The mechanism of manual muscle testing as proposed by the ventral horn theory

Abstract

It is hypothesized that the central integrative state (CIS) of the spinal cord’s ventral horn depends upon myriad inputs from primary afferentation secondary to gravitational perturbation of joint mechanoreceptors. Further, the current perspective of manual muscle testing (MMT) and diagnostic muscle testing (DMT) research—each being universially accepted by the medical community—tends to focus exclusively on the conditional state of the muscle and/or the α-motoneuron affecting that muscle. Diagnostic muscle testing, however, is mainly an assessment tool for functional disorders. Moreover, since the human brain is receptor dependent, the entirety of the human neurological environment extends from the primary peripheral receptor and its subsequent action potential to the dosral root ganglion, dorsal horn of the spinal cord, and rostral neuroaxial centers like the cerebellum, midbrain, thalamus, and cortex—and ultimately to the effector, including all components in between. The human nervous system concerns itself with whole body reactions, not individual muscles. The premise here is that the highest primary afferentation is secondary to mechanoreceptor deformation after gravitational perturbation. The goal of treatment is to facilitate the patient’s highest level of human performance by recognizing and treating discrete pathology while avoiding an iatrogenic effect. Merely focusing on the α-motoneuron and/or its influence on the effector generates a myopic understanding that loses appreciation of efferent autonomic drive and structural performance. An individual muscle focus does not recognize the complexity of homologous involvement.