Diagnostic test to find adhesions between muscles
David Leaf, D.C.
Abstract
The treatment of adhesions between structures in the body has been a part of
standard treatment since at least the 1930’s. Since then many treatments for this
condition have been created. The problem is knowing when to apply the various
treatments. This paper presents a simple diagnostic sign that indicates the
presence of adhesions between muscles or their tendons.
For the past five years, Goodheart has been using a procedure known as pincer
palpation to find structural problems of muscles. Basically, a muscle is pinched
and a strong muscle on that side of the body is tested for weakening. He
developed this procedure from the work of Travell. She originally described
pincer palpation in her volume I of her text.
Goodheart added in the muscle test to make it more objective than subjective.
In conversations with Michael Leahy, D.C., founder of ART (Active Release
Technique), I pointed out that there was no diagnostic procedure for the use of
his procedures. In ART, therapy is applied to stretch and release adhesions or
cross-links between muscles, articular capsules, tendons and ligaments. I
discussed with him the possible use of muscle testing as a diagnostic procedure.
I showed him that placing the median nerve under torque by rotation of the arm,
pronation of the forearm and extension of the wrist would uncover entrapments
that would normally be missed.
This is accomplished by first
contracting the scalenes, bringing the
arm into extension to aggravate a
thoracic outlet syndrome, the stretching
the biceps, fully pronating the forearm
and hand and then extending the wrist.
The picture shows the end position that
the arm should be in to stress the
median nerve.
The problem was still where were the
entrapments. Leahy had a lengthy list
of possible places where the median
nerve could be entrapped.
Using the pincer palpation of
Goodheart did not uncover all of the problems that Leahy demonstrated. It was
found that applying pressure against a muscle, or muscle section, at 90 degrees
to the line of the muscle fibers would at times cause weakness of the muscle
being tested.
Linear pressure applied to a muscle as it contracts should not cause weakening
of the muscle, Muscles must be able to adapt to external forces that do not
confine their expansion during contraction.
Using this diagonal stress to the muscle as a testing procedure quickly identified
those muscles that were
restricted in their normal motion
by cross-links. The
accompanying picture shows
testing the extensor carpi
radialis while diagonal pressure
is applied causing weakness of
a strong muscle.
Using the example of the
median nerve, the arm is placed
in a position to stress the nerve
and the opponens pollicis is
tested. The various muscle
areas that can be involved are then tested with linear pressure against the
muscle being held by the examiner or by the patient and the muscle is retested.
Therapy is then applied to those muscles that are found.
Example
In a case of retro-patella pain, it was obvious that there were problems in the
firing of different sections of the quadriceps. The tests to isolate the sections of
the quadriceps were used but showed no abnormal finds. The muscle sections
were then retested with linear pressure being applied at a 90-degree angel to the
line of the muscle fibers. This elicited a weakening effect in different sections of
the muscle. These sections were then palpated for the presence of cross-links or
adhesions. Therapy was then directed at releasing these adhesions and the
muscle then retested.
The patient was then asked to bend and twist and reported that the knee was
now freer.
This same technique has been used in shoulders, forearms and especially in
cervical problems.
A common finding is restriction
in motion between the three
scalene muscles. This can
quickly be determined by
applying linear pressure against
one of the scalenes while
performing the regular muscle
test. The video movie file here
shows the testing of a section of
the scalene while directional
pressure is applied. This is done
to a muscle that has been tested
and found strong and you
suspect either a decreased
range of motion or entrapment of a nerve or blood vessel.
This linear pressure does not cause global weakness or one-sided weakness.
The pressure to the muscle causes only weakness of the muscle being tested.
Goodheart, George : Presentation at Annual Meeting ICAK-USA June 2001,
2002 and 2003
P. Leahy, Michael, private conversations 2000 – 2003
P. Leahy, Michael: Active Release Techniques Soft tissue Management System
for the Upper Extremity: 1998 Active Release Techniques LLC, Colorado
Springs, Co p 80 –84
Travell, Janet, Simons, David : Myofascial Pain and Dysfunction The Trigger
Point Manual: Williams and Wilkins, Baltimore 1983 p. 60 - 61