Computational protocol: Common errors and clinical guidelines for manual muscle testing: "the arm test" and other inaccurate procedures

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[…] Much error in muscle testing is a result of testing a general group of muscles rather than a specific muscle. General tests such as "the arm test" are actually, at best, testing a gait function, a series of muscles, rather than a specific muscle. The type of response gathered from the MMT depends on the type of MMT employed, and "the arm test" gives a different response than do the standardized tests of specific muscles.The standard references for muscle testing evaluation as accepted by the I.C.A.K. are the original work of Kendall and Kendall, Muscles: Testing and Function [], and the modifications suggested by Goodheart in his Applied Kinesiology Research Manuals []. Goodheart's and the I.C.A.K.'s investigations into the use of the MMT for chiropractic diagnosis have been well organized and disseminated to the professions by Walther and others [,,,-].It is critical that the MMT protocol be highly reproducible by the examiner and by others. The earliest books on the use of the MMT for the functional assessment of patients argue that appropriate methodological techniques must be strictly followed before obtaining or interpreting MMT outcomes [,-]. This call still echoes among the numerous abuses that have been promulgated throughout the past 40 years of MMT use in the manipulative professions [-,].An understanding of the principles in the original works of Kendall, Goodheart, and Walther is necessary for using the MMT. The testing procedures from these volumes may be modified slightly, depending on the structure of the patient, but must be consistent from test to test on the same individual. Observe the difference between the two tests shown in Figures and . Figure shows "the arm test" while Figure shows the middle deltoid MMT. "The arm test" monitors all the arm flexors and abductors as a group, and the middle deltoid isolates a specific muscle and evaluates the neurological functions thereby identified. In figure the patient's head is also turned and she is leaning her torso onto her left hip. Figure shows that the MMT is not a contest between the patient and the doctor.It should be observed that a relationship between shoulder pain and dysfunction and specific muscle weakness has been established in a number of studies [-].The MMT should evaluate individual muscles as far as possible. There is an overlap of muscle actions, as well as an interdependence of muscles in movement. This close relationship in muscle function need not rule out the possibility or the practicability of testing individual muscles. There is an ideal starting position and vector of testing force that places the muscle being tested as the prime mover and the synergists at a disadvantage during the test.Janda (who also used the MMT to evaluate locomotor dysfunction) has emphasized that prime movers and synergists are tested with the MMT, not individual muscles []. However, it should be pointed out that every muscle is a prime mover in some specific action. In the search for that action, one is led into the field of precise, individual muscle testing. Manual muscle tests are designed to replicate the primary vector of motion of a muscle while minimizing the contribution of secondary mover muscles. During an individual MMT, the designated primary mover muscle should have the highest level of activity compared with the secondary mover or synergist muscles. When any one muscle in the body is inhibited in its strength or action, stability of the part is impaired or some exact movement is lost to some extent. When inhibition of a muscle results in the inability to hold the test position or perform the test movement ascribed to that muscle, the validity of the individual muscle test is substantiated (Figure ). […]

Pipeline specifications

Software tools MUSCLE, GATK
Application Nucleotide sequence alignment
Organisms Homo sapiens
Diseases Liver Diseases, Muscular Diseases