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International College of Applied Kinisiology - USA
AK CLINICAL APLLICATIONS UPDATE The International College of Applied Kinesiology® U.S.A (ICAK-USA) has played a crucial role in establishing the foundation for clinical and academic arena for investigating, substantiating, and propagating A.K. findings and concepts pertinent to the relationships between structural, chemical, and mental factors in health and disease.
Featured in this Issue: Dr. Stephan Ediss Dr. Jay Marienthal Dr. Tom Roselle Dr. William Tolhurst
913-384-5336
icak@dci-kansascity.com
4919 Lamar Ave Mission KS, 66202
OCTOBER 2023
VOLUME 1, NO. 2
AK CLINICAL APLLICATIONS UPDATE ICAK-USA Members: Welcome to the second issue of our new HTML publication, AK Clinical Applications Update! This is unlike our current e-newsletters. With AK Clinical Applications Update, we have asked the membership to get involved by sharing their knowledge, research and demonstrations. We are seeking doctor members and accepting submissions of their current findings (ie. Research), technique articles or a video demonstrating a technique that has helped diagnose and treat your patients. Our objective is to have 4 submissions per issue that would be distributed to the full membership and archived on the website as a resource. We are now accepting submissions! Please send your article, research summary or video, to icak@dci-kansascity.com for review. Please reach out to Angela Capra, 913-387-5608 or acapra@dci-kansascity.com, if you have questions or need additional information. Warm regards,
Richard Belli, DC, DIBAK ICAK-USA Chairman
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INDEX Dr. Stephan Ediss: TMJ & Low Back Pain ..........................................................................................................Page 3
Dr. Jay Marienthal: Mesenteric Root Technique...............................................................................................Page 5
Dr. Evan Mladenoff: A Response to a Challenge to Applied Kinesiology and Diagnostic Muscle Testing Efficacy and Validity..............................................................................Page 6
Dr. Tom Roselle: Zinc, The Missing Link.........................................................................................................Page 7
Dr. William Tolhurst: The Iliolumbar Ligament Revisited.................................................................................Page 10
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TMJ & LOW BACK PAIN By: Stephan Ediss, DC, PAK, FIACA
Proprioceptive qualities and their input to the Central Nervous System (CNS) are pivotal to the nervous system’s function and interaction with rest of the body. This is applicable, not only for the axial spine, pelvis and extremities, but to the dentate ligaments and temporal mandibular joints as well. As the proprioceptors report data to the CNS, the CNS responds by sending an appropriate response or “command” back to that area of the body in response. Any errant signals, which originate from old injuries, can cause compensatory patterns. The TMJ and dental health are often overlooked as they are key components to many neurologic functions that have very profound effects, biomechanically, which can ultimately contribute to upper cervical pain, low back pain or both. All too often, patient’s present with low back pain which has not responded to previous chiropractic care. Upon questioning these patients, it is discovered that their previous chiropractic experience was “…I told him my low back hurts, so he adjusted it a couple of times, but it didn’t help…”. Quoting Wally Schmitt, “Most of the time, where a person complains of pain, it is not the primary source, it is usually secondary or tertiary”. Upper cervical fixations often produce bilateral psoas, hamstring and TFL muscle weaknesses leaving the lumbar spine and pelvis vulnerable to failure and injury. The following technique is awesome, will blow your patient’s mind and increase your referrals!
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TMJ & LOW BACK PAIN
Make sure the patient is not switched. Challenge Left & Right Brain function and make any necessary corrections. Injury Recall Technique (IRT) and DTR-Reset (DTR-R) all old injuries. Use Eyes in Distortion (EID) to insure that all injuries have been “deleted”. The previous trauma assessment should also include colonoscopy, endoscopy, childbirth, mammograms, intubation for any other surgical procedures, root canals or any other dental injuries. With the patient supine, test the TFL and Gluteus Medius muscles bilaterally (it is easier on the low back than the psoas when their pain is more severe). These test results will only be used as an indicator muscle, so all that is necessary, is to note whether they are strong or weak. Have the patient rotate their head and retest. Does this change the muscle test? If so, an ipsilateral occiput/C1 fixation is suspected. Have the patient TL the ipsilateral TMJ. Did it change the muscle test again? If so, not only is the TMJ involved, but it is also most commonly the primary problem. The neck and low back pain are secondary and tertiary. Have the patient lay prone as C1/C2 fixations are commonly associated with the occiput/C1 fixation in this scenario. Bilateral weak hamstrings will also be observed. At this point, I usually make all prone corrections, pelvis, lumbar and thoracic spine as well as the C1/C2 fixation. With the patient supine, the occipitalis muscle on the side of the occiput/C1 fixation will be extremely tender to palpate. Locate the tender muscle for the patient. Once you have located the most tender point, have the patient place their fingers on it and illicit pain. With a gloved hand, place digital pressure on the internal pterygoid muscle. When the proper location and vector of pressure is achieved, the digital pressure on the occipitalis muscle will disappear. While maintaining pressure on both, pterygoid and occipitalis muscles, tap some DTRs and IRT. Finally, correct the occiput/C1 fixation by respiration assist initially, while standard manipulation to C1 can also follow (usually very easy at this point). Demonstrate to the patient the restored function of all muscle weaknesses and their pain level decrease(s). HCL, calcium, and black current seed oil supplementation should all be considered for nutritional support as well.
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MESENTERIC ROOT TECHNIQUE By: Jay Marienthal, DC, DIBAK
Mesenteric Root Technique was first presented at the Homecoming in San Diego in July 2019 and continues to be used by many AK practitioners. This technique was developed from the teachings of Jean Pierre Barral, DO and adapted to be used with muscle testing by the author. This technique is used to release the mesenteric root and other organs in the abdomen to aid in the treatment of the abdomen and lumbar spine. Contraindications of this technique include acute flare up of an inflammatory process, abdominal aortic aneurysm, bleeding ulcers, thrombosis, hemorrhage, fracture, pregnancy and stomach banding. Precautions should be taken in the case of diabetes, patients taking anticoagulant drugs or corticosteroids, after radiation therapy or chemotherapy, dilation of superficial veins, IUD’s, pacemakers and stents. The mesenteric root runs obliquely from the left side of the L2 vertebra to the right sacroiliac joint. It has visceral articulation with the Psoas major muscle, the horizontal part of the duodenum, the aorta, the inferior vena cava, the right ureter and the right testicular or ovarian vessels. The mesenteric root should be treated by first standing on the right side of the supine patient. The location of the mesenteric root runs between the area where an imaginary oblique line 1” superior and 1” to the left of the umbilicus and the right ASIS. A specific group muscle test appears to be a possible way to determine if there is a need for release of the mesenteric root, other visceral organs or other associated connective tissues. This is performed by the doctor attempting to externally rotate the foot on a patient that has an extended knee with full internal rotation. This motion is similar to a popliteus test; however, the patient has a fully extended knee. When using a challenge to determine the vector of treatment, a direct challenge or a static challenge should be used and the treatment should be in the direction of the challenge. The inferior leaf should be treated first and is located through by putting the thumbs together as the doctor allows the rest of the fingers to sink into the abdomen on the left lateral border of the rectus abdominus. The doctor then applies a superomedial force until the shelf of the inferior leaf of the mesenteric root is palpated. The superior leaf should be treated next and is located by putting the thumbs together then sinking the thumbs into the abdomen just superior to the imaginary oblique line. The doctor then applies an inferomedial force until the shelf of the superior leaf of the mesenteric root is reached. This can also be palpated in a left lateral decubitus position and can be an optimal way to palpate and treat the superior leaf. The iliopsoas should be treated last and is then located by letting the fingers sink into the inguinal fossa. The Iliacus, psoas muscles and connective tissue can then be followed around from posterior to anterior. Treating the mesenteric root, and performing other visceral manipulations, can be a crucial step in the treatment of GI complaints, organ function and lumbar discs. By following these steps and developing your touch, you will find this to be an effective Applied Kinesiology tool.
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A RE S PONS E TO A C HAL L E NG E TO APPL I E D KI NES I OL OG Y AND DI AG NOS TI C MUS C L E TE S TI NG E F FI C AC Y AND VAL I DI TY By: Evan Mladenoff, DC, DIBAK
Dr. H Haavik has published several research articlesshowing improved electrical signals and muscle strength with a trial of spinal manipulation. (Niazi IK, Kamavuako EN, Holt K, Janjua TAM, Kumari N, Amjad I, Haavik H. The Effect of Spinal Manipulation on the Electrophysiological and Metabolic Properties of the Tibialis Anterior Muscle. Healthcare (Basel). 2020 Dec 10;8(4):548. doi: 10.3390/healthcare8040548. PMID: 33321904; PMCID: PMC7764559.) The primary method used to determine muscle function in her research pre and post treatment was EMG. Although this demonstrates the positive outcomes of chiropractic manipulation it is clinically impractical to perform on a visit to visit basis or even to evaluate on every new patient. The question becomes how to efficaciously evaluate myotome function and its motor and sensory neurological integration? Simply and profoundly it is diagnostic functional neurological assessment using accurate muscle testing. The chiropractic approach of Applied Kinesiology has determined Diagnostic Muscle Testing as a vehicle to assess functional neurology. This has been utilized by others such as the Carrick Institute.
Click the QR code below for a video describing the neurology of muscle testing and the final common pathway.
Dr. Walter Schmitt was a Functional Neurology Diplomate from The Carrick Institute.
As I very briefly discussed in the presentation Sherrington called the lower motor neurons of the spinal cord the “final common pathway” that controls behavior. These motor neurons, also called the somatic motor neurons, directly command muscle contraction. They are the output of the motor system. Inputs to lower motor neurons include the sensory afferents entering the dorsal horn (providing information about muscle length), the upper motor neurons in the motor cortex, and the interneurons within the spinal cord that participate in spinal motor programs. Therefore sensory input information comes in from muscle length; upper motor neurons from the brain send information down the descending tracts and neurons in between the brain and the muscle all participate in spinal motor programs (central pattern generators). Regardless of the source of the input, the output is the lower motor neurons, the final common pathway. This is profound when the corollary version is stated meaning that muscle function can be used to evaluate spinal motor neurons, interneurons and upper motor neurons. According to Sherrington, muscle testing ultimately tests the central integrative state of the ventral horn.
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ZINC: THE MISSING LINK By: Tom Roselle, DC, LAc, DCCN, DCBCN
According to the current medical literature Zinc deficiencies are rare in Western Industrial cultures. But is it as abundant and usable as it is thought to be? According to the literature only a small amount of Zinc plays an important role in the body. Zinc is needed in many different, integral pathways; DNA creation and expression, immune support, cell repair and growth, tissue healing and amino acid coupling forming protein. Growth in pregnancy, childhood and gestation. Zinc deficiency can cause problems with slow growth, loss of taste and smell (remember COVID), and cognitive problems. If severe, it can even cause death. Patients who tend to have lower levels of Zinc are older, have a history of chronic alcohol use, eating disorders, chronic injury, and restricted diets. Malabsorption problems like permeable gut, those with bariatric weight loss surgery, and people who generally don’t eat well i.e. The SAD (Standard American Diet.) Zinc also is depleted by unremitted stress response (pain and emotion), with uncontrolled cortisol release. Years ago, I wrote a paper called, “Zinc and the Prostate Gland.” It was triggered by research that had been published through the WHO (World Health Organization) by doctors who had done biopsies on human prostates taken from cadavers. While examining prostates, they noticed that after drying them in the lab oven, they contained more than 50% metal…zinc! This finding had not been reported before. They continued, until they found one that contained considerably less (about 12-13% zinc). While examining more prostates they discovered more with very low zinc content. Especially in older specimens (older men). Examining the health records of the cadavers which exhibited low zinc, the researchers discovered that they all had serious prostate problems during their lifetime. They approached other doctors practicing general medicine, asking them to give zinc supplements to their patients, having prostate swelling or irritation (not cancer). The patients suffering with prostate problems were quickly relieved. After the research I began a search to see if my patients with symptoms and objective findings suggesting prostatic enlargement, swelling would respond to zinc supplementation and what type would work the best. The indicators I used to supplement were direct challenge to the prostate (similar to IRT challenge), therapy localization to prostate, Gluteus Medius and piriformis test. If those muscles were inhibited, would they be facilitated by therapy localizing the prostate and by gustatory challenge of zinc. PSA (prostate specific antigen) would be ordered. Additionally, we would do a gustatory zinc challenge test. Which we now do on every new patient that enters our clinic or complains of any type of gonadal or hormonal dysfunction. In every case, an inhibited Gluteus Medius muscle, that therapy localized to the prostate gland showed a sub optimal salivary Zinc challenge test and an altered PSA. Today we always run both Free and Total PSA tests.
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ZINC: THE MISSING LINK
Notably man loses much zinc in sexual activity. Since few foods contain zinc, and older men absorb less minerals than the young, due to intestinal malabsorption issues (hypochlorhydria, permeable gut) older men have a lower libido. When the “zinc storehouse” is replenished by daily zinc supplements, older men restore much of their sexual activity. Which type of zinc worked the best? What we have observed over the years and much research supports that zinc sulfate works best in hormonal and gonadal issues. Both in men and women. Zinc plays a very integral role in the regulation of the menstrual cycle and ovulation. Zinc deficiencies can make it harder to get pregnant due to a greater tendency of anovulation. Challenge the Gluteus Medius muscle and if inhibited check to see if Zinc negates the test and restores facilitation. We have looked at the fractionated elements of estrogen utilizing the “Dutch” hormonal test (estrone, estradiol, and estriol). It’s a balancing act. Too little zinc and the pituitary cannot release FSH, which triggers ovulation. But the “Catch 22” is too much zinc and the receptor sites that attach estrogen become inhibited. Hair analysis will give clues to excessive levels. Another application for zinc is acne. It is said that oil (sebum) that the body produces to keep the skin healthy, if one does not absorb minerals well (i.e., zinc), will begin to congeal as a solid as it approaches the surface of the skin (is affected by oxygen) and will result in clogged pores… acne “bumps.” Zinc levels if adequate, the oils will not solidify, but will pass easily through the skin’s pores. Blackheads and/or wax lumps behind the ears are often a common sign of low levels of Zinc. Zinc has significant anti-inflammatory properties that lower the sebum. Zinc also supports keratin and collagen formation. Zinc cannot be absorbed unless it is combined with adequate amino acid intake. Chelated zinc (zinc mixed with protein) is often the best use in these conditions. Lightly therapy localize the skin eruption and notice if the TL is abolished with challenge to Zinc. Correlated with gustatory challenge of Zinc. The clinical antidotal evidence suggests that perhaps Zinc Ascorbate would be best utilized in skin conditions because of the vitamin C. In the world of Covid and beyond it is important to notice that many of the successful therapies utilized Zinc. (Hydroxy)chloroquine, a well know anti-inflammatory and supposed anti-viral drug, has been used for decades. When Zinc was used in combination during Covid it has significant antiviral effect. Apparently, the effect is the ability of Zinc to stop the virus from multiplying. According to multiple studies reported in Pub Med, the effect was due to chloroquine acting as an ionophore for Zinc. We found that Quercetin, dosing up to 2400 mg (about twice the weight of a small paper clip) per day in divided doses, worked equally as well and without the potential side effects of Hydroxychloroquine. General testing of viral elements done utilizing “Brimhall’s” viral point and therapy localizing the thymus reflexes on the sternum or through viral samples.
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ZINC: THE MISSING LINK
Another overlooked application of Zinc is the effect it has on patients with hyper cortisol reactions. When we have used oral testing of zinc and a preliminary screen, those who have positive Zinc Challenge often have a high cortisol level. When measuring urinary adrenal cortisol levels, we note a significant correlation to hypozincemia. This is often seen in chronic pain patterns like Fibromyalgia. Challenging adrenal pathway by traditional Diagnostic Muscle Testing (DMT) will give a direct correlative suggestion of Zinc-Adrenal application. The type of zinc that is used for specific pathways is up for debate. Zinc gluconate is reported to be the most easily absorbable and subsequently less irritating to the stomach and GI system. Although not necessarily the most usable for all conditions. Zinc Sulfate and Zinc Picolinate seem to be the best for BPH symptoms. Zinc Gluconate seems to have the most impact on viral infections since high dosages can be well tolerated without or minimal GI upset. Absorption is optimized when used in conjunction with quercetin. Quercetin acts as an ionophore optimizing the absorption through the inflamed cell membrane. There are many papers found in Pub Med and other reputable journals that support the use of Zinc in many forms for multiple functions throughout the body. It is easy to test / challenge through DMT when done accurately. It truly maybe the missing link in hormonal, viral, adrenal presentations and even cancers. As well as overall immune support.
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THE ILIOLUMBAR LIGAMENT REVISITED By: William H Tolhurst, DC, DIBAK
One favorite topic of Dr. Goodheart from later in his career was the iliolumbar ligament. If we review pages 130-132 in David Walther’s Applied Kinesiology Synopsis, Second Edition we find a concise history, anatomical description, examination, and treatment protocol. A brief summary of this information is as follows: History- “Dr F.W. Illi performed numerous dissections of the lumbar spine while at National College of Chiropractic. His main intent was to show that the Sacroiliac joint was highly innervated with proprioceptive input for positional sensations and not just a fixed joint. Also he was looking for the existence of an intra-articular ligament, whose major function would be that of directing and limiting sacroiliac movement. With performing a unique lateral dissection of the lumbar spine, he was able to discover “Illi’s ligament”, the intra-articular sacroiliac ligament. Further study of the pelvis revealed… Compensatory, brief gyrating movement, obliquely up and down and concurrently anteriorly and posteriorly between the innominate bones, thus describing almost a horizontal figure eight. It is this movement and its control that allow proper compensation during walking. It has been proposed that the ligamentous structure has flexibility from its yellow elastic component and proprioceptive receptors to help organize the muscle function of gait.” “In normal walking gait there is a predictability of muscle facilitation and inhibition in contralateral leg and arm as well as the head and neck. Goodheart used this predictability to develop the iliolumbar technique. After an examination of standard simulated gait positions and correction of any faults present including foot and pelvic faults, we can test the patient in a neutral standing position. Bilateral latissimus dorsi, upper trapezius, and deep cervical extensors should all be facilitated. The patient is then asked to step one foot forward putting weight on it. In this position contralateral latissimus dorsi and the ipsilateral upper trapezius and deep cervical extensors should be inhibited. This is normal gait function. Then switch the forward foot and test the other side. Any faults present should be corrected first with gait receptor points in the feet. When the above all tests normal the patient is now ready to be tested for iliolumbar ligament technique. In the same neutral stance, the patient is now asked to step backward with one foot. The same pattern of predictability should be present. If altered have the patient push anteriorly on the L5 spinous process on the leading leg side. If the muscles return to their predictable pattern, then iliolumbar ligament technique is necessary. Apparently, the fault is an inability lumbo-sacro-iliac mechanism to gyrate properly with gait. Rigidity of the iliolumbar ligament is considered the primary limiting factor. Walther continues to describe an L5 /ilium challenge with the patient prone to determine the side of correction. Phase one of correction is to clear strain/counter strain technique on the gluteus maximus. With the patient still prone the physician forcefully approximates the involved side L5 spinous and ilium while maintaining hip hyperextension. This is held for 30 to 40 seconds. Reexamination of the rearward step gait test should now be normal.
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THE ILIOLUMBAR LIGAMENT REVISITED By: William H Tolhurst, DC, DIBAK
In the past fifteen years through clinical success and personal experience, I have been able to expand on this original information. What I have discovered is that there is an almost universal problem with this ligamentous structure and that its rigidity is a significant factor for L4-L5 and L5-S1 disc degeneration. One of our early ICAK members was Dr. Victor Frank. I attended one of his seminars in the 1980’s. In his notes he had a term called ‘The tight assed walk”, basically describing the lack of gyration of the pelvis during gait. He went on to say it is more common in men. The variation of the male versus female pelvis is well described and mainly involves the height of the ilia in relation to the lumbar vertebra. The female iliac crest is much lower allowing for greater movement during gait. Another hugely important factor is the involvement of the quadratus lumborum muscle during gait. If we observe from the posterior a freely moving and gyrating pelvis, it elevates on the forward moving leg and drops on the weight bearing foot side. In this motion the gluteus maximus and quadratus lumborum act as antagonists. Ipsilaterally in gait one is facilitated while the other is inhibited. It is essential that strain/counterstain also be evaluated with the quadratus lumborum muscle as well. The most significant corrective procedure for the iliolumbar ligament gets back to the very beginning of how Dr. Illi found it. His lateral dissection procedure. In orthopedics there is a side lying test named ‘Ober’s Position”. I have developed a variant of this test as follows: the side lying patient has their superior straight leg draped off the exam table behind and the superior arm in front for balance. The inferior arm is also placed behind the torso. In this position the lateral lumbar area opens up uniquely because the weight of the superior leg tractions the ilium away from the twelfth rib. Once in this position the doctor can either use deep gradual pressure, I use my elbow, or a percussor with the smaller foam fitting for approximately two minutes to release this area. It is helpful to have the patient slowly abduct the superior leg for four to six times while therapy is given. Re-examination of the patient in the rearward step position should be normal with proper facilitation and inhibition. In persistent cases treatment should be repeated and maintenance can be performed by the patient at home by doing the modified Ober’s position stretch. If you have any additional questions or comments, please contact Dr. Tolhurst : dr.tolhurst@gmail.com
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