuroscience. 1998, 96: 237-244.

Goodheart G: Failure of the musculo-skeletal system may produce major weight shifts in forward and backward bending. Proc Inter Conf Spinal Manip. 1990, Washington, DC, 399-402.

Scopp A: An Experimental Evaluation of Kinesiology in Allergy and Deficiency Disease Diagnosis. Journal of Orthomolecular Psychiatry. 1979, 7 (2): 137-8.

Carpenter SA, Hoffmann J, Mendel R: Evaluation of Muscle-Organ Association, Part I and II. J Clin Chiro. 1977, II (6): 22-33. and III(1):42–60.

Haas M, Bronfort G, Evans RL: Chiropractic clinical research: progress and recommendations. J Manipulative Physiol Ther. 2006, 29 (9): 695-706. 10.1016/j.jmpt.2006.09.005.

Cuthbert S: Proposed mechanisms and treatment strategies for motion sickness disorder: A case series. J Chiro Med Spring. 2006, 5 (1): 22-31.

Cuthbert S, Blum C: Symptomatic Arnold-Chiari malformation and cranial nerve dysfunction: a case study of applied kinesiology cranial evaluation and treatment. J Manipulative Physiol Ther. 2005, 28 (4): e1-6. 10.1016/j.jmpt.2005.03.001.

Meldener R: Post-surgical hip dislocation. Int J AK and Kinesio Med. 2005, 19: 27-

Chung AL, Shin EJ, Yoo IJ, Kim KS: Reliability of the kinesiologic occlusal position. Int J AK and Kinesio Med. 2005, 20: 6-10.

Caso ML: Evaluation of Chapman's neurolymphatic reflexes via applied kinesiology: a case report of low back pain and congenital intestinal abnormality. J Manipulative Physiol Ther. 2004, 27 (1): 66-10.1016/j.jmpt.2003.11.009.

Cuthbert S: Applied Kinesiology and Down syndrome: a study of 15 cases. Int J AK and Kinesio Med. 2003, 16: 16-21.

Maykel W: Pediatric case history: cost effective treatment of block naso-lacrimal canal utilizing applied kinesiology tenets. Int J AK and Kinesio Med. 2003, 16: 34-

Weiss G: A 39-year-old female cyclist suffering from total exhaustion caused by over-training and false nutrition. Int J AK and Kinesio Med. 2003, 15: 39-

Sprieser PT: Episodic paroxysmal vertigo. Int J AK and Kinesio Med. 2002, 14: 35-

Leaf D: Severe equilibrium problems non-responsive to pharmacological care treated with chiropractic and applied kinesiology: a case history. Int J AK and Kinesio Med. 2002, 13: 27-

Gregory WM, Mills SP, Hamed HH, Fentiman IS: Applied kinesiology for treatment of women with mastalgia. Breast. 2001, 10 (1): 15-9. 10.1054/brst.2000.0176.

Cuthbert S: An applied kinesiology evaluation of facial neuralgia: a case history of Bell's Palsy. Int J AK and Kinesio Med. 2001, 10: 42-45.

Calhoon J: Applied Kinesiology management of multiple sclerosis: a case history. Int J AK and Kinesio Med. 2001, 12: 28-29.

Mathews MO, Thomas E, Court L: Applied Kinesiology Helping Children with Learning Disabilities. Int J AK and Kinesio Med. 1999, 4-

Masarsky CS, Weber M: Somatic dyspnea and the orthopedics of respiration. Chiro Tech. 1991, 3 (1): 26-29.

Masarsky CS, Weber M: Chiropractic Management of Chronic Obstructive Pulmonary Disease. J Manipulative Physiol Ther. 1988, 11 (6): 505-510.

ICAK-International and ICAK USA websites, "Applied Kinesiology Research and Literature Compendium". and http://www.icakusa.com/ Accessed February 15, 2007, [ http://www.icak.com/college/research/publishedarticles.shtml ]

Sacro Occipital Technique Organization website. Accessed February 15, 2007, [ http://www.sotousa.org/SOTLiterature/Applied%20Kinesiology/Applied%20Kinesiology%20Literature.htm ]