Estimating the prevalence of use of kinesiology-style manual muscle testing: A survey of educators
Section snippets
Background
Manual muscle testing (MMT) is a non-invasive assessment method used to evaluate neuromusculoskeletal integrity [1], and is a fundamental component of physical examinations performed by physiotherapists, chiropractors, osteopaths and some medical specialists [2]. Different health professionals use MMT in different ways, and as a result, there exists some confusion surrounding the term itself, and how the tests are performed and interpreted. Consequently, research efforts to assess the validity
The evolution of MMT
First described in the literature in 1915 by Lovett and Martin, MMT was originally used to assess muscular weakness in polio patients [8], [9]. The tests were crude and generalised, and little was known about their validity.
In 1949, in their benchmark textbook, Muscles: Testing and Function, Kendall and Kendall outlined specific methodologies to isolate and test individual muscles or muscle groups [1], [10], [11]. Currently, it is this type of MMT that is used in orthopaedic, neurology and
The kinesiology-style Manual Muscle Test
A kMMT muscle test is distinctly different in a number of ways from its predecessors:
- (1)
kMMT is not as specific as either MMT or AK-MMT;
- (2)
the applications and interpretations of kMMT results are not standardised;
- (3)
typically only one muscle, commonly called “the indicator muscle,” is used for testing;
- (4)
the indicator muscle is tested repeatedly as the target condition changes;
- (5)
the specific muscle used as the indicator muscle is of little significance to the outcome of the test; and finally,
- (6)
the amount of
Applications of kMMT
Within the various technique systems that use kMMT, there exists literally hundreds of potential target conditions that kMMT is used to detect, ranging from physiological dysfunction to meridian imbalance to a patient's level of stress, and others. For example, in a review of the literature, kMMT was found to accurately predict low back pain [26], simple phobia [27], and food allergies [28]. On the other hand, other studies found that MMT was unable to accurately predict nutritional needs [29],
Study aims
Discussions about assessing the validity of kMMT may be premature. After all, if a test is not in common use, then there is no point in assessing its validity [44]. It has been reported that AK-MMT is used by approximately 40% of American chiropractors [45], [46], [47], yet the prevalence of use of kMMT has not yet been estimated. Therefore, the initial purpose of this study was this estimation, which, at first, seemed straight forward. However, when fully explored, it became apparent that it
Methods
The first step taken to estimate the number of people trained to use kMMT was to create a list of all organisations that offer or have offered training in kMMT or a system that uses kMMT. Electronic searches were conducted using Google and MEDLINE (May 2008 to November 2009). No time or language restrictions were used. Search terms were [“muscle test*” OR “kinesiology”]. When performing a Google search, pages were examined as presented until saturation was achieved. In addition, books on
Results
Seventy-nine technique systems were identified to use some form of kMMT. Despite attempts to contact all organisations, only 46 provided estimations of the number of people trained in their technique (see Table 1). Of the 33 organisations that did not provide estimates, some were not contactable (e.g. no current contact information was found), some did not respond to contact, some stated that an estimate could not be provided, and some refused to answer. Instead, in these instances, 2 or 3
Discussion
It is conservatively estimated that over 1 million people worldwide were trained in some form of kMMT technique system. However, there are several limitations in this study that may be sources of either overestimation or underestimation in the actual figure. Firstly, there are a number of potential sources of overestimation that must be noted. For instance, there are likely redundancies in this report since many kMMT practitioners undertake training in more than one kMMT technique system.
Summary
Through Internet searches, surveys, personal communications and expert opinion, kMMT has been estimated to be used by over 1 million people worldwide. This estimation might be amplified due to the possibility of redundancies or attrition. Likewise, it might be low due to misclassification or too narrow search methods. Regardless, the widespread use of kMMT merits further consideration and in-depth exploration of its usefulness in clinical settings.
Competing interests
The author declares that she has no competing interests – financial or otherwise. AJ completed this research in partial fulfilment for the degree of Doctor of Philosophy (DPhil) in Evidence-based Health Care through the University of Oxford, UK.
Author contributions
AJ conceived of the study, performed the literature search, designed the methods, collected and analysed the data, and drafted the manuscript for submission.
Acknowledgements
I thank Amanda Burls for her advice during the study conception and design, and Richard Stevens for his advice during the data analysis and manuscript preparation. In addition, gratitude goes to Martin Enderlin and Margit Janssen for their help with the German translation of the abstract. I also thank Parker University and Parker Research Institute who provided the site and telephone support during the data collection phase of this study.
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