Unusual Situations in Muscle Testing

Subclinical WeaknessThe Indirect Muscle Test

Subclinical Weakness

The “51%-er”

“51%-er”

Inhibition Facilitation

50% Tests WEAK Tests

STRONG

“51%-er”

Associated muscle But NOT all the time!

How it shows up in the clinic “Should be weak” Within the 5 Factors

Test for Subclinically Weak Muscle

Not really a TESTRun the “5 Factors” checklist

TL each factor If Involved - Strong or Weak?

CORRECTION = 5 Factor Correction

Indirect Muscle Test

Subclavius - Cannot Test Directly

Subclavius

Indirect Muscle Test

Levator Ani - Probably Do Not Want to Test Directly

Levator Ani

Levator Ani - Muscle Test

Levator Ani - Muscle Test

Can I TL a muscle that is inhibited?

NO, a “weak” muscle does NOT TL!

However, we CAN TL the weakness!

How do you TL muscle weakness?

TL tells you WHERE the problem is LOCATED

Where is the problem of an inhibited muscle located?

Subclavius - Indirect Mus. Test - Step 1 (any muscle)

Subclavius - Indirect Mus. Test - Step 1 (TL suspect mus.)

If the muscle is “WEAK”?

If the muscle is “STRONG”?

“Activate the Muscle” - Step 2

Patient contracts the Subclavius muscle

Weakness is now “transferred” to LOCATION of the Subclavius

Subclavius - Indirect Mus. Test - Step 3 (Re-test indicator)

If the muscle is “WEAK”?

If the muscle is “STRONG”?

How do you TL muscle weakness?

Find an INDICATOR muscleNormal muscle?

TL suspected weak muscle Check indicator

Strong?Weak?

Contract suspected weak muscle Test indicator

Strong?Weak?

Fixation Complexes

What are they?Why do I Care?How do I Find them?

Fixation Complexes Are:

NOT Subluxations Misalignment Aberrant motion

NO Motion May have normal alignment

Why Do I Care?

Some joints never seem to “go” Whole sections of the spine palpate

fixatedChronic problems but can’t find

anythingAnd…

Fixation ComplexesHIDE

Subluxations!!!

Fixations Hide Subluxations

Subluxations Within Locked AreasSubluxations Distant to Locked AreasAlso, they will hide OTHER Fixation

Complexes

Characteristics of Fixation Complexes

Subluxation MAY show on x-ray TL’s to Indicator m. TL’s to Associated

m. Challenges with a

single point contact Adjusts with a

single point contact

Fixation Complex NOT show on x-ray NO TL to Indicator

m. TL’s to Associated

m. Challenges with a

TWO point contact Adjusts with a TWO

point contact

Muscle Weakness

Subluxation Any muscle related

to the subluxation can be weak

Example:C5 subluxation could

affect any C4, C5, C6 innervated muscle

Maybe even C3 & C7

Fixation Complex Only ONE muscle

(usually bilateral) is related to EACH fixation complex

Fixation Complex Muscle Relationships

Fixation:OcciputUpper CervicalLower CervicalCervicothoracicThoracicThoracolumbarLumbar

Muscle Weakness:

(B) Psoas(B) Gluteus Maximus(B) Popliteus(B) Middle Deltoid(B) Teres Major(B) Lower Trapezius(B) Neck Extensors

Unusual Relationships

Lumbar Fixation

Sacroiliac Fixation

Sacrum Fixation

Neck Extensors “Tested Together” Bilaterally Weak

Neck Extensors “Tested Individually” Unilaterally

Weak

Neck Extensors “Tested Individually” Bilaterally Weak

Why this relationship?

Normal Inhibitory PatternDemonstrationNOT normal when patient is being

tested

How Do I Find Them?

BILATERAL Muscle Weakness Usually

Of ONLY the 7 Muscles Is a bilateral weakness of these 7

muscles ALWAYS a fixation complex?MUST VERIFY with TL or Challenge!

Fixation Complex Scan Neck Extensors - Tested Together

Neck Extensors - Tested IndividuallyOne side then the other (2 tests)

Middle Deltoid Teres Major

Lower Trapezius Popliteus

Gluteus Maximus Psoas

Neck Extensors - 1. Tested Together 2. Tested Individually (B)

Middle Deltoid - Supine

Teres Major

Lower Trapezius

Note:

There are 7 muscles to test but 9 tests

We only have to test one side if they are strong Cannot be bilaterally weak if one side is

strong!If muscle tests weak THEN test the

other side

Remember:

Fixation:

OcciputUpper CervicalLower CervicalCervicothoracicThoracicThoracolumbarLumbar

Muscle Weakness: (B) Psoas (B) Gluteus Maximus (B) Popliteus (B) Middle Deltoid (B) Teres Major (B) Lower Trapezius (B) Neck Extensors

AND...

Unusual Relationships

Lumbar Fixation

Sacroiliac Fixation

Sacrum Fixation

Neck Extensors “Tested Together” Bilaterally Weak

Neck Extensors “Tested Individually” Unilaterally

Weak

Neck Extensors “Tested Individually” Bilaterally Weak

Fixation Complex Analysis

Step 1: Find bilateral weaknessStep 2: TL appropriate area of the

spine If (B) muscles are Strong?

Fixation Complex If (B) muscles are STILL weak?

(B) Weak Muscles

Fixation Complex Analysis

Step 1: ID Top and Bottom of the Stack Adjacent SP’s Opposite Directions Laterally

Step 2: ID the Anterior and Posterior Side Top SP Left and Right

Step 3: ID the Primary Side Facet Joints P-A

Adjusting Rule

If it is a “Posterior Fixation,” adjust: the TOP vertebra and the one below.

If it is an “Anterior Fixation,” adjust: the BOTTOM vertebra and the one

above.

Sacral Fixation Analysis

Step 1: ID Top and Bottom of the Stack Already KNOW top and bottom of sacrum

Step 2: ID the Anterior and Posterior Side S2 tubercle Left and Right

Step 3: ID the Primary Side Sacral ala P-A

Unusual Corrections

Occipital Fixation Complex Palpate for tender nodule at Inferior

Nuchal Line LOC from nodule to glabella

SI Fixation Complex Simply open up the joint

Posterior Sacral Fixation Complex Adjust P-A & M-L at Sacral Ala

Right Posterior Sacral Fixation Complex

Left Anterior Sacral Fixation Complex

Unusual Corrections - Anterior Sacral Fixation ComplexSide lying - involved side UPStabilize POSTERIOR side of

sacrumContact shoulder and PUSH

NOT THRUST!Torques spine to move anterior

sacrum posteriorly

Fixation Complex Analysis “Easy Method”

Step 1: Find bilateral weaknessStep 2: TL appropriate area of the

spine If (B) muscles are Strong?

Fixation Complex If (B) muscles are STILL weak?

(B) Weak MusclesThen:

Just Challenge!

The proper two bones will challenge To the associated muscle To an indicator muscle

Two different bonesOpposite sides of the spine